AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

FROM SOCIAL CAPITAL TO FIRMS NETWORKS: SOME EVIDENCE FOR EUROPE

The concept of development is not only referred to the level or to the growth rate of GDP of a country, but it concerns different aspects of individual and social life. Development leads to a changing of values, culture, behaviours and attitudes of people interested in it. That is to say that not only quantitative dimensions, but also qualitative ones became relevant in fostering development trajectories. Reasoning in these general terms a long and rich intellectual debate grow up in social sciences within which we focused the social capital and firm network debate. Social capital is a multidimensional determinant at base of the industrial district framework as the “network capital†represent a driver of firm’s network framework. By moving from social capital, as a local development driver, to network capital, as a global development driver, the present paper analyzes the firms’ networks determinants by identifying the conditions for some European countries. The methodology through which the results are obtained is the multidimensional scaling method which allows to define relations between countries in terms of proximity/distance with respect to the considered determinants providing a spatial representation of them

FROM INDUSTRIAL DISTRICTS TO FIRMS NETWORKS: THE ITALIAN CASE

The local source for competitiveness is vital to achieve static and dynamic economies of scale for firms; it is useful to interact with the aim of learning and innovating. The local system can create benefit by opening to international markets and it should be a good source of knowledge and technology. Nowadays, the concept of industrial district, usually characterized by the spatial proximity of the involved firms, may evolve into firms network; this may emphasize the advantages deriving from cooperation, without the need of spatial proximity. Firms networks may represent the evolution of industrial districts, where territoriality is overcome by the dissolution of borders. The importance of firms networks is increased since they intensify information exchange, continuous learning, stimulate economies of scale, allow economic development and give more market opportunities. Firms networks share different aims, resource, common interests and factors, like material and immaterial inputs and outputs. This new form of cooperation may allow to overcome physical distance and replicate knowledge and information. Firms networks may represent a success organizational forms that may give impetus to development in an economy. They are based on mutual trust between partners and are created over time to facilitate information circulation, knowledge dissemination and innovation. Trust reduces uncertainty and transaction cost and limits the opportunistic behaviour by free-rider agents. The aim of the paper is to assess the determinants for firms networks training in the Italian context using regional data. Particularly, the firms networks development needs key factors such as ICTs diffusion, high rate of social security, open capability, RxD activities. These factor constitute the basis for a new kind of capital, the so called “network capital”. It consists of collaborative practices in a network as the result of cooperation in the ICTs era. Network capital may be considered as social capital evolution in a globalized context. The entrance in the knowledge economy era, in which technological advancement runs very quickly and the pace of innovation is intensified, significantly reduces the exploitation of competitive advantages. Industrial districts, therefore, should develop, improve and change their shape in a new competitive environment, where the globalization of markets cancels the boundaries of many firms that collaborate beyond national boundaries. The paper analyzes the firms networks determinant for Italian regions and the role of network capital as pre-condition for their development. The multidimensional scaling analysis it the chosen methodology that allows us to identify the relations among Italian regions in terms of proximity/distance with respect to considered determinants, and to provide a spatial representation of them

RESTRICTION OF CREDIT AFTER THE CRISIS OR A DIFFERENT ALLOCATION OF RESOURCES? THE ITALIAN CASE

The granting of credit, whose excessive diffusion was one of the causes of the economic and financial crisis of 2007, has suffered profound changes during the following period of economic recession. The granting of credit to households and businesses has been strongly influenced by the effects of the economic downturn, the banks’ choices and the intervention of the supervisory authorities. The credit, however, is also an instrument of monetary policy through which governments and central banks try to stimulate the economic growth. There are, nevertheless, several and complex limitations to the actions of banks and other financial intermediaries, information asymmetries and structural limits of the credit market. Should also be considered that in many Countries the economic recession had a strong influence on the choices and opportunities for all economic agents, making it difficult to lay the foundations for economic recovery. In the previous years, the lowering of standards of borrowers and the presence of low interest rates, setting the conditions for the so-called housing bubble. The subsequent reactions, the general worsening of the economy, the lack of funding and liquidity, in addition to the strict rules imposed by the supervisory authorities, have led banks to tighten securely controls on the characteristics of borrowers, being also obliged to put more attention on the composition of the balance sheet. Under these conditions, have risen subjects that do not meet the requirements to receive funding, and at the same time increased the difficulty to repay loans and interest. In this paper a multidimensional scaling analysis is used to observe the situation of credit in the Italian regions before and after the outbreak of the crisis, considering the average values for nine variables and for two different period, before and after 2007. Searching for dissimilarity between areas of the Country, is highlighted a clear separation before the crisis and remained essentially unchanged between northern and southern regions. Furthermore the analysis of time series showed that the granting of credit has declined slightly, but above all has changed destination, from productive purposes and investments, to support consumption

CREDIT AND ECONOMIC DEVELOPMENT: STRUCTURAL DIFFERENCES AMONG THE ITALIAN REGIONS

The international economic crisis of 2007 has had long-lasting negative effects on the financial markets and the real economy of many countries. The occurred uncertainty and the complications of the balance sheets of many banks, due to the strong international connections, particularly impacted on the ability and willingness of financial market, on granting credit to consumer households and companies. Credit, and the financial system in general, represent according to the economic literature, one of the determinants of economic development and, particularly, its efficiency determines the speed of growth and the potential level. The difficulties in the transmission of monetary policy and the structural inefficiency have worsened the negative effects of the economic crisis in many European countries, including Italy, where large differences in the socio-economic context of the various macro-areas still persist. The role of banks is to exploit tools and knowledge to the best addressing of funds, by subjects in excess to those in deficit, or towards who may exploit them for productive purposes. In addition, banks are locally a guidance to entrepreneurs and an entity aware of the local needs and potentials. In this paper we combine several variables on the credit and the quality of banking contracts, in addition to real economic and R&D variables, with reference to the Italian regions. The aim is to identify structural differences among the Italian regions in terms of financial and economic development, and in addition to observe the discrepancy between the various macro areas, even considering the effects of the international financial crisis broken out in the U.S. in 2007. We consider data over sufficiently long periods before and after the advent of the crisis and the long subsequent period of economic recession. The detail of the analysis is regional, in order to have a sufficient number of contexts that are grouped into homogeneous groups, helping to clarify and explain the dynamics of the socioeconomic differences that still exist. We use a Multidimensional scaling analysis with the aim of exploring the relationship between credit and socioeconomic development in the different Italian areas, observing in particular the structural differences that could lead to a deeper distance of the wellbeing of the poorest regions in the South compared to that of North-central

The 2018 assisi think tank meeting on breast cancer: International expert panel white paper.

We report on the second Assisi Think Tank Meeting (ATTM) on breast cancer which was held under the auspices of the European Society for RadioTherapy & Oncology (ESTRO). In discussing in-depth current evidence and practice it was designed to identify grey areas in diverse forms of the disease. It aimed at addressing uncertainties and proposing future trials to improve patient care. Before the meeting, three key topics were selected: 1) primary systemic therapy, mastectomy, breast reconstruction and post-mastectomy radiation therapy, 2) therapeutic options in ductal carcinoma in situ, and 3) therapy de-escalation in early stage breast cancer. Clinical practice in these areas was investigated by means of an online questionnaire. The time lapse period between the survey and the meeting was used to review the literature and on-going clinical trials. At the ATTM both were discussed in depth and research protocols were proposed