Evolution of Particle Radiotherapy: From Physical to Dual Targeting in Precision Medicine.

Area of Science:

• Oncology
• Medical Physics
• Radiotherapy

Background:

• Cancer remains a major global health issue, driving the need for advanced radiotherapy techniques.
• Particle radiotherapy (PRT), including proton therapy (PT) and carbon ion radiotherapy (CIRT), offers improved precision over conventional photon therapy.
• Current PRT modalities primarily rely on spatial dose distribution, with limitations in biological targeting.

Purpose of the Study:

• To review the latest advancements in particle radiotherapy, focusing on the transition from physical targeting to dual-targeting strategies.
• To analyze the mechanistic principles, technological progress, and clinical applications of boron neutron capture therapy (BNCT).
• To highlight BNCT's potential as a transformative precision therapy for challenging cancers.

Main Methods:

• Review of current literature on particle radiotherapy, including PT, CIRT, and BNCT.
• Analysis of mechanistic principles underlying BNCT's dual-targeting approach.
• Examination of technological advancements in accelerator-based neutron sources and boron delivery systems.

Main Results:

• PRT, particularly PT and CIRT, excels in physical targeting via the Bragg peak and high linear energy transfer (LET).
• BNCT introduces a novel dual-targeting strategy, combining tumor-specific boron-10 agents with localized high LET particles triggered by neutron irradiation.
• BNCT offers enhanced cellular-scale precision and biological selectivity compared to existing PRT methods.

Conclusions:

• BNCT represents a significant innovation in precision oncology, offering a unique dual-targeting mechanism.
• Further research and development are needed to optimize BNCT's therapeutic accuracy, reduce costs, and conduct clinical trials.
• BNCT holds substantial promise for treating intractable malignancies, potentially transforming precision cancer therapy.