Davide Franceschini1, Alessio Bruni2, Paolo Borghetti3, Niccolò Giaj-Levra4, Sara Ramella5, Lucio Buffoni6, Serena Badellino7, Maria Andolina2, Camilla Comin8, Emanuela Vattemi9, Michela Bezzi10, Marco Trovò11, Antonio Passaro12, Alessandra Bearz13, Rita Chiari14, Franchina Tindara15, Katia Ferrari16, Gaia Piperno17, Andrea Riccardo Filippi18, Domenico Genovesi19, Vieri Scotti20. 1. Radiation Oncology Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy. davide.franceschini@humanitas.it. 2. Radiotherapy Unit, University Hospital of Modena, Modena, Italy. 3. Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy. 4. Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy. 5. Radiation Oncology Department, Campus Bio-Medico, Rome, Italy. 6. Oncology Department, San Luigi Hospital University of Turin, Orbassano, Turin, Italy. 7. Radiation Oncology Department, A.O.U. Città della Salute e della Scienza, Turin, Italy. 8. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 9. Oncology Unit, Central Hospital, Bolzano, Italy. 10. Endoscopic Pneumology Unit, ASST Spedali Civili Brescia, Brescia, Italy. 11. Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata Udine, 33100, Udine, Italy. 12. Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy. 13. Medical Oncology Unit, Centro di Riferimento Oncologico-IRCCS, Aviano, Italy. 14. Medical Oncology Unit, Ospedale Madre Teresa di Calcutta, "AULSS6 Euganea-Padova", Padua, Italy. 15. Department of Human Pathology of the Adult and Evolutive Age "G. Barresi", Messina, Italy. 16. Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy. 17. Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy. 18. Department of Medical Sciences and Infectious Diseases, Unit of Radiation Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 19. Radiation Oncology Department, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy. 20. Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy.
Abstract
PURPOSE: To report criticisms and barriers to the "real-life" application of international guidelines and recent developments in the management of locally advanced non-small cell lung cancer (NSCLC) in Italy. METHODS: Three 2-day courses were organized. During the first day, experts in different fields of thoracic oncology gave their lecture on diagnosis and therapy for locally advanced NSCLC. During the second day, all participants were divided into four groups to discuss on a clinical case as a multidisciplinary team (MDT). The aim was to stimulate the discussion on practical issues in the management of NSCLC patients in the real-life practice. RESULTS: A total of 196 physicians were involved in the courses as learners. Invasive diagnosis of nodal disease for staging purposes, a priori definition of "surgical resectability" and a regular MDT with all crucial participants available were the three main key points identified for a good management of these patients. The main barriers to the clinical application of a good diagnostic and therapeutic approach to the patient were the absence of a regular and complete MDT in the South and Centre of Italy, while in the North of Italy, time for discussion of clinical cases in the MDT and waiting lists for staging and therapeutic interventions were deemed as the major concerns. CONCLUSION: The meetings showed that diagnosis and treatment of locally advanced NSCLC are still extremely variable between different Italian regions. Logistic issues, waiting lists, paucity of well-trained staff and expertise seem to be the main barriers to international guidelines application.
PURPOSE: To report criticisms and barriers to the "real-life" application of international guidelines and recent developments in the management of locally advanced non-small cell lung cancer (NSCLC) in Italy. METHODS: Three 2-day courses were organized. During the first day, experts in different fields of thoracic oncology gave their lecture on diagnosis and therapy for locally advanced NSCLC. During the second day, all participants were divided into four groups to discuss on a clinical case as a multidisciplinary team (MDT). The aim was to stimulate the discussion on practical issues in the management of NSCLCpatients in the real-life practice. RESULTS: A total of 196 physicians were involved in the courses as learners. Invasive diagnosis of nodal disease for staging purposes, a priori definition of "surgical resectability" and a regular MDT with all crucial participants available were the three main key points identified for a good management of these patients. The main barriers to the clinical application of a good diagnostic and therapeutic approach to the patient were the absence of a regular and complete MDT in the South and Centre of Italy, while in the North of Italy, time for discussion of clinical cases in the MDT and waiting lists for staging and therapeutic interventions were deemed as the major concerns. CONCLUSION: The meetings showed that diagnosis and treatment of locally advanced NSCLC are still extremely variable between different Italian regions. Logistic issues, waiting lists, paucity of well-trained staff and expertise seem to be the main barriers to international guidelines application.
Entities:
Keywords:
Multidisciplinary evaluation; Non small cell lung cancer; Stage III
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