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THE RAY OF HOPE
Finally the New Technology Curing Cancer

What is Hadron Therapy and how does it work?

The therapy  used is called hadron therapy, and it has an accuracy of two-tenths of a  millimeter.
In this way, the therapy focuses ONLY on the tissue affected by cancer and reduces it, session after session, until healed.
The technology that enables this short and focused treatment is called Synchrotron.  Synchrotron is an innovative tool to treat those tumors which are  resistant to conventional radiotherapy and is partly created in Italy.
The project comes from studies made by the CERN, in Geneva, and by the National Institute of Nuclear Physics, in which Italian scientists and researchers took part with great commitment and success.
Your specific  case will be analysed by specialist doctors. As the first thing, the  body is immobilized before getting treated. The therapy is made of a  variable amount of sessions, from 10 to 20, and each session lasts from 5 to 15 minutes.


Rapid technological progress in recent years has led to an evolution in all areas of medicine and has significantly influenced radiation oncology. Today, a new frontier in radiation therapy is represented by the hadrontherapy, which is the use of protons and atomic nuclei (ions) called hadrons (from the Greek hadrós, strong) that are subjected to a strong nuclear force.
The advantages of hadrontherapy compared to traditional radiotherapy are:
  1. The release of energy (and thus the destruction of cells) is done selectively, targeting only cancer cells. The damage incurred in the body on initial penetration is relatively small and  significant release of energy is confined only to the vicinity where  the cancer is located (a phenomenon referred to as the Bragg Peak). This maximizes the destruction of cancerous tissues while minimizing collateral effects on healthy tissues
  2. The beam of hadronic particles remains collimated as it penetrates the biological material. The high collimation of the beams of hadrons further minimizes damage to healthy tissues
  3. The energy release mechanism for hadrontherapy causes a large amount of breaks on the chemical links present in biological macromolecules, especially DNA. The latter has the ability to repair itself,  but if the number of broken links is excesive it loses its function of  self-reparation and the cells remain inactive and die. In conventional  radiotherapy the DNA damage is modest; on the contrary, in the hadrontherapy with carbon ions the number of breaks allows the destruction even of tumors resistant to conventional therapy.
Together these three benefits result in a significant destructive effect on biological tissues, for which reason the target (tumor) must be positioned  with a degree of  accuracy which is much greater than that associated with conventional radiotherapy.

Effective application of hadrontherapy requires the following:
  • a proton and / or ion accelerator (such as the circular accelerator or synchrotron) producing a number of particle beams
  • a system for transporting the beam in the treatment room
  • a procedure for precisely positioning the patient for treatment
  • complete control of the energy to be released i.e. the dose
  • a three-dimensional customized patient treatment system obtained by integrating diagnostic imaging results (CT, MRI, PET).
It is important to note that since hadrontherapy is a relatively recent addition to the modern oncological treatment panorama, a number of indications are still in the experimental stage.
The National Centre of Oncological Hadrontherapy (CNAO), located in Pavia, is the first Centre of Hadrontherapy in Italy provided with a beam able to irradiate patients with protons or carbon ions for the treatment of radioresistant tumors.


The Synchrotron: what it is and how it works

CNAO’s ‘High Technology’ components consist of a set of accelerators and transport lines of particle beams. The beams are generated by sources that produce carbon ions and protons. The most important accelerator machine is the Synchrotron. The synchrotron at CNAO is  a prototype resulting from the research in high energy physics made  possible through the collaboration of the Istituto Nazionale di Fisica  Nucleare (INFN), CERN(Switzerland), GSI (Germany), LPSC (France) and of the University of Pavia University (Italy). It is based mostly on Italian technology.
The synchrotron is a “donut” 80 meters long  with a diameter of 25 meters. In two areas inside the circumference the  beams of particles are created in devices called “sources”, which contain plasma formed by the gas atoms that have lost their electrons. Using magnetic fields and radio frequency pulses, these atoms are extracted and the protons and carbon ions are selected. In this way “packages” composed of beams -each one containing billions of particles- are formed.

These packages are pre- accelerated and sent to the  synchrotron where, initially, they travel at about 30,000 kilometers per  second. Subsequently they are accelerated to kinetic energies of 250 MeV for protons and 480 MeV for carbon ions (the MeV, equivalent to one million electron volts, is the unit of energy used in nuclear and atomic scale phenomena).
The particle beam is accelerated in the synchrotron and travels about  30,000 kilometers in a half second to reach the desired energy. The  beams are then sent to one of the three treatment rooms. Above this  station there is a magnet of 150 tons which bends 90 degrees the  particle beam and directs it from above to the person to be healed.
The beam that strikes the cells of the tumor is like a “brush” that moves in a manner similar to that of electrons in a TV and acts with a precision of 200 micrometers (two tenths of a millimeter).
This accuracy is achieved by means of:
  • Constant monitoring of the patient to follow any movements of the body (breathing, for example) that can change the location of the tumor, using infrared cameras to measure movement in a three-dimensional way
  • Two scanning magnets that, based on feedback of the beam monitoring system, move the “brush” along the outline of the tumor
In this way, section by section, the tumor is destroyed.  The transition from one section to another deeper section is achieved  by increasing the beam energy. The entire radiation lasts a few minutes.


HADRONTHERAPY INDICATIONS

Hadrontherapy is an advanced form of radiotherapy. Radiation  therapy alone, or combined with surgery and/or chemotherapy, improves  local control in different tumors.  In addition, the non-invasive nature  of radiation therapy represents a suitable alternative to surgery for  those tumors located in anatomical locations complicated by vital organs  or in sites where tumor removal would be too debilitating for the  patient. Today, about 50% of patients with cancer are undergoing  radiation therapy. Hadrontherapy is not a substitute for conventional  radiotherapy, but arises as an ideal technique for those cancers where  conventional radiotherapy does not provide significant advantages in  particular for “radio-resistant” tumors and for those located close to  organs at risk. “Radio-resistant” tumors are those  which, because of their biological behavior, are less likely to be cured  by conventional radiotherapy. Tumors located in the vicinity of  organs deemed “critical” or “at risk”,  often cannot be irradiated by doses high enough to be effective,  because it could harm healthy organs. The possibility of cure depends  not only on factors related to the tumor itself, such as its  radio-sensitivity and anatomic location, but also on factors related to  the radiation treatment, such as the total dose delivered and the  precision of the technique employed in irradiating the site  of the  disease. These “limits” can be overcome by hadrons (specifically protons  and carbon ions) due to their different physical nature compared to  X-rays used in conventional radiotherapy. The intrinsic physical  properties of these particles allow us to conform the dose “around the  tumor” with greater accuracy, while saving the surrounding healthy  tissue. With carbon ions in particular, one has the advantage of  inducing more damage to the tumor “overcoming” its intrinsic  radio-resistance.

The clinical use of these particles, especially that of carbon ions,  has been limited up to now due to the limited availability of this  therapy worldwide. However, initial clinical experiences have  demonstrated their therapeutic advantage in many cases and the  longer-term results continue to be encouraging .

Clinical trials have increased in recent years, and are aimed at  expanding the indications to include other anatomical sites. Here, it  should be noted that studies have shown that the results obtained with  hadrontherapy are as good as or better than those obtained with  conventional radiotherapy .

However, to estimate the real clinical benefits of hadrontherapy a  representative number of treated patients should be carefully followed  up for a long period of time.  Those indications in which the advantage  has been demonstrated are known as “consolidated indications”.  There are other cases where there have been promising results, but on  too few patients for a limited number of years for definite conclusions  to be reached. Thus, while there is a substantial amount of theoretical  evidence to support the efficacy of hadrontherapy in these cases, there  is a need for more empirical data from larger studies over a longer  period of time to confirm this evidence. These are potential  indications.In any case, only after assessment of individual cases by  medical specialists can one establish the best therapeutic approach and,  eventually, confirm the need for hadrontherapy treatment.

Currently, scientific literature has documented the following  consistent results for some cancers that have been treated for a long  time with protons and carbon ions.

Chordoma and chondrosarcomahave traditionally been  considered an indication for proton therapy. Their characteristic  anatomical location of onset, the base of the skull and spine, the  difficulties of treatment with surgery or radiotherapy and the local  growing trend rather than distant metastases provide the scientific  rationale for believing that an increase of local control can result in  increased survival and thus justify the use of sophisticated techniques  of radiotherapy. The results so far obtained and published in the  literature show that radiation therapy with protons could constitute the  standard treatment after surgery for these tumors. Results obtained so  far indicate that radiotherapy with carbon ions is equally safe and  could produce superior results over those obtained with protons. The  rationale for the use of hadrontherapy in the treatment of  atypical meningioma, malignant or recurrent meningioma is  mainly based on its high spatial selectivity. The frequent place of  occurrence of meningioma is at the base of the skull, in close proximity  to structures like the optic tract and the brainstem (vital organ)  makes it improbable, in most cases, for successful surgery. The presence  of any residual tumor after surgery amply justifies the use of this  technique.

Radiotherapy with protons for the treatment ofuveal melanomais  now an established alternative to radical surgical treatment requiring  enucleating the eye. Introduced in 1975, the proton therapy has gained  wide acceptance in the scientific community because it has been shown  that disease-free survival and overall survival results obtained with  protons are similar to those obtained by enucleation. Local control with  organ preservation is the most important goal of treatment with  protons.

Sarcomas of the bone tissue in difficult locations  such as the spine, pelvis and the skull  where the presence of the  spinal cord, internal organs and brain, respectively, fully justify the  use of proton therapy and carbon ion therapy given the well-known radio  resistance of this type of cancer. In the same way, carbon ions are the  ideal tool for the treatment of retroperitoneal soft tissue sarcoma,  inoperable or not radically operated, or recurrences. Salivary glands tumors are  radio-resistant and the treatment of choice is surgery, usually  combined with radiotherapy in cases of incomplete resection, advanced or  high grade tumors. Although this therapeutic approach has improved the  results in terms of local control compared with surgery alone, this is  still not optimal. The radio resistance of these tumors has led to the  use of neutrons due to their superior radiobiological properties  suitable to overcome their radio-resistance. Unfortunately, in spite of  the therapeutic success in terms of disease control, data from studies  using neutrons, showed significant toxicity. Carbon ions, thanks to  their intrinsic radiobiological properties that reduce tumor  radio-resistance without significant side effects, have shown better  results.

Radiotherapy with protons has aroused great interest for its possible use in pediatric therapy.  In recent decades, thanks to the improved effectiveness of new  treatment protocols, there is a significant increase in survival rates,  which at the same time, allow for assessment of the extent of late side  effects related to radiation treatment. Endocrine and neurosensory  deficits, growth retardation, malformations and other side effects that  occur close to or later after the end of the therapy have been well  studied. Numerous pre-clinical dosimetry studies have revealed  appreciable reduction of irradiation to healthy tissues from treatment  plans carried out with protons compared to those made by X-ray Another  important finding observed with the use of protons is the drastic  decrease of the integral dose, i.e. the total amount of energy  administered to the patient during irradiation, leading to increased  risk of second cancer (carcinogenic effect). These “savings” of  radiation are of substantial importance in children whose tissues, still  immature, are much more susceptible to the harmful effects of  radiation.

The head and neck cancersare the subject of  considerable interest. The potential benefit of hadrontherapy in the  treatment of these tumors derives from where they occur. They often  arise at or close to the base of the skull, surrounded by healthy vital  organs such as: the spinal cord, brainstem, temporal lobes of the brain,  auditory and optical pathways and pituitary gland. The location close  to these important organs makes it impossible for the administration of  the high radiation doses necessary to eradicate the disease.  Pre-clinical and clinical studies suggest a potential benefit of  treating those tumors characterized by low radio sensitivity and  critical location with hadrontherapy. Paranasal sinuses and adenoid cystic carcinoma, some selected tumors of the nasopharynx and bone and soft tissue sarcomas are  being studied. In the case of sarcomas of the head and neck, the use of  hadrontherapy is justified for those situations in which photons  therapy is unable to obtain adequate dose distributions. The use of  carbon ions is also reserved for cases with macroscopic disease in this  location.


What cancers we can cure?

Advanced Therapies that allow you to treat the most difficult cancers exist. Here is a list of curable cancers:

  • Chordoma and chondrosarcoma
  • Atypical meningioma
  • Malignant or recurrent meningioma
  • Uveal melanoma
  • Sarcomas of the bone tissue
  • Salivary glands tumors
  • Pediatric therapy
  • The head and neck cancers
  • Paranasal sinuses
  • Adenoid cystic carcinoma
  • Some selected tumors of the
  • nasopharynx
  • Bone and soft tissue sarcomas

Medical Staff


Prof. Dr. Francesca Valvo
Scientist , Hadrontherapy Scientific Director
Medical Director of National Center of
Oncological Hadrontherapy
(CNAO)
The clinical-therapeutic pathway
AT CNAO the reception and treatment processes come after the  selection of the clinical case following the first consultation or a  multidisciplinary evaluation.

The first time the patient arrives at CNAO corresponds to the start  of the reception process. Afterwards, the therapeutic pathway is  settled, so that the treatment plan is the best one in all respects.

The steps to be performed before the treatment itself are the following:
-together with the radiation oncologist, identification of the correct patient positioning and of the corresponding devices
-realization of the immobilization devices
-planning of the exams (CT - MR - CT/PET)
-contouring of the target volumes and of the organs at risk
-treatment plan preparation and optimization
-validation of the treatment plan by the radiation oncologist and the medical physicist
-quality assurance of the single treatment plan
-treatment


Come to Italy to get healed
Synchrotron is an advanced machinery and there are only four prototypes in the world.
This is because the medical specialization and the required techniques are very high, and the machineries and technologies are very expensive.
It is not available in America, because it’s based on Italian and European researches:
Italy is the place to treat cancer.

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