title: Rationale for carbon ion therapy in high-grade glioma based on a review and a meta-analysis of neutron beam trials.
abstract: OBJECTIVE
  The standard treatment of high-grade glioma is still unsatisfactory: the 2-year survival after radiotherapy being only 10-25%. A high linear energy transfer (LET) ionising radiotherapy has been used to overcome tumour radioresistance. An overview of the field is needed to justify future prospective controlled studies on carbon ion therapy.
  
  
  METHODS
  A meta-analysis of clinical trials on neutron beam therapy and a literature review of clinical investigations on light ion use in high-grade glioma were carried out.
  
  
  RESULTS
  Four randomised controlled trials on neutron beam therapy were retained. The meta-analysis showed a non-significant 6% increase of two-year mortality (Relative risk [RR]=1.06 [0.97-1.15]) in comparison with photon therapy. Two phase I/II trials on carbon and neon ion therapy reported for glioblastoma 10% and 31% two-year overall survivals and 13.9 and 19.0 months median survivals, respectively.
  
  
  CONCLUSIONS
  This meta-analysis suggests that neutron beam therapy does not improve the survival of high-grade glioma patients while there is no definitive conclusion yet regarding carbon therapy. The ballistic accuracy and the improved biological efficacy of carbon ions renew the interest in prospective clinical trials on particle beam radiotherapy of glioma and let us expect favourable effects of dose escalation on patients' survival.
authors.affiliation: Université de Lyon, France. jacques.balosso@centre-etoile.org
authors.forename: D
authors.initials: D
authors.lastname: Maucort-Boulch
authors.forename: M-H
authors.initials: MH
authors.lastname: Baron
authors.forename: P
authors.initials: P
authors.lastname: Pommier
authors.forename: D C
authors.initials: DC
authors.lastname: Weber
authors.forename: J-E
authors.initials: JE
authors.lastname: Mizoe
authors.forename: J
authors.initials: J
authors.lastname: Rochat
authors.forename: J-P
authors.initials: JP
authors.lastname: Boissel
authors.forename: J
authors.initials: J
authors.lastname: Balosso
authors.forename: H
authors.initials: H
authors.lastname: Tsujii
authors.forename: E
authors.initials: E
authors.lastname: Amsallem
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002250:Carbon Radioisotopes / Q000627:therapeutic use*; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D002250:Carbon Radioisotopes