Phase 1 Lattice Radiotherapy (spatially fractionated IMRT) adds vertex “boosts” for bulky tumors

This Duke University pilot interventional study tests whether adding Lattice Radiation Therapy (LRT)—a spatially fractionated form of intensity-modulated radiation therapy (IMRT)—to standard palliative external-beam radiation can safely improve shrinkage of large extracranial solid tumors. The intervention is one additional pre-treatment LRT fraction that delivers higher-dose “vertices” inside the mass while keeping the surrounding rim dose more conventional; the mechanism is physical dose painting (not a drug target) intended to improve tumor cell kill in very bulky disease without exceeding normal-tissue constraints. Patients are adults with a large solid-tumor lesion planned for palliative radiation, a group where symptom relief and local control can be limited when tumors are too large to safely dose-escalate uniformly. Today’s care is conventional palliative radiation (often with systemic therapy chosen by tumor type) aimed at pain/bleeding/obstruction relief, not durable tumor reduction. The scientific angle is whether modern planning can make “grid-like” spatial fractionation practical and tolerable in routine IMRT workflows at Duke, potentially offering a scalable radiation-only intensification option.