Emerging FLASH therapy platforms for stereotactic radiosurgery and body radiotherapy

Area of Science:

• Radiation Oncology
• Medical Physics
• Radiosurgery

Background:

• FLASH radiotherapy, a novel ultra-high dose rate technique, shows potential for normal tissue sparing.
• Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) require precise dose delivery to target tumors.
• Combining FLASH and stereotactic techniques could enhance therapeutic outcomes but faces significant technical challenges.

Purpose of the Study:

• To review emerging platforms and technical requirements for integrating FLASH radiotherapy with SRS and SBRT.
• To identify key challenges and necessary advancements for clinical translation of combined FLASH-stereotactic techniques.

Main Methods:

• Literature review of current and emerging technologies for FLASH radiotherapy delivery.
• Evaluation of technical requirements for photon, electron, proton, and heavy ion systems in stereotactic applications.
• Analysis of dosimetry, quality assurance, treatment planning, and image guidance needs.

Main Results:

• Electron beams are limited by penetration depth for stereotactic use.
• Photon systems face challenges in achieving high dose rates and stereotactic beam characteristics (heat, multi-angle delivery).
• Proton and heavy ion systems require further development for beam delivery and scanning speeds, despite Bragg peak advantages.

Conclusions:

• Successful clinical implementation of FLASH-SRS/SBRT requires overcoming substantial engineering and technical challenges.
• Novel accelerator designs, specialized dosimetry, advanced treatment planning, and improved image guidance are critical for translation.
• Further research and development are essential to realize the full potential of combined FLASH and stereotactic radiotherapy.