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Ronny Allan
A major challenge that cancer surgeons face currently is that there are no reliable methods to identify the tissue type during surgery (other than fast tracking tissue sampling). The surgical procedures, therefore, rely extensively on the experience and judgment of the surgeon to decide on how much tissue to remove around the tumor margins. Sometimes this can result in the removal of excessive healthy tissue. On the other hand, not removing some tumour cells can often need a follow-up surgery to remove residual cancer tissue. This just adds to patient morbidity and long-term detrimental effects on the patient’s outcome.
The use of tumour finding probes is not new and scientists have been looking at this for a number of years. Some healthcare commentators described some of these tools as working in the same way as a metal detector. For example, scientists developed a probe for breast cancer that works by measuring the difference in pH on the tissue surface, which actually correlates really well to whether the tissue is healthy or cancerous. The probe has a pH indicator attached to the tip, which changes the color of the light it emits depending on how acidic or basic the surface is. Another study involving breast cancer, scientists studied a near-infrared (NIR) fluorescence imaging probe using targeted peptides related to breast tissue. In the UK, I found that the NHS has recommended the use of Magtrace and Sentimag for locating sentinel lymph nodes for breast cancer in hospitals with limited or no access to radiopharmacy.
These probes which help to make a complete tumour removal at the initial surgical resection are critically needed in the operating room to help optimise the surgical procedure and to confirm tumour-free edges (R0 margins).
I could have listed several more cancer finding probes above, but I wanted to now focus on the small study which covers Neuroendocrine Tumours (NET) and Prostate Cancer, a natural combination when you read why below.
Remember, these studies are proofs of concept, they still need to go through the years of clinical trials to ensure safety and efficacy.
Tumour Finding Probes – the potential for NET
This small study caught my eye. Basically, it involves the use of a “surgical tumour probe” which is able to pick up “positrons”. When I googled that term, I found great complexity but hopefully the study detail below will expand on that. Positrons are antimatter, that is, positively charged beta-rays. Positrons are also called ‘positive electron’, positively charged subatomic particles.
This is way beyond most of us but let me just say two things and then you may be starting to click on the potential of this surgical probe. Positron is the P in PET i.e. Positron Emission Tomography (PET) scans. Beta particles are used in somatostatin receptor (SSTR) PET scans and beta-emitter PRRT such as Lutathera (Lu177).
I think most people would accept that many advanced gastrointestinal NETs (particularly small intestine NETs) with complications in the mesentery (and less commonly in the retroperitoneal cavity) can be stabilised for extended periods via debulking/cytoreductive surgery. Trying to get every single cell is extremely difficult thus why adjutant targeted therapy is often used as a follow-up in stable and particularly progressive situations (and less commonly neoadjuvant therapy prior to surgery).
The study below (translated from Italian) is also being conducted on prostate cancer. This makes sense as both SSTR PET and SSTR targeted PRRT is almost making vast inroads to prostate cancer. I’ve also seen some other initiatives using similar techniques in other cancers, but this is the first one in NETs.
This is all part of the drive towards precision surgery.
Key headlines from this small study in GI NETs:
- The probe is able to reveal the sites of disease with a sensitivity and specificity of 90%.
- 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.
- Surgery can be more precise avoiding the unnecessary removal or tissue, reducing post-surgical problems and morbidity.
- The probe is effective only if it is in the hands of an expert surgeon.
The “Tumour Probe” study for GI NETs.
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.
Disclaimer
I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me.
Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.
Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.
General Clinical Trials Disclaimer
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided in the clinical trials document. It’s very important to check the trial inclusion and exclusion criteria before making any contact. If you need questions, the articles here is very useful Questions to Ask About Clinical Trials | Cancer.Net
The inclusion of any trial within this blog should not be taken as a recommendation by Ronny Allan.
Finally
Whenever I post about a trial or study, some people get excited without understanding that these new treatments and capabilities can very often take years to come to fruition and it’s also possible that clinical trials can be halted, or that national approval agencies will not approve the final product. Plus, not everyone will be eligible, so always check the exclusion and inclusion criteria in the relevant clinical trials document. Please bear that in mind when reading studies/clinical trials posted on RonnyAllan.NET
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