ORIGINAL RESEARCH article
Front. Oncol.
Sec. Radiation Oncology
This article is part of the Research TopicRadiation Spatial Fractionation—A novel approach to integrate Physics, Biology, and Immunology for high therapeutic index radiotherapyView all 10 articles
Spatially Fractionated Radiation Therapy (SFRT) for Treating Recurrent Glioblastoma (GBM): a Dosimetric Feasibility Study
Provisionally accepted
Yuwei Zhou*
Sean Tanny
Michael T MilanoBrian Marples
Fiona Li
Hyunuk JungMatt J. WebsterAlexander R. PodgorsakJihyung YoonWesley RivaisMichael J. Hazoglou
Dandan Zheng*- University of Rochester Medical Center, Rochester, United States
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Spatially fractionated radiation therapy (SFRT) shows promise for treating bulky, advanced, or recurrent tumors. To evaluate the feasibility of SFRT for patients with recurrent glioblastoma (GBM), we conducted a planning study involving 14 patients, analyzing vertex target volume (VTV) contours and cumulative doses to both targets and organs at risk (OARs). The patients were divided into two groups based on gross tumor volume (GTV): 10 patients with GTV > 15 cc; 4 patients with GTV ≤ 15 cc. SFRT was planned as an upfront boost, using LATTICE radiotherapy (LRT) and stereotactic central ablative radiation therapy (SCART) respectively. With a LRT technique, vertex diameters ranged from 0.8–1.5 cm, with center-to-center spacing of 2–4 cm. GTV geometry—not size—determined mean vertex diameter (MVD: 0.99 ± 0.12 cm), spacing (2.93 ± 0.34 cm), and the VTV-to-GTV ratio (VGR: 6.6 ± 1.7%). With a SCART technique, the mean VGR was 25.8 ± 10.0%. Compared with the original sum plan, the cumulative EQD22 dose in the SFRT sum plan to critical OARs was well-controlled, such as the brainstem with a difference of 0.36 ± 1.00%. However, V120Gy to the brain in the SFRT sum plan increased by 4.51 ± 3.97 cc, for the 12 patients with an original V120Gy < 2 cc. Increased V120Gy to the brain might elevate the risk of radiation-induced necrosis. In summary, our planning study demonstrates that dosimetrically acceptable SFRT plans can be achieved for recurrent GBM. The main clinical consideration is balancing the potential benefit of SFRT against the risk of radiation-induced necrosis.
Keywords: EQD2, Lattice, Recurrent GBM, SCART, SFRT
Received: 22 Aug 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Zhou, Tanny, Milano, Marples, Li, Jung, Webster, Podgorsak, Yoon, Rivais, Hazoglou and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yuwei Zhou
Dandan Zheng
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