CNAO pioneer in Italy with the BNCT: an advanced form of radiotherapy for the control of complicate tumors
At CNAO, for the first time in Italy, a small particle accelerator for the production of neutron beams will be installed in a space dedicated to clinical and medical research that will be built over the next two years. It will be made available, by Tae Life Sciences (TLS), a USA company. The neutron accelerator, part of TLS’s Alphabeam™ Neutron System, will be used to deliver Boron Neutron Capture Therapy (BNCT), an advanced form of radiotherapy that allows the generation of a localized physical reaction, capable of destroying cancer cells, sparing normal ones.
The Alphabeam includes a compact neutron source based on a tandem accelerator and other components that offer a complete solution for BNCT delivery. The system is designed to be installed in hospital environments and can be configured in a single or multi-room BNCT center to meet various clinical, research and capacity needs. In CNAO two irradiation rooms will be built and equipped: one devoted to research and the other reserved to patient treatments. Treatment rooms include a fixed beam, a beam “shaping” assembly and a ceiling mounted robotic couch for optimal patient positioning.
The development of this technique, first conceived in 1936 by G.L. Locher from the Franklin Institute of Pennsylvania, was held back by the fact that, in the past, huge reactors were needed to produce neutrons, which had to be located outside healthcare structures. The recent development of neutron sources based on much smaller accelerators has allowed this technique to spread in many countries (several machines are being tested in Russia, Japan, United Kingdom, Argentina and United States).
BNCT consists of administering a drug (the most used today is Borophenylalanine-BPA), which carries the molecule of Boron-10 inside the cancer cells and which accumulates to a greater extent in cancer cells than in normal cells.
The next step involves irradiating the tumor with neutrons. The consequent reaction generates a therapeutic dose that selectively destroys cancer cells with boron-10 while sparing surrounding healthy cells. The combination of low-energy neutrons and boron-10 release an intense, highly localized capture reaction that emits alpha particles and destroys the cancer on a cell-by-cell basis.
Pavia has already been a pioneer in this technique, applied to the treatment of two patients with liver metastases, thanks to the work carried out in the early 2000s by experts from Policlinico San Matteo and Pavia University. This expertise will breathe new life in the CNAO “BNCT” project. Due to its characteristics, the BNCT requires multidisciplinary research, which involves physicists and engineers for the design and implementation of the technology necessary for the production of neutron beams; chemists and biologists for the study and optimization of the bio-distribution of boron and the analysis of radiobiological effects; medical physicists and physicians for dosimetry, preparation of treatment plans and patient management.
Recent clinical trials carried out in Japan for advanced or relapsing head and neck cancers has led to the approval of BNCT for clinical use with national insurance coverage. Finland has also seen similar results in treating head and neck cancers where other available therapies fail. BNCT represents a potential useful cancer treatment for tumor destruction, control, and significantly improving patients’ quality of life.