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Updated: May 12, 2026

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Published on: February 6, 2019

Optimizing Transmission FLASH Radiation Therapy for Large-Field Postmastectomy Breast Treatment.

Ahmal Jawad Zafar¹, Sunil William Dutta¹, Matthew Joseph Case¹

¹Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia.

International Journal of Radiation Oncology, Biology, Physics

|May 10, 2026

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Optimizing proton beam scanning patterns and speed significantly enhances the FLASH effect, reducing dose in healthy tissues. Genetic algorithm optimization further improves dose rate distribution for better treatment outcomes.

Area of Science:

Radiation Oncology
Medical Physics

Background:

The FLASH effect, a phenomenon where ultra-high dose rates reduce normal tissue toxicity, holds promise for improving cancer radiotherapy.
Optimizing proton therapy delivery techniques is crucial for maximizing the FLASH effect while ensuring accurate dose delivery to tumors.

Purpose of the Study:

To investigate the impact of scanning speed, beam configuration, and dose-rate modeling on the FLASH effect in post-mastectomy proton therapy.
To evaluate the potential of spot scanning path optimization using a Genetic Algorithm (GA) for enhancing the FLASH effect.

Main Methods:

Retrospective replanning of five post-mastectomy breast cancer patients using tangential proton transmission beams (TB) and an en face beam.
FLASH effect evaluation using Krieger's FLASH effectiveness model (FEM) and Folkerts' average dose rate (ADR) framework.

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Comparison of conventional Pencil Beam scanning, split-field delivery, and GA-optimized spot sequences with varying vertical scan speeds (10-20 mm/ms).

Main Results:

FLASH effect demonstrated high sensitivity to scanning patterns and model selection, with increased speed enhancing the effect in CTV and skin.
Split-field delivery and GA-based optimization improved the FLASH effect, leading to significant dose reductions in normal tissues (e.g., up to 9.2 Gy Dmean reduction in CTV with ADR model).
GA optimization shortened scan time and achieved FLASH comparable to split-field delivery, further improving dose rate distribution.

Conclusions:

FLASH radiotherapy outcomes are critically dependent on scanning trajectory, speed, and dose-rate model selection.
Optimizing spot delivery path using algorithms like GA can substantially enhance the dose rate distribution in healthy tissues, offering a promising avenue for improved radiotherapy.