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Advancing Proton FLASH Radiation Therapy: Innovations, Techniques, and Clinical Potentials.

Yangguang Ma1, Tengda Zhang2, Balaji Selvaraj3

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Proton FLASH radiation therapy (RT) advances offer conformal doses and potential organ protection. Current clinical use is limited to palliative transmission beam FLASH-RT due to complexity and uncertainties.

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Proton FLASH radiation therapy (RT) is an emerging technique.
  • It aims to deliver conformal doses like intensity-modulated proton therapy (IMPT).
  • It offers potential organ at risk (OARs) protection via the FLASH-sparing effect.

Purpose of the Study:

  • To review recent advancements in proton FLASH-RT techniques.
  • To discuss their advantages, limitations, and dosimetric comparisons.
  • To explore their clinical utilization.

Main Methods:

  • Review of transmission beams (TB), single-energy Bragg peak (SEBP), single-energy spread-out Bragg peak (SESOBP), hybrid FLASH, and multiple-energy spread-out Bragg peak (MESOBP).
  • Analysis of dose conformity, OAR protection, and technical complexities.
  • Comparison with IMPT and other FLASH techniques.

Main Results:

  • TB FLASH-RT achieves conformity but has exit doses.
  • SEBP and SESOBP improve OAR protection and conformity using range compensators/ridge filters.
  • Hybrid FLASH and MESOBP FLASH offer advanced targeting and rapid energy switching.
  • Only non-conformal TB FLASH-RT is currently used clinically for palliative RT.

Conclusions:

  • Various proton FLASH-RT techniques show promise for improved treatment outcomes.
  • Technical complexities and uncertainties regarding the FLASH effect limit widespread clinical adoption.
  • Further research is needed to optimize and validate advanced FLASH-RT methods for diverse anatomical sites.