AT CNAO, THE WORLD’S FIRST CHALLENGING CASE OF NATURAL PREGNANCY AFTER PELVIC HADRON THERAPY
The CNAO (National Centre for Oncological Hadron Therapy) in Pavia, Italy, celebrates the world’s first case of natural pregnancy after pelvic hadron therapy (use of protons and carbon ions to treat the pelvis) for chondrosarcoma of the sacrum.
This was a difficult and challenging case in which reproductive organs have been spared from the particle beam, thanks to a multidisciplinary collaboration at the highest level of specialisation. As a result, the young patient was able to undergo treatment in 2019, get pregnant in 2022 and today hold her own beautiful baby girl in her arms.
September 19th 2023. This extraordinary result achieved was made possible thanks to a task force of doctors from CNAO and the Policlinico San Matteo in Pavia, two centers of excellence that have joined their forces in a multidisciplinary collaboration. The protagonists are two radiation oncologists of the CNAO (Amelia Barcellini and Maria Rosaria Fiore), an anesthesiologist (Maria Paola Delmonte) and a gynecologist-oncologist (Chiara Cassani) of the Policlinico San Matteo. Worldwide, only six facilities can deliver proton and carbon ion hadrontherapy: CNAO is one of them and it’s the only one present in Italy.
Chondrosarcoma is a rare tumor that belongs to the sarcoma family, and its incidence is estimated between 0.5 and 0.8 per 100,000 inhabitants. The 20% of these chondrosarcomas affect the spine, sacrum, and coccyx. The first therapeutic choice is the surgical approach, when possible, but total resection is difficult either because of the advanced state of the disease, or because surgery can have important sequelae on the patient.
Moreover, this type of tumors is often highly radioresistant, therefore the hadrontherapy with protons and especially with carbon ions is particularly indicated in radioresistant tumors and is one of the most effective treatments, reducing the damage to surrounding healthy tissues and consequently the side effects. Finally, another significant advantage is that these particles are considered the most powerful ones for the treatment of these tumors.
The story of Angelica
Angelica’s case presented many difficulties and challenges. A radical dose, therefore high, of hadrontherapy (with carbon ions) would have been necessary to treat the tumor, but this dosage was’nt bearable by the adjacent organs, in particular the rectum, the uterus, and the ovaries. To overcome this major limitation, a silicone device, called ‘spacer‘ was surgically implanted, between the tumor to be irradiated and the organs at risk, in order to distance the rectum and uterus.
But, given the young age of Angelica and the need to preserve hormonal function, it became necessary to dislocate the ovaries during the spacer implantation, that is to relocate them anteriorly and “hang them” on the abdominal wall. Thanks to this complex surgical procedure, the organs were spared from the particle beam and thus from the high dose that would have damaged them. So, the hadrontherapy sessions started in 2019, Angelica became pregnant in 2022 and now she can hold her delightful little baby in her arms.
The therapeutic alliance between the patient and different specialists, belonging to different structures, was the real key to the success of Angelica’s story; an example of effective concreteness, and how such a multidisciplinary collaboration can lead to results that go even beyond expectations, in terms of innovation, trust and hope. Not only the team has found a remarkable solution to overcome the necessary radical dose, but it has also successfully achieved -for the first time worldwide -a natural pregnancy in this type of tumor.
References: Press release
Worldwide, only six facilities have the capacity to perform hadrontherapy treatments using protons and carbon ions. One of these is located in Pavia, just half an hour away from Milan: the CNAO, National Centre for Oncological Hadrontherapy, the only centre in Italy able to perform this task.
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Dr Maria Rosaria Fiore is Referee for Spinal and pelvic pathology, ocular pathology.
Specialist in Oncological Radiotherapy, she has worked at The Royal Marsden Hospital, Institute of Cancer Research, London (UK) and at the Department of Radiotherapy at the European Institute of Oncology, Milan.
She joined the CNAO Foundation in September 2007.
Hadrontherapy is a form of radiotherapy for the treatment and cure of tumours that are often surgically inoperable (located in particularly difficult locations) or resistant to traditional radiotherapy treatments (they do not respond sufficiently or adequately to the X-rays used in traditional radiotherapy). Since 2017, the Italian national healthcare service has incorporated this therapy into its basic service offerings.
Hadron therapy is based on the use of protons and carbon ions. Hadrons, atomic particles used in the therapy named after them, are more effective in destroying cancer cells than electrons due to their increased weight and energy.
To achieve precise tumour targeting, hadrons must undergo strong acceleration using a particle accelerator. At the National Centre for Oncological Hadron Therapy (CNAO) in Pavia, Italy, the treatment process occurs within the “synchrotron”, an 80-metre ring of medical equipment that links to the treatment rooms where patients receive care.
The synchrotron provided to the CNAO in Pavia is the sole unit in Italy that can extract carbon ions from the atom, which are the most potent particles, to treat tumours that resist conventional radiotherapy or are inoperable. There are only five other centres worldwide capable of achieving this.
Reference: For more information, please refer to the Hadrontherapy: Synchrotron webpage
The number of hadron therapy sessions necessary varies based on various factors, including the type of particle used, tumour type, size, and location. Typically, individuals require one session per day, five days a week, for 2 to 7 weeks.
The physical characteristics of carbon ions and protons utilized in hadron therapy provide several significant benefits over conventional radiotherapy.
The treatment of radioresistant tumours is possible with a high level of precision which helps in preserving healthy tissue.
The combination of these advantages results in a considerable destructive effect on the tumour tissue, making it a crucial requirement to position the tumour with millimetre accuracy, far more precise than conventional radiotherapy. The combination of these advantages results in a considerable destructive effect on the tumour tissue, making it a crucial requirement to position the tumour with millimetre accuracy, far more precise than conventional radiotherapy. Additionally, personalisation of the treatment at each phase further contributes to enhancing the treatment outcome. The combination of these advantages results in a considerable destructive effect on the tumour tissue, making it a crucial requirement to position the tumour with millimetre accuracy, far more precise than conventional radiotherapy.
Patients can determine if their cases or pathologies are treatable with hadron therapy by consulting the CNAO Foundation’s website. See
Upon verifying their eligibility, patients can learn about the preliminary assessment and subsequent steps required to begin treatment. Confirmation of eligibility will be granted after the first visit. See
Brain, skull base and spinal cord tumours
Head and neck cancers and cancer of the upper respiratory tract
Thoracic cancers
Abdominal tumours
Pelvic tumours
Limb and spinal tumours
Paediatric solid tumours
