Ultra-High Dose Rate (FLASH) Carbon Ion Irradiation: Dosimetry and First Cell Experiments

Tinganelli, Walter; Sokol, Olga; Quartieri, Martina; Puspitasari, Anggraeini; Đokić, Ivana; Abdollahi, Amir; Durante, Marco; Haberer, Thomas; Debus, Jürgen; Boscolo, Daria; Voss, B.; Brons, Stephan; Schuy, Christoph; Horst, Felix; Weber, Ulrich

doi:10.1016/j.ijrobp.2021.11.020

Cited by 50 publications

(38 citation statements)

References 47 publications

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“…This finding affirms the opinion of researchers who were skeptical about the mechanism of oxygen consumption (43,62). These studies (60)(61)(62) are significant to the research on the mechanisms of FLASH. Studies reported a slight reduction in oxygenation after FLASH irradiation, claiming a negligible effect on radiosensitivity (32,63,64).…”

Section: Flash-rt Biological Mechanismsupporting

confidence: 82%

FLASH radiotherapy: A promising new method for radiotherapy (Review)

Wang

et al. 2022

Oncol Lett

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Among the treatments for malignant tumors, radiotherapy is of great significance both as a main treatment and as an adjuvant treatment. Radiation therapy damages cancer cells with ionizing radiation, leading to their death. However, radiation-induced toxicity limits the dose delivered to the tumor, thereby constraining the control effect of radiotherapy on tumor growth. In addition, the delayed toxicity caused by radiotherapy significantly harms the physical and mental health of patients. FLASH-RT, an emerging class of radiotherapy, causes a phenomenon known as the 'FLASH effect', which delivers radiotherapy at an ultra-high dose rate with lower toxicity to normal tissue than conventional radiotherapy to achieve local tumor control. Although its mechanism remains to be fully elucidated, this modality constitutes a potential new approach to treating malignant tumors. In the present review, the current research progress of FLASH-RT and its various particular effects are described, including the status of research on FLASH-RT and its influencing factors. The hypothetic mechanism of action of FLASH-RT is also summarized, providing insight into future tumor treatments.

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Section: Flash-rt Biological Mechanismsupporting

confidence: 82%

FLASH radiotherapy: A promising new method for radiotherapy (Review)

Wang

et al. 2022

Oncol Lett

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“…This has been done by replacing the Ar–CO 2 gas mixture present in the chamber gap with helium, which produces collected currents much smaller than that for Ar–CO 2 27 . Tinganelli et al 27 . show that at UHDRs, the saturation curve for helium reaches the plateau at 500 V, providing a linear response at 1000 V, differently from the case of Ar–CO 2 curve, which is still increasing at 2000 V. This plateauing is due to the much lower density of the electron‐ion pairs produced, and the much faster drifting time for helium ions.…”

Section: Considerations On Beam Monitoring Dosimetry and Detector Fea...mentioning

confidence: 99%

“…Minimizing as much as possible the recombination in the in‐transmission chamber is, therefore, the only possible approach. This has been done by replacing the Ar–CO 2 gas mixture present in the chamber gap with helium, which produces collected currents much smaller than that for Ar–CO 2 27 . Tinganelli et al 27 .…”

Section: Considerations On Beam Monitoring Dosimetry and Detector Fea...mentioning

confidence: 99%

“…[11][12][13][14][15][16] These hypotheses continue to be met with vigorous and exciting debate in the scientific community. Various platforms for FLASH RT have been demonstrated using electrons generated by linear accelerators, [4][5][6]17,18 X-rays generated in a synchrotron facility, 7,19 protons using an isochronous cyclotron [20][21][22][23] and a synchrocyclotron, 24,25 as well as helium 26 and carbon 27 ion beams generated using a synchrotron (see Table 1).…”

Section: Introductionmentioning

confidence: 99%

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Ultra‐high dose rate dosimetry: Challenges and opportunities for FLASH radiation therapy

et al. 2022

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The clinical translation of FLASH radiotherapy (RT) requires challenges related to dosimetry and beam monitoring of ultra‐high dose rate (UHDR) beams to be addressed. Detectors currently in use suffer from saturation effects under UHDR regimes, requiring the introduction of correction factors. There is significant interest from the scientific community to identify the most reliable solutions and suitable experimental approaches for UHDR dosimetry. This interest is manifested through the increasing number of national and international projects recently proposed concerning UHDR dosimetry. Attaining the desired solutions and approaches requires further optimization of already established technologies as well as the investigation of novel radiation detection and dosimetry methods. New knowledge will also emerge to fill the gap in terms of validated protocols, assessing new dosimetric procedures and standardized methods. In this paper, we discuss the main challenges coming from the peculiar beam parameters characterizing UHDR beams for FLASH RT. These challenges vary considerably depending on the accelerator type and technique used to produce the relevant UHDR radiation environment. We also introduce some general considerations on how the different time structure in the production of the radiation beams, as well as the dose and dose‐rate per pulse, can affect the detector response. Finally, we discuss the requirements that must characterize any proposed dosimeters for use in UDHR radiation environments. A detailed status of the current technology is provided, with the aim of discussing the detector features and their performance characteristics and/or limitations in UHDR regimes. We report on further developments for established detectors and novel approaches currently under investigation with a view to predict future directions in terms of dosimetry approaches, practical procedures, and protocols. Due to several on‐going detector and dosimetry developments associated with UHDR radiation environment for FLASH RT it is not possible to provide a simple list of recommendations for the most suitable detectors for FLASH RT dosimetry. However, this article does provide the reader with a detailed description of the most up‐to‐date dosimetric approaches, and describes the behavior of the detectors operated under UHDR irradiation conditions and offers expert discussion on the current challenges which we believe are important and still need to be addressed in the clinical translation of FLASH RT.

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“…Several further research endeavors, e.g. multi-ion RT [37], hadron arc RT [38], and ultra-high dose rate CIRT [39], aim to further optimize biological effects for the best of the patient.…”

Section: Discussionmentioning

confidence: 99%

Ways to unravel the clinical potential of carbon ions for head and neck cancer reirradiation: dosimetric comparison and local failure pattern analysis as part of the prospective randomized CARE trial

et al. 2022

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Background Carbon ion radiotherapy (CIRT) yields biophysical advantages compared to photons but randomized studies for the reirradiation setting are pending. The aim of the current project was to evaluate potential clinical benefits and drawbacks of CIRT compared to volumetric modulated arc therapy (VMAT) in recurrent head and neck cancer. Methods Dose-volume parameters and local failure patterns of CIRT compared to VMAT were evaluate in 16 patients from the randomized CARE trial on head and neck cancer reirradiation. Results Despite an increased target dose, CIRT resulted in significantly reduced organ at risk (OAR) dose across all patients (− 8.7% Dmean). The dose-volume benefits were most pronounced in the brainstem (− 20.7% Dmax) and the optic chiasma (− 13.0% Dmax). The most frequent local failure was type E (extraneous; 50%), followed type B (peripheral; 33%) and type A (central; 17%). In one patient with type A biological and/or dosimetric failure after CIRT, mMKM dose recalculation revealed reduced target coverage. Conclusions CIRT resulted in highly improved critical OAR sparing compared to VMAT across all head and neck cancer reirradiation scenarios despite an increased prescription dose. Local failure pattern analysis revealed further potential CIRT specific clinical benefits and potential pitfalls with regard to image-guidance and biological dose-optimization.

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Ultra-High Dose Rate (FLASH) Carbon Ion Irradiation: Dosimetry and First Cell Experiments

Cited by 50 publications

References 47 publications

FLASH radiotherapy: A promising new method for radiotherapy (Review)

FLASH radiotherapy: A promising new method for radiotherapy (Review)

Ultra‐high dose rate dosimetry: Challenges and opportunities for FLASH radiation therapy

Ways to unravel the clinical potential of carbon ions for head and neck cancer reirradiation: dosimetric comparison and local failure pattern analysis as part of the prospective randomized CARE trial

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