LCA and contaminated sites

Life cycle assessment (LCA) is a tool for assessing the environmental impact of services or products. This project wants to explore the potential contribution of LCA for contaminated site management, via the comparison of several remediation strategies (excavation, phytoremediation and “do nothing” options) for soils contaminated by heavy metals. The study aims at identifying the main methodological gaps in modelling impacts at midpoint and endpoint levels and providing insights for filling in these gaps. In particular, emphasis is put on the impact of the site itself on the surrounding environment compared to remediation options. Excavation resulted to have the greater impact on the human health, while it is the smallest for the water ecosystem. Temporal and spatial dimension play a role in the evaluation of the damage. The results given by global and regional IMPACT2002 model are compared, and their allocation in short-term and long-term periods is shown with the introduction of the Stored Additional Impact (SAI), which goal is to help the comprehension of the outcome. The most important missing information in the method is the evaluation of the pollution impact on the contaminated site itself and its ecological and economical value after the management. To do this the combination of Ecological Risk Assessment (ERA) and LCA is suggested. The conclusion is that LCA can bring additional information that contribute to the decision making process of site management. In particular, the “do nothing” scenario serves as a reference impact and helps deducing the real efficiency and utility of the other remediation processes

Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists.

Background Stage III N2 non-small cell lung cancer (NSCLC) is a very heterogeneous disease associated with a poor prognosis. A number of therapeutic options are available for patients with Stage III N2 NSCLC, including surgery [with neoadjuvant or adjuvant chemotherapy (CTx)/neoadjuvant chemoradiotherapy (CRT)] or CRT potentially followed by adjuvant immunotherapy. We have no clear evidence demonstrating a significant survival benefit for either of these approaches, the selection between treatments is not always straightforward and can come down to physician and patient preference. The very heterogeneous definition of resectability of N2 disease makes the decision-making process even more complex. Methods We evaluated the treatment strategies for preoperatively diagnosed stage III cN2 NSCLC among Swiss thoracic surgeons and radiation oncologists. Treatment strategies were converted into decision trees and analysed for consensus and discrepancies. We analysed factors relevant to decision-making within these recommendations. Results For resectable "non-bulky" mediastinal lymph node involvement, there was a trend towards surgery. Numerous participants recommend a surgical approach outside existing guidelines as long as the disease was resectable, even in multilevel N2. With increasing extent of mediastinal nodal disease, multimodal treatment based on radiotherapy was more common. Conclusions Both, surgery- or radiotherapy-based treatment regimens are feasible options in the management of Stage III N2 NSCLC. The different opinions reflected in the results of this manuscript reinforce the importance of a multidisciplinary setting and the importance of shared decision-making with the patient