From Source to Target: The Neutron Pathway for the Clinical Translation of Boron Neutron Capture

Boron Neutron Capture Therapy (BNCT) is a radiotherapeutic modality which couples selective pharmacological delivery of 10B with irradiation by low-energy neutrons to achieve highly localized tumor cell killing. The BNCT therapeutic approach is undergoing rapid evolution driven primarily by advances in compact accelerator-driven neutron-source and associated facility-level nuclear infrastructure. This review examines the key physical and radiobiological principles of BNCT, with emphasis on the current engineering and operational aspects, such as neutron production and moderation, spectral shaping, beam optimization and dosimetric quantification, that critically influence clinical translation. Recent progress in 10B production and enrichment, as well as in strategies for efficient 10B delivery, is also briefly addressed. By tracing the pathway from neutron source to clinical target, this review defines the state of the art in BNCT technology, identifies the main physical and infrastructural challenges, and delineates the multidisciplinary advances needed to support widespread clinical implementation of next-generation BNCT systems.