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Volum 02, Numarul 3-4, 1996

VOLUME II, No 3 – 4 1996

Editor’s note

The delay and the concentrations of two issues are the consequence of the limited financial possi- bilities we have. We hope that this one dedicated to the Biennial Symposium of Oncology, Oradea, 1996, having as the main subject: „Therapeutical Mo- dalities in Operable Breast Cancer” will meet your demands, both in the quality of the papers and in the approach of the problems related to this aspect. We also hope that the objective of this issue to establish a consensus in the investigation, diagnosis and treat- ment of the operable breast cancer will be achieved.

The first study signed by N .Ghilezan et al. offers data regarding the morbidity and mortality in breast cancer in 9 regional centres and data regarding the therapeutical modalities and results. The conclusions of this study stress on the deficiencies in the organi- sation of oncological care, as well as on the lack of a consensus in treatment. They are a warning for the professional and governmental bodies in view of drawing up a common plan based on the assurance of the necessary resources, professional formation and public education.

  1. Pacuraru et al. report epidemiological data in breast cancer in Bihor County which has one of the highest morbidity rate in our country (38.6%). They present an algorithm of diagnosis in palpable breast lump.
  2. Rancea discusses the history of the concept of operable breast cancer. Fischer’s systemic model and Hellman and Harris’s spectrum model are well de- bated.
  3. Neagoe’s paper refers to the criteria of the conservative surgery treatment in breast cancer. In his study the locoregional recurrence rate is 9% for the conservative surgery and 3% for the radical sur- gery, the difference being irrelevant from a statisti- cal point of view.

Within the multidisciplinary treatment of opera- ble breast cancer, E. Tanasescu et al. deal with the adjuvant treatment. In their study the overall 5 years survival and the desease – free survival are compara- ble to that found in literature. The authors empha- size the superiority of the anthracyclines in the treat- ment of operable breast cancer

Neoadjuvant chemotherapy has been used more and more in the treatment of cancer, including breast cancer. C. Vitoc et al. show an objective response of 72% (RC+RP) following neoadjuvant chemothera- py and 9% histological complete remissions on a group of 32 patients. The possibility of a conserva- tive surgery is 47% following neoadjuvant chemo- therapy. It means a better life quality.

  1. Turdean et al. investigate the role of the com- plement (TCC) in the mechanism of the cell cycle regulation in MCF- 7-ER+ human breast cancer cell line.
  2. Răşinariu estimate the citohistological changes following CT and/or RT. The authors recommend the combination of the histological score with the nodal one for a more accurate evaluation of the tumour re- gression following CT+RT.

There are 3 more papers published besides the papers of the Symposium.

C.Szekely presents an epidemiological study of breast cancer in Arad county and stress on the im- portance of metabolic factors, as risk factors.

Secareanu deals with a psycho-oncology subject and stress on the necessity of psychotherapy of the patients suffering from cancer.

The Poster Session of the Symposium is dis- cussed by C. Vitoc and covers all the aspects related to operable breast cancer.

The papers in this issue provide an agreement on the operable breast cancer therapy, neoadjuvant CT and conservative surgery are usual practices for operable breast cancer and offer a real benefit to the patient.

Maria- Turdean Retegan

Modalities and Therapeutical Results in Breast Cancer Romania 1990-1992 SRRO’s Multicentre Study

  1. Ghilezan1, Cristina Vitoc1, V. Dimitriu2, M. R. Găleşanu3, V. Pacuraru4, Hortenzia Ionita5, Valeria Văleanu6, Romanta Lupşa7, Laura Rebegea8

1Cluj;2Constanţa; 3Iaşi; 40radea; 5Timişoara; 6Sibiu; 7Tg. Mureş; 8Galaţi

The breast cancer is the main cause of morbidity and mortality for the woman in Romania and is continously increasing with a much faster rate than for the other European countries. In his study organised by the Romanian Society of Radiation Oncology, 9 regional centres have participed and 2,425 breast cancer women were registered for the 1990- 1992 period, representing 38% from the whole number diagnosed in their respective territories (6,324). The date show the predominance of advanced stages at presentation (57% stages III-IV, 32% stage II and only 6% stage I), no consen- sus on diagnostic and therapeutic indications, very few modem approaches as conservative breast cancer treatment or neoadjuvants treatments for operable tumours, great deficiencies in the follow up of the patients and very low survivals. These deficiencies are the result of the failures in the organisation of oncological care and should be considered a serious warning for both, the professional and governmental bodies in view of the establishment of a common plan of actions oriented on the assurance of the necessary resources, professional formation and public education.

Key words: breast cancer, epidemiology.

Radioterapie & On cologie Medicală, 1996, 3-4: 1-7

Neoadjuvant chemotherapy for operable breast cancer

Cristina Vitoc1, Angela Răşinariu1, A. Rancea1,2, N. Todor1, N. Ghilezan1,2

1Institute of Oncology „Ion Chiricuţă” Cluj-Napoca

2 University of Medicine and Pharmacy „Iuliu Haţieganu” Cluj-Napoca

The results in neoadjuvant chemotherapy for locoregional advanced breast cancer have determined us to adopt this protocol for stage II operable breast cancer. This modem approach has been introduced since 1991 with 32 patients treated until 1995. The neoadjuvant protocol used FEC with a mean of 4 cycles, followed by local treatment. Our preliminary results were: 1) Objective response (CR + PR) to neoadjuvant chemotherapy 72% (23/32). 2) Pathological complete response (PToNo) to neoadjuvant chemotherapy 9% (3/32). 3) Incidence rates were 56% (18/32) for pNo and 44% for pT = 4 cm (2×2 cm2), with implications in local and systemic treatment. 4) Disease control rate of97% at the end of the treatment (only 1 patient with progressive disease). 5) Breast conservation for 47% (15/32) of patients, representing a higher quality of life for this group of patients, initial candidates for radical mastectomy.

Key words: surgical breast cancer, neoadjuvant chemotherapy, results

Radioterapie & Oncologie Medicală, 1996, 3-4:8-14

Adjuvant treatments in operable breast cancer

  1. Tanasescu1,2, Cristina Vitoc2, Natalia Galatar2, N.Ghilezan1,2

1UMF „Iuliu Haţieganu” Cluj-Napoca disciplina Oncologie & Radioterapie

2Institutul Oncologic „Prof I. Chiricuţă” Cluj-Napoca

In the last decade, concept of initially operable breast cancer suffered important modifications, that the micrometastatic disease could be present in stages I and II. The systemic therapy becomes rationale even for the early stages, existing suggestive data supporting this facts. In the present paper, we studied the patients entered in the Radiotherapy Departament having as first treatment a radical modified mastectomy. For the 160 patients, the 5 – years survival was 76%, 83% for stage IIA and 71 % for stage liB of the disease. The disease – free survival was 73% for IIA and 63% for stage liB. Adjuvant chemotherapy was applied to 61 patients, the schedule including antracyclines beeing significantly superior to the CMF regimen, reporting to the disease/free survival at 5 years.

Keywords: operable breast cancer, radical mastectomy, adjuvant treatement.

Radioterapie & Oncologie Medicală, 1996, 3-4: 15-19

The evolution of the concept of operable breast cancer and its implication in therapy

A.C. Rancea

„Prof I. Chiricuţă” Institute of Oncology, Cluj-Napoca

University of Medecine and Pharmacy I. Haţieganu Cluj-Napoca

The concept of operable breast cancer (OBC) developed through three periods of time. The first, prehalstedian (before 1882), had as a major feature the lack of a model of natural history for the breast cancer (BC) and as a consequence, the treatement ranged from local excision to modified radical mastectomy. OBC did not have a clear definition. The second period, halstedian (1882 – 1979) was dominated by Halsted’s paradigm on BC dissemination and by his radical mastec- tomy (RM). The best results of radical surgery alone were 50 – 60% of survival at 10 years (Haagensen). The third period (posthalstedian, after 1979) has as theoretical ground the systemic model of Fisher and the spectrum model of Hellman and Harris. The therapeutic consequence is the replacement of RM with conservative surgery and the association of radiotherapy and systemic therapy to surgery. In conclusion, the concept of OBC has evolved from the pure technical sugical conotations to those of natural history on tumour biology. The result was a treatment wich improved the survival rates and the quality of life of the patients.

Key words: operable breast cancer, spreading models, treatment

Radioterapie & Oncologie Medicală, 1996, 3-4:20-24

Conservative surgery in complex cancer

  1. Neagoe

Oncological Institute „Prof I. Chiricuţă”, Cluj-Napoca

Our paper try to bring face to face two surgical ways for breast cancer treatment – mastectomy vx. Conservative surgery – putting togheter the arguments for one or another of these treatment options. The study presents a retrpspective analyse for breast cancer new cases registered in our institute in 1990. There were 502 new patients with mammary carcinomas, from which 368 suffer surgical treatment: 314 (85.3%) radical mastectomy and 54 (14.7%) conservative surgery. Selection criteria for conservative surgery were as it follows: tumour size, nipple areolar complex invasion, multifocal disease (gross multicentric), extensive intraductal component, status of resection margins and cosmetic results. Survival at 5 years function of chosen surgical treatment (mastectomy vs. conservative surgery) reveals a p=0.14 statistic value which means an unsemnificative difference between these two surgical options. Breast recurrence following conservative surgery was 9% and 2% for mastectomizewd patients. So, our conclusion is that conservative surgery became the appropriate surgical manner in wel defined clinical and histological conditions. More, this new techinque offer a supperior life style.

Keywords: breast cancer, conservative surgery, mastectomy

Radioterapie & Oncologie Medicală, 1996, 3-4: 25-31

Complement activation and cell cycle in breast cancer Study in vitro on the MCF-7-ER+ cells

Maria Turdean-Retegan1, F. Niculescu2, H. Rus2, N. Ghilezan3

1Radiological Clinic, Cluj-Napoca, Romania

2Department of Pathology, University of Maryland, School of Medicine, Baltimore, USA

3UMPh „I. Haţieganu” Department of Oncology and Radiotherapy, Oncological Institute, Cluj-Napoca,

Activation of the complement system is present in the breast cancer cells: it generates the TCC assembly and its inser- tion in to the plasma membrane. The purpose of this study is to investigate the role of TCC on the modulation of cell cycle in the breast cancer cells. For this reason we have determined the DNA synthesis, cdc-2 activity, and cyclin B I on the MCF- 7-ER+ cells exposed to sublytic TCC. Our data showed a high level of the (3H) thymidine uptake when the cells were not exposed to TCC (UNTR) and it was reduced with 45 % when the cells were exposed \to TCC. Cyclin B 1 and cdc-2 activity were sharply reduced at 4 h by TCC. Our findings are consistent with the rolebf the TCC in the mechanism of cell cycle regulation. It is a negative regulator and inhibits the cell cycle on the MCF- 7-ER+ cells.

Keyword: breast cancer, cell cycle, TCC (Terminal Complement Complexes)

Radioterapie & OncologieMedicală, 1996, 3-4:32-41

Histological changes induced by chemo-radiotherapy in breast cancer

Angela Răşinariu1, Cristina Vitoc1, N.Ghilezan1,2

1Oncological Institute „I. Chiricuta” Cluj-Napoca

2U.MPh. „Iuliu Haţieganu” Cluj-Napoca, Oncology-Radiotherapy Department

We here present 33 cases of advanced breast cancer stage II-III, treated with chemotherapy and, or chemotherapy plus radiotherapy (CT:!:RT). Viewing a more precise evaluation of histological changes induced by CT -RT, a value for each histologic parameter was considered, according with the degree of histologic changes. The final score was counted from tumor score and lymphnode score. The score of group receiving CT and associated treatment group were compared. More cases (12) with better answer were found in the group with associated treatment, than in the group with CT alone.

Key words: breast carcinoma, radiotherapy, chemotherapy, neoadjuvant therapy, histological change, tumor regression.

Radioterapie &Oncologie Medicală, 1996, 3-4: 42-48

Breast cancer, morbidity, mortality and diagnostics methods

  1. Păcurar

Faculty of Medicine and Pharmacy Oradea

Breast cancer is the most frequent malignity with women, especially in european coWltries.Breast cancer has a frequency in gradual increase doubling or even trebling the number of new cases in the past twenty years.Mortality due to breast cancer is high too, breast screening) of breast cancer is very important. In this work the role of these actions for early diagnosis of breast cancer is stressed in order to improve the control of this malignancy. To complete the positive diagnosis ofbreast cancer is made by collaboration between clinic examination, mammographic and ecographic examination. The morphologic examination (cytologic and histologic) are im- portant for the explanation of the positive diagnosis of breast cancer.

Key words: breast cancer, morbidity, mortality, diagnosis

Radioterapie & Oncologie Medicală, 1996, 3-4:49-56

Morbidity and mortality data through breast cancer in Arad County

Cs. Szekely1, A. Szekely2, N. Todor3

1Spitalul Municipal Arad

2Cabinetul de Oncologie al Dispensarului Policlinic Municipal Arad,

3Institutul Oncologic „Prof I. Chiricuţă” Cluj

The authors planned the epidemiological analysis of breast cancer in Arad County, between 1976-1995, following the influence of various epidemiological factors concerning morbidity and mortality through breast cancer in this western region of the country, occupying the first place in Romania.

Keywords: breast cancer, morbidity, mortality

Radioterapie & OncologieMedicală, 1996, 3-4: 57-68

Issues of psychological assistance in breast cancer

  1. Secăreanu

UMPh Cluj-Napoca, Psychiatric and Medical Psychology Department

After a brief review of some aspects in oncopsychology, including the coping, we discuss some basic problems concern- ing the process of information, by taking into considerations some pecularities in connection with the mamectomy, chimio and radiotherapy. We call into question also the principles and the value of the behavior modeling for the prepa- ration of patient for radiotherapy. Finally, we expose the guidelines for the psychotherapeutical approach. Key words: coping, patient information, behaviour modelling, psychotherapy.

Radioterapie & Oncologie Medicală, 1996,3-4: 69-72

POSTER SESSION

Cristina Vitoc

Oncological Institute Prof „Ion Chiricuţă„, Cluj-Napoca

The 38 posters have been organized in 7 sections: 1) Epidemiology: it has been emphasized the actual increase in incidence and mortality of breast cancer, with a low percentage of operable cases (below 30%) and 1/3 of new cases not classified according to TNM. 2) Diagnosis: the importance of ultrasound and mammography in the diagnostic and follow-up of conservative treated patients; the description of a model county center for breast screening; cytological examination of the surgical specimen print as an alternative to frost histology; immunohistochemical analysis of natural evolution from normal tissue to atypical hyperpla- sia and non-invasive carcinoma of the breast 3) Prognostic factors: the correlation between histologic prognostic factors (classical and new) and the clinical evolution of the disease; evaluation of cytological and histological alterations in tumor cells and nodes after neoadjuvant chemo-radiotherapy in order to define a prognostic scale; the finding of histological markers expressing aggressivity in small tumors; gene alteration and genetic treatment in breast cancer. 4) Adjuvant radio-chemotherapy: improved local and distant control of the disease in operable breast cancer; neoadjuvant chemotherapy provides early disease control while increasing the conservative treatment rate in operable breast cancer, and an improvement in survival rates in locally advanced breast cancer in comparison with local treatment only. 5) Therapeutic approaches: pen- dular excentric irradiation, tangential fields irradiation, dosimetry, correct prescription of doses after ICRU; neoadjuvant chemotherapy with Taxol in locally advanced breast cancer is efficient and has good tolerabil ity; an original preoperative radio-citostatic treatment combined with electromagnetic hyperthermia has spectacular immediate results, though requiring validation over time. 6) Therapeutic results: rates of and time to locoregional recurrences; subjective and objective cosmetic evaluation after conservative treatment 7) Varia: association of breast cancer with other malignancies; celioscopic ovariectomy as estrogen suppres- sive treatment in young patients with breast cancer.

KEY WORDS: operable breast cancer; epidemiology; diagnosis; prognostic factors; adjuvant treat- ment; neoadjuvant treatment; therapeutic approaches; treatment results; varia.

Radioterapie & Oncologie Medicală, 1996, 3-4; 73-76