Key personnel making their mark in the world of lung cancer - 5:
Professor Umberto Ricardi, Professor of Radiation Oncology at the University of Turin and Chairman of Oncology Department at the San Giovanni Battista University Hospital in Turin, Italy.
Professor Ricardi is a radiation oncologist whose main areas of clinical and scientific interest include lung cancer, lymphoma, childhood tumours, and central nervous system tumours. He is an expert in the development of cutting-edge technologies in radiation oncology, including radiosurgery, stereotactic ablative radiation therapy, image-guidance, and volumetric IMRT.
Prof Ricardi is also a member of the Italian Association of Radiation Oncology, the European Society for Radiation and Oncology (currently serving as ESTRO President) and the EORTC Radiotherapy Group. In 2007, he was appointed to the Italian Ministry of Health’s National Oncological Commission.
What first motivated you to work in thoracic medicine and lung cancer?
There were really two factors that led me to thoracic medicine and later lung cancer: the clinical challenge and the technical challenge. When I was in training the prognosis of lung cancer patients was dismal. I believed that it was very important for me as a clinician to try and make the biggest effort possible to improve the prognosis of lung cancer patients. From the perspective of radiation oncology, lung cancer can be a very challenging disease to treat.
What is different about your role today from when you started your career?
A lot has changed over the last 30 years. There have been huge technical advances in the field which have changed my practice in the last two decades. New developments such as stereotactic ablative radiotherapy (SABR) and intensity modulated radiotherapy (IMRT), for instance, have increased the precision and effectiveness of radiation therapy, both in early stage and locally advanced lung cancer.
We can precisely target the tumour with a high dose of radiation, while the surrounding healthy tissue receives only a low dose. This has really changed the way we treat patients with lung tumors.
What have been the biggest advances in your specialty, in terms of how we have improved outcomes for people with lung cancer?
Two technical advances have really transformed the way that we work as radiation oncologists. SABR has made it possible to treat small tumours diagnosed at an early stage much more effectively, to the point that you could say we are curing patients without the need for surgery.
For those patients diagnosed with later stage cancers, combination of systemic treatments (platinum-based chemotherapy) and modern radiotherapy (4D-CT scan at simulation, planning with IMRT, image guided radiotherapy) has had a significant impact on outcomes.
In the 1990s, standard treatment for locally-advanced (stage III) NSCLC was radiotherapy alone, with a median survival rate of between 9-10 months; thanks to advances in medical oncology, radiation oncology, and imaging techniques, median survival has improved to around 30 months. This is better, but there is still plenty of room to improve.
What do you see as the most significant challenges to continuing to improve outcomes for people with lung cancer in the coming years?
In my view the biggest challenges are around ensuring access to high quality multi-disciplinary care, education and resourcing. Multi-disciplinary team working offers the optimum standard of care but this varies at a national and an international level. I believe we should be working to guarantee access to high quality multi-disciplinary care for everyone with lung cancer, as well as with other cancers sites.
We also need to educate the next generation of clinicians, ensuring that all the different healthcare professionals caring for people with cancer are well trained and supported to work in a multi-disciplinary way. This will mean finding new ways of working and pathways of care. For example, roles will need to change to support people who are on active treatment for much longer.
Globally, the availability of resources is also an issue. Patients in some countries simply do not have access to effective and up-to-date treatment. Widening access to new and better treatments and the workforce to deliver them will continue to be a challenge for many countries.
What are you most excited about in your field?
We are finding new ways to better target and treat lung cancer. For example, combining PDL1 inhibitors and radiations is an incredibly exciting new area of clinical research. I feel optimistic about the prospect of finding new ways to combine these medicines with radiation oncology to improve outcomes in different disease settings.
I also feel that the wider use of Patient Reported Outcome Measures (PROMs) is important. By directly capturing outcomes from the perspective of the patient, PROMs have the potential to narrow the gap between the clinician’s and patient’s view of what is needed and help tailor treatment plans to meet the patient’s preferences and needs.
What role do you see international collaboration playing in advances in lung cancer treatment?
International collaboration is fundamental to improving the treatment of lung cancer. In my role, as current President of ESTRO, I see on an almost daily basis how improving collaboration between international societies such as ESTRO and IASLC, is vital to sharing best practice and optimising education and care. I am certain that international collaboration will allow us to continue to improve multidisciplinarity and patient care across all cancer types.