Concept to Clinic: Introducing Spatially Fractionated Radiation Therapy
Abstract
Purpose
To establish a practical framework for implementing spatially fractionated radiation therapy (SFRT) in clinics without existing infrastructure by developing treatment planning workflows and identifying requirements for clinical adoption.
Methods
A GRID therapy planning workflow was developed by importing commercial collimator beam data files into the research version of RayStation TPS and investigating planning parameters. Lattice radiotherapy was investigated using VMAT and IMRT techniques. Treatment plans were created and validated on an anthropomorphic Rando phantom with film dosimetry. Immobilization considerations and QA requirements for SFRT delivery were evaluated. Current clinical trial guidelines and recommendations from emerging SFRT task groups were reviewed to assess consensus and barriers to widespread adoption.
Results
GRID collimator beam data were successfully imported and modeled in RayStation, enabling treatment planning capabilities. Lattice VMAT and IMRT plans demonstrated the feasibility of achieving spatially modulated dose distributions. Film dosimetry on Rando phantom validated planned dose patterns. Analysis identified key QA requirements, including patient-specific verification and delivery validation protocols. A review of SFRT literature revealed an evolving consensus on prescription practices, but ongoing debate regarding optimal fractionation schedules and patient selection. Primary barriers to clinical adoption included limited equipment availability, training requirements, and lack of standardized commissioning and clinical implementation guidelines.
Conclusion
This work provides a foundation for centers considering SFRT implementation. The planning workflows and QA framework established here address practical implementation challenges. Future standardization efforts by active task groups will be essential for generating clinical evidence and enabling broader adoption of SFRT techniques.