The National Center for Oncological Hadrontherapy

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 hadrontherapy with both protons and carbon ions, making it the only center in Italy – and one of 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. CNAO 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 research and innovation center. 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). CNAO 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.