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Volum 15 Numarul 3, 2009

151 In Memeoriam. Professor Dr. Vasile Dragon

Nicolae Ghilezan

153 Editorial

Gabriel Kacsó

166 Guidelines for Selective Neck Irradiation in Head and Neck Carcinoma

Ovidiu Vereşezan, Nicolae Ghilezan

1 Henri Becquerel Cancer Centre, Rouen, France, 2 Ion Chiricuţă Institute of Oncology, Cluj-Napoca, Romania.

Background: for the Intensity Modulated Radiotherapy (IMRT) of Head and Neck (H&N) malignancies, an adequate selection and delineation of target volumes is of critical importance. For the neck, the data on node distribution supports the concept of selective nodal irradiation according to nodal status. Methods: looking at the literature data, we will propose guidelines for selective neck irradiation in carcinoma of the head and neck. Results: For N0 and N1 patients, selective irradiation of level II–IV or level I–III can be recommended for oropharyngeal, hypopharyngeal/laryngeal, or for oral cavity primaries. For nasopharyngeal tumors and for patients with a neck staged higher than N2a, comprehensive irradiation of all neck levels is recommended. Conclusions: Taking the data of surgical, pathological and clinical series together, guidelines for selective neck node levels irradiation could be proposed. These guidelines were based more on logical assumptions than on definitive data, which are unfortunately still lacking. Implementation of these guidelines in the daily practice of radiation oncology should contribute to reduced treatment variations and help to conduct multi-institutional clinical trials or retrospective studies.

Key words: Selective neck irradiation, IMRT of H&N malignancies

170 Evidence Based Radiation Oncology in Early Breast Cancer: a Brief Review

Daniela Martin1, Cristina Vitoc2, Radu Tănăsescu2, Dana Grecea2, Carmen Lisencu2, Carmen Popa1,2, Valentin Cernea1, Nicolae Ghilezan1

Ion Chiricuţă Institute of Oncology, Cluj-Napoca, Radiotherapy Laboratory¹, Senology Department²

In breast cancer, radiotherapy (RT) is given after conservative or radical surgery, adapted to patient and tumor characteristics. The main goal of radiotherapy is to eradicate residual tumor deposits and to reduce their potential risk of dissemination. Radiotherapy given either after conservative surgery to N0/N+ patients (50-60 Gy) or after radical surgery to node positive (N+) patients (40-50 Gy), does not just reduce the local recurrences risk (LRR), but also improves long term survival. The local recurrences rate is significantly reduced by boosting the tumor bed with 10-16 Gy. The absolute reduction in the local recurrence rate as a result of the boost is 10 times greater for younger patients. 3D planning based on a CT-scan of the breast is necessary. CT simulation offers the potential to move to a 3D planning “zone”, where clinical target volume and organs at risk can be defined and margins can be added to account for the organs movement or set-up errors. All geometric uncertainties will be incorporated into the breast planning process, and, finally, the field’s geometry can be established.

Key words: Breast-conserving treatment, Boost, 3D conformal radiotherapy.

175 Prevention of Cervical Cancer: Progress and Challenges on HPV Vaccination and Screening

Viorica Magdalena Nagy

Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania;

Ion Chiricuţă Institute of Oncology, Cluj-Napoca, Romania

Cervical cancer represents an important global public health problem; there are an estimated 493,000 to 510,000 newly diagnosed cases of cervical cancer annually around the world, and 234,000 to 288,000 of those women will die of the disease. During the last decade, research progress on cervical cancer has elucidated the role of HPV in the pathogenesis of cervical cancer. The identification of the most common disease-causing HPV types has led to the development of the prophylactic vaccines. Clinical trials on the VLP HPV vaccines have good safety profiles and promising efficacy in preventing genital warts, cervical neoplasia, and cervical cancer. The prophylactic administration of the quadrivalent vaccine has resulted in a 96% efficacy in preventing persistent infection associated with HPV types 6, 11, 16 and 18. Similar to the quadrivalent vaccine, the bivalent vaccine is highly efficacious (96%) in preventing persistent infection against vaccine-specific HPV types (HPV-16 and HPV-18) among women who were HPV seronegative at the time of vaccination. However, the screening program will continue to serve as a critical component in prevention due to the limitations of the current vaccine.

179 Squamous Cell Carcinoma Antigen and Response to Therapy for Cervical Cancer

Teodora Flonta1, Nicolae Todor2, Viorica Magdalena Nagy1

Ion Chiricuţă Institute of Oncology: 1Dept. of Radiotherapy; 2Dept. of Medical Informatics Laboratory

Purpose: to determine the correlation of pretreatment squamous cell carcinoma antigen (SCC-Ag) level with the tumor size and the stage of disease and to determine the value of the use of SCC in assessing tumor response to radio-chemotherapy in patients with locally advanced carcinoma of the uterine cervix. Materials and methods: For 51 patients with primary squamous cell carcinoma of the cevix treated in the “Prof. Dr. Ion Chiricuta” Institute of Oncology Cluj-Napoca since March 2008 to April 2009, the pretreatment serum SCC level was assayed. Of those patients, 20 patients had stage II (one patient stage IIA and 19 patients stage IIB), 24 patients stage IIIA and 7 patients stage IIIB. Lesion size was <4 cm in 26 patients and >4 cm in 25 patients. Results: The mean value of pretreatment SCC-Ag was 7.1 microg/L: for stage II 3.83 microg/L and for stage III 9.13 microg/L, reflecting the correlation between pretreatment SCC level and the stage of disease (p=0.05). The mean value of pretreatment SCC-Ag was 7.1 microg/L: for stage II 3.83 microg/L and for stage III 9.13 microg/L, reflecting the correlation between pretreatment SCC level and the stage of disease (p=0.05). After treatment, 23 patients obtained CR, 18 patients PR and 10 patients were with stable disease or progression. Treatment response was correlated with the mean pretreatment SCC value: for patients with CR was 6 microg/L, for patients with PR 7.1 microg/L and for patients with SD and PD 9.4 microg/L, although the difference was not statistically significant. We also found a correlation between pre/post treatment value of SCC-Ag and clinical response. Conclusions: Our results confirm the good correlation between serum SCC antigen levels and extension of disease. We recommend that all patients with squamous cell carcinoma of cervix should have a pretreatment serum SCC assayed. For patients with raised serum SCC level, serial monitoring after treatment might enable early detection of recurrence.

Key words: SCC-Ag, Cervical cancer, Tumor size, Stage of disease, Clinical response.

187 Neoformation Tendons in Advanced Pericraniocervical Cancer

Octavian Chiş, Ioana Constantin, Ileana Hica, Vasile Popiţa, Mariana Bârsu, Rareş Buiga, Daniela Todea

Ion Chiricuţă Institute of Oncology Cluj-Napoca

Head and neck cancer presents a highly malignant cellular polymorphism, mainly based on the great structural histological diversity in this area, represented by: glands with a parenchymatous duct component, conjunctive tissue, dermal, hypodermal, sensitive, motor and vegetative neurovascular structures, bone, periostal, perichondral and cartilage, muscle, common peripheral or specific organic sensitive cells sensors. This paper report two cases of female patients, aged 81 and 83 respectively, hospitalized and treated in the E.N.T. department of the Ion Chiricuţă Institute of Oncology in Cluj-Napoca, for the same reason: hemorrhage. Following emergency respiratory and hemodynamic corrections, the patients required similar operations e.g. removal of huge tumors: total parotidectomy and radical neck dissection for a carcinoma on previous pleomorphic adenoma, respectively medial nose tumor resection for a melanoma with this location. No adjuvant treatment was given due to the age and co-morbidities.

Key words: Head and neck advanced cancer, Carcinoma expleomorphic adenoma, Melanoma, Total parotidectomy, Post hemorrhagic anemia.

192 Malignant Transformation of a Grade II Astrocytoma with an Unusual Recurrence in the Posterior Fossa

Dana Cernea1, Renata Zahu1, Ştefan Florian2, Magda Petrescu3, Liliana Rogojan3, Victor Bogdan1, Teodora Flonta1

1Ion Chiricuta Institute of Oncology, Department of Radiation Oncology, Cluj Napoca; County Emergency Hospital, Cluj Napoca: 2Department of Neurosurgery, 3Department of   Pathology

Gemistocytic astrocytomas tend to behave in a more aggressive fashion than other grade II tumors, with a high propensity for degeneration into anaplastic astrocytoma and glioblastoma multiform. We present the case of a 31 year old female, who was diagnosed with grade II astrocytoma with an important component of gemistocytic cells. The patient underwent biopsy, followed by conventional radiotherapy. The patient presented two relapses with malignant transformation of the tumor fenotype to glioblastoma multiform. 3D conformal reirradiation with concomitant chemotherapy with Temodal was administered. The third relapse occurred in the posterior fossa, in the vermis after a therapeutic abortion. This case reports aspects such as malignant transformation, reirradiation and relapse of secondary glioblastoma multiform.

Key words: Astrocytoma, Glioblastoma multiform, Radiotherapy, Reirradiation, Relapse.

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