Radiotherapy

Director

Barbara Alicja Jereczek

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Clinical Trials

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Radiation Therapy is available to hit selectively malignant tissue, using "Smart Ray" that allow identifying with precision the target tumor, saving the surronding healthy tissues, preserving the organs and their functions, reducing the treatments duration.
IEO Radiotherapy is equipped with the new generation machines able to perform high precision treatment by employing intensity modulation, image guidance, stereotacticapproach, intraoperative irradiation and brachitherapy.

The Division includes the following units:Brachitherapy Unit

Our Activities

The Division of Radiotherapy is fully committed to three main activities: patient care, research, and teaching. The Division has the latest equipment available for high-precision radiotherapy like Intensity Modulated Radiotherapy (IMRT, including dynamic arc and IMRT using RapidArc technology), Image-Guided Radiotherapy (IGRT), respiratory gating, intra- and extra-cranial stereotactic radiotherapy (SRS, SBRT), 3-D conformal radiotherapy, brachytherapy, and Proton Therapy. Every year more than 3000 patients receive highly selective radiotherapy based on the personalized treatment program defined in the majority of cases in the multidisciplinary tumor board.

High-precision radiotherapy allows for excellent tumor targeting and maximum sparing of normal tissue. In consequence, several clinical protocols with dose escalation and accelerated hypofractionated and ultra-hypofractionated schedules (higher dose per fraction, leading to the reduction of the overall treatment time) have been activated. Indeed, the majority of our patients receive short treatment fully compatible with normal life activities.

About 50 clinical research studies are ongoing at our Division, many of them including national and international collaboration and multidisciplinary cancer care pathways. The main and most innovative active trials in this regard are the CRYSTAL trial (https://clinicaltrials.gov/study/NCT04679454), which enrolls patients with early-stage breast cancer to receive a single-fraction ablative preoperative radiosurgery (stereotactic radiotherapy delivered in single fraction of high dose), and the PRO-SPEED trial (https://www.ieo.it/it/PER-I-PAZIENTI/Sperimentazioni-cliniche/Sperimentazioni-cliniche/IEO-1872/), concerning intermediate and high-risk localized prostate cancer, which aims to treat patients with SBRT in 5 fractions on alternate days using CyberKnife image-guided fiducial markers, and boosting dominant prostatic lesion (DIL).

The Division of Radiotherapy also participates in important multicentric international studies including large ESTRO-EORTC initiatives: the OligoRARE study, a randomized open-label phase 3 clinical trial evaluating the role of stereotactic radiotherapy as an adjunct to standard treatment in oligometastatic patients with rare carcinomas; the OLIGOCARE study, a pragmatic observational study to evaluate RT treatment with radical intent in oligo-metastatic patients; and the RE-CARE study, an observational study to evaluate reirradiation with curative doses.

Other important ongoing trials are the phase II RADIOSA trial (https://clinicaltrials.gov/study/NCT03940235), randomizing patients with prostate cancer to receive radiotherapy alone or radiotherapy plus a short course (6 months) of hormonal therapy, and the observational clinical trial MONDRIAN (https://clinicaltrials.gov/study/NCT05974475) that enrolls patients with lung cancer treated with either hypofractionated radiotherapy or surgery with the goal of understanding which clinical, imaging, and biological factors are associated with response to radiotherapy through the development of predictive models.

In research activities of the Division, the emphasis is placed on breast cancer, urological tumors, and head and neck and other adult solid tumors. The main accent is focused on the combined modality approach, high precision radiotherapy, hypofractionation and ablative radiotherapy, oligometastatic disease, and new prognostic and predictive factors. Last but not least, quality of life and reduction of radiotherapy toxicity are extensively studied.

The Brachytherapy Unit is a full-profile unit equipped with both pulsed- and high-dose-rate systems. The unit is committed to the integrated approach in the field of radiotherapy and multidisciplinary cancer care

The Division of Radiotherapy works in convention with the Milan University (Università degli Studi di Milano) and is chaired by Full Professor of Radiation Oncology Prof. Jereczek and includes numerous university research staff, PhD candidates and residents (residency program of radiation oncology). Educational activities of the Division include in-department teaching for pre- and postgraduate medicine, physics, biomedical omics, biotechnology students, and radiology & radiotherapy bachelor degree students (University of Milan and Politecnico of Milan). Every year our Division hosts about 10 observers from all over the world.

Proton Radiotherapy

Proton Therapy represents the latest frontier in radiotherapy, ensuring a further reduction in the exposure of healthy tissue and consequently a reduction in toxicity. In some cases, an increase in the total dose to the tumor will be possible with a potentially higher probability of oncological success. Since November 2023 a Proton Therapy center has been operational in the department allowing our patients access to this cutting-edge technology. The Radiotherapy Division is equipped with ProteusOne equipment (located in the new 'Proton Centre' building) which will allow Proton Therapy treatments to be performed.

Learn more about Proton Radiotherapy.

The Division includes the following unit: Brachitherapy Unit

Our staff
Radiotherapy
Director
Barbara Alicja Jereczek
- Brachytherapy Unit
  Director ad interim Barbara Alicja Jereczek
Staff Radiotherapy
- - High specialized physician Daniela Alterio
  - High specialized physician Roberta Lazzari
  - High specialized physician Maria Cristina Leonardi
  - High specialized physician Andrea Vavassori
  - Physician Luca Bergamaschi
  - Physician Samantha Dicuonzo
- - Physician Stefano Durante
  - Physician Annamaria Ferrari
  - Physician Marianna Alessandra Gerardi
  - Physician Giulia Marvaso
  - Physician Federico Mastroleo
  - Physician Giovanni Carlo Mazzola
- - Physician Anna Morra
  - Physician Gaia Piperno
  - Physician Damaris Patricia Rojas
  - Physician Stefania Volpe
  - Physician Maria Alessia Zerella
  - Physician Dario Zerini
offered treatments
- Cyberknife System - This is a miniature linac dedicated to robot-assisted radiosurgery i.e. delivery of a single high dose of radiation, stereotactically directed to the target. The robotic arm enables the system to deliver radiation from many different directions, verifying instantaneously the target position. This non-invasive, frameless, high precision (submillimetric accuracy) approach allows delivery of the ablative dose to any part of the human body. In IEO, CyberKnife is employed for radiosurgery of primary and metastatic cranial and spine tumors, selected tumors of lung, pancreas, liver, and other abdominopelvic malignancies.
- TomoTherapy - This is a novel system that combines CT imaging with a radiation treatment delivery system that administers the dose slice-by-slice. With this unique design, the intensity of the radiation beam delivered conforms to the patient’s tumor and helps avoid critical structures as the machine rotates 360 degrees around the patient. Large and irregularly shaped areas may be adequately treated.
- Trilogy™ System - This advanced radiotherapy versatile technology enables several irradiation modalities, including RapidArc approach (Volumetric Modulated Arc Therapy). By using real-time diagnostic data, the sculpted radiation beam pinpoints the tumor and protects the surrounding healthy tissue, while minimizing the patient's time on the treatment table. High precision radiation is delivered two to eight times faster than any other system making the experience more comfortable for the patient. In IEO, Trilogy is employed for head and neck cancer tumors (enabling parotid parotid-sparing approach) and for pelvic volumes (gynecological, urological, or intestinal malignancies when pelvic lymph node irradiation is necessary).
- Truebeam™ System - This advanced radiotherapy system represents a new possibility for effective treatment of patients with pelvic cancers, abdominal metastases, and inoperable tumors of the liver, pancreas, and lung. It allows the delivery of radiation in targeted, very high doses in seconds and is capable of delivering therapy to both static and moving targets, synchronizing irradiation with the patient's respiratory act, a requirement for treating motion-prone tumors, such as those affecting the lung and abdominal districts. The consequent therapeutic result is an increased likelihood of disease control, with sparing of healthy tissue.
CLINICAL TRIALS IN EVIDENCE
- Phase I/II trial “Single Fraction Preoperative Radiotherapy for Early Stage Breast Cancer (CRYSTAL)” is a single-arm and open-label single-center clinical trial with the aim to test the feasibility, safety and efficacy, in terms of complete pathological response, of preoperative ablative radiotherapy in single fraction for selected breast cancer patients. IEO 1308 - NCT04679454.
- Randomized phase II clinical study “Radioablation With or Without Androgen DeprIvation Therapy in Metachronous Prostate Cancer OligometaStAsis (RADIOSA)” in patients with prostate cancer who are randomized to receive radiotherapy alone or radiotherapy plus a short course (6 months) of hormonal therapy. IEO 997 - NCT03940235.
- Observational clinical trial “MONDRIAN: Multi-omics Integrative Modelling for Stereotactic Body Radiotherapy in Early-stage Non-small Cell Lung Cancer (MONDRIAN)” in patients with lung cancer with the goal of understanding which clinical, imaging, and biological factors are associated with response to hypofractionated radiotherapy through the development of mathematical models. IEO 1973 - NCT05974475.
- Prospective clinical trial “Ultra-hypofractionated stereotactic radiotherapy with CyberKnife for localized prostate cancer with boost on the dominant intraprostatic lesion - PRO-SPEED trial” in patients with prostate cancer aims to treat patients with hypofractionated radiotherapy in 5 fractions every other day using CyberKnife image-guided fiducial markers; 20 patients have already been treated and enrollment is currently underway. IEO 1872.
- Interventional study “Intervention Study in Prostate Cancer Patients Undergoing Radiotherapy (MicroStyle)” in prostate cancer patients aims to measure the effect of adherence to a healthy lifestyle (diet and increased level of physical activity and decreased sedentary time) on toxicity and gastrointestinal symptomatology. IEO 1442 - NCT05155618.
- Advanced Proton Therapy Approaches: a Multicenter High-quality Data Registry – POWER registry. The aim of the registry is to prospectively collect data on patients treated with proton therapy to provide a tool for systematic, prospective, harmonized, and multidimensional high-quality data collection to promote knowledge in the field of PT with a particular focus on the use of hypofractionation. IEO 1885 - NCT05860361
publications

Every year about 60 full papers are published with a total impact factor of about 250.

Here follow some selected recent publications:

Marvaso G, Jereczek-Fossa BA, Zaffaroni M, Vincini MG, Corrao G, Andratschke N, Balagamwala EH, Bedke J, Blanck O, Capitanio U, Correa RJM, De Meerleer G, Franzese C, Gaeta A, Gandini S, Garibaldi C, Gerszten PC, Gillessen S, Grubb WR, Guckenberger M, Hannan R, Jhaveri PM, Josipovic M, Kerkmeijer LGW, Lehrer EJ, Lindskog M, Louie AV, Nguyen QN, Ost P, Palma DA, Procopio G, Rossi M, Staehler M, Tree AC, Tsang YM, Van As N, Zaorsky NG, Zilli T, Pasquier D, Siva S. Delphi consensus on stereotactic ablative radiotherapy for oligometastatic and oligoprogressive renal cell carcinoma-a European Society for Radiotherapy and Oncology study endorsed by the European Association of Urology. Lancet Oncol. 2024 May;25(5):e193-e204. doi: 10.1016/S1470-2045(24)00023-8.

Zaffaroni M, Vincini MG, Corrao G, Lorubbio C, Repetti I, Mastroleo F, Putzu C, Villa R, Netti S, D'Ecclesiis O, Luzzago S, Mistretta FA, Musi G, Cattani F, Gandini S, Marvaso G, Jereczek-Fossa BA. Investigating Nutritional and Inflammatory Status as Predictive Biomarkers in Oligoreccurent Prostate Cancer-A RADIOSA Trial Preliminary Analysis. Nutrients. 2023 Oct 28;15(21):4583. doi: 10.3390/nu15214583.

Corrao G, Marvaso G, Mastroleo F, Biffi A, Pellegrini G, Minari S, Vincini MG, Zaffaroni M, Zerini D, Volpe S, Gaito S, Mazzola GC, Bergamaschi L, Cattani F, Petralia G, Musi G, Ceci F, De Cobelli O, Orecchia R, Alterio D, Jereczek-Fossa BA. Photon vs proton hypofractionation in prostate cancer: A systematic review and meta-analysis. Radiother Oncol. 2024 Jun;195:110264. doi: 10.1016/j.radonc.2024.110264.

Marvaso G, Isaksson LJ, Zaffaroni M, Vincini MG, Summers PE, Pepa M, Corrao G, Mazzola GC, Rotondi M, Mastroleo F, Raimondi S, Alessi S, Pricolo P, Luzzago S, Mistretta FA, Ferro M, Cattani F, Ceci F, Musi G, De Cobelli O, Cremonesi M, Gandini S, La Torre D, Orecchia R, Petralia G, Jereczek-Fossa BA. Can we predict pathology without surgery? Weighing the added value of multiparametric MRI and whole prostate radiomics in integrative machine learning models. Eur Radiol. 2024 Mar 20. doi: 10.1007/s00330-024-10699-3.

Alterio D, Vincini MG, Volpe S, Bergamaschi L, Zaffaroni M, Gandini S, Peruzzotti G, Cattani F, Garibaldi C, Jereczek-Fossa BA, Orecchia R. A multicenter high-quality data registry for advanced proton therapy approaches: the POWER registry. BMC Cancer. 2024 Mar 12;24(1):333. doi: 10.1186/s12885-024-12059-2.

Volpe S, Zaffaroni M, Piperno G, Vincini MG, Zerella MA, Mastroleo F, Cattani F, Fodor CI, Bellerba F, Bonaldi T, Bonizzi G, Ceci F, Cremonesi M, Fusco N, Gandini S, Garibaldi C, Torre D, Noberini R, Petralia G, Spaggiari L, Venetis K, Orecchia R, Casiraghi M, Jereczek-Fossa BA. Multi-omics integrative modelling for stereotactic body radiotherapy in early-stage non-small cell lung cancer: clinical trial protocol of the MONDRIAN study. BMC Cancer. 2023 Dec 15;23(1):1236. doi: 10.1186/s12885-023-11701-9.

Marvaso G, Ciardo D, Corrao G, Gandini S, Fodor C, Zerini D, Rojas DP, Augugliaro M, Bonizzi G, Pece S, Cattani F, Mazzocco K, Mistretta FA, Musi G, Alessi S, Petralia G, Pravettoni G, De Cobelli O, Di Fiore PP, Viale G, Orecchia R, Jereczek-Fossa BA. Radioablation +/- hormonotherapy for prostate cancer oligorecurrences (Radiosa trial): potential of imaging and biology (AIRC IG-22159). BMC Cancer. 2019 Sep 10;19(1):903. doi: 10.1186/s12885-019-6117-z.

Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Fodor C, Rondi E, Vigorito S, Botta F, Cremonesi M, Garibaldi C, Penco S, Galimberti VE, Intra M, Gandini S, Barberis M, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Single fraction ablative preoperative radiation treatment for early-stage breast cancer: the CRYSTAL study - a phase I/II clinical trial protocol. BMC Cancer. 2022 Apr 2;22(1):358. doi: 10.1186/s12885-022-09305-w.

Where research becomes treatment in real time

Radiotherapy

Barbara Alicja Jereczek

highlight

Our Activities

Radiotherapy

Barbara Alicja Jereczek

Brachytherapy Unit

Staff Radiotherapy