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Towards FLASH Radiotherapy in Lung Cancer: A Review on Preclinical Evidence and Technical Feasibility
Simone N Visser1,2, Steven J M Habraken1,2, Anggraeini Puspitasari-Kokko2
1Department of Radiation Oncology, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands.
Cancers
|August 13, 2026
Summary
FLASH proton therapy (FLASH-PT) shows potential for reducing lung cancer treatment side effects by sparing healthy tissue. Further research is needed to overcome technical challenges before clinical use.
Area of Science:
- Radiation Oncology
- Medical Physics
- Preclinical Research
Background:
- Radiotherapy is vital for lung cancer but causes side effects due to healthy tissue irradiation.
- Proton therapy offers better sparing than photon therapy via the Bragg peak.
- FLASH radiotherapy (FLASH-RT) uses ultra-high dose rates (UHDR) to potentially further reduce toxicity (FLASH-effect).
Purpose of the Study:
- To review preclinical evidence of the FLASH-effect on lung-related outcomes.
- To explore proposed mechanisms behind the FLASH-effect.
- To assess treatment planning and delivery strategies for FLASH-PT in lung cancer.
Main Methods:
- Literature search focused on preclinical studies.
- Analysis of studies examining FLASH-RT effects on lung endpoints.
- Evaluation of treatment planning and delivery techniques for FLASH-PT.
Main Results:
- Preclinical FLASH-RT reduced pulmonary fibrosis, inflammation, vascular damage, and oxidative stress.
- The FLASH-effect involves complex radiochemical/biological processes, varying by tissue and dose/delivery parameters.
- Clinically acceptable thoracic FLASH-PT plans were developed, but UHDR delivery with motion mitigation remains a challenge.
Conclusions:
- FLASH-PT has the potential to significantly decrease radiation-induced lung toxicity.
- It may broaden the therapeutic window for lung cancer radiotherapy.
- Addressing preclinical and technological hurdles is crucial for clinical implementation.
