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ZILELE INSTITUTULUI ONCOLOGIC „PROF. DR. ION CHIRICUŢĂ” CLUJ-NAPOCA
13 – 14 iunie 2014
REZUMATE
ABSTRACTS
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Organizator
Institutul Oncologic „Prof. Dr. Ion Chiricuţă” Cluj-Napoca
Președinte de onoare
Alexandru Irimie
Comitet de Organizare
Patriciu Achimaș Cadariu
Ioana Berindan Neagoe
Anca Burca
Anca Bojan
Cristian Nemeș
Rodica Cosnarovici
Cosmin Lisencu
Ovidiu Coza
Alexandru Eniu
Vlad Schiţcu
Secretariat
Catalin Vlad
Monica Groza
Laura Sabău
Liliana Policiuc
Claudia David
Alexandra Tolnai
Anca Salanţă
*În Volumul de rezumate sunt cuprinse lucrări ale căror titlu şi respectiv rezumat au fost predate
secretariatului acestei manifestări ştiinţifice până la data menţionată în primul anunţ. Cele predate
sau ajunse ulterior acestei date au fost publicate în măsura posibilităţilor tehnice.
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Stimați colegi,
De 85 de ani Institutul Oncologic ”Prof.dr. Ion Chiricuță din Cluj-Napoca” face toate
eforturile pentru a reda speranța persoanelor care se confruntă cu afecțiunile oncologice, fiind unul
dintre primele institute de acest gen din Europa.
La ceas aniversar, avem deosebita onoare de vă invita să luați parte alături de noi la Zilele
Institutului Oncologic ”Prof. Dr. Ion Chiricuţă”, o sărbătoare dedicată generațiilor medicale
trecute, spre consolidarea celor prezente și deschiderea celor viitoare, totul în beneficiul pacienților
noștri.
În acelaşi timp, IOCN este gazda unui eveniment internaţional de anvergură organizat în
premieră în România - OECI (Organization of European Cancer Institutes) Oncology Days &
General Assembly.
Sub deviza ”Istorie, Tradiție, Profesionalism”, Zilele IOCN 2014 prezintă bilanțul ultimilor
cinci ani și cuprinde Gala de Excelență, documentare în premieră, simpozioane științifice pe tema
principalelor tipuri de tumori canceroase, precum și evenimente conexe dedicate presei, pacienților
și publicului larg.
Sperăm să fiți alături de noi în semn de solidaritate cu oncologia europeană, oncologia
românească și cu persoanele pentru care luptăm în fiecare zi.
Vă așteptăm cu drag!
Conf.dr. Patriciu Achimaș-Cadariu
Manager Institutul Oncologic ”Prof.dr. Ion Chiricuță” Cluj-Napoca
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Cuprins
CANCERUL MAMAR
COMUNICĂRI ORALE
CANCERUL PULMONAR
COMUNICĂRI ORALE
CANCERELE DIGESTIVE
COMUNICĂRI ORALE
POSTERE
CANCER ŞI DIABET
COMUNICĂRI ORALE
CANCERELE GINECOLOGICE
COMUNICĂRI ORALE
CANCERELE UROLOGICE
COMUNICĂRI ORALE
POSTERE
HEMATOLOGIE ŞI ONCOPEDIATRIE
COMUNICĂRI ORALE
POSTERE
DISCIPLINE FUNDAMENTALE
COMUNICĂRI ORALE
POSTERE
CANCERELE TIROIDIENE ŞI SFERA ORL
COMUNICĂRI ORALE
POSTERE
ANESTEZIE ŞI TERAPIE INTENSIVĂ
COMUNICĂRI ORALE
ASISTENŢI
COMUNICĂRI ORALE
POSTERE
ISTORIA MEDICINII
COMUNICARE ORALĂ
REZIDENŢI ŞI DOCTORANZI
COMUNICĂRI ORALE
POSTERE
STUDENŢI
POSTERE
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CANCERUL MAMAR
COMUNICĂRI ORALE
1. Hipertermia ca tratament al cancerului
Autori: Radu Tanasescu
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Rezumat:
Alaturi de metodele terapeutice standard, hipertermia si-a castigat un loc bine conturat in
formele avansate si metastatice ale diverselor localizari maligne.
La Institutul Oncologic “Ion Chiricuta” beneficiem de o instalatie de hipertermie prin
microunde, care asigura penetrarea pana la o profunzime de 3-4 cm, ceea ce face posibil tratamentul
tumorilor situate superficial (san, sfera ORL, cutanat etc).
In lucrare este prezentata cazuistica personala a autorului, intre 2011-2013. Au fost tratati
221 pacienti, cancerul mamar fiind majoritar, cu 77 de paciente. Cei mai multi pacienti au beneficiat
doar de hipertermie singura (124), asocierea hipertermie-radioterapie la 79 de pacienti iar asocierea
cu chimioterapia a fost utilizata la 18 pacienti. S-au obtinut raspunsuri obiective importante,
(complet-4%, partial-33% si stationar-46%) ceea ce recomanda aceasta metoda nu numai in
tratamentul paliativ al cancerului, ci si integrarea sa in tratamentul curativ al formelor avansate
locoregional.
2. Impact of boost dose on local control and survival in breast conserving therapy of early
breast cancer: from theory to practice
Autori: Carmen Popa, Anamaria Sipos, Luca Abrudan, Radu Tanasescu, Daniela Martin
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie:
Rezumat:
3. Breast Angiosarcoma After Breast Cancer: 2 case experience;
Autori: C. Zlătescu, R. Elisei, F. Bogdan, M-A. Mureşan
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie:
Rezumat:
Background: Breast conserving therapy has become an important treatment option for
primary breast cancer. Most patients undergo postoperative radiation therapy. Angiosarcoma arising
in the irradiated breast is being reported with increasing frequency. It has been estimated to occur in
0.05- 0.2 % of patients treated with adjuvant radiotherapy after breast cancer.
Methods: We reviewed the clinical history, treatment plans and followed 2 patients
diagnosed in our service with Angiosarcoma of the breast. Both cases have arisen in patients treated
with conservative surgery and adjuvant radiotherapy after primary breast cancer.
Conclusions: Breast angiosarcoma is an aggressive tumor. This calls for vigilance regarding
the skin changes in patients treated with breast conserving therapy. The aggressive nature of this
tumor demands further investigation regarding therapy to control local recurrence.
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4. Molecular and cellular mechanisms of chemotherapy resistance in triple negative
breast cancer cells
Autori: Oana Tudoran, Olga Soritau, Loredana Balacescu, Otilia Barbos, Roxana CojocneanuPetric, Ovidiu Balacescu, Ioana Berindan-Neagoe
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: microarray, triple negative breast cancer, cancer stem-like cells, treatment resistance
Rezumat:
Introduction: Breast cancer is the leading causes of cancer mortality in women worldwide.
Triple negative breast tumors are characterized by an aggressive phenotype, develop at early ages
and have the poorer prognosis and overall survival among the breast cancer subtypes. Therefore,
efforts are being focused on describing the molecular mechanisms of therapy resistance with a view
to identify new targeting strategies.
Materials and methods: Triple negative MDA-MB-231 breast cancer cells and
Estrogen/Progesteron positive MCF7 breast cancer cells were treated with doxorubicin and
carboplatin and analyzed for changes in gene expression using whole human genome Agilent
microarrays. The molecular and functional classification of the identified genes was done using
Ingenuity Pathway Analysis software. Biological effects were measured in hanging drop and
mammosphere assays to monitor the treatment influence on stem-like associated proprieties.
Results: In triple negative MDA-MB-231 breast cancer cells, microarray analysis revealed
transcriptional alterations of 5943 genes in response to doxorubicin and 1137 genes in response to
carboplatin, while in ER, PR positive MCF 7 breast cancer cells, doxorubicin treatment induced
changes in the expression of 3880 genes and carboplatin induced changes for 1740 genes.
Functional analysis revealed that several of the altered genes are involved in stem cells related
signaling. Both doxorubicin and carboplatin treatments affected the MCF7 cells ability to survive in
anchorage independent growth conditions, while the MDA-MB-231 cells remained unaffected.
Discussions and conclusions: In comparison to ER/PR positive breast cancer cells, our
results suggest that one of the chemotherapy resistance mechanisms of triple negative breast cancer
cells is through the modulation of stem cells signaling pathways to maintain survival and selfrenewal.
5. Rolul imagisticii intervenţionale în patologia glandei mamare
Autori: Carmen Lisencu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
6. Evolution of some quality indicators of DCIS treatment in a decade at the Oncology
Institute „Prof Dr Ion Chiricuta” Cluj-Napoca
Autori: Cosmin-Codruţ Nistor-Ciurba
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: DCIS, quality indicators, surgery
Rezumat:
Evolution of DCIS treatment imposed quality indicators to measure the quality of both
diagnostic and therapeutic procedures. In Europe the most used are EUSOMA (2010) Quality
Indicators for DCIS treatment, which set standards for the diagnostic and therapeutic procedures
involved in DCIS treatment. Our study analyses the evolution of quality indicators from
international literature(1,2) in a 10 years period studying by comparison 2 series of DCIS’s treated
in the Oncology Institute „Prof Dr Ion Chiricuta” Cluj – Napoca (IOCN) between 2000 – 2002 and
2010 – 1012.
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Our results show statistic significant differences in improving quality indicators as: percent
of DCIS’s smaller than 2 cm treated by conservative surgery, a mammogram no older than 6
months prior to surgery, cases referral to radiation-therapist, clear mention of dimensions,
histological grade, nuclear grade hormonal receptors status and status of resection margins in
pathologic reports.
Our study also identifies cases treated by conservative surgery who skipped the radiation
therapy due to the usage of VNPI (3) or due to refuse or inaccessibility of the treatment.
7. Molecular characterization of peripheral blood immunological profile of breast cancer
patients
Autori: Oana Virtic1, Oana Tudoran2, Loredana Balacescu2, Gabriela Morar Bolba2, Ovidiu
Balacescu2, Ioana Berindan-Neagoe 1,2
Instituţie: 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
2- The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: breast cancer, cytokines, peripheral blood
Rezumat:
Introduction: Breast cancer is the worldwide leading cause of cancers in female population.
Current approaches of cancer treatment are oriented towards more effective targeted therapies. In
order to understand the underlying pathogenic mechanisms of breast carcinogenesis and tumor
progression we need to accomplish a better evaluation of the tumor microenvironment and its link
to inflammation. Cytokines are key signaling molecules, released by immune cells that are involved
in complex modulating inflammatory microenvironment responses to antitumor therapy. The aim of
this study is to investigate a panel of pro-inflammatory mediators in the peripheral blood cells of
patients with breast cancer with different response to the therapy.
Materials and methods: Forty patients with two different subtypes of breast cancer were
enrolled in this study. The two groups were defined by their prognosis according to their hormonal
estrogen and progesterone receptors(ER, PR) expression in primary tumors at diagnosis, both
groups lacking Her2 expression. Eighty-four genes including pro-inflammatory mediators,
cytokines and chemokines were investigated in the peripheral blood circulating cells (PBCs) by
PCR array. Data were analyzed with Web-designed software Cataloged and Custom Arrays for
expression levels and IPA software for functional analysis. Molecular data were correlated with
clinical-pathological characteristics.
Results and discussions: We identified 15 genes that were significantly expressed between
the two groups based on ER/PR expression. These genes are involved in regulating of inflammatory
responses through cell-to-cell interactions and signaling. Likewise cytokines manifest pleiotropic
actions with functions and implications in innate and adaptive immune responses. An association of
molecular data with clinical and histopathological characteristics was established for both breast
cancer subtypes. In conclusion, we believe that analyzing the immunobiological pathways of PBCs
may yield important information data with impact for therapy and prognosis.
8. A survey of the needs of women suffering from breast cancer
Autori: Alexandra-Ana Tolnai, Florina Pop
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: cancer, psychosocial intervention, anxiety, depression, QOL
Rezumat:
Introduction A lot of the patients diagnosed with breast cancer experience a myriad of
psychological, medical and social challenges. Recent studies have showed that psychosocial
problems are very common in patients throughout their treatment. Therefore, the aim of this paper
is to configures a survey of the needs of women suffering from breast cancer and to propose
psychosocial intervention strategies meant to improve their quality of life.
Material and method: In all, 15 patients suffering from breast cancer agreed to participate
in the survey. As such, they have completed the functional assessment of cancer therapy for breast
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cancer (FACT-B) form, (Romanian version), and a 20 question questionnaire regarding their
specific needs (NEQ) at the moment of its completion.
Results: The FACT-B Trial Outcome Index (TOI) showed that 3 patients (20%) had a score
of ≥72, 13 patients (86,67%) had a score of ≥48 and 2 patients (13,33%) had a score of <48.
Moreover, the FACT-G total score showed that non of the respondents have a maximum of 108
score, but there were 3 (33,33%) patients that scored ≥81. Finally, the FACT-B total score showed
that 5 patients (33,33%) had a score of ≥111, but non of them reached the maximum of 148.
Discutions: The FACT-B is appropriate for use in oncology clinical trials, as well as in
clinical practice. It demonstrates ease of administration, brevity, reliability, validity, and sensitivity
to change. On the other hand, the NEQ showed that psychosocial strategies, if carried out on regular
basis, proved their validity for the patients.
Conclusion: Overall, psychosocial care during breast cancer treatment, as an important cure
strategy, should be carried out in routine clinical practice. What is more, family support was the
most important source of support for patients protecting them from psychological distress,
anxiety and depression.
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CANCERUL PULMONAR
COMUNICĂRI ORALE
1. Milestones in the management of lung cancer and treatment algorithm
Autori: Dana Iancu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
According to Globocan 2008, in Romania 70,300 new patients with cancer and 46,300
cancer deaths were eccountered.Lung cancer is most frequently in both men and women and
remains the leading cause of death. Incidence of lung cancer was 10,384 new cases and mortality
was 9,427 cases. The death rates are now falling because of declining cigarette smoking and more
effective cancer management. The last 50 years have seen a real progress in the development of
effective treatment for lung cancer with significant and meaningful improvements in both quantity
and quality of life.
The surgical techniques for resection have evolved; relationship between cigarette smoking
and lung cancer has been defined; efficacy of chemotherapy in advanced lung cancer has been
recognized; role of adjuvant therapy following resection has been established; identification and
targeted treatment as well as identification and understanding of oncogenic drivers have become
possible, a CT scan screening was recently introduced for early detection of disease. Due to this
progress, the treatment algorithms were developed for both non small cell and small cell lung
cancer.
2. Pulmonary resection in pulmonary tumors. Anesthetic management
Autori: Laura Săndoiu
Instituţie: “Leon Daniello” Hospital, Cluj-Napoca,
Cuvinte cheie: pulmonary cancer, anesthetic management, one lung ventilation, pulmonary
resection, acute lung injury.
Rezumat:
Pulmonary cancer incidence has increased alarmingly in recent decades.
In Romania, pulmonary cancer showed a significant increase,occupied first place for men
and 3rd place for women after the breast and uterus.
Pulmonary cancer is a tumor that is extremely severe because clinical signs often appear
late, evolving asmptomatic for a long period of time.At the time of diagnosis only one third of cases
are found useful therapy .
Pulmonary cancer is the leading indication for elective surgery in the field of thoracic
surgery, often questionable in terms of possible therapeutic alternatives untill now. A resectable
cancer patient of severe local neoplastic or loco-regional, can be operated with an acceptable risk.
Should be kept in mind that only 13% of patients will benefit from a radical surgery and cure
survival rate from the remaining 87 % with unfavorable outcome.
Histopathological pulmonary cancer is divided into small pulmonary cell cancer of 20-25%
or without small cell (squamous - adenocarcinoma with enlarge cell) 75-80 %, smoking is
responsible for about 90 % of pathology. Small cell Cancer has survival rate of max.10 % of
treatment because of limited to chemo / radiotherapy. Frequently is associated with paraneoplastic
syndromes (SIADH, Chusing syndrome or miasteniform Eaton-Lambert syndrome). cancer without
small cell has a five year survival rate after surgery in approximately 40 %. More primary thoracic
carcinoid tumors are mostly benign , five year survival over 90% and pleural tumors ( malignant
mesothelioma does not respond to treatment, interventions are risky and have an average survival
rate of one year).
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Responsibility of anesthesiologist before surgery is to check all preoperative investigations
performed by pulmonologist and surgeon to establish perioperative risk, and to calculate the risk /
benefits so that they can focus more resources on higher -risk patient.
3. The role of radiotherapy in modern treatment of lung cancer
Autori: Petronela Rusu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
The principles and role of Radiation Therapy for Lung Cancer are reviewed according to
updated guidelines, the NCCN Guidelines version 3.2014, and ESMO Guidelines 2013.
Radiotherapy has a potential role in all stages of NSCLC and SCLC and is definitive or palliative as
part of multidisciplinary treatment. The appropriateness is made by board –certified radiation
oncologists who perform lung cancer radiotherapy as a part of their practice.
The critical goals of modern RT are to maximize tumor control and to minimize treatment
toxicity.
Recommendations and techniques are reviewed for early stage, locally advanced and
metastatic NSCLC, as well as for limited stage and extended stage SCLC.
A minimum technologic standard is CT-planned 3D-CRT. More advanced technologies,
which proved to reduce toxicity and improve survival in nonrandomized comparisons, include 4DCT and/or PET-CT simulation, IMRT/VMAT, IGRT, motion management and proton therapy,
which are also reviewed.
4. Maximum-tolerated dose reached with dose escalation using 3DCR
Autori: Petronela Petronela Rusu1, Tudor E. Ciuleanu 1,2, Nicolae Todor 1, Ioana Lupse1,Tiberiu
Guttman1
Instituţie: 1The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca;
2
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: locally advanced NSCLC, dose escalation 3DCRT, concurrent chem
Rezumat:
Purpose: In order to improve local and distant control, we aimed to evaluate the maximumtolerated dose (MTD) and efficacy of dose escalation using three-dimensional conformal
Radiotherapy (3DCRT) in concurrent setting with vinorelbine (Vrb) and Cisplatin (DDP) or
Carboplatin (CBDCA) in locally advanced non-small cell lung cancer (NSCLC), in a phase I-II
study.
Patients and methods: 84 patients (pts) were included from 09.02.2005 to 05.11.2012 with
median age 57.5 (41-74), M/F=77/7, PS 1/2=60/24, stage IIIA/IIIB=15/69, squamous cell
carcinoma 66, adenocarcinoma 10, large cell carcinoma 3, “non-small” cell carcinoma 5. Pts who
fulfilled the dose-volume histogram constraints underwent dose escalation of radiotherapy, if no
more than two grade 3 or one grade 4 (non-hematological or hematological toxicities lasting more
than 2 weeks or complicated with fever or bleeding) occurred, until MTD. If there were one grade 3
and one grade 4 toxicities, further expansion continued by 6 more pts. Chemotherapy consisted of 6
cycles of Vrb (25 mg/sqm, d1, 8, q21) and DDP (100 mg/sqm, d1, q21), or CBDCA (AUC 5, d1,
q21). In concurrent setting, doses were reduced: Vrb 15 mg/sqm, d1, 8, q21, DDP 80 mg/sqm, d1,
q21 or CBDCA AUC 4, d1, q21.
Results: 69 pts underwent dose escalation in nine cohorts from 64Gy to 80Gy. For each
dose level up to 7 pts were enrolled, with further expansion by 6 pts at 70 Gy dose level, as one
grade 3 pulmonary toxicity and one grade 4 neutropenia lasting more than two weeks occurred. At
the 80 Gy dose level, one grade 3 esophagitis and two grade 3 pulmonary toxicities occurred, so the
MTD was set at 78Gy. Severe acute grade 3 and 4 toxicities were: esophagitis 6%, pulmonary
toxicity 12%, digestive toxicity 4%, neutropenia 17% of the pts.
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The phase II portion of the study was delayed after detailed evaluation of the late toxicities. So far,
severe late esophageal adverse events occurred in 5 pts (7%), grade 3 pulmonary fibrosis in 8 pts
(12%), myocardial infarction in 1 pts, fatal hemoptysis in 4 pts (6%), at a time when progression of
the disease occurred. Objective response rate was 78%. With a median follow-up of 26.5 months,
median survival was 27.6months the 1 and 2.5-year survival rates were 87% and 46% ( CI 34%59%). Progression free survival at 1 year was 68%, at 2.5 years 26% (CI: 17%-39%) and mTTP
14.7 months. Local-regional progression- free survival at 1 year was 84%, at 2.5 years 38% ( CI:
25%-52%).
Conclusions: MTD was reached during dose escalation and set at 78 Gy using 3D-CRT
with concurrent Vrb and a platinum compound. RR and Survival data were promising in these
cohorts, but late toxicities need further evaluation.
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Translating lung cancer biology to the clinical setting
Autori: Claudia Burz
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie:
Rezumat:
Cancerul de plămân reprezintă o cauză importantă de deces prin cancer, adesea datorita
stadiului avansat în care este diagnosticat. Prin studii de biologie moleculară se incearcă
identiificarea indivizilor susceptibili de a dezvolta această neoplazie dar, și descifrarea
mecanismelor moleculare responsabile de apariția fenotipului malign.
Cele mai frecvente mutații genice identificate în cancerul de plămân afectează gena EGFR,
K-RAS, BKL-ALK, Her2, BRAF, FGF1, VEGF, incidența lor fiind diferită în tipurile
histopatologice cunoscute. Terapia individualizată prin administrarea unor produse care țintesc
modificările genice este tot mai utilizată în managementul cancerului de plămân.
6.
Presence of the Institute of Oncology “Prof. Dr. Ion Chiricuţă” on the
international lung cancer research scene.
Autori: TE Ciuleanu, P Rusu, D Iancu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: NSCLC, SCLC, multicentre clinical studies
Rezumat:
The purpose of this presentation is to review the involvement of the Institute of Oncology
“Prof. Dr. Ion Chiricuță” Cluj Napoca (IOCN) in the active clinical research in lung cancer in the
last 10 years. From 2004 to 2009, among 9129 patients included in selected prospective multicentric
lung cancer phase II&III studies, where IOCN took part, 549 (6%) were treated at IOCN. The range
of participation in different studies was among 2,2% and 39,2%. Briefly, the topics and results were
as follows:
NSCLC studies:
-demonstration of the benefit of adjuvant chemotherapy in prolonging survival (IALT study,
NEJM, 974 citations).
-survival benefit for erlotinib over placebo as rescue treatment (BR21 study, NEJM 2744
citations).
-lack of benefit for gefitinib as rescue treatment in an unselected patient population (ISEL
study, Lancet: 1146 citations).
-demonstration of the predictive role of EGFR activating mutations for gefitinib response (J
Clin Oncol, 454 citations).
-value of maintenance therapy in NSCLC pts. for pemetrexed (JMEN study, Lancet: 388
citări) and erlotinib (SATURN study, Lancet Oncol: 359 citations), in terms of overall survival.
-limited benefit for gemcitabine maintenance (CECOG study, Lung Cancer, 131 citations).
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-equivalent efficacy for eroltinib versus docetaxel or pemetrexed in 2nd line treatment
(TITAN study, Lancet Oncol: 43 citations).
-no advantage for paclitaxel-poliglumex + platinum versus paclitaxel plus platinum as first
line treatment (STELLAR 3 study, J Thorac Oncol: 52 citations).
-no benefit adding cediranib to pacltaxel and carboplatin first line therapy (BR 24 study, J
Clin Oncol: 97 citations).
SCLC studies
-survival benefit for oral topotecan vs best suportive care as rescue treatment (O’Brien
study, J Clin Oncol: 143 citations).
-25 Gy/ 10 fractions remains the standard prophylactic whole brain radiotherapy, less toxic
and as efficient as higher doses (PCI 99-01 study, Lancet Oncol: 73 citations).
-pemetrexed is inferior to etoposid, in combination with platinum as first line treatment in
extended disease (J Clin Oncol: 43 citations).
Conclusions: The participation of IOCN to multicentric clinical studies was active and
consistent. Some of these trials resulted in the first time registration of new molecules (such as
erlotinib, oral topotecan) or indications (maintenance for pemetrexed and erlotinib) or decisively
contributed to the acceptance by the medical community of a new treatment strategy (such as
adjuvant and maintenance chemotherapy in NSCLC, second line treatment in SCLC).
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CANCERELE DIGESTIVE
COMUNICĂRI ORALE
1. MRI evaluation in rectal cancer
Autori: C. Popiţa¹´², Anca-Raluca Popiţa¹´², Ramona Boja², Adina Andrei²
Instituţie: 1 – The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
2 – Phoenix Diagnostic Clinic, Cluj-Napoca, Romania
Cuvinte cheie: Magnetic Resonance, rectal cancer, pelvic MRI
Rezumat:
Rectal cancer is a common malignancy, representing one of the most common causes of
cancer death. The subsequent evolution of patients is variable, local pelvic recurrence after surgical
resection being a negative prognostic factor.
The success rate of surgical excision depends on the accuracy of staging.
Studies to date have indicated that the assessment of tumor invasion of perirectal fat and of
the mesorectal fascia are important factors for the T staging and for choosing the optimal treatment
plan.
Due to the high contrast resolution, magnetic resonance imaging (MRI) is nowadays
increasingly used to assess operability and to determine which of the patients will be treated
surgically and which will require adjuvant radiotherapy.
In this paper we present MRI findings encountered in patients with rectal cancer, at initial
staging.
The MRI exams were performed on a Siemens Avanto 1.5 T unit in the Phoenix Diagnostic
Clinic, in Cluj-Napoca. The protocol used for evaluating the patients included T2-weighted
sequences - in the long axis of the tumor and perpendicular to the longitudinal axis of the tumor diffusion sequence with ADC map and T1 sequences before and after administration of contrast
material.
The histopathological confirmation of the rectal cancer was obtained in all patients included
in the study. We correlated the MRI findings with the surgical and histopathologic data.
Magnetic Resonance is an examination that allows reproducible assessment of surgical
circumferential resection margins and extramural tumor extension. Pelvic MRI is used increasingly
frequently in the preoperative staging of rectal cancer, as its accuracy allows choosing the
appropriate therapeutic approach.
2. Morphopathological prognostic factors in rectal cancer. The experience of a tertiary
oncology center.
Autori: C. Vlad, P. Achimaş-Cadariu, C. Lisencu, E. Puscas, F. Ignat, T. Criste, A. Oltean, A.
Irimie
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: rectal cancer, prognostic factors, TNM stage, lymphatic invasion, perineural
invasion.
Rezumat:
Introduction: Despite the progresses of genetics and mollecular biology in the last decades,
morphopatologic factors remain primordial in the prognosis of colorectal cancer. This study
evaluates the most important morphopatologic prognostic factors and the link with rectal cancer.
Material and method: We have retrospectively analyzed a group of 317 patients with rectal
cancer resected at The Oncology Institute ”Prof. Dr. Ion Chiricuţă” Cluj-Napoca (IOCN), between
January 2000 and December 2008. Patients data was statistically analyzed.
Results: The 5-year overall survival rate was 55.6%. The univariated analysis revealed that
all morphopathologic factors had a prognostic significance in rectal cancer, respectively the radial
resection margin (p=0.038), TNM stage (p<0.001), ganglionary insvasion (p<0.001), venous
invasion (p=0.01), limphatic invasion (p<0.001), perineural invasion (p=0.014) şi degree of tumor
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differentiation (p=0.019). Venous invasion is frequently associated with advanced disease stages,
with high degree differentiation tumours and distant metastasis, and the lymphatic and perineural
invasion is associated with relapse and positive nodes. The multivariate analysis revealed
independent prognostic factors for global survival: tumor degree, (p = 0.0142), node invasion (p =
0.0135), venous invasion (p = 0.0174), limphatic invasion (p = 0.0001) and perineural invasion (p =
0.0082).
Conclusions: Apart from TNM stage and ganglionary insvasion, it was proved that venous,
limphatic and perineural invasions are also prognostic factors in rectal cancer. It is necessary to
identify an optimal therapeutic protocol according to all analyzed prognostic factors.
3. Rectal cancer extended to the adjacent anatomic structures: pathology features and
surgical implications
Autori: R. Simescu 1,2, O. Fabian 1,2 , M. Cazacu1,2, I. Domsa3, A. Zolog3, A. Mihailov1,2, G.
Petre1,2, I. Simon1,2, T. Oniu1,2, C. Lungoci1,2, D. Deceanu1,2, R. Galasiu1,2, C. Radu1,2, V.
Muntean1,2
Instituţie:
1 CF Clinical Hospital
2 “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
3 CF Clinic Cluj-Napoca
Cuvinte cheie: rectal cancer, local extension, surgical treatment
Rezumat:
Introduction: Surgery of rectal cancer invading adjacent structures (T4b) is still
controversial. Morbidity and mortality subsequent to R0 resections (multi-organ resections or total
pelvectomies) are considerable and often radio-chemotherapy and palliative surgery are the
preferred options.
Patients and method: Patients with rectal cancer extended to adjacent anatomical structures
(T4b) were compared with patients without extra-rectal extension (T1-T4a) and with ones having
serosal invasion (T4a). Information was drawn from a prospective database including operative
protocols, specimen pathology findings and follow-up data. The study included only patients who
had undergone elective surgery and whose database records were complete. Statistical analysis was
performed with Microsoft Excel and OpenEpi. Rates were compared using the chi-square test; p
values under 0,05 were considered statistically significant.
Results: Over 10 years (2004-2013) 268 patients with recto-sigmoid and rectal cancer were
treated.
Of the 237 eligible patients, 52 had adjacent structures invasion (pT4b). 185 patients didn’t
show extra-colic extension (pT1-pT4a), 30 of them had invasion in the serosa (pT4a). Compared
with T1-T4a tumors, T4b had statistically significant venous invasion and low tumor grade; there
were no significant differences regarding growth pattern, inflammatory infiltrate, lymph node
metastases or lymphatic and perineural invasion. No statistically significant evidence was found
between pT4b and pT4a groups. 43% of the pT4a and 38% of the pT4b cases were N0M0. For
anterior rectal and abdomino-perineal resections there was no significant difference between the
three groups of patients regarding type of resection performed (R0, R1 or R2), morbidity and
immediate perioperative mortality. Morbidity in pT4b patients with total pelvectomies was
significantly increased.
Conclusions: Rectal tumors extended to adjacent structures show a locally and regionally
increased invasion pattern. Multiorgan R0 resections are justified whenever perioperative morbidity
and mortality can be maintained within acceptable ranges. Regarding T4bN0M0 cases, R0 resection
should be performed in all patients with good operative risk.
15
4. Tailoring treatment in rectal cancer
Autori: Alina-Simona Muntean
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: radiochemotherapy, chemotherapy, rectal cancer, prognostic factors
Rezumat:
Overview : Rectal cancer treatment was improved in the last five decades. Surgery and
chemo (radiotherapy) remain the key elements of multimodality management of locally advanced
rectal adenocarcinoma (LARC). Improvement in surgical techniques with implementation of total
mesorectal excision (TME) dropped the local recurrence to 10-15% vs 50% in blunt dissection era.
Also, radiotherapy alone or combined with chemotherapy resulted in improvement of locoregional
control, but no differences in overall survival were reported. The optimum sequence of surgery,
combined modality treatment, radiotherapy and induction or adjuvant chemotherapy has been
addressed in several trials with the aim of reducing local failure and increase overall survival. In
1990, National Institute of Health Consensus Conference established adjuvant 5 FU- based
radiotherapy as standard of care in patients with pT3, T4 N0 or any T and positive lymph nodes.
After 15 years, German Rectal trial CAO/ARO/AIO -94 demonstrated that preoperative
chemoradiotherapy (CRT) is better than postoperative therapy in terms of local control (6% vs 13%,
p= 0,006), acute toxicity ( 27% vs 40%, p=0.001), chronic toxicity ( 14% vs 24%, p=0,012),
sphincter sparing surgery in patients judged initially to require an abdomino-perineal resection
(39% vs 19%, p=0,005). Due to these results, preoperative concomitent chemoradiotherapy was
established as standard of care in LARC. Four randomized phase III trials have added oxaliplatin to
5-FU or to capecitabine based preoperative radiotherapy. Three of these trials demonstrates that
oxaliplatin does not improve the endpoints of these studies : pathologic response rate, sphincter
preservation and disease-free survival but increases the toxicity and concluded that oxaliplatin has
no role in preoperative combined modality treatment.
The next step is to identify and to select patients for ideal treatment who must be adapted to
the tumor location, stage and to the individual patient's risk factors. The option of nonoperative
therapy in patients with pCR particularly in patients with distal rectal cancers who required an
abdominoperineal resection and permanent colostomy, assure a better quality of life. However the
majority of local recurrences occur in the first 3 years after treatment, therefore a close surveillance
and longer follow-up is needed. The selective use of chemoradiotherapy is also investigated in
patients treated with induction chemotherapy. Preoperative chemoradiotherapy is the current
standard, but to apply these treatment to all patients with stage II / III needs to be examined in
perspective. Avoiding radiotherapy or surgery remains investigational and are the endpoints of
phase II/III trials.
5. Predictors of response to neoadjuvant induction chemotherapy and chemoradiation in
rectal cancer. A prospective observational study.
Autori: Fekete Zsolt 1,2 , Muntean Alina 2, Irimie Alexandru1,2, Hica Ştefan 1, Rancea Alin1,2,
Resiga Liliana 2, Nagy Viorica Magdalena1,2
Instituţie: 1. “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca
2. The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: rectal adenocarcinoma, chemoradiation, down-staging, prognostic factors
Rezumat:
Introduction: The purpose of this prospective study was to analyze the prognostic factors
associated with a good response to induction chemotherapy and chemoradiation in the neoadjuvant
treatment of locally advanced rectal adenocarcinoma.
Material and methods: Between 03/2011-10/2013 we have included 88 patients in the
study. We have analyzed tumor and lymph node down-staging and the histological tumor response
grade as defined by the 7th edition of the TNM staging of the AJCC.
16
Results: The rate of T down-staging was 49.4% (40/81 evaluable patients). Independent
prognostic factors for T down-staging were: age >57 years (p<0.01), cN0 (p<0.01), distance from
anal verge >5 cm (p<0.01), initial CEA <6.2 ng/ml (p<0.01) and higher number of chemotherapy
cycles with Oxaliplatin (pROC=0.05). TRG correlated with T-down-staging. Nine patients from 81
(11.1%) presented complete response (7 pathological and 2 clinical); the independent prognostic
factors were stage cT2 versus cT3-4 (p<0.01), initial tumor size ≤3.5 cm and distance from anal
verge >5 cm (p=0.03). A smaller yN stage was encountered in 49/73 patients (67.1%); 10 patients
(13.7%) had N0 both on the initial and post-CRT staging; 11 patients had stable N stage (15.1%)
and 3 patients (4.4%) a higher N stage. Sixty-eight patients (79.1%) underwent radical surgery and
among them 35 patients (51.5 %) had a sphincter saving procedure.
Discussions: There are several factors which anticipate a suboptimal response to
neoadjuvant treatment and intensification of the neoadjuvant protocol for patients with negative
prognostic factors for down-staging worth consideration in well designed prospective studies.
Conclusions: Almost 50% of patients had T-down-staging and 78% N-down-staging. The
rate of complete response in this mixed cohort was 11%. Independent prognostic factors for T
down-staging were: age, cN0, distance from anal verge, initial CEA and the number of Oxaliplatin
cycles.
6. Locally advanced gastric cancer: pathological particularities and surgical implications
Autori: D. Constantinescu, O. Fabian, I. Domsa, A. Zolog, A. Mihailov, R. Toganel, F. Muresan,
O. Cebotari, E. Patrut, V. Muntean
Instituţie: Surgery IV Clinic, CF Clinical Hospital, Cluj-Napoca
Cuvinte cheie: gastric cancer, locally advanced, surgical treatment
Rezumat:
Introduction: Surgical treatment for locally advanced gastric cancer (T4) was limited for a
long period to palliative resections. Association of radio-chemotherapy and identification of patients
with a better prognosis among the T4 group, could sustain the therapeutic benefit of R0 resections
and justify the increased perioperative morbidity and mortality.
Patients and methods: Pathological examination and clinical data of patients with locally
advanced gastric cancer (T4) were compared with data from patients with tumor extension limited
to the stomach (T1-T3). Data were extracted from a prospective database, which includes operative
and pathological reports, as well as postoperative follow up. The study included only patients with
complete records, who underwent elective surgery. Statistical analysis was performed using
Microsoft Excel an Open Epi. Frequencies were compared using Chi square test; p values under
0.05 were considered significant.
Results: Over a period of 10 years (2004-2013) 248 patients with gastric cancer underwent
surgical resection.
The study included 200 patients, 100 patients for each half of the above mentioned period
(2004-2008, 2009-2013 respectively): 114 patients (92 / 22 from the first, respectively second
period) were pT1-pT3, and 86 patients pT4 (8 / 78). Compared with T1-T3 tumors, T4 tumors had a
better histological differentiation grade, while peritumoral inflammatory infiltrate and tumor
necrosis were significantly reduced. Metastases in regional lymph nodes, lymphatic emboli and
perineural invasion were significantly higher in T4 tumors compared with T1-T3; no significant
differences regarding tumor growth pattern and venous tumor emboli were observed.
There were no significant differences in pathological parameters between T4a and T4b
tumors. Regarding the type of surgery, between 2009-2013 there were more D1+ and D2
lymphadenectomies performed, compared with 2004-2008 period (with a significantly higher
number of resected lymphnodes), without a significant difference in the type of resection
performed: R0, R1 or R2 (which could be explained by the higher number of locally advanced
tumors resected during the second period). Perioperative morbidity was significantly increased in
patients with T4b tumors and in patients who underwent D1+ or D2 lymphadenectomies, while
immediate perioperative mortality remained unchanged. Conclusions: While perioperative mortality
17
and morbidity remain acceptable, multiorgan R0 resection and D1+ or D2 lymphadenectomy could
bring a therapeutic benefit in selected patients with locally advanced gastric cancer with favorable
biological characteristics of tumor growth
7. Modern Chemotherapy in stomach cancer after surgery
Autori: Cainap C, Muntean A, Lisencu C, Achimas P, Nagy V
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Rezumat:
Gastric cancer remains one of the most difficult tumour type despite his relative reduction of
his global incidence, it remains on of the most deadly cancer. The latest advances in therapy of the
gastric cancer ameliorate the results in terms of survival.
In our study which is a prospective nonrandomised one, we enrolled 40 patients with gastric
adenocarcinoma stage IB to IV (M0) who was operated, chemoradioterapy treated, but with the
chemotherapy compound modified with ECX regimen(epirubicine, cisplatine, xeloda) which is now
considered standard in metastatic setting. We report the toxicities and posible predictive factors to
toxicity.
The ECX regimen seems to be a reliable alternative to the clasic regimen with convienient
toxicity and therapeutical index.
8. PanINs in chronic pancreatitis: to resect or not to resect?
Autori: S.T. Barbu, I. Domsa, M. Cazacu
Instituţie: Univeristy of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca
Cuvinte cheie: pancreatic cancer, precursor lesions, pancreatic intraepithelial neoplasia, chronic
pancreatitis
Rezumat:
Introduction: Although pancreatic intraepithelial neoplasia (PanIN) are well-documented
precursor lesions of pancreatic cancer, there are few available data about their natural history and
rate of progression. As PanIN3 is carcinoma “in situ” and evolves toward invasive ductal
adenocarcinoma (IDC), such data would help to decide the surgical attitude when PanIN3 are
found.
Methods: We describe herein a patient with PanIN3, in whom IDC manifested in the
remnant pancreas 7.5 years after distal pancreatectomy for chronic pancreatitis (CP). We found 8
more documented cases in the literature. Furthermore, we analyzed 11 partial pancreatectomy
samples from CP patients operated in our Clinic for the presence, grade and number of PanIN foci.
Cases were graded by the highest PanIN grade focus identified. All patients were followedup yearly, until December 2013, or last personal contact or death. Statistical PanIN correlations
with clinical independent variables (age, sex, smoking, diabetes, alcohol consumption,
calcifications, CP duration) were calculated.
Results: In the 9 documented patients from the literature (including our patient) where
PanIN3 was found in partial pancreatectomy specimens, IDC manifested in the pancreatic remnant
17 months to 29 years after surgery (mean = 8.85 years). In our 11 CP pancreatectomy samples,
PanIN was present in 7 (58.4%). Pathology grading was PanIN1 in 4 (36.36%), PanIN2 in 2
(18.18%) and PanIN3 in 1 (9.1%). No other IDC developed on PanIN in 7.3 years mean follow-up.
PanIN3 presence was correlated with advanced age and smoking more than 20 cigarettes/day for
more than 10 years.
Conclusion: PanIN is a frequent founding in advanced CP. Progression to IDC may take
many years, pleading rather for a close follow-up than for total pancreatectomy in debilitated,
malnourished, CP patients. To individualize indication for surgery, further studies are needed,
looking for risk factors like molecular or genetic alterations that accelerate PanIN3 progression.
18
9. Human bile contains microRNA-laden extracellular vesicles that can be used for
cholangiocarcinoma diagnosis
Autori: Ciprian Tomuleasa, Ioana Berindan-Neagoe, Florin Selaru
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
Cholangiocarcinoma (CCA) presents significant diagnostic challenges, resulting in late
patient diagnosis and poor survival rates. Primary Sclerosing Cholangitis (PSC) patients pose a
particularly difficult clinical dilemma, since they harbor chronic biliary strictures that are difficult to
distinguish from CCA. MicroRNAs (miRs) have recently emerged as a valuable class of diagnostic
markers; however, thus far, neither extracellular vesicles (EVs) nor miRs within EVs have been
investigated in human bile. We aimed to comprehensively characterize human biliary EVs,
including their miR content.
Conclusion: We have established the presence of extracellular vesicles in human bile. In
addition, we have demonstrated that human biliary EVs contain abundant miR species, which are
stable and therefore amenable to the development of disease marker panels. Furthermore, we have
characterized the protein content, size, numbers and size distribution of human biliary EVs.
Utilizing Multivariate Organization of Combinatorial Alterations (MOCA), we defined a novel
biliary vesicle miR-based panel for CCA diagnosis which demonstrated a sensitivity of 67% and
specificity of 96%. Importantly, our control group contained 13 PSC patients, 16 patients with
biliary obstruction of varying etiologies (including benign biliary stricture, papillary stenosis,
choledocholithiasis, extrinsic compression from pancreatic cysts, and cholangitis), and 3 patients
with bile leak syndromes.
Clinically, these types of patients present with a biliary obstructive clinical picture that could
be confused with CCA. These findings establish the importance of using extracellular vesicles,
rather than whole bile, for developing miR-based disease markers in bile. Finally, we report the
development of a novel bile-based CCA diagnostic panel that is stable, reproducible, and has
potential clinical utility.
POSTERE
1. Pseudomyxoma peritonei: A Case Report and the Management of Disease
Autori: Ababneh Rami, Pompiliu Piso, Dumitrovici Anca, Burz Claudia
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Pseudomyxoma peritonei, cytoreductive surgery , HIPEC
Rezumat:
Pseudomyxoma peritonei (PMP) is a rare condition characterized by intra abdominal
extracellular gelatinous fluid collections and non-invasive mucinous implants on the peritoneum
containing mucus-producing epithelium. This disease affecting 1 per million population with an
estimated incidence of 2 cases per 10000 laparotomies, The etiology is a mucinous neoplasm, most
often arising in the appendix. The treatment protocol for PMP focuses on cytoreductive surgery
combined with intraperitoneal chemotherapy (more latterly hyperthermic intraperitoneal
chemotherapy). We herein describe a case of pseudomyxoma peritonei diagnosed in a 44 year-old
man. The patient was treated with aggressive Cytoreductive surgery in combination with
intraoperative HIPEC and HITHOC followed by systemic chemotherapy, with good tolerability.
19
2. Scintigraphy versus ultrasonography in assessment of liver tumors
Autori: Ioana Grigorescu 1, Oliviu Pascu 2, Radu Badea 2, Zeno Spârchez2, Mircea Dragoteanu2,
Cecilia Pîgleşan2, Dan Lucian Dumitraşcu1
Instituţie:
1 II Medical Clinic. University of Medicine and Pharmacy “Iului Hatieganu” Cluj-Napoca,
2 Regional Institute for Gastroenterology and Hepatology “O. Fodor” Cluj-Napoca
Cuvinte cheie: Ultrasonography, scintigraphy, liver nodules
Rezumat:
Aim: assessment of complementary contribution of the data offered by ultrasonography
(US) and scintigraphy, in order to establish the positive and differential diagnosis of liver focal
lesions, both in normal liver and in CLD (chronic liver diseases).
Methods: 238 patients (23 having at the same time 2 different types of tumors) with 261
hepatic tumors, were evaluated by: grey-scale and DopplerUS, Scintigraphy; some patients
underwent also: contrast-enhanced US (CEUS), Power-Doppler (PD), B-flow, hepatic
angioscintigraphy (HAS) „in vivo”-labeled-RBC-SPECT. The final diagnosis was established after
correlating US-scintigraphic data with other imaging methods (CT, MR), clinical, laboratory,
intraoperatory and histological aspects.
Results: Doppler-US revealed in 81.85% cases the classical criteria of hyperechoic, well
defined mass without vascular signal. Gray-scale, Doppler-US and CEUS had high specificities
(94,87%) in small hemangiomas in normal liver. CEUS established real positive diagnosis in
87.5%cases. Cavernous hemangiomas with non-enhancing central areas (central necrosis/
thrombosis/sclerosis) arised problems of differentiation with necrosis in malignancy. Similar did
high-shunt-flow hemangiomas because of the hypoenhancement (late phase). False negative
diagnosis of non-hemangiomatous tumor(n=5) might be explained by the correlation between
fibrotic stage and presence of sclerosis; US-scintigraphic concordances were found in 68.83%
hemangiomas, while non-concordances could be caused by: lack of scintigraphic performances in
tumors<2cm, decreased rate of detectability of isoechoic+ deep seated lesions. Angioscintigraphy
revealed a good correlation of tumoral volume and the increased HPI in hemangiomas (r=0.378
p=0.000) and FNH ( r=0.712 p=0.021). HPI≤45% suggests benign lesions but can be found also in
metastatic carcinoids; higher HPI>45% were correlated with malignancy, but also with voluminous
benign tumors (r=0,313; p=0.000).
Conclusion: US and scintigraphy are complementary diagnostic methods, US representing
the standard investigation for cysts, while HAS and labeled-RBC-SPECT are useful in
hemangiomas and FNH. Atypical features require often further investigations (CT, MR or
histology) to allow benign-malignant differentiation.
3. Tonic-Clonic Seizures During Chemotherapy Regimen in Gastric
Autori: Crinela Lupu, Blag Dorel, Burz Claudia
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: seizures, gastric cancer, chemotherapy
Rezumat:
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 chemotherapyis
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.
20
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.
4. Central pancreatectomy with Roux en y duct to mucosa pancreatico-jejunostomy for
neuroendocrine tumor of the pancreatic body
Autori: D. Munteanu, J.Serhal, P. Pădurean, Al. Munteanu, C. Iancu
Instituţie: Regional Institute for Gastroenterology and Hepatology “O. Fodor”, Cluj Napoca
Cuvinte cheie: pancreatic benign tumors, resection.
Rezumat:
Background: To analyse and discuss the particularities, clinic-pathological features and
technical aspects of a case of pancreatic body neuroendocrine tumor.
Method: The case of a 54 years old caucasian female patient with a pancreatic body neuroendocrine
tumor is discussed. Clinical features, intraoperative findings and technical solutions are debated on.
Results: At a routine percutaneous abdominal ultrasound examination the suspicion of a 10
mm pancreatic body “cyst” was raised. A subsequend CT scan revealed a pancreatic body solid
tumor, 10-11 mm in diameter, well delimited, with the imagistic features of a neuroendocrine
tumor. After admittance in our institute, a further endosonography excluded the invasion of the
adjacent vascular structures. Surgery has confirmed the diagnosis. A central pancreatectomy with
bilateral 1 cm security margins and preservation of both splenic vein and artery was performed; the
cephalic pancreatic stump was sutured after separate closure of the Wirsung duct. The left
pancreatic body stump was termino-lateral anastomosed to a Roux en Y transmesocolic loop, in the
duct-to-mucosa manner (Wirsung duct dilated – 3-4 mm in diameter). The outcome was uneventful.
Conclusions: -Central pancreatectomy the save procedure when well indicated; in
neuroendocrine benign tumors that cannot be enucleated it allowes a significant pancreatic
parenchyma preservation, as an alternative to a classic splenopancreatectomy of the entire tail and
body of the gland, thus preventing exo- and endocrine pancreatic insufficiency; preservation of the
spleen represents another important advantage.
In cases with ductal dilation, duct-to-micosa pancreatico-jejunostomy offers very good long
term functional results.
5. Neuroendocrine carcinoid tumor associated with right heart failure, treatment options.
A Case Report
Autori: C. Radu, R. Simescu, G. Petre, V. Muntean
Instituţie: CF Clinical Hospital, Department of Surgery, University of Medicine “Iuliu Haţieganu”
Cluj-Napoca, Romania
Cuvinte cheie: carcinoid tumors, carcinod syndrome, right heart failure, Sandostatin
Rezumat:
Introduction: Carcinoid tumors are rare neuroendocrine tumors with hormonal patterns
which differ depending on their site. Diagnosis is usually incidental. The carcinoid syndrome is the
clinical expression of systemic release of bioactive proteins, such as serotonin or histamine. Right
heart failure is common in patients with carcinoid syndrome, the left heart being protected by the
pulmonary inactivation of serotonin.
Patients and method: This is the case report of a 62 years old female patient with no
surgical history or comorbidities, presenting diffuse abdominal pain, important weight loss, appetite
loss, asthenia and facial flush. The patient had been incidentally diagnosed with hepatic lesions,
which were biopsied revealing neuroendocrine tumor metastases. Subsequent investigations led to
the diagnosis of a stage IV ascending colon neuroendocrine tumor with liver metastases, six months
21
prior to admission in the CF Clinical Hospital. The patient underwent two cycles of chemotherapy
(Carboplatin with Etoposide) and was also administered Sandostatin (Octreotide). Abdominal and
pelvic CT scan showed a para-caecal mass, multiple hepatic lesions and a moderate basic pleural
effusion. In December 2013 a right hemicolectomy was performed. During surgery the patient had
oscillating blood pressure and high pulmonary resistance to ventilation, both of which subsided
after the administration of Sandostatin. Pathology analysis of the tumor described a neuroendocrine
carcinoma G1, pT2N1M1L1V0. Post-operative the patient developed right heart failure which
subsided after the administration of Sildenafil (Viagra 25 mg tid); central venous pressure
oscillations and hyperglycemia normalized after administration of Sandostatin.
Conclusion: In patients with neuroendocrine tumors and carcinoid syndrome the
intraoperative hemodynamic instability and high respiratory resistance can be controlled with
Sandostatin. Right heart failure due to high pulmonary pressure can be efficiently controlled with
Sildenafil.
22
CANCERELE GINECOLOGICE
COMUNICĂRI ORALE
1) Raportul Unităţii Regionale de Nord-Vest de management al programului de screening
pentru cancerul de col uterin – rolul specialistului ginecolog
Autori: Florian Al. Nicula, Alexandru Irimie, Patriciu Achimaș-Cadariu
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: screening, cancer de col uterin
Rezumat:
În perioada 2002-20014, 1 din 2 din femeile din judeţul Cluj şi o medie de 2 din 10 femei
din judeţele Regiunii NV cu vîrste cuprinse între 25-64 de ani ( 762.558), au beneficiat de teste
gratuite Babeş-Papanicolaou în cadrul programelor de screening al cancerului de col uterin
organizate de Unitatea de Management din cadrul Departamentului de Prevenire şi Control al
Cancerului IOCN ( 75.568 teste în pilotul regional 2002-2008 şi 87.305 îm programul naţional
2012-2014 ).
Toate aceste activităţi au creat o povară de prelevare de frotiuri (76% din totalul de frotiuri
în pilotul regional 2002-2008 şi 66% în programul naţional 2012-2014) reţelei de ginecologie, la
care s-a cumulat şi povara evaluării celor mult peste 10 mii de displazii înregistrate la registrul de
screening, din care o mare parte au beneficiat de colposcopii, biopsii, tratamente şi urmăriri în timp
( activităţi suplimentare celor curative corespunzătoare numărului de peste 300 de cazuri noi de
cancere de col uterin operabile anual înregistrate de Registrul de Cancer NV - 67% din total ).
Medicul ginecolog are în programul de screening misiunea majoră de a asigura calitatea
finalizării, motiv pentru care am diseminat protocoale specifice de evaluare, tratament şi urmărire în
timp a displaziilor.
2) Evaluarea rezultatelor oncologice a tratamentului displaziilor agravate de col uterin
sau carcinom microinvaziv printr-o tehnică mai simplă de conizaţie
Autori: P. Achimas-Cadariu, C. Vlad, T. Criste, C. Lisencu, E. Puscas, F. Ignat, A. Irimie
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: displazii de col uterin, carcinom microinvaziv de col uterin, conizatie, rezultate
oncologice.
Rezumat:
Obiective: Obiectivele principale ale studiului de fata au constat in evaluarea rezultatelor
oncologice, respectiv supravietuire si calitatea vietii, la pacientele cu displazii agravate de col uterin
sau carcinoame microinvazive, tratate printr-o tehnică mai simplă de conizaţie (descrisa de
Ostergard, Berman si Yee in Atlas of Gynecologic surgery).
Material si metoda: Acest studiu retrospectiv a cuprins un numar de 211 paciente cu
displazii agravate de col uterin sau carcinoame microinvazive, tratate chirurgical prin conizatie.
Dintre acestea, un numar de 104 paciente au beneficiat de conizatie prin tehnica descrisa mai sus,
iar 107 de conizatie prin tehnica Green. Au fost analizate durata interventiei chirurgicale,
complicatiile, pierderea de sange, marginile de rezectie chirurgicala, rezultatele obstetricale, rata de
recidiva. De asemenea, folosind chestionarul EORTC QOL-C30 si un model de ecuatie structurala,
s-a evaluat si calitatea vietii (functia fizica, cognitiva, emotionala, sociala si sexuala) pacientelor
luate in studiu.
Rezultate: Nu au existat diferente semnificative statistic in ceea ce priveste rata
complicatiilor (o stenoza cervicala in primul grup), intre cele 2 grupuri. Durata interventiei
chirurgicale a fost semnificativ mai mica pentru noua tehnica (P<0.01), la fel ca si pierderea de
sange. Din cele 104 paciente ce au beneficiat de prima tehnica a conizatiei, 11 au ramas insarcinate
si au nascut 11 copii sanatosi.
In ceea ce priveste recidiva, au existat doua paciente cu recidiva, ambele din primul grup,
respectiv o pacienta cu tulpini HPV 16, 31 pozitive si o pacienta cu tulpini HPV 18, 31 pozitive.
23
Nu au existat diferente semnificative statistic in ceea ce priveste calitatea vietii intre cele
doua grupuri de paciente.
Concluzii: Tehnica mai simpla de conizatie pare fezabila, mai rapida din punct de vedere al
duratei interventiei chirurgicale, iar in ceea ce priveste rezultatele oncologice, nu au existat
diferente semnificative statistic intre cele doua grupuri de paciente, rezultatele fiind similare cu cele
publicate in literatura de specialitate.
3) Progresses in the multidisciplinary treatment of cervical cancer at the Institute of
Oncology “Prof. Ion Chiricuta”
Autori: Viorica Nagy, Claudia Ordeanu, Ovidiu Coza, Alin Rancea, Alexandru Traila, Rares
Buiga, Adriana Tudosescu, Nicolae Todor
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: cervical cancer, concomitant radiochemotherapy , surgery
Rezumat:
Cervical cancer is the second most common malignancy in Institute of Oncology ClujNapoca (IOCN), which explains the constant preoccupation of the institute’s specialists for
improving results.
A randomized phase III trial carried out in the IOCN between 1999-2002, in which 566
patients were involved, proved the obvious superiority of cisplatin (CDDP)-based concomitant
radiochemotherapy (RCT) versus radiotherapy alone (RT) (5-year-survival rate 74% vs 64%,
p<0.05), and thus concomitant RCT became standard treatment for locally advanced cervical cancer
in the institute.
In 2003, a phase 3 randomized study was started in our institute, which proposed the
comparison of two CDDP-based RCT regimens and in which 326 patients with stage IIB-IIIB
cervical cancer were involved. The results demonstrate that RCT with cisplatin 20 mg/ m²x5 days
every 21 days, is superior regarding local efficacy (5-year local relapse-free survival 87% vs 77%,
p<0.01), the patients’ quality of life and is less toxic compared with the 40 mg/m²/weekly
chemotherapy regimen.
In 2006, a third randomised institutional study was begun, in which 111 patients in stage IIB
were included with the aim to compare exclusive RCT with RCT associated with surgery. The
results show no statistically significant differences between the two treatment modalities, with
regard to overall survival (92% vs. 89%), disease free survival (89% vs 88%) and treatment failure.
In 2010, a nonrandomized feasibility study started with the aim of assessing neoadjuvant CT
(NACT) associated with RCT in locally advanced cervical cancer. The preliminary results show
that NACT administered before RCT brings a high response rate (68% negative surgical specimen)
with manageable toxicity, but randomized, larger number and long term evaluation trials are
necessary in order to confirm these data.
4) A new challenge: gynecological examination - TRUS - MRI
Autori: C.Ordeanu, D.C.Pop, R.Badea, C.Csutak, N.Todor, R.Kerekes, O.Coza, V.Nagy, A.Irimie
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: cervical cancer, transrectal ultrasound, MRI
Rezumat:
Objective: The aim of this study was to analyze the accuracy of TRUS (Transrectal
Ultrasound) in comparison to MRI (Magnetic Resonance Imaging) and clinical gynecological
examination estimation, in the evaluation of tumor dimensions and identification of residual tumor
in advanced cervical cancer.
Methods: The patients’ inclusion criterion was pathologically confirmed squamous cell
carcinoma (by tumor biopsy), the exclusion criterias were patients who didn’t undergo BT and
treated with palliative intent.
We offer two types of treatment for locally advanced cervical cancer: (a) radiochemotherapy
followed by surgery and (b) exclusive radiochemotherapy. The treatment schedule consists of
24
EBRT (External Beam Radiotherapy) to the pelvic region with 15/16 MV X-Rays, adding Cisplatin
as radiosensitizer and a boost by HDR BT (High Dose Rate Brachytherapy). At 46 Gy given to the
pelvis we do reevaluation of the patient and according to tumor response and/or patients option the
treatment continues with radiochemotherapy (RCT) up to 60 Gy or with surgery (after 4-6 weeks
interval).
Imaging tests follow the presence of tumor and tumor size (width and thickness). Each
examination (gynecological, TRUS and MRI) was performed by a different physician that had no
knowledge of each other’s findings. The TRUS and MRI were performed outside our institution,
according to the standard protocols of our collaborators. All patients underwent MRI prior to EBRT
while 18 of them also at the time of the first brachytherapy application.
For the analysis we used a measure of linear correlation between two variables x and y
giving a value between GYN-MRI-TRUS: R - Pearson correlation coefficient. The dimensions that
we used for the comparison were AP (anterior-posterior) and LL (latero-lateral).
Results: Between January-August 2013, 26 patients with cervical cancer were included. A
number of 44 gynecological examinations were performed, 44 MRI’s and 18 TRUS’s.
The median tumor thickness for the first gynecological examination was 32.5 mm, for
TRUS was 33.5 mm and for MRI was 35 mm. The median tumor width for the first gynecological
examination was 40 mm, for TRUS was 34 mm and for MRI was 37.5 mm.
For the comparisons prior to EBRT the correlation coefficient between TRUS vs. MRI was
R = 0.79 for AP and R=0.83 for LL, for GYN vs. MRI was R= 0.6 for AP and R = 0.75 for LL.
Prior to BT for GYN vs. MRI, R was 0.6 respectively 0.63 for AP and LL; for GYN vs. TRUS, R
was 0.56 respectively 0.78 for AP and LL.
Conclusions: A high correlation between the 3 examinations (gynecological, TRUS and
MRI) was obtained for the width of the tumor. TRUS is less expensive than MRI, a relatively quick
procedure, it has a widespread availability and it is recommended to be the imagistic technique in
the countries with low-income facilities. TRUS can be considered a suitable method in the
evaluation of tumor dimensions (width and thickness) for patients with cervical cancer, and can be
an alternative imaging method to MRI.
5) A model of immunohistochemical score useful in endometrioid tumors characterisation
Autori: Ignat F., Fetica B., Fit Ana Maria, Lisencu C., Achimas-Cadariu P., Puscas E., Vlad C.,
Irimie A.
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: endometrial cancer, biomarkers, immunohistochemical score
Rezumat:
The risk stratification of patients with endometrial cancer is generally based on histopathological evaluation of surgical specimens.
To improve the therapeutic management of these patients a wide range of molecular markers
are currently investigated and some researchers are trying to some extent to determine their role in
the attempt to individualise treatment.
The challenge of the moment in international research is the validation of such biomarkers,
detectable in the preoperative biopsy material, to be useful parameters in stratifing patients with
endometrial cancer to risk groups.
The objective of this study is to evaluate biomarkers ER, PR, P53, P16, Her2 and Ki -67 and
their ability to predict the dissemination of lymph nodes and the utility of the examined
immunohistochemical panel to stratify risk groups of patients with endometrial cancer by
cuantification of data in a immunohistochemical score.
62 patients were included in the study distributed as follows: 31 patients in the study group
(group A – node positive patients) and 31 patients in the control group (group B – node negative
patients). All patients were surgically staged at the Oncology Institute "Prof. Dr. Ion Chiricuţă" in
Cluj- Napoca (IOCN) by total hysterectomy with bilateral adnexectomy, peritoneal procedures and
retroperitoneal procedures (pelvic and/or para-aortic lymphadenectomy).
25
6) Rolul angiogenezei în cancerul ovarian
Autori: Milan-Paul Kubelac, Bogdan Fetica, Annamaria Fulop, Ioan-Catalin Vlad, Alexandru
Irimie, Patriciu Achimas-Cadariu
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: angiogeneză, cancer ovarian, proteinele ID, microarray
Rezumat:
Introducere: Angiogeneza tumorală reprezintă un element cheie în progresia cancerului
ovarian, iar rezultatele studiilor pe această temă validate prin intervenții terapeutice în trialuri
clinice au arătat o îmbunătățire a intervalului liber de boală sau a supraviețuirii globale. Proteinele
ID (inhibitor of DNA binding), reprezintă factori de transcripție din clasa HLH (helix-buclă-helix),
au deja un rol stabilit în carcinogeneză. Până în prezent expresia ID-1 a fost puţin evaluată în
cancerul ovarian în corelație cu neoangiogeneza tumorală.
Materiale şi metode: Am analizat cazuistica Institutului Oncologic “Prof. Dr. Ion
Chiricuţă” pe o perioadă de 7 ani ce a cuprins 933 de pacienţi. În urma aplicării criteriilor de
includere şi de excludere, prin tehnologia de tissue microarray, s-au efectuat colorații
imunohistochimice pentru evidențierea proteinei ID-1 și a vaselor de neoformație pe blocurile de
parafină corespunzătoare. Datele obținute au fost corelate cu variabilele pacientelor obținute din
foile de observație.
Rezultate: La majoritatea pacientelor, diagnosticul a fost stabilit în timpul menopauzei.
Scorul imunohistochimic pentru ID-1 cât şi microvascularizaţia tumorală au fost semnificativ
statistic mai mari în cazul pacienţilor cu stadii avansate de boală. În timpul perioadei de urmărire,
majoritatea pacienților au prezentat reluarea bolii. Supravieţuirea medie la 5 ani a fost de 45%.
Concluzii: Expresia ID-1 a fost pozitivă într-un număr mare de cazuri examinate, mai ales
în stadiile avansate de boală, arătând astfel o corelaţie cu istoria naturală a bolii, o verigă
patogenetică care poate prezenta interes, atât prin prognosticul infaust al unei cascade angiogenetice
abundente cât şi ca o posibilă ţintă terapeutică în viitor.
7) Surgical management of uterine sarcomas – ten year experience of a single tertiary
center of cancer care
Autori: Lisencu C, Sfîra Adriana, Ignat F, Achimaș P, Pușcaș EM, Vlad C, Mureșan MȘ, Pătcaș S,
Deac Daniela, Cheregi C, Irimie A.
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: Uterine sarcomas, total hysterectomy +/- bilateral adenexectomy
Rezumat:
Background: Uterine sarcomas are stromal-derived endometrial cancers with increased
aggressiveness and unfavorable prognosis. In most of the cases, definitive diagnosis is established
after surgery for supposedly benign uterine pathology. Preoperative diagnosis is rarely stated, and in
such situations it is achieved either by uterine hysteroscopic biopsy or by uterine chiurettage.
Clinical and radiology findings are unspecific. Surgical treatment varies with the patient’s history,
hormonal status and locoregional extension. The aim of the study was to evaluate the outcomes of
uterine sarcoma therapy of a single tertiary center of cancer care.
Materials and methods: We have performed a descriptive ten-year-retrospective study
(2002-2012) of patients treated for uterine pathology at “Prof. Dr. Ion Chiricuta” Oncology
Institute, Cluj-Napoca, Romania. The parameters followed were: preoperative histology findings,
surgical management, postoperative histology findings.
Results: Out of 1401 cases of uterine malignant tumors treated in our service, 121 (8.7%)
were uterine sarcomas and 115 (8.2%) were carcinosarcomas. The highest incidence was found for
40-60 years of age group. Out of the 115 cases of uterine sarcoma, only 22 (18.18%) of patients had
preoperative diagnosis. For 77 of the patients (63.63%), the preferred surgical intervention was total
hysterectomy with bilateral adenexectomy (THBA), for the remaining 36.36%, THBA was
26
associated with multiorgan resection/ilio-pelvic or paraaortic lymphadenectomy. 58.6% of the
postoperative histology consisted of endometrial stromal sarcoma, 26.4% - of leiomyosarcoma and
14.8% of undifferentiated sarcoma.
Discussion: The aim of surgery in uterine sarcomas is to achieve an R0 resection. Routine
lympadenectomy is not recommended. No specific symptoms or radiological findings link with the
disease. In most of the situations, preoperative histology is not achieved, mainly because of the
indication to operate of a benign uterine pathology.
Conclusions: Uterine sarcomas are rare forms of uterine cancer. Elective surgical treatment
involves total hysterectomy +/- bilateral adenexectomy. Due to the local extension of the disease, it
is sometimes necessary to perform multiorgan resection.
8) Immediate and long-term results in 80 patients with pelvic exenterations
Autori: V. Muntean1, A. Mihailov2, I. Domsa1, A. Zolog1, O. Fabian1, O. Cebotari1, F. Muresan1,
G. Petre1, R. Simescu1, M.V.Muntean1,2.
Instituţie:
1CF Clinical Hospital,
2 University of Medicine “Iuliu Haţieganu” Cluj-Napoca
Cuvinte cheie: pelvic exenteration, five-year survival, disease-free survival, progression-free
survival
Rezumat:
Introduction: Pelvic exenteration is now largely accepted, with clearly defined roles in the
multidisciplinary treatment of locally advanced or recurrent pelvic cancer. The purpose of the study
was to analyze the immediate and long-term results in patients with pelvic exenterations performed
in a community hospital.
Patients and method: A cross-sectional population analysis of the prospectively maintained
database was performed, including surgical and pathological reports and follow up recordings.
Results: In a 15-year interval (1998–2012), 152 multiorgan pelvic resections were
performed for locally advanced or recurrent cancers, 80 of which fulfilled the criteria of pelvic
exenterations (≥2 pelvisubperitoneal organs resected): 36 ano-rectal, 25 cervical, 4 uterine, 6 ovary,
4 urinary bladder, 2 prostate, and 3 pelvic sarcoma; 9 anterior, 20 posterior and 51 total; 11 with
sacrectomy and 28 with additional resections of abdominal organs.
Major morbidity was recorded in 29 patients (36.25%), with 13 reinterventions (16.25%). In
the follow-up period, 3 out of the 80 patients died in the first 30 postoperative days (operative
mortality 3.75%) and 48 afterwards, 43 of cancer and 5 of reasons unrelated to cancer. Of the 29
patients still alive, 25 are disease free and 5 show progressive disease. In the 55 patients with R0
resections, the median disease-free survival interval was 22 months. In the 22 patients with R1-R2
resections the median progression-free interval was 3 months. 37 patients had a follow-up longer
than 5 years and 12 are alive (five-year survival 32%). In the 24 R0 patients, the five-year survival
was 50% and the median disease-free survival interval 38 months. For the 13 patients with
palliative (R1-R2) resections, the five-year survival was 0 and the median progression-free interval
3 months.
Conclusions: Careful patient selection, R0 resections and quality surgery are the key to
good results after pelvic exenteration.
9) Pelvic and perineal reconstruction in 98 patients with pelvic exenterations
Autori: M.V. Muntean, I. Tichil, O. Fabian, G. Petre, F. Muresan, R. Simescu, V. Muntean
Instituţie: CF Clinical Hospital Cluj-Napoca
“Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: pelvic exenteration, pelvic perineal reconstruction, greater omentum, TRAM flap
Rezumat:
Introduction: Pelvic exenteration along with neo-adjuvant chemo-radiotherapy is
considered to be the standard treatment for locally advanced or recurrent pelvic malignancy. This
27
leads to a large, non-collapsible dead space and poor vascularity of the irradiated surrounding
tissue, which is the most important source of postoperative complications. The purpose of the study
was to analyze the results of pelvic and perineal floor reconstruction in patients operated in a
community hospital.
Patients and methods: A cross-sectional population analysis of the prospectively
maintained database, including surgical, pathological reports and follow up recordings, was
performed during a 16 year interval, between 1998 and 2013.
Results: 172 multiorgan pelvic resections have been performed for locally advanced or
recurrent cancers, 98 of which fulfilled the criteria of pelvic exenterations (≥2 pelvisubperitoneal
organs resected). The greater omentum was used for pelvic dead space filling in 86 patients;
perineal reconstruction was necessary in 22 patients, with TRAM flap in 16 and Gluteus Maximus
Flap in 6. Vaginoplasty was performed in 38 patients, TRAM in 17, VRAM in 5, DIEP in 8,
Gracilis in 4 and Posterior perineal in 4. Major morbidity was recorded in 12 patients (12.2%), with
8 reinterventions (8.2%) for intestinal obstruction and pelvic abscesses. In the 56 patients with
myocutaneous flaps there were 18 partial necrosis and 1 complete flap necrosis, with more
favourable results for TRAM, DIEP and Gluteus Maximus. In the follow-up, 28 patients with
vaginoplasty (73.7%) have resumed vaginal intercourse.
Conclusions: In patiens with pelvic exenteration, pelvic and perineal reconstruction is
necessary in all patients. Its impact on patient’s quality of life, body image and sexual function is
substantial, as well as the benefits of improving primary healing and reducing the rate of intestinal
complications and pelvic abscess. Careful selection of reconstructive method and good technique
are key to achieving good results.
10) Long-term results of exclusive adjuvant vaginal brachytherapy
Autori: Ovidiu Coza 1,2, Claudia Ordeanu2, Diana Pop2, Patriciu Achimaş 1,2, Dan Eniu1,2, Ştefan
Hica2
Instituţie:
1 “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca,
2The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: HDR-VBT, vaginal cylinder, endometrial carcinoma
Rezumat:
Introduction: This paper represents a retrospective non-randomized study designed to
analyze the results of high-dose rate vaginal brachytherapy (HDR-VBT) as exclusive adjuvant
treatment in postoperative management of endometrial carcinoma.
Material and method: Our study includes 208 patients - median age of 60 (38-79) years treated in our Institute in the period January 2006 - December 2012 for stage IA-IIB endometrial
carcinoma. All patients were submitted to radical surgery, followed after a median free interval of
49 days, by endocavitary brachytherapy. HDR-VBT was performed with vaginal cylinder: two
weekly insertions at 72 hours interval, for a total dose of 28 - 30 Gy/ 4 to 6 fractions. The dose
prescription was at 5 mm from the vaginal cylinder surface, with a median active length of 40 mm.
The brachytherapy total duration was 15 days.
Results: After a median follow-up of 24 (3-85) months, we observed 9 treatment failures
(4,32%): 3 local vaginal recurrences; another 3 patients presented with lymphnoderelapse (pelvic &
retroperitoneal); 2 patients developed distant hematogenous metastases (lung and liver), and one
case with multiple peritoneal disease. The local control was obtained in 98% of the included
patients. As for the late adverse effects (AE): we observed in 10 patients vaginal toxicity - 3 G1, 7
G2; another patient with G1 bladder AE and one patient with a rectal G2 late toxicity (CTCAE v
4.03).
Conclusions: Postoperative exclusive HDR-VBT in selected patients with endometrial
carcinoma represents an efficient treatment method. Main advantages are the low incidence of late
morbidity (5,77%) and that it can be performed in an outpatient basis for a reasonable period of
time.
28
CANCERELE UROLOGICE
COMUNICĂRI ORALE
1. Conformal irradiation in prostate cancer - 5 years experience
Autori: Andreea Marita1, Raluca Stahiescu1, Anamaria Rusu1, Victor Bogdan1, Dan Dordai1,
Gabriel Kacsó1,2
Instituţie: 1 The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj-Napoca
2 “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie:
Rezumat:
Purpose: evaluation of efficacy and toxicity of conformal radiotherapy (CRT) for prostate
adenocarcinoma (ADKP)
Material and Methods: From 2005 to 2011, 300 patients were treated with CRT at the
Oncologic Institute Cluj., The dose was 66 to 70 Gy after radical prostatectomy, 70-72Gy/25-26fr
for low-risk patients and 45-46 Gy/23-25fr associated with 110 Gy permanent implant or 74-76Gy /
37-38fr for high and intermediate risk group. Dose-volume constraints were pre-defined for bladder
and rectum. Acute and late toxicities were assessed using CTC 3.0 scale. Biochemical relapse was
defined as an 2 ng/ml increase above PSA nadir.
Results: With a median follow-up of 30 months [12-102], the overall survival and specific
survival was 93.6% and 98.9%, whereas the biochemical relapse free survival was 87.4%.
According to the D'Amico classification: 17 (5%) were low risk , 37 (11%) intermediate, 214 (74%)
high risk patients, 2% with unknown risk group and 25 (8%) patients received CRT adjuvant or as
salvage after radical prostatectomy. There were 38 (12.6%) biochemical relapses of which 18 (47%)
local recurrences, 14 (37%) metastases and 6 (16%) "occult". Of them, 21 patients were high risk, 3
intermediate, 1 low risk, 10 in the prostatectomy subgroup and 2 patients with unknown risk;
Hormonal therapy was given for 87.3% of patients. Severe acute urinary (U) and digestive (D)
toxicity (G3) was 11% and 2%. The severe late toxicity was 3 % for U, 0% for D.
Conclusion: CRT is a reliable method as curative treatment of T1-3NoMo ADKP with low
toxicity and a medium term specific survival of 98.9%.
2. Case report: multidisciplinary approach to poor prognosis renal cancer
Autori: Paula Pruteanu1, Laura Ardelean1, Crinela Lupu1 , Horatiu-Mircea Stan3,2, Petre Kiss 3,
Petrut Bogdan 1,2, Claudia Burz1,2
Instituţie: 1 The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj-Napoca,
2
Universitatea de Medicina si Farmacie Iulius Hatieganu, Cluj-Napoca,
3
Clinica de Neurochirurgie, Cluj-Napoca
Cuvinte cheie:
Rezumat: Din punct de vedere epidemiologic, cancerul renal se situeaza pe locul 8, incidenta sa
fiind crecuta la persoane in varsta. De multe ori pacientul este diagnosticat in faza metastatica , cand
prognosticul pacientilor ramane rezervat .
Prezentam cazul unui pacient de 44 ani care s-a prezentat in Institutul Oncologic Cluj cu
cefalee, tulburari de vedere ochi stang, vertig, sindrom astenic – simptomatologie care a debutat in
urma cu un an anterior prezentarii. Evaluarea imagistica a evidentiat o formatiune tumorala la nivel
occipital stang de aprox. 6 cm, care a fost rezecata in totalitate in serviciul de neurochirurgie cu
rezultat histopatologic de carcinom renal cu celule clare. In cadrul bilantului preterapeutic s-a
efectuat o tomografie abdomino-pelvina care a decelat o formatiune tumorala renala dreapta de 12
cm, fara plan de clivaj fata de ficat, adenopatii metastatice retroperitoneale , inter-aortico-cave.
Datorita prezentei factorilor de prognostic rezervati s-a initiaza terapie tinta cu
Temsirolimus. Pe parcursul terapiei starea generala a pacientului s-a ameliorat, iar evaluarea
efectuata dupa administrarea a 6 cicluri a aratat raspuns partial la nivelul formatiunilor tumorale. Sa intervenit chirurgical practicandu-se nefrectomie dreapta, limfadenectomie retroperitoneala, cu
29
excizie lambou de vena cava si cavorafie. Rezultatul histopatologic a confirmat prezenta
carcinomului renal cu celule clare grad IV Fuhrman, cu infiltrarea venei cave, stadiul
pT3cN1MxL1V1. Recuperarea postoperatorie dificila cu infectii severe la nivelul plagii nu au
permis continuarea tratamentului oncologic postinterventie chirurgicala. La 3 luni postinterventie
chirurgicala pacientul revine in IOCN cu deficit motor brusc instalat, imagistic decelandu-se
formatiune tumorala frontala stanga. Se intervine chirurgical practicandu-se ablatia formatiunii
tumorale. Se reinitiaza terapia cu Temsirolimus datorita evolutiei la distanta, asociat cu radioterapie
pe calota craniana. La doi ani de la diagnostic, pacientul este cu stare generala buna, in tratament cu
Temsirolimus.
3. Stage I testicular seminoma: results of survival and risk factors for relapse
Autori: Nicoleta Zenovia Antone, Cristina Ligia Cebotaru, Monica Groza, Nicolae Todor
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: survival, risk factor, seminoma
Rezumat:
Objective: evaluation of adjuvant treatment and risk factors for relapse for stage I testicular
seminoma.
Material and methods: retrospective study evaluated 112 patients aged between 18 and 78
years (median age-37,4 years) stage I testicular seminoma between January 1982-January 2007,
treated at The Oncology Institute Prof Dr Ion Chiricuta, Cluj-Napoca, Romania. The median
follow-up duration was 135,8 months (range 3 - 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 in 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 in 5 patients (4,46%), pelvic or lumboaortic lymph nodes was present in 17 cases
(15,18%), metastatic and adenopathy relapse in 2 patients (1,79%) and seric relapse in 1
patient(0,89%).
Risk factors evaluated for relapse were age at presentation (p=0,1), performance
status(p<0,01), stage of disease at presentation(p<0,01) and presence of 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: Stage I seminoma tumor prognosis is excellent. The rate of curability with
adjuvant treatment is high, the overall survival at 10 years with adjuvant chemotherapy is 96%,
followed by adjuvant radiotherapy 93% and overall survival for patients treated with orchiectomy
alone followed by surveillance is 41%.
4. Laparoscopic Adrenalectomy
Autori: Alexandra Alb, Maximilian Hogea, Vlad Schitcu, Dragos Feflea, Vasile Buda, Denes
Kaba, Vlad Hardo, Bogdan Petrut
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Laparoscopic Adrenalectomy learning curve
Rezumat:
Introduction: The adrenal gland is especially suited for laparoscopic surgery because of its
relative small and difficult retroperitoneal access. The minimally invasive approach allows for
lower perioperative morbidity, decreased blood loss, less pain relief medication need, shorter
hospital stay and faster recovery.
Objective: We aim to present our experience with the laparoscopic approach to adrenal
masses.
30
Material and method: Data was analyzed for patients undergoing laparoscopic surgery for
adrenal masses. Demographic characteristics and perioperative parameters are described in relation
to the learning curve for the procedure. All patients underwent laparoscopic adrenalectomy either
through a retroperitoneoscopic or transperitoneal approach.
Results: From 2010 until April 2014, 18 patients were operated in our institution for adrenal
masses, 14 women and 4 men. The pathological stage was pT1 – pT2. Average tumor diameter was
53mm. Pathology showed 4 cases (22.22%) of benign masses, 3 cases (16.67%) of
pheochromocitoma and 4 proved to be metastatic tumors. Surgical margins were negative in all
cases of primary adrenal lesions, and positive in 3 out of 4 cases of metastatic disease.
Average operation time decreased from 192 min (first 5 cases) to 137 min in latest 5 (overall
average duration 153 min). Average blood loss decreased as well with experience gain, with an
average of 1.2 units of RBC for the first 5 cases to under 0.2 units. Hospital stay was constant,
independent of the learning curve - average 6 days.
Conclusion: Laparoscopic adrenalectomy is a safe and effective surgical technique for the
management of adrenal masses, with the added benefits of a minimally invasive approach.
Adequate patient selection and surgical expertise are required for favorable patient outcomes.
5. Robotic radical cystectomy: operative technique, pathological and perioperative
outcomes
Autori: A. Boc, N. Crișan, P. Prunduș, V.D. Stanca, R.T. Coman, I. Coman.
Instituţie: Secția Clinică Urologie, Spitalul Clinic Municipal Cluj-Napoca, România.
Cuvinte cheie: Laparoscopic Adrenalectomy learning curve
Rezumat:
Introduction: Open radical cystectomy remains the gold standard treatment for muscleinvasive bladder cancer. Following the wide spread of robotic radical prostatectomy, robotic
techniques are now increasingly being applied to radical cystoprostatectomy. Robotic radical
cystectomy provides the potential benefit of lower complications while maintaining functional and
oncological outcomes. We report our experience, perioperative and pathological results, presenting
step by step our technique of radical cystectomy and the variants of urinary diversions used.
Material and method: We perform robotic radical cystectomy, extended lymphadenectomy
and urinary diversion. Orthotopic ileal neobladder is created extracorporeal or totally intracorporeal.
When the extracorporeal urinary diversion is chosen, the uretro-neobladder anastomosis is done
using the robotic system after re-docking the robotic cart. We use a laparoscopic stapler device for
reestablishing bowel continuity in order to reduce the operative time. Our surgical technique is
presented in the accompanying video.
Results: From January 2010 to February 2014 we performed 11 robotic radical
cystectomies. Mean patients age was 60.1 years (range 52 to 73). 5 patients underwent cutaneous
ureterostomy and 6 received an orthotopic ileal neobladder. In three cases the neobladder was
created extracorporeal and in the other three totally intracorporeal. Mean operative time was 6.5
hours and mean blood loss 378 ml. In 7 cases tumor stage was T2 or less and in 3 cases T3. A mean
of 16 lymph nodes were removed. There were no positive lymph node cases. In all cases surgical
margins were negative. Three patients presented grade II complications and one patient grade III
complications.
Conclusions: We have presented our technique of RRC with different types of urinary
diversions. Robot-assisted radical cystectomy can be accomplished safely with encouraging
perioperative and pathological outcomes and acceptable morbidity.
31
6. Overall survival and prognostic factors in metastatic renal cell carcinoma patients
treated with cytokines and targeted therapies at the “Prof. Dr. Ion Chiricuţă” Institute
of Oncology
Autori: Cristina Ligia Cebotaru, Elena Diana Olteanu, Cristina Mocan, Nicolae Todor
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: renal cell carcinoma, prognostic factors, targeted therapies
Rezumat:
Background: Survival in metastatic renal cell carcinoma (mRCC) has been definitely
improved by targeted therapies. This is a retrospective study to assess prognostic factors for
survival in mRCC/advanced patients treated with targeted therapies at the `Prof Dr Ion Chiricuta`
Institute of Oncology, Cluj Napoca.
Patients and methods: We retrospectively analysed the baseline characteristics, response to
targeted therapies and survival in 90 mRCC patients that were treated in our Institute between 20052011. Stratification was made for histology: clear cell histology: 70 pts.(92%), sex: M=70 (80%),
nephrectomy: 67 (77%), ECOG PS: 0/1=61 pts. (74%), unique metastatic site: 64 pts.(74%) vs.
multiple = 23 sites of metastases LDH, anemia, number of thrombocytes, lymphocytes, calcemia,
alkaline phosphatase, interval from diagnosis to progression, number of therapy lines, and Motzer
prognosis criteria. A number of 48 patients received targeted therapy in the first line, 34 received it
as second line and only 8 in the third. Altogether, 33 patients received sunitinib, 5 bevacizumab+
interferon, 10 temsirolimus and none sorafenib in the first line. Sorafenib was only given in second
and third line. We analyzed the overall survival (OS) and progression free survival (PFS) according
prognostic factors. Toxicities were also reported.
Results: The median OS since the diagnosis of the metastasis was 23,36 months (95%CI:
18,51-28,24). One patient obtained complete response, after targeted therapy in the first line and 1
after the second line. In the uni- and multivariate analysis, independent prognostic factors for
outcome were: the risk group according to Motzer criteria, the presence of anaemia. The sequence
of targeted therapies was as per guidelines.
Conclusion: Our study showed improved survival for patients with advanced/mRCC treated
with targeted therapies with mild and manageable toxicities.
7. Laparoscopic radical prostatectomy - operative and perioperative parameters analysis
of the first 100 cases
Autori: V Schiţcu, M Hogea, D Feflea, V Buda, D Kaba, V Hardo, Alexandra Alb, DS Popescu, B
Petruţ
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: radical lapascopic prostatectomy
Rezumat:
Radical prostatectomy continues to represent the gold standard of surgical treatment of
organ confined prostate cancer. The minimally invasive alternatives to the open approach have
already been proven to offer comparable oncological and functional outcomes. In spite of the
technical drawbacks and inherent difficulty, the prohibitive price of robot assistance still drives
urologists to overcome the steep learning curve of conventional laparoscopy. This presentation aims
to analytically describe perioperative parameters of the the first 100 cases, in order to quantify
progress on the learning curve, in the experience of the urologic team of the Oncology Institute
„Prof. Dr. I. Chiricuţă” Cluj-Napoca.
32
8. Alternativa laparoscopică în nefrectomia parţială – particularităţi şi avantaje
Autori: V Buda, M Hogea, V Schiţcu, D Feflea, D Kaba, V Hardo, B Petruţ
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
În mâini experimentate, laparoscopia reprezintă o opţiune viabilă în tratamentul tumorilor
renale ce se pretează la chirurgia de prezervare nefronală. Abordul laparoscopic prezintă anumite
particularităţi tehnice ce sporesc gradul de dificultate al intervenţiei, limitând accesabilitatea
metodei la centre cu experienţă şi volum crescut de pacienţi. Lucrarea de faţă îşi propune
prezentarea parametrilor operatori şi rezultatelor oncologice a nefrectomiei parţiale laparoscopice
într-o manieră descriptivă a curbei de învăţare, în experienţa Institutului Oncologic „Prof Dr I
Chiricuță” Cluj-Napoca.
9. Risk factors and long term survival in stage I germ cell tumors
Autori: Cristina Ligia Cebotaru, Nicoleta Zenovia Antone, Monica Groza, Nicolae Todor,
Maximilian Hogea
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: survival, risk factor, germ cell tumor
Rezumat:
Objective: evaluation of adjuvant treatment and risk factors for relapse in stage I germ cell
tumors.
Material and methods: retrospective study evaluated 253 patients aged between 14 and 78
years (median age - 33,9 years) with stage I germ cell testicular tumors, between January 1982January 2007, treated at The Oncology Institute Prof Dr Ion Chiricuta, Cluj-Napoca. The median
follow-up time was 126 months (range 3 - 285 months). Demographic, clinical and paraclinical
parameters of patients were observed.
The histological classification consisted of 126 patients with seminoma (50%), and
nonseminoma (choriocarcinoma, embryonal carcinoma, Yolk sac tumor, teratoma and malignant
mixed germ cell tumor).
Chemotherapy regimens administered in adjuvant setting were Carboplatin AUC 7 for stage
I seminoma, EP and BEP for nonseminoma. VAB6 protocol was used before the BEP era.
Results: Overall survival at 10 years was 93% (CI: 89%-96%).
Ninety nine seminoma patients (78,57%) presented relapse, metastatic relapse was observed
in 5 patients (3,97%), pelvic or lumboaortic lymph nodes was present in 19 patients (15,08%),
metastatic and adenopathy relapse in 2 patients (1,59%) and seric relapse in 1 patient(0,79%). For
nonseminoma patients the relapse was present in 11 cases (8,66%).
Risk factors evaluated for relapse were age at presentation (p=0,1), performance
status(p<0,01), stage of disease at presentation(p<0,01) and presence of markers(p=0,1).
Chemotherapy toxicity was moderate, main toxicity for Carboplatin was thrombocytopenia
(6,67%), and for the BEP protocol - leucopenia (4,76%), anemia(4,76%) and nausea and vomiting
(11,9%).
Our results are superposable with literature data.
Conclusion: Germ cell tumor prognosis is excellent. The rate of curability for adjuvant
treatment is high, the overall survival at 10 years being 93% (CI: 89%-96%).
33
10. Anterograde and retrograde nerve-sparing in robot-assisted radical prostatectomy –
surgical technique
Autori: H. Logigan, Iulia Pop, C.D. Pop, R. Coman, C. Manea, N. Crişan, I. Coman
Instituţie: Department of Urology, Clinical City Hospital, Cluj-Napoca, România
Cuvinte cheie:
Rezumat:
Introduction and objectives: Nerve-sparing (NS) in radical prostatectomy accounts for
being one of the most challenging surgical techniques where an expert knowledge of neurovascular
bundle anatomy is essential.
The purpose of this paper is presenting the anterograde and retrograde nerve-sparing
techniques used in our service.
Material and methods: The retrograde approach to nerve-sparing implies the dissection of
the anterior and lateral aspects of the prostate with the identification of the surgical planes between
the prostate and nerurovascular bundles, that is continued by the Denonvillier fascia. After
performing the dissection in the mid-lateral aspect of the prostate, the lateral prostatic pedicles are
clipped and the dissection is continued towards the apex of the prostate.
When the antegrade approach is considered, the posterior aspect of the prostate is dissected
from the anterior aspect of the Denonvillier fascia, laterally with the identification of the surgical
plane between rectum and posterior aspect of the prostate. The dissection is continued using this
plane towards the prostate apex until the neurovascular bundles are completely detached.
In order to avoid positive resection margins, frozen sections are performed and in case of
malignant involvement, the homolateral bundle is sacrificed.
Results: Among the 102 patients with localized stage prostate adenocarcinoma, there were
49 cases where bilateral NS was performed and 29 where one bundle was preserved.
Continence progressively improved and the results at 1, 6 and 24 months follow-up time for
both groups (bilateral and one sided NS) were 58%, 74% and respectively 93%.
Regarding sexual function, results at 6, 12 and 24 months follow-up were 45.4%, 67.4% and
respectively 79% in the case of bilateral bundle preservation and 20%, 28% and respectively 51%
for unilateral NS, with or without 5-PDE inhibitor therapy.
Conclusion: The robot-assisted surgery allows for a more accurate development of the
anterograde and retrograde nerve-sparing techniques with a beneficial impact on functional
outcomes.
11. Nefrectomia radicală laparoscopică - analiza curbei de învățare prin prisma
parametrilor operatori
Autori: D Feflea, M Hogea, V Schiţcu, V Buda, D Kaba, V Hardo, B Petruţ
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: nefrectomia radicala laparoscopica curba invatare
Rezumat:
Nefrectomia radicală laparoscopică a devenit standardul de aur în tratamentul tumorilor
renale în stadiile în care prezervarea parenchimului renal nu este fezabilă. Abordul minim invaziv
oferă avantaje multiple din punct de vedere al morbidităţii postoperatorii, duratei spitalizării şi
cosmetice, cu rezultate oncologice şi funcţionale comparative cu abordul clasic. Scopul acestei
prezentări este analiza acestor parametri în funcţie de avansarea pe curba de învăţare a echipei
operatorii urologice a Institutului Oncologic „Prof. Dr. Ion Chiricuță”, în raport cu datele existente
în literatură.
34
12. Modular teaching program for laparoscopic radical cystectomy at the Institute of
Oncology “Prof. Dr. Ion Chiricuţă”
Autori: Maximilian Hogea, Vlad Schitcu, Dragos Feflea, Alexandra Alb, Vasile Buda, Vlad Hardo,
Denes Kaba, Bogdan Petrut
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: laparoscopy, radical cystectomy, teaching
Rezumat:
Introduction: Radical cystectomy and pelvic lymph node dissection currently represents the
criterion standard for determining accurate pathologic staging, optimizing curative potential, and
minimizing the risk recurrence of bladder cancer. The laparoscopic approach is a challenging
procedure with a difficult learning curve that demands a high degree of technical skill.
Objective: The aim of this paper is to evaluate the surgical parameters and the oncological
results of laparoscopic radical cystectomy (LRC) performed in steps by trainer and trainees during
the modular training program implemented in our institution.
Methods: Our training program divides trainees depending on their expertise. The surgical
maneuvers are also grouped by degree of difficulty in three levels. When the proficiency of the
trainee is attested by objective parameters, they move on to perform surgical steps from the next
difficulty level. 6 LRC were performed in this fashion at our institution. 2 trainees from
intermediate level group acted as first assistants and performed obturatory lymphadenectomy during
the LRC. Previous surgical laparoscopic training was correlated with the surgical parameters.
Results: Performing the LRC with the same team the operative the operative time decreased
from 300 min to 210 min. When the first assistant was changed, the operative time increased to 240
min. The time to perform obturatory lymphadenectomy saw a decrease from 25 to 15 min for one
assistant and 20 min for the second. These times were correlated with previous surgical training.
There were no intraoperative or postoperative complications. The surgical margins were
negative in all cases, and all lymph nodes removed were negative.
Conclusion: Our mentor assisted modular training program allows the trainees to perform
independently, under mentor guidance, steps of the procedure according to their training level,
while simultaneously maintaining the standard of excellence and safety of the procedure, without
compromising the functional or oncological results.
13. Prostate cancer control following high intensity focused ultrasound (HIFU) by means
of robotically assisted laparoscopic radical prostatectomy (RALP)
Autori: C. Manea, N. Crisan, H. Logigan, T. Coroi, C. Ivan, I. Coman
Instituţie: Department of Urology, Clinical City Hospital, Cluj-Napoca, România
Cuvinte cheie:
Rezumat:
Introducere: Implementarea terapiei High Intensity Focused Ultrasound (HIFU) pentru
cancerul prostatic localizat este in crestere. La cazurile atent selectionate, rezultatele oncologice si
functionale pe termen mediu sunt comparabile cu rezultatele chirurgiei de exereza. In cazul
recidivei tumorale locale, exista alternative terapeutice fezabile pentru controlul patologiei
neoplazice
Material si metoda: Din 189 de pacienti cu adenocarcinom prostatic tratati HIFU, la 4
cazuri cu recidiva locala post HIFU s-a efectuat prostatectomie radicala laparoscopica asistata
robotic. Prezentam timpii operatori ai tehnicii de exereza radicala a ,,bontului” prostato-veziculodeferential
Rezultate: Conversia la chirurgia clasica nu a fost necesara la niciuna din interventiile
efectuate. Timpul operator mediu a fost de 115 minute, pierderea medie de sange a fost de 110 ml si
niciun pacient nu a fost transfuzat. Rezultatul histopatologic descris a fost stadiul pT2a la un caz,
pT2b doua cazuri si pT2cun caz. Scorul Gleason a fost 7 (3+4) pentru 3 pacienti si 7 cu pattern
35
primar 4 la cel de-al patrulea pacient. Marginile de rezectie au fost negative. Un caz este continent
si a obtinut erectie la 3 saptamani postoperator, iar celelalte 3 cazuri au prezentat incontinenta
urinara doar la efort, fara functie erectila. Timpul mediu de monitorizare prospectiva este de 4 luni.
Concluzii: Controlul adenocarcinomului prostatic prin prostatectomia radicala asistata
robotic este posibil la pacientii tratati initial prin tehnica HIFU. Tehnica de disectie si izolare a
blocului prostato-veziculo-deferential este mult mai dificila decat in abordul primar. Utilizarea
chirurgiei robotice creste siguranta in exereza piesei, prin disectia magnificata si minutioasa si astfel
se evita aparitia marginilor de rezectie pozitive. Numarul mic de cazuri si perioada scurta de
monitorizare limiteaza precizarea gradului morbiditatilor ulterioare, comparativ cu indicatia primara
de prostatectomie radicala
14. Chemotherapy in urinary bladder cancer – an overview of the treatment in IOCN of
the last 5 years
Autori: Cainap C, Campean C,Feflea D, Petrut B
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: bladder cancer, chemotherapy, neoadjuvant, adjuvant, intravesical
Rezumat:
Cancer is a major problem for health systems all over the world. With an increasing
incidence which will arrive at 19,3 millions new cases every year by 2020 (estimated by
GLOBOCAN) the importance of cancer management is growing. Bladder cancer is situated in the
first ten primary tumours in the world with more than 400000 new cases per year, males beeing
more affected than females. Surgery remains the cornerstone of the correct oncological approach;
radiotherapy and chemotherapy are underused despite the fact that they are improuving the general
prognosis of the patients.
In this presentation we will make an overview of the treatments in our institute for bladder
cancer patients: intravesical, neoadjuvant, adjuvant or metastatic setting. We will present the
hysthological types, types of medical treatments used, toxicities and prognostic factors in
correlations with previous published data.
36
POSTERE
1. Circulating tumor cells in testicular germ cell tumors
Autori: Cristina Cebotaru, Elena Diana Oteanu, Rares Buiga,
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: circulating tumor cells, testicular cancer
Rezumat:
Aim: Circulating tumor cells (CTCs) are rare malignant cells found in the peripheral blood.
As poor-prognosis germ-cell tumors patients still have a 50% `chance` to die of their disease with
standard treatment, we tested the hypothesis that CTCs detection could predict clinical, serologic,
radiologic and pathologic response, in order to guide treatment.
Patients and methods: In this prospective pilot study, in two poor-prognosis germ-cell
tumor patients, we isolated and enumerated the CTCs in the peripheral blood at baseline, after one
cycle, and at the end of first-line chemotherapy (BEP regimen), and correlations were made with
serum markers, radiologic and pathologic response. CTCs were measured using a density gradient
centrifugation separation technique and an immunocytochemistry technique ( citokeratinAE1/AE3).
Radiologic assessments consisted of CT-scans and PET-CTs, and pathology report was obtained
either from resected specimen or biopsy of persistent tumors with negative serum markers or
metabolic inactive PET-images.
Results: Enumeration of CTCs in the peripheral blood at baseline and after chemotherapy
correlated with serum markers decrease and radiologic and pathologic response. For the first
patient, the decrease of CTCs was slower than for the second patient, and correlated with the
response: partial response with positive serum markers versus partial response with negative
markers. The first patient had positive PET-CT and the second patient had negative PET images.
Biopsy from resected specimen PET-negative (second patient) showed no viable tumor. After 12
months the first patient was alive, with active disease and the second patient was alive, disease free
with stable PET-negative images.
Conclusion: The first results suggest that the number of CTSs might provide prognostic
information as their decrease after chemotherapy correlates well with clinical assessment, serum
markers, imaging, post-chemotherapy pathologic response and outcome.
37
HEMATOLOGIE ŞI ONCOPEDIATRIE
COMUNICĂRI ORALE
1. Indolent non-Hodgkin lymphomas - Clinical course and response to treatment Experience of the Haematology Department of the “Ion Chiricuta” Oncology Institute
in Cluj-Napoca
Autori: Anca Bojan2, Anca Vasilache1, Andrei Cucuianu2, Laura Urian2, Mariana Patiu1, Carmen
Basarab1, Bogdan Fetica1, Calin Coldea1, Tunde Torok2, Mihnea Zdrenghea2, Andrada Parvu2,
Ljubomir Petrov1.
Instituţie:
1- The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2 - University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca
Cuvinte cheie: follicular lymphoma, marginal zone lymphoma, lymph node
Rezumat:
Introduction: Indolent lymphomas are often insidious, presenting only with slow growing
lymphadenopathy, hepatomegaly, splenomegaly, or cytopenias. Examples of lymphomas that
typically have indolent presentations include follicular lymphoma, chronic lymphocytic
leukaemia/small lymphocytic lymphoma, and marginal zone lymphoma (MALT). This study
represents a non-randomized retrospective study aimed to evaluate the incidence of different forms
and the treatment outcome in the Haematology department of the “Ion Chiricuta” Oncology
Institute in Cluj-Napoca.
Methods: 122 patients with indolent lymphomas were treated in the Haematology
department of the Oncology Institute of Cluj-Napoca, in the last 10 years, between 2003 and 2012.
Diagnosis was made by lymph node biopsy for follicular lymphoma, nodal marginal zone
lymphoma, histology of the spleen in splenic marginal zone lymphoma and gastric, intestinal,
parotid, thyroidal, lung, rhinopharinx etc. biopsy in MALT lymphomas. The prognostic evaluation
was done according to the FLIPI score for follicular lymphoma.
Results: 122 patients with indolent lymphomas were included in the study: 41% with
follicular lymphoma, 37% with lymphocytic lymphoma, 5% lymphoplasmacytic lymphoma, 9%
MALT lymphomas, 4% splenic marginal zone lymphoma. 24 patients with follicular lymphoma had
a FLIPI score >3 and 80% were treated with CHOP-based regimens as first-line therapy. The
overall survival in patients with follicular lymphomas was significantly higher in patients with stage
I or II, FLIPI score<3 and complete remission after first line therapy.
Conclusion: Indolent lymphomas are characterized by a long median survival, are usually
in an advanced stage, respond to therapy, but relapse and the therapeutic options are increasing:
monoclonal antibody, radioimmunotherapy interferons, stem cell transplantation.
2. Prognostic significance of ZAP-70 and CD38 expression in Chronic Lympocytic
Leukemia
Autori: Ana-Maria Fit1, Laura Maja2, 2Gabriel Tanu, 3Delia Dima, 3Liubovici Petrov, 3Andrei
Cucuianu, 3Mihnea Zdrenghea, 4Luminita Blaga, 2Bogdan Fetica
Instituţie:
1 Clinical Emergency Hospital, Cluj-Napoca,
2 The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: chronic lymphocytic leukemia, CD38, ZAP-70, EBER
Rezumat:
Chronic lymphocytic leukemia (CLL) has a heterogeneous clinical course. Among useful
markers in identifiyng patients with poor outcome are unmutated IgVH, ZAP-70 and CD38
expression. Both ZAP-70 and CD38 were shown to be capable of identifying aggressive CLL.
38
We analysed data from 39 patients with CLL: 24 cases diagnosed by lymph node biopsy and
15 cases diagnosed by bone marrow biopsy. The clinical and immunophenotypic criteria (C23+,
CD5+, CD20+, CD10-, CD3-, cyclinD1-) for B-cell CLL were achieved in all 39 patients. The
median age of patients was 60 years and we noted a slight male predominance.
Cytoplasmic ZAP-70 and surface CD38 expression were evaluated by
immunohistochemistry and correlated with clinical course. In addition in-situ hybridization for
EBER-1was evaluated.
Prognostic information given by ZAP-70 and CD38 could be used in guiding treatment
decisions and they probably should be recommended to all patients with B-CLL in trying to obtain a
more clear profile of the disease at the time of diagnostic.
3. Anemia aplastica (AA). Actualitati in etiopatogeneza si tratament. Aplastic Anemia
(AA). Recent advances in pathogenesis and treatment.
Autori: L. Petrov
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Aplastic anemia, etiologic agent, pathogenesis, treatment
Rezumat:
Aplastic anemia is defined as pancitopenia with a hipocellular bone marrow without an
increase of reticulin or fibrosis and no morphologically anormal cells in blood or marrow.
The pathophysiology of AA is not entirely clear. There is a deficiency in the number of
hematopoetic stem cells. The nature of damage is nuclear.
There is a growing evidence of the role of cell-mediated damage of stem cells.
Although acquired aplastic anemia has been causally associated with many agents (drugs,
benzene, insecticides and viruses) no etiologic agent can be identified in most cases.
The severity of bone marrow failure is reflected by the depression of the peripheral blood
counts and is closely related to the prognosis.
First line treatment is determined by the severity of the marrow failure, the age of the
patient, the availability of a suitable donor and presence of comorbidity.
Young patients transplanted from HLA matched sibling donors have about 80-90% disease
free survival. Event free survivals falls to <50% in patients > 40 years. Succesfull outcome of
transplant diminishes with matched unrelated donors and with any degree of HLA mismatch.
Immunosupressive therapy with antithymocyte globulin (ATG) and cyclosporine (CSA) is
used in patients who are not candidates for bone marrow transplantation. The response rates with
ATG/CSA ranged between 60 and 80% with 5 year survival comparable to BMT.
Persistent cytopenia is common and many patients relapse, become dependent on CSA or
develop secondary clonal disease (PNH or MDS).
High dose cyclophosphamide without BMT can be used to treat AA.
There are no standard treatment for managing refractory and relapsed patients after
ATG/CSA treatment.
Therapeutic options include allogenic SCT, retreatment with ATG/CSA or high dose
cyclophosphamide.
4. Monoclonal B cell lymphocytosis in patients with hepatitis C virus infection:
prevalence, demographyc and laboratory correlations
Autori: Tünde Tőrők-Vistai , Anca Bojan , Manuela Sfichi , Cristina Pojoga
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: monoclonal B lymphocytosis, hepatitis C virus, nonhodgkin lymphoma, chronic
lymphocytic leukemia
Rezumat:
Introduction: Several studies have demonstrated an increased prevalence of HCV infection
in patients with B-cell nonhodgkin lymphoma. Monoclonal B lymphocytosis (MBL) is
39
characterized by the presence of a clonal B-cell population which might evolve into malignant Bcell lymphoproliferative disease. MBL can be detected in approximately 3.5% of healthy
individuals, but in HCV-infected patients it can be identified at a higher frequency. We aimed to
quantify monoclonal B-cell populations in patients with HCV and to identify demographyc and
laboratory features of patients with MBL.
Methods: We conducted a prospective study on 50 consecutive patients with chronic
hepatitis or cirrhosis. For detection of MBL we performed a four-colour flow cytometry. Statistical
analysis was performed using the Statistical Package for Social Sciences. The level of statistical
significance was set at p<0.05.
Results: Flow cytometric analysis revealed MBL in 22% of the patients. Prevalence of MBL
was higher in patients with cirrhosis then in those with hepatitis. In patients with MBL the
leucocyte count was significantly lower (p=0.04) and increased liver echogenicity was more
frequent (p=0.02).
Discussion: The prevalence of MBL in patients with HCV infection is significantly higher
then in the general population, sustaining the pathogenetic role of HCV in B-cell lymphoma.
Comparing patients with or without MBL, we didn’t find statistically significant demographyc
differences. Data differed only in terms of the leucocyte count and liver echogenicity.
Conclusions: In accordance to other studies, we have found a high prevalence of MBL in
patients with HCV infection. While in the general population, it is known that the rate of
progression of MBL to CLL is about 1.1% /year, in HCV infected patients further studies are
needed to investigate the rate of progression into lymphoprolyferative disease.
5. Prognostic Factors in Acute Myeloblastic Leukemia in Children
Autori: Popa Gheorghe
Instituţie: University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca
Cuvinte cheie: leukemia, child, prognostic factors
Rezumat:
Acute myeloblastic leukemias are a heterogenous group of hematologic malignancies. They
are rare in children and progress in diagnosis and treatment are recent. The identification of some
specific molecular markers allowed the new WHO classification since 2008 that distinguishes
subtypes defined by molecular markers. The author analyses the prognostic factors that have
particular significance: host factors, response to induction chemotherapy, cytogenetic changes and
molecular abnormalities in patients with normal karyotype. The personal experience in the
diagnosis and therapeutic strategy is presented, based upon the current knowledge about prognostic
factors.
6. Management decisions and outcome in bilateral Wilms tumor
Autori: Emilia Mihut, Rodica Cosnarovici, Stefania Neamtu, Popita Vasile
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat: Management of bilateral Wilms tumor is very challenging, focused on the
eradication of tumor and preservation of renal function. We report two cases of bilateral Wilms
tumor with discussion of its treatment and management. Although Wilms tumor is one of the most
common solid malignancies in children, bilateral disease is rare and is seen in only 5% of all
patients. The management of bilateral Wilms tumor depends on the individual clinical scenario and
requires a multidisciplinary clinic approach by a highly experienced team.
7. Realitate şi perspective în oncologia pediatrică
Autori: Rodica Cosnarovici
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
40
POSTERE
1. Systematic clinical, hematological, cytogenetic and molecular follow-up of chronic
phase CML patients treated with TKIS. Impact on treatment
Autori: Dima D, Cucuianu A, Patiu M, Trifa A, Selicean C, Balacescu O, Lelutiu L, Frinc IC,
Pavel C, Rosu I, Petrov L
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: mutation, imatinib, leukemia, T315I
Rezumat:
Introduction. Since the introduction of the tyrosine kinase inhibitor (TKI) imatinib
mesylate (IM) in the treatment of chronic myeloid leukemia (CML), a dramatic improvement in
hematologic, cytogenetic and molecular responses was noted. Also, the overall survival increased
significantly. Unfortunately, in certain patients, resistance to TKI develops relatively early,
especially due to point mutations in the ABL kinase domain, among which the T315I mutation
confers resistance to all three currently available TKIs (imatinib, dasatinib, nilotinib).
Methods. We performed a prospective study on 74 patients diagnosed with chronic phase
CML, for whom we analyzed the T315I mutation. Mutational analysis was performed using
ARMS-PCR (with subsequent confirmation by direct sequencing) at regular intervals of 6 months
or in case of suboptimal response, loss of response or progression. Correlations between the T315I
mutation and disease characteristics, response to treatment and survival were analyzed. A
comparative analysis between patients positive and negative for the mutation was performed. The
patients were followed and evaluated according to European Leukemia Net (ELN) criteria.
Results. T315I mutation was detected in 3 patients (4.05%) and its presence was correlated
with younger age at diagnosis, second line TKI therapy, progressive disease and decreased survival
from the moment of detection.
Conclusions. ARMS-PCR is a sensitive, easy to use method for the detection of T315I
mutation in chronic phase CML patients.
2. Prognostic value of the International Staging System in multiple myeloma.
Comparison with the Salmon Durie staging system
Autori: Rosu A, Frinc IC, Tomuleasa C, Pavel C, Bibirigea A, Rosu I, Dima D, Selicean CE, Patiu
M, Cucuianu A
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Multiple myeloma, staging, ISS, Salmon Durie
Rezumat:
Background: Multiple myeloma (MM) is a malignant monoclonal gammopathy
characterized by bone pain, lytic bone lesions, hypercalcemia, anemia, impaired renal function,
bone marrow plasmacytosis. Since 1975 the Salmon Durie staging (SDS) system has the been used
for the evaluation of prognosis of these patients, a staging system that takes into account the clinical
features listed above. The subjectivity of the interpretation of bone lesions, an important part of the
staging system, and the poor positive predictive value of the Salmon Durie system has led to the
design of a new staging system, the International Staging System (ISS) in 2005. ISS takes into
consideration the serum levels of beta 2 microglobulin and albumin. Several comparisons of the two
systems have demonstrated the superiority of ISS.
Aim: To compare the prognostic value of the ISS and Salmon Durie staging system for
patients with multiple myeloma treated in the hematology department in Cluj-Napoca
Material and method: The study is a prospective analytic study of the prognostic value and
survival rates of 57 MM patients treated in 2012-2014 in the hematology department in ClujNapoca, that were grouped according to both systems. 33 patients (59%) were female and the
median age was 60 years (range 42–82) Evaluation of response included immunoglobulin levels,
41
serum and urine immunofixation, radiologic evaluation of the plasmacytoma, bone marrow
aspiration/biopsy –plasmacytosis, and were done at the end of 8 cycles of chemotherapy.
Results: According to the Salmon Durie staging system, 9% of our patients were stage I,
30% stage II, and 61% stage III. Using the ISS, 27% of the patients were stage I, 33% stage II and
40% stage III. Until now 37 patients had undergone one or two evaluations, 12 of which had a
complete response and have stopped treatment. Among the complete responders, 8 patients were in
stage III, 3 patients were in stage II and 1 in stage I SDS, while according to ISS, 6 patients were in
stage I, 3 patients were in stage II and 3 patient was in stage 1. The non-responder group was
formed of 25 patients who had stable disease (15 in stage III SDS and 7 in stage II and 3 stage I
SDS); according to ISS, 8 patients were stage III, 11 patients were stage II and 6 patient was stage
I) and continue treatment with 2-nd or 3-nd line therapy. One patient, who initially had a complete
response (stage IIIB SDS and stage III ISS) had an early relapse (6 months after autologous stem
cell transplantation). Fifty five patients are currently alive and continuing observation regularly; one
patient (stage IIIB SDS and stage III ISS) died 18 months after diagnosis.
Conclusions: Between the responders group and the non responders group there were no
differences according to Salmon Durie system, stage III patients forming the majority in both
groups (66.6% and 60%), while, according to the ISS there were differences between the two
groups: in the responders group the majority were stage I (50%), while in the non responders group
stage II formed the majority of patients (44%). Therefore, the Salmon Durie staging system has a
poorer prognostic value than the ISS, because it tends to confer a poor prognosis to the majority of
patients.
3. Mutatia JAK2V617F in trombocitemia esentiala
Autori: Laura Urian, L. Petrov,A. P. Trifa, A. Bojan, A. Cucuianu, C. Basarab, M. Patiu, A.
Vasilache, M. Zdrenghea, T. Torok, D Gavril
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: trombocitemie esentiala, mutatia JAK2
Rezumat:
Introduction: Essential thrombocythemia (ET) is a clonal myeloproliferative disease
involving a hematopoietic stem cell and, manifesting predominantly as thrombocythosis, and it is
associated with thrombohemorrhagic complications and myeloid transformation to diseases such as
myelofibrosis and acute myeloid leukemia. In 2005 a unique acquired clonal mutation in JAK2 was
found. This mutation was observed in the majority of polycythemia vera patients and in about half
of ET or primary myelofibrosis patients.Methods We analyzed 107 cases of ET, from a single
institution to determine the prevalence of JAK2V617F mutation and the clinical correlations.
Mutation screening was performed on genomic DNA from peripheral blood from all 107 patients.
Results: The JAK2V617F mutation was found in 51,4% of cases. 7,2% were homozygous
for the mutant allele (>75%). Conclusions Patients with JAK2V617F positive had higher
haematocrit, leucocytes levels and advanced age.
4. Rare association of chronic myelomonocytic leukemia, hypereosinophilic syndrome
and aggressive systemic mastocytosis – diagnostic and therapeutic challenges
Autori: Anca Vasilache, Radu Dancu, Carmen Basarab, Muntean Lavinia
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: CMML, systemic mastocytosis, hypereosinophilic syndrome
Rezumat:
We present the case of a 52 years old man, who presented in our service in October 2011,
with a splenomegaly detected at a routine ultrasound exam. He was than suspected to have CML
but finally a diagnosis of Ph negative CMPS/CMML was made. After one year of unmonitored
evolution and no treatment, he associated a hypereosinophilic syndrome (α -PDGFR negative, lack
of response to imatinib 100 mg/day) and then aggressive systemic mastocytosis with abrupt onset
42
(important hepatosplenomegaly, enlarged lymph nodes, pleural effusion, positive histology in the
lymph node and bone marrow, c-Kit positive and elevated serum tryptase).
He had no response to cladribine and for a short time his disease was relatively stable with
IFN-α, hydroxiureea and intermittent corticosteroids. In September 2013, the CMML entered a
myeloblastic phase, resistant to aggressive chemotherapy and the patient died with hemorrhagic
stroke.
The association of myeloproliferative disease or CMML with hypereosinophilic syndrome
or systemic mastocytosis is noted in the literature but the association of the three conditions is rare.
We also considered the end as particular, due to the blastic phase of the CMML and not to
the aggressive systemic mastocytosis.
5. Dynamics of pediatric oncological pathology within 30 years
Autori: Ştefania Neamţu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: pediatric malignancy, distribution, survival, complications
Rezumat:
Purpose: Retrospective evaluation of uni-institutional pediatric malignancy during a period
of 30 years.
Material and Method: 3 groups have been compared, representing new cases of children
diagnosed and treated at the Oncology Institute “Prof.dr.Ion Chiricuta” Cluj-Napoca. The first
cohort consisted of 787 children (1983-1992), the second one consisted of 908 children, out of
which only 881 complied with the evaluation criteria (1993-2002) and the third cohort consisted of
760 children, out of which only 725 complied with the evaluation criteria (2003-2012).
We studied the annual pathology distribution, survival rate, and development of late
complications.
Conclusions:The number of cases has increased in the second decade, with the decrease in
the average age of disease manifestation, from 7, 8 years to 4, 7 years.
The structure of the treated casuistry has changed a decreasing in the number of the
malignant hemopathy has been registered and the increasing number of malignant solid tumors,
especially thyroid and CNS tumors.
There has been an increasing of the cases complexity and the diagnosis of rare pediatric
tumors. Survival rate has improved, and late side effects decreased.
6. Improved hematological and clinical responses in MDS with combination therapy:
blood transfusion and chelation. Case report.
Autori: Rosu A, Frinc IC, Tomuleasa C, Pavel C, Bibirigea A, Rosu I, Dima D, Selicean CE, Patiu
M, Cucuianu A.
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: SMD, iron chlelation, transfusion
Rezumat:
Introduction: The myelodysplastic syndrome (MDS) is a heterogeneous group of diseases
of the hematopoietic stem cell, characterized by infective hematopoiesis and increased risk of acute
leukemia transformation. The treatment varies from supportive care to potentially curative treatment
such as allogeneic bone marrow transplantation. For most patients, the elective supportive treatment
is packed red cell transfusions. Unfortunately, iron overload is an inevitable complication to
multiple transfusions. This complication has recently and successfully been addressed with oral
chelation therapy.
Case presentation. VI, 61 years old, orderly, presents in our clinic in December 2006 with
fatigue and dyspnea at slight effort. The symptomatology was present for several months. The
patient used to be an alcoholic but has been abstinent for the past 7 years. The physical exam
revealed severe pallor. The initial workout consisted of severe anemia (Hgb 6 g/dl) with normal
WBC 6x10³/µl and PLT count 367x10³/µl, low reticulocyte count 9%o. The blood smear showed
43
poikilocytosis with codocytes and erythrocytes with basophilic stippling with a normal leucocyte
differential count. The bone marrow aspiration revealed a hypercellular marrow with left shift of the
granulocytic series with 4% blasts, 11% promyelocytes; the erythrocyte series represented 26% of
nucleated cells with binucleated erythroblast, internuclear bridging, numerous codocytes and
basophilic stippling . The Prussian blue stain showed 20% ring sideroblasts. The karyotype was
normal and the JAK2V617F mutation was negative. Biochemically, there were no abnormalities
and the ferritin level was 250 µg/l. The diagnosis of MDS- RARS, IPSS low risk was established
and blood transfusions were recommended. The patient had since received 2-4 units of red cells
monthly. A treatment with vitamin B6 250 mg/day was given between January 2007 and March
2007. During May-July 2007, a treatment with erythropoietin was given with no response. Three
years after the diagnosis, the patient complained of increased fatigue, dyspnea and lower limbs
edema. There were no changes on the ECG, but the echocardiogram showed restrictive dysfunction.
A diagnosis of congestive heart failure, NYHA II was established. At the time, the ferritin level was
1800 µg/l. Given the heart condition, treatment with deferasirox 40 mg/kgc/day was started in
September 2010. The clinical, biochemical and hematological evolution was favorable. The patient
is still given 2-3 units of red cells every month to maintain a Hgb level of 8-9g/dl, but he has no
symptoms under minimum cardiological treatment. The ferritin level is <1000 µg/l. and there are no
signs of leukemic transformation.
Conclusions. Iron overload is an independent negative prognostic factor, especially in low
risk MDS patients. In MDS patients receiving red cell transfusions, the quality of life and survival
can be improved with correct chelation treatment. The patient is still in good clinical condition at 8
years after diagnosis and his hematological and biochemical parameters are stable. There might also
be a role for deferasirox in the hematological response. We expect a good overall survival for this
patient.
7. Primary non-Hodgkin’s lymphoma of the orbit presenting with massive bilateral
periorbital tumors
Autori: Tünde Tőrők-Vistai, Anca Bojan, Anca Vasilache, Laura Urian, Andrei Cucuianu, Delia
Dima, Andrada Pirvu, Daniela Gavril, Andrea Zsoldos
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: non-Hodgkin’s lymphoma, orbital tumors, vision loss.
Rezumat:
Extranodal onset can be seen in approximately 25-40% of the cases of nonohodgkin
lymphomas and diagnosis is often difficult due to nonspecific symptoms. Orbital lymphomas
represent approximately 50% of the orbital malignancies., Common symptoms and signs at
presentations are: palpable tumor, exophtalmos, dyplopia and decreased vision. Diagnosis can be
made only by biopsy and early treatment is important in order to increase the chance of cure. We
present the case of a patient whose diagnosis and treatment were delayed due to refusal of biopsy
and, although complete remission of lymphoma was obtained, the vision loss was permanent
because of prolonged compression on the optic nerves. A particularity of this case is the presence of
massive periorbital tumors on admision to the hospital, incorporating the eye globes completely and
causing impressive facial deformity.
44
8. Difficult diagnosis in a case of large granular lymphocyte leukemia
Autori: Cristina Băgăcean1, Mariana Patiu1, Horia Bumbea2, Bogdan Fetica1, Jean-Michel
Picquenot3, Mihaela Groșan1, Mihnea Zdrenghea1
Instituţie:
1. The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca and Iuliu Hațieganu
University of Medicine and Pharmacy Cluj-Napoca, Romania
2. University Hospital Bucharest, Romania and Carol Davila University of Medicine and
Pharmacy Bucharest
3. Centre Henri Becquerel, Rouen, France
Rezumat:
Large granular lymphocyte leukemia (LGLL) is a rare lymphoproliferative disorder thought
to arise from transformed NK or T cells and is one example of chronic exposure to a proinflammatory cytokine, IL-15, being clearly implicated in cancerogenesis. This pathogenetic feature
explains why treatment of T-LGLL is based on immunosuppressive therapy. However, the
pathways of cytokine signals fitting into the bigger picture of malignant transformation are unclear.
Molecular pathways that co-operate for malignant transformation downstream of prolonged
IL-15 receptor signaling have been recently described. Proteasome inhibitor bortezomib is known to
target some of these pathways and has been proposed as therapy in LGLL.
Diagnosis of the majority of T-LGLL is established by documentation of increased numbers
of clonal large granular lymphocytes in peripheral blood by specific morphology and phenotype.
We here report the case of a 60-year-old patient with a history of chronic neutropenia of
unknown origin since 2007, investigated in several hematology departments without the
establishment of a diagnosis, referred to us in 2013 because of recurrent respiratory infections with
severe neutropenia.
The patient underwent a full diagnostic checkup including cytological and histological
examination of bone marrow, which were at first attempt inconclusive, but cytology pointed
towards the presence of unidentified nuclei infiltrating the marrow and led to bone marrow flow
cytometric analysis, which finally allowed for the establishment of diagnosis. The patient was
treated in first line with bortezomib, with inconclusive results, but responded to a second line of
methotrexate in immunosuppressive doses.
9. Loss of CD20 tumoral expression after rituximab and chemotherapy in a nodular
follicular lymphoma
Autori: Cristina Băgăcean1,2, Adrian Tempescul3, Mihnea Zdrenghea1
Instituţie:
1. The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj-Napoca
2. “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,
3. Institute of Cancerology and Hematology, Brest University Medical School, France
Rezumat:
A humanized chimaeric antibody targeting CD20, rituximab is the first monoclonal antibody
approved in cancer treatment, and is currently used in practically all B cell malignancies.
Expression of CD20 is limited to mature and precursor B cells, and the histological and/or
immunophenotypic demonstration of its presence in a tumor warrants the inclusion of rituximab in
its therapy. However, repeated administration of rituximab can lead to the disappearance of CD20
molecule expression at B cell surface, rendering the drug useless. Despite this phenomenon being
reported in B cell lymphoma since the advent of the drug, awareness among hematology practicians
is still limited. We here present a case of nodular follicular lymphoma, treated with four courses of
chemoimmunotherapy or immunotherapy with rituximab alone, showing CD20 expression loss at
relapse. Our report emphasizes the importance of re-biopsy and CD20 expression assessment at
relapse/progression.
45
10. Hemophagocytic syndrome secondary to common variable immunodeficiency. Case
report.
Autori: Frinc IC, Dima D, Patiu M, Selicean CE, Pavel C, Bibirigea A, Fetica B, Tomuleasa C,
Cucuianu A
Instituţie: The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj-Napoca
Rezumat:
Introduction: Common variable immunodificiency (CVID) is a heterogenous group of
genetically determined primary humoral immune defects, manifested mainly in young adults, resulting
in increased susceptibility to infections. Hemophagocytic syndrome (HS) is a potentialy lethal
hyperinflamation syndrome caused by increased secretion of cytokines due to excessive but inefficient
immune stimulation. Although there are cases of inherited HS, most cases are acquired, secondary to
infections, immunodeficiency, autoimmunity or cancer.
Case presentation: OL, 34 years old, presented in June 2013 at our clinic with high fever (400
C), altered general status, fatigue and diahreea. Since April 2013, the patient was hospitalized in
various clinics with the same symptoms. He was treated with antibiotics and short courses of
corticosteroids with good, but short responses. The clinical exam revealed hepatomegaly 4 cm and
splenomegaly 6 cm under the costal margin.
The hematological examination showed severe normocytic normochromic anemia (Hgb 5.3
g/dl) and increased ESR (143mm at 1h). Biochemically, there were signs of hepatic failure: AST 222
UI/l, ALT 210UI/l, ALP 1080 UI/l, hypoproteinemia with hypoalbuminemia (total proteins 5,3 g/dl,
albumin 2.3 g/dl), increased ferritin (9770 microg/dl), increased procalcitonin (7,76 ng/mL) and
hypogammaglobulinemia (IgG 548,6mg/dl, IgA 50,2mg/dl, IgM 7mg/dl), hypertriglyceridemia (344
mg/dl). The bone marrow aspiration revealed a hypercellular marrow with granulocytic hyperplasia
with a left shift, toxic granulations within the neutrophils and frequent histio-monocytic cells with
important hemophagocytosis of erythrocytes, leukocytes, platelets, erythroblasts and neutrophils. Some
of the histiocytic cells displayed digestive vacuoles. The screening tests for HCV, HBV, HIV, EBV
and CMV were negative. The stool was positive for Clostridium difficile. The hemocultures were also
positive for Staphylococcus saprophyticus.
A diagnosis of Common variable immunodeficiency complicated with hemophagocytic
syndrome, septicemia with Staphylococcus saprophyticus and acute enterocolitis with Clostridium
difficile was established. The patient was treated with antibiotics, antifungals, corticoids, red cell
transfusions and intravenous immunoglobulins (10g). The response to therapy was good with
resolution of fever, improvement of hematological and biochemical parameters and normalization of
spleen volume. The patient was subsequently referred to Medical Clinic III, Immunopathology Dept.
for continuation of treatment with immunoglobulins. Unfortunately, the patient was hospitalized again
in less than a month due to reappearance of fever, anemia, and splenomegaly. Biochemically there was
worsening of hepatic failure, increased ferritin (17000 microg/dl). The CT scan showed left lobar
pneumonia, multiple mediastinal and abdominal adenopathies, hepatomegaly, ascites, bilateral pleural
effusions and splenomegaly with hypodense nodules. Treatment with antibiotics, antifungals, red cell
transfusions and corticosteroids was reinitiated, but the patient’s status deteriorated, with the
occurrence of seizure, coma and death shortly afterwards.
Conclusions. This case illustrates the difficult management and severe outcome of CVID
complicated with HS, due to repetead severe infections and multiple organ failure.
46
11. Late diagnosis of Hodgkin’s lymphoma: paraneoplastic, immune and infectious
complications and fatal outcome. Case report.
Autori: Pavel C, Patiu M, Fetica B, Dima D, Frinc IC, Rosu A, Rosu I, Bibirigea A, Selicean CE,
Tomuleasa C, Cucuianu A
Instituţie: The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj-Napoca
Reyumat:
Introduction. Hodgkin’s lymphoma is a neoplasm of the lymphoid tissue characterized by
the presence of malignant Reed-Sternberg and Hodgkin cells of germinal center origin in a specific
microenvironment composed by T, B cells, neutrophils, eosinophils, plasma cells, histiocytes.
With combination treatment- chemotherapy and radiotherapy, the survival expectation at 10
years for patients under the age of 65, is 70-80%.
Case presentation. HAR, 42 years old presents at our clinic in February 2014 with altered
general status, marked fatigue, important weight loss (17 kg) and persistent laterocervical
adenopathy. The symptomatology was present for 2 months. The patient has also complained of
persistent diarrhea, cough, fever and edema in lower limbs. The patient has presented a
laterocervical adenopathy for 4 years. There were 2 biopsies performed, both revealed a reactive
lymphoid tissue. At clinical exam: an important right cervical adenopathy 6/7 cm and lower limb
edema. Hematological exam shows moderate hemolytic anemia (Hgb 7.3 g/dl, reticulocyte count
140%o) and thrombocytopenia (Plt 90x10ᵌ/µl).
Biochemically, there was severe hypoporotidemia secondary to nephrotic syndrome,
hypogamaglobulinemia, increased ferritin and cholestasis. Bone marrow aspiration reveals
hypercellular marrow with left shift of granulocytic series and histio-monocytic cells with
hemophagocytic activity. The CT of thorax and abdomen did not show other lymphadenopathies,
but revealed effusions both pleural and ascites. The stool was positive for Clostridium difficile.
The bacteriologic exam of sputum was positive for Pseudomonas aeruginosa and Candida
albicans. There was a third biopsy of the lymphadenopathy perfomed and it has showed an
infiltration of Reed Sternberg cells. The diagnosis of HL stage I Bulky was established, complicated
with nephotic syndrome, autoimmune hemolytic anemia, hemophagocytic syndrome, acute
enterocolitis with Clostridium difficile and acute pneumonia with Pseudomonas aeruginosa and
Candida albicans.
The patient has received antibiotherapy, antifungals, corticotherapy, intravenous albumin
and packed red cell transfusions. The general and bioumoral status of the patient have improved. At
that time chemotherapy was offered. Considering the prognosis of the patient, a cycle of BEACOPP
chemotherapy was administered. The patient was discharged in good general health. Soon after the
chemotherapy, the patient presents another infectious complication that is treated in another hospital
with no response and alteration of general status and exitus.
Conclusions. The goal of treatment in Hodgkin’s lymphoma is cure, possible with current
combination therapy. Delayed diagnosis of HL is associated with advanced disease, complications
such as: paraneoplastic manifestations, immune deficiency, infectious complications and finally,
severe outcome despite aggressive chemotherapy.
47
DISCIPLINE FUNDAMENTALE
COMUNICĂRI ORALE
1. Comparison of one- and two-color microarray experiments, within Agilent platform
Autori: Loredana Balacescu1, Oana Tudoran1 , Ovidiu Balacescu1, Ioana Berindan-Neagoe1,2
Instituţie: 1- The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj-Napoca
2- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: one-color design, two-color design, microarray, Agilent
Rezumat:
Introduction. Agilent microarrays platforms allow both one- and two-color labeling of
samples to detect changes in gene expression. Although the performance of these approaches has
been widely demonstrated, there are advantages and disadvantages of each labeling design. In this
study we compared the results obtained from one- and two-color microarray experiments,
performed on Agilent platform.
Material and methods. Total RNA was isolated from negative- and PDGFBB-siRNA
treated Ca Ski cells, obtained in three independent experiments. PDGFBB inhibition upon siRNA
treatment was confirmed by qRT-PCR. The same three cell line replicates for each condition were
used for both one- and two-color experiments, negative–treated cell lines considered as reference.
Feature Extraction software were used to quantify the fluorescent images. For both experiments,
microarray data analysis was performed in R, using suitable methods for each design.
Results. The data were evaluated in terms of reproducibility and accuracy to determine if
this two approaches provide comparable results. Using one-color design, we identified 58 genes
whose differential expression exceeded 1.3-fold (adjusted p-value < 0.05) in PDGFBB-siRNA
treated compared to negative–siRNA treated Ca Ski cells. A very different transcriptional profile
was obtained using two-color design. The data analysis highlighted 671 differentially expressed
genes between PDGFBB-siRNA treated and negative–siRNA treated Ca Ski cells (Fc > 1.3,
adjusted p-value < 0.05). Of the 58 genes that were found to be differentially expressed in one-color
experiment, 52 genes were also identified in the two-color experiment. Significant down-regulation
of PDGFBB upon siRNA treatment, previously demonstrated by qRT-PCR, was observed just in
two-color experiment.
Conclusions. Our data showed a significant difference in the number of changing genes
detected with the two approached. The results indicate that two-color microarray experiments have
an increased power to find differentially expressed genes between groups with small differences in
expression.
2. The relationship between FA/BRCA pathway and therapy failure in advanced squamous
cervical cancer.
Autori: Ovidiu Balacescu1, Loredana Balacescu1,2 Rares Buiga1, Oana Tudoran1,2, Nicolae Todor1,
Viorica Nagy1,2, Claudia Ordeanu1,2, Ioana Berindan-Neagoe1,2
Instituţie: 1- The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca
2- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca
Cuvinte cheie: FANCD2, RAD51, BRCA1, BRIP1, cervical cancer, treatment prediction
Rezumat:
Introduction: Cervical cancer, the third most commonly diagnosed cancer in women,
represents a major problem in oncology. About half of the patients with advanced cervical cancer
will develop recurrence or metastasis in the first 2 years after completion of therapy. The aim of this
study is to identify new prognostic factors that could distinguish between patients with unfavorable
prognoses from others with better prognoses.
Material and methods: Forty five patients with locally advanced squamous cell carcinoma
were enrolled in this study. Fresh primary biopsies from twenty-one patients harvested prior to
therapy were analyzed for whole human gene expression (Agilent) based on the patient’s 6 months
48
clinical response. The rest of twenty-four FFPE primary biopsies were used for independent
validation of the proteins of interest.
Results: One hundred and twenty four genes involved in DNA replication, recombination
and repair were activated (92 were over-expressed and 32 were down-regulated) for patients with
unfavorable prognoses compared with that with better prognoses. Role of BRCA1 in DNA Damage
Response was predicted to be the most significantly altered canonical pathway involved in intrinsic
resistance (p = 1.86E-04, ratio = 0.262.
Conclusions: Our findings suggest that FA/BRCA pathway plays an important role in
treatment failure in advanced cervical cancer. The assessment of FANCD2, RAD51, BRCA1 and
BRIP1 nuclear proteins could provide important information about the patients at risk for treatment
failure.
3. Titanocene nanostructures modulate PARP-1 and Bax-α expression
Autori: E.Fischer-Fodor, S.Gomez-Ruiz, J.Ceballos-Torres, P.Virag, M.Cenariu, S.Prashar, M.
Fajardo
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: antitumor, nanostructures, apoptosis, PARP-1, metallodrug
Rezumat:
Chemotherapeutic treatments based on metallodrugs, traditionally platinum complexes has a
relatively high number of side effects and this opened up interest in the use of other metal
complexes with similar antineoplastic properties. Thus, we focused our efforts on the design of a
novel synthesized titanocene compounds series grafted onto a nanostructured porous material,
which act as vectors for the delivery of the metallodrug and as a protector of the active species for
the enhancement of its anti-cancer action. A very high in vitro activity has been observed against
colon, ovary and breast cancer cells. Their inhibitory effect is much higher than the majority of the
titanocene derivatives reported before and present superior cytotoxic activity and selectivity. From
studies of the apoptosis induction capacity, evaluation of the modulator effect on the intrinsic
apoptotic pathway (through Bax-α and Bcl-xL) and apoptosis regulation at the DNA level, one can
conclude that the dynamics of apoptotic morphological and functional changes is modified when
the active titanocenes are incorporated onto mesoporous materials.
Compounds are able to induce programmed cell death in tumor cell populations, by
impairing the damaged DNA repair mechanisms by PARP-1 inhibition and by up-regulation of
intrinsic and extrinsic apoptotic signaling pathways. The compounds are acting as Trojan horses for
the incorporation of the active species into the cells, leading to enhanced cellular uptake. Therefore,
these nanostructures are good candidates for targeted anti-cancer therapy, because of their
interesting biological properties and because the higher permeation of the membranes of cancer
cells in comparison with healthy cells and this may advantageous for the specific use of these
materials in chemotherapy.
49
3. Rectal cancer extended to the adjacent anatomic structures: pathology features and
surgical implications
Autori: R. Simescu 1,2, O. Fabian 1,2 , M. Cazacu1,2, I. Domsa3, A. Zolog3, A. Mihailov1,2, G.
Petre1,2, I. Simon1,2, T. Oniu1,2, C. Lungoci1,2, D. Deceanu1,2, R. Galasiu1,2, C. Radu1,2, V. Muntean1,2
Instituţie: 1 - CF Clinical Hospital
2 - “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
3 - CF Clinic Cluj-Napoca
Cuvinte cheie: colon cancer, invasive cancer, surgical treatment
Rezumat:
Introduction: Surgical treatment of the colon cancer invading adjacent anatomical
structures (T4b) remains a controversy. R0 resections go only by laborious surgery. Subsequent
morbidity and mortality cannot be justified unless there is significant therapeutical benefit.
Patients and method: Patients with colon cancer extended to adjacent anatomical structures
(T4b) were compared with patients without extracolonic extension (T1-T4a) and with ones having
invasions of the serosal layer (T4a). Information was drawn from a prospective database, including
operative protocols, specimen pathology findings and follow-up data. Only patients who underwent
elective surgery and with complete database information were included in the study. Statistical
analysis was performed using Microsoft Excel and OpenEpi. Rates were compared using the chisquare test; p values under 0,05 where considered statistically significant.
Results: During a 10-year period (2004-2013) 498 colon cancer patients were treated. Out
of the 462 patients included in the study, 161 had tumors invading adjacent structures (pT4b); 301
had no extracolonic invasion (pT1-pT4a), out of which 65 presented serosal invasion (pT4a).
Compared with T1-T4a, T4b tumors presented statistically significant low tumor grade (G),
infiltrative growth pattern, no increased inflammatory infiltrate, more frequent lymph node
metastases and venous, lymphatic and perineural invasion. As compared to T4a, T4b tumors
presented statistically significant low tumor grade (G), increased peritumoral inflammatory
infiltrate and venous invasion. One third of pT4b tumors were N0M0 (IIC stage; Dukes B; MAC
B3). There was no statistically significant difference between the three study groups regarding the
type of resection (R0, R1 or R2), morbidity and immediate perioperative mortality.
Conclusions: Colon tumors extended to the adjacent anatomical structures show a locally
and regionally increased invasion pattern. Multiorgan resections R0 are justified whenever
perioperative morbidity and mortality remain within acceptable ranges. In what regards cases
classified as T4bN0M0 (MAC B3), any palliative surgery would be inacceptable.
4. Nanotechnology in conversion of cancer stem cell resistance to chemotherapy
Autori: Soriţău O1,2, Tomuleasa C1,2, Orza A, Petrushev B, Aldea M3, Florian S2, Kacso G1, Irimie
A 1,2
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca,
2 - “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca,
3 - Babeş-Bolyai University Cluj-Napoca
Cuvinte cheie: gold nanoparticles, cancer stem cells
Rezumat:
The lack of efficacious pharmacological treatments in cancer has been recently attributed to
the presence, within the tumour, of cancer stem cells (CSC), which are poorly responsive to the
antineoplastic drugs because of their chemoresistant properties and ability to stimulate
neoangiogenesis. Glioblastoma is an example of oncological localization with high resistance to
chemotherapy. Recently, gold nanoparticles (GNPs) have developed into an attractive candidate for
the specific delivery of complex drugs, molecules, and/or biomolecules. Because of their ability to
accumulate selectively in tumor tissue, GNPs can serve as detectors of cancer cells or as targeted
drug delivery agents.
50
Glioma cancer stem cells were found to interact strongly with GNPs-based drug delivery
vectors. Phase contrast microscopy showed that GNP-L-aspartate was internalized within the first
hour. After 24 hours, the drug delivery vector affected the number of cells, their rate of
proliferation, and their shape, suggesting that the cells entered a pre-apoptotic stage. Measurements
of in vitro cytotoxicity and apoptosis indicate that combination with GNPs facilitated the ability of
temozolomide to deliver into CSC and to alter the resistance of these cells to therapy.
Temozolomide-loaded GNPs were able to reduce the CSC chemoresistance and destroy 82.7% of
CSC compared with a 42% destruction rate using temozolomide alone.
This approach based on nanotechnology proposes a novel chemotherapy strategy with
minimal toxicity and increased efficacy profiles for the destruction of cancer stem cells for patients
with unresectable recurrent malignant glioma.
5. Potential biomarkers for therapeutic response in colorectal cancers
Autori: P. Virag, I. Brie, E. Fischer-Fodor, O. Barbos, G. Chereches, Zs. Fekete, C. Cainap, E.
Cojocaru, A. Muntean
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: GDF-15, Treg, colorectal cancer, markers, therapeutic response
Rezumat:
Background: The outcome of the treatment of colorectal cancers (CRC) and the severity of
the delayed adverse effects impose the identification of potential markers of therapeutic response
(TR) in order to establish individually tailored therapies. Lately, a special interest was paid for the
growth and differentiation factor-15 (GDF-15), member of the TGF-beta superfamily, which
regulates the inflammatory and apoptotic processes in injured tissues, being proposed as biomarker
of the activation of the p53 pathway in some cancers. The TR is also influenced by the status of the
immune system; one of the responsibles for the immune suppression during the tumor progression
is the Treg subpopulation (CD4+, CD25+, FOXP3+). The aim of this study was to analyze the ratio
of the Treg subpopulation and the serum level of GDF-15 as potential TR markers in vivo.
Patients and methods: 25 patients with loco-regional advanced CC and a group of 6
healthy volunteers were included in this study. Blood samples were collected before therapy and
after radio- and chemotherapy (RT/ChT). Lymphocytes were isolated in density gradient for Treg
subpopulation establishment by flow-cytometry. Blood serum was also separated and stored until
ELISA was performed for the GDF-15 assessment. Results: Significant increases were registered
both in the Treg subpopulation and GDF-15 level after RT/ChT in the patients’ group vs before
treatment (p<0.05 and p<0.0001, respectively). Significant differences in the basal levels of the
Treg cells and GDF-15 were observed in the patients’ group as compared to the healthy volunteers’
with interindividual variations in the patients’ group.
Conclusion: These results support the idea that correlations may exist between the basal
levels of the tested parameters and the clinical evolution of the disease which might be exploited in
the establishment of TR markers in CC.
6. Introduction of personalized therapy in Romania
Autori: Tudor E. Ciuleanu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: personalized therapy, clinical research, pivotal trials
Rezumat:
As of May 2014, the recognized “official” standard of care in cancer is still represented by
the 2009 edition of the ESMO guidelines. Cancer treatment is free, as the National Program of
Oncology covers the budget for all cytotoxic agents and targeted therapy. However, reimbursement
for several expensive drugs for solid tumors such as bevacizumab, cetuximab, erlotinib, imatinib,
pemetrexed, sorafenib, sunitinib, trastuzumab, is individually approved by a centralized commission
with monthly reunions. Analyses of biomarkers are not covered by the insurance companies or the
state budget. Some of them are sponsored by the pharmaceutical industry (such as HER2 FISH
51
testing, mutational status for EGFR or KRAS). All the new drugs registered in Europe by a
common procedure by the European Medicines Agency are concomitantly authorized for medical
use in Romania. However, no new drugs (such as abiraterone, afatinib, aflibercept, axitinib,
cabazitaxel, cabozantinib, catumaxomab, crizotinib, dabrafenib, degarelix, denosumab,
enzalutamide, eribulin, everolimus, gefitinib, ipilimumab, lapatinib, panitumumab, pazopanib,
pertuzumab, regorafenib, sipuleucel, trabectedin, trastuzumab emtansine, vandetanib, vemurafenib,
vinflunine, vismodegib) and no new indications (such as 1st line TKIs or maintenance treatment in
NSCLC, trastuzumab in early breast cancer or advanced gastric cancer, bevacizumab in
gynecological cancers, sunitinib in neuroendocrine tumors) were accepted for reimbursement since
2008.
On the other hand, clinical research is rapidly growing and Romanian centers demonstrate a
high recruitment rate in pivotal trials, despite initial delays due to a slow approval of the studies by
the competent authorities.
8. Validation of molecular profiles in cancer through independent studies
Autori: Ioana Berindan Neagoe 1,2, Ovidiu Bălăcescu1, Cornelia Braicu2, Oana Tudoran1, Loredana
Bălăcescu 1, Roxana Ilies 2, Emilian Neagoe 1, Alexandru Irimie1,2
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca,
2 – “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca
Cuvinte cheie: molecular profiling, breast cancer subtypes patterns, bioinformatic data
Rezumat:
The development of new genomics throughout technologies in cancer research brought the
data generation facilities as one of the most important issue in the interpretation and generation of a
specific molecular profile pattern. Breast cancer is one of the most studied due to the heterogeneous
molecular subtypes and the number of new cases and death each year worldwide.
The concept of molecular profiling has fundamentally changed our understanding of breast
cancer in the last decade by creating a new genetics of breast cancers based on the expression
patterns. Actual we are looking into molecular profiles of breast cancer defined as distinct breast
cancer subgroups (luminal type A/B, HER2-enriched type, basal-like type). The use of gene
microarray approaches revealed individual properties of the intrinsic subgroups regarding the
clinical course and the responsiveness to chemotherapy. The new gene expression profile-based
morphology of breast cancer address as a major breakthrough on the way to individually tailored
therapies. However, validation of the gene signatures in prospective studies is necessary before
accepting these new technologies in daily clinical practice. The current data regarding the breast
cancer subtypes and the associated clinical implications as well as the methodology of molecular
profiling and complex use of bioinformatics data in identifying common patterns for different
subtypes come into discussion.
9. Mutation analysis of triple negative breast cancer patients using next generation sequencing
Autori: Laura Pop, Roxana Petric, Oana Virtic, Ioana Berindan-Neagoe
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca
Cuvinte cheie: triple negative breast cancer, mutations, next generation sequencing
Rezumat:
Introduction: Despite the intense research in the field of breast cancer, this disease still
remains the second most common cancer in women worldwide, being the first cause of death in
women in Romania. Among the different subtypes of breast cancer, triple negative breast cancer
(TNBC) needs a special attention due to its limitations in therapy and to its aggressiveness. Several
studies have tried to identify different new mutation both in oncogenes and tumor suppressor gene
in order to explain these limitations of TNBC treatment. The present study was aimed at the
identification of mutations in 46 genes involved in cancer in 31 patients with TNBC operated at the
Institute of Oncology ”Prof. Dr. I. Chiricuta”, Cluj-Napoca between 2006-2007, using Next
Generation Sequencing.
52
Material and methods: We used FFPE tissue samples, from which we extracted the DNA,
which was sequenced using the Ion Torrent Personal Genome Machine and the Ion Reporter 1.6
software for data analysis.
Discussions: After data analysis we obtained 103 mutations in 34 genes of the 46 studied.
The clinical assessment of the identified mutations showed that three mutations were benign, one
was likely benign, 42 were likely pathogenic, 28 were pathogenic and 29 had no assessment. This
study also identified KDR, TP53, PIK3CA, FGFR3 and FGFR2 genes as being the most frequently
mutated genes.
Conclusions: Our results show that TNBC has specific mutations leading to resistance to
therapy and poor outcome of these patients.
10. TGF-β siRNA therapy enhance doxorubicine antitumoral therapy in triple negative breast
cancer model
Autori: Cornelia Braicu1, Eve Ponthière1,2, Mahafarin Maralani3, Roxana Petric1, Valentina
Pileczki1,4, Gherman Claudia1,5, Ioana Berindan-Neagoe1,5,7
Instituţie:
1 - Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu
Hatieganu” University of Medicine and Pharmacy,
2 - Haute École Louvain en Hainaut, Fleurus, Belgique
3 - Department of Molecular Medicine, Dokuz Eylul University, Izmir, Turkey
4-Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy
5 - Department of Functional Genomics and Experimental Pathology, The Oncology Institute “Prof.
Dr. Ion Chiricuta” Cluj-Napoca
6 - National Institute for Research and Development in Animal Biology and Nutrition (IBNA)
7 - Department of Immunology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and
Pharmacy Cluj-Napoca
Cuvinte cheie: TGF-β siRNA , doxorubicine, triple negative breast cancer
Rezumat:
Doxorubicine is a chemotherapeutic agent routinely used for triple negative breast cancer
(TNBC) therapy. TNBC is characterized by the absence of estrogen, progesterone, and HER-2
receptors and a reduced response to classical therapy. Therefore, new therapeutic strategies should
be tested. In the present study was tested the combinatorial effect of doxorubicine with RNA
interference (RNAi) therapy. RNAi is a natural mechanism in which a double-stranded RNA causes
degradation of the complementary mRNA.
TGF-β siRNA in combination with doxorubicine was tested on the Hs578T cells. The
magnitude of cellular effects was tested using MTT test, invasion capacity using matrigel assay and
gene expression alteration was evaluate using PCR-array technology (Breast cancer Panel, Qiagen
cat no. PAHS-131Z).
TGF-β downregulation was connected with an increased reduction of cell proliferation and a
decreased invasion capacity as we were able to observe by fluorescence staining. Doxorubicin
therapy is associated with undesired pathological characteristics characteristics like, epithelialmesenchymal transition (EMT) or drug resistance. Our experimental data suggest that TGF-β
inhibition in the presence of doxorubicine leads to an enhanced antitumor theraphy via preventing
drug resistant mechanism and modulation of immune response.
53
11. In house informatics a framework for conducting clinical trial
Autori: Nicolae Todor
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: medical informatics, oncology project methodology
Rezumat:
Introduction. Firstly is presented “in house” informatics system of Institute "Prof. Dr. Ion
Chiricuţă" (IOCN). It consists of a complete informatic medical system adapted to the requirements
of modern oncology. Clinical trials have unfourtunately a precisely limited target but the
information is often difficult to retrieve.
Material and methods. The framework provided by us with the informatics “in house”
system allows instant access to all the information making it a very powerful tool in the hands of
investigators. Now a set of modules cover all functional areas of IOCN excepting Brachytherapy
and hematology laboratory where we have only ongoing solutions.
Results. In IOCN these studies are used extensively for doctoral works, residents and
seniors works or in IOCN projects as: BREAST-IMPACT, CERVIX-ARRAY, ANGIOCOL, etc.
Through these examples drawn from IOCN’s panel studies practical aspects of such an approach are
presented.
Discussions. Oncology centers in the world have such facilities since 70s, the era of
computer punch card, our solution taking advantage of the facilities present in IOCN rises to the
accepted standards in modern oncology.
Conclusions. Studies and projects successfully modular integrated until now increases our
confidence that chosen approach allows simple further development of the system.
54
POSTERE
1. Circulating tumor cells: a novel method of detection
Autori: Otilia Bărbos, Gabriela Cherecheş, R. Buigă, T.E.Ciuleanu, D.Eniu, Cristina Cebotaru
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: metoda, CTC, cancer
Rezumat:
The detection of circulating tumor cells (CTCs) in the peripheral blood of cancer patients
holds great promise but remains technically challenging. Many research groups are currently
assessing the clinical utility of CTCs for prognosis and monitoring response to systemic therapies.
We present here a novel method of detection, developed in our laboratory, performed on
different types of cancer cells wich were obtained from the blood of colorectal, breast and testicular
cancer patients and also from the lymph of operated breast cancer patients.
CTC analysis will contribute to a better understanding of the complex metastatic process in
cancer patients, which might unravel new strategies to eradicate metastatic cells or control their
outgrowth into life-threatening overt metastases.
2. Detection of Circulating Tumor Cells (CTCs) on metastatic colorectal cancer patients
Autori: G.Chereches, O. Barbos, R. Buiga, T.E. Ciuleanu, D. Iancu, V. Manolescu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: circulating, tumor, cells, chemotherapy
Rezumat:
Circulating tumor cells (CTCs) are released into the blood from primary and metastatic
tumors and have high clinical diagnostic potential in oncology. Enumeration of CTCs as a
prognostic and predictive factor of survival an overall disease progression in advanced colorectal
cancer patients has been reported in several studies.
We present a novel method of detection, performed on 50 cases of metastatic colorectal
cancer patients, following chemotherapy. 6ml of blood samples have been collected at baseline,
after 3 cycles of chemotherapy and a third one after completing 5 cycles of therapy. Each sample
was treated with a red blood cells (RBC) hemolysis solution, blood smears were than
imunohistochemic stained, followed by microscopic evaluation.
The integration of present method into routine immuno-chemotherapy could be suggested
for the research of the metastatic process and the determination of an eventual correlation between
circulating tumor cells and metastases in humans.
3. NextGen Sequencing: a tool for deciphering the BRCA1/2 and TNBC relationship
Autori: Roxana Cojocneanu Petric2, Laura Pop1, Ioana Berindan Neagoe1
Instituţie: 1 - “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca,
2 – Babeş-Bolyai University Cluj-Napoca
Cuvinte cheie:
Rezumat:
Introduction. Although during recent years science and technology have generated a great
deal of progress in medicine, breast cancer still is the most common malignancy and the leading
cause of death by cancer in women. Triple negative breast cancer (TNBC), characterized by the
absence of Estrogen and Progesterone receptors and Her2/neu, affects 15-20% of breast cancer
patients, has a more aggressive phenotype and occurs at younger ages. Because of its therapeutic
limitations, TNBC needs to be investigated in more detail with the help of new technologies.
Materials and method. Our study focuses on exploring the mutation status of BRCA1/2
genes involved in hereditary breast cancer, and with known mutations in TNBC. This retrospective
study on 30 TNBC patients who underwent surgery at The Oncology Institute “Prof. Dr. I.
Chiricuta” Cluj-Napoca was conducted with the help of the next generation sequencing platform
Ion Torrent PGM. The biological material consisted of FFPE tissue from which we extracted the
55
DNA
necessary for subsequent library preparation, amplification and sequencing.
Results. After data analysis, we observed that 20 of the 30 patients presented germline
BRCA1/2 mutations, of which seven in BRCA2, 10 in BRCA1, and three in both genes. We
identified two mutations that are frequent in patients of European descent with hereditary breast
cancers, two that are similar to mutations identified in families of Swedish origin, and several other
new mutations.
Conclusions. This is the first study that investigates BRCA1/2 mutations in TNBC patients
in Romania, and proves that NextGen Sequencing is a competitive and cost-effective BRCA
screening method especially in low-income countries where patients cannot afford early breast
cancer diagnosis.
4. 40 years of population-based Cancer Registration in the frame of 85 excellence years of
the Oncology Institute “Prof. Ion Chiricuta”, Cluj-Napoca
Autori: Coza D.1, Nicula F. Al.1, Șuteu O. E.1,2, Blaga L. M.1, Todescu Al.1, Marton A.1, Lovasz
L.1, Sîrbu M.1, Achimaș-Cadariu P1,2., Irimie Al.1,2
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2 – “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: cancer, registry, incidence, registration, population-based
Rezumat:
Introduction: Oncology Institute, set-up in 1929, had always a major field of interest in
cancer prevention and registration. Population-based cancer registration in Cluj County, started in
1974, supervised by Institute’s Department of Prevention and Cancer Control, 6 years before it
became compulsory by law, in Romania. Cancer data were used internationally, published in
WHO’s Monography Cancer Incidence in Five Continents (CIV) volumes IV, V, VI, (1974-1987)
and considered for national cancer estimates in GLOBOCAN 2008 and 2012 and EUCAN
databases (2000-2010).
Material and method: We analyzed average age-standardized incidence (ASRW), for five
years intervals, for Cluj County, since 1974 to 1987 and 2001 to 2010. The source of information
was CIV published data (1974-1987) and Cluj Cancer Registry (2001-2010). We computed percent
changes in incidence and hierarchy of the main primary sites, by sex.
Results: Overall, the number of new cancer cases almost doubled (96% increase) in the last
period compared with the first one (in men 8137/4151, in women 7587/3866), with an increase
ASRW of 40.3% in men (287.2/204.8) and 37% in women (227.4/166). The hierarchy of first five
primaries changed between first and last interval, in men, from stomach, lung, liver, prostate,
rectum to lung, prostate, stomach, colon, rectum and in women from breast, cervix, stomach, liver,
ovary to breast, cervix, colon, corpus uteri and thyroid.
Discussions: With few exceptions all cancer sites showed an increase in incidence, during
the 40 years, both in men and in women, the most significant concerned bladder, prostate and colon
in men and thyroid and colon in women. Stomach and liver cancers decreased with 48.5%,
respectively 13%, in men and 59.8% respectively 48.1%in women.
Conclusions: The overall burden of cancer continued to raise in Cluj County, partially due
to growth and ageing population, improvement in diagnostic methods and in cancerregistration.
5. Modulation of apoptotic mechanisms in ovarian cells A2780 and A2780 cisplatin
resistant cells
Autori: Claudia Gherman 1, Maralani Mahafarin 2, Flaviu Drigla 1, Ovidiu Leonard Braicu 3, Ioana
Berindan-Neagoe 1,3
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2 - Department of Molecular Medicine, Dokuz Eylul University, Izmir, Turkey
3 - “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: CAPE, ovarian cancer, apoptotic mechanisms
56
Rezumat:
Introduction. Ovarian carcinoma is still considered one of the most lethal gynecological
cancers. In this context, the chemoresistance to treatment is a clinical issue that drastically limits the
therapy success. We investigated the effect of caffeic acid phenethyl ester (CAPE), a major
component of propolis, in ovarian cancer cell lines.
Materials and methods. We used A2780 and A2780 cisplatin resistant cells to examine the
cell viability using MTT test, evaluation of apoptosis by flow cytometry and invasion assay with
Matrigel, followed by qRT-PCR to observe the expression of relevant apoptotic genes.
Results and discussions. As was expected, we have a significant reduction of cell
proliferation in both cell lines, due to the activation of the apoptotic mechanisms. qRT-PCR data
shows that CAPE was able reduce the expression of the proinflammatory phenotype, particularly in
the case of cisplatin resistant cells. The proapoptotic effect in both cell lines is also due to the
interaction with the TGF-β pathways.
Conclusions. CAPE alone or in combination might be implemented in the advancement of
anticancer therapies in ovarian cancer, particularly for the cisplatin-resistant tumours.
6. Pretherapeutic evaluation of lymphocyte radiosensitivity as a biomarker in cervix
carcinoma
Autori: Ioana Brie 1, Nicolae Todor 1, Piroska Virag 1, Maria Perde-Schreppler 1, Alexandra Ticle 2,
Viorica Nagy 1,2
Instituţie: 1 - The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca
2 - University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca
Cuvinte cheie: radiosensitivity, in vitro, comet assay, cervix carcinoma
Rezumat:
Background. The modern radiotherapy techniques and association of chemotherapy or
surgery (SY) improved the therapeutic results in cervix cancer. However, it remains the unsolved
problems of the increased rate of local failures, ranging between 20% and 30%, and of the late side
effects of radiotherapy. This raise the problem of finding new predictive and prognostic factors that
can be utilized for choosing the most efficient therapeutic modality for each patient. Among the
radiosensitivity (RS) tests, very promising are the DNA lesion assays such as the comet assay (CA)
- a sensitive and reproducible method which detects DNA alterations induced by radiation and other
genotoxic agents. CA is a fast, reproducible and relatively low-cost method that has the potential to
evaluate the basal level of DNA lesions as well as their induction and repair.
Aim. The aim of the present study was to test if the in vitro parameters of radiosensitivity
(RS) measured by Comet Assay in lymphocytes from patients with cervix carcinoma were able to
predict their clinical outcome and the late complications after radiochemotherapy (RCT).
Patients and methods. The study analyses 83 patients with stage IIB cervix carcinoma that
were included between 2006-2008 in a prospective randomized phase III trial with 2 arms: RCT
alone (41 patients) and RCT followed by SY (42 patients). Using comet assay, 3 parameters of in
vitro lymphocytes RS were determined before the beginning of therapy: the basal level of DNA
alterations, the induction of new lesions by irradiation and the repair capacity. The outcome of
patients (local, regional or distant relapse) was clinically assessed by regular controls after the end
of the treatment. Normal tissues late reactions were evaluated on the base of Common Toxicity
Criteria for Adverse Effects (CTCAE vs. 2.0). In vitro lymphocytes RS was correlated with patients
outcome and with the late normal tissues complications.
Results. With a median follow-up period of 69 month, 10 relapses were registered in the
group of 83 patients (12,05%). The rate of late complications (rectal and bladder side effects,
vaginal fibrosis and lymphoedema) was 19,28%. Using ROC analysis, significant correlations
between the late side effects of RCT (especially fibrosis) and 2 parameters of lymphocytes RS were
found in operated patients, who received lower doses of radiotherapy: the level of DNA lesions at 2
hours after in vitro irradiation (p = 0.02) and the DNA repair capacity (p = 0.03). Significant
correlations were also found between the locoregional tumor control and other 2 parameteres of
57
lymphocytes RS: the basal level of DNA alterations (p = 0.03) and the induction of supplementary
DNA lesions by in vitro irradiation (p=0.02).
Conclusions. Pre-therapeutic evaluation of lymphocytes RS predicts the individual clinical
outcome and late toxicity after RCT in patients with stage IIB cervix carcinoma. Determination of
lymphocytes RS by CA can be a simple, rapid and useful method for tailoring treatments in order to
obtain better results and a reduced complication rate with impact on patients survival and quality of
life.
7. Carbapenem-resistance in non-fermentative species and in Enterobacteriaceae isolates
from hospitalized patients
Autori: Mihaela Ionescu 1,2, Dan Neagoe 2, Claudia Chiorean 2, Loredana Dumitras 2, Aurelia Rus 2
Instituţie: 1 - “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca,
2 - County Emergency Clinic Cluj-Napoca
Cuvinte cheie: β-lactamase, carbapenems, antibiotic resistance, Gram-negative
Rezumat:
Aim. Nosocomial Gram-negative bacilli infections carbapenem-resistant strains among
hospitalized patients have become an increasing cause of concern. This study was focused in
evaluating carbapenem-resistance occurrence at hospitalized patients in various clinical wards.
Materials and methods. From January 2012 to November 2013, we evaluated 654 Gramnegative bacilli strains isolated from patients hospitalized in County Emergency Clinical Hospital
Cluj-Napoca in different clinical wards: surgery, anesthesia and intensive therapy unit,
neurosurgery, internal medicine, gynecology, dermatology, orthopedic unit, oto-rhino-laryngology,
and ophthalmology. The collection includes unique bacterial isolates and excludes duplicate
isolates. All isolates were tested and analyzed according to their antibiotic resistance phenotypic
pattern.
Results. We analyzed three non-fermentative species - Acinetobacter spp. (161; 24.61%),
Pseudomonas aeruginosa (62; 9.48%), and Stenotrophomonas maltophilia (6; 0.91%) and the
following Enterobacteriaceae - Escherichia coli (213; 32.56%), and Klebsiella spp. (130; 19.87%),
Enterobacter spp. (6; 0.91%), Proteus spp. (42; 6.42%), Providencia spp. (17; 2.59%), Morganella
spp. (6; 0.91%), Citrobacter spp. (7; 1.07%), and Serratia spp. (4; 0.61%). One hundred forty-five
ESBL strains (22.17%) were identified. Among 654 isolates, 192 (29.35%) carbapenemresistant/intermediate strains were detected: 154 (23.54%) Acinetobacter spp., 33 (5.04%)
Pseudomonas aeruginosa, 2 (0.31%) Escherichia coli, 2 (0.31%) Klebsiella spp., and 1 (0.15%)
Serratia spp. Among 192 carbapenem-resistant/intermediate strains (137; 71.35%) were isolated
from from anesthesia and intensive therapy units. Our data showed a predominant carbapenem
resistant Acinetobacter spp. strain in intensive care units. The main mechanism associated with
carbapenem resistance could be production of carbapenemase in combination with impermeability.
In the clinical laboratory the accurate identification is carbapenem-resistant strains can be difficult
to achieve due methodological limitations. In our study we do not identify any stains that exhibit
resistance at colistin.
Conclusions. Our study demonstrates that the carbapenem resistance of Gram-negative
bacilli is wide spread among non-fermenters species isolated from the patients hospitalized in
intensive care units.
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8. Double knockdown of apoptotic genes and their relationship with other mechanisms
involved in tumor cell survival
Autori: Valentina Pileczki 1, Laura Pop1, Cornelia Braicu 1,2, Mahafarin Maralani 3, Ioana Berindan
Neagoe 1,2
Instituţie: 1 – “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
2 - The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca
3 - Department of Molecular Medicine, Dokuz Eylul University, Izmir, Turkey
Cuvinte cheie: apoptosis, triple negative breast cancer, RNA silencing
Rezumat:
Introduction: Triple negative breast cancer (TNBC) presents one of the worst prognoses
due to the potential aggressive nature of the malignant illnesses, high rate of visceral metastasis and
limited therapeutic options. Therefore, in this experiment we directed our attention toward the
knockdown activity of the siRNA molecules, by simultaneously blocking the expression of the p53
gene and of the tumor necrosis factor alpha (TNF-α).
Material and methods: In our experiment we used a triple negative breast cancer cell line
(Hs578T) that was reverse transfected with p53 and TNF-α siRNA. After 24 hours from the
treatment, cells were harvested and the total RNA was extracted. RT-PCR array technology was
used in order to evaluate the most relevant genes involved in apoptosis. Viability and autophagy
assays were performed after 24 and 48 h from the treatment in order to give more relevant
assistance with the interpretation of the PCR data.
Results and discussions: After analyzing the transcript quantification data by using the
ΔΔCT formula, we calculated the fold-changes of each sample and obtained statistical relevant
results for 16 genes, of which 4 were down-regulated and 12 up-regulated. The effects of p53 and
TNF-α silencing led to the loss of cell viability first observed at 24 h, and increased at 48h. The
simultaneous inhibition of the two genes after 48 h led to the activation of autophagy machinery, as
it is known that defective autophagy plays a significant role in cancer induction.
Conclusion: A full comprehension of p53 and TNF biology using preclinical models
supports the development of novel and efficient therapeutic strategies in TNBC. Integrating the
expression profiles of Hs578T untreated cells with those from simultaneous p53 and TNF knockdown provided us with a network-based platform.
9. Novel Approaches in Testing BRCA Deleterious Mutation Related to Breast and
Ovarian Cancers
Autori: Madalina Stanciu, Gabriela Teodorescu
Instituţie: AstraZeneca Medical Department
Cuvinte cheie: BRCA mutation, PARP inhibitors
Rezumat:
Introduction: In women with a known BRCA mutation, the risk of developing breast
cancer increases to 45%-65% by age 70 and the risk for ovarian cancer increases to 10-17% by age
70. Women who are BRCA1 mutation carriers have approximately 40 % lifetime risk for ovarian
cancer and increased risk for other cancer types, such as breast, prostate or pancreatic cancer.
Objective: of this literature review is to discuss criteria of testing BRCA mutations in
women with a family history of breast or ovarian cancer, as well as in patients already diagnosed
with cancer.
Background: BRCA1/2 (“breast cancer, early onset.”) are human genes that codify tumor
suppressor proteins involved in normal DNA repair. Deleterious mutations of BRCA1/2 produce
abnormal proteins causing defects in DNA repair. Another crucial factor in DNA repair is PARP
(Poly-ADP-ribose polymerase), which becomes the preferential pathway in BRCA mutated cells.
Discussion: until now, individuals at 10% risk of carrying a mutation have been eligible for
BRCA testing. BRCA testing has also become available to patients with serous and endometrioid
ovarian cancer under 65 years. Meanwhile, there is an increasing number of data supporting
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therapeutic benefit of testing BRCA mutations. Several drugs that specifically inhibit PARP are
currently being tested in clinical studies and patients with BRCA mutations respond better to PARP
inhibitors than patients without this mutation.
Conclusions: currently the main goal is to test more genes in more people, a flexible,
patient-centered testing pathway for a novel therapeutic approach: genetic counseling, prophylactic
surgery, and chemoprevention.
10. Incidence trends of liver and biliary tract cancers in cluj county, 2000-2010
Autori: Ofelia Şuteu 1,2, Daniela Coza 1, Luminiţa Blaga 1, Florian Nicula 1, Alexandru Irimie 1,2
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca,
2 - ”Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: Liver, biliary tract cancers, incidence, trends
Rezumat:
Introduction. There is little information on the epidemiology of liver and biliary tract
cancers (LBTC) available in Romania. We aimed to examine and provide detailed data on the
incidence trends for liver and biliary tract cancers (BTC) between 2000-2010, in Cluj County.
Material and method. We calculated directly age-standardized incidence rates (world
standard population) by subsite for cancers of LBTC in Cluj County, using data provided by the
North-Western Cancer Registry. Time trends were expressed as the annual percent change (APC).
Results. A total of 673 (55.5%) male and 540 (44.5%) female LBTC cases were reported;
liver cancer was the most common subsite in both sexes: 80% in males and 59% in females. The
incidence of LBTC increased from 6.13%000 to 10.62%000 in males and from 4.92%000 to
6.41%000 in females, with a 3.22% APC (p=0.007). Hepatocellular carcinoma (HCC) increased by
3.55% APC (p=0.03) in both sexes and extrahepatic bile duct cancers increased in females by
0.10% APC (p=0.05) and by 0.05% APC in males (p=0.07). Gallbladder (GB) in men, intrahepatic
bile duct (IHBD) and ampulla of Vater cancers increased, while GB in women and BTC not
specified decreased, but these trends were not statistically significant. The agreement between
subsite and histological type showed that 90% in females and around 72% in males of
cholangiocarcinomas were coded as IHBD cancer and 100% of HCC were coded as liver cell
cancer.
Discussion. Except for hepatocellular cancer, BTC are rare but trends are upward by
increased diagnosis and certification of the disease. Increased surveillance of cirrhotic patients and
the substantial improvements in the detection affected the incidence trends of liver cancer.
Conclusions. From a public health perspective, the upward trends of hepatocellular cancers
are likely to be, at least partially, real, although our study cannot directly examine the causes for this
ascending trend.
11. Novel antitumor immunomodulatory metallodrugs
Autori: C.Tatomir 1, E. Fischer 1, N. Miklasova, P.Virag 1, M. Perde 1, C. Precup, F. Devinsky
Instituţie: 1 - The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: antitumor, immunomodulatory,palladium, curcumin
Rezumat:
The use of metal - based anticancer agents is an important part for treatment of cancer of
various types. Complexes with cis-platinum compounds have been used for the prevention and
treatment of cancers but cause several side effects and their success rate is limited in some
malignant casuistic. On the base of the structural analogy between Pt(II) and Pd(II) complexes,
some studies of palladium compounds as suitable drugs have been carried out. Geometry and
complex forming processes of palladium(II) are very similar to those of platinum(II) therefore it
was speculated that palladium complexes may also have antitumour activities and serve as good
models for the understanding of more inert platinum(II) anticancer drugs. We tested the in vitro/ex
vivo biologic response triggered by six Pd(II) curcumine complexes on human cell lines and
primary cell cultures. Antiproliferative effects of the palladium compounds was evaluated using a
60
system based on the tetrazolium yellow dye MTT. SEM electron microscopy were used for
determination in ultrasructural changes. Inhibition of tumor growth and the antitumoral immune
response was evaluated on peripheral mononuclear blood cell subpopulations by flow-cytometry.
Pro-apoptotic (Bax) and anti-apoptotic (Bcl-xL) molecules was determined using Elisa technique.
The Palladium complexes are cytotoxic against various tumor cell lines, they cause massive
DNA damages, which leads to programmed cell death. They show selectively low toxicity against
normal cell lines and human lymphocytes, while modulating the expression of molecules implicated
in antitumoral response. All these biologic effects emphasize the prodrug potential of palladium
curcumin complexes and their applicability in cancer care.
12. ”Artificial blood”- newly developed blood substitutes tested on laboratory animals and
cell culture. Preliminary results
Autori: Vlad-Alexandru Toma 1,2, Anca-Daniela Farcaş 1,2, Ioana Roman 1, Denisa-Gabriela
Hathazi 2, Eva Fischer-Fodor 3, Bogdan Sevastre 4, Radu Lucian Silaghi-Dumitrescu 2
Instituţie: 1 Biological Research Institute, Cluj-Napoca, Romania
2 Babeş-Bolyai University, School of Chemistry and Chemical Engineering
Cuvinte cheie: Blood substitutes, hemoglobin, hemerythrin, laboratory animals.
Rezumat:
Introduction. Newly developed blood substitutes are based on two different proteins,
hemoglobin and hemerythrin, respectively. In this paper we present the impact of the newly
developed blood substitutes based on hemoglobin in Wistar rats and also we mention that this
research is an explorative study. Hemoglobin-based blood substitutes are infusible oxygen-carrying
liquids, obtained from bovine blood. This blood substitutes have no need for refrigeration or crossmatching, and are ideal for treating hemorrhagic shock in remote situations.
Materials and methods. The experiment was performed in six Wistar male groups:
Control, Native Hemoglobin, Polymerized Hemglobin, Copolymerized Hemoglobin with BSA,
Copolymerized Hemoglobin with Rubrerythrin, Copolymerized Hemoglobin with RubrerythrinNROR and Polymerized Hemoglobin with o-ATP. All gropus received regular food and water ad
libitum. The animals were healthy males, weighting 230±20 g and hosted in zoohygienical
conditions into the zoobase of the Biological Research Institute from Cluj-Napoca. The blood
substitutes were administrated via intravenous injection. The experiment lasted two days. The
invitro tests were developed on human lymphocytes and their subpopulations also on the human
vascular endothelial cells.
Results and discussions. All the analyses that we have studied suggest a very good
collaboration between the newly developed hemoglobin blood substitutes and in vivo and in vitro
models used. The most important aspect of these tests is the fact that all blood substitutes do not
produce any significant immunological reaction and also there is no any toxicity on human cell
cultures. The biochemical and hematological tests do not suffer any significant changes.
Conclusions. All the parameters that we have studied encourage us to continue this
experiment we have already started. Acknowledgements to Florina Violeta Scurtu for the material
support.
13. Reality Map of Integrated Oncology and Palliative Care in Romanian Cancer Centers
Autori: Patriciu Ahimaş-Cadariu, Anca Burcă, Florina Pop, Alexandra Tolnai, Armeana Zgâia
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: palliative care, reality map, international partnership
Rezumat:
The joint partnership has a duration of 3 years and the research group consists of 18 people.
Our group aims to collect original data (“reality map”) about the implementation of defined KI-PCC
and specific outcome quality indicators. The hypothesis is that both predefined cofactors and
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appropriately delivered KI-PCC will predict quality of individual patient’s care, measured as
composite endpoint.
The results will provide the basis for further research on implementation of tailored
interventions of palliative care procedures provided by oncologists and other health care
professionals.
In the care of advanced incurable cancer patients medical oncologists and other cancerrelated healthcare professionals play a sentinel role in not only providing tumor directed treatment,
but also in identifying and treating palliative care needs. Models of integrating oncology and
palliative care are developing, but require local and national adaption of processes. The SwissRomanian partnership grant offers an opportunity to investigate this approach further.
The partnership involves 4 more Romanian centers: Alba, Braşov, Bucharest and Iaşi and
managed to create a strong liaison between each center on the basis of the common shared believe
the every life worth fighting for. The benefits of engaging in international collaboration are as
follows: access foreign or joint facilities and equipment, access techniques and skills, increase
knowledge capacity, cultural and personal experience, access foreign markets.
What we have learned from this collaboration so far is that it can increase the quality of
research and builds an understanding for palliative care rationale.
14. Identification of novel target networks as response to zearalenone mycotoxin exposure
Autori: Cornelia Braicu 1,2, Valentina Pileczki 1,3, Ovidiu Balacescu 3, Daniela Martin 4, Ionelia
Taranu 4, Ioana Berindan-Neagoe 1,3,5
Instituţie:
1 - Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu
Hatieganu University of Medicine and Pharmacy
2 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
3 - Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy,
4 - National Institute for Research and Development in Animal Biology and Nutrition (IBNA)
5 - Department of Immunology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and
Pharmacy
Cuvinte cheie: zearalenone, mycotoxin, microarray, gene expression
Rezumat:
Introduction. Zearalenone (ZEA) toxin is secondary fungal metabolite produced by
Fusarium species. ZEA proved to be an estrogenic mycotoxin. Most of the investigations are
focused on the cytotoxic or effect of this mycotoxin, but the precise mechanism of action of ZEA
still remains to be deciphered.
Materials and methods. Two-colour microarray (Agilent technology) was used for
screening the altered genes as response to a single dose of 10 µM ZEA, at 24 h post treatment.
Results. ZEA 10 µM was showed no cytotoxic effect, despite of that the microarray
evaluation selecting a fold change cut-off of ±1.5 and a p-value of <0.05 reveals a panel of 790
genes overexpressed and 1164 downregulated.
Discussion. In order to identify the modified key processes from the microarray data, we
used the Gene Ontology (GO) analysis of gene expression. The results showed some anticipated
gene class associations, such as apoptosis, cell cycle, differentiation and proliferation, as well as
others that were unforeseen, like cell invasion and adhesion molecules. Interpreting and integrating
these results by means of interaction network analysis of the genes that presented statistically
significant p-value give us the instruments for predicting the negative effects of this mycotoxin.
Conclusion. The effects of ZEA are complexes as we were able to see from the
bioinformatics analysis. The altered genes were connected with several key pathways even for the
case of a non-cytotoxic dose of this mycotoxin.
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15. In vitro effects of noble metal nanoparticles
Autori: M.Perde-Schrepler, E.Fischer-Fodor, G.Chereches, O.Barbos, I.Brie, C.Tatomir, L.David,
L. Olenic
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Nanoparticles, in vitro, green synthesis
Rezumat:
Nanoparticles (NP) are used nowadays in several biomedical fields as antimicrobian agents,
transfection vectors, fluorescent markers, etc. Despite the tremendous progresses made so far, there
are still big question marks regarding their potential adverse effects. The intracellular behavior, and
also their metabolic and immunologic effects are far from being completely understood. The
development of green processes for the synthesis of NP represents an important progress having
many advantages such as simplicity, rapid synthesis rate, eco-friendliness and economic viability.
The aim of our study was to evaluate the effects of some new biomaterials based on silver
and gold nanoparticles synthesized with polyphenols rich natural extracts on normal and tumoral
human keratinocytes. The effects were assessed by the evaluation of NPs internalization,
modifications in cell morphology (TEM), cytotoxicity (MTT), the generation of reactive oxygen
species (ROS) and the modulation of the secretion of inflammatory cytokines: Il1 α, IL6 and TNF α
both in basal condition and after the induction of inflammation by exposure to UVB radiation
(ELISA).
All NPs were in the range of 20-100 nm and had almost spherical shape. They had different
effects on the morphology of the treated cells and could be visualized in the treated keratinocytes by
TEM. The toxicity of NPs was dose- dependent and was also depending on the metal employed.
Their presence had a significant effect on the release of ROS and also they modulated the release of
inflammatory cytokines.
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CANCERELE TIROIDIENE ŞI SFERA ORL
COMUNICĂRI ORALE
1. How to diagnose and treat thyroid cancer in 2014?
Autori: V. Muntean 1, I. Domsa 1, A. Zolog 1, R. Simescu 1,2, G. Petre 1,2, C. Radu 1,2, D.
Constantinescu 1, M.V.Muntean 1, O. Fabian 1,2
Instituţie: 1 - CF Clinical Hospital
2 - “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: thyroid cancer, diagnosis, surgical treatment
Rezumat:
Introduction: Starting with 2010, a modified surgical protocol of differentiated thyroid
cancers has been applied systematically in our Surgery Department: total thyroidectomy in all
patients; frozen-section examination in all clinical, imagistic and macroscopic suspicious lesions;
central compartment lymphadenectomy (CCL) in all patients with malignant confirmed tumors and
selective cervical lymphadenectomy (SCL) for ultrasound-modified or intraoperative confirmed
malignant lymph nodes.
Patients and method: Pathology findings and clinical data were compared in patients with
thyroid cancer operated on before and after application of the new protocol. Information was drawn
from a prospective database including operative protocols, specimen pathology findings and followup data. Statistical analysis was performed with Microsoft Excel and OpenEpi. Rates were
compared using the chi-square test; p values under 0,05 were considered statistically significant.
Results: The study included 200 patients operated for differentiated thyroid cancer: 100
during 2004-2009 (Group 1) and 100 during 2013-2014 (Group 2). The two groups were similar,
with no statistically significant differences of age, sex, clinical and imagistic diagnosis, pathology
findings, tumor size and multicentricity. The number of total thyroidectomies was significantly
higher in recently operated patients (98 against 85), with a decrease in the number of reinterventions
for initially incomplete operations (14 against 0). The number of lymphadenectomies was
significantly higher in Group 2 compared to Group 1 (44 vs 15 CCL and 17 vs 10 SCL). The study
evidenced less stage I and II and more stage III in recently operated patients due to the increase of
T3 and IVA patients, as well as due to the higher number of N1a and N1b patients.
Conclusions: Systematic use of the new treatment protocol led to the disappearance of
reinterventions and to an improved staging of the disease. The therapeutic benefits of the new
protocol remain uncertain and are to be confirmed by patient follow-up.
2.
Second malignancies in patients with differentiated thyroid carcinoma treated with
low - medium I-131 doses
Autori: Doina Piciu
Instituţie: The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
Cuvinte cheie: thyroid cancer, second malignancies
Rezumat:
Background. Differentiated thyroid cancers represent the most frequent endocrine tumors,
with a 10-years overall survival of more than 90%. During the long-term follow-up these patients
may present other primary malignancies. The aim of the study is to demonstrate if there is a risk for
the development of second primary malignancies after low and medium radioiodine doses used
during the treatment of thyroid cancers.
Methods and patients. Second primary malignancies after differentiated thyroid cancer was
determined in 1990 patients diagnosed between 1970 and 2003 being in the database of the Ion
Chiricuta Institute of Oncology Cluj-Napoca (IOCN). This number represented 37.9% from all the
patients with thyroid cancer from our evidences. The long-term follow-up of these patients was
carried out exclusively in same center and it was of minimum 10 years, respectively 120 months,
with a mean of 202 months (range, 120–516 months). We analyzed the relation between the risk of
64
second malignancy and the radioiodine dose used for the therapy of differentiated thyroid cancer.
Results. The group had a ratio of female/male of 8:1, and a mean age of 47.2 years at the
moment of the thyroid cancer diagnostic. A percent of 51.7% of the patients were in stage I, 19.6%
in stage II, 17.5% of the cases were in stage III and 11.2% were in stage IV. The radioiodine as
adjuvant therapy was administrated in all these cases and the mean dose was 63.2 mCi (2338 MBq)
I-131, with a range between 30 mCi (1111 MBq) and 90 mCi (3330 MBq); all other cases treated
with higher dose were excluded. The overall survival rate was 94.7% at 10 years. There were
identified 93 patients with second primary malignancies: breast carcinoma, lung carcinoma,
malignant melanoma, Hodgkin lymphoma, cervix carcinoma, colorectal cancer, hepatocarcinoma,
leiomyosarcoma, larynx carcinoma, basocellular carcinoama, pancreatic neuroendocrine cancer.
The risk compared with the general population was not increased for none of these cases.
Conclusions: The overall risk of second primary malignancies was not related to the low
and medium doses of radioiodineadministered as adjuvant therapy in differentiated thyroid cancers.
3. Management of thyroid carcinoma – a long term single tertiary cancer center study
Autori: C Lisencu, S Pătcaș, Doina Piciu, F Ignat, P Achimaș, E Pușcaș, C Vlad, C Bădulescu, MȘ
Mureșan, Adriana Sfîra, Daniela Deac, C Cheregi, A Irimie.
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: thyroid carcinoma
Rezumat:
Background: Thyroid carcinoma was considered to be a rare form of cancer, but its’
incidence has grown in the past decade, mainly because of increased exposure to ionizing radiation.
The management of thyroid carcinoma relies upon the dominant histology and the risk factors
associated with the disease. The aim of the present study was to evaluate the standard of care for
thyroid carcinoma treated at Oncology Institute “Prof. Ion Chiricuta”, Cluj-Napoca (IOCN), over a
period of 42 years.
Materials and methods: We have performed a 42-year retrospective descriptive and
analytical study of 4774 thyroid carcinoma patients treated at IOCN between 1970 and 2012. The
parameters followed were: mean 5-year and 10-year overall survival rate, 5-year and 10-year
disease free interval, comparison of mean survival rate between gender, age, pathology results –
patients group clusters.
Results: Thyroid carcinoma is the 4th most commonly treated cancer type in our institution.
The female:male incidence ratio is 7:1, with a peak of incidence for the over 45 year age group.
Today’s thyroid carcinoma incidence is 43 times larger than the one from 1980. Almost 3000 cases
were papillary carcinomas. The overall gender-related-10 year-survival rate was 89.4%, with better
outcome for female patients (93.2%) vs. male patients (81.87%). The overall age-related-10 yearsurvival rate was 89.4% (91.7% for under 45 years vs. 87.8% for patients over 45 years). Global
histology-related-10 year-survival rate was 77.3% (80.4% papillary carcinoma vs 70% follicular
carcinoma vs 66.7% medullary carcinoma).
Discussion: In the past decades the incidence of thyroid carcinoma has exponentially
increased. The most frequent types are differentiated histologies (papillary and follicular). The
increase in incidence could be linked to better and sooner diagnosis measures and/or increased
ionizing radiation exposure.
Conclusions: Low risk thyroid carcinoma patients (young, differentiated histology,
localized disease) prove to have better survival outcome at 10 year follow-up interval.
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4. The increase in thyroid carcinoma frequency after the Chernobyl nuclear accident. A
study conducted in the The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Prezintă: Avram Manea
Autori: Cosmin Ioan Lisencu, Manea Avram, Ioan Claudiu Bădulescu, Patriciu Achimaş Cadariu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Carcinom tiroidian, microcarcinom, Cernobîl
Rezumat:
Accidentul de la Cernobal petrecut in 1986 a avut numeroase urmari atat imediate cat si pe
termen lung. Dintre efectele pe termen lung, cresterea incidentei cancerului tiroidian a fost
demonstrata prin multe studii realizate in alte tari afectate.
Acest studiu evidentiaza evolutia incidentei cancerului tiroidian pentru 2948 de pacientii
operati de tiroida in Institutul Oncologic Cluj Napoca , intre 2008 si 2012. Acestia au fost impartiti
in 3 grupe de varsta fata de momentul incidentului de la Cernobil: A(persoane >18 ani), B(0-18
ani), C (nenascuti in momentul accidentului).
Comparativ cu frecventa cancerului tiroidian la grupul A, procentul cancerului tiroidian a
inceput sa creasca in grupul B ajungand pana la 41,4% in grupul C.
Ca si alte studii facute in unele tari afectate de asemenea de radiatiile eliberate dupa
accident,acest studiul a demonstrat o crestere semnificativa statistic a incidentei diferitelor forme de
cancer tiroidian atat la cei care erau copii sau adolescenti in cat si la cei nascuti dupa evenimentul
nuclear.
5. Incidentaloamele tiroidiene şi asocierea cu tiroidita autoimună Hashimoto
Autori: Iulian-Claudiu Badulescu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: carcinom tiroidian, tiroida , tiroidita Hashimoto
Rezumat:
Introduction: Thyroid microcarcinoma accidentally discovered after surgery of the thyroid,
represents an increasingly common clinico-pathological entity. This study evaluates the incidence
of the thyroid microcarcinoma with all histopathological subtypes, particularly papillary form and
also the coexistence with autoimmune Hashimoto's thyroiditis, which may require attention in the
management of this chronic disease.
Methods: This is a retrospective analytical study, made out of Oncological Institute(IOCN)
of Cluj-Napoca casuistry, based on the analysis of the Institutional Register of Cancer surgery
protocols and histopathological results. Out of a total of 2961 thyroid surgeries performed between
2008-2012 2778 were performed for presumed benign thyroid pathology.Total tyroidectomies or
thyroid lobectomy were performed.
Results: Out of the total cases (2778) with benign presumed pathology, 506 cases were
confirmed to be carcinomas on histopathological results, out of which 305 were microcarcinomas.
There were found 207 (67,86%) papillary microcarcinoma and 43 (14,09%) multifocal
micropapillary thyroid cancer. Out of the 376 cases of Hashimoto autoimmune thyroiditis, 54
(14,36%) were associated with thyroid carcinoma.
Conclusion: This study confirms the recent years increased frequency of the thyroid
carcinoma and microcarcinoma incidentally discovered, especially papillary form, among the
supposedly benign cases ,as well as associating between Hashimoto thyroiditis and malignant
thyroid pathology. This suggests the need for a more thorough (surgical and endocrinological)
approach for the apparently benign thyroid cases.
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6. Head and neck vascular masses
Prezintă: Vasile Popita
Autori: Vasile Popita, Magdalena Chirila, Elisabeta Ciuleanu, Valentin Cernea, Octavian Chis, Dan
Gheorghiu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: vascular masses, head and neck
Rezumat:
Vascular masses of the head and neck region are a heterogeneous group of lesions with
different histology, clinical picture and variable treatment options. These type of lesions can be
subdivided in three categories: benign lesions, malignant lesions and congenital or acquired
vascular masses.
We need to use the imaging technique suitable to clinical symptoms to establish a correct
diagnosis.In this paper, we illustrate some cases of vascular masses of the head and neck region,
presenting clinical features, imaging methods used for diagnosis, imaging findings with emphasis
on the particularity of the cases and subsequent evolution of patients.
7. Data on the treatment and survival of patients with parotid cancer at the Oncology
Institute “Prof. I. Chiricuţă” in Cluj-Napoca
Autori: Octavian Chiş, Silviu Albu, Georgia Cirebea, Marilena Cheptea, Corina Vernic, Ciuleanu
Elisabeta, Gheorghiu Dănuţ, Sava Alexandru, Stănculescu Horaţiu, Chiş Amalia Andreea
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: primary parotid cancer, surgery, radiotherapy, post-therapeutic survival,
significance factors
Rezumat:
Introduction. The cancer of the parotid gland, a major pair salivary gland, is considered a
rare entity, dealt with in surgery and oncology centers of head an neck.
Material and methods. The authors analyze data recorded for 135 patients suffering from
primary parotid cancer, selected according to the criteria chosen for the inclusion in the present
study. The treatment consisted of surgery or surgery followed by radiotherapy and was administered
between 1995 and 2008 at the “Prof. Dr. I. Chiricuţă” Institute of Oncology in Cluj-Napoca. Both
univariate and multivariate methods of statistic analysis have been employed.
Results. The authors conclude that the disease-free interval after 3 years was of 78.5% with
a general survival rate of 88%, while after 5 years, these variables had the value of of 71.5% and
80.7% respectively.
Conclusion. The results indicate that the post-therapeutic interval at 3 years was
significantly influenced by parameters pT and pN, at 5 years by age and pT, while the survival rate
at 3 years was influenced, with statistic relevance, by age, pstage, pT, category pN, and the
perineural invasion, while at 5 years by age and pT.
8. Treatment results in Nasopharyngeal Carcinoma
Autori: Elisabeta Ciuleanu, Valentin Cernea, Tudor Eliade Ciuleanu, Danut Gheorghiu, Octavian
Chis
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Nasopharyngeal Carcinoma
Rezumat:
Aim of the study: to present o retrospective analysis of the cases with nasopharyngeal
carcinoma treated in the Oncology Institute „Prof. Dr. I. Chiricuta” Cluj, between 2006-2011. The
end points of the study were: response rate (RR), overall survival (OS), time to progression (TTP)
and the analyses of prognostic factors for RR, OS and TTP.
Material and methods: 163 patients with nasopharyngeal carcinoma were treated. Median
age was 44 years (range 15-78), 36,2% were female, 63,8% were male; 78,5% of them had an
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undifferentiated cc., 14,1% had a nonkeratinizing cc. and 7,3 % epidermoid cc.; 2,5 % of patients
were stage I, 21,4% stage II, 41% stage III, 20,8 % stage IVA, and 14 % stage IVB.
Results: 92,6 % of patients had induction chemotherapy (IC)(Epirubicin and Cisplatin 90,7% or Cisplatin and 5-Fluorouracil – 6,6%). All pts had RT; 86% of them with Cisplatin as
radiosensitizer. Median follow up was 51 months. RR at the end of primary treatment was 93,86 %
(89,57% CR; 4,29 % PR). RR was significantly influenced by: the stage (I, II, III vs IV) p<0.01;
level of Hb (<10 gr vs >10gr) p<0.01; ESR value (<40 vs >40) p<0,01. There was a trend towards
improved RR function of age (<45 vs >45) not reaching significant statistical value p=0,06;
5 year-OS was 78% (IC:70% - 85%). 5 year-OS was significantly influenced by: the stage (I, II, III
vs IV) p<0.01; Hb level (<10 gr vs >10gr) p<0.01; ESR value (<40 vs >40) p<0.01.There was a
trend towards improved OS for undifferentiated cc. and nonkeratinizing cc vs epidermoid
cc.(p=0,06)
5 year-TTP was 71%. It was significantly influenced by the stage (I, II, III vs IV) p<0.01 and was a
trend towards improved TTP for VSH value <40 vs >40, p<0.08.
Conclusions: RR and OS were significantly influenced by the stage, level of Hb and ESR
value. There was a trend towards improved OS for undifferentiated cc. and nonkeratinizing cc vs
epidermoid cc. TTP was significantly influenced by the stage.
9. The treatment of cervical lymph nodes metastasis from an unknown primary site
Autori: D. Gheorghiu, Elisabeta Ciuleanu, V. Cernea, O. Chiş, Diana Spârchez, N. Todor
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Cervical lymph node metastasis from unknown primary site, radio-surgical therapy,
prognostic factors
Rezumat:
Purpose: Cervical lymph node metastasis from unknown primary site represents a
heterogenic and pathological class without having unanimous consensus treatment. This study
aimed to analize the results and prognostic factors in a series of patients treated by means of radiosurgical therapy.
Methods and materials: A chart review was performed on 29 patients with cervical lymph
node metastasis from unknown primary site between14.10.2004 and 04.12.2009. 13 patients (45%)
had squamos cell carcinoma and 16 patients (55%) had nonkeratinizing or undifferentiated
carcinoma. 22 patients were treated with curative and 7 with palliative intent. For the patients
treated with curative intent, the treatment was represented by surgery, followed by radiotherapy.
Concomitant chemotherapy or induction chemotherapy was associated with radiotherapy.
Results: The 3-year overall survival rate for the entire group was 50% and the disease-free
survival rate was 39%, the group with undifferentiated carcinoma had a survival rate of 59%. The
univariate analysis reflected that the curative intention treatment and the absence of the
extracapsular spread were favorable prognostic factors for the radio-surgical therapy.
Conclusions: Patients with cervical lymph node metastasis from unknown primary site have
similar prognostic in comparison to patients with other head and neck carcinoma. The strategy of
curative therapy which includes neck-dissection with extensive irradiation of bilateral neck and
pharyngeal mucosa has shown the best results.
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10. Voice rehabilitation after laryngectomy using self retaining prosthesis (Provox)
Autori: Alma Maniu, Relu Marin, Marcel Cosgarea
Instituţie: Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and
Pharmacy, Cluj-Napoca
Cuvinte cheie: laryngeal carcinoma, total laryngectomy, voice restoration, voice prosthesis
Rezumat:
Introduction: The introduction of tracheoesophageal voice restoration by Blom and Singer
has provided laryngectomy patients with a successful alternative to the use of artificial larynx and
esophageal speech. Objective: To evaluate the indications, complications, and device life of the
Provox prostesis in a case series of 6 patients at the Department of Otorhinolaryngology, “Iuliu
Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca.
Methods: We reviewed the records of patients who used the Provox prostesis for general
indicators, device life, and complications All patients had advanced laryngeal squamous cell
carcinoma. Two patients had primary voice prosthesis inserted and four patients had a tracheoesophageal puncture (TEP) carried out as a secondary procedure.
Results: All the patients from both the primary insertion or the secondary insertion group,
developed good and understood speech using the prosthesis. No significant difference in quality of
speech was found between the two subgroups. Two patients required replacement of the prosthesis
at intervals of 8 and 10 months after insertion, because of salivary leakage and granulation
formation around the fistula.
Conclusions: TEP puncture and prosthesis insertion is a relatively simple, safe and effective
surgical procedure for voice restoration after laryngectomy. Provox voice prosthesis is a new and
useful modified device that has overcome the previous prosthesis drawbacks, is well tolerated by
the patients and can be easily changed via the front-loading technique.
11. Vaccination with quadrivalent HPV (type 6/11/16/18) vaccine in patients with
Recurrent Respiratory Papillomatosis
Autori: Magdalena B.Chirila, Sorana D. Bolboaca
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy
Cuvinte cheie: respiratory papillomatosis, HPV, vaccine
Rezumat:
Introduction: The aim of the study was to assess the clinical efficiency of quadrivalent
HPV (types 6/11/16/18) vaccine in patients with recurrent respiratory papillomatosis (RRP).
Material and Method: This was a prospective study of patients with RRP treated from
January 2009 to July 2012 at the Ear, Nose and Throat Department of the Emergency County
Hospital of Cluj-Napoca, Romania. Demographic characteristics, onset of RRP, HPV typing, use
and number of cidofovir injections, number of surgeries for RRP per year, and use of human
papillomavirus vaccine (types 6, 11, 16, 18) (recombinant, adsorbed)/Silgard® were considered
from all the patients included in the study. Charts were reviewed for follow-up after diagnosis, after
cidofovir, and after Silgard; all the statistical tests were applied at a significance level of 5 %.
Results: The recurrences were observed within 27.53 ± 11.24 days after intralesional
cidofovir injection. Thirteen patients with recurrence after cidofovir agreed and received Silgard®
vaccine. 85 % [54.44–99.41] of patients had no recurrences during 1-year follow-up. The
recurrence of papillomas was observed in two patients (15 %, 95 % CI [0.59–45.56]), one with
adult-onset RRP and one with juvenile-onset RRP. Both recurrences appeared after the first Silgard
dose; one month after the third vaccine dose each patient underwent a new surgery for remaining
papillomas with no recurrences at 1-year follow-up visit.
Conclusions: Silgard® vaccination had a good effect and proved to be efficient in the
treatment of our patients with RRR without appearance of recurrence in 85 % of the patients during
1-year follow-up.
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POSTERE
1. The Expression of Epidermal Growth Factor Receptor in Glioblastomas - a
preliminary study
Autori: Morosanu Cezar Octavian 1, Cioca Andreea 2, Vasiu Renata 2, Pop Bogdan 2, Cilean Ioana
2
, Florian Ioan Stefan 1
Instituţie: 1. “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
2. Department of Pathology, “Iuliu Hatieganu” University of Medicine and Pharmacy
Cuvinte cheie: glioblastoma, epidermal growth factor receptor, immunohistochemistry
Rezumat:
Introduction. Glioblastoma multiforme (GBM) is one of the most aggressive primary brain
tumor, with a severe malignant progression. Overall survival of patients under the current treatment
of radio/chemotherapy and surgical interventions is very poor and the high recurrence rate renders
every therapy as being futile. New therapeutical avenues are being investigated in the light of
molecular and cellular advancements targeting the growth factors implicated in epidermal
proliferation. Epidermal Growth Factor Receptor (EGFR) stimulates cell growth and differentiation,
and its overexpression can indicate variations in tumor pathology. The purpose of the study was to
analyze the expression of EGFR in patients with newly diagnosedGBM and in the recurrent tumor
of those patients.
Material and methods. Our study included a total of 48 samples collected from 24 patients
diagnosed with GBM. Immunohistochemical expression of EGFR was compared between primary
and recurrent tumor after surgery, chemotherapy and radiotherapy. The clinicopathological data
including sex, age, treatment and tumor type (primary/secondary) wererecorded from the Institute
database. The intensity of EGFR staining was scored on a scale of 1–3+ (weak, intermediate and
strong).
Results. Using immunohistochemical detection for EGFR with monoclonal human antibody
(clone EGFR.25), we found overexpression in 23 patients (96%), including strong reactivity in
cases 11 cases (46%), intermediate positivity in 9 (37%), and weak positivity in 4 (17%).
Conclusion. Our results suggest that EGFR is overexpressed in GBM and contributes to
more advance disease. Further studies are required for the full comprehension of the mechanism
that can eventually lead to new anti-tumoral strategies.
2. Calculation of I-131 activity administrated in hyperthyroidism
Autori: A. Sabo, C. Peştean, M. Cheptea, M.I. Larg, M. Crisan, C. Moisescu-Goia, E. Barbus, D.
Piciu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: hyperthyroidism, radioiodine, radionuclide treatment, I-131.
Rezumat:
Aim. The aim of the study is to demonstrate the utility of a personalized formula in order to
calculate the optimal activity to be administrated with the intention to treat hyperthyroidism, in
comparison with the empirical method where fixed activities are administrated to the patients with
hyperthyroidism.
Methods. The study was performed in the Nuclear Medicine department of the Oncology
Institute “Prof. dr. Ion Chiricuţă” Cluj-Napoca, over a period of 18 months. We included in our
study 60 patients with hyperthyroidism who received radioactive iodine treatment. Before iodine
treatment each patient underwent a clinical evaluation. The patients were divided into two groups.
First group G1 consists of 30 patients who received personalized activities calculated and the
second group G2 who received fixed empirical activities.
Results. For the both groups the age distribution is uniform. The average activity (expressed
in Mbq) for the G1 is 313.39±38.03:IC and for the G2 is 252.58±82.82:IC. It was noted a difference
with strong statistical significance between the average administrated activities of iodine for the G1
in comparison with G2. The recurrence of disease is higher for G2 (23.33.0%) in comparison with
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G1 3.33% (p=0.04). The odds ratio (OR) regarding the recurrence in the two groups is 8.82 and the
95% of coincidence interval of OR is between 1.01 to 76.96.
Conclusions. The therapeutic success is assessed related to the number and the frequency of
recurrence. OR value showed that in G2 the recurrence is higher comparative to G1 which
demonstrates the superiority of the method with personalized calculated activities, because it has a
higher success rate According to the results we may conclude that the presented personalized
calculation formula for the administrated radioiodine activities in hyperthyroidism is an efficient
method that improves the clinical response of patients undergoing radioiodine treatment for
hyperthyroidism.
3. 131I - optimization diagnosis and treatment in thyroid pathology
Autori: Cristina Moisescu, Doina Piciu, Alexandrina Sabo, Claudiu Pestean, Iulia Maria Larg,
Crisan Monica
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: radioiodine, thyroid carcinoma, and radiation protection
Rezumat:
Introduction: Patients treated with radioiodine present a radiation hazard and precautions
are necessary to limit the radiation dose to family members, nursing staff and general population.
The precautions advised are usually based on instantaneous dose rates or iodine retention and do not
take into account the time spent in close proximity with a patient.
Methods: After I-131 oral administration the gamma radiation from patients was detected
using a radioiodine uptake station (RIC) anterior or linear scanner. The thyroid cancer investigation,
based on whole body scan scintigraphy (WBS) after I-131 administration, was applied. The scan is
performed with collimated gamma camera with High Energy, and highlights residues of thyroid
tissue, cervical metastasis and slight metastasis of thyroid cancer.
We have combined whole-body dose rate measurements taken from 132 thyroid cancer patients
after radioiodine administration with known data on nursing and social contact times to calculate
the cumulative dose that may be received by an individual in contact with a patient. These estimates
dose have been used to calculate restrictions to patients' behavior to limit received doses to less than
1 mSv. We have also measured urinary iodide excretion in 19 patients to estimate the potential risk
from the discharge of radioiodine into the domestic drainage system.
Results: The dose rate decay was biexponential for patients receiving radioiodine to ablate
the thyroid after surgery (the ablation group, A) and monoexponential for these receiving
subsequent treatments for residual or recurrent disease (the follow-up group, FU). These values are
important because they depend on the future in terms of patient’s radiation and their family. Advice
given to patients receiving radioiodine therapy is based on retained activity or instantaneous dose
rate measurement and takes little or no account of patient behavior. The doses received by staff,
members of the public and family will be influenced by the patients' retained activity and the length
and proximity of contact with those individuals.
Discussion: RIC values recorded at 24 hours on the thyroid and at thigh indicate the
charging level and the presence of the radioisotopes in the bloodstream. The faster clearance in the
follow-up patients generally resulted in less stringent restrictions than those advised for ablation
patients. For typical activities of 1850 MBq for the ablation patients and 3700 MBq for the
persistent disease, the following restrictions were advised. Patients could travel in a private car for
up to 8 h on the day of treatment (for an administered activity of 1850 MBq in group A) or 4 h (for
activities of 3700 in group FU) respectively. Patients should remain off work for 3 days (1850
MBq/group A) or 2 days (up to 3700 MBq/group FU). Partners should avoid close contact and sleep
apart for 16 days (1850 MBq/group A) or 4-5 days (3700 MBq/group FU). Contact with children
should be restricted according to their age, ranging from 16 days (1850 MBq/group A) or 4-5 days
(3700 MBq in group FU) for younger children, down to 10 days (1850 MBq/group A) or 4 days (up
to 3700 MBq/group FU) for older children.
71
Conclusion: The main advantage of 131I isotope consists in the fact that is strictly for cell
tropism of thyroid. This is the reason of radioiodine use with great success in thyroid diseases,
especially in the treatment of thyroid cancer. Sensible guidelines can be derived to limit the dose
received by members of the public and staff who may come into contact with cancer patient treated
with radioiodine to less than 1 mSv. The rapid clearance of radioiodine in patients treated on one or
more than one occasion means that therapy could be administered at home to selected patients with
suitable domestic circumstances. In most cases the restriction times, despite the high activities, are
less than those for patients treated for thyrotoxicosis. The concentration of radioiodine in domestic
drainage systems should not pose a significant risk.
72
ANESTEZIE ŞI TERAPIE INTENSIVĂ
COMUNICĂRI ORALE
1. Intravenous lidocaine infusion in the management of acute and chronic oncologic pain
Autori: Adela Hilda Onuţu
Instituţie: Emergency Clinical County Hospital, Orthopedic and Trauma Clinic
Cuvinte cheie: lidocaine infusion, acute pain, cancer pain
Rezumat:
Lidocaine is known as a local anesthetic and an antiarrhythmic drug.Used for almost two
decades in the acute neuropathic pain management lidocaine infusion proved its usefulness in the
preventive analgesia strategy being recognized as an adjuvant analgesic and recommended in the
certain multimodal analgesic regimens, in the perioperative period.
Lidocaine infusion provides analgesia, anti-inflammatory and anti-hyperalgesic effects. The
analgesic effect is the result of the nociceptive blockade, by inhibition of the voltage dependent
sodium channels and G-coupled receptors. Anti-inflammatory effects are attributable to reduced
neurogenic inflammation and to the inhibition of the migration and adhesion of granulocytes, that
secondary leads to lower levels of pro-inflammatory cytokines. Acting as antagonist of the NMDA
receptors lidocaine, suppresses central sensitization phenomena and leads to an anti-hyperalgesic
effect.
Current evidence shows that in major abdominal surgery perioperative lidocaine infusion
(1,5-3 mg/kg/h) provides intraoperative anesthetic consumption reduction, lower postoperative 24hour opioid consumption, reduced postoperative pain scores, faster recovery of the bowel function
and a shorter time to patient discharge.
At the moment there are recommendation regarding lidocaine infusion use for patients with
colon, breast and prostatic cancer surgery. Several studies showed lidocaine infusion efficacy in
the management of refractory neuropathic cancer pain, providing reduced morphine consumption
and a better level of patient satisfaction. Chemotherapy-induced peripheral neuropathy,
plexopathies and other categories of pain could benefit of the complex analgesic effect of lidocaine
infusion but supplementary research is still needed.
Lidocaine infusion is recognized as a valuable adjuvant analgesic, with good results as a part
of multimodal analgesic regimens in order to reduce opioid consumption, in acute and chronic pain
management. The lecture will go further in order to emphasize the aspects discussed above and will
give supplementary data from recent literature and personal experience.
2. Profilaxia trombembolismului venos, noi protocoale, noi substante, noi tendinte?
Autori: Camelia Pascaru
Instituţie: Hospital for Medical Recovery, Cluj-Napoca
Cuvinte cheie:
Rezumat:
Datele stiintifice noi, din ce in ce mai numeroase si experienta medicala acumulata, au
condus la o abordare, in parte diferita, a diagnosticului, tratamentului si profilaxiei trombozei, in
general, si a TEV. Astazi este unanim acceptat ca preventia TEV este mai eficace decat tratamentul
TEV constituit. Noile anticoagulante orale aparute in ultimii 4-5 ani tind sa inlocuiasca clasicele
AVK. Eficienta si siguranta lor in terapie este dovedita. Noile antitrombotice, altele decat
antifactorXa si antitrombinice sunt in cercetare avansata si pot schimba orientarile in TEV.
In recomandarile actuale pentru tromboprofilaxie, dar si pentru tratamentul TEV sunt luati
in considerare atat factori de risc pentru tromboza cat si factori de risc pentru sangerare. Au aparut
noi scoruri de risc (Padua, Rogers, Caprini) si scoruri pentru sangerare. Folosirea acestor scoruri in
practica clinica sporeste baza stiintifica a tromboprofilaxiei (relatia eficienta/risc). S-au conturat mai
bine domeniile in care tromboprofilaxia are rol esential. Va voi prezenta cateva date
73
epidemiologice, date despre motivatia tromboprofilaxiei, stratificarea riscului de TEV, strategia
profilaxiei TEV, durata profilaxiei TEV, screeningul pentru TEV cat si metode de profilaxie.
Voi detalia despre profilaxia TEV la pacientii oncologici si la pacientii supusi chirurgiei
non-ortopedice (urologie, ginecologie, chirurgia gastro-intestinala, chirurgia vasculara, chirurgia
bariatrica, chirurgia reconstructiva). Factorii de risc generali si specifici la pacientii cu tumori
maligne sunt multipli si au pondere variabila. In ultimii ani au fost publicate mai multe ghiduri de
profilaxie si tratament al TEV la pacientii oncologici: ghidul ASCO 2007 (American Society of
Clinical Oncology), ghidul NNCN 2008 (National Comprehensive Cancer Network), ghidul ACCP
2012 (American College Chest Physicians). La pacientii supusi chirurgiei non-ortopedice fara
profilaxie adecvata incidenta TEV este de 10-40%. Toate ghidurile publicate considera ca profilaxia
adecvata (modalitate, doza, durata) reprezinta cea mai eficienta strategie in prevenirea TEP. La
pacientii operati factorii de risc sunt produsi direct de interventia chirurgicala (staza, leziune,
hipercoagulare) la care se adauga factorii ce tin de unele manevre terapeutice, comorbiditati,
prezenta factorilor mosteniti. Noile ghiduri ACCP au folosit impartirea pacientilor pe grupe de risc
si recomandarea masurilor de profilaxie fiecarei grupe. S-au elaborat doua scale de risc: scala
Rogers si scala Caprini. Aplicarea recomandarilor din ghiduri la patul bolnavului s-a dovedit a fi cel
mai dificil de realizat, de aceea, prin prezentarea mea doresc sa va prezint principalele tendinte in
tromboprofilaxie in practica actuala.
3. Perioperative management of pregnant women with renal tumor
Autori: T. Tat, B. Petruţ, I. Gădălean, V. Schiţcu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
The association of pregnancy with renal tumors is rare in cancer pathology. Pregnant
patient, diagnosed with left renal tumor, is subject to partial nephrectomy. Laparoscopic surgery
was chosen considering its benefits. Management case involving: compensation fluid loss, position
the patient on the operating table, deep vein thrombosis prophylaxis, prevention triggering
premature birth, postoperative pain therapy.
4. Studiu prospectiv, longitudinal, multicentric, international, cu privire la situatia reala
a integrari ingrijirilor paliative in centrele oncologice - Raport al IOCN
Autori: Zgaia A., Pop F., Tolnai A., Irimie A., Achimas-Cadariu P
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: palliative care, oncology, evaluation of needs
Rezumat:
Introducere. Pacientul oncologic reprezinta o provocare pentru sistemul sanitar datorita
numarului in crestere permanenta, a resurselor limitate si variabilitatii in furnizarea serviciilor
oncologice si paleative. Pentru pacienti oncologici in stadii avansate, rolul medicilor este esential in
oferirea unui tratament tintit spre tumora dar si in identificarea si abordarea nevoilor de ingrijire
paleativa. Acest studiu ofera oportunitatea investigarii aceastei abordari in detaliu.
Scop. Evidentierea situatiei reale a ingrijirilor oncologice paleative si a indicatorilor de
calitate asociati pentru o populatie specifica unei institutii, pentru a planifica in viitor interventii
adecvate.
Material si metoda. Studiul este prospectiv, longitudinal, multicentric si consta in
colectarea de date in cinci institutii oncologice din Romania si o institutie din Elvetia, pentru o
perioada de sase luni sau pana la deces. Se utilizeaza instrumente validate pentru evaluarea nevoilor
paliative şi indicatori de calitate definiţi rezultaţi.Criteriile de includere sunt: pacienti cu orice tip de
cancer, stadiu IV, ECOG 1-3 care au cel putin nevoi paleative minimale, definite ca ≥ 3 itemi pe
IPOS ≥ 2.
74
Criteriile de excludere sunt: prognostic mai mic de 1 lună, deficite cognitive evidente, vârstă sub 18
ani, ECOG 0 şi 4.
Rezultate. Studiul este in desfasurare.Vom prezenta datele obtinute pana in prezent in
IOCN. Sunt luati in studiu 74 pacienti care s-au prezentat la cabinetele ambulatorii sau pentru
internare in sectiile chimioterapie si radioterapie, in perioada noiembrie 2013- februarie 2014 .
Majoritatea pacientilor au avut diferite nevoi paleative.
Discutii. Rezultatele obtinute vor contura ‘realitatea’ nevoilor paleative.Vor fi evidentiate
caracteristici regionale pe baza carora se va realiza un program pentru corectarea deficientelor
constatate.
Concluzii. Ingrijirea pacientului oncologic terminal in Romania este deficitara. Proiectul
actual creaza premisele unei analize minutioase in domeniu si a crearii unui program menit sa
alinieze standardele nationale in ingrijirea pacientului oncologic din Romania la standardele
internationale.
75
ASISTENŢI
COMUNICĂRI ORALE
1. Interventii nutritionale in cancer
Autori:. Gyongyi Brigitta Szekely
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: malnutrition, nutritional intervention, quality of life
Rezumat:
One of the most important aspects of the treatment of the cancer patient is an adequate
nutrition to prevent malnutrition and the increase the quality of life.
Malnutrition is a common condition among cancer patients due to side effects of surgery,
chemo- and radiotherapy. Managing side effects which can influence the nutritional status of the
patient is the main theme of this paper. Nutritional intervention and monitoring the patient in early
stages and during treatment can positively influence the patient outcome and most importantly the
quality of life.
2. Combined epidural and general anesthesia versus general anesthesia in colorectal
cancer patients
Autori: Lia Iulia Alba 1, Ioana Gădălean 1, Simona Angheloiu 2, D. Blag 1, T. Tat 1, Simona
Mărgărit²
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2 – ICU Clinic, Cluj-Napoca
Cuvinte cheie: epidural, general anesthesia, colorectal cancer
Rezumat:
Introduction: Rapid postoperative rehabilitation after colorectal surgery is one of the goals
of modern surgery and is influenced by anesthesia and analgesia techniques used.
Objectives: The aim of this study is to compare two different methods of anesthesia and
analgesia used for elective surgery in patients with colorectal cancer and to compare postoperative
recovery in the first 48 hours postoperatively
Methods: The prospective study was conducted on two groups of patients with colorectal
cancer admitted to the Institute "Prof. Dr. I. Chiricuţă "C. The first group (PG=42) received general
anesthesia combined with epidural anesthesia, followed by postoperative epidural analgesia, and the
second group (G=44) received general anesthesia followed by IV multimodal analgesia.
Results: The dose of fentanyl administered intraoperatively was lower for PG group (110 ±
30 µg) than in group G (160 ± 80 µg). Number of patients who required additional boluses of
morphine in the first hour after surgery was lower in the group PG (18) than in group G (40). Bowel
movement into the first 24 hours was resumed to 15 patients in group PG compared with no patients
in group G. Postoperative nausea and vomiting into the first 24 postoperative hours were present in
18,2% of patients in group G compared with no patients in group PG.
Conclusions: General anesthesia combined with epidural anesthesia and analgesia provides
a better control of postoperative pain and a faster recovery compared with general anesthesia and IV
analgesia.
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3. Evaluation of patient satisfaction in an oncological ICU
Autori: Ioana Gadalean, Marilena Cheptea
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: nursing, patient satisfaction, quality
Rezumat:
Introduction. Patient satisfaction may influence the results of medical care and their
impact. Patient experience can be evaluated by different questionnaires or by direct observation.
The purpose of this study was to evaluate the satisfaction of the patients admitted in ICU and to
detect the most important insatisfaction factors.
Materials and methods. 106 patients admitted in ICU of the Oncological Institute were
included in the this prospective non-international study. Patients were given a questionnaire 24
hours after discharge. The original questionnaire included a Lickert scale with 5 grades for
evaluation of patient satisfaction as well as a list with the most frequent satisfaction and
insatisfaction factors as reported by patients in previous studies or identified by staff.
The results were statistically analyzed (SPSS software).To detect relationships/ associations
between qualitative variables the Chi-Square test was used. A p ≤ 0.05 was considered significant.
Results. Only two degrees of satisfaction were chosen on the Lickert scale. 53,8% of the
patients were very satisfied, respectively 46.2% were satisfied. The most important insatisfaction
factors were: lack of communication, accommodation facilities, factors arising from the lack of
personal , pain and lack of sleep.
Conclusions. We consider that patients’ satisfaction score in our study was good. The study
detected the most important 5 factors of discomfort for the patients; thus measures that may be
taken to ameliorate them. Patients’ satisfaction evaluation should be done periodically to detect both
improvements of the satisfaction, and to detect insatisfaction factors that can be further improved.
4. Infectious complications in cancer patients
Autori: Edit Boglár Tasnadi-Gazsi, Zsolt Fekete, Viorica Nagy, Alina Chezan
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: cancer patient, infection prevention, nursing care
Rezumat:
Infections are the most common life-threatening complications in oncology patients with
advanced disease, the leading cause of death accounting for about 70% of patients with acute
leukemia and 50% of deaths in patients with lymphomas and solid tumors. Hygiene and infection
prevention measures have the greatest impact in combating them.
Factors favoring the infections: people over the age of 65, immobilized patients, diabetes,
kidney diseases, metastatic diseases, chemotherapy and neutropenia in history. One of the most
important factors favoring infection is neutropenia, which changes the epidemiology of infections
and the resistance to the antibiotics. Often the only sign of infection in immunocompromised
patients is fever. Pathogen agents may be of bacterial, fungal or viral nature. Empirical treatment
may be PO and IV (depending on individual factors) but preferably based on antibiotic treatment.
Use of granulocyte colony stimulating factor is based on strict guidelines.
The requirements for a successful program of outpatient therapy of patients with fever,
neutropenia, but at low risk are: a dedicated medical team (doctors, nurses, pharmacists), adequate
institutional infrastructure, monitoring and rechecking, motivated patients, families and other caregivers.
Conclusions: Neutropenia and infectious complications are important problems in oncology.
With proper patient education and individualizing therapy for pathogens the impact of these
problems can be reduced.
77
5. Principles of medical pain therapy
Autori: Eliza Ciglenean
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Pain, medical pain therapy, opioids-nonopioids
Rezumat:
Pain is a complex physiological and emotional experience, which induces depression,
exacerbates anxiety, causes sleep disturbances, and contributes to fatigue and general deterioration.
At the time of diagnosis, one-third of cancer patients suffer from pain; in advanced stages, at least
two-thirds suffer. The World Health Organization published the guideline on cancer pain therapy.
Medical pain therapy adheres to certain principles:
- Priority of oral administration: oral administration of drugs has proven to be safe, effective, and
easy, supporting the autonomy of patients.
- Drugs are administered according to the duration of their activity. This means that medication
needs to be taken at fixed time intervals.
- Pain therapy is built up stepwise. Pain therapy is initiated with nonopioids. Weak opioids are
added in step II. If pain control remains insufficient, weak opioids are replaced by strong opioids.
Nonopioids should be continued in step II and III.
- Depending on the pain modality, coanalgesic drugs can be added at each level. Frequent and
serious unwanted side effects should be treated prophylactically.
- Breakthrough pain requires additional treatment in accordance with pain type.
In the course of treatment, efficacy, tolerability and safety should be reassessed. This can be
done with diaries or ranking scales. Adhering to these recommendations permits adequate pain
control in 80-90% of patients by noninvasives procedures.
6. Metode de depistare precoce a cancerului de col uterin
Autori: Margareta Rázmán
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: early detection, cervical cancer
Rezumat:
Cervical cancer is an aggressive form of gynecologic cancer, with important socio-medical.
It is one of main causes of mortality in cancer for women, globally being the second most frequent
cause of dheath from a malignancy in females. In Romania the incidence of cervical cancer is 2800
yearly (second in Europe) and the mortality is 1500-1600 per year (first in Europe).
The current study examines the precancerous lesions of the cervix and their early detection
by screening (cervico-vaginal cytology, colposcopy, biopsy under colposcopy, cervical cone
resection).
The screening progress is described and analyzed in this presentation. The goal of screening
in cervival cancer is the detection of the disease as precancerous lesion, and by its prompt treatment
the reduction of morbidity and mortality in cervical cancer.
7. Radioterapia-perspectiva pacientului
Autori: Calin Stelian Plesa
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Perspectiva pacientului in Radioterapie
Rezumat:
Obiectiv. Analizarea perspectivei pacientului in ceea ce priveste rolul Asistentului de
RadioTerapie (ART) si elaborarea unei definitii in ceea c ve priveste relatii dintre pacient si ART.
Metoda utilizata. Conversatia de pe parcurs si semi-interviul de la inceputul si de la
sfarsitul simularii.
Rezultate. Marea realizare consta in faptul ca Pacientul este constient de importanta
obtinerii unui confort psihic pe parcursul intregii perioade de tratament prin iradiere.Acest confort
psihic se obtine prin doua modalitati:
78
- realizarea unei relatii cu echipa RT-in special cu ART
- obtinerea de informatii referitoare la tratamentul si maladie.
Concluzie. ART joaca un rol important in a determina Pacientul sa o botina acel confort
psihic pe care si-l doreste. Chiar daca profesia este mai degraba una tehnica,totusi,ART trebuie sa
fie constient de rolul pe care il are in a oferi Pacientului tratamentul corect si sigur,o ingrijire care sa
urmeze etapele corect stabilite si sa ii furnizeze asistenta generarii confortului emotional.
8. Protocol în evaluarea imagistică a răspunsului terapeutic în cancerologie
Autori: N. Sas, S. Mihut, I. Gansca,Maria Beudean, Dorina Bocirnea, F.Gavris
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: imagistics, cancer, investigation protocols
Rezumat:
Introduction: Medical imaging is commonly used for the evaluation of the therapeutic
reponse in patients with oncological diseases.
Aims: The strategies of the diagnostic imaging in the follow-up of a neoplasic disease
should be closely related to clinical circumstances, therapeutic algorithm and response to treatment.
Discussion: CT and IMR are the most reproductible methods in measuring tumor size.
Results: The use of medical imaging helps to determine the efficiency in the response to
treatment taking into consideration both the complete as well as the partial response, without
making a distinction between a 50% decrease in tumor volume and a 90% response.
Conclusions: The complex imaging techniques should be permanently perfectible for the
increasing number of oncological patients in order to improve survival and quality of life.
9. The role of (FDG)PET/CT hybrid imaging in differentiated thyroid carcinoma
Autori: Claudiu Peștean, Maria Iulia Larg, Alexandrina Roman, Cristina Moisescu Goia, Monica
Crișan, Elena Bărbuș, Doina Piciu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: (FDG)PET/CT, differentiated thyroid carcinoma DTC
Rezumat:
Aim: To reveal the role of (FDG)PET/CT in the follow-up of differentiated thyroid
carcinoma (DTC).
Materials and methods: 27 patients with DTC treated by total/near-total thyroidectomy and
radioiodine therapy, performed (FDG) PET/CT. Inclusion criteria: no clinical recurrence signs,
increased thyroglobuline/anti-thyroglobuline, negative neck ultrasound, negative radioiodine wholebody scan (WBS). Hystopathological diagnostic: 9 (33.33%) papillary carcinomas, 6 (22.22%)
follicular carcinomas, 9 (3.33%) folliculo-papillary carcinomas, 3 (11.11%) carcinomas with
Hürthle cells. The group consists in 22 females, 5 males. Stadialization: 1 case in stage I, 8 in stage
II, 12 in stage III and 7 in stage IV.
Results: (FDG)PET/CT was positive in 23 cases (85.18%). 13 patients undergone surgical
treatment: in 5 cases – selective cervical lymphadenectomy, 2 cases – surgical treatment to remove
cutaneous tumors, 3 cases – thoracic surgical procedures, 1 case – orthopedic surgical procedure; 2
patients with a second malignancy undergone specific surgical treatment for colon, respectively
breast neoplasia (these patients undergone adjuvant chemotherapy). In 8 cases was administrated
additional radioiodine treatment. For 2 cases, the therapeutic alternative was external beam
radiotherapy. In 4 cases (14.82%) (FDG)PET/CT was negative. In 3 cases, the patients have been
followed-up until the data were collected, no recurrence occurred. In one case (FDG)PET/CT
shown false negative result, the presence of a latero-cervical nodule was later revealed;
subsequently, the patient undergone surgical treatment. Disscutions: In 23 cases (85.18%)
therapeutic strategy has been changed, (FDG)PET/CT played a key-role. The sensitivity of
(FDG)PET/CT in the follow-up process of DTC was 100%. The false positive rate of the results
was 0% and the false negative rate was 3.7%. (FDG)PET/CT allowed early diagnose of the second
malignancy, leading to a better prognosis.
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Conclusions: (FDG)PET/CT has an important role in patients with no clinical and imaging
signs of recurrence, negative WBS and increasing Tg/AntiTg.
80
POSTERE
Asistenţi medicali
1. Indicatori de raportare in radioterapie
Autori: Maria-Monica Gherman
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie:
Rezumat:
We analyzed step by step the development of processes in external radiation therapy and
how the data are collected and transformed in the computer system. Moreover we described the
stages of the data flow. Drafting of the radiotherapy form and collecting patient data (introducing
the identification number of every patient into the PC, on the localization field, doctor and
machine).
1. Delivery of the radiotherapy for at the Physics Department for consideration and calculation, than
the validation of the radiotherapy form with the physicist calculation into the data base.
2. The distribution of the calculated forms to the machines: Primus, Varian, iX and Theratron 1000.
3. Daily checking of data that were introduced in the PC: there is going to be a random data check
of the radiotherapy forms every day for each machines in order to see if there is consistency with
the reported data at the office of admissions and then on to the DRG.
4. Daily reporting on the number of ambulatory patients who are undergoing treatment in our
department.
5. Monthly, quarterly and annual reporting of data for the accounting department and moreover to
the Health Insurance House of the radiotherapy sessions conducted in our Institute.
6. Archiving of the radiotherapy forms and of the technical records for patients who completed
treatment. The electronic files are going to be closed when the treatment ends, and the file is
submitted to the doctor in its paper form and so the physician will end the file as well. The
archiving system is made by years, alphabetical order and localizations.
2. Managementul reacţiilor adverse la iniţierea tratamentului cu Rituximab
Autori: Vişan Loredana, Ionel Roşu, Andrei Cucuianu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Rituximab, reactii adverse
Rezumat:
Rituximab este un anticorp monoclonal antitumoral antiCD20 fiind utilizat in special in
tratamentul pacientilor cu limfoproliferari cronice CD20+. Rituximab este indicat si in boli
autoimune ca anemia hemolitica autoimuna sau purpura trombocitopenica idiopatica. Administrarea
Rituximabului, mai ales administrarea primei perfuzii trebuie facuta cu prudenta, deoarece pot sa
apara reactii adverse ca: reactii alergodermii pana la soc anafilactic.
Am efectuat un studiu retrospectiv, analizand cazuistica clinicii Hematologie Cluj pe o
perioada de un an (sept. 2012-2013). Au fost analizati pacientii carora li s-au administrat prima
perfuzie cu Rituximab in cadrul spitalului de zi al clinicii. Din 797 de perfuzii cu Rituximab, 56 au
reprezentat prima administrare. Administrarea s-a efectuat dupa un protocol standard. Aproximativ
60% din pacienti au suferit reactii adverse, predominand frisonul si alergodermia, care au cedat
rapid la oprirea perfuziei si corticoid iv. Au existat un numar mic de pacienti cu reactii adverse mai
severe, frison solemn sau 2 socuri anafilactice, cu evolutie favorabila dupa administrarea medicatiei
de urgenta.
In concluzie, supravegherea continua si interventia rapida la cele mai mici simptome au dus
la prevenirea si tratamentul precoce al reactiilor adverse, precum si la scurtarea timpului de
administrare a Rituximabului. Pacienti fara reactii alergice aprox. 40%. Premedicatia pacientilor
carora li se initiaza tratament cu Rituximab are importanta clinica majora, preintampinand reactiile
81
alergice, ducand astfel la imbunatatirea vietii pacientului si la o scadere a costului ingrijirilor
medicale.
3. The effectiveness of a 99mTc-planar-flood-phantom for body contouring in sentinel
lymph-node scintigraphy in malignant melanoma
Autori: M. I. Larg, C. Pestean, A.Sabo, M. Crisan, D. Piciu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: lymph-node scintigraphy , 99mTc-planar-flood-phantom , body contouring
Rezumat:
Aim: To evaluate the effectiveness of a 99mTc-planar-flood-phantom for body contouring
in sentinel lymph-node scintigraphy. Usually, for body contouring it is used a 57 Co-planar-floodsource.
Patients and methods: We studied a total number of 76 patients, 51 females (67%), 25
males (33%) with the mean age of 54 years old, with confirmed malignant melanoma. The
localization was as follows: 35 (46.0%) on thorax, 19 (25.0%) on lower limb, 14 (18.4%) on upper
limb and 8 (10.5%) on abdomen. All patients were without any macroscopic lymph-nodes
involvement. The lymph-node scintigraphy was performed in the previous day of scheduled
surgical intervention. Injection of 1 mCi (37 MBq) in 1 ml solution of nanocolloid has been
performed intradermally peritumoral. Acquisition protocol consisted in early planar images within
15 minutes, late images at 2-3 hours and when necessary, additional images at 6-7 hours. Matrix
used was 128x128 pixels and acquisition time, 5-7 min. For body contouring was used a 99mTcplanar-flood-phantom placed behind the patient, against gamma camera. The phantom was filled
with a homogenous aqueous solution of 1 mCi (37 MBq) 99mTc-pertechnetate. The skin projection
of detected lymph-node was marked on the skin and all the patients underwent a surgical procedure
using a gamma-probe, next day.
Results: The sentinel lymph-node was detected in 73 cases (96%) and in all cases lymphnodes were detected with gamma-probe and were surgically removed. According to histology, in 20
cases (26.3%) lymphatic metastatic invasion has been confirmed and the treatment strategy has
been changed. This study revealed comparable results related to sentinel lymph-node detection in
sentinel lymph-node scintigraphy using a 99mTc-planar-flood-phantom for body contouring with
published data in this field of interest.
Conclusion: The advantages of using 99mTc-planar-flood-phantom for body contouring in
the evaluation of the sentinel lymph-node are: reduced irradiation, cost effectiveness of the method,
no additional authorization required.
4. The impact of wearing lead aprons on the effective dose of staff working in Nuclear
Medicine departments during diagnostic procedures using 99mTc
Autori: M. I. Larg, C. Pestean, A.Sabo, M. Crisan, D. Piciu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: lead apron, dose reduction
Rezumat:
Aim. The aim of this study is to investigate the usefulness of lead aprons of thicknesses of
0,5mm, in shielding staff during eluation process of a 99mTc generator, preparation and
administration of radiopharmaceutical to patients. From a radiation point of view we want to
discuss the necesity of wearing those aprons taking into account the reduction of the exposure.
Material and methods. This study was conducted over a period of 2 couple weeks where
one physicist and one technologist were involved and they worn lead aprons. Each of them had an
electronic dosimeter DMC2000S under the lead apron and one above the lead apron. The total
activity which has been manipulated was 44GBq.
The physicist spent 1 hour and 50 minutes for doses preparation for the entire period of the study.
The technologist spent 4 hours and 9 minutes for radiopharmaceutical administration to the
patients. All the procedures were performed with shields of tungsten for syringes and vials.
82
Results. Technologist’s dosimeter situated under the lead apron measured an effective dose
of 0,018µSv and the other one situated above the lead apron measured 0,022µSv. The exposure
dose has been reduced with 0,004µSv, which means a reduction of 18,18%. Physicist’s dosimeter
worn above the lead apron measured 0,023µSv and the one situated under the lead apron measured
0,020µSv which means a reduction of 0,003µSv (13,04%).
Conclusions. Considering the work conditions described above as usual working conditions
over a year we estimated that the dose reduction wearing lead aprons would have a value of
0,096µSv which represents 0,48% from the dose limit for exposed workers.
Having the fact that the reduction of effective dose is minimal and the difficulty with which certain
procedures are performed when wearing the lead apron, we believe it is reasonable to not wear it.
83
ISTORIA MEDICINII
COMUNICARE ORALĂ
1. The acknowledgement of Constantin Stanca’s and Alexandru Pop’s achievements in
the management of the Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca,
from medico-historical perspective
Autori: Cristian Bârsu
Instituţie: “Iuliu Haţieganu” University of Medicine and Pharmacy
Cuvinte cheie: Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca, Constantin Stanca,
Alexandru Pop.
Rezumat:
The Institute of Oncology from Cluj has a rich and significant history, in which its leaders
had an important place. Constantin Stanca (1889-1969) was the first director of this Institute,
running successfully in this post between 1929 and 1940. Alexandru Pop (1895-1954) succeeded
him and headed the Institute during the refuge period in Sibiu, from 1940 until 1944.
We present this paper to celebrate 85 years of the existence of this Institute, 125 years since
C. Stanca was born and to commemorate 60 years after the death of Al. Pop. We point out the
professional and managerial achievements of these important professors.
It is significant that the names of these personalities are mentioned in most treaties of
Romanian history of medicine and in monographs about the history of Romanian surgery and
gynaecology. Referring to some dictionaries and encyclopaedias, it is surprisingly that the names of
C. Stanca and Al. Pop are omitted. Also, in few medico-historical memories their achievements are
distorted.
In our paper we analyze the causes of these omissions and we propose a few medicohistorical criteria to avoid such inconvenience.
84
REZIDENŢI ŞI DOCTORANZI
COMUNICĂRI ORALE
1. Does F18-FDG PET/CT changes the therapeutic strategy in patients with differentiated
thyroid carcinoma and TENIS syndrome?
Autori: E. Barbus, C.Pestean, M.I.Larg, A.Sabo, M.Crisan, C.Goia-Moisescu , D.Piciu
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: thyroid, low risk, FDG PET/CT
Rezumat:
Aim: The patients with differentiated thyroid carcinoma (DTC) benefit from surgery and
radioiodine therapy (RIT), which in most cases is the curative treatment. In low risk group, the
ablation decision is sometimes controversial. We analyzed how does the F18-FDG PET/CT is
changing the therapeutic strategy in patients with low risk differentiated thyroid carcinoma related
to ablation decision.
Material and methods: The study group consisted of 22 patients with papillary thyroid
carcinoma, with total thyroidectomy and all in stage I being in low risk group. All the patients were
evaluated at 1 month postsurgery and had the TSH level above 35 mIU/L. The mean +/-SD
thyroglobulin level was 12.4ng/mL +/- 6.2. We carried out F18-FDG PET/CT imaging with a lowdose CT without contrast at 1 month and after 1 year of follow-up.
Results: The F18-FDG PET/CT was positive in all 22 patients showing active thyroid
remnant. The SUVMax+/- SD was 3.3+/-2.2, in the first scan. At 1 year 19 patients decreased the
initially SUV values, 2 patient presented constant values and 1 patient increased the SUVMax from
3.4 at 5.2, without modified thyroglobulin levels.
Conclusions: The F18-FDG PET/CT might play a role in the decision of thyroid remnant
ablation in patients with DTC and low risk group. Further studies involving significant number of
patients are needed.
2. Implementation of IMRT technique for patients with soft tissue sarcomas
Autori: Silviu Halaşag, Dan Dordai, Gabriela Tufăscu, Victor Bogdan, Chiş Aurel, Dana Cernea,
Valentin Cernea
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: IMRT, sarcomas, radiotherapy
Rezumat:
Backround and purpose: The use of 3D conformal radiotherapy has become a common
practice in radiation oncology departments around the world. Using beam’s eye vieweing of
volumes defined on a treatment planning computed tomography scan , beam directions and beam
shapes can be selected to conform to the shape of the target volume while still minimizing dose to
normal structures. Intensity modulated radiation therapy can yeld dose distributions that conform
closely to the 3D shape of the target volume while still minimizing dose to normal structures by
allowing the beam intensity to vary across those shaped fields. The purpose of this study was to
implement the IMRT technique along with the quality assurance and quality control methods.
Patients and methods: We describe the stages in calculating IMRT plans in 5 patients
treated for soft tissue sarcomas. The anatomical data acquisition was performed on a GE Lightspeed
CT Scan system using 5mm slices and specific immobilization devices. Data acquisition was
exported to the Varian Eclipse Planning system where we delineated the planning target
volume(PTV) and the organs at risk(OAR). We used the Eclipse Inverse Planning system for
specifying the dose constraints for all the delineated volumes. After approving the treatment plan,
quality control was performed using three methods: portal dosimetry system (Varian Eclipse),
dosimetry with a multi-array PTV and direct measurement of the monitor units using a
homogeneous phantom plexiglass ionisation chamber.
85
Results: Fluence map calculations for each beam, were checked in each patient and
compared to the portal dosimetry using a Gamma index of ± 3%. They were consistent for all
treatment fields, in each treatment plan separately. The monitor units for every field were checked
and the results were consistent with the monitor units calculated by the planning system with dose
variations of ±5%. Dose distribution and conformity index were significantly in favor of IMRT
technique. The average time of treatment (MEP, the actual treatment delivery time) was about 13
minutes per patient, which was significantly higher in comparison to the classic 2D radiotherapy.
Conclusions: IMRT technique shows undeniable advantages regarding dose homogeneity
and conformity index for PTV in the treatment of soft tissue sarcomas, but the methods of quality
assurance and control must be performed strictly in each patient in order to ensure the accuracy and
safety in administering the prescribed dose to the volume of interest. After reaching a level of
routine in implementing this technique it will be extended to other tumor localisations with a
primary indication of IMRT such as ENT tumors, CNS tumors, pulmonary and others.
3. Adjuvant brachytherapy for sphincter preservation in early inferior rectal
adenocarcinomas
Autori: I. László 1, Anamaria Şipos 1, Diana Pop 1, Edina Dordai 1, G. Kacsó 1,2,3
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca;
2 - University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca;
3 - Amethyst Clinic Cluj-Napoca
Cuvinte cheie: Sphincter preservation, early-stage ano-rectal adenocarcinoma, brachytherapy
Rezumat:
Objectives: HDR Ir192 brachytherapy toxicity and effectiveness evaluation as an alternative
for patients with early ano-rectal adenocarcinomas (ERK) in sphincter preservation.
Methods: Twelve patients with T1-2N0M0 ERK treated between 2005 and 2012 received
adjuvant HDR brachytherapy after endoanal full thickness complete excision. Spinal anesthesia was
used for patients with interstitial perineal needles. For elderly and frail patients with
contraindication to anesthesia an endorectal cylinder was preferred. Doses ranged from 32Gy/5 fr
(certified R0 excision) to 42Gy/7 fr (uncertain R0 excision). Toxicity was assessed according to
CTCAE 4.0 scale. Recurrences were evaluated clinically, by imaging and mandatory biopsy.
Results: Median follow-up was 3.3 years (min 12, max 68 months). Sex-ratio was 3:1 for
women, median age - 66 years. Clinical and imaging staging was: 41.6% T1, 58.3% T2. Resection
margins were negative in 7 patients and uncertain for the others (surgery outside Institute). Specific
survival at 3 years was 100%, relapse-free survival was 91.6% (only 1 local relapse). Local control
was 91.6 %, the single local recurrence was saved by rectal amputation. Maximal acute and/or late
toxicity for anal incontinence was 41.6% G1 and 25% G2 for anal incontinence, 33.3% G1, 8.3%
G2 and 8.3% G3 for hematochezia (endoscopic argon plasma coagulation needed).
Conclusions: Interstitial HDR brachytherapy after full thickness endoanal excision for stage
T1-2N0M0R0 ano-rectal adenocarcinomas is a valid and valuable alternative to rectal amputation,
offering a higher quality of life and similar long term disease control.
4. Neoadjuvant chemotherapy before radiochemotherapy in stage IIB-IIIB cervical cancer: a
pilot study of the Oncology Institute “Prof. Ion Chiricuta” Cluj-Napoca
Autori: Adina Nemes 1, Andreea Marita 1, Claudia Ordeanu 1, Alin Rancea 1,2, Nicolae Todor 1,
Nagy Viorica 1,2
Instituţie: 1 - The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca
2 - “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca
Cuvinte cheie: neoadjuvant chemotherapy, cervical cancer, radiochemotherapy
Rezumat:
Background and aims: This study represents a nonrandomized,feasibility study conducted
in the Oncology Institute “Prof.Dr.Ion Chiricuta” Cluj-Napoca in which we assessed the response
86
and toxicity to neoadjuvant chemotherapy(NACT) before radiochemotherapy(RCT) in stage IIBIIIB cervical cancer.
Methods: In this study were included 112 patients with histologically confirmed stage IIBIIIB cervical cancer treated in OICN between November 2010-September 2012. Patients received
two or three cycles of NACT, two regimens Paclitaxel and Carboplatin (PC) or Topotecan and
Cisplatin(TC). After the completion of NACT patients underwent concurrent radiochemotherapy(RCT) with Cisplatin or Carboplatin. At 46Gy all patients were evaluated for surgery
and those with favorable parametrial response were optionally operated. Local response was
assessed at the end of NACT, at the end of RCT and for operated patients by the pathological
outcome.
Results: 112 patients with stage IIB-IIIB cervical cancer were included in this study: stage
IIB 31 patients ,stage IIIA 48 patients and stage IIIB 33 patients. Median age at diagnosis was 52
years old (22-72 years old) Scuamos cell carcinoma histology was predominant. 84 patients
performed NACT with PC and 28 patients performed NACT with TC.The objective response (OR=
complete response(CR)+partial response(PR)) evaluated at the end of NACT revealed 57% OR for
PC and 39% for TC (p=0.10), with an overall OR of 53%.65 of the 112 pacients performed
exclusive RCT with a CR in 14 patients and 47 patients underwent surgery with a CR in 19 patients,
with a CR at the end of treatment of 29%.68% of the 47 operated patients presented pCR
(pathological complete response). At a median follow-up of 17,4 months 98 patients (88%)
presented CR, 3 patients (3%) PR and 11 patients (10%) PD. Most hematological toxicities to
NACT were grade 1 and 2, observed on all medullary lines. Grade 3-4 anemia, leucopenia and
neutropenia occurred in 6%, 8% and 27% of cases respectively.
Conclusion: In stage IIB-IIIB cervical cancer NACT before RCT may bring high response
rates, with manageable toxicity but randomized, larger number and long term evaluation trials are
necessary in order to confirm these data.
5. Interstitial brachytherapy: an optimal tool for dose escalation or re-irradiation in head
and neck carcinomas.
Autori: Anamaria Sipos 1, Laszlo Istvan 1, Edina Dordai 1, Diana Pop1, Octavian Chis1, Gabriel
Kacsó 1,2,3
Instituţie: 1 - The Oncology Institute “Prof. Dr. Ion Chiricuta” Cluj-Napoca Cluj,
2 - Amethyst Clinic Cluj-Napoca,
3 - The “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca.
Cuvinte cheie: Interstitial brachytherapy, re-irradiation , dose escalation , head and neck
Rezumat:
Aim: Evaluation of toxicity and effectiveness of HDR Ir192 brachytherapy (BT) for patients
with head and neck (HNC) squamous cell carcinoma (SCC).
Material and Methods: We retrospectively analyzed 23 patients who had BT for HNC
SCC at the Institute of Oncology Cluj, between 2004 – 2013, based on one of three indications:
Group A - boost after chemoradiation (RCT), group B: after conservative resection for positive or
close margins (< 5 mm) or group C: local recurrence/second cancer in previously irradiated areas.
Results: Median age was 52 years [36-76], the sex-ratio was 2:1 in favor of men; 18
(78.26%) arised in oral cavity and 5 (21.74%) in the oropharynx. Study protocol was:
Group A: 7 patients received BT as “boost” of 18-30 Gy/5-10fr/3-7days, with 3-4Gy/fr.
Group B: 10 patients (3 pT1, 6 pT2, and 1 pT3, all N0M0) got postoperative BT only (2 because of
focal positive margin and 8 due to Ro but close margins). The total dose was 39-42 Gy/13-14fr/bid.
Group C: 6 patients (all N0M0) – half had initial surgical treatment (3 were pT1-T2) followed by
BT (39Gy/13 fr/ bid) and other half were judged inoperable:1 patient (T3 base of the tongue) and 2
with local recurrence got exclusive BT 54-55Gy/10fr/bid.
Overall local control was 82,61%, and the local control: 71.43%, 90%, 83.34%, for groups
A, B and C, late toxicity was noted for 5 patients (radionecrosis); one had radical surgery (G3-4)
and 4 were G1-G2, healing after conservative treatment. At the last follow-up 8.7 % had G2 fibrosis
87
and 13% had G2 xerostomia. Local failure occurred in 4 subjects (2 patients in group A, one of B,
and another from C) 3 patients within 1 year after BT, and one after 9 years.
Conclusion: BT offers an effective and very safe option, being the best choice with curative
intenti for salvage therapy 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.
6. Population-based lung cancer survival in Cluj County, 2006-2010
Autori: Patricia Şuteu 1, Ofelia Şuteu 1,2, Daniela Coza 1, Luminiţa Blaga 1, Viorica Nagy 1,2,
Florian Nicula 1, Alexandru Irimie 1,2
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2 - ”Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca
Cuvinte cheie: lung cancer, survival, population-based analysis
Rezumat:
Background. In Cluj County, lung cancer (LC) is the most common and lethal cancer in
men. During the last years, its incidence in men has decreased, but registered a constant increase in
women, placing it second as cause of death.
Objectives. To assess the 3-year overall survival (OS) rates of patients diagnosed with lung
cancer in Cluj County during 2006-2010, followed-up until December 2013, according to several
parameters.
Materials and method. Data on new cases and deaths by LC were obtained from the NorthWestern Cancer Registry. Survival analyses were performed using Kaplan-Meier curves.
Results. The study included 1756 LC cases (81.44% men, 18.56% women) with a mean age
of 64 years. 77.25% of cases were locally advanced and metastatic. The most common histological
types were squamous cell in men (37.06%) and adenocarcinoma in women (23.92%). 23.63% of
cases were excluded from the survival analysis, being registered from death certificates only
(DCO), leaving 1332 cases to analyze. The 3-year OS was similar for both sexes: 9.5% in men and
11% in women (p=0.82). OS decreased with stage and age. In women, small-cell had a slightly
higher OS rate (12.9%) than non-small cell (11.88%) (p<0.001) and was double compared to men
(6.45%) (p=0.57). There is a decreasing trend of OS from 15.21% in 2006 to 8.41% in 2010
(p=0.05), in men and similar in women from 17.1% to 10.96% in the same interval (p=0.53).
Discussions. OS depends on the completeness of follow-up, which has improved over the
past years, potentially explaining the decreasing OS. The discrepancy in the OS rates according to
histology could result from the large proportion of DCO cases.
Conclusions. LC remains a public health issue, due to its burden, the large proportion of
advanced stage cases and poor survival rates, highlighting the need for improvement of primary
prevention.
7. Abnormal sentinel lymph node detection sites revealed by SPECT/CT in melanoma
patients
Autori: Maria Mereuta 1, Alexandru Pavel 2, Alina Chirilă 3, Gheorghe Cobzac 2, Gabriel Andrieş 1,
3
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2 - Emergency Clinical County Hospital, Cluj-Napoca,
3 - ”Iuliu Hațieganu” University of Medicine and Pharmacy
Cuvinte cheie: sentinel lymph node biopsy, SPECT/CT, melanoma
Rezumat:
Introduction: Lymphoscintigraphy and intra-operative radio-guided detection of the
sentinel lymph nodes became mandatory for lymphatic staging in early-stage melanoma. They have
proven their benefits, being the only viable option to find sentinel lymph nodes in unexpected
regions. Our presentation’s aim is to prove the importance of this imaging technique in recognizing
these unusual cases, based on the experience of the Nuclear Medicine Department from the
Emergency Clinical County Hospital Cluj-Napoca.
88
Materials and methods: 227 consecutive patients with skin melanoma, examined between
2008-2013, were included in our study. Following the intradermal injection of 99mTc nanocolloid
around the tumor/excision scar, immediate and delayed planar and SPECT/CT images were
recorded using a SIEMENS Symbia T2 hybrid system. Projections of the sentinel lymph nodes
were marked on the patients’ skin. We used the EANM Guidelines, adapted to our laboratory.
Following a one day protocol, before surgery, Blue Dye was injected around the tumor and,
afterwards, we compared our results with the intraoperative gamma probe and histological findings.
Results: On planar imaging, we have detected a total of 782 sentinel lymph nodes of which
113 were located outside the regional lymphatic basins. Hybrid SPECT/CT made it possible to
accurately localize these abnormal (15%) sentinel lymph nodes: 20 in the cervical, supraclavicular,
occipital, retro and preauricular regions, 6 in the parotid gland, 7 infraclavicular, 15
axillary/pectoral, 8 in the scapular region, 5 femoral and one popliteal. A total of 51 were classified
as in-transit sentinel lymph nodes. The most frequent both abnormal and in-transit sentinel nodes
were derived from trunk located melanomas (over 45%).
Discussion: Lymphatic drainage toward sentinel nodes has its more or less expected
pathways, even outside the regional basins, sometimes being the only ones found.
Conclusion: Planar lymphoscintigraphy reveals most of these sentinel nodes, the exact anatomic
location being established by SPECT/CT.
8. Treatment of recurred primary brain tumors
Autori: Silviu Halaşag, Dana Cernea, Victor Bogdan, Raluca Stăhiescu, Nicolae Todor
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Brain Tumors, Radiotherapy, Reirradiation
Rezumat:
Background: Radiotherapy for recurrent brain tumors is usually limited because of the dose
tolerance of the normal nervous tissue. This study tries to evaluate the efficacy and feasibility of
reirradiation for patients diagnosed with recurrent brain tumors.
Patients and methods: In a prospective study we analyzed 11 patients with recurred
primary brain tumors, first treated between 2005-2012, with the following histologic types:
glioblastoma multiforme-7 patients, grade 2 astrocytoma-2 patients, 1 patient with grade 3
oligodendroglioma and 1 patient with grade 3 oligoastrocytoma. The first round of radiotherapy was
performed with a total dose of 50-60 Gy with 2Gy/fx in 8 patients and a total dose of 30 Gy with
3Gy/fx in one patient. The DFS until the recurrence was 5.3-90.6 months. The second round of
radiotherapy was associated with surgery and chemotherapy in 2 patients, with surgery or
chemotherapy in 2 patients and radiotherapy alone in 1 patient. At the beginning of the second
round of radiotherapy 9 patients had a Karnofsky performance index over 70 while 2 patients had a
KPI under 70. The second round of radiotherapy was delivered with a total dose of 10-44 Gy in 8
patients with a standard fractionation of 2Gy/fx, while 3 patients received a total dose of 30-44 Gy
with a hypofractionated regimen of 2.66-3Gy/fx. We compared the site of recurrence, isodose
distributions, the PTV at the first course of radiotherapy (PTV1) and the PTV at the
reirradiation(PTV2), as well as the KPI at the beginning and at the end of radiotherapy.
Results: Regarding the site of recurrence 7 patients had a central and marginal recurrence,
while 4 patients had a recurrence at distance. 4 patients had the same PTV at the second round of
treatment while 3 patients had a greater PTV2 than PTV1. The KPI remained the same at the end of
the second round of radiotherapy in 10 patients while one patient had a lower KPI due to a
deterioration in the general state. The median follow-up is 9.22 months with a range between 5.8
and 20.6 months. At the present time we have 6 patients alive and 5 deceased.
Conclusion: Even in case of larger target volumes reirradiation seems to be feasible without
observing major toxicity. Regardless of histologic type, reirradiation of recurred primary brain
tumors is a feasible therapeutic option alone or combined with other treatment methods for patients
with a good KPI, surgery at the time of recurrence and longer DFS rates from the first treatment.
89
POSTERE
1. Transient myeloid leukaemia in Down Syndrome
Autori: Baizat Melinda, Hasmasanu Monica, Zaharie Gabriela
Instituţie: Emergency Clinical County Hospital Cluj-Napoca
Cuvinte cheie: Transient myeloproliferative disorder, Down syndrome
Rezumat:
The present research depicts the case of a preterm newborn (36 WG) born from a twin
bicorial biamniotic pregnancy.
At birth the baby showed features of mongoloid slant, down inserted ears and axial
hypotonia. Moreover, routine investigations have highlighted leukocytosis marked monocytosis,
and thrombocytopenia. As such, the result of the karyotype test was 47XX+21.
Subsequently, the immunophenotyping from the peripheral blood highlights blasts of
approximatively 52%, a result compatible with an acute myeloid leukaemia with monocytic
component. However, at the 13th weeks revaluation an improvement of the blood picture was
noticed and treatment is not recommended.
The final diagnosis was final acute transient myeloid leukaemia in Down Syndrome.
2. Epigallocatechin gallate target cell death in human oral squamous carcinoma cell line
Autori: Ada Irimie1, Pileczki Valentina2 , Bobe Petrushev2, Diana Dudea1 , Radu Campeanu1,
Cornelia Braicu 2 Ioana Berindan-Neagoe2,3,4,
Instituţie: 1Faculty of Dentistry- University of Medicine and Pharmacy Iuliu Hatieganu - Cluj
Napoca,
2
Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu
Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania .
3
Department of Functional Genomics and Experimental Pathology, The Oncology Institute "Prof.
Dr. Ion Chiricuta" Cluj-Napoca
4
Department of Immunology, Faculty of Medicine, Iuliu Hatieganu University of Medicine and
Pharmacy Cluj-Napoca
Cuvinte cheie: squamous carcinoma, autophagy
Rezumat:
Introduction. The biologic active effect of natural phytochemicals like epigallocatechin-3gallate (EGCG) have been well studied in a wide range of in vitro system, but less knowledge in the
case of cell carcinoma cells. Therefore, we examined in detail the cellular effects of EGCG on
focusing on the modulation of apoptosis and autophagy signaling pathway, in SSC-4 cell line.
Materials and methods: We evaluated if EGCG could induce cell death in oral human
squamous cell lines (SSC-4). Cell proliferation was assessed using the xCELLigence system,
apoptosis by flow cytometry autophagy by fluorescence microscopy in parallel with the assessment
of apoptotic genes by qRT-PCR.
Results and discussion. We found that EGCG induced a cell death and apoptosis in a dosedependent and time dependent mode as displays the xCELLigence data on SSC-4 squamous
carcinoma cells in parallel with autophagy activation. This may be due to the inhibition of prosurvival genes and the activation of cell death mechanisms as results from the qRT-PCR evaluation.
Conclusions. EGCG has been shown to exhibit antitumor activities in the case of SSC-4 cell
line, and this finding supports the therapeutic implication in oral squamous carcinoma. This implies
the utility of autophagy modulators in order to enlarge the therapeutic response or to counteract the
chemoresistance.
90
3. Skp2: its role in colorectal cancer
Autori:. Bochis Ovidiu Vasile 2, Irimie Alexandru 1,2
Instituţie: 1 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca,
2 - ”Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca
Cuvinte cheie: Skp2, p27, colorectal cancer, prognostic
Rezumat:
Colorectal cancer (CRC) is the most frequent malignancy of the digestive tract. Studying
prognostic factors in CRC remains an important research domain, because an adequate therapeutic
approach must be correlated with the patients’prognosis.
To date, studies have as a goal the identification and validation of prognostic factors, such as
the cellular expression of Skp2,Cks1 and p27 proteins. It is known that p27 is an inhibitor of the cell
cycle, a negative regulator of protein kinases which transfer the cell in the S-phase (Cdk2/ciclin E
and Cdk2/ciclin A). As a consequence, a high cellular level of p27, keeps the cell in the G1-phase,
leading to the inhibition of cell proliferation. The degradation of p27 is realised by an ubiquitary
proteic complex, which facilites the action of the 26S proteasome. The binding of the complex to
the p27 is accomplished through the Skp2. Recently, a cofactor of Skp2 has been discovered, a
member of the protein family CKS/Suc1, known as subunit 1 of the ciclin-kinase (Cks1). A high
cellular level of Skp2 and Cks1 determines an increase in p27 degradation by the 26S proteasome.
Due to this aspect, Skp2 was associated to a more aggresive phenotype, promoting cellular
migration, the invasion and metastasis of tumoral cells in various cancer types, including CRC.
Current data present p27 as a positive prognostic factor in CRC, when it is cellular
expressed, and Skp2 and Csk1 as negativ prognostic factor, in cases of overexpression. Moreover,
there are studies that support that the overexpression of Skp2 in tumoral cells in rectal cancer is an
unfavourable response factor in the neoadjuvant therapy (radiochemotherapy).
In vitro, studies have established the decrease in Skp2 expression by using the proteasomic
inhibitor Bortezomib. This aspect opens doors to the discovery of new specific Skp2 inhibitors,
which would improve pacient outcome.
4. Anticancer effect of bioactive compounds of propolis – a screening test on breast
cancer cell lines
Autori: Flaviu Drigla 1,2, Claudia Gherman 1, Valentina Pileczki 1, Braicu Cornelia 1, Laura Pop 1,
Simona Visan 1, Ioana Berindan-Neagoe 1
Instituţie: 1. The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
2. University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca,
Cuvinte cheie: Breast cacer, propolis bioactive compounds, screening
Rezumat:
Introduction: Breast cancer incidence for European women has one of the highest rates,
with more than 30% of all new cancer cases per year. New strategies and therapeutic compounds
that are developed to help with the management of breast cancer started the new era of molecular
therapies, where the natural compounds hold one of the most important places due to their
antimitogenic, anticarcinogenic, and other beneficial medicinal properties.
Material and methods: In our experiment we conducted a screening test of 5 bioactive
compounds (caffeic acid, sinapic acid, syringic acid, chlorogenic acid and protocatechuic acid)
derived from honey bee hive propolis. We tested their cytotoxic activity on two breast cancer cell
lines (Hs578T and MCF-7) at different concentrations. To determine the cell viability, an MTT
assay was conducted after 24 hours from the treatment. The experiments were performed on 96 well
plates and the cells were preplated at least 20 hours before treatment.
Results: The MTT assay was used to evaluate the antiproliferative effect of bioactive
compounds. Logarithmic growth of the two breast cancer cell lines was assessed after 24 hours of
treatment and we observed that the most active compound that inhibited the growth of tumor cells
was the chlorogenic acid, followed by the caffeic acid, protocatechuic acid, and the least effective
being the syringic acid and sinapic acid.
91
Conclusion: Chlorogenic acid and caffeic acid are among the phenolic constituents of honey
that inhibited the two breast cancer cell lines’ growth most efficiently and in a dose-dependent
manner. Hence, these two natural compounds can be considered as potential candidates for inducing
apoptosis in breast cancer cells, possibly via the mitochondrial mediated mechanism. Nonetheless,
in order to consider these compounds as potential breast cancer prevention agents, it is necessary to
conduct further tests in preclinical and clinical settings.
5. Psychometric tools used in psychological assessment of cancer patients
Autori: Corina Lupau, Simona Mihutiu
Instituţie: University of Oradea, Romania, Clinical Hospital "G.Curteanu", Oradea
Cuvinte cheie: psychological assessment, anxiety, depression, psycho-oncology
Rezumat:
Background and aims: Cancer diagnosis is a major distress. Every patient reacts different
to this type of disease according to his own experience and expectations. Some of the patients
develop mental disorders such as: acute stress disorder, depression, anxiety and so on. Other mental
pathology may preexist: personality disorders, dementia, substance abuse, psychosis, etc.
Collaboration between oncologists and mental health specialists is important in order to manage
these patients. We also want to share our fifteen years experience in psychological assessing and
supporting cancer patients.
Method: The list of methods and techniques of evaluations and assistance approved by The
Romanian College of Psychologists along with psycho-oncology literature was reviewed.
Results: The psychometric instruments can be classified by the dimension which is
addressed: emotional status, personality, cognitive functions, behavior, coping mechanisms and
quality of life. Some instruments used all over the world have standards for Romanian population
others do not.
Conclusion: Appropriate mental status diagnosis of cancer patients if it is doubled by
appropriate intervention (psychotherapy and/or psychopharmacology) improve quality of life,
compliance to treatment.
6. Primary cutaneous large B-cell lymphoma, leg type – Clinical case
Autori: Anca Bojan, Carmen Seles
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: cutaneous lymphoma
Rezumat:
Introduction: Primary cutaneous large B-cell lymphoma, leg type represents a rare and
aggressive type of large B-cell Non-Hodgkin lymphomas. It affects especially old women and it’s
characteristic traits are elevated, red or bluish red lesions on the skin, localized on the lower half of
the lower limbs.
Clinical case: We present the case of an 85 years old pacient, ago 10 months attending the
Department of Surgery of the Oncological Institute "Ion Chiricuta" Cluj-Napoca, due to the
occurrence of an elevated, bleeding lesion on the right calf, associated with increased intensity pain
during walking. The radiological examination of the right calf showed a fracture zone on the tibia,
an opacity with several lobes, 7,7/6,2 cm, in the adjacent soft parts and other opacitys with the same
features in the lower right leg. The biopsy of the biger lesion was performed and the
histopathological and the Immunohistochemistry examination established the diagnosis- primary
cutaneous large B-cell lymphoma, leg type. Later, the pacient is hospitalized in the Hematology
Clinic for specialized treatment, for chemotherapy. At the presentation, on the right calf were
localized several elevated lesions, between 1,5 and 5 cm diameter and one larger, bleeding,
suppurative lesion, with deposits of fibrin, of 6 cm diameter. Biological examination revealed
anemia, normal leukocytes and platelets count; elevated LDH level. It was administered
chemotherapy- CEOP (Etoposide instead of Doxorubicin, due to the rising age), every 3 weeks,
with good clinical tolerance and favorable evolution. After 4 sessions of chemotherapy, the lesions
92
disappear. To the chemotherapy it was associated a monoclonal antibody- Rituximab and it were
administraded 2 sessions R-CEOP and 1 R. After the last one with R, the leasions on the right calf
reappear, up to 2-3 cm, construed as relapse, with the decision of a second-line of treatment- RCOP sessions; so far have been administered 2 sessions, with good clinical tolerance.
Conclusions: This case highlights typical features, the aggressive nature of thedisease and
the tendency to relapse.
7. Molecular characterization of peripheral blood immunological profile of breast cancer
patients
Autori: Oana Virtic 1, Oana Tudoran 2, Loredana Balacescu 2, Gabriela Morar Bolba 2, Ovidiu
Balacescu 2, Ioana Berindan-Neagoe 1,2
Instituţie: 1 – “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
2 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: breast cancer, cytokines, peripheral blood
Rezumat:
Introduction: Breast cancer is the worldwide leading cause of cancers in female population.
Current approaches of cancer treatment are oriented towards more effective targeted therapies. In
order to understand the underlying pathogenic mechanisms of breast carcinogenesis and tumor
progression we need to accomplish a better evaluation of the tumor microenvironment and its link
to inflammation. Cytokines are key signaling molecules, released by immune cells that are involved
in complex modulating inflammatory microenvironment responses to antitumor therapy. The aim of
this study is to investigate a panel of pro-inflammatory mediators in the peripheral blood cells of
patients with breast cancer with different response to the therapy.
Materials and methods: Forty patients with two different subtypes of breast cancer were
enrolled in this study. The two groups were defined by their prognosis according to their hormonal
estrogen and progesterone receptors(ER, PR) expression in primary tumors at diagnosis, both
groups lacking Her2 expression. Eighty-four genes including pro-inflammatory mediators,
cytokines and chemokines were investigated in the peripheral blood circulating cells (PBCs) by
PCR array. Data were analyzed with Web-designed software Cataloged and Custom Arrays for
expression levels and IPA software for functional analysis. Molecular data were correlated with
clinical-pathological characteristics.
Results and discussions: We identified 15 genes that were significantly expressed between
the two groups based on ER/PR expression. These genes are involved in regulating of inflammatory
responses through cell-to-cell interactions and signaling. Likewise cytokines manifest pleiotropic
actions with functions and implications in innate and adaptive immune responses. An association of
molecular data with clinical and histopathological characteristics was established for both breast
cancer subtypes. In conclusion, we believe that analyzing the immunobiological pathways of PBCs
may yield important information data with impact for therapy and prognosis.
8. Subtyping the triple negative breast cancer using a panel of immunohistochemical
markers
Autori: Simona Visan, Sergiu Susman, Rares Buiga, Loredana Balacescu, Flaviu Drigla, Ovidiu
Balacescu, Ioana Berindan-Neagoe
Instituţie: The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: triple negative breast cancer, immunohistochemistry, immunohistochemical
markers
Rezumat:
Introduction: Triple negative breast cancer (TNBC) represents a heterogeneous tumor
subtype characterized by the lack of estrogen and progesterone receptors (ER, PR) and Her2/neu
gene amplification. This type represents approximately 15-20 % of invasive breast cancers and is
associated with a poor prognosis, high grade tumors, increased risk of distant recurrence and death
within 3-5 years of follow up. Validation and standardization of new molecular markers for clinical
93
diagnosis are still challenging. The aim of this study is to subclassify triple negative breast tumors
based on a set of immunohistochemical markers.
Materials and methods: A manual tissue microarrayer (3D Histech®) was used to
construct two paraffin blocks, including 32 TNBC samples in triplicates. A panel of seven
immunohistochemical (IHC) markers including cytokeratin 5 (CK), epidermal growth factor
receptor (EGFR), claudin 3, claudin 4, claudin 7, p53 and Ki-67 was used to identify the subtypes
of TNBC.
Results: According to the immunohistochemical analysis, tumors were classified into 17
mixed, 4 basal-like, 1 claudin low, 4 Ki-67 positive, 4 p53 positive and 2 null (tumors without
matching other identified subtypes). The 17 mixed TNBCs included: 7 basal-like + claudin low, 5
basal-like + p53 positive + Ki-67 negative, 2 basal-like + p53 positive + Ki-67 positive, 2 p53
positive + Ki-67 positive and 1 claudin low + p53 negative + Ki-67 positive. The majority of TNBC
tumors included mixed subtypes presenting two or more characteristics and had the shorter overall
survival.
Conclusion: We classified TNBC into basal-like, claudin low, Ki-67 positive, p53 positive ,
mixed and null subtypes by immunohistochemical staining for CK5, EGFR, claudin 3, claudin 4,
claudin 7, p53 and Ki-67. To establish a more accurate immunohistochemical criteria used to
classify TNBC larger studies are required.
9. Paradigm of siRNA therapy in cervical cancer
Autori: Ovidiu Braicu 1, Valentina Pileczki 2, Braicu Cornelia 2, Ioana Berindan-Neagoe 1,2,3,
Alexandru Irimie 3
Instituţie: 1 - Department of oncological surgery, Faculty of Medicine “Iuliu Hatieganu”
University of Medicine and Pharmacy,Cluj Napoca, Romania
2 - Research Center of Functional Genomics, Biomedicine and Translational Medicine
of “Iuliu Hatieganu” University of Medicine and Pharmacy- Cluj Napoca, Romania
3 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: cervical cancer, siRNA, targeting therapy
Rezumat:
Introduction. Cervical cancer is a crucial medical issue in Romania, being the principal
factor of mortality in women, as is presented in the latest statistical data. Therefore there is an acute
demanding for developing novel therapeutic strategies.
Materials and methods. HeLa cells (human epithelial cell line, isolated from cervical
carcinoma) was transfected with p53siRNA. Apoptosis gene expression levels were determined
using qRT-PCR method, in parallel with cytotoxicity evaluation by MTT test and apoptosis by
fluorescence microscopy.
Results. An increased reduction of cell proliferation, in parallel with raised yield of
apoptotic cells was observed. Also was observed a inhibition of genes involved in apoptosis but also
in angiogenesis as displayed by qRT-PCR data, related with a decrease in invasion rate in the
situation of p53 siRNA therapy.
Discussions. siRNA therapies in order to inhibit oncogenic pathways like the case of
mutated p53 gene that elicit oncogenic role, can be considered as treasured tools to repair the
altered pathway and to restore the normal phenotype.
Conclusions. siRNAs denote an promising therapeutic approach, as a consequence of
targeting the activated oncogenes.
94
10. Microrna-126 mediates the interaction of cancer associated fibroblasts with malignant
cells in primary liver cancers
Autori: Ciprian Tomuleasa1,2, Mihai-Stefan Muresan1,2, Florin Zaharie2,3, Ioana Berindean-Neagoe
1,2
, Mihai-Andrei Muresan1,2, Alexandru Irimie1,2
Instituţie: 1 - The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania,
2 – “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,
3 – “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology
Cuvinte cheie: microRNA, cholangiocarcinoma, hepatocarcinoma, array
Rezumat:
Background: Liver malignancies are a major public health problem worldwide.
MicroRNAs are small noncoding RNA molecules that regulate gene expression at a
post‐ transcriptional level, with involvement of microRNAs in the pathogenesis of many human
cancers. The aim of this study was to determine the role of microRNA126 (miR-126) in regulating
the forming of the surrounding desmoplastic stroma in both intrahepatic cholangiocarcinoma (ICC)
and hepatocellular carcinoma (HCC).
Materials and methods: After isolating miR-126 from free-floating exosomes from bile
harvested via ERCP from patients with documented primary hepatic carcinoma, we have
transfected the genetic information from miR-126 on cell population via a synthesized retrovirus.
Next we have performed co-culture experiments using: HuCCT1-EV-GFP+ cells (intrahepatic
cholangiocarcinoma), HuH7-EV-GFP+ cells (hepatocellular carcinoma), LX2/LX2-mCherry Red+
cells (liver stellate cells), comparing HuCCT1-EV—LX2-NSM vs HuCCT1-EV—LX2-miR-126,
HuH7-EV—LX2-NSM vs HuH7-EV—LX2-miR-126 via flow cytometry analysis of the
co‐ cultures at days 1, 3, 8. Furthermore, we have investigated the cell-lines via invasion assays
(Scratch assay, Matrigel Invasion assay) and in vivo experiments with nude mice (in order to
evaluate the inflammatory/cytokine response).
Results: HuCCT1-EV co-cultured with LX2-miR-126 present less cell population at days 1,
3, 8, not due to decreased LX2 cell growth; at scratch assay the same cell population presents less
cell migration; all cell lines transfected with miR-126 show less invasive capacity on Matrigel
invasive assay.
Discussion: miR-126 suppresses cancer cell growth and proliferation, metastatic cell
invasion and metastasis by mediating the secretion of IGFBP2, IGFBP4, S100 A4, IL-2 and
WISP1v, potential biomarkers of early cancer detection.
Conclusion: Co-culture of fibroblasts cells with cancer cells non-cell-autonomously rescues
their miR-126-induced metastatic defect, revealing a novel and important role for desmoplastic
interactions in the initiation of malignancy. Through loss-of-function and invasion experiments, we
delineate a miRNA regulatory network's individual components as novel and cell-extrinsic
regulators of fibroblastic involvement and metastatic colonization.
95
STUDENŢI
POSTERE
1. Severe outcome of a case of malignant strum ovarii
Autori: Andra Piciu1, Doina Piciu1,2
Instituţie: 1 - “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca,
2 - The Oncology Institute ”Prof. dr. Ion Chiricuta”, Cluj-Napoca
Cuvinte cheie: struma ovarii, malignancy, radioiodine therapy
Rezumat:
Background: Struma ovarii (SO) is an extremely rare gynecologic disease, defined by the
presence of an ovarian tumor containing thyroid tissue as predominant cell type. The malignant
transformation is rare and lethal cases of SO are even rarer. SO may spread to contralateral ovary,
pelvic nodes, peritoneum, liver, lungs, and bones through hematogeneous system, which is different
from the dissemination pattern of papillary thyroid carcinomas. We report on a patient presenting
left ovarian cystic SO, skipped at the initial diagnostic, and with highly aggressive metastatic
outcome.
Summary: A 47-year-old woman with metastatic disease, including massive bilateral lung
metastases, brain and bones metastases, retrosternal and mediastinum lymphadenopathy, underwent
ovarian resection and total hysterectomy two years earlier for a non-malignant gynecologic
pathology. The removal of one spinal tumor revealed metastases of follicular variant of papillary
carcinoma, with specific pattern of malignant struma ovarii. She underwent thyroidectomy and
brain tumor resection; the patient received three I-131 treatments using thyrotropin stimulation and
radioiodine dosimetry. Imaging highlights the mixed behavior of this ovarian tumor. Posttherapy I131 imaging, anatomic images, and thyroglobulin levels showed significant diminution in the tumor
burdens and remarkable decline in thyroglobulin levels. This case provided valuable information on
assisted 131I ablation in conjunction with dosimetry in an unusual presentation of iodine-avid
malignant struma ovarii with bulky metastases.
Conclusions: Such an aggressive malignant disease and late diagnostic of SO is rare. Total
thyroidectomy is mandatory to exclude a primary thyroid neoplasm and for radioiodine therapy and
follow-up. This report should point out the special situation of ectopic thyroid hormone secretion,
which must aware the physicians also on this ovarian tumor presentation.
2. Non metastatic gestational trophoblastic neoplasia
Autori: Pătcaș Adela
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: Choriocarcinoma , hCG , single line chemotherapy
Rezumat:
Gestational Trophoblastic Neoplasia (GTN) is a term used to define malignant disorders
derived from components of the normal human placenta and include invasive moles (IM),
gestational choriocarcinoma (CCa) and placental site trophoblastic tumours (PSTT), each one of
them with particular features. As for the pathology, IM consist of edematous chorionic villi with
trophoblastic proliferation which invades the myometrium. Cca is an epithelial neoplasm formed by
elements of abnormall syncytiotrophoblast and cytotrophoblast without chorionic villi, appearing at
the histopathological exam with tipically central necrosis and biphasic architecture and tend to
metastasize early. PSTT consists of proliferation of the intermediate trophoblastic cells which
secrete low levels of hCG but in absence of chorionic villi, presenting histological features such as
infiltrating nests and sheets of monomorphic interstitial type trophoblast with moderate
pleomorphism and mitotic activity (pictures). The importance of GTN is that they metastasize early
throughout the hematogenous path to the lungs, lower genital tract, brain, liver, kidney and
gastrointestinal tract.
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Among the risk factors are mentioned the following: a complete hydatidiform mole which
can turn up into a malignant process, hormonal factors which are influenced by oral contraceptive
use. The international incidence reveals very high rates in India (1 case of Cca in 500-600
pregnancies), while the average is considered 1 case at 50,000 deliveries. Also, the risk of
developing Cca increses with age, being more frequent among women over 40 years (5 – 15 times
higher).
For the clinical diagnosis it is essential to measure human chorionic gonadotropin. In GTN
which follow a CHM, guidelines have been established by FIGO and include: 4 or more values of
hCG plateau over at the least three weeks; a 10 % or more rise of hCG for three or more values over
at the least two weeks; at the hystological exam the presence of Cca and the persistence of hCG six
months after molar evacuation. On the other hand, GTN should be taken in account at women of
childbearing age who present abnormal bleeding or unexplained metastatic disease. The symptoms
revealed by the metastasis are in compliance with the affected site: headaches, abdominal
tenderness, upper quadrant and back pain, hemoptysis, chest pain, dyspnea, vaginal bleeding. Along
with hCG level measurement, laboratory studies should be performed: complete blood count,
platelet determination, liver enzymes and renal function . The imaging studies are also important:
chest X-ray, pelvic ultrasonography, pelvic and chest CT scan and brain MRI.
Once the diagnosis of GTN is set, three systems are used for staging and assessing risk of
patients: FIGO Staging System, WHO Prognostic Scoring System (picture) and NIH Clincal
Classification System (picture), mainly used in our country. This system divides patients with nonmetastatic GTN and with metastatic GTN, because the NMGTN present a low risk and are usually
cured by single-agent chemotherapy. In addition, a total score of 7 or higher at the WHO Prognostic
Scoring System indicates a risk of developing resistance at single agent therapy.
As for treatment, for low risk NMGTN, Methotrexate is the first line medication, followed
by Actinomycin D, if the patient proves resistance of has liver function abnormalities. It is very
important that throughout the treatment period, the levels of hCG to be measured every week. A
second line therapy consisting of a combination between MTX, ActD and Cytoxan is applied if the
patient develops resistance to the first line treatment agents. Chemotherapy is maintained until hCG
achieves its normal level (< 5mIU/ml) and according to ESMO Guidelines another 6 weeks after.
For the management of PSTT which differs from Cca by growing slowly and metastasing early,
hysterectomy with pelvic node sampling may be needed at patients who present within 4 years of
their last known pregnancy, whilst for those who show up later multi-agent and subsequent highdose chemotherapy assesses. Chemotherapy with MTX and ActD is given by a scheme (table). As
for surveillance, the hCG level needs to be measured once a week until normal values are obtained,
then monthly for one year. Patients who wish to remain pregnant, can take this into consideration
after one year of remission.
3. The evolution under treatment of patients with follicular non-Hodgkin lymphoma
Autori: Stirbu Laura1, Parvu Andrada1,2, Bojan Anca1,2
Instituţie: 1 - “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca,
2 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: Rituximab, treatment, survival, Non-Hodgkin Lymphoma
Rezumat:
Introduction. Non-Hodgkin lymphomas(NHL) are a heterogenic group of malignant
lymphoproliferations. Follicular NHL is an indolent type usually having a slow progression, a good
response to therapy but relapses frequently. The current study analyzes the evolution under the
standard polychemotherapic CHOP scheme with and without the addition of Rituximab.
Materials and methods. From a total of 124 patients with NHL registered at the
Hematology Clinic of Cluj-Napoca, 54 of them had the follicular type. We have done a
retrospective analytic study dividing these patients into 2 lots depending if Rituximab was added
(18 patients-lot1) or not (36 patients- lot2) to the CHOP therapy. The following analysis were made:
total of complete (CR) and partial (PR) remissions and the survival probability under treatment in
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general and in the 2 lots ( Kaplan-Meier Survival , Cox regression applied); also the survival
probability in corelation to the type of remission.
Results. In general a 69%(78% in lot1,72% in lot2) of the patients went into CR, 25% - PR
and 6% had progressive disease. There were no cases of progressive disease in lot 1. In the survival
probability analysis: a) comparing the 2 lots the Cox regression indicated a HR ( hazard ratio ) of
0.38 ( 95% CI 0.12-1.17 ) and a p value of 0.09; b) comparing the CR and PR groups the Cox
regression indicated a HR of 2.8 ( 95% CI 1-7.3 ) and a p value of 0.03.
Conclusion. In the case of patients with follicular NHL, 69% of them underwent CR and the
survival was the same regardless if Rituximab was added. Obtaining CR was statistically proven in
our study to increase survival. Patients in PR have a 2.8 higher risk of death than those in CR.
4. Half-time thyroid hormone withdrawal in the follow-up of DTC
Autori: Andra Piciu1, Doina Piciu1,2
Instituţie: 1 - “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca,
2 - The Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca
Cuvinte cheie: thyroid carcinoma, hormone withdrawal, TSH
Rezumat:
Introduction: Differentiated thyroid carcinoma (DTC) is the most frequent thyroid tumor
with a high survival rate and long-term follow-up. This study aims to evaluate the efficiency and to
demonstrate the benefits of a shorter period of thyroid hormone withdrawal (THW), in the
assessment of DTC.
Patients and methods: This retrospective study was made on 583 patients from the
database of the Institute of Oncology “Prof. Dr. Ion Chiricuță” Cluj-Napoca (IOCN) and monitored
between 1 Jan – 31 Dec 2010. The mean age was 53.4 years. All patients were diagnosed with DTC
and underwent total thyroidectomy and radioiodine therapy; afterwards they were under suppressive
doses of thyroid hormone (Levothyroxine). During the follow-up protocol of these patients we
performed serological determinations of the Thyroglobuline (Tg), Anti-thyroglobuline (anti-Tg) and
TSH. All the blood samples were taken after 2 weeks of THW; in case of an inefficient TSH
increasing (above 40 mIU/L) the period was prolonged to 4 or 6 weeks. The analysis was made on
Roche kits and Cobas 6000 analyzer in the central laboratory of IOCN. P value <0.05 was
statistically significant.
Results and discussions: 39 patients out of 583 (6.68%) needed an extension of the 2 weeks
of THW because the serum TSH level did not raised adequately. The analysis were repeated after
another 4 weeks of THW. The increased level of the TSH determined a positive value of Tg (> 1
ng/ml) in 22 patients (3.7%) initially false negative, while the other 17 cases maintained
undetectable levels of Tg and were true negative. We obtained a p value of 0.037 (p < 0.05), with
statistical significance.
Conclusion: Because only 3.7% of the patients need more than 2 weeks of THW, we
concluded that it is not justified that all patients should undertake a 4 – 6 weeks period of
mixoedema before their routine oncology check-up.
5. Principles of brachytherapy post- hysterectomy in cervical cancer
Autori: Pătcaș Adela
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: Radiotherapy , vaginal applicators, dose prescription, multidisciplinary
Rezumat:
Introduction & Objectives. Brachytherapy is defined as a method of treatment using
radiation sources placed intracavitary in the nearby of the tumour site. It is one of the earliest forms
used in Radiotherapy, dating from 1912 and it is in a continuous improvement. The aim of this
poster is to create an approach of this treatment in cervical cancer, which has one of the highest
mortality rates in the European Union, placing our country on the top.
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Matherial and methods. For a patient who is diagnosed with cervical cancer the stage of
the tumour indicates whether the surgical act is needeed or not. Therefore hysterectomy is indicated
in non bulky stage I and IIA tumour and consists of removal of the parametrial tissue, a vaginal cuff
and also pelvic lymphadenectomy. Hereinafter intravaginal brachytherapy can be used along with
external beam therapy or alone. Both methods of treatment require vaginal applicators such as:
vaginal cylinders and vaginal ring or ovoids which can be inserted without general anaesthesia. In
case of using a vaginal ring , the dose will be delivered only to the upper 1-2 cm of the vagina,
whereas for cylinder use the length is 5 cm. The patient preparation is mandatory in dose speeds
like low dose rate(LDR) and pulsed dose rate (PDR) because the applicators remain in position for
20-24 hours. On the other side, high dose rate (HDR) is performed in a few minutes and does not
need special measures, but it can cause higher long term toxicity. After an external beam dose of 40
– 45 Gy in 20 – 25 fractions the prescripted dose can be one of the following: for LDR and PDR 15
Gy at 5 mm at 0.5 Gy per hour; HDR 11 Gy in 2 fractions.
In comparison with the method described above, brachytherapy can be given alone but the
prescription dose differs. For LDR /PDR: 40 – 50 Gy at 5 mm depth at 0.5 Gy per hour rate dose
and HDR: 22 Gy in four fractions at 5 mm depth or 21 Gy in three fractions at 5 mm depth..
However, the medical personnel should be aware of the complications that may occur: dysuria,
proctitis, vaginal teleangiectasia or stenosis and dyspareunia.
Results. Although the results of several trials have shown that there is no significant
increase in the survival rate, comparing it with external beam therapy, the quality of life is improved
and also this technique comes along with advantages towards EBRT: a clinical target volume
consisting of the gross tumour volume and microscopic tumour extension is defined with the
implant in situ and dose delivery is adjusted to cover this volume. Also, there is no need to redefine
an expanded planning target, because PTV includes CTV + set-up margin, so there is no set-up
error or organ motion to be taken in account.
Conclusions. To sum up, brachytherapy is an effective method of treatment which can be
optimized by the oncologyst and its goal in cervical cancer is to eliminate the tumour due to its bulk
by using high doses applied close to the tumour. All in all, it requires a multidisciplinary
cooperation because its safety and precision are related to the application of computer dosimetry,
3D image guided source placement based on a 3D CT data set and skilled personnel.
6. Atipic aspect of ewing sarcoma - a rare case report
Autori: Paul Mihai Boarescu, Dan Gheban, Ioana Chirilă
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: alveolar rhabdomyosarcoma, Ewing sarcoma, pediatric patient,
immunohistochemistry
Rezumat:
Introduction: Bone sarcoma is a rare disease, with an incidence of approximately 8 cases
per million/year. It occurs in all ages but has a characteristic bimodal distribution, with peak
incidences for adolescents and elderly. Ewing Sarcoma (EWS) is a mesenchymal-derived tumor
that generally arises in bone and soft tissue. Intensive research regarding the pathogenesis of EWS
has been insufficient to pinpoint the early events of Ewing sarcomagenesis.
Case presentation: An 11 year old male child was admitted to Children Hospital Cluj for
evaluation. At the physical examination a poorly delimitated tumor in the anterolateral muscle lodge
of the shin was found. Tumor was adherent to the fibular periosteum. Biopsy was taken from the
lesion.
Results: At macroscopic examination the tumor of 6/3/2cm had yellow color and strong
elastic consistency. Histopathological examination reveals a malignant structure of the tumor with
small and blue cells infiltrating the muscle and periosteum. Tumor cells are arranged in
islands separated by a well-represented conjunctive vascular tissue. In patches islands have a
compact aspect but there are also islands with intercellular spaces giving it an alveolar aspect .Cells
that have a syncytial aspect. Focal ischemic necrosis and capillary vascular permeation images are
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seen. Margins of the tumor piece are positives. PAS stain was focally positive.
Immunohistochemistry showed an intense and diffuse positive reaction for CD99, while DES and
SMA remained negative on tumor cells. Also ACL was negative, while S100 stain showed some
focal stains to isolated tumor cells.
Conclusions: The histological aspect of the tumor using HE resembles with alveolar
rhabdomyosarcoma but immunohistochemistry clearly proves that it is a neuroectodermal tumor
type, like Ewing Sarcoma. For a better differential diagnosis between the two entities, Actin
staining for nonspecific muscle staining and / or Myogenin would be required.
7. Partial Nephrectomy: open versus robotic-assisted with DaVinci Si FullHD Robot:
perioperative results and complications
Autori: Roxana Andra Coman, F. Dobrota, L. Grad, N. Crisan, C.N. Manea, R. Manescu, I. Coman
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: renal tumors, open partial nephrectomy, robotic partial nephrectomy
Rezumat:
Introduction:The widespread use of non-invasive abdominal imagistic methods increased
the rate of diagnosis of renal tumors stage T1-T2 and due to technical progress has been developed
the minimal invasive approach for partial nephrectomy. We compared the oncological and
functional results for patients undergoing open partial nephrectomy (OPN) versus robotic partial
nephrectomy (RPN).
Material and method:Since the formation of the Robotic Urology Center at the CityHospital Cluj-Napoca there were performed open and robotic partial nefrectomies. We compared
the first 20 OPN with the first 20 RPN. We performed the OPN with retroperitoneal approach and
the RPN 4 with retroperitoneal approach and 16 with transperitoneal approach. Intraoperatively
were noted the operating time, warm ischemia time, blood loss and complications and
postoperatively the recovery time, creatinin and hemoglobin seric values and complications.
Results:The analyssis was performed based on 40 patients with median tumor size of 3,5
cm. The mean warm ischaemia time (WIT) was shorter in the OPN group than in the RAPN group
12 (0-26)minutes vs 16 (0-32)minutes. In the RPN group there were 2 cases of enucleation. The
estimated blood loss (EBL) was 340 (250-580) ml in the OPN group and of 290 (190-520) ml in the
RPN group. The postoperative complications were hematuria (3 cases in OPN grup and 1 case in
RPN group who needed blood trasfusion) and urinary fistula (1 case in OPN group).
In terms of oncological results, all patients with classic approach had negative resection margins
and 19 out of 20 patients with robotic surgery had negative resection margins.
Conclusion:In the present series, RPN was associated with a significant reduction of blood
loss, surgical complications and postoperative bleeding, and with a shorter hospitalization. Longterm results should be evaluated for both tehniques, with a close postoperative follow-up.
8. Robotic radical prostatectomy for patients with locally advanced prostate cancer:
oncological and functional outcomes
Autori: Roxana Ilies, Cristina Ivan, Nicolae Crisan, Ioan Coman
Instituţie: “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
Cuvinte cheie: radical prostatectomy, Da Vinci SI, prostate cancer
Rezumat:
Objectives: This study aims to clarify the oncological and functional outcome of the robot
assisted radical prostatectomy (RALP) procedure performed on patients with locally advanced
prostate cancer.
Patients and methods: This study corroborates information from 175 patients which had
undergone RALP between November 2009 and March 2014. The technique used relied on the the
Vinci SI system, while the approach elected was transperitoneal. Among the 175 patients included
in this study, 44 presented locally advanced prostatic cancer, which we defined as having uni- or
bilateral extracapsular extension (above stage T3a). The results were quantified by the positive
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postoperatory margins (POM), biochemical relapse (PSA levels pre- versus postoperative),
continence (pad usage per 24 hours) and potency (number of erections).
Results. The mean age of the patients regarded was 63.5 years (+/- 5.7 years).
Positive POM were encountered in 20.5% of cases, while negative POM was displayed in 79.5% of
the cases. The pre-operatory PSA levels presented an average of 10.4 ng/d and seemed to correlate
with the POM values. Regarding the aspect of continence, one month after the procedure 53.2% of
the patients had regained continence, 12.4% showed improvement (pad usage 2-4 pads/24h) and
31.5% still presented incontinence (using more than 4 pads/24h). 2 years after the procedure, 88.9
of the patients were fully continent while 11.1% showed improvement in continence (pad usage 24/24h).
In 24 cases out of the total 175, a nerve sparing procedure was applied. In 20 cases out of
the 175, unilateral nerve sparing was employed. This explains the otherwise weak improvement in
postoperative sexual function: 1 month after the procedure 13.5% of the patients had had an
erection, while 86% were impotent. 1 year post-procedure, 38.9% of the patients had manifested an
erection, while 61.1% remained impotent.
Conclusion. The RALP procedure in the treatment of locally advanced prostatic cancer
shows great promise in improving the oncologic and functional status of the patient, with the
disadvantage that the rarely employable nerve-sparing option reduces the chance of a regain of
sexual function.
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