To propose Stereotactic Centralized Ablative Radiation Therapy (SCART) as a framework for treating bulky tumors that are difficult to manage with conventional radiotherapy techniques.
Approach:
Definition of SCART: SCART defines a central SCART treatment volume (STV) within the gross tumor volume (GTV) and prescribes treatment using a core-to-periphery dose ratio (Rcp), which is crucial for optimizing treatment delivery.
Key Findings:
SCART shifts the planning objective from uniform whole-tumor coverage to safe maximal core irradiation.
Early clinical experience suggests technical feasibility in carefully selected patients.
The framework remains hypothesis-generating, necessitating prospective studies to define various treatment parameters.
Interpretation:
SCART is designed to address the limitations of existing radiotherapy paradigms for bulky tumors by deliberately engineering intratumoral dose heterogeneity.
Limitations:
The framework is still in the hypothesis-generating stage and requires further validation through prospective studies.
SCART is not intended for small tumors or diffuse disease without a dominant bulky lesion.
Conclusion:
SCART aims to provide a reproducible framework for treating bulky tumors, which can be tested against existing radiotherapy modalities.
