Tumors, new treatment options at Sant’Anna thanks to an accelerator

A new accelerator for the treatment of cancer patients that allows you to reduce treatment time. This is one of the latest innovations arriving in Radiotherapy at the Sant’Anna hospital and, in the coming months, the arrival of other machines is expected. We talked about it with Ernestina Bianchi, manager of the facility.

Thanks to the funding allocated by the Pnrr, a new ‘TrueBeam’ accelerator has been installed for the treatment of cancer patients. The new technology replaced one of the three machines in use which had been installed in 2010. Last May 29th the new accelerator came into full use with the treatment of the first 5 patients. I believe it is also important to underline that, by the end of this year, the new CT dedicated to Radiotherapy should be installed as well as another ‘TrueBeam’ accelerator, with Pnrr financing, which will replace one of the two remaining “Linac Varian”.

It represents a new treatment possibility for cancer patients. It allows you to deliver treatments with targeted and very high doses, in a few seconds, thanks to the Flattening Filter Free technology. It also allows the use of altered fractionations of the dose (hypofractionation) with a consequent increase in the effectiveness of the treatment and, to the benefit of the patient, a reduction in the number of sessions.

It is useful to underline that the optimal positioning of the patient is guaranteed by a robotic bed capable of moving in six dimensions. The accelerator is able to synchronize the treatment with respiratory acts, this is a necessary requirement for treating tumors subject to movement, such as lung cancer or abdominal tumors. Furthermore, the respiratory gating system will also be implemented on the accelerator, a technique used in particular in the treatment of patients operated on for breast cancer, which arose in the left breast, as it allows the dose delivered to the heart to be reduced, with a consequent reduction in the risk of late cardiac toxicity.

Radiotherapy is based on the use of ionizing radiation: X-ray photons.

Radiotherapy is used for the treatment of oncology patients and is indicated as a curative treatment, associated or not with chemotherapy, but also as an adjuvant and therefore following surgical treatment, or palliative/symptomatic. In this last case, radiotherapy is performed to control a symptom such as pain, bleeding or breathing difficulty, or, performed in the case of advanced tumors to contain the evolution of the tumor and improve the patient’s quality of life.

When we talk about radiotherapy, we generally refer to transcutaneous radiotherapy or external beams, as the source of the beam is positioned outside the body. This differs from brachytherapy where the radiation source is in contact with or very close to the tumor being treated. What characterizes an external beam radiotherapy treatment is the type of technique used. Currently the most used treatment techniques in our division are the volumetric technique (Rapid Arc), the intensity modulated technique (Imrt) and thanks to the Rapid Arc technique we can perform stereotactic treatments.

External beam radiotherapy is a painless treatment. The patient, thanks to the use of dedicated restraint systems, lies on the treatment table (similar to the CT table) in a supine position and the accelerator head rotates around him with the emission of a radiation beam which is Invisible.

Side effects resulting from radiotherapy treatment vary depending on the irradiated area and are generally localized and limited to the irradiated site. In the case of irradiation for prostate cancer, for example, the patient may experience symptoms such as cystitis, rectal tenesmus or perianal skin erythema.

The indication for treatment is given after a multidisciplinary evaluation only for patients who turn to our facility for diagnosis and treatment. For several years, depending on the type of tumor, “ad hoc” multidisciplinary discussions have been organized. On Mondays, for example, the cases of patients diagnosed with lung, brain and cervico-cephalic neoplasia are discussed, on Tuesday the cases of patients operated on for breast cancer are discussed, on Wednesday the cases of patients diagnosed of neoplasia of the genitourinary tract such as prostate or bladder cancer. Finally, on Thursday, the cases of patients diagnosed with neoplasia in the gynecological and gastroenterological area are discussed. It is therefore clear that the specialist figures involved are different. To name a few, the radiotherapist, the oncologist, the radiologist, the anatomic pathologist, the surgeon, the geneticist. Obviously the specialists change, during the various discussions, depending on the district involved.

Yes. Our division, having always been a cutting-edge centre, also recruits patients who have turned to other hospital facilities for diagnosis and treatment and who, for logistical reasons, prefer to carry out radiotherapy treatment near their home. In these cases the patient accesses our department by booking the first visit.

Radiotherapy treatment is always performed on an outpatient basis, except in the case of hospitalized patients who require symptomatic or palliative treatment. Based on the intent of the treatment, which can be, as mentioned, curative, adjuvant or palliative, and the type of tumor, the total dose to be delivered and the number of sessions varies. However, there are national and international guidelines that define the doses and volumes to be irradiated based on the type of tumor and to which we always refer.

Yes, in some cases radiotherapy represents the first choice treatment option. This occurs for locally advanced cervical cancers, some tumors of the cervical and cephalic area (nasopharynx, oropharynx, larynx, hypopharynx), lung tumors, prostate tumors and anal canal tumors.

We expect the possibility of carrying out increasingly targeted treatments with a lower number of sessions and less toxicity.