Fig. 1

Illustration of the overall schema of the Phase III of the current trial. In the Phase III, the GBM patients will be randomized to receive either a a CIRT boost followed by standard PRT with concurrent TMZ (experimental arm) or b standard PRT with concurrent TMZ (control arm). Each patient will undergo an assessment of their tumor response based on imaging and immunologic serum studies. *Multi-modal MRI includes MRS, BOLD, DWI, DTI, PWI, and MRI. GBM glioblastoma, CIRT carbon ion radiotherapy, PRT proton radiotherapy, TMZ temozolomide, RT radiotherapy, MET/FET PET C-methionine positron/18F-fluoro-ethyl-tyrosine positron emission tomography, MRI magnetic resonance imaging, MRS magnetic resonance spectroscopy, BOLD blood oxygenation level-dependent imaging, DWI diffusion-weighted imaging, PWI perfusion-weighted imaging