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Volum 18 Numarul 2, 2012

51 Editorial

Dana Cernea

53 Long-term Survivors Following Radiotherapy for Metastatic Spinal Cord Compression

Dirk Rades1, Theo Veninga2, Steven E. Schild3

1) Department of Radiation Oncology, University of Luebeck, Germany; 2) Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; 3) Department of Radiation Oncology, Mayo Clinic Scottsdale, Arizona, U.S.A.

Background & Aims: There is a lack of data regarding long-term survivors after conventional radiotherapy (RT) for metastatic spinal cord compression (MSCC). This is the first study to investigate prognostic factors and treatment outcomes in these patients. Methods: Data of 661 patients who had survived for 12 months or longer following conventional RT for MSCC were retrospectively analyzed for potential prognostic factors for survival, functional outcome, post-RT ambulatory status, local control of MSCC, and late radiation associated toxicity. Univariate analyses of local control and survival were performed with the Kaplan-Meier-method and the log-rank test, multivariate analyses with the Cox proportional hazards model. Results: On multivariate analysis, survival was significantly associated with performance status (P=0.014), primary tumor type (P=0.007), visceral metastases (P<0.0001), pre-RT ambulatory status (P=0.006), longer-course RT (P=0.030), and marginally with the number of involved vertebrae (P=0.05). A favorable effect of RT on motor function was observed in 91% of patients. All ambulatory patients remained ambulatory after treatment, and 93% of non-ambulatory patients regained the ability to walk. The 1-year, 3-year and 5-year local control rates were 89%, 73% and 64%, respectively. Late RT associated toxicities such as vertebral fractures or myelopathy were not observed during the follow up of median 16 (range: 12-78) months. Conclusions: In long-term survivors after RT of MSCC, survival was significantly associated with several prognostic factors and longer-course RT. The patients had very favorable treatment outcomes. Survival and local control of MSCC may be further improved with the use of longer-course RT instead of short-course RT.

Key words: MSCC, long-term survivors, radiotherapy, motor function, local control.

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60 Opioids in Cancer – Induced Dyspnea – Friend or Foe?

Răzvan-OvidiuCurcă, ArianaRoşiu

Medical Oncology Department, Emergency County Hospital Alba Iulia, Romania

Abstract: In patients with advanced cancer, especially during their last weeks of life, maybe the most difficult symptom to relieve is dyspnea. The main question is: are opioids safe in this clinical setting? It is a very important question, especially in the Balkan region, where restrictive legislation for many years has been promoting opiophobia among many physicians and regulatory barriers regarding access to opioids are still in place. We review the mainstay therapy of dyspnea in cancer patients (opioids, benzodiazepines and non-pharmacological interventions).

Keywords: opioids, dyspnea, cancer, safe.

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64 The Assessment of Cancer Pain Treatment Using the Pain Management Index in Hospitalized Patients with Cancer. A Pilot Study

Ramona Palalogos1, Alexandru Mocanu1, Loredana Balacescu1, Ariana Nemes2, Robert Rajcsanyi2, Tobias Jozsef3, Calin Cainap1, Claudia Burz1

1) Department of Chemotherapy of Ion Chiricuta Institute; 2) Clinical Hospital; 3) Gastrointestinal Institute Octavian Fodor, Cluj-Napoca

Pain is a frequent symptom in oncological practice frequently being the first symptom of a tumor. The pain management index is a score linking the severity of pain with the medication recommended to treat it. Objectives The purpose of this study was to understand the cancer related-pain depending on sociodemographic characteristics of the patients, tumor sites and tumor stage and to assess the prevalence of inadequate pain management. Methods Fifty-three patients, with different tumor sites and stages were analyzed for patient-rated pain scores (EVA 0-10 scale), pain type and analgesic treatment. Pain scores were assigned 0, 1, 2, and 3 when patients reported no pain (0), mild (EVA 1-3), moderate (EVA 4-7), or severe pain (8-10), respectively. Analgesic scores of 0, 1, 2, and 3 were assigned when patients had no pain medication, nonopioids, ‘‘weak’’ opioids, and ‘‘strong’’ opioids. The pain management index (PMI) was calculated by subtracting the pain score from the analgesic score. A negative PMI score was considered an indicator of potentially inadequate pain treatment. Results Of 53 patients included in the study the pain was the first symptom for 43 patients (81.13%) from whom 62.25% suffered moderate-to-severe pain. The pain was neuropathic in 20.93% cases, nociceptive in 37.2 % and mixed in 41.8.%. The tumor stage correlates with pain intensity (p=0.0004). A negative PMI reflected the undertreatment of cancer pain was calculated for 27 patients (62.79%). Conclusions There are no correlations between the pain syndrome and sociodemographic characteristics of patients. The intensity of pain correlates only with tumor stage. The treatment of cancer pain remains suboptimal despite publication of numerous cancer pain management guidelines.

Key worlds : cancer, pain, pain management index PMI

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69 Malignant Meningioma after Radiotherapy for Tinea Capitis in Childhood

Dana Cernea, Doina P. Pruteanu, Victor Bogdan

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

We present the case of a 70 year old female diagnosed with malignant meningioma, treated with radiotherapy for tinea capitis in her childhood. The first symptoms of the disease, personality changes and left motor deficit, were present 5 years ago (2006). The imagistic evaluation at that time revealed a right frontal lobe mass. A macroscopic resection of the tumor was performed in August 2006. In 2008 the patient presented the first local recurrence and underwent surgical intervention with macroscopic resection of the lesion. One year later Gamma Knife radiosurgery with 12 Gy was performed for a second local recurrence and for a new lesion detected in the left frontal lobe. In 2011 the patient underwent a third surgical intervention and adjuvant external radiotherapy with 50Gy/25 fractions for the third recurrence in the right frontal lobe. Three months after completion of the treatment, the patient showed no clinical or imagistic signs of disease progression. The particularity of this case is the association with radiotherapy for tinea capitis in childhood, which is a proven etiologic factor for meningioma.

Key words: malignant meningioma, tinea capitis, radiotherapy

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73 Giant Cell Tumor of the Fourth Metacarpal: Case Report and Literature Review

Boris Matev, Hristo Georgiev, Georgi P. Georgiev

University Hospital of Orthopaedics “Prof. B. Boychev”, Medical University Sofia

Sofia, Bulgaria

Giant cell tumour of bone is an aggressive lesion, although benign. The involvement of the metacarpal bone is rare. We present the case of a 41-year-old male complaining of a painless swelling of the posterior surface of the fourth right metacarpal bone. The radiological examination showed a large expansile lesion with cortical destruction involving the entire fourth metacarpal. Two stages treatment was performed: the first stage included total resection of the metacarpal bone together with partial excision of the surrounding muscles and reconstruction with fibular autograft and carpo-metacarpal arthrodesis; in the second stage a metacarpo-phalangeal cement-free endoprosthesis was done. We also discuss clinical, radiological, and therapeutical characteristics of this pathology.

Key words: giant cell tumor, metacarpal, treatment.

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78 Adaptive Radiotherapy for H&N Cancers: What Forms of Rescheduling? Debates Surrounding a Clinical Case

Ovidiu Veresezan1, Catherine Dejean2, Mathieu Gautier2, Juliette Thariat3

1) Radiotherapy Department, Henri Becquerel Cancer Center, Rouen; 2) Physics Unit, Antoine Lacassagne Cancer Center, Nice; 3) Radiotherapy Department, Antoine Lacassagne Cancer Center, Nice, France

This work was realized in the cadre of the Inter-university diploma of the High Technicity Radiation Therapy at Antoine Lacassagne Cancer Center, Nice, France

Introduction: Many studies have suggested that anatomical changes of risk organs and target volumes occur during irradiation, especially for H&N cancers. We strived to analyze the clinically relevant thresholds and technical means currently available from treatment planning systems and additional software to adapt radiotherapy in the course of treatment. Material and method: We will describe the replanning process through the example of a patient, irradiated for oropharyngeal squamous cell carcinoma, who lost 10% of his body weight. Shape and volume changes of the target volumes and organs at risk / normal tissues were analyzed for the need to reschedule the initial dosimetry in order to avoid tumor under-coverage and excess toxicities.Results: Replanning represent a series of challenging issues for radiation oncologists and physicists: current treatment planning systems either allow accumulating two dosimetries using one single reference scanner or adding dose matrices obtained through different CT acquisitions, with uncertainties regarding periphery dose. Neither of the two systems respond in a satisfactory manner to all the challenges of rescheduling and do not represent the continuous variation of the patient anatomy. Conclusions: The routine use of adaptive radiotherapy requires optimization of current dosimetry systems in order to allow the “real-time” addition of doses per different scanners. Another prerequisite would be the evaluation of the actual administered doses with the aid of daily CBCTs.

Keywords: adaptive radiotherapy, H&N cancers, anatomical changes, replanning.

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84 Drug Induced Agranulocytosis – A Case Report

Camelia Carajan

Town Hospital Negresti-Oas, Romania

We present the case of a 54 year old patient with breast cancer treated with tamoxifen, with a concomitent diagnosis of reactive rheumatoid arthritis for which she received daily sulfasalazine, daily Colchicine and NSAIDs as required. Two months after initiation of the treatment for osteo-articular pathology, the patient presented with agranulocytosis.

Key words: breast cancer, rheumatoid arthritis, agranulocytosis, tamoxifen, colchicines, sulfasalazine.

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86 Report of RSRMO president 2011-2012

Răzvan Curcă

88 10th International Congress on Cell Biology – Highlights

Ioana-Carmen Brie

91 Group of radiation and medical oncology residents

Doina P. Pruteanu, Vlad Manolescu

92 Cursuri Postuniversitare UMF Cluj 2013 – Disciplina Oncologie Medicală şi Radioterapie

93 Guidance for Authors