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

By Feng Gao, Yiwei Yang, Hongyu Zhu, Jianxin Wang, Dexin Xiao, Zheng Zhou, Tangzhi Dai, Yu Zhang, Gang Feng, Jie Li, Binwei Lin, Gang Xie, Qi Ke, Peng Li, Xuming Sheng, Hanbin Wang, Longgang Yan, Chenglong Lao, Ming Li, Yanhua Lu, Jianheng Zhao, Song Feng, Dai Wu, Xiaobo Du

Posted 28 Nov 2020
bioRxiv DOI: 10.1101/2020.11.27.401869

Ultrahigh dose-rate (FLASH) radiotherapy has attracted immense attention because of its tumor control efficiency and healthy tissue protection during preclinical experiments with electrons, kilo-voltage X-rays, and protons. Using high-energy X-rays (HEXs) in FLASH is advantageous owing to its deep penetration, small divergence, and cost-effectiveness. This is the first report on the implementation of HEXs with FLASH (HEX-FLASH) and its corresponding application in vivo. With a high-current and high-energy superconducting linear accelerator, FLASH with a good dose rate and high penetration was achieved. Breast cancers artificially induced in BAL b/c mice were efficiently controlled, and normal tissues surrounding the thorax/abdomen in C57BL/6 mice were protected from radiation with HEX-FLASH. Theoretical analyses of cellular responses following HEX-FLASH irradiation were performed to interpret the experimental results and design further experiments. Thus, this study highlights the generation of HEX-FLASH for the first time and its potential in future clinical applications.

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