Due to its very high incidence rates and world record in terms of mortality, it is still nicknamed today “Big killer”: we are talking about the lung cancer, which only in Italy reaps about every year 32 thousand victims, the leading cause of death from cancer in men and whose mortality for women in Europe has exceeded that of the breast. Indeed, for the latter, the onset is growing in some European countries, a trend that goes hand in hand with a decrease in the male population, “perhaps because exposure to smoking began more late for women compared to men, so now those who have been exposed to active smoking for at least twenty years begin to get sick ». To specify the data is the Professor Giulia Veronesi, director of the strategic program in Robotic Thoracic Surgery of the Thoracic Surgery Unit of the San Raffaele Hospital IRCCS.
Milanese, born in 1969, mother of three children, Giulia Veronesi takes care of oncological thoracic surgery for over 20 years in terms of clinical, teaching and scientific research. He has to his credit 3,000 thoracic surgery and 230 scientific publications in the most prestigious national and international journals.
Robotic minimally invasive surgery: this is the extra weapon we have on our side to eradicate lung cancer and flagship not only of San Raffaele, but of medicine in Italy. «In 2006 there were only two in Europe to perform robotic interventions for lung cancer, when no one believed it yet – Veronesi says – Today this technique is recognized worldwide for its effectiveness in the radical removal of lung tumors and tumors of the mediastinum, that is the thoracic cavity between the two lungs ».
What exactly does it consist of? «Robotic chest surgery, with the Da Vinci Xi robotic system, it is a technique that combines low invasiveness of the intervention and radical removal of the tumor and involves for the patient a reduced trauma and a better quality of life after the intervention. In addition to the standard lobetcomia, it allows to perform the segmentectomy, or interventions aimed at the removal of lung segments for small tumors diagnosed when still at an early stage, also thanks to screening programs for prevention and early diagnosis. But not only that: it also allows a minimally invasive approach also on some locally advanced lung tumors which generally require a traditional thoracotomy surgical approach ».
“In practice, the surgeon works on one computerized console, connected to robotic arms, which perform what the surgeon commands remotely. In this way, our vision is magnified, therefore infinitely more precise, and above all the patient does not undergo cuts, but only intercostal holes of the size of 8 millimeters. The operation is more effective and successful than manual thoracoscopy and above all recovery is much faster than traditional surgery, with a reduction of postoperative hospital stay significant. Today 80% of lung cancer interventions in centers of excellence that have these machines are done this way “.
Surgical therapy becomes much more effective if combined with a timely early diagnosis. “For this, we started the research project SMAC (Smokers health Multiple Actions), a screening program designed for those at high risk of developing lung or heart disease associated with tobacco use ».
The study, aimed at people who have smoked for more than 20-30 years and former smokers over the age of 50, foresees that participants undergo a Preventive low-dose radiation CT scan even if they have no symptoms: “After several studies conducted in the USA and in Europe, in fact – comments Veronesi – Today we know that the low-dose CT scan is able to recognize lung cancer in the early stages of the disease, allowing to intervene in a manner effective and minimally invasive, also thanks to modern robotic surgery techniques. The goal of this research is to further improve the tools of early diagnosis and prevention, extending prevention to cardiovascular diseases which are the number one cause of death among smokers as suggested. The ultimate aim is that lung cancer screening becomes “popular” like other screenings, so that its use can be spread: on the current 2 million Italians at risk of cancer from smoking and potential candidates for screening, we could save about 10 thousand a year, thanks to this type of prevention.
Furthermore, the idea is to add to the low-dose CT scan – which sometimes returns some false positives – the discovery of new biomarkers in the blood of smokers, able to predict the onset of the disease. With a simple blood test, we could know if there are already diseased cells in circulation, and by taking these, we might be able to develop ad hoc therapies based on the tumor genome.
In this way, we could identify the tumor right in the bud and beat it thanks to the timeliness of the diagnosis and the creation of one personalized therapy, perfectly effective for him ».
And for the treatment of advanced stage tumors, therefore no longer operable, but chronic? “In that case, there are gods new molecular drugs, which treat specific mutations in those subjects who have developed a certain resistance to target drugs. Usually these mutations are not generated by exposure to smoke, but they also have a genetic link and occur in 5-10% of patients. Well, the discovery of these new molecular drugs allows for the continuation of treatments.
A second way is le immunoterapie, or drugs capable of strengthening the immune system, so that it can itself be an active part in the fight against cancer. With the molecules administered, it is reactivated, after the tumor had inhibited it. Well, there are incredible responses in stage 4 subjects, who become long survivors with a medium / high quality of life. And is aiming to administer these immunotherapies already in subjects with the third stage of cancer or with still operable neoplasms, precisely to urge the immune system to do its part in defending the organism.
Obviously, not all patients are eligible for this type of therapy: to understand who can benefit from it, the markers are searched for, through tissue biopsy. More precisely, we go in search of the mark PDL1, whose expression is directly proportional to the efficacy of immunotherapy ».
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