Radiotherapy at the Casa di Cura San Rossore has:

• Computed tomography (Siemens Open Sensation CT), 64 multislice, entirely dedicated to radiation therapy
• TrueBeam STx linear accelerator (see photo gallery above) from Varian Medical System, equipped with an integrated “cone beam CT” device that allows to perform, prior to treatment, a radiological evaluation thanks to which it is possible to monitor the real position of the tumor target and critical organs, correct any positioning errors, and evaluate any displacements even millimeters of the tumor target due to the often non-eliminable movement of internal organs ( organ motion ) and thus irradiate with greater precision.

The TrueBeam STx also has a micro-multilamellar system that allows for high-precision cranial and extracranial stereotactic treatments and, thanks to the machine’s ability to deliver X-radiation even in the FFF (Flattening Filter Free) mode, to decrease the time of dose delivery and thus of the treatment itself

RADICAL-CURATIVE:

• As an exclusive therapy:
  • treatments with conventional fractionations
  • hypofractionated treatments i.e., the ability to deliver high doses with the same or higher therapeutic efficacy thus reducing the overall duration of treatments compared to more traditional schemes
• As combination radiotherapy, integrated in various modalities with surgery (preoperative, intraoperative, postoperative) or in combination with chemotherapy (neoadjuvant, concomitant, sequential), or in combination with hormone therapy or immunotherapy

PALLIATIVE-SYMPTOMATIC:To decrease and/or eliminate symptoms due to neoplastic disease such as pain , compressive syndromes (e.g. mediastinal syndrome, spinal cord compression, etc..) or rarely otherwise uncontrollable bleeding, and/or combined with other therapeutic weapons.

RADIOTHERAPY OF BENEFICIAL LESIONS:For example, pituitary adenomas, meningiomas, arteriovenous malformations (AVMs), Basedow’s disease, keloids, aneurysmal cysts, cranial nerve pathologies (e.g. trigeminal), vascular pathologies.

Clinical evaluation Oncology:

The first contact between the patient and the Center occurs with the first visit to the Radiotherapy Department (“Radiotherapy Oncology Consultation”). During the consultation, the radiation oncology oncologist collects all information, through medical records, about the patient’s current and remote health status to determine the nature and extent of the disease thus proceeding to multidisciplinary consultations.

Once the clinical issue is identified, the radiation oncologist analyzes the possibility of radiation treatment, choosing the most suitable delivery modality for the individual patient, in consultation with colleagues in Medical Physics.

Centering TC:

Upon accepting the patient for radiation therapy, the Radiation Oncologist and the Medical Radiology Health Technician (TSRM) perform a centering CT scan by defining the patient’s position on the couch and determining the type of immobilization system best suited for the type of therapy to be delivered.

Contornation:

Next, the radiation oncologist identifies the sensitive structures to be contoured on the centering CT scan. To do this it also uses information from other diagnostic investigations such as MRI and PET. Thanks to modern software in the Center, the radiation oncologist has the ability to “fuse” all the patient’s diagnostic images, managing to pinpoint with millimeter precision the region to be irradiated.

Development of the treatment plan:

The Medical Physicist prepares the Treatment Plan by optimizing the dose in the target volume while trying to spare the healthy organs surrounding the disease as much as possible. Each patient will therefore have a Care Plan that is strictly individualized, and suitable for achieving the most accurate dose distribution; consequently it will be different from that of any other patient. After the planning is finished, the Medical Physicist presents the plan to the Radiation Oncologist, which will be analyzed, discussed, possibly modified, and accepted.

Before being dispensed on the patient, the Plan is verified on the ArcCheck dummy (for verification of rotational treatments) by evaluating its correct dose delivery (step in the overall Quality Control pathway)

Verification of positioning and treatment:

To carry out the treatment session, the patient is introduced inside the room (Bunker) where the linear accelerator is housed and is made to lie on the treatment couch. A CT scan is taken of the region to be irradiated before radiation is delivered and compared with the centering CT scan. With this procedure, it is possible to position the patient with millimeter precision.

The patient inside the therapy room is constantly monitored by the TSRM through a closed-circuit video system. In addition, an intercom system via intercom allows the patient to communicate with the technician. Throughout the radiotherapy treatment, the Patient will undergo follow-up visits during which any supportive therapy will be prescribed. Periodic follow-up visits are carried out after the conclusion of treatment.

Radiation treatment is performed either on an outpatient basis or on an inpatient or day-hospital basis for special clinical cases or for ‘performing combination therapies ( e.g., chemotherapy, nutrition, supportive medical therapy). Admission to ward or dedicated housing is also possible for special logistical situations (Click here to browse our solutions for your stay)

Radiation Therapy collaborates both within the Casa di Cura within dedicated Multidisciplinary Groups and with the various specialists at other National Centers for the discussion of the most complex clinical cases to ensure that each patient receives the proper integration and personalization of planned treatments based on international protocols and guidelines interior adapted to the clinical situation of each individual patient.

The Physician verifies and evaluates all the parameters of your treatment plan, verifies every radiological image performed before and during treatment including by Cone Beam verifications at the time of treatment for correctness of therapy; performs intercura

The medical physicist:

It ensures through periodic checks that the characteristics of the equipment are within the tolerance levels chosen to ensure the optimal performance of treatments. It ensures the treatment pathway: from the preparation of the treatment plan, to its approval following discussion with the physician, from the transfer of the plan to the treatment machine through the Record and Verify (ARIA) system that allows the identification of the patient, the correct association of his or her treatment plan and the recording of the dose delivered to each fraction, to the verification before the start of the treatment of the correct delivery of the plan by the equipment and also supervises with other working figures (physicians and technicians) during treatments with respiratory gating.

The TSRM health technician:

Works according to the instructions of the radiation oncologist at the various stages of the radiation therapy procedure: performs patient set up, if necessary using positioning and immobilization systems; during the simulation phase of the treatment, acquires the images necessary for the production of the treatment plan and prepares the accessories necessary for its implementation (shielding, etc.); performs the radiation treatment according to the indications of the plan prepared and approved by the physicist and physician and is responsible for the correct application of the plan itself; acquires the images produced with IGRT technology and assists the radiation oncologist in the “on line” control for the correction of the set up. Prior to the start of treatment carry out the check together with the physicist of the correct delivery of the plan by the machine.