ABSTRACTS FOR THE NATIONAL CONGRESS OF ENCOLOGY

 

 Primary intestinal melanoma: insights into a rare gastrointestinal tumor

Iris-Iuliana Adam^1,2, B. Moldovan¹, V. Untaru³, Liliana Vecerzan^2,4

1. General Surgery Department, “Sf. Constantin” Hospital, Braşov, Romania

2. Faculty of Medicine, “Lucian Blaga” University of Sibiu, Romania

3. Anesthesia and Intensive Care Unit, “Sf. Constantin” Hospital, Braşov, Romania

4. Oncology Outpatient Clinic, Military Emergency Clinical Hospital Sibiu, Romania

 

Aim. Although malignant melanoma (MM) is primar ily a skin cancer, it is known that it can also appear in various other tissues, including the gastrointestinal (GI) tract. The distinction between primary GI melanoma and metastatic MM is difficult, but increasing evidence sug gests that some melanomas may originate directly from the GI tract, most likely from melanoblastic or neuroen docrine cells. These cases are generally more aggressive and are associated with a worse prognosis. Materials and method. We present the case of a 75yearold male patient with persistent abdominal pain, nausea, vomit ing, and significant weight loss. The initial lab investiga tions indicated moderate anemia. Computed tomography (CT) and positron emission tomography (PETCT) imag ing revealed a tumor mass located in the distal ileum. Endoscopic biopsy results were inconclusive, prompting exploratory laparotomy. A segmental ileal resection was performed laparoscopically, with manual anastomosis and partial cystectomy due to tumor invasion of the bladder wall. Intraoperative tissue samples were sent for

histopathological and immunohistochemical analysis. Results. The histopathological examination confirmed the diagnosis of primary malignant melanoma of the small intestine. Immunohistochemical staining showed positivity for SOX10, PRAME and HMB45, with negative results for CKAE1/AE3, CD56, BRAF and synaptophy sin. Signs of malignancy were identified in two of the 15 excised lymph nodes, leading to the decision to initiate adjuvant therapy with nivolumab. Although the surgical resection was complete, adjuvant chemotherapy is used in this case due to the disease not being strictly localized, aiming to reduce the risk of recurrence. Conclusions. Primary intestinal melanoma is a rare and aggressive gastrointestinal neoplasm. Given the reserved progno sis and the difficulty in differentiating it from metastatic melanoma, immunohistochemical analysis is essential for an accurate diagnosis.

Keywords: primary intestinal melanoma, gastroin testinal melanoma, rare tumors, intestinal malignancy, hemorrhagic tumor

 

 

 

 

Current screening in early diagnosis of colorectal cancer in patients with previous risk factors

Carmen Anton^1,2, Mihaela Dimache^1,2, A. Cemîrtan¹, Oana Timofte^1,2, Elena Gologan², Sorana Anton², D. Andronic^2,3

1. Institute of Gastroenterology and Hepatology, “Sf. Spiridon” County Emergency Clinical Hospital, Iaşi, Romania

2. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

3. Clinic I Surgery, “Sf. Spiridon” County Emergency Clinical Hospital, Iaşi, Romania

 

Introduction. The International Agency for Research on Cancer (IARC) estimates that by 2040 the incidence of colorectal cancer (CRC) will increase to 63%, with a death rate of 73%. GLOBOCAN 2020 state that colo rectal adenocarcinoma is the third most common form of cancer, being the second cause of mortality in the world (and in Romania), after lung cancer. Materials and method. Current screening of CRC includes people around 45 years old with alarm signals (lower gastro intestinal bleeding, chronic anemia, intestinal transit disorders, abdominal pain, familial history of CRC, FAP and inflammatory bowel disease [IBD]). The diagnosis involves digital rectal examination with flexible rec tosigmoidoscopy for anorectal and left colonic tumors, total colonoscopy being the gold standard investigation, with 97% sensitivity, that provides histological confir mation by biopsy in malignant tumors or synchronous cancer and allows polypectomy. Results. Biological tests

suggestive of karyokinesis indicate iron deficiency ane mia, occult bleeding (FIT and the increase of the tumor markers AFP, CA199, CEA are particularly useful for monitoring treated CRC). Abdominal ultrasound visual izes liver metastases, and CT, MRI, echoendoscopy and immunoscintigraphy with monoclonal antibodies are the methods used for staging CRC before surgical and oncological treatment. Genetic testing of tumor DNA markers in stool is recommended in genetic syndromes (FAP, Turcot syndrome). Conclusions. The colonosco pic early diagnosis of CRC is essential in patients with adenomatous polyps and IBD, increasing the survival rate. CRC is more frequent in men over 60 years of age. Abdominal ultrasound, CT or MRI are the imaging in vestigations recommended in the staging of CRC before surgical and oncological treatment.

Keywords: colorectal cancer, screening, early diagnosis

A rare case of vulvar leiomyoma in a patient with multicentric breast cancer

C. Bacalam, O. Bochis

Medical Oncology Department, “Prof Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

Background. The detection of incidental masses in patients with multicentric breast cancer, such as vulvar leiomyoma, is uncommon and can complicate the di agnostic process. Vulvar leiomyomas represent 0.03% of all gynecological tumors. This report describes the unexpected discovery of a vulvar leiomyoma in a patient undergoing staging, initially suspected to be metastatic. Case presentation. A 62yearold woman presented with a neglected large breast tumor, raising clinical suspicion for advanced breast cancer. A staging com puted tomography (CT) scan revealed an osteosclerotic pelvic bone lesion, raising concern for bone metasta sis. A whole-body positron emission tomography (PET) scan was used to assess the extent of the disease. The PET scan revealed no bone metastasis, but did detect a hypermetabolic left vulvar mass. Notably, the CT scan detected no vulvar abnormalities, and the lump was only

discovered after several clinical examinations. The mass was presumed to be a Bartholin cyst. A surgical excision and histological examination identified it as a vulvar leiomyoma. Discussion. Vulvar leiomyomas are extre mely rare, with few cases reported in literature. Their rare incidental discovery during cancer staging can cause diagnostic confusion in oncology, potentially leading to alterations in systemic therapy. Conclusions. This case illustrates a unique presentation of an incidentally dis covered vulvar leiomyoma in a patient with multicentric breast cancer. It highlights the importance of a compre hensive and multidisciplinary differential diagnostic approach in the oncologic assessment of patients with multicentric breast malignancies to avoid misdiagnosis and guide the appropriate treatment approach.

Keywords: vulvar leiomyoma, differential diagnosis, vulvar mass, case report

 

 

 

 

Impact of chemoradiation on the quality of life of women diagnosed with cervical cancer

Maria-Alexandra Barbu

Department 8 Radiology, Oncology, Hematology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest; MedEuropa Center of Oncology and Radiation Therapy, Bucharest, Romania

Introduction. Cervical cancer is a significant public health concern worldwide, particularly in low and mid dleincome countries, although the primary cause of this type of cancer is a preventable and treatable disease: HPV infection. The quality of life (QoL) of patients diagnosed with cervical cancer is an important assessment for per sonalizing treatment and providing better care during the active treatment and for the follow-up years. Materials and method. A prospective study was conducted in two cancer care institutions in Bucharest from January 2023 to January 2024, and a total of 111 women diagnosed with locally advanced cervical cancer were included. The survey consisted of four parts: the first section included demographic information of women, the second section consisted of clinical characteristic, the third section was the FACT G questionnaire, and the fourth section – the

FACT G questionnaire six weeks after finalizing the treat ment plan. For statistical analysis, SPSS v16.0 was used. Each scale of FACT G score was dichotomized into prob lematic and nonproblematic. Results. Almost all patients experienced G1/G2 acute toxicity; the stage at diagnosis was statistically significant, with most patients diagnosed with stage III cervical cancer. The rural area of living, poor economic status and older patients had a negative impact on overall quality of life. Conclusions. More than half of our patients had a good QoL score at the beginning of treatment, and 10% experienced an improvement in symptoms after finishing it. The disease stage at diag nosis did not significantly correlate with the severity of adverse events during treatment.

Keywords: cervical cancer, chemoradiation therapy, quality of life

Neurofibromatosis type I – a genetic pathology with high oncological risk

Anca-Mirela Bârdan, Miruna-Floriana Triţă

Medical Genetics, Personal Genetics SRL, Bucharest, Romania

Objective. Importance of genetic testing and inter disciplinary management in neurofibromatosis type 1. Introduction. Neurofibromatosis type 1 is one of the most common hereditary neurocutaneous syndromes with a predisposition to numerous tumors, represented pathognomonically by neurofibromas. Although these are normally benign, they are at risk of malignancy. Materials and method. A 45yearold female patient presented to genetic counseling with a suggestive pheno type: caféaulait spots that appeared in childhood and multiple painful cutaneous neurofibromas that appeared in adulthood. Personal history: surgically resected lung carcinoma and hysterectomy. Heredocollateral ante cedents: the mother and sister had multiple caféau lait spots and cutaneous neurofibromas. The diagnosis was clinically suspected following genetic counseling, and it was molecularly confirmed by genetic testing. Results. A heterozygous NF1 pathogenic variant was

identified: c.7869+1G>A. As a result of the diagnosis, the patient received recommendations for multidis ciplinary monitoring and cascade testing of the first degree relatives. Following these, the patient’s sister was molecularly confirmed with the same variant. She received genetic counseling and guidance for her daugh ter’s testing. Conclusions. Neurofibromatosis type 1 is a genetic pathology with multisystemic involvement. NF1 gene mutations lead to disruption of the RAS path way, a known mechanism in tumorigenesis, therefore patients have an increased risk of malignancy during their lifetime. Neurofibromas can be treated with vari ous chemotherapy strategies, but show drug resistance, leading to poor overall survival rates. As a result, the management of the patient with neurofibromatosis type 1 is a multidisciplinary one.

Keywords: neurofibromas, malignant risk, RASopathies, molecular testing

 

 

 

 

 

Metastatic intrahepatic cholangiocarcinoma in a young patient: a multidisciplinary approach to the

case

Maria-Diana Bejan¹, Adina-Emilia Croitoru^1,2, Vlad Croitoru¹, Irina Cazacu-Croitoru^1,2, Monica Miron¹

1. Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

The fiveyear survival rate for cholangiocarcinoma (CCA), a relatively uncommon neoplasm, is between 18% and 23% for localized disease and between 2% and 3% for metastatic disease. Negative prognostic factors include lymphovascular invasion (LVI) and lymph node meta stasis. We present the case of a 53yearold female pa tient who was investigated for right hypochondriac pain and elevated liver enzymes. CT and MRI scans revealed an intrahepatic, subcapsular, 52/72/40 mm tumor mass in segments VVI. Hepatectomy of segment VI extended to segment V was performed, with histopathologic find ings suggesting a liver metastasis of neuroendocrine tumor (NET), intermediate grade (G2), LVI+. However, immunohistochemistry revealed the diagnosis of intra hepatic CCA, G2, LVI+ and pT3. The patient presented to the oncology department three months after the sur

gery, and a complete imaging evaluation was performed, which revealed a single pulmonary metastasis. The mul tidisciplinary team decided to perform lung surgery and initiate palliative chemotherapy. During followup, liver metastases were detected, for which the multidiscipli nary team decided to perform stereotactic body radia tion therapy (SBRT). Three months after SBRT, a new liver metastasis led to the declaration of progressive disease, at which point the second line of chemotherapy was initiated. We also performed a liquid biopsy to check for the isocitrate dehydrogenase 1 (IDH1) mutation, but the results were negative. In summary, a multidiscipli nary approach and multimodal treatment are critical for the management of CCA.

Keywords: cholangiocarcinoma, metastasis, surgery, SBRT, liquid biopsy

Endoscopic submucosal dissection (ESD) of early epithelial cancers in the digestive tract: a new piece of the puzzle offering organ sparing curative resections

Andreea Bengus¹, Teona Amza¹, V. Drăgan¹, B. Mateescu^1,2, A. Voiosu^1,2

1. Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Introduction. Identifying early neoplastic epithelial lesions of the digestive tract is an ideal goal in oncology pa tient care, as it allows minimally invasive treatment with curative intent. This study describes our experience with endoscopic submucosal dissection (ESD) for neoplastic lesions regarding curative resection rate, adverse events, need for complementary treatment, and local recurrence rate. Materials and method. The study represents a retrospective analysis of data from a local tertiary center covering the period from 2022 to 2024, involving con secutive patients treated with ESD for early neoplastic lesions of the digestive tract. Results. We analyzed a total of 40 patients (24 men, mean age: 66 years old). The le sions were located in the stomach (17.5%), colon (15%), and rectum (67.5%), having an average size of 11.4 cm². Histologically, 52.5% were adenocarcinomas, while the remaining were low and highgrade dysplasia. R0 resec

tion was achieved in 72.5% of cases. Three patients had adverse events: one had a perforation requiring an ex tended hospital stay, another had postprocedural bleed ing necessitating endoscopic reintervention, and the third patient had a perforation requiring surgical intervention. Following the decisions of the multidisciplinary team, 85% of patients required only endoscopic surveillance, while 15% of patients required additional treatment – four patients were referred for surgery, one for radiotherapy, and one for neoadjuvant radiochemotherapy followed by surgery. Conclusions. Endoscopic submucosal dissection for epithelial lesions of the digestive tract lesions is an organsparing alternative with excellent curative rates and low rate of adverse events, and should be offered as an option in highly selected cases.

Keywords: endoscopic submucosal dissection, early epithelial cancer, organ sparing

 

 

 

 

One patient, two different breast cancer tumors

Maria-Silvia Berdeli

“Elias” Emergency University Hospital, Bucharest, Romania

I am bringing to your attention a case of on old patient of our clinic, suffering from metastatic HERpositive left breast cancer and right metastatic TNBC, revealing chal lenges with the adverse effects of the treatment, along with our experience in treating a patient with a long survival with a metastatic disease. A 70-yearold female, with no significant personal or family history, was diagnosed in 2012 with invasive breast carcinoma of the left breast, cT4bN2Mx, ER positive, PGR negative and HER2 posi tive. The patient received preoperative chemotherapy and underwent radical mastectomy – ypT2N0M0 and locore gional RT, and in 2013 the adjuvant treatment with tras tuzumab + aromatase inhibitor was initiated, with good toleration. A PETCT was performed on the following year that revealed a bone lesion (on the right iliac bone), also confirmed by MRI, and the biopsy came back negative, showing a benign lesion. Regardless, bisphosphonates were added to the treatment plan, until 2016, when dis continued due to dental problems. In 2018, a bone scin tigram revealed progression of the bone metastasis, and the patient received palliative RT for the bone metastasis located on the right iliac bone. In January 2019, on a fol lowup mammography, a lesion of 2.5 cm was discovered in the right breast (BIRADS 4), confirmed by MRI (two separate lesions, the largest one of 2.27/0.8/2 cm, with two intramammary lymph nodes – BIRADS 5). The his topathological and immunohistochemical and molecular assay revealed invasive breast carcinoma pT2pN0 ER, PGR,

HER 2 negative, Ki67= 3035%, BRCA 1, 2 negative. The patient received surgical and adjuvant treatment (radi cal mastectomy of the right breast and ALND followed by six cycles of AC), with no evidence of disease (inactive bone lesions on PETCT). In October 2021, a PETCT scan showed progression through bone metastasis, and one of the metastases located on the L3 vertebra was biopsied – invasive breast carcinoma NST ER, PGR, HER2 negative, Ki67=10%. The PDL1 testing of the initial biopsy from 2019 was negative. The patient was administered pallia tive RT on the affected levels, followed by chemotherapy with capecitabine and osteoclasts inhibitor (amelioration of the dental problems). Six months later, a bone scinti gram revealed progression of the disease through bone metastasis and, unfortunately, the biopsy from one of the lesions that was not irradiated came inconclusive. After 10 administrations of taxanebased chemotherapy, the patient presented with severe peripheric neuropathy and also with mandibular osteonecrosis. Managing adverse effects of the oncological treatment in a multidisciplinary team increases the patient’s chance to continue the best choice of treatment for every particular case or to prevent/ intervene as quickly as possible for a better result. Also, living with metastatic disease is an ongoing fight, and con stant followups and a good compliance to treatment can sometimes lead to a spectacular survival, like in this case. Keywords: adverse effects, HER2 positive, TNBC,

bone metastasis

Peritoneal mesothelioma: a case with multiple surprises

A.G. Berescu

Oncology Department, “Elias” Emergency University Hospital, Bucharest, Romania

Background. Peritoneal mesothelioma is a rare can cer, associated with asbestos exposure. It is the second most frequent site of mesothelioma, after the pleural one. The main symptoms are ascites, pain and an abdominal mass. It extends in the abdominal cavity and rarely me tastasizes. Materials and method. A 78yearold male presented to the surgery department for an abdominal mass on the median line, situated above the umbilicus, with high consistency, painless, about 10 centimeters in diameter, that had grown for the past months. It was catalogued as an eventration. Preoperatively, an abdomi nal and pelvic computed tomography (CT) with contrast and an abdominal and pelvic magnetic resonance imag ing (MRI) were performed. Both described the abdomi nal wall eventration, and adjacent to it some nodules and nodules in the liver and spleen. Surgery was per formed, which described a tumoral mass that belonged to the greater omentum, multiple nodules adjacent to the tumor, and peritoneal carcinomatosis. The histo pathological diagnosis was peritoneal mesothelioma,

epithelioid type. Due to the low incidence of metastasis of this cancer, the patient was referred to the infectious disease department, to exclude a parasitic disease. But the patient was also diagnosed with hepatitis B. Bone scintigraphy was performed. A bone metastasis to the sternum was found, but the patient also suffered a trau ma there a few days before. Results. The case was evalu ated in the oncological board, and the patient started the treatment with carboplatin and pemetredxed. The specialized literature reveals that the epithelioid type responds well to chemotherapy, so immunotherapy is not necessary. Conclusions. The presented case shows that peritoneal mesothelioma could be a disease difficult to diagnose. This case has other many particularities: the presence of hepatic metastasis and the possibility of bone metastasis, the good performance status of the patient, the absence of pain and ascites, and the absence of asbestos exposure.

Keywords: peritoneal mesothelioma, eventration, hepatitis

 

 

 

 

Clinical experience with tebentafusp in metastatic uveal melanoma

Raul Bradea, Claudia Burz

“Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

Metastatic uveal melanoma is a disease that is dis tinct from cutaneous melanoma. With a low tumor mutational burden and a oneyear overall survival of approximately 50%, metastatic uveal melanoma is as sociated with poor prognosis and few treatment options. Tebentafusp has transformed the treatment paradigm for metastatic uveal melanoma, being the preferred frontline agent for HLA-A*0201positive patients, based on overall survival benefits seen in large phase III clinical trials. This novel bispecific antibody targets a specific HLA-A*02:01/gp100 complex, activating both CD4+/CD8+ effector and memory T cells that induce tu mor cell death. Tebentafusp is administered to patients by intravenous infusion daily or weekly, depending on the indication. The most common treatmentrelated ad verse events are cytokinemediated events (due to Tcell

activation) and skinrelated events (due to glycoprotein 100positive melanocytes), including rash, pyrexia and pruritus. These adverse events are decreased in inci dence and severity after the first three or four doses. The cytokine release syndrome which can occur is recognized as being lifethreatening. We present a review of the clinical experience of 12 patients who started treatment with tebentafusp in our hospital, this novel therapy be ing available in an “earlyaccess” program that started in May 2023. We followed the patients to detect clinical safety and tolerability, the rate of response, the rate of adverse reactions, and progressionfree survival. Data on overall survival are immature, some of the patients being still under this treatment.

Keywords: uveal melanoma, tebentafusp, bispecific antibody, novel therapies

Stochastic analysis of MMR proteins and KRAS in biological fluids for pathological features prediction in colorectal adenocarcinoma patients

Alexandru-Adrian Bratei¹, Raluca-Ioana van Staden²

1. Pathology Department, “Dr. Carol Davila” Clinical Hospital of Nephrology, Bucharest, Romania

2. Analytical Department, Polyethnic National University of Science and Technology, Bucharest, Romania

 

Aim. In our studies, we aimed to develop a new screen ing method based on stochastic microsensors that allows simultaneous determination of selected biomarkers in a short time (minutes), at a low cost, without requir ing expensive and sophisticated equipment in whole blood, saliva and urine samples, in order to evaluate and predict main pathological features in adenocarcinoma patients. Materials and method. Stochastic microsen sors have been developed and validated for each bio marker. Biological samples have been obtained from 116 colorectal adenocarcinoma patients (107 whole blood samples, 88 urine samples and 79 saliva samples). The levels of five biomarkers (MLH1, PMS2, MSH2, MSH6 and KRAS) were determined using stochastic sensors. The five biomarkers’ levels were analyzed to find correla tions, and mathematical criteriabased algorithms were elaborated to allow a fast evaluation of the pathological

features in colorectal adenocarcinoma patients. As the elaborated algorithms are mathematicalbased, they can be solved by using programming, and a Matlab code was developed. Results. By using the five proteins’ levels, we developed algorithms for the differentiation between gastric adenocarcinoma and colorectal adenocarcinoma, for the prediction of gross aspect and tumor dimensions, for the presence of mucus, for the tumor invasions, for the presence of tumor deposits, and for the evaluation of metastases developing risk. Conclusions. The levels of the four main MMR proteins and KRAS in whole blood, urine and saliva samples allow both the differentiation between gastric and colorectal adenocarcinomas and the evaluation of clinicopathological features in colorectal adenocarcinoma patients.

Keywords: stochastic sensors, pathological features, colorectal adenocarcinoma, bioanalysis

 

 

 

 

The other face of immunotherapy. Case report of two immune-mediated toxicities under treatment with pembrolizumab

Ioana-Roxana Cârlan, Eva-Maria Cojocaru, Elena-Rodica Gafton, Ana Muntenaşu, Larisa-Maria Rotariu, Maria Tomulesei

Medical Oncology Department, Regional Institute of Oncology Iaşi, Romania

Introduction. Immunotherapy has changed the para digm of cancer treatment in recent decades, leading to unprecedented benefits in terms of patients’ life expec tancy, especially for those with lung cancer. However, immunerelated adverse effects (irAEs) have also in creased with the exponential increase in the use of ICIs, and this requires specialized management and can affect the patients’ quality of life, and may even disrupt cancer therapy. Case presentation. A 63yearold female, with no significant personal medical history, was diagnosed in July 2021, following a routine chest Xray and subse quent chest CT, with a nodule in the upper left lung lobe. Further investigations confirmed the presence of stage IV lung adenocarcinoma (cT3N3M1a), ALK negative, EGFR wildtype, and PDL1 30%. Chemoimmunotherapy with pemetrexed, carboplatin and pembrolizumab was initiated. On the third cycle, the patient developed an erythematous, pruritic and mildly painful rash on the neck and anterior thorax (grade 1 rash). Topical corti costeroids were initiated after a dermatological consul tation, resulting in partial lesion resolution. After the fourth cycle, the CT scan showed a partial response to the treatment, but the assumption of pembrolizumab

induced dermatitis was considered, as the patient pre sented with a grade 3 maculopapular rash. Therefore, corticosteroid treatment was initiated, and the chemo immunotherapy was discontinued. Three weeks later, the patient presented with asthenia, extreme fatigue, grade 3 dyspnea and productive cough. A cardiology con sultation was performed (normal cardiac function and no evidence of pulmonary embolism). A chest CT scan revealed extensive bilateral “groundglass” infiltrates, raising the suspicion of immunemediated pneumonitis. High-dose corticosteroids were administered, leading to the remission of the respiratory symptoms and the im provement of the general condition. Pemetrexed mono therapy was continued for approximately eight months, with good clinical tolerance and no further toxicities. Conclusions. Although immunotherapy has earned its place in terms of effectiveness and there is evidence sug gesting a correlation between the occurrence of irAE and the effectiveness of the treatment, the adverse effects must be considered and managed as quickly as possible, because some of them can be lifethreatening.

Keywords: immunotherapy, toxicities, dermatitis, pneumonitis

Trick or treat? Approaching difficulties in gastric adenocarcinoma management. A case report

G. Ceapă

“Elias” Emergency University Hospital, Bucharest, Romania

Materials and method. We used the information from the database of the Medical Oncology Ward of the “Elias” Emergency University Hospital, Bucharest, Romania. Objective. This article describes the man agement of a case of gastric adenocarcinoma with its challenges regarding the diagnosis of certitude, treat ment protocols and toxicities. Results. We present the case of a 53yearold Caucasian male, with locally advanced gastric adenocarcinoma, HER2+, pMMR, who underwent surgery and six out of eight cycles of peri-surgical chemotherapy, with complete response to treatment, then he neglected the oncological followup. After two years, he presented to the emergency room with jaundice, due to an invading tumoral mass. He

underwent palliative surgical management and biop sies, which confirmed the relapse – negative for HER2, pMMR. The imaging revealed metastases in the liver and lymphatic nodes. He started the systemic treat ment for recurrent disease, with multiple challenges regarding the treatment options and adverse events. Throughout the treatment, he preserved his quality of life. Conclusions. In this case report, we underline the relevance of a tumor board, the difficulty of treatment choices, the close followup, the palliative care and the management of adverse events in patients with gastric adenocarcinoma.

Keywords: gastric adenocarcinoma, tumor board, case presentation

 

 

 

 

 

Financial toxicity in breast cancer patients treated with radiation therapy – a cross-sectional study

Monica-Emilia Chirilă^1,2, Renata Zahu^1,3

1. Amethyst Radiotherapy Center Cluj-Napoca, Romania

2. Mvision AI, Helsinki, Finland

3. “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

 

Background. Cancer patients benefit of publicly reimbursed investigations and treatments. However, there are additional costs that are not covered by insur ance. The aim of this study was to assess the outof pocket expenses of breast cancer patients. Materials and method. An online questionnaire was sent to fe male breast cancer patients who completed radiotherapy with curative intent in Amethyst Radiotherapy Centers from ClujNapoca, Alba and Timişoara, Romania, in the period August 2023 – September 2024. Results. We received answers from 80 participants, with a median age of 50 years old (3582). The majority (N=70; 87.5%) lived in urban area, had an education level of at least high school (N=76; 95%), were married (N=60; 75%), and had Romanian ethnicity (N=76; 92.5%). Most of the respondents were employed at diagnosis (N=58; 72.5%), had public insurance only (N=76; 95%), and an income ranging from 2000 to 5000 RON (N=49; 61.25%). All patients received radiation therapy as part of their mul

tidisciplinary treatment, and almost all received surgery (N=79; 98.75%). Intravenous and oral treatments were mentioned by 47 (58.75%) and 57 (71.25%) patients, respectively. Outofpocket expenses of more than 2000 RON for each of the following categories (investigations, transport, accommodation and side effects’ treatment) were mentioned by 55 (68.75%), 41 (51.25%), 38 (47.5%), and 16 (20%) participants, respectively. Of the patients who were working before diagnosis, half came back full time and one third permanently ceased the previous activity. Onethird searched for financial support from friends and relatives, less than onefifth from the au thorities, and one in eight did not search for support, despite they needed it. Conclusions. Breast cancer pa tients face various financial challenges after diagnosis, having significant outofpocket expenses compared to their income.

Keywords: breast cancer, radiation oncology, finan cial toxicity

Is maspin influencing tumor behavior in poorly cohesive gastric carcinoma?

Ioana-Anastasia Cibotariu¹, Laura-Elena Stanciu¹, Mirela Cioplea¹, Bogdan Mastalier^2,3, Luciana Nichita³, Radu Ionescu¹, Răzvan Neagu¹, Diana-Maria Marinoiu¹, Adelin Bordea¹, Cristiana Popp¹

1. Department of Pathology, Colentina Clinical Hospital, Bucharest, Romania

2. Department of General Surgery, Colentina Clinical Hospital, Bucharest, Romania

3. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Background and objectives. Mammary serine pro tease inhibitor (maspin) was shown to function as a tumor suppressor. This study aims to identify the influence of maspin expression on tumor behavior. Materials and method. We evaluated ecadherin and maspin expression in 11 cases of poorly cohesive gastric adenocarcinoma, using a semi-quantitative analysis of the immunohisto chemical slides. Data were analyzed in correlation with tu mor morphology, Ecadherin expression and pathological and preoperative imagistic staging. Results. Ten men and one woman with locally advanced tumors (pT3-pT4b) and no preoperative oncologic therapy were included, three of them having distant metastasis and eight having lymph node metastasis. Among the nine Ecadherin positive

cases, 44.4% showed cytoplasmatic maspin positivity and one showed nuclear maspin positivity. Among the two ecadherin negative cases, one showed loss of maspin ex pression and the other retained cytoplasmatic positivity. Maspin deficiency was positively correlated with distant and local lymph node metastases, while maspin positivity was negatively correlated with indepth tumor invasion. Conclusions. There is a significant correlation between maspin expression patterns and tumor progression, re garding indepth invasion, lymph node invasion, and the presence of distant metastasis. Maspin deficient tumors have a more aggressive behavior.

Keywords: maspin, poorly cohesive gastric carcinoma, e-cadherin, tumor suppressor

 

 

 

 

 

Treatment approach in metastatic NSCLC with KRAS G12C mutation in the era of targeted therapies – case report

Maria-Loredana Ciontea¹, Elena-Adriana Dumitrescu^1,2, Crina-Maria Siminiceanu¹, Irina-Alexandra Chirea¹, Anca-Alexandra Stolojanu¹, Radu Matei¹, Adelina-Silvana Gheorghe^1,2, Sânziana Prundianu¹, Ioana Geală¹, Dana-Lucia Stănculeanu^1,2

1. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

The KRAS G12C mutation is found in 13% of lung adenocarcinomas. First considered undruggable, now we dispose of KRAS G12C inhibitors such as sotorasib and adagrasib. However, the resistance installs rapidly. We present the case of a 47yearold patient, a former smo ker diagnosed with lung adenocarcinoma in March 2024, after a bronchoscopy with biopsy. The histopathologi cal and immunohistochemistry evaluation confirmed the diagnosis and revealed PDL1 status negative. The molecular biology identified only KRAS G12C mutation. CT scan exposed a large tumor mass in the left lung and multiple metastases in both pulmonary regions, liver, and mediastinal and hilar adenopathies. The treatment started in April 2024 with pembrolizumab 200 mg, pem etrexed 500 mg/m2 and carboplatin AUC 5. The treat ment was always administered with adjournment due to priority concerns that required proper interventions such as hematological abnormalities (severe anemia,

severe thrombocytosis), cardiovascular comorbidities (cardiac tamponade, atrial fibrillation), and thoracic emergencies (pleural effusion). At long last, he succeeded in receiving six series of chemoimmunotherapy, and he went into imagistic reevaluation. The results weren’t promising, the primary tumor mass progressed in di mension, and mediastinal adenopathies tended to form bulky nodes, which worsened the respiration and led to desaturation and the necessity of oxygen supply. In conclusion, we are searching for the best treatment ap proach due to this aggressive behavior of the disease. Considering that KRAS G12C mutation was identified, there is a promising opportunity for using KRAS G12C inhibitors in this challenging context, with a median progressionfree survival of 5.4 months and a median overall survival of 13 months for sotorasib.

Keywords: lung adenocarcinoma, KRAS G12C muta tion, targeted therapy

Metastatic colorectal cancer: the importance of multidisciplinary collaboration

M.F. Coadă, I.M. Cazacu-Croitoru, V.M. Croitoru

Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania

The management of colorectal cancer (CRC) is com plex, particularly in metastatic disease, where the defi nition of disease burden, the assessment of radiological response, and the identification of the right timing for potential radical surgery are crucial. We report the case of a 64yearold male patient investigated for anemia and significant asthenia, and diagnosed with a rec tosigmoid junction lesion during colonoscopy. The sub sequent biopsy results indicated a welldifferentiated adenocarcinoma, MSS, RAS wild type, with staging CT and MRI scans showing multiple liver lesions. After multidisciplinary team (MDT) discussions, the systemic treatment with an EGFR inhibitor (panitumumab) and mFOLFOX6 was initiated. Following a bowel obstruction and surgical intervention, complications arose, causing a delay in systemic treatment. Upon resuming therapy, a partial response was noted after four months. Despite

the multidisciplinary team’s suggestions for surgery on liver metastases, the patient chose to continue with the systemic treatment. After a year, minimal progression was observed in liver metastasis, and the MDT suggested liver metastasectomy once more, prompting a success ful liver metastasectomy. However, two new hepatic metastases were identified in the most recent imaging assessment, four months postsurgery. As a result, the MDT decided to reintroduce mFOLFOX6 alongside the antiVEGF agent bevacizumab. This case highlights the significant role of multidisciplinary collaboration and the clinical challenge in managing complex colorectal tu mors to achieve the best possible outcomes for patients. Keywords: metastatic colorectal cancer, RAS wild type, EGFR inhibitor, partial response, bowel obstruc tion, surgery, multidisciplinary approach, tumor recur

rence, antiVEGF agent

Clinical case – clear cell metastatic chondrosarcoma with complete response to chemotherapy

Simina Condruz

Medlife Hospital Braşov, Romania

Chondrosarcomas are rare tumors that occur in adults and the elderly, being usually treated surgically, present ing a low potential for metastasis, and being considered radio and chemoresistant tumors. Dedifferentiated chon drosarcomas are tumors with a more aggressive behavior, that can also affect younger patients, and have a greater potential for metastasis, the diagnosis and treatment be ing difficult because of the small number of cases. The presented clinical case is of a 32yearold patient with a positive biopsy for dedifferentiated chondrosarcoma of the right calcaneus. Amputation of the right lower limb was performed, the histopathological examination and immunohistochemistry suggesting the histology of clear cell chondrosarcoma. The CT scan three months postoperatively revealed two new pulmonary nodules suspect for malignancy. The subsequent PETCT evalu ation confirmed the bilateral pulmonary metastasis and mediastinal lymph nodes metastasis. Due to the aggres

sive behavior of the disease, the case was interpreted as a dedifferentiated chondrosarcoma. The treatment and prognosis of dedifferentiated chondrosarcoma are similar to those of osteosarcoma, the patient being treated with curative intent. Four cycles of doxorubicin/cisplatin were administered, the patient presenting important digestive toxicity which imposed lowering of the chemotherapy doses. The imaging reevaluation revealed partial response in lung lesions. An atypical resection of the lung nodule in the middle lobe was performed, and the histopathological exam showed complete response. The complete response of the other metastatic lesions was confirmed by PETCT. Two additional chemotherapy cycles to consolidate the response were presented as a treatment option, but the patient prefered surveillance. The complete response was maintained at the next evaluation.

Keywords: chondrosarcoma, osteosarcoma, pulmo nary metastasis, chemotherapy

Case report: a rare case of colorectal cancer diagnosed in a young pregnant woman – management and evolution

Bianca-Andreea Coţovanu¹, Florina Buică^1,2

1. Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania

2. “Titu Maiorescu” University, Bucharest, Romania

 

Introduction. Colorectal cancer in a young pregnant woman is a rare occurrence in clinical practice, with symp toms that are difficult to interpret, a poor prognosis, and a significant psychological impact. Case presentation. A 40yearold pregnant woman (28 weeks of gestation) presented to the emergency room with severe abdominal pain and constipation for about a week. An emergency caesarean section was performed due to the suspicion of an obstetric emergency, but a tumor was discovered in the sigmoid colon, invading the adnexal and uterine re gions. A radical rectosigmoid resection was subsequently performed. Following surgery, the patient was referred to our oncology department, where specific therapy with capecitabine and oxaliplatin was initiated. After an ap proximately 18month diseasefree interval, the imaging revealed the appearance of a peritoneal carcinomatosis

nodule, which was surgically excised. Given the meta static stage, palliative chemotherapy with FOLFOX and panitumumab was recommended. Nine months later, the disease progressed with new peritoneal, parietal and right adnexal lesions, prompting a restart of FOLFOX with panitumumab. During panitumumab administra tion, the patient developed significant cutaneous toxicity, leading to a temporary halt in treatment in the present. Conclusions. Detecting colorectal cancer in a pregnant woman is an unexpected event, often diagnosed late due to symptoms that can be attributed to normal pregnancy changes, resulting in advanced stages at discovery. The prognosis is poor, and the considerable toxicity of treat ment impacts the patient’s quality of life.

Keywords: colorectal cancer, pregnancy, case report, panitumumab

 

 

 

 

 

Cannabinoids for cancer pain: a systematic review and meta-analysis

Ioana Creangă-Murariu^1,2,3, Ioana-Irina Rezuş^1,2, Teodora Alexa-Stratulat^2,3, Roshanak Karami^1,4, Anett Rancz¹, Dániel Sándor Veres⁵, Maria Anne Engh¹, Mahmoud Obeidat¹, Ştefania Bunduc^6,7, Bogdan-Ionel Tamba², Péter Hegyi^1,8,9

1. Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

2. Advanced Center for Research and Development in Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

3. Regional Institute of Oncology, Iaşi, Romania

4. Faculty of Pharmacy, Semmelweis University, Budapest

5. Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary

6. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

7. Digestive Disease and Liver Transplant Center, Fundeni Clinical Institute, Bucharest, Romania

8. Institute for Translational Medicine, Medical School, University of Pécs, Hungary

9. Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary

 

Introduction. Most cancer patients are diagnosed with advanced disease, which is associated with dis tressing symptoms, pain being the most debilitating, with a great impact on the quality of life. Cannabinoids are a class of drugs intensively studied for their analge sic properties; however, they still lack clear indications for cancer patients. Our aim is to investigate the safety and efficacy of cannabinoids for analgesia in advanced cancer patients. Materials and method. The study pro tocol was registered on PROSPERO (CRD42023479375), and a systematic search was conducted using three main databases. Interventional and observational articles, where cancer patients were administered any type of cannabinoid for pain, were eligible for analysis. The mean difference between the baseline and afterinter vention values of symptom intensity were assessed, for which weighted means and pooled proportions were calculated with a 95% confidence interval (CI) and a randomeffects model. Results. After titleabstract

and fulltext selection, 96 articles were found to be eli gible. Pain was assessed using different symptom rat ing scales (0: the best; the highest number: the worst). The preliminary results reveal that analgesia greatly depends on the THC and CBD content. Patients receiv ing THCbased drugs had a decrease in pain of 1.27 (2.12 to 0.43; 95% CI), CBDbased drugs decreased

pain with 0.92 (1.97 to 0.13; 95% CI), whereas drugs which combined different ratios of THC and CBD failed to conduct to clinically relevant analgesia, the mean difference from baseline being 0.38 (0.7 to 0.06; 95% CI). Conclusions. Cannabinoids could be beneficial for cancer patients experiencing pain. However, the effects may vary significantly depending on the type of cannabinoid, dosage and form of administration. These preliminary results need to be followed by further analysis, so proper indications/contraindications of the drugs can be suggested.

Keywords: cannabinoids, cancer pain, data review

The potential role of gut microbiome composition as a predictor of response to chemotherapy in colon cancer: a pilot study

Ana-Maria Dudău¹, E. Nedea², Adina-Emilia Croitoru³

1. “Titu Maiorescu” University, Faculty of Medicine, Bucharest, Romania

2. Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania

3. Medical Oncology Department, Fundeni Clinical Institute, Bucharest, Romania

 

Objective. Finding predictive markers for response to chemotherapy in patients with advanced colon cancer by looking for potential associations between gut mi crobiome composition, both pre and posttherapy, and treatment response. Materials and method. Exclusion criteria: antibiotic treatment in the last 30 days; cur rent infections; diabetes; previous abdominal surgical procedures. Inclusion criteria: stage IV colon cancer pa tients before starting chemotherapy with FOLFOX (fo linic acid, fluorouracil and oxaliplatin) and antiEGFR/ antiVEGF agents. The bacterial composition will be defined based on the purified bacterial AND sequence from ~250 mg of feces. Biological specimens (feces) will be prospectively selfcollected by the enrolled patients before starting the treatment. After the imaging evalu ation performed after three months from the start of chemotherapy, at least 15 patients will be categorized

into one of the two cohorts (responsive or refractory/ progressive). At this point, patients will selfcollect their second biological specimen within a few days of the imaging evaluation. The 16S ribosomal gene of the bac terial genome, whose sequence allows to discriminate between different taxonomic groups, will be amplified by PCR. A series of bioinformatics programs will be used to extract DNA sequences, as well as to identify and cal culate the proportions of different bacterial taxonomic groups. Various parameters specific to bacterial ecology (“richness”, alpha, beta diversity, etc.) will be calculated. Perspective. This study aims to identify predictive markers for the response in relation to therapy in ad vanced colon cancer, such as the effects of this therapy on the gut microbiome.

Keywords: colon cancer, chemotherapy, gut micro biota, biomarker

 

 

 

 

Pseudomyxoma peritonei and the role of HIPEC in its management – case study and literature review

A. Evanghelides¹, Andra-Maria Stancu², T. Pătraşcu¹, D. Georgescu¹

1. First Surgical Department, “Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania

2. Oncology Department, Fundeni Clinical Institute, Bucharest, Romania

 

Objective. Pseudomyxoma peritonei (PMP) represents a rare clinical entity characterized by the dissemina tion of mucinous tumors throughout the peritoneal cav ity. This article aims to demystify PMP by elucidating diagnostic dilemmas and exploring the role of hyper thermic intraperitoneal chemotherapy (HIPEC) in its management. Materials and method. We present a case study of a 49yearold female patient who initially underwent an extensive surgical procedure to address a cystic tumor measuring approximately 30 cm. The tumor occupied the entire peritoneal cavity, involving the right ovary and appendix. Histopathological analy sis revealed a lowgrade mucinous neoplasm (LAMN) with extensive infiltration of the appendiceal wall and a secondary lowgrade mucinous tumor in the right ovarian location. Additionally, microscopic examina tion detected a lowgrade mucinous tumor metastasis in the left ovary and mucinous deposits at the peritoneal parameters, classified as pT4aM1b. Following delib

erations within the oncology committee, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) was determined as the further treatment approach. Discussion. In addition to the case presentation, a comprehensive literature review is conducted to provide insights into the diagnostic mo dalities and therapeutic strategies employed in PMP management. Emphasis is placed on the evolving role of HIPEC as a promising adjunctive treatment modal ity, aiming to eradicate residual tumor cells and im prove patient outcomes. Conclusions. Through this integrated approach of case presentation and literature review, we aim to enhance the understanding of PMP among clinicians and underscore the significance of timely diagnosis and appropriate management strate gies, including the utilization of HIPEC in optimizing patient care and prognosis.

Keywords: HIPEC, Pseudomyxoma peritonei, diagnos tic, management

The role of multidisciplinary collaboration in colorectal cancer management: a case report highlighting the impact of poor communication

C.V.I. Feier, S. Olariu

First Surgery Clinic, “Pius Brînzeu” County Emergency Clinical Hospital, Timişoara, Romania

Multidisciplinary collaboration is essential in the management of colorectal cancer, ensuring accurate di agnosis and appropriate treatment decisions. This case report illustrates the challenges arising from inadequate communication between surgical, pathological and on cological teams. We present the case of a patient who, following colorectal surgery, received a diagnosis of ade nocarcinoma G2 T4aN2b V1 R1, indicating an advanced stage and suggesting the need for further surgical inter vention. However, upon closer evaluation and multidis ciplinary discussion, it was revealed that the diagnosis was erroneous, primarily due to a lack of coordinated communication between the surgeon, pathologist and oncologist. The patient was initially recommended for

unnecessary surgical reintervention based on this mis communication. This case emphasizes the importance of a cohesive, interdisciplinary approach in cancer care, where all specialists involved actively contribute to the diagnostic and therapeutic decisions. Such collaboration not only improves patient outcomes, but also prevents avoidable interventions that may lead to increased mor bidity. This report serves as a reminder of the critical role of effective communication and teamwork in providing highquality oncological care, ultimately highlighting the need for streamlined protocols to avoid diagnostic errors and ensure optimal patient management.

Keywords: colorectal cancer, multidisciplinary col laboration, prognosis, postoperative management

 

 

 

 

Pancreatic head tumor diagnosed in a young patient known with viral hepatitis B – case study

A. Gal¹, Roxana Gal²

1. Faculty of Medicine and Pharmacy of Oradea, Romania

2. Bihor County Clinical Hospital, Romania

 

Introduction. Pancreatic tumor is a malignant formation with a reserved prognosis. Materials and method. A 34-yearold patient known to have viral hepatitis B presented to the emergency department of the Bihor County Clinical Emergency Hospital, Romania, exhibiting scleral and skin jaundice that had appeared approximately 24 hours before. Results. Upon admission, the patient presented with scleral and skin jaundice, hepatocellular syndrome, and he patic cholestasis. During the abdominal ultrasound, the gallbladder showed the presence of biliary sludge. Surgical consultation: jaundice of unspecified etiol ogy, chronic nonlithiasic cholecystopathy. During the hospitalization, the repeated tests revealed more pro nounced hepatocellular damage and cholestasis, which is why a native abdominal computed tomography (CT) was performed, revealing no significant changes. The patient’s condition continued to worsen, presenting with more pronounced scleral and skin jaundice, hepa tocellular lysis and ongoing cholestasis, necessitating further investigations with MR cholangiography, which indicated moderate dilation of intrahepatic bile ducts, a hydropic gallbladder and a dilated common bile duct (CBD) measuring 10 mm, with the caliber gradually re ducing until complete obstruction in the distal portion.

The Wirsung duct was dilated by 4 mm. At the level of the pancreatic head, there was suspicion of acute pan creatitis/pancreatic tumor. Subsequently, an abdominal CT scan with contrast was repeated, which revealed a hydropic gallbladder, a common bile duct measuring approximately 14 mm at the hilum with a sudden nar rowing distally, and an expansive tumor process in the pancreatic head. Tumor marker CA199>1200 u/l. Conclusions. 1) This type of cancer usually appears late in life, around the ages of 60 to 80. 2) The case pre sented is of a young patient, 34 years old, which raised a red flag particularly regarding the age of onset of such cancer. 3) The patient, known to have viral hepatitis B, was initially assessed for the possibility of reactiva tion of hepatitis B or a cholecystopathy. 4) Although in many cases a simple abdominal ultrasound resolves the diagnostic issue, in the presented case, in addition to the abdominal ultrasound and native CT, both a MR cholangiography and an abdominal CT with contrast material were necessary for a definitive diagnosis. 5) A periodic population medical screening could help in the early detection of such oncological conditions.

Keywords: pancreatic head tumor, viral hepatitis B, abdominal ultrasound, computed tomography, MR cholangiography

Surprising results in the management of HER2-positive, hormone receptor-positive breast cancer progressing to metastatic disease

Andreea-Ioana Geală¹, R. Matei¹, Anca Stolojanu¹, Crina Siminiceanu¹, Loredana Ciontea¹, Elena Dumitrescu¹, Sânziana Prundianu¹, Dana-Lucia Stănculeanu^1,2

1. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Corresponding author: Andreea-Ioana Geală, e-mail: ioana.geala99@yahoo.com

 

Introduction. HER2positive status is recognized as a critical prognostic and predictive factor in early breast cancer, playing a fundamental role in determin ing the appropriate and personalized systemic therapy. Case presentation. We present the case of a 52year old female who underwent primary surgery on April 23, 2014: left modified radical mastectomy with left axillary node dissection. The histopathological and im munohistochemical examination revealed ductal inva sive carcinoma, pT3pN2M0, stage IIIA, G2, ER=90%, PGR=70%, HER2+,(3+), Ki67=20%. Adjuvant chemo therapy was initiated: four cycles of docetaxel and cy clophosphamide. After that, radiotherapy of the chest wall was performed. Additionally, the patient completed adjuvant treatment with trastuzumab for one year, fol lowed by five years of hormonal therapy with tamoxifen and goserelinum (20152020). Two years later, the CT scan showed pulmonary, liver and lymphatic metastasis. Treatment was initiated with docetaxel, which was as

sociated with trastuzumab and pertuzumab. After six months, the PETCT showed regression of pulmonary and liver metastasis. Still, due to significant adverse effects, we stopped docetaxel (after eight cycles) and continued with trastuzumab + pertuzumab and hormo nal treatment with exemestane. Three months later, the disease progressed with brain metastasis, so the patient received palliative wholebrain radiotherapy (WBRT), and treatment with trastuzumab emtansine (TDM1) was initiated in August 2023. Currently, the patient is on the 17th cycle of therapy with TDM1, with the dis appearance of brain secondary lesions after WBRT and stationary disease. Conclusions. Even though studies have shown that TDM1’s ability to penetrate the blood brain barrier is limited, combining it with radiotherapy has led to positive results, allowing us to turn a negative prediction into a potential treatment goal.

Keywords: HER2 positive, chemotherapy, TDM1, radiotherapy, breast cancer

 

 

 

 

New frontiers in locally advanced cervical cancer management: is there any place left for radical surgery?

D.E. Georgescu¹, A. Evanghelides¹, M.T. Georgescu², Andra-Maria Stancu³, T. Pătraşcu¹

1. Department of Surgery 1, “Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania

2. Radiotherapy Department, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

3. Oncology Department, “Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania

 

Introduction. While definitive chemoradiother apy is the current standard treatment, the aim of this study is to retrospectively assess the impact of radical surgery following chemoradiotherapy on the progno sis of locally advanced cervical cancer in a cohort of 70 consecutive patients. Materials and method. All patients were admitted and operated in the surgery de partment of the “Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania, between March 2019 and March 2024. Chemoradiotherapy consisted of 25 fractions of IMRT/VMAT external radiotherapy, at 2 Gy/fraction, combined with platinumbased chemotherapy. In most cases, this was followed by brachytherapy in three frac tions, administered 34 days apart. The decision to perform radical surgery was based on the detection of significant residual disease on posttreatment imaging or the inability to achieve the optimal dose for defini tive chemoradiotherapy, being validated by the tumor

board. Results. The histopathological findings revealed residual active disease in over 70% of the cases, with active nodal tumor cells in more than 30%. No urinary or digestive fistulas were reported among immediate postoperative complications, with the main complica tion being lymphorrhagia from the drainage tube follow ing radical lymphadenectomy. Local control, recurrence, metastasis rates and overall survival were significantly better than those reported in the literature for locally advanced cervical cancers treated with definitive chemo radiotherapy alone. Conclusions. This study highlights the benefits of surgery following chemoradiotherapy for locally advanced cervical cancer in terms of local control and survival, without substantial postoperative complications. Further studies on larger patient cohorts are necessary to confirm the clinical recommendation. Keywords: cervical cancer, radical surgery, chemora

diotherapy, prognosis

ALK-positive lung adenocarcinoma in a patient with rare lysosomal disease

Danusia Gheorghiu-Puşcaşu, Claudia Burz

Medical Oncology Department, “Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

Objective. We present the case of a 48year-old former smoker who was diagnosed with ALKpositive low differentiated pulmonary adenocarcinoma and multiple metastases of the bones, liver and mediasti num (cT4N2M1). Materials and method. Treatment with alectinib 150 mg and Zometa® 4 mg was initiated, with a good overall response. Eleven months later, an evaluation CTTAP scan indicated progressive disease in lungs and liver, as well as splenomegaly with sig nificant subcapsular hemorrhage. As a result, the pa tient underwent in situ splenectomy. Histopathological examination of the spleen was highly suggestive for a lipid metabolic disease (Gaucher, NiemannPick or Wolman). Considering the evolving disease, treatment with lorlatinib 100 mg was initiated. After four cycles, the patient developed severe psychosis, characterized by aggressiveness. The treatment with antipsychot

ics was initiated, and the doses of lorlatinib were re duced, with a good overall response. Results. CTTAP scan performed after eight cycles of lorlatinib showed disease progression in the liver and lungs, as well as an increase of adenopathies in the upper abdominal quadrant. Treatment with atezolizumab TD=1500 mg, bevacizumab 15 mg/kg b.w. TD=1000 mg, carboplatin AUC6 TD=500 mg and paclitaxel TD=300 mg was ini tiated, with no immediate side effects. Conclusions. Lysosomal diseases are rare occurrences believed to play an important role in lung cancer pathogenesis, that can also influence prognosis. Still, targeted therapies such as lorlatinib represent effective treatments with various side effects, psychosis appearing in up to 6% of the cases treated with this medication.

Keywords: ALK mutation, lysosomal disease, tar geted therapies, lung adenocarcinoma

 

 

 

 

Complex management of advanced lung cancer in a patient with chronic lymphocytic leukemia (CLL): challenges of immunosuppression and adverse effects

Miruna Ghigeanu

Colţea Clinical Hospital, Bucharest, Romania

Introduction. Timely diagnosis and management of treatmentrelated adverse effects and comorbidi ties are crucial in the care of oncologic patients. Case report. In February 2023, a 75yearold male with a history of chronic lymphocytic leukemia (CLL) and hypertension presented with hematemesis. Diagnostic imaging and biopsy identified stage IV nonsmall cell lung cancer (NSCLC) with squamous carcinoma, nega tive for molecular testing, and programmed death ligand 1 (PDL1) tumor proportion score (TPS) of 5%. The patient began palliative radiotherapy in January 2024. He refused other oncological treatments. By June 2024, disease progression led to the initiation of firstline metastatic treatment with pembrolizumab, paclitaxel and carboplatin. However, the patient ex perienced significant toxicities, including recurrent thrombocytopenia, anemia and neutropenia. After

three cycles, the treatment was halted due to skin le sions suggestive of herpes zoster, complicated with purpuric vasculitis. Further investigation confirmed herpes zoster, which improved with antiviral treat ment. The patient resumed a new cycle of chemoim munotherapy, with low tolerance. Imaging after four cycles showed partial response, leading to a switch to maintenance pembrolizumab in August 2024, without further herpes zoster episodes. Conclusions. This case underscores the complexities of managing can cer patients with multiple comorbidities and poten tial adverse effects associated with systemic cancer therapies. The effective management requires vigilant monitoring and a multidisciplinary approach to op timize treatment efficacy and patient quality of life.

Keywords: lung cancer, herpes zoster, adverse effects, immunosuppression, integrative management

Prolonged survival in EGFR-mutant lung adenocarcinoma: the power of targeted and combination therapies

Alina-Lavinia Grigore

Oncology Department, “Elias” University Emergency Hospital, Bucharest, Romania

We present the exceptional journey of the remark able survival of a 60yearold, neversmoker female patient who was diagnosed with metastatic EGFR mutant (exon 19 deletion) lung adenocarcinoma in January 2017. Over the course of almost seven and a half years, the patient underwent three different systemic therapies for metastatic disease, defying the odds with each passing year. From January 2017 to May 2024, the therapies administered were: erlotinib, osimertinib, and the quadruplet combination of car boplatin, paclitaxel, bevacizumab and atezolizumab, followed by atezolizumabbevacizumab maintenance. The median progressionfree survival was 29 months. Zoledronic acid initially and later denosumab rep resented adjunctive therapies alongside all systemic treatments. Palliative radiotherapy on metastatic bone lesions was also administered. The clinical and bio logical status of the patient was well preserved during the treatment period. The only adverse event was the

development of erythema involving the cervical and retroauricular regions, 30 minutes after the fourth atezolizumab administration. The skin tests carried out were positive, so the patient became a candidate for the desensitization protocol. Thus, administration of another eight cycles of therapy was facilitated, un til massive disease progression with leptomeningeal metastases was registered. The patient died shortly after that. This case highlights the importance of cor rectly strategizing EGFRTKI treatment approaches in order to maximize the benefit of each treatment line. It also emphasizes the value of desensitization protocols, allowing for treatment continuation and further ex tending survival. Moreover, it stresses that the implicit mechanism of EGFRTKI resistance remains a major obstacle, while leptomeningeal metastases represent a devastating complication of metastatic cancer.

Keywords: longterm survival, lung adenocarcinoma, leptomeningeal metastases

 

 

 

 

Access to innovative medicine through early phase trials in Romania

Mirela Haţegan

“Prof. Dr. Ioan Chiricuţă” Institute of Oncology, Cluj-Napoca; ARENSIA Exploratory Medicine, Romania

In the last 10 years, in Romania the access to innova tive medicine in oncology through early phase trials has been limited. Our country remains an underdeveloped market, pharmaceutical corporations avoiding invest ing, as it has no “history”. Compared to other European Union (EU) countries, Romania has one of the smallest numbers of clinical trials per million inhabitants. Early phase trials refer to medical research studies where new drugs that have been developed in labs are given to hu mans. These are short and challenging studies, and they must be performed in authorized units only for which you need a special Phase 1 unit authorization from the Medicine Agency. Participation in early phase trials of fers patients access to innovative treatments prior to market authorization, along with stateoftheart inves tigations and financial compensation at the EU level. On the other hand, medical professionals have the chance to access new molecules, work with new protocols, and

participate in international development programs. The success of a new Phase 1 trials drug highly depends on the early stages of clinical development. Among the criticisms of early phase trials conduct are the cost, low response rate, and potential harm from toxicities. The average success rate from a preclinical trial to registra tion is about 10%(1), and it takes 1015 years for devel opment and testing(2). In 2024, the patients’ association advocated for increased availability of clinical trials and, hopefully, with the “history” that we have started to cre ate, more investors will see Romania as a credible plat form for innovative medical research and development. Keywords: early phase trials, innovative medicine,

ARENSIA Exploratory Medicine

References:

1. Kola I, Landis J. Can the pharmaceutical industry reduce attrition rates?. Nat Rev Drug

 

Discov. 2004;3(8):711-715.

2. Jacobs T. Trials and error. Nat Biotechnol. 2005;23:1481.

 

Is a headache always just a headache in patients treated with systemic immunotherapy?

Andreea Hopârtean¹, Cristina Smolenschi²

1. Medical Oncology, “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

2. Medical Oncology/Drug Development Department, “Gustave Roussy” Institute, Villejuif, France

 

Immunotherapy represents a revolutionary thera peutic weapon for cancer. Still, the immunerelated adverse events caused by immune checkpoint inhibitors (ICI) can complicate the therapeutic management, with consequences for the patient. We describe the case of a patient with gallbladder adenocarcinoma and liver recurrence treated with cisplatin, gemcitabine and pembrolizumab, a programmed cell death protein1 (PD1) inhibitor. After four cycles of chemotherapy and ICI, the patient presented herself in the emergency room with an altered general status, asthenia, anore xia, fever (39°C), chills, nausea, vomiting, diarrhea and right flank abdominal pain. She had been complaining about headaches since the second cycle of treatment, and she came twice to the emergency room, but the symptoms were considered secondary to chemotherapy. Also, the patient had hypotension and tachycardia. We completed our laboratory investigations with a large

endocrinology panel. The results showed an isolated adrenocorticotropic hormone deficiency with a very low cortisol level, suggesting secondary adrenal in sufficiency. The patient started the treatment with hydrocortisone, with rapid symptom relief, and contin ued longterm substitution. Brain magnetic resonance imaging (MRI) found a pituitary gland enlargement. Our final diagnosis was autoimmune hypophysitis with secondary adrenal insufficiency related to pembroli zumab. The adverse event probably started after the second cycle of chemotherapy and ICI, but the final diagnosis was delayed as the symptoms were not spe cific. This case highlights the need for physicians to be aware that endocrine immune-related side effects can occur early in patients treated with immunotherapy, and prompt diagnosis and treatment are needed.

Keywords: immunotherapy, secondary adrenal insuf ficiency, autoimmune hypophysitis, headache

 

 

 

 

An unexpected turn of a diagnosis – case report

Laura-Cristina Layis

MedLife Braşov, Romania

Introduction. NUT carcinoma is a very rare clini cal entity that can grow anywhere in the body, usu ally found in head, neck and lungs. In this case, a lung mass rapidly progressed with a gigantic ovarian mass, ascites and peritoneal carcinomatosis. Case presen- tation. A 37yearold nonsmoker woman presented to the general practitioner with anterior thoracic pain and dyspnea after a mild infection with SARSCoV2. After being treated with corticotherapy and antibiot ics, a reassessment thoracic CT scan demonstrated two nodular masses located paravertebral in the left lung. Multiple biopsies were performed, and the pathology was consistent with a lung squamous cell carcinoma. EGFR and ALK mutations were negative, and PDL1 was 70%, thus she started pembrolizumab monotherapy. After six cycles, the CT scan presented partial response of the

lung, but also a new mass in the left ovary, peritoneal carcinomatosis with “omental cake” aspect and ascites. A biopsy was done on the ovarian mass. ROMA index was 12.2, CA125 was 55.3 ng/ml, LDH was 1669 U/L, and AFP was 166.7 ng/ml. The patient received BEP chemo therapy, with no improvement. The pathology returned indicative of NUT carcinoma due to the positivity of p63 immunohistochemistry. Gene analysis was not routinely available, consequently it was not performed. The ovar ian mass was surgically removed but, unfortunately, the patient died two weeks after the surgery. Conclusions. The present case indicates the importance of recogniz ing NUT carcinoma, and further studies are mandatory to establish a treatment protocol and to obtain better outcomes for the patients.

Keywords: carcinoma, NUT, lung, ovarian mass, BEP

Could elevated serum alpha-fetoprotein levels be a prognostic indicator in metastatic gastric cancer? A case report

Diana-Elena Lazăr¹, Pompiliu Barbu²

1. Medical Oncology Department, “St. Hierarch Dr. Luca” Municipal Hospital, Oneşti, Bacău, Romania

2. Gastroenterology and Hepatology Department, “St. Hierarch Dr. Luca” Municipal Hospital, Oneşti, Bacău, Romania

 

Introduction. Alphafetoprotein (AFP) producing gas tric cancer is a rare and highly aggressive subtype, repre senting only 16% of all gastric cancer cases. Case pres- entation. We present the case of a 44yearold male with no significant family or personal medical history, who was diagnosed with HER2negative metastatic gastric adeno carcinoma (peritoneal carcinomatosis and ascites) in April 2024. At the time of diagnosis, laboratory investigations revealed a significantly elevated alphafetoprotein (AFP) level of 1020 ng/mL, while both CA 199 and carcinoem bryonic antigen (CEA) levels remained within normal lim its. The patient was treated with palliative chemotherapy according to the mFOLFOX6 regimen. After six cycles of treatment, the imaging evaluation showed a partial response, and the AFP levels significantly decreased to 12 ng/mL. However, three months after completion of chemotherapy, the patient’s general condition deteriorat ed rapidly and reached ECOG 4, which was accompanied by neurological impairment characterized by obtundation

and drowsiness. Currently, an MRI of the brain shows no metastatic lesions, but bone scintigraphy reveals the pres ence of bone metastases. Particularities of the case. The patient, who was young and had no classic risk fac tors for gastric cancer, was diagnosed with AFPsecreting HER2negative adenocarcinoma of the stomach in the metastatic stage. The clinical course was characterized by an initial favorable response to mFOLFOX6 chemother apy, followed by rapid progression, with the development of bone metastases. Conclusions. This case highlights the aggressiveness of AFPproducing gastric adenocar cinoma and the limited efficacy of mFOLFOX6 chemo therapy in the longterm control of metastatic disease. Although a favorable response was initially achieved, the subsequent progression with bone metastases confirms the poor prognosis associated with this rare subtype of gastric cancer.

Keywords: alphafetoprotein, gastric cancer, prog nostic indicator

 

 

 

 

 

Trastuzumab deruxtecan (T-DXd) – a single-center real-world data experience in HER2-positive patients

Vlad Lupu, Cristina Oprean

Oncohelp Medical Center Timişoara; ANAPATMOL Research Center, Timişoara; “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

The HER2positive breast cancer treatment land scape has significantly evolved during the previous 10 years, with major progresses in the early and ad vanced settings. The place for trastuzumab deruxtecan (TDXd) in the treatment algorithm of advanced HER2 positive breast cancer has been cemented through mul tiple pivotal trials, including DESTINYBreast02 and DESTINYBreast03. In this study, we aim to present an early realworld data cohort study of TDXd, as it per tains to our highvolume center in Timişoara, Romania. The cases were selected by performing a search in the institution’s database for TDXd. Subsequently, the pa tients with a HER2low status were eliminated, while the HER2=3+ or HER2=2+/ISH+ were selected and in cluded in the study. The selection included patients enrolled in early access programs. Data collected en compassed age, staging, the immunohistochemistry profile, the prior and current lines of treatment, the response and the toxicities that have occurred. The sta

tistical analysis was performed by the authors. In total, we identified 23 patients meeting the selected criteria, with 18 still ongoing treatment with TDXd (78.3%). As such, the median progressionfree survival (PFS) has not been reached yet. The median number of cycles completed is currently seven, while the median dura tion of treatment being 6.1 months. Among 18 patients with evaluable disease, the objective response rate was 55.5%, while the disease control rate was 94.4%. The number of prior lines was two in 65.2% of patients. While still a recently reimbursed drug in Romania, TDXd is being comprehensively used in highvolume centers, showing a robust response rate even in later lines of treatment, while maintaining an acceptable toxicity profile. Furthermore, the majority of the pa tients are still undergoing treatment. We look forward to the data maturing over time.

Keywords: breast cancer, realworld data, trastu zumab deruxtecan, HER2

A clinical case of luminal B breast cancer with cardiac tamponade

Ivona Măriuţă

“Colţea” Clinical Hospital, Bucharest, Romania

Cardiac tamponade is a rare lifethreatening condi tion in breast cancer. About 25% of patients who have pericardial metastasis develop pericardial effusion, and only a small proportion of cases develop cardiac tamponade. The prognosis of patients presenting with cardiac tamponade is shadowy, with a survival rate ranging from a few days to 14 months, with a medi an survival of 5.5 months. We present the case of a 55yearold woman diagnosed in 2020 with right lu minal B stage IIIB breast cancer. After eight cycles of neoadjuvant chemotherapy (four cycles of liposomal doxorubicin and four cycles of paclitaxel/carboplatin), a Madden mastectomy with right axillary lymph node dissection was performed, followed by intensitymodu lated radiation therapy (IMRT) and adjuvant hormonal therapy. After three years of no signs of oncological progression, the patient presented to the emergency room with clinical Beck’s triad. Echocardiography re

vealed a massive pericardial effusion with “swinging” heart and collapsed right atrium and right ventricle. To release the pericardial fluid, a pericardiocentesis followed by thoracocentesis were performed, signifi cantly decreasing the symptomatology. The cytology examination confirmed the pericardial effusion con taining metastatic breast cancer cells. The tumor board considered palliative chemotherapy treatment with liposomal doxorubicin/cyclophosphamide. After two cycles, no further accumulation of pericardial effusion was visible on the CT scan. In conclusion, given the fact that malignant pericardial effusion is considered to be an endstage disease because it may lead to sudden car diac death when left uncontrolled, the correct clinical diagnosis followed by the right therapeutic approach is crucial for the patient’s survival.

Keywords: breast cancer, cardiac tamponade, case presentation

 

 

 

 

Above and beyond: precision medicine in a rare case of chemotherapy-refractory yolk sac tumor

Radu Matei¹, Adelina-Silvana Gheorghe^1,2, Anca Stolojanu¹, Crina Siminiceanu¹, Elena Dumitrescu^1,2, Ioana Geală¹, Irina Chirea¹, Loredana Ciontea¹, Sânziana Prundianu¹, Dana-Lucia Stănculeanu^1,2

1. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Introduction. Yolk sac tumors represent the second most frequent subtype of the rare ovarian germ cell neoplasms. The backbone treatment of this pathology involves surgery followed by additional chemotherapy, ensuring an excellent prognosis. However, managing chemotherapyrefractory tumors can impose a signifi cant clinical challenge. Case presentation. Herein, we present the case of a 36yearold woman with no significant personal or hereditary history of cancer who was diagnosed with FIGO stage I (intact capsule) yolk sac tumor on the left ovary after undergoing fertility sparing surgery for a suspicious ovarian mass. Local recurrence appeared in less than three months after initial resection. After debulking surgery, adjuvant chemotherapy with a BEP regimen followed, but disease progression appeared shortly afterward. The patient underwent surgical reintervention and subsequently received chemotherapy with TIP and VAC regimens, with unfavorable outcome. Comprehensive genome se quencing revealed the presence of a KRASG12C mu tation, offering the opportunity for recruitment in a clinical study. Our patient received palliative treatment

with KRASG12C inhibitor alongside SHP2 inhibitor until disease progression after 11 months. Henceforth, surgical reintervention and treatment rechallenge with a different KRASG12C were the most promising thera peutic strategies, an approach that ensured five months of disease control. In the context of therapy resistance, exploring subsequent treatment options was grim in perspective. Hoping for the uptomoment unfavorable evolution of the oncological disease to take a favora ble turn, our patient enrolled in a CART cell therapy study but had to stop after only two cycles due to in testinal occlusion, which required emergency surgery and treatment halting. The patient follows supportive palliative care. Conclusions. This case highlights the importance of personalized medicine and clinical study enrollment in carefully selected patients, particularly those with rare diseases where treatment options are often narrow. Additionally, this report aims to present the limited data available on chemotherapyresistant yolk sac tumor therapeutic approaches.

Keywords: yolk sac tumor, chemotherapy-refractory, KRAS G12C inhibitor, CART cell therapy

Perioperative Takotsubo syndrome following cytoreductive surgery and HIPEC in a colorectal cancer patient: a rare case

B. Moldovan¹, Iris-Iuliana Adam^1,2, R.M. Pisică¹, V. Untaru³, Doly Stoica³, Alexandra Şpac³, Irina Modrigan⁴, Liliana Jupoiu⁵, Adina Frâncu⁵, Florentina Pescaru⁶, A. Hubeishie^7,8, Adriana Zolog⁹, Liliana Vecerzan^2,10

1. General Surgery Department, “Sf. Constantin” Hospital, Braşov, Romania

2. Faculty of Medicine, “Lucian Blaga” University of Sibiu, Romania

3. Anesthesia and Intensive Care Unit, “Sf. Constantin” Hospital, Braşov, Romania

4. Anesthesia and Intensive Care Unit, Sanador Hospital, Bucharest, Romania

5. Cardiology Department, “St. Constantin” Hospital, Braşov, Romania

6. Oncology Department, “St. Constantin” Hospital, Braşov, Romania

7. Oncology Department, Timiş County Emergency Clinical Hospital, Timişoara, Romania

8. Oncology Department, Oncohelp Medical Center, Timişoara, Romania

9. Pathology Department, “Regina Maria” Hospital, Cluj-Napoca, Romania

10. Oncology Department, “Dr. Alexandru Augustin” Military Hospital, Sibiu, Romania

 

Aim. Takotsubo syndrome (TTS), or stress cardiomyo pathy, is a temporary but acute heart failure condition marked by transient abnormalities in left ventricular (LV) wall motion, often without coronary artery obstruction. The clinical presentation can closely mimic acute coronary syndrome (ACS), characterized by chest pain, shortness of breath and electrocardiographic changes, leading to diagnostic challenges. Materials and method. We de scribe the case of a 44yearold female with a history of recurrent colon cancer and peritoneal carcinomatosis. She underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Approximately 18 hours postoperatively, she suffered a cardiac arrest caused by ventricular fibrillation. Immediate resuscita tion measures were initiated, and an echocardiogram revealed an LV ejection fraction of 20% with apical aki nesia, consistent with TTS. The patient was treated with inotropic support and recovered gradually. A subsequent

coronary angiography confirmed no obstructive coronary artery disease, affirming the diagnosis of stress cardio myopathy. Results. This case illustrates the occurrence of Takotsubo syndrome as a critical, though uncommon, postoperative complication in cancer patients undergoing extensive surgeries. The combination of significant physi cal and psychological stress, particularly in the context of oncological procedures like CRS and HIPEC, is a likely contributor to the onset of TTS. Early recognition and in tervention are essential for optimizing patient outcomes. Conclusions. Takotsubo syndrome should be considered when perioperative cardiac events occur, particularly in highrisk cancer patients. Multidisciplinary management can prevent further complications and improve longterm recovery prospects.

Keywords: Takotsubo syndrome, stress cardiomy opathy, broken heart syndrome, acute heart failure, Krukenberg tumor, cytoreductive surgery

 

 

 

 

From ICU to long survival

Ana-Maria Muntenaşu, Ioana-Roxana Cârlan, Eva-Maria Cojocaru

Medical Oncology, Regional Institute of Oncology Iaşi, Romania

Osimertinib monotherapy remains, for the moment, the preferred firstline treatment for patients with ad vanced nonsmall cell lung cancer (NSCLC) with EGFR mutations. We present the case of a 49yearold female patient, a nonsmoker with no professional exposure, who started experiencing symptoms in February 2019, manifesting as chest pain and moderate dyspnea. Subsequently, the patient was diagnosed with lung ad enocarcinoma, ALK negative, cT3N3M1a, stage IVa, through the identification of a spiculated nodular lesion in the right lower lobe, right posterior pleural thicken ing, along with pericardial effusion. The patient’s poor general condition at presentation necessitated the rapid initiation of chemotherapy. However, after the adminis tration of the first cycle of carboplatin and gemcitabine, the patient developed acute respiratory failure, hypercap nic coma, requiring orotracheal intubation and admis sion to the intensive care unit (ICU). A CT scan revealed

right pleural emphysema, bilateral carcinomatous lym phangitis, and moderate pericardial effusion. Despite the negative prognosis, the patient’s evolution was slowly fa vorable, allowing for videoassisted thoracoscopy, which confirmed the diagnosis of lung adenocarcinoma with visceral pleura invasion. After molecular testing (EGFR mutant, PDL1 negative) and the resolution of the acute event, the treatment with osimertinib 80 mg/day was initiated, administered for four years, at which point disease progression occurred both locally and at the he patic and bone levels. Therapy with atezolizumab, bevaci zumab, carboplatin and paclitaxel was initiated, with no disease progression to date. In conclusion, we highlight the benefits of treatment with osimertinib, reflected in both progressionfree survival and the patient’s quality of life, following a major acute event.

Keywords: lung cancer, EGFR, osimertinib, chemotherapy

Hepatocelullar carcinoma variants – a single-centre experience

Mădălina-Cristina Negulescu, Adina-Emilia Croitoru, Ioana-Niculina Luca, Florina Buică, Ioana-Mihaela Dinu, Monica-Ionela Miron, Irina-Mihaela Cazacu, Vlad-Mihai Croitoru, Raluca-Petruţa Ţui, Iulia-Magdalena Gramaticu

Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania

Background and purpose. Hepatocellular carcinoma (HCC) is one of the leading cause of cancer death. The 5th WHO Classification of Digestive System Tumors esti mates that up to 35% of HCCs can be classified in eight subtypes, defined by specific histopathological, molecu lar and clinical features. The aim of this study was to analyze the distribution and clinical relevance of these HCC subtypes in a realworld setting. Materials and method. This was a retrospective observational study including patients with advanced stage HCC, currently undergoing systemic treatment in the Fundeni Clinical Institute, Bucharest, Romania, and for whom clinical data from the time of initial diagnosis were available. For all patients, the presence of histologically confirmed or clinically diagnosed HCC could be documented. Results. A total of 74 HCC patients were currently under treat

ment in our department. A histological diagnosis of HCC was performed in 35% of the patients (surgical resec tion of the tumor, liver biopsies, and liver transplanta tion). The distribution of each HCC variant was largely similar to that in the WHO classification. Some vari ants were not identified in this small group of patients. The following hepatocellular carcinoma variants were identified: 80% conventional type, 7.7% scirrhous type, 3.8% macrotrabecular massive, 3.8% clear cell, and 3.8% steatohepatitic type. Conclusions. The hepatocellular carcinoma subtyping based on the 5th WHO from 2019 classification brings important clinical and prognostic information to the table, and assigning a case to the appropriate subtype is of utmost importance.

Keywords: hepatocellular carcinoma, scirrhous, clear cell, steatohepatitic, systemic therapy

 

 

 

 

 

Mesonephric-like adenocarcinoma – not only a clinical pathologic challenge

Sorina-Alexandra Niculescu

Radiotherapy Department, Colţea Clinical Hospital, Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Introduction. Mesonephriclike adenocarcinoma is a rare subtype of gynecologic malignancy with high risk of recurrence and increased tendency to metastasize, being frequently misdiagnosed. It comprises less than 1% of all gynecological malignancies, and it was only recently described. Case report. In August 2023, a 76yearold female presented with abnormal vaginal bleeding and asthenia. A transvaginal ultrasound re vealed an endometrial hypoechogenic mass with appar ent invasion in the upper onethird of the cervix and tumor invasion above 50%. Later, a whole body CT scan revealed the endometrial mass with cervix invasion, no abdominopelvic adenopathies, and no evidence of secondary lesions. A biopsy was imposed which showed the presence of endometrial mesonephriclike adeno carcinoma, stage FIGO II (cT2cN0M0). After MDT (mul tidisciplinary team) decision, the patient underwent surgery (hysterectomy with bilateral adnexectomy and

pelvic lymphadenectomy), radiotherapy with concomi tant radiosensitization chemotherapy, brachytherapy and adjuvant systemic therapy (carboplatin and pacli taxel, starting in February 2024). The patient remained under followup. Discussion. Due to its established aggressive behavior, changes in the followup of this patient should be taken into consideration. Being fre quently misdiagnosed, we should emphasize the role of a good pathologist for this rare finding. As its par ticular immunophenotype is associated with recurrent KRAS and PIK3CA mutations, the attention should be on the role of NGS testing. Conclusions. As an unusual subtype of endometrial carcinoma with high risk of recurrence and increased tendency to metastasize, it is critical to better understand the clinical and thera peutic implications of this diagnosis.

Keywords: mesonephriclike adenocarcinoma, rare, uterus

Molecular heterogeneity in breast cancer – case presentation

Irina Niţă, Alexandra Boboc

Oncology Department, Medicover Hospital, Bucharest, Romania

Purpose. Studies have shown that breast cancer exhibits molecular heterogeneity, with a distinct pre dilection for secondary metastases in various organs, depending on the molecular type, leading to differ ences in prognosis and treatment response. This pa per aims to update information regarding the clinical implementation of rebiopsy secondary metastases to identify molecular changes for the purpose of individu alizing therapy. Methodology. We present the case of a 68yearold female patient who presented with a tumor in the right breast and a supraclavicular adenopathy block. A biopsy established the diagnosis of ductal breast carcinoma, and immunohistochemistry revealed estro gen and progesterone receptor positivity, with HER2 negative status. PETCT identified metastases in the intrathoracic lymph nodes. The patient received treat ment with ribociclib plus letrozole, resulting in a partial metabolic response. After seven months, clinical recur rence has been detected, with rising tumor markers, and

PETCT revealed continued disease progression, with new secondary lymph node metastases. Chemotherapy with liposomal doxorubicin and cyclophosphamide was initiated for six cycles, achieving a partial response, after which treatment with liposomal doxorubicin was con tinued. Four months later, FDG uptake has been noted only in the right breast. A biopsy puncture revealed a change in the molecular profile, with the result indicat ing triplenegative breast cancer. Following a multidis ciplinary discussion, palliative radiotherapy was decided for the right breast and supraclavicular lymph node ar eas. Genetic testing revealed the presence of BRCA2 and CHRCK2 mutations, for which the patient is currently undergoing treatment with olaparib. Conclusions. Our case provides clinical evidence that molecular changes are present in breast cancer, with most being identified at the level of metastases or local recurrences.

Keywords: breast cancer, metastatic heterogeneity, therapeutic targets, BRCA

 

 

 

 

 

Dynamic HER2 status and multimodal management in metastatic breast cancer: a complex case report

Mădălina-Raluca Ostafe

Medical Oncology, Euroclinic Center of Oncology (Victoria Hospital), Iaşi, Romania

Purpose. This case report highlights the complexi ties of managing metastatic breast cancer with dynamic HER2 status in a 56yearold female with multiple comor bidities, including cardiovascular, endocrinological and renal conditions. Materials and method. The patient was diagnosed in January 2023 with ductal carcinoma in her left breast (ER 60%, PR 10%, HER2 negative, Ki67 70%). She began neoadjuvant chemotherapy in February 2023 with epirubicin and cyclophosphamide, followed by paclitaxel. In April 2023, a new pulmonary lesion was found and removed, revealing a typical pulmonary carci noid. In July 2023, she also underwent excision of a basal cell carcinoma from her nose. After completing chemo therapy, in September 2023 the patient had a radical left mastectomy and axillary lymphadenectomy. Pathology showed invasive ductal carcinoma (G3, Nottingham 8, ypT3 N3a), with residual disease, ER 90%, PR 15%, HER2 negative (1+). She received radiotherapy in December 2023

and started letrozole with abemaciclib in January 2024. Results. Despite the initial treatment, new hepatic le sions were discovered in July 2024. The biopsy revealed the presence of liver metastasis of moderately differenti ated NST breast carcinoma, with a significant change in HER2 status, from negative to positive (HER2 3+). The patient also experienced renal complications, requiring multiple nephrology interventions. Conclusions. This case highlights the importance of reassessing HER2 sta tus during metastatic progression, as receptor conversion can alter treatment options. The shift from HER2 nega tive to HER2 positive in liver metastasis shows the need for a tailored therapeutic approach and emphasizes the role of the dynamic tumor biology in guiding patients’ treatment.

Keywords: metastatic breast cancer, HER2 conver sion, neoadjuvant chemotherapy, liver metastasis, hor monal therapy, multimodal treatment

Drug-associated and malignancy-associated sarcoidosis in melanoma: case presentation of two young male patients

Annamária Patka¹, Claudia Burz², Raul Bradea¹, Danusia Gheorghiu-Puşcaşu¹

1. Clinical Oncology Resident, “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

2. MD, PhD, “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

 

Introduction. The relationship between melanoma and sarcoidosis is complex and multifaceted, involv ing both immune dysregulation and the effects of immunotherapeutic agents. Evidence suggests that sarcoidosis can occur as a paraneoplastic syndrome associated with melanoma, or it can emerge as an ad verse effect of immune checkpoint inhibitors like an tiCTLA4 and antiPD1/PDL1 therapies or targeted therapies, such as BRAF inhibitors used in the treat ment of melanoma. In this case, we speak about drug associated sarcoidosis (DAS). In contrast, patients who did not receive systemic antineoplastic therapy are categorized as malignancy-associated sarcoidosis (MAS). We present the cases of two young male pa tients, both undergoing adjuvant treatment for locally advanced melanoma. One patient was diagnosed with sarcoidosis prior to the initiation of targeted therapy with BRAF inhibitors (dabrafenib and trametinib), while the other was diagnosed with sarcoidosis after completing one year of adjuvant treatment with the PD1 inhibitor nivolumab. Discussion. Sarcoidosis

is an inflammatory disease that can affect multiple organs in the body, most commonly the lungs and lymph nodes. It is characterized by the formation of granulomas (small clumps of immune cells) in affected tissues. Sarcoidosis can mimic metastasis, especially in the mediastinum, which can pose a diagnostic chal lenge. This overlap can lead to diagnostic uncertainty and inappropriate management if not correctly identi fied. A multidisciplinary approach involving oncolo gists, pulmonologists, radiologists and pathologists is essential for the accurate diagnosis and effective management. Conclusions. Differentiating between MAS and DAS is crucial, as it influences the choice of therapy and monitoring strategies. Ongoing research is needed to better understand the pathophysiologi cal mechanisms linking melanoma and sarcoidosis and to develop tailored management guidelines for these patients.

Keywords: sarcoidosis, melanoma, targeted therapy, immunotherapy, drugassociated sarcoidosis, malig nancy-associated sarcoidosis

 

 

 

 

 

A case of immunotherapy-related myasthenia gravis

A.I. Pîntea¹, Laurenţia-Nicoleta Galeş^1,2

1. Medical Oncology II Department, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Case history. A 60yearold male, with a smoking history of 30 packyears and no other notable personal or family history, presented in November 2023 to a pneumology service with symptoms of shortness of breath, cough and weight loss. The initial investiga tions revealed a left pleural effusion on chest X-ray. Diagnostic workup. A subsequent CT scan identified a 1.6cm lung nodule in the left superior lobe, right hilar lymphadenopathy, left pleural effusion, and sev eral micronodules. Pleural fluid aspiration and biopsy confirmed pleural metastasis, consistent with adeno carcinoma (PDL1 90%, EGFR negative, ALK negative), leading to a diagnosis of metastatic nonsmall cell lung cancer (NSCLC). Treatment and evolution. The pa tient started pembrolizumab 200 mg q3w monotherapy. After two cycles of treatment, the patient developed fatigue, dyspnea, insomnia, anxiety and liver enzyme

elevation, leading to his transfer to our clinic. Further evaluation revealed elevated muscle enzymes (CK and CKMB) without chest pain or ECG abnormalities. A fol lowup CT scan showed persistent pleural effusion and pneumonitis in the left inferior lobe. He was diagnosed with immunotherapyrelated hepatitis, pneumonitis and myositis, and he was initiated on corticosteroid therapy. The patient’s condition worsened, develop ing dysphagia and increased dyspnea. A diagnosis of immunotherapy-induced myasthenia gravis was made, requiring ICU admission and treatment with methyl prednisolone and neostigmine. After no improvement, plasmapheresis was performed, but the patient expe rienced severe cardiovascular complications and died shortly thereafter.

Keywords: NSCLC, pembrolizumab, myasthenia gravis, toxicity

Real-world data of HER2-positivity spectrum in patients with breast cancer in Romania (SPECTRUM)

O. Pop^1,2, B. Fetica³, M. Stoicea⁴, Corina Voinea⁵, Maria Olinca⁶

1. Department of Morphology Sciences, University of Oradea, Romania

2. Resident Laboratory, Oradea, Romania

3. Oncopat Diagnostic Laboratory, Cluj-Napoca, Romania

4. Unirea Medical Center, “Regina Maria” Private Healthcare Network, Bucharest, Romania

5. Medical Department, AstraZeneca Bucharest, Romania

6. OncoTeam Diagnostic, Bucharest, Romania

 

Background. We present the results from a retrospec tive study (SPECTRUM) exploring the positivity rate of human epidermal growth factor receptor 2 (HER2) in breast carcinoma in Romania. The main aim of the study was to describe realworld HER2 testing practice in breast carcinoma patients with immunohistochemistry (IHC) performed in 2023 (Phase 1). Materials and method. This was a physicianled medical chart review conducted in pathology laboratories in breast cancer patients with HER2 IHC testing performed on formalin fixed paraffin embedded tissue between August and October 2023. Statistics were descriptive. Results. IHC testing practice in participating centers (n=22). Median number of breast cancer cases/year: 320; median number of IHC HER2 tests/month: 20; 77% performed reflex IHC, 68% per formed reflex in situ hybridization (ISH) only on cases from IHC=2+ category; 64% used prediluted VENTANA

antiHER2/new (4B5) clone, 68% with quality assur ance programs in place. Patients characteristics (n=151). Median age: 66 years old; 98% females; 68% obtained by core needle biopsy; 97% primary tumors; 72% hormone receptor positive; 96% invasive breast cancers; median ki67: 20%; median fixation time: 24 hours. HER2 test- ing results. 37% IHC=0 (34% IHC=0; 3% IHC=01), 32%

IHC=1+; 16% IHC=2+; 15% IHC=3+; 42% IHC=2+ISH/

IHC=1+ (HER2low); 16% IHC=3+/IHC=2+ISH+ (HER2

positive). Conclusions. This analysis provided recent insights into the HER2 IHC testing practices in Romania and explored the proportion of patients with HER2low score who could benefit from the novel therapeutic op tions (antibodydrug conjugates).

Keywords: breast cancer, HER2 testing, immunohis tochemistry, realworld, HER2 low

Funding: AstraZeneca

 

 

 

 

 

Familial adenomatous polyposis and colorectal cancer – case report

Diana Puşcaşu^1,2, Eliza Froicu^1,2, Lavinia Caba², L. Miron^1,2

1. Regional Institute of Oncology Iaşi, Romania

2. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

 

Introduction. Familial adenomatous polyposis (FAP) is an autosomal dominant hereditary disease and repre sents the most common polyposis syndrome, having vari ous phenotypic expressions such as Gardner and Turcot syndromes. Despite being an important risk factor for colorectal cancer, less than 1% of patients diagnosed annually with this cancer also have a diagnosis of FAP. However, 100% of FAP patients not treated surgically by total colectomy will develop colorectal cancer. Case presentation. A 13yearold patient with a family his tory of brain tumors was clinically diagnosed with stage IIIC synchronous sigmoid colon cancer. He presented to the Emergency Department of the Emergency Clinical Hospital for Children due to abdominal pain. The initial clinical and radiographic evaluation revealed a bulky

mass occupying the sigmoid colon, invading the bladder wall. The histopathological examination confirmed the diagnosis of colon adenocarcinoma, and the imaging as sessment was completed by CT scan evaluation which did not show the presence of secondary lesions. Gene tic testing showed multiple genetic mutations, includ ing mutations in the APC, PMS2 and MSH6 genes, and more than 100 polyps were identified on the resection specimen. The therapeutic approach chosen for the pa tient consisted of surgery and adjuvant chemotherapy. Conclusions. Colorectal cancer is an extremely rare en tity found in children and, once diagnosed, further explo ration is needed to identify possible genetic syndromes. Keywords: familial adenomatous polyposis, FAP,

APC, Turcot syndrome, colorectal cancer

Marantic endocarditis as a rare complication of metastatic pancreatic adenocarcinoma: case report

Claudia-Florina Radu, V.M. Croitoru, Irina-Mihaela Croitoru-Cazacu

Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania

Hypercoagulability is common in pancreatic cancer patients, and nonbacterial thrombotic endocarditis (ma rantic endocarditis) is an underdiagnosed manifestation of this prothrombotic state that can cause substantial morbidity in affected patients, most notably recurrent or multiple ischemic cerebrovascular strokes. We report the case of a 62yearold male patient who was investigated for an episode of deep venous thrombosis. A CT scan of the chest, abdomen and pelvis was performed at that time, showing a pancreatic tumor and liver metastases. A biopsy was obtained through endoscopic ultrasound guided fine needle aspiration from the pancreatic lesion, and the histopathological examination revealed a G2 adenocarcinoma. Given the good performance status, palliative polychemotherapy (PCT) with mFOLFIRINOX was initiated. Before the second cure of PCT, the patient presented with dysarthria and paresthesias in the right

upper limb. A cerebral CT scan was performed, and it revealed an ischemic stroke. The patient was admitted in the department of neurology, where he suffered another stroke. A transesophageal cardiac ultrasound was per formed which showed an oval hypoechogenic formation attached to the anterior mitral valve towards the atrial face, without mobility, but with an appearance sugges tive of vegetation with embolic risk. The blood cultures were also negative, thus the diagnosis of marantic en docarditis was established. In conclusion, oncological patients have a high risk of prothrombotic events, and neurological complications can hide difficult diagnoses such as marantic endocarditis. Early diagnosis and treat ment of these patients are crucial to improve mortality and morbidity rates.

Keywords: pancreatic cancer, metastatic disease, ma rantic endocarditis, hypercoagulability

 

 

 

 

 

Decision-making in a rare case of synchronous BRCA plus ovarian and breast cancer

Irina-Alexandra Răduţ

Department of Medical Oncology, “Elias” University Emergency Hospital, Bucharest, Romania

Although breast cancer and ovarian cancer can co occur, especially in hereditary breast and ovarian can cer syndrome (HBOC) patients, this is rare, and there is no well-established treatment strategy. A 66year old woman consulted her doctor because of abdominal pain and increased abdominal size. Contrast CT scans revealed a liver lesion, peritoneal carcinomatosis, omental cake sign, enlarged abdominal lymph nodes, ascites, a right ovarian tumor, as well as an inciden tally found right breast tumor and enlarged ipsilateral axillary lymph nodes. Subsequently, it was decided for liver and breast biopsies. The HP and IHC exams showed: the liver lesion – highgrade serous ovarian carcinoma metastasis (ER=60%), and the breast tu mor – invasive ductal carcinoma (NOS, G2, ER=97%, PR=60%, HER2 negative, ki67=80%). Baseline CA 125 was 1526 UI/ml. Therefore, it was a case of synchro

nous ovarian and breast cancer and, according to AJCC 8th edition, it was classified as stage IVB ovarian can cer and stage IIB breast cancer. The multidisciplinary board considered that the ovarian disease had spread more and was more potentially dangerous, therefore treatment priority over the breast disease was needed. The patient received neoadjuvant paclitaxel plus carbo platin and daily letrozole. Plasma NGS testing showed mutant gBRCA1. Considering the platinumsensitivity (PR at >6 months), the patient further received olapa rib maintenance and continuation of letrozole, which prolonged the response until debulking surgery could be performed, as well as afterwards. This case aims to be of help in treating similar rare cases of synchronous BRCA plus ovarian and breast cancers in the future.

Keywords: HBOC, BRCA, ovarian cancer, breast can cer, platinum sensitive

Diffuse tenosynovial giant cell tumor – a radiation oncologist approach

Mara Răzniceanu, E. Baltig

Department of Radiation Oncology, Regional Institute of Oncology Iaşi, Romania

Background. Tenosynovial giant cell tumor (TGCT) is a rare, benign tumor of mesenchymal origin that arises in the joints, bursae and tendon sheaths. It tends to be locally aggressive. TGCT exists in two forms: nodular (NGCT), which typically progresses slowly, and diffuse (DGCT), which shows more aggressive local behavior. Surgical resection is the primary treatment, but recur rence is common, leading to the use of radiation or newer targeted therapies like colonystimulating factor 1 re ceptor inhibitor (CSF1R inhibitor) pexidartinib. Case presentation. A 50yearold woman with a psychiatric history, including delirium managed with Depakine®, and a history of stage III Hodgkin’s lymphoma treated with ABVD chemotherapy, presented with a large, pain less subcutaneous tumor on the left forearm. The mass fluctuated in size with hand activity, being identified on MRI as an arthrosynovial cyst. Surgical resection

in January 2023 revealed a lobulated mass involving adipose and fascial tissue. Histopathology confirmed diffuse TGCT. Recurrence was detected in October 2023, necessitating further surgery. Histopathology confirmed diffuse TGCT. Postoperative external radiotherapy was delivered (60 Gy in 30 fractions). The patient tolerated well the treatment, the only associated acute toxicity being radiodermitis grade 3 (CTCAE 4). Conclusions. DTGCT is a rare, aggressive benign tumor that could cause significant morbidity through joint destruction and impaired function. The treatment must be personal ized, considering tumor location and patient’s factors. The lack of standardized clinical guidelines for TGCT leads to inconsistent global adoption of new treatments, often resulting in suboptimal outcomes.

Keywords: radiotherapy, tenosynovial giant cell tu mor, surgery, Hodgkin lymphoma

 

 

 

 

 

Atypical cutaneous secondary lesions – temporary accessories? Case report

Larisa-Maria Rotariu, Elena-Rodica Gafton, Teodora-Alexa Stratulat, Ioana-Roxana Cârlan, Maria Tomulesei

Regional Institute of Oncology Iaşi, Romania

Introduction. Bronchopulmonary neoplasm is one of the most frequently diagnosed neoplasms, with common metastatic sites including brain tissue, adrenal glands, bone tissue and liver. The appearance of secondary cutaneous lesions is noted in approximately 112% of cases, with those localized on the facial area having an incidence of about 0.5%. Here, we present the case of a 64yearold patient diagnosed with small cell bron chopulmonary neoplasm following a biopsy of a cutane ous tumor formation. Case presentation. The patient, a heavy smoker with a known hemangioma (inner side of the right upper limb and chin), reported the emer gence of a welldefined, vascularized and painless for mation on the left hemifacial area, which progressively evolved over approximately 34 months to a diameter of about 4 cm, against a background of general symp toms (asthenia, fatigue and dyspnea). An ultrasound guided puncture revealed a histopathological result of small cell carcinoma metastasis, leading to a complete assessment, which highlighted a parahilar right lung lesion. The final diagnosis was extensive stage small cell bronchopulmonary neoplasm, stage IVB cT3N3M1c. Palliative chemotherapy was initiated with a platinum doublet and immunotherapy, followed by monothera

py, during which the aforementioned cutaneous lesion changed its characteristics (reduction in vasculariza tion and size). Subsequent imaging evaluations showed favorable progression and complete disappearance of the cutaneous metastasis after six months of oncologi cal treatment. Discussion. In most patients, secondary cutaneous lesions appear during treatment, indicating an unfavorable prognosis; it is rare for them to represent the first alarm signal. Most skin metastases occur in re gions near the primary tumor, with bronchopulmonary neoplasm having an affinity for supradiaphragmatic skin regions. The most common histological type as sociated with cutaneous metastases is adenocarcino ma, followed by squamous cell carcinoma and small cell carcinoma. Conclusions. Cutaneous metastases represent a rare manifestation of bronchopulmonary neoplasm. Considering the patient’s benign cutaneous tumor pathology, the biopsy of the atypical secondary cutaneous lesion along with a thorough medical his tory facilitated diagnosis and subsequent therapeutic management, allowing for clinical monitoring of the patient’s progression.

Keywords: bronchopulmonary neoplasm, cutaneous metastasis, biopsy

Enduring the unbearable: refractory cancer pain in a young patient – case report

Crina-Maria Siminiceanu¹, Elena-Adriana Dumitrescu^1,2, Adelina-Silvana Gheorghe^1,2, Maria-Loredana Ciontea¹, Radu Matei¹, Irina Chirea¹, Anca-Alexandra Stolojanu¹, Ioana Geală¹, Sânziana Prundianu¹, Dana-Lucia Stănculeanu^1,2

1. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Introduction. The resulted pain from tumoral inva sion is a debilitating symptom experienced by oncologi cal patients, significantly impacting their quality of life. Case presentation. We present the case of a 30yearold patient who presented in June 2023 with significant epi sodes of metrorrhagia. Imaging revealed a cervical mass measuring 70x52 mm and no metastasis. The patient underwent total hysterectomy with bilateral adnexectomy along with pelvic and lombo-aortic lymphadenectomy, with the diagnosis of squamous cell carcinoma of the cer vix, pT2apN0pM0, CPS=35, stage II. The patient received concurrent chemoradiotherapy, five cycles of 50 mg of cisplatin and a total radiation dose of 45 Gy. Three months after the treatment, the patient accused acute right iliac fossa pain. Abdominal MRI confirmed pelvic tumor re currence with invasion of the right obturator nerve. The patient accused severe pain unresponsive to treatment with high doses of opioids (fentanyl patches and sub lingual tablets), NSAIDs, gabapentin and amitriptyline.

The multidisciplinary palliative care team decided on L5 cryoablation, with minimal improvement. The patient started the systemic palliative treatment with paclitaxel, cisplatin, bevacizumab and pembrolizumab. However, the patient’s overall clinical status did not improve, and imaging revealed tumor progression and concomitant exacerbation of pain. We opted for administering anes thetics and opioids using an epidural catheter, continu ous infusion of anesthetics through an external pump, alongside the previous antalgic scheme. Unfortunately, pain control was only transiently achieved. Despite these interventions, the patient’s clinical condition continued to deteriorate. The intensity of pain became unbearable, leading to sedation with propofol. Ultimately, the patient died. Conclusions. This report aims to explore the cur rent strategies and challenges in managing oncological pain, with a focus on novel approaches for improving the overall clinical state of patients.

Keywords: pain, opioids, anesthetics, fentanyl

 

 

 

 

Efficacy of chemotherapy for pain control in patients at the onset of their disease

Ştefan Spînu¹, Daniel Sur^2,3, Veronica Creciun⁴, Daniela Moşoiu^5,6, Daniel Ciurescu^6,7

1. MedLife Oncology Hospital, Braşov, Romania

2. Department of Medical Oncology, “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

3. Department of Oncology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

4. Department of Hematology, “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

5. Hospice Casa Speranţei, Braşov, Romania

6. Departments of Medical and Surgical Specialties, Faculty of Medicine, Transylvania University of Braşov, Romania

7. MedLife Hospital, Braşov, Romania

 

Corresponding author: Ştefan Spînu, e-mail: mailto:dr.stefanspinu@yahoo.com

Objective. The rationale of the present study is to measure the impact of antineoplastic treatment (chemo therapy) on the pain generated by the disease. Materials and method. The present study was based on the comple tion of two standardized questionnaires for the assess ment of physical symptoms (Brief Pain Inventory [BPI] and revised Edmonton Symptom Assessment System [ESASr]) in three different moments. The research was carried out in the Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania, between 2022 and 2023. Results. Twentyfour patients were included in the study (18 men), and they received different cytostatic treatment regimens, adapted to the underlying pathology. We have analyzed first the distribution of all symptoms from the ESASr and the total score. In terms of the general situation, if we exclude pain, there is never a difference between Time 2 and Time 3. Furthermore, in all cases where there is a statistically significant effect, there is a

difference between Time 1 and Time 3. We also analyzed the distribution of activities with which pain interacts – with BPI. Regarding the general situation, three pat terns of influence of pain on the examined parameters are found: for general activity, mood, ability to work and sleep, there are significant differences between moments 12 and 13, without significant differences between mo ments 23. The second pattern identified refers to the lack of effect of pain on the ability to walk and on the relationship with other people. The peculiarity is repre sented by the influence on the enjoyment of life that was significantly improved only from Time 1 to Time 3, not between 12 or 23. Conclusions. The present study dem onstrated a considerable effect of cytostatic treatment on the management of cancerrelated pain, as shown across different evaluations.

Keywords: palliation, pain, chemotherapy, questionnaire

Paraneoplastic scleroderma, first manifestation of breast cancer – a case report

Mihaela Stana^1,2, Fatima Cardoso²

1. Medical Oncology Department, Elysee Hospital, Alba Iulia, Romania

2. Breast Unit, Champalimaud Cancer Centre, Lisbon, Portugal

 

Purpose. Systemic sclerosis (SS) is a connective tis sue’s autoimmune disease. It is a multisystemic disease, with an increased risk of developing malignancy, mostly breast and lung cancer. Rarely, its manifestation lays in the panel of a paraneoplastic syndrome due to the anti bodies against primary tumor. Breast cancer and para neoplastic SS is a coexistence which requires multidis ciplinary approach. Materials and method. We present the case of a 72yearold female patient who developed at 68 years old Raynaud’s syndrome, heartburns, progres sive skin thickening and generalized muscle weakness, with extreme fatigue. In December 2020, a diagnosis of diffuse SS was established, and steroids were started, without clinical improvement. Cancer screening (breast, gastrointestinal and lung) was performed, without any primary tumor detected. Immunoglobulin treatment was refused by the patient and, due to disease progres sion (sclerodactyly, worse skin thickening and microsto mia), in March 2021, mycophenolate mofetil therapy was initiated, without improvement. Monthly cyclophospha

mide was initiated because of a fulminant evolution for nine months. After lung fibrosis’ diagnosis, nintedanib and mycophenolate were started in April 2022. Results. In September 2022, the abdominal CT revealed multiple liver lesions. Liver biopsy: invasive lobular breast cancer metastasis, grade 1, ER=90%, HER2=1+, Ki67 index 25%. Recent breast exams showed a lesion of 5.5 mm in the left breast. First line for stage IV lobular breast cancer luminalA like was initiated in October 2022, with anti CDK4/6 and aromatase inhibitor (ribociclib/letrozole), with partial response. Systemic sclerosis was worsening, and the rheumatologist suggested to initiate switch to rituximab while continuing the breast cancer treatment. Conclusions. Despite the fact that systemic sclerosis can mimic different rheumatologic diseases, it is worth to raise awareness about oncologic screening with this clinical appearance. The malignancy can be hidden, and it requires multidisciplinary communication.

Keywords: scleroderma, paraneoplastic syndrome, breast cancer, best supportive care

 

 

 

 

Caspases – new histopathological perspectives with potential therapeutic implications in the treatment of poorly cohesive gastric carcinoma

Laura-Elena Stanciu¹, Ioana-Anastasia Cibotariu¹, Gianina Micu¹, Luciana Nichita^1,2, C. Botezatu^2,3, A. Bordea¹, R.G. Ionescu¹, Diana-Maria Marinoiu¹, Violeta-Nicoleta Marin¹, R. Neagu¹, Cristiana Popp¹

1. Department of Pathology, Colentina Clinical Hospital, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

3. Department of General Surgery, Colentina Clinical Hospital, Bucharest, Romania

 

Objective. Although the overall incidence of gastric carcinoma has declined, the poorly cohesive subtype has shown an increasing frequency, often affecting younger individuals and typically being diagnosed at advanced stages (both locally and systemically). Investigating the pathophysiological mechanisms of local and distant dis semination is essential for the development of novel therapeutic strategies aimed at identifying potential treatment targets. Materials and method. This study included 11 patients with poorly cohesive gastric carci noma, diagnosed from gastrectomy specimens between 2020 and 2024, none of whom had received preopera tive oncologic treatment. Representative paraffin blocks were selected for each patient, and immunohistochemi cal staining was performed for Ecadherin, caspase1 and caspase9. The data obtained were correlated with histopathological staging and preoperative imaging findings, using Spearman’s correlation coefficient for statistical analysis. Results. Ecadherin expression

was preserved in all but two cases. Caspase1 expres sion was identified in 36.4% of tumors, while caspase9 was present in 27.3%. All patients had locally advanced tumors (pT34) and multiple lymph node metastases, while distant metastases were detected in three patients through MRI or CT imaging. Caspase expression was negatively correlated with primary tumor extension and positively correlated with the presence of lymph node and distant metastases. Tumors that lost Ecadherin membranous expression were also negative for caspase expression. Conclusions. Caspase1 and caspase9 ex pression appears to be associated with a more aggres sive tumor phenotype, characterized by both local and systemic dissemination. Although the study is limited by its small sample size, it highlights novel avenues for further research into potential therapeutic targets for poorly cohesive gastric carcinoma.

Keywords: poorly cohesive gastric carcinoma, cas pase1, caspase9, Ecadherin

Therapeutic management challenges in a polyallergic HER2-positive breast cancer patient

Mihaela-Andreea Stejeroiu

Department of Medical Oncology, “Elias” University Emergency Hospital, Bucharest, Romania

Introduction. Breast cancer is one of the most com mon neoplasms in women, and personalized treatment plays a crucial role in improving outcomes. In HER2 positive tumors, therapy with antiHER2 monoclonal antibodies is the standard of care in both neoadjuvant and adjuvant settings, significantly improving survival. Additionally, granulocyte colonystimulating factors are often used to prevent chemotherapyinduced neutrope nia. However, hypersensitivity reactions to these medica tions can pose a major challenge in therapeutic manage ment. Case report. A 44yearold female, smoker, with no family history of cancer, was diagnosed with invasive ductal carcinoma, hormone receptors negative, Human Epidermal Growth Factor Receptor 2 (HER2) positive, cT2cN1M0, following a routine breast ultrasound and biopsy in November 2023. She began treatment with docetaxel, carboplatin, trastuzumab, pertuzumab and pegfilgrastim for neutropenia prophylaxis. After the first administration, she developed a pruritic rash. An al

lergology consultation confirmed the hypersensitivity to trastuzumab and filgrastim. Given the need to continue neoadjuvant treatment, an attempt was made to pro ceed with therapy using desensitization for trastuzumab and filgrastim. The patient successfully completed the neoadjuvant treatment, achieving a partial response. A mastectomy with left lymphadenectomy was performed. Histopathology revealed ypT1ypN0, hormone receptors negative, HER2 1+ ductal carcinoma. Based on the re sults, the treatment with trastuzumab emtansine with a desensitization protocol was initiated, which the patient tolerates very well. Conclusions. This case underscores the challenges in managing HER2positive breast cancer patients with hypersensitivity to standard therapies. Desensitization allowed the patient to continue the es sential treatment, demonstrating its feasibility in man aging hypersensitivity to critical cancer therapies.

Keywords: breast cancer, hypersensitivity, filgrastim, trastuzumab

 

 

 

 

 

The impact of artificial intelligence on automatic contouring of target volumes and organs at risk in radiotherapy: a systematic review

Remus Stoica¹, Adrian Radu²

1. Global Medical Health Bucharest, Romania

2. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

 

Introduction. Radiotherapy (RT) plans must be per sonalized to accommodate each patient’s unique anatomy and cancer characteristics. This requires accurate deline ation of target volumes (CTV) and nearby organs at risk (OARs), a crucial and time-intensive task for radiation on cologists. Manual contouring, particularly on CT scans, is labor-intensive and prone to variability among observers, which can impact both the precision of CTV delineation and treatment outcomes. Materials and method. A sys tematic review was conducted using PubMed to identify studies published in the last five years (2019-2024) on the automatic delineation of OARs and CTVs for radiotherapy, focusing on adult populations. Both quantitative (DICE score, MSD, HD95, time) and qualitative (scale scoring, Turing tests) metrics were considered. Results. Manual contouring required an average of 28 minutes, while ar

tificial intelligence (AI) based methods reduced this time by 58.85%, saving approximately 13 minutes and 58 sec onds per case. Using the classification Dice Similarity Coefficient scores of Van Dijk et al., most organs from our review achieved “good” accuracy (>0.8). The esophagus, thyroid, vena cava, lens, optic nerve, pancreas, and seminal vesicles were rated as “goodintermediate” (0.70.8), while the renal artery, penile bulb, adrenal glands, pituitary, pineal gland, and brachial plexus fell into the “interme diatepoor” category (0.50.6). Conclusions. AIassisted contouring significantly improves the speed and accuracy of radiotherapy planning. This advancement supports the growing demand for efficient, precise treatments in imageguided radiotherapy.

Keywords: artificial intelligence (AI), radiotherapy, OARs, CTV

Therapeutic approach in a young woman with aggressive triple-negative breast cancer – case report

Anca Stolojanu¹, Elena Dumitrescu^1,2, Crina Siminiceanu¹, Loredana Ciontea¹, Radu Matei¹, Adelina Gheorghe^1,2, Irina Chirea¹, Sânziana Prundianu¹, Ioana Geală¹, Dana-Lucia Stănculeanu^1,2

1. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Objective. We present a case of aggressive tripleneg ative breast cancer (TNBC) in a young woman. Despite benefiting from promising therapies such as antibody drug conjugates and immune checkpoint inhibitors, the management still represents a challenge. Case pres- entation. We discuss the case of a 35yearold woman who was diagnosed with invasive left TNBC and PDL1 negative status in December 2022, following a core needle biopsy. Germline panel genetic testing including BRCA was negative. The multidisciplinary team decided to start neoadjuvant chemotherapy with epirubicin and docetaxel. However, the treatment was interrupted after five sessions because of the local progression of the dis ease. Docetaxel and carboplatin were then administered for an additional two sessions, but the local course of the disease continued. Subsequently, the patient underwent radiotherapy for the left breast and locoregional lymph node areas from July to August 2023. A PETCT investiga tion shortly after revealed disease progression, with the appearance of bone metastases. At this time, the mul tidisciplinary team decided to initiate treatment with sacituzumab govitecan in September 2023. The disease

remained stable until February 2024, when pulmonary and lymphatic metastases appeared. The treatment with sacituzumab govitecan continued until June 2024, when the disease progressed with the appearance of brain me tastases. The patient then underwent wholebrain ra diotherapy, and a decision was made to rebiopsy the left axillary lymph nodes. The result confirmed the diagno sis of triplenegative breast cancer metastasis, but with positive PDL1 expression in immune cells (IC=5%). The treatment with atezolizumab and paclitaxel was initi ated in July 2024. The patient has remained clinically stable since then, but local progression continues to pose a challenge for the multidisciplinary team. Conclusions. Although several promising therapeutic algorithms have emerged in recent years, the identification of effective therapies for TNBC remains a significant ongoing chal lenge. Additionally, our case underscores the importance of rebiopsy to determine the status of key biomarkers such as BRCA1/2, HER2 and PDL1, which could guide treatment in subsequent lines.

Keywords: triplenegative breast cancer, antibody drug conjugates, immune checkpoint inhibitors, rebiopsy

 

 

 

 

Comparison of circulating tumor DNA (ctDNA) with neutrophil-to-lymphocyte ratio (NLR) in the choice of oncologic treatments: case presentations in colon and gastric cancer

P. Şiancu^1,2, Ioana Dinu³, Monica Miron³, Ana-Maria Dudău³, Andreea Robu³, Elena Palamariu³, C. Tănăsescu^4,5, Adina-Emilia Croitoru^3,6

1. Oncology Department, County Emergency Clinical Hospital Sibiu, Romania

2. Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, Romania

3. Oncology Department, Fundeni Clinical Institute, Bucharest, Romania

4. Surgical Clinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, Romania

5. Surgical Department, County Emergency Clinical Hospital Sibiu, Romania

6. Clinical Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

 

Introduction. Monitoring disease progression and ad justing treatment based on biomarkers are essential in oncology. Circulating tumor DNA (ctDNA) is an emerging biomarker used for early detection of recurrence and for monitoring response to treatment, while the neutrophil tolymphocyte ratio (NLR) is a recognized inflammatory marker for oncological prognosis. The aim of this study is to compare the efficiency of ctDNA and NLR in guiding oncological treatments, by means of two clinical cases of colon and gastric cancer. Materials and method. Two clinical cases were analyzed: one patient with colon neoplasm and one patient with gastric neoplasm. In the case of the patient with colon neoplasm, five comparative determinations of ctDNA and NLR were performed, while for the patient with gastric neoplasm two such determina tions were performed. Both methods were compared in

terms of sensitivity and correlation with patients’ clinical course. Results. The findings indicated that, for colon neoplasms, ctDNA demonstrated heightened sensitivity and a more precise correlation with patient progression in comparison to NLR. In the case of gastric neoplasms, ctDNA values remained positive, whereas NLR exhibited normalization, suggesting that ctDNA possesses a supe rior capacity to detect disease persistence. Conclusions. The data indicate that ctDNA determination offers a more precise prognosis for patients with digestive oncological pathologies than NLR. Consequently, ctDNA may serve as a pivotal instrument in the surveillance and customi zation of oncological treatments, transcending the con straints of conventional inflammatory markers.

Keywords: digestive cancer, prognosis, ctDNA, neu trophiltolymphocyte ratio, biomarkers, genetic testing

Cancer-associated fibroblasts and their prognostic role in colorectal cancer

Alexandra-Elena Ştefan¹, Silvia Ilie², Laurenţia-Nicoleta Galeş¹, Ana-Maria Muşină³, Valentin Derangere⁴, Kevin Rouet³

1. Department of Medical Oncology, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology Bucharest, Romania

2. Department of Medical Oncology, Georges-François Leclerc Cancer Center, Dijon, France

3. Surgery Department, Regional Institute of Oncology Iaşi, Romania

4. Translational Research Platform, Georges Francois Leclerc Cancer Center, Dijon, France

 

Background. Cancerassociated fibroblasts (CAFs) play a major role in modulating the tumor microenvi ronment and seem to be correlated with relapse. This metaanalysis aims to evaluate the prognostic role of immunohistochemical biomarkers of CAFs in colorec tal cancer (CRC). Materials and method. A systematic literature search was conducted on Medline for studies evaluating CAFs biomarkers expression and their asso ciation with survival in CRC. The studies were selected according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines and the Population, Intervention, Comparator, Outcome (PICO) criteria. The NewcastleOttawa Scale (NOS) was used for the quality assessment of the selected publications. The outcome measure was the hazard ratio (HR) for disease free and (DFS) or overall survival (OS), with a statistical significance level of p value below 0.05. Results. A total of 1975 articles were identified on PubMed, of which 42

were selected for final analysis, including 9886 patients. The chosen studies were retrospective, had moderate to low risk of bias, and analyzed the following biomarkers: matrix metalloproteinase 2 (MMP2), FAP (fibroblast ac tivation protein a); alphasmooth muscle actin (a SMA); trasgelin (TGLN), calcium binding protein A4(S100A4), platelet derived growth factor subunit b (PDGFR b), peri ostin (POSTN); vimentin, tenascinC (TNC), podoplanin (PDPN), and CXC motif chemokine ligand 12 (CXCL12). The biomarkers significantly found associated with sur vival were MMP2, TGLN, PDGFR b, POSTN, S100A4, CD

163, TNC, vimentin, and CXCL12. Conclusions. Specific CAFs biomarker expressions are correlated with outcome in colorectal cancer, indicating the need for larger, pro spective studies to validate their prognostic role.

Keywords: cancerassociated fibroblasts, colorec tal cancer, prognosis metaanalysis, biomarker, tumor microenvironment

 

 

 

 

 

A challenging rechallenge

R. Todea¹, Claudia Burz^1,2

1. “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

2. “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

 

Cutaneous melanoma is notorious amongst malig nancies for being the most genetically heterogeneous type of cancer. This heterogeneity was responsible for the poor outcome of treating melanoma with classical chemotherapy, leaving clinicians with no real treat ment options until the advent of immunotherapy and targeted therapy. However, while there is a minor ity of patients that show outstanding benefit from novel treatment methods, most patients eventually lose the response to treatment. Facing this scenario, the clinician is once again left without any means of efficient therapy, and the question arises whether there is a better way in which we can sequence avail able therapies in order to maximize the benefit of current therapeutic options. One such method could be the reuse of prior lines of therapy, taking advan tage of the tumors own strong point, its heterogeneity

We present the case of a 67yearold female patient diagnosed with a 7x7mm cutaneous melanoma lo cated on her abdomen, which was excised and, in spite of good prognostic factors, it has metastasized less than two years away from the primary treatment. After progression on firstline antiPDL1 immuno therapy, secondline targeted therapy and thirdline antiCTLA4 immunotherapy, the patient was rechal lenged with targeted therapy with dabrafenib and trametinib. Once again, in spite of the fact that the patient had good predictive factors for response to the TKI rechallenge, her evolution was unfavorable. Our presentation showcases the need for better predictive biomarkers, so we can better select the patients who will benefit from TKI rechallenge.

Keywords: metastatic melanoma, rechallenge, predic tive biomarkers, heterogeneity

Dermatologic toxicity occurring during EGFR inhibitor therapy in patients with metastatic colorectal cancer

Maria Tomulesei, Elena-Rodica Gafton, Valentina Huţanu, Larisa-Maria Rotariu, Ioana-Roxana Cârlan

Department of Medical Oncology, Regional Institute of Oncology Iaşi, Romania

Introduction. EGFR inhibitors (EGFRIs) offer a valu able treatment option for patients with metastatic colo rectal cancer. The earliest and most commonly reported cutaneous event is acneiform rash (also known as papu lopustular rash), which develops in 6080% of patients, usually within the first two weeks. Case presentation. We present the case of a patient with stage IV colon cancer, RAS wildtype, complicated with liver metastases, who underwent in the first line of treatment palliative chemo therapy, associated with panitumumab, then, in the sec ond line, palliative chemotherapy and biologic medication with bevacizumab. Surgery was performed (segmental sigmoid resection with endtoend colorectoanastomosis), after that palliative chemotherapy and biologic medica tion with bevacizumab continued. The patient presented disease progression on imaging reevaluation. RAS genetic testing was performed from liquid biopsy, with wild type

result, and the treatment with cetuximab was initiated. During the treatment with EGFRI, the patient presented skin toxicity of varying degrees (up to grade 34), mani fested by a papulopustular rash, disseminated on the face, chest, posterior cervical region and scalp, with the exist ence of crusts of yellowbrown color. Adequate manage ment of the skin manifestations, prophylaxis (primary/ secondary), antibiotic therapy and corticosteroid therapy, systemic and topical, allowed the continuation of EGFRI treatment. Conclusions. Cutaneous toxicities – particu larly acneiform rash, xerosis and pruritus – can signifi cantly affect the patient’s quality of life, to the extent that many physicians feel it necessary to delay or discontinue the EGFRI treatment, with a potentially negative impact on treatment outcomes, including overall survival.

Keywords: skin toxicity, colon cancer, panitumumab, cetuximab

 

 

 

 

Long-term management of ovarian cancer – case report

Nicoleta-Andreea Tudose

Colţea Clinical Hospital, Bucharest, Romania

We present the clinical case of a 52yearold woman diagnosed in 2017 with ovarian cancer, with a medical history of chronic endometriosis and grade II obesity, who presented with diffuse hypogastric pain and ab dominal bloating. A pelvic ultrasound revealed a 9cm left ovarian mass. Initial suboptimal primary debulking surgery revealed the diagnosis of endometrioid ovarian cancer, estrogenpositive and progesterone receptorpos itive, BRCA 1 positive. Subsequent secondary debulking surgery confirmed stage IIIC FIGO. Systemic treatment with six cycles of carboplatin/paclitaxel led to a partial response, but the treatment was poorly tolerated be cause of grade II peripheral polyneuropathy. Followup CT scans were performed and showed progression of peritoneal carcinomatosis (M1PER) and omental cake by December 2021. Reinitiating carboplatin/paclitaxel resulted in grade III peripheral polyneuropathy, lead

ing to a switch to Caelyx®/bevacizumab, achieving a 14month progressionfree survival (PFS) until May 2023, when a CT scan described disease progression of M1PER with newonset abdominal ascites. The subse quent topotecan treatment provided a 10month PFS till March 2024, marked by progression of M1PER and new symptoms of partial bowel obstruction. Given re sidual grade I peripheral polyneuropathy, carboplatin was reinitiated, resulting in the symptomatic relief of bowel obstruction. A CT scan after six cycles is sched uled to assess treatment efficacy. In conclusion, this is a clinical case of a BRCA1positive ovarian neoplasm diagnosed in 2017, with multiple subsequent lines of treatment, with platinum sensitivity and symptomatic response to carboplatin monotherapy in the fourth line. Keywords: ovarian neoplasm, peritoneal carcinoma

tosis, BRCA1 mutation

The significance of genetic testing in cancer-associated venous thromboembolism

Petruţa-Raluca Ţui, Iulia Gramaticu

Department of Oncology, Fundeni Clinical Institute,

Bucharest, Romania

Introduction. Patients with malignancies are more likely to develop venous thromboembolism (VTE), with thrombotic events being the second largest cause of death in cancer patients, after cancer itself. Thromboembolic events that occur unexpectedly can even predict the on cological disease, having a significant impact on survival. A thorough clinical examination, accurate diagnosis and properly implemented treatment can tilt the balance in favor of the patient. Description. We discuss revisions to the international criteria for TVE care, such as clini cal detection, certification diagnosis and recommended therapy options. Recurrent VTE occurrences, when onco logical illness is ruled out, offer a common difficulty and impose a meticulous differential diagnosis. The increased

frequency of seemingly unprovoked VTE events can be explained by genetic testing for inherited abnormalities implicated in the coagulation cascade. One useful tool for anticipating the incidence of VTE in cancer patients is a preventive genetic testing. By way of parallelism, we describe distinct, but not necessarily unique, clinical case instances. Discussion. Deep venous thrombosis and pul monary embolism are two thromboembolic events that precede, accompany or worsen the oncological illness, and pose a significant risk factor. Although within reach, the oncological disease is not necessarily the cause but rather another less common condition or disorder.

Keywords: genetic testing, mutations, thromboem bolic events, cancer, anticoagulants