Radio-oncology

• Breast cancers: originate from the cells of the mammary gland and are taken care of by a dedicated multidisciplinary team. For more information on breast cancer: breast oncology.
• Uro-genital cancers: involve the organs of the urinary and genital system, particularly kidneys and bladder and in men prostate, testicles and rarely the penis. For more information on prostate cancer: prostate oncology.
• Thoracic and lung cancers: can develop from the cells that make up the bronchi, bronchioles and alveoli. For more information on lung cancer: lung oncology.
• Head-neck cancers: can develop in specific areas of the district: mouth, throat, nose, sinuses, larynx (vocal cords), pharynx, salivary glands. For more information: head and neck oncology.
• Tumors of the nervous system: develop in the nervous system and particularly in the brain. They may originate in the brain, or have spread (metastasized) to the brain from another part of the body. For more information on tumors of the nervous system: oncology of the nervous system.
• Gastro-enteric cancers: represent a substantial proportion of all solid tumors, and may originate from the colorectum, esophagus, stomach, liver, pancreas, and biliary tract. For more information on colorectal cancer: colorectal tract oncology.
• Gynecologic cancers: can develop in theuterus, ovaries, tubes or, more rarely, in the vulva and vagina. For more information: gynecologic oncology.
• Sarcoma: heterogeneous group of rare neoplasms that originate from connective tissue and affect bone, cartilage and soft tissues of the body such as muscle and fat.
• Melanoma and non-melanomatous skin tumors: skin tumors include 90% non-melanomas (mainly basal cell and squamous cell tumors) and 10% melanomas, i.e., tumors that result from tumor transformation of melanocytes, some of the cells that form the skin.
• Tumors of the blood and hematopoietic system: lymphoma, multiple myeloma and plasma cell neoplasia, and leukemia. These tumors are covered in detail in the hematology section.
• Pediatric cancers: acute and chronic benign hematologic diseases in children, as well as oncologic diseases typical of this age group. For more information on pediatric cancers: pediatric hemato-oncology.
• Benign pathologies: heterogeneous group of pathologies including for example pituitary adenoma, Graves-Basedow disease ocular exophthalmos, prevention of keloid formation and hormone therapy-induced gynecomastia, heterotopic ossification, and treatment of various inflammatory diseases.

Patient care is centered on the patient's needs and includes accompaniment through the treatment pathway that precedes and follows radiation therapy. Assisted by physicists, technicians, and nurses, radiation oncology physicians are specialists in the treatment of one or more cancer pathologies and can draw on a broad spectrum of medical and technological expertise to offer personalized, high-precision treatments.

Purpose of radiation therapy

• Radical intent: is performed for the purpose of radically eliminating all cancer cells present as an exclusive therapy or in combination with chemo- or immuno-therapy treatment.
• Preoperative (neoadjuvant) intent: is performed before surgery to reduce the size of the tumor and facilitate its complete removal with a less disabling approach.
• Postoperative (adjuvant) intent: is performed within a few months after surgery to eliminate any residual tumor cells and reduce the risk of local recurrence.
• Postoperative salvage intent: is performed after surgery in case of recurrence.
• Palliative (symptomatic) intent: is performed in patients with advanced neoplasia to ensure improvement in quality of life, for relief of pain, compression and/or infiltration symptoms, or to control hemorrhagic processes.

Oncology hyperthermia

The use of heat for the treatment of cancer has been successfully introduced only in recent decades; in fact, the establishment of the European Society of Oncological Hyperthermia (ESHO), which was deputed to define quality standards and guidelines related to hyperthermic treatments, dates back to 1975. In fact, medical hyperthermia requires advanced technologies that can effectively heat the tumor and closely adjacent tissues in a controlled manner to temperatures between 41°C and 44°C. Hyperthermia works by:

• inhibiting the repair of DNA damage to tumor cells caused by radiation therapy;
• increasing the oxygenation of tumor tissues, making them more sensitive to radiotherapy;
• by enhancing the immune-modulating mechanisms of cancer therapies.

Numerous clinical studies have shown that hyperthermia, when administered with radiotherapy, can increase its efficacy in numerous diseases.

The treatment has rare side effects and does not induce additional toxicities. It generally consists of weekly or biweekly one-hour treatments that are given immediately after radiation therapy treatment. It is performed on an outpatient basis and does not involve invasive procedures other than the placement of temperature sensors in cavitary organs via catheters and/or guides (bladder, rectum, etc.).

Indications:

• local recurrences of breast cancer;
• lymph node recurrences of tumors of the head and neck district;
• lymph node metastases and local recurrences of malignant melanoma;
• skin metastases of solid tumors;
• symptomaticlocal tumor recurrences;
• symptomaticbone metastases;
• tumors of the cervix;
• soft tissue sarcoma.

Each hyperthermia treatment is discussed in an interdisciplinary manner within the Swiss Hyperthermia Network Tumor Board and shared with professionals from other disciplines (medical oncologists, radiologists, nuclear physicians, pathologists, etc.).

Technology offerings

The Clinica di Radio-Oncologia EOC has a state-of-the-art technology park capable of ensuring high-precision treatments capable of improving disease control and reducing side effects.

Its technologies feature state-of-the-art machines, including two Varian TrueBeam® linear accelerators for external beam radiotherapy. Equipped with integrated imaging systems(IGRT, Image Guided Radiotherapy), these accelerators are dedicated to the realization of treatments with volumetric technique(VMAT - Volumetric Modulated Arc Therapy), stereotactic (SBRT - Stereotactic Body Radiation Therapy), andradiosurgery(SRS Stereotactic Radiosurgery). These treatments can be carried out in one or more sessions, combining optimal radiotherapy dose distribution with sub-millimeter precision sparing of non-tumor tissues.

These accelerators also integrate the C-RAD® surface imaging system for the realization of treatments synchronized with the respiratory cycle, essential to ensure cardiac and pulmonary protection in breast or lung cancers, and the BrainLab ExacTrac® stereotactic positioning system.

The Clinica di Radio-Oncologia also has an Axxent Xoft® system dedicated to brachytherapy treatments for gynecological tumors, intraoperative treatments(IORT - Intraoperative Radiation Therapy) for breast tumors, and superficial treatments for skin tumors.

Unique in Ticino and available in only a few national centers of excellence, the Clinica di Radio-Oncologia has been equipped since 2021 with an MRI with a dedicated planning configuration of the latest generation (Philips Ingenia Ambition ®-1.5 Tesla) that allows to improve the accuracy in 'identification of the area to be irradiated avoiding further exposure to ionizing radiation for our patients. Planning MRI is currently used in the planning of specific cancer pathologies (pelvic, urogenital, gynecological, brain, head-neck cancers) as a replacement for conventional CT imaging.

Since 2021, the Clinica di Radio-Oncologia has also been equipped with devices dedicated to the realization ofsuperficial and deep hyperthermia. By emitting radiofrequency electromagnetic waves to deposit energy into tumor tissues causing their temperature to rise, these devices are used in conjunction with standard radiation therapies to improve tumor control.
The two devices used in the Clinica di Radio-Oncologia are:

• TheALBA ON 4000D (MedLogix®) for the treatment of semi-deep or superficial tumors.
• TheALBA 4D (MedLogix®) for the treatment of deep tumors.

Certifications

Clinica di Radio-Oncologia medica since 1992 has been nationally certified by the Swiss Institute for Medical Education (ISFM) and the Federation of Swiss Physicians (FMH) as a Class A training center.