Boron Neutron Capture Therapy for High-Grade CNS Tumors: Mechanisms, Carriers, and Clinical Progress: A Narrative Review

TL;DR

Boron Neutron Capture Therapy (BNCT) is a targeted cancer treatment that uses boron and neutron sources to kill tumor cells, showing promise for high-grade brain tumors.

Contribution

This review summarizes the mechanisms, delivery strategies, and clinical outcomes of BNCT for high-grade central nervous system tumors.

Findings

BNCT is technically feasible and well tolerated with encouraging survival outcomes in glioblastoma and meningiomas.

Second-generation boron carriers are currently used clinically, while third-generation platforms are in preclinical stages.

BNCT shows acceptable safety in limited pediatric populations and potential for radioresistant tumors.

Abstract

Boron neutron capture therapy (BNCT) is a biologically targeted, high–linear energy transfer radiotherapy that selectively delivers cytotoxic α-particles to boron-loaded tumor cells and has re-emerged with the development of hospital-compatible accelerator neutron sources and improved boron carriers. We performed a structured literature review of PubMed, Embase, and the Cochrane Library through October 2025 to summarize the radiobiological rationale, boron delivery strategies, and clinical outcomes of BNCT in glioblastoma (GBM) and other high-grade central nervous system tumors. Eligible clinical and translational studies were screened independently, and data on patient populations, boron agents, neutron source technologies, dosimetry, survival, response, and toxicity were extracted. Contemporary series and phase II trials indicate that BNCT is technically feasible and generally well tolerated, with encouraging survival outcomes in selected newly diagnosed and recurrent GBM, meaningful activity in recurrent high-grade meningiomas, and acceptable safety in limited pediatric cohorts. Current practice relies primarily on second-generation carriers such as boronophenylalanine and sodium borocaptate, while third-generation molecular and nanocarrier platforms remain in preclinical development. Overall, BNCT represents a promising high-LET, pharmacologically targeted modality for heavily pretreated and radioresistant CNS tumors, and ongoing prospective studies are needed to define its comparative effectiveness and optimal integration into patient care.

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