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Volum 10 Numarul 4, 2004

223 Congresul XIV al SRRO

Arad, 23-25 septembrie 2004

Congresul anual al Societăþii Române de Radioterapie şi Oncologie medicală a fost organizat pentru a doua oară la Arad, cu sprijinul Universităţii de Vest „Vasile Goldiş” şi a colegilor oncologi din Arad, cu tema: „Tumorile ginecologice: probleme şi perspective pentru România la început de secol XXI”.

Prima zi a Congresului a fost consacrată sesiunii rezidenţilor, o premieră care s-a bucurat de participarea largă nu numai a rezidenţilor de oncologie din diverse centre universitare, dar şi a numeroşilor membri ai societăţii. După prezentarea „Recomandărilor ESTRO pentru pregătirea rezidenţilor de radioterapie” (O. Coza) au fost susţinute comunicările, de înalt nivel ştiinţific şi profesional. În urma succesului sesiunii s-a decis continuarea acestui început frumos al manifestării rezidenţilor cu ocazia conferinţelor viitoare ale SRRO.

Programul din ziua a doua a fost extrem de concentrat, structurat pe trei secţiuni mari: col uterin, ovar, endometru, în cadrul cărora pe lângă câte o conferinţă educaţională au fost susţinute numeroase comunicări care au oglindit în primul rând experienţa diverselor centre oncologice, dar şi tendinţe noi în diagnosticul şi tratamentul acestor localizări. În încheiere a avut loc Simpozionul prezidenţial, o altă premieră a congresului, în cadrul căruia profesorii invitaţi au expus conferinţe de mare interes, conturând totodată tendinţe de viitor, unele axate pe probleme legate de perspectiva integrării europene. La sesiunea postere au fost expuse lucrări de un remarcabil nivel ştiinţific. Congresul s-a bucurat de o participare largă a membrilor SRRO, din foarte multe centre din ţară, prezentările din diversele domenii ale oncologiei (radioterapie, oncologie medicală, chirurgie, ginecologie, cercetare fundamentală, anatomo-patologie etc) fiind deosebit de interesante.

Ultima zi a fost dedicată Adunării generale a SRRO în cadrul căreia a fost prezentat raportul anual de către preşedintele în exerciţiu (Viorica Nagy) şi evaluată activitatea revistei societăţii de către redactorul şef (Maria Retegan-Turdean). Secretarul SRRO (Prof. N.Ghilezan) a analizat activitatea societăţii pe cei trei ani ai electoratului care s-a încheiat şi a condus alegerile noului birou.

Raportul anual de activitate a cuprins perioada octombrie 2003 – septembrie 2004. Numărul membrilor SRRO arată tendinţă ascendentă continuă, astfel dacă în 2000 a fost de 196, în 2004 numărul membrilor cotizanţi a ajuns la 222, din care 210 activi şi 11 asociaţi. Membrii activi aparţin a 19 specialităţi, majoritatea oncologi medicali (97) şi oncologi radioterapeuţi (71). Din păcate, doar 40% din membri societăţii au avut cotizaţia achitată la zi, deşi jurnalul albastru a fost trimis cu regularitate tuturor celor înscrişi!

A fost prezentat bilanţul financiar pe anul 2004, exerciţiul bugetar a fost legal şi transparent cu privire la sursele de finanţare şi investiţii.

Înperioadaoctombrie 2003 – octombrie 2004 au apărut 4 numere ale RevisteiRadioterapie & OncologieMedicală.Încele 4 numere s-au publicat 45 articolerepartizateechilibratpestructurarevistei: Editorial – 4; Articolegenerale – 8; Studiioriginale – 22; Prezentări de caz – 4; Actualităţiînoncologie – 5; EMC – 1; Revistaliteraturii – 2. Estemeritoriufaptulcă a crescutstandardulşinumărulstudiilororiginale.

În numărul 3/2004 s-au publicat rezumatele lucrărilor prezentate la Congresul SRRO, Arad.

Din cele 45 de articole publicate, 4 sunt în limba engleză şi 41 în limba română. Majoritatea autorilor sunt de la IOCN (Institutul Oncologic „Prof. I. Chiricuţă” Cluj-Napoca), dar se remarcă o creştere a numărului autorilor din alte instituţii medicale din Cluj (16 autori), 5 autori din alte centre oncologice din ţară, precum şi 3 autori din străinătate. De asemenea, se remarcă o prezenţă activă în paginile revistei a rezidenţilor, lucru îmbucurător şi un exemplu de urmat pentru cât mai mulţi.

În continuare au fost trecute în revistă principalele evenimente şi realizări ale SRRO din acest an.

În 25-26 iunie preşedintele SRRO a participat la întrunirea organizată de conducerea ESTRO la Bruxelles: ESTRO – QUARTS Workshop, cu tema „Cuantificarea infrastructurilor de radioterapie şi a necesarului de personal din ţările Uniunii Europene”. Societatea noastră a fost invitată să prezinte situaţia radioterapiei din România în vederea pregătirii integrării europene. Din discuţiile avute este relevantă discrepanţa dintre standardul european în infrastructură şi personalul de radioterapie şi situaţia din România. Standardul european prevede 1 accelerator liniar/300.000 populaţie şi 1 aparat de cobalt/la 3000.000 persoane, în timp ce în România funcţionează 7 acceleratori liniari (1/3.300.000 locuitori) şi 16 aparate cobalt (1/1.400.000 locuitori)!

Societatea noastră de asemenea a fost prezentă (O. Coza, C. Căinap) la Forumul ESTRO pentru Europa Centrală şi de Est cu tema „Educaţie şi infrastructură în radioterapie” ţinut la Gliwice în perioada 8-11 iunie 2004. S-au discutat consecinţele lărgirii UE asupra radioterapiei, impactul acestei schimbări asupra ţărilor UE ne-membre, modalitatea de ajutor oferit de ESTRO în această tranziţie şi strategii de pregătire a rezidenţilor, tehnicienilor şi fizicienilor de radioterapie.

O realizare semnificativă din acest an a fost crearea site-lui SRRO (N. Todor) care oferă informaţii la zi despre membri, componenţa biroului, evenimentele oncologice din ţară şi străinătate şi se regăsesc rezumatele din toate numerele revistei societăţii. Site-ul (http://srro.org.iocn.ro) este important nu numai pentru reflectarea activităţii SRRO, dar facilitează şi comunicarea dintre membri.

Din păcate în continuare se menţin anumite deficienţe în activitatea SRRO, din care trebuie subliniate câteva: pasivitatea marii majorităţi a membrilor SRRO, insuficienta atenţie acordată EMC şi lipsa achitării cotizaţiilor.

Alegerea noului birou al SRRO pe următorii 3 ani a avut loc pe baza candidaturilor depuse: secretar – Prof. Dr. N. Ghilezan, preşedinţi – Dr. Dana Cernea, Prof. Dr. Rodica Anghel, Dr. G. Kacso, trezorier – Prof. Dr. Viorica Nagy, redactor şef al revistei – Dr. Maria Retegan-Turdean. În încheiere noul preşedinte SRRO, Dr. Dana Cernea şi-a expus obiectivele pentru anul 2005, conturând tematica congresului următor: tumorile cerebrale şi tumorile la copii, care va avea loc la Cluj.

Preşedintele SRRO,

Viorica Nagy

225 Editorial

The last issue of our journal for 2004 as in was foreseen, is mainly dedicated for the publication of the majority of the representative papers presented at the Romanian Society of Radiotherapy and Oncology Con­gress, held in Arad between the 23rd-25th September 2004, with a current topic: „Gynecological tumours problems and perspectives for Romania at the beginning of the 21st century”.

After the active presidents report, a number of articles drow the readers attention to recent information regarding the main gynecological tumours, belonging to different domains, that reflect the multidisciplinarity of modern oncology.: prevention, diagnoses, treatment results, that are a good omen for forming a professional team which common objective is to increase the standard of gynecological tumour approach.

The main histological and prognostic characteristics of low malignant potential ovarian tumours are de­scribed by R. Buigã, insisting on the two most common types: the serous and mucinous borderline tumours, with references to the recent discoveries and some controversies about this histological category.

The bulky presentation of two important gynecological tumours by D. Ona (endometrial cancer) and Cs. Szekely (ovarian cancer) remind as of known data and bring new information referring to these tumours, from the epidemiology till the treatment.

A less common malignancy, the vulvar cancer, is described by Gh. Peltecu, who presents a real diagnostic and treatment guideline, that couldnt been found in our journal up to now.

Three general articles deal with cervical cancer which still represents an unsolved problem in the Romanian oncology, and the solution for this is first of all the prevention. According to this, N. Ghilezan, after he presents the main controversies about the real value of the cytological screening, he recommends some efficious alter­natives with a positive cost/benefit ratio and thus useful in the countries with limited resources. Viorica Nagy writes about the main phases of evolution in the cervical cancer treatment and she presents the most remarcable results from the Oncological Institute Cluj. A.C. Rancea proposed an interesting topic: radio-surgical associa­tion in the treatment of cervical cancer stage IB-IIA, still used in our country, although it is not recommended by the international scientific literature. After presenting the data from the most important textbooks and medical guidelines, the author proposes a randomized trial to compare radiotherapy vs surgery vs radio-surgical assotiation in stage IB-IIA cervical cancer.

Maria Retegan-Turdean discusses about first line chemotherapy in ovarian cancer, from the beginnings till nowadays, presenting the results of many trials in this domain, ending with a few useful conclusions, from which we should mention the one referring to the standard first-line chemotherapy in the present.

We welcome the remarkable and encouraging articles published from the different domains of brachytherapy: from radiobiology (Claudia Ordeanu) to the role of brachytherapy in endometrial cancer treatment (G. Kacso) and the evaluation of the brachytherapy departments from Romania (O. Coza).

The topic of a paper published by Dana Cernea et al. is from the less common domain of gynecological malignancys, the germ cell tumours in teenagers, being presented the natural history, the treatments and their own results.

The usual sections of this issue contain a case report from the domain of myeloproliferative disorders

(D. Rãdulescu), the report of ASCO 2004 meeting. That we have already waited from T. Ciuleanu, and the review of literature (A. Sîrbu). Inaccordance with tradition, the last issue of the journal this year ends with the well-known administrative chapters: the topics index, the authors index and the list of RSRO members in 2004.

We hope that this issue reflects one of the complex preoccupations of own professional society and repre­sents a way for solving the different problems of gynecological tumours.

Viorica Nagy

227 Pathology of Low Malignant Potential (Borderline) OvarianTumors: Progress and Controversy

  1. Buiga1, Marina Bârsu1, C. D. Olinici2

1Cancer Institut „Prof. I. Chiricuţă“ Cluj-Napoca, Patology Dept.;

2U.M.Ph „IuliuHaţieganu” Cluj-Napoca, Chair of Morphopathology

Borderline tumors were introduced by Taylor in 1929 as a provisional category, situated somewhere between benign and malignant ovarian tumors. The term was adopted by FIGO in 1968 and subsequently by WHO classification in 1973. The diagnostic relies exclusively on histological assessment of the primitive ovarian tumor. By definition borderline tumors lack stromal invasion, but unlike theirs benign counterparts they have nuclear atypies, mitoses and variable degrees of epithelial pluristratification. The most common types are the serous and mucinous ones, while endometrioid, clear-cell and Brenner types are rather rarities. The general belief in the heterogeneity of the borderline group has gained only recently support by the identification of new relevant sub-types like „micropapillary serous tumors” (Burks, Kurman 1996) and the „intestinal” and „mullerian” subtypes of mucinous tumors. Equally important was the recent description of the „invasive” and „non­invasive” types of extraovarian extentions (Bell, Scully 1988). These new discoveries, made yet by „clasical” histological means, generated some controversy between gynecological pathologists, dividing them in two oppoºite camps (Kurman, Burks, Seidman vs Scully, Young, Kempson, Hendrickson). On stake is the very existance of the borderline category.

Key words: Borderline ovarian tumor, Micropapillary tumor, Extraovarian implant.

Radioterapie & Oncologie Medicală, 2004, 4:227-233

234 Invasive Vulvar Cancer. Diagnosis and Therapy

Gh. Peltecu, Geanina Dragnea, Laura Emanoil, C. Haiduc

„Filantropia” Clinical Hospital, Dept. of Obstetrics and Gynecology, Bucharest, Romania

Vulvar malignancies are reviewed with emphasis on etiology, screening, diagnosis, staging and treatment. The ethiology of the disease remains unclear, because the precursor state has not been defined accurately. Vulvar cancer is surgicaly staged. Therapy has to be individualised. Conservative surgery tends to have a place in therapy because of the severe psychosexual sequelae and body image alteration related to radical surgery and early detection, too. Detection in early stage and adequate therapy are necessary in the effort to cure.

Key words: Invasive vulvar cancer, Ethiology, Diagnosis, Therapy.

Radioterapie & Oncologie Medicală, 2004, 4:234-240

241 Controversies and Trends in the Preventions of Cervix Cancer

  1. Ghilezan

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

The cytological screening for cervix cancer during the 1950-2000 period in western countries was a tremendous success with 66% decrease of invasive lesions and 50% in mortality but the results have not been reproduced in the developing countries. In these countries, that concentrate about 80% of world cases, the cervix cancer continues to be a very important public health problem. The explanations for these disparities are the lack of well organized screening programs according to the international recommendations for quality assurance, the scarcity of available resources but also the inability of absorption the new methodologies especially those concerning the therapeutic finalizing of the new diagnosed cases. The present controversies on the real value of the cytological screening and especially on the unfavorable cost/benefit ratio, has lead to look for alternatives, one of them being the HPV testing. The particularities of the HPV infection which is strongly correlated to the subsequent risk for a cancer of the cervix as well of many other sites, favored the introduction the HPV testing as a very efficacious method for screening, with a positive cost/benefit ratio and is recommended to be introduced in the countries with limited resources. In the future, there are other developments in perspective as the application of some biological markers specific to the HPV infection and a not to far away, the development of an antiHPV vaccine, that will assure a high control of the cervix cancer.

Key words: Cervix cancer, Cytological screening, HPV Testing.

Radioterapie & Oncologie Medicală, 2004, 4:241-245

246 The Evolution of Cervical Cancer Treatment

Viorica Magdalena Nagy

UMPh „Iuliu Haþieganu”, Cancer Institute „Prof. I. Chiricuţã” Cluj-Napoca

Nowadays the cervical cancer is considered a model of multidisciplinary treatment. From the first radical hysterectomy achieved around 1880 and the first radiation therapy for cervical cancer around 1900 led to the association of the classic treatment with chemotherapy in the 1970s. The worldwide existing preoccupations in relation with cervical cancer treatment are completely reflected in the studies from the Oncological Institute Cluj (OIC) as well. The radio-surgical treatment has a tradition in OIC, Prof. I.Chiricuþã being one of the leaders of treatment recommandation. Remarcable results have been obtained in radiotherapy since 1965, starting with cobaltmachine utilisation and after with megavoltage linear accelerator since 1994. After the start of radio-chemotherapy associa­tion from 1988, a first retrospectiv study including 190 patients suggested the superiority of concomitent radio-chemotherapy in locally advanced cervical cancer, increasing local control with 6% and dicreasing the rate of metastasis with 5%, compared to radiotherapy alone. These first encouraging results determined the start in OIC of a single institution randomized trial which included 600 patients with locally advanced cervical cancer treated between 1999-2002, and which preliminary results showed a 15% benefit in 3 years survival by concomitent radio-chemotherapy vs radiotherapy alone 75% vs 65% (p<0.001). In the present a randomized trial is in process in OIC that compares two concomitent radio-chemotherapy regimens. Its main objective is the evaluation of the disease free survival, of the treatment toxicity and of the quality of lives.

Key words: Cervical cancer, Surgery, Radiotherapy, Radio-chemotherapy.

Radioterapie & Oncologie Medicală, 2004, 4:246-254

255 Elective Radio-Surgical Association in the Treatment of Cervical Cancer. A review

A.C.Rancea1,2

1UMPh „Iuliu Haţieganu”,

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

The aim of this review is to debate on the elective radio-surgical association in the treatment of cervical cancer stage IB-IIA because recent scientific data is not recommending it anymore, a fact in contrast with the daily medical practice in our country. We started presenting the arguments on which the association of irradiation (RT) with radical hysterectomy and lymphadenec­tomy (LHC) was based. In summary it was contended that preirradiation diminishes the risk of local recurrence and of septic complications and offers a better preparing of the organism for the surgical procedure. These arguments were based more on logic and less on reliable studies. As a counterargument we presented a plethora of historical studies and trials citied in the most important textbooks and medical guidelines which concluded that for stage IB -IIA the elective radio-surgical association is not indicated. In the end our last conclusion, adapted to the situation of Romania of the year 2004 is the following: to decide if we will abandon or not, the elective radio-surgical association we need a randomized trial to compare RT vs. LHC vs. RT+LHC in stage IB-IIA cervical cancer.

Key words: Cervical cancer, Elective radio-surgical association.

Radioterapie & Oncologie Medicală, 2004, 4:255-260

261 Radiobiological Characteristic of Brachytherapy Fractionation

Claudia Ordeanu

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

Clinical radiobiology is concerned with the relationship between a given physical absorbed dose and the resulting biological response, also with factors that influence this relationship. Because of unique spatial and temporal distributions of dose inherent with brachytherapy (BT), the way in which the 4Rs influence outcome can be different. Of all 4Rs, repair is the most important in terms of the rationale for fractionation, due to the difference between tumors cells and late-reacting normal tissue. The effect of repopulations in brachytherapy is little different from that in teletherapy, especially since brachytherapy is frequently an adjunct to a course of teletherapy and, most often, the length of the brachytherapy component is relatively short. The exception will be in permanent implants with radionuclide. The roles of reassortment and reoxygenation in influencing the outcome of a course of brachytherapy are ill-defined; probably the only time that this reoxygenation might significantly influence the effectiveness of brachytherapy is at very low dose rates, such as with permanent I125 implants. L-Q (linear quadratic) model is useful for the study of several brachytherapy problems, especially the comparison of HDR (high dose rate), LDR (low dose rate) and MDR (medium dose rate). The L-Q model demonstrated such as many reports the success of HDR brachytherapy for the treatment of the cervical cancer.

Key words: Radiobiology, Cervical cancer, Linear-quadratic model.

Radioterapie & Oncologie Medicală, 2004, 4:261-269

270 Actualities in Endometrial Cancer

  1. Ona, F. Stamatian

Obstetrics Gynaecological Clinic, U.M.Ph. „IuliuHaþieganu” Cluj-Napoca

The endometrial cancer is considered to be, in our days, a frequent tumor, situated on 4-th place after those of breast, colon and lung. Despite of diagnostic facilities in early stage, there are many errors in diagnosis and therapy, followed by a statistical increase of frequency. Are affected women at menopausal age, this group having a lot of estrogen dependent risk factors. The therapeutic attitude is decided reported to staging and operative findings, evaluation of peritoneal liquid, presence of metastases pelvic exploration; as surgery, total hysterectomy and anexectomy, excision of lymphatic node metastases. Surgical treatment is main therapeutic gesture, usually associated with X-ray, hormonal and chemo therapy; the recidives are more frequently at 1-3 years at 25% of patients in early stages. The treatment of recidives is specific to size, location and clinical features of metastases.

Key words: Endometrial cancer.

Radioterapie & Oncologie Medicală, 2004, 4:270-273

274 Brachytherapy in Endometrial Carcinoma – Treatment Guidelines

  1. Kacsó1,2 , A. Rancea1,2 , Z. Spârchez1,3 , Anca Hodorog2 , Viorica Nagy1,2

1UMPh „Iuliu Haţieganu” Cluj,

2Cancer Institute „Prof. I. Chiricuţă” Cluj,

33rd Medical Clinic Cluj

Endometrial cancer is the most frequent gynaecological malignancy in US and Western Europe. Brachytherapy (BT) become widely used in this pathology in the last years due mainly to the extension of celioscopic pelvic lymph node staging, absence of survival benefit of adjuvant external beam radiotherapy (EBRT) and favorable outcomes with BT in many prospective series regarding local control, survival and late toxicity. Nower days indications and techniques of BT in neoadjuvant, adjuvant or « salvage » setting are detailed, as they emerge of the evidence based medicine.

Key words: Endometrial cancer, Brachytherapy, Treatment guidelines.

Radioterapie & Oncologie Medicală, 2004, 4:274-278

279 Ovarian Cancer: Generaly Considerations, Principles of Treatment, Importance and Place of Chemotherapy in Multimodality Treatment

Székely O. Cs.

West University „Vasile Goldiş” Arad, General Medicin Faculty

Ovarian cancer is the sixth most common cancer in women worldwide and the leading cause of death from gynecological cancer [2]. In 1990, the estimated global mortality rate due to ovarian cancer was 4.2/100,000 people and in the European Union (EU) was 9.2/100,000 people [1]. Because of the position of the ovaries deep within the abdomen and the vague nature of the symptoms associated with the early stages of the disease, diagnosis of ovarian cancer is usually made late. Approximately 70% of patients present with advanced-stage disease. [5]. Ovarian tumors are sensitive to chemotherapy and most stage III and IV patients receive chemotherapy to increase their survival and improve their quality of life. The treatment intent for most patients with advanced disease is palliative, but a significant proportion of patients remain free of disease after surgery and chemotherapy. Until recently, standard chemotherapy involved a Platinum compound, either Cisplatin or Carboplatin, admin­istered either alone or in combination with cyclophosphamide. [7] The benefits of a Taxol-cisplatin based therapy for the first-line treatment of advanced ovarian cancer have been addressed in several trials and this combination is associated with a significantly improved progression – free survival and overall survival when compared with Cisplatin plus Cyclophospha­mide (77% vs. 62%) and may become the „gold standard” for first-line therapy for ovarian cancer in the future. [4]

Key words: Natural history, Chemosensitivity, „Gold-standard regimen”.

Radioterapie & Oncologie Medicală, 2004, 4:279-283

284 First Line Chemotherapy in Ovarian Cancer

Maria ReteganTurdean

1U.M.F. „I. Haţieganu” Cluj-Napoca;

2InstitutulOncologic „I. Chiricuţă” Cluj-Napoca

Ovarian cancer is the fifth most common women cancer and the principale cause of death from gynecological cancer in Western Europe and USA. IARC (International Agency for Research on Cancer) reported on 2000 a worldwide incidence of 202 250 new cases and 124 381 deaths. In the last years, the treatment of ovarian cancer was improved and 5 year survival rate for all stages was 52% in 1997 vs 38% in 1976 . Unfortunately the majority of ovarian cancer patients (75-80%) present an advanced stage disease and experience a 5 year survival rate of only 20%. Standard treatment for these patients are surgery (total abdominal hysterectomy, bilateral salpingoophorectomy, omentectomy and lymphadenectomy) followed by chemotherapy. Chemotherapy can vary from one clinician to other, from one center to other and from country to country. In any part of the world, first-line chemotherapy is based on the Platinum regimes. Cisplatin and carboplatin are equally effective. At the beginning of the 90s , despite 50 randomized trials, optimal first-line chemotherapy remained unsolved. Results of five meta-analyses, incorporating 45 randomized trials, nearly 10 000 patients, clarified the role of Cisplatin and Carboplatin in Ovarian Cancer and show that: Platinum based therapy was better than non-Platinum based therapy; Platinum in combination was better than simple Platinum; there are no differences between Carboplatin and Cisplatin. CP combination became the standard treatment for many years, particularly in USA. In the early 90s, Paclitaxel was first tested in ovarian cancer. The results of GOG111 and OV10 illustrated that paclitaxel-Cisplatin is better vs. CP. Today , the standard first-line chemotherapy in ovarian cancer is Paclitaxel-Platinum. Majority of patients with complete remission will relapse in 2 years. New therapeutically strategies, new drugs, new combinations are the subjects of ongoing clinical trials.

Key words: Ovarian cancer, First line chemotherapy.

Radioterapie & Oncologie Medicală, 2004, 4:284-291

292 Results of the PCBE Project (Patterns of Care for Brachytherapy in Europe) in Romania

O.Coza1,2

1U.M.Ph. „I. Haţieganu” Cluj-Napoca;

2Cancer Institute „I. Chiricuţă” Cluj-Napoca

The PCBE project was initiated by ESTRO in 2003 and its purpose is to aliniate the brachytherapy departments to the european standard in order to warrant equal acces to treatments for the patients all over in Europe. After validation of the radiotherapy departments in each country and confirmation of the ESTRO_ID unique number, each deparment has com­pleted the PCBE questionnaire on-line for the studied period: january december 2002. At the project have participated 1064 radiotherapy departments form 49 european countries. At the first evaluation (may 2004) 12 from the 17 deparments form Romania have answered, but at the second evaluation (october 2004) all centers have completed their data. In Romania, for 2002, anly three centers have performed brachytherapy: form the 1944 treated patients the vast majority were with gynae­cological cancers (1912) and only 32 patients were treated for other malignant tumors. In conclusion, brachytherapy is unsufficient developed in our country, both as number of departments and functional afterloading machines. This first data are considered essential for completion of other ESTRO projects and they represent a first step towards the european standards in this domain.

Key words: Brachytherapy, ESTRO Project.

Radioterapie & Oncologie Medicală, 2004, 4:292-295

296 The Ovarian Germ Cell Tumors in Teen-Agers

Dana Cernea, EmiliaMihuþ, RodicaCosnarovici, ŞtefaniaNeamţu

Cancer Institute „Prof. Ion Chiricuţă” Cluj

Purpose: Presenting the results obtained in treatment of germ cell tumors in teen-agers between 1989 and 2002: aspects of natural history, treatment and follow-up. Materials and methods: Six teen-agers, 14 to 17 years old, have been diagnosed and treated between 1989 and 2002. The histologic type of tumor was dysgerminoma in 2 patients, teratocarcinomas in other 2 patients, mixed tumor in one patient and immature teratoma in another patient. The treatment was surgery and adjuvant chemotherapy. In four patients second-look laparatomy was performed for restant tumors after chemotherapy. Radiotherapy was not indicated in treatment of this patients. Results: all patients are alive. The length of survival is between 2 years for patients diagnosed in 2002 and 15 years for patients diagnosed in 1989. The quality of life is good but is marked by the extension of surgery. Conclusions: The ovarian tumors in children are germ cell tumors, the epithelial tumors are rare. The treatment is surgery followed by chemotherapy. For all ovarian germ cell tumors the reported probabillity of survival is 60%-98%. The quality of life is a very important parameter which must be aimed.

Key words: Germ cell tumors, Ovary, Dysgerminoma, Pediatric tumors.

Radioterapie & Oncologie Medicală, 2004, 4:296-299

300 Ischemic Heart Disease in Patients with Myeloproliferative Disorders

  1. Rădulescu, C. Duncea

Medical Hospital, U.M.Ph. „I. Haţieganu” Cluj, România

The association between myeloproliferative disorders and coronary heart disease is mentioned in the literature. We report the case of a man hospitalized with acute myocardial infarction in whom a policythemia vera was also diagnosed, and the case of a woman admitted with unstable angina, in whom an essential throbocythemia was diagnosed. We discuss the pathogenesis of this association, and therapeutic options in these patients.

Key words: Policythemia vera, Essential thrombocythemia, Myocardial infarction, Unstable angina.

Radioterapie & Oncologie Medicală, 2004, 4:300-302

303 Report on the 40th ASCO Meeting, 2004, June 5 th – 8th New Orleans, LA, USA

T.E.Ciuleanu

U.M.Ph. „I. Haţieganu”, Cancer Institute „Prof. I. Chiricuţă”, Cluj-Napoca, Romania

This is a brief presentation of the new aspects in the management of some solid tumors (such as head and neck, lung, digestive, genitourinary, CNS tumors) that emerged from the plenary lectures and oral presentations, held at the 40th annual ASCO meeting, in New Orleans. Our report does not cover the poster, educational and meet the professor sessions.

Key words: ASCO, Trial.

Radioterapie & Oncologie Medicală, 2004, 4:303-306

307 REVIEW OF LITERATURE

309 CONTENTS of Journal of Romanian Society of Radiation Therapy and Medical Oncology: Volumul X, 2004

313 TOPIC’S INDEX 2004

316 AUTHOR’S INDEX 2004

317 MEMBERS of Romanian Society of Radiation Therapy and Medical Oncology 2004

318 GUIDELINES FOR AUTHORS