Key changes in the future clinical application of ultra-high dose rate radiotherapy

Abstract

Ultra-high dose rate radiotherapy (FLASH-RT) is an external beam radiotherapy strategy that uses an extremely high dose rate (≥40 Gy/s). Compared with conventional dose rate radiotherapy (≤0.1 Gy/s), the main advantage of FLASH-RT is that it can reduce damage of organs at risk surrounding the cancer and retain the anti-tumor effect. An important feature of FLASH-RT is that an extremely high dose rate leads to an extremely short treatment time; therefore, in clinical applications, the steps of radiotherapy may need to be adjusted. In this review, we discuss the selection of indications, simulations, target delineation, selection of radiotherapy technologies, and treatment plan evaluation for FLASH-RT to provide a theoretical basis for future research.

FLASH radiotherapy using high-energy X-rays: validation of the FLASH effect triggered by a compact single high-energy X-ray source device

“…Current published [25,26] and ongoing (NCT05724875, NCT05524064, NCT04986696) clinical studies on FLASH-RT have mostly employed two-dimensional radiation therapy technology in patients with skin tumors and bone metastases for palliative pain relief purposes. However, in tumors with more complex shapes that implicate internal organs, three-dimensional (3D) conformal therapy techniques, such as FLASH-RT, may be necessary [27]. PHASER is a conceptual shared research platform designed to achieve highly conformal electronic FLASH-RT.…”