Professor Roberto Orecchia, congratulations on becoming the Scientific Director of the European Institute of Oncology.

Thanks.

Thank you for giving us an interview to ecancer, I think your first as Director, and we look forward to hearing what your plans are.

It’s a pleasure.

How did you get into medicine? Tell us about that. What made you become a doctor?

Become a doctor?

Because I like person, first, so I think that is useful to face some problems related to the health of the individuals.

So I think it’s a good job.

And when did you decide, during medical school or after that, to go into radiotherapy and into oncology?

During my medical school I started in radio-diagnostics first.

After two years I shifted to radiation oncology and oncology in general.

And where did you train?

In Turin, in Torino.

When did you come to Milano?

I came to Milano in ’94.

At the beginning of IEO?

At the beginning, yes, a few months after the opening of the institute.

I arrived in November and the institute opened in May.

What was the attraction? A new field or breast cancer or innovation or Veronesi?

Yes, Veronesi surely but not only.

The official reason was that I won here the Chair of Radiation Therapy at the University of Milan, I am in charge, still in charge, to the University of Milan.

So I had to move from Turin where I worked before here and at the same time there was the opportunity to have some contact here, they are asking for a young, at the time, radiation oncologist and this started the adventure here.

Were you already sub-specialised into breast cancer or were you a radiation therapist for every kind of cancer?

No, at the beginning of my activity I was quite devoted to brachytherapy, that is a special technique, and this is the role that they asked for here.

So they are trying to rind a brachytherapist and so it was the first contact.

But in general, so radiation therapy is quite transversal and we have different options – now breast, prostate, but in the past also head and neck roles and especially from the point of view of brachytherapy.

Not gynae?

No, not particularly gynae.

Because that’s where brachytherapy…

Yes, but I was specialised in head and neck and so at the time it was shifted from radium to iridium, a new kind of technique that I learned in France at the beginning.

So I adopted it in Turin before and after here.

So twenty years on, ’94 to 2014, twenty years of IEO, how big is the radiation therapy department now?

Now it’s quite big, at least for the Italian size.

So now we have six LinAccs, very modern and high sophisticated LinAccs for external therapy.

We have a huge department of brachytherapy with three machines and permanent implant with iodine and also a special programme for intraoperative radiation with two additional LinAccs.

And Gamma Knife?

We don’t have Gamma Knife, we have CyberKnifes, so that is a very similar machine we are using for stereotactic radiosurgery.

Now you’ve made a very special alliance with Umberto Veronesi in breast and you’re one of the world experts now in intraoperative radiotherapy. How did that come about? Tell us how that happened.

It happened because at the end of ’90 there was the appearance on the market of a new LinAccs totally devoted to intraoperative irradiation, the so named mobile LinAccs. Intraoperative irradiation is not a new technique, it is quite old – one hundred years ago, but the difficulty was to move the patient from the operating theatre to the radiation therapy and back.

Appearing this new machine I remember well that I spoke with Umberto Veronesi and I said to him, “There is this kind of new machine,” and he said to me, “Yes, but some classic indication rectal we have not this kind of expertise.” “Yes, but I was thinking about breast.” And obviously I remember he smiled and this is the start with this.

I remember you did a wonderful randomised trial in one institute, 1,200 patients.

Yes, yes, a lot because here it is possible because our breast surgeons recruit a lot of patients every year.

So we had the opportunity to start with this study and also other studies, the boost and other techniques.

Now we have probably understood something more than fifteen years ago when we started with it.

Where is radiation therapy going?

Radiation therapy is going well.

Understand that we have really today the possibility to perform radiation therapy in a very, very precise manner and selective target, sophisticated machine, imaging etc.

What we have to do is to increase the connection between the biology and the treatment because, from the physical point of view, we are very close to the top.

And of course you’ve been the Director of the Hadron Facility in Pavia and this is pretty close to the top.

Yes, absolutely.

This is a quite unique situation also in Europe. Similar characteristics are in Heidelberg in Germany, which we have a huge radiation therapy department here.

We have this part, the proton, especially carbon ion therapy, that is really interesting for the future because it’s not only the physical property of the particles but also the biological properties of carbon ions.

Proton therapy is now in the news all over the place.

Yes, yes.

We started with a phase, it’s a prototype that has been designed in CERN in Geneva.

We have to test and to certify it according to CE rules.

We have done and now we are in the clinical setting.

And that’s going to work. So now you’re the Director of Scientific Affairs in IEO. What’s the big plan? What’s going to happen?

Happen that we are to continue what Umberto made for twenty years.

Obviously we have also to adapt in a new reality, new environment.

We are designing, or trying to design, the institute for the next ten years, remaining some major issues like the link between clinical activity and research activity.

I would like to use only one word – research, not dividing it.

I think that we have to enforce some areas that in the past were not so developed, like liver surgery, like haemato-oncology, like the melanoma and sarcoma areas, rare tumours in general.

We’ve not managed to produce an MD/PhD programme in IEO yet but I can imagine that that might be on your list of things for the future.

Yes, this is one of the points.

Because a lot of the young Italian doctors who want to do a PhD, they go to the States and don’t come back.

Yes, it’s true.

So we need to try and get that.

Yes. Fortunately we have rules from the university side that it is not easy to combine certification, post-doc certification, and a degree obtained by the university.

IEO is a private institute, it’s linked with the university but at the moment we have to find the formulation in order to guarantee also this kind of degree.

One of Umberto’s strengths was prevention and he really did do a lot of work in prevention medicine. Is this a theme that you want to continue?

Absolutely.

Prevention is absolutely important; primary prevention, obviously, and also early screening of the tumour because obviously we have to face the problem when the problem exists but also we have increased our capability to sensitise populations in order to decrease the incidence because obviously we cure more but also we have an increasing number of at least some kind of tumour.

We have to face both those aspects.

Roberto, congratulations again and good luck. Thank you very much.

Thanks, I need it.