An integrated physico-chemical approach for explaining the differential impact of FLASH versus conventional dose rate irradiation on cancer and normal tissue responses. (October 2019)

• Record Type: Journal Article
• Authors: Spitz, Douglas R.; Buettner, Garry R.; Petronek, Michael S.; St-Aubin, Joël J.; Flynn, Ryan T.; Waldron, Timothy J.; Limoli, Charles L.
• Is Part Of: Radiotherapy and oncology. Volume 139(2019)
• Page Start: 23
• Page End: 27
• Publication Date: 2019-10
• Subjects: Free radical chemistry -- Organic hydroperoxides -- Oxygen -- Redox active iron -- FLASH radiation -- Tumor versus normal tissue responses; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2019.03.028
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: FLASH radiation dose-rates consume all the local tissue O2 to form reactive organic hydroperoxides. Fenton type reactions will be limited in normal vs . cancer tissues due to lower levels of labile Fe. Normal tissues are expected to remove organic hydroperoxides more effectively relative to tumor tissues. Since tumor tissue cannot remove hydroperoxides as effectively, FLASH and conventional dose rate irradiation are more isoefficient at killing tumor cells compared to normal cells. Abstract: For decades the field of radiation oncology has sought to improve the therapeutic ratio through innovations in physics, chemistry, and biology. To date, technological advancements in image guided beam delivery techniques have provided clinicians with their best options for improving this critical tool in cancer care. Medical physics has focused on the preferential targeting of tumors while minimizing the collateral dose to the surrounding normal tissues, yielding only incremental progress. However, recent developments involving ultra-high dose rate irradiation termed FLASH radiotherapy (FLASH-RT), that were initiated nearly 50 years ago, have stimulated a renaissance in the field of radiotherapy, long awaiting a breakthrough modality able to enhance therapeutic responses and limit normal tissue injury. Compared to conventional dose rates used clinically (0.1–0.2 Gy/s), FLASH can implement dose rates of electrons or X-rays in excess of 100 Gy/s. The implications of this ultra-fast delivery of dose are significant and need to be re-evaluated to appreciate the fundamental aspects underlying this seemingly unique radiobiology. The capability of FLASH to significantly spare normal tissue complications in multiple animal models, when compared to conventional rates of dose-delivery, while maintaining persistent growth inhibition of select tumor models has generated considerable excitement, as well as skepticism. Based on fundamental principles of radiation physics, radio-chemistry, and tumor vs . normal cell redox metabolism, this article presents a series of testable, biologically relevant hypotheses, which may help rationalize the differential effects of FLASH irradiation observed between normal tissue and tumors.