2023-07-20 13:47:09
A ‘tumor-finding’ probe that improves anticancer surgery. It is the made in Italy device at the center of a clinical study conducted by a joint team of doctors and researchers from the European Institute of Oncology (IEO) in Milan, the National Institute of Nuclear Physics (INFN) and the Sapienza University of Rome. The team, coordinated by the IEO with Emilio Bertani of the Digestive System Surgery Division and director of the Neuroendocrine Tumor Surgery Unit, and Francesco Ceci, head of the Nuclear Medicine Division, demonstrated in particular that the use of the device increases the effectiveness of surgery for gastrointestinal neuroendocrine tumors (Net). The special probe was developed by Infn and Sapienza.
It is an innovative tool – reported by the IEO – capable of detecting positrons, particles emitted by radiopharmaceuticals such as those commonly used to perform Pet diagnostics. The probe demonstrated high sensitivity in detecting tumor cells labeled with a radiopharmaceutical specific for neuroendocrine tumours. An ability that makes it effective in guiding the surgeon’s hand exactly to the site of the lesion, however microscopic or located in a difficult position. The study, conducted in the IRCCS founded by Umberto Veronesi between May 2022 and April 2023 on 20 patients, in fact shows that “the new probe is able to reveal the sites of disease with a sensitivity and specificity of 90%”. The procedure involves the injection of a minimum dose of a specific radiopharmaceutical, which is selectively positioned on the tumor cells. Thanks to the device, surgical operations – both traditional and with robots – will be “more precise and conservative”, the experts are convinced, since “it will be possible to detect with great precision the presence of tissue to be removed, while avoiding unnecessary removals”.
“Radio-guided surgery up to now has used gamma-ray probes, which” however “do not work when what you want to detect is close to organs that absorb a lot of radiopharmaceuticals, such as in the abdomen – explain Francesco Collamati of Infn and Riccardo Faccini of Sapienza – A probe like the one we designed, which detects positrons rather than photons, allows us to detect exactly specific forms of cancer in areas of the body where it would otherwise be impossible to detect them. Thanks to the collaboration with Ieo, we were able to validate the probe for the first time during surgery”.
Ceci, creator of the clinical trial conducted at Ieo, says: “My research focus has always been theranostics, the discipline that combines latest generation diagnostics with precision therapies. When I learned about this device, I immediately sensed its incredible potential and a fruitful collaboration with Dr. Collamati began. The real innovation of this surgical procedure lies in administering to patients during surgery the same cancer-specific radiopharmaceutical used for Pet diagnostics. First we identify the tumor locations with the Pet and then we use the probe to remove them with great accuracy. Diagnosis and therapy, the basis of theranostics, this time applied to surgery”.
“IEO is getting ever closer to the goal of ‘precision surgery’, capable of removing nothing more and nothing less than what is necessary to heal – comments Bertani – Even the most experienced surgeon in one case out of three can leave residual disease, not visible even to the PET because it is located, for example, in the small lymph nodes near the mesenteric vessels. The beta probe is able to detect even the slightest presence of tumor cells and in 80% of cases the surgeon manages to remove them without causing excessive damage sivi.The strength of the procedure is that it balances the ability to find disease and the need to preserve vital tissue for the patient.”
“It is important to remember – adds Bertani – that for neuroendocrine tumors surgery is the only form of radical cure. Unfortunately, however, up to 30% of laparotomies fail to sterilize the tumor bed and therefore to control the tumor. Lymph node metastases recur in 10% of cases. The new probe therefore represents great progress and hope in the treatment of NETs, although it must be emphasized that what changes the result is not so much the technology as the procedure. The probe is effective only if it is in hand to an experienced surgeon”. The use of the device is destined to expand: “The excellent results obtained on neuroendocrine tumors – says Ceci – encourage us to extend the study. A study in prostate cancer is already underway in IEO, and we plan to apply the procedure with the beta probe also to other gastrointestinal tumors and gynecological tumors”.
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