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Volum 06 Numarul 1, 2000


Editorial: a program for the 2000!

This first issue for the year 2000 of our Journal proposes a program for the Romanian Oncology in the XXIst century drafting out its objectives and the strategies for their accomplishment.

The papers we are offering to our readers in this issue, cover diverse domains of interest that reflect the multidisciplinarity of the modern oncology: some of them illustrate the main trends in therapy, others describe the practical approaches to solve the specific problems of the cancer control. The diversity of the subjects but more, the number of specialties and of authors as well their affiliation, is a good omen for the formation of a multidisciplinary conception for our Society having as main objective, to increase the quality of care provided to the cancer patient.

Ofelia Şuteu et al. offer a complete and very documented review of the trends in cancer morbidity and mortality In Romania at the end of the millenium. In almost 30 years, from 1970 to 1998, the cancer death in Romania have increased with 57%, reaching 40.000 cases. The curve is ascending and diverse aspects are analysed with suggestions for improvement the registering and reporting of data. Well known for his experience in the organization of the Cancer Registry of Bihor County, V Păcuraru reports in detail on the methodology. A Cancer Registry is a working instrument for preparation, management and evaluation of all the national and regional programs for cancer control and should be understood like a living structure, alive as long as it is fed with pertinent data and how these are used to improve our approaches.

In the same way, Maria Retegan-Turdean reports on the integration of the general hospital in the cancer network, from the point of view of a cancer specialist working in a nonspecialized structure.As long as more than 60% of the patients with cancer, are first seen by GPs or organ specialists, it is mandatory to identify the practical solutions to assure the multidisciplinary circuit of the patient and to increase the role of the general hospital in cancer care.

The need and the possibility of the integration aof the GPs in cancer care is sustained on a basis of a very valuable personal experience, by D. Baciu et al., and Ileana Hica. The home and palliative care are a new field for the medical system in our country, that became reality due to the cooperation between two GPs and an outstanding specialist, commited to these very important aspects but nevertheless ignored of the cancer pathology. Their efforts was supported by NGOs and the Cluj community but more their entusiasm and committement allowed them to step over the obstacles that were not few.

The problem of innovative therapeutics is presented by well recognized specialists who describe what will be routine in the XXI century: T.E. Ciuleanu in medical oncology, V Cernea and G. Kacso in radiotherapy. We are confident that the endorsement of the program for upgrading radiotherapy equipment and the organization of the cancer care network, actions initiated by the Health Department at the end of last year, will provide the necessary structures and means to improve professional standards in Romanian oncology. In the same context, Dana Cernea adresses on the quality of life from the patient’s perspective, a dimension that should not be ignored when taking the therapeutic decision.

Viorica Nagy and O. Coza, approach with professionalism one of the most critical aspects of

Romanian oncology: the precarious status of cervix cancer. Even if the results of the Cancer Institute Cluj have known a continous improvement, that paralleled the development of the technical equipment, the authors cannot be satisfied so long as the national statistics are among the least favourable in Europe and the world. A possible answer and a hope, brings us Mihalea Beuran and the Society of Family Practitioners who assumed the dificult task to organize a diagnosis system for early cervix cancer. With the same committement as demonstrated by their collegues who initiated the home care, M. Beuran succeded to get a sponsorhip from the part of some NGO for a pilot program for screening and control of the cervix cancer in the Cluj county. Approximately 10,000 women between 25 and 65 years, enlisted by 17 collegues from several urban and rural areas, will have a Pap test during the year 2000. We enthusiastically greet this program, a novelty for the public health in Romania and we wish much luck to all partners involved, especially to GPs who will do the most difficcult part.

The therapeutic results and innovation in breast cancer, the most predominant for all cancer services in Romania, is commented with authority by Cristina Vitoc, on the basis of the experience of the Breast Tumor Center of the Cancer Institute Cluj. The practical aspects of the treatment are inseparable from the clinical research, especially in the last decade when the introduction of new molecules have challenged many of the classical strategies. The answer to these questions cannot be given outside well organized clinical trials and an integration into international research efforts is desirable and was most successfully performed by the group of Mrs. Vitoc.

The project Prostate Cancer Task Force presented by M. Ghilezan for the European Institute of Oncology Milano, unravels the „kitchen” from behind the developments of any strategy of diagnosis, treatment and research, based on a multidisciplinary team oriented toward innovation and progress. The Italian experience can be a model to follow for initiation of similar programs in our institutions, for which there is a need of opinions and ideas from diverse specialists with common interest.

What an information system could and should provide for the medical management, is outlined by N. Todor and the practical benefit is demonstrated at the Cancer Institute Cluj, so we only say that we can no more imagine to exist without!

Eventually,… in a look in the future from the perspective of oncology, given our successes and

unfulfillments from last years compared to the international standards with, we are trying to establish a hierarchy of our priorities for the XXI century. Many of the good initiatives were not fully finalized, mainly, due to a lack of communication among collegues, specialties, professional boqies, services and institutions and all these make me to consider that our first priority must be a good management of all cancer services through their integration in a national network. To achieve this goal, we should foster a permanent communication system to imply in dialog the governmental structures and our professional community. The positive example provided by our GP colegues in two essential domains of the cancer control, prevention and palliative & home care, is eloquent enough. The cancer care cannot be limited to some centres or specialists and should open to all professional the cancer patient need at a some moment of his evolution. Oncology, by vocation means multidisciplinarity and this concept should be present in our daily activity, our programatic issue for year 2000 being a plea for education, research and communication with the goal to offer our patients as much as possible from the progresses medical science has and will have in the 3rd millenium.

  1. Ghilezan

5 Cancer Epidemiology. Actual Tendencies and Perspectives at the End of the Millennium

Ofelia Şuteu, Ecaterina Scorţan, N. Todor, N. Ghilezan

UMPh „Iuliu Hetieganu” Cluj-Napoca

Cancer Institute”Prof I. Chiricuta” Cluj-Napoca

Cancer morbidity and mortality have registered a continuous ascent throughout this century, allover the world. Every year about 10 million new cases and almost 8 million death cases are registered. Nearly half of these affect four major anatomic sites: lung, stomach, upper aerodigestive tract and liver. With the exception of a few cancer cases whose risk of emergence is running low in the developed countries, some localizations of the neoplasm disease (lung, breast, prostate, colon, rectum) have become more frequent in some countries where the risk factors such as smoking, feeding customs and exposure to chemical substances in the professional and social environment are now common.

In Romania, the incidence and global mortality through cancer have registered in the last three decades a continuous ascending rate. With the exception of the gastric cancer whose rate of mortality is constantly running low, there is an increasing tendency mortality rate for the most localizations, especially for bronhopulmonary, buccal cavity, prostate, colorectal, breast, laryngeal, cervical cancer.

Evolving similarly to the rate of mortality, the ascending course of the incidence is reflected in bronhopulmonary, colorectal cancer and leukaemia for both sexes, and it is differentiated for men as prostate, oesofageal, pancreatic cancer, while for women breast cancer holds the first place.

The constantly ascending evolution tendency of the incidence and mortality through cancer in our country, underlines the necessity of a pressing intervention, motivating the efforts to adopt efficient strategies for prevention and control of the population.

Key words: cancer, epidemiology, incidence, mortality, time trends, prevention.

Radioterapie & Oncologie Medicală, 2000, 1:5-20

21 Cancer Control and Cancer Registry

  1. Păcurar

Cancer Hospital, Oradea

An important component of the National Cancer Control Program refers to the role of the Cancer Registries in the fight against cancer. The present paper describes the structure of Cancer Registries and their main activities: the professional authority of accreditation, the investigated population, the confidentiality of data, evaluation of Cancer Registries dimension and their administration and financing. The new cancer cases are passively registered, but an active collecting of data is necessary. The follow-up, study of overall and disease free survival are common activities of the cancer registries. The presented data are based on the experience of Cancer Registry Bihor and are included in the European Network of Cancer Registries from Lyon, France.

Key words: Cancer Registry, Cancer Control, Survival curves

Radioterapie & Oncologie Medicală, 2000. 1:21-27

28 District General Hospital and Cancer Care

Maria Retegan-Turdean

University District General Hospital, Medical Oncology Department Cluj Romania

District General Hospital should be actively involved in control and the treatment of cancer. Its activity must be integrated into the general cancer network. A good colaboration with all the units where are treated cancer patients (Interdistrictal Centers and Oncology Institutes) as well as GP is necessary in order to assure the high quality of cancer care.

Key word: District General Hospital, cancer care.

Radioterapie & Oncologie Medicală, 2000, 1:28-31

32 Home Health Care and Palliative Home Care Services Offered by The Foundation for Elderly Care ClujNapoca

  1. Baciu1, T. Simionescu1, Ileana Hica1,2

1Foundation for Elderly Care Cluj-Napoca

2Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

Because of inefficient use of resources in the Romanian health care system, the Foundation for Elderly Care has considered the need to promote models of alternative medical and social care in the community.

The Foundation for Elderly Care runs three projects. The Adult Day Care Center is a model of alternative community care where direct services are provided to more than 1000 older citizens from the city ofCluj-Napoca, being, also, a training center for general practitioners, nurses, social workers and psychologists.

Home health care services are offered to persons of any age from the city of Cluj-Napoca, home bound, by an interdisciplinary team of nurses, physical therapists, speech therapists and home aids. The objectives of the services are to reduce the number of days the patient spends in the hospital and to prevent unnecessary hospitalization, thus, reducing the costs in the health system.

Palliative home care services are offered to the terminally ill cancer patients by an interdisciplinary team with the same professionals as above but also the psychologist and the priest.

In order to insure the quality of the home care services all the professionals attend a continuous education program, use practical guidelines and the every patient’s satisfaction is tested. We emphasize on the health education of the patient and her/his family in order to attain as quickly as possible the final objective of home care which is a lower dependence degree.

Key words: alternative community care, adults day care center, home health care, paliative home care, interdisciplinary team, patient education, patient satisfaction

Radioterapie & Oncologie Medicală, 2000, 1:32-36

37 The Program Home Paleative Care

Ileana Hica

Foundation for Elderly Care Cluj-Napoca

Cancer Institute „Prof I. Chiricuta” Cluj-Napoca

Terminal cancer patients vere given palliative care at home. We present the activity of the palliative care team of Foundation for Care of the Elderly in Cluj-Napoca

Key words: temlinal cancer patients, palliative care at home

Radioterapie & Oncologie Medicală, 2000, 1:37-42

43 Tendencies in Medical Oncology at the Eve of the Third Millennium

T.E. Ciuleanu

UMPh „Iuliu Haţieganu” Cluj-Napoca Cancer Institute „Ion Chiricuţă” Cluj-Napoca

A tremendous growth in the knowledge of molecular biology (cell cycle, signal transduction pathways, DNA repair mechanisms, oncogenes and tumour suppresser genes, apoptosis, imortalization/ senescence, angiogenesis) was noted the last two decades. Occurrence of new anticancer agents, lead to a change in the pattern-of-care in some tumour types, but the improvement in patients’ prognosis is yet modest. Their high cost makes the development of a ladder of priori ties in the clinical practice of the medical oncology mandatory. The use of the new drugs in well designed clinical research protocols, is the guarantee of a maximal clinical benefit for the patients, and is mandatory for keeping at an acceptable level the clinical research in medical oncology in our country.

Key words: medical oncology, new anticancer agents, clinical trials.

Radioterapie & Oncologie Medicală, 2000, 1:43-53

54 Radiotherapy in the Year 2000: Present and Future

  1. Cernea, G. Kacso

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

UMPh „Iuliu Haţieganu” Cluj-Napoca

Some of the major changes in radiotherapy over the last years are reviewed in this paper. Radiotherapy has played a role in the changes in oncological practice including an increase in organ-sparing treatment and achieving good local control and improving survival. Organ preservation, usually with multimodality t11erapy, has also been further developed in the treatment of cancers in the head and neck, anus, bladder and soft tissue sarcomas. Developments in radiobiology have led to the development of new fractionation schedules. Hyperfractionation allows an increase in the tumour dose whilst sparing normal tissues and accelerated fractionation combats accelerated tumour proliferation during treatment. Advances in accelerator technology and computerized treatment planning have enabled the development of three- dimensional conformal radiotherapy. This gives the oportunity to spare normal tissues and escalate the dose to the tumour. Combination Chemoradiation has increased organ conservation in carcinoma of the anal canal and is under investigation for carcinomas of the larynx (laryngeal preservation), other head arid and neck sites. The equation – increased local tumor control + decreased distant metastasis = increased survival- is the paradigm. Systemic therapy with cytotoxic drugs or hormones needs to address both potential sites of failure.

Key words: radiotherapy, technology, radiobiology, comdined modality treatments

Radioterapie & Oncologie Medicală, 2000, 1:54-64

65 A Modern Perspective Regardind the Therapeutical Decision

Dana Cernea

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

The patient / physician relationship become more and more important in modem oncology. An increasing number of patients need to have more informations about their disease and treatment options. They need details of the treatment regimen, early and late side-effects, survival, and effects of treatment on disease symptoms. Desired role in decision- making does not predict treatment preference. Patients generally want a wide of information on treatment options in order to participate in treatment decision.

Key words: cancer; treatment option

Radioterapie & Oncologie Mediclă 2000. 1:65-68

69 Cervical Cancer -An Unsolved Problem in Romanian Oncology

Viorica Nagy, O.Coza

UMPh „Iuliu Haţieganu” Cluj-Napoca

Cancer Institute „I.Chiricuţă” Cluj-Napoca

In Romania, cervical cancer is the second death cause by cancer in women, with raising rate of mortality. A continuous raising in the number of new cervical cancer cases can be seen at the Cancer Institute „I.Chiricuţă”, stages III and IV representing over 50%.

F or therapeutical results improvement in these advanced stages, there have been several studies in finding new treatment modalities at Cancer Institute ,,I.Chiricuţă„. Classical external beam radiotherapy („box” technique) was associated with cervical „boost” arc therapy and concurrent chemotherapy with cisplatin as radiosensitizer. Since 1995, high energy photons (15 MV, produced by liniar accelerator) therapy is used in uterine cervix carcinoma treatment. All these new methods led to local control and survival improvement. A randomized study which compares concurrent chemoradiation vs radiotherapy in advanced cervical cancer was started at Cancer Institute ,,I. Chiricuţă „. As a new method, LDR/MDR after loading intracavitary brachytherapy was associated with external beam radiotherapy or surgery. In the future, the sudies will be based on altered fractionation schedules and new radio-chemotherapy associations. The real cervical cancer problem resolution in Romania could be possible only after screening developement in the whole country, which can assure the detection in early stages.

Key Words: concurrent chemoradiation, altered fractionation schedules, early detection.

Radioterapie & Oncologie Medicală, 2000, 1:69-75

76 The Role of the GPs in the Program of Screening and Control of Cervix Cancer

Mihaela Beuran

General Physicians Society

The cervix cancer is a most important problem for our country given the increasing incidence and the high mortality rate. The great majority of patients are presenting in advanced stages when the therapeutic intervention is less efficacious. The only solution to improve the present situation is the development of a program for screening and early diagnosis, on a permanent basis and oriented for the whole population especially for those with high risk (rural areas, poor families). In this program, the role of GP is crucial as he is the only one who assures a permanent contact with the patients in his territory and their follow-up. The program covers a group of 10,000 women enlisted by 17 GP, from urban and rural areas and the preliminary results are presented.

Key words: cervix cancer, screening, GP.

Radioterapie & Oncologie Medicală, 2000, 1: 76-79

80 Breast Cancer at the Threshold between Millennia

Cristina Vitoc

Cancer Institute „Prof I.Chiricuţă” Cluj-Napoca

The threshold between millennia is the proper occasion to analyze our activity, but also the launch of a development program in the near future. In this way we may review the last decade accomplishments: the participation to randomized, multicentrical and multinational clinical studies; the establishment of the Breast Tumor Center; the Breast Committee activity; the elaboration of the Breast Cancer Therapeutical Guide; our contribution to the activity of the Romanian Society of Cancer Radiotherapy and the Romanian Society of Cancer; the participation to the four editions of the Breast Cancer Biennial Symposium, Oradea, Felix Spa. The development program has as reference points the objectives presented in the ” Florence Statement” in 1998. After a concise review of the main European principles this paper presents the topics of our program proposed to be accomplished.

Key words: analyze our activity, European principles, our development program

Radioterapie & Oncologie Medicală, 2000, 1:80-86

87 The „Prostate Cancer Task Force” Project at the European Institute of Oncology

  1. Ghilezan, H. Marsiglia, G. Ivaldi, S. Castiglioni, A. Polo, R. Orecchia

European Institute of Oncology Milan, Italy

The recruitment of prostate cancer patients has had a steadily increase since the opening of the European Institute of Oncology in 1994. Given the modem radiation therapy equipment available, the promising preliminary results obtained with the recently introduced technique of 3D conformal radiotherapy together with the increased awareness of the public regarding prostate cancer and its treatment options, the Department of Radiation Oncology has taken the lead in the field and treated the majority of these patients. The „Prostate Cancer Task Force” was created in an attempt to provide an organizational frame to this rapidly evolving activity and to define future strategies of development in terms of clinical and basic research. Last but not least, one of the main goals of the task force is to support and promote collaboration between all specialties dealing with prostate cancer so that an unifying effort can lead to significant breakthroughs, otherwise impossible to obtain on an individual basis. These issues will be outlined and discussed in this overview. References are not given since this document is the result of fruitful informal discussions between the individuals participating in this project and was created primarily as a baseline for future developments.

Key words: prostate cancer, management, research

Radioterapie & Oncologie; Medicală, 2000, 1 :87-91

92 Information management

  1. Todor

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

All elements wich must be bundled in a standard concerning information in a hospital are discussed. A large space has informatic pointing out the status of our days.

Key words: information, management, standard.

Radioterapie & Oncologie Medicală, 2000. 1:92-95

96 Romania on the Threshold Between Millenniums: Oncology Looks Into the Future

  1. Ghilezan

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

UMPh „I. Haţieganu” Cluj-Napoca

The state of oncology in Romania at the beginning of the 3rd millennium, in spite of some very innovative initiatives, is characterized by the formalism that dominated our professional and social life in the 2nd part of the XXth century. The main caveats of cancer care in Romania are the lack of an efficient information system for evaluation and follow-up of cancer patients and a poor quality management of cancer care, as are shown by the mediocre values of national statistics. The increase of professional performances at the level of international standards, imply a conjugated effort of all professionals but also support from the part of governmental structures as well from the community as a whole. To reach these objectives, the Romanian Society of Radiation Oncology, is committed to promote the following core values: continuous medical education, clinical research, fostering an image of leadership in Romanian oncology for our Society, and an efficient management of cancer care at national, regional and institutional level.

Key words: professional education, clinical research, profession’s image, management

Radioterapie & Oncologie Medicală, 2000, 1:96-101

102 Well-Differentiated Inflammatory Liposarcoma of the Mediastinum in a Child

Svetlana Encica1, C.D. Olinici2,3

1Heart Institute „Nicolae Stăncioiu”,

2Department of Pathology, UMPh „Iuliu Haţieganu”,

3Cancer Institute „Ion Chiricuţă” Cluj-Napoca

Mediastinal sarcoma is an extremely rarely noted neoplasm in children. We report the unusual case of a 5 – year – old girl who showed a large intrathoracic tumor. Biopsy showed a well-differentiated inflammatory liposarcoma. The tumor was partially resected and the child is under chemotherapy. The study of additional cases is necessary in order to appreciate the evolution of mediastinal liposarcoma in this age group, although some authors believe that the prognosis is better in young patients.

Keywords: liposarcoma; mediastinum; child.

Radioterapie & Oncologie Medicală, 2000, 1:102-105