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Life sciences · Journal article
Frontiers in Oncology · October 28, 2026
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Background Bulky unresectable stage III non-small cell lung cancer (NSCLC) presents a clinical challenge during definitive radiotherapy, as homogeneous dose escalation is often constrained by organ-at-risk (OAR) tolerance. Spatially fractionated radiotherapy (SFRT), including lattice radiotherapy (LRT), creates an intratumoral peak-valley dose distribution and may provide a means to intensify local dose delivery. However, the optimal dose, fractionation, vertex geometry, treatment sequence, and contribution of LRT to clinical response remain uncertain. Case presentation We report a 41-year-old never-smoking Han Chinese man with bulky unresectable stage IIIB (cT4N2M0, AJCC 8th edition) disease, with a primary tumor measuring 71×53 mm at baseline. After two cycles of induction platinum-based chemotherapy, the disease was classified as stable disease. The patient subsequently received thoracic VMAT to 60 Gy in 15 fractions, during this course, a LRT plan was interleaved within the VMAT plan and delivered using an interleaved “4 VMAT treatments plus 1 LRT per week” pattern. Sixteen spheres were placed within the gross tumor volume (GTV), achieving a peak-to-valley dose ratio (PVDR) of 3.52. Serial CT showed a reduction in the sum of lesion diameters (SOD) of 20.7% after eight VMAT fractions, 29.6% after 14 fractions, and 40% at the 2-month post-treatment assessment. The patient developed grade 4 hematologic toxicity and grade 1 radiation pneumonitis after additional systemic therapy. Conclusion This case demonstrates the delivery of weekly LRT during thoracic VMAT in a patient with bulky stage IIIB NSCLC, with significant tumor regression observed. This approach should be regarded as technically feasible in this case only, rather than as evidence that LRT can circumvent OAR (organs at risk) constraints or improve tumor control.