A joint team of doctors and researchers from the European Institute of Oncology (IEO), the National Institute of Nuclear Physics (INFN) and Sapienza University of Rome, coordinated by Emilio Bertani of the Digestive System Surgery Division and Director of the Neuroendocrine Tumor Surgery Unit of the IEO, and Francesco Ceci Director of the Nuclear Medicine Division of the IEO, demonstrated with a clinical study that the use of an innovative Tumor-finding probe improves surgery efficacy for gastrointestinal neuroendocrine tumors.
The probe being studied is an innovative tool capable of detecting positrons, particles emitted by radiopharmaceuticals such as those commonly used to perform PET diagnostics. The device, developed by INFN and Sapienza, has demonstrated high sensitivity in identifying tumor cells labeled with a specific radiopharmaceutical for neuroendocrine tumours. A capability that makes the probe effective in guiding the surgeon’s hand exactly to the site of the lesion, however microscopic or in a difficult location. The study conducted at IEO between May 2022 and April 2023 on 20 patients demonstrated that the new probe is able to reveal the sites of disease with a sensitivity and specificity of 90%.
Thanks to the use of the probe, surgical operations, both traditional and with robots, will therefore be more precise and conservative, as it will be possible to detect with great precision the presence of tissues to be removed, while avoiding unnecessary removals. In summary, the procedure involves the injection of a minimal dose of specific radiopharmaceutical for neuroendocrine tumors which selectively targets the tumor cells.
“Radio-guided surgery – explain Francesco Collamati of INFN and Riccardo Faccini of Sapienza University of Rome – has so far used gamma-ray probes which do not work when what you want to reveal is close to organs that absorb a lot of radiopharmaceuticals, such as in the abdomen. A probe like the one we have devised, which detects positrons instead of photons, makes it possible 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 during surgical interventions for the first time”.
The creator of the possibility of carrying out this experimentation at the IEO was Francesco Ceci, Director of the Division of Nuclear Medicine, as well as one of the leading experts in the sector. “My research focus has always been Theranostics, the discipline that combines the latest generation diagnostics with precision therapies. When I learned about this device, I immediately understood its incredible potential and a fruitful collaboration with Dr. Collate yourself. The real innovation of this surgical procedure lies in the administration to patients during surgery of the same cancer-specific radiopharmaceutical used for PET diagnostics. We first identify the locations of the tumor with PET and then use the probe to remove them with great accuracy. Diagnosis and therapy, the foundations of Theranostics, this time applied to surgery”.
“IEO is ever closer to the goal of “precision surgery”, capable of removing nothing more and nothing less than what is necessary to heal – explains Emilio Bertani, surgeon of the Digestive System Surgery Division and coordinator of the clinical study – Even the most experienced surgeon in one case out of three can leave residual disease, not even visible on 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 is able to remove them without causing excessive damage. 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 that for Neuroendocrine Tumors surgery is the only form of radical cure – continues Bertani – unfortunately, however, up to 30% of laparotomies do not manage to sterilize the tumor bed and therefore to control the tumour. Lymph node metastases recur in 10% of cases. The new probe therefore represents great progress and hope in the treatment of NETs, even if it should 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 the hands of an expert surgeon”.
“The excellent results obtained on neuroendocrine tumors encourage us to extend the study. A study in prostate cancer is already underway at IEO, and we plan to apply the procedure with the beta probe also to other gastrointestinal cancers and gynecological cancers” concludes Ceci.