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Volum 10 Numarul 1, 2004

2 Editorial

The first issue for this year of our journal brings us a new fIrst, the debut of a young collaborator and as well, a model for a systematic review of the literature in the domain so hot of the molecular biology. With these words I have the pleasure to present you I. Cotarla, a graduate from UMF Cluj, who at present is a fellow at Georgetown University, Washington DC where he is working to his thesis for Ph.D. The topic of his research is the role of the STAT proteins (Signal Transduction and Activator of Transcription) in oncology and the published paper is interesting for two reasons: for the amount of infonnation provided and de level of requirements for these reviews, that as in Romania, are mandatory for obtaining the Ph.D. degree. It is an invitation to meditation for our readers and hopefully, some of our thoughts will reach also those who are in charge with the science and research in Romania because who should be infonned, can do it anywhere, no matter his nationality but not his working conditions. And I don’t mean only the journal but also the actual possibilities and the techniques for searching the information. ..

Also, with the same pleasure we notice an increase in the number of the collaborators, from many other centers and specialties than we were used: for all we have a WanD greeting and we are waiting fonD many others to join our efforts!

The two papers signed by the pathologists Svetlana Encica and Daniela Diaconescu, signal us the progress in surgical diagnosis registered through the routine use of immunohistochemical methods, now available also outside the traditional university centers. The thymus tumors are great beneficiaries of these techniques, the present study being the result of a fine model of cooperation between two university centers and three institutions that have ul)derstood to put together their research and therapeutic capacities. The second morphologic study, presented by the group fonned and led by Professor C.D. Olinici, is an approach of a basic problem of apoptosis and the meaning of Bcl-2 in the prostate cancer, and hopefully it will provide in the future new cues in understanding the phenomena of honnonal independence and resistance to chemotherapy for this tumor.

  1. Kacso et al. present the results of a conservative treatment for invasive bladder cancer, a retrospective study done in the Oncological Institute Cluj: the results suggests a real possibility to improve the fate of these patients and it is an impetus to develop this modem concept. The efficacy of radiochemotherapy in association with a debulking resection is real and has a favorable toxicity profile so it remains to be still improved especially introducing some of the new promising compounds as gemcitabine.

We enjoyed to have the paper sent by A. Moga and Codruta Carstea from Sibiu, that „broke the ice” regarding their contribution in original clinical studies. Their experience is interesting because reflects specific working condi- tions and is an encouragement for all other radiotherapy services to look back at their patients and how they have been treated. We are expecting more contributions and we have the pleasure to announce our readers that in the portfolio of the j oumal there a enough material for the next two issues: it is a sign of appreciation of the journal and we thank to all who hve sent them, and this is also an obligation for us to be more scrupulous and demanding in accepting those for publication.

We are mentioning one more paper, with somewhat polemical intent, from S. Pop and D. Filip that mentions some actual and uncomfortable opinions, for physicians as well financing people. In the conditions of a certain evidence-based medicine which is not understood by the financial regulations, it becomes more and more important to express our concerns and problems in order to find the best solutions for a high quality medical care as an answer to a budget far to be ideal. It is an opportunity this paper, to address an invitation to all SRRO members to send us your comments and proposals, especially on the billing of the radiotherapy procedures. We would like to create an working group on the opportunity to establish standards for a QA&QC program for radiotherapy and medical oncology, and to be discuss in our fall meeting and to be sent to the National College, Health Department and the National Insurance House.

Thank you and we are looking forward for your proposals,

  1. Ghilezan

3 PI 3-Kinase Superfamily and Breast Cancer

  1. Cotârlă

Georgetown University, Lombardi Cancer Center, NW Washington

The PI3-kinase superfamily is involved in many cellular processes and cancerogenesis as are the cell growth and prolifera- tion, differentiation, cell survival, adhesion and cell motility or angiogenesis. Moreover, PI3K signalling is involved also in development, homeostasis, sugar immunity and vesicle trafficking that suggest a very important biological role. The main structural and functional characteristic of this enzyme are presented and the possibilities to be used as a novel therapeutic target are discussed, with special emphasis for breast cancer.

Key words: PI3K, Target therapy, Breast cancer.

Radioterapie & Oncologie Medicală, 2004. 1:3-27

27 The Significance of Pancytokeratin and High Molecular Weight Cytokeratin in Diagnosis of Thymus Tumors

Svetlana Encică1, Anca Cîmpeanl, T. Scridon2, M. Bârsan2, M. Raica1

1UMPh Victor Babeş” Timişoara. Dept. of Histology,

2Heart Institute, “Niculae Stăncioiu” Cluj-Napoca

A series of 18 cases of thymomas and a normal thymus were studied on routine microscopie and immunohistochemically, The pancytokeratin MNF116 and 3413E12 high molecular weigh cytokeratin reactions were studied too. The immunohisto- chemically stains was performed on automated slide processing system for LSAB 2. The final reaction product was visualised with DAB. A case of cardiac mixoma is the negative extern control, The distribution and the reactivity to the cytokeratins of the normal thymic epithelial cells are presented. The thymomas immunoreactivity is intense for both cytokeratins but significantly stronger for 3413EI2. The observation of the cytokeratins reactions allow us to review and reclassifie the subtypes of the thymomas, from the point of view of the epithelial component, on predominantly epithelial tymomas on 3 cases. Two of the thymic carcinoma cases were negative for 34~E 12 cytokeratin; other possible origin should be considered. High density cytokeratins let us to identify perineural and intravascular minimal invasion. Our observation have shown that immunohistochemically considerations based on cytokeratins high’ molecular weigh reac- tions presents diagnostic and prognostic value in malignant epithelial thymic tumors.

Key words: Thymoma, Thymic carcinoma, Cytokeratin, Immunohistochemistry.

Radioterapie & Oncologie Medicală, 2004, 1:27-33

34 Immunohistochemical Analisys of Bcl-2 Expression in Prostatic Carcinomas

DanielaDiaconescu1, Doinita Crişan2, C.D. Olinici2

1”Transilvania” University of Braşov, Faculty of Medicine,

2U.MPh. „I. Haţieganu” Cluj-Napoca, Dept.of Pathology

The BCL-2 proto-oncogene has an antiapoptotic effect in some human malignant tumours like breast, lung or colorectal carcinomas. Data concerning the expression of the oncogene in prostatic cancer are debatable. The aim of this study is to analyse the immunohistochemical expression of the Bcl-2 oncoprotein in prostatic carcinomas. We have examined 36 prostatic adenocarcinomas, immunostained with the anti-BCL-2 monoclonal antibody (Dako) and we have ana lysed the presence of the Bcl-2 in tumour cells in relation with the Gleason histological grade and score. Fourteen tumours (38,89%) showed a heterogeneous cytoplasmic Bcl-2 positivity; the oncoprotein expression paralleled the histological grade of the lesions. There were significant differences in the number of positive cases between high grade (Gleason scores 8-10) and low grade (Gleason score 2-4) tumours.

Key words: BCL-2 proto-oncogene, Bcl-2 oncoprotein, Prostatic carcinoma.

Radioterapie & Oncologie Medicală, 2004, 1:34-39

40 Organ-Sparing Treatment of Muscle Invasive Bladder Cancer

G.Kacso1,2, N. Todor1, Cristina Cebotaru1, Gabriela Morar1, A.Fodor3, T. Guttman1, Anca Hodorog1, S.Popescu1, N. Ghilezan1,2

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

2UMPh „Iuliu Halieganu” Cluj,

3Instituto Europeo Di Oncologia Milano, Italia

Due to lack of randomised trials comparing to chemoradiation, radical cystectomy is still the stand ad treatment of muscle invasive bladder cancer (MIBC). However, several recent trials have shown a high efficacy of chemoradiation as bladder sparing curative aproach. Purpose: Institutional retrospective analysis of efficacy and toxicity of chemoradiation as curative organ- sparing treatment ofMIBC. Materials & methods: from 1991 to 2001, 49 patients with 12- T 4a (1997 TNM) transitional cell MIBC received chemoradiation in our Institute following a maximal transurethral excision. A bioptic re-evaluatian was done 6 weeks after 40- 50 Gy, 2Gy/fr, plus Cisplatin 20 mgim1/d, 1-5 /q21 for all operable patients. Those with complete response (CR) were simply followed while the others were advised to undergo radical cystectomy. Patients unfit medically or those refusing cystec- tomy received a „boost” of20 Gy/ 10 fr without split, with a third cycle of Cis plat in. Results: with a median follow-up of 18 months (6 to 141 months), the 3 year survival (SV3) was 54 %, local control with intact bladder 53 % and SV3 with intact bladder 38 %, as 14 % of patients underwent radical cystectomy (6 % for less than CR and 8 % for recurrent invasive tumor). Acute G3-4 NC12.0 and late SOMA LENT urinary respectively digestive toxicity was 6 and 18% , respectively 2 and 8%. Conclusion: chemoradiation is highly effective, with acceptable acute toxicity, significant late toxicity which can be lowered by keeping the total dose between 50 – 60 Gy. Patients who might benefit mostly from curative chemoradiation as organ-sparing treatment are younger than 55 years, without hydronephrosis, T2 tumors in CR after standard fraction 40- 50Gy + 2 CDDP cycles, 20mgim1/d,D 1- 51 q21.

Key words: Invasive bladder cancer, Radiochemotherapy, Organ sparing.

Radioterapie & On cologie Medicală, 2004, 1:40-47

48 The Superior Vena Cava Syndrome: the Therapeutic Approach in the Oncological University Hospital, Sibiu

Moga A.1,2, Codruţa Marina Cârstea1,2

1UMPh Victor Papilian” Sibiu

20ncological Hospital, Sibiu

The aim of the study is to analyze the diagnosis and the results of the treatment of superior vena cava syndrom in the Oncology Clinic ofSibiu. The study involved 67 patients hospitalized with the diagnosis of vena cava syndrom between 1994 -2002. All of them were investigated imagistically for establishing the etiology of the syndrom. Radiotherapy was delivered with Co60 telegammatherapeutic machine, with daily radiation dose of 4Gy to a total dose of 12Gy. The leading cause of the superior vena cava syndrom is the inoperable bronhogenic carcinoma. The major therapeutic goals include palliation of symptoms in the noncurable situation. Radiotherapy remains the most frequently used definitive therapeutic modality. With adequate management two – thirds of the patients can be palliated. The overall survival outlook for superior vena cava syndrome continues to remain very poor of only 6 month. The study is a plea for the collaboration between the GP, pneumologist and oncologist.

Key words: Superior vena cava syndrom, Malignancy, Radiotherapy, Median survival

Radioterapie & Oncologie Medicaid, 2004, 1:48-52

53 Burkitt’s Lymphoma of the Vermiform Appendix

R.Buiga1, C.D.Olinici2, Rodica Cosnarovicil, Doinita Crişan2

1Cancer Institute „Prof Ion Chiricuţă”, Cluj-Napoca,

2 UMPh”Iuliu Haţieganu „ Cluj-Napoca, Dept. of Pathology

We report a case of primary Burkitt’s lymphoma of the appendix in a 12-year-old boy. The child presented with abdominal pain and fever, the tumor being discovered during routine apendicectomy for suspected „appendicitis”. Accurate diagno- sis was established histologically on resected specimen. The clinico-pathologic features and the treatment of this unusual manifestation of the disease are briefly discussed.

Key words: Burkitt’s lymphoma, Appendix, Pathology.

Radioterapie & Oncologie Medicală, 2004, 1:53-5

57 Who Needs an Evidence Based Medicine?

  1. Popl, D. Filip2

1Satu Mare County Hospital, Dept. of Oncology Satu-Mare

2Maramureş County Hospital, Dept. of Oncology Baia-Mare

We are heading toward an expensive and inaccessible medicine for the ordinary people. How ready are we to make decisions based on evidence vs impressions, emotions, routine? Are we prepared? How much will the System allow us to do? The necessary changes are more profound than they seem on first glance.

Key words: Evidence-based medicine, Quality & medical care.

Radioterapie & Oncologie Medicala, 2004, 1: 57-60