Envisioning an Italian Head and Neck Proton Therapy Model-Based Selection: Challenge and Opportunity

Giulia Fontana¹, Matteo Pepa², Anna Maria Camarda³, Mimoza Strikchani⁴, Michela Meregaglia⁵, Alessandro Vai⁶, Alfredo Mirandola⁶, Barbara Vischioni³, Andrea Pella², Guido Baroni^{2

7}, Barbara Alicja Jereczek-Fossa^{8

9}, Marta Scorsetti^{10

11}, Marco Cianchetti¹², Elisa D'Angelo¹³, Pierluigi Bonomo¹⁴, Marco Krengli^{15

16}, Ester Orlandi^{17

3}

Affiliations

¹ Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
² Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
³ Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁴ Administrative Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁵ Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy.
⁶ Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁷ Department of Electronics, Information and Bioengineering, Politecnico di Milano (POLIMI), Milan, Italy.
⁸ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
⁹ Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
¹⁰ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
¹¹ Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
¹² Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
¹³ Radiation Oncology Department, Bellaria Hospital, AUSL of Bologna, Bologna, Italy.
¹⁴ Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
¹⁵ Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy.
¹⁶ Radiotherapy Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
¹⁷ Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.

PMID: 40230401
PMCID: PMC11995119
DOI: 10.1016/j.ijpt.2025.100745

Editorial

Envisioning an Italian Head and Neck Proton Therapy Model-Based Selection: Challenge and Opportunity

Giulia Fontana et al. Int J Part Ther. 2025.

. 2025 Mar 20:16:100745.

doi: 10.1016/j.ijpt.2025.100745. eCollection 2025 Jun.

Authors

Affiliations

¹ Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
² Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
³ Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁴ Administrative Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁵ Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy.
⁶ Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁷ Department of Electronics, Information and Bioengineering, Politecnico di Milano (POLIMI), Milan, Italy.
⁸ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
⁹ Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
¹⁰ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
¹¹ Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
¹² Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
¹³ Radiation Oncology Department, Bellaria Hospital, AUSL of Bologna, Bologna, Italy.
¹⁴ Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
¹⁵ Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy.
¹⁶ Radiotherapy Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy.
¹⁷ Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.

PMID: 40230401
PMCID: PMC11995119
DOI: 10.1016/j.ijpt.2025.100745

No abstract available

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Figures

**Figure 1**
Schematic proposal of NTCP-based MBS in Italy and interplay between the variables involved.

**Figure 2**
Envisioned Italian model-based selecting proton therapy for HNC patients: key factors and pipeline. *Abruzzo (2), Basilicata (2), Calabria (4), Campania (18), Emilia-Romagna (12), Friuli Venezia Giulia (3), Lazio (19), Liguria (5), Lombardia (35), Marche (4), Molise (1), Piemonte (14), Puglia (11), Sardegna (4), Sicilia (18), Toscana (15), Trentino Alto Adige (3), Umbria (5), Valle D’Aosta (1), Veneto (10). Abbreviations: AIFM, Italian Association of Medical Physics; AIOM, Italian Association of Medical Oncology; AIPT, Italian Association for Particle Therapy (*hypothetic acronym*); AIRO, Italian Association of Radiotherapy and Clinical Oncology; AITRO, Italian Association of Radiation Therapists and Physicist Technicians; CT, computed tomography; EMR, electronic medical record; IT, information technology; MBS, model-based selection; NHS, National Health System; NTCP, normal tissue complication probability; PT, proton RT; QA, quality assurance; RT, radiation therapy; TPS, Treatment Planning System.

See this image and copyright information in PMC

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Envisioning an Italian Head and Neck Proton Therapy Model-Based Selection: Challenge and Opportunity

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Envisioning an Italian Head and Neck Proton Therapy Model-Based Selection: Challenge and Opportunity

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