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Volum 06 Numarul 2, 2000 | Srrom

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Volum 06 Numarul 2, 2000

119 Editorial

In the first article published in this issue of „Radiotherapy & Medical Oncology”, V. Cernea presents the linear quadratic model (LQ) and its clinical application. The focus is on the fact the LQ is suitable for calculating the change in the total dose and dose per fraction in a new schedule if the overall time is the same. In the second one T. E. Ciuleanu reviews the progress made in the management of the side effects of chemotherapy. The antibiotics, the growth factors, the antiemetics and the cytoprotective agents used for this purpose improve the quality of life and the patients’ compliance to the treatment. Youlia Kirova from the University Hospital „H. Mondor”, France, describes the Kaposi Syndrom, from history to treatment, underlining the role ofRT in this desease. The next two papers deal with the carcinoma of the uterine cervix which represents the second cause of death in women in Romania. Thus, in the article „Natural History of Cervical Carcinoma”. Olga Burghelea reviews the uterine cervix precancer lesions and the ways of the cervical carcinoma extention. The second one signed by Viorica Nagy is a study of 256 patients with cervical carcinoma treated at the Cancer Institute ,,1. Chiricuta” during the period 1990-1995. The authors analyse the prognostic significance of pelvic lymph nodes and show a 5 year survival in 84% for the patients wih negative pelvic lymph nodes (N-) vs 41 % for the positive pelvic lymph nodes (N+ ) patients. The failures rate were higher (46%) for the N+ pts., in comparison with the N- pts. (11 %) We welcome the initiative of the group from the Hospital Oradea who present in the article signed by Gh. Bumbu et al. the preliminary results of early detection of prostatic cancer. In this way they used digital rectallexamination and fine needle aspiration. Their efforts require special attention because in only 9 days they succeeded in examining 701 patients. Such action should be integrated within the National Programme Cancer Control. Youlia Kirova et al present the experience of „H. Mondor” Hospital, France, concerning the role of RT with X ray in skin cancer. The local control was 98,2% in the 99 patients with skin cancer treated during the period 1989-1995. G. Kacso analyse the RT results in 71 pts. with low grade glioma irradiated between 1990-1995 at „Pitie-Salpetriere” Radiotherapy Department Paris. The median follow up was 42 month and the overall 5 year survival was higher for oligodendrogliomas (82%) and for oligoastrocytomas (80%) vs 40% for low grade astrocytomas. Elisabeta Patca~ et al. report a case of a 54 year old man with paraganglioma of jugular glomus. A brief presentation of the new aspects in the therapy of the head and neck, lung and digestive cancer, presented at the 36th ASCO Congress (USA, 2000) is reported by T. E. Ciuleanu. In the paper „Innovation and Progress in the Organization of Health System in France”, N. Ghilezan gives us a model for the organization of our Health System. The main objectives are the improving of the medical service quality and of the cost benefit ration. Maria Turdean et al., in the next article, report the oncological activity of the University Hospital of Cluj. Revue of litterature and CME end this issue.

Maria Retegan Turdean

121 Mathematical Modeling of Radiation Response: from Theory to Clinical Applications

  1. Cernea

UMPh „Iuliu Haţieganu” Cluj-Napoca, Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

The linear quadratic model describes satisfactorily the relationship between total isoeffective dose and dose per fraction in a range of dose per fraction from I Gy up to large single doses of about lOGy. The α/β ratio describes the shape of fractionation response: a low α/β (0,5-6 Gy) is characteristic of late responding normal tissues and indicates a rapid increase of total dose with decreasing dose per fraction. A higher α/β ratio (7 -20 Gy) is characteristic of early responding normal tissues and tumors; it indicates a less rapid increase in total dose with decreasing dose per fraction. The BED fonnulae provide a simple way of calculating isoeffective schedules based on LQ model. The basic LQ model is appropriate for calculating the change in total dose for an altered dose per fraction, assuming the new and old treatments are given in the same overall time. For late reactions it is probably unnecessary to modify total dose in response to a change in overall time, but for early reactions (and tumor response) the effect of overall time is complex. The effect of this later should be calculated separately from the basic LQ calculation.

Key words: linear quadratic model, fractionation, α/β ratio, isoeffective doses

Radioterapie & Oncologie Medicală, 2000, 2: 121-128

129 Management of Side Effects of Chemotherapy

T.E. Ciuleanu

UMPh „Iuliu Haţieganu” Cluj-Napoca

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

Management of side effects of chemotherapy has evolved last decade, with the advent of new efficient antibiotics, growth factors, potent antiemetics, cytoprotective agents. Progress was done in defining their optimal use. These achievements lead to a safer delivery and an improved patient compliance.

Key words: chemotherapy, side effects

Radioterapie & Oncologie Medicală, 2000. 2: 129-145

146 Kaposi Sarcoma

Y.M. Kirova, E. Belembaogo, J.P. Le Bourgeois

Henri Mondor University Hospital, Dept. of Cancerology, Creteil, France

In 1872 Moriz Kaposi was the first who described 5 patients with „multiple hemoragic idiopathic sarcoma”. In 1912, Sternberg proposed the name „Kaposi sarcoma”. Since then there have been observed different forms of this rare disease. In 1914, Hallenberg described the first cases of the African or endemic form. In the sixties began several reports about the Kaposi Sarcoma (KS) after organ transplant and immunodepressive therapy. After 1981 the epidermic form associated: with the acquired immuno-deficiency syndrome (AIDS) is more frequently described. All these forms of the KS, history, treatment methods, role of the radiotherapy are discussed and the literature is upadated.

Key words: Kaposi Sarcoma, treatment, radiotherapy.

Radioterapie & Oncologie Medicală, 2000, 2: 146-152

153 Natural History of Cervical Carcinoma

Olga Burghelea, O. Coza

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

Cervical carcinoma is extremely rear in an unmodified tissue and is preceded by intraepithelial neoplasia – cellular proliferation placed a long time within the limits of epithelial layer, which embedded this organ mucosa. According to experts. cervical epithelial neoplasia (CIN) shows three degrees of severity: GIN 1 – mild dysplasia, GIN 2 – moderate dysplasia, GIN 3 – severe dysplasia (carcinoma in situ). From the moment, when malignant cells exceed the basal membrane and infiltrate the subjacent tissues, cervical neoplasia get (acquires) a new feature: irreversibility and, by the direct contact with the vascular network, the possibility of metastasis.

Key words: dysplasia, carcinoma in situ, intraepithelial neoplasia.

Radioterapie & Oncologie Medicală, 2000, 2: 153-159

160 The Significance of Pelvic Lymph Node Status in Cervical Cancer

Viorica Nagy1,2, N.Todor1

1UMPh „I. Haţieganu” Cluj-Napoca

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

Pelvic lymph node invasion is an important prognostic factor for cervical cancer. It is generally accepted the necessity of lymph node areas treatment, but the association of different therapeutical methods is open to discussion. 256 patients with cervical cancer were treated pre-or postoperatory in the Radiotherapy II Departement of Cancer Institute „I.Chiricuta” betwen 1990-1995. 64 patients were treated by postoperative radio:tchemotherapy, and 192 patients performed preoperative radio:tchemotherapy. Earlier stages were included in the postoperative radio:tchemotherapy cathegory and more advanced cases (liB-IliA) were in preoperative radio:tchemotherapy group. Pelvic lymph node invasion was more important (20%) for the cases treated by surgery as a first treatment, in comparison to the patients with preoperative radio:t chemotherapy (8%). Pelvic lymph node status is an important prognostic factor in 5-year survival: 89% for the patients with negative pelvic lymph node vs 41 % in the case of lymph node invasion (p<0.05). The therapeutical failures were more important for positive lymph node cases (46%) than for the category withaut lymph node invasion (11 %) (p<0.05). The results reveal the importance of the best decision in primary treatment (surgery or radiotherapy) and the use of some adjuvant treatments (cytotoxic chemotherapy, para-aortic lymph node irradiation) in pelvic node invasion.

Key words: cervical cancer, lymph node invasion, prognostic factor, radio-chemotherapy

Radioterapie & Oncologie Medicală, 2000, 2: 160-166

167 Screening Prostate Cancer. Diagnosis. Preliminary Results

Gh. Bumbu1, M. Raica2, Marieta Torna2, T. Maghiar1

1 Clinical Hospital, Department of Urology, Oradea

2 UMPh, Department of Histology, Timişoara

Objectives: the aim of this study is the early detection of prostatic cancer when is still intracapsular and has a little volume. Patients, material, methods: In the screening were included 701 men with age between 50-80 years. All the subjects were assessed by digital rectal examination and abdominal echography. We identified subjects with clinical suspicions of prostatic cancer. To all these patients we performed transrectal guided aspirative biopsies with a fine needle: only one aspiration for four of the subjects and two aspiration biopsies for each of the last seventeen subjects. Results: From 19 subjects, 4 were known with prostatic cancer and they were not included in this study. From the rest of 15 subjects 11 presented at the cytological test, malignant cells, one patient with suspicion of positive result, and 3 patients with negative results. The prostatic origin of the malignant cells was demonstrated by cytological immune chemistry using the PSA identification. Conclusions: The digital rectal examination combined with prostatic punction with a fine needle can be very useful in the early diagnosis of the prostatic cancer.

Key words: screening, guided aspirative biopsie, citology, prostatic cancer.

Radioterapie & OncologieMedicală, 2000, 2: 167-171

172 Low- grade Gliomas Treatment: Surgery or Radiotherapy?

  1. Kacso1,2, C. Turcu1

1 Cancer Institute „Prof I. Chiricuţă”

2 UMPh „Iuliu Haţieganu” Cluj-Napoca

Purpose: Single institution retrospective analysis of radiotherapy results in cerebral low- grade gliomas.

Material & methods: Between 1990 and 1995,71 patients over 16 years of age, with low- grade cerebral nonpilocytic gliomas were irradiated as their sole treatment or after surgical excision. Radiotherapy (RT) was delivered with multiple izocentric shrinking fields according to tumor volume, with doses ranging from 36 t072 Oy, depending on tumor position, – patient’s age and performance status (IK). In 37 cases RT was delayed until clinical and imaging tumor evolution was :” documented, as initially the patient was asymptomatic or with mild symptoms. Based on that time institutional protocol a few patients received also chemotherapy, intraarterial with ACNUor intravenous with 5FU + Cisplatin.

Results: With a median follow-up of 42 months, overall five year survival for low- grade astroytomas, oligo astrocytomas (OA) and oligodendrogliomas (ODO) is 40%, 80% and 82%. Thirtyone patients relapsed locally, two-thirds of them being alive at the end of the study, with a median survival of 42 months. Malignat transformation was pathologically or/ and CT/MRI documented in 45% of our patients, being the main cause of death. Radiotherapy late toxicity, evaluable ~;, only on 40% of cases was mainly represented by leucoencephalopaty and ventricular system enlargement with mild ~ clinical impact.

Conclusions: The favorable prognostic factors identified by this study are: IK before treatment ~ 90 and it’s improvement after RT, absence of paresis at diagnosis, histological subtype of ODO or OA, surgical excision, RT total dose above 500y, absence of chemotherapy. However, the optimal treatment- surgery, radiotherapy or both- need to be precised in randomised trials.

Key words: low- grade glioma, surgery, radiotherapy, prognostic factors.

Radioterapie & OncologieMedicală, 2000. 2: 172-180

181 X-ray Therapy in the Management of Skin Cancer

Y.M. Kirova, E. Calitchi, J.P. Le Bourgeois

Hospital Henri Mondor; Departement de Cancerologie, Creteil, France

Between 1989 and 1995, eighty four patients with 114 skin carcinomas were treated in Cancerology Department of Henri Mondor University Hospital with cutaneous irradiation. There were 99 (86,8%) basal cell carcinomas and 15 (13,2%) squamous cell carcinomas. According TNM classification (UICC 1987) and AJC Staging System, there were 86 (75,4%) Tl tumors, 26 (22,8%) T2-, and 2 (1,8%) T3 carcinomas. All 1141esions were treated with localized irradiation using 45- 100 kV x-ray energy. The total prescribed dose was 33 Gy in 3 fractions (days 1,8, and 15). Objective tumor control rate was 98,2% (112/114). There were observed 2 local recurrences (1,8%) at the border of the field. The tolerance was excellent in 36% of the cases, good- in 48,2%, and satisfactory in 15,8% of the cases. The cosmetic results were as follows: excellent- 68 lesions (59,6%), good- 40 (35,1 %), and satisfactory in 6 cases (5,3%). The follow-up ranged from 6 to 86 months, sometimes was difficult because age of the patients (median age 81,9 years).

Key words: Skin Cancer, Basal Cell Carcinoma, Squamous Cell Carcinoma,Radiotherapy

Radioterapie & Oncologie Medicală, 2000, 2: 181-183

184 Jugular Glomus Vein Praganglioma

Elisabeta Pătcaş, Dana Cernea

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

We present a case of 54 year old man admitted at the Cancer Institute Cluj, with diagnoses Jugular glomus vein Paraganglioma, stage III Glasscock Jackson for external radiotherapy.

Key words: Jugular Glomus Vein Paraganglioma, radiotherapy.

Radioterapie & OncologieMedicală, 2000, 2: 184-185

186 Report on ASCO Meeting from 19-23 May, 2000, New Orleans, LA, SUA (I)

T.E. Ciuleanu

1UMPh „I. Haţieganu”

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

The 36th annual ASCO meeting was held between May, 19 -23, 1999, in New Orleans, LA. This is a brief presentation of the new aspects, as reflected in the oral communications, in various tumor types such as head and neck, lung and digestive tumors. Our report does not cover the poster, educational and meet the professor sessions. Some tumors were deliberately excluded from this report, as they will be presented in the next issue of this publication.

Key words: ASCO, trial

Radioterapie & Oncologie Medicală, 2000, 2: 186-192

193 Innovation and Progress in Management of Health Care System in France

  1. Ghilezan

Cancer Institute „Prof. I. Chiricuţă”, UMF “I. Haţieganu „, Cluj-Napoca

The French health system was radically transformed beginning 1996 through some very innovative measures with the main objectives to improve the quality of services and the cost-benefit ratio of care. The planning of the health actions and their funding is done through annual health regional and national conferences, under the coordination of the Government. The priorities and the measures to be taken should be endorsed by the Parliament. The main instruments are described: the Regional Agency for Hospitalization, the project of institutional development, multiannual contract for objectives and resources, regional conventions and health care networks, and a program of a medical information system.

Radioterapie & Oncologie Medicală, 2000, 2: 193-198

199 Oncological Care in the University Hospital of Cluj

Maria Retegan Turdean1, Cristiana Ciortea2, Catalina Covalcic3, Gh.Cruciat4, R. Scurtu4, V. Surcel4, Gh. Funariu4

  1. 1. University District Hospital Cluj-Napoca, România

2 Radiological Hospital

3 Cancer Institute „Prof I.Chiricuţă” Cluj-Napoca, România

  1. 4. U.M.Ph. „Iuliu Haţieganu” Cluj-Napoca, România

The University Hospital of Cluj is one of the bigest in the country. The human and technical resources allow a high quality oncologic~l care. We can notice a good cooperation between the University Hospital Cluj and the Cancer Institute „I. Chiricut~”. There are the failures in the organization of the oncologic~l care and the lack of local coordinating forum with cleare responsabilities concerning cancer care. The abvious absence of any evidence of patients makes hard any acction of the evaluation of oncologic~l activity and it is a warning for professional and govermental bodie to impose the reactualization of the institutional cancer registrers.

Key words: University District Hospital Cluj, Oncological Care

Radioterapie & Onclogie Medicală, 2000, 2: 199-206