(by Nicola Simonetti) Thermo-ablation and Interventional Radiology: at the Campus Bio-Medico University Hospital, there is a center of excellence able to guarantee a patient path with all the therapeutic options necessary for the treatment and care of the cancer patient
A leap forward to four feet, each of which is called surgery, chemotherapy, radiotherapy and, lastly, loco-regional therapies such as thermo ablation.
A procedure, the latter, which sees Italian pioneers, and not by chance, as Italy boasts cutting-edge facilities, clinicians and researchers.
"The Campus Bio-Medico University Hospital - says Mario Magheri, coordinator of the presentation conference held in Rome - has become a real pole and uses a tumor board able to guarantee the best patient path with all the therapeutic options necessary for a multidisciplinary approach to the disease.
Curative, palliative, increased effectiveness of cancer treatment. These are the areas of application of thermal ablation. Market studies predict an increase in the use of ablative techniques in the 2017-2024 period, estimated at around 10,2%. The reasons are to be found in the increase in average age and related cancers and above all on the proven clinical effectiveness of such treatments ”.
"Multiple areas of application of this therapy. In particular - says prof. Vincenzi, professor of oncology Campus Biuomedico - primary and secondary liver tumors, primary and secondary lung tumors, primitive kidney tumors, bone tumors: (palliation of pain in metastases, first-rate curative treatment in osteoid osteoma) " . The indication - adds the prof. Rosarui F. Grasso, head of interventional radiology at the Biomedivo campus polyclinic - is placed after the study of the single case carried out during one of the weekly meetings by the tumor board. An oncologist, a surgeon, a radiotherapist and an interventional radiologist participate in this.
Introduced in the 90 years, the percutaneous thermoablation procedure for the treatment of some types of tumors has seen a progressive evolution of the technologies used, with the aim of achieving an ever greater precision, efficacy and safety for the patient.
Thermoablation techniques are based on the development of heat within a 'target' lesion, reaching a temperature above 60 degrees. In oncology these cause the denaturation of intracellular proteins and the dissolution of membrane lipids, causing cell death. These procedures can be performed both against primary and secondary tumors of parenchymal tissues (liver, kidney, lung) and bones.
This is a targeted therapy that, despite its minimally invasive nature, must be practiced in a hospital center able to guarantee advanced technologies, high levels of experience, a multidisciplinary team, and the possibility of carrying out follow-up over time, to ensure that the patient is carefully selected, so that he can get the best benefit from this type of treatment ”.
"Thermal ablation, apart from specific cases such as primary hepatocellular carcinoma," says prof. Vincenzi - is not a substitute, but complementary to traditional surgery and medical treatments, and has very specific indications that consider the volume, number and location of tumor lesions. For this reason it is essential that the patient is taken in charge by a multidisciplinary team. The important thing is to define therapeutic appropriateness: understanding, that is, what is the right patient and the right time to perform this procedure. "
The goal is to control the disease and reduce the associated symptoms. The focus remains on improving the quality of life of the patient, together with an increase in life expectancy and, therefore, a reduction in mortality ".
"Depending on the type of patient - continues Professor Grasso - we can ask ourselves different aims: the 'curative', when we are able to eliminate the lesion (generally single and alone), the" cytoriductive ", performed on an important tumor mass, both as a single lesion, and multiple lesions, in order to facilitate the effectiveness of drug therapy. Last but not least the "palliative" purpose, aimed at improving the symptomatology of the disease and, consequently, the patient's quality of life. It should not be forgotten, in fact, that the 20% of patients with cancer pain has an unresolved problem and that, even in the most advanced radiotherapy centers, the percentage of patients who do not respond to radiation therapy for analgesic purposes is always of 20% . ".
In recent years, another strong point of thermoablation has emerged, which consists in its ability to cause an important inflammatory response capable of stimulating the immune system to react against cancer cells still present in the area, thereby reducing also untreated injuries.
It is important to point out, then, that thermoablation is also performed in "benign" tumors, particularly of the thyroid and uterus.
In specific cases, cryoablation is useful, which allows the tumor to be frozen by inserting cryoprobes, causing necrosis. This last treatment finds particular indications in the treatment of kidney tumors and in the palliation of bone pain.
"The benefits of this technique for the cancer patient mainly concern the fact that it is a less bloody method than traditional surgery, faster, less painful, it is repeatable in case of relapses. It reduces the days of hospitalization and the period of illness, with a consequent decrease in direct and indirect costs, to the benefit also of the National Health System - says prof. Fat - Our patients are treated in deep sedation and in some cases even under general anesthesia. Hospitalization is generally by 1 or 2 days. By eliminating general anesthesia, all patients who are otherwise not eligible for other therapies for advanced age or for the presence of comorbidities can be treated. "
For some types of cancer such as primary hepatocellular carcinoma (HCC) with dimensions smaller than 3 cm, the National and International Scientific Society Guidelines have established that radiofrequency or microwave thermal thermoablation treatment is equivalent to traditional surgery.
Regarding renal cancer under 3 cm the clinical success of thermoablation is around 98%.
"It is important that the patient and the public are aware of the fact that we are talking about a consolidated methodology, implemented by the Guidelines of national and international Scientific Societies, with a robust scientific literature that supports their effectiveness and safety. "
The critical issues concern the fact that there is still no appropriate and widespread information on the procedure and that fair access to therapy is not guaranteed in all regions and there are no specific routes.