Practice Patterns of Spatially Fractionated Radiation Therapy: A Clinical Practice Survey.

Spatially fractionated radiation therapy (SFRT) is increasingly used for bulky advanced tumors, but specifics of clinical SFRT practice remain elusive. This study aimed to determine practice patterns of GRID and Lattice radiation therapy (LRT)-based SFRT. A survey was designed to identify radiation oncologists' practice patterns of patient selection for SFRT, dosing/planning, dosimetric parameter use, SFRT platforms/techniques, combinations of SFRT with conventional external beam radiation therapy (cERT) and multimodality therapies, and physicists' technical implementation, delivery, and quality procedures. Data were summarized using descriptive statistics. Group comparisons were analyzed with permutation tests. The majority of practicing radiation oncologists (United States, 100%; global, 72.7%) considered SFRT an accepted standard-of-care radiation therapy option for bulky/advanced tumors. Treatment of metastases/recurrences and nonmetastatic primary tumors, predominantly head and neck, lung cancer and sarcoma, was commonly practiced. In palliative SFRT, regimens of 15 to 18 Gy/1 fraction predominated (51.3%), and in curative-intent treatment of nonmetastatic tumors, 15 Gy/1 fraction (28.0%) and fractionated SFRT (24.0%) were most common. SFRT was combined with cERT commonly but not always in palliative (78.6%) and curative-intent (85.7%) treatment. SFRT-cERT time sequencing and cERT dose adjustments were variable. In curative-intent treatment, concurrent chemotherapy and immunotherapy were found acceptable by 54.5% and 28.6%, respectively. Use of SFRT dosimetric parameters was highly variable and differed between GRID and LRT. SFRT heterogeneity dosimetric parameters were more commonly used ( SFRT has already evolved as a clinical practice pattern for advanced/bulky tumors. Major treatment approaches are consistent and follow the literature, but SFRT-cERT combination/sequencing and clinical utilization of dosimetric parameters are variable. These areas may benefit from targeted education and standardization, and knowledge gaps may be filled by incorporating identified inconsistencies into future clinical research.

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© 2023 The Author(s).

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Nina A. Mayr reports that administrative support (distribution of the survey to recipients) was provided by the Radiosurgery Society. Beatriz E. Amendola reports speaker honorarium. Robert J. Griffin reports speaker honorarium and meeting travel support. Simon Lo reports a relationship with the Radiosurgery Society that includes board membership. Majid Mohiuddin has the patent “Proton Spatially Fractionated Radiotherapy.” Naipy C. Perez reports speaker honorarium. James W. Snider reports consulting fee and speaker honoraria and has the patent “Proton Spatially Fractionated Radiotherapy.” Xiaodong Wu has the patent “Method of 3D Lattice Radiotherapy” and reports speaker honoraria and waived meeting registration fee. Nina A. Mayr, Charles B. Simone II, Hualin Zhang, Xiaodong Wu, and Robert Griffin report a relationship with Radiosurgery Society that includes committee leadership. Majid Mohiuddin and James W. Snider report a relationship with Radiosurgery Society that includes committee co-leadership.