Frontiers in oncology · 2026
Novel Bragg peak FLASH radiotherapy: treatment of base-of-skull tumors within existing clinical guidelines.
СтатьяНазвание и аннотация: Перевод в очереди
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Pennock Michael, Selvaraj Balaji, Cheng Chingyun, Kyler Alex, Lin Haibo, Hasan Shaakir, Chhabra Arpit, Choi Jehee Isabelle, Bakst Richard, Kabarriti Rafi, Lee Nancy Y, Simone Charles B, Kang Minglei
Аннотация
BACKGROUND AND PURPOSE: Proton therapy is commonly delivered for base-of-skull (BOS) tumors to minimize risk of normal-tissue injury. Novel Bragg peak FLASH may improve protection for organs at risk (OARs). We investigated if proton pencil-beam scanning (PBS) Bragg peak FLASH could achieve comparable dosimetry at ultra-high dose rates to conventional-rate (CONV)-intensity-modulated proton therapy (IMPT) for potential clinical use.
MATERIALS AND METHODS: PBS Bragg peak FLASH and CONV-IMPT plans were optimized for 10 consecutive patients with BOS tumor in an in-house treatment-planning system and hypofractionation regimen (30 GyE in five fractions) to assess dosimetric quality while reflecting clinical practice, parameters, and hypothetical fraction doses for FLASH effect. FLASH dose-rate coverage (V 40Gy/s) and dose-rate volume histograms (DRVHs) were quantified across OARs. FLASH (≥40 Gy/s) was achieved with a minimum MU per spot of 300-500 and a minimum spot time (MST) of 0.5 ms. FLASH dose-rate coverage, OAR sparing, and target coverage were averaged across all cases.
RESULTS: FLASH generated higher CTV D max than CONV-IMPT (114% vs. 108%). Dose metrics for OARs were comparable between modalities (p > 0.05). Average dose rate (ADR) DRVHs of OARs indicated 74.1% V 40Gy/s FLASH dose-rate coverage without dose threshold, and 94.4% V 40Gy/s FLASH dose-rate coverage with 1-Gy dose threshold.
CONCLUSION: PBS Bragg peak FLASH can deliver conformal target dosimetric coverage, ultra-high dose rates, and comparable OAR dosimetry to CONV-IMPT, suggesting that this novel technique is feasible for BOS tumor FLASH radiotherapy. The study supports future research to explore FLASH's biological and clinical benefits in BOS tumors and OAR sparing.
MATERIALS AND METHODS: PBS Bragg peak FLASH and CONV-IMPT plans were optimized for 10 consecutive patients with BOS tumor in an in-house treatment-planning system and hypofractionation regimen (30 GyE in five fractions) to assess dosimetric quality while reflecting clinical practice, parameters, and hypothetical fraction doses for FLASH effect. FLASH dose-rate coverage (V 40Gy/s) and dose-rate volume histograms (DRVHs) were quantified across OARs. FLASH (≥40 Gy/s) was achieved with a minimum MU per spot of 300-500 and a minimum spot time (MST) of 0.5 ms. FLASH dose-rate coverage, OAR sparing, and target coverage were averaged across all cases.
RESULTS: FLASH generated higher CTV D max than CONV-IMPT (114% vs. 108%). Dose metrics for OARs were comparable between modalities (p > 0.05). Average dose rate (ADR) DRVHs of OARs indicated 74.1% V 40Gy/s FLASH dose-rate coverage without dose threshold, and 94.4% V 40Gy/s FLASH dose-rate coverage with 1-Gy dose threshold.
CONCLUSION: PBS Bragg peak FLASH can deliver conformal target dosimetric coverage, ultra-high dose rates, and comparable OAR dosimetry to CONV-IMPT, suggesting that this novel technique is feasible for BOS tumor FLASH radiotherapy. The study supports future research to explore FLASH's biological and clinical benefits in BOS tumors and OAR sparing.