Journal ArticleDOI
Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review
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TLDR
The goal of this review article is to present the current state of this intriguing radiotherapy technique by reviewing existing publications on FLASH radiotherapy (RT) in terms of its physical and biological aspects.Abstract:
Ultrahigh dose-rate radiotherapy (RT), or 'FLASH' therapy, has gained significant momentum following various in vivo studies published since 2014 which have demonstrated a reduction in normal tissue toxicity and similar tumor control for FLASH-RT when compared with conventional dose-rate RT. Subsequent studies have sought to investigate the potential for FLASH normal tissue protection and the literature has been since been inundated with publications on FLASH therapies. Today, FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. The goal of this review article is to present the current state of this intriguing RT technique and to review existing publications on FLASH-RT in terms of its physical and biological aspects. In the physics section, the current landscape of ultrahigh dose-rate radiation delivery and dosimetry is presented. Specifically, electron, photon and proton radiation sources capable of delivering ultrahigh dose-rates along with their beam delivery parameters are thoroughly discussed. Additionally, the benefits and drawbacks of radiation detectors suitable for dosimetry in FLASH-RT are presented. The biology section comprises a summary of pioneering in vitro ultrahigh dose-rate studies performed in the 1960s and early 1970s and continues with a summary of the recent literature investigating normal and tumor tissue responses in electron, photon and proton beams. The section is concluded with possible mechanistic explanations of the FLASH normal-tissue protection effect (FLASH effect). Finally, challenges associated with clinical translation of FLASH-RT and its future prospects are critically discussed; specifically, proposed treatment machines and publications on treatment planning for FLASH-RT are reviewed.read more
Citations
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Journal ArticleDOI
Does FLASH deplete oxygen? Experimental evaluation for photons, protons, and carbon ions.
Jeannette Jansen,Jeannette Jansen,Jan Knoll,Jan Knoll,Elke Beyreuther,Jörg Pawelke,Raphael Skuza,Raphael Skuza,Rachel Hanley,Rachel Hanley,Stephan Brons,Francesca Pagliari,Joao Seco,Joao Seco +13 more
TL;DR: In this paper, the oxygen consumption in sealed, 3D printed water phantoms during irradiation with X-rays, protons and carbon ions at varying dose rates up to 340Gy/s was investigated.
Journal ArticleDOI
Tumour irradiation in mice with a laser-accelerated proton beam
Florian Kroll,Florian-Emanuel Brack,Constantin Bernert,Stefan Bock,Elisabeth Bodenstein,Kerstin Brüchner,Thomas E. Cowan,Lennart Gaus,René Gebhardt,U. Helbig,Leonhard Karsch,T. Kluge,Stephan Kraft,Mechthild Krause,Elisabeth Lessmann,U. Masood,Sebastian Meister,Josefine Metzkes-Ng,Alexej Nossula,Jörg Pawelke,J. Pietzsch,Thomas A. Püschel,M Reimold,Martin Rehwald,Christian Richter,Hans-Peter Schlenvoigt,Ulrich Schramm,Marvin Elias Paul Umlandt,Tim Ziegler,K. O. Zell,Elke Beyreuther +30 more
TL;DR: In this article , a stable, compact laser-driven proton source with energies greater than 60 MeV enables radiobiological in vivo studies, and the results demonstrate a complete laser driven proton research platform for diverse user-specific small animal models, able to deliver tunable single shot doses up to around 20 Gy to millimetre-scale volumes on nanosecond timescales.
Journal ArticleDOI
Ultra-high dose rate electron beams and the FLASH effect: from preclinical evidence to a new radiotherapy paradigm.
Emil Schüler,Munjal M. Acharya,Pierre Montay-Gruel,Billy W. Loo,Marie-Catherine Vozenin,Peter G. Maxim +5 more
TL;DR: A new standard for beam parameter reporting is proposed and a systematic path to the clinical translation of FLASH radiation therapy is discussed, to demonstrate the robust effects ofFLASH RT on normal tissue sparing in preclinical models.
Journal ArticleDOI
FLASH Radiotherapy With Electrons: Issues Related to the Production, Monitoring, and Dosimetric Characterization of the Beam
Fabio Di Martino,Patrizio Barca,Salvatore Barone,Eleonora Bortoli,Rita Borgheresi,Silvia De Stefano,Massimo Di Francesco,Luigi Faillace,Lucia Giuliano,L. Grasso,Stefania Linsalata,Daniela Marfisi,Mauro Migliorati,M. Pacitti,Luigi Palumbo,Giuseppe Felici +15 more
TL;DR: The problems and solutions concerning the realization of an electron accelerator dedicated to FLASH therapy and optimized for in vivo experiments are investigated and the saturation problems of the most common radiotherapy dosimeters when used in the very high dose-per-pulse FLASH conditions are discussed.
Journal ArticleDOI
Commissioning of a clinical pencil beam scanning proton therapy unit for ultrahigh dose rates (FLASH)
Konrad Pawel Nesteruk,M. Togno,Martin Grossmann,Antony J. Lomax,Damien C. Weber,Jacobus M. Schippers,Sairos Safai,David Meer,Serena Psoroulas +8 more
TL;DR: In this paper, the PSI Gantry 1 was adapted for FLASH research with protons by adapting a former clinical pencil beam scanning gantry to irradiations with ultrahigh dose rates.
References
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