Lattice meaning5/28/2023 ![]() In addition, unacceptably toxic effects to the skin and surrounding tissues and difficulty in dosimetry for bulky lesions represent a challenge despite advances in intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT). The common problems faced by the delivery of traditional radiation to a large tumor volume include poor blood supply and hypoxia within the tumor microenvironment, which stimulates factors such as hypoxia-inducible factor 2 alpha (HIF-2α), leading to protection against apoptosis. The lattice technique may provide equivalent or superior clinical response in the management of large tumors while limiting toxicity to surrounding structures. Instead, these vertices are placed inside the tumor, depending on its size and shape as well as the proximity of critical structures. The term lattice, as described by Wu et al., has only a figurative purpose and does not imply a rigorous and symmetric repeated three-dimensional arrangement. By adjusting the old 2D grid technique into a 3D lattice using multiple high-dose areas called vertices distributed within the central areas of the gross tumor volume (GTV), high-dose radiation is delivered within the bulk of the tumor and not in the peripheral areas adjacent to normal tissues. High-dose 2D grid therapy has been available since the early 1900s but has not gained widespread acceptance by the radiation oncology community, presumably because of unacceptably high doses of radiation to normal tissues. Recent case reports have demonstrated very effective local control of bulky lesions, thereby decreasing overall tumor burden and expanding options for subsequent surgical intervention. Linear accelerator (LINAC)-based LRT can precisely deliver inhomogeneous high doses of radiation to different areas within the clinical target volume (CTV) while limiting the dose to the organs at risk adjacent to the tumor. An emerging technique is the use of lattice radiotherapy (LRT). The management of voluminous lung tumors presents a challenge, particularly when surgical resection is not an option and conventional radiation and chemotherapy have limited efficacy for local control. In this small cohort, LRT appears to be a safe and effective modality to treat bulky NSCLC. Further research is needed to establish its efficacy in the management of voluminous NSCLC. The overall survival of the entire group ranged from four to 86 months (mean 22, median 16). There was no mortality related to LRT. No significant acute or chronic toxicity was noted. With a median follow-up of six months (range: one to 71 months), the mean decrease in tumor volume was 42%. ![]() After the LRT, all patients continued with conventional radiation: 25 to 29 daily fractions of 1.8 Gy to 2 Gy. The main goals of the study were the evaluation of tumor response and the overall safety of LRT in this cohort of patients with bulky non-small cell lung cancer.ĭuring a seven-year period, 10 patients with non-small cell lung cancer (NSCLC), who presented with bulky, unresectable tumors, were treated using a single fraction of LRT followed by conventionally fractionated radiation. Patients received one initial LRT fraction of 18 Gy in the vertices and 3 Gy in the periphery. Built from the conventional two-dimensional grid, LRT utilizes the power of new technology, three-dimensional radiation allowing the delivery of higher doses of radiation to small spheres, also called vertices, inside bulky tumors while limiting exposure to surrounding healthy tissue. Lattice radiotherapy (LRT) is a novel technique of delivering heterogeneous doses of radiation to voluminous tumors not amenable to surgery. ![]()
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