Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

High linear energy transfer (LET) radiotherapy has long held the promise of improved efficacy against tumors that are refractory to conventional radiotherapy. While such an increase in efficacy is achievable with fast neutron therapy, poor physical dose distribution characteristics have limited its potential. Carbon ions are an elegant solution in that they combine the biological effectiveness of fast neutron therapy with physical dose shaping characteristics even better than proton therapy. However, the cost of technology to deliver this treatment is tremendous and its clinical potential remains largely unproven. Clinical trials are underway in several countries, helping us gather the necessary data to demonstrate its efficacy. However, the United States, a traditional world leader in the development and implementation of advanced healthcare technology, is not among them. Considering the substantial potential benefit of this treatment and also our current efforts to contain the costs of healthcare, is now the time for the United States to step from the sidelines to participate in this research? This is the subject of this month’s 3DCRT debate. Arguing for the proposition will be Drs. Eleanor Blakely, Bruce Faddegon, and Christopher Tinkle. Dr. Blakely is a senior staff in biophysicist (rehired retiree since 2015) at the Lawrence Berkeley National Laboratory (LBNL) with more than 44 yr of professional experience in molecular, cellular, and animal radiobiological research directed at studying the basic mechanisms of radiation responses, with an emphasis on charged particle radiation effects. Dr. Faddegon is a professor of medical physics in the radiotherapy department of UCSF. His research focus is to bring technical innovation into the clinic to improve radiotherapy by advancing linear accelerator, imaging, and particle therapy equipment and methods including Monte Carlo simulation tools and techniques. Dr. Tinkle is a radiation oncologist and Assistant Member in the department of radiation oncology at St. Jude Children’s Research Hospital. His focus is on preclinical and translational studies in pediatric cancers exploring the interactions of proton and photon radiotherapy and emerging targeted systemic therapy. Arguing against the proposition will be Drs. Charles Bloch, Michael Dominello, and Robert Griffin. Dr. Bloch is a medical physicist who started his career in proton therapy over 25 yr ago. Currently, he is an associate professor in the department of radiation oncology at the University of Washington and serves as an associate director of education, research, and development at the Seattle Proton Therapy Center. Dr. Dominello is an assistant professor in oncology department and practicing radiation oncologist at Wayne State University, Karmanos Cancer Center. His interests include stereotactic radiosurgery for brain and spine and therapeutic ratio. He currently serves as the Karmanos/McLaren‐wide PI for NRG, Karmanos Cancer Network Medical Director for Quality and participates as a member of numerous committees through NRG and ASTRO. Dr. Dominello serves as the Assistant Program Director for the Radiation Oncology Residency Program and as an instructor in courses for both graduate and undergraduate students at the university. Dr. Griffin is a professor of radiation biology at the University of Arkansas for Medical Sciences. His group studies living tissue response to high‐dose radiotherapy (SBRT) and spatially fractionated radiation approaches with targeted drug delivery to tumors. He served as a president of the Society for Thermal Medicine, is a Vice Chair of the Science Education and Professional Development Committee and Annual Meeting biology track chair for ASTRO and is an associate senior editor for Technology in Cancer Research and Treatment and the International Journal of Radiation Oncology, Biology and Physics.