Focused very high-energy electron beams as a novel radiotherapy modality for producing high-dose volumetric elements

Kokurewicz, Karolina; Brunetti, E.; Welsh, G. H.; Wiggins, Sean M.; Boyd, Marie; Sørensen, Annette; Chalmers, Anthony J.; Schettino, Giuseppe; Subiel, Anna; DesRosiers, Colleen; Jaroszynski, D. A.

doi:10.1038/s41598-019-46630-w

Cited by 54 publications

(54 citation statements)

References 34 publications

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“…A single beam delivery might prove essential for retaining the FLASH effect in clinical trials. Unfortunately, these beams are currently limited to research accelerators which are either rather large (linear accelerator) or suffers from a low pulse rate, a small beam size, and stability issues (laser-based accelerators) (68)(69)(70)(71). A recent paper showed (using a 160 kV X-ray beam) that conventional X-ray tubes could potentially be used for FLASH-RT studies (72).…”

Section: Clinical Applications Of Flash-rtmentioning

confidence: 99%

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

et al. 2020

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Radiotherapy is a cornerstone of both curative and palliative cancer care. However, radiotherapy is severely limited by radiation-induced toxicities. If these toxicities could be reduced, a greater dose of radiation could be given therefore facilitating a better tumor response. Initial pre-clinical studies have shown that irradiation at dose rates far exceeding those currently used in clinical contexts reduce radiation-induced toxicities whilst maintaining an equivalent tumor response. This is known as the FLASH effect. To date, a single patient has been subjected to FLASH radiotherapy for the treatment of subcutaneous T-cell lymphoma resulting in complete response and minimal toxicities. The mechanism responsible for reduced tissue toxicity following FLASH radiotherapy is yet to be elucidated, but the most prominent hypothesis so far proposed is that acute oxygen depletion occurs within the irradiated tissue. This review examines the tissue response to FLASH radiotherapy, critically evaluates the evidence supporting hypotheses surrounding the biological basis of the FLASH effect, and considers the potential for FLASH radiotherapy to be translated into clinical contexts.

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Section: Clinical Applications Of Flash-rtmentioning

confidence: 99%

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

et al. 2020

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“…Moreover, VHEE beams can provide more conformal dose distributions to deep seated tumours, in comparison to current advanced electron radiotherapy techniques, whilst reducing the integral dose and organ-at-risk dose [13][14][15] . There is also the possibility of focusing VHEE beams into the patient, reducing peak surface and exit doses for a single beam by more than one order of magnitude compared with a collimated beam 16 . Moreover, VHEE radiotherapy would benefit from reduced scattering and divergence, leading to a reduction in healthy tissue irradiation surrounding the tumour.…”

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confidence: 99%

The challenge of ionisation chamber dosimetry in ultra-short pulsed high dose-rate Very High Energy Electron beams

McManus

Romano

Lee

et al. 2020

Sci Rep

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High dose-rate radiotherapy, known as FLASH, has been shown to increase the differential response between healthy and tumour tissue. Moreover, Very High Energy Electrons (VHEEs) provide more favourable dose distributions than conventional radiotherapy electron and photon beams. Planeparallel ionisation chambers are the recommended secondary standard systems for clinical reference dosimetry of electrons, therefore chamber response to these high energy and high dose-per-pulse beams must be well understood. Graphite calorimetry, the UK primary standard, has been employed to measure the dose delivered from a 200 MeV pulsed electron beam. This was compared to the charge measurements of a plane-parallel ionisation chamber to determine the absolute collection efficiency and infer the ion recombination factor. the dose-per-pulse measured by the calorimeter ranged between 0.03 Gy/pulse and 5.26 Gy/pulse, corresponding to collection efficiencies between 97% and 4%, respectively. Multiple recombination models currently available have been compared with experimental results. This work is directly applicable to the development of standard dosimetry protocols for VHEE radiotherapy, FLASH radiotherapy and other high dose-rate modalities. However, the use of secondary standard ionisation chambers for the dosimetry of high dose-per-pulse VHEEs has been shown to require large corrections for charge collection inefficiency.

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“…Beside the increasing suggestions that VHEE may actually show comparable (or even better) performances to photon radiotherapy for certain kind of tumors, in terms, for instance, of dose volume histograms, evidence have recently emerged related to the potential offered by magnetic focusing of VHEE beams, in contrast to the case of photons. For instance, in a recent paper on magnetic focusing of VHEE, a noticeable improvement in the PDD curve was found in simulations 66 . Furthermore, the possibilities offered by steering the electron beams by (fast) magnetic scanning, to reduce issues related to physiological motion, is also considered an appealing feature 67 ; this is in contrast to the relatively slow adjustement carried out in multileaf collimators.…”

Section: Discussionmentioning

confidence: 88%

Toward an effective use of laser-driven very high energy electrons for radiotherapy: Feasibility assessment of multi-field and intensity modulation irradiation schemes

Labate

Palla

Panetta

et al. 2020

Sci Rep

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Radiotherapy with very high energy electrons has been investigated for a couple of decades as an effective approach to improve dose distribution compared to conventional photon-based radiotherapy, with the recent intriguing potential of high dose-rate irradiation. Its practical application to treatment has been hindered by the lack of hospital-scale accelerators. High-gradient laser-plasma accelerators (LPA) have been proposed as a possible platform, but no experiments so far have explored the feasibility of a clinical use of this concept. We show the results of an experimental study aimed at assessing dose deposition for deep seated tumours using advanced irradiation schemes with an existing LPA source. Measurements show control of localized dose deposition and modulation, suitable to target a volume at depths in the range from 5 to 10 cm with mm resolution. The dose delivered to the target was up to 1.6 Gy, delivered with few hundreds of shots, limited by secondary components of the LPA accelerator. Measurements suggest that therapeutic doses within localized volumes can already be obtained with existing LPA technology, calling for dedicated pre-clinical studies.

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Focused very high-energy electron beams as a novel radiotherapy modality for producing high-dose volumetric elements

Cited by 54 publications

References 34 publications

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

The challenge of ionisation chamber dosimetry in ultra-short pulsed high dose-rate Very High Energy Electron beams

Toward an effective use of laser-driven very high energy electrons for radiotherapy: Feasibility assessment of multi-field and intensity modulation irradiation schemes

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