Efficiency of modulated and dose rate altered flattening filter free beams in high dose per fraction radiotherapy applications on the survival of prostate cancer cell lines

Background: The radiobiological effect of high dose rate FFF beams on the DU-145 cells was investigated with SBRT plans which have >10 Gy. Methods and Materials: To compare the radiobiological effect on DU-145 cell line four experiments designed: (1) the constant dose rate of 6 MV and 6 MV FFF with increased dose per pulse (2) the effect of dose per pulse while increasing instantaneous dose rate for 6 MV and 6 MV FFF, (3) the effect of increased average dose rate for 6 MV FFF and (4) the effect of protracted treatment time and modulation of 6 MV FFF beams. The survival fraction was counted with WST. Results: FF and FFF for 6 MV with same dose rate and treatment time has no effect on cell survival. Significant differences was observed on survival which were irradiated with 6 MV 600 MU/min and 6 MV FFF 1400 MU/min (p=0.024). There was no difference between 6 MV FFF 600 MU/min and 6 MV FFF 1400 MU/min for 10 Gy. The significant survival difference obtained for 20 Gy. The survival percentages for both 10 Gy and 20 Gy with Cyberknife were obtained higher than FFF. Conclusion: Our in-vitro study presented here show that higher dose rate and reduced treatment time might become a crucial factor for SBRT especially which has >10 Gy fraction dose.