Prof. Dr. Piero Fossati MD, Radiation Oncologist
Making the benefits of carbon-ion therapy accessible to all patients.
Since October 2022, Prof. Dr. Piero Fossati MD, has been heading the Department of Radiation Oncology with an emphasis on particle therapy, at the Karl Landsteiner University (KL). He also serves as Scientific Director at MedAustron, a teaching and research location of KL. MedAustron is one of only a handful of centres worldwide that combine highly specialised cancer treatment with research and teaching. As a radiation oncologist, Fossati focuses on highly precise, innovative forms of radiotherapy, particularly carbon-ion therapy. His aim is to bring this therapy out of its niche and make it accessible to as many patients as possible.
Fossati began his academic career in his home country, Italy. In 1997, he completed a Master’s degree in Biomedical Engineering at the University of Rome. Building on this, he decided to study medicine at the same university and continued his training with a specialisation in radiotherapy at the University of Milan. Fossati gained formative experience during his clinical fellowships at the National Institute of Radiological Sciences (NRIS) in Japan, where he worked for the first time with carbon ion therapy, which was still relatively uncommon at the time. After holding a dual role as a researcher at the University of Milan and as a radiation oncologist at the CNAO in Italy, he eventually moved to Austria to join the MedAustron Cancer Treatment and Research Centre. Since 2017, Fossati has been working there as a consultant in radiation oncology, scientific director and head of the carbon ion programme, making a significant contribution to the further development of the site in Wiener Neustadt.
Upon joining MedAustron, a key focus of Fossati’s work was to demonstrate the clinical significance of carbon-ion therapy. “We need to show that the results are reproducible – not only in Japan, but also in Europe,” emphasises the radiation oncologist. The aim is to confirm these early results from Japan under European conditions and to build on them in prospective studies. This is not just about efficacy, but also about the application of the therapy. “With carbon ions, it is not enough simply to define the dose; one must also take the biological effect into account,” explains Fossati. For a long time, differing models of relative biological effectiveness (RBE) made international comparability difficult. Put simply, RBE describes how strongly the radiation actually affects the tumour tissue – in other words, not just how much energy is delivered, but what biological effect it causes in the cells. Harmonising different approaches from Japan and Europe on this issue is a central part of his work and forms the basis for further clinical studies and collaborations.
Today, attention is increasingly turning to new areas of application, particularly for patients for whom conventional therapies have reached their limits. “We have treated around 30,000 patients worldwide with carbon ions – that is still a very small number. We are still a long way from having tried everything that is possible,” says Fossati. Together with international partners such as the Mayo Clinic Florida, his team is monitoring patients during treatment to better understand how tumours respond to the therapy on an individual basis. The aim is to make the treatment more targeted in future through personalised adaptation.
Collaboration with KL as part of the ACCESS POINT Oncology (APOG NÖ) project also plays a key role in this. Fossati is involved as a co-principal investigator and is working to establish translational research structures in Lower Austria. The aim is to translate findings from the laboratory into concrete applications for patients more quickly. The objective is to systematically combine clinical data and biological samples in order to better understand how tumours develop, progress and respond to therapies. A particular focus is on treatment resistance, i.e. the question of why treatments do not work in some patients and how this can be used to develop new diagnostic and therapeutic approaches.
At the same time, Fossati is investigating how tumours change early on during treatment and how these processes interact with the immune system: “Something happens in the tumour after the first round of radiotherapy – we don’t yet understand exactly what, but it seems to make it more vulnerable,” he explains. Initial evidence suggests that carbon ions destroy cancer cells in a way that could trigger a stronger response from the immune system. This finding opens up an approach that is to be used in future to better coordinate therapies and specifically enhance their effect.
Alongside research and clinical work, teaching is a central part of his role at the KL. Fossati teaches medical students and regularly supervises dissertations. “Teaching has always been part of my professional life, and I take great pleasure in passing on my passion to aspiring young scientists,” he says. His aim is to convey complex concepts in an accessible way and, above all, to spark interest in this still-emerging field of research.
His long-term vision remains clear: “Carbon-ion therapy must not remain a niche procedure.” Instead, it should be gradually introduced into broader clinical practice on the basis of robust data, international collaboration and well-trained scientists.
