Fondazione IRCCS Istituto Nazionale dei Tumori

1. Pathology

G. Pruneri

The  Department of Pathology of the National Cancer Institute of Milan  includes Divisions of Surgical Pathology, Molecular Pathology and Laboratory Medicine, highly integrated and fully equipped with the most recent technologies, including next-generation sequencing platforms. Its mission is to provide clinically actionable diagnoses including all the prognostic and predictive data for patients with all cancer types except CNS tumors. The Department is also very active in translational research, focused on the discovery and the clinical relevance of predictive biomarkers, genomic and epigenetic profiling, and resistance to targeted therapy.

2. Radiation Oncology Unit

L. Lozza

Visiting observership

Intermediate English if Italian is not spoken

The Radiation Oncology Unit, directed by Doctor Laura Lozza, is a University center and provides curative and palliative radiation therapy to patients based on a multidisciplinary approach, following national or international guidelines and research protocols. The clinical activity is driven by teams specialized in specific cancer types, who are in charge of the radiotherapy treatment of breast cancer, pediatric tumors, tumors of the genitourinary district, tumors of the digestive system, lung cancer, soft tissues sarcomas, lymphomas, head and neck cancer, gynecologic cancer, brachytherapy treatments, cranial and body stereotaxis. A specific clinic dedicated to patients who need palliative radiation. The Radiation Oncology Unit also includes a ward with six beds.

This Unit can rely on six Linac and one HDR brachytherapy unit. In 2022, our Radiation Oncology Unit has treated 2390 patients. Treatments use recent technologies, such as IMRT (Intensity Modulated Radiotherapy), VMAT (Volumetric Modulated Arc Therapy), IGRT (Image Guided Radiotherapy), breath gating, breath hold, SBRT (Stereotactic Body Radiotherapy), GPS localization (Calypso), High-Dose Rate Brachytherapy (HDRBCT) and Proton therapy provided thanks to our close cooperation with CNAO, the National Center for Hadron therapy. Hypo fractionation is routinely used, especially in breast cancer and palliative treatments. The Radiation Oncology Unit participates in national and international trials and focuses its research activity on the development of predictive models of radio-induced toxicity with evaluation of clinical, radiomics and genetic variables. Comparison of toxicity data and predictive modeling have been carried out in a recent European multicenter project (REQUITE) in breast, lung and prostate cancer. Further research is focused on head and neck cancer, in which a multidisciplinary approach (surgery, chemotherapy, radiotherapy with photons and/or heavy ions) could offer a more efficient and less toxic treatment, both in operable and inoperable patients. Research on gynecologic cancer studies treatment quality in terms of applicability, clinical and dosimetric outcomes on locally advanced cervix cancer according to European excellence standards.  One of our goals is to reduce toxicity, improving quality of life, in the treatment of all cancer types, but particularly gastrointestinal and pelvic cancer.

Our Institute is a referral center for adult soft tissue sarcomas, with highly skilled radiation oncologists for their treatment. Hematological treatments follow the most recent guidelines and, when needed, TBI may be performed. Proton therapy is used more and more in pediatrics neoplasms, with excellent outcomes.

Visiting observers can modulate their training by specializing in one type of cancer or rotating in all the groups of the Radiation Oncology Unit.

Tutors: All our radiation oncologists are eligible to train and supervise visiting observers.  The tutor will be identified according to the subject of interest for the individual student.

3. Hepato-Pancreatic-Biliary (HPB) Oncology: an integrated medical-surgical and interventional training program.

Dr Davide Citterio

Surgery, Gastroenterology and Hepatology, Oncology, Interventional Radiology

English or Italian

Integrated, multidisciplinary program of diagnosis, treatment and research on malignancies of the liver, biliary tract and pancreas. The program, although based in a surgical-oriented Unit is a comprehensive HPB-Oncology clinical-based program, focused on combined approaches of distinctive specialties integrated in a single, multifaced scheme of decision-making and technical applications. Experiences on clinical trials, technical features, pre-clinical research, medical management of HPB diseases including transplantation are distinctive components that will be developed with the trainees joining the program.

Tutor: Carlo Sposito MD

4. Hereditary Digestive Tract Tumours

Marco Vitellaro, MD

Medical Oncology, OncoGenetics, Surgical Oncology

3 - 6 months

Visiting observership

English or Italian

The Hereditary Digestive Tract Tumours Unit (TEAD), belonging to the SC Surgical Oncology 2 Colo-Rectal, is one of Europe's largest referral centers for Familial Polyposis and Lynch Syndrome, actively involved in the European Reference Network GENTURIS (Genetic Tumor Risk Syndromes) programs. TEAD operates at the intersection of clinical care and research and specializes in counseling, molecular testing, and the clinical management of individuals with a genetic predisposition to major hereditary gastrointestinal cancer syndromes.

Over time, more than 5,000 families from various Italian regions have been referred to TEAD, often in collaboration with patient advocacy organizations. Currently, approximately 800 patients with colonic polyposis or Lynch Syndrome are under regular surveillance at TEAD's outpatient department. Additionally, TEAD's activities include a nutritional outpatient clinic and weekly multidisciplinary meetings.

During the observership program, participants will take part in the genetic evaluation, surveillance strategies, and surgical activities of these patients.

Tutor: Maria Teresa Ricci, Emanuele Rausa, Sara Lauricella

5. Adult soft tissue sarcomas, bone sarcomas and gastrointestinal stromal tumors

Medical Oncology 2 Unit is the medical oncology facility of the Sarcoma multidisciplinary tumor board of Fondazione IRCCS Istituto Nazionale Tumori, Milan, which serves as one of the reference centres in Italy for patients with adult soft tissue sarcomas, bone sarcomas and gastrointestinal stromal tumours. The Unit also coordinates the rare adult cancer professional network within the Italian Rare Cancer Network and the Sarcoma domain of EURACAN, the European Reference Network on rare adult solid cancers.  A full range of inpatient and out-patient services are available for the management of sarcoma patients, covering all sarcoma subtypes. All activities are strongly multidisciplinary, in partnership with the Sarcoma surgical and radiation oncology units. The Unit is actively involved in several national and international clinical trials and has ongoing translational projects especially on very rare sarcoma subtypes. As part of the observership programme, free participation in educational events on sarcomas and rare cancers will be offered.

Tutor: Anna Maria Frezza, Salvatore Provenzano

6. Head and Neck Cancers