FLASH radiotherapy: an emerging approach in radiation therapy

Natalia Matuszak; Wiktoria Maria Suchorska; Piotr Milecki; Marta Kruszyna-Mochalska; Agnieszka Misiarz; Jacek Pracz; Julian Malicki

doi:10.5603/RPOR.a2022.0038

FLASH radiotherapy: an emerging approach in radiation therapy

Rep Pract Oncol Radiother. 2022 May 19;27(2):344-351. doi: 10.5603/RPOR.a2022.0038. eCollection 2022.

Authors

Natalia Matuszak^{1

2}, Wiktoria Maria Suchorska^{1

2}, Piotr Milecki^{1

3}, Marta Kruszyna-Mochalska^{1

4}, Agnieszka Misiarz⁵, Jacek Pracz⁶, Julian Malicki^{1

4}

Affiliations

¹ Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland.
² Radiobiology Lab. Medical Physics Department, The Greater Poland Cancer Centre, Poznan, Poland.
³ Department of Radiotherapy I, The Greater Poland Cancer Centre, Poznan, Poland.
⁴ Medical Physics Department, The Greater Poland Cancer Centre, Poznan, Poland.
⁵ Department of Nuclear Techniques and Equipment, National Centre for Nuclear Research, Otwock, Poland.
⁶ Centre of High Technology HITEC, Swierk, Otwock, Poland.

Abstract

FLASH radiotherapy (RT) is a technique involving the delivery of ultra-high dose rate radiation to the target. FLASH-RT has been shown to reduce radiation-induced toxicity in healthy tissues without compromising the anti-cancer effects of treatment compared to conventional radiation therapy. In the present article, we review the published data on FLASH-RT and discuss the current state of knowledge of this novel approach. We also highlight the technological constraints and complexity of FLASH-RT and describe the physics underlying this modality, particularly how technology supports energy transfer by ionising radiation (e.g., beam on/off sequence, pulse-energy load, intervals). We emphasise that current preclinical experience is mostly based on FLASH electrons and that clinical application of FLASH-RT is very limited. The incorporation of FLASH-RT into routine clinical radiotherapy will require the development of devices capable of producing FLASH photon beams.

Keywords: FLASH RT; FLASH electrons; FLASH photons; biological effect; dosimetric parameters; ionising radiation; radiotherapy; ultra-high dose rate.

Publication types

Review