Sparing effects of FLASH irradiation in patient-derived lung tissue

BACKGROUND AND PURPOSE: Radiation toxicities, such as pneumonitis and fibrosis, are major limitations affecting patients' quality of life. Developed a decade ago, FLASH radiotherapy is an innovative method that, by delivering radiation at ultrafast dose rate, reduces radiation toxicities on healthy tissue while preserving the anti-tumoral effect of radiotherapy. This so-called FLASH effect has been described in different preclinical models but has not been observed in human tissue. This study aims to determine if FLASH irradiation can induce a sparing effect on human healthy lung tissue. MATERIALS AND METHODS: To address this question, precision-cut lung slices (Hu-PCLS) were prepared from healthy lung samples collected from 19 lung cancer patients undergoing lobectomy. These Hu-PCLS were irradiated ex vivo at a dose of 9 Gy using the ElectronFLASH (SIT) device operated either in conventional or FLASH mode. We monitored cell division for each patient and performed RNAseq analysis to uncover some mechanistic insights. RESULTS: Analysis of cell division 24 h after treatment with conventional or ultra-high dose rate showed a higher proportion of dividing cells in Hu-PCLS after FLASH irradiation. Consistently, RNAseq analysis from irradiated lung samples confirmed an attenuated cell cycle checkpoint inhibition, p53 pro-apoptotic genes, DNA damage, and antioxidant pathways after ultra-high dose rate compared to conventional treatment. CONCLUSION: Altogether, this study shows that, using freshly isolated patient-derived lung samples, cell proliferation can serve as an early marker of the normal lung response to FLASH irradiation. These findings hold great promises for future applications of FLASH radiotherapy in the clinic.