FLASH radiotherapy: State-of-the-art 2021–2022

Verrelle, Pierre

FLASH radiotherapy: State-of-the-art 2021–2022 - 2022.


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Irreversible damage is one of the main limitations of external beam radiotherapy. FLASH radiotherapy (RT), which delivers ultra-high dose rate radiation to the target, could be a promising strategy to circumvent this issue. In FLASH-RT, a radiation dose of 5 to 15 Gy is delivered in a single microsecond pulse or as a series of pulses administered in sequence, each lasting ≤100 milliseconds. In mouse models, FLASH-RT has been shown to significantly reduce lung fibrosis while maintaining its antitumoral effects. This sparing of normal tissue from radio-induced injury has been confirmed in all organs investigated so far in both mice and large mammals, making FLASH-RT an attractive treatment approach in anticancer radiotherapy. The molecular mechanisms underlying the effects of FLASH-RT remain only partially understood. However, the evidence that this technique spares healthy tissues, especially progenitor cells, is compelling. Large companies are becoming interested in new-generation accelerators dedicated to FLASH-RT and several clinical trials have already been designed. It is hoped that the use of FLASH-RT in clinical practice will expand the indications for curative radiotherapy, particularly in children.

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