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Liew H, Mairani A. Comment on 'Modeling for predicting survival fraction of cells after ultra-high dose rate irradiation'. Phys Med Biol 2024; 69:108001. [PMID: 38700989 DOI: 10.1088/1361-6560/ad3edb] [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: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
We comment on the recently published study 'Modeling for predicting survival fraction of cells after ultra-high dose rate irradiation' by Shiraishiet al. While the general approach of the study may be appropriate, we wish to comment on its limitations and point out issues concerning their choice of the benchmarking and fitting data. The approach by the authors could become viable in an extended form once more comprehensive data is available.
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Affiliation(s)
- Hans Liew
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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Shiraishi Y, Matsuya Y, Fukunaga H. Possible mechanisms and simulation modeling of FLASH radiotherapy. Radiol Phys Technol 2024; 17:11-23. [PMID: 38184508 DOI: 10.1007/s12194-023-00770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
FLASH radiotherapy (FLASH-RT) has great potential to improve patient outcomes. It delivers radiation doses at an ultra-high dose rate (UHDR: ≥ 40 Gy/s) in a single instant or a few pulses. Much higher irradiation doses can be administered to tumors with FLASH-RT than with conventional dose rate (0.01-0.40 Gy/s) radiotherapy. UHDR irradiation can suppress toxicity in normal tissues while sustaining antitumor efficiency, which is referred to as the FLASH effect. However, the mechanisms underlying the effects of the FLASH remain unclear. To clarify these mechanisms, the development of simulation models that can contribute to treatment planning for FLASH-RT is still underway. Previous studies indicated that transient oxygen depletion or augmented reactions between secondary reactive species produced by irradiation may be involved in this process. To discuss the possible mechanisms of the FLASH effect and its clinical potential, we summarized the physicochemical, chemical, and biological perspectives as well as the development of simulation modeling for FLASH-RT.
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Affiliation(s)
- Yuta Shiraishi
- Graduate School of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
- Faculty of Health Sciences, Japan Healthcare University, 3-11-1-50 Tsukisamu-Higashi, Toyohira-Ku, Sapporo, Hokkaido, 062-0053, Japan
| | - Yusuke Matsuya
- Faculty of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Hisanori Fukunaga
- Faculty of Health Sciences, Hokkaido University, N12 W5 Kita-Ku, Sapporo, Hokkaido, 060-0812, Japan.
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Kaulfers T, Lattery G, Cheng C, Zhao X, Selvaraj B, Wu H, Chhabra AM, Choi JI, Lin H, Simone CB, Hasan S, Kang M, Chang J. Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy. Cancers (Basel) 2024; 16:798. [PMID: 38398188 PMCID: PMC10886659 DOI: 10.3390/cancers16040798] [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: 12/18/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Bragg peak FLASH radiotherapy (RT) uses a distal tracking method to eliminate exit doses and can achieve superior OAR sparing. This study explores the application of this novel method in stereotactic body radiotherapy prostate FLASH-RT. An in-house platform was developed to enable intensity-modulated proton therapy (IMPT) planning using a single-energy Bragg peak distal tracking method. The patients involved in the study were previously treated with proton stereotactic body radiotherapy (SBRT) using the pencil beam scanning (PBS) technique to 40 Gy in five fractions. FLASH plans were optimized using a four-beam arrangement to generate a dose distribution similar to the conventional opposing beams. All of the beams had a small angle of two degrees from the lateral direction to increase the dosimetry quality. Dose metrics were compared between the conventional PBS and the Bragg peak FLASH plans. The dose rate histogram (DRVH) and FLASH metrics of 40 Gy/s coverage (V40Gy/s) were investigated for the Bragg peak plans. There was no significant difference between the clinical and Bragg peak plans in rectum, bladder, femur heads, large bowel, and penile bulb dose metrics, except for Dmax. For the CTV, the FLASH plans resulted in a higher Dmax than the clinical plans (116.9% vs. 103.3%). For the rectum, the V40Gy/s reached 94% and 93% for 1 Gy dose thresholds in composite and single-field evaluations, respectively. Additionally, the FLASH ratio reached close to 100% after the application of the 5 Gy threshold in composite dose rate assessment. In conclusion, the Bragg peak distal tracking method can yield comparable plan quality in most OARs while preserving sufficient FLASH dose rate coverage, demonstrating that the ultra-high dose technique can be applied in prostate FLASH SBRT.
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Affiliation(s)
- Tyler Kaulfers
- Department of Physics and Astronomy, Hofstra University, Hempstead, NY 11549, USA; (T.K.); (G.L.)
| | - Grant Lattery
- Department of Physics and Astronomy, Hofstra University, Hempstead, NY 11549, USA; (T.K.); (G.L.)
| | - Chingyun Cheng
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA;
| | - Xingyi Zhao
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Balaji Selvaraj
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Hui Wu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China;
| | - Arpit M. Chhabra
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Jehee Isabelle Choi
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Haibo Lin
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Charles B. Simone
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Shaakir Hasan
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Minglei Kang
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Jenghwa Chang
- Department of Physics and Astronomy, Hofstra University, Hempstead, NY 11549, USA; (T.K.); (G.L.)
- Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY 11042, USA
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Daugherty EC, Mascia A, Zhang Y, Lee E, Xiao Z, Sertorio M, Woo J, McCann C, Russell K, Levine L, Sharma R, Khuntia D, Bradley J, Simone CB, Perentesis J, Breneman J. FLASH Radiotherapy for the Treatment of Symptomatic Bone Metastases (FAST-01): Protocol for the First Prospective Feasibility Study. JMIR Res Protoc 2023; 12:e41812. [PMID: 36206189 PMCID: PMC9893728 DOI: 10.2196/41812] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In preclinical studies, FLASH therapy, in which radiation delivered at ultrahigh dose rates of ≥40 Gy per second, has been shown to cause less injury to normal tissues than radiotherapy delivered at conventional dose rates. This paper describes the protocol for the first-in-human clinical investigation of proton FLASH therapy. OBJECTIVE FAST-01 is a prospective, single-center trial designed to assess the workflow feasibility, toxicity, and efficacy of FLASH therapy for the treatment of painful bone metastases in the extremities. METHODS Following informed consent, 10 subjects aged ≥18 years with up to 3 painful bone metastases in the extremities (excluding the feet, hands, and wrists) will be enrolled. A treatment field selected from a predefined library of plans with fixed field sizes (from 7.5 cm × 7.5 cm up to 7.5 cm × 20 cm) will be used for treatment. Subjects will receive 8 Gy of radiation in a single fraction-a well-established palliative regimen evaluated in prior investigations using conventional dose rate photon radiotherapy. A FLASH-enabled Varian ProBeam proton therapy unit will be used to deliver treatment to the target volume at a dose rate of ≥40 Gy per second, using the plateau (transmission) portion of the proton beam. After treatment, subjects will be assessed for pain response as well as any adverse effects of FLASH radiation. The primary end points include assessing the workflow feasibility and toxicity of FLASH treatment. The secondary end point is pain response at the treated site(s), as measured by patient-reported pain scores, the use of pain medication, and any flare in bone pain after treatment. The results will be compared to those reported historically for conventional dose rate photon radiotherapy, using the same radiation dose and fractionation. RESULTS FAST-01 opened to enrollment on November 3, 2020. Initial results are expected to be published in 2022. CONCLUSIONS The results of this investigation will contribute to further developing and optimizing the FLASH-enabled ProBeam proton therapy system workflow. The pain response and toxicity data acquired in our study will provide a greater understanding of FLASH treatment effects on tumor responses and normal tissue toxicities, and they will inform future FLASH trial designs. TRIAL REGISTRATION : ClinicalTrials.gov NCT04592887; http://clinicaltrials.gov/ct2/show/NCT04592887. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41812.
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Affiliation(s)
- Emily C Daugherty
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Yong Zhang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Eunsin Lee
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Zhiyan Xiao
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Mathieu Sertorio
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Woo
- Varian, A Siemens Healthineers Company, Palo Alto, CA, United States
| | - Claire McCann
- Varian, A Siemens Healthineers Company, Palo Alto, CA, United States
| | - Kenneth Russell
- Varian, A Siemens Healthineers Company, Palo Alto, CA, United States
| | - Lisa Levine
- Varian, A Siemens Healthineers Company, Palo Alto, CA, United States
| | - Ricky Sharma
- Varian, A Siemens Healthineers Company, Palo Alto, CA, United States
| | - Deepak Khuntia
- Varian, A Siemens Healthineers Company, Palo Alto, CA, United States
| | - Jeffrey Bradley
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States
| | - John Perentesis
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
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Friedl AA, Prise KM, Butterworth KT, Montay-Gruel P, Favaudon V. Radiobiology of the FLASH effect. Med Phys 2022; 49:1993-2013. [PMID: 34426981 DOI: 10.1002/mp.15184] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
Radiation exposures at ultrahigh dose rates (UHDRs) at several orders of magnitude greater than in current clinical radiotherapy (RT) have been shown to manifest differential radiobiological responses compared to conventional (CONV) dose rates. This has led to studies investigating the application of UHDR for therapeutic advantage (FLASH-RT) that have gained significant interest since the initial discovery in 2014 that demonstrated reduced lung toxicity with equivalent levels of tumor control compared with conventional dose-rate RT. Many subsequent studies have demonstrated the potential protective role of FLASH-RT in normal tissues, yet the underlying molecular and cellular mechanisms of the FLASH effect remain to be fully elucidated. Here, we summarize the current evidence of the FLASH effect and review FLASH-RT studies performed in preclinical models of normal tissue response. To critically examine the underlying biological mechanisms of responses to UHDR radiation exposures, we evaluate in vitro studies performed with normal and tumor cells. Differential responses to UHDR versus CONV irradiation recurrently involve reduced inflammatory processes and differential expression of pro- and anti-inflammatory genes. In addition, frequently reduced levels of DNA damage or misrepair products are seen after UHDR irradiation. So far, it is not clear what signal elicits these differential responses, but there are indications for involvement of reactive species. Different susceptibility to FLASH effects observed between normal and tumor cells may result from altered metabolic and detoxification pathways and/or repair pathways used by tumor cells. We summarize the current theories that may explain the FLASH effect and highlight important research questions that are key to a better mechanistic understanding and, thus, the future implementation of FLASH-RT in the clinic.
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Affiliation(s)
- Anna A Friedl
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Pierre Montay-Gruel
- Department of Radiation Oncology, University of California at Irvine, Irvine, California, USA
| | - Vincent Favaudon
- Institut Curie, Inserm U 1021-CNRS UMR 3347, Université Paris-Saclay, PSL Research University, Centre Universitaire, Orsay, France
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Abstract
FLASH radiotherapy is a novel technique that has been shown in numerous preclinical in vivo studies to have the potential to be the next important improvement in cancer treatment. However, the biological mechanisms responsible for the selective FLASH sparing effect of normal tissues are not yet known. An optimal translation of FLASH radiotherapy into the clinic would require a good understanding of the specific beam parameters that induces a FLASH effect, environmental conditions affecting the response, and the radiobiological mechanisms involved. Even though the FLASH effect has generally been considered as an in vivo effect, studies finding these answers would be difficult and ethically challenging to carry out solely in animals. Hence, suitable in vitro studies aimed towards finding these answers are needed. In this review, we describe and summarise several in vitro assays that have been used or could be used to finally elucidate the mechanisms behind the FLASH effect.
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Adrian G, Konradsson E, Beyer S, Wittrup A, Butterworth KT, McMahon SJ, Ghita M, Petersson K, Ceberg C. Cancer Cells Can Exhibit a Sparing FLASH Effect at Low Doses Under Normoxic In Vitro-Conditions. Front Oncol 2021; 11:686142. [PMID: 34395253 PMCID: PMC8358772 DOI: 10.3389/fonc.2021.686142] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background Irradiation with ultra-high dose rate (FLASH) has been shown to spare normal tissue without hampering tumor control in several in vivo studies. Few cell lines have been investigated in vitro, and previous results are inconsistent. Assuming that oxygen depletion accounts for the FLASH sparing effect, no sparing should appear for cells irradiated with low doses in normoxia. Methods Seven cancer cell lines (MDA-MB-231, MCF7, WiDr, LU-HNSCC4, HeLa [early passage and subclone]) and normal lung fibroblasts (MRC-5) were irradiated with doses ranging from 0 to 12 Gy using FLASH (≥800 Gy/s) or conventional dose rates (CONV, 14 Gy/min), with a 10 MeV electron beam from a clinical linear accelerator. Surviving fraction (SF) was determined with clonogenic assays. Three cell lines were further studied for radiation-induced DNA-damage foci using a 53BP1-marker and for cell cycle synchronization after irradiation. Results A tendency of increased survival following FLASH compared with CONV was suggested for all cell lines, with significant differences for 4/7 cell lines. The magnitude of the FLASH-sparing expressed as a dose-modifying factor at SF=0.1 was around 1.1 for 6/7 cell lines and around 1.3 for the HeLasubclone. Similar cell cycle distributions and 53BP1-foci numbers were found comparing FLASH to CONV. Conclusion We have found a FLASH effect appearing at low doses under normoxic conditions for several cell lines in vitro. The magnitude of the FLASH effect differed between the cell lines, suggesting inherited biological susceptibilities for FLASH irradiation.
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Affiliation(s)
- Gabriel Adrian
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Elise Konradsson
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Sarah Beyer
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anders Wittrup
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund, Sweden
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Stephen J McMahon
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Mihaela Ghita
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Kristoffer Petersson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Crister Ceberg
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
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Wardman P. Radiotherapy Using High-Intensity Pulsed Radiation Beams (FLASH): A Radiation-Chemical Perspective. Radiat Res 2020; 194:607-617. [DOI: 10.1667/rade-19-00016] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/31/2020] [Indexed: 11/03/2022]
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Mazal A, Prezado Y, Ares C, de Marzi L, Patriarca A, Miralbell R, Favaudon V. FLASH and minibeams in radiation therapy: the effect of microstructures on time and space and their potential application to protontherapy. Br J Radiol 2020; 93:20190807. [PMID: 32003574 PMCID: PMC7066940 DOI: 10.1259/bjr.20190807] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
After years of lethargy, studies on two non-conventional microstructures in time and space of the beams used in radiation therapy are enjoying a huge revival. The first effect called “FLASH” is based on very high dose-rate irradiation (pulse amplitude ≥106 Gy/s), short beam-on times (≤100 ms) and large single doses (≥10 Gy) as experimental parameters established so far to give biological and potential clinical effects. The second effect relies on the use of arrays of minibeams (e.g., 0.5–1 mm, spaced 1–3.5 mm). Both approaches have been shown to protect healthy tissues as an endpoint that must be clearly specified and could be combined with each other (e.g., minibeams under FLASH conditions). FLASH depends on the presence of oxygen and could proceed from the chemistry of peroxyradicals and a reduced incidence on DNA and membrane damage. Minibeams action could be based on abscopal effects, cell signalling and/or migration of cells between “valleys and hills” present in the non-uniform irradiation field as well as faster repair of vascular damage. Both effects are expected to maintain intact the tumour control probability and might even preserve antitumoural immunological reactions. FLASH in vivo experiments involving Zebrafish, mice, pig and cats have been done with electron beams, while minibeams are an intermediate approach between X-GRID and synchrotron X-ray microbeams radiation. Both have an excellent rationale to converge and be applied with proton beams, combining focusing properties and high dose rates in the beam path of pencil beams, and the inherent advantage of a controlled limited range. A first treatment with electron FLASH (cutaneous lymphoma) has recently been achieved, but clinical trials have neither been presented for FLASH with protons, nor under the minibeam conditions. Better understanding of physical, chemical and biological mechanisms of both effects is essential to optimize the technical developments and devise clinical trials.
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Affiliation(s)
| | - Yolanda Prezado
- IMNC, University Paris-Sud and Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - Carme Ares
- Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Ludovic de Marzi
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France.,Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
| | - Annalisa Patriarca
- Institut Curie, Institut Curie, PSL Research University, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, Orsay 91898, France
| | | | - Vincent Favaudon
- Institut Curie, Inserm U 1021-CNRS UMR 3347, Paris-Saclay and PSL Research Universities, Orsay, France
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Adrian G, Konradsson E, Lempart M, Bäck S, Ceberg C, Petersson K. The FLASH effect depends on oxygen concentration. Br J Radiol 2020; 93:20190702. [PMID: 31825653 PMCID: PMC7055454 DOI: 10.1259/bjr.20190702] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Recent in vivo results have shown prominent tissue sparing effect of radiotherapy with ultra-high dose rates (FLASH) compared to conventional dose rates (CONV). Oxygen depletion has been proposed as the underlying mechanism, but in vitro data to support this have been lacking. The aim of the current study was to compare FLASH to CONV irradiation under different oxygen concentrations in vitro. METHODS Prostate cancer cells were irradiated at different oxygen concentrations (relative partial pressure ranging between 1.6 and 20%) with a 10 MeV electron beam at a dose rate of either 600 Gy/s (FLASH) or 14 Gy/min (CONV), using a modified clinical linear accelerator. We evaluated the surviving fraction of cells using clonogenic assays after irradiation with doses ranging from 0 to 25 Gy. RESULTS Under normoxic conditions, no differences between FLASH and CONV irradiation were found. For hypoxic cells (1.6%), the radiation response was similar up to a dose of about 5-10 Gy, above which increased survival was shown for FLASH compared to CONV irradiation. The increased survival was shown to be significant at 18 Gy, and the effect was shown to depend on oxygen concentration. CONCLUSION The in vitro FLASH effect depends on oxygen concentration. Further studies to characterize and optimize the use of FLASH in order to widen the therapeutic window are indicated. ADVANCES IN KNOWLEDGE This paper shows in vitro evidence for the role of oxygen concentration underlying the difference between FLASH and CONV irradiation.
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Affiliation(s)
- Gabriel Adrian
- Division of Oncology and Pathology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Elise Konradsson
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Michael Lempart
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Crister Ceberg
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Kristoffer Petersson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Favaudon V, Fouillade C, Vozenin MC. Radiothérapie « flash » à très haut débit de dose : un moyen d’augmenter l’indice thérapeutique par minimisation des dommages aux tissus sains ? Cancer Radiother 2015; 19:526-31. [DOI: 10.1016/j.canrad.2015.04.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/29/2015] [Indexed: 01/27/2023]
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12
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Favaudon V, Caplier L, Monceau V, Pouzoulet F, Sayarath M, Fouillade C, Poupon MF, Brito I, Hupé P, Bourhis J, Hall J, Fontaine JJ, Vozenin MC. Ultrahigh dose-rate FLASH irradiation increases the differential response between normal and tumor tissue in mice. Sci Transl Med 2015; 6:245ra93. [PMID: 25031268 DOI: 10.1126/scitranslmed.3008973] [Citation(s) in RCA: 652] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In vitro studies suggested that sub-millisecond pulses of radiation elicit less genomic instability than continuous, protracted irradiation at the same total dose. To determine the potential of ultrahigh dose-rate irradiation in radiotherapy, we investigated lung fibrogenesis in C57BL/6J mice exposed either to short pulses (≤ 500 ms) of radiation delivered at ultrahigh dose rate (≥ 40 Gy/s, FLASH) or to conventional dose-rate irradiation (≤ 0.03 Gy/s, CONV) in single doses. The growth of human HBCx-12A and HEp-2 tumor xenografts in nude mice and syngeneic TC-1 Luc(+) orthotopic lung tumors in C57BL/6J mice was monitored under similar radiation conditions. CONV (15 Gy) triggered lung fibrosis associated with activation of the TGF-β (transforming growth factor-β) cascade, whereas no complications developed after doses of FLASH below 20 Gy for more than 36 weeks after irradiation. FLASH irradiation also spared normal smooth muscle and epithelial cells from acute radiation-induced apoptosis, which could be reinduced by administration of systemic TNF-α (tumor necrosis factor-α) before irradiation. In contrast, FLASH was as efficient as CONV in the repression of tumor growth. Together, these results suggest that FLASH radiotherapy might allow complete eradication of lung tumors and reduce the occurrence and severity of early and late complications affecting normal tissue.
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Affiliation(s)
- Vincent Favaudon
- Institut Curie, Centre de Recherche, 91405 Orsay, France. INSERM U612, 91405 Orsay, France.
| | - Laura Caplier
- Pathology Laboratory, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 94704 Maisons Alfort, France
| | - Virginie Monceau
- Université Paris-XI, 91405 Orsay, France. INSERM U1030, Institut Gustave-Roussy, 94805 Villejuif, France
| | - Frédéric Pouzoulet
- Institut Curie, Centre de Recherche, 91405 Orsay, France. INSERM U612, 91405 Orsay, France
| | - Mano Sayarath
- Institut Curie, Centre de Recherche, 91405 Orsay, France. INSERM U612, 91405 Orsay, France
| | - Charles Fouillade
- Institut Curie, Centre de Recherche, 91405 Orsay, France. INSERM U612, 91405 Orsay, France
| | - Marie-France Poupon
- Institut Curie, Centre de Recherche, 91405 Orsay, France. INSERM U612, 91405 Orsay, France
| | - Isabel Brito
- Institut Curie, Centre de Recherche, 75248 Paris 05, France. INSERM U900, 75248 Paris 05, France
| | - Philippe Hupé
- Institut Curie, Centre de Recherche, 75248 Paris 05, France. INSERM U900, 75248 Paris 05, France. Mines ParisTech, 77305 Fontainebleau, France. CNRS, UMR144, 75248 Paris 05, France
| | - Jean Bourhis
- Université Paris-XI, 91405 Orsay, France. INSERM U1030, Institut Gustave-Roussy, 94805 Villejuif, France. Radio-Oncologie/Radiothérapie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Janet Hall
- Institut Curie, Centre de Recherche, 91405 Orsay, France. INSERM U612, 91405 Orsay, France
| | - Jean-Jacques Fontaine
- Pathology Laboratory, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 94704 Maisons Alfort, France
| | - Marie-Catherine Vozenin
- Université Paris-XI, 91405 Orsay, France. INSERM U1030, Institut Gustave-Roussy, 94805 Villejuif, France. Radio-Oncologie/Radiothérapie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. INSERM U967, Commissariat à l'Énergie Atomique (CEA), Division des Sciences du Vivant (DSV), Institut de Radiobiologie Cellulaire et Moléculaire (IRCM), 92265 Fontenay aux Roses, France
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. REFERENCES. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/jicru/ndh016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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