Lattice Radiation Therapy Versus Conventional Radiation Therapy for the Palliation of Large Tumors (LATTICE-PAL)

The goal of this randomized, phase III trial is to to determine if Spatially Fractionated Lattice Radiotherapy (SFRT) known as LATTICE therapy, leads to a greater reduction in pain or discomfort compared with conventional Radiation Therapy (RT) in patients with large tumours. This is evaluated by assessing if a greater proportion of patients who receive RT with SFRT will have an improvement in pain/discomfort at 30 days defined using the International Consensus Pain Response (ICPR) compared with those treated with conventional RT.

Study Overview

• Status: Recruiting
• Conditions: Histopathologically or Cytologically Confirmed Solid Tumor Who Require Palliation Radiation Therapy to a Lesion ≥5cm
• Intervention / Treatment: Radiation: Conventional Radiation Therapy; Radiation: Spatially fractionated radiation therapy

Detailed Description

This study aims to compare the pain scores of patients receiving conventional radiotherapy and spatially fractionated lattice radiotherapy (SFRT). About half of all cancer patients will undergo palliative radiotherapy (RT) during their illness to manage distressing symptoms such as pain and bleeding. Great and more durable pain responses have been observed with higher dose RT, including stereotactic body radiation therapy (SBRT). Unfortunately, it is not possible to treat large tumors with SBRT for several reasons. SFRT is an innovative RT technique that addresses some of the limitations of SBRT. SFRT uses very high doses of radiation on specific spots inside the tumour, creating a lattice-like pattern. The outer edges of the tumor get a much lower dose, which helps protect nearby healthy organs from radiation. Early phase studies have shown excellent response rates in terms of pain as well as dramatic and rapid resolution of large tumours. Similar results with high responses and low toxicity have been reported in the setting of locally advanced and bulky lung cancer, head and neck cancer, and cervical cancer. This study determines if SFRT leads to a greater reduction in pain or discomfort compared with conventional radiation therapy (RT), defined using the International Consensus for Pain Response (ICPR) which includes the short form Brief Pain inventory questionnaire and self-reporting of opioid and/or co-analgesic use, measured at 30 +/- 7 days following treatment. Pain is defined by a worst pain score of 2 or greater at the target site on the short form Brief pain inventory, within 7 days prior to randomization. The primary endpoint of this study is improvement in pain response with secondary endpoints including treatment-related toxicity above grade 2, objective tumor response, survival, and health-economics endpoints.

• Study Type: Interventional
• Enrollment (Estimated): 148
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Jelena Lukovic, MD FRCPC MPH MRMD; Phone Number: 416 946 4483; Email: Jelena.lukovic@uhn.ca

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5G 2M9
      • Recruiting
      • Princess Margaret Cancer Center
      • Principal Investigator: Jelena Lukovic, MD FRCPC MPH MRMD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosis of solid tumor by at least one criterion below:

  a. Pathologically or cytologically proven solid tumor greater than 5 cm (largest dimension) from a primary site or site of metastasis and unsuitable for surgical resection or definitive RT. b. HCC diagnosed by standard imaging criteria permitted: arterial enhancement and delayed washout on multiphasic computerized tomography (CT) or magnetic resonance imaging (MRI) in the setting of cirrhosis or chronic hepatitis B or C without cirrhosis

• Eastern Cooperative Oncology Group (ECOG) Status: 0-4 within 14 days of randomization
• In the investigator's opinion, patient requires palliative radiation therapy to a lesion >5 cm measured in one of the following ways:
• Imaging performed within 90 days prior to randomization per Response Evaluation Criteria in Solid Tumors (RECIST)
• CT simulation performed for radiation planning
• Able to understand and provide written consent
• Willing and have the ability to complete the baseline and post-treatment questionnaires (short form brief-pain inventory) and to maintain a pain diary
• Patient is not pregnant, planning on becoming pregnant or planning on fathering a child in the next 90 days
• Patient must be accessible for treatment and follow-up. Investigators must ensure the patients randomized on this trial will be available for complete documentation of the treatment, adverse events, and follow-up

Exclusion Criteria:

• Prior radiotherapy that would result in substantial overlap of the irradiated volume thus precluding per protocol treatment
• Requirement for urgent surgical intervention prior to radiation treatment
• Confirmed pregnancy
• Hematologic primary malignancy
• Medical condition precluding the delivery of per protocol treatment (e.g. connective tissue disorder)
• Tumors overlying critical CNS, heart or spinal cord compression

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm A "Conventional Radiation Therapy"; Homogenous RT (20Gy to 35Gy in 5 fractions), planned using volumetric modulated arc therapy or 3D conformal radiotherapy (3DCRT)	Radiation: Conventional Radiation Therapy; Delivered using simple techniques and includes dose prescriptions of: 8Gy in 1 fraction, 20Gy in 5 fractions, and 30Gy in 10 fractions
Experimental: Arm B "Lattice Radiation Therapy"; Spatially fractionated radiation therapy, via LATTICE Radiotherapy (LRT), 20Gy in 5 fractions with boost of 67Gy in 5 fractions with boost of 67Gy in 5 fractions to discrete sub-volumes within a tumour	Radiation: Spatially fractionated radiation therapy; LRT delivers ablative doses to discrete vertices within a tumor, forming a "lattice" while restricting the periphery of the tumor to a safe, low dose thereby minimizing radiation exposure to nearby OAR.; Other Names: LRT; SFRT; LATTICE

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Response in pain	The primary outcome measure is the proportion of patients achieving a complete response in pain per the ICPR at 30 +/- 7 days after treatment.	30 +/- 7 days after treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain response pattern	Measured using ICPRE	1, 3, and 6 months post RT
Reirradiation rate	Measured by counting the number of patients receiving reirradiation	6 months following radiotherapy
Treatment-related toxicity	Common Terminology Criteria for Adverse Events (CTCAE) v5	at baseline, after treatment, and at 1, 3 and 6 months after treatment
Objective tumour response	Measured using RECIST with the CT scans	Baseline and at 3 and 6 months post-treatment
Overall survival	Overall survival (OS): time alive following treatment	Measured from randomization to date of death or last follow up (6 months post RT)
Progressive-free survival (PFS)	Progressive-free survival (PFS): time to progression or death	measured from randomization to progression at any site (until 6 month follow up post RT) or death

Collaborators and Investigators

• Sponsor: University Health Network, Toronto

Study record dates

Study Major Dates

• Study Start (Actual): November 18, 2025
• Primary Completion (Estimated): January 1, 2028
• Study Completion (Estimated): January 1, 2028

Study Registration Dates

• First Submitted: February 2, 2026
• First Submitted That Met QC Criteria: February 24, 2026
• First Posted (Actual): March 3, 2026

Study Record Updates

• Last Update Posted (Actual): March 3, 2026
• Last Update Submitted That Met QC Criteria: February 24, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Conventional Radiation Therapy; SFRT; Lattice Radiation Therapy; Spatially fractionated radiation therapy
• Additional Relevant MeSH Terms: GRL1 protein, Tetrahymena thermophila
• Other Study ID Numbers: 24-6019

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No