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Petrella F, Danuzzo F, Sibilia MC, Vaquer S, Longarini R, Guidi A, Raveglia F, Libretti L, Pirondini E, Cara A, Cassina EM, Tuoro A, Cortinovis D. Colorectal Cancer Pulmonary Metastasectomy: When, Why and How. Cancers (Basel) 2024; 16:1408. [PMID: 38611086 PMCID: PMC11010871 DOI: 10.3390/cancers16071408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is the third-most-diagnosed cancer in males and in females, representing 8% of estimated new cases, and the third cause of cancer-related death in both sexes, accounting for 9% of cancer deaths in men and 8% in women. About 20% of patients diagnosed with CRC present metastatic disease. Although lung metachronous or synchronous metastatic spread without other involved sites has been reported in only a small proportion of patients, considering that this tumor is frequently diagnosed, the clinical approach to CRC pulmonary metastases represents a major issue for thoracic surgeons and CRC oncologists. Among patients diagnosed with pulmonary metastases from CRC, about 9-12% are eligible for local treatments with radical intent, including surgical resection, SBRT (stereotactic body radiation therapy) and ablation therapy. Due to the lack of randomized controlled trials among different local strategies, there is no definitive evidence about the optimal approach, although surgical resection is considered the most effective therapeutic option in this clinical scenario. Oncological achievement of primary radical resection, the biology of primary tumor and metastatic sites, disease free interval and or progression free survival are independent prognostic factors which make it possible to define a cohort of patients which might significantly benefit from pulmonary metastasectomy.
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Affiliation(s)
- Francesco Petrella
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Federica Danuzzo
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Maria Chiara Sibilia
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Sara Vaquer
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Raffaella Longarini
- Division of Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (R.L.); or (D.C.)
| | - Alessandro Guidi
- Division of Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (R.L.); or (D.C.)
| | - Federico Raveglia
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Lidia Libretti
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Emanuele Pirondini
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Andrea Cara
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Enrico Mario Cassina
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Antonio Tuoro
- Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (L.L.); (E.P.); (A.C.); (E.M.C.); (A.T.)
| | - Diego Cortinovis
- Division of Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi 33, 20900 Monza, Italy; (R.L.); or (D.C.)
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
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Rizzo S, Bellesi L, D'Ermo A, Bonomo L, D'Ecclesiis O, Magoga F, Presilla S, Spanò A, Minzolini V, Lo Piccolo F, Heinkel J, Rezzonico E, Del Grande M, Merli M, Del Grande F. Body CT examinations in oncologic patients: the impact of subspecialty radiology on radiation exposure in the clinical practice. A quality care study. LA RADIOLOGIA MEDICA 2024; 129:429-438. [PMID: 38341817 PMCID: PMC10943144 DOI: 10.1007/s11547-024-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/13/2024]
Abstract
PURPOSES The primary objective of this retrospective study was to assess whether the CT dose delivered to oncologic patients was different in a subspecialty radiology department, compared to a general radiology department. The secondary explorative objective was to assess whether the objective image quality of CT examinations was different in the two settings. MATERIALS AND METHODS Chest and abdomen CT scans performed for oncologic indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDIvol) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. A P-value < 0.05 was considered significant. RESULTS A total of 7098 CT examinations were included. CTDIvol was evaluated in 12,804 phases; DLP in 10,713 phases and in 6714 examinations. The CTDIvol and DLP overall were significantly lower in the subspecialty radiology department compared to the general radiology department CTDI median (IQR) 5.19 (3.91-7.00) and 5.51 (4.17-7.72), DLP median and IQR of 490.0 (342.4-710.6) and 503.4 (359.9-728.8), p < 0.001 and p = 0.01, respectively. The objective image quality showed no significant difference in the general and subspecialty radiology departments, with median and IQR of 4.03 (2.82-5.51) and 3.84 (3.09-4.94) for SNRLiv (p = 0.58); 4.81 (2.70-7.62) and 4.34 (3.05-6.25) for SNRAo (p = 0.30); 0.83 (0.20-1.89) and 1.00 (0.35-1.57) for CNRLiv (p = 0.99); 2.23 (0.09-3.83) and 1.01 (0.15-2.84) for CNRAo (p = 0.24) with SNRLiv (p = 0.58), SNRAo (p = 0.30), CNRLiv (p = 0.99) and CNRAo (p = 0.24). CONCLUSION In a subspecialty radiology department, CT protocols are optimized compared to a general radiology department leading to lower doses to oncologic patients without significant objective image quality degradation.
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Affiliation(s)
- Stefania Rizzo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Luca Bellesi
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Andrea D'Ermo
- Service of Process Organization and Information, EOC, Support Area, Via Lugano 4D, 6500, Bellinzona, Switzerland
| | - Luca Bonomo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Magoga
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Stefano Presilla
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Arturo Spanò
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Veronica Minzolini
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesca Lo Piccolo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Jurgen Heinkel
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Ermidio Rezzonico
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Matteo Merli
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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Volpe S, Zaffaroni M, Piperno G, Vincini MG, Zerella MA, Mastroleo F, Cattani F, Fodor CI, Bellerba F, Bonaldi T, Bonizzi G, Ceci F, Cremonesi M, Fusco N, Gandini S, Garibaldi C, Torre DL, Noberini R, Petralia G, Spaggiari L, Venetis K, Orecchia R, Casiraghi M, Jereczek-Fossa BA. Multi-omics integrative modelling for stereotactic body radiotherapy in early-stage non-small cell lung cancer: clinical trial protocol of the MONDRIAN study. BMC Cancer 2023; 23:1236. [PMID: 38102575 PMCID: PMC10722797 DOI: 10.1186/s12885-023-11701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Currently, main treatment strategies for early-stage non-small cell lung cancer (ES-NSCLC) disease are surgery or stereotactic body radiation therapy (SBRT), with successful local control rates for both approaches. However, regional and distant failure remain critical in SBRT, and it is paramount to identify predictive factors of response to identify high-risk patients who may benefit from more aggressive approaches. The main endpoint of the MONDRIAN trial is to identify multi-omic biomarkers of SBRT response integrating information from the individual fields of radiomics, genomics and proteomics. METHODS MONDRIAN is a prospective observational explorative cohort clinical study, with a data-driven, bottom-up approach. It is expected to enroll 100 ES-NSCLC SBRT candidates treated at an Italian tertiary cancer center with well-recognized expertise in SBRT and thoracic surgery. To identify predictors specific to SBRT, MONDRIAN will include data from 200 patients treated with surgery, in a 1:2 ratio, with comparable clinical characteristics. The project will have an overall expected duration of 60 months, and will be structured into five main tasks: (i) Clinical Study; (ii) Imaging/ Radiomic Study, (iii) Gene Expression Study, (iv) Proteomic Study, (v) Integrative Model Building. DISCUSSION Thanks to its multi-disciplinary nature, MONDRIAN is expected to provide the opportunity to characterize ES-NSCLC from a multi-omic perspective, with a Radiation Oncology-oriented focus. Other than contributing to a mechanistic understanding of the disease, the study will assist the identification of high-risk patients in a largely unexplored clinical setting. Ultimately, this would orient further clinical research efforts on the combination of SBRT and systemic treatments, such as immunotherapy, with the perspective of improving oncological outcomes in this subset of patients. TRIAL REGISTRATION The study was prospectively registered at clinicaltrials.gov (NCT05974475).
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Affiliation(s)
- Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy.
| | - Gaia Piperno
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, 28100, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology (IEO) IRCCS, Milan, 20141, Italy
| | - Cristiana Iuliana Fodor
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Federica Bellerba
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Tiziana Bonaldi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Giuseppina Bonizzi
- Biobank for Translational and Digital Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Cristina Garibaldi
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Davide La Torre
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- SKEMA Business School, Université Côte d'Azur, Sophia Antipolis, France
| | - Roberta Noberini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Konstantinos Venetis
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Monica Casiraghi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
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Subramanian MP, Yang Z, Chang SH, Willis D, Zhang J, Semenkovich TR, Heiden BT, Kozower BD, Kreisel D, Meyers BF, Patterson GA, Nava RG, Puri V. Minimum Volume Standards for Surgical Care of Early-Stage Lung Cancer: A Cost-Effectiveness Analysis. Ann Thorac Surg 2022; 114:2001-2007. [PMID: 35780816 DOI: 10.1016/j.athoracsur.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/17/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple stakeholders have advocated for minimum volume standards for complex surgical procedures. The Leapfrog Group recommends that patients with non-small cell lung cancer (NSCLC) receive surgical resection at hospitals that perform at least 40 lung resections annually. However, the cost-effectiveness of this paradigm is unknown. METHODS A cost-effectiveness analysis was performed on 90-day and 5-year horizons for patients with clinical stage I NSCLC undergoing surgical resection at hospitals stratified by Leapfrog standard. Model inputs were derived from either the literature or a propensity score-matched cohort using the National Cancer Database. For the 5-year horizon, we simulated using a Markov model with 1-year cycle. Incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. RESULTS For the 90-day horizon, resection at a Leapfrog hospital was more costly ($25 567 vs $25 530) but had greater utility (0.185 vs 0.181 quality-adjusted life-years), resulting in an ICER of 10 506. Similarly, for the 5-year horizon, resection at a Leapfrog hospital was more costly ($26 600 vs $26 495) but more effective (3.216 vs 3.122 quality-adjusted life-years), resulting in an ICER of 1108. When the costs for long-distance travel, lodging, and loss of productivity for caregivers were factored in, the ICER was 20 499 during the 5-year horizon for resection at Leapfrog hospitals. Using a willingness-to-pay threshold of $50 000, resection at a Leapfrog hospital remained cost-effective. CONCLUSIONS Receiving surgery for clinical stage I NSCLC at hospitals that meet Leapfrog volume standards is cost-effective. Payers and policymakers should consider supporting patient and caregiver travel to higher volume institutions for lung cancer surgery.
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Affiliation(s)
- Melanie P Subramanian
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Zhizhou Yang
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Su-Hsin Chang
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri
| | - Daniel Willis
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jianrong Zhang
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Tara R Semenkovich
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Brendan T Heiden
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri.
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Petrella F, Rizzo S, Casiraghi M, Bardoni C, Mohamed S, Musso V, Simonini E, Spaggiari L. State of the art and new perspectives in surgical treatment of lung cancer: a narrative review. Transl Cancer Res 2022; 11:3869-3875. [PMID: 36388035 PMCID: PMC9641123 DOI: 10.21037/tcr-22-1491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022]
Abstract
Background and Objective Lung cancer is the leading cause of cancer-related deaths worldwide, and its incidence has increased over the past two decades. The standard care for stage I, stage II, and selected cases of stage IIIA non-small cell lung cancer (NSCLC) is surgical resection; in some cases, patients may be offered adjuvant systemic therapy after surgical resection. Patients with lung cancer presenting with distant metastases belong to stage IV: in this setting, some carefully selected patients may benefit from surgery within a multimodality approach. Methods We performed a comprehensive, non-systematic review of the latest literature to define the present role of surgery in lung cancer treatment. Key Content and Findings The literature review disclosed a pivotal role of surgery in early stage lung cancer and a complimentary role in locally advanced lung cancer; in very selected cases, surgery might be considered in oligometastatic disease. Conclusions Surgical treatment of lung cancer still plays a pivotal role in early stages of the disease while, in locally advanced stages, it may contribute to improve overall survival in combination with medical treatments and radiotherapy. More recently, an effective role of surgery has been advocated in carefully selected oligometastatic patients with encouraging initial results.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy;,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Lugano, Switzerland;,Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy;,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Valeria Musso
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Emanuele Simonini
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy;,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Petrella F, Bardoni C, Casiraghi M, Spaggiari L. The Role of Surgery in High-Grade Neuroendocrine Cancer: Indications for Clinical Practice. Front Med (Lausanne) 2022; 9:869320. [PMID: 35402456 PMCID: PMC8990252 DOI: 10.3389/fmed.2022.869320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 01/09/2023] Open
Abstract
Pulmonary neuroendocrine tumors (pNET) represent a particular type of malignant lung cancers and can be divided into well-differentiated low-grade NET and poorly-differentiated high-grade NET. Typical and atypical carcinoids belong to the first group while large cell neuroendocrine carcinomas (LCNEC) and small-cell lung cancers (SCLC) belong to the second one. The aim of this mini-review is to focus on the role of surgical therapy for high grade neuroendocrine tumors. SCLC has the worst prognosis among all lung cancer neoplasms: in fact, the two-year survival rate is about 5% and median survival usually ranges between 15 and 20 months. The surgical treatment of SCLC has thus infrequently been judged as a valuable aspect of the therapeutic approach, the gold standard treatment being a combination of platinum-based chemotherapy and radiotherapy. As LCNEC are rare, there is a lack of extensive literature and randomized clinical trials, therefore the curative approach is still controversial. Current treatment guidelines suggest treating LCNEC by surgical resection in non-metastatic stages and recommend adjuvant chemotherapy according to SCLC protocol. Upfront surgery is suggested in early stages (from I to IIB), a multimodality approach is recommended in locally advanced stages (III) while surgery is not recommended in stage IV LCNEC. The rate of surgical resection is quite low, particularly for SCLC, ranging from 1 to 6% in limited diseases; lobectomy with radical lymphadenectomy is considered the gold standard surgical procedure in the case of limited disease SCLC and resectable LCNEC; pneumonectomy, although reported as an effective tool, should be avoided in the light of local and distant recurrence rates.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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7
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Rizzo S, Del Grande M, Espeli V, Stathis A, Nicolino GM, Del Grande F. Do oncologists prefer subspecialty radiology reports? A quality care study. Insights Imaging 2021; 12:64. [PMID: 34037872 PMCID: PMC8155173 DOI: 10.1186/s13244-021-01007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background The main objective was to assess whether CT reports of radiologists subspecialized in oncologic imaging respond better to oncological referrals than reports from general radiologists. The secondary objective was to assess differences in ratings between a senior and junior oncologist. Two hundred radiological reports pertaining to oncological patients were retrospectively selected of which 100 each were written by subspecialized radiologists and general radiologists, respectively. The senior and junior oncologists each rated all CT reports using a Likert scale from 1 to 5 (1 = very poor, 5 = excellent) for the following information: anatomical details; interpretation of findings; need for further explanations; appropriateness of conclusions; overall satisfaction. Comparisons between ratings assigned to reports from generalist radiologists and subspecialty radiologists were performed using the Mann–Whitney U test. Agreement between both oncologists was assessed through Gwet's coefficient. Results For all but two of the five items obtained from the senior oncologist, oncologists' ratings were significantly higher for subspecialty radiologists' reports (p < 0.01); mean values from both oncologists were generally higher for subspecialty reports (p < 0.001). Agreement between the senior and junior oncologist in the rating of reports from general and subspecialty radiologists was either moderate to substantial (0.5986–0.6788) or substantial to almost perfect (0.6958–0.8358). Conclusions According to a senior and junior oncologist, CT reports performed by subspecialized radiologists in oncologic imaging are clearer, more accurate, and more appropriate in the interpretation and conclusions compared to reports written by general radiologists. Likewise, the overall satisfaction of the oncologist from a subspecialized radiologist report is higher. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01007-4.
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Affiliation(s)
- Stefania Rizzo
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia EOC, Via Tesserete 46, 6900, Lugano, Switzerland. .,Facoltà Di Scienze Biomediche, Università della Svizzera italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Vittoria Espeli
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Gabriele Maria Nicolino
- Post-Graduate School in Radiodiagnostics, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Filippo Del Grande
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia EOC, Via Tesserete 46, 6900, Lugano, Switzerland.,Facoltà Di Scienze Biomediche, Università della Svizzera italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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Petrella F, Casiraghi M, Radice D, Cara A, Maffeis G, Prisciandaro E, Rizzo S, Spaggiari L. Prognostic Value of the Hemoglobin/Red Cell Distribution Width Ratio in Resected Lung Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13040710. [PMID: 33572378 PMCID: PMC7916257 DOI: 10.3390/cancers13040710] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The ratio of hemoglobin to red cell distribution width (HRR) has been described as an effective prognostic factor in several types of cancer. The aim of this study was to investigate the prognostic role of preoperative HRR in resected-lung-adenocarcinoma patients. METHODS We enrolled 342 consecutive patients. Age, sex, surgical resection, adjuvant treatments, pathological stage, preoperative hemoglobin, red cell distribution width, and their ratio were recorded for each patient. RESULTS Mean age was 66 years (SD: 9.0). There were 163 females (47.1%); 169 patients (49.4%) had tumors at stage I, 71 (20.8%) at stage II, and 102 (29.8%) at stage III. In total, 318 patients (93.0%) underwent lobectomy, and 24 (7.0%) pneumonectomy. Disease-free survival multivariable analysis disclosed an increased hazard ratio (HR) of relapse for preoperative HRR lower than 1.01 (HR = 2.20, 95%CI: (1.30-3.72), p = 0.004), as well as for N1 single-node (HR = 2.55, 95%CI: (1.33-4.90), p = 0.005) and multiple-level lymph node involvement compared to N0 for both N1 (HR = 9.16, 95%CI:(3.65-23.0), p < 0.001) and N2 (HR = 10.5, 95%CI:(3.44-32.2, p < 0.001). CONCLUSION Pre-operative HRR is an effective prognostic factor of disease-free survival in resected-lung-adenocarcinoma patients, together with the level of pathologic node involvement.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.); (A.C.); (G.M.); (E.P.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
- Correspondence: or ; Tel.: +39-025-748-9362; Fax: +39-029-437-9218
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.); (A.C.); (G.M.); (E.P.); (L.S.)
| | - Davide Radice
- Department of Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Andrea Cara
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.); (A.C.); (G.M.); (E.P.); (L.S.)
| | - Gabriele Maffeis
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.); (A.C.); (G.M.); (E.P.); (L.S.)
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.); (A.C.); (G.M.); (E.P.); (L.S.)
| | - Stefania Rizzo
- Department of Radiology, Ente Ospedaliero Cantonale (EOC) Istituto di Imaging della Svizzera Italiana (IIMSI), 6903 Lugano, Switzerland;
- Facoltà di Scienze Biomediche, Università della Svizzera italiana, via Buffi 13, 6900 Lugano, Switzerland
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.C.); (A.C.); (G.M.); (E.P.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20141 Milan, Italy
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