{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:13:42Z","timestamp":1792800822875,"version":"4.5.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>A 63-year-old male patient was admitted to the Affiliated Hospital of Jiangsu University on December 26, 2025, with a diagnosis of local recurrence in the mediastinal metastatic lymph nodes after radiotherapy, four years following the initial diagnosis of right-sided lung cancer. The patient was diagnosed with advanced small cell lung cancer of the right lung (cT3N3M1) and had previously received a combination of radiotherapy, chemotherapy, targeted therapy, and immunotherapy. Despite these treatments, the disease continued to progress, with resistance to both chemotherapy and immunotherapy, accompanied by widespread metastases. Palliative radiotherapy was administered for mediastinal lymph node enlargement starting July 2, 2025 (P_GTVn: 48 Gy\/12 Fx). A follow\u2212up CT scan on December 26, 2025, confirmed local in\u2212situ recurrence of multiple mediastinal lymph nodes, accompanied by tracheal and superior vena cava compression and stenosis, indicating progressive disease (PD). From January 6, 2026, the patient underwent Spatially Fractionated Radiation Therapy (SFRT) targeted at the mediastinal metastatic lymph nodes, with a total dose of 30 Gy in 6 fractions, combined concurrently with atezolizumab immunotherapy. After five fractions of radiotherapy, follow\u2212up computed tomography showed that the tumor volume decreased from 146\u00a0ml to 27\u00a0ml, representing a tumor regression rate of over 80%. Significant relief of left main bronchus compression was observed. No obvious radiation\u2212related adverse events were noted during treatment or subsequent follow\u2212up. Long\u2212term efficacy requires further observation and evaluation.<\/jats:p>","DOI":"10.3389\/fonc.2026.1829803","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:24:05Z","timestamp":1778473445000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Spatially fractionated radiation therapy for local recurrence after prior radiotherapy in advanced right-sided small cell lung cancer with mediastinal lymph node metastases"],"prefix":"10.3389","volume":"16","author":[{"given":"Tian","family":"Tian","sequence":"first","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhua","family":"Dai","sequence":"additional","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yang","sequence":"additional","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyao","family":"Liu","sequence":"additional","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jicheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuyang","family":"Yang","sequence":"additional","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"You","sequence":"additional","affiliation":[{"name":"Tumor Center, Affiliated Hospital of Jiangsu University","place":["Zhenjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA: A Cancer J For Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in China, 2022","volume":"46","author":"Rongshou","year":"2024","journal-title":"Chin J Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)33326-3","article-title":"Global surveillance of trends in cancer survival 2000\u201314 (CONCORD-3): analysis of individual records for 37\u2008513\u2008025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries","volume":"391","author":"Allemani","year":"2018","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1002-1671.2010.08.027","article-title":"CT-guided 125I seeds implantation in treating metastases of mediastinal lymph nodes after artificial pneumothorax","volume":"26","author":"Deguo","year":"2010","journal-title":"J Pract Radiol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23063366","article-title":"Radiobiological and treatment-related aspects of spatially fractionated radiotherapy","volume":"23","author":"Leyla","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2019.10.004","article-title":"Spatially fractionated radiation therapy: History, present and the future","volume":"20","author":"Yan","year":"2020","journal-title":"Clin Trans Radiat Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.01.073","article-title":"A current review of spatial fractionation: Back to the future","volume":"104","author":"Billena","year":"2019","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1017\/erm.2021.34","article-title":"Divide and conquer: spatially fractionated radiation therapy","volume":"24","author":"Prezado","year":"2022","journal-title":"Expert Rev Mol Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.12.013","article-title":"Overview and recommendations for prospective multi-institutional clinical trials of spatially fractionated radiation therapy (SFRT)","volume":"119","author":"Heng","year":"2023","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13133290","article-title":"Lattice or oxygen-guided radiotherapy: What if they converge? 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