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Volum 12 Numarul 4, 2006

250 EDITORIAL

251 Guideline forTreatment of Colorectal Cancer

T.E. Ciuleanu, R. Curcã, I. Popescu, Rodica Anghel, Adina Croitoru, M. Dediu, L. Miron, Şt. Curescu

263 Radiochemotherapy in Locoregionally Advanced Esophageal Cancer

C. Cãinap, Viorica Magdalena Nagy

„I. Kiricuta“ Cancer Institute Cluj-Napoca

Iuliu HaţieganuU.M.Ph. Cluj-Napoca, Discipline of Oncology & Radiotherapy

Esophageal cancer count about 1% of all cancer diagnosticated worldwide. Despite his frequency, over 90% of patients with this type of cancer will die due to subjacent malignancy. Nowadays persist doubts concerning the useful of radiochemotherapy in multimodal treatment of locoregionally advanced oesophageal cancer. In this paper we reviewed the principal trials which have used radiotherapy, chemotherapy or radiochemotherapy in preoperative or exclusively manner. Actual knowledge’s are in favor to use radiochemotherapy at least as a part of multimodal treatment or exclusively in advanced locoregionally esophageal cancer with the same results concerning local relapse and overall survival.

Key words: Radiochemotherapy, Esophageal cancer.

Radioterapie & Oncologie Medicală, 2006, 4:263

268 Rectal Cancer: From Local Excision To Multimodality Treatments

Viorica Magdalena Nagy

“IuliuHaţieganu” UMPhCluj-Napoca, “I. Kiricuta” Cancer Institute, Cluj-Napoca, România

The last 20 years are witnessing many and important changes in the treatment of rectal cancer. The analysis of the topography and frequency of local recurrences and lymph node involvement has moved rectal cancer from a surgically managed condition to a multimodality treated disease. The introduction of total mesorectal excision led to significant decrease in local recurrence rate in respectable rectal cancer.The use of radiotherapy, either pre- or postoperatively, decreases the local recurrence rate and improves survival in locally advanced rectal cancer. Chemotherapy has been shown to enhance the efficacy of pelvic radiation. Recent data demonstrated that preoperative radiochemotherapy increases downsizing and downstaging, and improves sphincter preservation and local control in advanced rectal cancer. Therefore, preoperative radiochemotherapy should be the new standard treatment of advanced rectal cancer.

Key words: Rectal cancer, Treatment failure, Radiochemotherapy.

Radioterapie & Oncologie Medicală, 2006, 4:268-274

275 Radiochemotherapy in Gastric Adenocarcinoma after Curative Resection. Experience of “I. Kiricuta” Cancer Institute Cluj-Napoca*

Alina-Simona Muntean1, Ioana Covaciu1, L. Lazãr1,2, Anca Mihailov3, M. Cazacu2,3,Anca Hodorog1, Liliana Resiga1, N. Todor1, N. Ghilezan1

1 “I. Kiricuta“ Cancer Institute Cluj-Napoca;

2“Iuliu Haţieganu” UMPh Cluj-Napoca;

3University Hospital, 4th Surgical Clinic Cluj-Napoca

Purpose: The published results of Intergroup 0116 established the relapse-free (p < 0.0001) and overall survival (p = 0.01) benefit of adjuvant radiochemotherapy in completed resected high-risk T3,T4 and/or node positive adenocarcinoma of the stomach and gastroesophageal junction. The purpose of our study was to assess the toxicity and feasibility of postoperative radiochemotherapy in resected gastric adenocarcinoma. The second endpoints were: disease – free survival (DFS) and overall survival (OS). Patients and methods: Ninety-four patients with gastric adenocarcinoma were treated with adjuvant postoperative radiochemotherapy after radical surgery (R0). Median age was 56 years, the pathologic stage was: IB for 6 patients, II for 26 patients, III A for 33 patients, III B for 19 patients and IVA for 10 patients. Nodal metastases were present at 85,1%. The treatment consisted in 425 mg/m2 of 5-FU (Fluorouracil) plus 20 mg/m2 of LV (Leucovorin) i.v. bolus for 5 days, followed by radiochemotherapy. Radiotherapy was given with 45 Gy/25 fractions (fr.)/33 days on tumor bed, anastomosis or stump and lymph nodes with 1.8 Gy/fr. associated with 5FU (400 mg/m2) and LV (20 mg/m2) i.v. bolus on days 1 through 4 and on the last 3 days of radiotherapy.Two additional cycles of 5FU /LV were given at 28 days interval after the completion of radiochemotherapy. Results: Compliance was 100%. The grade 3 toxicity was hematologic (52,97%) and gastrointestinal (19,15 %). We have no grad 4 toxicity and none toxic deaths. With a median follow – up period of 36 month (minimum 12 months) 55 % of patients are Disease Free Survival (DSF). Conclusion: Postoperative radiochemotherapy is in generally well tolerate and can be safely administered in ambulatory conditions. The clinic results suggest a clear therapeutic potential.

Key words: Gastric cancer, Surgery, Radiotherapy, Chemotherapy.

Radioterapie & Oncologie Medicală, 2006, 4:275-281

282 The Correlation Between Tumor Response and Specif ic TumorMarker Levels in Chemotreated Pancreatic Cancers*

Sz. Bereczki, A. Udrea, AlinaPopa, Cristina Furtoş

“I. Kiricuta” Cancer Institute, Cluj-Napoca, Dept. of Medical Oncology

Introduction: Pancreatic cancer remains a great problem of oncology, because worldwide 119.544 men (3%) and 107.479 women (4%) die yearly from this disease. The response’s evaluation after therapy in pancreatic cancer is made by taking in consideration: imagistic tumor response and specific marker levels, pain control, performance status, and quality of life. Objective: The objective of this study is to evaluate the accuracy of Carbohydrate Antigen 19.9 (CA19.9) and Carcinoembryonic Antigen (CEA) in monitoring responses in patients with pancreatic cancer after chemotherapy. Patients and methods: This retrospective study was carried out on 50 patients with biliopancreatic cancers in the period between 01 Jan. 2004 – 30 June 2006 in the „ Ion Kiricuta” Cancer Institute (IOCN). The evaluation of CA19.9, CEA and imagistic evaluation were performed at the beginning and the end of 2 months of chemotherapy. As adjuvant chemotherapy 5Fluorouracil based regimens, and in metastatic disease Gemcitabine based regimens were used. Results and Discussions: We obtained 1 complete response (2%), 7 partial responses (14%), 21 stable diseases (42%) and 21 progressive diseases (42%). CA19.9 and CEA are correlated with tumor response in 70% of cases. Conclusions: The markers can be considered prognostic factors, hereby they may be used to guide physicians to individualize treatment plans.

Key words: Biliopancreatic cancers, Tumor markers, Tumor response, Chemotherapy.

Radioterapie & Oncologie Medicală, 2006, 4:282-285

286 The Importance of the Carcinoembryonal Antigen in Monitoring Patients with Colorectal Adenocarcinomas, for Early Diagnosis of the Recurences

  1. Marcu1, C. Cãinap1,3, N. Todor2

„I. Kiricuta” Cancer Institute, 1 Dept. of Medical Oncology,

„I. Kiricuta” Cancer Institute, 2 Dept. of Medical Informatics;

3 UMPh „Iuliu Haţieganu” Cluj-Napoca, Discipline of Oncology & Radiotherapy;

This is a retrospective study that has as main objectives to set some correlations between the Carcinoembryonal Antigen (CEA) value at the begining of the treatment of the colorectal adenocarcinomas, and the tumor differentiation grade, TNM stage, time to local relapse and metastases free interval. Patients and method: The study included 56 patients, that were treated for a colorectal adenocarcinoma în the Cluj-Napoca Cancer Institute, between 1995 and 2005, 25 of them presenting a colon adenocarcinoma and 31 rectal adenocarcinoma. We chose a cutoff refference value of 20ng/dl for the CEA. Results: All of the patients heaving a CEA<20ng/dl presented G1/G2 adenocarcinomas, 90% of the ones with a CEA value greater than 20ng/dl presented G2/G3 adenocarcinomas, over 90% of the cases with a CEA value >20ng/dl had a local advanced disease., 60% of the N2+ patients had CEA>20ng/dl, CEA>20ng/dl is corelated with a shorter metastases free survival., CEA<20ng/dl is corelated with a shorter local progresion interval. Conclusions: CEA<20ng/dl is corelated with G1 adenocarcinomas, limitated regional disease with a low node invasion but with a short period to the local relapse. CEA>20ng/dl is more commomn with the low grade adenocarcinomas, advanced local disease, with more than 4 limphnodes involved and with a short metastases free survival.

Key words: Carcinoembryonal antigen, Adenocarcinomas, Recurrences.

Radioterapie & Oncologie Medicală, 2006, 4:286-290

291 A Syndrome of Severe Hyponatremia and Hypoosmolality In Small Cell Lung Carcinoma. Case Report and Review of the Literature

  1. Rãdulescu1, Delia Bunea1 , S .Pripon1, Letiţia I. Rãdulescu2

1 Vth Medical Hospital, “Iuliu Haţieganu” UMPh, Cluj-Napoca;

2Diagnosis and Treatment Center, Cluj-Napoca

It is well documented in the literature that a vast majority of small cell lung cancers are associated with paraneoplastic phenomena. We report the case of a 71-year old man diagnosed with small cell lung carcinoma in whom a severe hyponatremia and renal sodium loss with inappropriate antidiuresis was also found during a routine laboratory testing. We discuss the pathogenesis and the clinical aspects of this association as well as the therapeutic options in this kind of patients.

Key words: Hyponatremia, Paraneoplastic syndrome, Small cell lung cancer.

Radioterapie & Oncologie Medicală, 2006, 4:291-294

295 Particular Evolution in a Case of Medulloblastoma in Adult

  1. Mocanu, Dana Cernea, IolandaSicoe

“I. Kiricuta” Cancer Institute Cluj-Napoca, Dept. of 2nd Radiotherapy

It is presented a case of 29 years patient diagnosed with medulloblastoma in the left emisfer of the cerebellum, with favorable prognostic factors. After a disease free survival of 6 month from the end of radiation therapy, the patient is diagnosed with multiple bone metastases. Are discussed the particularities of the case regarding diagnosis, treatment and evolution, mentioning that cases of medulloblastoma in adult and the incidence of metastases in this tip of neoplasia are rare.

Key words: Medulloblastoma, Bone metastasis, Radiotherapy, Chemotherapy.

Radioterapie & Oncologie Medicală, 2006, 4:295-299

300 Between Consensus and Reality in the Treatment of Digestive Cancers

Viorica Magdalena Nagy

301 SRRO’s Elections

G. Kacsó

302 The Certificate for Honour

Marius Alexandru Liţu

305Continuous Medical Education’s Credit System

307 CONTENTS OF JOURNAL OF ROMANIAN SOCIETY OF RADIATION THERAPYAND MEDICAL ONCOLOGY, VOLUME XII, 2006

311 TOPIC’S INDEX 2006

314 AUTHOR’S INDEX 2006

316 MEMBERS of Romanian Society of Radiation Therapy and Medical Oncology 2006

319 GUIDELINES FOR THE AUTHORS