ArticleFrontiers in oncology2021
FLASH Radiotherapy Using Single-Energy Proton PBS Transmission Beams for Hypofractionation Liver Cancer: Dose and Dose Rate Quantification.
Article in Frontiers in oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Impact assessment of current knowledge gaps and mitigation strategies in clinical FLASH proton therapy through a systematic review.Frontiers in oncology · 2025Pooled it
- Harnessing the sparing effect of FLASH-RT: From phenomenon observation, radiophysical determinants to molecular mechanisms and synergistic strategies.Materials today. Bio · 2026Review
- FLASH radiotherapy preserves hepatic function and maintains metabolic homeostasis in a murine breast cancer model: an experimental preclinical study.Radiation oncology (London, England) · 2026Article
- Use of apertures in single-energy pristine Bragg peak FLASH radiotherapy.Journal of applied clinical medical physics · 2026Article
- Research progresses on FLASH radiotherapy and its application for the treatment of digestive system tumors.Discover oncology · 2026Review
- Review
- Single-field-uniform-dose-per-fraction simultaneous dose and dose rate optimization (SFUDPF-SDDRO) method for proton FLASH therapy.Medical physics · 2026Article
- Review
- Novel Bragg peak FLASH radiotherapy: treatment of base-of-skull tumors within existing clinical guidelines.Frontiers in oncology · 2026Article
- FLASH Radiotherapy in Lung Cancer: Translational Mechanisms, Preclinical Evidence, and Barriers.Cureus · 2026Review
- Seeing the invisible: In vivo dosimetry in radiotherapy with radiacoustic IMAGING.Medical physics · 2025Review
- Article
- Validation of fully automated intensity-modulated proton therapy with and without transmission beams for nasopharyngeal cancer.Physics and imaging in radiation oncology · 2025Article
- Implementation of a novel pencil beam scanning Bragg peak FLASH technique to a commercial treatment planning system.Medical physics · 2025Article
- Transmission beam planning for improved robustness and efficiency in proton therapy for head and neck cancer.Physics and imaging in radiation oncology · 2025Article
- Feasibility study of modularized pin ridge filter implementation in proton FLASH planning for liver stereotactic ablative body radiotherapy.Physics in medicine and biology · 2024Article
- FLASH Radiotherapy: What Can FLASH's Ultra High Dose Rate Offer to the Treatment of Patients With Sarcoma?Seminars in radiation oncology · 2024Review
- Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy.Cancers · 2024Article
- Feasibility and constraints of Bragg peak FLASH proton therapy treatment planning.Frontiers in oncology · 2024Article
- Navigating the straits: realizing the potential of proton FLASH through physics advances and further pre-clinical characterization.Frontiers in oncology · 2024Review
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 1 country.
Funding
Abstract
purposeThis work aims to study the dose and ultra-high-dose rate characteristics of transmission proton pencil beam scanning (PBS) FLASH radiotherapy (RT) for hypofractionation liver cancer based on the parameters of a commercially available proton system operating under FLASH mode. METHODS AND MATERIALS: An in-house treatment planning software (TPS) was developed to perform intensity-modulated proton therapy (IMPT) FLASH-RT planning. Single-energy transmission proton PBS plans of 4.5 Gy × 15 fractions were optimized for seven consecutive hepatocellular carcinoma patients, using 2 and 5 fields combined with 1) the minimum MU/spot chosen between 100 and 400, and minimum spot time (MST) of 2 ms, and 2) the minimum MU/spot of 100, and MST of 0.5 ms, based upon considerations in target uniformities, OAR dose constraints, and OAR FLASH dose rate coverage. Then, the 3D average dose rate distribution was calculated. The dose metrics for the mean dose of Liver-GTV and other major OARs were characterized to evaluate the dose quality for the different combinations of field numbers and minimum spot times compared to that of conventional IMPT plans. Dose rate quality was evaluated using 40 Gy/s volume coverage (V
resultsAll plans achieved favorable and comparable target uniformities, and target uniformity improved as the number of fields increased. For OARs, no significant dose differences were observed between plans of different field numbers and the same MST. For plans using shorter MST and the same field numbers, better sparing was generally observed in most OARs and was statistically significant for the chest wall. However, the FLASH dose rate coverage V
conclusionThis is the first attempt to assess liver FLASH treatment planning and demonstrates that it is challenging for hypofractionation with smaller fractional doses (4.5 Gy/fraction). Using fewer fields can allow higher minimum MU/spot, resulting in higher OAR FLASH dose rate coverages while achieving similar plan quality compared to plans with more fields. Shorter MST can result in better plan quality and comparable or even better FLASH dose rate coverage.
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