Towards clinical translation of FLASH radiotherapy
Towards clinical translation of FLASH radiotherapy
复制标题
FLASH放射治疗的临床转化
DOI：
10.1038/s41571-022-00697-z
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发表时间：
2022-10-27
影响因子：
78.8
通讯作者：
Durante, Marco
中科院分区：
文献类型：
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作者：
Vozenin, Marie-Catherine;Bourhis, Jean;Durante, Marco
放射肿瘤学的最终目标是根除肿瘤而不对非恶性组织产生毒性。FLASH放射疗法，或超高剂量率放射（>40戈伊/s）的递送，作为一种放射方式出现，其使得能够维持肿瘤控制，同时减少对周围非恶性组织的毒性。在过去的几年中，临床前研究表明，FLASH放射治疗可以在很短的时间内进行，并且可以大大拓宽放射治疗的治疗窗口。这种超快的辐射输送可以减少毒性，从而使剂量增加，以提高抗肿瘤疗效，减少治疗时间和器官运动相关问题的额外好处，最终增加可以治疗的患者数量。目前，FLASH被认为是放射肿瘤学中最有前途的突破之一，站在技术，物理，化学和生物学的十字路口;然而，一些障碍使其临床转化困难，包括需要更好地了解生物学机制，优化参数和技术挑战。在这个角度来看，我们提供了一个概述的基本原则FLASH放疗和讨论的挑战沿着其临床应用的路径。FLASH放疗涉及提供超高剂量率的辐射，这使得持续的肿瘤控制与周围组织的毒性降低。该观点的作者描述了FLASH放疗的基本原理，介绍了测试这种模式的临床前研究的可用证据，并讨论了其在常规临床实践中应用的挑战。
The ultimate goal of radiation oncology is to eradicate tumours without toxicity to non-malignant tissues. FLASH radiotherapy, or the delivery of ultra-high dose rates of radiation (>40 Gy/s), emerged as a modality of irradiation that enables tumour control to be maintained while reducing toxicity to surrounding non-malignant tissues. In the past few years, preclinical studies have shown that FLASH radiotherapy can be delivered in very short times and substantially can widen the therapeutic window of radiotherapy. This ultra-fast radiation delivery could reduce toxicity and thus enable dose escalation to enhance antitumour efficacy, with the additional benefits of reducing treatment time and organ motion-related issues, eventually increasing the number of patients who can be treated. At present, FLASH is recognized as one of the most promising breakthroughs in radiation oncology, standing at the crossroads between technology, physics, chemistry and biology; however, several hurdles make its clinical translation difficult, including the need for a better understanding of the biological mechanisms, optimization of parameters and technological challenges. In this Perspective, we provide an overview of the principles underlying FLASH radiotherapy and discuss the challenges along the path towards its clinical application.FLASH radiotherapy involves delivering ultra-high dose rates of radiation, which enables sustained tumour control with reduced toxicity to surrounding tissues. The authors of this Perspective describe the principles underlying FLASH radiotherapy, present the available evidence from preclinical studies testing this modality and discuss the challenges for its application in routine clinical practice.