Future Horizons in Lung Cancer
State of the art imaging and lung cancer management
Dr Giulia Veronesi - Humanitas Research Hospital, Milan, Italy
At this meeting I’ve been asked to talk about imaging and new horizons in lung cancer management, in this field. As a thoracic surgeon I focussed the presentation on the advancement of imaging that is related to thoracic surgery and the improvement in lung cancer management. We can say that the most important advancement has been done in the personalised treatment and surgical planning of lung cancer, particularly small nodules. So we now have tools to learn before surgery and before biopsy the type of aggressiveness of the lesions and so we can plan conservative treatment in a more precise way than before. These parameters include in particular SUV at PET scan but also the size of the tumour, the density and volume doubling time. We have a very sophisticated way to calculate the volume of the nodules at different time points and calculate the growth rate of the tumours. These are all predictive of outcome.
So the treatment is becoming more and more personalised; with new technology we are able now to perform sublobar resection and we use robotics to do segmentectomy, for example. For the future the new tools in imaging will be also the possibility to have three dimensional reconstruction of the lesions and the organs and thus planning the segmentectomy and sublobar resection in a more precise way. This facilitated a minimal invasive approach for us and this is the present. The future will be also the combination of imaging with robotic surgery.
So what is the very promising field is the possibility to integrate the imaging reconstruction and CT scan of that patient with the vision you have during surgery so that you can have a virtual reality and augmented reality and you can in transparency have definition of the structure of the segments and the organ you want to operate. So this is a very fascinating prospect for the future.
What are the benefits for the patient?
For the patient the benefit is that you can avoid lobectomies and major resection, maintaining the oncological margins and so reducing the possibility of recurrence close to the margins. Also you have the prospect of improved quality of life by lung sparing resection and minimally invasive surgery.
