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Related Experiment Video

Updated: Jul 13, 2025

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Dosimetric and biologic intercomparison between electron and proton FLASH beams.

A Almeida1, M Togno2, P Ballesteros-Zebadua3

  • 1Laboratory of Radiation Oncology/Radiation Oncology Service/Department of Oncology/CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|October 15, 2023
PubMed
Summary

Electron and proton FLASH therapy show similar efficacy in tumor control and normal tissue sparing. The mean dose rate, rather than beam type, appears crucial for the FLASH effect, preserving neurocognitive function and activating anti-tumor immunity.

Keywords:
DosimetryFLASHIntercomparisonNeurocognitionTumor response

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Area of Science:

  • Radiation Oncology
  • Preclinical Research
  • Medical Physics

Background:

  • The FLASH effect, characterized by ultra-high dose rates (>40 Gy/s), has shown promise in preclinical studies using electrons (eFLASH) and protons (pFLASH).
  • A direct comparison between eFLASH and pFLASH to understand their relative efficacies and underlying mechanisms has been lacking.

Purpose of the Study:

  • To systematically intercompare the FLASH effect produced by electron beams (eFLASH) and proton beams (pFLASH).
  • To evaluate dosimetric consistency and biological outcomes, including normal tissue sparing and tumor control, between eFLASH and pFLASH.

Main Methods:

  • Utilized electron (5.5 MeV) and proton (170 MeV) beams to deliver conventional (0.1 Gy/s) and FLASH (≥110 Gy/s) dose rates in preclinical murine models.
  • Conducted dosimetric intercomparisons using established methods and assessed biological effects on neurocognitive capacity and tumor response.
  • Protons were delivered in transmission mode.

Main Results:

  • Dosimetric differences between electron and proton beams were minimal (-1.9% to +2.5%) across dose rates.
  • Both eFLASH and pFLASH protected normal brain function, with irradiated mice showing indistinguishable neurocognitive capacity compared to controls.
  • Conventional dose rates (eCONV, pCONV) resulted in cognitive deficits, while complete tumor response was achieved with both eFLASH and pFLASH, activating anti-tumor immunity upon rechallenge.

Conclusions:

  • Dosimetric standards are achievable despite differences in electron and proton beam microstructures, enabling effective FLASH radiotherapy.
  • Normal brain protection and tumor control were achieved with both electron and proton beams, with mean dose rate identified as a key parameter for the FLASH sparing effect.
  • A systemic anti-tumor immunological memory response was observed irrespective of beam type or dose rate following high-dose irradiation.