1- What are the main differences between Proton Therapy and other forms of radiotherapy? 

Proton therapy reduces irradiation to the tissues surrounding the tumour mass, maximising its protection.  It is therefore characterised by a low risk of side effects, which results in faster patient recovery. Moreover, in some cases, it is possible to deliver a higher dose to the tumour, resulting in more effective treatment and a better chance of recovery.

According to the recommendations on the use of protons issued by the Istituto Superiore di Sanità in 2021, the greatest benefits of proton therapy are obtained in the treatment of:

• Solid tumours in paediatric patients; 
• Tumours located in critical locations, surrounded by sensitive structures;
• Tumours that are unresponsive to conventional radiotherapy and for which a dose-escalation approach is useful, as well as in cases where there is a need to reduce the overall toxicity of treating large volumes in combination with concomitant chemotherapy.

2- Are there any side effects from Proton Therapy treatment, such as hair loss, nausea and vomiting?

Proton Therapy generally results in reduced side effects, contributing to a faster and more comfortable recovery for the patient, both during and after treatment. In any case, side effects are almost always limited to the radio-treated areas. Thus, nausea and (rarely) vomiting may occur in the case of Proton Therapy in the abdomen, while hair loss may be observed if scalp (head) areas are treated. In rare cases, systemic problems such as fatigue may occur.

3- Is Proton Therapy a pain-free treatment?

Proton Therapy is a completely pain-free treatment and the session lasts about 30 minutes. What’s more, treatment takes place on an outpatient basis, without the need for hospitalisation. The patient will not be radioactive following treatment and can carry out normal daily activities.

4- Are there any limitations or contraindications for Proton Therapy?

Proton Therapy may not be feasible in patients with difficulty maintaining a stable position during treatment (e.g. patients with severe Parkinsonism).

5- What is the typical duration of a cycle of Proton Therapy treatment?

The duration of a treatment varies according to each individual clinical situation (histology, neoplasm stage, site, treatment intent, etc.). A complete cycle averages 14-20 sessions, a boost (i.e. overdose in addition to photon treatment) consists of up to a maximum of 6 sessions, while stereotactic (ablative) protontherapy involves only 1 to 3 sessions.

6- Is Proton Therapy reimbursed by the National Health System?

In 2017 (Prime Ministerial Decree 12/01/2017) the Ministry of Health identified the oncological diseases for which Proton Therapy is considered appropriate and therefore guaranteed by the National Health System. In any case, it is advisable to undergo an evaluation by the referring specialist and inquire about access to therapy through the IEO International Office, by sending an e-mail to [email protected].

7- What are the future research and development prospects for Proton Therapy?

Numerous studies are currently underway in Proton Therapy centres in Europe and around the world. A Tumour Registry has been set up at the IEO through which the clinical and radiological data of patients undergoing treatment with Proton Therapy will be collected. This data will contribute to the improvement of knowledge in the application of this new and modern form of radiotherapy.

The hope, both for researchers and for patients, is that the list of Proton Therapy services guaranteed by the public health service will also be extended in Italy in the future, as studies on the effectiveness of Proton Therapy in combination with other treatments (many of which will also be carried out at the IEO) continue to flourish.

8- Can Proton Therapy be used at IEO in pediatric tumours?

No pediatric cases are treated at IEO.

9- If no indications emerge in favour of the use of Proton Therapy in my specific case, can I continue treatment at IEO?

Certainly, at the Proton Center, each case is always carefully assessed by IEO’s multidisciplinary team. If Proton Therapy does not prove to be the most advantageous treatment pathway, the Institute offers the option of radiotherapy treatment or the most appropriate therapeutic strategy for the individual.

In order to have more information about the radiotherapy treatments visit the following link. 

10- How do I request a clinical assessment for Proton Therapy treatment? 

The first step is to book an appointment at the dedicated outpatient clinics of the Radiotherapy Division with one of the radiation oncologists. Outpatient visits (RTP Proton Therapy Outpatient Clinics) can be booked with a simple referral from the attending physician who writes an email to the IEO International Office ([email protected]) bearing the words “Outpatient Radiotherapy Visit”. Remote consultations are also offered for patients with logistical difficulties (bookable as a private, paid activity), to be followed by an in-person outpatient visit if an indication for Proton Therapy treatment is given.

If you have not found an answer to your question and need more information, please write to IEO [email protected]