Accelerator-based BNCT systems (NeuCure, nuBeam, NeuPex)
Boron neutron capture therapy used to need a nuclear reactor. These hospital-sized accelerators make the neutron beam instead, and in 2020 Japan approved the first one, with its boron drug, for head and neck cancers that have come back or cannot be removed.
Overview
A BNCT system accelerates protons to a few million electronvolts with a cyclotron or a linear accelerator, fires them at a beryllium or lithium target to knock out neutrons, then slows and filters those neutrons in a beam-shaping assembly so that mostly epithermal neutrons reach the patient. The patient has been given a boron-10 carrier, today the amino-acid analogue borofalan (Steboronine), which tumour cells take up through amino-acid transporters; when a slow neutron hits boron-10 the atom splits into an alpha particle and a lithium nucleus that travel about one cell diameter, so the cell that took up the boron is killed and its neighbours are spared. Treatment is typically a single session of under an hour.
Sumitomo Heavy Industries' cyclotron-based NeuCure system and Stella Pharma's borofalan were approved in Japan in March 2020 for unresectable locally advanced or recurrent head and neck cancer, the first regulatory approval for BNCT anywhere, and are used at the Southern Tohoku BNCT Research Center in Koriyama and the Kansai BNCT Medical Center in Osaka. Neutron Therapeutics installed its lithium-target nuBeam system at Helsinki University Hospital; Neuboron Medtech built the NeuPex system for the Xiamen Humanity Hospital in China; TAE Life Sciences sells the Alphabeam system; and several Japanese university programmes run Sumitomo and Mitsubishi-derived machines. Trials are testing glioblastoma, melanoma, angiosarcoma and recurrent tumours in previously irradiated tissue.
Against protons and carbon ions BNCT delivers its selectivity biologically rather than by beam shaping, so it can treat diffuse or previously irradiated disease that no external beam can safely target, in one session. Its limits are the small number of machines, dependence on how much boron each patient's tumour takes up, dose that is hard to measure directly, a shielded vault as large as a proton room, and evidence still confined to small single-arm studies.
- Thermal neutrons
- B-10 capture → α + Li
- Boron-loaded tumour cell
How it works
A proton accelerator and neutron-producing target with a beam-shaping assembly deliver epithermal neutrons to a patient loaded with a boron-10 carrier; the boron-10 neutron capture reaction releases short-range alpha and lithium-7 particles inside the cells that took up the drug.
- Selectivity comes from the drug, so diffuse and re-irradiation cases can be treated
- Single-session treatment
- Hospital siting without a reactor
- Very few machines and one approved indication
- Dose depends on boron uptake, which varies by patient
- Evidence limited to small studies
Latest papers
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