Life sciences · Journal article
Letters in Oncology Science · October 22, 2026
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Radiotherapy (RT) remains a cornerstone of oncological management, indicated for over half of all cancer patients. Although technological iterations — intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) — have refined spatial precision relative to conventional two-dimensional approaches, radiation-induced normal tissue toxicity persists as a critical dose-limiting constraint. The radiobiological mechanisms of ionising radiation encompass direct macromolecular DNA damage and indirect oxidative stress propagated by reactive oxygen species, with cellular outcomes heavily modulated by the dose delivery rate. Consequently, ultra-high dose-rate FLASH-RT has emerged as a novel paradigm, executing therapeutic delivery within millisecond intervals at dose rates exceeding 40 Gy/s. Preclinical and nascent clinical data demonstrate that FLASH irradiation maintains robust tumouricidal efficacy while substantially attenuating normal tissue sequelae. This differential response is hypothesised to arise from transient microenvironmental oxygen depletion, altered reactive oxygen species kinetics, differential DNA damage repair pathways, and distinct immunomodulatory interactions. While the precise molecular orchestration requires further elucidation, FLASH-RT possesses the potential to optimise the therapeutic index. Systematic experimental and clinical validation remains imperative to standardise delivery parameters and integrate this modality into routine clinical oncology.