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Volum 15 Numarul 2, 2009


Gabriel Kacsó

89 The Basic Immunology of Stem Cell Trafficking and Cancer Metastasis

Ciprian Tomuleasa¹,², Sergiu Şuşman¹, Olga Soriţău², Dan Rus Ciucă¹, Emöke Páll³, Ioana Brie¹,², Carmen Mihu¹

¹ Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; ² Ion Chiricuţă Institute of Oncology, Cluj-Napoca; ³ University of Veterinary Medicine and Agricultural Sciences, Cluj-Napoca

Over the past years medicine has undergone intensive changes, evolving from classical semiology and internal medicine to individu­alized treatments, based on recent breakthroughs in immunology and genetics. This concept has had a profound impact in all medical specialties and as a consequence pharmacology and various treatment plans will be based on monoclonal antibodies and targeted cell therapies. One such target is the SDF-1-CXCR4 axis bacause it plays a critical role in many physiological processes that involve cell migration and cell fate decisions, ranging from stem cell homing, angiogenesis and neuronal development to immune cell trafficking. The chemokine receptor CXCR4 and its ligand stromal cell-derived factor 1α are also implicated in various pathological conditions, including metastatic spread and HIV infection. In this review, we present the concept that the SDF-1-CXCR4 axis is a master regula­tor of trafficking of both normal and cancer stem cells, based on the growing evidence that it plays a pivotal role in the regulation of trafficking of normal hematopoietic stem cells and their homing to the bone marrow. Because most malignancies originate in the progenitor cell compartiment, cancer stem cells also express CXCR4 on their surface and migrate to organs that highly express SDF­

1. Hence, we postulate that the metastasis of cancer stem cells and trafficking of normal stem cells involve similar mechanisms, which may be regulated by several small molecules related to inflammation. Consequently, strategies aimed at modulating the SDF­1-CXCR4 axis could have important clinical applications in both tissue engineering and in clinical hematology and oncology to in­hibit metastasis of cancer stem cells.

Key words: SDF-1-CXCR4 axis, Stem cell trafficking, Cancer metastasis.

95 Ovarian Cancer – From Accurate Imaging to Optimal Treatment

Adina Stoian1, Radu Badea2, Ion Răzvan Ivan1, Jacques Salvat3

¹ Hôpital Georges Pianta, Service de Radiologie et Imagerie Médicale, Thonon les Bains, France; 2 Department of Medical Ultrasonography, 3rd Medical Clinic Cluj-Napoca, Romania; 3 Hôpital Georges Pianta, Service de Gynécologie, Thonon les Bains, France

Ovarian cancer is the sixth leading cause of death from cancer in women and the leading cause of death from gynecological cancer. The greatest difficulty in ovarian lesions is to determine the risk of malignancy after identifying it. The difference between a malign and benign ovarian lesion is difficult to establish in almost 100% of cases. Most of the lesions do not involve an invasive examina­tion of the patient. As a first step, patients with suspicious adnexal masses, benefit from an ultrasound exam by endovaginal and ab­dominal approaches. If ultrasound cannot conclude, MRI is the examination of choice to characterize an adnexal mass and guide the surgeon. CT is necessary for ovarian cancers’ extension assessment.

Key words: Ovarian cancer, Ultrasound, CT, MRI.

103 Brachytherapy for soft tissue sarcomas: a forgotten technique?

Gabriel Kacsó1,2, Zsolt Fekete1

1 Ion Chiricuţă Institute of Oncology, Cluj-Napoca; 2 Iuliu Haţieganu University of Medicine and Pharmacy of Cluj-Napoca, Romania

Brachytherapy (BT) is integrated in the multimodal treatment of soft tissue sarcomas (STS) primordially to decrease local relapse rates. This is a common goal with external beam radiotherapy (EBRT), with which it is sometimes associated in achieving curative doses (65-70 Gy) without increasing radiotoxicity. BT can replace EBRT as adjuvant treatment in completely resected high grade STS of the extremities or su­perficial trunk. For local recurrences in previously irradiated areas, BT after complete resection might be an alternative to mutilating surgery. Currently there are no published clinical trials comparing adjuvant EBRT with BT in STS. Data underlining the role of BT comes from sev­eral retrospective studies and one clinical trial comparing surgery plus BT with surgery alone.

Key words: Brachytherapy, Soft tissue sarcomas, Review.

110 Acute and Subacute Side Effects of Germ Cell Tumors Chemotherapy: a Retrospective Analysis of the Ion Chiricuţă Institute of Oncology Series

Cristina Ligia Cebotaru1, Nicolae Todor1, Nicolae Ghilezan1,2

1 Ion Chiricuţă Institute of Oncology, Cluj-Napoca, Romania 2Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Background and aims: To assess chemotherapy acute and subacute side effects in patients treated for germ cell testicular and extra-gonadal tumors at the Ion Chiricuta Institute of Oncology, Cluj-Napoca. Methods: We retrospectively analyzed 570 germ cell pa­tients treated with chemotherapy in our Institution from January 1982 to January 2005. Adjuvant chemotherapy was administered in 38.07% of patients, neoadjuvant in 40.35%, second-line in 14.21% and 7.37% received treatment for relapse. Protocols used were as follows: VAB6 (Vinblastin, Adriamycine, Bleomicyn – 24.91%), BEP (Bleomicyn, Etoposide, Cisplatin – 35.44%), EP (Etoposide – 15.96%), VeIP (Vepeside, Ifostamide, Cisplatin – 14.21%), TIP (Taxol, Ifostamide, Cisplatin – 4.91%) and Carboplatin (3.51%). Acute and subacute toxicities in term of gastrointestinal, hematological, cutaneous, neurological, renal, pulmonary and allergic reac­tions were graded and analyzed according to National Cancer Institute of Canada common toxicity criteria (NCIC CTC). Results: According to risk factors, stage and chemotherapy regimens used, the main toxicities were: gastrointestinal (max 60%), hematologi­cal, with maximum of: 44% anemia, 30% leucopenia, 9% thrombocytopenia, neutropenic fever 10%), neurological (max. 10%), cu­taneous (max 7%), renal (max. 3%), allergy (max. 2%), pulmonary (2%), and of course, alopecia (100%, except patients treated with carboplatin). Conclusions: Acute toxicities in our patients were mild/moderate and manageable, with no toxic deaths.

Key words: Germ cell tumors, Chemotherapy, Acute toxicity.

119 CorCorrelation Between Histopathological Minor Prognostic Factors in Laryngeal and Pyriform Sinus Carcinoma

Magdalena Chirilă1, Sorana D. Bolboacă2, Marcel Cosgarea1 , Ermil Tomescu1, Marius Pop1, Cristina Ţiple1

Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania: 1 ENP Department; 2Medical Informatics and Biostatic Department

Objective: To investigate the correlation between perineural, lymphatic and vascular invasion in patients with squamous cell carci­noma of the larynx and pyriform sinus. Study Design: Prospective study of patients with laryngeal and hypopharyngeal squamous cell carcinoma who had undergone total or partial laryngectomy. Methods: Patients with squamous cell carcinoma of the larynx and pyriform sinus who had undergone laryngectomy between 2002 and 2006 in the ENT Clinic of Cluj-Napoca were investigated for perineural, lymphatic and vascular invasion. A correlation analysis between those minor factors on disease-free survival was per­formed. Results: 396 patients were included in the study. The mean disease-free survival of patients with or without perineural inva­sion of the minor nerves proved to be statistically significant (p = 0.000102). The mean disease-free survival of patients with or with­out lymphatic invasion proved to be statistically significant (p = 0.000000). The mean disease-free survival of patients with or with­out vascular invasion proved to be statistically significant (p = 0.000021). No significant correlation was identified between the three minor prognostic factors on their cumulative effect on disease-free survival. Conclusion: Perineural, lymphatic and vascular invasion influence independently disease-free survival.

Key words: Perineural, Lymphatic, Vascular, Invasion, Correlation.

124 The Role of Recombinant TSH on the Lipid Metabolism in Patients with Differentiated Thyroid Carcinoma

Doina Piciu1, Cosmin Lisencu1, Carmen Georgescu2, Ileana Duncea2, Letiţia Blag3 , Cristina Moisescu1, Claudiu Peştean1, Alexandra Roman1, Adela Bara1

1 Ion Chiricuţă Institute of Oncology Cluj-Napoca; 2 Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca; 3 Synevo Laboratory Cluj-Napoca, Romania

Background: Differentiated thyroid carcinoma (DTC) has an increasing incidence and is presently on the 4th highest position regarding the different malignant tumors in the Ion Chiricuţă Institute of Oncology Cluj-Napoca, in 2008. The aim of the study was a comparative analysis of lipid changes after hormonal withdrawal of patients with DTC or by stimulation with recombinant TSH (Thyrogen). Patients and meth­ods: We studied 2 groups of patients with DTC and normal initial lipid profile. Group A – 40 patients, mean age 47 years, with a fe­male/male ratio of 9:1. The evaluation after therapy consisted of TSH (thyroid stimulating hormone) increasing by stopping the hormone administration for 2 weeks and lipid profile analysis before and after the hormonal withdrawal. Group B – 10 patients B (9 women and 1 man) with the same mean age but with Thyrogen given for TSH increasing. Results: In group A the TSH values rose to 10 ng/ml in 72.5% cases and the lipid parameters varied by 47- 92.5 %. Group B revealed a higher increase of TSH, more than 500 times over basal, and the value of the lipid profile varied between 0-21%. Conclusions: The repeated changes of lipid profile during long-term monitoring of DTC may involve secondary pathologies. Limiting these complications by using recombinant TSH seems to be a reasonable solution.

Key words: Thyroid cancer, Lipid profile, Recombinant TSH.

129 Multiple Synchronous Primary Cancers: Gastric, Hepatic and Soft Tissue. A Rare Case Report

Mircea Cazacu1,2, Răzvan Simescu1,2, Gabriel Petre1,2, Flaviu Mureşan1,2, Iacob Domşa1, Anca Mihailov1

1 4th Surgery Clinic Cluj-Napoca; 2 Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca

It is known that the incidence of neoplasic disease increases with age. The incidence of multiple primary cancers follows the same pattern. Although rare, these multiple tumors are encountered more frequently in the last years. As the number of older people in­creases, the occurrence of multiple cancers is also likely to increase. We report the case of a 72 year old patient in whom gastric can­cer, hepatocellular carcinoma and sarcoma of the right thigh were simultaneously diagnosed. The only possible predisposing factors were smoking habits and excessive drinking. We also discuss the risk factors of each individual tumor, their possible association and new theories that might explain this rare tumor association. It is important for clinicians to keep in mind the possibility of simultane­ous malignancies in a patient and thus to investigate them properly. To our knowledge, this is the first report of three simultaneous cancers with such pathological diagnostics.

Key words: Multiple Primary Cancer, Risk Factors, Gastric Cancer, Hepatocellular Carcinoma, Soft Tissue Sarcoma.

134 Pulmonary Endobronchial Chondroid Hamartoma. A Case Report and Review of the Literature

Minerva Miloiu3, Constantin D. Olinici1,2,3, Bogdan Popovici4

1 Dept. of Pathology, Emergency Clinical Hospital Cluj-Napoca; 2 Dept. of Pathology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca; 3 Dept. of Pathology, I. Chiricuţă Institute of Oncology, Cluj-Napoca; 4 Clinic of Thoracic Surgery, Leon Daniello Clinical Hospital of Pneumology Cluj-Napoca

Pulmonary hamartomas are benign, usually parenchymatous lesions, discovered incidentally. In this paper we report the case of a 42­year-old male with several pneumonia episodes in the last year. Both CT scan and bronchoscopy revealed an endobronchial lesion. The patient underwent a pulmonary lobectomy and histopatologic examination revealed a lesion composed of islands of cartilage, fat, bronchial epithelium and nervous structures. The clinicopathological features of the entity are discussed.

Key words: Lung, Hamartoma, Endobronchial.

138 Highlights from the Breast Cancer Oral Presentations of the 45th Annual Meeting of the American Society of Clinical Oncology (ASCO)

May 29th – June 2nd 2009, Orlando, Florida, USA

Gabriela Morar-Bolba, Alexandru Eniu

Ion Chiricuţă Institute of Oncology Cluj-Napoca, Dept. of Breast Tumors

The 45th annual meeting of the American Society of Clinical Oncology took place on May 29th – June 2nd 2009 in Orlando, Florida. Im­portant clinical and research data in the field of breast cancer presented during this prestigious meeting is reviewed in this material.

Key words: Breast Cancer, Adjuvant therapy, Metastatic breast cancer therapy.

145 Guidance for Authors on the Preparation and Submission of Manuscripts to the Journal of Radiotherapy and Medical Oncology