Thérapie CAR T à San Raffaele

• Cancer Center
• Radiotherapy
• Hematology and Bone Marrow Transplant
• Neurosurgery
• Cardiac Surgery
• Gastroenterology & GI Surgery
• Breast Center
• Obstetrics and Gynecology

Ospedale San Raffaele Hospital was founded in 1971. It belongs to the Gruppo San Donato, the leading private hospital network in Italy. 5 million patients undergo treatment at Gruppo San Donato facilities every year.

San Raffaele Research Hospital is composed of over 60 specialized departments and research centers. In 2018, scientists of these centers were conducting 822 new clinical trials.

San Raffaele Research Hospital is well connected with any part of Milan and is easily reachable from any of Milan area airports (10 km - Linate Airport, 62 km - Malpensa International Airport, 45 km - Orio al Serio International Airport located in Bergamo).

 

San Raffaele Hospital Advantages

• Advanced medical technologies: PET, PET-CT, MRI, PET-MRI devices, Gamma Knife for brain tumors radiotherapy, and Cyber Knife, 3 Tomotherapy machines, RapidArc, Total Body Irradiation (TBI), Cyclotron, 3 da Vinci Robot,  Hybrid operating rooms.
• New therapies: Multiple Sclerosis early diagnosis and treatment, gene therapy for ADA-SCID, SMA therapy with Spinraza
• Unique operations: Intrauterine fetal surgeries for congenital malformations (Spina Bifida), removal of a brain tumor with the use of a robotiscope

 

San Raffaele in figures

Cancer Center

Every year 12,000 cancer patients undergo treatment at the Cancer Center, 6,000 of them receive a surgical treatment.

The Cancer Center develops complex diagnostic and therapeutic pathways for different types of tumors:

• breast tumors
• lung and mesothelial tumors
• head and neck tumors and melanomas
• gastrointestinal tumors (colon, intestines, stomach, esophagus, liver and biliary tract)
• pancreatic tumors
• brain tumors
• neuroendocrine tumors
• urological tumors

Physicians work closely in a well-integrated multidisciplinary team that consists of surgeons, clinical oncologists, diagnostic radiologists, radiotherapists, pathologists, immunologists, psychologists, plastic and reconstructive surgeons.

All cases are discussed collegially by experts.

Radiotherapy

2,000 patients undergo radiotherapy treatment at San Raffaele annually. Every treatment follows international protocols and internal guidelines to offer the best possible therapy to patients.

The Radiotherapy Unit offers the most innovative treatments:

• 3D-conformal radiotherapy, 3D-CRT
• Intensity modulated radiotherapy, IMRT
• Tomotherapy
• RapidArc
• Total Body Irradiation, TB

San Raffaele was the first center in Italy and Europe to provide Tomotherapy treatment. Tomotherapy includes a CT-scan system which controls and varies automatically the patient position and a helical Intensity Modulated Radiotherapy (IMRT) system allowing the application of a highly precise radiation beam on the tumor volume, sparing healthy tissues.

This treatment is often combined with PET/CT scans to obtain accurate images of volumes that need to be treated and with techniques that check breathing movements for the treatment of moving lesions. This results in an unique system (PET-guided Tomotherapy). Unlike conventional treatments (3D conformal radiation therapy or IMRT intensity modulated radiation therapy), which provide 60-70 Gy doses in 30-35 fractions, this system, thanks to a helical intensity modulation (helical IMRT), allows to apply radiation doses selectively. This results in a higher sparing of healthy tissues and allows to apply higher radiation doses in a lower number of fractions (1-15 fractions according to the type of treatment).

Why is treatment at San Raffaele effective?

Patients are treated by an multidisciplinary team of doctors. It consists of diagnosticians, medical oncologists, immunologists, surgeons, and radiotherapists. Physicians gather for a consilium to discuss the most complex cancer cases and make an effective treatment plan. As a result, a patient gets the most adequate treatment in his/her case.

Hematology and Bone Marrow Transplant (BMT)

Doctors of the unit specialize in the treatment of patients with blood disorders including cancer. In its lifetime, the Unit has performed over 1,000 bone marrow transplants and is applying transplants for treatment of a broader range of diseases from leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and multiple myeloma, to bone marrow deficiencies, inborn errors of metabolism and immune disorders.  In collaboration with European centres and Department of Biotechnology the Unit works on: 

• onco-haematologic clinical research, 
• congenital immunodeficiencies, 
• autoimmune diseases, 
• hemoglobinopathies 
• neurodegenerative accumulation lysosomal pathologies 

Physicians of the department provide over 140 bone marrow transplants per year. 60% of them are allogeneic. It means bone marrow cells are taken from a matched non-relative donor. And 40% — autologous BMT, when a donor is a patient him/herself.

 

Doctors of the San Raffaele Hospital Milano

Neurosurgery

The department possesses 3 operating rooms, one of which has the Gamma Knife. This radiosurgery device treats tumors without skin excision. Since 1994, doctors have performed more than 10,000 Gamma Knife procedures.

The Department is specialised in the treatment of pituitary and skull base tumors, as well as vascular and spinal pathologies.

To offer optimal treatment, patients are followed by a multidisciplinary team of neurosurgeons, endocrinologists, neuroradiologists, neurophthalmologists, neurologists, neuropsychologists, otolaryngologists and radiotherapists.

The main pathologies treated are:

• benign brain tumors, such as pituitary adenomas, meningiomas and craniopharyngiomas
• malignant brain tumors, mainly gliomas and brain metastases
• vascular malformations, aneurysms, cavernous angiomas and dural fistulas

The main pediatric diseases treated are:

• craniostenosis
• hydrocephalus
• Chiari malformation
• spina bifida
• pediatric brain tumors.

In October 2018, the medical team of San Raffaele performed the world's first surgery to treat spina bifida in the unborn child in the woman's womb. This disorder may lead to heavy complications as neurological diseases or even lower limb paralysis after birth. The doctors Massimo Candiani and Pietro Mortini did a unique operation in an unborn baby at 22 weeks, the surgery lasted more than 2 hours. Source: The Local

Cardiac Surgery 

Surgeons perform 1,400 heart operations annually.

The Cardiac Surgery Unit is an international reference center for restorative surgery of the valve (aortic, mitral and tricuspid), treatment of complex pathology of the aortic arch, ascending and descending aorta using surgical, hybrid, and minimally invasive techniques with the aid of advanced 3D cameras. The minimally invasive approach guarantees the same quality of surgical treatment, allowing functional recovery in less time than traditional techniques.

The Unit deals with:

• valvular pathologies (aortic and mitral and tricuspid), through reparative and replacement surgery, with minimally invasive treatment, also with the aid of suturless prostheses or percutaneous treatment (TAVI, MitraClip®, Cardioband® performed in a robotic hybrid room)
• aortic aneurysms, with complex treatment of the pathology of the ascending aorta, the aortic arch and the descending aorta with traditional surgery and hybrid E-Vita technique
• coronary artery disease, through surgery with arterial bypass, beating heart and treatment of refractory angina with spinal cord stimulation
• hypertrophic-obstructive cardiomyopathy
• heart failure, through the implantation of mechanical assistance devices to the circulation (LVAD - Left Ventricle Assist Device), ECMO, Impella, Bi-VAD and thanks to left ventricular remodeling techniques, myocardial revascularization and mitral valve plastic, resynchronization
• congenital heart disease with surgical or percutaneous correction

Gastroenterology and GI Surgery 

The Department of Gastrointestinal Surgery performs 2,000 interventions and delivers 5,000 outpatients services every year.

The Department is specialized in gastrointestinal laparoscopic operations. Laparoscopy — a procedure through 3-4 incisions up to 1-3 cm. This operation is less traumatic than the open surgery so a patient recovers faster. He/she doesn't feel much pain in the postoperative period and there are no large scars in the abdomen.

The main pathologies treated surgically are:

• tumors of the esophagus, stomach, small intestine, colon, rectum and anal canal and secondary tumors of the peritoneum
• benign esophageal pathology (gastroesophageal reflux disease, hiatal hernia, achalasia, esophageal diverticula)
• hereditary gastroenterological syndromes (Lynch syndrome / HNPCC / hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, Peutz-Jeghers syndrome, juvenile polyposis, familial pancreatic cancer, familial gastric cancer) 
• peritoneal carcinosis
• gallbladder and biliary tract stones
• benign and inflammatory colorectal disease (diverticular disease of the colon, Crohn's disease, ulcerative colitis)
• proctological pathologies (hemorrhoids, fistulas, fissures, anorectal pathology, prolapse)
• pelvic floor disorders
• pathology of the abdominal wall (hernias)
• endocrine pathology (benign and malignant adrenal tumors)
• hematological pathology (hematopoietic and neoplastic diseases of the spleen).

 

Single room, San Raffaele Hospital in Milan

Breast Unit

The Department specializes in benign and malignant breast tumors treatment. Surgeons perform over 700 operations every year. In 85% of cases, they remove only a tumor and leave as much healthy tissues as possible. 

Breast surgery is performed with minimally invasive approach techniques - such as quadrantectomy or sentinel lymph node biopsy. In women in whom a mastectomy is indicated, breast reconstruction is performed in the same session with the insertion of prostheses or expanders.1-2 days is the average duration of hospitalization after a surgery according to the department’s statistics.

The areola-nipple complex can also be preserved (nipple-sparing mastectomy) in compliance with the female image and the criteria of oncological radicality. Finally, pre-pectoral breast reconstruction is performed, an innovative technique that allows for better cosmetic results and with greater respect for anatomy and functionality.

Dedicated therapeutic courses are also offered for young women, for which fertility preservation technologies are available - in collaboration with the Fertility Center - and for pregnant women, who are offered a course of tailor-made care.

Obstetrics and Gynecology Department

Obstetricians and gynecologists of the department give women follow-up care during their pregnancy and deliver a baby. They also specialize in infertility treatment in women and men. Doctors perform 2,600 in vitro fertilization (IVF) procedures annually.

The Obstetrics and Gynecology Department at San Raffaele is the top center to treat malignant and benign tumors of the female reproductive system according to the hospital data. 1,200 operations are carried out here each year.

 

Delivery room, Ospedale San Raffaele, Milan