Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Clin Oncol. Jun 24, 2026; 17(6): 118731
Published online Jun 24, 2026. doi: 10.5306/wjco.118731
Published online Jun 24, 2026. doi: 10.5306/wjco.118731
Spatially fractionated radiotherapy: Integrated dose heterogeneity and radiobiology for bulky tumor
Ling-Ling Meng, Department of Radiotherapy, Chinese PLA General Hospital, Beijing 100853, China
Lin Ma, Bao-Lin Qu, Department of Radiation Oncology, Senior Department of Oncology, The First Medical Center of PLA General Hospital, Beijing 100853, China
Yu-Peng Di, Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
Co-first authors: Ling-Ling Meng and Lin Ma.
Co-corresponding authors: Bao-Lin Qu and Yu-Peng Di.
Author contributions: Meng LL and Ma L performed the literature search and drafted the original manuscript contributed equally to this work thus qualified as the co-first authors of the paper; Di YP provided data validation and contributed to writing the initial draft; Qu BL and Di YP conceptualized the study, provided critical revisions, and finalized the manuscript thus qualified as the co-corresponding authors of the paper; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Corresponding author: Yu-Peng Di, MD, Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, No. 28 Fucheng Road, Beijing 100142, China.
Received: January 12, 2026
Revised: February 21, 2026
Accepted: May 8, 2026
Published online: June 24, 2026
Processing time: 164 Days and 5.4 Hours
Revised: February 21, 2026
Accepted: May 8, 2026
Published online: June 24, 2026
Processing time: 164 Days and 5.4 Hours
Core Tip
Core Tip: Spatially fractionated radiotherapy (SFRT) offers a novel solution to the clinical challenge of treating bulky tumors. By creating controlled dose heterogeneity (“peaks” and “valleys”), SFRT leverages the regenerative capacity of normal tissues to maximize sparing while potentially triggering systemic antitumor immunity via bystander and abscopal effects. This article critically examines the dual mechanistic pathways of SFRT-integrating physical dose modulation with biological signaling-and reviews emerging clinical evidence suggesting its potential to safely expand the therapeutic index for difficult-to-treat malignancies.