Cost-Effectiveness of Carbon Ion Radiotherapy in Oncology: A Systematic Review

Carbon ion radiotherapy (CIRT) offers significant physical and biological advantages compared to conventional photon or proton therapies, particularly in the treatment of chemoradio-resistant tumors. However, the widespread adoption of CIRT has been limited due to high treatment and infrastructure costs. This systematic review evaluated the cost-effectiveness of CIRT relative to other treatment modalities across different cancer types. A structured literature search identified five eligible studies encompassing 486 patients with skull base chordoma, locally recurrent rectal cancer, localized hepatocellular carcinoma, and stage I non-small-cell lung cancer. Although CIRT was associated with higher primary treatment costs compared to conventional therapies, it consistently demonstrated favorable cost-effectiveness ratios, with incremental cost-effectiveness ranging from up to $88,663 per additional life-year or quality-adjusted life-year gained. In cases of recurrent tumors, CIRT resulted in lower overall treatment costs than comparator therapies. Additionally, CIRT exhibited a favorable toxicity profile, with minimal severe adverse events reported. These findings suggest that despite higher initial expenditures, CIRT represents a cost-effective and clinically advantageous treatment option across a range of malignancies, warranting broader consideration in oncologic practice.