FLASH放射治疗的变革性技术：Snowmass 2021白皮书
Transformative Technology for FLASH Radiation Therapy: A Snowmass 2021 White Paper
摘要：
传统的癌症治疗包括手术、放射治疗、化学治疗，以及最近的免疫治疗。这些方式往往结合起来，以提高治疗指数。放射治疗的一般概念是通过精确的剂量靶向、图像引导和以高适形性递送放射剂量的高放射射束在肿瘤和正常组织之间产生物理剂量差异来增加治疗指数，例如，质子和离子。然而，治疗和治愈仍然受到正常组织辐射毒性的限制，许多患者经历急性和长期副作用。然而，最近，一个根本不同的范例，增加放射治疗的治疗指数已经出现，支持临床前研究，并基于闪光辐射效应。FLASH放射治疗（FLASH-RT）是一种在几分之一秒内以超高剂量率输送治疗辐射剂量的方法。实验研究表明，正常组织似乎普遍在这些高剂量率下幸免，而肿瘤则不然。剂量输送条件尚未完全表征。尽管如此，目前估计在200 ms或更短时间内递送的10 Gy或更高的大剂量产生正常组织保留效应，但有效地杀死肿瘤细胞。加速器社区有很大的机会，但也有许多技术挑战，以创造所需的剂量率与新颖和紧凑的加速器，以确保安全提供闪光辐射束。
英文摘要：
Conventional cancer therapies include surgery, radiation therapy, chemotherapy, and, more recently, immunotherapy. These modalities are often combined to improve the therapeutic index. The general concept of radiation therapy is to increase the therapeutic index by creating a physical dose differential between tumors and normal tissues through precision dose targeting, image guidance, and high radiation beams that deliver radiation dose with high conformality, e.g., protons and ions. However, treatment and cure are still limited by normal tissue radiation toxicity, with many patients experiencing acute and long-term side effects. Recently, however, a fundamentally different paradigm for increasing the therapeutic index of radiation therapy has emerged, supported by preclinical research, and based on the FLASH radiation effect. FLASH radiation therapy (FLASH-RT) is an ultra-high dose-rate delivery of a therapeutic radiation dose within a fraction of a second. Experimental studies have shown that normal tissues seem to be universally spared at these high dose rates, whereas tumors are not. The dose delivery conditions are not yet fully characterized. Still, it is currently estimated that large doses of 10 Gy or more delivered in 200 ms or less produce normal tissue sparing effects yet effectively kill tumor cells. There is a great opportunity, but also many technical challenges, for the accelerator community to create the required dose rates with novel and compact accelerators to ensure the safe delivery of FLASH radiation beams.
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