A Current Review of Spatial Fractionation: Back to the Future

Spatially fractionated radiation therapy (SFRT) intentionally delivers a nonhomogeneous pattern of high dose radiation to the gross tumor volume with impressive clinical results and tolerability in bulky tumors with historically low response rates. Potential mechanisms such as radiation-induced bystander effects, microvasculature alterations, and immunomodulation have been studied and are reviewed. Additional pre-clinical work, translational studies and thoughtful clinical trials are needed to optimize SFRT for larger randomized phase III trials and for clinical practice.

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