Core clinical procedures and efficacy-enhancing strategies in boron neutron capture therapy

Boron Neutron Capture Therapy (BNCT) is a binary targeted radiotherapy modality based on nuclear capture reactions. This technique exploits the tumor-targeting capability of boron compounds and their high thermal neutron capture cross-section, inducing localized nuclear reactions within cancer cells that generate α particles and lithium ions. This process enables selective tumor cell destruction at the cellular level. Clinical evidence demonstrates significant therapeutic efficacy of BNCT in treatment-refractory malignancies including glioblastoma, recurrent head and neck carcinomas, and cutaneous melanoma. Compared to conventional radiotherapy, BNCT leverages its inherent biological selectivity to achieve precise eradication of geometrically complex tumors and microscopic metastases, demonstrating significant clinical potential. However, the widespread adoption of BNCT remains constrained by several limitations, most notably the inadequate tumor selectivity of boron delivery agents. This review examines the literature published since the emergence of BNCT clinical research in 1970 up to the present, summarizing key clinical practices and strategies to enhance therapeutic efficacy, including boron carriers, administration regimens, treatment planning systems, real-time boron monitoring, and combination therapies. It aims to provide guidance for the clinical application of BNCT and support its broader adoption in practice.