Table 1.
Summary of different clinical trials with carbon ions in treatment of glioblastoma
| Study | Disease | Patients | Time range | Radiation Modality | Total dose/fractions | Prior treatment | Concurrent treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
| Mizoe et al,44 2007 | Glioblastoma and Anaplastic glioma | 48 | 1994 - 2002 | Photon + Carbon ion radiotherapy + chemotherapy | 10 MV x-ray (50 Gy/25 fractions); Nimustine hydrochloride (100 mg/m2 in weeks 1, 4, or 5 of XRT); carbon (from 16.8-24.8 Gy/8 fractions) | - | - | The median survival time: 17 mo for glioblastoma and 35 mo for anaplastic glioma; main side effect: bone marrow suppression No grade 3 or higher acute reaction |
| Qiu et al,39 2022 | Glioblastoma | 16 | 2017 - 2019 | Carbon ion radiotherapy + Proton radiotherapy | Carbon ion boost [9,12, 15, and 18 Gy] in 3 fractions before proton (60 Gy RBE in 30 fractions) | - | Chemotherapy during proton therapy (Temozolomide 75 mg/m2, 7 d/wk) | Median follow-up: 17.9 mo-PFS and OS at 12 mo: 50.6% and 78.6% respectively; no severe acute or late toxicities were perceived in doses (9, 12, 15 Gy) |
| Combs et al,53 2013 | Glioblastoma | 32 | 1996 - 2011 | Retrospective comparison between carbon boost and photon (or photon with chemotherapy) | Carbon ion boost versus (photon ± TMZ) | - | - | Median overall survival: 9 mo (photon); 14 mo (photon + chemotherapy) and 18 mo (carbon ions) Figure median PFS: 5 mo (photon); 6 mo (photon + chemotherapy) and 8 mo (carbon ions) |
| Kong et al,54 2019 | High-grade glioma |
47 | 2015 - 2019 | Proton alone and proton with carbon ion | PRT only (60 GyE/30 Fx/6 wk); PRT + CIRT (either PRT 50 Gy/25 Fx + CIRT 10-12 GyE/4-5 Fx, or PRT 60 GyE/30 Fx + CIRT 9-12 GyE/3 Fx) | - | Chemotherapy (Temozolomide) | 1-y OS and PFS rates: 100% vs 75% (P = .049) and 100% vs 58% (P = .004) for grade 3 and 4 gliomas |
| Kong et al,52 2020 | Glioblastoma multiforme or anaplastic glioma | 50 | 2015 - 2018 | Proton radiotherapy (24 patients) and proton radiotherapy plus a carbon-ion radiotherapy (CIRT) boost (26 patients) | Proton radiotherapy (60 gray-equivalents in 30 daily fractions); proton radiotherapy plus a carbon-ion radiotherapy (CIRT) boost (various dose-escalating schemes) | - | Chemotherapy (Temozolomide) (first day 75 mg/m2, 7 d/wk, followed by at least 6 cycles of adjuvant treatment at 150-200 mg/m2 for 5 d during each 28-d cycle) | 12-mo OS rate: 87.8% 18-mo OS rates: 72.8% 12-mo PFS rate: 74.2% 18-mo PFS rates: 59.8% |
| Combs et al,36 2010 | Glioblastoma | Accruing | Since 2010 | Carbon ion boost / Proton boost | Carbon ion boost (18 Gy/6 fraction)/Proton boost (10 Gy /5 fractions) | Radiochem-otherapy with TMZ up to 50 Gy | Chemotherapy with TMZ (conventional dosing of 75 mg/m2 per d) | Awaiting results |
Abbreviations: CIRT = carbon ion radiotherapy; Fx = fraction; OS = overall survival; PFS = progression free survival; PRT = proton radiotherapy; RBE = relative biologic effectiveness; TMZ = temozolomide; XRT = x-ray therapy.