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Dai T, Sloop AM, Schönfeld A, Flatten V, Kozelka J, Hildreth J, Bill S, Sunnerberg JP, Clark MA, Jarvis L, Pogue BW, Bruza P, Gladstone DJ, Zhang R. Electron beam response corrections for an ultra-high-dose-rate capable diode dosimeter. Med Phys 2024. [PMID: 38762909 DOI: 10.1002/mp.17121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Ultra-high-dose-rate (UHDR) electron beams have been commonly utilized in FLASH studies and the translation of FLASH Radiotherapy (RT) to the clinic. The EDGE diode detector has potential use for UHDR dosimetry albeit with a beam energy dependency observed. PURPOSE The purpose is to present the electron beam response for an EDGE detector in dependence on beam energy, to characterize the EDGE detector's response under UHDR conditions, and to validate correction factors derived from the first detailed Monte Carlo model of the EDGE diode against measurements, particularly under UHDR conditions. METHODS Percentage depth doses (PDDs) for the UHDR Mobetron were measured with both EDGE detectors and films. A detailed Monte Carlo (MC) model of the EDGE detector has been configured according to the blueprint provided by the manufacturer under an NDA agreement. Water/silicon dose ratios of EDGE detector for a series of mono-energetic electron beams have been calculated. The dependence of the water/silicon dose ratio on depth for a FLASH relevant electron beam was also studied. An analytical approach for the correction of PDD measured with EDGE detectors was established. RESULTS Water/silicon dose ratio decreased with decreasing electron beam energy. For the Mobetron 9 MeV UHDR electron beam, the ratio decreased from 1.09 to 1.03 in the build-up region, maintained in range of 0.98-1.02 at the fall-off region and raised to a plateau in value of 1.08 at the tail. By applying the corrections, good agreement between the PDDs measured by the EDGE detector and those measured with film was achieved. CONCLUSIONS Electron beam response of an UHDR capable EDGE detector was derived from first principles utilizing a sophisticated MC model. An analytical approach was validated for the PDDs of UHDR electron beams. The results demonstrated the capability of EDGE detector in measuring PDDs of UHDR electron beams.
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Affiliation(s)
- Tianyuan Dai
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan Shandong, China
| | - Austin M Sloop
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | | | | | | | | | - Simon Bill
- Sun Nuclear Corp, Melbourne, Florida, USA
| | - Jacob P Sunnerberg
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Megan A Clark
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Lesley Jarvis
- Department of Medicine, Geisel School of Medicine, Dartmouth College Hanover, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin, USA
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College Hanover, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Radiation Medicine, New York Medical College, Valhalla, New York, USA
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Horst F, Bodenstein E, Brand M, Hans S, Karsch L, Lessmann E, Löck S, Schürer M, Pawelke J, Beyreuther E. Dose and dose rate dependence of the tissue sparing effect at ultra-high dose rate studied for proton and electron beams using the zebrafish embryo model. Radiother Oncol 2024; 194:110197. [PMID: 38447870 DOI: 10.1016/j.radonc.2024.110197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE A better characterization of the dependence of the tissue sparing effect at ultra-high dose rate (UHDR) on physical beam parameters (dose, dose rate, radiation quality) would be helpful towards a mechanistic understanding of the FLASH effect and for its broader clinical translation. To address this, a comprehensive study on the normal tissue sparing at UHDR using the zebrafish embryo (ZFE) model was conducted. METHODS One-day-old ZFE were irradiated over a wide dose range (15-95 Gy) in three different beams (proton entrance channel, proton spread out Bragg peak and 30 MeV electrons) at UHDR and reference dose rate. After irradiation the ZFE were incubated for 4 days and then analyzed for four different biological endpoints (pericardial edema, curved spine, embryo length and eye diameter). RESULTS Dose-effect curves were obtained and a sparing effect at UHDR was observed for all three beams. It was demonstrated that proton relative biological effectiveness and UHDR sparing are both relevant to predict the resulting dose response. Dose dependent FLASH modifying factors (FMF) for ZFE were found to be compatible with rodent data from the literature. It was found that the UHDR sparing effect saturates at doses above ∼ 50 Gy with an FMF of ∼ 0.7-0.8. A strong dose rate dependence of the tissue sparing effect in ZFE was observed. The magnitude of the maximum sparing effect was comparable for all studied biological endpoints. CONCLUSION The ZFE model was shown to be a suitable pre-clinical high-throughput model for radiobiological studies on FLASH radiotherapy, providing results comparable to rodent models. This underlines the relevance of ZFE studies for FLASH radiotherapy research.
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Affiliation(s)
- Felix Horst
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Elisabeth Bodenstein
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Michael Brand
- Center for Regenerative Therapies TU Dresden and Cluster of Excellence 'Physics of Life', Technische Universität Dresden, Dresden, Germany
| | - Stefan Hans
- Center for Regenerative Therapies TU Dresden and Cluster of Excellence 'Physics of Life', Technische Universität Dresden, Dresden, Germany
| | - Leonhard Karsch
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Elisabeth Lessmann
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiation Physics, Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Schürer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jörg Pawelke
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Elke Beyreuther
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiation Physics, Dresden, Germany.
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Borghini A, Labate L, Piccinini S, Panaino CMV, Andreassi MG, Gizzi LA. FLASH Radiotherapy: Expectations, Challenges, and Current Knowledge. Int J Mol Sci 2024; 25:2546. [PMID: 38473799 DOI: 10.3390/ijms25052546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Major strides have been made in the development of FLASH radiotherapy (FLASH RT) in the last ten years, but there are still many obstacles to overcome for transfer to the clinic to become a reality. Although preclinical and first-in-human clinical evidence suggests that ultra-high dose rates (UHDRs) induce a sparing effect in normal tissue without modifying the therapeutic effect on the tumor, successful clinical translation of FLASH-RT depends on a better understanding of the biological mechanisms underpinning the sparing effect. Suitable in vitro studies are required to fully understand the radiobiological mechanisms associated with UHDRs. From a technical point of view, it is also crucial to develop optimal technologies in terms of beam irradiation parameters for producing FLASH conditions. This review provides an overview of the research progress of FLASH RT and discusses the potential challenges to be faced before its clinical application. We critically summarize the preclinical evidence and in vitro studies on DNA damage following UHDR irradiation. We also highlight the ongoing developments of technologies for delivering FLASH-compliant beams, with a focus on laser-driven plasma accelerators suitable for performing basic radiobiological research on the UHDR effects.
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Affiliation(s)
| | - Luca Labate
- Intense Laser Irradiation Laboratory (ILIL), CNR Istituto Nazionale di Ottica, 56124 Pisa, Italy
| | - Simona Piccinini
- Intense Laser Irradiation Laboratory (ILIL), CNR Istituto Nazionale di Ottica, 56124 Pisa, Italy
| | | | | | - Leonida Antonio Gizzi
- Intense Laser Irradiation Laboratory (ILIL), CNR Istituto Nazionale di Ottica, 56124 Pisa, Italy
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Oesterle R, Bailat C, Buhlmann D, Bochud F, Grilj V. Construction and dosimetric characterization of a motorized scanning-slit system for electron FLASH experiments. Med Phys 2024; 51:1396-1404. [PMID: 37439505 PMCID: PMC10787038 DOI: 10.1002/mp.16610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Beam scanning is a useful technique for the treatment of large tumors when the primary beam size is limited, which is the case with radiation beams used in FLASH radiotherapy. PURPOSE To optimize beam scanning as a dose delivery method for FLASH radiotherapy, it is necessary to first understand the effects of beam scanning on the FLASH effect. To do so, biological FLASH experiments need to be done using defined beam parameters with beam scanning and compared to the situation without beam scanning. In this regard, we propose implementation of a simple slit scanning system with an electron FLASH beam to obtain a scanned radiation field that closely resembles a static field. METHODS A pulsed electron linear accelerator (linac) was used in combination with a scanning slit system in order to simulate a scanned electron beam. Three configurations that produced homogeneous lateral profiles and high enough doses per pulse for FLASH experiments were established. The optimal scanning parameters were found for each configuration by examining the flatness of the obtained lateral dose profiles. Using the optimal scanning parameters, the scanned FLASH beams were dosimetrically characterized and compared to non-scanned open field beam. RESULTS A final electron FLASH beam scanning configuration was found for a 1 mm wide slit at a distance of 350 mm from the linac and a 2 mm wide slit at distances of 350 and 490 mm from the linac. The lateral profiles for these final configurations were found to have a homogeneity that is comparable to the open field profiles. The percentage depth dose (PDD) values found for these final configurations closely matched (by a few percentage) the PDD of the open field beam. CONCLUSIONS Three electron FLASH beam scanning configurations achieved by the motorized slit system were found to produce radiation fields similar to a non-scanned open field electron beam. These final configurations can therefore be used in future biological FLASH experiments to compare to non-scanned beam experiments in order to optimize beam scanning as a technique permitting the treatment of larger tumors with FLASH radiotherapy.
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Affiliation(s)
- Roxane Oesterle
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Claude Bailat
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Damien Buhlmann
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Francois Bochud
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Veljko Grilj
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
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5
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Byrne KE, Poirier Y, Xu J, Gerry A, Foley MJ, Jackson IL, Sawant A, Jiang K. Technical note: A small animal irradiation platform for investigating the dependence of the FLASH effect on electron beam parameters. Med Phys 2024; 51:1421-1432. [PMID: 38207016 DOI: 10.1002/mp.16909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/30/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The recent rediscovery of the FLASH effect, a normal tissue sparing phenomenon observed in ultra-high dose rate (UHDR) irradiations, has instigated a surge of research endeavors aiming to close the gap between experimental observation and clinical treatment. However, the dependences of the FLASH effect and its underpinning mechanisms on beam parameters are not well known, and large-scale in vivo studies using murine models of human cancer are needed for these investigations. PURPOSE To commission a high-throughput, variable dose rate platform providing uniform electron fields (≥15 cm diameter) at conventional (CONV) and UHDRs for in vivo investigations of the FLASH effect and its dependences on pulsed electron beam parameters. METHODS A murine whole-thoracic lung irradiation (WTLI) platform was constructed using a 1.3 cm thick Cerrobend collimator forming a 15 × 1.6 cm2 slit. Control of dose and dose rate were realized by adjusting the number of monitor units and couch vertical position, respectively. Achievable doses and dose rates were investigated using Gafchromic EBT-XD film at 1 cm depth in solid water and lung-density phantoms. Percent depth dose (PDD) and dose profiles at CONV and various UHDRs were also measured at depths from 0 to 2 cm. A radiation survey was performed to assess radioactivation of the Cerrobend collimator by the UHDR electron beam in comparison to a precision-machined copper alternative. RESULTS This platform allows for the simultaneous thoracic irradiation of at least three mice. A linear relationship between dose and number of monitor units at a given UHDR was established to guide the selection of dose, and an inverse-square relationship between dose rate and source distance was established to guide the selection of dose rate between 20 and 120 Gy·s-1 . At depths of 0.5 to 1.5 cm, the depth range relevant to murine lung irradiation, measured PDDs varied within ±1.5%. Similar lateral dose profiles were observed at CONV and UHDRs with the dose penumbrae widening from 0.3 mm at 0 cm depth to 5.1 mm at 2.0 cm. The presence of lung-density plastic slabs had minimal effect on dose distributions as compared to measurements made with only solid water slabs. Instantaneous dose rate measurements of the activated copper collimator were up to two orders of magnitude higher than that of the Cerrobend collimator. CONCLUSIONS A high-throughput, variable dose rate platform has been developed and commissioned for murine WTLI electron FLASH radiotherapy. The wide field of our UHDR-enabled linac allows for the simultaneous WTLI of at least three mice, and for the average dose rate to be modified by changing the source distance, without affecting dose distribution. The platform exhibits uniform, and comparable dose distributions at CONV and UHDRs up to 120 Gy·s-1 , owing to matched and flattened 16 MeV CONV and UHDR electron beams. Considering radioactivation and exposure to staff, Cerrobend collimators are recommended above copper alternatives for electron FLASH research. This platform enables high-throughput animal irradiation, which is preferred for experiments using a large number of animals, which are required to effectively determine UHDR treatment efficacies.
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Affiliation(s)
- Kevin E Byrne
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Physics, School of Natural Sciences, University of Galway, Galway, Ireland
| | - Yannick Poirier
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Junliang Xu
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew Gerry
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mark J Foley
- Department of Physics, School of Natural Sciences, University of Galway, Galway, Ireland
| | - Isabel Lauren Jackson
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kai Jiang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Pettinato S, Felici G, Galluzzo L, Rossi MC, Girolami M, Salvatori S. A readout system for highly sensitive diamond detectors for FLASH dosimetry. Phys Imaging Radiat Oncol 2024; 29:100538. [PMID: 38317851 PMCID: PMC10839766 DOI: 10.1016/j.phro.2024.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
Accurate dosimetry of ultra-high dose-rate beams using diamond detectors remains challenging, primarily due to the elevated photocurrent peaks exceeding the input dynamics of precision electrometers. This work aimed at demonstrating the effectiveness of compact gated-integration electronics in conditioning the current peaks (>20 mA) generated by a highly sensitive (S ≃ 26 nC/Gy) custom-made diamond photoconductor under electron FLASH irradiation, as well as in real-time monitoring of beam dose and dose-rate. For the emerging FLASH technology, this study provided a new perspective on using commercially available diamond dosimeters with high sensitivity, currently employed in conventional radiotherapy.
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Affiliation(s)
- Sara Pettinato
- Dept. of Engineering, Niccolò Cusano University, via don Carlo Gnocchi 3, 00166 Rome, Italy
| | - Giuseppe Felici
- SIT – Sordina IORT Technologies S.p.A., Aprilia, Latina, Italy
| | | | - Maria Cristina Rossi
- Dept. of Industrial, Electronic, and Mechanical Engineering, Roma Tre University, Via Vito Volterra 62, 00146 Rome, Italy
| | - Marco Girolami
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM–CNR), Sede Secondaria di Montelibretti, Strada Provinciale 35/D n. 9, 00010 Montelibretti, Rome, Italy
| | - Stefano Salvatori
- Dept. of Engineering, Niccolò Cusano University, via don Carlo Gnocchi 3, 00166 Rome, Italy
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7
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Metzkes-Ng J, Brack FE, Kroll F, Bernert C, Bock S, Bodenstein E, Brand M, Cowan TE, Gebhardt R, Hans S, Helbig U, Horst F, Jansen J, Kraft SD, Krause M, Leßmann E, Löck S, Pawelke J, Püschel T, Reimold M, Rehwald M, Richter C, Schlenvoigt HP, Schramm U, Schürer M, Seco J, Szabó ER, Umlandt MEP, Zeil K, Ziegler T, Beyreuther E. The DRESDEN PLATFORM is a research hub for ultra-high dose rate radiobiology. Sci Rep 2023; 13:20611. [PMID: 37996453 PMCID: PMC10667545 DOI: 10.1038/s41598-023-46873-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
The recently observed FLASH effect describes the observation of normal tissue protection by ultra-high dose rates (UHDR), or dose delivery in a fraction of a second, at similar tumor-killing efficacy of conventional dose delivery and promises great benefits for radiotherapy patients. Dedicated studies are now necessary to define a robust set of dose application parameters for FLASH radiotherapy and to identify underlying mechanisms. These studies require particle accelerators with variable temporal dose application characteristics for numerous radiation qualities, equipped for preclinical radiobiological research. Here we present the DRESDEN PLATFORM, a research hub for ultra-high dose rate radiobiology. By uniting clinical and research accelerators with radiobiology infrastructure and know-how, the DRESDEN PLATFORM offers a unique environment for studying the FLASH effect. We introduce its experimental capabilities and demonstrate the platform's suitability for systematic investigation of FLASH by presenting results from a concerted in vivo radiobiology study with zebrafish embryos. The comparative pre-clinical study was conducted across one electron and two proton accelerator facilities, including an advanced laser-driven proton source applied for FLASH-relevant in vivo irradiations for the first time. The data show a protective effect of UHDR irradiation up to [Formula: see text] and suggests consistency of the protective effect even at escalated dose rates of [Formula: see text]. With the first clinical FLASH studies underway, research facilities like the DRESDEN PLATFORM, addressing the open questions surrounding FLASH, are essential to accelerate FLASH's translation into clinical practice.
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Affiliation(s)
| | | | - Florian Kroll
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Constantin Bernert
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- TUD Dresden University of Technology, Dresden, Germany
| | - Stefan Bock
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Elisabeth Bodenstein
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Michael Brand
- Center for Regenerative Therapies (CRTD), TUD Dresden University of Technology, Dresden, Germany
- Cluster of Excellence - Physics of Life, TUD Dresden University of Technology, Dresden, Germany
| | - Thomas E Cowan
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- TUD Dresden University of Technology, Dresden, Germany
| | - René Gebhardt
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Stefan Hans
- Center for Regenerative Therapies (CRTD), TUD Dresden University of Technology, Dresden, Germany
- Cluster of Excellence - Physics of Life, TUD Dresden University of Technology, Dresden, Germany
| | - Uwe Helbig
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Felix Horst
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Jeannette Jansen
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Mechthild Krause
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Medizinische Fakultät and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | | | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Dresden, Germany
| | - Jörg Pawelke
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | | | | | | | - Christian Richter
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Dresden, Germany
| | | | - Ulrich Schramm
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- TUD Dresden University of Technology, Dresden, Germany
| | - Michael Schürer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Medizinische Fakultät and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Joao Seco
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, Ruprecht-Karls-University, Heidelberg, Germany
| | - Emília Rita Szabó
- ELI ALPS, ELI-HU Non-Profit Ltd., Szeged, Hungary
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Marvin E P Umlandt
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- TUD Dresden University of Technology, Dresden, Germany
| | - Karl Zeil
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Tim Ziegler
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- TUD Dresden University of Technology, Dresden, Germany
| | - Elke Beyreuther
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
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Böhlen TT, Germond JF, Petersson K, Ozsahin EM, Herrera FG, Bailat C, Bochud F, Bourhis J, Moeckli R, Adrian G. Effect of Conventional and Ultrahigh Dose Rate FLASH Irradiations on Preclinical Tumor Models: A Systematic Analysis. Int J Radiat Oncol Biol Phys 2023; 117:1007-1017. [PMID: 37276928 DOI: 10.1016/j.ijrobp.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/19/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Compared with conventional dose rate irradiation (CONV), ultrahigh dose rate irradiation (UHDR) has shown superior normal tissue sparing. However, a clinically relevant widening of the therapeutic window by UHDR, termed "FLASH effect," also depends on the tumor toxicity obtained by UHDR. Based on a combined analysis of published literature, the current study examined the hypothesis of tumor isoefficacy for UHDR versus CONV and aimed to identify potential knowledge gaps to inspire future in vivo studies. METHODS AND MATERIALS A systematic literature search identified publications assessing in vivo tumor responses comparing UHDR and CONV. Qualitative and quantitative analyses were performed, including combined analyses of tumor growth and survival data. RESULTS We identified 66 data sets from 15 publications that compared UHDR and CONV for tumor efficacy. The median number of animals per group was 9 (range 3-15) and the median follow-up period was 30.5 days (range 11-230) after the first irradiation. Tumor growth assays were the predominant model used. Combined statistical analyses of tumor growth and survival data are consistent with UHDR isoefficacy compared with CONV. Only 1 study determined tumor-controlling dose (TCD50) and reported statistically nonsignificant differences. CONCLUSIONS The combined quantitative analyses of tumor responses support the assumption of UHDR isoefficacy compared with CONV. However, the comparisons are primarily based on heterogeneous tumor growth assays with limited numbers of animals and short follow-up, and most studies do not assess long-term tumor control probability. Therefore, the assays may be insensitive in resolving smaller response differences, such as responses of radioresistant tumor subclones. Hence, tumor cure experiments, including additional TCD50 experiments, are needed to confirm the assumption of isoeffectiveness in curative settings.
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Affiliation(s)
- Till Tobias Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean-François Germond
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Kristoffer Petersson
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden; MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Esat Mahmut Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Fernanda G Herrera
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Claude Bailat
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - François Bochud
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
| | - Gabriel Adrian
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden; Division of Oncology and Pathology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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9
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Dal Bello R, von der Grün J, Fabiano S, Rudolf T, Saltybaeva N, Stark LS, Ahmed M, Bathula M, Kucuker Dogan S, McNeur J, Guckenberger M, Tanadini-Lang S. Enabling ultra-high dose rate electron beams at a clinical linear accelerator for isocentric treatments. Radiother Oncol 2023; 187:109822. [PMID: 37516362 DOI: 10.1016/j.radonc.2023.109822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND AND PURPOSE Radiotherapy delivery with ultra-high dose rates (UHDR) has consistently produced normal tissue sparing while maintaining efficacy for tumour control in preclinical studies, known as the FLASH effect. Modified clinical electron linacs have been used for pre-clinical studies at reduced source-surface distance (SSD) and novel intra-operative devices are becoming available. In this context, we modified a clinical linac to deliver 16 MeV UHDR electron beams with an isocentric setup. MATERIALS AND METHODS The first Varian TrueBeam (SN 1001) was clinically operative between 2009-2022, it was then decommissioned and converted into a research platform. The 18 MeV electron beam was converted into the experimental 16 MeV UHDR. Modifications were performed by Varian and included a software patch, thinner scattering foil and beam tuning. The dose rate, beam characteristics and reproducibility were measured with electron applicators at SSD = 100 cm. RESULTS The dose per pulse at isocenter was up to 1.28 Gy/pulse, corresponding to average and instantaneous dose rates up to 256 Gy/s and 3⋅105 Gy/s, respectively. Beam characteristics were equivalent between 16 MeV UHDR and conventional for field sizes up to 10x10cm2 and an overall beam reproducibility within ± 2.5% was measured. CONCLUSIONS We report on the first technical conversion of a Varian TrueBeam to produce 16 MeV UHDR electron beams. This research platform will allow isocenter experiments and deliveries with conventional setups up to field sizes of 10x10 cm2 within a hospital environment, reducing the gap between preclinical and clinical electron FLASH investigations.
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Affiliation(s)
- Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Jens von der Grün
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Silvia Fabiano
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Rudolf
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Natalia Saltybaeva
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Luisa S Stark
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Md Ahmed
- Varian Medical Systems a Siemens Healthineers Company, Palo Alto, CA, USA
| | - Manohar Bathula
- Varian Medical Systems a Siemens Healthineers Company, Palo Alto, CA, USA
| | | | - Joshua McNeur
- Varian Medical Systems a Siemens Healthineers Company, Palo Alto, CA, USA
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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10
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Ghannam Y, Chiavassa S, Saade G, Koumeir C, Blain G, Delpon G, Evin M, Haddad F, Maigne L, Mouchard Q, Servagent N, Potiron V, Supiot S. First evidence of in vivo effect of FLASH radiotherapy with helium ions in zebrafish embryos. Radiother Oncol 2023; 187:109820. [PMID: 37516363 DOI: 10.1016/j.radonc.2023.109820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
The ability to reduce toxicity of ultra-high dose rate (UHDR) helium ion irradiation has not been reported in vivo. Here, we tested UHDR helium ion irradiation in an embryonic zebrafish model. Our results show that UHDR helium ions spare body development and reduce spine curvature, compared to conventional dose rate.
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Affiliation(s)
| | - Sophie Chiavassa
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France; Institut de Cancérologie de l'Ouest, site Saint-Herblain, France
| | | | - Charbel Koumeir
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France; GIP ARRONAX, Saint-Herblain, France
| | - Guillaume Blain
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France
| | - Grégory Delpon
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France; Institut de Cancérologie de l'Ouest, site Saint-Herblain, France
| | - Manon Evin
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France
| | - Ferid Haddad
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France; GIP ARRONAX, Saint-Herblain, France
| | - Lydia Maigne
- Université Clermont Auvergne, CNRS/IN2P3, LPC, 63000, Clermont-Ferrand, France
| | - Quentin Mouchard
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France
| | - Noël Servagent
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes Université, France
| | - Vincent Potiron
- CNRS, UMR 6286, Nantes Université, France; Institut de Cancérologie de l'Ouest, site Saint-Herblain, France.
| | - Stéphane Supiot
- CNRS, UMR 6286, Nantes Université, France; Institut de Cancérologie de l'Ouest, site Saint-Herblain, France
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11
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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] [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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12
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Klett KC, Martin-Villa BC, Villarreal VS, Melemenidis S, Viswanathan V, Manjappa R, Ashraf MR, Soto L, Lau B, Dutt S, Rankin EB, Loo BW, Heilshorn SC. Human enteroids as a tool to study conventional and ultra-high dose rate radiation. Integr Biol (Camb) 2023; 15:zyad013. [PMID: 37874173 PMCID: PMC10594601 DOI: 10.1093/intbio/zyad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
Radiation therapy, one of the most effective therapies to treat cancer, is highly toxic to healthy tissue. The delivery of radiation at ultra-high dose rates, FLASH radiation therapy (FLASH), has been shown to maintain therapeutic anti-tumor efficacy while sparing normal tissues compared to conventional dose rate irradiation (CONV). Though promising, these studies have been limited mainly to murine models. Here, we leveraged enteroids, three-dimensional cell clusters that mimic the intestine, to study human-specific tissue response to radiation. We observed enteroids have a greater colony growth potential following FLASH compared with CONV. In addition, the enteroids that reformed following FLASH more frequently exhibited proper intestinal polarity. While we did not observe differences in enteroid damage across groups, we did see distinct transcriptomic changes. Specifically, the FLASH enteroids upregulated the expression of genes associated with the WNT-family, cell-cell adhesion, and hypoxia response. These studies validate human enteroids as a model to investigate FLASH and provide further evidence supporting clinical study of this therapy. Insight Box Promising work has been done to demonstrate the potential of ultra-high dose rate radiation (FLASH) to ablate cancerous tissue, while preserving healthy tissue. While encouraging, these findings have been primarily observed using pre-clinical murine and traditional two-dimensional cell culture. This study validates the use of human enteroids as a tool to investigate human-specific tissue response to FLASH. Specifically, the work described demonstrates the ability of enteroids to recapitulate previous in vivo findings, while also providing a lens through which to probe cellular and molecular-level responses to FLASH. The human enteroids described herein offer a powerful model that can be used to probe the underlying mechanisms of FLASH in future studies.
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Affiliation(s)
- Katarina C Klett
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Victoria S Villarreal
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - M Ramish Ashraf
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Luis Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Suparna Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Erinn B Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah C Heilshorn
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
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13
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Beyreuther E, Horst F, Brand M, Hans S, Karsch L, Lessmann E, Löck S, Schürer M, Pawelke J. In Regard to Böhlen et al. Int J Radiat Oncol Biol Phys 2023; 115:1006-1007. [PMID: 36822772 DOI: 10.1016/j.ijrobp.2022.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/06/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Elke Beyreuther
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
| | - Felix Horst
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Michael Brand
- Center for Regenerative Therapies and Cluster of Excellence "Physics of Life", Technische Universität Dresden, Dresden, Germany
| | - Stefan Hans
- Center for Regenerative Therapies and Cluster of Excellence "Physics of Life", Technische Universität Dresden, Dresden, Germany
| | - Leonhard Karsch
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Elisabeth Lessmann
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Dresden, Germany
| | - Steffen Löck
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Schürer
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Jörg Pawelke
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
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14
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FLASHlab@PITZ: New R&D platform with unique capabilities for electron FLASH and VHEE radiation therapy and radiation biology under preparation at PITZ. Phys Med 2022; 104:174-187. [PMID: 36463582 DOI: 10.1016/j.ejmp.2022.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
At the Photo Injector Test facility at DESY in Zeuthen (PITZ), an R&D platform for electron FLASH and very high energy electron radiation therapy and radiation biology is being prepared (FLASHlab@PITZ). The beam parameters available at PITZ are worldwide unique. They are based on experiences from 20 + years of developing high brightness beam sources and an ultra-intensive THz light source demonstrator for ps scale electron bunches with up to 5 nC bunch charge at MHz repetition rate in bunch trains of up to 1 ms length, currently 22 MeV (upgrade to 250 MeV planned). Individual bunches can provide peak dose rates up to 1014 Gy/s, and 10 Gy can be delivered within picoseconds. Upon demand, each bunch of the bunch train can be guided to a different transverse location, so that either a "painting" with micro beams (comparable to pencil beam scanning in proton therapy) or a cumulative increase of absorbed dose, using a wide beam distribution, can be realized at the tumor. Full tumor treatment can hence be completed within 1 ms, mitigating organ movement issues. With extremely flexible beam manipulation capabilities, FLASHlab@PITZ will cover the current parameter range of successfully demonstrated FLASH effects and extend the parameter range towards yet unexploited short treatment times and high dose rates. A summary of the plans for FLASHlab@PITZ and the status of its realization will be presented.
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15
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Ultrahigh-Dose-Rate Proton Irradiation Elicits Reduced Toxicity in Zebrafish Embryos. Adv Radiat Oncol 2022; 8:101124. [PMID: 36578276 PMCID: PMC9791798 DOI: 10.1016/j.adro.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Recently, ultrahigh-dose-rate radiation therapy (UHDR-RT) has emerged as a promising strategy to increase the benefit/risk ratio of external RT. Extensive work is on the way to characterize the physical and biological parameters that control the so-called "Flash" effect. However, this healthy/tumor differential effect is observable in in vivo models, which thereby drastically limits the amount of work that is achievable in a timely manner. Methods and Materials In this study, zebrafish embryos were used to compare the effect of UHDR irradiation (8-9 kGy/s) to conventional RT dose rate (0.2 Gy/s) with a 68 MeV proton beam. Viability, body length, spine curvature, and pericardial edema were measured 4 days postirradiation. Results We show that body length is significantly greater after UHDR-RT compared with conventional RT by 180 µm at 30 Gy and 90 µm at 40 Gy, while pericardial edema is only reduced at 30 Gy. No differences were obtained in terms of survival or spine curvature. Conclusions Zebrafish embryo length appears as a robust endpoint, and we anticipate that this model will substantially fasten the study of UHDR proton-beam parameters necessary for "Flash."
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16
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Ha B, Liang K, Liu C, Melemenidis S, Manjappa R, Viswanathan V, Das N, Ashraf R, Lau B, Soto L, Graves EE, Rao J, Loo BW, Pratx G. Real-time optical oximetry during FLASH radiotherapy using a phosphorescent nanoprobe. Radiother Oncol 2022; 176:239-243. [PMID: 35964762 DOI: 10.1016/j.radonc.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 12/14/2022]
Abstract
The rapid depletion of oxygen during irradiation at ultra-high dose rate calls for tissue oximeters capable of high temporal resolution. This study demonstrates a water-soluble phosphorescent nanoprobe and fiber-coupled instrument, which together are used to measure the kinetics of oxygen depletion at 200 Hz during irradiation of in vitro solutions.
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Affiliation(s)
- Byunghang Ha
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Kaitlyn Liang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA; Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
| | - Cheng Liu
- Molecular Imaging Program at Stanford, Departments of Radiology and Chemistry, Stanford University, Stanford, CA 94305, USA
| | - Stavros Melemenidis
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Neeladrisingha Das
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Ramish Ashraf
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Luis Soto
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Edward E Graves
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Jianghong Rao
- Molecular Imaging Program at Stanford, Departments of Radiology and Chemistry, Stanford University, Stanford, CA 94305, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Guillem Pratx
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
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17
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Potential Molecular Mechanisms behind the Ultra-High Dose Rate "FLASH" Effect. Int J Mol Sci 2022; 23:ijms232012109. [PMID: 36292961 PMCID: PMC9602825 DOI: 10.3390/ijms232012109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
FLASH radiotherapy, or the delivery of a dose at an ultra-high dose rate (>40 Gy/s), has recently emerged as a promising tool to enhance the therapeutic index in cancer treatment. The remarkable sparing of normal tissues and equivalent tumor control by FLASH irradiation compared to conventional dose rate irradiation—the FLASH effect—has already been demonstrated in several preclinical models and even in a first patient with T-cell cutaneous lymphoma. However, the biological mechanisms responsible for the differential effect produced by FLASH irradiation in normal and cancer cells remain to be elucidated. This is of great importance because a good understanding of the underlying radiobiological mechanisms and characterization of the specific beam parameters is required for a successful clinical translation of FLASH radiotherapy. In this review, we summarize the FLASH investigations performed so far and critically evaluate the current hypotheses explaining the FLASH effect, including oxygen depletion, the production of reactive oxygen species, and an altered immune response. We also propose a new theory that assumes an important role of mitochondria in mediating the normal tissue and tumor response to FLASH dose rates.
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18
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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] [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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19
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Hageman E, Che PP, Dahele M, Slotman BJ, Sminia P. Radiobiological Aspects of FLASH Radiotherapy. Biomolecules 2022; 12:biom12101376. [PMID: 36291585 PMCID: PMC9599153 DOI: 10.3390/biom12101376] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Radiotherapy (RT) is one of the primary treatment modalities for cancer patients. The clinical use of RT requires a balance to be struck between tumor effect and the risk of toxicity. Sparing normal tissue is the cornerstone of reducing toxicity. Advances in physical targeting and dose-shaping technology have helped to achieve this. FLASH RT is a promising, novel treatment technique that seeks to exploit a potential normal tissue-sparing effect of ultra-high dose rate irradiation. A significant body of in vitro and in vivo data has highlighted a decrease in acute and late radiation toxicities, while preserving the radiation effect in tumor cells. The underlying biological mechanisms of FLASH RT, however, remain unclear. Three main mechanisms have been hypothesized to account for this differential FLASH RT effect between the tumor and healthy tissue: the oxygen depletion, the DNA damage, and the immune-mediated hypothesis. These hypotheses and molecular mechanisms have been evaluated both in vitro and in vivo. Furthermore, the effect of ultra-high dose rate radiation with extremely short delivery times on the dynamic tumor microenvironment involving circulating blood cells and immune cells in humans is essentially unknown. Therefore, while there is great interest in FLASH RT as a means of targeting tumors with the promise of an increased therapeutic ratio, evidence of a generalized FLASH effect in humans and data to show that FLASH in humans is safe and at least effective against tumors as standard photon RT is currently lacking. FLASH RT needs further preclinical investigation and well-designed in-human studies before it can be introduced into clinical practice.
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Affiliation(s)
- Eline Hageman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, 1081 HV Amsterdam, The Netherlands
| | - Pei-Pei Che
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, 1081 HV Amsterdam, The Netherlands
| | - Max Dahele
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ben J. Slotman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Peter Sminia
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Radiation Oncology, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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20
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Jansen J, Beyreuther E, García-Calderón D, Karsch L, Knoll J, Pawelke J, Schürer M, Seco J. oChanges in Radical Levels as a Cause for the FLASH effect: Impact of beam structure parameters at ultra-high dose rates on oxygen depletion in water. Radiother Oncol 2022; 175:193-196. [PMID: 36030933 DOI: 10.1016/j.radonc.2022.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/15/2023]
Abstract
The influence of different average and bunch dose rates in electron beams on the FLASH effect was investigated. The present study measures O2 content in water at different beam pulse patterns and finds strong correlation with biological data, strengthening the hypothesis of radical-related mechanisms as a reason for the FLASH effect.
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Affiliation(s)
- Jeannette Jansen
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Beyreuther
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiation Physics, Dresden, Germany
| | - Daniel García-Calderón
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Ruprecht-Karls-University, Heidelberg, Germany
| | - Leonhard Karsch
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Jan Knoll
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Ruprecht-Karls-University, Heidelberg, Germany
| | - Jörg Pawelke
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Michael Schürer
- National Center for Tumor Diseases Dresden (NCT/UCC), Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Joao Seco
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Ruprecht-Karls-University, Heidelberg, Germany.
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21
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Comparing radiolytic production of H 2O 2 and development of Zebrafish embryos after ultra high dose rate exposure with electron and transmission proton beams. Radiother Oncol 2022; 175:197-202. [PMID: 35868604 DOI: 10.1016/j.radonc.2022.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022]
Abstract
The physico-chemical and biological response to conventional and UHDR electron and proton beams was investigated, along with conventional photons. The temporal structure and nature of the beam affected both, with electron beam at ≥1400 Gy/s and proton beam at 0.1 and 1260 Gy/s found to be isoefficient at sparing zebrafish embryos.
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22
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Karsch L, Pawelke J, Brand M, Hans S, Hideghéty K, Jansen J, Lessmann E, Löck S, Schürer M, Schurig R, Seco J, Szabó ER, Beyreuther E. Beam pulse structure and dose rate as determinants for the flash effect observed in zebrafish embryo. Radiother Oncol 2022; 173:49-54. [PMID: 35661675 DOI: 10.1016/j.radonc.2022.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Continuing recent experiments at the research electron accelerator ELBE at the Helmholtz-Zentrum Dresden-Rossendorf the influence of beam pulse structure on the Flash effect was investigated. MATERIALS AND METHODS The proton beam pulse structure of an isochronous cyclotron (UHDRiso) and a synchrocyclotron (UHDRsynchro) was mimicked at ELBE by quasi-continuous electron bunches at 13 MHz delivering mean dose rates of 287 Gy/s and 177 Gy/s and bunch dose rates of 106Gy/s and 109 Gy/s, respectively. For UHDRsynchro, 40 ms macro pulses at a frequency of 25 Hz superimposed the bunch delivery. For comparison, a maximum beam intensity (2.5 x 105 Gy/s mean and ∼109 Gy/s bunch dose rate) and a reference irradiation (of ∼8 Gy/min mean dose rate) were applied. Radiation induced changes were assessed in zebrafish embryos over four days post irradiation. RESULTS Relative to the reference a significant protecting Flash effect was observed for all electron beam pulse regimes with less severe damage the higher the mean dose rate of the electron beam. Accordingly, the macro pulsing induced prolongation of treatment time at UHDRsynchro regime reduces the protecting effect compared to the maximum regime delivered at same bunch but higher mean dose rate. The Flash effect of the UHDRiso regime was confirmed at a clinical isochronous cyclotron comparing the damage induced by proton beams delivered at 300 Gy/s and ∼9 Gy/min. CONCLUSION The recent findings indicate that the mean dose rate or treatment time are decisive for the normal tissue protecting Flash effect in zebrafish embryo.
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Affiliation(s)
- Leonhard Karsch
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Jörg Pawelke
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Michael Brand
- Center for Regenerative Therapies TU Dresden (CRTD), and Cluster of Excellence 'Physics of Life', Technische Universität Dresden, Dresden, Germany
| | - Stefan Hans
- Center for Regenerative Therapies TU Dresden (CRTD), and Cluster of Excellence 'Physics of Life', Technische Universität Dresden, Dresden, Germany
| | - Katalin Hideghéty
- ELI-ALPS, ELI-HU Non-Profit Ltd., Szeged, Hungary; Oncotherapy Department, University of Szeged, Szeged, Hungary
| | - Jeannette Jansen
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabeth Lessmann
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiation Physics, Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Schürer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Rico Schurig
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiation Physics, Dresden, Germany
| | - Joao Seco
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Heidelberg University, Germany
| | | | - Elke Beyreuther
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiation Physics, Dresden, Germany.
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23
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Schüler E, Acharya M, Montay-Gruel P, Loo BW, Vozenin MC, Maxim PG. Ultra-high dose rate electron beams and the FLASH effect: From preclinical evidence to a new radiotherapy paradigm. Med Phys 2022; 49:2082-2095. [PMID: 34997969 PMCID: PMC9032195 DOI: 10.1002/mp.15442] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/14/2021] [Accepted: 12/17/2021] [Indexed: 12/30/2022] Open
Abstract
In their seminal paper from 2014, Fauvadon et al. coined the term FLASH irradiation to describe ultra-high-dose rate irradiation with dose rates greater than 40 Gy/s, which results in delivery times of fractions of a second. The experiments presented in that paper were performed with a high-dose-per-pulse 4.5 MeV electron beam, and the results served as the basis for the modern-day field of FLASH radiation therapy (RT). In this article, we review the studies that have been published after those early experiments, demonstrating the robust effects of FLASH RT on normal tissue sparing in preclinical models. We also outline the various irradiation parameters that have been used. Although the robustness of the biological response has been established, the mechanisms behind the FLASH effect are currently under investigation in a number of laboratories. However, differences in the magnitude of the FLASH effect between experiments in different labs have been reported. Reasons for these differences even within the same animal model are currently unknown, but likely has to do with the marked differences in irradiation parameter settings used. Here, we show that these parameters are often not reported, which complicates large multistudy comparisons. For this reason, we propose a new standard for beam parameter reporting and discuss a systematic path to the clinical translation of FLASH RT.
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Affiliation(s)
- Emil Schüler
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA,Graduate School of Biomedical Sciences, The University of Texas, Houston, TX 77030 USA
| | - Munjal Acharya
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, CA, USA
| | - Pierre Montay-Gruel
- Department of Radiation Oncology, University of California Irvine, Irvine, CA, USA
| | - Billy W. Loo
- Department of Radiation Oncology and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland,Corresponding authors: Peter G. Maxim, PhD, Department of Radiation Oncology, University of California, Irvine, Irvine, CA 713-563-4019, , Marie-Catherine Vozenin, PhD, Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital and University of Lausanne, Switzerland. +41 216925901,
| | - Peter G. Maxim
- Department of Radiation Oncology, University of California Irvine, Irvine, CA, USA,Corresponding authors: Peter G. Maxim, PhD, Department of Radiation Oncology, University of California, Irvine, Irvine, CA 713-563-4019, , Marie-Catherine Vozenin, PhD, Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital and University of Lausanne, Switzerland. +41 216925901,
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24
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Moon EJ, Petersson K, Oleina MM. The importance of hypoxia in radiotherapy for the immune response, metastatic potential and FLASH-RT. Int J Radiat Biol 2022; 98:439-451. [PMID: 34726575 PMCID: PMC7612434 DOI: 10.1080/09553002.2021.1988178] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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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25
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Ruan JL, Lee C, Wouters S, Tullis IDC, Verslegers M, Mysara M, Then CK, Smart SC, Hill MA, Muschel RJ, Giaccia AJ, Vojnovic B, Kiltie AE, Petersson K. Irradiation at Ultra-High (FLASH) Dose Rates Reduces Acute Normal Tissue Toxicity in the Mouse Gastrointestinal System. Int J Radiat Oncol Biol Phys 2021; 111:1250-1261. [PMID: 34400268 PMCID: PMC7612009 DOI: 10.1016/j.ijrobp.2021.08.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Preclinical studies using ultra-high dose rate (FLASH) irradiation have demonstrated reduced normal tissue toxicity compared with conventional dose rate (CONV) irradiation, although this finding is not universal. We investigated the effect of temporal pulse structure and average dose rate of FLASH compared with CONV irradiation on acute intestinal toxicity. MATERIALS AND METHODS Whole abdomens of C3H mice were irradiated with a single fraction to various doses, using a 6 MeV electron linear accelerator with single pulse FLASH (dose rate = 2-6 × 106 Gy/s) or conventional (CONV; 0.25 Gy/s) irradiation. At 3.75 days postirradiation, fresh feces were collected for 16S rRNA sequencing to assess changes in the gut microbiota. A Swiss roll-based crypt assay was used to quantify acute damage to the intestinal crypts to determine how tissue toxicity was affected by the different temporal pulse structures of FLASH delivery. RESULTS We found statistically significant improvements in crypt survival for mice irradiated with FLASH at doses between 7.5 and 12.5 Gy, with a dose modifying factor of 1.1 for FLASH (7.5 Gy, P < .01; 10 Gy, P < .05; 12.5 Gy, P < .01). This sparing effect was lost when the delivery time was increased, either by increasing the number of irradiation pulses or by prolonging the time between 2 successive pulses. Sparing was observed for average dose rates of ≥280 Gy/s. Fecal microbiome analysis showed that FLASH irradiation caused fewer changes to the microbiota than CONV irradiation. CONCLUSIONS This study demonstrates that FLASH irradiation can spare mouse small intestinal crypts and reduce changes in gut microbiome composition compared with CONV irradiation. The higher the average dose rate, the larger the FLASH effect, which is also influenced by temporal pulse structure of the delivery.
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Affiliation(s)
- Jia-Ling Ruan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Carl Lee
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, United Kingdom
| | - Shari Wouters
- Interdisciplinary Biosciences Group, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium; Molecular Pathology Group, Cell Biology and Histology and Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium
| | - Iain D C Tullis
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Mieke Verslegers
- Interdisciplinary Biosciences Group, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Mohamed Mysara
- Interdisciplinary Biosciences Group, Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Chee Kin Then
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Sean C Smart
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Mark A Hill
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Ruth J Muschel
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Amato J Giaccia
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Borivoj Vojnovic
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Anne E Kiltie
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom
| | - Kristoffer Petersson
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, United Kingdom; Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
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26
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Boscolo D, Scifoni E, Durante M, Krämer M, Fuss MC. May oxygen depletion explain the FLASH effect? A chemical track structure analysis. Radiother Oncol 2021; 162:68-75. [PMID: 34214612 DOI: 10.1016/j.radonc.2021.06.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Recent observations in animal models show that ultra-high dose rate ("FLASH") radiation treatment significantly reduces normal tissue toxicity maintaining an equivalent tumor control. The dependence of this "FLASH" effect on target oxygenation has led to the assumption that oxygen "depletion" could be its major driving force. MATERIALS AND METHODS In a bottom-up approach starting from the chemical track evolution of 1 MeV electrons in oxygenated water simulated with the TRAX-CHEM Monte Carlo code, we determine the oxygen consumption and radiolytic reactive oxygen species production following a short radiation pulse. Based on these values, the effective dose weighted by oxygen enhancement ratio (OER) or the in vitro cell survival under dynamic oxygen pressure is calculated and compared to that of conventional exposures, at constant OER. RESULTS We find an excellent agreement of our Monte Carlo predictions with the experimental value for radiolytic oxygen removal from oxygenated water. However, the application of the present model to published radiobiological experiment conditions shows that oxygen depletion can only have a negligible impact on radiosensitivity through oxygen enhancement, especially at typical experimental oxygenations where a FLASH effect has been observed. CONCLUSION We show that the magnitude and dependence of the "oxygen depletion" hypothesis are not consistent with the observed biological effects of FLASH irradiation. While oxygenation plays an undoubted role in mediating the FLASH effect, we conclude that state-of-the-art radiation chemistry models do not support oxygen depletion and radiation-induced transient hypoxia as the main mechanism.
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Affiliation(s)
- Daria Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Emanuele Scifoni
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Trento, Italy
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany; Institut für Physik Kondensierter Materie, Technische Universität Darmstadt, Germany.
| | - Michael Krämer
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Martina C Fuss
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
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