ADVANCES IN RADIOTHERAPY OF ADRENAL GLAND LESIONS.

Primary adrenal tumors include a broad variety of lesions, from nonfunctioning incidentalomas to secreting adrenocortical adenomas including Aldosteronism, Cushing or androgen secreting lesions. Primary tumors can occur either in the cortex or the medulla of the adrenal glands, having different histopathological features and also different clinical appearances and treatment approaches. In addition, the adrenal glands can become distant metastatic sites of numerous primary malignancies. The first line of treatment in a broad variety of cases is surgery. After pathology results, in selected cases, apart the oncologic approach, radiotherapy could be an important therapeutic tool. In this paper we will discuss the role of radiotherapy in the treatment of adrenal gland lesions.

Actualities in Involvement of Estrogens in the Pathogenesis of Colorectal Cancer.

Gastrointestinal effects of estrogens are emerging as an important topic in colorectal cancer management. Current research demonstrated the link between inflammation and this malignancy, so important estrogen dependent mediators of the inflammatory response have been identified. Radioresistance and chemoresistance still represent an important cause of therapeutic failure in colorectal cancer and lead to further studies of colorectal carcinogenesis and predictive markers.

CLINICAL PROGNOSTIC FACTORS IN PRE- AND POST-MENOPAUSAL WOMEN WITH OVARIAN CARCINOMA.

AIMS: To assess the impact of prognostic factors on the outcome of ovarian carcinoma (OC) and to determine the difference between pre and postmenopausal patients. DESIGN: Retrospective cohort, single centre study. SUBJECTS AND METHODS: One-hundred-sixty patients with stage IC-IV OC diagnosed between 2004-2016 were included. Treatment consisted in primary surgery followed by adjuvant chemotherapy (n=127, 79.4%), neoadjuvant chemotherapy followed by surgery (n=27, 16.9%) and chemotherapy alone (3.7%). RESULTS: At diagnosis 62 patients (38.8%) were premenopausal. Most patients presented with advanced OC (stage III/IV, 63.1%). After a median follow-up of 60 months, median progression free survival (PFS) for all stages was 36 months and median overall survival (OS) was 96 months. Postmenopausal patients had a poorer oncologic outcome compared with pre-menopausal women (PFS 24 vs. 72 months, p=0.0001, HR=2.32). Other clinical prognostic factors identified were performance status 1 vs. 0 (p=0.0001), ascites (p=0.027). Pathology prognostic factors were tumour grade (G1 vs. G2 and G3, p=0.0001) and endometrioid subtype compared to serous (p=0.008). Patients with residual disease after surgery had an increased risk of recurrence and death (HR=6.1, p=0.0001 and HR=4.2, p=0.0001). CONCLUSION: Premenopausal patients had a better oncologic long-term outcome and stage, ascites, grading, residual disease, were independent prognostic factors.

Can endobronchial or endotracheal metastases appear from rectal adenocarcinoma?

Background: Endobronchial and endotracheal metastases from extra-pulmonary solid tumors are rare. Patients and methods: We reported the case of a patient diagnosed with endobronchial and endotracheal metastases from rectal adenocarcinoma. Case report: Patient P.G., 62 years old, was diagnosed with a rectal tumor in 2011, for which, a surgical intervention was performed (pT3 pN2a M0, stage IIIB). Afterwards, she underwent adjuvant chemotherapy and concomitant radiochemotherapy. In September 2013, the chest CT showed 2 nodules for which, an incomplete surgical resection was done and which were histopathologically diagnosed as metastases from rectal cancer. The patient continued the treatment with chemotherapy associated with Bevacizumab and after 6 months only Bevacizumab for maintenance. In June 2015, the chest CT pointed out a nodule in the right upper lobe and the bronchoscopy highlighted a 4-5 mm lesion at the level of the right primary bronchus, whose biopsy proved the rectal origin. Afterwards, another surgical intervention was performed. Unfortunately, the postoperative chest CT revealed an intratracheal tissue mass (11/ 7mm) and multiple metastases in the right lung. The bronchoscopy showed 2 endotracheal lesions, out of which one was biopsied (histopathological result of metastasis from rectal cancer). Despite the fact that chemotherapy was continued, other endobronchial lesions appeared. All of them were removed and the patient started radiotherapy on the tracheal area. Afterwards, she refused to continue chemotherapy. The last bronchoscopy highlighted one endobronchial and two endotracheal secondary malignant lesions. Conclusion: Endobronchial and endotracheal metastases must be taken into consideration in all the patients with a history of extra-pulmonary cancer. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging, IMRT = intensity-modulated radiotherapy, ESMO = European Society for Medical Oncology, NCCN = National Comprehensive Cancer Network, iv = intravenous, PET - CT = Positron Emission Tomography - Computed Tomography.

The evaluation of the oxidative stress for patients receiving neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

Hypothesis: Nowadays, rectal cancer is an important healthcare challenge that affects many thousands of people each year worldwide, being diagnosed especially after the age of 50 years. Objective: This study attempted to evaluate the oxidative stress in patients with rectal cancer. Methods and results: 30 patients from the "Prof. Dr. Al. Trestioreanu" Institute of Oncology in Bucharest were treated with neoadjuvant radiochemotherapy during 2014 and 2016 and were included in the clinical study. Blood samples were obtained in dynamics during the treatment. From the blood samples, the serum was separated and used to identify the biochemical oxidative stress parameters. Results: Regarding the determination of lipid peroxides, albumin thiols, the cuprum oxidase activity of ceruloplasmin, the values registered in the dynamic of the treatment highlighted their increase to a maximum at the treatment's endpoint due to an important oxidative stress. Regarding the serum values for total antioxidants, the results pointed out the activation of the natural protection systems, which in time were overwhelmed, due to the installed oxidative stress. Conclusion: Part of the cytotoxic effect of radiotherapy was due to the production of oxidative stress. The cell was constantly exposed to the cytotoxic action of the reactive oxygen species. The obtained results indicated the dual relation to which the tumoral cell exposed itself and the installed oxidative stress, respectively, the oxidative stress being a cause or a consequence of the malign transformation. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging, ESMO = European Society for Medical Oncology, ECOG = performance status scale.

PREDICTIVE CIRCULATING MARKERS FOR ANTHRACYCLINE CHEMOTHERAPY IN NON-METASTATIC BREAST CANCER.

Anthracyclines are used in breast cancer both in early and advanced stages and their recommendation together with taxanes, either concurrently or sequentially, is debatable and individualized by phenotype. Circulating biomarkers have already been introduced in clinical practice for metastatic disease monitoring. We questioned whether it might be a role for these markers in neoadjuvant and adjuvant settings too and a general review was conducted. CK18 and CTC were found predictive for anthracycline related response in preoperative setting. Soluble E-cadherin is promising, a retrospective analysis showing a direct correlation with clinical response. CEA, CA 15-3 and HER2 ECD are not of interest for their predictive role.

Outcome of urinary bladder cancer after combined therapies.

Rationale:Urinary bladder cancer is the fourth most common cancer in men and the eighth in women, being an important public health issue. Methods:: Medical files of 155 patients (132M/ 23F) with urinary bladder cancer treated between 2006 and 2012 were retrospectively analyzed. The median age at diagnosis was 65 years (range: 19-85 years). Disease free survival (DFS) for patients with complete tumor resection receiving adjuvant treatment and progression free survival (PFS) for patients with post-operative residual disease was estimated. Results:The distribution of the stage disease was: 50 patients (32.2%) stage II, 47 (30.3%) stage III, 58 (37.4%) stage IV. Radical cystectomy was performed in 56 patients (36.1%), while 99 patients (63.9%) underwent repeated transurethral resection of the urinary bladder tumor (TURBT). Postoperative treatment included multimodal therapy in 47 patients (30.3%) (chemotherapy and external beam radiation), external beam radiation alone in 57 patients (36.8%) and chemotherapy alone (methotrexate, vinblastine, doxorubicin, and cisplatin-MVAC or gemcitabine+platinum) in 51 patients (32.9%). After a median follow-up of 31 months (range: 3-79 months), 51 patients (32.9%) presented local recurrence, 32 patients (21%) distant recurrence (metastases), 10 patients (6.4%) both local and distant recurrence, and 62 patients (40%) were free of disease. The median duration until progression was 27 months. Discussion:Despite the combined therapy approaches, urinary bladder carcinoma remains an aggressive disease, with a high relapse rate. Earlier diagnosis, aggressive radical surgery in intention to cure (cystectomy), and adjuvant multimodal treatment (radiotherapy and chemotherapy) are needed for survival improvement.

Outcome of urinary bladder cancer after combined therapies.

RATIONALE: Urinary bladder cancer is the fourth most common cancer in men and the eighth in women, being an important public health issue. OBJECTIVE: to assess the outcome of patients with urinary bladder cancer treated in an oncologic center. METHODS: Medical files of 155 patients (132M/ 23F) with urinary bladder cancer treated between 2006 and 2012 were retrospectively analyzed. The median age at diagnosis was 65 years (range: 19-85 years). Disease free survival (DFS) for patients with complete tumor resection receiving adjuvant treatment and progression free survival (PFS) for patients with post-operative residual disease was estimated. RESULTS: Stage disease's distribution was: 50 patients (32.2%) stage II, 47 (30.3%) stage III, 58 (37.4%) stage IV. Radical cystectomy was performed in 56 patients (36.1%), while 99 patients (63.9%) underwent repeated transurethral resection of the urinary bladder tumor (TURBT). The postoperative treatment included multimodal therapy in 47 patients (30.3%) (chemotherapy and external beam radiation), external beam radiation alone in 57 patients (36.8%) and chemotherapy alone (methotrexate, vinblastine, doxorubicin, and cisplatin-MVAC or gemcitabine + platinum) in 51 patients (32.9%). After a median follow-up of 31 months (range: 3-79 months), 51 patients (32.9%) presented local recurrence, 32 patients (21%) distant recurrence (metastases), 10 patients (6.4%) both local and distant recurrence, and 62 patients (40%) were free of disease. The median duration until progression was of 27 months. DISCUSSION: Despite combined therapy approaches, urinary bladder carcinoma remains an aggressive disease, with high relapse rate. Earlier diagnosis and an aggressive radical surgery with the intention to cure (cystectomy), and adjuvant multimodal treatment (radiotherapy and chemotherapy) are needed for survival improvement.