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The history of the European Institute of Oncology

Born in 1994, IEO celebrated 20 years of activity in 2014. The following are the most important stages of its growth and future prospects.

1994


The European Institute of Oncology is the creation of Umberto Veronesi whose vision was to found an innovative model of hospital which applied the principles of private management to public health. The inauguration ceremony on 30th May was attended by the most distinguished members of the Italian science and entrepreneurship. The Scientific Committee of the Institute was born, which included some of the most prestigious names in international oncology, including two Nobel Prize winners, Renato Dulbecco (Nobel Prize for Medicine 1975) and J. Michael Bishop (Nobel Prize for Medicine 1989). In anticipation of the 1998 legislation, the Institute organized its own Ethical Committee structured according to the most advanced criteria. IEO became the coordinating center of the main ongoing researches in our country in the field of oncology, particularly in breast cancer. One important example was pharmaco-prevention studies, a discipline that developed studies for the definition of individual risk on the one hand, and on the other hand research on medications that have the ability to prevent the onset of cancer, such as Tamoxifen.

 

1995


As an initiative of the Division of cervical-facial Surgery of the Institute, the "Program Chernobyl" started, with the aim of assessing whether children born in Milan at the time of the famous explosion of the nuclear power plant showed an increased incidence of thyroid neoplasms as a result of exposure to the ionizing radiation cloud. From the examination of 4,000 children under study, no particular increase in risk emerged. The study and treatment of diseases of the thyroid gland has been confirmed as one of the excellence of the Institute. The Division of Nuclear Medicine, the first in Italy, began studies on radio-immunotherapy, that is cancer treatment using radiation-loaded antibodies that target malignant cells but spare the healthy ones. This was one of the most innovative research areas of the Institute. An original contribution was the technique called avidin-biotin that allowed only those antibodies positioned on the tumor to loading radioactivity.

 

1996


  The European Institute of Oncology was recognized by the Ministry of Health as Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) (Institute for Hospitalization and Health Care Research). The laboratories of Experimental Oncology were opened where scientists, a large percentage of which came from the United States and Northern Europe, work united by the project to identify the altered mechanisms in the diseased cancer cell and to develop therapies that can modify them. This was the year in which accreditation from the National Health System was awarded. IEO started delivering its services also within the NHS regime. A contract was signed with the University of Milan, according to which the Institute became the site of university specialisation courses. Meanwhile, the training of the doctors working at IEO was organized following advanced international systems. Once again anticipating the national legislation, a continuing medical education program was established (CME, Continuing Medical Education) as well as for interdisciplinary training.

 

1997


The Institute was equipped with the most advanced linear accelerator on the market and started the treatment of initial prostate cancers using conformational radiotherapy. IEO would become the center with the largest number of cases treated and with outcomes similar to surgery. The Divisions of Radiotherapy, Breast, and Nuclear Medicine tuned the R.O.L.L. (Radio-guided Occult Lesion Localization), a new radio-guided surgical technique that allowed the removal of microscopic non-palpable breast tumors. To guarantee the best possible quality of life, the Institute became the first cancer center in Italy, where the Division of Plastic Surgery systematically worked in combination with the Oncology Division, using cutting-edge methods to make the restitution of the breast to the woman an integral part of the cancer treatment. The scientific association "Sanità senza fumo"(Healthcare without smoking) is constituted, located in the Institute, bringing together all the health professionals in the fight against tobacco. The Association was committed to reducing the percentage of smokers among the Italian doctors, that is still too high today.

 

1998

 

The first work signed by a team from the European Institute of Oncology was published in the prestigious scientific journal, NATURE. The researchers discovered that a natural substance, retinoic acid, can block the mechanisms of action of the leukemic cell, returning it to normal operation. Thus the first "molecular drug" was born. On the initiative of the Italian Foundation for Cancer Research, the FIRC Institute project on Molecular Oncology (IFOM) kicks off. IEO was the main promoter of the IFOM project, that was born as a centralized technology infrastructure, aimed at enabling research groups from several Italian scientific institutions, to make use of equipments and techniques otherwise individually inaccessible for both the extent of costs and the specialized skills required. An article was published on LANCET ruling the entry into the clinical practice of a new technique for the treatment of breast cancer developed by the European Institute of Oncology. The "sentinel lymph node" proves to be a safe method to carry out the extraction of the axillary lymph nodes only when needed, thereby avoiding to patients the harmful and unnecessary removals that used to be systematically practiced.

1999 was the year of a historic publication on NATURE, on the discovery of P66, the ageing gene. IEO researchers discovered that animals in which this gene is removed lived 30% longer. This opened fascinating perspectives not only for the treatment of cancer, but of all the ageing diseases, such as Alzheimer's or Parkinson's. The European Institute of Oncology started the first clinical trial in Italy for the early diagnosis of lung cancer. In few months, thousands of smokers were recruited who, once a year for five years, underwent a chest Computerized Axial Tomography (CAT) Spiral test. Preliminary data showed that this easy, quick, and non-invasive test may soon be able to reduce the high mortality rate associated with this type of cancer, identifying it at an early stage, such as with mammography, when the chances of recovery are high. In the Institute, the “Ospedale senza dolore” (Pain-free hospital) project kicked off, realizing, with the participation of doctors and nurses, a structured intervention program that made the pain a parameter to be measured systematically and to keep under control.

 

2000 The Heart Center Monzino Foundation of Milan was acquired; it was the only cardiology IRCCS in Italy, as well as a university site. A period of collaboration started between the respective research areas of the two institutes, which together address the major causes of morbidity and mortality in humans. From the collaboration between the radiotherapy and breast units in the Institute the IORT (intra-operative radiotherapy) technique was born, that, thanks to the use of a mobile linear accelerator with a robotic arm, allowed radiotherapy treatment for breast cancer during surgery. At the Division of Nuclear Medicine, studies on the therapeutic potential of Receptor Radiotherapy were in progress using drugs loaded with radioactive substances capable of emitting radiations of short-range and high energy. The collaboration between clinical and laboratory allowed the creation of a new Unit dedicated to the development of new drugs; among the first in Italy this Unit dealt with pharmacogenomics, namely the development of therapies as much as possible personalized, less toxic and more effective. Umberto Veronesi was appointed Minister of Health.

 

2001 The European Institute of Oncology initiated the first integrated cancer diagnostics center for women located at via San Luca, in Milan. This was a unique organizational model in Italy. Within a single structure, women could run all the most advanced tests made available from science and technology for the prevention and early detection of women’s cancers. In NATURE, another important article signed by IEO was published on the ubiquitination of proteins. In the "box where proteins are assembled" the researchers found a new mechanism controlling protein function that could have important implications in the development of various diseases, including cancer. Another frontier had been crossed in understanding  cell functioning. It was a year of a great result for Experimental Research, as among the publications on NATURE oncology, half of the Italian ones came from IEO. The breast unit reacheed the world record for number of cases annually treated.

 

2002 was the year when the project for the Institute expansion was approved, involving the construction, next to the existing building, of a new structure for the development of outpatient clinic, day hospital and day surgery. This project would be the first model in Italy of a modern hospital based on the separation between diagnostic and clinical activities for better efficacy of the treatment plans. The Institute received a visit from the auditors of the Joint Commission, the prestigious American agency accrediting North American hospitals since 1953 in accordance with the highest standards of quality existing in health care. IEO was the first non-US cancer center to obtain the prestigious accreditation. The IEO technological equipment increased with the linear accelerator for modular radiotherapy (IMR), the apparatus for stereotactic radio-surgery, and the expansion of diagnostic imaging, which ranked among the most advanced and precise in the world.

 

2003 The sentinel lymph node technique was internationally recognized as standard practice to detect the spread of breast cancer in the presence of small nodules. The publication on the New England Journal of Medicine showed that patients with breast cancer under two inches in diameter, examined with this methodology, achieved a cure rate of 98% after five years, similar or even higher than that of women undergoing removal of the lymph nodes of the armpit. Lancet published the preliminary results of the study on early diagnosis of lung cancer, showing that the association of the CAT Spiral and PET (Positron Emission Tomography) was able to detect even the smallest lung tumors and to evaluate their benign or malignant nature. It was shown that in 95% of cases the combination of the two tests had allowed to locate tumors at an early stage, when they can be operated with high probability of success.

 

2004 On the occasion of its first ten years of operation, the Institute promoted a unique initiative in Europe. Concentrating some of the most important international European oncology events in one month, in Milan, in an ad hoc structure set up next to our building. The goal was to understand and communicate how the fight against cancer would outline in the future. Hence the idea of the Crossroads in the fight against cancer, 40 meetings of different nature, from the frontiers of molecular biology to the rights of the sick and healed of cancer - to create a meeting point between research, treatment, prevention, information, health education, training of medical staff, care organization. A mix of cultures and experiences, from the United States to the new Europe up to the Gulf area, because the "international thinking" is an important factor for good care. IEO confirmed its role as a cultural laboratory that focuses on humans not just as patients, but with their psyche and their sociability. From the international experience of the Crossroads emerged that biomedical science alone is not enough for cancer control. We need the aware participation of the population.

 

2005 Based on the results of the pilot study in 1999, COSMOS (Continuous Observation of Smoking Subjects) study started, offering 10,000 smokers the possibility of early diagnosis of a possible lung cancer, through a low-dose CAT once a year. The study would confirm the efficacy of this test to identify lung cancer at an initial stage, when the chances of cure are around 70%. It is therefore a lifesaver examination, as definitively would prove further, larger American studies. It's the year of the laying of the foundation stone of IEO 2 Day center, dedicated to the day hospital and outpatient visits. It was not only a spatial extension, but the application of a philosophy of care that, thanks to the reduced invasiveness, tends to return the patient to his social life and work as soon as possible. With its spaces dedicated to outpatient visits and examinations, IEO 2 is also a concrete sign of the centrality of early diagnosis in the IEO strategy.

In this context, the Institute lied at the forefront in promoting the HPV test for the prevention of cervical cancer, quickly becoming a landmark for women and their doctors. With the subsequent introduction in Italy of the vaccine against the Human Papilloma Virus for girls of twelve years, the goal became clearing that female cancer in the next generations. IEO activated a study to measure the effects of the vaccine in girls of the age of eighteen.

 

2006 Radiotherapy, the flagship of the IEO since its founding, performs basic steps forward as a result of the enlargement of the equipment allowing to cross the last frontier of radiotherapy, the treatment in four dimensions, which takes into account not only the volume, but also the motion. In practice, it became possible to accurately identify the target and "chase" it in its motion. The technology made possible tuning innovative schemes such as radiotherapy FAST, (Accelerated Fractionation of the Therapeutic Scheme), arriving to reduce up to 50% the total duration of radiotherapy treatment for major cancers, with equal efficacy compared to the traditional treatment schemes and with fewer side effects. It was expanded the application of methods of precision that had revolutionized the treatment of certain cancers, such as prostate cancer; out of 1,800 patients with early prostate cancer treated with radiotherapy at IEO in ten years (1996-2006), 85% were living in good health conditions. Data on FENRETINIDE, a derivative of vitamin A, were published, demonstrating the ability of this molecule to reduce the incidence of breast cancer in younger women. A key result in drug prevention, a research area in which IEO is a reference point in Europe.

 

2007 The activity of robotic surgery in urology with the Da Vinci system began. The first application was the prostate tumor at initial stage and the results were immediately excellent, less side effects, less pain, better recovery, and identical outcome on the tumor. The use of the robot was extended immediately to the surgical treatments of certain gynecological, gastrointestinal, and lung cancers. Compared to traditional surgery, the robot provides a better view of the operative field and allows performing high-precision and high-speed maneuvers. Even compared to laparoscopy, of which the robotic represents an evolution, the visual depth of the field and the precision in the movement of the operating grippers are improved; for example, it is possible a 360 degrees rotation that a human wrist could never do. On the research front the Campus IFOM - IEO was born. With the inauguration of the new research laboratories of the European Institute of Oncology adjacent to those of IFOM, the FIRC Institute of Molecular Oncology, the largest center for cancer research in Europe kicked off. The first results were immediately available. A new technology platform for the identification of mutated genes (BRAC1 and BRAC2), responsible for hereditary breast cancer, allowed to perform genetic testing at a lower costs and shorter time (one week compared to six months normally required).

 

2008 The IORT technique for breast cancer was tested, intra-operative avidination for radiotherapy. It was an innovative system of the IEO nuclear medicine designed to perform radiation treatment, in part during the conservative surgery and in part on the following day, thus reducing the whole care duration in a span of only 48 hours. In association with ELIOT (intra-operative radiotherapy) the method developed the philosophy of a cure for breast cancer having a constantly reducing impact on the woman’s life, with equal efficacy. In the Division of Gynecologic Oncology, the first center of High specialization for ovarian cancer in Italy was born, modeled as the analogous center at Johns Hopkins, the prestigious university hospital in Baltimore. The goal is to offer the patient a medical-surgical service in line with the best international standards, to guarantee access to the most innovative therapies and the full spectrum of competencies, technologies, and pathways needed for the most effective prevention, diagnosis and treatment of this tumor. On June 18, we held the first meeting for women who had lived or were still living the experience of breast cancer at IEO. The subject of the meeting was "Women want to know" and would become an annual event titled "IEO for women". This is a unique initiative in Italy because it is dedicated entirely to listening to patients and former patients. A tremendous success thanks to the participation of over 1,000 women each year.

 

2009 At the end of the year, the cover of CELL was dedicated to the results of the research of a group of the European Institute of Oncology, who discovered the biological mechanism for the duplication of cancer stem cells and how this process can be blocked by a drug. It is a milestone for the treatment of cancer because these cells (called "stem" because, like the latter, have the unique ability of unlimited self reproduction) are responsible for the spread of the disease in the body, the metastasis. With the purchase of a second Da Vinci Robot, robotics activity at IEO reached volumes and quality standards are among the highest in Italy and in Europe. After the first three years of robotic surgery, IEO was the cancer center in Italy with the wider experience in minimally invasive robotic techniques. From November 2006, nearly 1,000 interventions were performed, around 50 per month. The research on circulating tumor cells was presented, a system that allows to evaluate the aggressiveness of the tumor through a simple blood test. The detection of the presence of circulating tumor cells allows an assessment of the prognosis of the tumor and provides a snapshot of the state of the disease, allowing the oncologist a more targeted and effective therapeutic management.

 

2010 On March 23, the IEO 2 Day Center was inaugurated so realizing the modern idea of the hospital in which the diagnostic activity is separated from therapeutic for greater efficiency of both and for the benefit of the patient quality of life. The IEO radiology presented the early imaging, that is a new use of X-rays, Ultrasound and magnetic resonance for picking up early signs of cell proliferation before a small tumor mass even develops. On occasion of the IEO Day, the Institute announced a study on the feasibility of one of the dreams of oncology, introducing people in a "magic box" that virtually explores within few minutes their whole body to find the first signs of any abnormalities. The dream became a scientific hypothesis through the total body magnetic resonance, that allows taking a virtual trip in the whole organism, in a single session of magnetic resonance. The most recent MR apparatuses at IEO have a new technology that allows to produce images of the whole body in about 15-20 minutes, without ionizing radiations and without contrast materials. IEO tested the possibility of using this system to verify the accuracy of a screening of the entire body for the early diagnosis of cancers.

 

2011 IEO inaugurates the first Breast Day Surgery in Europe. In just 12 hours a woman can receive the same advanced and accurate treatments for breast cancer that are usually performed in one or two days of hospitalization. The treatment of breast cancer in a single day is a new frontier for Europe. An IEO clinical study has shown that early breast cancer, properly treated, can be cured in 98% of cases, and that to every centimeter of tumor reduction corresponds one percentage point of increased healing. It is strengthened the hypothesis that anticipating the diagnosis up to discovering the impalpable lesions detectable only with instrumental examinations, coupled with the accuracy of the therapies, will transform breast cancer into a manageable disease, with curability close to 100%. The model of day surgery, which makes the treatment less traumatic for women, with equal effectiveness, is a significant step in this direction. IEO became the Italian partner of the International Human Epigenome Consortium. The epigenomics is the last frontier of genetics that studies the relationship between the environment and the genome. The IEO biomolecular studies were developed in particular on nutrition and the role of caloric restriction, namely the reduction of calories daily eaten, in the duration of life and the onset of cancer.

 

2012 On January 30, ARC was inaugurated, a new Center for Advanced Radiotherapy of the European Institute of Oncology, which is positioned at the forefront in Italy and among the top 5 in the world. The Centre has a concentration of the latest generation technologies unique in our country, thanks to which up to 4500 patients a year can be treated with treatments reflecting the highest international standards of quality. The Center carried out a new program and a new vision of radiotherapy, which introduced the quality of life as a criterion for the selection of therapies and used some methods as treatments of choice for certain types of cancer with high incidence, such as those of the prostate, chest, and uterus. In addition, the connection to the newborn CNAO (National Center of Oncological Hadrontherapy) allows to integrate therapy with hadrons with traditional therapies, providing patients with all the technologies, knowledge and competencies existing in the radiotherapy field.

 

2013 ARC, the Center for Advanced Radiotherapy, the first in Italy, offered a new program of radiotherapy for the treatment of intra-capsular prostate cancer, which allowed to treat the disease in only 5 sessions. The results were similar to those of the more extended cycles and side effects further reduced.

In Lancet, data related to intra-operative radiotherapy were published, showing that for small size breast cancers the ELIOT had the same efficacy as the cycles of external radiotherapy. The intra-operative radiotherapy solves the problem of women living far from a radiotherapy center and is also less toxic than the traditional one. Avoiding to radiate the skin and the region near the lung and the heart (in the case of the left breast), many side effects are also avoided. The overall toxicity of the whole treatment for breast cancer is therefore very much reduced. IEO suggested that the intra-operative mode become a standard treatment for all women with small size breast cancer. The prestigious international journal Cell published the research on Junk DNA (DNA Rubbish), the result of a worldwide project of the highest scientific level on Genomics and Cancer, funded by the European Union, and having as Italian partner the European Institute of Oncology in Milan and the IIT in Genoa. The European Institute of Oncology was among the first in Italy to invest in innovative technologies needed to genome sequencing, collectively referred to as Next Generation Sequencing. These technologies, mainly used in research, in a few years may get into the routine diagnostic evaluation for each patient. IEO is close to the goal of sequencing the DNA of all its patients. In recent years, IEO invested a lot in genomic research in collaboration with the Italian Institute of Technology, with which it shares a technological platform. IEO is also a founding member of the two major consortia dedicated to Next Generation Sequencing Technologies, Blueprint and IHEC (International Human Epigenome Consortium).

 

 

2014 IEO has been living in the future for 20 years

IEO has designed and promoted a new way to treat the person, taking into account the efficacy of the therapy, but also the quality of life during and after treatment.

 

IEO has generated discoveries and methods that have improved and continue to improve clinical practice and have opened up new frontiers in molecular research.

 

IEO has created and developed an hospital model of private law but for the public interest, in which the criteria of a private facility management are applied to clinical and research, without profit objetives, for all patients.

 

Over the next twenty years, IEO will continue to carry out its mission of permanent laboratory for innovation in the fight against cancer.

 

PARTNERSHIP

Università degli Studi di Milano Ecancer Medical Science IFOM-IEO Campus

CREDITS

Ministero della Salute Joint Commission International Breastcertification bollinirosa

© 2013 Istituto Europeo di Oncologia - via Ripamonti 435 Milano - P.I. 08691440153

IRCCS - ISTITUTO DI RICOVERO E CURA A CARATTERE SCIENTIFICO

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