Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA.
Adv Exp Med Biol. 2022;1395:315-321. doi: 10.1007/978-3-031-14190-4_51.
The delivery of radiation at an ultra-high dose rate (FLASH) is an important new approach to radiotherapy (RT) that appears to be able to improve the therapeutic ratio by diminishing damage to normal tissues. While the mechanisms by which FLASH improves outcomes have not been established, a role involving molecular oxygen (O) is frequently mentioned. In order to effectively determine if the protective effect of FLASH RT occurs via a differential direct depletion of O (compared to conventional radiation), it is essential to consider the known role of O in modifying the response of cells and tissues to ionising radiation (known as 'the oxygen effect'). Considerations include: (1) The pertinent reaction involves an unstable intermediate of radiation-damaged DNA, which either undergoes chemical repair to restore the DNA or reacts with O, resulting in an unrepairable lesion in the DNA, (2) These reactions occur in the nuclear DNA, which can be used to estimate the distance needed for O to diffuse through the cell to reach the intermediates, (3) The longest lifetime that the reactive site of the DNA is available to react with O is 1-10 μsec, (4) Using these lifetime estimates and known diffusion rates in different cell media, the maximal distance that O could travel in the cytosol to reach the site of the DNA (i.e., the nucleus) in time to react are 60-185 nm. This calculation defines the volume of oxygen that is pertinent for the direct oxygen effect, (5) Therefore, direct measurements of oxygen to determine if FLASH RT operates through differential radiochemical depletion of oxygen will require the ability to measure oxygen selectively in a sphere of <200 nm, with a time resolution of the duration of the delivery of FLASH, (6) It also is possible that alterations of oxygen levels by FLASH could occur more indirectly by affecting oxygen-dependent cell signalling and/or cellular repair.
超高剂量率(FLASH)下的放射治疗是放射治疗(RT)的一种重要新方法,它似乎能够通过减少对正常组织的损伤来提高治疗效果。虽然FLASH 改善疗效的机制尚未确定,但经常提到涉及分子氧(O)的作用。为了有效地确定 FLASH RT 的保护作用是否通过 O 的直接差异耗竭(与常规放射治疗相比)发生,必须考虑 O 在改变细胞和组织对电离辐射的反应(称为“氧效应”)中的已知作用。需要考虑的因素包括:(1)相关反应涉及辐射损伤 DNA 的不稳定中间体,该中间体要么通过化学修复恢复 DNA,要么与 O 反应,导致 DNA 中不可修复的损伤,(2)这些反应发生在核 DNA 中,可用于估计 O 扩散穿过细胞到达中间体所需的距离,(3)DNA 的反应性位点可用于与 O 反应的最长寿命为 1-10 μsec,(4)使用这些寿命估计值和不同细胞介质中的已知扩散率,O 可以在细胞质中扩散的最大距离是 60-185nm,以在为时已晚之前到达 DNA 的反应部位(即核),(5)此计算定义了与直接氧效应相关的氧气的相关体积,(6)因此,直接测量氧气以确定 FLASH RT 是否通过 O 的差异放射化学耗竭来操作,将需要能够在 <200nm 的球体中选择性地测量氧气,并且时间分辨率要达到 FLASH 输送的持续时间,(6)也有可能通过影响氧依赖性细胞信号转导和/或细胞修复,FLASH 对氧气水平的改变更间接。
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