Abstract
Simple SummaryThe development of innovative approaches that would reduce the sensitivity of healthy tissues to irradiation while maintaining the efficacy of the treatment on the tumor is of crucial importance for the progress of the efficacy of radiotherapy. Recent methodological developments and innovations, such as scanned beams, ultra-high dose rates, and very high-energy electrons, which may be simultaneously available on new accelerators, would allow for possible radiobiological advantages of very short pulses of ultra-high dose rate (FLASH) therapy for radiation therapy to be considered. In particular, very high-energy electron (VHEE) radiotherapy, in the energy range of 100 to 250 MeV, would be particularly interesting both from a ballistic and biological point of view for the establishment of this new type of irradiation technique. In this review, we examine and summarize the current knowledge on VHEE radiotherapy and provide a synthesis of the studies that have been published on various experimental and simulation works.The development of innovative approaches that would reduce the sensitivity of healthy tissues to irradiation while maintaining the efficacy of the treatment on the tumor is of crucial importance for the progress of the efficacy of radiotherapy. Recent methodological developments and innovations, such as scanned beams, ultra-high dose rates, and very high-energy electrons, which may be simultaneously available on new accelerators, would allow for possible radiobiological advantages of very short pulses of ultra-high dose rate (FLASH) therapy for radiation therapy to be considered. In particular, very high-energy electron (VHEE) radiotherapy, in the energy range of 100 to 250 MeV, first proposed in the 2000s, would be particularly interesting both from a ballistic and biological point of view for the establishment of this new type of irradiation technique. In this review, we examine and summarize the current knowledge on VHEE radiotherapy and provide a synthesis of the studies that have been published on various experimental and simulation works. We will also consider the potential for VHEE therapy to be translated into clinical contexts.
Highlights
Cancer is one of the leading causes of disease/death worldwide, with around 14 million new cases and 8 million deaths each year
As already highlighted a few years ago, very high-energy electron (VHEE) beams have potential advantages for radiation therapy compared to conventional electrons or X-ray intensity-modulated radiation therapy (IMRT) [116]
VHEEs are potentially superior to photon beams, as VHEEs can be scanned at high speed, allowing for simultaneous tracking and IMRT treatment, and neutron production is relatively low and not an obstacle
Summary
Cancer is one of the leading causes of disease/death worldwide, with around 14 million new cases and 8 million deaths each year. Very high-energy electron (VHEE) radiotherapy, in the energy range of 100 to 250 MeV, first proposed in the 2000s, would be accurate and minimally affected by tissue heterogeneities (unlike low-energy electrons or photons), and could be applicable in a large number of deep anatomical localizations [3] It is potentially less expensive than particle therapy techniques, and would allow for accelerated treatment, for example through electromagnetic scanning of charged particle beams, with high doses per fraction, thereby improving its effectiveness. Electron beam radiation therapy has been an important part of treatment for breast or chest wall irradiation [4], and gradually limited itself to more specific techniques It has long been favored for treatments of the skin, eyes, salivary glands or part of the breasts, and often considered as a complementary method to the use of X-rays [5]. Monte Carlo dose algorithms have played a significant role in electron beam planning, as they have been shown to significantly improve dose calculation accuracy, for example with a more accurate handling of heterogeneities and irregular surface contours [18]
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