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Volum 16 Numarul 1, 2010

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

7 Editorial

Gabriel Kacsó

8 Targeted Therapy in Oncology – Mechanisms of Action and Classification (II)

Răzvan Ovidiu Curcă1, Andrei Fodor2 1Medical Oncology Department, Emergency County Hospital Alba Iulia, Romania 2 Divison of Radiotherapy, Scientific Institute San Raffaele, Milano, Italy

The present paper is the second part of a comprehensive review of the mechanisms of action of a new weapon in the therapeutic armamentarium used in oncology – molecular targeted therapy.

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

15 Guidelines for the Evaluation of Thyroid Nodules

Alexandru Irimie1,2, Doina Piciu1, Ileana Duncea2, Cristina Goia-Moisescu1 , Claudiu Peştean2, Adela Bara1, Andra Piciu2 1Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania; 2 Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Background: Thyroid nodules are common and are frequently benign. The increasing number of patients presenting this pathology, asks for the introduction of a well defined strategy of evaluation, that will lead to substantially improving the management of thyroid nodules (TN). Patients and methods: The database consists of 1238 patients with thyroid nodules referred to the Institute of Oncology from Cluj-Napoca (IOCN) in 2009. There were 1022 female (82.6 %) and 216 (17.4%) male, with a median age of 48.7 years old. These patients underwent at least 1 procedure in IOCN: clinical examination, thyroid hormones analysis, thyroid ultrasound, thyroid scan, fine needle aspiration (FNA), radioiodine treatment or surgery. Results and discussions: A large number of these patients were sent to IOCN from many departments of endocrinology from the North Eastern part of the country. We were able to compare the management of patients with the strategy indicated by the international guidelines for thyroid nodule. The introduction of sensitive thyroid-stimulating hormone (TSH) assays, the widespread application of FNA, and the availability of high-resolution US have different impacts on a patient’s management in different medical centers. Conclusions: Because of the high prevalence of nodular thyroid disease, it is neither economically feasible nor necessary to submit all or even most thyroid nodules for a complete work-up for the assessment of their structure and function. Therefore, it is essential to develop and follow a reliable, cost-effective strategy for diagnosis and treatment of thyroid nodules.

Key words: Thyroid nodule, Evaluation, Guidelines.

20 Results of Treatment for Head and Neck Cancer in Elderly Patients: the Experience of Ion Chiricuţă Institute of Oncology Cluj

Andreea Oprea1, Elisabeta Ciuleanu1, Valentin Cernea2, Daniela Martin1 , Iolanda Hosu2, Marius Muresan3, Dănuţ Gheorghiu1, Octavian Chiş1, Vasile Popiţa1 , Nicolae Todor1 1Prof. Dr. Ion Chiricuţă Institute of Oncology, Cluj-Napoca, Romania; 2Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 3CHU Henry Mondor, Creteil, Université Paris 12, France

Purpose: To evaluate treatment results for head and neck cancer for elderly patients. Material and method: This is a retrospective study which included 127 newly diagnosed patients, with head and neck cancer, with ages over 70 years, treated in the Ion Chiricuta Oncology Institute of Cluj, from 2000 to 2006. The patients were treated by exclusive or associated surgery, irradiation or chemotherapy. Results: The median age of the patients was 74 years (range, 70-88); 114 were males, 13 females. The sites of the primary tumors were: oral cavity – 59 patients (46.6%), oropharynx – 15 cases (11.81%), hypopharynx – 13 (10.24%) and larynx – 40 patients (31.5%). The types of treatment included: exclusive surgery (S) for 50 patients (39.37%), radiotherapy (RT) for 41 patients (32.28%), associated S + RT for 23 (18.11%), radiochemotherapy (RCT) in 9 cases (7.09%) and only 2 patients had exclusive chemotherapy and 2 others – S + RCT. The response rates (% including complete response and partial response) for oral cavity, larynx, and hypopharynx and oropharynx carcinoma were: 95, 90, 77 and 53% respectively. With a median follow-up of 63.5 months (37117 months), the 5-year overall survival rate was: 84% for oral cavity, 78% for larynx, 36% for hypopharynx and 34% for oropharynx. Conclusions: In our experience, the most common location of head and neck cancer for elderly patients (above 70 years) is the oral cavity, followed by the larynx, oropharynx and hypopharynx. Early stages predominate for oral cavity and larynx, opposed to advanced ones for oropharynx and hypopharynx Surgery or/ and radiotherapy are the main treatment options, whereas chemotherapy was rarely used. However, adjusted for stage and site, the results are comparable to younger patients.

Key words: Head and Neck Cancer, Elderly, Therapy.

26 PET/CT-Guided Helical Tomotherapy Re-Irradiation in an “In Field” Breast Recurrence

Filippo Alongi1,2,3, Andrei Fodor1, Ana Maria Samanes Gajate4, Pierpaolo Alongi5 , Laura Longoni1, Luigi Gianolli4, Nadia Di Muzio1 1 Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy; 2IBFM-CNR (Istituto di Bioimmagini e Fisiologia Molecolare-Consiglio Nazionale delle Ricerche), Italy; 3LATO (Laboratorio di Alte Tecnologie Oncologiche), H San Raffaele G.Giglio, Cefalù, Italy; 4Nuclear Medicine Department, Scientific Institute San Raffaele, Milan, Italy; 5Medicine and Surgery School, University of Palermo, Italy.

The role and the modalities of re-irradiation of breast loco-regional recurrences are still to be established. In this paper we report a case of “in field” recurrence of breast carcinoma. The patient was re-irradiated after 12 years, with a second course of radiotherapy using 18FDG PET-guided Helical Tomotherapy. In our preliminary experience, the first reported using 18FDG PET-guided Tomotherapy, breast region re-treatment is safe and feasible. The clinical and instrumental follow-up after the last Tomotherapy fraction was 36 months, with no evidence of local disease and no acute or late toxicities. A Literature review of breast loco-regional radiation re-treatment was also discussed.

Key words: Re-irradiation, Tomotherapy, Breast, PET/CT.

30 Metastatic Breast Cancer in Men. Case Report and Review of the Literature

Adriana Mureşan1, Andrei Vlad Mureşan1, Adina Retegan2 , Alina-Simona Muntean1, Nicolae Ghilezan1 1Ion Chiricuta Institute of Oncology, Cluj, Romania; 2 County Emergency Hospital Cluj, Romania

Cancer of the breast among men is uncommon, accounting for less than 1 % of cancer incidence and mortality. Little is known about its etiology, clinical behavior, treatment and outcome. We present the history of a 35-year-old man who was diagnosed with metastatic breast cancer in 2006. After surgical consolidation for C3-C4 vertebral metastases, he underwent multidisciplinary treatment (chemotherapy, bilateral mastectomy with axillary dissection, radiation therapy, hormonal treatment with tamoxifen and letrozole and subsequent bisphosphonates and targeted therapy). Four years after the first diagnosis, the patient is still alive, with partial response and good quality of life (PS ECOG=1).

Key words: Men, Metastatic breast cancer, Treatment.

34 Complete Response after Chemotherapy with Dacarbazine in Metastatic Malignant Melanoma. Case Report and Review of the Literature

Alin Sîrbu, Răzvan Ovidiu Curcă, Dan Silviu CrainicEmergency County Hospital Alba Iulia, Romania

Dacarbazine still remains the standard of care in community practice. With dacarbazine as the single agent, an approximately 15-20% objective response rate can be achieved, with median response duration of 5 to 6 months and complete response rates of 5%. We report a case of a 36-yr old patient with malignant melanoma and lung metastases showing a complete remission after chemotherapy with Dacarbazine.

Key words: Metastatic malignant melanoma, Dacarbazine, Complete response.

37 Report on the 45th ASCO Meeting,

Orlando, Florida, May 29th-June 2nd 2009

Dana Ioana Iancu1, Tudor Eliade Ciuleanu1,2, Loredana Ioana Aracs Tamas3 , Helen Homokos4

1Ion Chiricuţă Institute of Oncology Cluj-Napoca; 2Iuliu Haţieganu, University of Medicine and Pharmacy Cluj-Napoca; 3Emergency County Hospital Cluj-Napoca, Romania; 4Institut Gustave Roussy, Villejuif, France

This is a brief presentation of new aspects in the management of several solid tumors (lung, gastrointestinal and renal cell cancer), that emerged from the plenary lectures and oral presentations held at the 45th annual ASCO meeting (Orlando, Florida, 29th May – 2nd June 2009). Our report does not cover the poster, educational and meet the professor sessions. References in brackets […] refer to the original assignment given in the ASCO abstract book.

Key words: ASCO, Trial.

Highlights from the Metastatic Breast Cancer Session of the 32nd Annual San Antonio Breast Cancer Symposium (SABCS)

40 San Antonio, Texas, USA, December 9-13, 2009

Carmen Bodale, Daniela Grecea

Ion Chiricuță Institute of Oncology

The 32nd Annual San Antonio Breast Cancer Symposium took place on December 9th – December 13th 2009 in San Antonio, USA. This article is a brief review of the most relevant results for clinical practice that were presented during the metastatic breast cancer therapy section. This year a significant part of the meeting was dedicated to anti-angiogenic treatment. Many oral presentations focused on the latest results regarding treatment with Bevacizumab, Sunitinib and Sorafenib in the metastatic setting. One of the main aspects of the 2009 San Antonio meeting was the confirmation of the major impact of Trastuzumab on blocking HER-2 receptor.