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Volum 17 Numarul 2, 2011

75 Why Ethics, Efficiency and Effectiveness?

  Stelian Pop

82 The Role of Radiotherapy in Pancreatic Cancer

  1. Fodor, P. Passoni, N. Slim, I. Dell’Oca, B. Pappalardi, N.A. Iacovelli, N.G. Di Muzio

Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy

The radiotherapy role in pancreatic cancer is under debate. The most relevant studies were reviewed trying to draw a conclusion re­garding the role of the radiotherapy in the management of pancreatic cancer.

Key words: A Pancreatic Cancer, Neoadjuvant, Adjuvant, Radical, Radiochemotherapy.

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90 Osteoclast Targeted Therapy in Prostate Cancer

Gabriel Kacsó

“Ion Chiricuta” Institute of Oncology, “Iuliu Hatieganu” Medical University of Cluj, Romania

Current standards of osteoclast targeted therapy in different stages of prostate cancer are reviewed, based on recent randomized trials with Denosumab for the prevention of skeletal related events, bone metastases and androgen deprivation therapy related fragility fractures.

Key words: Prostate Cancer, Bone, Targeted Therapy.

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94 Good Clinical Practice: Historical Background and Basic Principles

Ovidiu F. Coza1,2

1 Institute of Oncology “I.Chiricuţă” Cluj-Napoca; 2 University of Medicine and Pharmacy “I. Haţieganu” Cluj-Napoca

Clinical research trials are increasingly playing a role in medical research and knowledge for and compliance with good clinical practice (GCP) is essential for everyone involved. GCP is an international ethical and scientific quality standard for designing, conducting, recording and reporting trials that involve the participation of human subjects. The main objective of GCP guidelines is to provide a unified standard and to facilitate the mutual acceptance of clinical data. In this review article, key aspects of GCP are described, focusing on their justification, creation, improvement and use. GCP combine evidence-based medicine (when such an evidence exists) with expert opinion (on topics for which there is no evidence), in order to help clinicians to address these problems, creating documents that summarize knowledge and provide guidance to assist in delivering high-quality medicine. The 13 core principles established in this guideline are applicable to all clinical inves­tigations that may have an impact on the safety and well-being of human subjects.

Key words: Good Clinical Practice, Guidelines..

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97 Psychiatric Morbidity Among The Parents of Children Suffering from Central Nervous System Tumors and Bone Tumors

Mădălina Lamia Neamţu¹, Ştefania Neamţu², Mihaela Iancu³

¹University of Medicine and Pharmacy “Iuliu Hatieganu”, Department of Clinical Psychology, Cluj-Napoca, Romania; ²Oncology Institute “Prof. I. Chiricuta”, Department of Pediatric Oncology, Cluj-Napoca, Romania; ³University of Medicine and Pharmacy “Iuliu Hatieganu”, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania

Objectives: The aim of this study was to assess the frequency and associations of psychiatric disorders among the parents of children suffering from central nervous system (CNS) and bone tumors. Methods: The study included 24 parents of children suffering from CNS and bone tumors, who received treatment at the Oncology Institute in Cluj-Napoca between 2004-2008. The parents were inter­viewed and rated using the Zung Rating Depression Scale, the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Results: The children were diagnosed with CNS tumors (meduloblastoma) and with bone tumors. An average of 5 in 9 moth­ers on the Hamilton Depression Rating Scale (37.5%) – indicated a mild depression, an average score of 13.25 in 5 mothers (20.83%) indicated a moderate depression and an average score of 17.33 in 3 mothers (12.5%) indicated a severe depression. Fathers had symptoms of mild depressive episodes and did not have symptoms of anxiety and the scales were not applied. Severe depression oc­curred in a mother whose 11- month old child developed a second malignant neoplasm. Severe depressions were also registered in parents whose children died. One of the deceased children was 11 years old and was diagnosed with ependymoma, while the other subject was 5 years old and was diagnosed with astrocytoma. Another significant correlation was found between depression scores and anxiety scores. Conclusions: In the case of increased depression scores, we noticed increased emotional reactions in mothers. The mothers were diagnosed with moderate to severe depression including anxiety and were subsequently given treatment and psy­chotherapy.

Key words: Brain Cancer, Bone Tumor, Depression, Anxiety, Parents.

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102 Treatment of Gynecological Malignancies with Interstitial Brachytherapy

Ioana Lupşe1, Claudia Ordeanu1, Viorica Nagy1,2, Diana Patcaş1, Margareta Bako1

1Oncology Institute “Prof. I. Chiricuta”, Cluj-Napoca, Romania; 2University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania

Objective: The purpose of this study was to assess treatment outcome for patients with locally advanced and recurrent gynecological malignancies treated with Interstitial High-Dose Brachytherapy and to study late sequelae after treatment by this technique. Methods: 27 patients with advanced and recurrent gynecological cancers were treated by Interstitial High-Dose Irradiation between 2006 and 2011 at the Department of Brachytherapy, “Ion Chiricuta” Oncological Institute, Cluj-Napoca. A retrospective study on these cases was performed to evaluate the technique and local control. Results: In 18,51% of the cases needles, flexible tubes for 77.77% and for one patient(3.7%) a Freiburg applicator was used.The total radiation dose was between 14 and 56 Gy, with a median dose of 35 Gy and equivalent dose tumor effect (EDTE) between 18.8 Gy and 89.6 Gy. At the end of treatment, for primary tumors complete tumor regression and partial tumor regression in 40%, respectively 50% of cases was obtained. For recurrences, complete and partial tumor regression were identical, 47%. At the first control, performed 2 months after treatment, the complete response for primary and recur­rent tumors was 50%, respectively 70%.The local control obtained at the last check for primary tumors and relapses was 70%, re­spectively 84%. One patient had late grade 2 rectal morbidity and 1 patient had grade 2 urinary morbidity. Conclusions: Interstitial brachytherapy can be safely used to treat patients with selected types of gynecological tumors and allows excellent local control and a low rate of morbidity.

Key words: Interstitial Brachytherapy, Gynecological Malignancies, Local Control.

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107 Technical Aspects of 3D Conformal Radiotherapy for Cervical, Uterine and Rectal Tumors

  1. Fekete1,2, A. Muntean1, D. Dordai1, V. Bogdan1, V. Suşa1, L. Lihiouel1, V. Nagy1,2

1Oncology Institute “Prof. I. Chiricuta”, Cluj-Napoca, Romania; 2University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania

Background & Objectives: We have introduced 3D conformal radiotherapy (3DCRT) techniques for the treatment of gynecologic and rectal cancers at the Cluj Institute of Oncology. The purpose of this study was to describe the technical aspects of these modern approaches and to compare them with classical planning. Material & Methods: The classical and conformal radiotherapy plans of 14 patients with gynecologic cancers and 11 patients with rectal cancer were compared. Results: For both gynecologic and rectal cancers in the conformal plans there was an increase of coverage of the PTV compared with the classical 3-field or box technique. For cervical cancers the location of better coverage was seen especially in the posterior pelvic region and for rectal cancers especially in the obturatory and internal iliac lymph node chains. For gynecologic cancers the volume of the rectum which received more than 40Gy or 50Gy was higher for the 3DCRT plans, but there was no statistically significant difference in the rectal volume which received 60Gy. In both gynecologic and rectal cancers there was no statistically significant increase in the bladder dose, neither in the femoral heads receiving more than 45Gy or 50Gy. The intestinal volume receiving more than 50Gy was not statistically different between the two sets of plans. Conclusions: There is a better coverage of the target volume with 3DCRT in gynecologic and rectal tumors with minimal increase in the irradiated rectal volume in gynecologic cancers. Probably IMRT would be the solution for these situations. Follow-up is necessary to see if these dosimetric changes would translate into gains in local control or will modify late side-effects.

Key words: 3D Conformal Radiotherapy, Dosimetric Comparison, Cervical Cancer, Endometrial Cancer, Rectal Cancer.

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113 Adenocarcinoma of the Lung with Multiple Brain Metastases at First Presentation

Hollo Gergely, Petronela Rusu

Institute of Oncology “Ion Chiricuţă” Cluj-Napoca

We present a case of a 65-year-old female, non smoker throughout her life, with hypertension and a history of headaches in the right parietal region, an episode of hypertension, vomiting and generalized tonicoclonic seizures. The MRI revealed multiple brain metas­tases and she underwent an excision biopsy of the lesion in the parietal region. The histological examination revealed adenocarci­noma and a thorough workup was planned to determine the primary tumour. Subsequent examinations and imunohistochemistry sug­gested lung cancer to be the primary site. We considered this case a good opportunity of reviewing the workup of determining the primary tumour in cases of metastatic carcinomas of unknown origin and the therapeutic decisions.

Key words: Adenocarcinoma of the lung, brain metastases at first presentation.

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