A Comparative Analysis of Virtual 2D VMAT-Based SFRT and 3D Lattice Radiotherapy: Evaluation of Dosimetric and Therapeutic Outcomes

Background: Spatially Fractionated Radiotherapy (SFRT) can be implemented using Volumetric-Modulated Arc Therapy (VMAT) in either two-dimensional (2D) or three-dimensional (3D) configurations.Objective: This study aimed to compare the dosimetric and clinical outcomes of two VMAT-based SFRT techniques for large lung tumors.Material and Methods: In this experimental study, SFRT plans were designed for each patient using cylindrical and spherical grid targets. Single-fraction prescription doses of 15 and 20 Gy were delivered to the grid target isocenters using 6 MV Flattening-filter-free (FFF) photon beams.Results: The 2D SFRT plan demonstrated higher Gross Tumor Volume (GTV) mean dose, GTV Equivalent Uniform Dose (EUD), and Valley-to-peak Dose ratio (VPDR) compared to the 3D lattice plan. However, the 3D Lattice Radiotherapy (3D-LRT) technique provided a better therapeutic ratio and more uniform valley-peak dose distribution. Both plans demonstrated therapeutic ratios greater than one with minimal Normal Tissue Complication Probability (NTCP). Conclusion: Both 2D and 3D lattice VMAT-based SFRT techniques effectively delivered high radiation doses with steep dose gradients within the GTV, minimizing normal tissue exposure and reducing the risk of complications.