The global landscape of particle beam radiotherapy trials over the past 15 years.

In stark contrast, the index for carbon ion therapy trials has remained low and has not shown a significant trend over time, quantitatively confirming its continued concentration within specific geographic areas—primarily Asia—and a lack of global dispersal [ Supplementary Figure 1 ].

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This evolving geographic pattern is further quantitatively supported by temporal trends in the Shannon index: For proton therapy trials, the index gradually increased, indicating a positive trend toward greater global diversity and a more even distribution across continents.

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