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Volum 16 Numarul 4, 2010

169 Editorial: RSRMO 20 – Congress Report, 30 September-2 October 2010, Cluj-Napoca

Viorica Magdalena Nagy

171 The Utility of PET-scan in the Clinical Management of Epithelial Ovarian Cancers

Simona Mihuţiu1,2, Oreste Straciuc2,3, Ioana Puşcaş1

1Clinical Emergency County Hospital of Oradea, 2Oradea University, Faculty of Medicine and Pharmacy, 3Pozitron Diagnostika Oradea

The purpose of this paper is to analyse the data from the literature regarding the utility of PET-CT in the management of patients with epithelial ovarian cancer. We reviewed the data regarding the role that FDG PET-CT could play in the screening of ovarian can­cer, principally in the diagnosis and staging, in detecting positive lymph nodes and peritoneal implants. Also we analysed the infor­mation that PET-CT could add to the evaluation of the response to treatment and in detecting recurrent disease when serologic mark­ers are normal. The second part of this article is an example of the role that FDG PET-CT can play in current clinical practice: two clinical cases in which PET-CT had an important role in treatment and follow-up are described.

Key words: Positron emission tomography, Ovarian cancer.

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177 Radio-chemotherapy in Cervical Cancer: Proved Efficacity

Viorica Magdalena Nagy

Iuliu Haţieganu” University of Medicine and Pharmacy, „Prof.Dr.Ion Chiricuţă” Institute of Oncology Cluj-Napoca

For patients with locally advanced cervical cancer the standard choice of treatment until 1999 was radical radiotherapy with modest results. In that year, the results of five randomized trials led to a National Cancer Institute recommendation that concomitant chemo­radiotherapy should be considered standard care for women with cervical cancer. Two Cochrane reviews by Green from 2001 and 2005 concurred with this recommendation. In the new Cochrane review published by Vale in 2010 there was a 6% improvement in 5­year survival with chemoradiotherapy (HR =0.81, P < 0.001). At the “Prof.Dr.Ion Chiricuţă” Oncology Institute Cluj-Napoca, two randomized phase III single institutional studies were completed. The first study was initiated in 1999, and compared radiotherapy (RT) to concurrent radio-chemotherapy (RTCT) in locally advanced (IIB-IIIB) cervical carcinoma. 566 patients were included in the RT arm (284 patients) and in the RTCT arm with cisplatin 20 mg/m²×5 days, at 21 days (282 patients). The results showed the bene­fits of concurrent RTCT compared to RT alone in patients with locally advanced cervical carcinoma, regarding local control (78% vs. 67%) and 5 year survival rates (74% vs. 64%) (p < 0.05). In 2003 at the “Prof.Dr.Ion Chiricuţă” Oncology Institute “the second ran­domized phase III study was initiated which compared two concomitant RTCT regimens in stage IIB-IIIB cervical carcinoma. 326 patients were randomly assigned in the two arms of the protocol: 164 in the RTCT arm with cisplatin 20 mg/m²×5 days at 21 days and 162 in the RTCT arm with weekly 40 mg/m² cisplatin. The local control was significantly superior (87% vs 75%, p<0.01) and the 5 year overall survival was 6% better (78% vs 72%, p=0.14) in the 5 day regimens’ arm in comparison with the weekly cisplatin arm. Several molecular targeted agents possessing radiosensitizing properties opened the way for their testing either alone or with known cytotoxic radiosensitizers for cervical cancer. These results proved the obvious superiority of chemoradiotherapy compared with radiotherapy for women with cervical cancer.

Key words: Cervical cancer, Radiochemotherapy, Radiosensitizer.

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186 The role of adjuvant radiotherapy in endometrial cancer treated in the “Ion Chiricuţă” Institute of Oncology

Claudia Ordeanu1, Raluca Stăhiescu2, Ovidiu Coza1,2, Nicolae Todor1 , Alexandru Irimie1,2, Alexandru Trăilă1, Mihai Mureşan1,2, Ştefan Hica1 , Alin Rancea1,2, Viorica Nagy1,2, Eric Lartigau3

1 Ion Chiricuţă Institute of Oncology, Cluj-Napoca, Romania; 2 Iuliu Haţieganu University of Medicine and Pharmacy of Cluj-Napoca, Romania; 3 Centre Oscar Lambret, Lille, France

Background & Aims: Endometrial cancer remains the most common malignancy of the female genital tract and is usually managed surgically; generally adjuvant radiotherapy is necessary for patients who have a high risk of recurrence. The purpose of this study was to assess the efficacy of adjuvant RT following surgery in endometrial cancer with endometrial histology. Material and Method: From January 2001 to December 2004, 389 patients with endometrial cancer were treated at the Oncology Institute “Ion Chiricuţă”; 277 (71.21%) patients presented stage I, 74 (19.02%) – II, 34 (8.74%) – III, and 4 (1,03%) stage IV respectively. 96 (34.6%) patients, 51 (68.9%), and 21 (61.7%) of patients with stage I, II and III respectively, received adjuvant RT. Patients were stratified by age into the following groups: 50-59, 60-69, respectively ≥ 70 years of age. Results: The median follow-up was 87.95 months. Overall sur­vival was 97%, 91% and 80% respectively for the low, intermediate and high-risk group factor (p<0.01). Patients with endometrial cancer have different risks of local recurrence depending on the presence of risk factors including stage, grade, lymphovascular space invasion and age. 46.67% patients from the high risk group including stage 1C and grade G3, IIA-G3 and IIB, without adjuvant ra­diotherapy, developed locoregional recurrence vs.12.28% who were treated with adjuvant RT (p<0,01). Patients with lymphovascular space invasion developed locoregional recurrence 17.31% vs. 7.42% respectively (p=0.04); 15 (9.26%), 13 (10.48%) and 12 (24.49%), patients aged 50-59, 60-69, respectively ≥ 70 presented locoregional recurrence (p<0.01). Conclusions: According to risk groups, adjuvant RT for patients with endometrial cancer has been shown to reduce locoregional recurrences in patients with stage I and II with high risk group factors.

Key words: Endometrial cancer, Adjuvant radiotherapy.

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184 Ovarian cancer epidemiology in Bihor County, Romania

Simona Mihuţiu1,2, Elisabeta Patcaş1, Ioana Puşcaş1

1Clinical Emergency County Hospital of Oradea, 2Oradea University, Faculty of Medicine and Pharmacy

Ovarian cancer is an important cause of morbidity and mortality for women around the globe. The most important prognostic factor in ovarian cancer is the clinical stage; because the early stage does not manifest clinically all the time and the majority of cases are discovered in advanced stages This is reflected in the high mortality rate. We analyzed the number of new cases per year and the characteristics of ovarian cancer in Bihor County and also the access to diagnostic and treatment methods. The purpose of this pa­perwork is to underline the importance of collecting and analyzing epidemiologic data and the imperative need of a national cancer registry.

Key words: Ovarian cancer, Epidemiology, Bihor Count.

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198 Therapeutic results for recurrent and metastatic cervical cancer

Vlad Alexandru Manolescu1, Mirela Haţiegan1, Claudia Ordeanu1, Nicolae Todor1 , Ovidiu Coza1,2, Viorica Nagy1,2

1“Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj Napoca, Romania, 2“Iuliu Haţieganu” University of Medicine and Pharmacy

Background and Aims: This retrospective study included 43 patients with recurrent or metastatic cervical cancer treated in the “Prof. Dr. Ion Chiricuţă Oncology Institute”, Cluj-Napoca, between 01January2008-31December 2009. The treatment consisted of chemo­therapy +/- radiotherapy or surgery. The study was performed in order to evaluate the chemotherapeutic response of this malignancy. Patients and Methods: According to the initial staging, 9 patients (21%) suffered from stage I cervical cancer, 13 (30%) stage II and 21 patients (49%) with stage III disease. The main pathologic type was squamous cell cervical carcinoma (93%). The main cause of primary treatment failure was the local relapse for 29 patients (51%), local relapse and metastatic disease for 7 patients (16.5%) and 14 patients (32.5%) presented metastatic disease. The management of the primary treatment failure consisted of chemotherapy for 17 patients (39.5%) while chemotherapy was associated with a form of local treatment (radiotherapy+/-surgery) in 26 cases (60.5%). Two chemotherapy regimens (3-6 cycles) were evaluated: 28 patients (65%) received Paclitaxel 175mg/m2 + Carboplatin AUC5 and 15 patients(35%) received Topotecan 0.75mg/m2 day 1-3 + Cisplatin 50mg/m2 day 1. Results: The therapeutic results consisted of complete response for 14 patients (32.5%), partial response for 5 patients (11.5%), and stationary disease in 8 cases (18.5%). Disease evolution was not influenced by the treatment for 19 patients (37.5%). The overall survival for a median 16.5 month follow-up was 51 %. Conclusions: The two chemotherapeutic regimens (Paclitaxel+Carboplatin and Topotecan+Cisplatin) are efficient for the treatment of recurrent and metastatic cervical cancer. Consequently, 19 patients (44%) obtained objective response (complete and partial response). However, a randomized prospective trial is necessary in order to compare the two chemotherapy regimens included in this study.

Key words: Metastatic cervical cancer, Recurrent cervical cancer, Chemotherapy, Topotecan, Cisplatin.

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202 Treatment of Glioblastoma Multiformethe Experience of the Radiotherapy Department of Sibiu

Adrian Moga

“Victor Papilian” Faculty of Medicine Sibiu

Background: Primary brain tumours are uncommon and comprise only 1.6 per cent of cancers. Malignant gliomas include a spec­trum of primary brain tumors that represent some of the most lethal and debilitating neoplasms known. Despite more than 30 years of extensive clinical trials, progress has been made only recently in the treatment of these neoplasms. Material and methods: We per­formed a retrospective analysis of 273 brain tumors from which 49 patients with histological proven glioblastoma multiforme were treated with radiotherapy and chemotherapy in the Radiotherapy Department of the Emergency County Hospital of Sibiu from 2000

– 2008. Results: Forty- nine patients with glioblastoma multiforme were treated in our Department of Radiotherapy. The initial therapeutic approach was surgery in all 49 patients.Chemoradiotherapy was administered in 29 patients. Concomitant chemoradio­therapy was administered in 6 patients. Conclusions: Concomitant Temozolomide/ radiotherapy followed by adjuvant Temo­zolomide increases survival in patients with glioblastoma multiforme and it is also necessary to improve the treatment planning tech­nique. Radiotherapy should be fully conformal.

Key words: Glioblastoma multiforme, Radiotherapy, Temozolomide.

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206 Complex, Immuno-chemo-antiviral Therapy in Hepatitis C Virus Related Non-hodgkin’s Lymphoma: A Case Report and Review of the Literature

Andrei Cucuianu1, Bogdan Fetica2, Delia Dima1, Călin Coldea1

1“Ion Chiricuţă” Cancer Institute, Hematology Department, Bvd. 21 Decembrie Nr 73, 400124, Cluj-Napoca, Romania; 2“Ion Chiricuţă” Cancer Institute, Pathology Department, Str. Republicii 34-36, Cluj-Napoca, Romania

Abstract. Several epidemiological and experimental studies published during the past 15 years have found a relationship between hepatitis C virus (HCV) infection and the development of certain types of B-cell non-Hodgkin’s lymphoma. In our country this asso­ciation seems even more significant than in other European countries, probably due to the high overall prevalence of HCV infection. The addition of antiviral treatment to standard chemo-immunotherapy may benefit not only by acting on a possible pathogenetic link but also by preventing an exacerbation of HCV-induced liver damage after immunosuppressive chemo-immunotherapy. We present the clinical case of a patient who was known as a HCV carrier since 2003 when he was diagnosed in 2006 with extranodal (liver, pa­rotid and bone marrow) diffuse large B-cell lymphoma and was successfully treated with a complex chemo-immuno-antiviral asso­ciation (R-CHOP + interferon/ribavirin). We believe that such a treatment association should be offered to all patients with HCV-related NHL, being both effective and safe.

Key words: Non-Hodgkin’s lymphoma, Hepatitis C virus, Rituximab, Interferon.

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212 The XXth Congress of RSRMO. “Resident’s Afternoon” Highlights, Cluj-Napoca 30th September – 2nd November, 2010

Vlad Manolescu

213 The 21st Congress of the Romanian Society for Radiotherapy and Medical Oncology ETHICS, EFFICIENCY and EFFECTIVENESS in ONCOLOGY, October 13-15, 2011 Satu-Mare, Romania

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