Combining FLASH and spatially fractionated radiation therapy: The best of both worlds

Radiother Oncol. 2022 Oct;175:169-177. doi: 10.1016/j.radonc.2022.08.004. Epub 2022 Aug 8.


FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.

Keywords: FLASH therapy; Normal tissue toxicity; Spatially fractionated radiation therapy.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dose Fractionation, Radiation*
  • Humans
  • Radiotherapy Dosage