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Volum 18 Numarul 1, 2012

5 Editorial

Alexandru Eniu

7 The Impact of the Multidisciplinary Committee on Cancer Care

Viorica Magdalena Nagy

University of Medicine and Pharmacy „Iuliu Hatieganu”, Institute of Oncology „Prof.Dr.Ion Chiricuta” Cluj Napoca, Romania

Multidisciplinarity is a basic principle recommended in cancer patients’ management. The therapeutic decision does not have to depend on one specialist’s decision; it has to be discussed by a multidisciplinary team, which takes into consideration all the relevant therapeutic options and elaborates

a personalized therapeutic plan for each patient. The multidisciplinary committee’s role is to ensure the application of these decisions based on “good clinical practice”. The multidisciplinary tumor board offers numerous benefits for patients, for health care professionals and for the health system, as

well. In the “Prof.Dr.Ion Chiricuta” Oncology Institute, as a consequence of the Gynecology Tumour Board’s activity, the number of presented cases

was increased from 35% from the total gynecology tumours treated in the institute in 1995 to 79% in 2001, obtaining a significant improvement in the

therapeutic protocol application. The analysis of these tumour treatments offered the basis for the elaboration of new therapeutic protocols, such as the endometrial cancer guide. In the context of the rising incidence of cancer and the complexity of the current treatments, the multidisciplinary committee has an important role in the improvement of the patients’ care and survival. The multidisciplinary committee has evolved to being the guarantor of the correct therapeutic decision in oncology.

Keywords: multidisciplinary committee, therapeutic decision, tumour board

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11 Endometrial Cancer – Therapeutic Guideline Oncological Institute “Prof. Dr. Ion Chiricuta”

Claudia Ordeanu¹, Ovidiu Coza1,2, Viorica Nagy1,2

1 Institute of Oncology „Prof.Dr. Ion Chiricuta”; 2 University of Medicine and Pharmacy „Iuliu Hatieganu”, Cluj Napoca, Romania

Approved by de Gynecologic Tumour Board of the Institute of Oncology „Prof.Dr.Ion Chiricuta” Cluj Napoca: Viorica Nagy, Claudia Ordeanu, Ovidiu Coza, Alin Rancea, Alexandru Traila, Sorin Gavris, Adriana Tudosescu, Rares Buiga

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15 Uterine Sarcomas – Therapeutic Guideline Oncological Institute “Prof. Dr. Ion Chiricuta”

Ovidiu Coza1,2, Claudia Ordeanu¹, Viorica Nagy1,2

1 Institute of Oncology „Prof.Dr. Ion Chiricuta”; 2 University of Medicine and Pharmacy „Iuliu Hatieganu”, Cluj Napoca, Romania

Approved by de Gynecologic Tumour Board of the Institute of Oncology „Prof.Dr.Ion Chiricuta” Cluj Napoca: Viorica Nagy, Claudia Ordeanu, Ovidiu Coza, Alin Rancea, Alexandru Traila, Sorin Gavris, Adriana Tudosescu, Rares Buiga

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18 Radiological Incident in the Radiotherapy Department. Presentation and Actions of Intervention

Mihaela Dumitru1, Laura Rebegea1,2, Dorel Firescu2,3

1 1 „Sf.Ap.Andrei” Emergency Clinical Hospital; 2 „Dunarea de Jos” University of Galati, Faculty of Medicine, Clinic Department; 3 „Sf. Ap. Andrei” Emergency Clinical Hospital, Galati, Surgery Clinic II, Galati Romania

This paper presents a radiological incident which occurred with the radiotherapy equipment, Theratron Elite 100 from the Radiotherapy Department

– Emergency Clinical Hospital „Sf. Ap. Andrei”, Galati at the beginning of February 2009 and describes the actions of subsequent intervention. The radiological incident concerned the framework which lies in a 180° position, under the treatment table, which prevented the possibility of manually returning to the source using the T-bar, a problem which is not mentioned in the operator’s manual of the radiotherapy unit. The radiological incident consisted of a radioactive source blocking in the TRANSIT position between BEAM OFF and BEAM ON positions at the start of treatment. We want to state that all personnel – physicians, physicists, operators and service staff acted with professionalism and promptitude, conforming to emergency

procedures and and regulations. After this incident the Radiotherapy Department’s Emergency Plan was modified and updated including the emergency

procedures described in this paper; the night shift was removed from the Radiotherapy Department’s work program. Also, we want to mention that misinformation and confusion regarding this incident must be avoided in order not to raise false alarms with other hospital staff and the public.

Keywords: radiological incident, radioactive source, emergency procedure

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22 Comparison of Ultrasound and CT Scan in the Imaging Diagnosis of Pancreatic Cancer in Type 2 Diabetes Mellitus Patients

Daniela Elisabeta Berdea¹, Aurel Petru Babeş¹, Katalin Babeş¹, Elisabeta Pătcaş²

1 University of Oradea; 2 Clinic of Oncology and Radiotherapy of Emergency Clinical County Hospital, Oradea, Romania

About 80% of pancreatic cancer patients have glucose intolerance or frank diabetes. This observation has led to the following two hypotheses: 1)

pancreatic cancer causes the associated diabetes; 2) conditions associated with diabetes promote the development of pancreatic cancer. Evidence supporting both hypotheses have been accumulated in previous studies. This article reviews imagistic aspects of pancreatic cancer in type 2 diabetes mellitus patients.

Key words: diabetes mellitus, pancreatic cancer, ultrasound, CT-scan

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27 The Psychologist Role in Oncology

Andrea Fekete1, Zsolt Fekete2,3

1 Care and Assistance Center; 2 “Iuliu Hatieganu” University of Medicine and Pharmacy; 3 “Prof. Dr. Ion

Chiricută” Institute of Oncology, Cluj-Napoca, Romania

Introduction: Oncopsychology is an interdisciplinary science and it may seem more volatile than other aspects of oncological care, because the psychological symptoms are difficult to measure; psychotherapy can be tough to standardize and results are hard to measure. Material and methods: Summary of current knowledge regarding the role of the psychologist in cancer care. Results: Cancer patients frequently present with anxiety, depression, post-traumatic stress disorder, cognitive disorders and delirium. There is abundant evidence that psychotherapy increases quality of life, decreases emotional distress, assists survivors in changing harmful health behaviors, increases social support, reduces variability in chemotherapy dose, improves immunity

and results in higher functional status. In retrospective studies defective coping with stress and certain personality traits have favorized death in cancer. One randomized trial (2008) in breast cancer found that psychological intervention may delay recurrence with a median of 6 months and prolong cancer specific and overall survival with about one year. There is also evidence that psychological measures can decrease the incidence of cancer, partially

due probably to interference with stress hormones and immunity. Proven psychotherapeutic methods for cancer patients include relaxation techniques,

Simonton visualization techniques, cognitive behavioral techniques, psychoanalytic therapy, psychodrama, art and music therapy, support group, psycho-education, etc. Conclusion: The role of oncopsychology has been justified by multiple studies and its benefits should be utilized widely in Romania.

Keywords: psycho-oncology, evidence-based, snapshot of current knowledge, psychotherapy

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30 Lumbar Insufficiency Fracture: a Rare Complication after Radiochemotherapy for Gastric Cancer

Mehmet Fuat Eren1, Didem Çolpan Öksüz1, Ayfer Ay1, Fatih Kantarcı2, Nuran Şenel Beşe1

1 Medical Faculty of Radiation Oncology Department; 2 Medical Faculty of Radiology Department, Istanbul

University Cerrahpaşa, Istanbul, Turkey

The incidence of bone complications after radiation therapy with megavoltage equipment is quite low. Radiation-induced pelvic insufficiency fractures after pelvic irradiation for gynecologic and rectal cancers are the most frequent ones among bone complications. Lumbar insufficiency fractures after radiotherapy are even rarer. Here, we present three cases with lumbar insufficiency fractures due to postoperative irradiation for gastric adenocarcinoma.

All cases were treated with radiotherapy to a total dose of 45 Gy with concomitant chemotherapy. Within 9-17 months after the completion of radiotherapy,

patients presented with severe lumbar pain. Lumbar magnetic resonance Imaging (MRI) revealed abnormal signal intensity with insufficiency fractures at the lumbar vertebras with bone marrow edema near the fractures which were in the radiation field. Neither distant nor loco-regional recurrence was observed. The final diagnosis was insufficiency fractures of the lumbar bones owing to irradiation and conservative care treatment was given. Dramatic

clinical improvement was obtained in one year, and objective healing was revealed with MRI. Awareness of this benign complication is important to avoid

over diagnosis of bone metastasis and inappropriate treatment. Based on this case, risk factors, the diagnosis and management of lumbar insufficiency

fracture are discussed and the literature was reviewed.

Keywords: radiotherapy, chemotherapy, gastric cancer, insufficiency fractures

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36 Advanced Stage of Anal Squamous Cell Carcinoma. A Case Report

Anamaria Rusu1, Tănase Timiş2, Raluca Popiţă3, Gabriel Kacsó4,5

Institute of Oncology „Ion Chiricuta”, Departments of 1) Radiation Oncology; 2) Medical Oncology, 3) Radiology, 4) Brachytherapy; 5) University of Medicine and Pharmacy „Iuliu Hatieganu” Cluj, Romania

Carcinoma of the anal canal accounts for 2% of digestive-system cancers, with squamous cell carcinoma the most common histological type. Combination

chemotherapy and radiotherapy is firmly established as the primary therapy for patients with locally advanced squamous cell anal cancer undergoing

curative-intent treatment, with anal sphincter preservation in most patients. We present the case of a 42 year old woman, T4N2Mo G3 squamous anal carcinoma, achieving a complete response after external beam radiotherapy concomitant with Capecitabine and Cisplatin, plus interstitial brachytherapy boost and adjuvant chemotherapy.

Key words: curative conservative therapy, squamous anal cancer

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41 Renal Cell Carcinoma Treated with New Molecules of Chemotherapy -a Case Report

Ştefania Neamţu1, Emilia Mihuţ1, Dana Cernea1, Mihaela Galatâr1, Vasile Popiţă1, Tiberiu Guttman1, Mădălina Neamţu2

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

Treatment options for patients with metastatic renal cell carcinoma are limited. We report a renal cell carcinoma in a 17 year-old girl who was treated with tyrosine kinase inhibitors after failure of immunotherapy. The treatment has resulted in complete remission with stable disease for 15 months so far. Tyrosine kinase inhibitors seem to be a safe treatment option for children with renal cell carcinoma, but further studies are required.

Key words: renal cell carcinoma, interferon, tyrosine kinase inhibitors, radiotherapy

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45 ICACT – 23rd International Congress on Anti-Cancer Treatment – Highlights

Vlad Alexandru Manolescu

Institute of Oncology „Prof.Dr.Ion Chiricuta”, Cluj Napoca, Romania

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48 Guidance for Authors