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Volum 15 Numarul 4, 2009

201 The 20th Congress of the Romanian Society for Radiotherapy and Medical Oncology A Continuous Challenge: The Gynecologic Cancers

205 What are the Factors Determining Authorship?

Viorica Magdalena Nagy1,2, Mihai Ghilezan3

1Iuliu Hatieganu University of Medicine and Pharmacy, Cluj; 2Ion Chiricuţă Institute of Oncology, Dept. of Radiotherapy, Cluj, Romania; 3William Beamount Hospital, Dept. of Brachytherapy, Michigan, USA

Authorship has aroused many controversies in the scientific literature and the elaboration of a clear guideline regarding who to include as an author and who not to has became necessary worldwide. The International Committee of Medical Journal Editors (ICMJE) has produced multiple editions of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. The last version from 2008 of the Uniform Requirements for Manuscripts (URM) includes many chapters. Below the Ethical Considerations referring to Authorship and Contributorship are presented. Authorship credit should be based on: 1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; 3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3. All contributors who do not meet the criteria for authorship should be listed in an acknowledgments section.

208 What are the Factors Determining Authorship? Targeted Therapy in Oncology – Mechanisms of Action and Classification (I)

Răzvan Ovidiu Curcă1, Andrei Fodor2

1Emergency County Hospital Alba Iulia, Medical Oncology Department, 2 Scientific Institute San Rafaelle, Radiotherapy Department, Milan, Italy

The present paper is the first part of a comprehensive review of the mechanisms of action of a new weapon in the therapeutic armamentarium used in oncology‑ molecular targeted therapy. In addition, a classification of the current targeted therapy drugs based on these criteria is proposed.

Key words: Targeted, Therapy, Mechanism, Action, Classification.

217 Multidisciplinary Treatment of Head and Neck Cancer

Elisabeta Ciuleanu1, Marius Mureşan2

1Ion Chiricuta Institute of Oncology, Dept. of Radiotherapy, Cluj, Romania; 2CHU Henri Mondor, Creteil, Université Paris XII, Dept. of Radiotherapy, France.

Head and neck cancer refers to a heterogeneous group of tumors that comprise: nasopharynx, nasal cavity, paranasal sinuses, oropharynx, oral cavity, larynx, hypopharynx, salivary glands and thyroid gland. The most frequent sites are oral cavity, larynx and hypopharynx. About two‑thirds of patients with head and neck cancer present with locally advanced disease, with or without regional lymph node involvement. The rate of curability for them is around 30 %. Treatment is multidisciplinary (including surgery, radiotherapy, chemotherapy and targeted therapy) and depends on a variety of factors including the tumor stage, precise anatomic location, histological type and overall health status of the individual patient.

Key words: Head and neck cancer, Multidisciplinary treatment.

222 The Maintenance Phase in the Management of Advanced Non‑small Cell Lung Cancer: Modalities and Recommendations

Tudor Eliade Ciuleanu1,2, Dana Iancu1, Helen Homokos3

1Ion Chiricuţă Institute of Oncology, Dept. of Medical Oncology, Cluj; 2Iuliu Haţieganu University of Medicine and Pharmacy, Cluj; 3Institute Gustave Roussy, Villejuif, Dept. of Medical Oncology, Paris, France

After the demonstration of the efficacy of new molecules in 2nd line setting in advanced non‑small cell lung cancer (NSCLC), the concept of maintenance therapy was revisited. The terms maintenance, consolidation or early second‑line are often used interchangeably. Either one drug included in the induction regimen (continuation maintenance) or another non‑cross‑resistant agent can be used (sequential therapy). Four different approaches were investigated. The evidence from recent randomized trials and a meta‑analysis suggest that by giving an active treatment immediately after first‑line chemotherapy in patients that are not progressing, overall survival is prolonged. Recommended drugs for sequential maintenance after a platinum doublet are pemetrexed (for non‑squamous patients) and erlotinib. Maintenance with bevacizumab, or cetuximab is recommemded if these agents were included in the initial combination .The benefits of the maintenance therapy are demonstrated only for patients with performance status 0‑1.

Key words: Maintenance therapy, Advanced non‑small cell lung cancer.

226 Instruments Used in the Quality of Life Evaluation for Localised Prostate Cancer Patients Treated with Permanent Brachytherapy

Laura Rebegea Paraschiv1, Rodica Anghel2, Mihaela Dumitru1

1St. Ap. Andrew Clinic Emergency Hospital, Dept. of Medical Oncology and Radiotherapy, Galaţi, Romania
2 Prof. Dr. Alexandru Trestioreanu Institute of Oncology, Bucharest, Romania

Quality of life represents one of the evaluation methods for side effects of a treatment. It is influenced by a number of factors and can be evaluated with a variety of validated instruments by different medical associations and societies. Brachytherapy for localized prostate cancer is followed by urinary, rectal and sexual morbidity. This study reviews the recommended instruments for the evaluation of morbidity after permanent prostate brachytherapy, with their advantages and limits.

Key words: Prostate cancer, Brachytherapy, Quality of life.

231 Selective Neck Dissections in Larynx and Pyriform Sinus Carcinoma

Magdalena Chirilă1,2, Cristina Ţiple2, Mihaela Mureşan4, Sorana D. Bolboacă3, Mirela Stamate2, Ermil Tomescu1, Marcel Cosgarea1,2

1Iuliu Haţieganu University of Medicine and Pharmacy, ENT Dept.; 2Emergency County Hospital Cluj, ENT Dept.; 3Iuliu Haţieganu University of Medicine and Pharmacy Medical Informatics and Biostatistic Dept.; 4Emergency County Hospital, Pathology Dept.

Objective: To investigate the role of selective neck dissection in patients with squamous cell carcinoma of the larynx and pyriform sinus. Study Design: Prospective study of patients with laryngeal and pyriform sinus squamous cell carcinoma who have undergone selective or comprehensive neck dissection. Methods: We have examined specimens from 396 patients in whom neck dissection was part of the primary treatment of laryngeal and hypopharyngeal carcinoma. For N+ neck we performed 334 selective neck dissections and 64 comprehensive neck dissections. For N0 neck we performed elective neck dissection of node levels I, II, III, IV. Results: The difference between survival at 2 years after surgery was statistically significant, dichotomized in No, N1 – N2a – N2b and N2c – N3 (No vs. N1 p=0.00081; No vs. N2a p=0.04280; No vs. N2b p=0.0000; No vs. N2c p=0.0000; No vs. N3 p=0.0000). There was no difference between survival of the patients with N1 vs. N2a or N2b or N2a vs. N2b in whom neck dissection was performed in the selective type of node levels II, III, IV, V and VI. Cox hazards showed that the final point of the recurrence was significantly correlated with pyriforn sinus and subglottis as the primary site of the tumour, resection borders status and N stage. Conclusion: Our results support the use of elective dissection of node levels II to IV for No laryngeal and hypopharyngeal carcinoma. We suggest the inclusion of level VI nodes for tumors invading the subglottis and pyriform sinus apex.

Key words: Neck Dissections, Larynx, Sinus Carcinoma

237 A Comparison of Weekly versus Daily Imaging for Prostate Intensity‑Modulated Radiotherapy

Niamh Sheehy, Luke Rock, Jennifer Freeland

Beacon Cancer Centre, Sandyford, Dublin, Ireland

Background and purpose: To assess a standard weekly imaging protocol for prostate IMRT patients against daily on‑line imaging to determine if increased accuracy due to the elimination of random error has an impact on the dose distribution and workload. Materials and Methods: Orthogonal kV image sets acquired for 480 fractions of 11 patients’ treatment sessions were analysed retrospectively to determine those random errors that would have been missed without the daily correction of setup deviation. The effect of both large errors and shifts that fall within previously acceptable tolerances was then simulated on a planning system to determine their impact on the dose distribution. Results: Even with regular imaging it was found that 19% of fractions would have been delivered incorrectly without daily verification. There was also considerable variability between patients highlighting the difficulty in using a population‑based imaging protocol. Shifts that were within action thresholds were found to lead to a decrease in the minimum PTV dose and increase in the rectal V50%. Conclusions: Daily on‑line image guidance and correction of all setup deviations is the only way to eliminate all random errors and achieve the intended dose distribution.

Key Words: Image guided radiotherapy (IGRT), Setup error, Position verification, On‑line imaging.

242 Treatment of Renal Cell Carcinoma with Liver Metastases: A Case Report

Constantin Ciuce1, Bogdan Feciche2, S. Şerban1, R. Scurtu1, Victor Matei3, Ion Coman2

1Surgical 1st Clinic Cluj‑Napoca; 2 Clinical Municipal Hospital, Dept. of Urology, Cluj‑Napoca; 3 European Institute of Oncology, Dept. of Urology, Milan, Italy

Renal cell carcinoma represents approximately 3% of all adult malignacies. Its incidence has increased in the last two decades mainly due to a better imagistic diagnosis . One third of patients present a systemic disease from the beginning and 40% of those with organ-confined disease will develop metastases. Renal tumors spread mainly by hematogenous way and hepatic metastases represent only the 5th place between M+ sites after lung, brain, cerebrum, skeletal system, lymph nodes. Hepatic involvement represents a poor prognostic factor; in 95% of cases it is not the only metastatic site.

We present the case of a 59 years patient with a left renal Bellini’s duct carcinoma T3aN1M1 (M1 – unique liver lesion in the left hepatic lobe of 3.5 cm diameter), emphasizing the up front surgical approach as complete excision.

Key words: renal carcinoma, liver metastasis, complete excison

245 Acute Myeloid Leukemia and Type 2 Diabetes Mellitus in Complete Remission After Allogeneic Stem Cell Transplantation

Delia Dima1, Andrei Cucuianu1, Smaranda Arghirescu2, Hartmut Dohner3

1Ion Chiricuta Institute of Oncology, Dept. of Hematology, Cluj; 2 University Timişoara, Children’s Hospital, Bone Marrow Transplant Unit, Romania; 3 Department of Internal Medicine, University III of Ulm, Germany

Gemistocytic Hematopoietic stem cell transplantation has become an important aspect of treatment for malignant hematological disorders, but also shows promise in the treatment of metabolic disorders and autoimmune diseases. We present the clinical observation of a female, 54 year old patient, who was diagnosed in our institution with AML‑ M1, normal karyotype (FLT3 and NPM1 wild type) in January 2008. Between January and July 2008 she was treated with the ICE induction chemotherapy regimen, followed by high dose cytarabine and idarubicine consolidation chemotherapy. Complete hematological remission was obtained after the induction chemotherapy. The patient had previously been diagnosed with severe type 2 diabetes mellitus and was under insulin treatment. In October 2008 the patient underwent sibling HLA‑identical allogeneic stem cell transplantation, with busulfan/cyclophosphamide conditioning. The post‑transplant hematological recovery was satisfactory with the persistence of mild thrombocytopenia, anemia and lymphocytosis. After transplantation, there was also no need for insulin treatment, since the blood glucose remained constantly under 150 mg/dl. There was an episode of acute hepatic and cutaneous GVHD which was resolved after corticosteroid therapy and an increase in cyclosporine dosage. No significant increase of serum glucose was observed despite corticosteroid therapy. Presently, the patient is still in complete hematological remission, with 100% donor chimerism and normal glucose levels. As autoimmunity seems to play a role in type 2 insulin‑dependent diabetes mellitus, it is conceivable that the complete hematological overhaul following allogeneic stem cell transplantation, including a “reset” effect on the immune system has played a role in the complete recovery from type 2 diabetes mellitus in our patient. An alternative explanation may be a repopulation of pancreatic islets with donor derived stem cells. Allogeneic stem cell transplantation may emerge as a powerful, albeit an extreme tool for treating autoimmune diseases associated or not with malignant hematological diseases.

Key words: Acute myeloid leukemia, Diabetes mellitus type 2, Allogeneic stem cell transplantation

249 Contents of Journal of the Romanian Society for Radiotherapy and Medical Oncology, Vol. XV, 2009

253 Index of Themes 2009

256 Index of Authors 2009

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