This issue (4/2000) of our Blue Journal brings in attention to our readers, besides the dedicated headings, the proceedings of the Annual Convention of the Romanian Society of Radiation Oncology: „Quality of cancer treatment in: breast, cervix, lung” held in C1uj-Napoca on October 6-7, 2000. In the first part there are presented the general management challenge of our society and specialty: Administrative report N. Ghilezan; Strategies in Oncology St. Pop; Continuous medical education G. Kacso; Training in radiotherapy. Institutional infrastructure V. Cernea and not in the last some aspects correlated with international cancer control and European network of cancer registry presented by our guest R. Sankila from „Unit O.fDescriptive Epidemi1ogy International Agency for Research on Cancer” Lyon, France. The top authority transfer of leadership was an appropriate opportunity for the two presidents to consciously review the activities developed in 2000 (Cristina Vitoc) and to present the program and the commitment of the members of our society for 2001 (V.Păcurar). The second part of the Annual Conference is dedicated to present the protocols for radiotherapy in malignant sites with high incidence in our country: breast (Daniela Grecea), cervix (Viorica Nagy), lung (Petronela Rusu). The section concerning II General articles „, two papers present the personal and the literature experience concerning hepatoblastom (Dana Cernea) and breast carcinoma with neuroendocrine features (C.D. Olinici). The third article is a guideline for clinical use of tumoral markers classified by level of evidence by international medical societies and the useful recommendations in current practice for our country (Al. Eniu). One of the two articles of the section II Original studies II presents the prognostic factors of the patients with brain metastases of breast carcinoma (Daniela Martin), while the other article, the morphohistochemica1 and immunohistochemical particularities of hormone resistant carcinoma of the prostate (M. Raica). „Oncological News points out the principal international events: Economic evaluation of cancer therapy. The 2nd European Conference on the Economics of Cancer September 3-52000, Brussels, Belgium (Luciana Lupşa); Endocrine treatment of advanced prostate: September 22, 2000, Berlin, Germany. (N. Ghilezan); 2-nd European Breast Conference. September 26- 30, 2000, Brussels, Belgium (N. Ghilezan) and The 18th Annual Chemotherapy Foundation Symposium: „Innovative Cancer Therapy for Tomorrow”. November 8-11, 2000, New- York, USA. (T.E. Ciuleanu). The very efficient ” Oncological Life in Romania” presented on the first line the debates which took place in The National Oncology Committee of the Health Ministry at the meeting on October 6th 2000 (N. Ghilezan). Considering the high incidence of the advanced stages cervix cancer in our country, the main concern of the National Committee is to organize the activity of the early diagnosis of the cervix cancer (Al. Eniu). The result of the pilot program developed in the Cluj county is critical reviewed by Mihaela Beuran who presents a project for a blue print for extending this positive experience into another 4 counties in Transi1vania. Following a current epidemiological analysis and considering the recommendations of the Guide for Screening Practice for Cervix Uteri Cancer elaborated by NCCN (National Comprehensive Cancer Network), V. Pacurar proposes one „Pilot Model for cervical cancer screening in Orade~”. The breast cancer goes on to be the main site of the women malignant disease on international and national level, and that is the reason for that we welcome the setting up of The Breast Tumor Center at the Oncological Institute „I.Chiricuta” Cluj- Napoca. Cristina Vitoc, head of The Radiotherapy I Department and Breast Tumor Center, presents an address after one year of successful ,activity, on September 27, 2000. In the section „In memoriam” Prof. Dr. D. Radulescu and Prof. Dr. N.Ghilezan bring an homage to the personality and the activity of Prof. Dr. Ion Pana. Teacher of a lot of students and doctors generations, promoter of our professional activity, he was the head of The „Colţea” Radiotherapy Clinical Hospital and Oncological Institute Bucure~ti and not in the last, the first SRRO president. In the section „Book Reviews” it is pointed out the publication in two volumes of a „General Ecographic Compendium” at the publishing house of The University of Oradea 1999-2000. Signed by the impressive authors Prof. Dr. Aurel Văleanu, Prof Dr. Nicolae Costin, Prof. Dr. Dumitru Zdrenghea, the book offers the training opportunity in ecography skills in many medical fields: oncology, cardiology, obstetrics etc. In the end of the volume 4/2000 there are the well known administrative and educational points: the questionnaire of the CME, the guidelines for the authors, the topic index 2000, – the author index 2000 and the members of Romanian Society of Radiation Oncology.
U.MPh. „Iuliu Haţieganu „,
Institute of Oncology „Prof I. Chiricuţă” Cluj-Napoca
Continuous Medical Education (CME) is a programme of educational activities to guarantee the maintenance and upgrading of professional knowledge and skills each five years. CME is an ethical and moral obligation for each oncologist. Government and consumer presure for enhanced quality assurance in medicine will strengthen the case for mandatory CME. Introduced in several European countries in recent years, including Romania, CME is required more and more by employing authorities, professional licensing bodies or medical insurance companies.
The CME system recently aproved by ESTRO is more accurate for radiotherapy than the presently and one in Romania. It reflects better the active effort in improving his/her professional education.
SRRO will promote the EORTC system for radiotherapy, to integrate it into the present Romanian CME credits.
Key words: continuous medical education, ESTRO
Radioterapie & Oncologie Medicală, 2000, 4:339-343
1UMPh „Iuliu Haţieganu” Cluj- Napoca
2Institute of Oncology „Prof I. Chiricuţă”, Dept. of Radiotherapy, Cluj-Napoca
The guidelines for infrastructure on training institutions in radiooncology have to account for the resources provided at present in the EU member states. The standards of excellence by ESTRO, reflected in the minimal requirements for. ,infrastructure and required for continuous improvements in the treatment of cancer, therefore, cannot be applied as a 1 baseline. However, the training institution either alone or in co-operation with other regional departments should aim to be adequately equipped to serve the regional demands for patients with malignant tumors. According to a survey via the national professional societies the realistic level of infrastructure to be achieved within the near future.
Key words: radiotherapy, residents training, institution, infrastructure.
Radioterapie & Oncologie Medicală, 2000, 4: 344-346
PROTOCOLS FOR RADIOTHERAPY
Dana Grecea1, N. Ghilezan1,2, R. Tănăsescu1,2
1 Institute of Oncology „Prof I. Chiricuţă” Cluj-Napoca
2U.MPh. „Iuliu Haţieganu” Cluj-Napoca
Radiation therapy has an integral role in the curative treatment of breast cancer. After the conservative surgery for ductal carcinoma in situ or invasive carcinoma, radiation therapy of the breast improves the likelihood of loco regional freedom from disease and thereby enhances the long-term possibility of breast preservation. After mastectomy, in carefully selected patients, locoregional radiation therapy will reduce the risk of recurrence and possibly prolong survival. Therefore, clinicians caring for patients who have breast cancer require a clear understanding of the pertinent principles of radiation therapy: selection criteria, techniques of treatment, beneficial results, and side effects.
Key words: target volumes, simulation, critics organs, doses, dosimetry.
Radioterapie & Oncologie Medicală. 2000, 4:348-356
Viorica Nagy, N.Ghilezan
UMPh „Iuliu Haţieganu” Cluj-Napoca
Institute of Oncology „Prof I. Chiricuţă” Cluj-Napoca
Irradiation is the most effective treatment for cervical cancer. The goal for radiation therapy is to produce the maximum potential for control of the disease with the minimum complications. Cervical cancer irradiation includes different aspects: the treated volumes, treatment planning, treatment techniques, dosimetry, fractionation/ protraction.
Key words: treated volumes, treatment planning, treatment techniques, dosimetry
Radioterapie & Oncologie Medicală, 2000, 4:357-363
Institute of Oncology „Prof I. Chiricuţă”, Cluj-Napoca
Radiation therapy (RT) is an integral component of multi – modality treatment for patients with lung cancer. Basic elements of radiotherapy of lung cancer include target volumes delineation, dose/ fractionation! time specificaton, dose calculation and technique wich means design of beam energy available, beam arrangements and modifiers (blocks, wedges, compensators) in order to asure adequate coverage of intended volumes, and proper sparing of uninvolved structures at risc. Plan implementation requires: patients positioning, immobilization, establishing coordinates and treatment verification with simulator radiographs to confirm isocenter position and portal films.
Based on high incidence of hilar and mediastinal nodal metastases the traditional practice has been to iradiate large volumes, not only encompassing the primary tumor but also regional lymph nodes in hilum, mediastinum and even supraclavicular (in upper lobe tumors), whether they are grossly or potenlially involved (subclinical disease).
Lately, several new developments and observations have had an impact on every basic elements of radiotherapy and contributed to the decline in utilization of these large fields.
A major innovation has been the development of modem imaging technologies (CT, MRI, PET) which permits optimization of target volumes and have set the stage for image based three dimensional radiation therapy which asures a better conformation to the tumor and sparing of critical tissues, allowing dose escalation to tumoricidal dose. Informations concerning cell kinetics explain the benefit of altered fractionation.
Clinical observation showed that outcome is improved with the increase of the agressiveness of treatment. New generations of drugs given concomitently with RT with altered fractionation asure a better local and spatial cooperation in the management of lung cancer, but determin by necessity smaller target volumes in order to avoid complicalions.
Key words: radiotherapy treatment planning, lung cancer, basic elements, perspectives.
Radioterapie & Oncologie Medicală, 2000, 4:364-374
Dana Cerneal, Emilia Mihuţ1, A. Rancea1,2, Voichita Suciu1,Ştefania Neamţu1, Rodica Coznarovici1
1Institute of Oncology „Prof I. Chiricuta„, Cluj-Napoca
2U.MPh. „Iuliu Hatieganu„, Cluj-Napoca. Dept. Surgical Oncology
Hepatoblastoma affects approximately 1 in 100000 children and is the most common primary malignant liver tumor in children. The article present the experience of our Institute in treating these tumors, the most recent data from literature concerning pathogenesis, treatment options and the importance of pretreatment prognostic factors for children with hepatoblastoma.
Key words: hepatoblastoma, children, prognostic factors, treatment
Radioterapie & Oncologie Medicală. 2000, 4:375-383
1Institute of Oncology „Prof I. Chiricuţă”
2U.MPh. „Iuliu Haţieganu” Cluj-Napoca
Tumoral markers may be used to evaluate the risk, presence, status or future behaviour of cancer. A number of tumoral markers have been already proposed for use in clinical practice. However, inappropriate use of tumoral markers to make clinical decisions may result in worse outcomes for the patients.
In order to eliminate the ambiguity that exists between available data and the clinical use of markers, several medical societies (and especially ASCO) have established a set of evidence-based practical guidelines, using medical data classified on levels of evidence. The goal of this paper was to assimilate and to adapt these guidelines for clinical practice use, in the context of the Romanian health system. Due to the elevated costs generated by the use of tumoral markers, their utilisation should be justified by offering clinical relevant information for the patients. We present here data and conclusions for the following chapters of pathology: colorectal cancer, breast cancer, ovarian cancer, testicular cancer, gestational trophoblastic disease, prostate cancer, hepatocarcinoma, pancreatic cancer and lung cancer.
Key words: Tumoral markers, gudelines.
Radioterapie & Oncologie Medicală, 2000,4:384-401
Daniela Martin, Dana Grecea, Cristina Vitoc, N. Todor
Institute of Oncology „Prof I. Chiricuţă”, Cluj-Napoca
Even though metastases to organs other than the brain are more common, brain metastases (BM) are more debilitating and rapidly fatal if untreated than metastases to other organ systems.
Our retrospective single institution study identified prognostic factors: performance status (PS), size of brain lesions, whole brain radiotherapy (WBRT) and hormonotherapy (HT) as adjuvant treatment. Recognition of prognostic factors allowed that simple identification of favourable and unfavourable subgroups of patients with brain metastases to be constructed.
Key words: prognostic factors, brain metastases, whole brain radiotherapy, breast cancer.
Radioterapie & Oncologie Medicală, 2000, 4:407-413
University of Medicine and Pharmacy Timişoara
1 Clinic of Urology,
2 Dept. of Morphopathology
3 Dept. of Histology
There were investigated morphohistochemical and immunohistochemical iopsies taken by transurethral resection from 84 patients admitted with prostate carcinoma, treated by bilateral orchiectomy and estrogens. Clinical evolution after 24 months of treatment reveals complete remission in 36 cases and progression in 48. Retrospective analysis of primary biopsies signalled out in patients with complete remission a monomorph histological feature, Gleason score 2-7, metachromasia of the stroma, few or even absent neuroendocrine cells, low expression of prostate specific antigen and strong immunoreaction with anti-estrogen-receptor antibody. In patients with progression there were noticed: mixed histological structure, Gleason score over 5, loss of metachromasia, many neuroendocrine cells, strong expression ofPSA and weak or negative reaction with anti-estrogen receptor. The proliferation index, cytokeratins expression and sulphomucins secretion had no value in order to predict the response to hormone-therapy. The pathological form, Gleason score and PSA immunoexpression can suggest, but not predict hormonesensitivity. Our results suggest that estrogen receptors and neuroendocrine cells are useful markers for hormone-insensitive carcinoma of the prostate.
Key words: carcinoma of the prostate, hormono-registence, histochemistry, immunohistochemistry, prognostic
Radioterapie & Oncologie Medicală, 2000, 4:414-419
ONCOLOGICAL LIFE IN ROMANIA
Mihaela Beuran1, N. Ghilezan2
1Medical Asociation Cluj-Napoca,
2 Institute of Oncology „Prof I. Chiricuţă” Cluj-Napoca .
A project for a blue print for a departmental and regional screening program for cervix cancer is presented. The blue print contains the rationale for implementing the program in Romania with the implication of the general practitioner. The sections of the draft envisages all the components of such a program: main and specific objectives, the target population, activities to be perfonned and their calendar frame, methodologies & standards, organisation and personnel, monitoring & program evaluation. The main objective is the development of an efficacious and pennanent methodology for the screening of cervix cancer that in the next 5 years should reduce the invasive cases and increase the survival with at least 20%. The activities, their time scheduling are described in detail as well the efficiency indicators and the monitoring of the program, that to be successful, the Health Department should assume its responsability.
Key words: cervix cancer, screening
Radioterapie & Oncologie Medicală. 2000, 4:449-455
1Faculty of Medicine and Pharmacy Oradea;
2County Clinic Hospital Oradea;
3County Clinic of Gyneclogy,Oradea;
4Health Ministry Department Bihor;
Authors propose a screening for program the early diagnosis of cervix cancer in which the general practitioner has the role of pivot. The involvement of primary medicine in active diagnosis of cervix cancer is an important point for the quality assurance of this action. The complexity of this action needs a network in which the general practitioner, pathologist and gynecologist (specialized in colposcopy), have clearly defined tasks. The link in a network is made by the general practitioner. Authors mention the actual epidemiological situtation of cervix cancer bringing arguments that this neoplasic site is a health public problem in our country. The pattern proposed by the authors is corelated with Guide for Screening Practice for Cervix Uteri Cancer’s recommendations elaborated by NCCN (National Comprehensive Cancer Network)
Key words: cervix cancer, screening, general practitioner
Radioterapie & Oncologie Medicală, 2000, 4:460-465