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Title: FLASH radiotherapy: ultra-high dose rates to spare healthy tissue

Abstract

A recent addition to the treatment options in external beam therapy, so-called FLASH radiotherapy, shows remarkable healthy-tissue-sparing properties in a number of pre-clinical studies without impacting the overall treatment efficacy. Its potential in clinical applications is attracting a great deal of interest in the medical community. The use of ultra-high dose rates at extremely short irradiation times has been shown to significantly enhance the differential effects between normal and tumor tissue. This makes it possible to increase treatment doses without further harming the surrounding healthy tissue. While most studies to date have focused on the use of electron beams, X-ray and proton FLASH radiotherapy have also shown beneficial effects, although for these latter two the results still need to be independently confirmed. Additionally, the mechanisms underlying the biological effects remain to be elucidated. Very recently, the FLASH effect has been demonstrated in the first human patient, with promising results, supporting further clinical studies. In this work, we present an overview of the investigations into FLASH radiotherapy to date.

Authors:
ORCiD logo [1]
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  1. Delft Univ. of Technology (Netherlands); Argonne National Lab. (ANL), Argonne, IL (United States)
Publication Date:
Research Org.:
Argonne National Lab. (ANL), Argonne, IL (United States)
Sponsoring Org.:
USDOE Laboratory Directed Research and Development (LDRD) Program; USDOE Office of Science (SC)
OSTI Identifier:
1645018
Grant/Contract Number:  
AC02-06CH11357; 2019-0296
Resource Type:
Accepted Manuscript
Journal Name:
International Journal of Radiation Biology
Additional Journal Information:
Journal Volume: 96; Journal Issue: 4; Journal ID: ISSN 0955-3002
Publisher:
Taylor and Francis
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; FLASH-RT; normal tissue protection; ultra-high dose-rate irradiation; differential effect

Citation Formats

de Kruijff, R. M. FLASH radiotherapy: ultra-high dose rates to spare healthy tissue. United States: N. p., 2019. Web. doi:10.1080/09553002.2020.1704912.
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de Kruijff, R. M. FLASH radiotherapy: ultra-high dose rates to spare healthy tissue. United States. https://doi.org/10.1080/09553002.2020.1704912
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de Kruijff, R. M. Thu . "FLASH radiotherapy: ultra-high dose rates to spare healthy tissue". United States. https://doi.org/10.1080/09553002.2020.1704912. https://www.osti.gov/servlets/purl/1645018.
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@article{osti_1645018,
title = {FLASH radiotherapy: ultra-high dose rates to spare healthy tissue},
author = {de Kruijff, R. M.},
abstractNote = {A recent addition to the treatment options in external beam therapy, so-called FLASH radiotherapy, shows remarkable healthy-tissue-sparing properties in a number of pre-clinical studies without impacting the overall treatment efficacy. Its potential in clinical applications is attracting a great deal of interest in the medical community. The use of ultra-high dose rates at extremely short irradiation times has been shown to significantly enhance the differential effects between normal and tumor tissue. This makes it possible to increase treatment doses without further harming the surrounding healthy tissue. While most studies to date have focused on the use of electron beams, X-ray and proton FLASH radiotherapy have also shown beneficial effects, although for these latter two the results still need to be independently confirmed. Additionally, the mechanisms underlying the biological effects remain to be elucidated. Very recently, the FLASH effect has been demonstrated in the first human patient, with promising results, supporting further clinical studies. In this work, we present an overview of the investigations into FLASH radiotherapy to date.},
doi = {10.1080/09553002.2020.1704912},
journal = {International Journal of Radiation Biology},
number = 4,
volume = 96,
place = {United States},
year = {2019},
month = {12}
}
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Journal Article:
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Publisher's Version of Record
https://doi.org/10.1080/09553002.2020.1704912
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Cited by: 25 works
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Works referenced in this record:

Long-term neurocognitive benefits of FLASH radiotherapy driven by reduced reactive oxygen species
journal, May 2019

  • Montay-Gruel, Pierre; Acharya, Munjal M.; Petersson, Kristoffer
  • Proceedings of the National Academy of Sciences, Vol. 116, Issue 22
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Reduced cognitive deficits after FLASH irradiation of whole mouse brain are associated with less hippocampal dendritic spine loss and neuroinflammation
journal, October 2019

(P003) Delivery of Ultra-Rapid Flash Radiation Therapy and Demonstration of Normal Tissue Sparing After Abdominal Irradiation of Mice
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Clinical translation of FLASH radiotherapy: Why and how?
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Unexpected Dose-rate Effect in the Killing of Mice by Radiation
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The Advantage of FLASH Radiotherapy Confirmed in Mini-pig and Cat-cancer Patients
journal, June 2018

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X-rays can trigger the FLASH effect: Ultra-high dose-rate synchrotron light source prevents normal brain injury after whole brain irradiation in mice
journal, December 2018

Experimental Platform for Ultra-high Dose Rate FLASH Irradiation of Small Animals Using a Clinical Linear Accelerator
journal, January 2017

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Feasibility of proton FLASH effect tested by zebrafish embryo irradiation
journal, October 2019

Ultrahigh dose-rate FLASH irradiation increases the differential response between normal and tumor tissue in mice
journal, July 2014

Irradiation in a flash: Unique sparing of memory in mice after whole brain irradiation with dose rates above 100 Gy/s
journal, September 2017

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journal, January 2000

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Ultrahigh Dose-rate Radiotherapy: Next Steps for FLASH-RT
journal, August 2018

Biological effects in normal cells exposed to FLASH dose rate protons
journal, October 2019

Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis
journal, September 2006

Comparative toxicity of synchrotron and conventional radiation therapy based on total and partial body irradiation in a murine model
journal, August 2018

  • Smyth, Lloyd M. L.; Donoghue, Jacqueline F.; Ventura, Jessica A.
  • Scientific Reports, Vol. 8, Issue 1
  • DOI: 10.1038/s41598-018-30543-1
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