The importance of hypoxia in radiotherapy for the immune response, metastatic potential and FLASH-RT

Abstract

Purpose

Hypoxia (low oxygen) is a common feature of solid tumors that has been intensely studied for more than six decades. Here we review the importance of hypoxia to radiotherapy with a particular focus on the contribution of hypoxia to immune responses, metastatic potential and FLASH radiotherapy, active areas of research by leading women in the field.

Conclusion

Although hypoxia-driven metastasis and immunosuppression can negatively impact clinical outcome, understanding these processes can also provide tumor-specific vulnerabilities that may be therapeutically exploited. The different oxygen tensions present in tumors and normal tissues may underpin the beneficial FLASH sparing effect seen in normal tissue and represents a perfect example of advances in the field that can leverage tumor hypoxia to improve future radiotherapy treatments.

Keywords:

• FLASH
• immune system
• metastasis
• cancer
• women in research
• ultra-high dose rate
• tumor microenvironment

Acknowledgement

The authors would like to thank Jia-Ling Ruan for her work on the clonogenic assay.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study was funded by the Medical Research Council – MRC [MC_UU_00001/9], [4050620859], [MC_UU_00001/10], [MC_UU_00001/11].

Notes on contributors

Eui Jung Moon

Eui Jung Moon, PhD, is Group Leader and MRC Investigator at the MRC Oxford Institute for Radiation Oncology, University of Oxford, UK.

Kristoffer Petersson

Kristoffer Petersson, PhD is Group Leader and MRC Investigator at the MRC Oxford Institute for Radiation Oncology, University of Oxford, UK, and at Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden.

Monica M. Olcina

Monica M. Olcina, DPhil, is Group Leader and MRC Investigator at the MRC Oxford Institute for Radiation Oncology, University of Oxford, UK.