Could you name one moment in the history of interventional oncology that you look back at and think, “wow”.
I remember how it all started. The meetings organised in the early 90s during the RSNA by a small group of pioneers. We used to meet at Gino’s Pizza in Chicago: there were no sponsors at that time, we did not have the money to book a conference room! But the enthusiasm was unbelievable, we had the feeling that something was happening. And I still recall when— few years later—we agreed that the time was come to give a name to the growing number of vascular and non-vascular interventions increasingly used in cancer treatment. It was the birth of interventional oncology.
What are the three most interesting current trials in hepatocellular carcinoma that you are waiting to see the results of?
I think one of the most important areas for research in hepatocellular carcinoma is to explore the synergies between locoregional interventional treatments—ablation or chemoembolization—and systemically-administered drugs. If I have to mention three key trials that are currently on-going, I would refer to the ones assessing (1) the use of the molecular target agent with anti-angiogenic and antiproliferative properties, sorafenib, in combination with transarterial chemoembolization; (2) the clinical benefit of drug-eluting beads over conventional transarterial chemoembolization; and (3) the value of thermally-sensitive liposomal doxorubicin carriers in combination with radiofrequency ablation. Each of these trials will recruit hundreds of patients, and each also has a randomised study design. These are trials that have the potential to revolutionise the current therapeutic management of hepatocellular carcinoma.
What has your research contributed to the field of interventional oncology?
An area that I have extensively investigated is the use of image-guided ablation in cancer treatment: the seminal paper we produced in 1998 on radiofrequency ablation for colorectal metastases was awarded as the most cited publication of European radiology. We also completed the first randomised trial on radiofrequency ablation for hepatocellular carcinoma in 2003 and the first analysis on long-term survival of treated patients in 2005, both studies published in Radiology. I think the publication in The Lancet Oncology of the first multicentre trial on radiofrequency ablation of lung malignancies in 2008 was also an important step forward for interventional oncology, given that it appeared in a top oncology title. Another area in which I focused my research is the combination of transcatheter and percutaneous approaches in cancer treatment: we have produced several publications on this topic, including the first pilot clinical study on the combined use of radiofrequency ablation and drug-eluting beads for hepatocellular carcinoma treatment that appeared in the Journal of Hepatology recently. Currently, I am a co-principal investigator of a few clinical trials exploring the synergies between locoregional interventional treatments and systemically-active drugs.
What are most interesting new concepts to have emerged in interventional oncology?
I think we are at the point where we understand “yes we can”, but we need to persuade the oncology community that what we can do is worth doing. This means to run trials according to accepted research standards and to produce sound evidence of clinical benefit. I think we all acknowledge the importance of creating a common framework for research. As a former professional soccer referee, I fully acknowledge that the rules are important! That is why I was happy to be part of the panel that has crafted the guidelines for the design of clinical trials in hepatocellular carcinoma, an effort that also led to the development of new criteria for tumour response assessment—the mRECIST model—that seem to better reflect the anticancer activity of interventional procedures and molecular targeted therapies. Hopefully, similar efforts will be conducted in other cancers as well.
What are your interests outside of medicine?
I live on the coast in Tuscany, so I love the sea, sailing or just walking on the beach (but I do not own a boat!). I am now writing a book—not on medicine or interventional radiology. In reality now, my main activity is to spend time with my daugther, Elisabetta, who is four years old.
Key academic and professional appointments
1994 Board Certification in Radiology, University of Pisa, Italy
1995 Contract professor of Interventional Radiology, University of Pisa, Italy
2000 Tenured associate professor of Radiology, University of Pisa, Italy
2008 Director, Diagnostic Imaging and Intervention, University Hospital, Pisa, Italy
2010 European Board of Interventional Radiology
Recent activities in scientific societies
2005 Chairman, CIRSE Standard of Practice Committee
2006 Co-chair, 1st World Conference on Interventional Oncology
2007 Chairman, ECR Subcommittee “Abdominal and Gastrointestinal”
2008 Co-chair, 1st European Conference on Interventional Oncology
2008 Chairman, Oncology Division, CIRSE Foundation
2009 Chairman, CIRSE Membership Committee
2010 Co-chair, 2nd European Conference on Interventional Oncology
2011 Executive secretary, International Liver Cancer Association
2011 Co-chair, 6th World Conference on Interventional Oncology
2012 Co-chair, 3rd European Conference on Interventional Oncology
153 articles in peer-reviewed international journals
61 chapters in textbooks of radiology, IR, surgery, oncology, gastroenterology / hepatology
Cumulative impact factor >500, more than 6,000 citations
Invited lecturer at 450 international meetings or conferences held in 58 different countries