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Divide and conquer: spatially fractionated radiation therapy

Part of: Advancements in the radiobiology of low and high-LET radiation

Published online by Cambridge University Press:  12 January 2022

Yolanda Prezado Open the ORCID record for Yolanda Prezado [Opens in a new window]
Yolanda Prezado*
Affiliation:
Institut Curie, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer Institut Curie, Université PSL, Orsay, France Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
*
Author for correspondence: Yolanda Prezado, E-mail: yolanda.prezado@curie.fr
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Abstract

Spatially fractionated radiation therapy (SFRT) challenges some of the classical dogmas in conventional radiotherapy. The highly modulated spatial dose distributions in SFRT have been shown to lead, both in early clinical trials and in small animal experiments, to a significant increase in normal tissue dose tolerances. Tumour control effectiveness is maintained or even enhanced in some configurations as compared with conventional radiotherapy. SFRT seems to activate distinct radiobiological mechanisms, which have been postulated to involve bystander effects, microvascular alterations and/or immunomodulation. Currently, it is unclear which is the dosimetric parameter which correlates the most with both tumour control and normal tissue sparing in SFRT. Additional biological experiments aiming at parametrizing the relationship between the irradiation parameters (beam width, spacing, peak-to-valley dose ratio, peak and valley doses) and the radiobiology are needed. A sound knowledge of the interrelation between the physical parameters in SFRT and the biological response would expand its clinical use, with a higher level of homogenisation in the realisation of clinical trials. This manuscript reviews the state of the art of this promising therapeutic modality, the current radiobiological knowledge and elaborates on future perspectives.

Keywords

Bulky tumoursnormal tissue toxicitiesradioresistant tumoursspatially fractionated radiotherapy

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Type
Review
Information
Expert Reviews in Molecular Medicine , Volume 24 , 2022 , e3
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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