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Volum 20 Numarul 1, 2014

3 Dear RSRMO members

Ovidiu Coza

5 Efficacy and Toxicity of Neoadjuvant Chemotherapy Followed by Radiochemotherapy in Locally Advanced Cervical Cancer

Nemes Adina1, Nagy Viorica1, 2, Todor Nicolae1, Marita Andreea1, Ordeanu Claudia1,Rancea Alin1, 2

1) Oncology Institute „Prof.Dr.IonChiricuta” Cluj-Napoca; 2) The „IuliuHatieganu” University of Medicine and Pharmacy Cluj-Napoca

Background and aims: This study conducted in the”Prof.Dr.IonChiricuta” Oncology Institute, Cluj-Napoca (OICN) represents a nonrandomized, feasibility study in which the efficacy and toxicity of neoadjuvant chemotherapy (NACT) was analyzed before radiochemotherapy (RCT) in patients with locally advanced cervical cancer (LACC). Methods:In this study patients with histologically confirmed stage IIB-III cervical cancer treated in OICN between November 2010-September 2012 were included. Patients were administered two or three cycles of NACT two regimens Paclitaxel and Carboplatin (PC) or Topotecan and Cisplatin (TC),then they underwent concurrent RCT with Cisplatin or Carboplatin.External beam radiation therapy (EBRT) was administered at a total dose (TD) of 46Gy when patients were evaluated for surgery and those with favorable parametrial response were optionally operated.Remaining patients underwent exclusive RCT up to a TD of 60Gy.Brachitherapy was associated to EBRT TD=10-20Gy. Local response was assessed at the end of NACT,at the end of RCT and for operated patients by the pathological outcome. Results :In this study 112 patients with LACCwere included: stage IIB 31,stage IIIA 48 and stage IIIB 33 with a median age at diagnosis of 52 years.Histology was mostly squamos cell carcinoma (86%).84 patients out of the 112 patients performed NACT with PC and 28 patients with TC.Tumor response evaluated at the end of NACT revealed a 53% objective response (OR= complete response(CR)+partial response(PR)): 81% OR for PC and 19% for TC (p=0.10). Complete response (CR) at the end of therapy was 29%:22% CR for the 65 patients that underwent exclusive RCT and 40% for the 47 patients that underwent surgery.The pathological CR (pCR) was obtained in 32 (68%) of the 47 patients that were operated. At a median follow-up of 17.4 months 98 patients (88%) presented CR,3 patients (3%) PR and 11 patients (10%) PD.Grade 1-2 hematological toxicity on all medullary lines were the most common hematological toxicity observed to NACT. Grade 3-4 anemia, leucopenia and neutropenia occurred in 6%, 8% and 27% of cases respectively. Conclusion: NACT administered before RCT brings a high response rate with manageable toxicity, but randomized, larger number and long term evaluation trials are necessary in order to confirm these data.

Key words: advanced cervical cancer, neoadjuvant chemotherapy, local response

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10 Second Line Anti VEGF Options after Bevacizumab First Line Based Therapy Disease Progression in Metastatic Colorectal Cancer: Review of the Literature

Claudiu Hopirtean1, Viorica Nagy1,2

Institute of Oncology Prof. Dr. I. Chiricuta Cluj Napoca, 2) „Iuliu Hatieganu” University of Medicine and PharmacyCluj Napoca, Romania

Chemotherapy based on fluoropyrimidine is the standard treatment for first and second line metastatic colorectal cancer, in combination with monoclonal antibodies such as Bevacizumab or anti-EGFR (for patients with RAS over-expression). Results from 2 observational studies, BRITE and ARIES, launched the hypothesis that by continuing treatment with an antiangiogenic agent after disease progression, for patients given Bevacizumab + chemotherapy as first-line treatment , could induce overall survival benefits. Because the results of the 2 studies may be affected by various factors, this hypothesis requires confirmation by randomized clinical trials. For this reason 2 large phase III clinical studies, ML18147 and VELOUR appeared both multicentric and randomized, that have as primary end points to improve overall survival; The overall survival for these two studies were: 11.2 months in the bevacizumab arm vs. 9.8 months in the control arm, respectively 13.5 months in the aflibercept arm vs. 12.06 months in the control arm.

Key words: metastatic colorectal cancer, bevacizumab, VEGF, oxaliplatin, irinotecan, capecitabine.

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20 Tonic-clonic Seizures During Chemotherapy Regimen in Gastric Cancer: A Case Report

Lupu Crinela-Alina1, Blag Dorel1, Burz Claudia1, 2

1) Institute of Oncology Prof. Dr. I. Chiricuta Cluj Napoca; 2) The „Iuliu Hatieganu” University of Medicine and Pharmacy Cluj Napoca

Due to late diagnosis, gastric cancer remains a severe disease, with a 5-year survival of 15% for all stages. Surgery is the only curative treatment. Radiotherapy and chemotherapy used as neoadjuvant or adjuvant regimens, alone or in combination, have yielded encouraging results. Regarding metastatic gastric cancer a slow but indisputable progress of palliative chemotherapy has been’ observed. The main chemotherapy regimens used for the advanced stages of the disease are ECF (epirubicin, cisplatin, 5 fluorouracil), EOX (epirubicin, oxaliplatin, capecitabine), DCF (docetaxel, cisplatin, 5 fluorouracil), FOLFOX (5 fluorouracul, folinic acid, oxaliplatin), XELOX (oxaliplatin, capecitabine), with an inclination towards EOX due to low toxicity and overall survival improvement. Chemotherapy is a systemic treatment which causes a large number and a variety of side effects to the body. The toxicity limits the dose and rate of cytostatic administration.

In this study we report a case of a 34 year old patient, without a personal history of pathologic disease, who developed seizures after the 4th EOX cycle for gastric cancer. After eliminating other causes through cerebral CT and IRM scans, lumbar puncture and neurological examination, it was considered that the seizures were caused by the chemotherapeutic drugs Epirubicin or Oxaliplatin.

Key words: gastric cancer; EOX chemotherapy; tonic-clonic seizures

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24 Progress in the multidisciplinary treatment of cancer

32 Textbook of digestive oncology vol. 1. Esophageal and gastric cancer – Book review

Dan L. Dumitrascu

34 Guidance for Authors