First demonstration of the FLASH effect with ultrahigh dose rate high-energy X-rays

Purpose: This study aimed to evaluate whether high-energy X-rays (HEXs) of the PARTER (platform for advanced radiotherapy research) platform built on CTFEL (Chengdu THz Free Electron Laser facility) can produce ultrahigh dose rate (FLASH) X-rays and trigger the FLASH effect. Materials and methods: EBT3 radiochromic film and fast current transformer (FCT) devices were used to measure absolute dose and pulsed beam current of HEXs. Subcutaneous tumor-bearing mice and healthy mice were treated with sham, FLASH, and conventional dose rate radiotherapy (CONV), respectively to observe the tumor control efficiency and normal tissue damage. Results: The maximum dose rate of HEXs of PARTER was up to over 1000 Gy/s. Tumor-bearing mice experiment showed a good result on tumor control (p < 0.0001) and significant difference in survival curves (p < 0.005) among the three groups. In the thorax-irradiated healthy mice experiment, there was a significant difference (p = 0.038) in survival among the three groups, with the risk of death decreased by 81% in the FLASH group compared to that in the CONV group. The survival time of healthy mice irradiated in the abdomen in the FLASH group was undoubtedly higher (62.5% of mice were still alive when we stopped observation) than that in the CONV group (7 days). Conclusion: This study confirmed that HEXs of the PARTER system can produce ultrahigh dose rate X-rays and trigger a FLASH effect, which provides a basis for future scientific research and clinical application of HEX in FLASH radiotherapy. (C) 2021 The Authors. Published by Elsevier B.V.

Automated summary

This study aimed to evaluate the potential of high-energy X-rays (HEX) from the PARTER platform built on CTFEL to produce ultrahigh dose rate X-rays and trigger the FLASH effect. The results showed that the HEXs achieved a maximum dose rate of over 1000 Gy/s and demonstrated effective tumor control and improved survival rates in tumor-bearing mice as well as reduced risks of death in healthy mice subjected to thoracic irradiation.