Fenwick, John D;
Mayhew, Christopher;
Jolly, Simon;
Amos, Richard A;
Hawkins, Maria A;
(2024)
Navigating the straits: realizing the potential of proton FLASH through physics advances and further pre-clinical characterization.
Frontiers in Oncology
, 14
, Article 1420337. 10.3389/fonc.2024.1420337.
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Abstract
Ultra-high dose-rate ‘FLASH’ radiotherapy may be a pivotal step forward for cancer treatment, widening the therapeutic window between radiation tumour killing and damage to neighbouring normal tissues. The extent of normal tissue sparing reported in pre-clinical FLASH studies typically corresponds to an increase in isotoxic dose-levels of 5–20%, though gains are larger at higher doses. Conditions currently thought necessary for FLASH normal tissue sparing are a dose-rate ≥40 Gy s-1, dose-per-fraction ≥5–10 Gy and irradiation duration ≤0.2–0.5 s. Cyclotron proton accelerators are the first clinical systems to be adapted to irradiate deep-seated tumours at FLASH dose-rates, but even using these machines it is challenging to meet the FLASH conditions. In this review we describe the challenges for delivering FLASH proton beam therapy, the compromises that ensue if these challenges are not addressed, and resulting dosimetric losses. Some of these losses are on the same scale as the gains from FLASH found pre-clinically. We therefore conclude that for FLASH to succeed clinically the challenges must be systematically overcome rather than accommodated, and we survey physical and pre-clinical routes for achieving this.
| Type: | Article |
|---|---|
| Title: | Navigating the straits: realizing the potential of proton FLASH through physics advances and further pre-clinical characterization |
| Location: | Switzerland |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3389/fonc.2024.1420337 |
| Publisher version: | http://dx.doi.org/10.3389/fonc.2024.1420337 |
| Language: | English |
| Additional information: | Copyright © 2024 Fenwick, Mayhew, Jolly, Amos and Hawkins. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
| Keywords: | FLASH, proton, radiotherapy, ridge filter, adaptation, time-structure |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Physics and Astronomy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10195942 |
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