Very High-Energy Electron Therapy Toward Clinical Implementation
Year: 2025
Authors: Panaino C.M.V., Piccinini S., Andreassi M.G., Bandini G., Borghini A., Borgia M., Di Naro A., Labate L.U., Maggiulli E., Portaluri M.G.A., Gizzi L.A.
Autors Affiliation: Natl Res Council Italy, Natl Inst Opt, Intense Laser Irradiat Lab, I-56124 Pisa, Italy; Natl Res Council Italy, Inst Clin Physiol, I-56124 Pisa, Italy; ASL Brindisi, Radiotherapy, I-72100 Brindisi, Italy; ASST Papa Giovanni XXIII Hosp, Radiotherapy, I-24127 Bergamo, Italy; Natl Inst Nucl Phys, I-56127 Pisa, Italy; ASL Brindisi, Med Phys, I-72100 Brindisi, Italy.
Abstract: The use of very high energy electron (VHEE) beams, with energies between 50 and 400 MeV, has drawn considerable interest in radiotherapy due to their deep tissue penetration, sharp beam edges, and low sensitivity to tissue density. VHEE beams can be precisely steered with magnetic components, positioning VHEE therapy as a cost-effective option between photon and proton therapies. However, the clinical implementation of VHEE therapy (VHEET) requires advances in several areas: developing compact, stable, and efficient accelerators; creating sophisticated treatment planning software; and establishing clinically validated protocols. In addition, the perspective of VHEE to access ultra-high dose-rate regime presents a promising avenue for the practical integration of FLASH radiotherapy of deep tumors and metastases with VHEET (FLASH-VHEET), enhancing normal tissue sparing while maintaining the inherent dosimetric advantages of VHEET. However, FLASH-VHEET systems require validation of time-dependent dose parameters, thus introducing additional technological challenges. Here, we discuss recent progress in VHEET research, focusing on both conventional and FLASH modalities, and covering key aspects including dosimetric properties, radioprotection, accelerator technology, beam focusing, radiobiological effects, and clinical outcomes. Furthermore, we comprehensively analyze initial VHEET in silico studies on coverage across various tumor sites.
Journal/Review: CANCERS
Volume: 17 (2) Pages from: 181-1 to: 181-43
More Information: We acknowledge financial support from the Tuscany Health Ecosystem-THE Spoke 1-Advanced Radiotherapies and Diagnostics in Oncology funded by the NextGenerationEU (PNRR), Codice progetto ECS_00000017, D.D. MUR No. 1055 23 May 2022. We also acknowledge contributions from the following projects: NextGeneration EU Integrated Infrastructure Initiative in Photonic and Quantum Sciences-I-PHOQS (CUP B53C22001750006, ID D2B8D520, IR0000016); Horizon 2020 Framework Programme Research and Innovation; Program EuPRAXIA Preparatory Phase (No. 101079773); EuPRAXIA Advanced Photon Sources-EuAPS (CUP I93C21000160006, IR0000030), INFN CSN5 funded project FRIDA.KeyWords: external beam radiotherapy; VHEE; FLASH radiotherapyDOI: 10.3390/cancers17020181
