S Krishnan¹*, P Montay-gruel²*, M Kim³*, C Desrosiers⁴*, A Mascia⁵*, (1) MD Anderson Cancer Center, Houston, TX, (2) Uc Irvine Health, (3) University of Pennsylvania, Philadelphia, PA, (4) University Hospital, Zionsville, IN, (5) University of Cincinnati Medical Center, Cincinnati, OH

• 
  S Krishnan
• 
  P Montay-gruel
• 
  M Kim
• 
  C Desrosiers
• 
  A Mascia

MO-AB-TRACK 5-0 (Monday, 7/26/2021) 10:30 AM - 12:30 PM [Eastern Time (GMT-4)]

Title: New Developments in Flash RT

Abstract: Ultrahigh dose-rate (FLASH) radiotherapy in on the forefront of radiotherapy with the potential to ‘revolutionize cancer treatment’. There is a great interest as well as skepticism about this novel radiotherapy technique. The goal of this symposium is not re-iterate the most known results to date, but to present the newest developments in terms of preclinical and clinical trials as well as technology developments.

The session will be opened by Sunil Krishnan, MD by discussing clinical challenges of FLASH in his talk entitled FLASH RT – the devil is in the details. Dr. Krishnan will speak about the conflicting data and focus more on the negative results to date. For balance, he will acknowledge that there are compelling positive results. Then he will discuss the recent results from Dresden, Australia, MDACC and MGH. He will wrap up by saying that it is critical to democratize FLASH and make it readily accessible to all so that more group can perform benchmarking studies with appropriate controls and implore all groups to publish both positive and negative data and minimize publication bias.

Pierre Montay-Gruel, PhD, a radiobiologist, will present on the Benefits of hypo-fractionated FLASH-RT on the brain function. The advantages of single doses of FLASH-RT on the preservation of neurocognitive functions along with brain homeostasis has been intensively described. Recently, his group showed that FLASH-RT delivered with hypo-fractionated regimen was able to delay murine glioblastoma growth. Investigations of the impact of such hypo-fractionated doses to the normal brain are currently being performed, on the neurocognitive aspect but also on the preservation of the blood brain barrier and brain homeostasis

Michelle Kim, PhD will present a talk entitled Implementation and Design of a Proton FLASH System for the First Canine Clinical Trial. Dr. Kim will talk about the initial experiences with our dedicated proton research room and talk about the efforts on the design and commissioning of the proton FLASH capabilities of our system. Additionally, she will discuss the current ongoing canine clinical trial for osteosarcoma.

Colleen Des Rossiers, PhD will present a talk entitled VHEE – rationale for therapy and FLASH potential. In her presentation, she will summarize the work on very high-energy electrons (VHEE), a candidate modality for clinical FLASH to large deep-seated tumors. The utility of very high energy electrons in the energy range from 150 MeV – 250 MeV (VHEE) in radiation therapy has been explored by many researchers in the last twenty years, but currently there are no commercially available medical accelerators producing electrons in this energy range. The FLASH effect has been most demonstrated with electron beams and data supporting the FLASH effect with photon beams is sparse. The dosimetric benefits of VHEE as compared with photons will be presented with the potential for FLASH therapy using VHEE. Additionally, the current state of the VHEE medical accelerator will be presented.
Anthony Mascia, PhD will conclude the session by presenting the technical and perhaps some clinical challenges of the first FLASH clinical trial with proton beams. Dr. Mascia’s presentation will focus mostly on preparation, commissioning and delivery of FAST-01, the first FLASH clinical trial. The narrative is to present the pre-existing scientific literature then show some Cincinnati data that supported the clinical trial. Dr. Mascia will describe their animal irradiation systems that prepared them for commissioning a clinical gantry for a clinical trial. Most of the presentation will focus on the FAST-01: study design, technical challenge, planning, dosimetry, measurements, procedures and summary of data thus far available.


Learning Objectives
1. To learn about the clinical barriers for translation of FLASH
2. To learn about the most current understanding of FLASH radiobiology
3. To learn about the technology developments potentially enabling clinical FLASH
4. To learn about the ongoing canine and clinical FLASH trials

Handouts

• 166-57663-15651646-176514-533186390.pdf (Colleen Desrosiers)

Keywords

Electron Therapy, Protons

Taxonomy

TH- External Beam- Electrons: Very high energy electron (VHEE) beam therapy

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