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  03-12-2002: A YEAR FROM TAORMINA  
 COMPLETE LIST 
Researchers at work on the Taormina project
Researchers at work on the Taormina project

© 2002 Infn The use of photos is free of charge. Please request authorisation from the Infn Communication Office


The first operation in the world using neutron therapy on a patient affected with cancer of the liver is now a year old.

A year has gone by since the first operation in the world using neutron therapy. The patient, a 48-year old man affected by cancer of the liver, was in a desperate condition. The operation caused the destruction of all metastase present in the organ, including those that had previously gone undetected. Today, doctors say, the patient is fully recovered. The operation took place within the Taormina (advanced treatment of organs through neutron radiation and auto-transplanting). The new technique in radiotherapy was perfected by a group of physicist from the Pavia section of Infn (the Italian National Institute for Nuclear Physics), led by Tazio Pinelli, and a medical team of Pavia’s San Matteo hospital directed by Aris Zonta.

The Taormina project is the result of 15 years of research. It is based on the idea of using netrons to destroy tumoral cells: a method that had already been imagined as far back as 1938, four years after the discovery of the neutron. Since then, many countries have repeatedly endeavoured to apply this technique, but always without success. The problem probably lay in the fact that these early experiments were concentrated on brain tumours, while today research focalises on organs that can be explanted. Taormina was conceived precisely in this direction, and it was successful in becoming the first case in the world of neutron treatment of a tumour in an explanted liver.
“ The basis of the neutron therapy is a technique that uses some of the properties of boron, called Bnct (Boron Neutron Capture Therapy). In this therapy, the patient is first treated with an aminoacid, borophenilalanin, which contains boron 10, a boron isotope. The aminoacid is then absorbed by the cells together with the other nutrients. However, neoplastic cells absorb much more, about five times the quantity received by normal cells, probably thanks to their greater greed for nutrients (due to the metabolic needs connected with a great proliferation). Boron then accumulates inside the tumoural cells. At this point, if the boron 10 is radiated with a neutron beam, it decays, emitting a lithium ion and two alpha particles. Both the alpha particles and the lithium ion release their energy inside the cell, effectively killing it. This method is therefore highly selective, since it strikes the pathologic cells while the majority of the healthy cells remain intact”, explains Tazio Pinelli.
The weak point in this therapy, and the reason that has caused it to fail until now, lies in the difficulty connected with radiating the whole organ with a neutron beam: if only one small metastasis escapes, the tumour will form once again. To solve this problem, explantable organs were chosen. The Pavia group decided to operate on the liver.
On December 9th, 2001, the operation was performed on a patient who in May of the previous year had been diagnosed with the presence of many metastase produced by a carcinoma of the colon that had already been surgically removed a few months before. The prognosis left no room for hope. “The patient was first treated with boronphenilalanin, then his liver was explanted and transferred to the nuclear reactor in the University of Pavia and exposed to neutron radiation. This ensured a homogenous radiation of the organ. The liver was then reimplanted into the patient, who had meanwhile been kept alive by a system of extra-corporial circulation”, remembers Aris Zonta, the surgeon who carried out the operation.

Bnct has shown itself not to be toxic or harmful for the patient, who remains immune from radiation damage. Moreover, to the contrary of what happens in techniques commonly used today in clinical applications, in Bnct the therapeutic action is not due to radiation coming from the outside and directed towards the patient. The active particles, in this case, are produced inside the very tumoral cell: the alpha particles and lithium ions created in the reactions induced by a neutron beam on a target containing boron. “Each atom of this chemical element entering the cell becomes similar to a microscopic mine which explodes at the passage of a neutron”, says Tazio Pinelli.
The mechanism of destruction of the tumoral cells is not known to date. It is still not clear whether they die by apoptosis (programmed cell death) or by cellular necrosis, following the destruction of cellular apparatus.

“The experiment can be considered to be fully successful and extremely promising for the future. Three more patients will now undergo this same operation. In the meantime, the attention of the medical and scientific community towards our country’s pre-eminence have grown considerably. Some of the most qualified specialists worldwide have expressed a lively interest towards the Taormina project, stressing the fact that Italy is in the world’s vanguard for this kind of operation” says Aris Zonta, “we hope to be able to treat up to 30% of cancers to the liver and to all those organs that can be transplanted, such as lungs and pancreas”.

The colon-rectum tumour is the neoplasy that most frequently causes hepatic metastase. In most patients, the liver (together with the lymph nodes) represents the only organ reached by the illness at a distance. The incidence of hepatic metastase in colon-rectum tumours in Italy is of 8000 new cases every year. A third of the patients with intestine neoplasy already had hepatic metastase when the tumour is first diagnoses and a further 20% of the patients will develop metastase at a later stage, thus bringing the total number to 50% of the patients.
A surgical treatment of metastase, associated to chemotherapy, is the therapeutic choice that guarantees a satisfactory survival rate, but only a third of hepatic metastase are normally treatable.



 RELATED SITES 
http://http://www.pv.infn.it/~altieri/bnct/index.html
http://http://www.sanmatteo.org/

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