Radiotherapy treatment makes use of high-energy radiation (photons or electrons ) concentrated on the tumour to eliminate the tumour cells while seeking to save as much of the healthy tissue as possible. Special radiotherapy machines known as linear accelerators (LINAC) are used. The purpose of the radiotherapy may be curative, prophylactic or palliative. Radiotherapy may be administered as an exclusive treatment or in combination with surgery and/or chemotherapy. It is described as neoadjuvant when used to reduce the size of the tumour before surgery, adjuvant if administered after surgery, or radical when used as an exclusive therapy.
Constant technological development has allowed radiation therapy to be administered in an ever safer way and with ever greater precision.
Before administration of radiotherapy, CT images are acquired, by means of a Toshiba CT simulator®, or in some cases Magnetic Resonance and PET/CT images, in order to outline the target (tumour) and the organs at risk (tissues to be saved) accurately. At times, as with pulmonary lesions, it is necessary to make use of particular CT images which must be synchronized with breathing, and, in this case, we refer to 4D CT images. 4D CT images allow reconstruction of the entire volume in which the lesion is free to move, with consequently improved accuracy in the assessment of the target volume. On the basis of these images, the radiation oncologists outline the tumour and the organs at risk, and prescribe the dose required to destroy the tumour. The data are then processed by specialists in medical physics using sophisticated software to establish the dose of energy to be administered in order to destroy the tumour and to save the organs at risk, and the plan of care thus obtained is approved jointly by the specialist in medical physics who proposes it and by the patient's radiation therapy consultant. Before the start of treatment, at least two physicists check all parameters relating to the treatment and to the radiotherapy equipment involved so as to eliminate the eventuality of any possible error. The treatment generally lasts between 22 and 35 sessions, that is to say, between 4.5 and 7 weeks.
- Tomoterapia® e True Beam®
Our centre is equipped with two Accuray Tomotherapy® systems and a linear accelerator (TrueBeam® VARIAN) which today, in terms of radiation therapy treatments, the best offer for cancer patients. These systems make possible treatments which were previously impossible, and allow all types of tumour to be treated.
Tomotherapy provides an integrated approach of radiation therapy combined with imaging for daily localization of the target. We can think of it as being like a CT which, as the table moves forward administers IMRT (Intensity Modulated RadioTherapy) treatment. Tomotherapy is the technique of choice for the treatment of very extensive tumours and of multiple tumours located throughout the body.
- Intensity Modulated Radiotherapy - IMRT
Techniques such as IMRT make it possible to programme the three-dimensional dose distribution which is best suited to the shape of the tumour in three dimensions. This type of treatment spares a greater amount of healthy tissue reducing to a minimum the exposure to radiation where the tumour receives the greatest quantity.
- Image Guided Radiotherapy - IGRT
IGRT makes it possible to verify the actual position of the target volume on a daily basis and immediately before administration of the radiations. To this end, tomographic images of the patient in treatment position are acquired directly by LINAC before the beginning of the session. All this makes it possible to irradiate with precision those tumours susceptible to even the slightest of movements, spare the organs at risk and to increase the dose prescribed for the tumour.
With the type of technology present, the Institute's radiotherapy is particularly suited for the treatment of breast cancer, also with the “partial breast” technique, of gynecological tumours (association between IMRT-IGRT and brachytherapy), of the tumours of the prostate, of the tumours of the gastrointestinal tract (rectum, anus, pancreas) and of cervico-facial tumours with IMRT-IGRT modulated intensity techniques (SIB) and lastly of the sarcomas of the soft tissue.
Through this technique the radiation source is placed in direct contact with the tissue to be irradiated. It is a technique which is used for some gynecological tumours, tumours of the skin, of the cervicocephalic area, of the bronchi and the bile ducts. The radioactive source reaches the tumour to be treated through appropriate applicators, the length of time in operation of the radioactive source is calculated with software which estimates the distribution of the dose necessary to ensure the control of the tumour and to reduce, at the same time, any collateral damage to healthy tissue.
- Stereotactic Body Radiation Therapy / Stereotactic Radiation Surgery
SBRT and SRS are innovative radiotherapy techniques which make it possible to administer an elevated dose of ionizing radiation to the target volume with extreme accuracy and precision. Multimodal imaging (PET,MRI,4D CT) is used to localize the tumour with a high degree of precision. SBRT and the SRS are used predominantly to irradiate small (<3cm) lesions of the brain, of the lung, of the bone or of the lymph nodes. The treatment is very short in duration (from one to five sessions).
This technique makes it possible, through the use of microwave beams, to raise the temperature of the tumour up to 40.5/43°, in such a way as to sensitize it to radiotherapy and/or chemotherapy treatment. The Institute is equipped with apparatus capable of enabling treatment of recurrences on the chest wall, on surface lymph nodes and on melanomas / metastatic sarcomas.
- Quality and safety dose
Medical Physics checks daily on the dose administered to the patient during the Tomotherapy and Intensity Modulated Radiation Therapy (VMAT) treatments, in order to ensure maximum quality and safety of radiotherapy care. The systems in place are the first such installed in Italy.