Riccardo Lencioni

How did you come to choose medicine as a career?

Well, my father is a doctor, so I grew up with the idea of studying medicine. At four, I was already playing the “amateur surgeon” game all day, trying to deal with diseased organs by using a bizarre armamentarium of strange tools. Some might say things have not changed much since then!

Who are the people who have influenced you most? What advice of theirs do you follow even today?

Of course, my mind first recalls my mentor, Professor Carlo Bartolozzi. The year he moved to Pisa to take the chair of radiology, I was ranked number one in the admission test for radiology residency. I began learning in a very lively clinical, scientific and academic environment, under the common denominators of a rigorous methodology and a full-time dedication to work. His advice I follow even today: practice, practice, practice! I also had the privilege of meeting many pioneers and international thought leaders in interventional radiology early in my professional life. Professor Andy Adam is probably the one who has influenced me most and who drew me to fully embrace interventional radiology. Andy has the unique ability to set you thinking: in soccer terms, he makes the perfect “assist”—the kind of pass that enables you to score a goal. You think it is your goal, but in fact it is his.

Which interventional radiology innovations have shaped your career?

I was lucky enough to be right in the middle of the action when most interventional procedures for cancer treatment were developed. Transarterial chemoembolization (TACE) and ablation were introduced in liver cancer treatment in the early 90s, while I was doing my radiology residency. I was thrilled by the idea of using image-guided interventions to cure cancer and I dedicated myself full-time to this new field. The year I completed my radiology residency, 1994, I had already published in Cardiovascular and Interventional Radiology on the first western experience on the combination of TACE and ablation for hepatocellular carcinoma, followed one year later by the first report, in Cancer, analysing survival outcomes and prognostic factors. In a few years, interventional oncology became one of the most inspiring areas of development within interventional radiology, and I had the opportunity of investigating several new techniques and devices and to explore novel clinical applications.

As an internationally recognised expert in interventional oncology, what are three big questions in the field you would like to see the answers to?

First, will image-guided ablation ever be considered as a true replacement for surgical resection, i.e., will it ever become the first-line approach in cancer treatment? Second, will locoregional transcatheter therapies ever reach another dimension and become a firmly established regimen in oncology protocols beyond HCC? Third – and most important – will interventional radiologists be able to implement a structured educational programme in interventional oncology that will eventually create physicians who are full interventional radiologists but at the same time share the same basic background in cancer biology and treatment with medical oncologists, surgical oncologists, and radiation oncologists? I certainly predict a “yes” to all these questions!

Can you describe a memorable case, and how interventional oncology came to the rescue?

The first case that comes to my mind is a procedure that I actually denied to a patient. A young woman was referred to us with the diagnosis of multiple unequivocal hepatic metastases from an unknown primary cancer. She was in the fifth month of pregnancy, and was clearly distraught at such a diagnosis. The plan was to perform a biopsy in the operating room for her, obtain immediate confirmation of malignancy, and proceed with the abortion followed by chemotherapy. As soon as I was shown the case, I had a flashback to another case I had seen, maybe ten years before. I told the referring clinicians that the lesions were not metastases and that in my opinion the patient had an epithelioid hemangioendothelioma.

This is an extremely rare tumour, and the diagnosis is extremely difficult: even biopsy findings may be misleading and direct toward metastatic adenocarcinoma. I assumed all the responsibilities of the management of the patient and persuaded the young lady not to do anything and to keep going with the pregnancy. You would not believe how many phone calls I received from all my colleagues who were involved in the case! I think that if they had not known me, they would have thought that I was completely crazy. Well, the baby is now three, and his mother’s epitheliod hemangioendothelioma is under control.

Which developing techniques and technologies are you watching closely for the future?

Well, there are so many. In the field of image-guided ablation, I am intrigued by the several novel thermal and non-thermal techniques which have potential to overcome the limitations of radiofrequency ablation to reach a new dimension in local tumour treatment. On the other hand, I have no doubt that interventional techniques for transcatheter drug delivery will substantially expand their role in regional cancer treatment, perhaps in combination with systemically-active drugs. The next few years will see key developments as several pivotal clinical trials are currently on-going.  

Can you share some of the proudest moments in your career?

I do not have an inflated ego. But of course it was great when I became a tenured professor of radiology before 40, something not so common in Italy. I was also thrilled when I was invited to deliver honorary lectures, such as the Hans Popper lecture at the Mount Sinai School of Medicine in New York and the Andreas Gruentzig lecture at the CIRSE annual meeting. Seeing my name written next to those who have made the history in the field was simply amazing.

What still fascinates you about interventional radiology?

Innovation. Interventional radiology is such a dynamic specialty. Almost every single day there is something new: a new device, a new approach, a new clinical application, or just a new idea. No two days are the same.