Flourish of Proton and Carbon Ion Radiotherapy in China

Abstract

Proton and heavy ion therapy offer superior relative biological effectiveness (RBE) in the treatment of deep-seated tumors compared with conventional photon radiotherapy due to its Bragg-peak feature of energy deposition in organs. Many proton and carbon ion therapy centers are active all over the world. At present, five particle radiotherapy institutes have been built and are receiving patient in China, mainly including Wanjie Proton Therapy Center (WPTC), Shanghai Proton Heavy Ion Center (SPHIC), Heavy Ion Cancer Treatment Center (HIMM), Chang Gung Memorial Hospital (CGMH), and Ruijin Hospital affiliated with Jiao Tong University. Many cancer patients have benefited from ion therapy, showing unique advantages over surgery and chemotherapy. By the end of 2020, nearly 8,000 patients had been treated with proton, carbon ion or carbon ion combined with proton therapy. So far, there is no systemic review for proton and carbon ion therapy facility and clinical outcome in China. We reviewed the development of proton and heavy ion therapy, as well as providing the representative clinical data and future directions for particle therapy in China. It has important guiding significance for the design and construction of new particle therapy center and patients’ choice of treatment equipment.

The rationale for a carbon ion radiation therapy facility in Australia

“…Various recent (2020-2023) reviews and other publications consider clinical applications, experience, trials and outcomes for CIRT, some overviewing most or all sites with varying levels of detail 3,4,27,36,38,42,62,[100][101][102] and others discussing single applications only. [103][104][105][106][107][108][109] In 2022, Pompos et al 36 succinctly summarised the clinical indications as: radiation resistant malignancies, such as ACC, mucosal melanoma, NSCLC, liver cancer, bone and soft tissue sarcoma; recurrent previously irradiated cancers (especially rectal cancer), advanced gynaecological malignancies, oesophageal cancer, pancreatic cancer and hypoxic malignancies.…”

“…The clinical efficacy of CIRT has been demonstrated for many tumours, both for toxicity reduction and for improved local control and survival. 3,4,27,38,42,62,[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] However, all discussion recognises that direct high-level clinical evidence for CIRT benefit is limited, 117 since most clinical CIRT investigations are retrospective single arm studies. This is similar in principle to many PBT applications, although PBT phase III trial numbers are increasing.…”

“…Various recent (2020–2023) reviews and other publications consider clinical applications, experience, trials and outcomes for CIRT, some overviewing most or all sites with varying levels of detail 3,4,27,36,38,42,62,100–102 and others discussing single applications only 103–109 . In 2022, Pompos et al 36 .…”

“…The clinical efficacy of CIRT has been demonstrated for many tumours, both for toxicity reduction and for improved local control and survival 3,4,27,38,42,62,86–102 . However, all discussion recognises that direct high‐level clinical evidence for CIRT benefit is limited, 117 since most clinical CIRT investigations are retrospective single arm studies.…”

Dosimetric comparison between stereotactic body radiotherapy and carbon-ion radiation therapy for prostate cancer

“…The 12 C 6+ beam used in carbon-ion radiation therapy (CIRT) has high linear energy transfer (LET), and its relative biological effect is about 2.5–3 times that of X-ray. The reversed dose distribution and spread-out Bragg peak (SOBP) enable it to release a large amount of energy in the target volume, which can achieve targeted tumor killing ( 18 , 19 ).…”