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Volum 01, Numarul 1, 1995

1 Contents Editor’s note

Editor’s note

With the present edition, the journal of the Romanian Society of Oncological Radiotherapy (RSOR) is at its first apparition. Its content parti- cularly refers to the present problems of the radio- therapy in to day’s Romania and to radiotherapists training as well.

The first paper whose author is Prof. N. Ghilezan is a minute and extremely realist „inven tory” of the present state of radiotherapy in Romania as it was assessed by specialists in 1994. The re search is a result of an extensive activity which has been held since the beginning of 1993 in the view of an evaluation of the human and technical resources as well as of the difficulties met by radiotherapy in our country. Details presented reveal that the equipment is completely inadequate in matters of both supply and technical, while the prescriptive norms so necessary to clearly organise radiotherapy is almost absent. On basis of the existent data, propositions have been elaborated on the organisation of modern oncological radiotherapy network. The final remarks-not in the least optimistic, might help as well any reader to become fully aware of the present situation and to think over its improvement.

The next paper belongs to Dr. V.Cernea and it deals with problems of radiotherapy resident’s training in the EEC countries. The syllabus of the theoretical special training is broadly presented and also material and human resources that are required by authorised institutions which can assist training of personnel (radiotherapy residents), aspects of practical training as well as general evaluation of the whole training program. Within a time of rapid and utter political changes in Europe, in the last years, specialists’ mobility is going to become a foregone conclusion and standardisation of their training is going to become a necessary requirement – as much as possible. Because radiotherapy is still considered a „pre- clinic” speciality in our country and syllabuses have little changed as compared to those functioning some twenty years ago, RSOR decided to adopt and internalise such a syllabus.

Prof N. Ghilezan refers to the quality control in radiotherapy. His paper emphasises the idea that limits imposed on material resources require their highly-efficient use in order to improve com- munity’s health and to be also used favourably from a socio-medical and economic point of view. Quality control is ultimately an evaluation of medical procedure and a real gain for the individual, but also an evaluation of the cost price-benefit ratio. The stages followed in the evaluation and the means used to perform standard control are explained with details.

The last two papers, which are not less important are Prof. J. B. Dubois’ (Montpellier) and Dr. J. C. Sabourin’s (H. Mondor Hospital, Paris); the first paper is a survey on the role of radiotherapy on lung cancer and the latter elaborates on mam- mary dysplasia. Both papers were presented in a Seminar organised by RSOR, under the patronage ofESO, a seminar which was held in Cluj, October, 1993. Written in a „cartesian” style, they are both extremely useful to the reader who looks for a systematic and rapid information over these matters. The publication of both papers in the first edition of the journal is benefice for the reader’s unmediated information and it shows the good, outstanding relationship existing since long time between RSOR and the French Society of Oncological Radiotherapy, as well as the constant support that the French colleagues have given and still give to our Society.

In the last part of the edition the Statute ofRSOR and a project of the inner structure of the future editions of the journal is being published. Editors apologise in advance for possible omissions of our Society’s members from the list, and they kindly request to be notified at once for immediate corrections.

Our proposition is for four issues apparition per year that should be timed to concrete requirements of everyday practice in order to answer the needs of the trainers as well as radio therapist specialists. As the editors are aware that our bibliography in the field is not very rich, they reclaim for sug- gestions in order to approach some issues of high interest and importance for both residents and young specialists. The editors would try to answer your claims. We hope that dialogue between specialists working in clinical and research oncology is endorsed by the journal’s heading „Correspondence with the Editor”

We are grateful to General Electric, Theratronics and Nucleotron for their help and material support as we are aware that, without them, the publication of the journal would have been extremely difficult.

The editor’s wish is for it to become a real „blue journal” of Romanian radiotherapy and they also hope that all the colleagues will cooperate for that matter. They honestly believe that the „long life” of the journal extensively relies on the work and effort of us all.

Cluj-Napoca, 11.02 1995

Editors in chief V: Cernea, N. Ghilezan

 

Radiotherapy – Romania 1994: present situation and proposals for a modernization program N.Ghilezan

UMF „Iuliu Hatieganu” Cluj-Napoca Institutul Oncologic „Prof I. Chiricuţă” Cluj-Napoca

The material and human resources for radiotherapy in Romania 1994 are scarce with less than 20 % of the new patients registered in that year, having acces to treatment by iradiation. The equipment, obsolete physically and moraly, is the main obstacle to improving the results of Romanian radiotherapy. A long term program is mandatory to be developed under the responsability of Health Department in close cooperation with profes- sional societies like Romanian Society of Oncological Radiotherapy and Romanian Association of Medical Physicists in order to assure the quality of care and the accesibility to treatment. Practical proposals for improv- ing the present situation are forwarded, with three main objectives: equipment, training of the personnel and management & evaluation.

Radioterapie & Oncologie Medicală, 1995, 1:4-22

Radiotherapy training in European Community

  1. Cernea, N. Ghilezan UMF „Iuliu Hatieganu” Cluj-Napoca lnstitutul Oncologic „Prof. I. Chiricuţă” Cluj-Napoca

The training in radiation oncology is different in European countries. Differences with respect to radio- therapy training programs and radiotherapy facilities exists. The adherence of National Radiotherapy Societ- ies to a minimwn curriculum is recommendable. The content of curriculum, material and hwnan resources as the evaluation systems of the training program are presented in this paper.

Keywords: resident, radiotherapy training, curriculum.

Radioterapie & Oncologie medicală, 1995, 1:23-27

Quality assurance and quality control in radiotherapy

  1. Ghilezan UMF „Iuliu Hatieganu” Cluj-Napoca lnstitutul Oncologic „Prof I. Chiricuţă” Cluj-Napoca

The development of a program for the Quality assurance and Quality control in radiotherapy (QA & QC) is in accordance with the present trends in medicine. Its objectives are a high performance of the medical actions with a most favourable cost-benefit ratio for the community. The practical development of a QA & QC plan implies: a consensus on „the best treatment”, development of a checking mechanism with specific points, identifications of the deviations from the standard and the implementation of a system for the permanent evalu- ation of the results and identification of the solutions for a continuous amelioration. The system has to be individualized at the 3 levels of existing activity: department or service, region and national. The responsability for the fIrst level comes to ohysicians of the service, but the quality aspects at the regional and national levels belong to the health politic of the govermnent which has to be done by the official institutions in cooperation with the professional societies.

Radioterapie & Oncologie Medicală, 1995, 1:28-35

La radiotherapie dans Ie cancer bronchique

J.B. Dubois Dépt. de Radiothérapie-CRLC Val d ‘Aurelle-34094 Montpellier-France

Lung cancer accounts for aproximately 25% of cancer deaths in European countries. Loco-regional failures represents about 50%. The paper deals with the modalities to deliver radiotherapy (RT) as a single treatment or in association with chemotherapy (CT). Between 1984-1988 at CRLC Vald’Aurelle 15 patients where treated with intraoperative RT. All patients have had macroscopic complete resection of the tumor. The local control rate was 86,6% with only 2 failures in the RT field. Postoperative RT does not improve survival despite improvement of local control in patients with positive mediastinal nodes (EORTC protocol 08741). Endobronchic brahitherapy with Iridium 192 improve local control in patients with locally advanced turnours (76% vs 63% in surgery alone series of patients). The altered fractionation regimens are under investigation. Median survival for patients treated with combination CT and RT is not significantly improved. The complete response to induction CT seems to be an prognostic factor for better outcome.

Key words: lung cancer, radio-chemotherapy, intraoperative radiotherapy.

Radioterapie & Oncologie medicală, 1995, 1:36-43

Dysplasies mammaires (dystrophies mammaires)

J.C. Sabourin Hôpital Henri Mondor, Service Anatomie Pathologique

The breast dysplasias are a real challenge for the pathologist. The borderline lesions with the distinction between benign and malignant are difficult to interpret. The fibrocystic lesions are high risk conditions which are more frequent associated with a neoplasm in evolution. The Scarff, Bloom & Richardson (SBR) grading is a semi quantitative system for prognostic evaluation of the breast tumours based on the grade of differentiation, the aspect of the nucleus and mitotic activity.

Radioterapie & Oncologie medicală, 1995, 1 :44-47