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A Quantitative Analysis of the Role of Oxygen Tension in FLASH Radiation Therapy

Petersson, Kristoffer LU ; Adrian, Gabriel LU orcid ; Butterworth, Karl and McMahon, Stephen J. (2020) In International Journal of Radiation Oncology Biology Physics 107(3). p.539-547
Abstract

Purpose: Recent demonstrations of normal tissue sparing by high-dose, high-dose-rate FLASH radiation therapy have driven considerable interest in its application to improve clinical outcomes. However, significant uncertainty remains about the underlying mechanisms of FLASH sparing and how deliveries can be optimized to maximize benefit from this effect. Rapid oxygen depletion has been suggested as a potential mechanism by which these effects occur, but this has yet to be quantitatively tested against experimental data. Methods and Materials: Models of oxygen kinetics during irradiation were used to develop a time-dependent model of the oxygen enhancement ratio in mammalian cells that incorporates oxygen depletion. The characteristics of... (More)

Purpose: Recent demonstrations of normal tissue sparing by high-dose, high-dose-rate FLASH radiation therapy have driven considerable interest in its application to improve clinical outcomes. However, significant uncertainty remains about the underlying mechanisms of FLASH sparing and how deliveries can be optimized to maximize benefit from this effect. Rapid oxygen depletion has been suggested as a potential mechanism by which these effects occur, but this has yet to be quantitatively tested against experimental data. Methods and Materials: Models of oxygen kinetics during irradiation were used to develop a time-dependent model of the oxygen enhancement ratio in mammalian cells that incorporates oxygen depletion. The characteristics of this model were then explored in terms of the dose and dose-rate dependence of the oxygen enhancement ratio. This model was also fit to experimental data from both in vitro and in vivo data sets. Results: In cases of FLASH radiation therapy, this model suggests that oxygen levels can be depleted by amounts that are sufficient to affect radiosensitivity only in conditions of intermediate oxygen tension, with no effect seen at high or very low initial oxygen levels. The model also effectively reproduced the dose, dose rate, and oxygen tension dependence of responses to FLASH radiation therapy in a range of systems, with model parameters compatible with published data. Conclusions: Oxygen depletion provides a credible quantitative model to understand the biological effects of FLASH radiation therapy and is compatible with a range of experimental observations of FLASH sparing. These results highlight the need for more detailed quantification of oxygen depletion under high-dose-rate radiation exposures in relevant systems and the importance of oxygen tension in target tissues for FLASH sparing to be observed.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal of Radiation Oncology Biology Physics
volume
107
issue
3
pages
9 pages
publisher
Elsevier
external identifiers
  • pmid:32145319
  • scopus:85083015589
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2020.02.634
language
English
LU publication?
yes
id
a6b5bb18-256e-45d9-bfd1-8611582d72d7
date added to LUP
2020-05-07 15:58:06
date last changed
2024-04-03 05:58:10
@article{a6b5bb18-256e-45d9-bfd1-8611582d72d7,
  abstract     = {{<p>Purpose: Recent demonstrations of normal tissue sparing by high-dose, high-dose-rate FLASH radiation therapy have driven considerable interest in its application to improve clinical outcomes. However, significant uncertainty remains about the underlying mechanisms of FLASH sparing and how deliveries can be optimized to maximize benefit from this effect. Rapid oxygen depletion has been suggested as a potential mechanism by which these effects occur, but this has yet to be quantitatively tested against experimental data. Methods and Materials: Models of oxygen kinetics during irradiation were used to develop a time-dependent model of the oxygen enhancement ratio in mammalian cells that incorporates oxygen depletion. The characteristics of this model were then explored in terms of the dose and dose-rate dependence of the oxygen enhancement ratio. This model was also fit to experimental data from both in vitro and in vivo data sets. Results: In cases of FLASH radiation therapy, this model suggests that oxygen levels can be depleted by amounts that are sufficient to affect radiosensitivity only in conditions of intermediate oxygen tension, with no effect seen at high or very low initial oxygen levels. The model also effectively reproduced the dose, dose rate, and oxygen tension dependence of responses to FLASH radiation therapy in a range of systems, with model parameters compatible with published data. Conclusions: Oxygen depletion provides a credible quantitative model to understand the biological effects of FLASH radiation therapy and is compatible with a range of experimental observations of FLASH sparing. These results highlight the need for more detailed quantification of oxygen depletion under high-dose-rate radiation exposures in relevant systems and the importance of oxygen tension in target tissues for FLASH sparing to be observed.</p>}},
  author       = {{Petersson, Kristoffer and Adrian, Gabriel and Butterworth, Karl and McMahon, Stephen J.}},
  issn         = {{0360-3016}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{3}},
  pages        = {{539--547}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Radiation Oncology Biology Physics}},
  title        = {{A Quantitative Analysis of the Role of Oxygen Tension in FLASH Radiation Therapy}},
  url          = {{http://dx.doi.org/10.1016/j.ijrobp.2020.02.634}},
  doi          = {{10.1016/j.ijrobp.2020.02.634}},
  volume       = {{107}},
  year         = {{2020}},
}