Yupeng Di, Chen Liu, Yingjie Wang, Boning Cai, Lingling Meng
By integrating extensive data from both WoSCC and PubMed, this study documents the safety-led maturation of FLASH-RT from an experimental physics curiosity to a viable clinical precision tool. The evolving synergy between dose-rate optimization and clinical oncology emphasizes that solving real-time dosimetric challenges remains the essential frontier for achieving widespread clinical adoption and widening the therapeutic window.
BACKGROUND: Ultra-high dose rate FLASH radiotherapy (FLASH-RT) holds the potential to revolutionize oncology by dramatically sparing normal tissue while maintaining tumor control. To capture both physical breakthroughs and biomedical translation, this study provides a comprehensive bibliometric mapping to evaluate the global research landscape and translational frontiers of FLASH-RT.
METHODS: To ensure maximum comprehensiveness, a systematic dual-database retrieval was conducted using the Web of Science Core Collection (WoSCC) and PubMed for articles published between January 1, 2014, and December 31, 2025. Following software-assisted deduplication using bibliometrix and independent, researcher-guided manual screening to exclude non-relevant document types, analytical protocols utilizing the R package bibliometrix, VOSviewer, and CiteSpace were applied to visualize publication trends, co-authorship networks, and keyword bursts.
RESULTS: A final analytical cohort of 807 high-quality articles was identified, revealing a rapidly accelerating, non-linear growth pattern relative to the 2014 baseline, with a marked surge after 2021, corresponding to the onset of prospective human FLASH-RT trials. The fitted annual-output trend followed a quadratic polynomial model with R2 = 0.9458. The United States (30.4%) and China (18.7%) led quantitatively, while Switzerland drove deep multi-institutional innovation. We identified a definitive interdisciplinary paradigm shift: early investigations focused on fundamental physics and X-ray dosimetry, whereas contemporary research has rapidly pivoted toward proton FLASH therapy, oxygen depletion kinetics, and phase-1 clinical workflows. Furthermore, keyword burst detection highlighted "ion recombination" and "delivery methods" as the most critical ongoing technical challenges.
CONCLUSION: By integrating extensive data from both WoSCC and PubMed, this study documents the safety-led maturation of FLASH-RT from an experimental physics curiosity to a viable clinical precision tool. The evolving synergy between dose-rate optimization and clinical oncology emphasizes that solving real-time dosimetric challenges remains the essential frontier for achieving widespread clinical adoption and widening the therapeutic window.