From the preliminary evaluation request to follow-up. All the stages in our treatment process
1 - CHECK IF YOUR CASE CAN BE TREATED
Patients can check if their cases are among those that can be treated with hadrontherapy at the CNAO Foundation. Visit the pages of the site dedicated to the preliminary check, and/or call the dedicated telephone number (0382-078 963). Our clinical staff operator is available running hours from Monday to Friday, from 9am to 4pm.
2 - ANSWER FOR A POSSIBLE TREATMENT
The two possible answers to the question "is it a pathology admitted to the treatments given at CNAO foundation?" are:
- No: the case cannot be treated
- Yes: the case is potentially treatable (eligibility can only be confirmed after the first visit).
3 - SENDING DOCUMENTATION FOR PRELIMINARY EVALUATION
If it is potentially treatable, the patient is asked to send the following documentation (clinical and bureaucratic) necessary for the preliminary evaluation.
Documentation required for the preliminary evaluation:
- "Access to treatment" questionnaire, filled in and signed by the patient
- Copy of waiver (if available)
- Copy of the end-of-treatment report (in case of previous radiotherapy)
- Copy of the histological test
- Copy of reports of recent diagnostic tests (CT scans, PET, MRI, bone scintigraphy), whenever possible accompanied by DICOM format images
- Copy of any specialist reports relating to the pathology
- Supporting report by referring physician, not earlier than 3 months, which contains the following information: disease diagnosis, stage of the disease, non-oncological medical history, detailed oncological medical history, ongoing therapies, drugs, active problems and any other information useful for the evaluation
The patient is requested to send the documentation by CNAO site or by fax to: 0382-078903 or by hand deliver or by registered mail with return receipt to the following address: CNAO Foundation Preliminary consultation Via Erminio Borloni, 1 27100 Pavia (PV)
4 - EVALUATION OF CLINICAL DOCUMENTATION SUBMITTED
Once received, the documentation undergoes a more in-depth clinical evaluation by the radiotherapist, who, if necessary, prescribes further instrumental examinations (CT scans, MRI, TC-Pet, specialist outpatient visits), which can be useful for understanding the case. The documentation submitted is clinically evaluated daily, from Monday to Friday.
On average, the time it takes to analyse the documentation is less than 10 business days, the period within which CNAO Foundation sends a response to the potential patient.
5 - RESULT OF THE CLINICAL EVALUATION
Two alternative situations may arise from the clinical evaluation:
- Untreatable case: the case cannot be treated at CNAO and the notification is sent via e-mail
- Treatable case: an appointment for a first visit to the CNAO Foundation of Pavia is scheduled
6 - FIRST VISIT PLANNING
If the preliminary clinical evaluation is successful, the first visit is scheduled. The doctors schedule visits one day a week for each pathology. Therefore, there are dedicated days depending on whether they are head and neck, chest and pelvis, neurological or paediatric pathologies
- Chest and pelvis: visits are on Thursday morning with waiting times of about a week for NHS visits
- Head and neck: visits are on Tuesday morning with waiting times of about 10 days for NHS visits
- Neuro-oncological pathologies: visits are on Wednesday morning with waiting times of about two weeks for NHS visits
- Paediatric: visits are on Wednesday morning with waiting times of about one week for NHS visits
The first visit is always in the morning because the afternoon is dedicated to follow-up visits and controls of already treated patients.
7 - INTERDISCIPLINARY MEETING
After the first visit, the individual case is discussed in an interdisciplinary meeting, held on Fridays, in order to give patients the final evaluation on the following Monday. The professionals involved in the interdisciplinary meeting are:
- radiation oncologists and the medical director
- radiodiagnosis team involved in the diagnosis and the therapeutic phases
- external specialists who collaborate with CNAO
8 - LAST EXAMINATIONS AND PLANNING TREATMENT
After the first visit and following the interdisciplinary meeting, the patient that is finally considered as treatable, is contacted to set the date on which two preparatory examinations will be conducted at CNAO in one single day:
- CT scanning, not for diagnosis but for therapeutic reasons, necessary to set the immobilization device for the treatment, and to centring the beam focus
- Magnetic Resonance Imaging with contrast agent, partly performed with the immobilisation device setup during the CT scanning, and partly in stages
After this day of further tests and preparatory activities, the patient can return home. The actual treatment begins 1 or 2 weeks later. A few days before the treatment, the patient is contacted to be informed about the treatment plan, the particle that will be used, the therapy times, which vary according to the pathology and the treatment chosen by the team for the specific case. The patient is also informed of possible side effects, for which he is requested to accept by signing the informed consent form before the therapy is delivered.
9 - TREATMENT
Treatment times DEPEND ON THE CHOICE OF THE PARTICLE THAT WILL BE; USED:
- Carbon ion treatment: 4 days a week for a maximum of 4 weeks
- Proton treatment: 5 days a week for 7 weeks
The medical team chooses the particle to be used at the planning step. There are midweek check-up throughout the therapy. In addition, on the;last day the patient meets again the doctor and nurse who follow his/her case, and the follow-up visits are scheduled.
10 - FOLLOW-UP PLANNING
Once the radiation treatment is over, the radiation oncologist plans radiological tests and periodic follow-up visits at CNAO Foundation on a schedule basis.