Evidence mapPaperPMID 42459836Full record

ReviewFrontiers in cell and developmental biology2026

Microenvironmental remodeling in FLASH radiotherapy.

Yubo Zhao, Hang Li, Jiaqiao Zhong, Jianguo Xu, Liangxue Zhou, Yi Liu, Yuelong Wang

Abstract readReview
In one paragraph

Review in Frontiers in cell and developmental biology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Yubo Zhao *Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Hang Li *State Key Laboratory of Biotherapy and Cancer Center, Research Unit of Gene and Immunotherapy, Chinese Academy of Medical Sciences, Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Jiaqiao Zhong *Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Jianguo XuDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Liangxue ZhouDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Yi LiuDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Yuelong WangDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

FLASH radiotherapy (FLASH-RT), characterized by ultra-high dose rate irradiation (>40 Gy/s), has emerged as a promising strategy for expanding the therapeutic window by sparing normal tissues while preserving tumor control. This review proposes a microenvironment-centered framework that interprets FLASH-RT as a physical-chemical-biological continuum: beam parameters and energy deposition shape oxygen dynamics and radical chemistry, which subsequently influence cellular stress responses, tissue repair, immune regulation, and late remodeling. Within this framework, we integrate current evidence regarding physical prerequisites, organ-specific normal-tissue responses, tumor-control outcomes, early clinical translation, and biological mechanisms. Preclinical studies across the central nervous system, lung, gastrointestinal tract, skin, and other organ systems suggest that FLASH-RT can attenuate acute inflammation, preserve stem and progenitor cell populations and regenerative capacity, reduce persistent DNA damage and cellular senescence, and mitigate late fibrosis. In several tumor models, FLASH-RT has maintained tumor control comparable to that achieved with conventional dose rate radiotherapy, without clear evidence of compromised antitumor efficacy. Early clinical studies have demonstrated feasibility and preliminary safety in superficial skin lesions and palliative treatment of bone metastases. Mechanistically, FLASH-induced microenvironmental remodeling may involve altered oxygen dynamics and radical chemistry, attenuation of inflammatory and fibrotic signaling, preservation of mitochondrial homeostasis, and modulation of immune responses. However, these responses are not uniform and depend on radiation modality, linear energy transfer, dose-rate structure, tissue context, and postirradiation time. By linking upstream irradiation conditions to downstream microenvironmental remodeling, this framework clarifies both shared responses and beam- or context-specific mechanisms. Standardized dosimetry, dynamic

Indexed as

FLASH radiotherapyimmune microenvironmentmicroenvironmental remodelingnormal-tissue sparingradiation biologyradiosensitizationredox biologyultra-high dose rate radiotherapy

Identifiers

PMID42459836
PMCPMC13368930

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.