Hadron Therapy Achievements and Challenges: The CNAO Experience

Abstract

Protons and carbon ions (hadrons) have useful properties for the treatments of patients affected by oncological pathologies. They are more precise than conventional X-rays and possess radiobiological characteristics suited for treating radio-resistant or inoperable tumours. This paper gives an overview of the status of hadron therapy around the world. It focusses on the Italian National Centre for Oncological Hadron therapy (CNAO), introducing operation procedures, system performance, expansion projects, methodologies and modelling to build individualized treatments. There is growing evidence that supports safety and effectiveness of hadron therapy for a variety of clinical situations. However, there is still a lack of high-level evidence directly comparing hadron therapy with modern conventional radiotherapy techniques. The results give an overview of pre-clinical and clinical research studies and of the treatments of 3700 patients performed at CNAO. The success and development of hadron therapy is strongly associated with the creation of networks among hadron therapy facilities, clinics, universities and research institutions. These networks guarantee the growth of cultural knowledge on hadron therapy, favour the efficient recruitment of patients and present available competences for R&D (Research and Development) programmes.

Is motherhood still possible after pelvic carbon ion radiotherapy? A promising combined fertility-preservation approach

“…To avoid the risk of POF, an ovarian transposition was suggested to the patient. However, the only possible geometry for treatment according to the fixed beamlines available at CNAO 24 would require a posterior and two lateral fields of carbon ions. Then, the only safe and untraditional place to dislocate would be the anterior abdominal wall.…”

The rationale for a carbon ion radiation therapy facility in Australia

“…19,28 The heavier the ion, the larger is the total energy, requiring larger accelerators and bending magnet systems along the beam transport lines, mandating larger footprint facilities of greater cost. All current clinical CIRT facilities use synchrotrons, with large circular accelerator diameters, for example, 25 m for the similarly designed Italian or Austrian 400 MeV/u facilities 38,39 (Fig. 2).…”

“…Various recent (2020-2023) reviews and other publications consider clinical applications, experience, trials and outcomes for CIRT, some overviewing most or all sites with varying levels of detail 3,4,27,36,38,42,62,[100][101][102] and others discussing single applications only. [103][104][105][106][107][108][109] In 2022, Pompos et al 36 succinctly summarised the clinical indications as: radiation resistant malignancies, such as ACC, mucosal melanoma, NSCLC, liver cancer, bone and soft tissue sarcoma; recurrent previously irradiated cancers (especially rectal cancer), advanced gynaecological malignancies, oesophageal cancer, pancreatic cancer and hypoxic malignancies.…”

“…The clinical efficacy of CIRT has been demonstrated for many tumours, both for toxicity reduction and for improved local control and survival. 3,4,27,38,42,62,[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] However, all discussion recognises that direct high-level clinical evidence for CIRT benefit is limited, 117 since most clinical CIRT investigations are retrospective single arm studies. This is similar in principle to many PBT applications, although PBT phase III trial numbers are increasing.…”

“…Continuous improvements in design, construction and capability of accelerators and other PT technology promise to decrease the size and capital cost of facilities. 22,27,[36][37][38][144][145][146][147][148] Figure 5a illustrates the layout of the MedAustron hybrid (CIRT and PBT) particle therapy facility. 149 For accelerator, beam lines, three treatment rooms and a research room, its footprint is approximately 50 m 9 140 m, a similar area for these components to the original multi-ion NIRS clinical facility with the same number of rooms.…”