Clinical translation of FLASH radiotherapy: Why and how?

  • Jean Bourhis
    Correspondence
    Corresponding author at: Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland.
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland

    Radiation Oncology Laboratory, Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • Pierre Montay-Gruel
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland

    Radiation Oncology Laboratory, Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • Patrik Gonçalves Jorge
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland

    Radiation Oncology Laboratory, Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland

    Institute of Radiation Physics, Lausanne University Hospital Lausanne University, Switzerland
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  • Claude Bailat
    Affiliations
    Institute of Radiation Physics, Lausanne University Hospital Lausanne University, Switzerland
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  • Benoît Petit
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland

    Radiation Oncology Laboratory, Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • Jonathan Ollivier
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland

    Radiation Oncology Laboratory, Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • Wendy Jeanneret-Sozzi
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • Mahmut Ozsahin
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • François Bochud
    Affiliations
    Institute of Radiation Physics, Lausanne University Hospital Lausanne University, Switzerland
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  • Raphaël Moeckli
    Affiliations
    Institute of Radiation Physics, Lausanne University Hospital Lausanne University, Switzerland
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  • Author Footnotes
    1 Contributed equally to this work.
    Jean-François Germond
    Footnotes
    1 Contributed equally to this work.
    Affiliations
    Institute of Radiation Physics, Lausanne University Hospital Lausanne University, Switzerland
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  • Author Footnotes
    1 Contributed equally to this work.
    Marie-Catherine Vozenin
    Footnotes
    1 Contributed equally to this work.
    Affiliations
    Department of Radiation Oncology, Department of Oncology, Lausanne University Hospital and Lausanne University, Switzerland
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  • Author Footnotes
    1 Contributed equally to this work.

      Highlights

      • FLASH-RT a paradigm-shifting method of delivering doses within an extremely short irradiation time.
      • FLASH-RT is a promising new tool to enhance the differential effect between tumors and normal tissues.
      • The consistency of the preclinical data clinical justifies transfer of FLASH-RT.
      • The most relevant parameters for FLASH are the combination of dose, dose-rate within the pulse, and overall time of irradiation.
      • A first proof of concept could be done with low-energy electrons and further tested with VHEE, protons and X-rays.

      Abstract

      Over the past decades, technological advances have transformed radiation therapy (RT) into a precise and powerful treatment for cancer patients. Nevertheless, the treatment of radiation-resistant tumors is still restricted by the dose-limiting normal tissue complications. In this context, FLASH-RT is emerging in the field. Consisting of delivering doses within an extremely short irradiation time, FLASH-RT has been identified as a promising new tool to enhance the differential effect between tumors and normal tissues. Indeed, preclinical studies on various animal models and a veterinarian clinical trial have recently shown that compared to conventional dose-rate RT, FLASH-RT could control tumors while minimizing normal tissue toxicity.
      In the present review, we summarize the main data supporting the clinical translation of FLASH-RT and explore its feasibility, the key irradiation parameters and the potential technologies needed for a successful clinical translation.

      Keywords

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