{
  "abstract": "Background: Lattice Radiotherapy (LRT) delivers ablative doses to intratumoral vertices alternating with low-dose valleys to treat bulky tumors. While VMAT-LRT is widely adopted, Helical Tomotherapy (HT-LRT) may offer enhanced spatial dose modulation. This study provides the first paired dosimetric comparison of HT-LRT versus VMAT-LRT across scalar, directional, and DVH-based endpoints.\n\nMethods: Paired HT-LRT and VMAT-LRT plans were evaluated in a cohort of 22 patients with bulky tumors using a staggered triangular lattice geometry (5.0 cm inter-vertex spacing, 1.0 cm diameter). Spatial dose modulation was characterized using three scalar Valley-to-Peak Dose Ratio (VPDR) computational methods (VPDR Wu , VPDR D90/D10 , VPDR median ) and a directionally resolved decomposition along principal and diagonal spatial axes. Target coverage, OAR sparing, and morphological correlations were systematically analyzed.\n\nResults: HT-LRT demonstrated statistically significant superiority over VMAT-LRT across all scalar VPDR metrics ( p < 0.05). Directional analysis revealed that HT-LRT advantage is anisotropic, concentrating along intra-plane radial and principal axes, whereas oblique inter-plane diagonals showed comparable modulation between techniques. HT-LRT yielded significantly cooler valley doses and improved low-dose OAR sparing without compromising target coverage ( D 95% ). Target elongation positively correlated with radial VPDR in both modalities due to inter-plane dose summation, while compactness influenced radial VPDR exclusively in HT-LRT.\n\nConclusion: HT-LRT should provide superior, directionally selective spatial dose modulation compared with VMAT-LRT in bulky tumors. Directionally resolved VPDR analysis exposes technique-specific geometric strengths obscured by scalar summary metrics, supporting HT-LRT as a promising platform for LRT execution, while the relative contribution of delivery technique and planning strategy warrants further investigation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione “G. Pascale”",
    "Radiation Oncology Unit, Responsible Research Hospital",
    "Medical Physics Unit, Responsible Research Hospital",
    "Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS Fondazione “G. Pascale”",
    "Laboratory Medicine Unit, Istituto Nazionale Tumori - IRCCS Fondazione “G. Pascale”",
    "University of Perugia",
    "Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna",
    "Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna",
    "Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica ed Ematologia"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Mottareale R"
    },
    {
      "affs": [
        0
      ],
      "name": "Serra M"
    },
    {
      "affs": [
        1
      ],
      "name": "Pezzulla D"
    },
    {
      "affs": [
        2
      ],
      "name": "Cilla S"
    },
    {
      "affs": [
        0
      ],
      "name": "Borzillo V"
    },
    {
      "affs": [
        0
      ],
      "name": "Scipilliti E"
    },
    {
      "affs": [
        0
      ],
      "name": "Silvestro G"
    },
    {
      "affs": [
        0
      ],
      "name": "De Palma G"
    },
    {
      "affs": [
        0
      ],
      "name": "Ametrano G"
    },
    {
      "affs": [
        0
      ],
      "name": "Buonanno F"
    },
    {
      "affs": [
        0
      ],
      "name": "Arrichiello C"
    },
    {
      "affs": [
        0
      ],
      "name": "d’Alesio V"
    },
    {
      "affs": [
        0
      ],
      "name": "di Franco MA"
    },
    {
      "affs": [
        0
      ],
      "name": "Mercogliano S"
    },
    {
      "affs": [
        3
      ],
      "name": "Cuomo A"
    },
    {
      "affs": [
        4
      ],
      "name": "Cavalcanti E"
    },
    {
      "affs": [
        5
      ],
      "name": "Maranzano E"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Donati C"
    },
    {
      "affs": [
        8
      ],
      "name": "Cellini F"
    },
    {
      "affs": [
        0
      ],
      "name": "Ravo V"
    },
    {
      "affs": [
        0
      ],
      "name": "Di Franco R"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/57sffpwq280hg.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1986573",
  "fulltext_url": null,
  "id": "57sffpwq280hg",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1986573/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3108|Advanced Radiotherapy Techniques"
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  ],
  "openalex": "W7223950493",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1986573/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-27",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/57sffpwq280hg.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:14Z",
      "native_id": "10.3389/fonc.2026.1986573",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1986573/full"
    }
  ],
  "subjects": [
    {
      "field": "physics",
      "origin": "openalex:3108|Advanced Radiotherapy Techniques",
      "subfield": "applied-instrumentation"
    }
  ],
  "title": "Dosimetric feasibility of lattice radiotherapy for bulky tumors: a paired VMAT vs. helical tomotherapy comparison - the STRYKE trial",
  "title_text": "Dosimetric feasibility of lattice radiotherapy for bulky tumors: a paired VMAT vs. helical tomotherapy comparison - the STRYKE trial",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:14Z",
  "url": "https://research.draconitic.com/paper/57sffpwq280hg",
  "venue": "Frontiers in Oncology",
  "versions": []
}