Robotic FLASH radiotherapy: A technical, biological, clinical and societal evaluation.

FLASH radiotherapy (RT) is an emerging technique that delivers radiation at ultra-high dose rates
(UHDR, >40 Gy/s) showing promising results in preclinical studies. At UHDR, tumor control can be
maintained while sparing healthy tissues and reducing toxicities compared to conventional RT.
FLASH-RT is mainly available in pre-clinical settings, with clinical trials conducted using preclinical
and intraoperative devices, limiting their applications. The goal of this project is to pioneer FLASH-RT
using FLASHKNiFE, the only system fully designed to deliver FLASH-RT using a robotic arm. This
enables exploration of the FLASH effect in both intraoperative and external beam RT. Within a single
session, FLASHKNiFE delivers a very high radiation dose in a fraction of a second with an UHDR
electron beam treating up to 6 cm-deep superficial and intraoperative solid tumors. Several key
research areas will be explored to further understand the underlying mechanisms of FLASH, optimize
FLASH-RT and pave the way for clinical translation. In a first phase, FLASH-RT will be part of R&D
and translational research, focusing on optimizing treatment planning and delivery, while
investigating in parallel the underlying biological mechanisms in a series of interdisciplinary studies.
The ultimate goal is to safely and successfully implement this cutting-edge technique into clinical
setting to offer the best care to our patients and to make it available to a significantly broader
patient population