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Ultra-High Dose Rate (FLASH) Radiotherapy : Silver Bullet or Fool's Gold?

Wilson, Joseph D. ; Hammond, Ester M. ; Higgins, Geoff S. and Petersson, Kristoffer LU (2020) In Frontiers in Oncology 9.
Abstract

Radiotherapy is a cornerstone of both curative and palliative cancer care. However, radiotherapy is severely limited by radiation-induced toxicities. If these toxicities could be reduced, a greater dose of radiation could be given therefore facilitating a better tumor response. Initial pre-clinical studies have shown that irradiation at dose rates far exceeding those currently used in clinical contexts reduce radiation-induced toxicities whilst maintaining an equivalent tumor response. This is known as the FLASH effect. To date, a single patient has been subjected to FLASH radiotherapy for the treatment of subcutaneous T-cell lymphoma resulting in complete response and minimal toxicities. The mechanism responsible for reduced tissue... (More)

Radiotherapy is a cornerstone of both curative and palliative cancer care. However, radiotherapy is severely limited by radiation-induced toxicities. If these toxicities could be reduced, a greater dose of radiation could be given therefore facilitating a better tumor response. Initial pre-clinical studies have shown that irradiation at dose rates far exceeding those currently used in clinical contexts reduce radiation-induced toxicities whilst maintaining an equivalent tumor response. This is known as the FLASH effect. To date, a single patient has been subjected to FLASH radiotherapy for the treatment of subcutaneous T-cell lymphoma resulting in complete response and minimal toxicities. The mechanism responsible for reduced tissue toxicity following FLASH radiotherapy is yet to be elucidated, but the most prominent hypothesis so far proposed is that acute oxygen depletion occurs within the irradiated tissue. This review examines the tissue response to FLASH radiotherapy, critically evaluates the evidence supporting hypotheses surrounding the biological basis of the FLASH effect, and considers the potential for FLASH radiotherapy to be translated into clinical contexts.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
FLASH, hypoxia, immune, normal tissue, radiotherapy
in
Frontiers in Oncology
volume
9
article number
1563
publisher
Frontiers Media S. A.
external identifiers
  • pmid:32010633
  • scopus:85078966400
ISSN
2234-943X
DOI
10.3389/fonc.2019.01563
language
English
LU publication?
yes
id
2495a255-76e2-4df9-968e-2498caee56a2
date added to LUP
2020-02-18 15:47:45
date last changed
2024-06-27 13:21:14
@article{2495a255-76e2-4df9-968e-2498caee56a2,
  abstract     = {{<p>Radiotherapy is a cornerstone of both curative and palliative cancer care. However, radiotherapy is severely limited by radiation-induced toxicities. If these toxicities could be reduced, a greater dose of radiation could be given therefore facilitating a better tumor response. Initial pre-clinical studies have shown that irradiation at dose rates far exceeding those currently used in clinical contexts reduce radiation-induced toxicities whilst maintaining an equivalent tumor response. This is known as the FLASH effect. To date, a single patient has been subjected to FLASH radiotherapy for the treatment of subcutaneous T-cell lymphoma resulting in complete response and minimal toxicities. The mechanism responsible for reduced tissue toxicity following FLASH radiotherapy is yet to be elucidated, but the most prominent hypothesis so far proposed is that acute oxygen depletion occurs within the irradiated tissue. This review examines the tissue response to FLASH radiotherapy, critically evaluates the evidence supporting hypotheses surrounding the biological basis of the FLASH effect, and considers the potential for FLASH radiotherapy to be translated into clinical contexts.</p>}},
  author       = {{Wilson, Joseph D. and Hammond, Ester M. and Higgins, Geoff S. and Petersson, Kristoffer}},
  issn         = {{2234-943X}},
  keywords     = {{FLASH; hypoxia; immune; normal tissue; radiotherapy}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Oncology}},
  title        = {{Ultra-High Dose Rate (FLASH) Radiotherapy : Silver Bullet or Fool's Gold?}},
  url          = {{http://dx.doi.org/10.3389/fonc.2019.01563}},
  doi          = {{10.3389/fonc.2019.01563}},
  volume       = {{9}},
  year         = {{2020}},
}