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Poulsen PR, Johansen JG, Sitarz MK, Kanouta E, Kristensen L, Grau C, Sørensen BS. Oxygen Enhancement Ratio-Weighted Dose Quantitatively Describes Acute Skin Toxicity Variations in Mice After Pencil Beam Scanning Proton FLASH Irradiation With Changing Doses and Time Structures. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00358-4. [PMID: 38462015 DOI: 10.1016/j.ijrobp.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The aim of this work was to investigate the ability of a biological oxygen enhancement ratio-weighted dose, DOER, to describe acute skin toxicity variations observed in mice after proton pencil beam scanning irradiations with changing doses and beam time structures. METHODS AND MATERIALS In five independent experiments, the right hind leg of a total of 621 CDF1 mice was irradiated previously in the entrance plateau of a pencil beam scanning proton beam. The incidence of acute skin toxicity (of level 1.5-2.0-2.5-3.0-3.5) was scored for 47 different mouse groups that mapped toxicity as function of dose for conventional and FLASH dose rate, toxicity as function of field dose rate with and without repainting, and toxicity when splitting the treatment into 1 to 6 identical deliveries separated by 2 minutes. DOER was calculated for all mouse groups using a simple oxygen kinetics model to describe oxygen depletion. The three independent model parameters (oxygen-depletion rate, oxygen-recovery rate, oxygen level without irradiation) were fitted to the experimental data. The ability of DOER to describe the toxicity variations across all experiments was investigated by comparing DOER-response curves across the five independent experiments. RESULTS After conversion from the independent variable tested in each experiment to DOER, all five experiments had similar MDDOER50 (DOER giving 50% toxicity incidence) with standard deviations of 0.45 - 1.6 Gy for the five toxicity levels. DOER could thus describe the observed toxicity variations across all experiments. CONCLUSIONS DOER described the varying FLASH-sparing effect observed for a wide range of conditions. Calculation of DOER for other irradiation conditions can quantitatively estimate the FLASH-sparing effect for arbitrary irradiations for the investigated murine model. With appropriate fitting parameters DOER also may be able to describe FLASH effect variations with dose and dose rate for other assays and endpoints.
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Affiliation(s)
- Per Rugaard Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jacob Graversen Johansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mateusz Krzysztof Sitarz
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eleni Kanouta
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Kristensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Rank L, Dogan O, Kopp B, Mein S, Verona-Rinati G, Kranzer R, Marinelli M, Mairani A, Tessonnier T. Development and benchmarking of a dose rate engine for raster-scanned FLASH helium ions. Med Phys 2024; 51:2251-2262. [PMID: 37847027 PMCID: PMC10939952 DOI: 10.1002/mp.16793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Radiotherapy with charged particles at high dose and ultra-high dose rate (uHDR) is a promising technique to further increase the therapeutic index of patient treatments. Dose rate is a key quantity to predict the so-called FLASH effect at uHDR settings. However, recent works introduced varying calculation models to report dose rate, which is susceptible to the delivery method, scanning path (in active beam delivery) and beam intensity. PURPOSE This work introduces an analytical dose rate calculation engine for raster scanned charged particle beams that is able to predict dose rate from the irradiation plan and recorded beam intensity. The importance of standardized dose rate calculation methods is explored here. METHODS Dose is obtained with an analytical pencil beam algorithm, using pre-calculated databases for integrated depth dose distributions and lateral penumbra. Dose rate is then calculated by combining dose information with the respective particle fluence (i.e., time information) using three dose-rate-calculation models (mean, instantaneous, and threshold-based). Dose rate predictions for all three models are compared to uHDR helium ion beam (145.7 MeV/u, range in water of approximatively 14.6 cm) measurements performed at the Heidelberg Ion Beam Therapy Center (HIT) with a diamond-detector prototype. Three scanning patterns (scanned or snake-like) and four field sizes are used to investigate the dose rate differences. RESULTS Dose rate measurements were in good agreement with in-silico generated distributions using the here introduced engine. Relative differences in dose rate were below 10% for varying depths in water, from 2.3 to 14.8 cm, as well as laterally in a near Bragg peak area. In the entrance channel of the helium ion beam, dose rates were predicted within 7% on average for varying irradiated field sizes and scanning patterns. Large differences in absolute dose rate values were observed for varying calculation methods. For raster-scanned irradiations, the deviation between mean and threshold-based dose rate at the investigated point was found to increase with the field size up to 63% for a 10 mm × 10 mm field, while no significant differences were observed for snake-like scanning paths. CONCLUSIONS This work introduces the first dose rate calculation engine benchmarked to instantaneous dose rate, enabling dose rate predictions for physical and biophysical experiments. Dose rate is greatly affected by varying particle fluence, scanning path, and calculation method, highlighting the need for a consensus among the FLASH community on how to calculate and report dose rate in the future. The here introduced engine could help provide the necessary details for the analysis of the sparing effect and uHDR conditions.
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Affiliation(s)
- Luisa Rank
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Karlsruhe Institute of Technology (KIT), Faculty of Physics, Karlsruhe, Germany
| | - Ozan Dogan
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Faculty of Physics and Astronomy, Heidelberg, Germany
| | - Benedikt Kopp
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stewart Mein
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital (UKHD), Heidelberg Faculty of Medicine (MFHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Rafael Kranzer
- PTW-Freiburg, Freiburg, Germany
- University Clinic for Medical Radiation Physics, Medical Campus Pius Hospital, Carl von Ossietzky University Oldenburg, Germany
| | - Marco Marinelli
- Industrial Engineering Department, University of Rome “Tor Vergata”, Rome, Italy
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital (UKHD), Heidelberg Faculty of Medicine (MFHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Physics, National Centre of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital (UKHD), Heidelberg Faculty of Medicine (MFHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Shiraishi Y, Matsuya Y, Fukunaga H. Possible mechanisms and simulation modeling of FLASH radiotherapy. Radiol Phys Technol 2024; 17:11-23. [PMID: 38184508 DOI: 10.1007/s12194-023-00770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
FLASH radiotherapy (FLASH-RT) has great potential to improve patient outcomes. It delivers radiation doses at an ultra-high dose rate (UHDR: ≥ 40 Gy/s) in a single instant or a few pulses. Much higher irradiation doses can be administered to tumors with FLASH-RT than with conventional dose rate (0.01-0.40 Gy/s) radiotherapy. UHDR irradiation can suppress toxicity in normal tissues while sustaining antitumor efficiency, which is referred to as the FLASH effect. However, the mechanisms underlying the effects of the FLASH remain unclear. To clarify these mechanisms, the development of simulation models that can contribute to treatment planning for FLASH-RT is still underway. Previous studies indicated that transient oxygen depletion or augmented reactions between secondary reactive species produced by irradiation may be involved in this process. To discuss the possible mechanisms of the FLASH effect and its clinical potential, we summarized the physicochemical, chemical, and biological perspectives as well as the development of simulation modeling for FLASH-RT.
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Affiliation(s)
- Yuta Shiraishi
- Graduate School of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
- Faculty of Health Sciences, Japan Healthcare University, 3-11-1-50 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, Hokkaido, 062-0053, Japan
| | - Yusuke Matsuya
- Faculty of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Hisanori Fukunaga
- Faculty of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan.
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Cordoni FG. A spatial measure-valued model for radiation-induced DNA damage kinetics and repair under protracted irradiation condition. J Math Biol 2024; 88:21. [PMID: 38285219 PMCID: PMC10824812 DOI: 10.1007/s00285-024-02046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/01/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
In the present work, we develop a general spatial stochastic model to describe the formation and repair of radiation-induced DNA damage. The model is described mathematically as a measure-valued particle-based stochastic system and extends in several directions the model developed in Cordoni et al. (Phys Rev E 103:012412, 2021; Int J Radiat Biol 1-16, 2022a; Radiat Res 197:218-232, 2022b). In this new spatial formulation, radiation-induced DNA damage in the cell nucleus can undergo different pathways to either repair or lead to cell inactivation. The main novelty of the work is to rigorously define a spatial model that considers the pairwise interaction of lesions and continuous protracted irradiation. The former is relevant from a biological point of view as clustered lesions are less likely to be repaired, leading to cell inactivation. The latter instead describes the effects of a continuous radiation field on biological tissue. We prove the existence and uniqueness of a solution to the above stochastic systems, characterizing its probabilistic properties. We further couple the model describing the biological system to a set of reaction-diffusion equations with random discontinuity that model the chemical environment. At last, we study the large system limit of the process. The developed model can be applied to different contexts, with radiotherapy and space radioprotection being the most relevant. Further, the biochemical system derived can play a crucial role in understanding an extremely promising novel radiotherapy treatment modality, named in the community FLASH radiotherapy, whose mechanism is today largely unknown.
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Hu A, Zhou W, Qiu R, Wei S, Wu Z, Zhang H, Li J. Computational model of radiation oxygen effect with Monte Carlo simulation: effects of antioxidants and peroxyl radicals. Int J Radiat Biol 2024; 100:595-608. [PMID: 38166197 DOI: 10.1080/09553002.2023.2295292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/20/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE Oxygen plays a crucial role in radiation biology. Antioxidants and peroxyl radicals affect the oxygen effect greatly. This study aims to establish a computational model of the oxygen effect and explore the effect attributed to antioxidants and peroxyl radicals. MATERIALS AND METHODS Oxygen-related reactions are added to our track-structure Monte Carlo code NASIC, including oxygen fixation, chemical repair by antioxidants and damage migration from base-derived peroxyl radicals. Then the code is used to simulate the DNA damage under various oxygen, antioxidant and damage migration rate conditions. The oxygen enhancement ratio(OER) is calculated quantifying by the number of double-strand breaks for each condition. The roles of antioxidants and peroxyl radicals are examined by manipulating the relevant parameters. RESULTS AND CONCLUSIONS Our results indicate that antioxidants are capable of rapidly restoring DNA radicals through chemical reactions, which compete with natural and oxygen fixation processes. Additionally, antioxidants can react with peroxyl radicals derived from bases, thereby preventing the damage from migrating to DNA strands. By quantitatively accounting for the impact of peroxyl radicals and antioxidants on the OER curves, our study establishes a more precise and comprehensive model of the radiation oxygen effect.
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Affiliation(s)
- Ankang Hu
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Wanyi Zhou
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Rui Qiu
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Shuoyang Wei
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Zhen Wu
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Nuctech Company Limited, Beijing, China
| | - Hui Zhang
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Junli Li
- Department of Engineering Physics, Tsinghua University, Beijing, China
- Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
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Zhu H, Schuemann J, Zhang Q, Gerweck LE. Modeling the impact of tissue oxygen profiles and oxygen depletion parameter uncertainties on biological response and therapeutic benefit of FLASH. Med Phys 2024; 51:670-681. [PMID: 36939370 PMCID: PMC10509320 DOI: 10.1002/mp.16366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Ultra-high dose rate (FLASH) radiation has been reported to efficiently suppress tumor growth while sparing normal tissue; however, the mechanism of the differential tissue sparing effect is still not known. Oxygen has long been known to profoundly impact radiobiological responses, and radiolytic oxygen depletion has been considered to be a possible cause or contributor to the FLASH phenomenon. PURPOSE This work investigates the impact of tissue pO2 profiles, oxygen depletion per unit dose (g), and the oxygen concentration yielding half-maximum radiosensitization (the average of its maximum value and one) (k) in tumor and normal tissue. METHODS We developed a model that considers the dependent relationship between oxygen depletion and change of radiosensitivity by FLASH irradiation. The model assumed that FLASH irradiation depletes intracellular oxygen more rapidly than it diffuses into the cell from the extracellular environment. Cell survival was calculated based on the linear quadratic-linear model and the radiosensitivity related parameters were adjusted in 1 Gy increments of the administered dose. The model reproduced published experimental data that were obtained with different cell lines and oxygen concentrations, and was used to analyze the impact of parameter uncertainties on the radiobiological responses. This study expands the oxygen depletion analysis of FLASH to normal human tissue and tumor based on clinically determined aggregate and individual patient pO2 profiles. RESULTS The results show that the pO2 profile is the most essential factor that affects biological response and analyses based on the median pO2 rather than the full pO2 profile can be unreliable and misleading. Additionally, the presence of a small fraction of cells on the threshold of radiobiologic hypoxia substantially alters biological response due to FLASH oxygen depletion. We found that an increment in the k value is generally more protective of tumor than normal tissue due to a higher frequency of lower pO2 values in tumors. Variation in the g value affects the dose at which oxygen depletion impacts response, but does not alter the dose-dependent response trends, if the g value is identical in both tumor and normal tissue. CONCLUSIONS The therapeutic efficacy of FLASH oxygen depletion is likely patient and tissue-dependent. For breast cancer, FLASH is beneficial in a minority of cases; however, in a subset of well oxygenated tumors, a therapeutic gain may be realized due to induced normal tissue hypoxia.
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Affiliation(s)
- Hongyu Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Qixian Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Leo E Gerweck
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States of America
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Shiraishi Y, Matsuya Y, Kusumoto T, Fukunaga H. Modeling for predicting survival fraction of cells after ultra-high dose rate irradiation. Phys Med Biol 2023; 69:015017. [PMID: 38056015 DOI: 10.1088/1361-6560/ad131b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023]
Abstract
Objective. FLASH radiotherapy (FLASH-RT) with ultra-high dose rate (UHDR) irradiation (i.e. > 40 Gy s-1) spares the function of normal tissues while preserving antitumor efficacy, known as the FLASH effect. The biological effects after conventional dose rate-radiotherapy (CONV-RT) with ≤0.1 Gy s-1have been well modeled by considering microdosimetry and DNA repair processes, meanwhile modeling of radiosensitivities under UHDR irradiation is insufficient. Here, we developed anintegrated microdosimetric-kinetic(IMK)model for UHDR-irradiationenabling the prediction of surviving fraction after UHDR irradiation.Approach.TheIMK model for UHDR-irradiationconsiders the initial DNA damage yields by the modification of indirect effects under UHDR compared to CONV dose rate. The developed model is based on the linear-quadratic (LQ) nature with the dose and dose square coefficients, considering the reduction of DNA damage yields as a function of dose rate.Main results.The estimate by the developed model could successfully reproduce thein vitroexperimental dose-response curve for various cell line types and dose rates.Significance.The developed model would be useful for predicting the biological effects under the UHDR irradiation.
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Affiliation(s)
- Yuta Shiraishi
- Graduate school of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
- Faculty of Health Sciences, Japan Healthcare University, 3-11-1-50 Tsukisamu-higashi, Toyohira-ku, Sapporo, Hokkaido, 062-0053, Japan
| | - Yusuke Matsuya
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
- Nuclear Science and Engineering Center, Japan Atomic Energy Agency, 2-4 Shirakata, Tokai, Ibaraki, 319-1195, Japan
| | - Tamon Kusumoto
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Hisanori Fukunaga
- Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
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Iturri L, Bertho A, Lamirault C, Brisebard E, Juchaux M, Gilbert C, Espenon J, Sébrié C, Jourdain L, de Marzi L, Pouzoulet F, Muret J, Verrelle P, Prezado Y. Oxygen supplementation in anesthesia can block FLASH effect and anti-tumor immunity in conventional proton therapy. Commun Med (Lond) 2023; 3:183. [PMID: 38102219 PMCID: PMC10724215 DOI: 10.1038/s43856-023-00411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Radiation-induced neurocognitive dysfunction is a major adverse effect of brain radiation therapy and has specific relevance in pediatric oncology, where serious cognitive deficits have been reported in survivors of pediatric brain tumors. Moreover, many pediatric patients receive proton therapy under general anesthesia or sedation to guarantee precise ballistics with a high oxygen content for safety. The present study addresses the relevant question of the potential effect of supplemental oxygen administered during anesthesia on normal tissue toxicity and investigates the anti-tumor immune response generated following conventional and FLASH proton therapy. METHODS Rats (Fischer 344) were cranially irradiated with a single high dose of proton therapy (15 Gy or 25 Gy) using FLASH dose rate proton irradiation (257 ± 2 Gy/s) or conventional dose rate proton irradiation (4 ± 0.02 Gy/s), and the toxicities in the normal tissue were examined by histological, cytometric and behavioral analysis. Glioblastoma-bearing rats were irradiated in the same manner and tumor-infiltrating leukocytes were quantified by flow cytometry. RESULTS Our findings indicate that supplemental oxygen has an adverse impact on both functional and anatomical evaluations of normal brain following conventional and FLASH proton therapy. In addition, oxygen supplementation in anesthesia is particularly detrimental for anti-tumor immune response by preventing a strong immune cell infiltration into tumoral tissues following conventional proton therapy. CONCLUSIONS These results demonstrate the need to further optimize anesthesia protocols used in radiotherapy with the goal of preserving normal tissues and achieving tumor control, specifically in combination with immunotherapy agents.
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Affiliation(s)
- Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Charlotte Lamirault
- Translational Research Department, Institut Curie, Experimental Radiotherapy Platform, Université Paris Saclay, Orsay, France
| | | | - Marjorie Juchaux
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Cristèle Gilbert
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Julie Espenon
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Catherine Sébrié
- Service Hospitalier Frederic Joliot, CEA, CNRS, Inserm, BIOMAPS Universite Paris-Saclay, Orsay, France
| | - Laurène Jourdain
- Service Hospitalier Frederic Joliot, CEA, CNRS, Inserm, BIOMAPS Universite Paris-Saclay, Orsay, France
| | - Ludovic de Marzi
- Institut Curie, Université PSL, Université Paris-Saclay, Inserm U1288, Laboratoire de Recherche Translationnelle en Oncologie (LITO), Orsay, France
- Institut Curie, Radiation Oncology Department, Campus universitaire, Orsay, France
| | - Frédéric Pouzoulet
- Translational Research Department, Institut Curie, Experimental Radiotherapy Platform, Université Paris Saclay, Orsay, France
- Institut Curie, Université PSL, Université Paris-Saclay, Inserm U1288, Laboratoire de Recherche Translationnelle en Oncologie (LITO), Orsay, France
| | - Jane Muret
- Institut Curie, Université PSL, Department of Anesthesia and Intensive Care, Paris, France
| | - Pierre Verrelle
- Institut Curie, Radiation Oncology Department, Campus universitaire, Orsay, France
- Institut Curie, Université Paris-Saclay, Inserm U1196, CNRS UMR9187, Chimie et Modélisation pour la Biologie du Cancer (CMBC), Orsay, France
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France.
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France.
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Gupta S, Inman JL, De Chant J, Obst-Huebl L, Nakamura K, Costello SM, Marqusee S, Mao JH, Kunz L, Paisley R, Vozenin MC, Snijders AM, Ralston CY. A Novel Platform for Evaluating Dose Rate Effects on Oxidative Damage to Peptides: Toward a High-Throughput Method to Characterize the Mechanisms Underlying the FLASH Effect. Radiat Res 2023; 200:523-530. [PMID: 38014573 PMCID: PMC10754258 DOI: 10.1667/rade-23-00131.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/05/2023] [Indexed: 11/29/2023]
Abstract
High dose rate radiation has gained considerable interest recently as a possible avenue for increasing the therapeutic window in cancer radiation treatment. The sparing of healthy tissue at high dose rates relative to conventional dose rates, while maintaining tumor control, has been termed the FLASH effect. Although the effect has been validated in animal models using multiple radiation sources, it is not yet well understood. Here, we demonstrate a new experimental platform for quantifying oxidative damage to protein sidechains in solution as a function of radiation dose rate and oxygen availability using liquid chromatography mass spectrometry. Using this reductionist approach, we show that for both X-ray and electron sources, isolated peptides in solution are oxidatively modified to different extents as a function of both dose rate and oxygen availability. Our method provides an experimental platform for exploring the parameter space of the dose rate effect on oxidative changes to proteins in solution.
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Affiliation(s)
- Sayan Gupta
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Jamie L. Inman
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Jared De Chant
- Accelerator Technology and Applied Physics Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Lieselotte Obst-Huebl
- Accelerator Technology and Applied Physics Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Kei Nakamura
- Accelerator Technology and Applied Physics Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Shawn M. Costello
- Biophysics Graduate Program, Department of Chemistry; California Institute for Quantitative Biosciences, University of California, Berkeley, Califormia; Chan Zuckerberg Biohub, San Francisco, California
| | - Susan Marqusee
- Department of Molecular and Cell Biology, Department of Chemistry; California Institute for Quantitative Biosciences, University of California, Berkeley, Califormia; Chan Zuckerberg Biohub, San Francisco, California
| | - Jian-Hua Mao
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Louis Kunz
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ryan Paisley
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Antoine M. Snijders
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
| | - Corie Y. Ralston
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720
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10
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Hu S, Lan X, Zheng J, Bi Y, Ye Y, Si M, Fang Y, Wang J, Liu J, Chen Y, Chen Y, Xiang P, Niu T, Huang Y. The dose-related plateau effect of surviving fraction in normal tissue during the ultra-high-dose-rate radiotherapy. Phys Med Biol 2023; 68:185004. [PMID: 37586385 DOI: 10.1088/1361-6560/acf112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023]
Abstract
Objective.Ultra-high-dose-rate radiotherapy, referred to as FLASH therapy, has been demonstrated to reduce the damage of normal tissue as well as inhibiting tumor growth compared with conventional dose-rate radiotherapy. The transient hypoxia may be a vital explanation for sparing the normal tissue. The heterogeneity of oxygen distribution for different doses and dose rates in the different radiotherapy schemes are analyzed. With these results, the influence of doses and dose rates on cell survival are evaluated in this work.Approach.The two-dimensional reaction-diffusion equations are used to describe the heterogeneity of the oxygen distribution in capillaries and tissue. A modified linear quadratic model is employed to characterize the surviving fraction at different doses and dose rates.Main results.The reduction of the damage to the normal tissue can be observed if the doses exceeds a minimum dose threshold under the ultra-high-dose-rate radiation. Also, the surviving fraction exhibits the 'plateau effect' under the ultra-high dose rates radiation, which signifies that within a specific range of doses, the surviving fraction either exhibits minimal variation or increases with the dose. For a given dose, the surviving fraction increases with the dose rate until tending to a stable value, which means that the protection in normal tissue reaches saturation.Significance.The emergence of the 'plateau effect' allows delivering the higher doses while minimizing damage to normal tissue. It is necessary to develop appropriate program of doses and dose rates for different irradiated tissue to achieve more efficient protection.
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Affiliation(s)
- Shuai Hu
- School of Physics and Astronomy, China West Normal University, Nanchong 637009, People's Republic of China
- School of Science, Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Xiaofei Lan
- School of Physics and Astronomy, China West Normal University, Nanchong 637009, People's Republic of China
| | - Jinfen Zheng
- Dermatology, Center for Chronic Disease Prevention of Shenzhen, Guangdong Shenzhen 518020, People's Republic of China
| | - Yuanjie Bi
- School of Science, Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Yuanchun Ye
- Department of Hematology, Oncology and Cancer Immunology Campus Benjamin Franklin Charité-Universitätsmedizin Berlin Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Hindenburgdamm, 30,12203, Berlin Germany
| | - Meiyu Si
- School of Science, Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
- Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, People's Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Yuhong Fang
- School of Science, Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Jinghui Wang
- Varian Medical Systems, Palo Alto, CA 94304, United States of America
| | - Junyan Liu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94304, United States of America
| | - Yuan Chen
- The Institute for Advanced Studies of Wuhan University, 299, Bayi Road, Wuhan, 430072, People's Republic of China
| | - Yuling Chen
- Department of Rheumatology and Immunology, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen 518107, People's Republic of China
| | - Pai Xiang
- The Institute for Advanced Studies of Wuhan University, 299, Bayi Road, Wuhan, 430072, People's Republic of China
| | - Tianye Niu
- Shenzhen Bay Laboratory, Shenzhen 518107, People's Republic of China
| | - Yongsheng Huang
- School of Science, Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
- Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, People's Republic of China
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11
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Pennock M, Wei S, Cheng C, Lin H, Hasan S, Chhabra AM, Choi JI, Bakst RL, Kabarriti R, Simone II CB, Lee NY, Kang M, Press RH. Proton Bragg Peak FLASH Enables Organ Sparing and Ultra-High Dose-Rate Delivery: Proof of Principle in Recurrent Head and Neck Cancer. Cancers (Basel) 2023; 15:3828. [PMID: 37568644 PMCID: PMC10417542 DOI: 10.3390/cancers15153828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Proton pencil-beam scanning (PBS) Bragg peak FLASH combines ultra-high dose rate delivery and organ-at-risk (OAR) sparing. This proof-of-principle study compared dosimetry and dose rate coverage between PBS Bragg peak FLASH and PBS transmission FLASH in head and neck reirradiation. PBS Bragg peak FLASH plans were created via the highest beam single energy, range shifter, and range compensator, and were compared to PBS transmission FLASH plans for 6 GyE/fraction and 10 GyE/fraction in eight recurrent head and neck patients originally treated with quad shot reirradiation (14.8/3.7 CGE). The 6 GyE/fraction and 10 GyE/fraction plans were also created using conventional-rate intensity-modulated proton therapy techniques. PBS Bragg peak FLASH, PBS transmission FLASH, and conventional plans were compared for OAR sparing, FLASH dose rate coverage, and target coverage. All FLASH OAR V40 Gy/s dose rate coverage was 90-100% at 6 GyE and 10 GyE for both FLASH modalities. PBS Bragg peak FLASH generated dose volume histograms (DVHs) like those of conventional therapy and demonstrated improved OAR dose sparing over PBS transmission FLASH. All the modalities had similar CTV coverage. PBS Bragg peak FLASH can deliver conformal, ultra-high dose rate FLASH with a two-millisecond delivery of the minimum MU per spot. PBS Bragg peak FLASH demonstrated similar dose rate coverage to PBS transmission FLASH with improved OAR dose-sparing, which was more pronounced in the 10 GyE/fraction than in the 6 GyE/fraction. This feasibility study generates hypotheses for the benefits of FLASH in head and neck reirradiation and developing biological models.
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Affiliation(s)
- Michael Pennock
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY 10461, USA;
| | - Shouyi Wei
- Department of Physics, New York Proton Center, New York, NY 10035, USA; (S.W.); (H.L.); (S.H.); (M.K.)
| | - Chingyun Cheng
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA;
| | - Haibo Lin
- Department of Physics, New York Proton Center, New York, NY 10035, USA; (S.W.); (H.L.); (S.H.); (M.K.)
| | - Shaakir Hasan
- Department of Physics, New York Proton Center, New York, NY 10035, USA; (S.W.); (H.L.); (S.H.); (M.K.)
| | - Arpit M. Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, NY 10035, USA; (A.M.C.); (J.I.C.); (C.B.S.II)
| | - J. Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY 10035, USA; (A.M.C.); (J.I.C.); (C.B.S.II)
| | - Richard L. Bakst
- Department of Radiation Oncology—Radiation Oncology Associates, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Rafi Kabarriti
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY 10461, USA;
| | - Charles B. Simone II
- Department of Radiation Oncology, New York Proton Center, New York, NY 10035, USA; (A.M.C.); (J.I.C.); (C.B.S.II)
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Minglei Kang
- Department of Physics, New York Proton Center, New York, NY 10035, USA; (S.W.); (H.L.); (S.H.); (M.K.)
| | - Robert H. Press
- Department of Radiation Oncology, Baptist Health South Florida, Miami Cancer Institute, Miami, FL 33176, USA;
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12
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Hami R, Apeke S, Redou P, Gaubert L, Dubois LJ, Lambin P, Visvikis D, Boussion N. Predicting the Tumour Response to Radiation by Modelling the Five Rs of Radiotherapy Using PET Images. J Imaging 2023; 9:124. [PMID: 37367472 DOI: 10.3390/jimaging9060124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Despite the intensive use of radiotherapy in clinical practice, its effectiveness depends on several factors. Several studies showed that the tumour response to radiation differs from one patient to another. The non-uniform response of the tumour is mainly caused by multiple interactions between the tumour microenvironment and healthy cells. To understand these interactions, five major biologic concepts called the "5 Rs" have emerged. These concepts include reoxygenation, DNA damage repair, cell cycle redistribution, cellular radiosensitivity and cellular repopulation. In this study, we used a multi-scale model, which included the five Rs of radiotherapy, to predict the effects of radiation on tumour growth. In this model, the oxygen level was varied in both time and space. When radiotherapy was given, the sensitivity of cells depending on their location in the cell cycle was taken in account. This model also considered the repair of cells by giving a different probability of survival after radiation for tumour and normal cells. Here, we developed four fractionation protocol schemes. We used simulated and positron emission tomography (PET) imaging with the hypoxia tracer 18F-flortanidazole (18F-HX4) images as input data of our model. In addition, tumour control probability curves were simulated. The result showed the evolution of tumours and normal cells. The increase in the cell number after radiation was seen in both normal and malignant cells, which proves that repopulation was included in this model. The proposed model predicts the tumour response to radiation and forms the basis for a more patient-specific clinical tool where related biological data will be included.
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Affiliation(s)
- Rihab Hami
- INSERM UMR 1101 "LaTIM", CEDEX 3, 29238 Brest, France
| | - Sena Apeke
- INSERM UMR 1101 "LaTIM", CEDEX 3, 29238 Brest, France
- CERV, European Center for Virtual Reality, ENIB, CEDEX 3, 29238 Brest, France
| | - Pascal Redou
- INSERM UMR 1101 "LaTIM", CEDEX 3, 29238 Brest, France
- CERV, European Center for Virtual Reality, ENIB, CEDEX 3, 29238 Brest, France
| | - Laurent Gaubert
- INSERM UMR 1101 "LaTIM", CEDEX 3, 29238 Brest, France
- CERV, European Center for Virtual Reality, ENIB, CEDEX 3, 29238 Brest, France
| | - Ludwig J Dubois
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Dimitris Visvikis
- INSERM UMR 1101 "LaTIM", CEDEX 3, 29238 Brest, France
- CHRU BREST, 29200 Brest, France
| | - Nicolas Boussion
- INSERM UMR 1101 "LaTIM", CEDEX 3, 29238 Brest, France
- CHRU BREST, 29200 Brest, France
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13
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Atkinson J, Bezak E, Le H, Kempson I. The current status of FLASH particle therapy: a systematic review. Phys Eng Sci Med 2023; 46:529-560. [PMID: 37160539 DOI: 10.1007/s13246-023-01266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
Particle therapies are becoming increasingly available clinically due to their beneficial energy deposition profile, sparing healthy tissues. This may be further promoted with ultra-high dose rates, termed FLASH. This review comprehensively summarises current knowledge based on studies relevant to proton- and carbon-FLASH therapy. As electron-FLASH literature presents important radiobiological findings that form the basis of proton and carbon-based FLASH studies, a summary of key electron-FLASH papers is also included. Preclinical data suggest three key mechanisms by which proton and carbon-FLASH are able to reduce normal tissue toxicities compared to conventional dose rates, with equipotent, or enhanced, tumour kill efficacy. However, a degree of caution is needed in clinically translating these findings as: most studies use transmission and do not conform the Bragg peak to tumour volume; mechanistic understanding is still in its infancy; stringent verification of dosimetry is rarely provided; biological assays are prone to limitations which need greater acknowledgement.
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Affiliation(s)
- Jake Atkinson
- Future Industries Institute, University of South Australia, Mawson Lakes, South Australia, 5095, Australia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, 5000, Australia
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, 5000, Australia
| | - Ivan Kempson
- Future Industries Institute, University of South Australia, Mawson Lakes, South Australia, 5095, Australia.
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14
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Song H, Kim Y, Sung W. Modeling of the FLASH effect for ion beam radiation therapy. Phys Med 2023; 108:102553. [PMID: 37021608 DOI: 10.1016/j.ejmp.2023.102553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Normal tissue sparing has been shown in preclinical studies under the ultra-fast dose rate condition, so-called FLASH radiotherapy. The preclinical and clinical FLASH studies are being conducted with various radiation modalities such as photons, protons, and heavy ions. The aim of this study is to propose a model to predict the dependency of the FLASH effect on linear energy transfer (LET) by quantifying the oxygen depletion. METHODS We develop an analytical model to examine the FLASH sparing effect by incorporating time-varying oxygen depletion equation and oxygen enhancement ratios according to LET. The variations in oxygen enhancement ratio (OER) are quantified over time with different dose rate (Gy/s) and LET (keV/μm). The FLASH sparing effect (FSE) is defined as the ratio of DFLASH/Dconv where Dconv is the reference absorbed dose delivered at the conventional dose rate, and DFLASH is the absorbed dose delivered at a high dose rate that causes the same amount of biological damage. RESULTS Our model suggests that the FLASH effect is significant only when the oxygen amount is at an intermediate level (10 ∼ 100 mmHg). The FSE is increased as LET decreases, suggesting that LET less than 100 keV/μm is required to induce FLASH sparing effects in normal tissue. CONCLUSIONS Oxygen depletion and recovery provide a quantitative model to understand the FLASH effect. These results highlight the FLASH sparing effects in normal tissue under the conditions with the intermediate oxygen level and low-LET region.
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15
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Liew H, Mein S, Tessonnier T, Abdollahi A, Debus J, Dokic I, Mairani A. Do We Preserve Tumor Control Probability (TCP) in FLASH Radiotherapy? A Model-Based Analysis. Int J Mol Sci 2023; 24:5118. [PMID: 36982185 PMCID: PMC10049554 DOI: 10.3390/ijms24065118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Reports of concurrent sparing of normal tissue and iso-effective treatment of tumors at ultra-high dose-rates (uHDR) have fueled the growing field of FLASH radiotherapy. However, iso-effectiveness in tumors is often deduced from the absence of a significant difference in their growth kinetics. In a model-based analysis, we investigate the meaningfulness of these indications for the clinical treatment outcome. The predictions of a previously benchmarked model of uHDR sparing in the "UNIfied and VERSatile bio response Engine" (UNIVERSE) are combined with existing models of tumor volume kinetics as well as tumor control probability (TCP) and compared to experimental data. The potential TCP of FLASH radiotherapy is investigated by varying the assumed dose-rate, fractionation schemes and oxygen concentration in the target. The developed framework describes the reported tumor growth kinetics appropriately, indicating that sparing effects could be present in the tumor but might be too small to be detected with the number of animals used. The TCP predictions show the possibility of substantial loss of treatment efficacy for FLASH radiotherapy depending on several variables, including the fractionation scheme, oxygen level, and DNA repair kinetics. The possible loss of TCP should be seriously considered when assessing the clinical viability of FLASH treatments.
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Affiliation(s)
- Hans Liew
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stewart Mein
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104-6303, USA
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Amir Abdollahi
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ivana Dokic
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University Hospital and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Medical Physics Unit, National Centre of Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
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16
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Lv Y, Lv Y, Wang Z, Lan T, Feng X, Chen H, Zhu J, Ma X, Du J, Hou G, Liao W, Yuan K, Wu H. FLASH radiotherapy: A promising new method for radiotherapy. Oncol Lett 2022; 24:419. [PMID: 36284652 PMCID: PMC9580247 DOI: 10.3892/ol.2022.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
Among the treatments for malignant tumors, radiotherapy is of great significance both as a main treatment and as an adjuvant treatment. Radiation therapy damages cancer cells with ionizing radiation, leading to their death. However, radiation-induced toxicity limits the dose delivered to the tumor, thereby constraining the control effect of radiotherapy on tumor growth. In addition, the delayed toxicity caused by radiotherapy significantly harms the physical and mental health of patients. FLASH-RT, an emerging class of radiotherapy, causes a phenomenon known as the 'FLASH effect', which delivers radiotherapy at an ultra-high dose rate with lower toxicity to normal tissue than conventional radiotherapy to achieve local tumor control. Although its mechanism remains to be fully elucidated, this modality constitutes a potential new approach to treating malignant tumors. In the present review, the current research progress of FLASH-RT and its various particular effects are described, including the status of research on FLASH-RT and its influencing factors. The hypothetic mechanism of action of FLASH-RT is also summarized, providing insight into future tumor treatments.
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Affiliation(s)
- Yinghao Lv
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Yue Lv
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Zhen Wang
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Tian Lan
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xuping Feng
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Hao Chen
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Jiang Zhu
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xiao Ma
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Jinpeng Du
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Guimin Hou
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Wenwei Liao
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Kefei Yuan
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Hong Wu
- Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, West China Hospital, Chengdu, Sichuan 610000, P.R. China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
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17
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Zou W, Kim H, Diffenderfer ES, Carlson DJ, Koch CJ, Xiao Y, Teo BK, Kim MM, Metz JM, Fan Y, Maity A, Koumenis C, Busch TM, Wiersma R, Cengel KA, Dong L. A phenomenological model of proton FLASH oxygen depletion effects depending on tissue vasculature and oxygen supply. Front Oncol 2022; 12:1004121. [PMID: 36518319 PMCID: PMC9742361 DOI: 10.3389/fonc.2022.1004121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Radiation-induced oxygen depletion in tissue is assumed as a contributor to the FLASH sparing effects. In this study, we simulated the heterogeneous oxygen depletion in the tissue surrounding the vessels and calculated the proton FLASH effective-dose-modifying factor (FEDMF), which could be used for biology-based treatment planning. Methods The dose and dose-weighted linear energy transfer (LET) of a small animal proton irradiator was simulated with Monte Carlo simulation. We deployed a parabolic partial differential equation to account for the generalized radiation oxygen depletion, tissue oxygen diffusion, and metabolic processes to investigate oxygen distribution in 1D, 2D, and 3D solution space. Dose and dose rates, particle LET, vasculature spacing, and blood oxygen supplies were considered. Using a similar framework for the hypoxic reduction factor (HRF) developed previously, the FEDMF was derived as the ratio of the cumulative normoxic-equivalent dose (CNED) between CONV and UHDR deliveries. Results Dynamic equilibrium between oxygen diffusion and tissue metabolism can result in tissue hypoxia. The hypoxic region displayed enhanced radio-resistance and resulted in lower CNED under UHDR deliveries. In 1D solution, comparing 15 Gy proton dose delivered at CONV 0.5 and UHDR 125 Gy/s, 61.5% of the tissue exhibited ≥20% FEDMF at 175 μm vasculature spacing and 18.9 μM boundary condition. This percentage reduced to 34.5% and 0% for 8 and 2 Gy deliveries, respectively. Similar trends were observed in the 3D solution space. The FLASH versus CONV differential effect remained at larger vasculature spacings. A higher FLASH dose rate showed an increased region with ≥20% FEDMF. A higher LET near the proton Bragg peak region did not appear to alter the FLASH effect. Conclusion We developed 1D, 2D, and 3D oxygen depletion simulation process to obtain the dynamic HRF and derive the proton FEDMF related to the dose delivery parameters and the local tissue vasculature information. The phenomenological model can be used to simulate or predict FLASH effects based on tissue vasculature and oxygen concentration data obtained from other experiments.
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Vozenin MC, Bourhis J, Durante M. Towards clinical translation of FLASH radiotherapy. Nat Rev Clin Oncol 2022; 19:791-803. [DOI: 10.1038/s41571-022-00697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
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Gao Y, Liu R, Chang C, Charyyev S, Zhou J, Bradley JD, Liu T, Yang X. A potential revolution in cancer treatment: A topical review of FLASH radiotherapy. J Appl Clin Med Phys 2022; 23:e13790. [PMID: 36168677 PMCID: PMC9588273 DOI: 10.1002/acm2.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
FLASH radiotherapy (RT) is a novel technique in which the ultrahigh dose rate (UHDR) (≥40 Gy/s) is delivered to the entire treatment volume. Recent outcomes of in vivo studies show that the UHDR RT has the potential to spare normal tissue without sacrificing tumor control. There is a growing interest in the application of FLASH RT, and the ultrahigh dose irradiation delivery has been achieved by a few experimental and modified linear accelerators. The underlying mechanism of FLASH effect is yet to be fully understood, but the oxygen depletion in normal tissue providing extra protection during FLASH irradiation is a hypothesis that attracts most attention currently. Monte Carlo simulation is playing an important role in FLASH, enabling the understanding of its dosimetry calculations and hardware design. More advanced Monte Carlo simulation tools are under development to fulfill the challenge of reproducing the radiolysis and radiobiology processes in FLASH irradiation. FLASH RT may become one of standard treatment modalities for tumor treatment in the future. This paper presents the history and status of FLASH RT studies with a focus on FLASH irradiation delivery modalities, underlying mechanism of FLASH effect, in vivo and vitro experiments, and simulation studies. Existing challenges and prospects of this novel technique are discussed in this manuscript.
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Affiliation(s)
- Yuan Gao
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Ruirui Liu
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Chih‐Wei Chang
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Serdar Charyyev
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Jeffrey D. Bradley
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGeorgiaUSA
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Wei S, Lin H, Isabelle Choi J, Shi C, Simone CB, Kang M. Advanced pencil beam scanning Bragg peak FLASH-RT delivery technique can enhance lung cancer planning treatment outcomes compared to conventional multiple-energy proton PBS techniques. Radiother Oncol 2022; 175:238-247. [PMID: 35961583 DOI: 10.1016/j.radonc.2022.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the dosimetric characteristics between an advanced proton pencil beam scanning (PBS) Bragg peak FLASH technique and conventional PBS planning technique in lung tumors. To evaluate the "FLASHness" of single-field in a multiple-field delivery scheme for a hypofractionation regimen and move a step forward to clinical application. METHODS Single-energy PBS Bragg peak FLASH treatment plans were optimized based on a novel Bragg peak tracking technique to enable Bragg peaks to stop at the distal edge of the target. Inverse treatment planning using multiple-field optimization (MFO) can achieve sufficient FLASH dose rate and intensity-modulated proton therapy (IMPT)-equivalent dosimetric quality. The dose rate of organs-at-risk (OARs) and the target were calculated under FLASH machine parameters. A group of 10 consecutive lung SBRT patients was optimized to 34 Gy/fraction using a standard treatment of PBS technique with multiple energy layers as references to the Bragg peak plans. The dosimetric quality was compared between Bragg peak FLASH and conventional plans based on RTOG0915 dose metrics. FLASH dose rate ratios (V40Gy/s) were calculated as a metric of the FLASH-sparing effect. RESULTS For higher dose thresholds, the Bragg peak plans achieved greater V40Gy/s FLASH coverage for all major OARs. The V40Gy/s was close to 100% for all OARs when the dose thresholds were > 5 Gy for full plan and single beam evaluations. The less "FLASHness" region was associated with a low dose distribution, mainly occurring in the PBS field penumbra region. The conventional IMPT treatment plans yielded slightly superior target dose uniformity with a D2%(%) of 108.02% versus that of Bragg peak 300 MU plans of 111.81% (p < 0.01) and that of Bragg peak 1200 MU plans of 115.95% (p < 0.01). No significant difference in dose metrics was found between Bragg peak and IMPT treatment plans for the spinal cord, esophagus, heart, or lung-GTV (all p > 0.05). CONCLUSION Hypofractionated lung Bragg peak plans can maintain comparable plan quality to conventional PBS while achieving sufficient FLASH dose rate coverage for major OARs for each field under the multiple-field delivery scheme. The novel Bragg peak FLASH technique has the potential to enhance lung cancer planning treatment outcomes compared to standard PBS treatment techniques.
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Affiliation(s)
- Shouyi Wei
- New York Proton Center, New York, NY 10035, USA
| | - Haibo Lin
- New York Proton Center, New York, NY 10035, USA.
| | | | - Chengyu Shi
- City of Hope, Orange County, Irvine, CA 92618, USA
| | | | - Minglei Kang
- New York Proton Center, New York, NY 10035, USA.
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Blain G, Vandenborre J, Villoing D, Fiegel V, Fois GR, Haddad F, Koumeir C, Maigne L, Métivier V, Poirier F, Potiron V, Supiot S, Servagent N, Delpon G, Chiavassa S. Proton Irradiations at Ultra-High Dose Rate vs. Conventional Dose Rate: Strong Impact on Hydrogen Peroxide Yield. Radiat Res 2022; 198:318-324. [PMID: 35675499 DOI: 10.1667/rade-22-00021.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Abstract
During ultra-high dose rate (UHDR) external radiation therapy, healthy tissues appear to be spared while tumor control remains the same compared to conventional dose rate. However, the understanding of radiochemical and biological mechanisms involved are still to be discussed. This study shows how the hydrogen peroxide (H2O2) production, one of the reactive oxygen species (ROS), could be controlled by early heterogenous radiolysis processes in water during UHDR proton-beam irradiations. Pure water was irradiated in the plateau region (track-segment) with 68 MeV protons under conventional (0.2 Gy/s) and several UHDR conditions (40 Gy/s to 60 kGy/s) at the ARRONAX cyclotron. Production of H2O2 was then monitored using the Ghormley triiodide method. New values of GTS(H2O2) were added in conventional dose rate. A substantial decrease in H2O2 production was observed from 0.2 to 1.5 kGy/s with a more dramatic decrease below 100 Gy/s. At higher dose rate, up to 60 kGy/s, the H2O2 production stayed stable with a mean decrease of 38% ± 4%. This finding, associated to the decrease in the production of hydroxyl radical (•OH) already observed in other studies in similar conditions can be explained by the well-known spur theory in radiation chemistry. Thus, a two-step FLASH-RT mechanism can be envisioned: an early step at the microsecond scale mainly controlled by heterogenous radiolysis, and a second, slower, dominated by O2 depletion and biochemical processes. To validate this hypothesis, more measurements of radiolytic species will soon be performed, including radicals and associated lifetimes.
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Affiliation(s)
- Guillaume Blain
- Laboratoire SUBATECH, UMR 6457, CNRS IN2P3, IMT Atlantique, Université de Nantes, France
| | - Johan Vandenborre
- Laboratoire SUBATECH, UMR 6457, CNRS IN2P3, IMT Atlantique, Université de Nantes, France
| | | | - Vincent Fiegel
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Giovanna Rosa Fois
- Université Clermont Auvergne, CNRS/IN2P3, LPC, 63000 Clermont-Ferrand, France
| | - Ferid Haddad
- Laboratoire SUBATECH, UMR 6457, CNRS IN2P3, IMT Atlantique, Université de Nantes, France.,GIP ARRONAX, Saint-Herblain, France
| | | | - Lydia Maigne
- Université Clermont Auvergne, CNRS/IN2P3, LPC, 63000 Clermont-Ferrand, France
| | - Vincent Métivier
- Laboratoire SUBATECH, UMR 6457, CNRS IN2P3, IMT Atlantique, Université de Nantes, France
| | | | | | | | - Noël Servagent
- Laboratoire SUBATECH, UMR 6457, CNRS IN2P3, IMT Atlantique, Université de Nantes, France
| | - Grégory Delpon
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
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Van den Heuvel F, Vella A, Fiorini F, Brooke M, Hill M, Ryan A, Maughan T, Giaccia A. Using oxygen dose histograms to quantify voxelised ultra-high dose rate (FLASH) effects in multiple radiation modalities. Phys Med Biol 2022; 67:125001. [PMID: 35594854 PMCID: PMC9174700 DOI: 10.1088/1361-6560/ac71ef] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/20/2022] [Indexed: 11/12/2022]
Abstract
Purpose.To introduce a methodology to predict tissue sparing effects in pulsed ultra-high dose rate radiation exposures which could be included in a dose-effect prediction system or treatment planning system and to illustrate it by using three published experiments.Methods and materials.The proposed system formalises the variability of oxygen levels as an oxygen dose histogram (ODH), which provides an instantaneous oxygen level at a delivered dose. The histogram concept alleviates the need for a mechanistic approach. At each given oxygen level the oxygen fixation concept is used to calculate the change in DNA-damage induction compared to the fully hypoxic case. Using the ODH concept it is possible to estimate the effect even in the case of multiple pulses, partial oxygen depletion, and spatial oxygen depletion. The system is illustrated by applying it to the seminal results by Town (Nat. 1967) on cell cultures and the pre-clinical experiment on cognitive effects by Montay-Gruelet al(2017Radiother. Oncol.124365-9).Results.The proposed system predicts that a possible FLASH-effect depends on the initial oxygenation level in tissue, the total dose delivered, pulse length and pulse repetition rate. The magnitude of the FLASH-effect is the result of a redundant system, in that it will have the same specific value for a different combination of these dependencies. The cell culture data are well represented, while a correlation between the pre-clinical experiments and the calculated values is highly significant (p < 0.01).Conclusions. A system based only on oxygen related effects is able to quantify most of the effects currently observed in FLASH-radiation.
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Affiliation(s)
- Frank Van den Heuvel
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Radiation Oncology, Zuidwest Radiotherapeutic Institute, Vlissingen (Flushing), Zeeland, The Netherlands
| | - Anna Vella
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Oxford University Hospitals, Department of Hæmatology & Oncology, Oxford, United Kingdom
| | - Francesca Fiorini
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Rutherford Cancer Centre Thames Valley, Reading, United Kingdom
| | - Mark Brooke
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Mark Hill
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Anderson Ryan
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Tim Maughan
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Oxford University Hospitals, Department of Hæmatology & Oncology, Oxford, United Kingdom
| | - Amato Giaccia
- University of Oxford, Department of Oncology, Oxford, United Kingdom
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Taylor E, Hill RP, Létourneau D. Modeling the impact of spatial oxygen heterogeneity on radiolytic oxygen depletion during FLASH radiotherapy. Phys Med Biol 2022; 67. [PMID: 35576920 DOI: 10.1088/1361-6560/ac702c] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/16/2022] [Indexed: 12/12/2022]
Abstract
Purpose.It has been postulated that the delivery of radiotherapy at ultra-high dose rates ('FLASH') reduces normal tissue toxicities by depleting them of oxygen. The fraction of normal tissue and cancer cells surviving radiotherapy depends on dose and oxygen levels in an exponential manner and even a very small fraction of tissue at low oxygen levels can determine radiotherapy response. To quantify the differential impact of FLASH radiotherapy on normal and tumour tissues, the spatial heterogeneity of oxygenation in tissue should thus be accounted for.Methods.The effect of FLASH on radiation-induced normal and tumour tissue cell killing was studied by simulating oxygen diffusion, metabolism, and radiolytic oxygen depletion (ROD) over domains with simulated capillary architectures. To study the impact of heterogeneity, two architectural models were used: (1) randomly distributed capillaries and (2) capillaries forming a regular square lattice array. The resulting oxygen partial pressure distribution histograms were used to simulate normal and tumour tissue cell survival using the linear quadratic model of cell survival, modified to incorporate oxygen-enhancement ratio effects. The ratio ('dose modifying factors') of conventional low-dose-rate dose and FLASH dose at iso-cell survival was computed and compared with empirical iso-toxicity dose ratios.Results.Tumour cell survival was found to be increased by FLASH as compared to conventional radiotherapy, with a 0-1 order of magnitude increase for expected levels of tumour hypoxia, depending on the relative magnitudes of ROD and tissue oxygen metabolism. Interestingly, for the random capillary model, the impact of FLASH on well-oxygenated (normal) tissues was found to be much greater, with an estimated increase in cell survival by up to 10 orders of magnitude, even though reductions in mean tissue partial pressure were modest, less than ∼7 mmHg for the parameter values studied. The dose modifying factor for normal tissues was found to lie in the range 1.2-1.7 for a representative value of normal tissue oxygen metabolic rate, consistent with preclinical iso-toxicity results.Conclusions.The presence of very small nearly hypoxic regions in otherwise well-perfused normal tissues with high mean oxygen levels resulted in a greater proportional sparing of normal tissue than tumour cells during FLASH irradiation, possibly explaining empirical normal tissue sparing and iso-tumour control results.
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Affiliation(s)
- Edward Taylor
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Richard P Hill
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Létourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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El Naqa I, Pogue BW, Zhang R, Oraiqat I, Parodi K. Image guidance for FLASH radiotherapy. Med Phys 2022; 49:4109-4122. [PMID: 35396707 PMCID: PMC9844128 DOI: 10.1002/mp.15662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
FLASH radiotherapy (FLASH-RT) is an emerging ultra-high dose (>40 Gy/s) delivery that promises to improve the therapeutic potential by limiting toxicities compared to conventional RT while maintaining similar tumor eradication efficacy. Image guidance is an essential component of modern RT that should be harnessed to meet the special emerging needs of FLASH-RT and its associated high risks in planning and delivering of such ultra-high doses in short period of times. Hence, this contribution will elaborate on the imaging requirements and possible solutions in the entire chain of FLASH-RT treatment, from the planning, through the setup and delivery with online in vivo imaging and dosimetry, up to the assessment of biological mechanisms and treatment response. In patient setup and delivery, higher temporal sampling than in conventional RT should ensure that the short treatment is delivered precisely to the targeted region. Additionally, conventional imaging tools such as cone-beam computed tomography will continue to play an important role in improving patient setup prior to delivery, while techniques based on magnetic resonance imaging or positron emission tomography may be extremely valuable for either linear accelerator (Linac) or particle FLASH therapy, to monitor and track anatomical changes during delivery. In either planning or assessing outcomes, quantitative functional imaging could supplement conventional imaging for more accurate utilization of the biological window of the FLASH effect, selecting for or verifying things such as tissue oxygen and existing or transient hypoxia on the relevant timescales of FLASH-RT delivery. Perhaps most importantly at this time, these tools might help improve the understanding of the biological mechanisms of FLASH-RT response in tumor and normal tissues. The high dose deposition of FLASH provides an opportunity to utilize pulse-to-pulse imaging tools such as Cherenkov or radiation acoustic emission imaging. These could provide individual pulse mapping or assessing the 3D dose delivery superficially or at tissue depth, respectively. In summary, the most promising components of modern RT should be used for safer application of FLASH-RT, and new promising developments could be advanced to cope with its novel demands but also exploit new opportunities in connection with the unique nature of pulsed delivery at unprecedented dose rates, opening a new era of biological image guidance and ultrafast, pulse-based in vivo dosimetry.
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Affiliation(s)
- Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA,Corresponding Author:
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA,Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Rongxiao Zhang
- Giesel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Ibrahim Oraiqat
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Katia Parodi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching 85748, Germany
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Cooper CR, Jones D, Jones GDD, Petersson K. FLASH irradiation induces lower levels of DNA damage ex vivo, an effect modulated by oxygen tension, dose, and dose rate. Br J Radiol 2022; 95:20211150. [PMID: 35171701 PMCID: PMC10993968 DOI: 10.1259/bjr.20211150] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE FLASH irradiation reportedly produces less normal tissue toxicity, while maintaining tumour response. To investigate oxygen's role in the 'FLASH effect', we assessed DNA damage levels following irradiation at different oxygen tensions, doses and dose rates. METHODS Samples of whole blood were irradiated (20 Gy) at various oxygen tensions (0.25-21%) with 6 MeV electrons at dose rates of either 2 kGy/s (FLASH) or 0.1 Gy/s (CONV), and subsequently with various doses (0-40 Gy) and intermediate dose rates (0.3-1000 Gy/s). DNA damage of peripheral blood lymphocytes (PBL) were assessed by the alkaline comet assay. RESULTS Following 20 Gy irradiation, lower levels of DNA damage were induced for FLASH, the difference being significant at 0.25% (p < 0.05) and 0.5% O2 (p < 0.01). The differential in DNA damage at 0.5% O2 was found to increase with total dose and dose rate, becoming significant for doses ≥20 Gy and dose rates ≥30 Gy/s. CONCLUSION This study shows, using the alkaline comet assay, that lower levels of DNA damage are induced following FLASH irradiation, an effect that is modulated by the oxygen tension, and increases with the total dose and dose rate of irradiation, indicating that an oxygen related mechanism, e.g. transient radiation-induced oxygen depletion, may contribute to the tissue sparing effect of FLASH irradiation. ADVANCES IN KNOWLEDGE This paper is first to directly show that FLASH-induced DNA damage is modulated by oxygen tension, total dose and dose rate, with FLASH inducing significantly lower levels of DNA damage for doses ≥20 Gy and dose rates ≥30 Gy/s, at 0.5% O2.
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Affiliation(s)
- Christian R Cooper
- Leicester Cancer Research Centre, University of Leicester,
Robert Kilpatrick Clinical Sciences Building, Leicester Royal
Infirmary, Leicester,
UK
| | - Donald Jones
- Leicester Cancer Research Centre, University of Leicester,
Robert Kilpatrick Clinical Sciences Building, Leicester Royal
Infirmary, Leicester,
UK
| | - George DD Jones
- Leicester Cancer Research Centre, University of Leicester,
Robert Kilpatrick Clinical Sciences Building, Leicester Royal
Infirmary, Leicester,
UK
| | - Kristoffer Petersson
- MRC Oxford Institute for Radiation Oncology, University of
Oxford, Old Road Campus Research Building,
Oxford, UK
- Department of Haematology, Oncology and Radiation Physics,
Skåne University Hospital Lund University,
Lund, Sweden
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Schiavo F, Kjellsson Lindblom E, Toma-dasu I. Towards the virtual tumor for optimizing radiotherapy treatments of hypoxic tumors: a novel model of heterogeneous tissue vasculature and oxygenation. J Theor Biol 2022. [DOI: 10.1016/j.jtbi.2022.111175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
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Chaudhary P, Gwynne DC, Odlozilik B, McMurray A, Milluzzo G, Maiorino C, Doria D, Ahmed H, Romagnani L, Alejo A, Padda H, Green J, Carroll D, Booth N, McKenna P, Kar S, Petringa G, Catalano R, Cammarata FP, Cirrone GAP, McMahon SJ, Prise KM, Borghesi M. Development of a portable hypoxia chamber for ultra-high dose rate laser-driven proton radiobiology applications. Radiat Oncol 2022; 17:77. [PMID: 35428301 PMCID: PMC9013042 DOI: 10.1186/s13014-022-02024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background There is currently significant interest in assessing the role of oxygen in the radiobiological effects at ultra-high dose rates. Oxygen modulation is postulated to play a role in the enhanced sparing effect observed in FLASH radiotherapy, where particles are delivered at 40–1000 Gy/s. Furthermore, the development of laser-driven accelerators now enables radiobiology experiments in extreme regimes where dose rates can exceed 109 Gy/s, and predicted oxygen depletion effects on cellular response can be tested. Access to appropriate experimental enviroments, allowing measurements under controlled oxygenation conditions, is a key requirement for these studies. We report on the development and application of a bespoke portable hypoxia chamber specifically designed for experiments employing laser-driven sources, but also suitable for comparator studies under FLASH and conventional irradiation conditions. Materials and methods We used oxygen concentration measurements to test the induction of hypoxia and the maintenance capacity of the chambers. Cellular hypoxia induction was verified using hypoxia inducible factor-1α immunostaining. Calibrated radiochromic films and GEANT-4 simulations verified the dosimetry variations inside and outside the chambers. We irradiated hypoxic human skin fibroblasts (AG01522B) cells with laser-driven protons, conventional protons and reference 225 kVp X-rays to quantify DNA DSB damage and repair under hypoxia. We further measured the oxygen enhancement ratio for cell survival after X-ray exposure in normal fibroblast and radioresistant patient- derived GBM stem cells. Results Oxygen measurements showed that our chambers maintained a radiobiological hypoxic environment for at least 45 min and pathological hypoxia for up to 24 h after disconnecting the chambers from the gas supply. We observed a significant reduction in the 53BP1 foci induced by laser-driven protons, conventional protons and X-rays in the hypoxic cells compared to normoxic cells at 30 min post-irradiation. Under hypoxic irradiations, the Laser-driven protons induced significant residual DNA DSB damage in hypoxic AG01522B cells compared to the conventional dose rate protons suggesting an important impact of these extremely high dose-rate exposures. We obtained an oxygen enhancement ratio (OER) of 2.1 ± 0.1 and 2.5 ± 0.1 respectively for the AG01522B and patient-derived GBM stem cells for X-ray irradiation using our hypoxia chambers. Conclusion We demonstrated the design and application of portable hypoxia chambers for studying cellular radiobiological endpoints after exposure to laser-driven protons at ultra-high dose, conventional protons and X-rays. Suitable levels of reduced oxygen concentration could be maintained in the absence of external gassing to quantify hypoxic effects. The data obtained provided indication of an enhanced residual DNA DSB damage under hypoxic conditions at ultra-high dose rate compared to the conventional protons or X-rays. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02024-3.
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van Marlen P, Verbakel WFAR, Slotman BJ, Dahele M. Single-fraction 34Gy lung SBRT using proton transmission beams: FLASH-dose calculations and the influence of different dose-rate methods and dose/dose-rate thresholds. Adv Radiat Oncol 2022; 7:100954. [PMID: 35634574 PMCID: PMC9130077 DOI: 10.1016/j.adro.2022.100954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Research suggests that in addition to the dose-rate, a dose threshold is also important for the reduction in normal tissue toxicity with similar tumor control after ultrahigh dose-rate radiation therapy (UHDR-RT). In this analysis we aimed to identify factors that might limit the ability to achieve this “FLASH”-effect in a scenario attractive for UHDR-RT (high fractional beam dose, small target, few organs-at-risk): single-fraction 34 Gy lung stereotactic body radiation therapy. Methods and Materials Clinical volumetric-modulated arc therapy (VMAT) plans, intensity modulated proton therapy (IMPT) plans and transmission beam (TB) plans were compared for 6 small and 1 large lung lesion. The TB-plan dose-rate was calculated using 4 methods and the FLASH-percentage (percentage of dose delivered at dose-rates ≥40/100 Gy/s and ≥4/8 Gy) was determined for various variables: a minimum spot time (minST) of 0.5/2 ms, maximum nozzle current (maxN) of 200/40 0nA, and 2 gantry current (GC) techniques (energy-layer based, spot-based [SB]). Results Based on absolute doses 5-beam TB and VMAT-plans are similar, but TB-plans have higher rib, skin, and ipsilateral lung dose than IMPT. Dose-rate calculation methods not considering scanning achieve FLASH-percentages between ∼30% to 80%, while methods considering scanning often achieve <30%. FLASH-percentages increase for lower minST/higher maxN and when using SB GC instead of energy-layer based GC, often approaching the percentage of dose exceeding the dose-threshold. For the small lesions average beam irradiation times (including scanning) varied between 0.06 to 0.31 seconds and total irradiation times between 0.28 to 1.57 seconds, for the large lesion beam times were between 0.16 to 1.47 seconds with total irradiation times of 1.09 to 5.89 seconds. Conclusions In a theoretically advantageous scenario for FLASH we found that TB-plan dosimetry was similar to that of VMAT, but inferior to that of IMPT, and that decreasing minST or using SB GC increase the estimated amount of FLASH. For the appropriate machine/delivery parameters high enough dose-rates can be achieved regardless of calculation method, meaning that a possible FLASH dose-threshold will likely be the primary limiting factor.
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Liew H, Mein S, Tessonnier T, Abdollahi A, Debus J, Dokic I, Mairani A. The Impact of Sub-Millisecond Damage Fixation Kinetics on the In Vitro Sparing Effect at Ultra-High Dose Rate in UNIVERSE. Int J Mol Sci 2022; 23:ijms23062954. [PMID: 35328377 PMCID: PMC8954991 DOI: 10.3390/ijms23062954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
The impact of the exact temporal pulse structure on the potential cell and tissue sparing of ultra-high dose-rate irradiation applied in FLASH studies has gained increasing attention. A previous version of our biophysical mechanistic model (UNIVERSE: UNIfied and VERSatile bio response Engine), based on the oxygen depletion hypothesis, has been extended in this work by considering oxygen-dependent damage fixation dynamics on the sub-milliseconds scale and introducing an explicit implementation of the temporal pulse structure. The model successfully reproduces in vitro experimental data on the fast kinetics of the oxygen effect in irradiated mammalian cells. The implemented changes result in a reduction in the assumed amount of oxygen depletion. Furthermore, its increase towards conventional dose-rates is parameterized based on experimental data from the literature. A recalculation of previous benchmarks shows that the model retains its predictive power, while the assumed amount of depleted oxygen approaches measured values. The updated UNIVERSE could be used to investigate the impact of different combinations of pulse structure parameters (e.g., dose per pulse, pulse frequency, number of pulses, etc.), thereby aiding the optimization of potential clinical application and the development of suitable accelerators.
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Affiliation(s)
- Hans Liew
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.L.); (J.D.)
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
- Faculty of Physics and Astronomy, Heidelberg University, 69120 Heidelberg, Germany
| | - Stewart Mein
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Amir Abdollahi
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Jürgen Debus
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.L.); (J.D.)
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
- Faculty of Physics and Astronomy, Heidelberg University, 69120 Heidelberg, Germany
| | - Ivana Dokic
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
| | - Andrea Mairani
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.M.); (A.A.); (I.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany;
- Correspondence: ; Tel.: +49-0-6221-56-37535
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Khatib ME, Van Slyke AL, Velalopoulou A, Kim MM, Shoniyozov K, Allu SR, Diffenderfer EE, Busch TM, Wiersma RD, Koch CJ, Vinogradov SA. Ultrafast Tracking of Oxygen Dynamics during Proton FLASH. Int J Radiat Oncol Biol Phys 2022; 113:624-634. [DOI: 10.1016/j.ijrobp.2022.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
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Favaudon V, Labarbe R, Limoli CL. Model studies of the role of oxygen in the FLASH effect. Med Phys 2022; 49:2068-2081. [PMID: 34407219 PMCID: PMC8854455 DOI: 10.1002/mp.15129] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022] Open
Abstract
Current radiotherapy facilities are standardized to deliver dose rates around 0.1-0.4 Gy/s in 2 Gy daily fractions, designed to deliver total accumulated doses to reach the tolerance limit of normal tissues undergoing irradiation. FLASH radiotherapy (FLASH-RT), on the other hand, relies on facilities capable of delivering ultrahigh dose rates in large doses in a single microsecond pulse, or in a few pulses given over a very short time sequence. For example, most studies to date have implemented 4-6 MeV electrons with intra-pulse dose rates in the range 106 -107 Gy/s. The proposed dependence of the FLASH effect on oxygen tension has stimulated several theoretical models based on three different hypotheses: (i) Radiation-induced transient oxygen depletion; (ii) cell-specific differences in the ability to detoxify and/or recover from injury caused by reactive oxygen species; (iii) self-annihilation of radicals by bimolecular recombination. This article focuses on the observations supporting or refuting these models in the frame of the chemical-biological bases of the impact of oxygen on the radiation response of cell free, in vitro and in vivo model systems.
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Affiliation(s)
- Vincent Favaudon
- Institut Curie, Inserm U 1021- CNRS UMR 3347, University Paris-Saclay, PSL Research University, Centre Universitaire, 91405 Orsay Cedex, France
- Corresponding author:
| | - Rudi Labarbe
- Ion Beam Applications S.A. (IBA), Louvain-la-Neuve, Belgium
| | - Charles L. Limoli
- Dept. of Radiation Oncology, Medical Sciences I, B146B, Irvine, California 92697-2695, USA
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Kim MM, Darafsheh A, Schuemann J, Dokic I, Lundh O, Zhao T, Ramos-Méndez J, Dong L, Petersson K. Development of Ultra-High Dose-Rate (FLASH) Particle Therapy. IEEE Trans Radiat Plasma Med Sci 2022; 6:252-262. [PMID: 36092270 PMCID: PMC9457346 DOI: 10.1109/trpms.2021.3091406] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Research efforts in FLASH radiotherapy have increased at an accelerated pace recently. FLASH radiotherapy involves ultra-high dose rates and has shown to reduce toxicity to normal tissue while maintaining tumor response in pre-clinical studies when compared to conventional dose rate radiotherapy. The goal of this review is to summarize the studies performed to-date with proton, electron, and heavy ion FLASH radiotherapy, with particular emphasis on the physical aspects of each study and the advantages and disadvantages of each modality. Beam delivery parameters, experimental set-up, and the dosimetry tools used are described for each FLASH modality. In addition, modeling efforts and treatment planning for FLASH radiotherapy is discussed along with potential drawbacks when translated into the clinical setting. The final section concludes with further questions that have yet to be answered before safe clinical implementation of FLASH radiotherapy.
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Affiliation(s)
- Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arash Darafsheh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ivana Dokic
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 222, Heidelberg, Germany
| | - Olle Lundh
- Department of Physics, Lund University, Lund, Sweden
| | - Tianyu Zhao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - José Ramos-Méndez
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristoffer Petersson
- Department of Oncology, The Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Abstract
FLASH radiotherapy is a novel technique that has been shown in numerous preclinical in vivo studies to have the potential to be the next important improvement in cancer treatment. However, the biological mechanisms responsible for the selective FLASH sparing effect of normal tissues are not yet known. An optimal translation of FLASH radiotherapy into the clinic would require a good understanding of the specific beam parameters that induces a FLASH effect, environmental conditions affecting the response, and the radiobiological mechanisms involved. Even though the FLASH effect has generally been considered as an in vivo effect, studies finding these answers would be difficult and ethically challenging to carry out solely in animals. Hence, suitable in vitro studies aimed towards finding these answers are needed. In this review, we describe and summarise several in vitro assays that have been used or could be used to finally elucidate the mechanisms behind the FLASH effect.
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Hu A, Qiu R, Wu Z, Zhang H, Li J. CPU-GPU coupling independent reaction times method in NASIC and application in water radiolysis by FLASH irradiation. Biomed Phys Eng Express 2022; 8. [DOI: 10.1088/2057-1976/ac52d9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/08/2022] [Indexed: 11/11/2022]
Abstract
Abstract
The mechanism of the FLASH effect remains unclear and could be revealed by studying chemical reactions during irradiation. Monte Carlo simulation of the radiolytic species is an effective tool to analyze chemical reactions, but the simulation is limited by computing costs of the step-by-step simulation of radiolytic species, especially when considering beam with complex time structure. The complexity of the time structure of beams from accelerators in FLASH radiotherapy requires a high-performance Monte Carlo code. In this work, we develop a CPU-GPU coupling accelerating code with the independent reaction times (IRT) method to extend the chemical module of our nanodosimetry Monte Carlo code NASIC. Every chemical molecule in the microenvironment contains time information to consider the reactions from different tracks and simulate beams with complex time structures. Performance test shows that our code significantly improved the computing efficiency of the chemical module by four orders of magnitude. Then the code is used to study the oxygen depletion hypothesis in FLASH radiotherapy for different conditions by setting different parameters. The transient oxygen consumption rate values in the water are calculated when the pulses width ranges from 2 ps to 2 μs, the total dose ranges from 0.5 Gy to 100 Gy and the initial oxygen concentration ranges from 0.1% to 21%. The time evolution curves are simulated to study the effect of the time structure of an electron linear accelerator. Results show that the total dose in several microseconds is a better indicator reflecting the radiolytic oxygen consumption rate than the dose rate. The initial oxygen greatly affects the oxygen consumption rate because of the reaction competition. The diffusion of oxygen determined by the physiological parameters is the key factor affecting oxygen depletion during the radiation using electron linear accelerators. Our code provides an efficient tool for simulating water radiolysis in different conditions
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Perstin A, Poirier Y, Sawant A, Tambasco M. Quantifying the DNA-damaging effects of FLASH irradiation with plasmid DNA. Int J Radiat Oncol Biol Phys 2022; 113:437-447. [PMID: 35124135 DOI: 10.1016/j.ijrobp.2022.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate a plasmid DNA nicking assay approach for isolating and quantifying the DNA damaging effects of ultra-high dose rate (i.e., FLASH) irradiation relative to conventional dose rate irradiation. METHODS We constructed and irradiated phantoms containing plasmid DNA to nominal doses of 20 Gy and 30 Gy using 16 MeV electrons at conventional (0.167 Gy/s) and FLASH (46.6 Gy/s and 93.2 Gy/s) dose rates. We delivered conventional dose rates using a standard clinical Varian iX linac and FLASH dose rates (FDR) using a modified Varian 21EX C-series linac. We ran the irradiated DNA and controls (0 Gy) through an agarose gel electrophoresis procedure that sorted and localized the DNA into bands associated with single strand breaks (SSBs), double strand breaks (DSBs), and undamaged DNA. We quantitatively analyzed the gel images to compute the relative yields of SSBs and DSBs, and applied a mathematical model of plasmid DNA damage as a function of dose to compute relative biological effectiveness (RBE) of SSB and DSB (RBESSBandRBEDSB) damage for a given endpoint and FDR. RESULTS Both RBESSBandRBEDSB were less than unity with the FDR irradiations, indicating FLASH sparing. With regard to the more deleterious DNA DSB damage, RBEDSBs of FLASH beams at dose rates of 46.6 Gy/s and 93.2 Gy/s relative to the conventional 16 MeV beam dose rate were 0.54 ± 0.15 and 0.55 ± 0.17, respectively. CONCLUSION We have demonstrated the feasibility of using a DNA-based phantom to isolate and assess the FLASH sparing effect on DNA. We also found that FLASH irradiation causes less damage to DNA compared to a conventional dose rate. This result supports the notion that the protective effect of FLASH irradiation occurs at least partially via fundamental biochemical processes.
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Affiliation(s)
- Alan Perstin
- Physics Graduate Student, San Diego State University
| | - Yannick Poirier
- Assistant Professor, Oncology, Department of Radiation Oncology, University of Maryland
| | - Amit Sawant
- Professor and Vice Chair, Department of Radiation Oncology, University of Maryland
| | - Mauro Tambasco
- Associate Professor/Medical Physicist, Associate Program Director, Medical Physics Residency, Associate Director, Medical Physics , Department of Physics, San Diego State University.
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Guerrieri P, Jacob NK, Maxim PG, Sawant A, Van Nest SJ, Mohindra P, Dominello MM, Burmeister JW, Joiner MC. Three discipline collaborative radiation therapy (3DCRT) special debate: FLASH radiotherapy needs ongoing basic and animal research before implementing it to a large clinical scale. J Appl Clin Med Phys 2022; 23:e13547. [PMID: 35104025 PMCID: PMC8992943 DOI: 10.1002/acm2.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Patrizia Guerrieri
- Department of Radiation Oncology, Bon Secours Mercy Health, Youngstown, Ohio, USA
| | | | - Peter G Maxim
- Department of Radiation Oncology, University of California, Irvine, California, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA.,Maryland Proton Treatment Center, Baltimore, Maryland, USA
| | - Samantha J Van Nest
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA.,Maryland Proton Treatment Center, Baltimore, Maryland, USA
| | | | - Jay W Burmeister
- Department of Oncology, Wayne State University, Detroit, Michigan, USA.,Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michael C Joiner
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
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Wei S, Lin H, Choi JI, Press RH, Lazarev S, Kabarriti R, Hajj C, Hasan S, Chhabra AM, Simone CB, Kang M. FLASH Radiotherapy Using Single-Energy Proton PBS Transmission Beams for Hypofractionation Liver Cancer: Dose and Dose Rate Quantification. Front Oncol 2022; 11:813063. [PMID: 35096620 PMCID: PMC8794777 DOI: 10.3389/fonc.2021.813063] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This work aims to study the dose and ultra-high-dose rate characteristics of transmission proton pencil beam scanning (PBS) FLASH radiotherapy (RT) for hypofractionation liver cancer based on the parameters of a commercially available proton system operating under FLASH mode. METHODS AND MATERIALS An in-house treatment planning software (TPS) was developed to perform intensity-modulated proton therapy (IMPT) FLASH-RT planning. Single-energy transmission proton PBS plans of 4.5 Gy × 15 fractions were optimized for seven consecutive hepatocellular carcinoma patients, using 2 and 5 fields combined with 1) the minimum MU/spot chosen between 100 and 400, and minimum spot time (MST) of 2 ms, and 2) the minimum MU/spot of 100, and MST of 0.5 ms, based upon considerations in target uniformities, OAR dose constraints, and OAR FLASH dose rate coverage. Then, the 3D average dose rate distribution was calculated. The dose metrics for the mean dose of Liver-GTV and other major OARs were characterized to evaluate the dose quality for the different combinations of field numbers and minimum spot times compared to that of conventional IMPT plans. Dose rate quality was evaluated using 40 Gy/s volume coverage (V40Gy/s). RESULTS All plans achieved favorable and comparable target uniformities, and target uniformity improved as the number of fields increased. For OARs, no significant dose differences were observed between plans of different field numbers and the same MST. For plans using shorter MST and the same field numbers, better sparing was generally observed in most OARs and was statistically significant for the chest wall. However, the FLASH dose rate coverage V40Gy/s was increased by 20% for 2-field plans compared to 5-field plans in most OARs with 2-ms MST, which was less evident in the 0.5-ms cases. For 2-field plans, dose metrics and V40Gy/s of select OARs have large variations due to the beam angle selection and variable distances to the targets. The transmission plans generally yielded inferior dosimetric quality to the conventional IMPT plans. CONCLUSION This is the first attempt to assess liver FLASH treatment planning and demonstrates that it is challenging for hypofractionation with smaller fractional doses (4.5 Gy/fraction). Using fewer fields can allow higher minimum MU/spot, resulting in higher OAR FLASH dose rate coverages while achieving similar plan quality compared to plans with more fields. Shorter MST can result in better plan quality and comparable or even better FLASH dose rate coverage.
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Affiliation(s)
- Shouyi Wei
- New York Proton Center, New York, NY, United States
| | - Haibo Lin
- New York Proton Center, New York, NY, United States
| | | | | | | | | | - Carla Hajj
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | | | - Minglei Kang
- New York Proton Center, New York, NY, United States
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Abstract
PURPOSE Hypoxia (low oxygen) is a common feature of solid tumors that has been intensely studied for more than six decades. Here we review the importance of hypoxia to radiotherapy with a particular focus on the contribution of hypoxia to immune responses, metastatic potential and FLASH radiotherapy, active areas of research by leading women in the field. CONCLUSION Although hypoxia-driven metastasis and immunosuppression can negatively impact clinical outcome, understanding these processes can also provide tumor-specific vulnerabilities that may be therapeutically exploited. The different oxygen tensions present in tumors and normal tissues may underpin the beneficial FLASH sparing effect seen in normal tissue and represents a perfect example of advances in the field that can leverage tumor hypoxia to improve future radiotherapy treatments.
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Affiliation(s)
- Eui Jung Moon
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK,Equal Contribution and to whom correspondence should be addressed. ; :
| | - Kristoffer Petersson
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK,Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden,Equal Contribution and to whom correspondence should be addressed. ; :
| | - Monica M. Oleina
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK,Equal Contribution and to whom correspondence should be addressed. ; :
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Abstract
A reemergence of research implementing radiation delivery at ultra-high dose rates (UHDRs) has triggered intense interest in the radiation sciences and has opened a new field of investigation in radiobiology. Much of the promise of UHDR irradiation involves the FLASH effect, an in vivo biological response observed to maintain anti-tumor efficacy without the normal tissue complications associated with standard dose rates. The FLASH effect has been validated primarily, using intermediate energy electron beams able to deliver high doses (>7 Gy) in a very short period of time (<200 ms), but has also been found with photon and proton beams. The clinical implications of this new area of research are highly significant, as FLASH radiotherapy (FLASH-RT) has the potential to enhance the therapeutic index, opening new possibilities for eradicating radio-resistant tumors without toxicity. As pioneers in this field, our group has developed a multidisciplinary research team focused on investigating the mechanisms and clinical translation of the FLASH effect. Here, we review the field of UHDR, from the physico-chemical to the biological mechanisms.
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Affiliation(s)
- Houda Kacem
- Department of Oncology, Laboratory of Radiation Oncology, Radiation Oncology Service, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Aymeric Almeida
- Department of Oncology, Laboratory of Radiation Oncology, Radiation Oncology Service, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Cherbuin
- Department of Medical Radiology, Institute of Radiation Physics, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Catherine Vozenin
- Department of Oncology, Laboratory of Radiation Oncology, Radiation Oncology Service, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Tinganelli W, Sokol O, Quartieri M, Puspitasari A, Dokic I, Abdollahi A, Durante M, Haberer T, Debus J, Boscolo D, Voss B, Brons S, Schuy C, Horst F, Weber U. Ultra-High Dose Rate (FLASH) Carbon Ion Irradiation: Dosimetry and First Cell Experiments. Int J Radiat Oncol Biol Phys 2021:S0360-3016(21)03129-1. [PMID: 34813912 DOI: 10.1016/j.ijrobp.2021.11.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To establish a beam monitoring and dosimetry system to enable the FLASH dose rate carbon ion irradiation and investigate, at different oxygen concentrations, the in vitro biological response in comparison to the conventional dose rate. METHODS AND MATERIALS CHO-K1 cell response to irradiation at different dose rates and at different levels of oxygenation was studied using clonogenic assay. The Heidelberg Ion-Beam Therapy Center (HIT) synchrotron, after technical improvements, was adjusted to extract ≥5 × 108 12C ions within approximately 150 milliseconds. The beam monitors were filled with helium. RESULTS The FLASH irradiation with beam scanning yields a dose of 7.5 Gy (homogeneity of ±5%) for a 280 MeV/u beam in a volume of at least 8 mm in diameter and a corresponding dose rate of 70 Gy/s (±20%). The dose repetition accuracy is better than 2%, the systematic uncertainty is better than 2%. Clonogenic assay demonstrates a significant FLASH sparing effect which is strongly oxygenation-dependent and mostly pronounced at 0.5% O2 but absent at 0% and 21% O2. CONCLUSION The FLASH dose rates >40 Gy/s were achieved with carbon beams. Cell survival analysis revealed FLASH dose rate sparing in hypoxia (0.5%-4% O2).
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Oesterle R, Gonçalves Jorge P, Grilj V, Bourhis J, Vozenin M, Germond J, Bochud F, Bailat C, Moeckli R. Implementation and validation of a beam-current transformer on a medical pulsed electron beam LINAC for FLASH-RT beam monitoring. J Appl Clin Med Phys 2021; 22:165-171. [PMID: 34609051 PMCID: PMC8598141 DOI: 10.1002/acm2.13433] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To implement and validate a beam current transformer as a passive monitoring device on a pulsed electron beam medical linear accelerator (LINAC) for ultra-high dose rate (UHDR) irradiations in the operational range of at least 3 Gy to improve dosimetric procedures currently in use for FLASH radiotherapy (FLASH-RT) studies. METHODS Two beam current transformers (BCTs) were placed at the exit of a medical LINAC capable of UHDR irradiations. The BCTs were validated as monitoring devices by verifying beam parameters consistency between nominal values and measured values, determining the relationship between the charge measured and the absorbed dose, and checking the short- and long-term stability of the charge-absorbed dose ratio. RESULTS The beam parameters measured by the BCTs coincide with the nominal values. The charge-dose relationship was found to be linear and independent of pulse width and frequency. Short- and long-term stabilities were measured to be within acceptable limits. CONCLUSIONS The BCTs were implemented and validated on a pulsed electron beam medical LINAC, thus improving current dosimetric procedures and allowing for a more complete analysis of beam characteristics. BCTs were shown to be a valid method for beam monitoring for UHDR (and therefore FLASH) experiments.
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Affiliation(s)
- Roxane Oesterle
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Patrik Gonçalves Jorge
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Veljko Grilj
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Jean Bourhis
- Radiation Oncology DepartmentLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Marie‐Catherine Vozenin
- Radiation Oncology DepartmentLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Jean‐François Germond
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - François Bochud
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Claude Bailat
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
| | - Raphaël Moeckli
- Institute of Radiation PhysicsLausanne University Hospital and Lausanne UniversityLausanneSwitzerland
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Hu A, Qiu R, Wu Z, Zhang H, Li WB, Li J. A Computational Model for Oxygen Depletion Hypothesis in FLASH Effect. Radiat Res 2021; 197:175-183. [PMID: 34739052 DOI: 10.1667/rade-20-00260.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
Experiments have reported low normal tissue toxicities during FLASH irradiation, but the mechanism has not been elaborated. Several hypotheses have been proposed to explain the mechanism. One hypothesis is oxygen depletion. We analyze the time-dependent change of oxygen concentration in the tissue to study the oxygen depletion hypothesis using a computational model. The effects of physical, chemical and physiological parameters on oxygen depletion were explored. The kinetic equation of the model is solved numerically using the finite difference method with rational boundary conditions. Results of oxygen distribution is supported by the experiments of oxygen-sensitivity electrodes and experiments on the expression and distribution of the hypoxia-inducible factors. The analysis of parameters shows that the steady-state oxygen distribution before irradiation is determined by the oxygen consumption rate of the tissue and the microvessel density. The change of oxygen concentration after irradiation has been found to follow a negative exponential function, and the time constant is mainly determined by the microvessel density. The change of oxygen during exposure increases with dose rate and tends to be saturated because of oxygen diffusion. When the dose rate is high enough, the same dose results in the same reduction of oxygen concentration regardless of dose rate. The analysis of the FLASH effect in the brain tissue based on this model does not support the explanation of the oxygen depletion hypothesis. The oxygen depletion hypothesis remains controversial because the oxygen in most normal tissues cannot be depleted to radiation resistance level by FLASH irradiation.
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Affiliation(s)
- Ankang Hu
- Department of Engineering Physics, Tsinghua University, Beijing, China.,Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Rui Qiu
- Department of Engineering Physics, Tsinghua University, Beijing, China.,Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Zhen Wu
- Department of Engineering Physics, Tsinghua University, Beijing, China.,Nuctech Company Limited, Beijing, China
| | - Hui Zhang
- Department of Engineering Physics, Tsinghua University, Beijing, China.,Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
| | - Wei Bo Li
- Institute of Radiation Medicine, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH) Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Junli Li
- Department of Engineering Physics, Tsinghua University, Beijing, China.,Key Laboratory of Particle & Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, China
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Zakaria AM, Colangelo NW, Meesungnoen J, Jay-Gerin JP. Transient hypoxia in water irradiated by swift carbon ions at ultra-high dose rates: implication for FLASH carbon-ion therapy. CAN J CHEM 2021. [DOI: 10.1139/cjc-2021-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large doses of ionizing radiation delivered to tumors at ultra-high dose rates (i.e., in a few milliseconds) paradoxically spare the surrounding healthy tissue while preserving anti-tumor activity (compared with conventional radiotherapy delivered at much lower dose rates). This new modality is known as “FLASH radiotherapy” (FLASH-RT). Although the molecular mechanisms underlying FLASH-RT are not yet fully understood, it has been suggested that radiation delivered at high dose rates spares normal tissue via oxygen depletion followed by subsequent radioresistance of the irradiated tissue. To date, FLASH-RT has been studied using electrons, photons, and protons in various basic biological experiments, pre-clinical studies, and recently in a human patient. However, the efficacy of heavy ions, such as energetic carbon ions, under FLASH-RT conditions remains unclear. Given that living cells and tissues consist mainly of water, we set out to study, from a pure radiation chemistry perspective, the effects of ultra-high dose rates on the transient yields and concentrations of radiolytic species formed in water irradiated by 300-MeV per nucleon carbon ions (LET ∼ 11.6 keV/µm). This mimics irradiation in the “plateau” region of the depth–dose distribution of ions, i.e., in the “normal” tissue region in which the LET is rather low. We used Monte Carlo simulations of multiple, simultaneously interacting radiation tracks together with an “instantaneous pulse” irradiation model. Our calculations show a pronounced oxygen depletion around 0.2 μs, strongly suggesting, as with electrons, photons, and protons, that irradiation with energetic carbon ions at ultra-high dose rates is suitable for FLASH-RT.
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Affiliation(s)
- Abdullah Muhammad Zakaria
- Département de médecine nucléaire et de radiobiologie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Nicholas W. Colangelo
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jintana Meesungnoen
- Département de médecine nucléaire et de radiobiologie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Jean-Paul Jay-Gerin
- Département de médecine nucléaire et de radiobiologie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
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Zhu H, Li J, Deng X, Qiu R, Wu Z, Zhang H. Modeling of cellular response after FLASH irradiation: a quantitative analysis based on the radiolytic oxygen depletion hypothesis. Phys Med Biol 2021; 66. [PMID: 34464946 DOI: 10.1088/1361-6560/ac226d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022]
Abstract
Purpose.Recent studies suggest ultra-high dose rate (FLASH) irradiation can spare normal tissues from radiotoxicity, while efficiently controlling the tumor, and this is known as the 'FLASH effect'. This study performed theoretical analyses about the impact of radiolytic oxygen depletion (ROD) on the cellular responses after FLASH irradiation.Methods.Monte Carlo simulation was used to model the ROD process, determine the DNA damage, and calculate the amount of oxygen depleted (LROD) during FLASH exposure. A mathematical model was applied to analyze oxygen tension (pO2) distribution in human tissues and the recovery of pO2after FLASH irradiation. DNA damage and cell survival fractions (SFs) after FLASH irradiation were calculated. The impact of initial cellular pO2, FLASH pulse number, pulse interval, and radiation quality of the source particles on ROD and subsequent cellular responses were systematically evaluated.Results.The simulated electronLRODrange was 0.38-0.43μM Gy-1when pO2ranged from 7.5 to 160 mmHg. The calculated DNA damage and SFs show that the radioprotective effect is only evident in cells with a low pO2. Different irradiation setups alter the cellular responses by modifying the pO2. Single pulse delivery or multi-pulse delivery with pulse intervals shorter than 10-50 ms resulted in fewer DNA damages and higher SFs. Source particles with a low linear energy transfer (LET) have a higher capacity to deplete oxygen, and thus, lead to a more conspicuous radioprotective effect.Conclusions. A systematic analysis of the cellular response following FLASH irradiation was performed to provided suggestions for future FLASH applications. The FLASH radioprotective effect due to ROD may only be observed in cells with a low pO2. Single pulse delivery or multi-pulse delivery with short pulse intervals are suggested for FLASH irradiation to avoid oxygen tension recovery during pulse intervals. Source particles with low LET are preferred for their conspicuous radioprotective effects.
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Affiliation(s)
- Hongyu Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, People's Republic of China.,Department of Engineering Physics, Tsinghua University, Beijing 100084, People's Republic of China.,Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Beijing, People's Republic of China
| | - Junli Li
- Department of Engineering Physics, Tsinghua University, Beijing 100084, People's Republic of China.,Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Beijing, People's Republic of China
| | - Xiaowu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Rui Qiu
- Department of Engineering Physics, Tsinghua University, Beijing 100084, People's Republic of China.,Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Engineering Physics, Tsinghua University, Beijing 100084, People's Republic of China.,Nuctech Company Limited, Beijing 100084, People's Republic of China
| | - Hui Zhang
- Department of Engineering Physics, Tsinghua University, Beijing 100084, People's Republic of China.,Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Beijing, People's Republic of China
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Cao X, Zhang R, Esipova TV, Allu SR, Ashraf R, Rahman M, Gunn JR, Bruza P, Gladstone DJ, Williams BB, Swartz HM, Hoopes PJ, Vinogradov SA, Pogue BW. Quantification of Oxygen Depletion During FLASH Irradiation In Vitro and In Vivo. Int J Radiat Oncol Biol Phys 2021; 111:240-248. [PMID: 33845146 PMCID: PMC8338745 DOI: 10.1016/j.ijrobp.2021.03.056] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Delivery of radiation at ultrahigh dose rates (UHDRs), known as FLASH, has recently been shown to preferentially spare normal tissues from radiation damage compared with tumor tissues. However, the underlying mechanism of this phenomenon remains unknown, with one of the most widely considered hypotheses being that the effect is related to substantial oxygen depletion upon FLASH, thereby altering the radiochemical damage during irradiation, leading to different radiation responses of normal and tumor cells. Testing of this hypothesis would be advanced by direct measurement of tissue oxygen in vivo during and after FLASH irradiation. METHODS AND MATERIALS Oxygen measurements were performed in vitro and in vivo using the phosphorescence quenching method and a water-soluble molecular probe Oxyphor 2P. The changes in oxygen per unit dose (G-values) were quantified in response to irradiation by 10 MeV electron beam at either UHDR reaching 300 Gy/s or conventional radiation therapy dose rates of 0.1 Gy/s. RESULTS In vitro experiments with 5% bovine serum albumin solutions at 23°C resulted in G-values for oxygen consumption of 0.19 to 0.21 mm Hg/Gy (0.34-0.37 μM/Gy) for conventional irradiation and 0.16 to 0.17 mm Hg/Gy (0.28-0.30 μM/Gy) for UHDR irradiation. In vivo, the total decrease in oxygen after a single fraction of 20 Gy FLASH irradiation was 2.3 ± 0.3 mm Hg in normal tissue and 1.0 ± 0.2 mm Hg in tumor tissue (P < .00001), whereas no decrease in oxygen was observed from a single fraction of 20 Gy applied in conventional mode. CONCLUSIONS Our observations suggest that oxygen depletion to radiologically relevant levels of hypoxia is unlikely to occur in bulk tissue under FLASH irradiation. For the same dose, FLASH irradiation induces less oxygen consumption than conventional irradiation in vitro, which may be related to the FLASH sparing effect. However, the difference in oxygen depletion between FLASH and conventional irradiation could not be quantified in vivo because measurements of oxygen depletion under conventional irradiation are hampered by resupply of oxygen from the blood.
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Affiliation(s)
- Xu Cao
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education & School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Tatiana V Esipova
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Chemistry, School or Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srinivasa Rao Allu
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Chemistry, School or Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramish Ashraf
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Mahbubur Rahman
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Benjamin B Williams
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Harold M Swartz
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - P Jack Hoopes
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Sergei A Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Chemistry, School or Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
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Tessonnier T, Mein S, Walsh DWM, Schuhmacher N, Liew H, Cee R, Galonska M, Scheloske S, Schömers C, Weber U, Brons S, Debus J, Haberer T, Abdollahi A, Mairani A, Dokic I. FLASH dose-rate helium ion beams: first in vitro investigations. Int J Radiat Oncol Biol Phys 2021; 111:1011-1022. [PMID: 34343608 DOI: 10.1016/j.ijrobp.2021.07.1703] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To establish and investigate the impact of dose, linear energy transfer (LET) and O2 concentration on biological response to ultra-high dose-rate (uHDR, FLASH) helium ion beams compared to standard dose-rate (SDR) irradiation. METHODS AND MATERIALS Beam delivery settings for raster-scanned helium ions at both uHDR and SDR were tuned to achieve >100 Gy/s and ∼0.1 Gy/s, respectively. For both SDR and uHDR, plan optimization and calibration for 10 × 10mm2 fields was performed to assess in vitro response at LET range of 4.5-16 keV/µm. Clonogenic survival assay was conducted at doses ranging from 2 Gy to 12 Gy in two human lung epithelial cell lines (A549 and H1437). Radiation induced nuclear γH2AX foci (RIF) were assessed in both epithelial cell lines and primary human pulmonary fibroblasts. RESULTS Average dose-rates achieved were 185 Gy/s and 0.12 Gy/s for uHDR and SDR, respectively. No differences in cellular response to SDR vs. uHDR were observed for all tested doses at 21% O2, as well as at 2 and 4 Gy at 1% O2. In contrast, at 1% O2 and dose threshold of ≳8Gy cell survival was higher and correlated with reduced nuclear γH2AX RIF signal indicating FLASH sparing effect in the investigated cell lines irradiated with uHDR as compared to SDR . CONCLUSION The first uHDR delivery of raster-scanned particle beams was achieved using helium ions, reaching FLASH-level dose-rates of >100 Gy/s. Baseline oxygen levels and delivered dose (≳ 8 Gy) play a pivotal role, irrespective of the studied cell lines, for observation of a sparing effect for helium ions.
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Affiliation(s)
- Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stewart Mein
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietrich W M Walsh
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nora Schuhmacher
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans Liew
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Heidelberg University, Germany
| | - Rainer Cee
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Galonska
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Scheloske
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schömers
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Uli Weber
- GSI Helmholtzzentrum für Schwerionenforschung;Darmstadt, Germany
| | - Stephan Brons
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Heidelberg University, Germany
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Amir Abdollahi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy.
| | - Ivana Dokic
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Adrian G, Konradsson E, Beyer S, Wittrup A, Butterworth KT, McMahon SJ, Ghita M, Petersson K, Ceberg C. Cancer Cells Can Exhibit a Sparing FLASH Effect at Low Doses Under Normoxic In Vitro-Conditions. Front Oncol 2021; 11:686142. [PMID: 34395253 PMCID: PMC8358772 DOI: 10.3389/fonc.2021.686142] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background Irradiation with ultra-high dose rate (FLASH) has been shown to spare normal tissue without hampering tumor control in several in vivo studies. Few cell lines have been investigated in vitro, and previous results are inconsistent. Assuming that oxygen depletion accounts for the FLASH sparing effect, no sparing should appear for cells irradiated with low doses in normoxia. Methods Seven cancer cell lines (MDA-MB-231, MCF7, WiDr, LU-HNSCC4, HeLa [early passage and subclone]) and normal lung fibroblasts (MRC-5) were irradiated with doses ranging from 0 to 12 Gy using FLASH (≥800 Gy/s) or conventional dose rates (CONV, 14 Gy/min), with a 10 MeV electron beam from a clinical linear accelerator. Surviving fraction (SF) was determined with clonogenic assays. Three cell lines were further studied for radiation-induced DNA-damage foci using a 53BP1-marker and for cell cycle synchronization after irradiation. Results A tendency of increased survival following FLASH compared with CONV was suggested for all cell lines, with significant differences for 4/7 cell lines. The magnitude of the FLASH-sparing expressed as a dose-modifying factor at SF=0.1 was around 1.1 for 6/7 cell lines and around 1.3 for the HeLasubclone. Similar cell cycle distributions and 53BP1-foci numbers were found comparing FLASH to CONV. Conclusion We have found a FLASH effect appearing at low doses under normoxic conditions for several cell lines in vitro. The magnitude of the FLASH effect differed between the cell lines, suggesting inherited biological susceptibilities for FLASH irradiation.
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Affiliation(s)
- Gabriel Adrian
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Elise Konradsson
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Sarah Beyer
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anders Wittrup
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund, Sweden
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Stephen J McMahon
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Mihaela Ghita
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Kristoffer Petersson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Crister Ceberg
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
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48
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Weber UA, Scifoni E, Durante M. FLASH radiotherapy with carbon ion beams. Med Phys 2021; 49:1974-1992. [PMID: 34318508 DOI: 10.1002/mp.15135] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
FLASH radiotherapy is considered a new potential breakthrough in cancer treatment. Ultra-high dose rates (>40 Gy/s) have been shown to reduce toxicity in the normal tissue without compromising tumor control, resulting in a widened therapeutic window. These high dose rates are more easily achievable in the clinic with charged particles, and clinical trials are, indeed, ongoing using electrons or protons. FLASH could be an attractive solution also for heavier ions such as carbon and could even enhance the therapeutic window. However, it is not yet known whether the FLASH effect will be the same as for sparsely ionizing radiation when densely ionizing carbons ions are used. Here we discuss the technical challenges in beam delivery and present a promising solution using 3D range-modulators in order to apply ultra-high dose rates (UHDR) compatible with FLASH with carbon ions. Furthermore, we will discuss the possible outcome of C-ion therapy at UHDR on the level of the radiobiological and radiation chemical effects.
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Affiliation(s)
- Uli Andreas Weber
- Biophysics Department, GSI Helhmoltzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Emanuele Scifoni
- Istituto Nazionale di Fisica Nucleare (INFN), Trento Institute for Fundamental Physics and Applications (TIFPA), Trento, Italy
| | - Marco Durante
- Biophysics Department, GSI Helhmoltzzentrum für Schwerionenforschung, Darmstadt, Germany.,Institute of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
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49
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Velalopoulou A, Karagounis IV, Cramer GM, Kim MM, Skoufos G, Goia D, Hagan S, Verginadis II, Shoniyozov K, Chiango J, Cerullo M, Varner K, Yao L, Qin L, Hatzigeorgiou AG, Minn AJ, Putt M, Lanza M, Assenmacher CA, Radaelli E, Huck J, Diffenderfer E, Dong L, Metz J, Koumenis C, Cengel KA, Maity A, Busch TM. FLASH proton radiotherapy spares normal epithelial and mesenchymal tissues while preserving sarcoma response. Cancer Res 2021; 81:4808-4821. [PMID: 34321243 DOI: 10.1158/0008-5472.can-21-1500] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
In studies of electron and proton radiotherapy, ultrahigh dose rates of FLASH radiation therapy appear to produce fewer toxicities than standard dose rates while maintaining local tumor control. FLASH-proton radiotherapy (F-PRT) brings the spatial advantages of PRT to FLASH dose rates (>40 Gy/sec), making it important to understand if and how F-PRT spares normal tissues while providing anti-tumor efficacy that is equivalent to standard-proton radiotherapy (S-PRT). Here we studied PRT damage to skin and mesenchymal tissues of muscle and bone and found that F-PRT of the C57BL/6 murine hind leg produced fewer severe toxicities leading to death or requiring euthanasia than S-PRT of the same dose. RNAseq analyses of murine skin and bone revealed pathways upregulated by S-PRT yet unaltered by F-PRT, such as apoptosis signaling and keratinocyte differentiation in skin, as well as osteoclast differentiation and chondrocyte development in bone. Corroborating these findings, F-PRT reduced skin injury, stem cell depletion, and inflammation, mitigated late effects including lymphedema, and decreased histopathologically detected myofiber atrophy, bone resorption, hair follicle atrophy, and epidermal hyperplasia. F-PRT was equipotent to S-PRT in control of two murine sarcoma models, including at an orthotopic intramuscular site, thereby establishing its relevance to mesenchymal cancers. Finally, S-PRT produced greater increases in TGF-β1 in murine skin and the skin of canines enrolled in a phase 1 study of F-PRT versus S-PRT. Collectively, these data provide novel insights into F-PRT-mediated tissue sparing and support its ongoing investigation in applications that would benefit from this sparing of skin and mesenchymal tissues.
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Affiliation(s)
| | | | | | - Michele M Kim
- Radiation Oncology, University of Pennsylvania School of Medicine
| | | | - Denisa Goia
- Radiation Oncology, University of Pennsylvania
| | - Sarah Hagan
- Radiation Oncology, University of Pennsylvania
| | | | | | - June Chiango
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | - Michelle Cerullo
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | - Kelley Varner
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | - Lutian Yao
- Orthopedic Surgery, University of Pennsylvania
| | - Ling Qin
- Orthopedic Surgery, University of Pennsylvania
| | | | - Andy J Minn
- Abramson Family Cancer Research Institute, Philadelphia
| | - Mary Putt
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania
| | - Matthew Lanza
- Pathobiology, University of Pennsylvania School of Veterinary Medicine
| | | | | | - Jennifer Huck
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine
| | | | - Lei Dong
- Radiation Oncology, University of Pennsylvania
| | - James Metz
- Radiation Oncology, University of Pennsylvania
| | | | | | - Amit Maity
- Radiation Oncology, University of Pennsylvania School of Medicine
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50
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Kang M, Wei S, Choi JI, Simone CB 2nd, Lin H. Quantitative Assessment of 3D Dose Rate for Proton Pencil Beam Scanning FLASH Radiotherapy and Its Application for Lung Hypofractionation Treatment Planning. Cancers (Basel) 2021; 13:3549. [PMID: 34298762 DOI: 10.3390/cancers13143549] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/24/2022] Open
Abstract
To quantitatively assess target and organs-at-risk (OAR) dose rate based on three proposed proton PBS dose rate metrics and study FLASH intensity-modulated proton therapy (IMPT) treatment planning using transmission beams. An in-house FLASH planning platform was developed to optimize transmission (shoot-through) plans for nine consecutive lung cancer patients previously planned with proton SBRT. Dose and dose rate calculation codes were developed to quantify three types of dose rate calculation methods (dose-averaged dose rate (DADR), average dose rate (ADR), and dose-threshold dose rate (DTDR)) based on both phantom and patient treatment plans. Two different minimum MU/spot settings were used to optimize two different dose regimes, 34-Gy in one fraction and 45-Gy in three fractions. The OAR sparing and target coverage can be optimized with good uniformity (hotspot < 110% of prescription dose). ADR, accounting for the spot dwelling and scanning time, gives the lowest dose rate; DTDR, not considering this time but a dose-threshold, gives an intermediate dose rate, whereas DADR gives the highest dose rate without considering any time or dose-threshold. All three dose rates attenuate along the beam direction, and the highest dose rate regions often occur on the field edge for ADR and DTDR, whereas DADR has a better dose rate uniformity. The differences in dose rate metrics have led a large variation for OARs dose rate assessment, posing challenges to FLASH clinical implementation. This is the first attempt to study the impact of the dose rate models, and more investigations and evidence for the details of proton PBS FLASH parameters are needed to explore the correlation between FLASH efficacy and the dose rate metrics.
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