The clinical-therapeutic pathway
AT CNAO the reception and treatment processes come after the selection of the clinical case following the first consultation or a multidisciplinary evaluation.
The first time the patient arrives at CNAO corresponds to the start of the reception process. Afterwards, the therapeutic pathway is settled, so that the treatment plan is the best one in all respects.
The steps to be performed before the treatment itself are the following:
-together with the radiation oncologist, identification of the correct patient positioning and of the corresponding devices
-realization of the immobilization devices
-planning of the exams (CT - MR - CT/PET)
-contouring of the target volumes and of the organs at risk
-treatment plan preparation and optimization
-validation of the treatment plan by the radiation oncologist and the medical physicist
-quality assurance of the single treatment plan
Description of treatment
Once the possibility of treatment with hadrons is established, the patient follows a process that does not differ substantially from that of radiation therapy treatment with photons.
The patient undergoes a clinical evaluation by the radiation specialist at the CNAO Foundation, which includes the collection of all information relating to the patient and his/her condition and a complete physical examination.
Once the possibility of treatment with hadrons is established, the patient follows a process that does not differ substantially from that of radiation treatment with photons. The patient undergoes a clinical evaluation by the radiation specialist at the CNAO Foundation, which includes the gathering of all information relating to the patient and his/her condition and a complete physical examination.
The histological and any other diagnostic tests performed by the patient in another facility will be collected and retained by the radiotherapist for a period of time necessary to study and discuss the case. Further exams required for the correct evaluation and discussion of the case will be requested.
When the indication for treatment is established by a multidisciplinary meeting, a custom-made immobilization device for high precision positioning during therapy sessions with heavy particles will be prepared.
Before the fist radiation treatment the patient will undergo a non-diagnostic CT scan (called “centering” or “simulation” scan) in order to obtain images of the region of interest i.e. location of the lesion to be irradiated. This examination will be carried out by the radiotherapy technicians and the biomedical engineers. Based on the specific expertise of each of these professionals the best localization and mode of immobilization of the patient during the treatment session will be established. CT scans will be performed and sent to the Treatment Planning System (TPS) for the dose map calculations.
The radiation oncologist, using the TPS software will identify and define the target volume (the tumor site) and the volumes represented by healthy organs in contact with the tumor. Given the type of disease and the healthy organs involved, the radiation oncologist will prescribe the total dose of treatment, its fractionation and daily doses of tolerance or “dose limits” for the organs at risk.
Based on this prescription the medical physicist will calculate the doses and determine the best geometry of the beam /s to be used for each particular region. The treatment plan will be then evaluated by both the medical physicist and the radiation oncologist in order to ensure an optimal final treatment plan for the patient.
The patient could then begin the daily sessions of therapy at CNAO that will be performed by the radiotherapy technicians. The radiotherapy technician together with the biomedical engineer are responsible for ensuring the maintenance of the immobilization set up previously established and for reporting any machine, device or patient variations to the radiation oncologist and the medical physicist. Radiological verification of the treatment position will be performed on a regular basis and, at the same time, the patient will be clinically monitored by the physician for the duration of the treatment.
At the end of therapy, the radiation oncologist will perform the final treatment visit, record any side effects observed and/or supportive therapy used. At the same time the radiation oncologist will prepare the follow-up plan to anticipate any eventual side effects at home and establish the follow up schedule.
The patient will be issued a clinical report on the treatment carried out.