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Volum 17 Numarul 1, 2011

5 The War on Cancer Turns Forty: a View from the Foggy Window of Acute Myeloid Leukemia

Andrei Cucuianu

9 Controversy on Radiotherapy Indications in the Management of Endometrial Cancer

Ovidiu F. Coza1,2

1“Ion Chiricuţă” Institute of Oncology Cluj-Napoca; 2“Iuliu Haţieganu” UMPh Cluj-Napoca

Surgical treatment represents the milestone of curative therapy for patients with endometrial carcinoma (EC). Adjuvant therapy is necessary in patients at high risk for recurrence. In early stage EC the role and type of adjuvant radiotherapy is still under debate. Several trials have evidenced that postoperative radiotherapy is able to reduce the risk of isolated local recurrence, without improving recurrence-free or overall survival. The PORTEC and GOG-99 trial randomized patients with intermediate-risk stage I, showing that external pelvic radiotherapy inproves local control but does not increase survival in patients with EC confined to the uterus, with or without surgical staging. The ASTEC trial randomized patients with IC-IIC or IA-IIA G3 or serous papillary/clear cell for lymphadenectomy, did not show a survival benefit for adjuvant radiotherapy in women with intermediate- or high-risk early stage EC. The PORTEC-2 trial compared the efficacy of adjuvant brachytherapy versus external radiotherapy in patients with early stage EC: they were equally effective in preventing vaginal recurrences but with less toxicity in brachytherapy patients. Therefore, brachytherapy should be considered the standard for these patients. In conclusion: early endometrial cancer with low-risk factors can be successfully treated by surgery alone. Patients with advanced EC (stage IIB-IV) should be considered for adjuvant radiotherapy, that would reduce local recurrence, with or without vaginal brachytherapy. The role and type of adjuvant radiotherapy in early stage (IB-IIA) EC remains controversial

Key words: Endometrial cancer, Adjuvant radiotherapy, Brachytherapy.

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13 CT Simulation for Radiotherapy in Breast Cancer Patients

Daniela Martin1, Dan Dordai1, Radu Tănăsescu1, Carmen Popa1, Daniela Grecea1 , Victor Bogdan1, Gabriela Tufăscu1, Aurel Chiş1, Lavinia Negruţ1, Călin Pleşa1 , Valentin Cernea1,2

1“Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania, 2“Iuliu Haţieganu” UMPh Cluj-Napoca, Romania

The implementation of 3D conformal and other modern techniques in a radiotherapy department is a complex process that requires sophisticated equipment, but at the same time, a clear and detailed description of the procedures and staff responsibilities involving all planning steps, from CT simulation to the verification of the designed treatment.

Key words: Virtual simulation, Radiotherapy, Breast cancer.

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23 Relationship of Circulating Tumor Cells’ Detection to Serologic and Imaging Response in Germ Cell Tumors: a pilot study. Is it a new prognostic factor in a new Era?

Cristina Ligia Cebotaru1, Rareş Buiga2, Alina Alexandra Lazăr4 , Adriana Plăcintar5, Nicolae Ghilezan1,3

1“Ion Chiricuţă” Institute of Oncology, Dept Radiotherapy I Chemotherapy, Cluj-Napoca, Romania; 2 “Ion Chiricuţă” Institute of Oncology, Head Dept Anatomopathology, Cluj-Napoca, Romania; 3“Iuliu Haţieganu” UMPh Cluj-Napoca, Romania; 4“Niculae Stăncioiu” Heart Institute, Dept of Cardiology, Cluj-Napoca, Romania; 5“Ion Chiricuţă” Institute of Oncology, Day Hospital Dept, Cluj-Napoca, Romania

Purpose: As treatment options are currently standardized for germ-cell tumors, and poor-prognosis patients still have a 50% chance to die of the disease, a blood marker with a prognostic and a predictive role could guide treatment. We tested the hypothesis that cir­culating tumor cells (CTCs) could predict clinical and serologic outcome in patients with germ-cell tumors with poor-prognosis fea­tures. Patients and Methods: We prospectively enumerated CTCs in the peripheral blood in two patients with poor-prognosis germ-cell tumors at baseline, before starting chemotherapy, and after one cycle and at the end of chemotherapy, with correlation with se­rum markers decrease and radiological response. CTCs were measured using a density gradient centrifugation separation technique and a immucytochemistry technique. Results: Enumeration of CTCs in the peripheral blood at baseline and after treatment correlated with serum markers decrease and radiologic response. Conclusions: The number of CTCs before, during and at the end of the treat­ment correlates with serum markers decrease and radiologic response in poor-prognosis germ cell tumor patients. CTCs may provide prognostic information in addition to former prognostic scores in order to adjust the therapy.

Key words: Circulating tumor cells, Germ cell tumors, Poor prognosis group, Prognostic factors.

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36 Low Dose Rate Brachytherapy with I-125 for Localised Prostate Cancer: Late Urinary and Rectal Morbidity Analysis

Laura Rebegea Paraschiv3, Rodica Anghel1, Mihai Harza2, Cătălin Dudu2 , Ionel Sinescu2, Mihaela Dumitru3, Liliana Domnişor2, Mihai Radulescu4

1Oncology Institute “Prof. Dr. A. Trestioreanu”, Bucharest, 2Clinical Institute Fundeni, Bucharest, 3Clinical Emergencies “Sf. Ap. Andrei” Hospital Galaţi Romania, 4Facharzt für Urologie/Andrologie, Kleinlbittersdorf, Germany

Objective: The evaluation of late urinary and rectal toxicity after iodine–125 permanent implant, establishing correlations between late urinary and rectal toxicities with clinical and dosimetric parameters. Materials and Methods: This is a prospective study that analyses the data of 110 patients with localized prostate cancer who underwent permanent implant with I-125 brachytherapy (BT) as monotherapy. The uniform modified implant technique was used for the implantation of seeds; the prescribed dose was 145Gy. Tox­icity was assessed using RTOG modified criteria. Results: The median follow up was 32 months (range 18-45 months). In this group, urinary late morbidity grade 1, 2 and respective 3 was recorded at 16.82%, 9.35% and respective 4.67% of cases. The urethral stric­tures and urinary incontinence occurred in 3.74% and 0.93% of cases, respectively. The late grade 1 urinary toxicity (TU1) was cor­related with pre-implant prostate volume and number of seeds (p<0.05). Logistic regression evidenced for late TU1 only one parame­ter with statistical significance being D90 real-time (p=0.044). The post-implant dosimetric parameters were not predictive factors for late urinary toxicity grade 1 (p>0.05), but post-implant prostate volume was. Late rectal morbidity grade 1 presented 3 patients (2.8%). Self limiting intermittent rectal bleeding presented in patients with the combined treatment (14.29%). We did not find > G1 complications. Conclusions: In our study, late urinary toxicities were mild/moderate with a greater incidence of late rectal morbidity in the combined therapy group.

Key words: Prostate brachytherapy, Late urinary and rectal toxicity.

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41 Bone Mineral Density Assessment in Children with Malignant Diseases

Adrienne Horvath1, Maria D. Baghiu1, Martha Pap2, Mihaela Chincesan1

1University of Medicine and Pharmacy Targu-Mures, Romania, Pediatric Clinic nr.1; 2Association for Prevention of Osteoporosis in Romania ASPOR Targu-Mures, Romania

Background: The developing bone mass, its mineral content and micro-architecture are negatively influenced by malignant dis­eases,-and when treated, chemotherapy, radiotherapy, life-style changes, imbalanced diet, malnutrition and decreased sun-exposure. The aim of the paper was to screen treated pediatric cancer patients for bone mineral density BMD and identify risk factors for osteo­porosis. Material and methods: this was a cross-sectional study performed on 20 children treated for different malignancies at the Pediatric Clinic nr.1 from Targu-Mures. Anthropological measurements, laboratory tests and calcanean osteodensitometry using the ALOKA AOS 100 ultrasound osteodensitometer were carried out during April 2010 in pediatric cancer patients during treatment, at a median of 16,4 months post diagnosis. Results: Low BMD (z-score < -1,5) was found in 65% of the patients. Low BMD appeared significantly more frequent in younger (Spearman correlation factor r=-0.-6526, p=0,0047) and leaner (r=-5975, p=0.0054) patients and in those hypocalcemic at presentation. The mean glucocorticoid therapy was 88 days (0-225 days) and the mean chemotherapy was 16.-4 months (2-36 months). We found a very weak positive correlation (r=0,018) between the length of glucocorticoid plus chemotherapy and low BMD. The observed risk factors for low BMD were additional cranial radiotherapy beside the chemotherapy (n=4), malnutrition (n=2), prior rachitism (n=4), gastrointestinal disorders (n=10) and reduced sun-exposure as well as decreased physical activity (n=20). Conclusions: In our cross-sectional study performed on 20 children treated for different malignancies, low BMD measured with calcanean ultrasound osteodensitometry was detected in 13 patients (65%). Calcanean ultrasound osteodensi­tometry is a cheap, harmless and easy investigational tool to assess osteopenia and osteoporosis in children with cancer, so that early diagnosis and treatment can be implemented.

Key words: Osteoporosis, Pediatric cancers, Risk factors.

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48 Survival and Treatment Failure in Uterine Sarcomas

Patricia Şuteu1, A. Irimie1,2, S. Hica2, O. Coza1,2, C. Căinap1,2, R. Buiga2, N. Todor2 , Viorica Nagy1,2

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

Background: Uterine sarcomas have an aggressive clinical behavior with a propensity to recur both locally and at remote sites. There is no definite evidence that adjuvant pelvic irradiation or systemic chemotherapy improves survival. The aim of this retrospective study was to evaluate the 5-year survival rate and the treatment failure in patients with uterine sarcomas. Materials and methods: We analyzed a group of 51 patients with uterine sarcomas treated in “Ion Chiricuţă” Institute of Oncology, Cluj-Napoca during 2004­2008. Surgery was the initial treatment for all patients; 53% of them received postoperative irradiation and/or chemotherapy. We de­termined the overall survival by the Kaplan-Meyer method and analyzed the overall survival rates according to histological type, grade, stage, type of treatment. Results: The 5-year overall survival was 60%: for stage I it was 70%, compared to stage II-III: 20% (p<0.01). The survival was 87 % for grades 1-2 tumors and 50 % for grade 3 (p=0.08). Patients who received adjuvant chemotherapy had a 5-year survival of 69%, compared to 55% in patients without chemotherapy, but the difference was not statistically significant. Survival, according to adjuvant radiotherapy, was similar in irradiated and non-irradiated patients. Treatment failure was observed in 51% of cases; 62% of the patients with grade 3 tumors relapsed vs. 13% of patients with grade 1-2 (p<0.01). Recurrence occurred in 38% of patients with stage I and in 83% of patients with stages II-III (p<0.01). Irradiation did not influence the recurrence rate. Che­motherapy tended to control better local and distant recurrences (36% relapse compared to 56% in patients without chemotherapy, p=0.18). Conclusions: The most important prognostic factor for survival is the surgical stage. Treatment failure was correlated with the tumor grade as well as the surgical stage. Adjuvant chemotherapy tended to ensure better local and distant control and, conse­quently, better overall survival.

Key words: Uterine sarcomas, Adjuvant treatment, Survival.

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56 Risk-adapted Chemotherapy in Germ Cell Tumors in a Single Institution Series: Long Term Results and Prognostic Factors

Cristina Ligia Cebotaru1, Nicolae Todor2, Nicolae Ghilezan1,3

1“Ion Chiricuţă” Institute of Oncology, Dept Radiotherapy Medical Oncology, Cluj Napoca, Romania, 2“Ion Chiricuţă” Institute of Oncology, Dept Informatics-Mathematics; 3“Iuliu Haţieganu” UMPh Cluj Napoca, Romania

Purpose: To assess long-term results of chemotherapy and surgery in germ cell tumors (GCT) at the “Ion Chiricuţă” Institute of On­cology, Cluj Napoca, between January 1982-January 2004, retrospectively. Patients and Methods: Five hundreds and seventy GCT patients received VAB6, BEP, EP, Carboplatin or TIP chemotherapy (CT) after orchidectomy. In partial responders (PR) with nega­tive markers (Mk-) a secondary resection was performed. In PR with positive Mk (Mk+), VeIP/VIP second-line chemotherapy was the standard treatment. For low-risk stage I non-seminoma patients, an active surveillance was an acceptable setting, as well as for stage I seminoma. Carboplatin for stage I seminoma was another treatment option instead of adjuvant radiotherapy. Results: There were 448 objective responses (OR) with 294 complete responses (CR), 73 patients having partial responses (PR) with negative mark­ers and 58 with PR and positive markers. All patients underwent surgery for RP, Mk-; complete resection (R0) was possible in 62 pa­tients and viable tumor was more frequent after VAB 6 than BEP/EP or TIP chemotherapy. With a median follow-up of 106.5 months (range 22-1222.1), the 8-year overall survival was 82%(CI 95%:78%-85%). Prognostic factors for survival in univariate analysis were: histology, age, stage, risk-group, initial and post-chemotherapy tumor markers and response to chemotherapy. Con­clusions: Risk-adapted treatment followed by response-guided secondary surgery for patients with germ-cell tumors results in very good outcomes. Other modern prognostic factors to adjust adequate treatment are required.

Key words: Germ-cell tumors, Chemotherapy, Secondary surgery, Prognostic factors, Survival.

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65 Solid-pseudopapillary Neoplasm of the Pancreas A report of eight cases and review of the literature

  1. Buiga1, I. Domşa2, Doiniţa Crişan3, Liliana Resiga1, Adriana Zolog2, C. D. Olinici3

1Department of Pathology, “Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania; 2Department of Pathology, 4-th Clinical Hospital, Cluj-Napoca, Romania; 3Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Cluj-Napoca, Romania

Solid-pseudopapillary tumors (SPT) of the pancreas are rare entities. In this paper we report eight cases and review the literature. In general, the tumors were usually large (6.6-20 cm diameter in our study) and frequently showed degenerative changes and micro­scopically they exhibited a dominant pseudopapillary pattern. The immune-histochemistry revealed the positivity for AE1/AE3, CD10, vimentin, synaptophysin, NSE and progesterone receptor.

Key words: Pancreas, Pseudopapillary tumor, Pathology.

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71 Primary Therapy of Early Breast Cancer 12th International Conference, Saint Gallen, Switzerland, 16-19 March 2011

Larisa Ciule

Department of Oncology, County Emergency Hospital Cluj-Napoca

The 12th International Conference of Primary Therapy of Early Breast Cancer took place between March 16-19, 2011 in St.Gallen, Switzerland. This is an annual international scientific conference for interaction and dissemination of information among scientists and clinicians working in the field of breast cancer and its consensus session, always at the end of the conference , influences treat­ments globally.

Key words: Breast Cancer, Cancer Therapy, Clinical Research.

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