Alexandru Eniu1, Gabriela Morar-Bolba1, Carmen Lisencu1, Daniela Martin1, Mihaela Galatâr1, Bogdan Fetica1, Alin Rancea1,2
1) Institutul Oncologic «Prof. Dr. I. Chiricuţă Cluj Napoca»; 2) Universitatea de Medicină şi Farmacie «Iuliu Haţieganu» Cluj Napoca
Comitetul de lucru
Dr. AlexandruEniu – oncologiemedicală, coordonator Dr. RaduTănăsescu – radioterapie, oncologiemedicală, coordonator Dr. Gabriela Morar-Bolba – oncologiemedicală Dr. Carmen Lisencu – imagistică, radioterapie Dr. Daniela Martin – radioterapie Dr. MihaelaGalatâr – anatomiepatologică Dr. BogdanFetica – anatomiepatologică Dr. AlinRancea – chirurgie Dr. Daniela Grecea – radioterapie, oncologiemedicală Dr. Carmen Popa – radioterapie
Scopul acestui articol este de a prezenta Protocolul pe care Comitetul Multidisciplinar pentru Decizie terapeutică al Institutului Oncologic „Prof. Dr. Ion Chiricuţă” l-a elaborat pentru a standardiza conduita diagnostică şi terapeutică propusă pacientelor cu cancer de sân ce se adresează Institutului. Membrii comitetului au alcătuit şi discutat aceste indicaţii, selectând dintre opţiunile terapeutice multiple oferite de ghidurile internaţionale actuale propuse de European Society for Medical Oncology (ESMO), St. Gallen Consensus Conference, Advanced Breast Cancer Consensus Conference (ABC), Societatea Germană (AGO), National Comprehensive Cancer Network (NCCN), cele considerate adecvate nivelului de resurse şi intervenţiilor terapeutice disponibile în Institut. Acest protocol a fost prezentat şi discutat în plen, în decursul ultimilor 3 ani, la conferinţele naţionale de oncologie din România, şi a fost supus procesului de peer-review extern de către 5 experţi internaţionali în domeniul cancerului mamar. Datorită evoluţiei continue, rapide, a cunoştinţelor în acest domeniu, după publicare, recomandările protocolului vor fi actualizate semestrial în varianta on-line publicată pe site.
Cuvinte cheie: protocol terapeutic, cancer mamar
Abrevieri: AGO – Arbeitsgemeinschaft Gynaekologische Onkologie; AHC – antecedente heredo-colaterale; APP – antecedente personale patologice; CDIS – carcinom ductal in situ; CDT – comitet decizie terapeutică; CLI – carcinom lobular invaziv; CLIS – carcinom lobular in situ; CMI – carcinom mamar invaziv; CMO – cancer mamar operabil; DT – doză totală; GMI – ganglioni mamari interni; GSC – ganglioni supraclaviculari; IA – Inhibitor de Aromatază; ICV – ganglioni infraclaviculari; LA – limfadenectomie axilară; LVI – invazia spaţiului limfovascular; MRM – mastectomie radicală modificată; MS – mastectomie simplă;NCI – NationalCancer Institute;PCT– polichimioterapie; PT– peretetoracic; QA–asigurareacalităţii;R – margini piesă de excizie;R1 – margini microscopic pozitive; RE – receptori estrogenici; RPg – receptori progesteronici; RT – radioterapie; RTE – radioterapie externă; S+A – sectorectomie cu limfadectomie axilară.
III. ANATOMIA PATOLOGICĂ
Nicoleta Zenovia Antone1, Monica Iulia Groza1, Maximilian Hogea1, NicolaeTodor1, Cristina Ligia Cebotaru1
1) Institute of Oncology „Prof Dr Ion Chiricuta” Cluj-Napoca, Romania
Purpose: Retrospective study to assess treatment results and risk factors for relapse in stage I seminoma patients treated at the Institute of Oncology „Prof Dr Ion Chiricuta”. Material and methods: This study evaluated 112 patients aged between 18 and 78 years (medium age-37.4 years) stage I testicular seminoma between January 1982-January 2007, treated at Ion Chiricuta Cancer Center, Cluj-Napoca. The medium follow-up period was 135.8 months (range minimum 3 months-maximum 233 months). Demographic, clinical and paraclinical parameters of patients were observed. Chemotherapy regimen administered in adjuvant setting was 1 cycle Carboplatin AUC 7 or 2 cycles Carboplatin AUC 6 for 31 (27.68%) patients for stage I seminoma, 44 (39.29%) patients were treated with adjuvant radiotherapy and 37 (33.04) were managed by surveillance. Results: Overall survival at 10 years was 92%(CI: 85%-96%). Eighty seven seminoma patients (77.68%) have not presented relapse; metastatic relapse was observed in5 patients (4.46%), pelvic or lomboaortic lymph nodes was present in17 patients (15.18%), metastatic and adenopatic relapse in 2 patients (1.79%) and seric relapse int 1 patient(0.89%). Risk factors evaluated for relapse were age (p=0.1), performance status(p<0.1), stage of disease at presentation(p<0.1) and positivity of tumor markers(p=0.1). Chemotherapy toxicity was moderate, main toxicity for Carboplatin was thrombocytopenia (6.67%), anemia(3,7%), leucopenia (3.33%), and nausea and vomiting (3.33%). Conclusion: In our retrospective study, stage I seminoma tumor prognosis has been excellent. The rate of curability for adjuvant treatment was high, the overall survival at 10 years with adjuvant chemotherapy was 96% and with adjuvant radiotherapy 93%.
Key words: stage I seminoma, risk factors, long term survival.
Muhammad Isa1, 2, 3, Khalid Iqbal1, 3, M. Afzal1, Saeed Ahmad Buzdar1, James Chow2
1) Department of Physics, The Islamia University Bahawalpur Pakistan; 2) Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada; 3) Shaukat khanum cancer hospital & research center Lahore Pakistan
Background: Wedges are frequently used in radiotherapy to modify the isodose distribution by compensating dose inhomogeneity. In this study, we compared the dosimetry of physical wedges (PWs) and evaluate dynamic wedges (EDWs) used in radiotherapy for rectal cancer. Two wedge angles of 45o and 60o were used for the physical and dynamic wedges due to the large separation in the pelvis contour. Material Methods: A Varian 2100 C/D linear accelerator was used to utilize the mix beam treatment flair using the 6 and 15 MV. Treatment plans using the above wedges for thirty patients were made on the Eclipse treatment planning system. Mean monitor unit, plan normalization value, maximum and minimum doses in the planning target volume (PTV), dose conformity index, dose homogeneity index and uniformity index were determined for each treatment plan. The average dose coverage for the PTV with EDW and PW plans were compared. Results: The PTV received prescription doses of 100.9±0.74%, 101.01±1.63% for the EDW (45o, 60o) compared to 101.2±1.65%, 101.3±1.33% for the PW (45o, 60o). Homogeneity indices were (0.11±0.02%, 0.11±0.05%) for the EDW (45o, 60o), and (0.15±0.1%, 0.16±0.11%) for the PWs respectively. The EDW at 45o had a better target coverage with a higher conformity index value of 0.98 ± 0.01 compared to the other wedges. A statistically significant (p < 0.01) difference was noticeable in the plan normalization values and fewer monitor units were found using the EDW at 45o. Conclusions: We conclude that the EDW at 45o results in an improvement to the plan evaluation parameters presented and thus increases dose efficacy for radiotherapy of rectal cancer.
Key words: homogeneity index, conformity index, uniformity index, plan normalization.
Anamaria Sipos1, Laszlo Istvan1, Edina Dordai1, Octavian Chis1, Gabriel Kacsó1,2
1) Institute of Oncology Prof. Dr. I. Chiricuta Cluj Napoca, 2) The “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca
Aim: Prospective intrainstutional evaluation of toxicity and efficacy of newly implemented interstitial high-dose-rate Iridium brachytherapy (Ir192 HDR BT) as a last resort treatment for inoperable tumours in same site recurrence or secondary head and neck carcinomas. Material and methods: Inclusion criteria were unifocal histologically confirmed recurrent or second squamous cell carcinoma with no evidence of nodal or distant metastasis, nor esophageal or lung synchronous cancer, tumor size and site implantable by BT and signed informed consent. From 2006 to 2009, 6 patients were included, 4 with second HNC cancers and 2 local recurrences, all having received higher than 50 Gy radiotherapy during the primary treatment. The BT dose was 39 Gy/13 fr/5days (2 or 3 fr/day at least 6 hours apart) after limited close or positive margin surgery and 55 Gy/10fr/ 10 days as sole therapy. Local control and CTCAE 3.0 acute and late toxicity were the end points. Results: At 30 months median follow-up, the local control was 83.34 % with
16.6 % G3 acute severe toxicity and only one case of radionecrosis, conservatively resolved. Conclusion: BT has definitely a role in the management of HNC, being the best choice with curative intention in selected patents with local recurrence or a second HNC in previously irradiated areas. Technical precaution should be taken to minimize the risk of radionecrosis
Key words: head and neck cancer, recurrence, salvage brachytherapy
Laura Rebegea1,2, Dorel Firescu2,3, Rodica Anghel4, Mihaela Dumitru1
1) „Sf. Ap. Andrei” Emergency Clinical Hospital, Galati, Radiotherapy Department, Galati; 2) „Dunarea de Jos” University of Galati, Faculty of Medicine, Clinic Department, Galati; 3) „Sf. Ap. Andrei” Emergency Clinical Hospital, Galati; 4) ”Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania
Purpose: identifying the potential risk factors for contralateral breast cancer, (CBC) in patients who undergo specific treatment for breast neoplasm. Patients and methods. This is a retrospective study and evaluates 507 patients who underwent treatment in the Radiotherapy Department of “Sf. Ap. Andrei” Emergency Clinical Hospital, Galati, between 1995 and 2002. The following parameters were taken into consideration: age of the patient at the time of treatment, disease stage, histologic type, surgical treatment, radiotherapy technique, chemotherapy and/or schemas. The relative risk (RR) for CBC was estimated for the following risk factors: hormonal therapy, age at the time of treatment, histologic type. Results: The median follow up was 12 years (range 9-16 years). 19 women developed CBC, out of 507 analyzed cases (3.75%). The median time of CBC occurrence was 5.22 years (range 1-12 years). The chemotherapy did not increase the risk for CBC; statistically, patients under 50 years (RR=1.35), with infiltrating ductal carcinoma (RR=1.89) and who had not received hormonal therapy (RR=0.58), presented a significantly increased rate of CBC. Conclusions: The administration of hormonal therapy proved to be a protection factor regarding CBC occurrence. The risk factors for CBC were the following: age under 50 years and histologic type of infiltrating ductal carcinoma. Women with breast cancer evidenced an increased risk for the second primary cancer development, not only as contralateral breast, but also in other organs (colon, ovary, thyroid, corpus uteri and malignant melanoma), thus, monitoring breast cancer patients is of major importance
Key words: contralateral breast cancer, radiotherapy
Claudia Burz1, Alexandru Mocanu2, Raluca Popita3, Cristian Popita3, Rares Buiga4, Lavinia Terec1
1)Department of Chemotherapy, Institute of Oncology, Cluj-Napoca; 2) Clinic of Dermatology, Cluj-Napoca; 3) Department of Radiology, Institute of Oncology, Cluj-Napoca; 4) Department of Pathology, Institute of Oncology, Cluj-Napoca, Romania
CNeuroendocrine tumors of the gallbladder (NET) account for 0.5% of all neuroendocrine tumors and 2% of the gallbladder (GB) cancers. The symptoms of GB-NETs are nonspecific and the diagnosis is made preoperatively at the time of cholecystectomy for cholelithiasis. The main treatment for these tumors remains surgery. The role of adjuvant therapy after complete resection is undefined, whereas in metastatic disease some chemotherapeutic drugs besides Sandostatin or interferon alpha (IFN) have some activity. Here we report a case of a 69 year old female who underwent emergency laparoscopy for a diagnosis of acute lithiasic cholecystitis. Macroscopic examination of the gallbladder revealed the presence of an intraluminal tumoral mass and histopathological investigation concluded the diagnosis of a carcinoid tumor of the gallbladder. Post-operative evaluation completed by serologic detection of neuroendocrine markers and imaging established the diagnosis of a locally advanced gallbladder neuroendocrine tumor. The patient received 6 cycles of chemotherapy, associated with Sandostatin, with partial tumoral response. After 12 months, under maintainance treatment with Sandostatin, the disease progressed loco-regionally. We reinitiated chemotherapy with XELOX regimen, and elevated the doses of Sandostatin. After 4 cycles of treatment the
patient is once again in partial remission.
Key words: neuroendocrine, gallbladder, tumor, carcinoid, chemotherapy, cholecystitis, cholecystectomy, somatostatine, immunohistochemistry, PET-CT