Framework for Quality Assurance of Ultrahigh Dose Rate Clinical Trials Investigating FLASH Effects and Current Technology Gaps

作者：Wei Zou, Rongxiao Zhang, Emil Schüler, Paige A. Taylor, Anthony Mascia, Eric S. Diffenderfer, Tianyu Zhao, Ahmet S. Ayan, M. L. SHARMA, Amy S. Yu, Weiguo Lu, Walter Bosch, Christina Tsien, Murat Sürücü, Julianne Pollard‐Larkin, Jan Schuemann, Eduardo G. Moros, Magdalena Bazalova‐Carter, David J. Gladstone, Heng Li, Charles B. Simone, Kristoffer Petersson, Stephen F. Kry, Amit Maity, Billy W. Loo, Lei Dong, Peter G. Maxim, Ying Xiao, Jeffrey C. Buchsbaum · 发表于：International Journal of Radiation Oncology*Biology*Physics · 年份：2023 · DOI：10.1016/j.ijrobp.2023.04.018 · 被引用次数：74 · 研究领域：Advanced Radiotherapy Techniques、Radiation Therapy and Dosimetry、Radiation Detection and Scintillator Technologies

FLASH radiation therapy (FLASH-RT), delivered with ultrahigh dose rate (UHDR), may allow patients to be treated with less normal tissue toxicity for a given tumor dose compared with currently used conventional dose rate. Clinical trials are being carried out and are needed to test whether this improved therapeutic ratio can be achieved clinically. During the clinical trials, quality assurance and credentialing of equipment and participating sites, particularly pertaining to UHDR-specific aspects, will be crucial for the validity of the outcomes of such trials. This report represents an initial framework proposed by the NRG Oncology Center for Innovation in Radiation Oncology FLASH working group on quality assurance of potential UHDR clinical trials and reviews current technology gaps to overcome. An important but separate consideration is the appropriate design of trials to most effectively answer clinical and scientific questions about FLASH. This paper begins with an overview of UHDR RT delivery methods. UHDR beam delivery parameters are then covered, with a focus on electron and proton modalities. The definition and control of safe UHDR beam delivery and current and needed dosimetry technologies are reviewed and discussed. System and site credentialing for large, multi-institution trials are reviewed. Quality assurance is then discussed, and new requirements are presented for treatment system standard analysis, patient positioning, and treatment planning. The tables and fi...