<p indent="0mm">Ultra-high dose rate radiotherapy (FLASH-RT) has emerged as a hot topic in the field of radiotherapy in recent years. A series of experimental data indicate that FLASH-RT can effectively kill tumors while significantly spare normal tissues from radiation damage. This unique phenomenon is known as the FLASH effect. Whether the FLASH effect is triggered or not is influenced by various factors, including physical parameters and biochemical parameters. Physical parameters include dose rate, total dose, dose fractionation strategy, and beam structure, whereas biochemical parameters include tissue oxygenation level, tissue type, and biological endpoint. Adjusting these parameters can have differing degrees of impact on tissue responses to FLASH-RT. For instance, experimental data indicate that, compared to conventional radiation therapy (CONV-RT), FLASH-RT with an average dose rate exceeding <sc>100 Gy/s</sc> can completely protect mice’s cognitive function. However, this protective effect diminishes as the dose rate decreases and disappears when the dose rate falls below <sc>30 Gy/s.</sc> A review of published data suggests that the degree of reduction in normal tissue toxicity by FLASH-RT is influenced by the dose in a single fraction. Higher single doses result in greater reductions in toxicity, but excessively high doses can trigger severe late-stage adverse effects, which warrant caution. For beam structure and radiation type, the types of radiation currently used in preclinical FLASH-RT research include low-energy electrons, very high energy electrons (VHEE), low-energy X-rays, high-energy X-rays, protons, and heavy ions. Overall, the biological effects of FLASH-RT produced by different types of radiation are similar and consistent. However, the technical routes used to generate FLASH-RT beams reported in the literature vary widely, and the beam structures used in different studies differ significantly. It is necessary to clearly describe the detailed beam structure information used in experiments, including dose, dose rate, irradiation time, pulse repetition frequency, pulse width, and single pulse dose. Regarding biochemical factors, oxygen concentration is one of the key factors affecting radiobiological effects. The biological effects of FLASH-RT are also regulated by oxygen content, but it is worth investigating the differential responses of normal and tumor tissues to changes in oxygen content induced by FLASH-RT. The radiation sensitivity of different tissues and organs varies, leading to differences in the benefits gained from FLASH-RT. Additionally, the choice of study endpoints significantly impacts the conclusions of preclinical research on the biological effects of FLASH-RT. For instance, using different markers of DNA damage or analyzing acute versus late-phase indicators post-radiotherapy may yield different conclusions. This study will systematically analyze the effects of physical and biochemical parameters on the FLASH effect based on published experimental data, and the findings will provide useful suggestions for further research on FLASH biological effects.
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