FLASH radiotherapy is delivered with ultra-high dose rates that are several hundred times higher than those currently used clinically. Pre-clinical FLASH studies have shown reduced normal tissue toxicity with unaltered tumor response compared to conventional dose rates. It indicates a great potential for cancer treatment with reduced side effects, and the first clinical trial using high-dose rate proton therapy has demonstrated safe use for the palliative treatment of bone metastases. However, many questions related to biology, physics, and oncology remain open regarding the safe clinical translation of FLASH for curative cancer care. Early implementation of FLASH dose rates in the treatment of cats has led to unexpected toxicity. A rushed, premature clinical implementation with unforeseen toxicity would be harmful not only to the involved patients but to the entire field of radiotherapy.
The goal of this Research Topic is to identify and address the most important knowledge and technology gaps that must be filled for the clinical translation of FLASH for curative cancer treatments. With its multidisciplinary nature FLASH poses a wealth of research questions related to radiobiology, radiochemistry, physics, and oncology. What pre-clinical work should we prioritize to enable clinical implementation? How important is an understanding of the underlying mechanisms behind FLASH? Which temporal and spatial metrics should be optimized in a treatment plan to induce FLASH, and can the plan be realistically delivered with existing technology? Can we predict the optimal radiotherapy modality for clinical FLASH?
This Research Topic investigates the knowledge and technology gaps that should be filled for effective clinical translation of FLASH. We welcome papers that focus on, but not limited to, the following themes:
- Open radiobiology questions may include the underlying mechanisms behind FLASH, the impact of dose, dose rate, and scanning sequencing on the degree of normal tissue sparing
- differences between early and late damage sparing, and evidence that FLASH will not spare the tumor
- Physics questions include ultra-high dose rate dosimetry, quality assurance, dose rate definitions, and the development of FLASH treatment planning and delivery with acceptable dose distributions.
- Questions for clinical trials include selection of the most suitable disease sites for FLASH, appropriate clinical trial design, and integration of FLASH into a clinical workflow.
Please note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal.
FLASH radiotherapy is delivered with ultra-high dose rates that are several hundred times higher than those currently used clinically. Pre-clinical FLASH studies have shown reduced normal tissue toxicity with unaltered tumor response compared to conventional dose rates. It indicates a great potential for cancer treatment with reduced side effects, and the first clinical trial using high-dose rate proton therapy has demonstrated safe use for the palliative treatment of bone metastases. However, many questions related to biology, physics, and oncology remain open regarding the safe clinical translation of FLASH for curative cancer care. Early implementation of FLASH dose rates in the treatment of cats has led to unexpected toxicity. A rushed, premature clinical implementation with unforeseen toxicity would be harmful not only to the involved patients but to the entire field of radiotherapy.
The goal of this Research Topic is to identify and address the most important knowledge and technology gaps that must be filled for the clinical translation of FLASH for curative cancer treatments. With its multidisciplinary nature FLASH poses a wealth of research questions related to radiobiology, radiochemistry, physics, and oncology. What pre-clinical work should we prioritize to enable clinical implementation? How important is an understanding of the underlying mechanisms behind FLASH? Which temporal and spatial metrics should be optimized in a treatment plan to induce FLASH, and can the plan be realistically delivered with existing technology? Can we predict the optimal radiotherapy modality for clinical FLASH?
This Research Topic investigates the knowledge and technology gaps that should be filled for effective clinical translation of FLASH. We welcome papers that focus on, but not limited to, the following themes:
- Open radiobiology questions may include the underlying mechanisms behind FLASH, the impact of dose, dose rate, and scanning sequencing on the degree of normal tissue sparing
- differences between early and late damage sparing, and evidence that FLASH will not spare the tumor
- Physics questions include ultra-high dose rate dosimetry, quality assurance, dose rate definitions, and the development of FLASH treatment planning and delivery with acceptable dose distributions.
- Questions for clinical trials include selection of the most suitable disease sites for FLASH, appropriate clinical trial design, and integration of FLASH into a clinical workflow.
Please note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal.