The work of the GOM, the multidisciplinary oncology group, introduced into the company by the Health Directorate in 2020, gives its fruits and offers the inspiration for the realization of the conference, scheduled for May 7, 2022 at the Sala Teatro Comunale “Costanzo Costantini” of Isola del Liri, starting at 10.00, focused on the “Multidisciplinary treatment of patients suffering from brain metastases”, it is the opportunity to deeply enter the Neurosurgery sector of the ASL of Frosinone, born in June 2018 and since then directed by Dr. Giancarlo D’Andrea, which boasts cutting-edge services.
We do this together with Dr. Catello Costagliola, Neurosurgeon of the Local Health Authority.
Dr. Costagliola, where did the idea for this meeting come from?
This meeting, open to various medical specialists, not least General Practitioners, and accredited by the ECM, was strongly desired by both Neurosurgeons and fellow Oncologists of our ASL. What has driven us strongly to want it is in the numbers: every year in Italy, from 16,000 to 20,000 new cases of patients with secondary brain lesions are diagnosed, most of them originating from lung, breast and skin melanomas. It goes without saying that this epidemiological framework absolutely requires a moment of common reflection among the various specialists involved in the treatment of these patients.
Brain metastases are in fact the most common of brain tumours and up to 1/3 of patients who have a tumour elsewhere, especially if present in the lung, breast, kidney, colon or skin, may present one or more metastases to the brain. Any clinical signs or symptoms such as severe headache, appearance of motor deficits, spatio-temporal confusion, epileptic seizures must be interpreted as potential brain damage and, especially if present in patients with known primary neoplasms, be interpreted as possible manifestations of secondary lesion (s).
New chemotherapy treatments, the refinement of radiotherapy techniques and the role of surgery are at the centre of this meeting, which aims to underline the importance of taking charge of the patient by a team of experts and the role that the PDTA (Diagnostic Therapeutic Care Pathway) can play in the correct clinical-therapeutic framework of these patients.
What other professional figures were involved?
They were invited to present their experiences regarding fellow Radiotherapists, Radiologists, Anatomo Pathologists and Physiatrists/Physiotherapists who will make their very valid scientific contribution to a better definition of the diagnostic-therapeutic-rehabilitative process of these patients. During the meeting, a round table will also be held with the authoritative presence of fellow Neurosurgeons who practice at University centres in Rome such as Prof. Antonio Santoro, Full Professor at the Umberto I Polyclinic, Prof. Alessandro Frati, Associate Professor at the S. Andrea Hospital/University Hospital and Prof. Maurizio Salvati, Associate Professor at the Tor Vergata Polyclinic.
Explain the role of the multidisciplinary team
It is very important. In fact, multidisciplinary meetings have been held at our ASL for some time, on a weekly basis, coordinated by Dr. Vincenza Maiola, who is part of our neurosurgical team, during which the clinical cases of brain cancer patients to be treated, the review of clinical cases already treated as well as the analysis of patient follow-up are discussed.
What are the tumors that can give brain metastases?
There are three in particular, that of the lung, breast and melanoma. However, there are other neoplasms that can cause metastasis and are those of the kidney and colon.
Are there any symptoms you need to know about?
Yes, and it is essential to be able to recognise them. These are headaches, focal force deficits (inability to move a limb), cognitive deficits (memory and temporal space disorders) and epileptic seizures. These signs and symptoms are in fact also common to other brain neoplastic lesions, but what is important is the timeliness of the diagnosis. It is not uncommon that from the identification of a brain metastasis it is possible to go back to the primary tumour.
What role does surgery play in the treatment of brain metastases?
I would say that surgery plays a key role in the therapeutic pathway. It is intended to remove one or more brain metastases, when necessary, so that subsequent chemo/radiotherapy treatments can be more successful.
Dr. Costagliola, what tools can our Neurosurgery rely on?
The Neurosurgical Operating Room of the “F. Spaziani” Hospital is equipped with the most modern technologies to be able to conduct brain surgeries in optimal conditions for the surgeon in order to obtain the best results for the patient: operating microscope (with modules for fluorescence) and latest generation Neuronavigator, possibility of neurophysiological monitoring during operations, possibility of performing surgeries in “awake surgery” or surgery with an awake patient, when the lesions are in the vicinity of the so-called critical areas such as the language area and the motor area.
The PREVAILING index rewards the Asl department of Frosinone
From the periodic data PREVAILS of the Region, it follows that the Neurosurgery of the ASL of Frosinone is the one with the lowest mortality of the Lazio Region on patients operated for brain neoplasms. A result that rewards the work of the entire Neurosurgery Unit led by Dr. Giancarlo D’Andrea.
