Carbon Ion Radiotherapy: A Necessity for Tomorrow's Radiotherapy?

Abstract

Introduction: Carbon ion therapy is an advanced and highly precise form of radiotherapy, offering significant physical and radiobiological benefits over traditional photon and proton therapies. With its adoption on the rise, there are now 12 treatment centers across five countries worldwide utilizing carbon ions in radiotherapy. Despite its promising advantages, the field faces substantial challenges due to inherent complexity and high costs, which represent the primary barriers to further implementation.

The aim of this study was to evaluate the advantages and disadvantages of carbon ion therapy, as well as to examine the role of this treatment in current and future cancer therapy.

Method: A partially systematic literature review was conducted using the database PubMed with the following keywords: “carbon ion”, “carbon ion therapy”, “c-ion”, “radiotherapy”, “heavy ion”, “future”, “potential”, and “advantages”. The search process took place from February 27, 2024, to March 11, 2024. Articles were included based on selected inclusion and exclusion criteria and were subsequently analyzed independently by the first and second author.

Results: The search process identified nine relevant articles that highlighted the benefits of the Bragg peak for precise energy deposition and the high LET value of carbon ions, which increases treatment efficacy for radioresistant and hypoxic tumors. Challenges such as the fragmentation tail and various calculations of Relative Biological Effectiveness (RBE) need to be addressed for optimal treatment planning. Economic barriers, including high costs for facilities and operations, limit global accessibility. Further studies on standardization, miniaturization, and the clinical effectiveness of carbon ion therapy are needed.

Conclusion: Further development and research on carbon ion therapy are necessary due to its physical and radiobiological advantages, such as high LET value and targeted energy deposition. Economic barriers and uncertainties related to the fragmentation tail and RBE calculations must be addressed. International collaboration and clinical studies are crucial to assess the role of carbon ion treatment in future cancer therapy.