title: Clinical and radiological features driving patient selection for antiangiogenic therapy in non-small cell lung cancer (NSCLC).
abstract: BACKGROUND
  The use of antiangiogenic therapy in non-small cell lung cancer (NSCLC) requires thorough evaluation of patient characteristics in order to avoid potential safety issues, particularly pulmonary haemorrhage (PH). The aim of this consensus by a panel of experts was to identify important criteria for the selection of patients with NSCLC who would benefit from antiangiogenic therapy.
  
  
  METHODS
  Radiologists and oncologists were selected for the expert panel. The nominal group technique (NGT) and the Delphi questionnaire were used for consensus generation. The NGT consisted of four steps, the result of which was used to set the Delphi questionnaire. A final report was generated based on the opinions of the experts from the panel.
  
  
  RESULTS
  An extremely important prerequisite for the evaluation of an antiangiogenic therapeutic approach in patients with NSCLC was thorough clinical and radiological analysis of the relationships between tumour and vascular or anatomical structures (performed in close co-operation by oncologists and radiologists). The panel identified major parameters to be considered before the use of antiangiogenic treatment, collectively agreeing on the relevance of tumour cavitation, vascular infiltration, endobronchial growth and thromboembolism for chest tumour sites, and of the presence of aneurysms, extra-thoracic bleeding, brain metastases or thrombi for extra-thoracic sites. Moreover, a structured report containing information not only on the tumour but also on the general vascular status is essential to guide the treatment choice The experts agreed that tumour localization in the absence of vessel infiltration, cavitation, and the use of antiplatelet therapy are relevant parameters to be assessed, but their presence should not necessarily exclude a patient from receiving antiangiogenic therapy.
  
  
  CONCLUSIONS
  Close co-operation between oncologists and radiologists in the diagnosis, treatment selection, and assessment of response is essential for ensuring therapeutic appropriateness in the NSCLC setting. It should be noted that neither the use of antiplatelet therapy nor tumour localisation are to be considered as contraindications to antiangiogenic treatment.
authors.affiliation: Division of Medical Oncology, S. G. Moscati Hospital, Contrada Amoretta 8, 83100, Avellino, Italy. cgridelli@libero.it.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
authors.affiliation: Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore (LU), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Camerini
authors.affiliation: Epidemiology & Clinical Trials Office, General Hospital, Mirano (VE), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pappagallo
authors.affiliation: Psychologist, Psychotherapist, Lecturer at the School of Specialization in Health Psychology, "Sapienza" University, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Pennella
authors.affiliation: Department of Radiology, "Sapienza" University, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.affiliation: Division of Radiology, Istituto Europeo di Oncologia, Milan, Italy.|Department of Oncology, University of Milan, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.affiliation: Medical Oncology, East Piedmont University, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Buosi
authors.affiliation: Department of Radiology, Campus BioMedico University, Rome, Italy.
authors.forename: Rosario Francesco
authors.initials: RF
authors.lastname: Grasso
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D018579:Patient Selection; D017410:Practice Guidelines as Topic
chemical_list: D020533:Angiogenesis Inhibitors
keywords: Antiangiogenic therapy; Clinical features; Delphi questionnaire; Nominal group technique; Non-small cell lung cancer; Pulmonary haemorrhage; Radiological features