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Volum 05 Numarul 2, 1999

69 Editorial

This issue contains a wide range of subjects largely organized in the following headings: review articles, original studies (clinical and experimental investigations), case reports, oncological news, book reviews.

In the first paper, Elisabeta Ciuleanu presents the role and place of prognostic factors in nasopharyngeal carcinoma. The importance of parana so pharyngeal space extension for the local control and the impact ofN category on metastases are emphasized.

Cutaneous Lymphomas are a heterogeneous group oflymfoprolifetative diseases ofT Lymphocytes. Youlia M. Kirova et.al. (from Le Bourgeois’ Group, Henri Mondor University Hospital Paris) reviewed the classification, diagnosis and treatment of cutaneous lymphomas. They show that radiotherapy is efficient in limited and superficial forms of Mycosis fungoides as well in locally advanced of non-epidermotropic lymphoma.

Natural history of. breast cancer, from molecular biology to clinical aspects, is synthetized by Cs. Szekely (Clinical Hospital, Arad). We appreciate this collaboration and are loking for more members of SRRO to be so active.

We are honored to publish another paper signed by Le Bourgeois’ Group. The authors report a retrospective study of 21 patients with glioblastomas and compare the results of radiation therapy alone with radiation therapy and Fotemustine 100 mg/m2. There is no significant difference in survival between radiotherapy alone vs. radiotherapy plus Fotemustine.

Radiotherapy can induce malignant tumors after long periods of time. Two published papers, signed by Youlia M. Kirova et. al. and by C. D. Olinici et.al. are dedicated to postradiation sarcomas. The first reports 8 patients presenting sarcomas after 5-18 years postiradiation following surgery for breast cancer. The second paper presents a patient with breast angiosarcoma developed after 5 years from breast irradiation. Both of them make a review of literature concerning induced-radiation sarcomas.

The preliminary results of high-energy photons irradiation in advanced carcinoma of the uterine cervix, are presented by Viorica Nagy et al. from Oncological Institute Cluj. They show that irradiation with 15 MV x-ray allows surgery in 65% patients and 3 years survival were 71%, comparative with 39% and 65% for cobalt irradiation.

The resistance of tumor breast cells to complement mediated damage is, in large part, through specific inhibitors of complement. Maria Turdeanu et.al. ,using imunohistochemical technique, show that two of complement inhibitors, (CD59 and clusterine) are presented on breast cancer cells.

Daniela Martin et. al. present a case report of35 years patient with gastric adenocarcinoma developed 13 years after abdominal irradiation for testis seminoma. The second tumors developed late after irradiation is a strong argument for long term follow up of patients after irradiation.

The section regarding the oncological news is opened with the „Florence Statement” adopted at the 1st European Breast Cancer Conference. We underline the importance of this Statement which marks for the first time the involvement of a large group of women, more exactly, the Europa Donna Organisation represented by Gloria Freilich, member in United Kingdom’s Parliament and the European Community. Through this document, are affirmed the civil community’s engagement in protecting and developing an international system of medical insurance, than can assure equal accesibility on diagnosis, treatment and protection of all the women from the world.

  1. Marsiglia reports the. Programme of Latino-American Group Curietherapy-Radiotherapy (GLAC-RO) 1998- 2000. GLAC-RO is a very active professional Association, and our Society should learn a lot from it. There are real opportunities to realise an official cooperation with GLAC-RO.

The progress in diagnosis and treatment of glioma discussed at simposioum „Glioma Perceptorship Programme”, Royal Masrden Hospital, London, 26.27 aprill999, are syntetised by Dana Cernea. ” Oncological life in Romania and CMEtest end this issue. We hope this new form of presentation will be appreciated by the reader.

Maria Turdeanu

71 Prognostic factors for the nasopharingeal carcinoma

Elisabeta Ciuleanu

Institute of Oncology „Prof I.Chiricuţăi”: Cluj-Napoca, Dept. Radiotherapy II

There are many prognostic factors for the nasopharyngeal carcinoma (host, tumour, treatment factors, serological prog- nostic factors) but their importance is different. For tumoral prognostic factors it has recently been done specifications regarding the prognostic role ofT category, so the grade of tumoral extension in the nasopharynx it does not seem to have prognostic value, but the grade of extension in the paranasopharyngeal space has an important prognostic role, having an impact both on the local control and the metastasis. Distant disease (the main failure cause in nasopharyngeal carcinoma) is linked principally to N category (nodes dimension, their mobility and level). Because each of the above elements are included either in UICC/AJCC classification or in Ho classification and have a special prognostic importance, it has recently been achieved a new classification system adopted by the 5-th edition of the AJCC classification system and witch tend to fuse the most predictive prognostic factors from each system into a new one. As regards serological markers like Ig G anti ZEBRA, Ig G anti EA and ADCC they could be the most important markers with the prognostic role in nasopharyngeal carcinoma. The problem is that these markers represent a prognostic indicator only after radiotherapy treatment, but not at the beginning of the disease. Relying on these markers we could select the patients who would need the adjuvant chemotherapy even if they are in the incipient stages. The prognostic of the patients with nasopharyngeal carcinoma could be also Influenced by the response to the primary treatment, type of treatment, irradiation technique and the total dose.

Keywords: nasopharyngeal carcinoma, prognostic factors.

Radioterapie & OncologieMedicală, 1999,2:71-81

82 Radiotherapy of cutaneous lymphomas

Youlia M. Kirova, Y. Piedbois, Q. Pan, L. Guo, J. P. Le Bourgeois

Dept. of Cancerology, Henri Mondor Hospital, Créteil, France

Radiotherapy plays an important role in the treatment of cutaneous lymphomas. In the treatment of Mycosis fungoides, total skin electron beam radiation therapy is efficient also for patients with limited and superficial forms of disease. The radiotherapy is efficient also for the locally advanced forms of non-epidermotropic lymphomas. The palliative radio- therapy is indicated for advanced, nodular and treatment resistent forms of cutaneous lymphomas and for volumineous lymphadenopathies.

Key words: Radiotherapy, Cutaneous lymphomas, Mycosis fungoides, Total skin electron beam radiation therapy.

Radioterapie & Oncologie Medicală. 1999.2:82-88

89 Natural history of breast cancer

Cs. Szekely

Clinical Hospital Arad, Department of Oncology

The exact knowledge of natural history of breast cancer, in all its stages, begining with precancerous lesions, the irrevers- ible genetic modifications from the begining stage of neoplasia and continuing with the local extension mechanism – invasion and metastasion – represents the first condition of successful outcome in the continuous battle of decreasing morbidity and mortality through breast cancer.

The purpose of this study is a schematic synthesis of the genetic, biomolecular, hormonal, physiopathologic, anatomopathologic and clinical processes from the successive stages, often unpredictable, of natural history of breast cancer.

Key words: cancerogenesis, initiation, promotion, progression, cancer genes, neoangiogenesis, invasion, metastasis, prognostic factors.

Radioterapie & Oncologie Medicală, 1999,2:89-96

97 Post-radiation sarcoma after breast cancer: 8 case report and review of the literature

Youlia M. Kirova, F. Feuilhade, E. Calitchi, Y. Otmezguine, J.P. Le Bourgeois

Henry Mondor University Hospital, Créteil, France

Background: We repor 8 cases of sarcoma after radiotherapy for breast cancer.

Patients and methods: 8 patients, presenting postradiation sarcoma, had been treated between 1983 – 1977 at Henry Mondor Hospital Creteil France with irradiation following breast surgery. One of patients received chemotherapy, also. 5-8 years later (mean 10,3 years) they developed sarcoma: angiosarcoma (two cases), fibrosarcoma (3 cases), osteosa- rcoma (one case), malignant mesenchymoma (one case) and unclassified sarcoma (one case). All the patients had breast cancer in complete remission at the moment of sarcoma diagnosis. The ages ranged from 39 to 88 years (average 57, 6 years). Sarcomas were localized on the breast (3 cases), the thoracic wall (2 cases), the clavicular region (1 case) and axillary region (2 cases)

Results: Two patients are still alive in complete remission. Overall survival varies between 5 to 115 months (average 29, 8 months, six patients died with local resurences and lor methastasis.

Conclusion: Raditherapy can include malignant tumors after some years. The radiation-induced sarcomas are soar prog- nostic. It is necesary to survey the patients with breast cancer a long period after irradiation.

Key words: radiation-induced sarcoma, breast cancer, radiotherapy.

Radioterapie & Oncologie Medicală, 1999,2:97-102

103 Post-radiation angiosarcoma of the breast. Case report and review of the literature

C.D. Olinici1, Angela Răşinariu2, R. Buigă2, Liliana Resiga1, S. Hica2, C. Ciuce3

1Department of Pathology, University of Medicine and Pharmacy „Iuliu Haţieganu „, Cluj-Napoca

20ncological Institute „Professor Ion Chiricuţă”, Cluj-Napoca

3 2nd Clinic of Surgery, Cluj-Napoca

Angiosarcoma of the breast is an uncommon tumor that may develop after radiation therapy. The authors present an additional case, a female who showed an angiosarcoma five years after irradiation for an invasive duct carcinoma treated by sectorectomy. Five months after mastectomy she developed local reccurences and an echographic examination re- vealed liver metastates. The differential diagnostic with the so-calles atypical vascular lesions which also appear after irradiation is briefly discurssed.

Key words: breast angiosarcoma, post-radiation, diagnosis.

Radioterapie & Oncologie Medicaid, 1999, 2:103-108

109 Radiation therapy and Fotemustine versus radiation therapy alone in the treatment of glioblastoma multiforme. A retrospective study of 21 cases

Youlia M. Kirova1, L. Chossiere1, L. Martin1, Caroline Le Guerinel2, Ph. Niclot3, J.P. Le Bourgeois1

1Department of CancerologyHenri Mondor University Hospital, Créteil, France

2Department of Neurosurgery Henri Mondor University Hospital, Créteil, France

3Department of Neurology Henri Mondor University Hospital, Créteil, France

Glioblastomas multiformes (GBM) are glial neoplasms with poor prognosis. This study is presented to compare the results of radiation therapy alone with these of radiation therapy and Fotemustine in the treatment of glioblastoma multiforme. Twenty-one patients with GBM, treated from 1993 to 1995 in Henri Mondor University Hospital, Creteil, France form the subject of this report. All the patients underwent operation (gross total tumor resection- 14,3%, subtotal tumor resection-33,3 %, and stereotactic biopsy-52,4%), followed by radiation therapy to a total tumor dose of 60 Gy. For 14 patients (66,7%) the radiotherapy was combined with Fotemustine (100 mg/m2). The median survival rate for all 21 patients was 10 months (ranged from 1 to 35 months). The median disease free survival /DFS/ rate was 7,5 months. The minimal follow-up was 12 months. In Radiotherapy group the survival ranged from 2 to 35 months (median 8,8 months), and DFS from 2 to 35 months (median 7,9 months). In Radiotherapy-Fotemustine group the survival was from I to 26,5 months (median 10,8 months), and DFS ranged from 1 to 17 months. This retrospective study reports our experience in the treatment of patients with GBM. There is no significant difference between patients treated with radio- therapy alone and these treated with radiotherapy-fotemusine. But for more conclusions, the prospective randomized study is needed.

Key words: Brain tumors, Glioblastoma Multiforme, Radiotherapy, Fotemustine.

Radioterapie & Oncologie Medicală, 1999, 2:109-114

115 Results of linear accelerator irradiation in advanced cervical carcinoma

Viorica Nagy1,2, N.Todor1, N. Ghilezan1,2

1UMF „Iuliu Hatieganu” Cluj-Napoca

2Institutul Oncologic „I.Chiricuţă” Cluj-Napoca

Radiotherapy is the main therapeutical methods for locally advanced cervical cancer. The preliminary results of high energy photons (15 MV) irradiations in carcinoma of the uterine cervix are evaluated through local control, therapeutic recurrence, survival rate and comparison to cobalt-60 irradiation results.

This nonrandomized prospectiv study consisting of 201 pacients with locally advanced cervical cancer (lIB-11m) was performed at Oncological Institute „I.Chiricuţă” Cluj, Department of Radiotherapy II, during 1st of January 1995 – 31st of December 1996. Irradation with 15 MV x-rays, with or without cisplatin as radiosensithiser detennined a good local res- ponse to allow surgery in 65% patients. This result is superior to the one obtained through cobalt irradiation (39%). 2 years local control and 3 years survival were better, due tu high-energy photon irradiation (92 % and 77%) than cobalt-60 irradia- tion results (67% and 65%), and this proves the superiority of 15 MV x-rays irradiation in advnaced cervix carcinoma.

Key-words: locally advanced cervical carcinoma, high-energy photons irradiation, concurrent radio-chemotherapy.

Radioterapie & Oncologie Medicală, 1999, 2:115-123

124 Immunohistochemical study of CD 59 (Protectin) and Clusterin in breast cancer

Maria Retegan- Turdeanu1, F.Niculescu2, H.Rus2

1Radiology Clinic, Cluj-Napoca, Romania

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

The resistance of human cells to complement-mediated damage is, in large part, mediated by specific inhibitors of complement. I this study we examinated, using immunohistochemical technique, expression of complement regulators CD59 and clusterin in 21 human breast cancer. Specific deposits of CD59 and clusterine were expressed by all the tumor on the membrane of tumor cells in the cytoplasm and in the connective tissue matrix. Its expression varied ranging from weak to strong. In conclusion CD59 and clusterine are expressed by breast cancer cells and may be involved in the resistance of cell to complement mediated damage.

Key words: CD59, clusterin, breast cancer, complement

Radioterapie & Oncologie Medicală, 1999, 2:124-130

124 Immunohistochemical study of CD 59 (Protectin) and Clusterin in breast cancer

Maria Retegan- Turdeanu1, F.Niculescu2, H.Rus2

1Radiology Clinic, Cluj-Napoca, Romania

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

The resistance of human cells to complement-mediated damage is, in large part, mediated by specific inhibitors of complement. I this study we examinated, using immunohistochemical technique, expression of complement regulators CD59 and clusterin in 21 human breast cancer. Specific deposits of CD59 and clusterine were expressed by all the tumor on the membrane of tumor cells in the cytoplasm and in the connective tissue matrix. Its expression varied ranging from weak to strong. In conclusion CD59 and clusterine are expressed by breast cancer cells and may be involved in the resistance of cell to complement mediated damage.

Key words: CD59, clusterin, breast cancer, complement

Radioterapie & Oncologie Medicală, 1999, 2:124-130

131 Gastric adenocarcinoma following radiotherapy for testis seminoma. A case report

Daniela Martin1, Dana Cernea1, N. Ghilezan1,2

1Oncological Institut „Prof. I. Chiricuţă” Cluj-Napoca.

2UMPh „Iuliu Haţieganu” Cluj Napoca

This paper deals with the case of a pacient with gastric adenocarcinoma after 13 years treatment of testis seminoma with radiotherapy alone. It is most likely that the second cancer is a consequence of including epigastric area in the irradiation field, but we don’t have to forget personal pathologyc history of gastroduodenal ulcer, Helicobacter pylori infection and also chronic atrophic gastritis and intestinal metaplasia, as precursor lesions. The particularity of this case consists in irradiation tolerance low threshould, that is shown by digestiv, skin and neurological effects.

Key words: radiotherapy, atrophic gastritis, intestinal metaplasia, Helicobacter pylori, late effects, second cancer. Radioterapie & OncologieMedicală, 1999, 2:131-135

136 Florence Statement, 1st European Breast Cancer Conference, 3 October 1998

L. Cataliotti, C. van de Velde, Gloria Freilich

137 General politics 1998-200 of the Latino-American Group for Curietherapy and Oncological Radiotherapy (GLAC-RO)

  1. Marsiglia

140 Progress of diagnostical and therapeutical approach in brain tumors

Dana Cernea

Oncological Institute „Prof I. Chiricuţă” Cluj-Napoca

The symposium „Glioma Perceptorship Program” was carryed on at Royal Marsden Hospital in London, between 26-27 april 1999. There was presented a comprehensive review of the state-of-the-art approaches to Glioma management. The symposium was sponsored by Schering-Plough Pharmaceuticals.

Key words: glioma, aetiology, surgery, radiotherapy, chemotherapy

Radioterapie & Oncologie Medicală, 1999, 2:140-144

145 ONCOLOGICAL LIFE IN ROMANIA

147 BOOK REVIEW

149 CME

153 GUIDELINES FOR AUTHORS