Boron Neutron Capture Therapy (BNCT)
Boron Neutron Capture Therapy (BNCT) is a unique form of treatment that utilizes a nuclear reaction between boron-10 and neutrons to selectively destroy tumor cells. The process begins by administering a boron-containing compound to the patient, which preferentially accumulates in tumor cells. The tumor is then irradiated with low-energy neutrons. When the neutrons interact with the boron-10 atoms within the tumor, a nuclear reaction occurs, releasing high-energy particles (lithium-7 and alpha particles) with extremely short penetration ranges, which selectively destroy the tumor cells.
Advantages
The alpha particles and lithium-7 ions generated by BNCT have an extremely short range—only about 5 to 9 micrometers, which is less than the diameter of a typical tumor cell (10 to 20 micrometers). Ideally, this means the damage is confined to the tumor cells, causing minimal harm to surrounding healthy tissue. In addition, alpha particles have a higher Relative Biological Effectiveness (RBE) than photons, making BNCT potentially more effective against radioresistant tumors. Currently, only a few thousand BNCT treatments have been performed worldwide.
BNCT may be suitable for the following cases:
-
Radioresistant malignant tumors:
Such as malignant gliomas and melanomas. Similar to heavy particle therapy, the alpha particles produced in BNCT have a high RBE, potentially offering greater therapeutic benefits for tumors resistant to conventional radiation. -
Recurrent tumors:
Including recurrent malignant brain tumors, head and neck cancers, skin cancers, and pediatric tumors. When traditional treatments have failed, BNCT can sometimes yield remarkably positive results.




Mechanism of Action
- A boron-10–containing drug is administered; tumour cells preferentially accumulate the isotope.
- The patient is exposed to a thermal or epithermal neutron beam.
- Inside boron-laden cells, B captures a neutron and fissions into an alpha particle and a lithium nucleus.
- Both particles travel only a few micrometres—roughly a cell diameter—destroying the malignant cell from within and sparing adjacent healthy tissue.
- Key features: single-session capability, intracellular precision, and a biologically favourable dose fall-off.
Cancer Types
Clinically validated (late-phase trials or routine use)
- Recurrent head-and-neck squamous-cell carcinoma after prior irradiation
- Glioblastoma multiforme and other high-grade gliomas
- Cutaneous and mucosal melanomas, particularly radio-resistant subtypes
- Recurrent or unresectable salivary-gland tumours
- Non-small-cell lung cancer that is inoperable or has recurred
- Hepatocellular carcinoma in select Asian trials
Early-phase or exploratory studies
- Prostate, cervical, and bladder cancers
- Soft-tissue sarcomas and mesothelioma
- Paediatric high-grade brain tumours
Hospitals with Operational BNCT Units (mid-2025 snapshot)
- Taipei Veterans General Hospital, Taiwan ( More TW Hospitals under preparation )
- Kansai BNCT Center / Osaka Medical University, Japan
- Helsinki University Hospital, Finland
- INFN-CNAO campus, Pavia, Italy
- Multiple Chinese centres in Beijing and Shanghai
Cross-Treatment Strategy with Proton Therapy
Where both platforms coexist, oncologists can:
- Use proton beams for primary tumour bulk or margin-critical regions (e.g., paediatric brain, spine, ocular sites).
- Apply BNCT to microscopic residual disease, radio-refractory recurrence, or tumour cores with hypoxic zones.
- Sequence BNCT first to debulk radio-resistant clones, then proton therapy to sterilise peripheral microscopic extension.
- Exploit BNCT's immunogenic cell-death signature to prime an immune response before checkpoint blockade. These combined approaches can lower cumulative radiation dose, shrink treatment times, and potentially enhance systemic antitumour immunity.
Clinical OutcomesCompared with Conventional Modalities
Head-and-neck cancer (post-radiation recurrence)
- Overall response rates around 75–85 % with BNCT, versus 30–40 % for re-irradiation using photons.
- Many patients otherwise deemed unresectable achieve long-term locoregional control.
Glioblastoma multiforme
- Japanese multicentre data (Nakamura et al., 2021) show a median overall survival of roughly 22–24 months when BNCT is paired with temozolomide; conventional salvage regimens seldom exceed 14–16 months.
Toxicity profile
- Typical adverse events are mild, local, and transient: mucosal swelling, skin erythema, and short-term fatigue.
- Absence of systemic chemotherapy side-effects, minimal alopecia, and negligible long-term organ damage.
- Median hospital stay is one to two days; most patients resume normal activity within 48 hours, contrasting sharply with multi-week photon radiotherapy courses or radical surgery recovery.
Future Horizons: BNCT Plus Immunotherapy
Pre-clinical work indicates BNCT-induced double-strand DNA breaks release neoantigens that may upregulate PD-L1. Early compassionate-use cases combining BNCT with anti-PD-1 agents (e.g., nivolumab) have shown durable complete responses in melanoma and head-and-neck cancers, warranting formal trials.
Additional frontiers include:
- Boron-encapsulated liposomes that home to tumour vasculature.
- Accelerator-based neutron sources small enough for standard radiotherapy bunkers, promising wider access.
- Integration with circulating-tumour-DNA monitoring to time BNCT when minimal residual disease is highest.
A Successful Case Of Malignant Glioma 惡性腦膠質母細胞瘤案例
Taiwan and Japan are currently the only two countries in the world offering Boron Neutron Capture Therapy (BNCT) for cancer treatment. The BNCT Center at National Tsing Hua University (NTHU) is the world's only team currently treating brain cancer with this cutting-edge technology. NTHU recently announced that Swiss author Lars Jaeger traveled to Taiwan at the end of July to receive treatment for a malignant brain tumor. After the treatment, Jaeger shared that he experienced no discomfort during BNCT, saying it felt like "a peaceful 30-minute nap."
Swiss Author Undergoes BNCT at NTHU: "Like a 30-Minute Nap"
According to NTHU, Jaeger was diagnosed with glioblastoma multiforme (GBM) four years ago. Despite undergoing five craniotomies, Gamma Knife, and even carbon ion therapy, the tumor repeatedly recurred. After two years of researching new treatments and consulting with doctors in Switzerland and Japan, he ultimately chose Taiwan, saying:
"BNCT is my last hope, and NTHU has the most experienced team in the world."
After evaluation and treatment planning by Dr. Yi-Wei Chen, Director of the Particle Therapy Committee of the Taiwan Society for Therapeutic Radiology and Oncology, and radiation oncologist at Taipei Veterans General Hospital, Jaeger underwent a 90-minute intravenous infusion of boron-containing drugs to target diffuse cancer cells in the brain. He was then taken to a treatment room adjacent to the nuclear reactor for a 24-minute neutron beam irradiation.
How BNCT Works
BNCT involves the injection of boron-containing drugs that selectively accumulate in tumor cells. Once the drug has been absorbed by the cancer cells, a neutron beam is used to irradiate the tumor area. The boron atoms undergo nuclear fission, releasing highly destructive alpha particles and lithium nuclei, which self-destruct and kill the tumor cells. Because the boron compound specifically targets cancer cells, normal brain cells remain unaffected.
During the treatment, Jaeger's wife and daughter communicated with him via microphone. After the session, he reported no discomfort, likening it to a short, restful nap. Since BNCT typically requires only one session, Jaeger and his family returned to Switzerland afterward, hopeful for positive results.
BNCT Effective Against Brain and Head & Neck Cancers — Liver Cancer is Next Target
Dr. Tsung-Kuang Yeh, Director of the NTHU Nuclear Science and Technology Development Center, stated that the Tsing Hua Neutron Medical Irradiation System (THOR), developed for BNCT, received Taiwan's first-ever medical device license for this type of treatment in June — also the first globally. This opens the possibility for BNCT to become a routine frontline cancer therapy, bringing new hope to cancer patients worldwide.
Dr. Yeh explained the principle of BNCT, "It's like a Trojan Horse, where boron-containing drugs disguise themselves as sugar-coated poison, infiltrating cancer cells and detonating from within."
Because the destructive radius of the boron reaction is only about the size of a single cell, it avoids damaging nearby healthy tissues — making it ideal for treating diffuse or inoperable tumors, such as brain cancers.
So far, over a thousand patients with brain tumors, head and neck cancers, and melanoma have received BNCT at NTHU in collaboration with Taipei Veterans General Hospital. These patients include hundreds of international cases from the U.S., Australia, Spain, Italy, Switzerland, Japan, Brazil, Singapore, Hong Kong, and China.
Taiwan and Japan remain the only two countries in the world capable of offering BNCT, and NTHU is the only center globally providing BNCT specifically for brain cancer — serving as a final refuge for many terminal brain tumor patients.

BNCT PROCESS
- Application Process for Compassionate Use Therapy / IRB After Physician Approval
- Schedule Axumin PET scan in advance (PET/MR or PET/CT)
- If necessary, create custom molds to immobilize the body part
- If required, undergo photon therapy or chemotherapy (e.g., Avastin) beforehand
- Admit to hospital on the scheduled day and administer boron drug to allow cancer cells to absorb it
- Proceed to the nuclear reactor for BNCT (Boron Neutron Capture Therapy) irradiation
- After irradiation, return to the ward for several sessions of immunotherapy, if needed
- If the effect is insufficient, a second irradiation may be considered