Purpose: This report offers a detailed examination of the inception and current state of the Heavy-ion Therapy Center (HITC) at the Yonsei Cancer Center (YCC), setting it apart as the world’s first center equipped with a fixed beam and two superconducting gantries for carbon-ion radiation therapy (CIRT). Materials and Methods: Preparations for CIRT at YCC began in 2013; accordingly, this center has completed a decade of meticulous planning and culminating since the operational commencement of the HITC in April 2023. Results: This report elaborates on the clinical preparation for adopting CIRT in Korea. It includes an extensive description of HITC’s facility layout at YCC, which comprises the accelerator and treatment rooms. Furthermore, this report delineates the clinical workflow, criteria for CIRT application, and the rigorous quality assurance processes implemented at YCC. It highlights YCC’s sophisticated radiation therapy infrastructure, collaborative initiatives, and the efficacious treatment of >200 prostate cancer cases utilizing CIRT. Conclusion This manuscript concludes by discussing the prospective influence of CIRT on the medical domain within Korea, spotlighting YCC’s pioneering contribution and forecasting the widespread integration of this groundbreaking technology.

Carbon-ion radiotherapy (CIRT) offers superior dose distributions and greater biological effectiveness than conventional photon-based radiotherapy (RT). Due to its higher linear energy transfer and relative biological effectiveness, CIRT is particularly effective against radioresistant tumors and those located near critical organs. Since the first dedicated CIRT facility was established in Japan in 1994, CIRT has demonstrated remarkable efficacy against various malignancies, including head and neck tumors, skull base and upper cervical spine tumors, non-small-cell lung cancer, hepatocellular carcinoma, pancreatic cancer, prostate cancer, and bone and soft tissue sarcomas. This narrative review provides a comprehensive overview of the current status of CIRT, highlighting its clinical indications and future directions. According to clinical studies, CIRT achieves high local control rates with manageable toxicity across multiple cancer types. For instance, in head and neck tumors (e.g., adenoid cystic carcinoma and mucosal melanoma), CIRT has achieved local control rates exceeding 80%. In early-stage non-small-cell lung cancer, CIRT has resulted in local control rates over 90% with minimal toxicity. Moreover, CIRT has shown promise in treating challenging cases of hepatocellular carcinoma and pancreatic cancer, where conventional therapies are limited. Nonetheless, the global adoption of CIRT remains limited due to high costs and complexity. Future directions include conducting randomized controlled trials to establish high-level evidence, integrating new technologies such as ultrahigh-dose-rate (FLASH) therapy, and expanding CIRT facilities globally with strategic planning and cost-effectiveness analyses. If these challenges are addressed, CIRT is poised to play a transformative role in cancer treatment, improving survival rates and the quality of life.

Purpose: This report offers a detailed examination of the inception and current state of the Heavy-ion Therapy Center (HITC) at the Yonsei Cancer Center (YCC), setting it apart as the world’s first center equipped with a fixed beam and two superconducting gantries for carbon-ion radiation therapy (CIRT). Materials and Methods: Preparations for CIRT at YCC began in 2013; accordingly, this center has completed a decade of meticulous planning and culminating since the operational commencement of the HITC in April 2023. Results: This report elaborates on the clinical preparation for adopting CIRT in Korea. It includes an extensive description of HITC’s facility layout at YCC, which comprises the accelerator and treatment rooms. Furthermore, this report delineates the clinical workflow, criteria for CIRT application, and the rigorous quality assurance processes implemented at YCC. It highlights YCC’s sophisticated radiation therapy infrastructure, collaborative initiatives, and the efficacious treatment of >200 prostate cancer cases utilizing CIRT. Conclusion This manuscript concludes by discussing the prospective influence of CIRT on the medical domain within Korea, spotlighting YCC’s pioneering contribution and forecasting the widespread integration of this groundbreaking technology.

Carbon-ion radiotherapy (CIRT) offers superior dose distributions and greater biological effectiveness than conventional photon-based radiotherapy (RT). Due to its higher linear energy transfer and relative biological effectiveness, CIRT is particularly effective against radioresistant tumors and those located near critical organs. Since the first dedicated CIRT facility was established in Japan in 1994, CIRT has demonstrated remarkable efficacy against various malignancies, including head and neck tumors, skull base and upper cervical spine tumors, non-small-cell lung cancer, hepatocellular carcinoma, pancreatic cancer, prostate cancer, and bone and soft tissue sarcomas. This narrative review provides a comprehensive overview of the current status of CIRT, highlighting its clinical indications and future directions. According to clinical studies, CIRT achieves high local control rates with manageable toxicity across multiple cancer types. For instance, in head and neck tumors (e.g., adenoid cystic carcinoma and mucosal melanoma), CIRT has achieved local control rates exceeding 80%. In early-stage non-small-cell lung cancer, CIRT has resulted in local control rates over 90% with minimal toxicity. Moreover, CIRT has shown promise in treating challenging cases of hepatocellular carcinoma and pancreatic cancer, where conventional therapies are limited. Nonetheless, the global adoption of CIRT remains limited due to high costs and complexity. Future directions include conducting randomized controlled trials to establish high-level evidence, integrating new technologies such as ultrahigh-dose-rate (FLASH) therapy, and expanding CIRT facilities globally with strategic planning and cost-effectiveness analyses. If these challenges are addressed, CIRT is poised to play a transformative role in cancer treatment, improving survival rates and the quality of life.

Purpose: This report offers a detailed examination of the inception and current state of the Heavy-ion Therapy Center (HITC) at the Yonsei Cancer Center (YCC), setting it apart as the world’s first center equipped with a fixed beam and two superconducting gantries for carbon-ion radiation therapy (CIRT). Materials and Methods: Preparations for CIRT at YCC began in 2013; accordingly, this center has completed a decade of meticulous planning and culminating since the operational commencement of the HITC in April 2023. Results: This report elaborates on the clinical preparation for adopting CIRT in Korea. It includes an extensive description of HITC’s facility layout at YCC, which comprises the accelerator and treatment rooms. Furthermore, this report delineates the clinical workflow, criteria for CIRT application, and the rigorous quality assurance processes implemented at YCC. It highlights YCC’s sophisticated radiation therapy infrastructure, collaborative initiatives, and the efficacious treatment of >200 prostate cancer cases utilizing CIRT. Conclusion This manuscript concludes by discussing the prospective influence of CIRT on the medical domain within Korea, spotlighting YCC’s pioneering contribution and forecasting the widespread integration of this groundbreaking technology.

Carbon-ion radiotherapy (CIRT) offers superior dose distributions and greater biological effectiveness than conventional photon-based radiotherapy (RT). Due to its higher linear energy transfer and relative biological effectiveness, CIRT is particularly effective against radioresistant tumors and those located near critical organs. Since the first dedicated CIRT facility was established in Japan in 1994, CIRT has demonstrated remarkable efficacy against various malignancies, including head and neck tumors, skull base and upper cervical spine tumors, non-small-cell lung cancer, hepatocellular carcinoma, pancreatic cancer, prostate cancer, and bone and soft tissue sarcomas. This narrative review provides a comprehensive overview of the current status of CIRT, highlighting its clinical indications and future directions. According to clinical studies, CIRT achieves high local control rates with manageable toxicity across multiple cancer types. For instance, in head and neck tumors (e.g., adenoid cystic carcinoma and mucosal melanoma), CIRT has achieved local control rates exceeding 80%. In early-stage non-small-cell lung cancer, CIRT has resulted in local control rates over 90% with minimal toxicity. Moreover, CIRT has shown promise in treating challenging cases of hepatocellular carcinoma and pancreatic cancer, where conventional therapies are limited. Nonetheless, the global adoption of CIRT remains limited due to high costs and complexity. Future directions include conducting randomized controlled trials to establish high-level evidence, integrating new technologies such as ultrahigh-dose-rate (FLASH) therapy, and expanding CIRT facilities globally with strategic planning and cost-effectiveness analyses. If these challenges are addressed, CIRT is poised to play a transformative role in cancer treatment, improving survival rates and the quality of life.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Purpose: This report offers a detailed examination of the inception and current state of the Heavy-ion Therapy Center (HITC) at the Yonsei Cancer Center (YCC), setting it apart as the world’s first center equipped with a fixed beam and two superconducting gantries for carbon-ion radiation therapy (CIRT). Materials and Methods: Preparations for CIRT at YCC began in 2013; accordingly, this center has completed a decade of meticulous planning and culminating since the operational commencement of the HITC in April 2023. Results: This report elaborates on the clinical preparation for adopting CIRT in Korea. It includes an extensive description of HITC’s facility layout at YCC, which comprises the accelerator and treatment rooms. Furthermore, this report delineates the clinical workflow, criteria for CIRT application, and the rigorous quality assurance processes implemented at YCC. It highlights YCC’s sophisticated radiation therapy infrastructure, collaborative initiatives, and the efficacious treatment of >200 prostate cancer cases utilizing CIRT. Conclusion This manuscript concludes by discussing the prospective influence of CIRT on the medical domain within Korea, spotlighting YCC’s pioneering contribution and forecasting the widespread integration of this groundbreaking technology.

Carbon-ion radiotherapy (CIRT) offers superior dose distributions and greater biological effectiveness than conventional photon-based radiotherapy (RT). Due to its higher linear energy transfer and relative biological effectiveness, CIRT is particularly effective against radioresistant tumors and those located near critical organs. Since the first dedicated CIRT facility was established in Japan in 1994, CIRT has demonstrated remarkable efficacy against various malignancies, including head and neck tumors, skull base and upper cervical spine tumors, non-small-cell lung cancer, hepatocellular carcinoma, pancreatic cancer, prostate cancer, and bone and soft tissue sarcomas. This narrative review provides a comprehensive overview of the current status of CIRT, highlighting its clinical indications and future directions. According to clinical studies, CIRT achieves high local control rates with manageable toxicity across multiple cancer types. For instance, in head and neck tumors (e.g., adenoid cystic carcinoma and mucosal melanoma), CIRT has achieved local control rates exceeding 80%. In early-stage non-small-cell lung cancer, CIRT has resulted in local control rates over 90% with minimal toxicity. Moreover, CIRT has shown promise in treating challenging cases of hepatocellular carcinoma and pancreatic cancer, where conventional therapies are limited. Nonetheless, the global adoption of CIRT remains limited due to high costs and complexity. Future directions include conducting randomized controlled trials to establish high-level evidence, integrating new technologies such as ultrahigh-dose-rate (FLASH) therapy, and expanding CIRT facilities globally with strategic planning and cost-effectiveness analyses. If these challenges are addressed, CIRT is poised to play a transformative role in cancer treatment, improving survival rates and the quality of life.