What have the three most interesting findings from your research so far been?
Recently, we have been developing a brand new technique with diode laser fibres for the percutaneous ablation of metachronous malignant cervical adenopathies from thyroid papillary carcinomas which do not take up 131 I (and are thus not treatable with radioiodine), but FDG-avid on CT-FDG PET, in patients who have already undergone thyroidectomy and lymphadenectomy. In these patients, repeat surgery, although challenging and with high rate of side effects, would be again the only possible therapy. Even though our experience is preliminary, laser ablation under simple local anaesthesia in outpatients is allowing us to achieve excellent results on follow-up without side effects. Accordingly, we are now starting to use the same treatment for parathyroid adenomas in primary hyperparathyroidism, in patients with contraindications to surgery or during acute hypercalcaemic crisis. The third research field we have been studying for the last 10 years is that of real-time fusion of sonography and CT (or MRI or FDG-PET) for the guidance of ablations of challenging targets (in liver, kidney, etc) poorly visible with sonography alone or visualised only in the short phase of arterial enhancement. The most recent advancement we are working on is the development of a microwave antenna with an internal canal in which a magnetic microsensor applied on tip of a stylet can be inserted. This would allow us to achieve an extremely precise localisation of the antenna position during the whole procedure, in spite of the formation of gas and/or patient movements.
What are the three most interesting papers you read in 2011 in the field of interventional oncology?
In the field of interventional oncology more and more interesting papers are being published monthly. It is very challenging to select the most interesting. Of course, everyone will indicate the papers that are most relevant for his own specific fields of interest within the world of interventional oncology. Following this way, among the papers published between the end of 2011 and the beginning of 2012, I indicate three articles dealing with HCC. The first was published in The Lancet by Forner et al, which analysed the most recent data in the literature and the existing BCLC classification of HCC. The authors review the therapeutic flow-chart of HCC, replacing (for the first time) resection with ablation as the treatment of choice for very early stage HCC in patients who are not candidates to liver transplantation.
This fundamental recognition of the role of ablation in this pathology is confirmed also by the paper published in Radiology by Peng et al who retrospectively compare the outcomes of HCCs smaller than 2cm treated with either ablation or resection. Efficacy and safety of radiofrequency ablation are better than those of resection, particularly for centrally located HCCs. The third paper was published by Shiina et al in American Journal of Gastroenterology on 10-year outcome and prognostic factors of HCC treated with radiofrequency ablation. The cumulative five- and 10-year survival rates of 60.2% and 27.3% with a 2.2% major complication rate conclusively demonstrates the role of ablation in this disease.
Can ablation replace resection for curative liver treatment?
Ablation is a local therapy and therefore local control (preventing tumoural growth) is the primary goal of ablation, while “cure” means complete recovery from disease. For HCC, the only curative therapy (although not in 100% of cases) is liver transplantation. For liver metastases, ablation can be curative only if combined with effective systemic chemotherapy.
However, according to the recent BCLC staging and treatment strategy (Forner A, et al, The Lancet, 2012), ablation is the first-line treatment for very early stage HCC in patients who are not candidates for liver transplantation and for early stage HCC in patients with associated diseases. For liver metastases from colorectal carcinoma, in our experience (Radiology 2012, in press) local control can be achieved in almost 93% of nodules within 2cm in size and accordingly ablation may be considered the first-line treatment for metastases of this size, replacing surgery.
If you had a wish-list what would you improve in interventional oncology practice?
From the clinical side, given the long dedication of my group to the ablation of hepatic metastases, my first wish would be the official recognition of ablation as first-line treatment of hepatic metastases within the size range of 2cm. From the organisational side, my first wish would be for a much stronger support of healthcare leadership to departments of interventional oncology in terms of equipment, staff and space, taking into increasing account the cost-effectiveness of interventional procedures compared to that of surgery. My third wish is for a new organisational model of the departments of interventional oncology which may include also beds for day procedures and a few beds for the 24–48 hours hospitalisation following major ablative interventions.
What are the three honours you have received that you are proud of?
The acknowledgments and thanks coming from patients successfully treated have always been the most valuable recognition for my professional activity. Among the honours officially received, I remember the invitation to give teaching lectures at the famous Mayo Clinic in Rochester on ultrasound-guided aspiration biopsies and ethanol injection of parathyroid tumours and HCC when I was still very young, in 1989. More recently, the invitations to give the Andreas Gruentzig lecture at the CIRSE Annual Meeting, and the memorial lecture for the 150th anniversary of the death of Christian Doppler at the historic Billrothhaus in Vienna (where I was asked to put my signature just below those of Virchow, Billroth, Rokitansky, Freud, etc!) are the most prestigious honours that I have received.
What are your interests outside of medicine?
Even if family and work take up most of my time, I have some interests that I began cultivating when I was young and hope to be able to improve even more after my retirement (which is not very far-off): travelling as a tourist throughout the world, landscape and technical photography, computer technology, watching various films and listening to music, mostly pop-rock, but also classical.
1977 Degree in Medicine at the University of Milan, Italy
1981 Board Certification in Radiology, University School of Milan
Postgraduate education completed through residencies at:
Department of Ultrasound (Prof D O Cosgrove), Royal Marsden Hospital in Sutton, UK (1981)
Department of Medical Physics (Prof J Woodcock), Bristol Hospital, UK (1982)
Department of Radiology (Prof E van Sonnenberg), University of San Diego (USA) (1988)
Academic and professional appointments
1980–1989 Assistant, Department of Radiology, Busto Arsizio General Hospital, Italy
1989–1999 Vice-chairman, Department of Radiology, General Hospital of Busto Arsizio
1999–2002 Chairman, Ultrasound Division, Department of Radiology, General Hospital of Busto Arsizio
2002 to date Chairman, Diagnostic Imaging Department, General Hospital of Busto Arsizio
2010 to date Chairman, Department of Interventional Oncologic Radiology, General Hospital of Busto Arizio
1988 to date Contract professor of Techniques and Methods of Diagnostic Imaging, School of Radiology, University of Milan, Italy
Italian Society of Radiology (SIRM)
Radiological Society of North America (RSNA)
Society of Interventional Radiology (SIR)
Cardiovascular and Interventional Radiological Society of Europe (CIRSE)
Italian Society of Ultrasound in Medicine and Biology (SIUMB)
More than 500 presentations (keynote lectures, lessons and papers) to international and
national meetings, courses and congresses in 36 different countries