# Carbon-ion therapy

Source: https://onco.cc/technologies/carbon-ion/  
OnCo record `carbon-ion` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Heavier charged particles that kill even radiation-resistant tumours, available at only a handful of centres worldwide.

## Summary

Carbon-ion therapy uses carbon nuclei that deposit high-LET tracks and clustered DNA damage at a sharp Bragg peak. Relative biological effectiveness is typically around 2 to 3 and is model-dependent (local effect model, microdosimetric kinetic model). The oxygen enhancement ratio falls toward 1, which is the argument in hypoxic, radioresistant tumours (sarcoma, chordoma, adenoid cystic carcinoma, pancreas). About 15 centres operate worldwide (Japan, Germany, Italy, China, Austria); Mayo Clinic Jacksonville is building the first US centre. Randomised comparisons with protons or photons are scarce. The simple version is that heavier charged particles can kill tumours that ordinary radiation cannot, but only a handful of centres can deliver them.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-17
- Principle: Carbon nuclei deposit dense ionisation tracks causing clustered DNA damage with a sharp Bragg peak.
- Strengths: Effective in radioresistant tumours
- Limitations: Very few facilities; Cost

## Sources

- Malouff et al., Carbon ion therapy: a modern review of an emerging technology (Frontiers in Oncology 2020): https://doi.org/10.3389/fonc.2020.00082

## Connected records

- technologies: [Carbon-ion synchrotrons and facilities](https://onco.cc/technologies/carbon-ion-synchrotrons/), [Proton therapy](https://onco.cc/technologies/proton-therapy/), [The linear-quadratic model and fractionation](https://onco.cc/technologies/linear-quadratic-model/), [Very-high-energy electron therapy](https://onco.cc/technologies/vhee-radiotherapy/)
- cancers: [Adenoid cystic carcinoma](https://onco.cc/cancers/adenoid-cystic-carcinoma/), [Chondrosarcoma](https://onco.cc/cancers/chondrosarcoma/), [Chordoma](https://onco.cc/cancers/chordoma/), [Osteosarcoma](https://onco.cc/cancers/osteosarcoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Salivary gland cancers](https://onco.cc/cancers/salivary-gland/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- companies: [Hitachi (particle therapy)](https://onco.cc/companies/hitachi/), [Toshiba Energy Systems & Solutions](https://onco.cc/companies/toshiba-energy-systems/)
- terms: [Alpha/beta ratio](https://onco.cc/terms/alpha-beta-ratio/), [Bragg peak](https://onco.cc/terms/bragg-peak/), [Linear energy transfer (LET)](https://onco.cc/terms/linear-energy-transfer/), [Oxygen enhancement ratio](https://onco.cc/terms/oxygen-enhancement-ratio/), [Relative biological effectiveness (RBE)](https://onco.cc/terms/relative-biological-effectiveness/)
- key papers: [Carbon Ion Therapy: A Modern Review of an Emerging Technology](https://onco.cc/key-papers/paper-malouff-front-oncol/)
- institutions: [Comprehensive Cancer Center Vienna, Medical University of Vienna / AKH](https://onco.cc/institutions/ccc-vienna/), [European Society for Radiotherapy and Oncology](https://onco.cc/institutions/estro/), [Fudan University Shanghai Cancer Center](https://onco.cc/institutions/fuscc/), [Gunma University Heavy Ion Medical Center](https://onco.cc/institutions/gunma-heavy-ion-medical-center/), [Heidelberg University Hospital / NCT / DKFZ](https://onco.cc/institutions/heidelberg-nct/), [Mayo Clinic](https://onco.cc/institutions/mayo-clinic/), [Mayo Clinic Comprehensive Cancer Center in Florida](https://onco.cc/institutions/mayo-clinic-florida/), [QST Hospital (National Institutes for Quantum Science and Technology)](https://onco.cc/institutions/qst-hospital/), [Severance Hospital, Yonsei University](https://onco.cc/institutions/severance/), [Taipei Veterans General Hospital](https://onco.cc/institutions/taipei-veterans-general-hospital/)
- people: [Jürgen Debus](https://onco.cc/people/juergen-debus/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- ideas: [A regulatory pathway for new radiotherapy techniques modelled on drug development](https://onco.cc/ideas/idea-fund-radiotherapy-innovation-pathway/), [Pooled coverage-with-evidence for proton therapy across all centres](https://onco.cc/ideas/idea-fund-proton-coverage-with-evidence/), [Use LET, RBE and alpha/beta to decide when protons beat IMRT](https://onco.cc/ideas/idea-bio2-let-rbe-ab-selects-protons/)
- roadmaps: [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)

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