Impact of beam pulse structure on yield of reactive oxygen species during proton FLASH radiotherapy
This study investigates the yield of reactive oxygen species (ROS) under proton FLASH irradiation in well-oxygenated healthy tissue to identify the beam time structure for the lowest ROS yield. Examining the influence of proton beam time structure on radiolytic oxygen consumption and ROS production directly addresses the oxygen depletion hypothesis for the FLASH effect. A bespoke Monte Carlo Geant4-DNA model was used to simulate water radiolysis under a proton FLASH dose rate and output time-resolved G values for the principal radiolysis products. A 1.6 μm cube of water with fixed oxygen concentration was modelled for pulse lengths and periods ranging from 1 ns to 1 ms and 10 ns to 10 ms, respectively. The study was limited to two ROS species (hydroxyl radical [OH•] and hydrogen peroxide [H2O2]) and a pulse-structure grid for which the pulse period was constrained to be 10 times the pulse length. The maximum and total G values, Gmax and Gtot, were used to determine the beam time structure that produced the fewest OH• and H2O2. The model shows that the pulse period affected the yield of ROS more than the pulse length. This indicates that the yield of the investigated ROS decreases most under short pulse periods combined with the longest possible pulse duration within those periods. The method of high dose rate proton delivery that is closest to these parameters is an isochronous cyclotron emitting 2 ns pulses separated by 13.7 ns. However, this study also suggests that the oxygen depletion hypothesis cannot fully explain the FLASH effect, as the yield of OH• in healthy tissue is higher for FLASH irradiation than for conventional irradiation. These conclusions should be interpreted within the limitations of the model, which assumes static oxygenation in a single microscopic volume and explores a restricted set of pulse structures and ROS species. Further work is therefore required to assess the generality of these findings under more realistic biological conditions.
- Matuszak N, Suchorska WM, Milecki P, et al. FLASH radiotherapy: an emerging approach in radiation therapy. Rep Pract Oncol Radiother. 2022;27(2):343-351. doi: 10.5603/RPOR.a2022.0038
- Espinosa-Rodríguez A, Sánchez-Parcerisa D, Ibáñez P, et al. Radical Production with Pulsed Beams: Understanding the Transition to FLASH. Int J Mol Sci. 2022;23(21):13484. doi: 10.3390/ijms232113484
- Gaide O, Herrera F, Jeanneret Sozzi W, et al. Comparison of ultra-high versus conventional dose rate radiotherapy in a patient with cutaneous lymphoma. Radiother Oncol. 2022;174:87-91. doi: 10.1016/j.radonc.2021.12.045
- Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: Integrating a survivorship clinical lens to better serve patients. Current Oncology. 2020;27(2):107–112. doi: 10.3747/co.27.6233
- Hughes JR, Parsons JL. FLASH Radiotherapy: Current Knowledge and Future Insights Using Proton-Beam Therapy. Int J Mol Sci. 2020;21(18):6492. doi: 10.3390/ijms21186492
- Zhang Q, Gerweck LE, Cascio E, et al. Proton FLASH effects on mouse skin at different oxygen tensions. Phys Med Biol. 2023;68(5):055010. doi: 10.1088/1361-6560/acb888
- Petusseau AF, Clark M, Bruza P, Gladstone D, Pogue BW. Intracellular Oxygen Transient Quantification in Vivo During Ultra-High Dose Rate FLASH Radiation Therapy. Int J Radiat Oncol Biol Phys. 2024;120(3):884-893. doi: 10.1016/j.ijrobp.2024.04.068
- Li M, Zhou S, Dong G, Wang C. Emergence of FLASH‑radiotherapy across the last 50 years (Review). Oncol Lett. 2024;28(6):602. doi: 10.3892/ol.2024.14735
- Zhang J, Wu X, Qi P, Wang J. Prediction of the treatment effect of FLASH radiotherapy with synchrotron radiation from the Circular Electron-Positron Collider (CEPC). J Synchrotron Radiat. 2024;31(5):1189-1196. doi: 10.1107/S1600577524006878
- Koch CJ, Kim MM, Wiersma RD. Radiation-Chemical Oxygen Depletion Depends on Chemical Environment and Dose Rate: Implications for the FLASH Effect. Int J Radiat Oncol Biol Phys. 2023;117(1):214-222. doi: 10.1016/j.ijrobp.2023.04.001
- Cengel KA, Kim MM, Diffenderfer ES, Busch TM. FLASH Radiotherapy: What Can FLASH’s Ultra High Dose Rate Offer to the Treatment of Patients With Sarcoma?. Semin Radiat Oncol. 2024;34(2):218-228. doi: 10.1016/j.semradonc.2024.02.001
- Zhou G. Mechanisms underlying flash radiotherapy, a novel way to enlarge the differential responses to ionizing radiation between normal and tumor tissues. Radiat Med Prot. 2020;1(1):35–40. doi: 10.1016/j.radmp.2020.02.002
- Ma J, Gao H, Shen X, Bai X, Tang M. A FLASH model of radiolytic oxygen depletion and reactive oxygen species for differential tumor and normal-tissue response. medRxiv. 2023. doi: 10.1101/2023.10.20.23297337
- Sartorio C, Angiolini M, Flammini D, et al. Preliminary Assessment of Radiolysis for the Cooling Water System in the Rotating Target of SORGENTINA-RF. Environments. 2022; 9(8):106. doi: 10.3390/environments9080106
- Dewey DL, Boag JW. Modification of the oxygen effect when bacteria are given large pulses of radiation. Nature. 1959;183(4673):1450-1451. doi: 10.1038/1831450a0
- Boscolo D, Scifoni E, Durante M, Krämer M, Fuss MC. May oxygen depletion explain the FLASH effect? A chemical track structure analysis. Radiother Oncol. 2021;162:68-75. doi: 10.1016/j.radonc.2021.06.031
- Adrian G, Konradsson E, Lempart M, Bäck S, Ceberg C, Petersson K. The FLASH effect depends on oxygen concentration. Br J Radiol. 2020;93(1106):20190702. doi: 10.1259/bjr.20190702
- Geant4 Collaboration. Geant4-DNA physics processes and models. Updated January 14, 2026. Accessed March 3, 2026. https://geant4.web.cern.ch/documentation/dev/prm_html/PhysicsReferenceManual/electromagnetic/geant4_dna/dna.html
- Incerti S, Baldacchino G, Bernal M. The Geant4-DNA project. Int J Model Simul Sci Comput. 2010;1(2):157-178. doi: 10.1142/S1793962310000122
- Incerti S, Ivanchenko A, Karamitros M. Comparison of Geant4 very low energy cross section models with experimental data in water. Med Phys. 2010;37(9):4692-4708. doi: 10.1118/1.3476457
- Bernal MA, Bordage MC, Brown JMC, et al. Track structure modeling in liquid water: A review of the Geant4-DNA very low energy extension of the Geant4 Monte Carlo simulation toolkit. Phys Med. 2015;31(8):861-874. doi: 10.1016/j.ejmp.2015.10.087
- Incerti S, Kyriakou I, Bernal MA, et al. Geant4-DNA example applications for track structure simulations in liquid water: A report from the Geant4-DNA Project. Med Phys. 2018;45(8):722-739. doi: 10.1002/mp.13048
- Chappuis F, Tran HN, Jorge PG, et al. Investigating ultra-high dose rate water radiolysis using the Geant4-DNA toolkit and a Geant4 model of the Oriatron eRT6 electron linac. Sci Rep. 2024;14(1):26707. doi: 10.1038/s41598-024-76769-0
- Lin B, Du H, Hao X, et al. The influence of beam parameters on FLASH effect. Front Oncol. 2025;15:1431700. doi: 10.3389/fonc.2025.1431700
- Ruan JL, Lee C, Wouters S, et al. Irradiation at Ultra-High (FLASH) Dose Rates Reduces Acute Normal Tissue Toxicity in the Mouse Gastrointestinal System. Int J Radiat Oncol Biol Phys. 2021;111(5):1250-1261. doi: 10.1016/j.ijrobp.2021.08.004
- Karsch L, Pawelke J, Brand M, et al. Beam pulse structure and dose rate as determinants for the flash effect observed in zebrafish embryo. Radiother Oncol. 2022;173:49-54. doi: 10.1016/j.radonc.2022.05.025
- Geant4 Collaboration. Release 11.4 beta. Updated June 26, 2025. Accessed October 11, 2025. Available from: https://geant4.web.cern.ch/news/2025-06-26-release11-4-beta
- Geant4 Collaboration. Release 11.4. Updated December 5, 2025. Accessed June 12, 2026. https://geant4.web.cern.ch/news/2025-12-05-release11-4
- Ramos-Méndez J, Shin WG, Karamitros M, et al. Independent reaction times method in Geant4-DNA: Implementation and performance. Med Phys. 2020;47(11):5919-5930. doi: 10.1002/mp.14490
- Bui A, Bekerat H, Childress L, Sankey J, Seuntjens J, Enger SA. Effects of incoming particle energy and cluster size on the G-value of hydrated electrons. Phys Med. 2023;107:102540. doi: 10.1016/j.ejmp.2023.102540
- Jagannathan L, Cuddapah S, Costa M. Oxidative stress under ambient and physiological oxygen tension in tissue culture. Curr Pharmacol Rep. 2016;2(2):64-72. doi: 10.1007/s40495-016-0050-5
- Colizzi I, Poulsen PR, Sørensen B, Meer D, Lomax AJ, Psoroulas S. Which ‘dose rate’ definition describes the FLASH sparing effect for scanned proton beams? A meta-analysis of skin murine data. Radiother Oncol. 2025;213:111206. doi: 10.1016/j.radonc.2025.111206
- Bourhis J, Sozzi WJ, Jorge PG, et al. Treatment of a first patient with FLASH-radiotherapy. Radiother Oncol. 2019;139:18-22. doi: 10.1016/j.radonc.2019.06.019
- Rezaee M, Iordachita I, Wong JW. Ultrahigh dose-rate (FLASH) x-ray irradiator for pre-clinical laboratory research. Phys Med Biol. 2021;66(9):095006. doi: 10.1088/1361-6560/abf2fa
- Gonçalves Jorge P, Geyer R, Kinj R, et al. Machine stability and dosimetry for ultra-high dose rate FLASH radiotherapy human clinical protocol. J Appl Clin Med Phys. 2025;26(6):e70102. doi: 10.1002/acm2.70102
- Panda D, Barik J. Flooding tolerance in rice: Focus on mechanisms and approaches. Rice Sci. 2021;28(1):43-57. doi: 10.1016/j.rsci.2020.11.006
- Tvrdá E, Benko F. Free radicals: what they are and what they do. In: Pathology. Elsevier; 2020:3-13. doi: 10.1016/B978-0-12-815972-9.00001-9
- Prior RL. Oxygen radical absorbance capacity (ORAC): New horizons in relating dietary antioxidants/bioactives and health benefits. J Funct Foods. 2015;18(Pt B):797-810. doi: 10.1016/j.jff.2014.12.018
- Geant4 Collaboration. Physics processes. Updated September 16, 2024. Accessed April 6, 2026. https://geant4.web.cern.ch/documentation/pipelines/master/bfad_html/ForApplicationDevelopers/TrackingAndPhysics/physicsProcess.html
- Romano F, Bailat C, Jorge PG, Lerch MLF, Darafsheh A. Ultra-high dose rate dosimetry: Challenges and opportunities for FLASH radiation therapy. Med Phys. 2022;49(7):4912-4932. doi: 10.1002/mp.15649
- Pias SC. Pathways of Oxygen Diffusion in Cells and Tissues: Hydrophobic Channeling via Networked Lipids. Adv Exp Med Biol. 2020;1232:183-190. doi: 10.1007/978-3-030-34461-0_23
