{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:34:34Z","timestamp":1792510474381,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T00:00:00Z","timestamp":1650499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>For fast, safe, and effective management of large and bulky (\u22658\u00a0cm) non\u2010resectable tumors, we have developed a conebeam CT\u2010guided three\u2010dimensional (3D)\u2010conformal MLC\u2010based spatially fractionated radiation therapy (SFRT) treatment. Using an in\u2010house MLC\u2010fitting algorithm, Millennium 120 leaves were fitted to the gross tumor volume (GTV) generating 1\u2010cm diameter holes at 2\u2010cm center\u2010to\u2010center distance at isocenter. SFRT plans of 15\u00a0Gy were generated using four to six coplanar crossfire gantry angles 60\u00b0 apart with a 90\u00b0 collimator, differentially weighted with 6\u2010 or 10\u2010MV beams. A dose was calculated using AcurosXB algorithm, generating sieve\u2010like dose channels without post\u2010processing the physician\u2010drawn GTV contour within an hour of CT simulation allowing for the same day treatment. In total, 50 extracranial patients have been planned and treated using this method, comprising multiple treatment sites. This novel MLC\u2010fitting algorithm provided excellent dose parameters with mean GTV (V7.5\u00a0Gy) and mean GTV doses of 53.2% and 7.9\u00a0Gy, respectively, for 15\u00a0Gy plans. Average peak\u2010to\u2010valley dose ratio was 3.2. Mean beam\u2010on time was 3.32\u00a0min, and treatment time, including patient setup and CBCT to beam\u2010off, was within 15\u00a0min. Average 3D couch correction from original skin\u2010markers was &lt;1.0\u00a0cm. 3D MLC\u2010based SFRT plans enhanced target dose for bulky masses, including deep\u2010seated large tumors while protecting skin and adjacent critical organs. Additionally, it provides the same day, safe, effective, and convenient treatment by eliminating the risk to therapists and patients from heavy gantry\u2010mounted physical GRID\u2010block\u2014we recommend other centers to use this simple and clinically useful method. This rapid SFRT planning technique is easily adoptable in any radiation oncology clinic by eliminating the need for plan optimization and patient\u2010specific quality assurance times while providing dosimetry information in the treatment planning system. This potentially allows for dose\u2010escalation to deep\u2010seated masses to debulk unresectable large tumors providing an option for neoadjuvant treatment. An outcome study of clinical trial is underway.<\/jats:p>","DOI":"10.1002\/acm2.13608","type":"journal-article","created":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T09:26:45Z","timestamp":1650533205000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Conebeam CT\u2010guided 3D MLC\u2010based spatially fractionated radiation therapy for bulky masses"],"prefix":"10.1002","volume":"23","author":[{"given":"Damodar","family":"Pokhrel","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine, University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Mallory","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"St Clair","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Kudrimoti","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-27-319-407"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19900701)66:1<114::AID-CNCR2820660121>3.0.CO;2-L"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6823(1996)4:1<41::AID-ROI7>3.0.CO;2-M"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00170-4"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2241998"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4801902"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canlet.2013.10.032"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2003.07.003"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/02841868409136015"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.05.016"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13133290"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.2478\/pjmpe-2021-0015"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2140116"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.01.065"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.07.047"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v17i1.5934"},{"key":"e_1_2_10_18_1","first-page":"e9","article-title":"On modern technical approaches of three\u2010dimensional high\u2010dose lattice radiotherapy (LRT)","volume":"2","author":"Wu X","year":"2010","journal-title":"Cureus"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12807"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.01.073"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12826"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.07.2404"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.07.1436"},{"issue":"6","key":"e_1_2_10_24_1","first-page":"e255","article-title":"Rapid delivery of GRID therapy for deep\u2010seated bulky tumors: a novel 3D MLC\u2010based forward planning treatment technique via 10MV\u2010FFF beam","volume":"47","author":"Pokhrel D","year":"2020","journal-title":"Med Phys"},{"key":"e_1_2_10_25_1","unstructured":"A Randomized Phase II Study Comparing 2 Stereotactic Body Radiation Therapy (SBRT) Schedules for Medically Inoperable Patients with Stage I Peripheral Non\u2010Small Cell Lung Cancer; 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