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New Technology Is Making a Difference in the Fight Against Cancer

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.


Synchrotron and hadrontherapy are ideally suited to treat tumours that are deep-seated, located close to critical organs and respond poorly to conventional photon or electron radiotherapy.
  • cancer of the prostate and rectum (pelvic district)
  • pancreatic cancer
  • melanoma of the rectum and vagina
  • abdominal area - cancer of the liver and bile
  • brain cancer
  • cranial base cancer
  • central nervous system
  • lung cancer
  • tumors of epithelial origin
  • eyeball and eye socket
  • head and neck
  • paranasal sinuses and nasal cavities
  • salivary glands
  • bone and soft tissue

    Facility Spot on

    The history of the National Centre for Oncological Hadrontherapy (CNAO) began with the publication in May 1991, of a report entitled “For a Centre of Teletherapy with hadrons” by Ugo Amaldi and Giampiero Tosi. Tosi was a well-known Italian medical physicist and the director of the Health Physics of the Niguarda Hospital (Milan, Italy). Ugo Amaldi, a particle accelerator physicist, was a former member of the ’Istituto Superiore di Sanità, and was then at CERN in Geneva where he directed the collaboration of about five hundred physicists for the creation and use of one of the four main LEP accelerator experiments.

    How does it work?

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    Action 3

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    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.


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