iBet uBet web content aggregator. Adding the entire web to your favor.
iBet uBet web content aggregator. Adding the entire web to your favor.



Link to original content: https://pubmed.ncbi.nlm.nih.gov/37160539
The current status of FLASH particle therapy: a systematic review - PubMed Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;46(2):529-560.
doi: 10.1007/s13246-023-01266-z. Epub 2023 May 9.

The current status of FLASH particle therapy: a systematic review

Jake Atkinson  1 , Eva Bezak  2   3 , Hien Le  4 , Ivan Kempson  5
Affiliations

The current status of FLASH particle therapy: a systematic review

Jake Atkinson et al. Phys Eng Sci Med. 2023 Jun.

Abstract

Particle therapies are becoming increasingly available clinically due to their beneficial energy deposition profile, sparing healthy tissues. This may be further promoted with ultra-high dose rates, termed FLASH. This review comprehensively summarises current knowledge based on studies relevant to proton- and carbon-FLASH therapy. As electron-FLASH literature presents important radiobiological findings that form the basis of proton and carbon-based FLASH studies, a summary of key electron-FLASH papers is also included. Preclinical data suggest three key mechanisms by which proton and carbon-FLASH are able to reduce normal tissue toxicities compared to conventional dose rates, with equipotent, or enhanced, tumour kill efficacy. However, a degree of caution is needed in clinically translating these findings as: most studies use transmission and do not conform the Bragg peak to tumour volume; mechanistic understanding is still in its infancy; stringent verification of dosimetry is rarely provided; biological assays are prone to limitations which need greater acknowledgement.

Keywords: Biological mechanisms; Cancer treatment; Carbon therapy; FLASH radiotherapy; Normal tissue sparing; Proton therapy; Ultra-high dose rate.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flowchart summary of the search strategy employed in this systematic review. Search terms were filtered through either Scopus or Medline databases and then excluded based upon their relevance to the radiobiological effect of FLASH and ultra-high dose rates. Additional terms were then added from keywords or terminology discovered whilst reading through relevant literature and searches repeated in both databases. Sources were then reviewed by co-authors of this review and categorised. 34 proton- and carbon-FLASH studies are incorporated into the final review
Fig. 2
Fig. 2
Temporal evolution of the treated lesion: (a) before treatment; the limits of the PTV are delineated in black; (b) at 3 weeks, at the peak of skin reactions (grade 1 epithelitis NCI-CTCAE v 5.0); (c) at 5 months. Reprinted from Bourhis et al. 2019 [34], Copyright (2019), with permission from Elsevier
Fig. 3
Fig. 3
Representation of the oxygen depletion hypothesis, depicting relative radiosensitivity of normal versus tumour tissues as a function of oxygen tension. Normal tissues see a more significant change in intracellular O2 levels, affording a brief period of hypoxia which protects normal tissues from ROS related damage during FLASH irradiation. On average, cancerous cells are already relatively hypoxic, so radiation resistance is unchanged by O2 consumption via FLASH. Permitted reprinting from Wilson et al. 2020 [87]
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Baskar R, Lee KA, Yeo R, Yeoh K-W. Cancer and Radiation Therapy: current advances and future directions. Int J Med Sci. 2012;9(3):193–199. doi: 10.7150/ijms.3635. - DOI - PMC - PubMed
    1. Barnett GC, West CML, Dunning AM, Elliott RM, Coles CE, Pharoah PDP, et al. Normal tissue reactions to radiotherapy: towards tailoring treatment dose by genotype. Nat Rev Cancer. 2009;9(2):134–142. doi: 10.1038/nrc2587. - DOI - PMC - PubMed
    1. Paganetti H, Beltran C, Both S, Dong L, Flanz J, Furutani K et al (2021) Roadmap: proton therapy physics and biology. Phys Med Biol 66(5). 10.1088/1361-6560/abcd16 - PMC - PubMed
    1. Giuranno L, Ient J, De Ruysscher D, Vooijs MA (2019) Radiation-Induced Lung Injury (RILI). Front Oncol 9. 10.3389/fonc.2019.00877 - PMC - PubMed
    1. Palmer SL, Goloubeva O, Reddick WE, Glass JO, Gajjar A, Kun L, et al. Patterns of Intellectual Development among Survivors of Pediatric Medulloblastoma: a longitudinal analysis. J Clin Oncol. 2001;19(8):2302–2308. doi: 10.1200/jco.2001.19.8.2302. - DOI - PubMed

Publication types

LinkOut - more resources