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Volum 08 Numarul 2, 2002

80 Editorial

This issue covers a wide range of topics related to cancer immunity, early diagnosis ill cervix cancer, clinical studies, psycho-oncology and quality of oncological care.

Over the last year significant advances have been made in the cancer biology, and the therapeutical results are emerging. Clearly there is still a need for the development of these new therapeutical modalities. The complement activation and its cytolitic action on the tumor cells could be the base of other classes of drugs with new mechanism of action. The first studies which suggest the cyto1itic role of complement in cancer were published in the ’70, but only after 1990 were reported more studies that certify this activity of complement. It is surprising to note how little attention has been paid to exploit the „biological power” of the complement system for the eradication of tumor cells. A thorough review of this area is done by Maria Retegan Turdean at al.

The cervical cancer is a medical and social problem due to the high incidence, mortality and the great number of patients with advanced stages. Further efforts, from the professional association and governmcntal institutions, are necessary in order to implement the screening and to improve the quality of parameters. Accordingly, Ofelia Şuteu at al. offer us an analysis of the methodology of the Pilot Project for the Early Detection of Cervical Cancer, in Cluj. District, initiated by General Practitioners. In spite of the difficulties met in the running of the program, the results deserve a special attention because it is the first such program organised in Romania and the experience and results could be use for developing a screening program at national level.

Head and neck cancer has a central place over the years in the clinical activities of thc Oncological Institute „I.Chiricuta” and Elisabeta Ciuleanu at al. show the prognostic value of paranasopharyngeal space extension in nasopharyngeal carcinoma. The experience of Paediatric Oncology Department, from the same institute, in Non-Hodgkins Lymphomas treatment is presented by Emilia Mihuţ at al.

Psychological reactions of cancer patients and their families are important to COil sider in thc managcmcl1t of’ the patients. We welcome the conective from Psychiatric Clinic, A. Secăreanu at al., and Aura Vaida, who are presented with 2 papers in the field.

  1. Todor, using some numerical examples, comments that the value of „p” is important, but it is not enough for evaluating the results. Of no less importance is also the confidence interval to ascertain the real significance of clinical results, for comparison of the results.

The good quality of medical care, the monitoring and permanent evaluation of the performances are the guarantee of the high standard medical service. Two reports that evaluate the Breast Tumor Centre, and the Gynecological Tumors Committee activity are signed by Cristina Vitoc and Viorica Nagy, respectively. The rigour of these analyses, must be an example for an oncological network.

Revue of literature closes this issue and we hope all are of interest for you.

Maria Retegan Turdean

81 The Role of Complement System Activation in Cancer

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

1Radiology Clinic. Cluj-Napoca.

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

Previous studies suggested that tumour cells induce a immune response. but not always active enough to eradicate the tumour. Nucleated cells such as tumour cells are natural targets for complement and activation of the complement path- ways may result in cytolysis. Activation of the complement system generates cytolitic C5b-9 channels in the membranes. : Several tumour cells are resistant to complement mediated killing, Expression of one or more inhibitory proteins could explain how many cancers evade lysis by complement. Neutralization of complement inhibitory complement lysis. It is increasingly evident that identification of complement inhibitors on tumor cells is crucial before considering any biological therapy attempts based on the complement activation.

Key Word: Complement System. C5b-9. cancer. complement inhibitors.

Radioterapie & Oncologie Medicală 2002, 2: 81-88

89 Estimation of Primary Care Pilot Project for the Early Detection of Cervical Cancer in Cluj District

Ofelia Şuteu 1,2 , Mihaela Beuran3, Rodica Paiş4, N. Todor2, Daniela Coza2,

Luciana Lupşa2, N. Ghilezan2,5

1U.MPh. „Iuliu Hatieganu’ University a/Medicine and Pharmacy – Dept. of Epidemiology.

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

3General Physician Society CIuj-Napoca,

4Diagnosis and Treatment Center Cluj-Napoca.

5″Iuliu Hatiegan” U.M.Ph Cluj-Napoca. Dept.. of Oncology

Background. In 1999. the Cluj NapocaAssociation of General Practitioners in partnership with the Romanian Cancer Society initiated and implemented a Primary Care Pilot Project for the Detection of Cervical Cancer in Cluj District. The target population was represented by women aged 25-65 on the lists of 17 family physicians voluntary selected from urban and rural practices in Cluj District. The aim of the project was to get high coverage rate of the target women population. the quality of sampling and cytological smear reporting, as well as the follow-up and the treatment of the abnormal cases. Material and method. The paper presents tactical and operational ways of estimation of the constituent parts and the activities carried on in the pilot project between 1999-2000. The main performance indicators of the project were compared with the standards established by the European guidelines for quality assurance in cervical cancer screening. Results. From 865 test smears corresponding to 819 women examined. 27 abnormal smears were found from which 5 cases of carcinoma in situ. Abnormal cytology rate was 3.3% and that of carcinoma in situ was of 0.61 %. After one year. the project proved that in spite of a low coverage rate and of an inadequate follow-up. the constant examination may include a low socio-economic status female population who hadn’t been tested before. explaining the relatively high rate of dysplasia lesions and of carcinoma in situ. The standards were exceeded by the quality sampling and smear reporting, compulsory conditions for an efficient screening. Conclusions. The Pilot Project from Cluj showed that making the screening a part of the primary care with the direct assistance of the family physicians is the best strategy to reach the goals: to create special organizing structures to cover the aimed population, the sampling and smear reporting quality. the circuit of the information and patients from the sampling to the final treatment, communication modalities between partners, estimate the results to diminish the incidence and mortality through cervical cancer with the tested population.

Key words: pilot project. screening. cervical cancer. estimate.

Radioterapie & Oncologie Medicală. 2002. 2:89-99

100 Prognostic Value of Paranasopharyngeal Extension of Nasopharyngeal Carcinoma

Elisabeta Ciuleanu1, T.E. Ciuleanu1,2, V. Popiţa1, N. Todor1, A. Fodor1, N. Ghilezan,1,2

1Cancer Institute „Prof Ion Chiricufa”, Cluj Napoca:

2UM.F, “I. Haţieganu” Cluj-Napoca

Purpose: To assess the correlation between paranasopharyngeal extension and T category and to evaluate the prognostic

value of parana so pharyngeal space (PPS) extension in local control and distant metastasis in patients (pts) with nasopharyn-

geal carcinoma (NPC). Methods: Between 1995-98, 142 NPC pts entered the study. TN categories were defined according to Ho’s staging system (CT scan mandatory). Tumor extension into the PPS was defined as: grade (G) 0 – no extension, 1 – extension to the retrostyloid space, 2 – extension to the prestyloid space and 3 – extension to the anterior part of the masticator space. Relapse free, local relapse free, and distant metastasis free survival (S) were estimated using Kaplan-Meier method. Results: 107 (75%) were men, age 48 [15-77], histology (WHO): I vs II vs III: I I v.V 40 V.V 9 I pts. The G 0, 1,2 and 3 extension were 31%,28%, 23% and 18% respectively. Extensive involvement ofPPS (G2/3) appears in 37%ofT2 tumors vs 55% forT3 tumors

(p<.05). The2-yearrelapse free S rate for GO/I v.V G2/3 extension was 67%v.v 35%.(p<.01 .). The2-yearoverall S for GO/] vsG21

3 extension was 80% v.V 54% (p<.05). The 2-year local control rate was 700/0 in GOI I vs 46% in G2/3 (p<.O I ). When stratified for T classification (T2 vs T3), the difference was observed only in T3 disease. There was no difference in distant metastasis free S depending on the PPS extension (GO/I v.V G2/3: 9 I % v.V 78%). Conclusions: 1) Extensive paranasopharyngeal involvement

(G2/3) was associated with poorer treatment outcome regarding relapse free survival rate, overall survival and local control

rate. 2) Extensive involvement of the PPS correlates with advanced tumor (G2/3 more frequent in T3 vs T2 category).

Key words: nasopharyngeal carcinoma, paranasopharyngeal extension.

Radoterapie & Oncologie Medicală 2002. 2:100-105

106 Non-Hodgkin’s Lymphomas in Children. Therapeutical Aspects and Prognostic Criteria

Emilia Mihuţ, Ştefania Neamţu, Rodica Cosnarovici, Milena Duma, Dana Cernea, N. Todor

Oncological Institute „Prof I.Chiricuta „, Cluj-Napoca

Purpose: retrospective evaluation of therapeutically results in the treatment of non-Hodgkin’s lymphomas using BFM’90 and CHOP protocols, toxicity of the treatment and influence of prognostic factors. Patients and methods: 53 children, 2 to 18 years of age were eligible for the study. Histologies represented were: Burkitt lymphoma 24, lymphoblastic lymphoma 15 and large cells lymphoma 14 patients. Six had stage I disease, 15 stage II, 16 stage III and 16 stage IV disease. Patients were stratified into the therapy groups „B” or „non-B”, according to histopathology and immunophenotype. Results: the event free survival.(EFS) at 3 years was 70% and the overall survival 61 % for the whole group. Treatment results were comparable between the therapy groups as well as between NHL subtypes. Hematological and gastro-intestinal were the most frequent side effects. In a univariate analysis, the following variables were associated with prognosis in term of survival: clinical stage, performance status, serum LDH and the presence of B symptoms. Conclusions: The results of the study indicate that in order to obtain the best results, it is necessary to separate the patients as a function of prognostic factors in risk groups with differentiated therapy.

Key word: non-Hodgkin lymphomas, chemotherapy, prognostic factors, children.

Radioterapie & Oncologie Medicală 2002, 2:106-113

114 Observations About the Maternal Perception of Stress in Pediatric Oncology

  1. Secăreanu1, Ştefania Neamţu2, Carina Şomlea2

1UMPh „I. Haţieganu” Cluj-Napoca,

2Cancer Institute Prof I. Chiricuţă, Cluj-Napoca

The comparative assesment of two pools of n = 30 mothers having their children affected by malignant hemopathies, the first pool being in the stage of diagnosis confrontation and the second one in the stage of adaptation to disease and treatment, had revealed that the perception of stress was higher in the frame of diagnosis confrontation. We found also significative correlations between the level of stress perception and the magnitude of the concomitant affective reactions, respectively anxiety and depressive mood.

Key word : pediatric oncology, stress perception, anxiety, depression.

Radioterapie & Oncologie Medicală, 2002. 2:114-117

118 Psychological Adjustment Modalities (Coping) to Malignant Illness

Aura Vaida

The Clinical Hospital for Adults. Dept. of Psychiatry, Cluj-Napoca

Objectives: The purpose of this paper is to identify the main modalities of patients’ reaction to malignant illness, as well as coping mechanisms to which patients resort to with a view to obtain more proper psychological adjustment. Also we intended to identify some differences which concern the coping mechanism to which patients’ resort to depending on knowing whether the diagnostic is of cancer illness or not. Subjects, material and method: It was achieved a pilot study which contained two groups of 25 patients with malignant illness (recent diagnosticate and with certain historic past concerning the illness evolution) to who were administrate questionnaires to follow the autoevaluation of depressive level, anxiety and modalities to coping at illness. Results and discussions: Patients tend to reactionate through depressive and anxious moods to illness situation, reactions that turned out to be more intense in diagnosis moment. It is ascertained a preference for using emotional-avoidable coping mechanisms, which offers a lower adaptation comparative with the situation in which it would resort to use some cognitiv-comportamental active coping mechanisms. Conclusions: The diagnosis knowledge influences in positive sense the adaptation to illness through appeal to positive reinterpretation of the situation and its acceptability wich determines a semnificative improvement of depressive and anxious moods.

Key words: cancer, adaptation, coping, depression, anxiety.

Radioterapie & Oncologie Medicală, 2002, 2: 118-124

125 Comparing Two Studies. Relative Risk or Percentage Difference?

  1. Todor

Cancer Inslitute Prof I. Chiricuţă” Cluj-Napoca

Many papers still contain statements like: “The results are comparable with literature” but have no rational basis. Using some numerical examples, made by the author, one can see how badly could be simplistic numerical appreciation only by differences in percentage and/or relative risk.

Key words: Chi squared test, relative risk, percentage difference, Mantel-Haenzel test.

Radioterapie & Oncologie Medicală 2002, 2:125-128

129 The Activity Raport of the 05 Committee for 2001 Year Based by Breast Tumor Center (BTC) and Radiotherapy I Department (RT – I)

Cristina Vitoc1, R.Tanasescul,2, Dana Greceal, Al.Eniu1, A.Rancea1,2, D.Mureşan1, Angela Răşinaru1, N. Todor1, N.Ghilezan1,2

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

2UMPh. „I. Hatieganu”, Cluj-Napoca

Activity’s analyze of the 05 Committee for 200 I years, comparative 1999 and 2000 years. reflects the dynamic issue of the breast tumors in our Institute. First of all we have seen the increase of the weight of the breast cancer new cases presented to us (20.3%.21.7%,22.2%) but with the same stage distribution 20% early and 67.7% advanced stages. No stage cases or indefinite stage appreciably decreased (7.4%). BTC discharges four function: I) Diagnosis function manifested by clinical consultation points out 30% more consultations in the last 3 years with improvement malign/benign ratio to 2.4, for 200 I years. Mammography examinations decreased to 1/3 at the resumption of the activity for 21/2 months, after a break time more one year; II) Day’s Hospital activity increased by number of the perfusions by change of the schedules of treatment, while the important number of treatments were made at county oncology medical department; III) 05 Committee increased activity by number of debates files for 75% new cases; IV) Two intern clinical studies are on going and a new study is launched, but two international clinical studies are finished, another two are launched. We started the agreement s negotiation with IBCSG. RT-I department’s indicators were under optimization due his specific profile dedicated radiologi- cal treatment lasting 4-5 weeks. The number of irradiation patients decreased comparing last years. but it exceeded normal rate accorded our department. In the intern level, the number of the issues published were increased. and in the interna- tional level we participated at two papers presented at ASCO- 200 I. With a view to changing the experiences and up grating continue medical education, our team participated to a lot of internal and international symposium. After the enumeration of faced difficulties, we presents immediately and perpetually objectives.

Key words: The annual activity’s report; the new breast cancer cases; the distribution by stage; Breast Cancer Center; Radiotherapy- I Department; the issues published; Symposiums; the difficulties; the objectives.

Radioterapie & Oncologie Medicală, 2002, 2:129-137

138 The Analysis of the Gynecological Tumours Committee Activity in 2001

Viorica Nagy1,2, N.Ghilezan1,2, O.Cozal,2, Claudia Ordeanul, S.Gavrişl, N. Todor1

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

2UMPh „Iuliu Haţieganu” Cluj-Napoca

The analysis of the year 2001 in comparison with the past represent the main objective of the Gynecological Tumours Committee. Starting from 1995, a continuous raise in presenting clinical files is observed, with an increase of the total number of different gynecological tumours. As the most important and predominant disease among gynecological tumours, cervical cancer was analysed in different stages and treatment modalities.

Key word: gynecological tumours, cervical cancer, treatment modalities.

Radiolerapie & Onclogie Medicală 2002, 2:138-143

144 REVUE OF LITERATURE 147 QUESTIONNAIRE CME

150 GUIDELINES FOR AUTHORS