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CC BY 4.0 · Brazilian Journal of Oncology 2020; 16: e-20200012
DOI: 10.5935/2526-8732.20200012
Letter to the Editor
Radiotherapy

Evolving radiation oncology techniques in the 21st century: the FLASH technique

A técnica FLASH: evolução das técnicas de radiação oncológica no século XXI

Antonio Cassio Assis Pellizzon 
1   Ac Camargo Cancer Center, Radiation Oncology - São Paulo - N/A = Not Applicable - Brazil
› Author Affiliations Funding There was no source of funding for the research.
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ABSTRACT

Radiation therapy (RT) uses high doses of high energy X-rays to kill cancer cells. Fractionation and volume optimization were the main methods used to increase the dose given to the tumor and reduce the dose and side effects to the normal tissues (NT). Conventional RT works with dose rates up to 0.1 Gy per second. Opportunities to improve the biological efficacy of RT have been explored and options involving dose rate modulation are now available. Preclinical studies showed a drastic reduction in NT toxicity with preserved antitumor efficacy when using FLASH RT, furthermore this method enables higher doses to be given to the tumor. We reviewed the principles of FLASH RT.

RESUMO

A terapia de radiação (TR) utiliza altas doses de raios X de alta energia para matar células cancerígenas. O fracionamento e a otimização do volume foram os principais métodos utilizados para aumentar a dose administrada ao tumor e reduzir a dose e os efeitos colaterais aos tecidos normais (TN). A TR convencional funciona com taxas de dose de até 0,1 Gy por segundo. Oportunidades para melhorar a eficácia biológica da TR foram exploradas e agora estão disponíveis opções envolvendo modulação da taxa de dose. Estudos pré-clínicos mostraram uma redução drástica da toxicidade em TN com eficácia antitumoral preservada ao usar o FLASH RT; além disso, esse método permite que doses mais altas sejam dadas ao tumor. Revisamos os princípios do FLASH RT.

Keywords:

Toxicity - Radiation dosage - Free radicals - Oxidation-reduction - Adverse effects

Descritores:

Toxicidade - Dosagem de radiação - Radicais livres - Redução de oxidação - Efeitos adversos

AUTHORS' CONTRIBUTIONS

The author, himself, was responsible for the design, acquisition, analysis and interpretation of data.


Financial support: none to declare.


Ethics approval and consent to participate:

This manuscript does not report studies involving human participants, human data or human tissue.


Consent for publication

This manuscript does not report studies involving human participants, human data or human tissue.


Availability of data and materials

Data supporting the results reported in this article can be found and accessed by the internet. Site suggested: PubMed.


Competing interests

The author declare that he has have no competing interests.




Publication History

Received: 14 January 2020

Accepted: 06 March 2020

Article published online:
10 June 2020

© 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Bibliographical Record
Antonio Cassio Assis Pellizzon. Evolving radiation oncology techniques in the 21st century: the FLASH technique. Brazilian Journal of Oncology 2020; 16: e-20200012.
DOI: 10.5935/2526-8732.20200012
 

  • REFERENCES

  • Bentzen SM. Preventing or reducing late side effects of radiation therapy: Radiobiology meets molecular pathology. Nat Rev Cancer 2006; Sep; 6 (09) 702-713
    Search in Google Scholar
  • Bortfeld T. IMRT: a review and preview. Phys Med Biol 2006; Jul; 51 (13) R363-79
    Search in Google Scholar
  • Bristow RG, Alexander B, Baumann M, Bratman SV, Brown JM, Camphausen K. et al Combining precision radiotherapy with molecular targeting and immunomodulatory agents: a guideline by the American Society for Radiation Oncology. Lancet Oncol 2018; May; 19 (05) e240-e251
    Search in Google Scholar
  • Herrera FG, Bourhis J, Coukos G. Radiotherapy combination opportunities leveraging immunity for the next oncology practice. CA Cancer J Clin 2017; Jan; 67 (01) 65-85
    Search in Google Scholar
  • Fowler JF. Review: total doses in fractionated radiotherapy-implications of new radiobiological data. Int J Radiat Biol Relat Stud Phys Chem Med 1984; Aug; 46 (02) 103-120
    Search in Google Scholar
  • Vozenin MC, Hendry JH, Limoli CL. Biological benefits of ultra-high dose rate FLASH radiotherapy: sleeping beauty awoken. Clin Oncol (R Coll Radiol) 2019; Jul; 31 (07) 407-415
    Search in Google Scholar
  • Favaudon V, Caplier L, Monceau V, Pouzoulet F, Sayarath M, Fouillade C. et al Ultrahigh dose-rate FLASH irradiation increases the differential response between normal and tumor tissue in mice. Sci Transl Med 2014; Jul; 16; 6 (245) 245-293
    Search in Google Scholar
  • Montay-Gruel P, Petersson K, Jaccard M, Boivin G, Germond JF, Petit B. et al Irradiation in a flash: unique sparing of memory in mice after whole brain irradiation with dose rates above 100Gy/s. Radiother Oncol 2017; Sep; 124 (03) 365-369
    Search in Google Scholar
  • Adrian G, Konradsson E, Lempart M, Bäck S, Ceberg C, Petersson K. The FLASH effect depends on oxygen concentration. Br J Radiol 2019; Dec; 93 (1106) 20190702
    Search in Google Scholar
  • Epp ER, Weiss H, Ling CC. Irradiation of cells by single and double pulses of high intensity radiation: oxygen sensitization and diffusion kinetics. Curr Top Radiat Res Q 1976; Dec; 11 (03) 201-250
    Search in Google Scholar
  • Spitz DR, Buettner GR, Petronek MS, St-Aubin JJ, Flynn RT, Waldron TJ. et al An integrated physico-chemical approach for explaining the differential impact of FLASH versus conventional dose rate irradiation on cancer and normal tissue responses. Radiother Oncol 2019; Oct; 139: 23-27
    Search in Google Scholar
  • Bourhis J, Sozzi WJ, Jorge PG, Gaide O, Bailat C, Duclos F. et al Treatment of a first patient with FLASHradiotherapy. Radiother Oncol 2019; Oct; 139: 18-22
    Search in Google Scholar