- Schulte, Reinhard;
- Johnstone, Carol;
- Boucher, Salime;
- Esarey, Eric;
- Geddes, Cameron;
- Kravchenko, Maksim;
- Kutsaev, Sergey;
- Loo, Billy;
- Méot, François;
- Mustapha, Brahim;
- Nakamura, Kei;
- Nanni, Emilio;
- Sheng, Ke;
- Snijders, Antoine;
- Snively, Emma;
- Tantawi, Sami;
- Van Tilborg, Jeroen;
- Sampayan, Stephen;
- Schroeder, Carl;
- Obst-Huebl, Lieselotte
The general concept of radiation therapy used in conventional cancer treatment is to increase the therapeutic index by creating a physical dose differential between tumors and normal tissues through precision dose targeting, image guidance, and radiation beams that deliver a radiation dose with high conformality, e.g., protons and ions. However, the treatment and cure are still limited by normal tissue radiation toxicity, with the corresponding side effects. A fundamentally different paradigm for increasing the therapeutic index of radiation therapy has emerged recently, 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. While dose delivery conditions to achieve a FLASH effect are not yet fully characterized, it is currently estimated that doses delivered in less than 200 ms produce normal-tissue-sparing effects, yet effectively kill tumor cells. Despite a great opportunity, there are many technical challenges for the accelerator community to create the required dose rates with novel compact accelerators to ensure the safe delivery of FLASH radiation beams.