Send to

Choose Destination
Cancer. 2018 Dec 1;124(23):4467-4476. doi: 10.1002/cncr.31662. Epub 2018 Oct 11.

Clinical trials involving carbon-ion radiation therapy and the path forward.

Author information

Department of Preventive and Restorative Dental Sciences, University of California San Francisco (UCSF), San Francisco, California.
Department of Epidemiology and Biostatistics, UCSF, San Francisco, California.
Department of Radiation Oncology, UCSF, San Francisco, California.
Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, California.
Division of Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California.


To describe the international landscape of clinical trials in carbon-ion radiotherapy (CIRT), the authors reviewed the current status of 63 ongoing clinical trials (median, 47 participants) involving CIRT identified from the US trial registry and the World Health Organization International Clinical Trials Platform Registry. The objectives were to evaluate the potential for these trials to define the role of this modality in the treatment of specific cancer types and identify the major challenges and opportunities to advance this technology. A significant body of literature suggested the potential for advantageous dose distributions and, in preclinical biologic studies, the enhanced effectiveness for CIRT compared with photons and protons. In addition, clinical evidence from phase I/II trials, although limited, indicated the potential for CIRT to improve cancer outcomes. However, current high-level phase III randomized clinical trial evidence does not exist. Although there has been an increase in the number of trials investigating CIRT since 2010, and the number of countries and sites offering CIRT is slowly growing, this progress has excluded other countries. Several recommendations are proposed to study this modality to accelerate progress in the field, including: 1) increasing the number of multinational randomized clinical trials, 2) leveraging the existing CIRT facilities to launch larger multinational trials directed at common cancers combined with high-level quality assurance; and 3) developing more compact and less expensive next-generation treatment systems integrated with radiobiologic research and preclinical testing.


carbon; clinical trials; heavy-ion radiotherapy; ions; particle therapy


Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center