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

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...

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Bibliographic Details
Published in:Frontiers in oncology Vol. 9; p. 1563
Main Authors: Wilson, Joseph D., Hammond, Ester M., Higgins, Geoff S., Petersson, Kristoffer
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 17.01.2020
Subjects:
Cancer and Oncology
Cancer och onkologi
Clinical Medicine
FLASH
hypoxia
immune
Klinisk medicin
Medical and Health Sciences
Medicin och hälsovetenskap
normal tissue
Oncology
radiotherapy
radiotherapy
hypoxia
normal tissue
immune
FLASH
ISSN:2234-943X, 2234-943X
Online Access:Get full text
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Summary: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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Geoff S. Higgins orcid.org/0000-0003-3072-909X
Ester M. Hammond orcid.org/0000-0002-2335-3146
Kristoffer Petersson orcid.org/0000-0003-0300-5790
ORCID: Joseph D. Wilson orcid.org/0000-0001-8878-5882
Edited by: Ira Ida Skvortsova, Innsbruck Medical University, Austria
This article was submitted to Radiation Oncology, a section of the journal Frontiers in Oncology
Reviewed by: Virginie Monceau, Collège de France, France; Anne-Sophie Wozny, Université Claude Bernard Lyon 1, France; Marie-Catherine Vozenin, Lausanne University Hospital (CHUV), Switzerland
ISSN:2234-943X
2234-943X
DOI:10.3389/fonc.2019.01563