FLASH Radiotherapy: Expectations, Challenges, and Current Knowledge

Year: 2024

Authors: Borghini A., Labate L., Piccinini S., Panaino C.M.V., Andreassi MG., Gizzi L.A.

Autors Affiliation: CNR, Inst Clin Physiol, I-56124 Pisa, Italy; CNR, Ist Nazl Ott, Intense Laser Irradiat Lab ILIL, I-56124 Pisa, Italy.

Abstract: Major strides have been made in the development of FLASH radiotherapy (FLASH RT) in the last ten years, but there are still many obstacles to overcome for transfer to the clinic to become a reality. Although preclinical and first-in-human clinical evidence suggests that ultra-high dose rates (UHDRs) induce a sparing effect in normal tissue without modifying the therapeutic effect on the tumor, successful clinical translation of FLASH-RT depends on a better understanding of the biological mechanisms underpinning the sparing effect. Suitable in vitro studies are required to fully understand the radiobiological mechanisms associated with UHDRs. From a technical point of view, it is also crucial to develop optimal technologies in terms of beam irradiation parameters for producing FLASH conditions. This review provides an overview of the research progress of FLASH RT and discusses the potential challenges to be faced before its clinical application. We critically summarize the preclinical evidence and in vitro studies on DNA damage following UHDR irradiation. We also highlight the ongoing developments of technologies for delivering FLASH-compliant beams, with a focus on laser-driven plasma accelerators suitable for performing basic radiobiological research on the UHDR effects.

Journal/Review: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES

Volume: 25 (5)      Pages from: 2546-1  to: 2546-17

More Information: All the figures in this manuscript were created with biorender.com. We acknowledge the Horizon Europe Research and Innovation Programme EuPRAXIA PP under Grant Agreement No. 101079773 (CUP B83C22003930001) and NextGeneration EU Integrated Infrastructure I-PHOQS-Initiative in Photonic and Quantum Sciences- (CUP B53C22001750006, ID D2B8D520, IR0000016).
KeyWords: FLASH radiotherapy; FLASH effect; ultra-high dose rate; very high-energy electrons; normal tissue response; tumor response; nuclear DNA damage; gamma-H2AX; CBMN assay; mitochondrial DNA
DOI: 10.3390/ijms25052546

Citations: 8
data from “WEB OF SCIENCE” (of Thomson Reuters) are update at: 2024-12-15
References taken from IsiWeb of Knowledge: (subscribers only)