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FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function

FLASH radiotherapy (FLASH RT) is a technique to deliver ultra-high dose rate in a fraction of a second. Evidence from experimental animal models suggest that FLASH RT spares various normal tissues including the lung, gastrointestinal track, and brain from radiation-induced toxicity (a phenomenon kno...

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Autores principales: Jo, Hye-Ju, Oh, Taerim, Lee, Ye-Rim, Kang, Gi-Sue, Park, Hye-Joon, Ahn, G-One
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Brain Tumor Society; The Korean Society for Neuro-Oncology; The Korean Society for Pediatric Neuro-Oncology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10641319/
https://www.ncbi.nlm.nih.gov/pubmed/37953445
http://dx.doi.org/10.14791/btrt.2023.0026
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author Jo, Hye-Ju
Oh, Taerim
Lee, Ye-Rim
Kang, Gi-Sue
Park, Hye-Joon
Ahn, G-One
author_facet Jo, Hye-Ju
Oh, Taerim
Lee, Ye-Rim
Kang, Gi-Sue
Park, Hye-Joon
Ahn, G-One
author_sort Jo, Hye-Ju
collection PubMed
description FLASH radiotherapy (FLASH RT) is a technique to deliver ultra-high dose rate in a fraction of a second. Evidence from experimental animal models suggest that FLASH RT spares various normal tissues including the lung, gastrointestinal track, and brain from radiation-induced toxicity (a phenomenon known as FLASH effect), which is otherwise commonly observed with conventional dose rate RT. However, it is not simply the ultra-high dose rate alone that brings the FLASH effect. Multiple parameters such as instantaneous dose rate, pulse size, pulse repetition frequency, and the total duration of exposure all need to be carefully optimized simultaneously. Furthermore it is critical to validate FLASH effects in an in vivo experimental model system. The exact molecular mechanism responsible for this FLASH effect is not yet understood although a number of hypotheses have been proposed including oxygen depletion and less reactive oxygen species (ROS) production by FLASH RT, and enhanced ability of normal tissues to handle ROS and labile iron pool compared to tumors. In this review, we briefly overview the process of ionization event and history of radiotherapy and fractionation of ionizing radiation. We also highlight some of the latest FLASH RT reviews and results with a special interest to neurocognitive protection in rodent model with whole brain irradiation. Lastly we discuss some of the issues remain to be answered with FLASH RT including undefined molecular mechanism, lack of standardized parameters, low penetration depth for electron beam, and tumor hypoxia still being a major hurdle for local control. Nevertheless, researchers are close to having all answers to the issues that we have raised, hence we believe that advancement of FLASH RT will be made more quickly than one can anticipate.
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spelling pubmed-106413192023-11-15 FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function Jo, Hye-Ju Oh, Taerim Lee, Ye-Rim Kang, Gi-Sue Park, Hye-Joon Ahn, G-One Brain Tumor Res Treat Review Article FLASH radiotherapy (FLASH RT) is a technique to deliver ultra-high dose rate in a fraction of a second. Evidence from experimental animal models suggest that FLASH RT spares various normal tissues including the lung, gastrointestinal track, and brain from radiation-induced toxicity (a phenomenon known as FLASH effect), which is otherwise commonly observed with conventional dose rate RT. However, it is not simply the ultra-high dose rate alone that brings the FLASH effect. Multiple parameters such as instantaneous dose rate, pulse size, pulse repetition frequency, and the total duration of exposure all need to be carefully optimized simultaneously. Furthermore it is critical to validate FLASH effects in an in vivo experimental model system. The exact molecular mechanism responsible for this FLASH effect is not yet understood although a number of hypotheses have been proposed including oxygen depletion and less reactive oxygen species (ROS) production by FLASH RT, and enhanced ability of normal tissues to handle ROS and labile iron pool compared to tumors. In this review, we briefly overview the process of ionization event and history of radiotherapy and fractionation of ionizing radiation. We also highlight some of the latest FLASH RT reviews and results with a special interest to neurocognitive protection in rodent model with whole brain irradiation. Lastly we discuss some of the issues remain to be answered with FLASH RT including undefined molecular mechanism, lack of standardized parameters, low penetration depth for electron beam, and tumor hypoxia still being a major hurdle for local control. Nevertheless, researchers are close to having all answers to the issues that we have raised, hence we believe that advancement of FLASH RT will be made more quickly than one can anticipate. The Korean Brain Tumor Society; The Korean Society for Neuro-Oncology; The Korean Society for Pediatric Neuro-Oncology 2023-10 2023-10-27 /pmc/articles/PMC10641319/ /pubmed/37953445 http://dx.doi.org/10.14791/btrt.2023.0026 Text en Copyright © 2023 The Korean Brain Tumor Society, The Korean Society for Neuro-Oncology, and The Korean Society for Pediatric Neuro-Oncology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Jo, Hye-Ju
Oh, Taerim
Lee, Ye-Rim
Kang, Gi-Sue
Park, Hye-Joon
Ahn, G-One
FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function
title FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function
title_full FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function
title_fullStr FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function
title_full_unstemmed FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function
title_short FLASH Radiotherapy: A FLASHing Idea to Preserve Neurocognitive Function
title_sort flash radiotherapy: a flashing idea to preserve neurocognitive function
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10641319/
https://www.ncbi.nlm.nih.gov/pubmed/37953445
http://dx.doi.org/10.14791/btrt.2023.0026
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