Novel Physical and Biological Applications of Carbon Ion Radiotherapy

Carbon ion radiation therapy (CIRT) is a high-LET radiotherapy, which distinguishes itself from traditional low-LET radiation, such as photons and protons, through its unique physical aspects, biological attributes, and the dramatically increased damage it causes within cellular DNA. Given its distinctive characteristics, it is expected to improve the therapeutic ratio of radiation treatments and enhance treatment outcomes in traditionally radiation-resistant tumor histologies. Despite these unique properties, much remains to be understood regarding the clinical use of CIRT before its full potential can be realized. In this review, we summarize the distinct advantages of CIRT with regard to its physical and biological qualities and discuss the possibilities for novel applications of this technology through the exploitation of its immunomodulatory potential, abscopal impacts, and its ability to generate direct, oxygen-independent radiation damage within treated tumors.