Radiotherapy and Tomotherapy

The Radiotherapy Department of Ospedale San Raffaele has been operating within the Oncology Department since the late ’70s. The Radiotherapy and Tomotherapy has been an independent Unit since 2003, owing to the impressive refinements that have occurred both in oncology and radiotherapy.

Tipically, the majority (roughly 85-90%) of the clinical actvity is devoted to outpatients 2,000 new patients/ Year. There are many clinicians working in the department each of whom is involved in a specific pathological area. This implies weekly meetings of our clinicians with the surgeons, oncologists ,pathologists, radiologist working on each specific disease, in order to give the patients the best integrated treatment options. Most of the clinicians are involved in peer review activity for the best scientific Journals in the field of Radiation Therapy.

Main conditions treated

Our Radiotherapy and Tomotherapy Department has several facilities to meet patient needs and the demands of any oncology clinician. The High Technology currently available allows us to treat tumors of all sizes, regardless of their location in the body. Most of our patients are affected by neoplasms in the following districts:

  • prostatic
  • breast
  • lung
  • gynecologic
  • head and neck
  • colorectal
  • pancreatic
  • hematologic
  • central nervous system

Before treatment, most of the patients are submitted to a simulation CT scan on a dedicated machine, 60% of the patients received also an MRI evaluation (Prostate, Colorectal, Head and Neck, Brain and Gynaecological pts) and 50% Pet/Tc simulation.

Research

Currently four out five Senior assistants (Cesare Cozzarini, Paolo Passoni, Fodor Andrei and Italo Dell’Oca) are actively involved in clinical research. Their activity is supervised by the Director, Dr. Nadia Di Muzio

The Department is involved in a variety of studies.

  1. Feasibility of ultra-high dose escalation by Helical Tomotherapy on dominant intra-prostatic lesions (DILs) identified by means of MRI.
  2. TOMOSIB study (radical treatment of clinically localized prostate cancer by means of hypofractionated Tomotherapy delivering concomitant boosts on different tumoral volumes.
  3. Feasibility and safety of PET-guided, moderately hypofractionated Tomotherapy on lymph-nodal metastases from prostate cancer.
  4. Coordination of study DUE-01 (Disfunzione Urinaria Erettile) : multi-Institute, prospectic, observational analysis aimed at investigating possible relationships between clinical and physico-dosimetric variables and risk of urinary toxicity and erectile disfunction following radical radiotherapy for the treatment of clinically localized prostate carcinoma.
  5. Hypofractionated Tomotherapy concomitant to 5-fluororacil based chemotherapy in the treatment of clinically localized, non surgically resectable, pancreatic cancer. Phase I-II study of dose escalation (from 48 Gy to the Maximum Tolerated Dose – MTD) to the tumoral subvolume surrounding mesenteric vessels, while concomitantly delivering a fixed RT dose of 44.25 Gy to the remaining pancreatic tumor.
  6. Investigating the role of CT/PET in defining pancreatic tumor in patients whose breath is monitored during radiotherapy (gated radiotherapy).
  7. Radiochemotherapy with hypofractionated Tomotherapy and concomitant systemic chemotherapy with oxaliplatin + 5-FU (continous infusion) as neoadjuvant (pre-surgical) treatment of stage T3 N0, T3 N1 rectal adenocarcinoma.
  8. Radiochemotherapy with hypofractionated Tomotherapy and concomitant chemotherapy: feasibility of an “adaptive” approach based on Tomotherapy re-planning after the first 10 fractions and delivery of a radiotherapy boost (2.9 Gy x 5 fracion) on residual tumor subvolume.
  9. Evaluation of pulmonary perfusion by means of SPECT/CT aimed at reducing radio-induced pulmonary toxity.
  10. Evaluation of the use of IMRT-SIB (Intensity Modulated Radiation Therapy – Simultaneous Integradet Boost) technique in association with systemic chemotherapy in the radical and postoperative treatment of locally advanced, non metastatic, Head and Neck neoplasms.
  11. Evaluation of different imaging modalities, such as MRI, PET, to individuate possibly radioresistant tumoral subvolumes to be included in future studies of SIB dose escalation.
  12. Evaluation of parameters predicting major volumetric changes of salivary glands during radiation treatment of cervico facial neoplasms.

Technology

Available technology: The machines available in our Department are

  • 3 Helical Tomotherapy (one of these is the TomoTherapy® H™ Series, of which there are only two in Europe, one being installed in our centre.)
  • 2 Varian Linacs (one of which able to deliver dual energy, 6 and 18 MeV, and one Rapid Arc equipped with multileaf collimator (MLC),

The TomoTherapy® System is a premiere, comprehensive solution that is capable of treating all standard radiation therapy indications, in addition to complex cases. It is the only radiation system specifically designed for integrated, 3D image-guided, intensity modulated radiation therapy (IG-IMRT) and 3DCRT (3D conformal radiation therapy). Based on a CT scanner platform, the TomoTherapy System enables helical dose delivery through continuous 360 degree gantry rotations, or delivery from user-specified beam angles. These unique features, combined with daily 3D image guidance, allow you to apply highly conformal, individualized dose distributions to any target volume, at its true location, during each treatment fraction. The TomoTherapy® System design combines CT imaging with a radiation treatment delivery system. With this unique design, the TomoTherapy System enables efficient daily 3D CT imaging to ensure the accuracy of the patient position before each treatment delivery and leverages the ring geometry to then deliver state-of-the-art radiation treatments, including intensity-modulated radiation therapy (IMRT) and 3D conformal radiation therapy (3DCRT). Radiation delivered by the TomoTherapy System is aided by its sophisticated multi-leaf collimator (MLC), a patented device that opens and closes quickly to permit, or block, the passage of radiation, dividing the radiation beams into many smaller beamslets. The patterns of movement is precisely calculated before treatment begins, so the intensity of the radiation beam delivered conforms to the patient’s tumor and helps avoid critical structures as the machine rotates 360 degrees around the patient. Created to make personalized treatments an option for radiation therapy, the TomoTherapy® H™ Series offers interactive planning and efficient delivery of highly sculpted doses for personalized and consistent treatments. Seamless daily CT image guidance enables precise patient positioning, margin reduction, adaptive planning and pinpoint dose accuracy for every radiation therapy patient.

RapidArc® radiotherapy technology is a major advance from Varian Medical Systems that improves dose conformity while significantly shortening treatment times. RapidArc delivers treatments two to eight times faster than our fastest dynamic treatments today and increases precision – a winning combination that enables physicians to improve the standard of care and treat more patients.

RapidArc is a volumetric arc therapy that delivers a precisely sculpted 3D dose distribution with a single 360-degree rotation of the linear accelerator gantry. It is made possible by a treatment planning algorithm that simultaneously changes three parameters during treatment:

  • rotation speed of the gantry
  • shape of the treatment aperture using the movement of multileaf collimator leaves
  • delivery dose rate.

Volumetric modulated arc therapy differs from existing techniques like helical IMRT or intensity-modulated arc therapy (IMAT) because it delivers dose to the whole volume, rather than slice by slice. And the treatment planning algorithm ensures the treatment precision, helping to spare normal healthy tissue.

Staff

Organization: the staff is composed by the Director Dr. Nadia Di Muzio, six senior assistant and four young, but already specialized, Radiation Oncologist.