National Center for Oncological Hadrontherapy

9.50

Pavia, Italy

User Score	Rating	Price Range	Media Files	Certificates	Founded In	Patients	Departments	Ownership	Clinical trials	Age Group	Clinic Type	Type of Care	Size	Online Consultations
93%	9.5/10	$$$	97	16	2011	500	1 medical unit	State hospital	Conduct clinical trials	Kids, Adults	Specialized	Outpatient	Large	Yes

Overview

Size

Large

Clinic type

Specialized

Type of care

Outpatient

Age group

Kids, Adults

Certificates

Features & Facts

Global Position

One of only six centers worldwide treating tumors with both protons and carbon ions; the fourth such center in Europe.

Almost 3k Carbon-Ion Patients

By November, 2025, CNAO had treated 2,872 patients with carbon ions. This center-specific figure demonstrates substantial accumulated experience with heavy-ion treatment beyond its proton program.

Unique Technology

Houses Italy’s only synchrotron dedicated to hadrontherapy, a 25 m-diameter, 80 m-circumference ring in a heavily shielded bunker.

Research & Innovation

Acts as a significant research and development center, with work spanning clinical trials, radiobiology, medical physics, and accelerator technology.

Documented Proton Patient Number

By November, 2025, the center had treated 3,040 patients with proton therapy. The figure comes from an accelerator-physics presentation documenting clinical activity through 2025.

Clinical Activity

Focuses on solid tumors that are inoperable or resistant to conventional radiotherapy, including skull-base, brain, spinal, head and neck, thoracic, abdominal, pelvic, limb, and selected pediatric tumors.

Results for ACC Patients

The facility treated 129 patients with head-and-neck adenoid cystic carcinoma using curative proton therapy between 2017 and 2022. At 5 years, overall survival was 86.7% and local control was 84%.

Certification & Safety

CNAO is a CE-labelled medical device for hadron therapy; at the time of accreditation, it was the only dual proton–carbon center with this status.

Treatment Capacity & Patient Numbers

The center was designed to deliver around 20,000 treatment fractions per year, corresponding to roughly 3,000-3,500 patients annually once fully ramped up. In the first years of operation, several hundred patients per year were treated. By 2017, about 1,600 patients had received therapy at CNAO, with steadily increasing activity since then.

Tracking Number of Chordoma Cases

The clinical report evaluated the first 10 sacral chordoma patients treated using a new LET-optimized carbon-ion planning strategy. Plans incorporated multiple RBE models and explicit LET escalation within the tumor.

Patient Positioning & Imaging

Robotic couches with 6 degrees of freedom and in-room imaging (orthogonal X-rays and cone-beam CT) achieve positioning accuracy of ±0.3 mm and ±0.1°, respectively.

Results for Pelvic Sarcomas

A clinic-based study evaluated 46 patients receiving carbon-ion reirradiation for recurrent pelvic sarcomas. Three-year overall survival was 83.1%, while 3-year locoregional progression-free survival was 25.1%.

Clinical Rooms & Beamlines

CNAO operates three clinical treatment rooms that share four fixed beam ports (three horizontal and one vertical), plus a separate experimental room reserved for research. This layout allows parallel clinical activity and scientific experiments without disrupting patient treatments.

About the clinic

The National Center for Oncological Hadrontherapy (CNAO) in Pavia, Italy, is a specialized cancer center focused on treating complex tumors that are difficult to operate on or resistant to standard radiotherapy. It uses advanced hadron therapy with both protons and carbon ions, making it the only center in Italy, and one of the very few worldwide, to offer both particle types in a single facility. Based in Pavia, roughly 30 minutes from Milan, CNAO is part of the Italian National Health Service. Since January 1, 2014, hadrontherapy has been included among reimbursed treatments, so eligible patients from all over Italy (and, in specific contexts, from abroad) can access this highly targeted form of radiotherapy. By carefully shaping beams of charged particles to the tumor, CNAO aims to deliver high doses to cancer cells while better preserving surrounding healthy tissue and potentially lowering the risk of radiation-induced secondary cancers compared with conventional X-ray techniques. National Center for Oncological Hadrontherapy treats a wide variety of tumors, including brain and skull-base tumors, spinal tumors, head and neck cancers, thoracic, abdominal, pelvic, and limb tumors, as well as selected pediatric solid cancers, often in situations where surgery is not an option or standard radiotherapy is insufficient. Alongside its clinical activity, CNAO is a necessary center for research and innovation. It operates its own synchrotron, an 80-meter circular accelerator that produces proton and carbon-ion beams, and supports extensive radiobiological and translational research. Its teams work on refining clinical indications, improving dose delivery, and exploring new particle types and technologies (such as BNCT and additional ion species). The facility is also active in education and public engagement through guided visits, virtual tours, and outreach initiatives, positioning itself as both a state-of-the-art treatment center and a national leader in oncologic innovation.

Departments & Doctors

Radiotherapy

Dr. Ester Orlandi

head & neck tumors, oncological radiotherapy

Gallery

Video Tiesse Robot

Technology Transfer from Experimental Physics to Medicine

Visit of the Minister of Health Lorenzin to the CNAO

Dr. Sandro Rossi presents the CNAO treatment room

Dr. Sandro Rossi presents the CNAO Foundation

Dr. Marco Pullia introduces the Synchrotron

Extra services

Language Assistance

Telemedicine

Parking Space

Cafeteria

Accessibility Features

Location

Via Erminio Borloni, 1, 27100 Pavia PV, Italy

FAQ

What technology does CNAO use?

The center uses a large synchrotron accelerator to generate proton and carbon-ion beams that are guided into three clinical treatment rooms and one research room. It employs advanced pencil-beam scanning and motion-management techniques (gating, repainting) to treat even moving tumors with high precision.

How does hadrontherapy differ from conventional radiotherapy?

Hadrontherapy uses charged particles (protons and carbon ions) rather than X-rays. These particles deposit most of their energy precisely at a chosen depth (Bragg peak), allowing high doses to the tumor while better sparing surrounding healthy tissues and reducing the risk of radiation-induced secondary tumors.

Which types of tumors are treated at the facility?

National Center for Oncological Hadrontherapy mainly treats solid tumors that are inoperable or resistant to conventional radiotherapy, including head and neck sarcomas, brain and skull-base tumors, spinal and paraspinal tumors, thoracic and abdominal tumors, pelvic tumors, sarcomas of the extremities, ocular melanoma, gynecologic tumors, liver and pancreatic cancers, and selected pediatric solid tumors or re-irradiation cases.