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Volum 13 Numarul 3, 2007

197 EDITORIAL Viorica Magdalena Nagy

199 Xeloda – Evidence in Colorectal Cancer

Anca Mihailov, Alina Munteanu

1University Hospital C.F. Cluj-Napoca;

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

An important advance in the treatment of colorectal cancer was the development of oral fluoropyrimidines. Preferential activation of Xeloda at the tunour site results in higher intratumoral concentrations of 5FU, potentially avoiding systemic exposure and improving tolerability while maintaining high intratumoral activity. Obviously, there where three logical trends for further research: the first one was to see whether the benefits of Capecitabine could be transfered into the adjuvant setting: second, to establish its role as an effective and well tolerated partned for combinations with Oxaliplatin and Irinotecan in metastatic setting: third, to show its activity and tolerability either alone or in the above combinations, together with radiotherapy in rectal cancers.

Key words: Xeloda, Fluoropyrimidines, Colorectal cancer, Adjuvant setting, Metastatic, Radiochemotherapy.

Radioterapie & Oncologie Medicală, 2007, 3:199-204

205 A New Prognostic Model Compri sing Galectin-3, BAX and Cycline E in Advanced Stage Ovarian Carcinoma

  1. Buiga1, Doris Pelau2, Carmen Floareş2, Al. Eniu3, N. Todor4, C. D. Olinici5, 1

„Prof. I. Kiricuta” Cancer Institute, Cluj-Napoca: 1Department of Pathology; 2 Department of Chemotherapy;3 Department of Breast Tumors; 4Informatics and Biostatistics; 5„Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca

Purpose: Galectin-3 is a multifunctional glycoprotein participating in a variety of normal and pathologic processes, including tumor progression and metastasis. The aim of the present study was to determine the prognostic and predictive value of the galectin-3, and other 7 molecular factors (c-erb B2, BAX, Bcl-2, Cyclin E, Ki67, CD34, PDECGF), in advanced stage ovarian carcinoma. Patients and Methods: Intratumoral expression of galectin-3, and other molecular factors, was retrospectively examined in a series of 89 patients with advanced stage ovarian carcinoma, treated in Cancer Instiute of Cluj-Napoca between 1999 and 2001. Results: Multivariate analysis identified galectin-3, BAX and cyclin E as independent prognostic factors for overall survival. On univariate analysis, other prognostic determinants were: age (p=0,03), quality of surgery (p=0,02), arhitectural grade (p=0,01) and nuclear grade (p=0,09, borderline significance). On multivariate analysis, BAX and cyclin E were the only independent predictive factors for response to chemotherapy, assessed by the „Time To Progression”. Other predictive determinants on univariate analysis were: arhitectural grade (p=0,05), nuclear grade (p=0,06, borderline significance), and the differential expression of galectin-3 between the tumor and his peritoneal metastasis (p=0,04). Conclusion: These results confirms that galectin-3, along with BAX and cyclin E, is an important prognostic, but not predictive, factor in advanced stage ovarian carcinoma. For clinical use, two mathematical prognostic and predictive models are proposed.

Key words: Ovarian cancer, Prognosis, Galectin-3, BAX, Cyclin E.

Radioterapie & Oncologie Medicală, 2007, 3:205-218

219 Ten Years Results for Operable Breast Cancer: Cancer Institute Cluj Experience – 1995-1996 Period

Cristina Vitoc1, N.Ghilezan1,2, N.Todor1, R. Tănăsescu1, Dana Grecea1, Al. Eniu1 ,
Carmen Lisencu1, A. Rancea1,2, D. Mureşan1, Mihaela Galatîr1

1 „I.Chiricuţă” Cancer Institute Cluj-Napoca; 2 UMPh „Iuliu Haţieganu” Cluj-Napoca

Objectives: evaluation of the results for operable breast cancer in Cancer Institute Cluj, the cohorts 1995-1996 to identify the causes of failures and to assess the quality of multidisciplinary treatment (overall and diseases-free survival). Patients and methods: 368 patients with operable breast cancer are analyzed: their treatment and follow-up were supervised by the Breast Tumor Committee. All the patients who had surgery (radical mastectomy, sectorectomy) as the first treatment have been included. The decision of the adjuvant treatment was based on the pathological findings following the standards available in Romania in that period. The clinical staging was – st. 0:2; I: 41; IIa: 81; IIb: 129 and IIIa: 15. The median age: 49 (limits 24-84 years); 195 premenopausal and 173 postmenopausal patients. Results: The analysis was done in March 2007 by calculating survival and performing uni- and multivariate analyses to identify the prognostic factors. After a minimum follow-up of 124 months (minimum 10 years for all patients) and maximum 152 month (median 124) 108 deaths have been registered (78 by breast cancer and 30 – other causes) with an overall 10 year survival of 71%. The great majority of the failures were due to distant evolution alone (79 – 74%) or concomitantly associated with local recurrences (11); only 28 patients (26%) had local recurrences from a total of 107 cases. The type of failure was correlated with the known risk factors. Comments: The local vs. distant control was analyzed in relation with the technical parameters of the multidisciplinary treatment available in that period as well with the individual characteristic of the patients. Conclusions: The local and distant results of the patients with operable breast cancer treated in the Cancer Institute Cluj during 1995 and 1996 are within the limits published in the literature and underscore the positive impact of a multidisciplinary team for coordinating and establishing the standards for a good clinical practice and quality of care, according to international experience.

Key words: Operable breast cancer, Adjuvant treatment, Failures, Therapeutical standards.

Radioterapie & Oncologie Medicală, 2007, 3:219-228

229 Perspectives in Treatment of Primitive Brain Tumors

Dana Cernea

„Prof. I. Kiricuta“ Cancer Institute Cluj-Napoca, 2ndDept. of Radiotherapy

This paper is a short presentation of the progress in treatment and diagnosis of central nervous system malignancies from PCNSM 3, ASCO and ESTRO 2007. There is little consensus about the optimal treatment strategy for diffusely infiltrating low-grade gliomas (LGG), and the clinical management of LGGs is one of the most controversial in neurooncology. The standard of care has not been established but several randomized trials are beginning to provide some answers. Results in the treatment of high grade gliomas are steel poor despite of progress in diagnostic and management. The use of chemotherapy is limited by drug ditribution and toxicity. New molecular agents administered alone or in tandem with other drugs or with radiotherapy are being evaluated in clinical trials. This molecular therapy works on specific targets that can influence cell growth, invasion/migration, angiogenesis and apoptosis.

Key words: Low-grade glioma, High-grade glioma, CNS lymphoma, Targeted therapy.

Radioterapie & Oncologie Medicală, 2007, 3:229-232

233 Update and Perspectives in the Management of Head and Neck Tumors

Elisabeta Ciuleanu

„ I. Kiricuta“ Cancer Institute Cluj-Napoca: 2nd Radiotherapy Dept.

Patients with squamous cell carcinoma of head and neck cancer often present with advanced locoregional disease, defined as either stage III ( T3 N0 M0, T1-T3 N1 M0) or stage IV (T4 N0-N1 M0,T1-T4 N2-N3 M0). Despite of progresses recorded in the treatment of head and neck carcinoma, the prognosis has remained poor for this group of patients. Combined modality treatment with chemoradiotherapy has become the standard of care for locally advanced disease. Even with this therapeutic option only 45% of patients will be alive and disease free three years after the treatment; aproximatly 30-40% will develop locoregional recurrences, and 20-30% will develop distant metastases [1]. New trials incorporating new drugs, new combinations of drugs as well as IC are necessary for this tumors.The efficacy of new agents which inhibit EGFR activity (such small molecules tyrosine kinase inhibitors and monoclonal antibodies) should be assesed in clinical trials that combine IC and chemoradiotherapy to increase the efficacy of these treatments.

Key wor ds: Head and neck cancer, Induction chemotherapy, Epidermal growth factor receptor.

Radioterapie & Oncologie Medicală, 2007, 3:233-238

239 Progress in the Management of Gastric Cancer

Viorica Magdalena Nagy

„Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Dept. of Oncology; „I. Kiricuta” Cancer Institute, 2nd Dept. of Radiotherapy

The optimal management of gastric cancer continues to evolve. Surgical resection remains the only curative treatment of early gastric cancer. The significant improvements, demonstrated in INT 0116, made adjuvant combined radiation and chemotherapy a standard of care in patients with resected gastric cancer. Evidence-based current recommendations for the surgical treatment of invasive local-regional gastric adenocarcinoma include negative-margin surgical resection, avoidance of routine total gastrectomy, pancreatic and splenic resection, unless required for negative margin. Future applications of newer cytotoxics, targeted therapies and integration of molecular determinants of tumour behaviour, prognosis and response to therapy may ultimately help to improve on current standards and facilitate the delivery of more tailored therapeutic interventions.

Key words: Gastric cancer, Surgical resection, Radiochemotherapy.

Radioterapie & Oncologie Medicală, 2007, 3:239-243

244 New Trends in Uro-Oncology

  1. Kacsó, C. Căinap

„Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca; „I. Kiricuta” Cancer Institute Cluj-Napoca

Urologic malignancies increased in the third millenium, mainly due to prostate and kidney cancers. The 2006- 2007 progresses in this field are related to the multitargeted tirosinkinase inhibitors as new standard for metastaic renal carcinom; neoadjuvant chemotherapy prior to radical surgery in locally advanced bladder urothelial carcinoma; active surveillance avoiding overtreatment in early prostate cancers without compromising curability, optimisation in hormonal treatment associated with curattive radiotherapy, with better understanding of metabolic toxicity of long term androgen deprivation; finnally, watchfull waiting policy or minimal adjuvant chemotherapy rather than agressive aproach (i.e radiotherapy or several cycles of polichemotherapy) for stage I testicular cancers.

Key words: Urologic cancers, New options/Standards of therapy.

Radioterapie & Oncologie Medicală, 2007, 3:244-247

248 Diagnostic and Treatment Guidelines for Hodgkin`s Disease/Lymphoma. NCCN Guidelines v.1.2007

Cristina Cebotaru

“Prof. I. Kiricuta” Cancer Institute Cluj-Napoca, Dept. of 1st Radioterapy

For the patients with classical Hodgkin`s disease, with the current management programs, a high cure rate was reached. Relapse is uncommon, but secondary management with high dose chemotherapy and autologous peripheral stem cell rescue may be very effective. The excellent prognosis for these patients mandates careful long-term follow-up.

Key words: Hodgkin`s Disease/Lymphoma, Chemotherapy, Radiotherapy.

Radioterapie & Oncologie Medicală, 2007, 3:248-250

251 Diagnostic and Treatment Guidelines for Hodgkin`s Disease/Lymphoma. NCCN Guidelines v.1.2007

Cristina Cebotaru

“Prof. I. Kiricuta” Cancer Institute Cluj-Napoca, Dept. of 1st Radioterapy

For the patients with classical Hodgkin`s disease, with the current management programs, a high cure rate was reached. Relapse is uncommon, but secondary management with high dose chemotherapy and autologous peripheral stem cell rescue may be very effective. The excellent prognosis for these patients mandates careful long-term follow-up.

Key words: Hodgkin`s Disease/Lymphoma, Chemotherapy, Radiotherapy.

Radioterapie & Oncologie Medicală, 2007, 3:248-250

257 Classic and Modern Tumor Markers

  1. Căinap1,2, G. Kacsó1,2

1„Iuliu Hatieganu“ University of Medicine and Pharmacy, Cluj-Napoca2„Prof. I. Kiricuta“ Cancer Institute, Cluj-Napoca

The evolutions of the last years put the oncologist in a situation with a lot of informations, whitch need to be put toghether, integrated. Tumour markers represent one of the piece of a puzzle disposeble at this time. In this paper will be presented the indications of the utilisation, the etyologies responsible of abnormal values of AFP, HCG, PSA, ACE, CA 15-3, CA 19-9. Althout of valuos help, tumour markers’s place in screening, diagnosis and oncological treatement remains under investigation, actual and future trials will respond to the actual questions.

Key words: Tumour markers, AFP, HCG, PSA, ACE, CA 15-3, CA 19-9.

Radioterapie & Oncologie Medicală, 2007, 3:257-261

262 ESTRO Workshop on Radiation Oncology in Europe: Recent Developments and Future Perspectives in Patient Care, Research, Training & Legislation, Brussel, April 16, 2007

N. Ghilezan, Viorica Magdalena Nagy

263 ESTRO Course: Molecular Oncology for the Radiation Oncologist, Estoril, Portugal, April 29-May 3, 2007

Maria Perde-Schrepler

267 Report on the 43rd ASCO Meeting, 2007, June 1st – 5th, Chicago, IL, USA

T.E. Ciuleanu

270 ONCOLOGICAL LIFE IN ROMANIA

2007 SRRO’s Election. The Candidatures for SRRO’s Management

275 GUIDELINDES FOR AUTHORS