Background: Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. Methods: To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO’s clinical activity over the last 10 years of CIRT. Results: The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. Conclusions: After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.
背景：目前全球共有13家位于亚洲和欧洲的机构开展碳离子放射治疗（CIRT）的临床前及临床研究，迄今已登记55项针对成人与儿童实体肿瘤的CIRT临床研究。意大利国家肿瘤强子治疗中心（CNAO）是该国唯一能同时加速质子和碳离子用于肿瘤治疗与研究的机构。方法：为系统总结并批判性评估碳离子放疗在肿瘤治疗领域应用的最新进展，作者检索了截至2022年12月PubMed、Web of Science、MEDLINE、Google Scholar及Cochrane数据库的相关文献。采用叙述性综述方法呈现68项研究结果，重点阐述CNAO近十年CIRT临床实践进展。结果：CIRT在弹道学与放射生物学方面的特性使其成为治疗多种罕见、放射抗拒及难治性肿瘤的有效选择。CNAO在特定肿瘤类型的CIRT实施方面为知识体系发展作出了重要贡献。结论：经过初期建设阶段，CNAO已逐步完善其临床、技术与剂量学能力。通过加强与国内外复杂癌症研究网络及团队的协作，实现了更精准的CIRT患者筛选，并降低了治疗可及性门槛。
肿瘤(癌症)患者之家