Tumors, in Milan the first thermoablation intervention performed with magnetic resonance

It is the first intervention of this kind ever performed in Italy, with more than satisfactory results: it is the thermoablation with microwaves guided by magnetic resonance, that is, a minimally invasive surgical technique for the treatment, in this case, of liver cancer. The novelty concerns the use of magnetic resonance, because it allows to extend this type of intervention potentially to all solid tumors in early stages and to metastases.

The technique represents – says the group of radiology clinicians at the Policlinico di Milano, where the operation was performed – “an important step forward in local-regional tumor surgery, which opens up completely new scenarios for interventional radiology, with the transformation of a technology normally dedicated to diagnostics (i.e., magnetic resonance imaging, ed. ) into a high-precision operating tool”. A case, in short, in which an instrument used until now only for diagnosis is also revealed to be useful and precise for treating various types of tumors in a minimally invasive way.

What is thermal ablation?

As the name suggests, thermal ablation is a minimally invasive technique used to destroy tumor cells through heat. It is mainly used to treat solid tumors in organs such as the liver, lungs, kidneys and bones; the procedure involves inserting a needle or probe directly into the tumor, without having to use a scalpel. The tip of the needle emits high-temperature heat in the form of electromagnetic waves in the radiofrequency or microwave range, or laser light or even focused ultrasound.

"Traditionally, this type of treatment is performed under ultrasound or tomographic guidance," explains Gianpaolo Carrafiello , director of radiology at the Policlinico di Milano and full professor at the University of Milan. "However, these imaging modalities allow us to intervene only on tumors that are visible with these technologies, thus excluding many other undetectable lesions. Magnetic resonance imaging, on the other hand, allows us to identify almost all tumors."

Not only that, the expert explains: compared to tomography, resonance does not expose the patient to ionizing radiation and provides much higher quality images, which allows for guiding the insertion of the needle with millimetric precision. “The procedure we performed,” he emphasizes, “is a revolution in the treatment of neoplasms.”

From cold to hot

Until now, in Italy, oncological surgery guided by magnetic resonance imaging has been performed almost exclusively by cryoablation, a technique that uses cold to “freeze” the tumor and induce necrosis. Now the prospects are much broader, with new treatment options for a large number of patients, who will have access to a less invasive procedure than traditional surgery, with shorter recovery times and greater safety.

When can thermoablation be done?

Thermal ablation is particularly indicated when the tumor is small (usually less than 3-5 cm), or if surgery is not possible or advisable, or if there are contraindications to other treatments such as chemotherapy or radiotherapy, or finally if a localized and targeted treatment is needed. In addition to being minimally invasive, its advantages are that it is not very painful, can often be performed under local anesthesia, allows for a rapid recovery of the patient and can be repeated, even in combination with other treatments.

“Microwave treatment of primary tumors like that of our patient and of liver metastases – continues the clinician – falls within international guidelines and represents, in the case of primary tumors, the first therapeutic choice for neoplasms in the early or very early stages”.

Now we need a protocol (and compatible needles)

The goal – Carrafiello continues – is for more and more hospitals to be able to perform the procedure with this pioneering approach. To do this, high-field magnetic resonance imaging is needed, which is already widespread in Italy, and non-magnetic materials, such as needles, which must be able to get close to the machine without interfering with the accuracy of the imaging and the safety of the patient.

"The peculiarity of our treatment is in the use of these needles compatible with magnetic resonance imaging. With this in mind, we want to create a procedural protocol that puts all the facilities that have this equipment in the condition of being able to use it as a guide in these interventions. It would mean being able to treat many tumors in a precise and minimally invasive way, not only of the liver but also of the kidney, lung and pancreas."

As always, the multidisciplinary approach was essential: the intervention was in fact carried out thanks to a collaboration between radiologists, interventional radiologists, hepatologists and anesthetists. “This intervention demonstrates the concrete commitment of the Policlinico di Milano towards innovation across the board,” concludes Matteo Stocco , general director of the Milanese hospital. “From artificial intelligence applied to clinical practice and hospital management, to the most advanced interventional radiology technologies.”