“I think the future success of ablation was truly unforeseeable, in 1986, when Tito Livraghi published his first paper about ethanol injection in a liver tumour. If we accurately match the energy source, the route of energy delivery, and imaging with the specifics of the lesion, we can treat lesions in almost every organ and anatomical space. Sometimes, it is necessary to enter the operating room together with the surgeon in order to get the best treatment results for the patient, but this should be seen as another opportunity—not an event to escape from,” says Laura Crocetti, associate professor of Radiology, Division of Interventional Radiology, Nuovo Santa Chiara University Hospital, Pisa, Italy. An internationally recognised ablation expert, she is also deputy chairperson of the European Conference on Interventional Oncology (ECIO) for 2022 and 2023.
What attracted you to a career in interventional radiology?
When I was in medical school, I was attracted by minimally-invasive treatments that enabled the possibility of curing patients with minimal damage and discomfort. The other passion I had was for technology and the latest developments on the horizon. So, when I heard of interventional radiology, I immediately realised that represented my future.
Could you share a positive and negative experience you have had as a woman in the interventional field?
I will start with a negative experience: I am a small-framed woman (my son says I am “short”) typically dressed in a non-slim-fit green working uniform and perhaps looking a few years younger than her age. Unfortunately, that is not what most patients expect when told they are scheduled to meet “professor” Crocetti, a “well-known” expert in the field of ablation who will perform the procedure. Still, an empathetic bond is almost always immediately formed, and they feel reassured and protected “in my hands”. Patients often witness their appreciation with very kind messages and emails afterwards.
The first surprise is unfortunately also sometimes observed in older, male leaders and colleagues who do not know you. Interestingly, you can seem transparent or invisible to their eyes. The important thing is that in the long term, I have always been able to convince my colleagues about my professional capacity and am very proud of this.
The positive experience as a woman physician often comes from everyday interactions with my female colleagues: the positive and supportive feeling is immediate and the desire to cooperate and work together is very strong. As female physicians, we are thorough, efficient, and well organised, and our results are usually very good!
What are the most important cancer imaging techniques that you see on the horizon?
I am extremely optimistic about the future of magnetic resonance (MR) and would like to emphasise its as-yet insufficiently explored aspects. Function, metabolism, and vascularisation can all be investigated with this technique. The vast amount of information that magnetic fields can provide is almost infinite. I am fortunate to have a very interesting opportunity to cooperate with the 7T consortium in Pisa (IMAGO 7) and the team really conveys that we are only at the beginning with MR. The application of MR in cancer imaging, for example before and after chemoradiotherapy or interventional radiology procedures, will remain a hot topic in the future.
Where do you see the greatest potential for ablative therapy?
I think the future success of ablation was truly unforeseeable, in 1986, when Tito Livraghi published his first paper about ethanol injection in a liver tumour. The potential of ablative treatments stem from their ductility combined with efficacy. If we accurately match the energy source, the route of energy delivery, and imaging with the specifics of the lesion (its size and location, roughly speaking), we can treat lesions in every organ and anatomical space. Sometimes, it is necessary to enter the operating room together with the surgeon in order to get the best treatment results for the patient, but this should be seen as another opportunity—not an event to escape from.
Do you see different niches for radiofrequency, microwave, and cryoablation?
Each ablative modality has its specificity. Generally speaking, at the moment my workhorse for the liver is microwave ablation, but for kidney, soft tissue, and prostate, I prefer cryoablation. I can see a future of selected microwave devices in thyroid and lung as well, but at the moment I still prefer radiofrequency here. A personalised approach for patient care includes not only choosing an interventional treatment and selecting the correct timing for it, but also picking from all the different energy sources and imaging approaches available to optimise treatment success.
What evidence would you like to see generated in your field of special interest–liver ablation?
Liver ablation is an area where we actually have quite a lot of evidence, especially when compared with other organs. Its efficacy and cost-effectiveness, for example, has been well established in hepatocellular carcinoma (HCC) and it is recognised in the major guidelines. I am very much looking forward to the results of the COLLISION trial, the noninferiority randomised study comparing ablation and resection in ablatable and resectable colorectal liver metastases of less than 3cm.
In the near future, I think we should produce evidence about the role of combination therapies including ablation and immunotherapy.
You have declared the International Accreditation System for Interventional Oncology Services (IASIOS) accreditation to be an important milestone for your hospital. Why?
IASIOS accreditation is a way of demonstrating first to us and then to the global community that the interventional oncology service we provide is of high quality and meets rigorous international standards. It helps to improve the whole process of patient care and treatment and is specifically designed for medical facilities offering interventional oncology. Accreditation already exists for other specialties or services, and it is extremely important to have it already up and running for interventional oncology.
As deputy chairperson for ECIO 2022 (24–27 April, Vienna, Austria), what would you like the programme to reflect?
ECIO is by definition a multidisciplinary meeting and the programme will reflect this special attitude of the congress. All topics will be addressed from multiple points of view and there will also be lots of opportunities to speak about ongoing research and new technologies. It is really a privilege for me to work with Philippe Pereira, the chairperson of ECIO 2022, to prepare the programme (www.ecio.org).
Could you describe a memorable case that has stayed with you?
It is the first liver radiofrequency ablation I performed many years ago, for sure. My heart was beating very fast…but everything went smoothly. I also recall all the difficult cases, those in which I had complications; I remember them all very well. Many of my patients have, fortunately, been able to live with a very long disease history and two of them, in particular, have become family friends. It has been very difficult to say to them that there was nothing further I could offer them and their families from an interventional treatment perspective.
What are your interests outside of medicine?
I love the sea, and particularly enjoy fishing and have a licence for a boat. My other passion is music and I am a conservatory graduate in piano. Hiking with my husband, Francesco, and son, Aurelio, is a family activity we enjoy together.