FLASH-Radiotherapy: A Potential Innovation Driver in Radiation Therapy
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FLASH-Radiotherapy: A Potential Innovation Driver in Radiation Therapy Young-Seok Seo Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea
Woo-Yoon Park∗ Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea and Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju 28644, Korea
Byung Jun Min Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea
Kyungdon Choi RAON Users Association, Daejeon 34126, Korea
Ki-Whwan Kim Department of Radiation Oncology, Chungnam National University Hospital, Daejeon 27478, Korea (Received 8 January 2020; revised 25 February 2020; accepted 27 Febuary 2020) In recent times, radiation therapy (RT) involving ultra-high dose rates of ionizing radiation, known as FLASH-RT, has been of great interest. Through this technology, the radiation dose can be delivered almost instantaneously within milliseconds. Many in vitro and in vivo studies have demonstrated that FLASH-RT can significantly improve normal tissue tolerance from radiation induced toxicity; this improvement is called the FLASH effect. Very recently, encouraging results from FLASH-RT on human patients have been reported, which has extended the applicability of FLASH-RT to clinical practice. In this review, we will discuss the results of the current research on FLASH-RT and consider the challenges to be overcome prior to the clinical application of FLASHRT. Keywords: FLASH, Radiation Therapy DOI: 10.3938/jkps.77.357
I. INTRODUCTION Radiation therapy (RT) plays a major role in the treatment of cancer and is usually performed on a large number of cancer patients. Finding ways to protect normal tissues while eradicating cancer cells has been a longstanding research question in radiation oncology. Over the last few decades, fractionation and precise volume optimization have been considered to be the most effective means of increasing radiation doses on tumors while protecting normal tissues [1,2]. However, based on strong theoretical evidence form preclinical studies, FLASHradiotherapy (FLASH-RT) has emerged as a new technique that can significantly improve normal tissue tolerance; this improvement is called the FLASH effect [3–7]. Through this technology the radiation dose can be delivered almost instantaneously within milliseconds (ms). ∗ E-mail:
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pISSN:0374-4884/eISSN:1976-8524
A ultra-high dose rate of ionizing radiation, known as FLASH, has been of great interest since its introduction in 2014 [3]. In fact, the beginning of the study of normal tissue protection by FLASH is known to date back to a 1966 study by Hornsey and Alper [8], who thought that this inding was due to tissue oxygen depletion at very high dose rates [7]. However, in the decades following this discovery, research in this area remained dormant and interest has recently been renewed.
II. DISCUSSION 1. Ultra-high Dose Rate of RT vs. Conventional Dose Rate RT
The biggest difference betw
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