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Volum 08 Numarul 1, 2002

4 Editorial

Th1is first issue for the 2002 of our Journal covers several domains of the clinical oncology, with specific characteristics for some distinct patients group such children, brain tumors or precancerous cervix uteri. In this context we have the pleasure to signal an extremely valuable paper by Gh. Peltecu (Bucharest) who presents recent advances in the management of the precursor lesion of the cervix, from diagnosis to treatment. We are sure that these guidelines will be fully appreciated by gynecologists, general practitioners and oncologists as well.

Dana Cernea et al. (Cluj), who describes the acute and late effects, especially children, based on the Cancer Institute Cluj experience, comments upon the problems encountered during the central nervous system irradiation.

In spite of the progress realized in the biology of cancer, of the efforts in the discovery and development of new compounds and therapeutic strategies, the clinical results in lung cancer are still awaited. Petronela Rusu (Cluj) makes an overview of the main recent trials in the treatment of the non-small lung cancer. The results are : still modest but with a continuous trend for improving that gives us hope for the future.

Another first for our Journal is the presence of the colleagues from the Forensic Medicine, UMPh Tg. Mureş, L. Hecser and Katalin Palfi-Sikiodi who sign the paper Euthanasia, assisted suicide, a topic of hot philosophical and ethical debates in all democratic societies.

An analysis of the cervix cancer patients treated in the Oncological Institute Cluj, done by Olga Burghelea (Chişinău), is integrating in the continuous efforts of the staff of the department of Brachytherapy to evaluate Pe;riodically their techniques and results. We are glad to acknowledge this first active presence of a colleague from Moldavia in the pages of our Journal and we hope that this will be the start for a further and valuable cooperation between our countries. N. Todor and A. Rancea (Cluj) based on the UICC recommendations on the quality assurance and quality control for cancer treatments, are looking on the development of criteria on the evaluation of the cervix treat- ments. The authors have developed an original mathematical model with the data from the Oncological Institute Cluj, on the number of pelvic lymph nodes required to be removed to get significant results for appreciating the. prognosis and a quality standard.

An interesting experience, in a controversial domain, is published by M. Cazacu et al. (Cluj) with postoperative adjunctive immunotherapy for colorectal cancer. The authors found an increase in the total lymphocyte number and NK cells that is attributed to Isorel treatment. The conclusion, interesting but not definitive due to an insufficient number of cases, is an invitation to continuation and completion of this otherwise original study.

  1. Coza (Cluj) who comments on a leiomyosarcoma with many tricky diagnostic and therapeutic problems presents the clinical report. The 2nd part of ASCO 2001 highlights, by T.E. Ciuleanu, is closing this issue of our Joumal.

Maria Retegan Turdean

5 New Approaches for the Diagnosis and Therapy of Cervical Cancer Precursors

  1. C. Peltecul,2

1UMPh „Carol Davila” Bucureşti,

2Clinic of Obstetrics and Gynecology „Filantropia” Bucureşti

Precursors of the cervical cancer are presented from terminology, pathophysiology, diagnosis and management point of view.

Key words: precursors of cervical cancer, diagnosis, management.

Radioterapie & Oncologie Medicală, 2002, 1:5-12

13 Effects of Radiation Therapy on Nervous Tissue

Dana Cernea, Ştefania Neamţu, Emilia Mihuţ, Rodica Cosnarovici

Cancer Institute „Ion Chiricuţă” Cluj-Napoca

The use of radiation therapy in the management of nervous system cancers must be determined by a knowledge of the acute and late effects of radiation on normal nervous tissues. This effects depends on therpay, patient and tumor factors. Therapy factors include the total and fractional dose of irradiation, dose rate, overall treatment time, machine energy, treatment volume, dose distribution, and the use of other therapies. Patient factors include the general developmental status, genetic predispo- sition, inherent tissue sensitivities and capacity for normal tissue repair, underlying disease or abnormalieties. Tumor factors include direct tissue effects and systemic effects of tumor-induced organ dysfunction. In this paper will be mentioned the acute, subacute and late effects of radiation on normal nervous tissue.

Key words: radiation therapy, acute effects, subacute effects, late effects, radiation miellitis, prevention.

Radioterapie & Oncologie Medicală, 2002, 1: 13-21

22 Chemo- Radiotherapy Strategies in Locally Advanced Non-Small Cell Lung Cancer

Petronela Rusu

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

Combined modality treatment has become standard for advanced non small cell lung cancer (NSCLC), in the effort to improve the modest results in terms of local control (LC) and survival (S. failure patterns analyses show that locally persistance or recurrent disease and distant metastases are still significant problems).

Several trials investigating innovative treatment strategies with a particular focus on combined chemoradiotherapy (ChRT) 1 regimens in different sequencing and including new drugs and new biologic agents, along with altered radiation fractionation 1 schema or 3- dimensional confomal radiotherapy (3-D-RT) for patients with advanced NSCLC, are reviewed.

Ongoing investigations are warranted to combat both local-regional and systemic failures for patients with locally ad- vanced NSCLC. Treatment strategies need to consider not only the traditional endpoints of survival and local control, but also quality of life

Key words: chemoradiotherapy, locally advanced „non small cell” lung cancer.

Radioterapie & Oncologie Medicală, 2002, 1: 22-29

30 Euthanasia, Physician Assisted Suicide: the Right to Autonomy

  1. Hecser, Katalin Palfi-Siklodi

UMPh Târgu Mureş, Deptm. of Forensic Medicine

The euthanasia and physician assisted-suicide remains preoccupation of debate for a democratic society, especially after recently legislation in Netherlands. Forty four state of United State and the District of Columbia currently ciminalise assisted suicide by statute or common law. Polls of the general population have repeatedly shown that about 60% of the American public favor legal reforms allowing for physician assisted suicide to end the suffering of competent patients. It is especially remarkable that this debate flourishes in the absence of any social provision for basic medical services in the United States and it remains to be seen whether societal acceptance of physicians assisted suicide will increase and how it will affect both social support for vulnerable and dying citizens and trust between patients and their doctors.

Key words: euthanasia, physician assisted suicide, autonomy right.

Radioterapie & Oncologie Medicală, 2002,1: 30-35

36 Prognostic Factors for the Local Control and Survival for the Uterine Cervix Carcinoma

Olga Burghelea

Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

The cervix cancer in Romania is one of the main causes of mortality. The present study evaluates 233 patients with cervix cancer treated in the Curietherapy Department of the Oncological Institute Cluj between 1996 to 1997. The treatment protocol is adapted to the stage of disease and the dimensions of the cervix, favouring a preoperative irradiation either by brachytherapy or external beam radiotherapy, followed by a radical histerectomy with anexectomy and regional lymphadenectomy. The 4 year survival was correlated with the stage of disease: 80% for stage ffi, 74% for stage IIA and 62% for stage IB (p<0.05). The local control was 84% for stages IB and II A vs 73% for stage II B (p<0.05). For the stages IB-IIA, the dimensions of the ce’:Yix > 4 cm were significant for prognosis: 62% vs 90% for lesions less than 4 cm (p <0.05). The presence of metastatic lymph nodes after radiotherapy also influenced negatively the survival [(86% for nodes negative vs 42% for node positive (p <0.01)] and the local control (87% for pNO vs 58% for N+). No correlation was recorded with the age of the patients. The experience of the Curie Department of Oncological Institute of Cluj confirms the data reported in the literature on the eficacy of the combined radio-surgical approach in the early stages of cervix carcinoma, and the necessity to tailor the treatment according to the main pr~gnostic factors stage of disease, cervix dimensions and pTN.

Key words: prognostic factors, tumor volume, pathological N status, radio-surgery.

Radioterapie & Oncologie Medicală, 2002, 1:36-42

43 Limits in Using Numbers of Positive Nodes as Prognostic and Therapeutic Factors

  1. Todorl, A. Rancea1,2

1Cancer Institute „Prof I. Chiricuţă” Cluj-Napoca

2UMPh „Iuliu Haţieganu” Cluj-Napoca

By statistical argument the recommendation of UICC concerning the number of excised nodes in cervical cancer is stressed. The error is computed and a new attitude is suggested.

Key words: cervical cancer, number of nodes, statistic error.

Radioterapie & Oncologie Medicală, 2002, 1:43-48

49 The Immunotherapy with Isorel Modifies the Immunological Profile and the Survival in Patients Operated on for Colorectal Cancers

  1. Cazacu1, Anca Mihailov2, Elvira Toganel3, C. Lungocil, T. Oniu1

1The 4th Surgical Clinic, UMPh „Iuliu Halieganu”, the MT Clinical University Hospital Cluj-Napoca

2The Chemotherapy Department, the MT University Clinical Hospital Cluj-Napoca

3The Clinical Hospital for Adults Cluj-Napoca

The survival of the patients operated on for colorectal cancers depends mainly on the stage of the disease. In the advanced stages (Dukes C and D), the surgical treatment and the adjuvant therapy (chemo and radiotherapy) can offer a five year survival of30-50%. We tried to improve this prognosis by adding the immunotherapy with ISOREL with the intent to increase the immunological potential of the patients and to enhance the tolerance to the classical adjuvant therapy.

Matherial and methods: This is a prospective randomised study that compares the changes in the immunological profile and the concordance between this profile and the chances of survival in 27 patients which underwent surgery for the removal, either with curative or palliative intention, of their colorectal tumour. This patients received in the postoperative period either chemotherapy alone or chemotherapy with ISOREL (NOVIPHARM -Austria). The changes in the immuno- logical profile were calculated by the comparative ratio of the total and NK lymphocytes (natural killer), the prognosis of the patients was appreciated by calculating (Kaplan-Meier) the cumulative procentual surviving, p<O,O5 being considered as significant.

Results: Almost half of the colorectal cancer patients show low lymphocyte and NK count preoperatively. These values get even lower 7 days postoperatively. The patients that are treated with postoperative chemotherapy show an increase in these counts after one month. This increase becomes significant (p<O,O5) six months after the operation. In patients that were treated with postoperative chemotherapy and immunotherapy, the total lymphocyte and the NK count present a significant increase one month postoperatively (p<O,O5) and six months postoperatively the values are even bigger than the preoperative ones.

COnclusions: The immune depression caused by the colorectal cancer and enhanced by the operation and the postoperative chemotherapy seems to be efficiently improved by the addition of ISOREL to the chemotherapy. The survival of the patients operated on for colorectal cancers depends significantly on their immunological status.

Key words: colorectal cancer, lymphocyte, NK cell, chemotherapy, immunotherapy.

Radioterapie & Oncologie Medicală, 2002, 1: 49-53

54 Uterine Leiomyosarcoma is There a Place for Radiotherapy?

  1. Cozal,2, Liliana Resigal, D. Eniul,2, Angela Răşinariul

ICancer Institute „Prof I. Chiricuţă” Cluj-Napoca

2UMPh „Iuliu Haţieganu” Cluj-Napoca

The paper present the clinical observation of a 48-years old women with a uterine leiomyosarcoma with primary incomplete surgical treatment; after a 6 months free interval local and distal rec:J.lrrences appeared, treated by an multidisciplinary approach: radical surgery + 6 cycles of ADIC chemotherapy + 50 Gy EBRT and lOGy endocavitary MDR-BT. A second free interval of 6 months was followed by another pelvic recurrence treated by a wide radical surgery + 5 cycles of MAID chemotherapy. After discussions concerning the main prognostic factors the treatment options are presented, maintaining a focus on adjuvant radiotherapy relying also on the data of some important clinical trials. 1

Key words: uterine leiomyosarcoma, treatment options, adjuvant radiotherapy.

Radioterapie & Oncologie Medicală, 2002, 1: 54-58

59 Report on ASCO Meeting, May 12-15,2001, San Francisco, CA (II)

T.E. Ciuleanu1,2,Elisabeta Ciuleanu2

1UMPh „Iuliu Hatieganu”,

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

The 37th annual ASCO meeting was held between May, 12-15, 2001, in San Francisco, CA. The data selected for this second synthesis briefly present some new aspects, as reflected mainly in the oral communications, in some tumor types such as head & neck, urological and gynecological tumors and sarcomas. Our report does not cover the poster, educational and meet the professor sessions.

Key words: ASCO, trial.

Radioterapie & Oncologie Medicală, 2002, 1: 59-63