ABSTRACTS FOR THE NATIONAL CONGRESS OF ONCOLOGY, 2025

Second chance: long course treatment of metastatic breast cancer

C. Achiroaei^1,2, Diana-Ioana Panaite^1,2, C. Volovăț^1,2

1. Victoria Hospital – Euroclinic Oncology Center, Iași, Romania

2. “Grigore T. Popa” University de Medicine and Pharmacy, Iași, Romania
 

Purpose. Modern treatment modalities, including combined systemic chemotherapy, external beam radiation therapy and stereotactic body radiotherapy, add to an arsenal of treatment strategies that offer patients better survival and quality of life, even in metastatic settings. Materials and method. A 44-year-old patient presented with stage IIA Luminal A breast cancer, and underwent curative treatment and adjuvant hormone therapy. After five years, liver and bone metastases were detected on PET-CT, for which antalgic external beam radiotherapy and first-line systemic therapy, consisting of CDK4/6 inhibitors and bisphosphonate, were initiated. On progression, second-line chemotherapy achieved complete response. Two years later, on ulterior progression of the liver lesions, stereotactic body radiotherapy was used. Results. Early detection of disease relapse, using highly sensitive imaging techniques, allowed the timely start of therapy which achieved good disease control. Conclusions. A prolonged control of metastatic disease was achieved by multidisciplinary intervention.

Keywords: breast cancer, oligometastatic disease, SBRT, long course

 

 

Oncology-surgery collaboration: a mandatory step in the favorable evolution of bone tumors. Case of humeral osteosarcoma

Răzvan Adam^1,2, Cosmin Moldovan^1,3, Sorin Tudorache¹, Mark Pogărășteanu^4,5

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

2. “Elias” Orthopedics and Traumatology Clinic, Bucharest, Romania

3. General Surgery Clinic, CF1 Witting Clinical Hospital, Bucharest, Romania

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

5. Orthopedics and Traumatology Clinic, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
 

Introduction. Osteosarcoma is one of the main bone tumors, with rapid progression and metastasis in the absence of adequate oncological and surgical treatment. Collaboration between the two disciplines, in accordance with the working protocol, chemotherapy – surgery – chemotherapy, is the key to success in managing these cases. Materials and method. A patient was diagnosed with proximal humeral osteosarcoma by bone biopsy. Preoperative chemotherapy was initiated, resulting in a reduction of approximately 40% in tumor size. Surgical intervention was performed, with en bloc tumor resection, oncological safety margins, and reconstruction with a modular reverse-type prosthesis. The biopsy was performed using a different approach than that required for resection, necessitating a double approach. Lack of prosthetic augments for muscle suture. Coverage with Polytape for muscle reinsertion. Postoperative chemotherapy was resumed. Results. There was a favorable local and general evolution of the patient, without local or systemic complications. Discussion. Osteosarcoma is one of the most aggressive bone tumors, with a natural evolution towards rapid metastasis, especially to the lungs, and death. The development of new oncological therapies and surgical techniques, in compliance with oncological resection, has led to a marked increase in the life expectancy of these patients. The patient benefited from the case being processed by the tumor board, with the correct approach to therapeutic times, leading to an excellent evolution of the case.

Keywords: osteosarcoma, tumor board, chemotherapy, resection reconstruction, shoulder tumor prosthesis

 

 

Radiology as a strategic partner in modern oncology: better decisions together

S.A. Artene¹, Elena-Luiza Artene²

1. Department of Biochemistry, University of Medicine and Pharmacy of Craiova, Romania

2. Oncolab Private Oncology Center, Craiova, Romania
 

Modern oncology is based on a continuous integration of clinical, biological and imaging data. Radiology is no longer just an auxiliary tool but an indispensable partner in early diagnosis, staging, therapeutic decision-making, and monitoring treatment response. The purpose of this presentation is to highlight the importance of oncologists updating their knowledge of radiological indications, ensuring that patient pathways are more efficient and oriented toward improved clinical outcomes. The presentation is based on a comparative analysis of international guidelines and best clinical practices, correlated with the personal experience of a physician with dual training in oncology and radiology. Essential imaging modalities and selection criteria according to clinical context are discussed, with emphasis on the value of interdisciplinary collaboration. Modern radiology enables early lesion detection, detailed cha­rac­terization and accurate staging, directly shaping therapeutic decisions. However, its true value depends on how well oncologists understand when and how to use specific investigations. This presentation is designed both for young oncologists, who need a structured overview of imaging indications at the start of their career, and for experienced specialists, who can refine and update their practice in line with the latest advances. By bridging knowledge gaps, reinforcing evidence-based choices, and strengthening collaboration with radiologists, the session encourages oncologists to fully integrate imaging into their decision-making process. Ultimately, this shared expertise enhances the quality of cancer care and ensures that patients benefit from faster, safer and more effective diagnostic pathways.

Keywords: oncology, radiology, diagnosis, imaging, in­ter­dis­ci­plina­rity

 

 

Atypical faces of lung cancer – imaging aspects between benignity and malignancy

Eddan Athir

“Marius Nasta” Institute of Pneumophtisiology, Bucharest, Romania
 

Lung cancer is one of the most common and complex neoplasms, with a wide imaging spectrum ranging from typical manifestations to atypical or deceptive presentations that can delay the establishment of an early diagnosis and complicate differentiation from other pathological entities. Beyond the classic characteristics associated with malignancy, such as spiculated margins, progressive growth or invasion of adjacent structures, there are numerous cases where lung cancer mimics benign or inflammatory lesions, requiring careful and detailed evaluation. This presentation aims to explore the “multiple faces” of lung cancer from a radiological perspective, focusing on recognizing the typical and atypical imaging characteristics of malignant tumors, as well as entities that can mimic or conceal a lung neoplasm. Through illustrative clinical cases, the importance of an integrated approach will be emphasized, including correlating imaging findings with clinical, biological and histopatholo­gical data. The role of complementary investigations, such as positron emission tomography-computed tomography (PET-CT), image-guided biopsy or serial monitoring by computed tomography (CT), in establishing diagnostic and therapeutic strategies will be discussed. Essential diffe­rential diagnoses will also be addressed, including infections, inflammatory lesions, benign tumors or systemic diseases with pulmonary involvement. The goal is to highlight the complexity of imaging interpretation in pulmonary oncologic pathology, as well as the importance of discussing cases in a multidisciplinary framework to make appropriate decisions for each individual case. Thus, the radiologist not only has the role of identifying suspicious lesions, but he becomes a true partner in the complex decision-making process of pulmonary oncologic pathology.

Keywords: lung cancer, imaging characteristics, benign or inflammatory lesions

 

 

Proven prognostic and predictive micro-RNA signatures in early-stage non-small cell lung cancer

Iolanda-Georgiana Augustin¹, Ileana Constantinescu²

1. PhD Student, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. Department of Immunology, “Carol Davila” University of Medicine and Pharmacy, Bucharest; Fundeni Clinical Institute, Bucharest, Romania
 

Introduction. Despite recent advances with neoadjuvant chemo-immunotherapy, a significant proportion of early-stage NSCLC patients remain at risk for disease recurrence following apparently curative surgery, highlighting the continued need for reliable prognostic biomarkers to guide personalized management. MicroRNAs (miRNAs), such as let-7, miR-146a, miR-34, miR-200, miR-16, miR-320a and miR-613, have emerged as minimally invasive biomarkers in serum and plasma, reflecting tumor biology and informing patient management. Materials and method. Recent meta-analyses and prospective cohort studies analyzed miRNA expression profiles in serum/plasma from patients with early-stage (I-III) NSCLC undergoing curative resection. Quantitative RT-PCR and high-throughput platforms were used to correlate pre- and post-treatment miRNA dynamics with overall survival (OS), disease-free survival (DFS) and recurrence risk. Results. Signatures featuring reduced let-7 and miR-34 family levels, as well as increased miR-21 and miR-200 expression were independently associated with adverse prognosis, higher risk of relapse, and lower OS after surgery. Panels combining multiple miRNAs performed better than single markers, achieving up to 0.78 area under curve (AUC) for OS prediction and stratifying low- versus high-risk patients (p<0.05). Dynamic reduction in oncogenic miR levels after surgery correlates with improved outcomes, while persistently high or upregulated expression signals poor prognosis. Conclusions. Circulating miRNA signatures (let-7, miR-34, miR-200 family) demonstrate proven value for prognostic and predictive stratification in early-stage operable NSCLC. Multi-miRNA panels may guide risk-adapted management and adjuvant therapy selection, supporting implementation as noninvasive biomarkers in routine practice.

Keywords: microRNA, NSCLC, prognosis, early stage, biomarker, predictive

 

 

Long-term management of advanced ALK-positive and ROS1-rearranged NSCLC with crizotinib: a case report with recurrent adverse events requiring dose modifications

Iolanda-Georgiana Augustin¹, Elena Popa², Lidia-Anca Kajanto²

1. PhD Student, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

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

Introduction. Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) is a molecular subset benefitting from targeted therapy. Crizotinib, an ALK inhibitor, with proven activity in the ROS1 rearranged patients, improves progression-free survival versus chemotherapy, but it is associated with adverse events (AEs) that often require therapy modification or interruption, particularly in long-term responders. Materials and method. We report the case of a 56-year-old woman diagnosed in 2022 with ALK-positive and ROS1-rearranged NSCLC with multiple cerebral, hepatic and bone metastasis, who started crizotinib therapy in April 2022. Clinical, laboratory and imaging findings, adverse events and therapeutic interventions were prospectively recorded and reviewed. Results. The patient achieved a partial radiologic response, maintained for over 42 months. However, she experienced recurrent adverse events, including grade 2-3 nausea, elevated transaminases, grade 3 peripheral edema and grade 2 vision disorders. These required several temporary interruptions and subsequent stepwise dose reductions to 200 mg BID, then to 250 mg QD. Supportive therapy enabled adverse event resolution and successful rechallenge. Despite dose reductions, disease control was maintained, with an acceptable quality of life. No severe (grade ≥4) events, interstitial lung disease, or fatal toxicity occurred during follow-up. Conclusions. This case underscores the importance of proactive AEs monitoring and flexible dose individualization in long-term crizotinib management for ALK-positive NSCLC. Ongoing therapy interruptions and reductions, guided by multidisciplinary care, can allow durable disease control and good tolerability, supporting treatment continuation when feasible.

Keywords: crizotinib, ALK positive, NSCLC, adverse events, dose reduction, case report

 

 

The challenges in the treatment of metastatic gastric cancer expressing claudin 18.2
with zolbetuximab and FOLFOX6: case report

A.C. Banu

Medical Oncology Department, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
 

The purpose of this case report is to highlight the adverse events which can occur in the treatment of metastatic gastric cancer which expresses claudin 18.2 based on zolbetuximab in combination with FOLFOX6 regimen and the methods of symptom relief and for improved tolerability. We report the case of a patient diagnosed with gastric adenocarcinoma and liver metastases which express claudin 18.2>75%. This patient receives treatment based on zolbetuximab in combination with FOLFOX6 regimen administered every two weeks under strict monitoring by clinical examination and analysis of the CBC and biochemical profile. The regimen is ongoing for three months, and the adverse events are documented until cycle number 3, days 15 and 16. During the first two cycles of treatment, the patient experienced grade 2 nausea, abdominal pain, heartburn, diarrhea, dizziness, fatigue and muscle weakness. Due to these symptoms, it was considered necessary to gradually increase the treatment infusion rate for better symptom control, using a scheme in accordance with the therapeutic protocol and with studies that have documented steps in the rate of administration of zolbetuximab. After the first administration of zolbetuximab, it was also noticed that total creatine kinase (CK) values increased by eight times the upper limit of normal and CK-MB values by 122 times. The cardiological examination revealed no signs of heart failure due to myocarditis or myocardial infarction. Thus, increased creatine kinase levels could be interpreted as a result of tumor necrosis from multiple liver metastases, or they could be a manifestation of paraneoplastic effect from gastric cancer. However, creatine kinase values normalized with subsequent cycles. Nausea and other adverse events associated with therapy improved significantly in the subsequent cycles, and this result was facilitated by adapting the infusion rate in combination with antiemetic premedication.

Keywords: zolbetuximab, nausea, infusion rate, creatine kinase

 

 

Unmet needs beyond third line in metastatic colorectal cancer 

A.A. Barnonschi¹, Iulia-Magdalena Gramaticu¹, Adina-Emilia Croitoru^1,2

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

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

Objective. Colorectal cancer represents a huge challenge amongst physicians, being the third most common cancer and the second leading cause of death in cancer. Despite the undoubtful progress made in the last decades regarding the prognosis, treatment options beyond third line are currently limited. Notably, around 40% of metastatic colorectal cancer (mCRC) patients undergo third-line therapy regimens and more than 85% of the patients receiving third-line treatment have a performance status (PS) of 0-1. Therefore, an important category of patients are fit for therapy beyond third line, and might be unable to benefit due to restricted therapeutic possibilities. Case description. We report the case of a 51-year-old male patient evaluated in 2021 for diffuse abdominal pain, rectorrhagia and altered bowel habits. CT scan and colonoscopy revealed a superior rectum tumor and multiple secondary lesions in the liver and lungs. Histopathological and molecular analysis confirmed moderately differentiated colorectal adenocarcinoma, mismatch repair proficient (pMMR), RAS wild type. The patient underwent anti-EGFR-based therapy followed by two additional lines of systemic treatment, maintaining good performance status throughout therapy. A reassessment via liquid biopsy reconfirmed RAS wild-type status, supporting a cetuximab monotherapy rechallenge in the fourth line. CT imaging from October 2025 showed stable disease. Discussion and conclusions. This paper highlights the narrow range of therapeutic options in the fourth line and further in metastatic colorectal cancer, and we should raise awareness among medical specialists, taking into account the significant proportion of patients who might not benefit from treatment because of limited therapeutic options. However, the importance of repeated molecular profiling in mCRC management opens opportunities for rechallenging with targeted therapies, such as anti-EGFR agents, that might improve patients’ clinical outcomes.

Keywords: metastatic colorectal cancer, performance status, liquid biopsy, targeted therapy

 

 

Case report: extended survival in MSS, HER 2-positive gastric cancer with cardiotoxicity
and suspected Enhertu®-induced pulmonary complications

Andra-Elena Băloi¹, Adina Croitoru^1,2, Ioana Dinu¹

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

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

Introduction. Metastatic gastric cancer with microsatellite stability (MSS), HER2 overexpression and PD-L1 negativity carries a poor prognosis, with a median overall survival below 16 months. Standard first-line therapy consists of trastuzumab combined with CAPOX or FOLFOX. Trastuzumab, a humanized monoclonal antibody against HER2, is associated with adverse effects such as cardiotoxicity, hematologic and gastrointestinal toxicities. Rarely, interstitial lung disease (ILD) may occur and can be life-threatening. Case presentation. A 54-year-old male was diagnosed with intestinal-type gastric adenocarcinoma and synchronous hepatic metastases. He was enrolled in a clinical trial, and he received trastuzumab plus CAPOX. Trastuzumab was discontinued due to cardiotoxicity (LVEF 45%), and the treatment continued with CAPOX, later capecitabine monotherapy, achieving a partial response (a PET-CT from August 2023 revealed the disappearance of hepatic lesions). In January 2024, he underwent gastrectomy and hepatic metastasectomy, followed by FOLFIRI and IMRT/VMAT radiotherapy for advanced disease (ypT4a, ypN3b, LVI+, PNI+). After progression (January 2025), he received Lonsurf® and later trastuzumab deruxtecan (Enhertu®). The adverse events included severe cardiotoxicity, grade III neutropenia (during capecitabine), postoperative pneumonia and recurrent febrile neutropenia under Enhertu®. Currently, he is hospitalized for fever and dry cough; chest CT revealed fibro­tic and inflammatory changes with bronchiectasis, suggesting infectious pneumonia versus Enhertu®-induced pneumonitis. Empiric antibiotics were initiated, with favorable evolution. He also has chronic hemorrhoidal disease with microcytic anemia requiring transfusions. During this hospitalization, another echocardiography showed once again cardiotoxicity (considering the fact he regained his systolic function after trastuzumab). Discussion. This case highlights the exceptional survival in metastatic HER2-positive gastric cancer despite multiple severe toxicities. The coexistence of cardiotoxicity and possible ILD is uncommon and underscores the importance of close monitoring for multiorgan adverse effects during anti-HER2 therapy.

Keywords: case presentation, HER2 positive, cardiotoxicity, interstitial lung disease, prolonged survival

 

 

Nutritional strategies for weight management in hormone-treated cancer patients: clinical cases

Roxana-Raluca Bârzu

Registered dietitian in clinical oncology
 

Background. Hormonal therapy, widely used in hormone-dependent cancers (e.g., breast, prostate), is frequently associated with weight gain and metabolic alterations, which may affect prognosis and quality of life. Personalized nutritional interventions are increasingly recognized as integral to oncology care. Objective. To highlight the role of nutritional interventions in weight management among oncology patients undergoing hormonal therapy, through case presentations from current clinical practice. Materials and method. We present cases of patients with hormone-dependent malignancies who underwent nutritional assessment and received individualized dietary plans. Monitoring focused on weight evolution, metabolic parameters and treatment adherence. Results. Early and tailored nutritional strategies (controlled caloric intake, adequate protein supply, balanced macronutrient distribution) proved effective in limiting weight gain and in improving metabolic outcomes. The presented cases align with recent evidence supporting the integration of nutrition in oncology. Conclusions. Personalized nutritional management is a key component of the multidisciplinary oncology approach, with positive effects on weight control, treatment adherence and quality of life. Randomized controlled trials are warranted to further assess its impact on survival and recurrence.

Keywords:weight management, hormonal treatment, case presentation

 

 

Onco Multi Support Project improving quality of life in cancer patients

Roxana R. Bârzu¹, Alexandra Cazacu¹, Lidia Kajanto¹, Iulia Minea¹, Daniel P. Plăiașu¹, Laura F. Rebegea², Daniela L. Zob¹

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

2. Radiotherapy and Oncology Department, County Emergency Clinical Hospital Galaţi, Romania
 

Introduction. The Onco Multi Support Project was designed to improve the quality of life (QoL) of cancer patients through an integrated, multidisciplinary approach combining nutritional counseling, oncological rehabilitation and psychological support. Interventions were delivered both during and after treatment, ensuring continuity of care by medical specialists. Methodology and recent evidence. Evidence from recent trials confirms that: nutritional counseling improves nutritional status and QoL while reducing re-hospitalization (Yan, 2023; Chewaskulyong, 2024); psychological interventions such as cognitive-behavioral therapy and mindfulness significantly reduce anxiety, depression and distress, with clear QoL benefits (Anghel, 2025; Bognár, 2024; Ashton, 2024); integrated palliative care has also been shown to improve physical, emotional and social functioning (Wang & Ding, 2025). Results. After two years, patients enrolled in the project – particularly those with breast, colorectal, and head and neck cancers – reported better symptom management, less anxiety and depression, improved recovery, and greater overall satisfaction. Case studies highlighted the effectiveness of multidisciplinary interventions in enhancing daily functioning and well-being. Conclusions. The project demonstrated that integrated, patient-centered care produces measurable benefits for oncology patients’ QoL. However, implementation challenges remain: the collaboration with some physicians was limited due to reluctance to adopt multidisciplinary models, while others – including public institutions – showed openness and strong support. Partner engagement proved uneven, but the real impact on patients was indisputable: improved health, trust and resilience. Onco Multi Support Project confirms that holistic, integrated interventions can transform the cancer experience. Strengthening collaboration across medical teams and institutions is essential to embed this model into standard oncology care in Romania.

Keywords: quality of life, oncologic patients, interventions

 

 

Success of immunotherapy in de novo metastatic NSCLC with multiple brain metastases: sustained clinical response and preserved quality of life – a case report

Andreea-Cosmina Belu, Maria-Victoria Cojocaru, F. Bejinaru, M. Schenker

“Sf. Nectarie” Oncology Center, Craiova; University of Medicine and Pharmacy of Craiova, Romania 
 

Introduction. Lung cancer remains a leading cause of cancer-related mortality worldwide, with brain metastases at presentation being associated with particularly poor prognosis. The introduction of immune checkpoint inhibitors has significantly improved outcomes in selected subgroups of patients, especially those with high PD-L1 expression. Case presentation. We describe the case of a male patient diagnosed in 2019 with metastatic pulmonary adenocarcinoma of the right upper lobe (solid subtype; Ki67: 60%), initially presenting with multiple brain metastases and extensive mediastinal, as well as cervical lymph node involvement (stage cT2N3M1). Molecular testing revealed EGFR, ALK and ROS1 negativity, with PD-L1 strongly positive (>50%), guiding the choice of systemic therapy. The patient underwent whole-brain radiotherapy with tumor boost, achieving a favorable neurological response. He was subsequently treated with anti-PD1 monotherapy, which was well tolerated and resulted in sustained disease stabilization. Notably, the patient maintained an excellent performance status (ECOG 0-1) throughout treatment, without significant adverse events. Conclusions. This case highlights the potential of anti-PD1 monotherapy to achieve durable disease control and preserve the quality of life in patients with advanced NSCLC and high PD-L1 expression, even in the challenging context of multiple brain metastases at diagnosis.

Keywords: non-small cell lung cancer, cerebral metastasis, immunotherapy

 

 

Management challenges in metastatic jejunal gastrointestinal stromal tumor: a case report

Maria-Diana Bejan¹, Adina-Emilia Croitoru^1,2

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

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

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. For malignant GISTs, the lymphatic spread is extremely rare, and these lesions most commonly spread hematogenously (most commonly to the liver) or to the peritoneum. We present the case of a 56-year-old male patient with no medical history who underwent surgery after he had presented to the emergency department with severe abdominal pain, vomiting and black stools. CT scan of the abdomen and pelvis revealed an abscessed tumor located in the mesentery with ileal loops involvement and pneumoperitoneum. A segmental enterectomy was performed, with histopathological findings suggesting a jejunal GIST. One month after the surgery, an abdominal MRI scan showed liver and peritoneum metastases, so we initiated first-line therapy with imatinib. The patient received four tyrosine kinase inhibitors (imatinib, sunitinib, regorafenib, cabozantinib), one cycle of chemotherapy (gemcitabine and oxaliplatin) and underwent four surgeries (the first one for the primary tumor and the other three for debulking). The best overall response was stable disease (14 months) in the first-line setting. After the second surgery, we performed FoundationOneCDx test, and the results showed a gene alteration (KIT Y503_F504insAY, N822T), therefore imatinib and sunitinib were targeted therapies with potential resistance. After the third debulking surgery, we also performed Onconomics plus test, and we started chemotherapy accordingly. The patient was diagnosed in 2018 and died in 2023, with an overall survival of 58 months. In summary, it has been proved that most cases who initially respond to TKIs develop resistance eventually, secondary to mutations in driver genes. Although debulking surgery is controversial in GISTs, it may be helpful in reducing the tumor burden, thus increasing the effectiveness of TKIs. It can also reduce mass effect symptoms, improving the quality of life. A multidisciplinary approach is critical for the management of gastrointestinal stromal tumors.

Keywords: gastrointestinal stromal tumor, metastasis, surgery, TKI, molecular testing

 

 

Real-world analysis on de novo hormone-sensitive metastatic prostate cancer: three years
of experience in a regional center from Romania

S.L. Bereczki

County Emergency Clinical Hospital Oradea, Romania
 

Introduction. We present the results of a retrospective study exploring the characteristics of patients with de novo metastatic hormone-sensitive metastatic prostate cancer (mHSPC). The main objective was to describe the treatment options and outcomes in current practice in patients with mHSPC treated at the Bihor County Emergency Clinical Hospital. Materials and method. Data were collected from the charts of patients with de novo mHSPC patients registered between January 2021 and December 2023. Statistics were descriptive. Results. Patient characteristics (n=88): median age 72 years old; 52 patients had a performance status between 0 and 2, and 37 had a performance status higher than 2; median baseline PSA (prostate specific antigen): 126 ng/mL (values available for 87/88 patients), with values between 5.4 and 2400 ng/dL. Tumor characteristics. Gleason score was registered for 83/88 patients, 51 had an unfavorable score, greater or equal to 8; most patients had bone metastases at diagnosis, approximately 60% presented high-volume disease, according to Charted criteria. A total of 88 patients were treated with androgen-deprivation therapy (ADT), 53 (60.22%) underwent monotherapy, six (6.81%) in combination with docetaxel, five (5.68%) with abiraterone, 13 (14.77%) with apalutamid, and four patients (4.54%) with the triple combination of ADT, docetaxel and abiraterone. Eight patients (9.09%) received local radiotherapy after initiation of ADT. Median PSA after six months was 0.465 ng/mL (values available for 62/88 patients). At data analysis (December 2024), the median time to progression to castration-resistant metastatic stage was 13 months, calculated for 82 patients. Six patients were lost to follow-up, and 20 patients had not progressed to castration-resistant metastatic stage. Conclusions. This real-world analysis provided information about the characteristics of patients with de novo mHSPC and the management of this pathology in a regional center in Romania at a time when new hormonal agents started to be reimbursed. Considering the therapeutic advances, the identification of the treatment regimen appropriate to the patient profile is essential.

Keywords: de novo metastatic hormone-sensitive prostate cancer, real world, treatment patterns

 

 

From lymphoma suspicion to gastric cancer diagnosis: a case of claudin 18.2-positive diffuse adenocarcinoma with extensive metastasis

A.G. Berescu¹, Cornelia Niţipir^1,2

1. Department of Medical Oncology, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania

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

Gastric cancer is the fifth cause of cancer worldwide. Ap­pro­xi­mately 50% of patients are metastatic at diagnosis. Claudin18.2 is a tight junction molecule, which becomes accessible on the tumor cell surface during malignant transformation and a target for the novel drug zolbetuximab. A 43-year-old male patient presented with fatigue, weight loss and elevated CA 19-9 levels (1521 U/mL). Contrast-enhanced computed tomo­graphy (CT) of the thorax, abdomen and pelvis revealed multiple supradiaphragmatic and subdiaphragmatic lymphadenopathies. Doppler ultrasound of the neck identified a left internal jugular vein thrombosis, and low-molecular-weight heparin was initiated. Hematology consultation raised the suspicion for a B-cell non-Hodgkin lymphoma. Upper gastrointestinal endoscopy (UGIE) with biopsy of perihepatic and peripancreatic lymph nodes showed poorly differentiated adenocarcinoma, suggestive of gastrointestinal, biliary or pancreatic origin. Subsequent UGIE identified a pancreatic lesion; however, fine-needle biopsy ruled out pancreatic origin. Positron-emitted CT demonstrated an esogastric tumor with widespread metastases: supradiaphragmatic and subdiaphragmatic lymph nodes, lungs, bones and peritoneum. A third UGIE revealed a benign-appearing ulcerative lesion, but histopathology confirmed diffuse-type gastric adenocarcinoma with signet ring cells G3, HER2-negative, microsatellite stable and claudin 18.2 expression in 95% of tumor cells. The multidisciplinary tumor board recommended systemic treatment with mFOLFOX6 plus zolbetuximab and denosumab for bone metastases. Despite standard antiemetic prophylaxis (palonosetron, netupitant, dexamethasone), the patient experienced grade 3 nausea and vomiting after the loading dose of zolbetuximab. The addition of olanzapine and slower infusion improved tolerance in subsequent administration, with grade 2 nausea and vomiting. After three months, the CA 19-9 levels decreased to 184 U/mL, and the CT imaging showed partial regression of lymph node metastases with stable disease elsewhere. Subsequently, the patient developed cardiac tamponade and pleural effusion, which required drainage. This case illustrates an atypical presentation of a gastric adenocarcinoma, initially mimicking lymphoma, a complex differential diagnosis, with extensive metastatic spread and poor prognostic factors.

Keywords: gastric cancer, claudin 18.2, zolbetuximab, lymphoma, nausea

 

 

Deep inspiration breath hold (DIBH) for cardiac dose reduction in a patient with left-sided breast cancer treated with anthracycline-based chemotherapy and radiotherapy – case report

Valentin Blaga¹, Crina Atitei¹, Alexandru Zara², Elena Manea^1,3

1. Department of Radiotherapy, Regional Institute of Oncology Iaşi, Romania

2. Department of Physics, Regional Institute of Oncology Iaşi, Romania

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

Introduction. Cardiac toxicity is a major concern in patients with left-sided breast cancer receiving anthracycline-based chemotherapy and adjuvant radiotherapy, as both modalities contribute to cumulative myocardial injury. The dose-risk relationship established between mean heart dose (MHD) and major coronary events highlights the importance of limiting cardiac radiation exposure. Incorporating deep inspiration breath hold (DIBH) into treatment planning is a key cardio-oncology strategy to mitigate long-term cardiac risk in this high-risk group. Case presentation. We present the case of a 52-year-old woman with left-sided, node-positive, HER2-low, hormone receptor-negative breast cancer, treated with neoadjuvant anthracycline-based chemo­therapy, followed by breast-conserving surgery and adjuvant radiotherapy. Considering the cumulative cardiotoxic potential of anthracyclines and the patient’s cardiovascular risk factors, DIBH was implemented during radiotherapy planning. The DIBH plan achieved reduction in mean heart dose and a significant decrease in LAD dose compared with Free Breathing (FB), while maintaining optimal target coverage. Discussion. The DIBH technique increases thoracic volume and displaces the heart away from the treatment field, substantially decreasing radiation exposure to critical cardiac structures. Multiple studies and meta-analyses have validated DIBH as an effective heart-sparing method, particularly beneficial for patients receiving anthracycline- or trastuzumab-based therapy, where cumulative cardiotoxicity is a concern. This case exemplifies the importance of integrating DIBH into multimodal treatment to improve long-term cardiac safety. Conclusions. Deep inspiration breath hold is a practical and effective technique to reduce cardiac irradiation. For patients with left-sided breast cancer treated with anthracyclines, it should be regarded as a standard of care within a comprehensive cardio-oncology approach.

Keywords: deep inspiration breath hold (DIBH), left-sided breast cancer, anthracycline-induced cardiotoxicity, cardiac sparing radiotherapy, cardio-oncology, heart dose reduction

 

 

Endometrioid endometrial carcinoma with atypical morphology: a case underscoring the value of immunohistochemistry

A. Bordea¹, Cristiana Popp¹, Ana-Maria Tănase², Oana Ștefan¹

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

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

Objective. Endometrioid endometrial carcinoma, although a frequent diagnosis in postmenopausal women, can pose diagnostic difficulties, especially if it presents a low degree of differentiation or has a morphology similar to another type of cancer. Materials and method. We present a case of a 49-year-old female whose imagistic investigations showed a tumor extending from the cervix to the endometrium, with right inguinal adenopathy and a metastasis in the pouch of Douglas. Total hysterectomy with bilateral adnexectomy, right inguinal lymphadenectomy and excision of metastasis were performed, and the surgical specimens were submitted for histopathological examination. Results. The microscopic examination revealed two distinct tumoral proliferations, one with morphology of endometrioid carcinoma (FIGO II) which was confined to uterine corpus, and the other with morphology of basaloid squamous cell carcinoma which extend from uterine body to the level of superior vaginal walls, with the invasion of full thickness of uterine corpus, cervical wall and parameters. Despite the morphology of the second tumor, exocervical mucosa was not affected. Upon immunohistochemical analysis, tumor cells of primary lesion show intense expression of Vimentin, ER, PR and PAX-8 and microsatellite instability markers, while the second tumor was negative for ER, PR, PAX-8, p63, p40, CEA and SOX-10, MLH-1 and MSH-2, and positive for AE1/AE3, Vimentine (weak) and MSH2/MSH6 markers. Both components had p53 wild-type. A diag­nostic of endometrioid endometrial carcinoma FIGO III was made. Inguinal adenopathy, metastasis in the Douglas pouch, and a left ovarian metastasis also had the morphology of the second lesion. Conclusions. Even though endometrioid carcinoma is one of the most common malignancies, its morphology can pose diagnostic problems to pathologist, highlighting the importance of immunohistochemistry in this type of cancers.

Keywords: endometrioid endometrial carcinoma, immunohistochemistry, FIGO III, metastasis

 

 

Differentiation between colorectal and gastric adenocarcinomas using maspin, MLH1, PMS2
and KRAS levels in whole blood, urine and saliva, assessed by stochastic sensors

A.A. Bratei¹, Raluca-Ioana Stefan van Staden²

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

2. Faculty of Chemical Engineering and Biotechnologies, National University of Science and Technology Politehnica, Bucharest; Laboratory of Electrochemistry and PATLAB, National Institute of Research for Electrochemistry and Condensed Matter, Bucharest, Romania
 

Introduction. Gastrointestinal adenocarcinomas are a worldwide and some of the most important causes of death related to cancers. MLH1, PMS2 and KRAS are some of the main molecules responsible for the control of cellular proliferation, while maspin is a tumor suppressor which inhibits invasion and angiogenesis and also regulates apoptosis. They are widely used as biomarkers for the evaluation of the features of tumoral processes and the clinicopathological characteristics. Materials and method. Patients with their clinical and pathological features were selected from the database of the project GRAPHSENSGASTROINTES and used accordingly with the Ethics committee approval no. 32647/2018 awarded by the County Emergency Hospital from Târgu-Mureş. Three kinds of samples have been analyzed (saliva, whole blood and urine) using a stochastic method using stochastic microsensors. Results. The results obtained using stochastic sensors were correlated with the location of cancer, and there have been elaborated a series of criteria to differentiate gastric cancers from colorectal ones. Conclusions. There can be differentiation between the two types of cancers by using the concentrations of MLH1, PMS2 and KRAS in saliva and urine samples or the levels of maspin in whole blood and urine or in whole blood, urine and saliva. The data analysis led to a series of criteria for evaluation of the cancer location. Using only MLH1 and PMS2 concentrations in one of the two kinds of samples was only indicative, and did not cover most cases. The use of the criteria only for MLH1 and PMS2 increased the probability of finding out the location, but the best results require the concentrations of KRAS in the two kinds of samples as additional criteria. This result can become part of new screening method for cancer using stochastic sensing and mathematical criteria, being given the advantages of stochastic sensors.

Keywords: stochastic sensors, screening, gastrointestinal adenocarcinomas, KRAS, MLH1, PMS2

 

 

Early nutritional intervention in oncology patients with diabetes mellitus: prevention
of malnutrition and sarcopenia

Ana Bratu¹, Alexandra Pompaș²

1. Clinical Dietitian, County Emergency Clinical Hospital Bacău; MiniMed Private Clinic, Bacău, Romania

2. Clinical Dietitian, Arcadia Hospital, Iași; Associate Lecturer, Faculty of Animal and Food Resources Engineering, “Ion Ionescu de la Brad” University of Life Sciences, Iași; Member in the Regional Council of the Romanian College of Dietitians; Olimpia Med Clinic of Diabetes and Nutrition Disorders, Iași, Romania
 

Introduction. Disease-related malnutrition is highly prevalent in oncology, and it is associated with decreased treatment tolerance, poor functional outcomes and reduced quality of life. The presence of sarcopenia and metabolic comorbidities, such as diabetes mellitus, further worsens the clinical course. Early and individualized nutritional intervention is essential to optimize clinical outcomes. Objective. To highlight the impact of personalized nutritional intervention in the prevention and treatment of malnutrition in hospitalized oncology patients, based on recent literature, and a representative case study. Materials and method. We performed a narrative review of current clinical guidelines and peer-reviewed literature, focusing on the implementation of the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition assessment and the Global Leadership Initiative on Sarcopenia (GLIS) for muscle mass and function evaluation. Nutritional intervention was based on the Nutrition Care Process (NCP), including standardized assessment, nutritional diagnosis, goal-oriented intervention and outcome monitoring. A clinical case is included to illustrate real-world application. Results.  Early personalized nutritional support, including a high-protein oral diet and structured follow-up, led to improved nutritional status, better glycemic control and functional recovery. The integration of the clinical dietitian into the interdisciplinary oncology care team allowed for timely interventions that contributed to treatment adherence and reduced sarcopenia risk. Conclusions. Personalized clinical nutrition, guided by GLIM and GLIS criteria and delivered through a structured NCP framework, is essential in cancer care. Multidisciplinary integration of nutrition professionals significantly improves therapeutic response and quality of life in malnourished oncology patients.

Keywords: cancer malnutrition, clinical nutrition, GLIM, sarcopenia, interdisciplinary care

 

 

High-grade serous ovarian carcinoma with BRCA2 mutation: a case report of long-term maintenance therapy with olaparib

Ioan-Adrian Buda

Department of Oncology, County Emergency Hospital Satu Mare, Romania
 

We present the case of a 71-year-old female diagnosed with high-grade serous ovarian adenocarcinoma, FIGO stage IVA, with peritoneal and pleural metastases and rectal invasion. The initial clinical manifestations included dyspnea, abdominal distension, asthenia and constipation. Imaging revealed bilateral pleural effusion, ascites, mediastinal and periaortic lym­phadenopathy, and a right adnexal mass. Histopathological and immunohistochemical analyses confirmed a high-grade serous ovarian carcinoma, BRCA2-mutated. The initial CA-125 level was 3427.9 U/mL. The patient underwent six cycles of neoadjuvant chemotherapy with paclitaxel and carboplatin, resulting in a significant biological and radiological response (CA-125 decreased to 19.38 U/mL). Due to comorbidities and suboptimal performance status, cytoreductive surgery was deferred. Maintenance therapy with the PARP inhibitor olaparib was initiated on 2 September 2022. Throughout 41 cycles of olaparib administered until October 2025, the patient demonstrated sustained disease control and stable radiological findings, with CA-125 levels remaining below 10 U/mL. Adverse events were limited to grade I thrombocytopenia, grade II anemia and mild sensory neuropathy. Concurrent comorbidities included left femoro-popliteal-tibial deep vein thrombosis and varicophlebitis, managed with anticoagulation. This case illustrates the efficacy and tolerability of long-term olaparib maintenance therapy in BRCA2-mutated advanced ovarian carcinoma. It highlights the clinical relevance of molecular testing in guiding targeted therapy and supports the use of PARP inhibitors as a cornerstone in the management of advanced high-grade serous ovarian cancer, particularly in patients unfit for optimal cytoreductive surgery.

Keywords: high-grade serous ovarian carcinoma, BRCA2 mutation, olaparib, maintenance therapy, case report

 

 

Outcomes of nact regimens in HER2-positive disease – keeping or skipping anthracyclines?

Raluca-Elena Bulboacă¹, Oana-Gabriela Trifănescu^1,4, Raluca-Ioana Mihăilă², Laurenţia-Nicoleta Galeş^3,4

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

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

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

4. Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

Introduction. The optimal neoadjuvant chemotherapy (NACT) for HER2-positive breast cancer remains debatable, although anthracycline-free regimens have demonstrated efficacy. We investigated whether adding anthracyclines improves pathological complete response (pCR) and disease-free survival (DFS) compared with a carboplatin-taxane regimen, when both are combined with dual HER2 blockade using trastuzumab (H) and pertuzumab (P). Materials and method. A single-center retrospective observational study included 84 patients aged ≥18 years old, with stage IIA-IIIC HER2-positive breast cancer, treated with NACT between 2020 and 2025. Patients receiving taxane-only therapy, those with bilateral breast cancer, or prior malignancy were excluded. All patients received dual HER2 blockade combined with either an anthracycline-containing regimen (n=39; epirubicin and cyclophosphamide [EC] followed by docetaxel [T] with H and P added during the taxane phase, EC→THP), or an anthracycline-free regimen (n=45; T, carboplatin [C], H and P; TCHP). The primary endpoint was pCR (ypT0/is ypN0), and the secondary endpoint was DFS, defined as the time from surgery to recurrence or progression. Clinicopathologic data, treatments and outcomes were collected from electronic medical records. Results. pCR was achieved in 24/39 patients (61.5%) in the EC→THP group and 23/45 patients (51.1%) in the TCHP group. Estimated DFS for the entire cohort was 98% at 24 months, 92% at 36 months, and 82% at 48 months after surgery; median DFS was not reached. No DFS events occurred in the anthracycline group. For TCHP, estimated DFS at 24, 36 and 48 months were 97%, 80% and 64%, respectively. DFSs significantly favored anthracycline-containing therapy (p=0.01). Conclusions. There was no significant difference in pCR between regimens, while DFS favored anthracycline-containing therapy, which may remain valuable for selected high-risk patients.

Keywords: HER2-positive breast cancer, neoadjuvant chemotherapy, anthracyclines, TCHP, trastuzumab, pertuzumab

 

 

Clinical impact of pulmonary hypertension on postoperative recovery following major pulmonary resection

Ion Burlacu, Serghei Guțu, Igor Maxim

“Nicolae Anestiadi” Department of Surgery 1, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chișinău; Institute of Emergency Medicine, Chișinău, Republic of Moldova
 

Introduction. Pulmonary hypertension (PH) is a frequent comorbidity among patients undergoing lung resection for malignancy. Elevated pulmonary artery pressure increases perioperative risk due to right ventricular strain, impaired oxygen exchange and hemodynamic instability. Materials and method. A retrospective observational study was conducted on patients who underwent major pulmonary resections (lobectomy or pneumonectomy) between January 2020 and December 2024. Pulmonary hypertension was assessed preoperatively by transthoracic echocardiography (TTE), using Doppler-derived estimations of pulmonary artery systolic pressure (PASP). Pulmonary hypertension was defined as a mean pulmonary artery pressure ≥25 mmHg. Postoperative outcomes, including respiratory failure, arrhythmias, right heart dysfunction and intensive care unit (ICU) stay, were compared between patients with and without PH. Results. Forty patients were included in the study. Twelve (30%) had echocardiographic evidence of pulmonary hypertension, with a mean estimated pulmonary artery pressure of 41±0.6 mmHg. The incidence of postoperative complications was significantly higher in the PH group (41.7%) compared with non-PH patients (21.4%; p<0.001). Respiratory failure occurred in 25% of PH patients, right ventricular dysfunction in 16.7%, and arrhythmias in 8.3%. Median ICU stay was prolonged (six versus three days). Although operative mortality did not differ significantly, recovery time and hospital discharge were delayed in the PH group. Conclusions. Pulmonary hypertension substantially increases postoperative morbidity and delays recovery after major lung resection. Patients with elevated pulmonary artery pressure exhibit greater susceptibility to cardiopulmonary complications and prolonged critical care requirements. Early identification and tailored perioperative optimization are essential to improve functional recovery and overall outcomes.

Keywords: pulmonary hypertension, transthoracic echocardiography, lung resection

 

 

Lymphovascular invasion as a major determinant of prognosis in bladder cancer: a meta-analysis of 60,000 patients

Anamaria Burnar¹, Camelia Coadă², Gloria Ravegnini³, Francesca Gorini³, Ramona Matei⁴, Federico Giorgi³, Patricia Dulf⁵, Tudor Ciuleanu¹, Daniel Dulf⁴

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

2. Department of Morphofunctional Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

3. Department of Pharmacy and Biotechnology (FABIT), University of Bologna, Italy

4. Clinical Municipal Hospital Cluj-Napoca, Romania

5. “Prof. Dr. Nicolae Stăncioiu” Heart Institute, Cluj-Napoca, Romania
 

Introduction. Lymphovascular invasion (LVI) is a frequently reported pathological feature in bladder cancer; however, its prognostic significance has been variably interpreted across studies and clinical guidelines. This meta-analysis aimed to definitively quantify the impact of LVI on survival outcomes in bladder cancer, in order to clarify its role in clinical practice. Materials and method. A systematic review and meta-analysis was conducted according to PRISMA guidelines, including 131 studies comprising over 60,000 patients. Hazard ratios (HRs) were analyzed for disease-free survival (DFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS), using both fixed- and random-effects models. Results. The findings conclusively demonstrate that the presence of LVI is a strong negative prognostic factor, associated with adverse clinical outcomes. Patients with LVI positivity had approximately a twofold higher risk of unfavorable evolution. This increased risk was consistently observed across all survival endpoints, including a significant decrease in DFS (HR=1.96), PFS (HR=2.24), CSS (HR=2.05), and OS (HR=2.01). Although some degree of heterogeneity was noted among studies, the direction and magnitude of this effect remained stable across all analyses. Conclusions. This meta-analysis provides definitive evidence that LVI is an independent and powerful predictor of poor survival in bladder cancer. The authors emphasize the urgent need to incorporate LVI status into postoperative risk stratification models. Furthermore, adjuvant systemic therapy, such as chemotherapy or immunotherapy, should be considered for LVI-positive patients – even in the absence of lymph node involvement – to improve their prognosis.

Keywords: urothelial carcinoma, prognosis, lymphovascular invasion, survival

 

 

Beyond the unknown: the challenge of safe reirradiation without dosimetric data

Ioana-Maria Calancea¹, Ana-Maria-Cecilia Păuleț², Mara Răzniceanu¹, Monica Buzemurgă¹

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

2. Oncology Department, Regional Institute of Oncology Iaşi, Romania
 

Introduction. Reirradiation poses significant challenges when historical dosimetric records are incomplete, particularly in elderly patients treated with older techniques. Without accurate cumulative dose data to critical organs, clinicians face substantial uncertainty in treatment planning and increased risk of normal tissue toxicity. Case presentation. Two contrasting cases highlight the clinical challenges of reirradiation in the absence of comprehensive historical dosimetric data. A 68-year-old male, previously treated with adjuvant radiotherapy on Linac 2100, after total laryngectomy for cancer of the larynx (70 Gy/35 fractions in 2010) and total gastrectomy (2015) for gastric cancer, presented in October 2023 with oropharyngeal squamous cell carcinoma. CT imaging showed extensive disease involving bilateral tonsils, posterior oropharynx, base of tongue and cervical lymphadenopathies. Reirradiation (60 Gy/30 fractions) was initiated in December 2023 and required enteral nutrition via a nasojejunal tube for supportive care. The treatment was discontinued at 48 Gy, secondary to clinical deterioration; the patient was transferred to the palliative care unit, where he subsequently died. Conversely, a 68-year-old female with history of cervical cancer, treated with cobalt-60 radiotherapy in 2001, presented with middle rectal adenocarcinoma in August 2022. She received neoadjuvant treatment – definitive external radiotherapy (45 Gy/25 fractions) with concurrent capecitabine and colostomy placement. Despite the absence of detailed dosimetric records from her previous cobalt treatment, the patient tolerated reirradiation well, and she achieved complete pathological response (ypT0N0) following total mesorectal excision. Conclusions. Despite divergent clinical outcomes, these two cases reflect the challenges of type 1 reirradiation when dosimetric data are unavailable, making cumulative dose to organs at risk hard to predict.

Keywords: reirradiation, cumulative dose, dosimetric uncertainty

 

 

Incidental findings in cancer-predisposing genes: insights from NGS testing in the Romanian population 

A. Capcelea^1,2, C. V. Munteanu^1,3, Adela Chiriță-Emandi^3,4,5

1. Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

2. Department of Medical Oncology, OncoHelp Oncology Center, Timișoara, Romania

3. Regional Center of Medical Genetics Timiș; “Louis Țurcanu” Emergency Clinical Hospital for Children, Timișoara, Romania

4. Department of Microscopic Morphology, Genetics Discipline, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

5. Center for Genomic Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
 

Introduction. Recent advances in next-generation sequencing (NGS) have greatly reduced the time and costs of testing, thus transforming NGS into a widely available and increasingly popular tool that aids clinicians from various specialties. However, NGS testing generates a considerable amount of incidental discoveries, which may not be related to the patient’s phenotype. Managing such findings can be challenging. We aimed to establish the prevalence of incidental findings in cancer-predisposing genes in a Romanian population undergoing NGS testing. Materials and method. The COSMIC database along with a comprehensive review of literature were used to compile a list of 110 genes associated with predisposition to various malignancies. A retrospective analysis was performed on data from 677 patients who underwent NGS testing (n=614; TruSightOne 4813 gene panel and n=63 – Whole Exome Sequencing) between June 2017 and August 2023. Results. A total of 186 significant variants were identified in the selected genes. Of these, 50 variants correlated with the patients’ phenotype, and seven benign and one likely benign variants were excluded from the study. Overall, 83 disease-causing variants, distributed among 82 (12.1%) subjects were identified, along with 45 variants of unknown significance (VUS). Out of 83 variants, 27 (32.9%) are located in high penetrance genes, listed in the American College of Medical Genetics guidelines. Three founder heterozygous variants previously reported in literature were identified, BLM (c.1642C>T), MUTYH (c.1103G>A, c.452A>G) and NBN (c.657_661del). Conclusions. The management of incidental findings requires careful consideration of any potential risks and benefits, and should be limited to highly penetrant and actionable genes. Given their high prevalence, an expert panel that will develop recommendations tailored to the Romanian population is urgently required.

Keywords: cancer predisposition, incidental findings, genetic testing, oncogenetics

 

 

Two lives, one battle: successful multidisciplinary management of breast cancer during pregnancy 

Ioana Cârlan, Eva Cojocaru, Georgiana Baciu, Ecaterina Cărbune, Olivia Murariu

Regional Institute of Oncology Iaşi, Romania
 

Introduction. Breast cancer during pregnancy is a rare and complex clinical scenario, representing less than 1% of all breast cancer cases. It poses unique diagnostic and therapeutic challenges, requiring a balance between optimal oncologic management and fetal safety. A multidisciplinary approach involving oncology, obstetrics, surgery and neonatology is essential, in accordance with current guidelines. Case presentation. We report the case of a 25-year-old woman diagnosed during her second pregnancy with locally advanced Luminal B HER2-low invasive breast carcinoma. The patient had initially noted a right axillary lymphadenopathy during her first pregnancy, which progressed postpartum into a retroareolar mass. At 24 weeks of gestation of her second pregnancy, she was diagnosed with invasive carcinoma of no special type (NST), grade 3 (G3), ER+ (60%), PR+ (30%), HER2 1+ (HER2-low), Ki67 80%. Genetic testing was negative for BRCA1/2 mutations. Clinical staging was cT2N3Mx, limited by the inability to perform a CT scan during pregnancy. Management. Neoadjuvant chemotherapy was initiated during pregnancy, consisting of four cycles of epirubicin and cyclophosphamide (EC). At 37 weeks, the patient underwent a caesarean section, followed by 12 weekly doses of paclitaxel postpartum. A subsequent CT scan raised suspicion for hepatic metastasis, which was later ruled out via abdominal MRI. The patient then underwent a right mastectomy and axillary lymph node dissection with immediate breast reconstruction. Postoperative histopathology showed ypT1aN1mi G2, L1, V1. Adjuvant radiotherapy was administered, followed by endocrine therapy with anastrozole and ovarian suppression. Extended adjuvant therapy with the CDK4/6 inhibitor ribociclib was planned following radiotherapy. Conclusions. This case illustrates the feasibility and safety of neoadjuvant chemotherapy during pregnancy in patients with high-risk, locally advanced breast cancer. A coordinated multidisciplinary approach enabled favorable oncologic and obstetric outcomes, ensuring timely delivery of surgical and systemic treatment, including the integration of CDK4/6 inhibitor therapy in the adjuvant setting.

Keywords: pregnancy, breast cancer, multidisciplinarity, safety

 

 

Olaparib and abiraterone in mCRPC: perspectives from local clinical practice

Cristina-Ligia Cebotaru, Marilena Neculache, Larisa Cosier, Iunia-Patricia Cebotaru, Cristian Streianu

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

Objective. Prostate cancer remains a major clinical challenge due to its aggressive progression and poor prognosis, especially in the metastatic castration-resistant stage (mCRPC). This case report describes the management of a patient with mCRPC, focusing on the clinical efficacy and tolerability of combined olaparib [poly(ADP-ribose) polymerase inhibitor; PARPi] and abiraterone (androgen biosynthesis inhibitor) therapy, while highlighting the integration of current clinical guidelines and recent PROpel trial evidence into real-world oncology practice. Materials and method. We report the case of a 62-year-old male diagnosed with high-risk prostate adenocarcinoma (Gleason score 9, stage cT3bN0M0), managed initially by radical prostatectomy, lymphadenectomy, adjuvant hormone therapy and radiotherapy. After over one year of clinical and biochemical remission, recurrence was detected by elevated prostate-specific antigen (PSA) and presence of pelvic lymphadenopathy on prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT). At the time of treatment decision, the patient was asymptomatic (ECOG 0), and he began the combined therapy with olaparib plus abiraterone, based on current international guidelines and recent clinical evidence for mCRPC. Results. The combination therapy resulted in a rapid and sustained reduction in PSA (from 1.44 to 0.006 ng/mL), stable imaging findings for more than one year, and maintained quality of life. The patient experienced no grade 3/4 adverse events, and he did not require treatment interruptions. Clinical and radiological follow-up confirmed ongoing disease control. Conclusions. Combined olaparib and abiraterone therapy, as demonstrated by the PROpel trial, provides effective and well-tolerated management of mCRPC regardless of homologous recombination repair (HRR) gene status. This case further supports the importance of integrating clinical trial evidence into real-world oncology practice, with close monitoring and a multidisciplinary approach for optimal patient outcomes.

Keywords: olaparib, abiraterone, prostate cancer, mCRPC, real-world evidence, PROpel

 

 

The role of zebrafish (Danio rerio) in modern oncology: emerging applications and perspectives

A.N. Ceobanu¹, A.F. Branişte², G. Luta³

1. Medical Oncology Department, Regional Institute of Oncology Iaşi; “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. Endocrinology Department, “Sf. Spiridon” County Emergency Clinical Hospital, Iaşi; “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

3. Transcend Center; Regional Institute of Oncology Iaşi, Romania
 

Objective. The aim of this study is to highlight the usefulness of zebrafish (ZF; Danio rerio) xenografts in cancer research by presenting original experimental data and integrating observations from the scientific literature, emphasizing the potential translational applications of this model in modern oncology. Materials and method. ZF embryos aged 48-72 hours were xenografted with the HCT116 colorectal cancer (CRC) cell line and subsequently subjected to therapeutic protocols commonly used in clinical practice: FOLFOX, FOLFIRI and FOLFIRINOX. Tumor activity was monitored over a period of three days to evaluate proliferation dynamics. To highlight the clinical relevance of this animal model, we also conducted a literature review, including preclinical studies that used either patient-derived cellular material or standardized cell lines. Results. Our experimental model enabled the direct observation of biological processes involved in tumor progression, such as neovascularization and metastasis, while also revealing differences in tumor response among the treatment protocols used – confirming the feasibility of employing this system as a translational platform. The literature review highlighted significant clinical implications. Studies show that zebrafish xenografted with patient-derived tumor cells correlate with disease-free survival, and can predict treatment resistance. Conclusions. The data obtained in our experimental model are consistent with those reported in the scientific literature. Existing research supports the idea that xenografting with patient-derived material can provide relevant predictive information regarding clinical outcomes and treatment efficacy. This represents a significant advantage in hard-to-treat cases where there is no clear distinction between available therapeutic options. However, to validate and standardize the clinical applicability of this model, prospective multicenter randomized studies are needed.

Keywords: zebrafish, xenografting, translational research, colorectal cancer

 

 

New options for staging and assessing treatment response in breast cancer patients –
a comparative evaluation of Fluoroestradiol and FDG-PET

Monica-Emilia Chirilă^1,2, Sandrine Parisse Dimartino³, Arnaud Coulomb⁴, Adelina Brezae⁴, Gabriel Kacso^1,2, Waisse Waissi⁴

1. Radiotherapy Department, Amethyst Radiotherapy Center Cluj, Romania

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

3. Nuclear Medicine Department, Centre Leon Berard, Lyon, France

4. Radiotherapy Department, Centre Leon Berard, Lyon, France
 

Objective. Estrogen Receptor-Targeted Positron Emis­sion Tomography Imaging with 16a-18F-Fluoro-17b-Fluoro­es­tra­diol (FES-PET) represents a new option for breast cancer patients. The aim of this study was to compare the clinical impact of using FES-PET and fluorodeoxyglucose F18 (FDG-PET) in selected cases. Material and method. Patients with a confirmed breast cancer who were investigated using both FDG and FES-PET in the Nuclear Medicine Department of Centre Leon Berard, from October 2022 to July 2025, were included. Clinical data were retrospectively collected. The results and impact of both investigations were analyzed using descriptive statistics. Results. Thirty-four patients matched the inclusion criteria. The median age when FES-PET was performed was 65 (range: 36-84 years old). The most frequent types were lobular cancer (N=20; 58.8%) and ductal cancer (N=13; 38.2%). Hormone receptor positivity was documented at diagnosis for 31 patients (94.1%). Most of them had HER2-negative tumors (N=29; 85.3%) and grade 2 SBR (N=24; 70.6%). Nine patients (26.5%) were metastatic at diagnosis. Twenty-six patients (76.5%) received surgery for their primary breast tumors, almost half (N=12; 46.2%) being treated with mastectomy, and most of them having axillary lymph node dissection (N=21; 80.8%). Fifteen patients (44.1%) received adjuvant chemotherapy, 20 (58.8%) received adjuvant hormonotherapy and 13 patients (38.2%) received postoperative radiation therapy. There were 38 FED-PET doubled by FDG-PET investigations in 34 patients. The median interval between diagnosis and FES-PET was 5.5 years (0-29), and the main indications were initial staging (N=6; 15.8%), restaging (N=14; 36.8%) and ER detection (N=19; 50%). Thirty-five (92.1%) of the 38 FES-PET had differences in tracer uptake intensity and/or distribution, compared to the FDG-PET. In 26 cases (68.4%), the FES-PET result had an impact on redefining disease extension and/or on treatment decision. Conclusions. FES-PET evaluation can provide a significantly different result in selected breast cancer patients. The investigation had an impact on patients’ clinical management in the majority of the cases.

Keywords: breast cancer, FDG PET-CT, FES PET-CT, sta­ging, relapse

 

 

Pancreatectomy in elderly patients: risks versus benefits

D. Chiriţă¹, C. Găluşcă¹, A. Martiniuc¹, N. Boleac¹, Cristina Iosif², N. Copca¹

1. General Surgery and Transplant Center, “Sf. Maria” Clinical Hospital, Bucharest, Romania

2. Histopathological Department, “Sf. Maria” Clinical Hospital, Bucharest, Romania
 

Objective. The increase of life expectancy also requires an increase in the age of patients who require surgical interventions, even with high complexity, such as pancreatectomies. Materials and method. We present our clinic’s experience in the surgical treatment of pancreatic tumors in elderly patients. In the last 10 years, 332 surgical interventions associated with pancreatic tumors were performed in our clinic: 251 pancreaticoduodenectomies (PD), 67 distal splenopancreatectomies (DSP), seven total pancreaticoduodenectomies (TPD), and se­ven enucleoresections. Of these, 27 were performed on elderly pa­tients, above 75 years old: 22 PD and five DSP. Out of these, two patients died as a result of postoperative complications, the rest having different degrees of complications, classified according to the Clavien-Dindo grades (CD). Results. There were seven patients with grade 0 CD, five patients with grade 1 CD, nine patients with grade 2 CD, two patients with grade 3 CD, two patients with grade 4 CD, and two patients with grade 5 CD. Conclusions. Even at an advanced age and with a major surgery, the post-pancreatectomy complications are similar to those from general ages.

Keywords: major pancreatic resections, pancreaticoduodenectomy, splenopancreatectomy, elderly patients

 

 

An unexpected turn: melanoma masquerading as small bowel occlusion

Ioana-Anastasia Cibotariu¹, Laura-Elena Stanciu¹, Andreea Ciauşu⁴, Marian Forminte³, Sabina Zurac^1,2, 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

4. Department of Radiology and Medical Imaging, Fundeni Clinical Institute, Bucharest, Romania
 

Introduction and objectives. Malignant melanoma is an invasive tumor with high metastatic potential in both regional and distant sites, the gastrointestinal tract being among the most frequent target, having a high propensity to involve the small bowel. Materials and method. An 81-year-old male with multiple comorbidities was admitted to the neurology department at Colentina Clinical Hospital, following the sudden onset of severe headache and vomiting during the first round of functional stereotactic radiotherapy (FSRT). Prior CT imaging revealed multiple hemorrhagic brain lesions suspicious for metastasis, concerning masses in the pancreas and iliopsoas muscle, and a Bosniak IV cyst in the left kidney which was initially thought to be the primary location for the malignancy. Not far after the initial symptoms, the patient started having severe abdominal pain combined with an absent intestinal transit, which warranted the transfer to the general surgery department, where a segmental enterectomy for small bowel occlusion was performed. The surgical specimen was grossed and analyzed histologically and stained with immunohistochemical markers. Results. The diagnosis was established on a 50-cm enterectomy specimen with multiple, gray, polypoid lesions on the mucosa associated with extensive areas with white deposits on the serosa and an area of perforation. Microscopically, the polypoid lesions exhibited the same morphology of a densely cellular tumor, arranged in sheets and nests, composed of medium-sized pleomorphic cells, with conspicuous nucleoli with focal accumulation of dark-brown pigment granules in the cytoplasm. Immunohistochemistry revealed positivity for melanocytic markers (MelanA, PRAME) and the Fontana-Masson special stain emphasized the melanin-containing cells, prompting the diagnosis of a metastatic malignant melanoma of unknown primary. Conclusions. This case emphasizes the difficulty to diagnose a metastatic melanoma in the context of a low suspicion index supported by a lack of specific symptoms and no information regarding a cutaneous lesion.

Keywords: melanoma, metastasis, MelanA, PRAME

 

 

Seven years on HER2 blockade: success and setbacks

Loredana Ciontea¹, Laura Iovanovici¹, Adrian Hălăucă¹, Andreea Lăzescu^1,2, Adelina-Silvana Gheorghe^1,2, Radu Matei¹, Anca Stolojanu¹,
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
 

HER2-positive breast cancer, accounting for 15-20% of metastatic cases, is associated with aggressive disease, but it has become more treatable due to HER2-directed therapies. We report the case of a 77-year-old female with a history of chronic hepatitis C, diagnosed in November 2016 with hormone receptor-positive, HER2-positive left breast invasive ductal carcinoma, clinical stage IIIB (cT4dcN1M0). She underwent neoadjuvant chemotherapy with docetaxel and trastuzumab, followed by surgery, achieving a partial pathological response (ypT1cypN1b). Adjuvant radiotherapy (50 Gy), one year of trastuzumab, and letrozole were completed. In March 2019, imaging revealed lymph node metastases, and a subcutaneous nodule was confirmed as a cutaneous metastasis. Treatment with trastuzumab and pertuzumab was initiated until November 2020, when further lymphatic progression occurred. Trastuzumab emtansine was then administered until January 2023, resulting in a good oncologic response, but causing uncontrollable thrombocytopenia. Subsequent therapy included trastuzumab combined with fulvestrant. In November 2024, a new right breast skin lesion was treated with radiotherapy (40 Gy) and metronomic capecitabine added to trastuzumab, achieving complete lesion resolution. In May 2025, after further cutaneous progression on the right breast and arm, biopsies confirmed metastatic disease. Treatment with trastuzumab deruxtecan was initiated, leading to the disappearance of skin lesions. After two months, imaging demonstrated portal vein thrombosis with secondary portal hypertension and suspected pneumonitis. Concurrently, the patient reported severe nausea and fatigue. Oncologic therapy was interrupted, and anticoagulation was started, achieving partial thrombus resolution after two weeks. This case highlights the complex management of HER2-positive metastatic breast cancer, emphasizing the need to balance sustained oncologic efficacy with treatment-related toxicity. It underscores individualized therapy sequencing, vigilant monitoring for adverse effects, and prompt management of life-threatening complications such as thrombosis. The patient’s course exemplifies the “double-edged sword” of HER2-directed therapies, which provide substantial clinical benefit while requiring careful side-effect management.

Keywords: HER2-positive breast cancer, trastuzumab deruxtecan, portal vein thrombosis, cutaneous remission

 

 

Cervical cancer – molecular profiling and clinical implications

Ana-Maria Ciurea^1,2, Michael Schenker^1,2, Alina-Maria Mehedințeanu¹, Alexandra Dumitrescu¹, Patricia Nicolae¹, Ciprian Berisha¹, Mihaela Pițurcă¹,
Florin Bejinaru¹, Cătălina Nuță¹

1. “Sf. Nectarie” Oncology Center, Craiova, Romania

2. University of Medicine and Pharmacy of Craiova, Romania
 

Objective. To provide a comprehensive overview of the current landscape of cervical cancer, the role of molecular profiling in guiding clinical decisions is critical. This review covers the epidemiological burden, particularly in Romania, the evolution of treatment paradigms, and the emerging importance of biomarkers in predicting prognosis and therapeutic response. Materials and method. This work is based on a synthesis of current scientific literature, including data from global cancer statistics (GLOBOCAN 2022) and recent clinical guidelines such as the NCCN Guidelines for Cervical Cancer. The review analyzes key clinical trials and studies that have shaped treatment strategies from conventional chemotherapy to targeted therapies and immunotherapy. Results and discussion. Romania faces a significant public health challenge with cervical cancer incidence and mortality rates nearly three times the European Union average, largely due to low HPV vaccination and screening uptake. The therapeutic landscape has evolved dramatically, with advancements in understanding the tumor microenvironment (TME) and the role of the cervicovaginal microbiota. Molecular testing may be mandatory to patient management. Key actionable biomarkers include PD-L1 for immunotherapy, HER2 testing and various gene fusions (e.g., NTRK, RET), which open avenues for targeted treatments like antibody-drug conjugates (ADCs), PARP inhibitors, and immune checkpoint inhibitors. The interplay between HPV oncoproteins (E6/E7), immune evasion mechanisms and the influence of the microbiota on viral persistence underscores the complexity of the disease. Conclusions. Molecular profiling has become indispensable in the management of cervical cancer, moving beyond a “one-size-fits-all” approach. Integrating genomic and molecular markers into clinical practice is essential for improving patient outcomes, personalizing treatment strategies and overcoming the significant burden of this disease in high-risk regions like Romania.

Keywords: cervical cancer, molecular profiling, biomarkers, tumor microenvironment, HPV

 

 

Remarkable response to chemotherapy in a patient with stage IV breast cancer and visceral crisis

Maria-Victoria Cojocaru, Andreea Belu, F. Bejinaru, Michael Schenker

“Sf. Nectarie” Oncology Center, Craiova, Romania
 

Objective. This case report presents a complex and advanced oncological scenario of a 48-year-old female newly diagnosed with metastatic breast carcinoma. Emphasis is placed on the management of acute respiratory failure secondary to massive right pleural effusion and a locally advanced ulcerated breast tumor, as well as on the multidisciplinary approach required in end-stage disease with limited therapeutic options. Materials and method. A 48-year-old female experienced a fulminant onset of disease within two months after self-detection of a right breast lump. In April 2025, she presented to the emergency department with posterior thoraco-lumbar pain, marked asthenia, resting dyspnea and dry cough. Imaging revealed a massive right pleural effusion, for which thoracentesis was performed. The right breast was ulcerated and infiltrated, consistent with carcinomatous mastitis, and a firm, fixed axillary nodal mass was palpable. Core needle biopsy confirmed invasive breast carcinoma, no special type (G2). CT staging demonstrated osseous, pulmonary, lymphatic, muscular, subcutaneous and peritoneal metastases. Immunohistochemistry identified a luminal B subtype (ER 100%; PR 80%; HER2 equivocal/non-amplified; Ki67 50%), stage IV (cT4N3M1). Given the presence of visceral crisis, the multidisciplinary tumor board initiated palliative chemotherapy in association with osteoclast inhibition therapy. Results. Follow-up CT imaging demonstrated a remarkable therapeutic response, with regression of the primary breast lesion and significant reduction of secondary metastases. Clinically, the patient experienced marked pain relief, dyspnea only on exertion, disappearance of dry cough, and notable improvement of the ulcerated breast lesion. The patient has completed the planned chemotherapy cycles and is scheduled for follow-up imaging to evaluate the disease status. Conclusions. This case underscores the therapeutic challenge and clinical importance of early recognition and management of visceral crisis in advanced luminal B breast carcinoma. It also highlights the role of appropriate palliative chemotherapy in achieving rapid tumor control and in improving patient quality of life.

Keywords: breast cancer, metastases, systemic therapy, visceral crisis, biopsy

 

 

Immune-related adverse events influence on survival in metastatic malignant melanoma patients –
real-life experience from Colţea Clinical Hospital

Simona Coniac^1,2, Andreea-Iuliana Ionescu^2,3,4, Ana-Maria Barbu², Victor-Teodor Bardan², Ionuţ-Lucian Antone-Iordache^2,3

1. Department of Medical Oncology, Hospice Hope Bucharest, Romania

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

3. Department of Radiotherapy, Colţea Clinical Hospital, Bucharest, Romania

4. Department of Medical Oncology, Colţea Clinical Hospital, Bucharest, Romania
 

Objective. Immune checkpoint inhibitors (ICIs) outstandingly reformed the treatment for malignant melanoma (MM) patients, providing unforeseen progression-free and overall survivals with the cost of unpredictable immune-related adverse events (irAEs). This study aims to generate real-world evidence of irAEs being prognostic markers for overall survi­val (OS) and progression-free survival (PFS) in metastatic MM. A secondary objective is analyzing if endocrine irAEs alone could predict better survival in these patients. Materials and method. This is a retrospective cohort study that included all metastatic MM treated with ICIs in the Colțea Clinical Hospital, Bucharest, from 1 January 2017 until June 2025, which have completed at least one cycle of immunotherapy. We performed Kaplan-Meyer curves and log-rank tests, then we calculated the hazard ratio using Cox regressions. Results. Our cohort was composed of 59 patients, with a median age of 66 years old, and median follow-up of 8.5 months, out of which 35.6% developed irAEs. These patients showed a statistically significant longer median OS (27 versus 7.3 months; p=0.022) and PFS (26.9 versus 3.6 months), with hazard ratio of 0.45 (95% CI; 0.23 to 0.9) and 0.42 (95% CI; 0.21 to 0.83). Only 16.9% of our cohort developed endocrine irAEs; despite showing better median OS (20.3 versus 9.6 months) and PFS (20.3 versus 4.9 months), the differences were not statistically significant. Conclusions. In our study, irAEs showed better OS and PFS for metastatic MM patients treated with ICIs. A more powerful multicentric cohort is needed in order to identify what specific type of irAEs are involed in longer survival.

Keywords: malignant melanoma, immune checkpoint inhibitors, immune-related adverse events, real-world data

 

 

When breast cancer changes its face: the crucial role of re-biopsy in emerging metastases

Andreea Costache, Adelina-Silvana Gheorghe

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

We report the case of a 70-year-old woman with a long history of breast carcinoma, initially diagnosed in 2006 and treated with surgery, radiotherapy and adjuvant hormonotherapy. After years of follow-up, disease progression was noted in 2024, with pulmonary metastases. The clinical course raised questions regarding the nature of newly detected lesions. Histopathological assessment of pulmonary biopsies suggested small cell lung carcinoma, a finding suggesting a second cancer. However, we asked for a second immunohistochemical evaluation which contradicted this, identifying the lesions as pulmonary metastases from breast carcinoma with neuroendocrine differentiation. This discrepancy profoundly altered the treatment approach, emphasizing the importance of re-biopsy in the context of new or atypical metastases. We initiated systemic therapy, imaging follow-up demonstrating partial regression of certain lesions, but also the appearance of new consolidations, requiring close monitoring. Throughout the disease course, the patient’s case highlighted the dynamic nature of tumor biology and the clinical risks of assuming that metastatic lesions always reflect the original histology. This case illustrates that re-biopsy and immunohistochemical reassessment are indispensable tools in modern oncology. They ensure accurate diagnosis, reveal phenotypic shifts such as neuroendocrine differentiation, and allow adaptation of therapeutic strategies. In the era of personalized oncology, repeated tissue sampling should be regarded not as optional, but as a cornerstone of evidence-based care when facing disease progression or unexpected metastatic patterns.

Keywords: re-biopsy, neuroendocrine differentiation, immunohistochemistry, personalized oncology

 

 

Therapeutic challenges and evolutive insights in a very young patient with grade IV midline glioma, H3K27M-

Laura-Diana Costănel¹, Diana Panaite^1,2, F.C. Amurăriți-Proca¹, C. Volovăț^1,2

1. Victoria Hospital – Euroclinic Oncology Center, Iași, Romania

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

Objective. To highlight the evolutive course and therapeutic challenges of a grade IV midline glioma diagnosed in a very young patient with H3K27M-negative status and to emphasize the need for individualized, multimodal treatment strategies. Materials and method. Grade IV midline glioma is a rare central nervous system tumor, marked by pronounced biological aggressiveness and poor prognosis, most often associated with H3K27 alterations. The absence of this alteration defines an atypical phenotype with still uncertain clinical implications. We report the case of a 20-year-old female diagnosed in May 2024 with a right thalamic mass, who underwent gross total resection. Histopathological and immunohistochemical evaluation confirmed WHO (World Health Organization) grade IV glioma, H3K27M-, with a Ki67 index of 20%. Postoperatively, the patient received external radiotherapy. In February 2025, off-label everolimus therapy was initiated. Results. Following five months of everolimus therapy, the patient developed early progression with neurological decline and radiological evidence of leptomeningeal dissemination. The treatment regimen was subsequently switched to bevacizumab combined with temozolomide, leading to marked clinical improvement and partial radiological response, with good tolerability. The patient remains under close surveillance, with ongoing imaging follow-up. Conclusions. This case highlights the aggressive behavior of WHO grade IV midline glioma in a very young patient and underscores the relevance of comprehensive molecular profiling, particularly the rare finding of H3K27M negativity. The limited efficacy of mTOR (target of rapamycin) inhibition, contrasted with the partial benefit observed under anti-VEGF (vascular endothelial growth factor) therapy, reflected the current therapeutic limitations and reinforces the need for innovative, personalized strategies within a multidisciplinary framework.

Keywords: glioma, H3K27M-, everolimus, progression, bevacizumab, temozolomide

 

 

From rapid progression to durable response: immunotherapy in a 22-year-old patient
with dMMR sigmoid adenocarcinoma

Cristina-Alexandra Coțovanu¹, Smaranda-Iuliana Tabarcea¹, B. Gafton^1,2

1. Department of Medical Oncology, Regional Institute of Oncology Iași, Romania

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

Introduction. Colorectal cancer (CRC) in very young patients is extremely rare and often associated with distinct molecular features. Tumors with mismatch repair deficiency (dMMR) or high microsatellite instability (MSI-H) account for approximately 15% of CRC cases, being characterized by high mutational burden, distinct prognosis and poor response to fluoropyrimidine-based chemotherapy. In this context, immune checkpoint inhibitors have become the therapeutic standard, and the CheckMate-142 trial demonstrated durable clinical benefits of nivolumab ± ipilimumab in advanced MSI-H/dMMR colorectal cancer. Case presentation. We report the case of a 22-year-old female, without comorbidities but with a possible family history of gastrointestinal malignancy, diagnosed in July 2024 with poorly differentiated sigmoid adenocarcinoma (pT4bN1aR1, Bd3, L1, Pn1), invading ileal loops and with positive radial margin. Immunohistochemistry revealed loss of MSH2/MSH6 expression (dMMR), and genetic testing confirmed a KRAS mutation. Following surgical resection and adjuvant CAPEOX chemotherapy (four cycles), the patient developed early disease progression with peritoneal carcinomatosis. In December 2024, treatment with nivolumab + ipilimumab (four cycles) was initiated, followed by nivolumab monotherapy. The clinical outcome was favorable: complete clinical improvement (ECOG 0, pain resolution, weight gain), normalization of tumor markers and partial radiologic response (>50% reduction of peritoneal lesions at CT in March 2025). The subsequent evaluations (May-August 2025) confirmed stable disease with further regression, without hepatic, pulmonary or bone metastases. Toxicity was limited to subclinical immune-related hypothyroidism, which was controlled with replacement therapy. Conclusions. This case highlights the aggressive behavior of colorectal cancer in very young patients and the limited benefit of chemotherapy in dMMR tumors. Immune checkpoint inhibition achieved durable disease control with minimal toxicity, underlining the importance of early MSI/dMMR testing and the role of immunotherapy in tailoring treatment for advanced colorectal cancer.

Keywords: colorectal cancer, dMMR, immunotherapy, nivolumab, ipilimumab

 

 

Cannabinoids in glioblastoma: strengthening the preclinical basis for clinical application

Ioana Creangă-Murariu^1,2,3, Ioana-Irina Rezuș^1,3, Roshanak Karami^3,4, Anett Rancz³, Peter Martay⁵, Maria Anne Engh³, Mahmoud Obeidat³,
Ştefania Bunduc^6,7, Péter Hegyi^3,8,9, Bogdan-Ionel Tamba¹

1. “Prof. Ostin C. Mungiu” Advanced Research and Development Center for Experimental Medicine – CEMEX, Iaşi, Romania

2. Medical Oncology-Radiotherapy Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 

3. Center for Translational Medicine, Semmelweis University, Budapest, Hungary

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. Glioblastoma (GBM) is an aggressive brain tumor with poor prognosis and limited treatment options. Cannabinoids exhibit antitumor activity, but current in vivo evidence in glioblastoma remains scattered and heterogeneous. This inconsistency has hindered the translation of promising preclinical findings into clinical investigation. To address this gap, we conducted a meta-analysis of murine studies evaluating the effects of various cannabinoid-based therapies on tumor volume in GBM models. Materials and method. We followed PRISMA 2020 guidelines and registered the meta-analysis on PROSPERO (CRD42025543744). We included in vivo studies that evaluated natural cannabinoids (THC, CBD) or synthetic analogs (e.g., WIN55,212-2, JWH-133) in mouse models of glioblastoma. The primary outcome was the change in tumor volume after intervention. We applied random-effects models to calculate pooled mean differences (MDs) with 95% confidence intervals (CIs), and we performed subgroup analyses based on cannabinoid type. Results. Our study reveals a significant tumor volume reduction in cannabinoid-treated groups versus controls (MD: -980.58 mm³, CI: -1270.82; -690.88). Synthetic cannabinoids, particularly WIN55,212-2, showed the most substantial antitumor effect (MD: -1259.11 mm³; CI: -3651.12; -1132.79). THC also significantly reduced tumor volume (MD: -1082.49 mm³; CI: -2024.75; -140.22), while THC:CBD combinations demonstrated a consistent benefit (MD: -1133.60 mm³; CI: -1395.72; -871.48). Pure CBD and CB2-selective agonists showed variable but favorable effects. Conclusions. Cannabinoid therapies, particularly synthetic and THC-rich compounds, exert potent antitumor effects in glioblastoma models. These findings provide compelling preclinical evidence supporting the clinical investigation of cannabinoids as adjuncts to standard glioblastoma therapy. Rigorous translational studies are now warranted to explore safety, dosing and combinatorial potential in humans.

Keywords:canabinoids, glioblastoma, clinical application

 

 

From superior vena cava syndrome to small cell lung carcinoma. Diagnosis, management
and evolution – case report

Amalia-Corina Dinu, Cornelia Nițipir, Cristina Orlov-Slavu

Department of Medical Oncology, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest; Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

Superior vena cava (SVC) syndrome represents an oncology emergency that results from the obstruction of the blood flow through the SVC. The obstruction can be caused by the extrinsic compression of the SVC by the mediastinal structures or the direct invasion of tumor or in some cases both mechanisms. We present the case of a 56-year-old male, smoker (40 packages per year), who presented in the ER in July 2025 for severe dyspnea, cough, edema of the upper limbs, neck and head and thoracic collateral veins – a clinical exam suggestive for grade 2 superior vena cava syndrome, with ECOG 2 performance status. In the ER, the patient underwent a cardio-pulmonary RX and thoracic CT scan that revealed a tumoral mass situated in the right mediastinum with the maximum diameter of 13.7 cm that surrounding the pulmonary artery and the right bronchia, with presence of moderate right pleural effusion and minimal pericardial effusion. The patient underwent additional investigations for disease staging: histopathological exam from endobronchial biopsy demonstrated the diagnosis of small cell lung carcinoma, Ki67=90%; the CT scan of brain, chest, abdomen and pelvis revealed progression of the tumoral mass on the right side with complete atelectasis of the right lung, subocclusion of the right pulmonary artery, azygous vein and SVC cT4cNxM0. Following specialist consultation, the patient began prophylactic therapy for deep vein thrombosis. The first cycle of chemotherapy with cisplatin, etoposide and durvalumab was initiated as per the treatment protocol. At the second cycle of chemotherapy, the patient no longer exhibited clinical signs of SVC syndrome. Due to decrease of glomerular filtration ratio, cisplatin was switched to carboplatin 5 AUC. The patient is currently receiving treatment with carboplatin, etoposide and durvalumab, according to the ongoing therapy protocol.

Keywords: small cell lung cancer, immunotherapy, cis­pla­tin, carboplatin

 

 

Two cancers, one protocol: the challenges of treating synchronous malignant tumors

Raluca-Bianca-Elena Dospinescu, Ana-Maria-Cecilia Păuleț, Mălina Nicoară, Teodora Alexa-Stratulat

Oncology Department, Regional Institute of Oncology Iaşi, Romania; “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
 

Introduction. The incidence of synchronous tumors in renal cell carcinoma (RCC) patients is low (0.8-2%), and may be influenced by genetic predisposition, shared exposure to carcinogens and associated comorbidities. Therapeutic strategies should be tailored according to the IMDC risk score, tumor burden, the patient’s functional status and tolerance to immunotherapy or targeted therapy. Case presentation. The first case involves a 78-year-old patient diagnosed with clear cell RCC synchronous with hepatocellular carcinoma (HCC, BCLC stage C), in the setting of Child-Pugh A liver cirrhosis complicated by previously ligated esophageal varices, portal hypertension and secondary thrombocytopenia. Given the inoperable nature of both lesions, the preserved hepatic function and the potential hepatotoxicity associated with anti-VEGF or tyrosine kinase inhibitor (TKI) therapies, the multidisciplinary tumor board recommended initiating palliative systemic therapy with the combination of nivolumab and ipilimumab. The treatment decision aimed to achieve durable tumor control of the RCC while concurrently addressing the HCC. The second case involves a 67-year-old male diagnosed with renal cell carcinoma concomitant with hepatocellular carcinoma and prostate cancer. Given the presence of multiple synchronous tumors and the need for rapid disease control, immunotherapy with nivolumab and cabozantinib was initiated. This combination was selected for its rapid efficacy and ability to target all malignancies simultaneously, with treatment tailored to disease aggressiveness and the patient’s clinical profile. Conclusions. The differences in therapeutic decisions reflect the distinct clinical characteristics and treatment goals of each patient: in the first case, the objective was to achieve a durable immunologic response, whereas in the second case, priority was given to rapid and simultaneous control of multiple tumors.

Keywords: synchronous malignancies, immunotherapy, multidisciplinary management, tyrosine kinase inhibitors, systemic therapy

 

 

Li-Fraumeni syndrome: clinical and genetic correlation in a patient with multiple neoplasms

I.M. Drozd¹, Viorica-Elena Rădoi^2,4, Alexandra Novac², Cornelia Nițipir^1,3

1. Department of Medical Oncology, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania

2. “Alfred Rusescu” National Institute for Mother and Child Health, “Polizu” Maternity, Bucharest, Romania

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

4. Department of Genetics, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

Li-Fraumeni syndrome is an autosomal dominant hereditary disorder characterized by a spectrum of early-onset malignancies. The main cause of this syndrome is a germline mutation in the TP53 tumor suppressor gene. Individuals with Li-Fraumeni syndrome are predisposed to develop “core” cancers, such as soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, brain tumors, adrenocortical carcinoma, leukemias and lymphomas. We report the case of a 30-year-old female with a significant family history of cancer, in whom genetic testing through whole exome sequencing (WES) confirmed a TP53 mutation, consistent with Li-Fraumeni syndrome. The clinical evolution was marked by a left high-grade adrenocortical carcinoma, resulting in ACTH-independent Cushing’s syndrome, requiring laparoscopic adrenalectomy followed by adjuvant mitotane therapy and glucocorticoid replacement. Subsequently, the patient was diagnosed with right breast neoplasm (high-grade ductal carcinoma in situ), managed by bilateral mastectomy with reconstructive surgery. Additional disease features included bilateral adrenal nodularity, ovarian fibroma, polycystic ovary syndrome, uterine leiomyoma, and an episode of severe cutaneous drug reaction with viral exanthema during mitotane therapy. The therapeutic approach integrated complex surgical, endocrine, oncologic and reproductive management. Imaging surveillance and multidisciplinary follow-up were critical, given the syndrome’s broad malignant potential and the occurrence of multiple primary neoplasms. Given the significant family history, as well as the presentation pattern with various cancer types at a young age, WES was performed. Testing identified the following variant: TP53 NM_000546.6:c.800G>C p.Arg267Pro (rs587780075) in heterozygous state, classified as pathogenic/likely pathogenic, associated with Li-Fraumeni syndrome with autosomal dominant (AD) inheritance. This case highlights the diagnostic and therapeutic challenges of Li-Fraumeni syndrome, emphasizing the importance of early genetic diagnosis, individualized surveillance strategies and coordinated, interdisciplinary care, as well as early detection within families, bringing significant benefits by enabling timely interventions, risk reduction and improved outcomes for relatives at risk.

Keywords: Li-Fraumeni syndrome, Cushing syndrome, mitotane, adrenalectomy

 

 

Balancing risks and benefits of repeat cytoreduction and reHIPEC in recurrent pseudomyxoma peritonei – case report and literature review

A. Evanghelides¹, Andra-Maria Stancu³, T. Pătrașcu^1,2, D. Georgescu^1,2

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

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

3. Oncology Department, Sanador, Bucharest, Romania
 

Objective. Pseudomyxoma peritonei (PMP) is a rare and heterogeneous clinical entity, most frequently arising from appendiceal mucinous neoplasms, characterized by progressive dissemination of gelatinous ascites and mucinous implants throughout the peritoneal cavity. Although cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has significantly improved outcomes, disease recurrence remains common and its management is not supported by standardized therapeutic protocols. The objective of this report is to evaluate the feasibility and oncological relevance of repeat CRS with or without reHIPEC in recurrent PMP, considered as salvage therapy. Materials and method. We report the case of a 49-year-old female initially diagnosed with low-grade appendiceal mucinous neoplasm (LAMN) associated with bilateral ovarian involvement and extensive peritoneal dissemination (pT4aM1b). The patient underwent complete cytoreduction followed by HIPEC, with favorable disease control for 18 months. Surveillance imaging (CT and MRI) subsequently demonstrated recurrence involving pelvic cavity, the splenic fossa and the intersplenic-diaphragmatic peritoneum, distinct from the original surgical sites. Following deliberation within a multidisciplinary tumor board, repeat CRS was performed. Results. Macroscopic complete cytoreduction was achieved. A review of the literature highlights that, in recurrent PMP, reCRS remains the most frequently performed intervention, offering local control and survival benefit in carefully selected cases. Data on reHIPEC are limited, but suggest possible oncological advantages at the cost of higher perioperative risk and morbidity. Conclusions. The management of recurrent PMP remains an unresolved therapeutic challenge due to the absence of standardized protocols. This case highlights that repeat CRS, performed in specialized centers and within a multidisciplinary framework, may constitute a rational therapeutic option, balancing oncological efficacy with procedural risks and offering to selected patients the possibility of improved survival outcomes. In the absence of standardized guidelines, the management should be individualized, guided by multidisciplinary assessment and tailored to balance oncological efficacy against procedural risks.

Keywords: pseudomyxoma peritonei, recurrence, cytoreductive surgery, reHIPEC, surgical oncology, multidisciplinary management

 

 

Sequential anti-HER2 therapies and long-term disease control in metastatic gastric cancer:
a case report

D.G. Florea^1,2, Ioana Luca¹

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

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

Introduction. HER2-positive gastric adenocarcinoma represents approximately 15-20% of gastric cancers. Patients achieving prolonged survival beyond three years constitute a rare subset, with multiple sequential treatment lines required. Despite extended disease control, the patients may present late-onset complications requiring multidisciplinary intervention for a better quality of life. Case presentation. A 50-year-old man with a prior history of caustic soda ingestion during childhood presented in April 2022 with epigastric pain, postprandial vomiting, melena and weight loss. Initial diagnostic evaluation identified a 5-cm ulcerated, stenosing tumor infiltrating the pyloric antrum, along with three hepatic lesions. The patient underwent palliative total gastrectomy and metastasectomy which diagnosed an intestinal-type gastric adenocarcinoma, pT3N2bM1 with HER2 overexpression. The initial systemic management comprised HER2-targeted therapy in combination with platinum doublet chemotherapy. Six-month imaging evaluation revealed a complete response, prompting de-escalation to trastuzumab and fluoropyrimidine as maintenance strategy. Disease progression occurred after 12 months, characterized by newly emergent lombo-aortic lymphadenopathy, warranting initiation of second-line ramucirumab plus taxane. Twenty-four months post-diagnosis, progressive hepatic disease with new lesions prompted transition to irinotecan-based regimen. Subsequent radiological progression in June 2025 led to commencement of trastuzumab deruxtecan. In August 2025, the patient presented with an epigastric mass and marked jaundice. Cross-sectional imaging identified multiple intraabdominal biliomas amenable to percutaneous CT-guided drainage for fluid evacuation. The patient is presently under observation for clinical optimization and reinitiation of systemic therapy. Conclusions. This case demonstrates that initial complete response to HER2-targeted therapy can herald prolonged survival exceeding three years through sequential evidence-based regimens. Uncommon late complications, including bilioma formation, may emerge in long-term survivors, requiring interventional management. Aggressive sequential therapy with novel agents and multidisciplinary management remain essential for optimizing outcomes in exceptional responders.

Keywords: metastatic gastric cancer, HER2-target therapy, antibody-drug conjugate, sequential therapy

 

 

Exploring the therapeutic complexity of advanced vulvar melanoma: a case involving multiple recurrences and combined treatment strategies

Andreea-Ioana Geală¹, R. Matei¹, Anca Stolojanu¹, Crina Siminiceanu¹, Loredana Ciontea¹, Sânziana Prundianu¹, Adelina-Silvana Gheorghe^1,2,
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. Although vulvar malignant melanoma accounts for less than 1% of all melanomas and roughly 5% of vulvar malignancies, its aggressive nature and late detection contribute to significant morbidity and mortality. Case presentation. We present the case of a 49-year-old woman with a history of smoking, subtotal hysterectomy and right adnexectomy in 2013 for a benign adnexal cyst. In 2015, she developed a nodular vulvar lesion diagnosed as nodular vulvar melanoma, Clark level IV, Breslow thickness 3.1 mm. A right posterior hemivulvectomy was performed in November 2015, followed by a left partial vulvectomy in June 2016 due to recurrence. Sentinel lymph node biopsies were negative. In 2019, imaging and biopsy confirmed locoregional recurrence in the left external iliac lymph nodes. She received four cycles of combination immune checkpoint inhibitors (ipilimumab and nivolumab), then continued the nivolumab monotherapy, but she developed an autoimmune response (autoimmune thyroiditis). She came back under our observation in 2023, and a PET-CT performed in April 2023 revealed metabolically active lymph nodes in the pelvic and subdiaphragmatic areas, along with a large, septated cystic mass in the pelvis (18×12.3×17 cm), containing tracer-avid nodules with an SUV lbm of 10.88. In May 2023, she presented with bowel obstruction due to tumor compression. She underwent extensive en bloc resection, including pelvic tumor removal, segmental enterotomy, cystectomy with cystography and terminal ileostomy. Histopathology confirmed metastatic melanoma with epithelioid and spindle cells; BRAF mutation testing remained negative. Postoperatively, she received palliative radiotherapy without long-term disease control. She then underwent four cycles of dacarbazine chemotherapy, which was poorly tolerated. Due to limited options, immunotherapy rechallenge with pembrolizumab was initiated. The treatment was well tolerated, and after six cycles the imaging revealed stable disease, indicating a potential benefit. Conclusions. This case reflects the complexity of managing advanced vulvar melanoma and demonstrates that rechallenging with immune checkpoint inhibitors, such as pembrolizumab, may still offer benefit even after disease progression in selected patients.

Keywords: immunotherapy, BRAF mutation, vulvar melanoma, radiotherapy

 

 

Clinical experience with low-dose chemotherapy in palliative gastrointestinal cancer:
focus on quality of life and survival

Bogdan Georgescu^1,2,3, Adelina-Silvana Gheorghe^1,3, Lidia-Anca Kajanto^1,3, Raluca-Ioana Mihăilă^1,3, Isabela-Anda Komporaly^1,4, Elena Iovanescu^1,3

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

2. Neolife Băneasa Oncology Centre, Bucharest, Romania

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

4. Memorial Hospital, Bucharest, Romania
 

Low-dose chemotherapy, also referred to as metronomic chemotherapy, represents an evolving therapeutic strategy in the management of advanced gastrointestinal cancers, including pancreatic, gastric, hepatocellular and esophageal malignancies. Unlike conventional high-dose regimens, this approach involves continuous or frequently administered chemotherapy at sub-maximal tolerated doses, with minimal or no drug-free intervals. In the palliative setting, where quality of life (QoL) and symptom control become primary therapeutic goals, low-dose chemotherapy offers a better-tolerated alternative, particularly for elderly, frail or comorbid patients. Conventional chemotherapy is often limited by toxicities such as neutropenia, mucositis and fatigue, which can worsen functional status and diminish survival. This review presents a retrospective analysis of a cohort of 31 patients diagnosed with pancreatic, gastric, hepatocellular or esophageal cancer, treated with dose-reduced or delayed chemotherapy protocols. The primary endpoints included the relationship between dose modifications and clinical outcomes, with a focus on toxicity reduction, hospitalization rates, overall survival (OS) and patient-reported QoL. The results from statistical analyses indicate: reduced hematologic toxicity and fewer treatment-related complications; decreased frequency of hospitalization; preservation or improvement in quality-of-life measures; a trend toward prolonged overall survival, suggesting clinical benefit even in a palliative context. These findings support the integration of low-dose chemotherapy into individualized treatment plans for selected patients with gastrointestinal cancer, emphasizing tolerability, symptom control and quality of life over aggressive disease eradication.

Keywords: low-dose chemotherapy, metronomic chemotherapy, gastrointestinal cancers, palliative care, quality of life, toxicity reduction, survival

 

 

Rare rectal cancer complications associated with bevacizumab treatment: case reports
and literature review

D.E. Georgescu^1,2, A. Evanghelides¹, Andra-Maria Stancu, T. Pătrașcu^1,2

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

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

3. Oncology Department, Sanador, Bucharest, Romania
 

Objective. Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), is widely used in advanced and metastatic colorectal cancer treatment. While its clinical benefit is well established, bevacizumab has been associated with perforations or fistulas. Fistula formation is a well-known complication of anti-angiogenic therapy, emphasizing the need for thorough clinical and paraclinical evaluation to prevent potential septic events, particularly in cases of low rectal tumor localization. This report presents two patients who developed severe surgical complications during treatment and discusses their clinical significance and therapeutic implications. Materials and method. We reviewed the records of two patients in whom bowel perforation or fistula appeared during bevacizumab therapy. For each case, we examined the disease background, the previous oncologic treatments, the clinical course, the imaging findings, the operative management and outcome. Results. The first case involves a patient with locally recurrent rectal cancer treated with reirradiation and neoadjuvant chemotherapy, including bevacizumab, who developed a low rectal fistula complicated by septic shock. In the second case, a patient who underwent upfront rectal surgery declined adjuvant therapy; two years later, pulmonary metastases developed, and following prolonged bevacizumab-based systemic therapy, the patient developed a rectal fistula near the colorectal anastomosis, in the absence of local recurrence. These scenarios illustrate different timings and locations of bowel injury and point to the multifactorial nature of these events. Conclusions. Although rare, bowel perforations and fistulas during bevacizumab therapy are serious and often life-threatening. Patients with prior surgery or irradiation appear particularly vulnerable. Careful assessment before initiating treatment, close monitoring for abdominal symptoms and prompt imaging are essential. When complications occur, timely surgical intervention can be lifesaving. More clinical evidence is needed to better define which patients are at highest risk and how to prevent these events.

Keywords: bevacizumab, gastrointestinal perforation, fistula, anti-angiogenic therapy, VEGF

 

 

Defying prognosis: extended survival in metastatic cholangiocarcinoma. A case report

Maria-Alexandra Gheorghiade, V.M. Croitoru

Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania
 

Introduction. Cholangiocarcinoma is a type of malignancy arising from the biliary tract, accounting for less than 1% of the total of cancers. Based on the anatomical location of the tumor, it is classified into intrahepatic, perihilar and distal subtypes. Intrahepatic cholangiocarcinoma has been increasing in incidence, and it is associated with poor prognosis. Its aggressive and insidious nature leads to challenges in daily practice, making it an ongoing battle for discovering diagnosis and treatment developments suitable for these patients. Case description. This paper describes the case of a 75-year-old female diagnosed with metastatic intrahepatic cholangiocarcinoma. The patient presented with multiple hepatic and pulmonary space-occupying lesions, with a primary tumoral mass in the fifth hepatic segment on CT. Hepatic biopsy was performed and revealed a poorly differentiated intrahepatic bile duct carcinoma. After a multidisciplinary team analyzed all the clinical, pathological and imaging aspects, first-line palliative chemotherapy with gemcitabine and cisplatin was initiated, being the current standard of care at that time. After four cycles, adjustments were made due to a lowering creatinine clearance (40 ml/min), and the patient continued with gemcitabine alone for five more cycles. Following an interval CT scan, numerical and dimensional progression of the hepatic metastases was assessed, and the patient started second-line treatment with FOLFIRI. The surprising fact is that the patient had a stable disease and proceeded with this treatment for up to thirty-one cycles, when progressive disease eventually occurred. Discussion. The majority of patients with cholangiocarcinoma initially present with unresectable or metastatic disease, making the management of the case limited. While first-line therapy recommendations are well established, second-line therapy in metastatic cholangiocarcinoma still remains controversial when there are no molecular targets to be approached, highlighting the importance of individual conduct and the hope for future developments.

Keywords: cholangiocarcinoma, intrahepatic, metastatic, chemotherapy, survival

 

 

Achieving complete pathological response in HER2-positive breast cancer through multimodal therapy: a case report

Luiza-Florentina Gherghe, Michael Schenker, Nelly Cherciu, Diana-Ana-Maria Peta

 “Sf. Nectarie” Oncology Center, Craiova, Romania
 

Objective. To present the case of a young patient with HER2-positive breast cancer treated through an integrated multimodal strategy, achieving complete pathological response. Materials and method. A 41-year-old woman was diagnosed with invasive ductal carcinoma of the left breast, ER 90%, PR 70%, HER2 3+, Ki67 70%, clinical stage cT2N1M0. The neoadjuvant treatment consisted of four cycles of epirubicin-cyclophosphamide followed by four cycles of docetaxel, combined with dual anti-HER2 therapy (trastuzumab and pertuzumab). Results. The patient underwent breast-conserving surgery with sentinel lymph node biopsy. Postoperative histopathology revealed no residual invasive tumor, confirming a complete pathological response. Adjuvant treatment included external beam radiotherapy (DIBH, 40 Gy + 10 Gy boost), the continuation of dual anti-HER2 therapy up to 14 administrations, and endocrine therapy with goserelin and tamoxifen. The patient maintained a good general condition, with no severe toxicities. Conclusions. This case highlights the importance of early diagnosis, biomarker assessment and a personalized multimodal approach in HER2-positive breast cancer. Integration of neoadjuvant chemotherapy with dual anti-HER2 blockade and adjuvant radiotherapy can achieve complete pathological response, optimizing the prognosis of young patients with this aggressive subtype.

Keywords: breast cancer, HER2-positive, neoadjuvant chemotherapy, anti-HER2 therapy, breast-conserving surgery, complete pathological response

 

 

Sustained response and survival beyond expectations in HER2+ metastatic breast cancer:
three illustrative clinical cases

Iolanda Goga, Mihaela Croitoru, Monica Nichita, Elena-Adriana Iovanescu, Adelina-Silvana Gheorghe, Radu Matei, Raluca-Ioana Mihăilă, Daniela Zob

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

Objectives. To evaluate long-term survival and toxicity in patients with metastatic HER2-positive breast cancer treated sequentially with anti-HER2 therapies, by presenting three clinical cases with exceptional evolution. Materials and method. This is a retrospective descriptive analysis of three women (aged 55, 59 and 63 years old, respectively) with metastatic HER2-positive breast cancer diagnosed between 2012 and 2020. All received multiple treatment lines, multidisciplinary monitoring, and had distinct disease courses. Results. Case 1: a 55-year-old woman with a history of ova­rian cancer (treated surgically and with chemotherapy in 2009), who was subsequently diagnosed in 2012 with stage IV HER2-positive breast cancer, achieving sustained re­sponse and remarkable survival (over 13 years) with conti­nuous trastuzumab therapy. Case 2: a 63-year-old woman initially diagnosed with breast cancer in 2013, who experienced relapsing visceral and local HER2-positive disease and is currently deriving benefit from trastuzumab emtansine (T-DM1) for more than seven years, markedly exceeding median therapeutic expectations. Case 3: a 59-year-old woman diagnosed at the end of 2020 with de novo bilateral HER2-positive breast cancer, who progressed systemically and neurologically through more than seven lines of therapy. Notably, her clinical course was complicated by ecthyma gangrenosum – an exceptionally rare manifestation when caused by cutaneous Staphylococcus aureus infection – and staphylococcal sepsis during her sixth line of therapy with vinorelbine and trastuzumab. Conclusions. The median duration for trastuzumab therapy in metastatic breast cancer is typically 4-5 years, and 6-20 months for T-DM1, but these cases highlight exceptionally long responders, with far greater survival than reported averages, underlining marked interpatient heterogeneity. Close monitoring for rare but severe toxicities – especially infectious events – is crucial. Sustained multidisciplinary management enables successful ongoing oncologic treatment and risk mitigation. This approach supports the recommendation for personalized strategies in metastatic patients with exceptional response profiles.

Keywords: HER2 positive, metastatic breast cancer, trastuzumab, trastuzumab emtansine, long-term survival, ecthyma gangrenosum

 

 

Management of oncologic patient rehabilitation – the integrated role of physiotherapy

I.B. Goga

Therapy for Movement Clinic, Bucharest; Kinetodidactica Bucharest, Romania
 

Objective. Oncologic rehabilitation is a complex and multidimensional process aimed at improving functionality, quality of life and social reintegration of cancer patients. Physiotherapy, as an integral part of this process, plays a crucial role in preventing and reducing complications resulting from surgery, chemotherapy and radiotherapy, while supporting the maintenance and recovery of functional capacity. Materials and method. This presentation highlights physio­therapeutic approaches from the current available evidence and literature such as therapeutic exercises, mobilization techniques, lymphatic drainage, fatigue management strategies and patient education. The integration of individualized interventions is emphasized, tailored to the clinical status and needs of oncologic patients. Results. Evidence shows that early integration of physiotherapy in the oncologic care pathway reduces disability risk, enhances postoperative recovery, decreases cancer-related fatigue and improves adherence to oncology treatments. Furthermore, physiotherapy contributes to psychosocial well-being and the reintegration of patients into daily and professional life. Conclusions. Physiotherapy is a cornerstone in oncologic rehabilitation. Its individualized and multidisciplinary integration ensures optimal patient outcomes, reinforcing the need for structured rehabilitation programs within oncologic care teams.

Keywords: physiotherapy, oncology, rehabilitation, quality of life, multidisciplinarity

 

 

The road ahead: navigating bone and brain metastases in stage IV, HER2-positive breast cancer 

Eliza Gorduz¹, Mariana Tofan¹, C. Volovăț^1,2

1. Victoria Hospital – Euroclinic Oncology Center, Iași, Romania

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

Objective. HER2-positive tumors are characterized by their aggressive behavior but also by a notable sensitivity to targeted treatments, which have markedly improved patient outcomes in recent years. However, metastasis to the central nervous system remains a clinical challenge. Materials and method. A 50-year-old female patient presented in March 2023 with bone pain. Magnetic resonance imaging (MRI) examination revealed multiple bone metastases with an unclear primary origin. Computed tomography (CT) evaluation identified multiple nodules in the left breast, axillary lymphadenopathy, distant bone dissemination, multiple costal fractures and a suspicious hepatic nodule. Biopsy analysis confirmed moderately differentiated invasive ductal carcinoma, luminal B, HER2-positive, stage IV. Treatment with monoclonal antibodies (Xgeva®) was initiated, followed in July 2023 by first-line palliative treatment:  docetaxel + pertuzumab + trastuzumab, later maintained with trastuzumab + pertuzumab, until March 2024. In March 2024, the patient developed headache and vomiting. Brain MRI revealed an infracentimetric nodular lesion adjacent to the lateral ventricle body – cerebral metastasis. Stereotactic irradiation was administered in a single session, with a total dose of 25 Gy. The lesion showed significant dimensional reduction, followed by a stable appearance until present. Because of intense pain, the patient received palliative external radiotherapy to the lumbosacral and femoral bone, 20 Gy in five fractions. After disease progression, second-line palliative treatment with trastuzumab-deruxtecan was initiated in July 2024 and continued until June 2025, when routine CT examination detected bilateral pulmonary embolism. Following specialized treatment and CT reevaluation in August 2025, pulmonary embolism was no longer detected, and the pulmonary function was fully preserved. The treatment with trastuzumab-deruxtecan was resumed. Results. The patient showed complete response at the breast and axillary lymph node levels, with stable lesions: bones, hepatic nodule and cerebral metastasis. Conclusions. Despite advanced stage, the disease remains controlled, and the treatment retains its efficacy – a courageous oncologic journey with remarkable outcomes in the metastatic setting.

Keywords: HER2 positive, breast cancer, antibody-drug conjugate, brain metastasis

 

 

CCND1 amplification – marker of immunosuppression and poor prognosis to immune checkpoint inhibitor therapy

Sarah-Teona Gradea¹, C. Volovăț^1,2

1. Victoria Hospital – Euroclinic Oncology Center, Iași, Romania

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

Objective. The aim of this presentation is to highlight, through a case of PD-L1 positive non-keratinizing squamous cell lung carcinoma, how CCND1 gene amplification contributes to an immunosuppressive tumor microenvironment, reducing the efficacy of immune checkpoint inhibitors. By illustrating this molecular alteration, we aim to emphasize the importance of genetic characterization in patient stratification and in anticipating the response to immunotherapy, given that the presence of CCND1 amplification correlates with poor prognosis even in patients apparently eligible for treatment based on PD-L1 expression. We present the case of a 57-year-old patient with non-keratinizing squamous cell lung carcinoma, G3, TPS=25%, EGFR negative, ALK, ROS1, NTRK, RET negative, harboring a CCND1 gene amplification, staged cT2bN2bM1c2, stage IVB, who received treatment with pembrolizumab, carboplatin and paclitaxel for four cycles (3.09.2024-5.12.2024). Results. A CT evaluation on 18.12.2024 revealed disease progression, with a newly developed lesion in the left superior segment, measuring approximately 24x20 mm, increased size of the primary lung lesion in the right inferior segment, enlargement of secondary hepatic lesions, and increased size of paratracheal and subcarinal lymph nodes. Second-line treatment was initiated (8.01.2025) with ramucirumab + docetaxel, resulting in a dimensional reduction of the pulmonary and secondary lesions. Conclusions. PD-L1 expression provides useful information, but it is not always sufficient to predict immunotherapy efficacy. Combining immunohistochemistry with genetic testing can provide a more comprehensive view and support better treatment personalization.

Keywords: NSCLC, pembrolizumab, PD-L1, CCND1 gene, progression

 

 

Rare synchronous malignancies: a shared opportunity for cure

Alina-Lavinia Grigore

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

We present the case of a 56-year-old woman with no significant comorbidities, who was admitted to the emergency department for gross hematuria and severe symptomatic anemia. Her medical history revealed recurrent urinary tract infections and neglected episodes of microscopic hematuria. Abdominal CT identified a left renal mass with features of localized renal cell carcinoma (T3N0M0) and active bleeding risk. The patient underwent urgent radical nephrectomy with an uneventful postoperative recovery. Subsequent staging revealed a left breast mass of 3.5 cm and palpable ipsilateral axillary nodes. Core biopsy confirmed triple-negative breast cancer (cT2N1M0, stage IIB). Given the diagnosis, she was started on neoadjuvant chemo-immunotherapy following the KEYNOTE-522 regimen, consisting of carboplatin-paclitaxel followed by anthracycline-based chemotherapy plus pembrolizumab. The patient achieved significant clinical response, and after completion of neoadjuvant treatment, she underwent mastectomy with axillary lymph node dissection, showing partial pathologic response. Adjuvant pembrolizumab was continued for one year, in line with both the breast cancer protocol (continuation after neoadjuvant treatment) and the renal cancer protocol (KEYNOTE-564), effectively addressing both malignancies simultaneously. During adjuvant pembrolizumab, at cycle 14, the patient developed abrupt-onset hyperglycemia and diabetic ketoacidosis. Work-up confirmed new-onset autoimmune type 1 diabetes, requiring lifelong insulin therapy. Despite this immune-related endocrine toxicity, pembrolizumab was maintained, given the strong evidence of benefit in both triple-negative breast cancer and the high-risk clear-cell renal carcinoma. This clinical case illustrates the rare occurrence of two synchronous malignancies: triple-negative breast cancer and renal cell carcinoma – both treated with curative intent. Its uniqueness lies in the use of a single immunotherapeutic agent, pembrolizumab, as adjuvant therapy for both tumors, enabling an integrated and effective treatment strategy. The case also highlights the dual nature of immunotherapy: while it provides substantial clinical benefits, it may induce irreversible autoimmune adverse events, permanently affecting the patient’s quality of life.

Keywords: synchronous, renal carcinoma, breast cancer, immunotherapy

 

 

A head and neck cancer patient in an early-phase clinical trial – a happy journey

Mirela Haţegan

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

Participation in early-phase clinical trials provides patients with access to innovative drugs prior to market authorization and state-of-the-art diagnostic and monitoring procedures. However, Romania remains an underdeveloped market in this domain, with pharmaceutical companies often reluctant to invest due to a perceived lack of historical clinical research infrastructure and limited credibility. The success of investigational agents in early-phase clinical trials is closely linked to the robustness of initial clinical development. It is estimated that the probability of a drug progressing from preclinical development to market approval is approximately 10%, with the entire development process typically spanning 10 to 15 years. A review of early-phase oncology trials reported an overall objective response rate of 10.6% and a treatment-related mortality rate of 0.49%. We present the case of a male patient diagnosed with recurrent squamous cell carcinoma of the right pyriform sinus, with high PD-L1 expression. The initial diagnosis was established in March 2019, cT1N2M0. The patient received neoadjuvant chemotherapy, followed by concurrent chemoradiotherapy. The treatment was completed in August 2019, achieving a complete clinical and radiological response. The patient was subsequently monitored through regular clinical and imaging evaluations. In September 2023, he developed a locoregional recurrence, deemed unresectable. He was subsequently enrolled in a phase I/II clinical trial investigating combination immunotherapy with pembrolizumab and anti-LAG-3 monoclonal antibody. The patient has now been on the study for two years. The treatment has been well tole­rated, with only grade 1 fatigue and grade 2 hypothyroidism. The best observed response was stable disease, which has been maintained, as confirmed by the most recent restaging CT scan in August 2025. The patient is expected to complete the two-year treatment protocol in October 2025. Clinically, he remained stable, with minimal tumor burden. Management decisions regarding further therapeutic stra­tegies post-trial are currently under consideration.

Keywords: head and neck cancer, clinical trial, early phase

 

 

One kidney, one chance: local control with SBRT in recurrent renal cell carcinoma

Mălina-Elena Ioschici¹, Iulia Andraș^2,3, C. Hopîrtean⁴

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

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

3. Medicover Hospital Cluj-Napoca, Romania

4. Department of Radiation Oncology, Amethyst Radiotherapy Center, Cluj-Napoca, Romania
 

Introduction. The management of renal cell carcinoma (RCC) in a solitary kidney presents a therapeutic dilemma. Radical surgery may result in end-stage renal dysfunction and dialysis, particularly when nephron-sparing surgery is not feasible. Recent evidence supports stereotactic body radiotherapy (SBRT) as a kidney-preserving alternative in this context. Early reports demonstrated good local control with minimal impact on renal function, even in solitary kidneys. Case presentation. We report the case of a 66-year-old female with bilateral RCC. She underwent right partial nephrectomy in 2019 (multifocal pT3a RCC) and left total nephrectomy in 2020 (clear cell RCC, pT1). In August 2024, CT documented a 46-mm recurrence in the right renal inferior pole and a 20-mm left adrenal nodule, most consistent with a benign adenoma. Radical nephrectomy was recommended, but the patient declined in favor of kidney-sparing therapy. In early September 2024, SBRT was delivered to the right renal recurrence (50 Gy in five fractions) and was well tolerated. Serial imaging from November 2024 to August 2025 demonstrated stability of the right renal lesion (approximately 25 mm), while the left adrenal adenoma remained unchanged. Importantly, renal function was preserved throughout follow-up, avoiding the need for dialysis and maintaining quality of life. Conclusions. This case illustrates the feasibility and efficacy of SBRT for RCC recurrence in a solitary kidney. At the latest follow-up (August 2025), the treated right renal lesion remained radiologically stable, corresponding to 11 months of durable local control after SBRT. In line with recent evidence, SBRT provided oncologic stability with preservation of renal function, supporting its role as a nephron-sparing treatment in carefully selected patients where surgery is contraindicated or declined.

Keywords: SBRT, RCC, kidney-sparing therapy, solitary kidney, local control

 

 

Sustained stabilization of disease progression in a case of HER2-positive metastatic breast cancer in a heavily pretreated patient – clinical case

L. Iovanovici¹, A. Lăzescu^1,2, L. Ciontea¹

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

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

HER2-positive breast cancer is an aggressive subtype, frequently associated with visceral, bone and brain metastasis. However, recent advances in targeted therapies have significantly improved outcomes. We report a case of advanced disease successfully managed with sequential HER2-directed agents. This case is about a 39-year-old female patient diagnosed in 2018 with right breast cancer, T3N2M1, HER2-positive, who underwent surgery followed by systemic therapy with chemotherapy and trastuzumab, then maintenance with trastuzumab in monotherapy. Imaging (CT, PET/CT, brain MRI) revealed pulmonary metastasis and tumorous ovaries. Regarding the disease progression, the therapeutic line changed to trastuzumab-emtansine. After an additional reassessment imaging, a disease progression was detected, and thus the therapeutical line changed to lapatinib and capecitabine. The disease remained stationary, but not for long, since another radiological progression was revealed. After that, the patient underwent several series of chemotherapy, when another progression occurred. At the last disease progression, it was decided to administrate trastuzumab-deruxtecan. The patient is under treatment for already two years, without signs of radiological progression. Treatment tolerance was moderate to good, with no severe adverse events reported. Serial cardiac evaluations revealed preserved left ventricular ejection fraction of 56%, with no signs of heart failure. Successive imaging confirmed ongoing disease control and the absence of new cerebral or abdominal metastases. This case underscores the therapeutic benefit of trastuzumab-deruxtecan in HER2-positive metastatic breast cancer, highlighting both efficacy and safety under careful monitoring. In conclusion, sequential targeted therapy provided durable disease control in this patient with advanced HER2-positive breast cancer. Regular imaging and cardiac monitoring remain essential for optimizing treatment outcomes and minimizing toxicity.

Keywords: breast cancer, HER2-positive, trastuzumab-deruxtecan, chemotherapy, trastuzumab-emtansine

 

 

Adverse events of axitinib and avelumab as a potential prognostic factor in metastatic renal cell carcinoma – case report

Diana-Elena Lazăr¹, Raluca Bălăceanu²

1. Department of Oncology, “Sf. Ierarh Dr. Luca” Municipal Hospital, Oneşti, Bacău, Romania

2. Department of Endocrinology, “Sf. Ierarh Dr. Luca” Municipal Hospital, Oneşti, Bacău, Romania
 

Objective. Given the overlapping toxicities of the anti-PD-L1 antibodies and tyrosine kinase inhibitors, the toxicity profile of each drug must be considered when assessing and managing toxicities in patients treated with avelumab and axitinib. Here, we describe the case of a patient with metastatic renal cell carcinoma (mRCC) treated with avelumab and axitinib, highlighting a systematic approach to toxicity management. A 69-year-old man with bone metastatic clear cell renal cell carcinoma (IMDC favorable risk) began the treatment with axitinib (5 mg twice daily) and avelumab (800 mg every two weeks) in 2023. One year later, the patient reported fatigue, somnolence, decreased appetite, five to six loose stools in the previous 24 hours, accompanied by abdominal pain and cramping. At that time, laboratory evaluation revealed endocrine toxicity consistent with hypothyroidism, and levothyroxine (Euthyrox®) replacement therapy was initiated. The oncological treatment continued without dose modification, and the disease remained stable on imaging. Conclusions. Thyroid dysfunction is a common adverse event of immune checkpoint inhibitors and tyrosine kinase inhibitors. Early detection and prompt thyroid hormone replacement allow the safe continuation of oncological therapy, without compromising the treatment.

Keywords:avelumab, axitinib, prognostic factors

 

 

Objective response to treatment for liver metastases in HR+, HER2- metastatic breast cancer

C. Lobont, A. Hora

Oncology Center, County Emergency Clinical Hospital Bihor, Oradea, Romania
 

Objective. Metastatic breast cancer has a variable prognosis, depending on the biological and clinical factors, such as visceral metastases, but it also depends on the molecular subtypes of breast cancer. Hormone receptor positive (HR+) and negative HER2 expression (HER2-) in metastatic breast cancer accounts for approximately 70% of all breast cancers. Using anti-HER2 therapies in HER2-negative breast cancer is not feasible, but HR-positive and negative-HER2 expression molecular subtypes benefit from first-line metastatic therapy, by receiving CDK4/6 inhibitors in association with hormone therapy. The objective of this paper is to evaluate the therapeutic response of the primary tumor and liver metastases after using CDK4/6 inhibitors in association with hormone therapy in HR+, HER2- metastatic breast cancer. Materials and method. The case report is focused on a 45-year-old premenopausal female diagnosed with lobular breast cancer with liver metastases, moderately differentiated G2, positive estrogen receptors=99%, positive progesterone receptors=99%, high proliferation index ki67=25%, and negative HER2 expression. The CT imaging showed a T4b (54/32/18 mm), N3 (fixed axillary adenopathy, measuring 3 cm, multiple supraclavicular adenopathies), M1 (three liver metastases, measuring 35/30 mm) tumor. Considering tumoral invasion and molecular cancer subtype, the patient received first-line metastatic therapy: ribociclib in association with letrozole and gonadotropine-releasing hormone goserelin (giving the premenopausal status). Results. At seven months of follow-up, CT imaging revealed a smaller primary tumor measuring 16/27 mm versus 54/32 mm, with great reduction in metastatic lesions size. The patient requested a second opinion on liver metastases response. An abdominal MRI revealed a complete reduction of liver metastases and two hemangioma lesions. Conclusions. A hormone-positive, HER2-negative metastatic breast cancer with liver metastasis was treated successfully with CDK4/6 inhibitors and hormone therapy, with complete response of liver metastases.

Keywords: metastatic, hormone, cancer, therapy, inhibitors

 

 

Implementing INTERLACE – a single-center experience incorporating neoadjuvant chemotherapy in locally advanced cervical cancer treatment (INTERLACE-OH)

Vlad Lupu

OncoHelp Oncology Center, Timișoara; ANAPATMOL Research Center, Timişoara; “Victor Babeș” University of Medicine and Pharmacy, Timişoara, Romania
 

Cervical cancer represents a serious health issue in Romania, with multiple socioeconomic implications having contributed to our country consistently showing the highest rates of incidence and mortality due to cervical cancer in Europe. As such, curing more patients in the locally-advanced cervical cancer (LACC) setting has profound implications, given the large scale of the problem. The GCIG-INTERLACE trial represented a turning point in LACC treatment, being the first trial that demonstrated improved survival with the addition of a neoadjuvant chemotherapy regimen prior to chemoradiotherapy. INTERLACE-OH aims to ultimately assess the feasibility of implementing this regimen into daily-practice and to validate these findings. This abstract presents the dose-intensity and acute toxicity data. The cases were selected by performing a search in the institution’s database for LACC patients treated with radiotherapy between November 2023 and July 2025. Data collected encompassed age, staging, height, weight, total radiotherapy dosage, chemotherapy dosage in the neoadjuvant and concomitant portions of the treatment, treatment delays, radiotherapy period and receipt of brachytherapy. The statistical analysis was performed by the author. In total, we identified 83 patients receiving chemoradiotherapy in the LACC setting, with 52 patients receiving the INTERLACE protocol. The induction cohort received a median of 143.2 mg/m² of cisplatin, while the non-induction group received a median of 146.8 mg/m². Furthermore, only 61.5% of the induction cohort received at least four cisplatin doses, as opposed to 85% in INTERLACE. While the toxicity profile was similar in the two groups from our center, there was a higher proportion of grade 3 and grade 4 toxicities in the induction cohort. Overall, the toxicity was significantly higher than in the reference study. The reported findings suggest that implementing induction chemotherapy in addition to the standard treatment of the patients is feasible, albeit with a higher toxicity cost, more delays, and driving higher economic costs to the health provider.

Keywords: cervical cancer, INTERLACE, neoadjuvant chemotherapy, radiotherapy, gyneco-oncology

 

 

Synchronous small cell lung cancer and HER2-positive breast cancer in a patient with systemic sclerosis and autoimmune overlap syndromes: a multidisciplinary therapeutic challenge

Andreea-Georgiana Manasia, Alina-Maria Mehedințeanu, Michael Schenker

“Sf. Nectarie” Oncology Center, Craiova, Romania
 

Objective. To report a rare case of synchronous tumors – small cell lung cancer (SCLC) and HER2-positive breast cancer – in a patient with systemic sclerosis, secondary Sjögren syndrome and interstitial lung disease, highlighting the diagnostic and therapeutic challenges in this unique autoimmune background. Materials and method. A 55-year-old woman was diagnosed with invasive NST breast carcinoma (HER2 3+; ER/PR low; Ki67=50%; stage III) and synchronous SCLC (stage IIB; Ki67=80%). The therapeutic strategy was planned within a multidisciplinary team. The patient received anti-HER2 targeted therapy (trastuzumab and pertuzumab; six completed cycles) and four cycles of etoposide-cisplatin for SCLC, along with prophylactic whole-brain radiotherapy. Results. The treatment led to significant response in the breast tumor and regression of axillary nodes, with concomitant reduction of the pulmonary lesion and mediastinal lymphadenopathy. Based on the achieved response, a curative-intent breast surgery was scheduled during the chemotherapy-free interval of SCLC treatment. The subsequent plan includes continuation of systemic therapy for SCLC followed by adjuvant radiotherapy for both breast and thoracic disease, a particular challenge given their ipsilateral location. A major issue for future management concerns the potential role of immunotherapy in SCLC. However, the presence of systemic autoimmune disorders raises complex questions regarding safety versus oncologic benefit. Conclusions. This case illustrates the rarity of synchronous SCLC and HER2-positive breast cancer in a patient with systemic autoimmune overlap syndromes, emphasizing the importance of personalized, multidisciplinary decision-making. Integrating systemic therapies, surgery and radiotherapy in a sequential strategy enabled the simultaneous tumor control while minimizing risks. The experience highlights how individualized approaches may offer valuable insights for managing exceptional oncological scenarios and opens discussion about the feasibility of immunotherapy in autoimmune backgrounds.

Keywords: synchronous tumors, small cell lung cancer, HER2-positive breast cancer, autoimmune overlap syndromes, multidisciplinary oncology

 

 

The evolution of a case of metastatic clear cell renal carcinoma: management and therapeutic strategies after multiple lines of treatment 

Oana-Ștefania Matei, Ioana Dinu

Department of Oncology, Fundeni Clinical Institute, Bucharest, Romania
 

Introduction. Clear cell renal carcinoma (ccRCC) is the most common form of renal cancer, with an aggressive course in advanced stages. Approximately 25-30% of patients are diagnosed with distant metastases, while 30% present with bone metastases at diagnosis. The management of these patients is complex and often requires the sequential use of targeted therapies and immunotherapy to achieve disease control. Description. We present the case of a 53-year-old female patient, with no significant medical history, incidentally diagnosed by imaging with a left renal tumor. Histopathological examination confirmed the diagnosis of clear cell renal carcinoma. At the time of diagnosis, the patient also presented with multiple secondary bone metastases at the vertebral level. A total left nephrectomy was performed, followed by neurosurgical intervention for cervical spine metastases (C4-C6) with spinal reconstruction. The patient required endoureteral stent placement due to acute renal failure secondary to a solitary kidney. Oncological treatment included sequential administration of sunitinib, axitinib, nivolumab, cabozantinib and, finally, sorafenib. During the course of the disease, progression occurred, with the appearance of new bone, cutaneous, suprarenal, pulmonary and muscular metastases. The patient required additional neurosurgical intervention for bone involvement at the T12 vertebral level. Conclusions. This case highlights the complexity of managing metastatic clear cell renal carcinoma, emphasizing the need for multimodal treatment tailored to disease progression. It underlines both the benefits of available therapies and the challenges related to treatment resistance. Surgical interventions for bone metastases and the management of associated complications significantly contributed to maintaining the quality of life, once again demonstrating the importance of interdisciplinary collaboration in patient care.

Keywords: renal carcinoma, bone metastases, nivolumab, neurosurgery

 

 

Long-term management in mCRC: from transient RAS mutational loss to KRAS G12C emergence and precision medicine

Radu Matei^1,2, Adelina-Silvana Gheorghe^1,2, Anca Stolojanu¹, Crina Siminiceanu¹, Elena Dumitrescu^1,2, Ioana Geală¹, Iolanda Goga^1,2, 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. The therapeutic landscape of metastatic colorectal cancer (mCRC) increasingly relies on molecular stratification and the sequential use of targeted agents. However, acquired resistance and tumor heterogeneity often limit durable responses. Serial RAS assessment, including circulating tumor DNA (ctDNA) analysis, may guide timely therapeutic interventions and identify potential windows for targeted therapy. Case presentation. We report the case of a 58-year-old man diagnosed in July 2018 with stage IV colorectal adenocarcinoma, staged pT4b pN1b (2/14) pM1a, following curative-intent colectomy and hepatectomy. He subsequently received six months of adjuvant XELOX and remained disease-free until 2021, when, in the context of rising tumor markers, surveillance imaging revealed pulmonary metastases. The biopsy of a metastatic lesion confirmed the colorectal origin and identified a KRAS mutation. First-line systemic therapy with bevacizumab plus FOLFOX was initiated, later modified to bevacizumab plus FUFOL due to grade 3 neuropathy, achieving sustained disease control for over 20 months. Upon progression, indicated by rising tumor markers and newly detected pulmonary and lymphatic metastases, serum ctDNA analysis indicated RAS wild-type profile, suggesting a transient molecular shift that could allow EGFR-targeted therapy. Second-line treatment with panitumumab plus FOLFIRI achieved a partial response lasting six months before progression involving hepatic, lymphatic and osseous sites. Subsequent regimens with aflibercept plus FOLFIRI and, later, bevacizumab plus trifluridine/tipiracil achieved stable disease as best response. Upon further progression and limited treatment options, re-biopsy of a pulmonary lesion revealed a KRAS G12C mutation, enabling targeted therapy with sotorasib alongside panitumumab, which maintained durable disease control for approximately seven months. Conclusions. This case highlights the clinical relevance of clonal plasticity in metastatic colorectal cancer, where serial molecular profiling, including ctDNA, is essential to guide dynamic treatment sequencing. The transient RAS wild-type state provided an opportunity for anti-EGFR therapy, while the subsequent emergence of a KRAS G12C mutation enabled targeted treatment.

Keywords: metastatic colorectal cancer, clonal plasticity, ctDNA, KRAS G12C mutation

 

 

Nutritional challenges and targeted interventions in patients with digestive cancers

Ioana-Irina Mateieș

Nutrition Department, Amethyst Radiotherapy Center, Cluj-Napoca, Romania
 

Objective. To review the main nutritional challenges in patients treated for digestive cancers and to highlight practical, targeted interventions, with particular emphasis on observations from clinical practice in Romania. Materials and method. This narrative review integrates evidence from recent scientific literature with clinical insights from patients diagnosed with gastrointestinal, gastric, hepatocellular, pancreatic and gallbladder cancers. The focus is on nutrition-related side effects of anticancer therapies, their impact on quality of life, and feasible interventions adapted to the Romanian healthcare context. Results. Patients undergoing treatment for digestive cancers frequently experience gastrointestinal toxicity such as mucositis, nausea, vomiting, diarrhea or constipation, early satiety and fatigue. These symptoms contribute to reduced food intake, malnutrition, muscle wasting and impaired quality of life, potentially compromising treatment adherence and outcomes. Nutrition interventions aim to ensure sufficient calorie and protein intake, using energy- and protein-dense foods, oral nutrition supplements or, when required, enteral or parenteral support. In Romania, limited access to specialized dietitians and variability in the availability of nutritional products represent significant challenges. Clinical practice shows that individualized counseling, culturally adapted dietary strategies, and timely initiation of nutritional support can reduce weight loss and maintain muscle mass, thus improving the tolerance to oncologic therapies. Conclusions. Nutritional care is an essential component of comprehensive cancer management in digestive malignancies. Early identification of nutritional risk, proactive interventions and personalized strategies are crucial to prevent malnutrition and support treatment efficacy. Greater awareness among healthcare professionals and improved integration of clinical nutrition into oncology care pathways are needed, particularly in Romania, where resources are still limited.

Keywords: digestive cancers, malnutrition, nutritional challenges, nutritional interventions

 

 

The neoadjuvant therapy in advanced cutaneous melanoma

Alina-Maria Mehedinţeanu¹, Michael Schenker^1,2, Ana-Maria Ciurea^1,2, Nicoleta Gidea¹, Patricia Nicolae¹, Mihaela Piţurcă¹, Andrei Ioan¹,
Oana Andrei¹, Ioana Irimie¹, Andreea Manasia¹

1. “Sf. Nectarie” Oncology Center, Craiova, Romania

2. University of Medicine and Pharmacy of Craiova, Romania
 

Introduction. Advanced cutaneous melanoma represents a major oncological challenge, although therapeutic advances have led to a considerable reduction in the global mortality rate. According to GLOBOCAN 2022 data, approximately 331,000 new cases and 58,645 deaths were reported worldwide. In the context of a significant recurrence rate after standard surgery (therapeutic lymph node dissection; TLND), the treatment paradigm has rapidly evolved from adjuvant therapy to neoadjuvant therapy. Objective. This abstract summarizes the role and benefits of neoadjuvant systemic therapy, particularly immunotherapy (IO), in patients with resectable stage III/IV melanoma, as well as its impact on survival and surgical morbidity. Methodology and key results. The neoadjuvant-adjuvant strategy (pre- and post-surgical systemic treatment) was investigated in phase I-II trials, which included pembrolizumab (Pembro) monotherapy, the combination of nivolumab (Nivo) + ipilimumab (Ipi), or the combination Nivo ± Ipi. OpACIN/OpACIN-neo: updated data from these studies confirm the sustained response of the IO-IO combination in the neoadjuvant setting for high-risk stage III melanoma. The major pathological response (MPR or pCR) at week 6 remains the strongest predictor for disease-free survival (DFS), with a two-year recurrence-free survival (RFS) rate of 100% for patients with a partial pathological response (pPR) in the OpACIN-neo cohort. PRADO: this study confirmed the high pathological response rate observed in OpACIN-neo, showing that TLND could potentially be omitted in a substantial subset of patients who achieve a favorable pathological response. SWOG S1801: neoadjuvant-adjuvant therapy with anti-PD-1 (pembrolizumab) demonstrated a significantly longer event-free survival (EFS) compared to adjuvant immunotherapy alone (EFS at two years: 72% versus 49%). NADINA also confirmed the superiority of EFS for the neoadjuvant-adjuvant regimen (Nivo + Ipi) over the adjuvant one. Conclusions. Neoadjuvant immunotherapy (anti-PD-1 monotherapy or Ipi 1 mg/kg + Nivo 3 mg/kg) improves EFS compared to surgery followed by adjuvant immunotherapy, without negatively affecting surgical morbidity. This approach allows for the de-escalation of adjuvant therapy based on the pathological response and may avoid extensive lymph node dissection in patients who achieve a major response. Particularities and future directions. The optimal regimen and duration for neoadjuvant systemic therapy are not yet well-established in large randomized trials. Although a solid benefit in EFS and DFS has been confirmed, there are not yet sufficient data regarding overall survival. For patients with contraindications to immunotherapy, a short neoadjuvant course of BRAF/MEK inhibitors may be an option.

Keywords:malignant melanoma, neoadjuvant therapy, pathological respons

 

 

“One size fits all”: adjuvant pembrolizumab in synchronous clear cell renal carcinoma and PD-L1 high pulmonary adenocarcinoma

I.C. Mihai¹, E.C. Nuță¹, T.C. Berisha¹, M. Schenker^1,2

1. “Sf. Nectarie” Oncology Center, Craiova, Romania

2. University of Medicine and Pharmacy of Craiova, Romania
 

Objective. To present a case of synchronous renal and pulmonary malignancies, emphasizing the clinical rationale and therapeutic advantage of immunotherapy over conventional systemic treatment, and highlighting the critical role of differential diagnosis between pulmonary metastasis and a second primary lung neoplasm. Materials and method. A 70-year-old male was initially diagnosed in June 2025 with right renal clear cell carcinoma, stage pT3N0cM0, stage III, surgically resected with negative margins. On follow-up CT scan, imaging revealed a spiculated right lower lobe pulmonary nodule, subsequently resected, pT1bN0, stage IA2, and identified as non-mucinous adenocarcinoma. Histopathology and immunohistochemistry demonstrated poorly differentiated adenocarcinoma, EGFR wild type, equivocal ALK and strong PD-L1 positivity (tumor cell score 100%). Following multidisciplinary evaluation, pembrolizumab monotherapy (200 mg q3w) was initiated in accordance with current guidelines, for the renal disease. Baseline clinical status, imaging and laboratory results were documented. Results. The indication for systemic immunotherapy was primarily based on the diagnosis of resected renal clear cell carcinoma, where adjuvant immune checkpoint blockade is now the standard of care in high-risk disease. For the pulmonary adenocarcinoma, the recommended approach after complete resection would have been observation and close surveillance. However, the initiation of pembrolizumab was additionally supported by maximal PD-L1 expression (tumor cell score 100%), which confers a high likelihood of response and a potential survival advantage. Thus, immunotherapy was expected to provide systemic protection against both recurrence and micrometastatic disease. The patient was scheduled for regular clinical and imaging follow-up, including CT of the chest, abdomen and pelvis, to detect any recurrence at an early stage. Laboratory monitoring and supportive measures were implemented to promptly identify and manage potential immune-related adverse events, ensuring treatment safety and adherence. Conclusions. This case illustrates how immunotherapy can address the therapeutic needs of patients with synchronous malignancies, providing an evidence-based indication for renal cancer while simultaneously offering potential benefit for lung adenocarcinoma with high PD-L1 expression. Careful clinical and imaging surveillance remains essential to balance efficacy with safety. The case highlights the importance of individualized, biology-driven treatment strategies.

Keywords: synchronous malignancies, clear cell renal car­cinoma, lung adenocarcinoma, PD-L1 high, adjuvant im­mu­no­therapy

 

 

The role of psycho-oncologist in breast cancer

A.R. Mihoc

OncoHelp Oncology Center, Timișoara, Romania
 

Objective. This case study aims to highlight the role of psycho-oncological intervention throughout the oncological trajectory of a patient diagnosed with stage IIIC breast cancer with pulmonary, hepatic, bone and cerebral metastases. The psycho-oncological intervention was personalized according to the stages the patient went through, as well as her personal and medical particularities. Materials and method. The patient, aged 31 at the time of diagnosis, with stage IIIC breast carcinoma, underwent neoadjuvant chemotherapy, surgical intervention, adjuvant chemotherapy and radiotherapy. The initial evaluation indicated severe anxiety (HADS-Anxiety = 15) and high oncological distress (Distress Thermometer = 8). The intervention consisted of monthly individual sessions based on cognitive-behavioral techniques (restructuring catastrophic thoughts), relaxation exercises and emotional support, addressing topics such as adaptation to diagnosis and side effects, body image, fertility-related concerns, as well as coping with multiple recurrences and fear of death. The patient provided informed consent, and the confidentiality was respected. Results. At the end of the program, the HADS-Anxiety score decreased to 5, and oncological distress, as measured by the Distress Thermometer, decresed to 3, indicating a significant reduction in anxiety symptoms and perceived distress. The patient reported better adaptation to the disease, increased sense of control over the illness and improved body image after surgery, as well as deeper exploration of the idea of “being a woman without children”. Clinical observations confirmed these positive changes. Discussion and conclusions. The psycho-oncological intervention played an essential role in the patient’s adaptation to the disease and in reducing the emotional suffering caused by cancer and its impact on her personal life and goals. This case study supports the integration of psychological services into multidisciplinary oncological teams and emphasizes the need for further research on larger samples to validate these findings.

Keywords: psycho-oncology, case study, breast cancer

 

 

From chemotherapy to antibody-drug conjugates: the therapeutic odyssey of a metastatic urothelial carcinoma

Diana Militaru, Ramona Matei

Department of Medical Oncology, Municipal Clinical Hospital Cluj-Napoca, Romania
 

Introduction. Metastatic urothelial carcinoma (mUC) remains a therapeutic challenge, particularly in elderly patients with comorbidities. Case report. We report the case of a 70-year-old patient diagnosed with upper tract urothelial carcinoma of the right renal pelvis and ureteropelvic junction, with pulmonary metastases at presentation. First-line cisplatin-gemcitabine (split dose) was initiated but discontinued because of acute grade 3 renal toxicity after first cisplatin dose; carboplatin was substituted without efficacy, as disease progression was documented. Second-line pembrolizumab was administered, yet evaluation again showed progression. We recommended NGS which revealed an FGFR mutation, leading to the debut of third-line erdafitinib, the patient being the first in Romania to be put on this therapy. The treatment was limited by ocular toxicity, and soon the disease showed signs of progression again. The patient was subsequently transitioned to fourth-line therapy with the antibody-drug conjugate enfortumab vedotin. Discussion. This case illustrates the complexity of sequential therapy in mUC, where diverse mechanisms of resistance and cumulative toxicities limit long-term benefit. It emphasizes both the resilience of patients undergoing multiple systemic treatments and the evolving therapeutic landscape, now including checkpoint inhibitors, FGFR inhibitors and ADCs. Conclusions. The management of mUC requires individualized strategies that integrate patient fitness, molecular profiling and careful sequencing of available therapies. Despite recent advances, the outcomes remain modest, highlighting the need for ongoing research into resistance mechanisms and novel agents capable of improving survival and quality of life in this challenging disease.

Keywords: metastatic urothelial carcinoma (mUC), chemotherapy, immunotherapy, FGFR inhibitors, antibody-drug conjugates, therapy-related toxicity

 

 

Beyond the usual diagnosis: the breast as a site of rectal metastases

I.A. Mirea, Ioana-Niculina Luca, Adina-Emilia Croitoru

Department of Medical Oncology, Fundeni Clinical Institute, Bucharest, Romania
 

Introduction. Rectal neoplasms represent a major challenge in oncological practice, requiring a complex and multidisciplinary approach. Modern therapeutic strategies integrate local and systemic treatments, along with continuous monitoring for recurrence or metastasis, aiming to optimize patient prognosis. Case presentation. We report the case of a 48-year-old patient diagnosed with locally advanced rectal neoplasm, for whom treatment according to the TNT (Total Neoadjuvant Therapy) protocol was initiated. The clinical course was unfavorable, with the patient developing lymphatic and cerebral metastases during neoadjuvant therapy, necessitating the initiation of palliative systemic treatment. Several months later, after a mildly favorable disease course, the patient presented with a breast lesion associated with local inflammatory signs, initially suggestive of a second primary tumor. Histopathological and immunohistochemical analyses ruled out a primary breast tumor, confirming that the lesion represented a secondary metastasis of the rectal neoplasm to the breast. Conclusions. This case highlights the diagnostic challenges in distinguishing primary breast tumors from breast metastases of rectal origin, a rare entity in the literature. Accurate identification of the tumor origin has a significant impact on therapeutic management and patient quality of life. Multidisciplinary collaboration is essential in such complex clinical scenarios, where the integration of oncological, imaging, pathological and surgical expertise allows for an individualized treatment strategy. This case underscores both the diagnostic difficulties and the importance of continuous, personalized monitoring in the management of advanced rectal neoplasms.

Keywords: rectal neoplasm, breast tumor, multiple meta­stases, aggressive disease, breast metastasis

 

 

Dual primary cancers, one coordinated plan: a case of lung and cervical malignancies managed in sequence

I. Mologani¹, A. Dumitrache², L. Antone-Iordache¹, H.D. Lișcu^1,3

1. Radiotherapy Department, Colțea Clinical Hospital, Bucharest, Romania

2. Medical Oncology Department, Colțea Clinical Hospital, Bucharest, Romania

3. Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

Case presentation. A 71-year-old female with a history of chronic obstructive pulmonary disease, hypertension, stage II NYHA heart failure and type II diabetes mellitus, active smoker, was simultaneously diagnosed with two distinct malignancies: pulmonary adenocarcinoma stage IIIA (PD-L1 TPS 55%) and cervical squamous cell carcinoma stage IIA2. Given the symptomatic presentation of the lung lesion (persistent cough and dyspnea), the multidisciplinary tumor board prioritized the treatment of the pulmonary tumor. Considering the patient’s age and comorbidities, surgical treatment was contraindicated. She received external-beam radiotherapy (EBRT), using the VMAT technique, to a total dose of 60 Gy in 30 fractions, with concomitant weekly chemosensitization using carboplatin (AUC 2) and paclitaxel (50 mg mg/m²). The treatment was well tolerated, with no notable adverse effects. This regimen was strategically chosen, as it also provided an effective induction chemotherapy option for cervical carcinoma, consistent with the outcomes of the INTERLACE trial. Consequently, for the cervical malignancy, this initial phase functioned as induction chemotherapy, followed by VMAT pelvic EBRT (45 Gy), with a nodal boost to 54 Gy, and high-dose-rate brachytherapy to the cervix. Concurrently, the patient received cisplatin 40 mg/m² weekly as a radiosensitizer; however, the systemic treatment was limited to three cycles due to moderate rectal toxicity. Post-treatment imaging of the thoracic disease showed marked tumor regression, supporting the initiation of consolidation immunotherapy with durvalumab 1500 mg, every 28 days, in line with the PACIFIC protocol for PD-L1-positive stage IIIA NSCLC. Conclusions. This case illustrates the importance of treatment sequencing and regimen selection in managing synchronous malignancies. The chosen approach provided cross-benefit between the two cancers, ensured symptom control, and allowed timely transition from combined-modality therapy to consolidation immunotherapy.

Keywords: synchronous malignancies, cervical cancer, pulmonary cancer, radiotherapy, brachytherapy, immunotherapy

 

 

Multidimensional evaluation of cancer-related pain in patients from eastern Romania

Natalia Gherasim-Morogai¹, Teodora Alexa-Stratulat², Vlad-Adrian Afrasanie², Andreea Vornicu-Puiu³, Alexandru Hamod², Doina-Elena Motan-Ganea¹, Silvia Ginghina¹, Mihai-Vasile Marinca²

1. Oncology Department, “Sf. Ioan cel Nou” County Emergency Hospital, Suceava, Romania

2. Regional Institute of Oncology Iași, Romania
3. “Mavromati” County Emergency Hospital, Botoşani, Romania
 

Objective. Cancer pain remains one of the most frequent and distressing symptoms in oncology, with multifactorial impact on physical, psychological and social dimensions. The present study aimed to evaluate the characteristics, intensity and influencing factors of pain in oncological patients, as well as the therapeutic approaches used, through a standardized questionnaire. Materials and method. A prospective observational study was conducted on patients treated at the Regional Institute of Oncology Iași and at the “Sf. Ioan cel Nou” County Emergency Hospital Suceava, Romania. Data collected included demographics, ECOG status, tumor site, metastases, pain type, triggers, pain scores and treatment efficacy according to the WHO analgesic ladder. Information was obtained from personalized cancer pain questionnaires, clinical and outpatient observation sheets. The database was created and processed in MS Excel 2019 for Windows, and the statistical analysis was performed using SPSS v26. Results. The study highlighted a high prevalence of mixed pain syndromes, with significant variation according to tumor location and disease stage. Most patients reported worsening of pain with movement, stress or cold, while relief was commonly achieved through medication and positional adjustment. Psychological symptoms such as anxiety and depression were frequent and correlated with higher pain scores. Adherence to the WHO analgesic ladder was noted, though adjuvant therapies and multimodal strategies were underutilized. Conclusions. Systematic assessment through structured questionnaires provides valuable insights into the multidimensional nature of cancer pain. Identifying patterns of pain relief and aggravation can guide individualized therapeutic strategies, with emphasis on integrating psychological support and adjuvant medication in routine oncological care.

Keywords: cancer pain, quality of life, questionnaire, palliative care, pain management

 

 

Pathophysiology and therapeutic strategies of secondary lymphedema in head and neck cancers 

Cătălina Musteață

College of Physiotherapists in Romania, Iaşi, Vaslui, Neamţ Subsidiary, Romania
 

Introduction. Secondary lymphedema is a frequent complication in patients treated for head and neck cancers, arising as a consequence of surgical lymphadenectomy, radiotherapy or combined oncological therapies. It is characterized by impaired lymphatic drainage, interstitial fluid accumulation, tissue fibrosis, pain and reduced functional mobility. Beyond the physical burden, secondary lymphedema in the head and neck region profoundly impacts breathing, swallowing, speech and overall quality of life. Understanding the underlying pathophysiology is crucial for developing effective and individualized treatment strategies. Materials and method. A cohort of patients diagnosed with secondary lymphedema following treatment for head and neck cancers was included in a therapeutic program based on complete decongestive therapy (CDT). The protocol combined manual lymphatic drainage, targeted compression, skin care and therapeutic exercises. Patients were evaluated at baseline and after four weeks, using circumferential measurements, tissue elasticity assessment, pain scores and functional outcomes related to swallowing and speech. Results. The implementation of CDT led to a significant reduction in edema volume, improved tissue elasticity and to decreased pain intensity. Functional outcomes showed improved swallowing efficiency and better speech quality. Patients reported enhanced comfort, reduced sensation of heaviness and an improved ability to engage in daily activities. No adverse effects were observed during the intervention. Conclusions. Secondary lymphedema in head and neck cancers is the result of complex pathophysiological mechanisms, including lymphatic obstruction, inflammatory processes and fibrosis. Decongestive therapy offers a safe and effective strategy for reducing edema, improving function and enhancing the quality of life. Multidisciplinary collaboration and early intervention are key in optimizing patient outcomes. Further studies are required to validate these findings on larger populations and to establish standardized treatment guidelines.

Keywords: secondary lymphedema, head and neck cancers, pathophysiology, decongestive therapy, rehabilitation

 

 

Max Access Solutions in the Republic of Moldova: milestones and perspectives

Vasile Musteaţă

“Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău; Institute of Oncology Chişinău, Republic of Moldova
 

Introduction. Max Access Solutions (MAS) is an end-to-end platform under the auspices of The Max Foundation (TMF), that ensures therapeutic and diagnostic products reach for cancer patients in need from low-and-middle income countries, thus decreasing the global disease burden and eradicating the apparent survival and quality of life disparities. The aim of the study was the assessment of the MAS management options for patients with cancers in the Republic of Moldova. Materials and method. MAS platform was launched on a basis of the Institute of Oncology from Moldova. Patient access tracking system is used by healthcare professionals – partner physicians around the world who are accessing cancer treatment options on behalf of their patients. The targeted medications for chronic myeloid leukemia (CML), chronic eosinophilic leukemia (CEL), gastrointestinal stromal tumors (GIST), renal cell carcinoma (RCC) and metastatic ALK + non-small cell lung cancer (NSCLC) were provided by TMF as a donation via MAS platform. Our unicentric observational and cohort study included 134 CML patients, who were treated and followed-up between 2007 and 2024 at the comprehensive cancer center – the Institute of Oncology. The quantitative real-time PCR was used with the aim to determine the expression of the BCR-ABL chimeric gene p210 and p190 transcripts while confirming CML diagnosis. Imatinib mesylate and nilotinib were used as a front-line therapy in newly diagnosed CML patients and in cases of resistance to non-TKIs chemotherapy and IFN a-2b. The research was attributed to the ambulatory and hospitalized care. Results. Recently, 369 patients have been actively provided with targeted antineoplastic drugs via MAS. Imatinib mesylate is administered in 185 patients with CML, GIST and CEL; sunitinib – in 87 patients with RCC and GIST; axitinib – in 28 cases with RCC; nilotinib – in 35 patients with CML; bosutinib – in six patients with CML; ponatinib – in 20 patients with CML; and crizotinib – in eight patients with NSCLC. The CML patients’ age varied between 14 and 81 years old. The median age was 51.4±2.13 years old. There were 78 (58.2%) males and 56 (41.8%) females. The diagnosis of CML was confirmed in chronic phase in 122 (91.04±2.32%) patients, in the accelerated and acute phases – in 12 (8.96±2.03%). In the majority of cases (72.7%), the Ph-chromosome was identified in over 70% of the bone marrow cells. BCR-ABL p210 transcript range was 9.5-100% IS. In most cases (69.8%), the expression of fusion BCR-ABL gene transcripts exceeded 65% in the peripheral blood cells. Seven patients (5.2%) also proved to be positive for BCR-ABL p190 transcript. Under the therapy with the first- and second-line TKIs, the complete hematological response was obtained in 92.8% of cases, and the complete/major molecular response – in 74.8% of cases. There were no subsequent short-term hematological relapses. The overall one-, three- and five-year survival of CML patients treated with TKIs was 98.5%, 95.7% and 95.6%, respectively. IFN a-2b was used in rare cases of resistance to conventional chemotherapy and TKIs, with partial response. In the majority of CML patients (79%), previously treated with the conventional chemotherapy, only the minor cytogenetic response was obtained. Conclusions. MAS program proved to be an expanded partnership with local oncological centers reaching patients with cancers in low- and middle-income countries in order to provide a spectrum of lifesaving drugs on a regular and equity basis. MAS platform may be appraised as an efficient, transparent and reliable management approach to deliver potentially curable targeted therapy for cancer and CML patients in the emerging regions, regardless age, gender and social categories.

Keywords: access, platform, cancers, chronic myeloid leukemia, tyrosine kinase inhibitors, survival

 

 

Solid pseudopapillary pancreatic tumor: clinical and pathological characteristics and treatment approach in 16 patients

Alexandra-Irene Neculau, O. Bochiș, Emilia Mihuţ, R. Buiga, A. Irimie

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

Introduction. Solid pseudopapillary tumor (SPT) of the pancreas is rare, representing about 1-3% of exocrine pancreatic neoplasms. SPT usually occurs in young females, without notable symptoms, with a low malignant potential and generally with a favorable long-term prognosis. Study design. This is a retrospective study, during the period January 2005 – September 2025. Patients and methodology. We reviewed SPT patients admitted in our institution, focusing on the demographic data, clinicopathologic and radiological features, therapeutic management and prognosis records. Results. Sixteen patients with SPT were identified (13 wo­men and three men), with a median age of 32 years old. The main clinical presentation was abdominal pain (93.75%). The tumor was mostly located in the body or tail of the pancreas (62.5%), and the mean size was 8.4 cm. Regarding surgical approach, there were five distal pancreatectomies with splenectomy, five body and tail pancreatectomies and two of them with splenectomy, three pancreaticoduodenectomy, one partial enucleation, and no indication for surgery for two patients. Cytology plays an essential role in the assessment and diagnosis of pancreatic tumors in all cases. None of the patients had lymph nodes metastases. There were two local and two venous invasions, and one hepatic metastasis. There were three cases who developed postoperative complications: one experienced intraperitoneal abscesses that required drainage, one was diagnosed with peritoneal carcinomatosis, while another died after a pancreatic fistula. Four cases followed adjuvant systemic chemotherapy, and in one case radiotherapy was administered. Conclusions. Solid pseudopapillary pancreatic tumor should always be included in the differential diagnosis when evaluating a pancreatic mass in young women. Surgical resection remains the treatment of choice, and it is usually curative, guided by tumor location. Systemic therapy should be considered on an individualized basis, particularly for patients with unresectable, recurrent or metastatic disease.

Keywords: solid pseudopapillary tumor, pancreas, cyto­logy, surgery

 

 

Stage IV laryngeal cancer in a high-risk cardiac patient: management challenges and strategies

I.V. Niculcea¹, A. Hordilă¹, C. Volovăț^1,2

1. Victoria Hospital – Euroclinic Oncology Center, Iași, Romania

2. “Grigore T. Popa” University de Medicine and Pharmacy, Iași, Romania
 

Introduction. Treatment selection is challenging in stage IV laryngeal carcinoma patients with high cardiovascular risk, as fluoropyrimidine-based regimens may be contraindicated. Case presentation. A 71-year-old male with a history of myocardial infarction, treated with PCI and with right coronary artery stenting, grade 3 hypertension and a 40 pack-year smoking history, presented in October 2022 with a five-month history of progressively worsening dysphonia and dyspnea. Videofibroscopy revealed an infiltrative-proliferative lesion involving the right true vocal cord and right ventricular band, with a keratinized appearance and an approximately 50% obstruction of the glottic airway. Biopsy demonstrated moderately differentiated squamous cell carcinoma of the larynx (NOS), with reduced keratinization and infiltrative growth. The patient underwent definitive transisthmic tracheostomy. CT (28.10.2022) revealed a solid, heterogeneously enhancing mass involving the right lateral wall of the larynx, anterior and posterior commissures, right true and false vocal cords, measuring 26×18×37 mm (AP×T×CC) causing luminal narrowing of approximately 2 mm. Necrotic right paralaryngeal lymph node measuring 9×12 mm was observed, along with multiple subcentimetric nodes in Ia, IIa and IIb bilaterally. Additional nodular formations were noted in the anterior segment of the LSD (11×13 mm), the Fowler segment and in the right hilum, as well as infracentimetric paratracheal, left hilar and subcarinal nodes, suggestive of metastatic dissemination. Stage IVC laryngeal carcinoma (cT3N1M1, AJCC 8^th Edition). PD-L1: CPS 1%. Pembrolizumab was initiated (NCCN Category 1 recommendation). A CT from 3.04.2023 revealed: significant increase in the size of the laryngeal mass, with extension to the base of the right half of the epiglottis; increase in the number and size of cervical lymph nodes; enlargement of pulmonary lesions. The treatment was switched to carboplatin and paclitaxel. Another CT (21.12.2023) revealed a reduction in the size of the laryngeal mass (13×12×21 mm), a decrease in the size and number of cervical lymph nodes, while the pulmonary lesions remained stable. The treatment is ongoing, with good tolerance.

Keywords: larynx, carcinoma, PCI, pembrolizumab, carboplatin, paclitaxel

 

 

Pancreatic neuroendocrine tumor with aggressive behavior: between limited therapeutic options and progressive hepatic dysfunction

E.C. Nuță^1,2, I.C. Mihai¹, A.M. Ciurea^1,2, M. Schenker^1,2

1. Medical Oncology Department, “Sf. Nectarie” Oncology Center, Craiova, Romania

2. University of Medicine and Pharmacy of Craiova, Romania
 

Objective. To present the clinical and therapeutic evolution of a female patient diagnosed with a poorly differentiated (G3) pancreatic neuroendocrine tumor (NET) with multiple liver metastases, treated through four lines of systemic therapy. Each treatment line was preceded by recurrent episodes of hepatic cytolysis and cholestasis. This case aims to highlight how liver impairment influenced the therapeutic strategy and clinical management, in alignment with current NCCN and ESMO guidelines. Materials and method. A 49-year-old female patient, with no significant comorbidities, was diagnosed with a poorly differentiated pancreatic NET and extensive liver metastases. The disease progression under first-line cytotoxic chemotherapy was unfavorable, which led to a re-biopsy and immunohistochemical reassessment. Each therapeutic line initiation was delayed due to significant episodes of hepatic cytolysis and cholestasis, requiring close biochemical monitoring and treatment strategy adjustments. Results. Hepatic function disturbances had a decisive impact on therapeutic decisions, administered doses and treatment scheduling. Despite an overall good tolerance, liver impairment limited therapeutic options and required frequent modifications based on the dynamic biochemical profile. Disease progression following the initial therapeutic sequences necessitated the use of higher-line therapies and a personalized clinical approach. Conclusions. In patients with poorly differentiated neuroendocrine tumors, high proliferation index and extensive liver metastases, the associated hepatic impairment can be a major limiting factor in treatment planning. Monitoring liver function, tailoring therapeutic strategies in accordance with ESMO and NCCN guidelines, and adopting a multidisciplinary approach are essential for optimizing treatment outcomes and for maintaining the quality of life.

Keywords: neuroendocrine tumor, hepatic function, liver metastases, chemotherapy, re-biopsy

 

 

Different therapeutic approaches in metastatic intestinal neuroendocrine tumor – case report

Denisa-Elena Oprea¹, Adina-Emilia Croitoru^1,2

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

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

Introduction. Intestinal neuroendocrine tumors (NETs) are neoplasms arising from neuroendocrine cells of the small intestine, particularly the ileum. Their incidence has been rising over the past decades. They account for 30-40% of gastrointestinal neuroendocrine tumors, and diagnosis often occurs in adults between the 5^th and 7^th decades of life. Prognosis depends on tumor grade, size, stage and the presence of metastases. Well-differentiated, localized tumors often have an excellent long-term survival, while metastatic or high-grade lesions carry a worse prognosis. Common sites of metastasis include the liver and mesenteric lymph nodes. Functional tumors producing hormones such as serotonin can lead to carcinoid syndrome, which may complicate the disease course and impact survival. Case description. A 43-year-old male from Bangladesh presented with a three-month history of intermittent abdominal pain, flushing and diarrhea, subtle symptoms that concealed a more complex pathology. Initial imaging revealed multiple hepatic lesions and mesenteric adenopathy, suggestive of metastatic disease, while endoscopic evaluations remained unremarkable. Subsequent investigations through blood work showed markedly elevated serotonin, 5-HIAA and chromogranin A, and histopathology confirmed the presence of a well-differentiated intestinal neuroendocrine tumors, a G1 tumor with a probable ileocecal origin, confirming a functional NET. The patient underwent a stepwise, multidisciplinary treatment approach: surgical and long-acting somatostatin analog therapy. Follow-up imaging demonstrated stable disease, reflecting the effectiveness of integrated surgical and clinical management. Discussion. NETs often present with nonspecific symptoms such as abdominal pain, diarrhea and flushing, leading to late diagnosis with metastatic disease. Our patient had liver and mesenteric lymph node metastases at presentation. Although he was diagnosed with NET, G1, typically associated with slow progression, the metastatic involvement required a multimodal approach. This case highlights the importance of early recognition of functional symptoms, the role of somatostatin analogs, and the benefit of a multidisciplinary treatment strategy in achieving long-term disease control in metastatic intestinal neuroendocrine tumors.

Keywords: neuroendocrine tumor, intestinal, metastatic, hormonal therapy, atypical hepatectomy, carcinoid syndrome

 

 

Small cell neuroendocrine carcinoma of the cervix: diagnostic complexity and therapeutic success

Mădălina-Raluca Ostafe, Diana-Ioana Panaite, C. Volovăț

Medical Oncology, Victoria Hospital – Euroclinic Oncology Center, Iași; “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
 

Objective. Small cell neuroendocrine carcinoma (SCNEC) of the cervix is an uncommon and highly aggressive malignancy, often associated with poor outcomes. We report the case of a young patient with advanced disease who achieved complete response following the multimodal treatment. Materials and method. A 40-year-old woman, with unremarkable personal and family medical history, was followed-up between 2021 and 2022 for repeated inflammatory findings on cervical cytology without evidence of dysplasia. In March 2025, she presented with a cervical mass, being diagnosed with FIGO stage IIIC1 disease. Biopsy revealed a poorly differentiated carcinoma, further characterized by immunohistochemistry as small cell neuroendocrine carcinoma. MRI and CT confirmed a 6.7-cm cervical tumor with vaginal extension and bilateral pelvic lymphadenopathy, without distant metastases. The patient underwent definitive concurrent chemoradiotherapy, including external beam radiotherapy, three sessions of brachytherapy, and four cycles of cisplatin-etoposide. Results. The treatment was complicated by recurrent hypomagnesemia, grade 3 anemia and grade 4 neutropenia, all managed with supportive therapy. Despite these toxicities, the patient completed the planned therapy. Restaging in August 2025 with pelvic MRI and thoraco-abdominal CT demonstrated no residual tumor, absence of lymphadenopathy and no secondary lesions, consistent with a complete radiological response. Conclusions. This case illustrates the diagnostic complexity and aggressive course of cervical SCNEC, a rare histological subtype. Despite its poor prognosis, combined modality treatment with external beam radiotherapy, brachytherapy and platinum-etoposide chemotherapy may induce complete remission even in advanced stages. Timely diagnosis, accurate histopathological and immunohistochemical characterization along with integrated therapeutic strategies are essential for optimizing outcomes in this challenging entity.

Keywords: small cell neuroendocrine carcinoma, cervical cancer, concurrent chemoradiotherapy, brachytherapy, complete response

 

 

Navigating toxicity in metastatic renal cell carcinoma: when the standard of care needs
a reality check

Ana-Maria-Cecilia Păuleț^1,3, Ioana-Maria Calancea^2,3, Mara Răzniceanu^2,3, Teodora Alexa-Stratulat^1,3

1. Oncology Department, Regional Institute of Oncology Iaşi, Romania

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

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

Introduction. Renal cell carcinoma (RCC) accounts for 2-3% of all cancers worldwide, with clear cell carcinoma (ccRCC) being the most common subtype (70-80%). Metastatic disease is present at diagnosis or emerges later in approximately one-third of patients. The management of metastatic RCC has evolved rapidly over the past decade, with novel therapeutic combinations improving survival. However, treatment-related toxicities remain a substantial challenge, emphasizing the need for individualized sequencing and dose adjustment to optimize efficacy and tolerability. Case presentation. A 72-year-old hypertensive male presented in April 2022 with left lumbar pain and intermittent macroscopic hematuria. Imaging revealed a 54-mm left upper pole renal mass, and laparoscopic radical nephrectomy confirmed ccRCC (pT1b, pNx, G2). One year postoperatively, surveillance imaging revealed local recurrence and bilateral lung micronodules. Despite negative PET-CT findings, progressive enlargement of retroperitoneal lesions prompted initiation of first-line systemic therapy with avelumab and axitinib (5 mg twice daily). Early complications including fever and grade II gastrointestinal toxicity required axitinib interruption. Following symptom resolution, axitinib was resumed at reduced dose; however, severe uncontrolled hypertension led to permanent discontinuation. Avelumab monotherapy maintained the disease control until March 2024, when subsequent progression prompted minimal-dose axitinib rechallenge, which proved intolerable due to persistent hypertension and debilitating asthenia. After further progression in June 2024, second-line cabozantinib was initiated at standard dose, but required dose reduction due to severe cutaneous toxicity, hypertensive crises and cholestatic syndrome, with disease progression in February 2025. Initiation of third-line temsirolimus (25 mg weekly) resulted in mucositis, cutaneous toxicity, lower limb edema, and dyspnea. Dose reduction to 15 mg weekly improved tolerance, with imaging from May 2025 revealing stable disease. The patient continues on temsirolimus therapy. Conclusions. This case highlights the complexity of sequential therapy in metastatic ccRCC, emphasizing the need for ongoing dose adjustments to maximize therapeutic benefit while managing toxicity.

Keywords: metastatic renal cell carcinoma, tyrosine kinase inhibitors, immunotherapy, mTOR inhibitors, treatment toxicity

 

 

Malignant melanoma and colon cancer – a twisted bond. Case report

Bianca-Alexandra Păuniţă, Nicoleta Gidea, M. Schenker

“Sf. Nectarie” Oncology Center, Craiova, Romania
 

We report the case of a patient diagnosed with two distinct malignancies: malignant melanoma harboring a BRAF V600K mutation and left-sided colonic adenocarcinoma with three synchronous tumor foci. The melanoma was diagnosed in December 2020 (Clark level IV, Breslow thickness 4 mm), loca­ted on the left anterior thoracic region. The patient underwent surgical excision followed by adjuvant immunotherapy with nivolumab. The clinical course was complicated by cutaneous recurrences and metastatic inguinal lymphadenopathy, which were surgically managed (in-transit metastases), followed by targeted therapy with dabrafenib and trametinib. In November 2022, a second oncologic diagnosis was established: left-si­ded colon adenocarcinoma (pT3(m)N0M0, stage IIa), treated through left hemicolectomy and adjuvant chemotherapy with XELOX. Cross-sectional imaging (CT, PET-CT, MRI) revealed stable pulmonary nodules, a suspicious renal mass (Bosniak IV), regression of inguinal lymphadenopathy, and bone lesions under surveillance. At present, the patient is receiving systemic dual targeted therapy, with evidence of partial radiologic response and good clinical tolerance. Partial response to targeted therapy, regression of inguinal lymphadenopathy, and no evidence of colonic cancer recurrence. Conclusions. The association between malignant melanoma with a BRAF mutation and colonic adenocarcinoma is rare, and it raises suspicions of a possible genetic predisposition or shared risk factors. This case highlights the importance of a multidisciplinary approach, continuous monitoring and the need to adapt the therapeutic strategy based on oncologic dynamics.

Keywords: BRAF mutation, surgical intervention, melanoma, immunotherapy, in-transit metastasis

 

 

Neoadjuvant and adjuvant management of BRCA-positive triple-negative breast cancer:
the role of chemotherapy, anti-PD-1 immunotherapy, and perspectives for targeted therapy –
a case report

Ana-Maria-Diana Peța, Luiza Gherghe, Cătălina Nuță, Nelly Cherciu, M. Schenker

Department of Oncology, “Sf. Nectarie” Oncology Center, Craiova, Romania
 

Objective. To present the clinical course and therapeutic management of a young patient with BRCA-positive triple-negative breast cancer (TNBC), treated with neoadjuvant chemotherapy and anti-PD-1 immunotherapy, followed by surgery and adjuvant immunotherapy, highlighting the criteria for PARP inhibitor therapy and the reasons it was not indicated. Materials and method. A 30-year-old female patient with a history of endometriosis presented with a left breast mass. Imaging studies (ultrasound, mammography, CT chest-abdomen-pelvis) revealed a BIRADS 4b lesion. Biopsy confirmed grade 3 invasive ductal carcinoma, hormone receptor-negative, HER2 0, BRCA mutation positive; clinical stage cT2N1M0. Neoadjuvant treatment included four cycles of paclitaxel-carboplatin + pembrolizumab, followed by four cycles of epirubicin-cyclophosphamide + pembrolizumab. Bilateral subcutaneous mastectomy (prophylactic on the right) with nipple-areola complex preservation, sentinel lymph node biopsy, and immediate pre-pectoral reconstruction was performed. The patient’s course was monitored through regular clinical and imaging evaluations. Results. Postoperative histopathology revealed a pathological complete response (ypT0 ypN0). The treatment was well tolerated, with no grade ≥3 adverse events. The patient continues adjuvant immunotherapy with pembrolizumab according to protocol (nine months). Although she carried a germline BRCA mutation, she did not meet the high-risk criteria for adjuvant olaparib, due to the pathological complete response and absence of residual disease. The management included genetic counseling and careful clinical and paraclinical monitoring. Conclusions. This case highlights the importance of early genetic testing and a personalized, multidisciplinary approach in BRCA-positive TNBC. Combining chemotherapy with neoadjuvant anti-PD-1 immunotherapy can achieve a pathological complete response, potentially reducing the need for PARP inhibitor therapy when high-risk factors are absent. Continuous monitoring and adaptive therapeutic strategies remain essential to optimize prognosis.

Keywords: breast cancer, triple-negative, BRCA, neoadjuvant chemotherapy, anti-PD-1 immunotherapy, mastectomy, pathological complete response, multidisciplinary management

 

 

Respiratory rehabilitation in restrictive ventilatory dysfunction for the oncological patient –
a comparative case study

Denisa Piele, Ligia Rusu

Department of Kinesiotherapy and Sports Medicine, Faculty of Physical Education and Sport, University of Craiova, Romania
 

Objective. Restrictive ventilatory dysfunction is a frequent consequence of oncological treatments, and it is associated with reduced vital capacity, diminished exercise tolerance and impaired quality of life. The aim of this study is to compare the evolution of two oncologic patients with restrictive ventilatory dysfunction: one enrolled in a structured exercise program and the other receiving only standard care. Materials and method. Two oncologic patients (69 and 68 years old, respectively) with restrictive ventilatory dysfunction confirmed by spirometry were evaluated. The monitored parameters included forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and the FEV1/FVC ratio. Baseline evaluation was monitored after a five-month period. The first patient participated in a structured respiratory exercise program. The program was organized twice a week, into 50-minute sessions of medium intensity. The second patient received standard oncological care, without specific respiratory rehabilitation. Spirometry reassessment was performed at the end of the intervention period. Results. The patient enrolled in the rehabilitation program presented an initial FVC value of 3.8 l versus 5.4 l predicted FVC. After five months, the FVC parameter increased to 4.14 l. Clinically, the patient reported reduced dyspnea and better exercise tolerance, assessed through Borg scale (initial value 14 versus 12 after completing the program). In contrast, the patient who did not undergo rehabilitation showed no improvement, with FVC values ranging from of 3.9 l versus 5.54 predicted to 3.4 l after five months and with persistent symptoms of dyspnea (a constant value of 15 on Borg scale). Conclusions. The comparison of the two cases highlights the decisive role of respiratory rehabilitation in improving restrictive ventilatory dysfunction in oncologic patients. Spirometry monitoring objectively confirmed the benefits of the exercise program, supporting its early integration into oncologic care.

Keywords: respiratory rehabilitation, spirometry, restrictive ventilatory dysfunction

 

 

OncoSil brachytherapy in locally advanced pancreatic adenocarcinoma: a case report

A.I. Pîntea^1,2, Claudia-Florina Radu¹, Adina-Emilia Croitoru^1,2

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

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

Introduction. Locally advanced pancreatic adenocarcinoma remains a major therapeutic challenge, with limited options for inoperable patients. OncoSil, a brachytherapy device using radioactive phosphorus-32 (P-32) embedded in silicon microparticles, provides an innovative approach by delivering intratumoral beta radiation, with potential to reduce tumor burden and improve symptom control. Case history. A 59-year-old male, heavy smoker, presented with nonspecific right hypochondrial pain and was diagnosed in December 2024 with corporeal pancreatic ductal adenocarcinoma, locally advanced, invading the spleno-mesenteric confluence, and deemed unresectable. He received seven cycles of systemic chemotherapy with mFOLFIRINOX (January-April 2025). With radiologically stable disease, a decrease in CA 19-9 (from 707 U/mL to 99 U/mL), but persistent pain, OncoSil brachytherapy was performed on 10 May 2025, via endoscopic ultrasound (EUS), with technical success confirmed by imaging and radiation detection. One month later, the patient developed acute pancreatitis, which was resolved under symptomatic and supportive treatment. In August 2025, PET-CT demonstrated reduced metabolic activity within the pancreatic lesion (stable dimensions), but with two new FDG-avid nodules in the celiac trunk and retroanal regions. CA 19-9 levels were rising. The multidisciplinary tumor board considered this progressive disease, and second-line systemic therapy with gemcitabine and nab-paclitaxel was initiated. Conclusions. OncoSil achieved partial local tumor response, with clinical benefit in pain control and temporary biochemical improvement. This case illustrates the feasibility of combining intratumoral brachytherapy with systemic chemotherapy in locally advanced pancreatic cancer within a multidisciplinary setting.

Keywords: OncoSil, pancreatic adenocarcinoma, brachytherapy, multidisciplinary team

 

 

Case report: modern therapeutic strategies in ER+/HER2- breast cancer with PIK3CA mutation

Andreea-Ștefania Pîrcălabu, Nicoleta Gîdea, Michael Schenker

“Sf. Nectarie” Oncology Center, Craiova, Romania
 

Introduction. Hormone receptor-positive, HER2-negative invasive breast carcinoma represents the most common subtype of breast cancer. In the presence of risk factors, such as nodal invasion and a high Oncotype DX score, the likelihood of recurrence and distant metastasis is increased. In advanced stages, therapeutic strategies aim to prolong survival and preserve quality of life through a multimodal, molecularly personalized approach. Objective. To present the clinical and imaging evolution and therapeutic management of a patient with ER+/PR+, HER2- invasive breast carcinoma, exhibiting metastatic progression to bone and brain, harboring a PIK3CA mutation, and treated through modern combinations of endocrine therapy, CDK4/6 inhibitors, targeted therapy and stereotactic radiotherapy. Materials and method. A 55-year-old female patient was diagnosed in July 2021 with right breast carcinoma treated by breast-conserving surgery. Histopathological and immunohistochemical examination revealed invasive ductal carcinoma, grade 2, pT2pN1 (2/16), ER+/PR+, HER2-, Ki67 25%, and Oncotype DX score of 32. The initial treatment included sectoral resection with axillary lymph node dissection, adjuvant chemotherapy (4EC-TAX), external beam radiotherapy, and endocrine therapy with anastrozole. During follow-up, a PET-CT performed in July 2023 demonstrated multiple bone metastases. Sequentially, the patient received abemaciclib in combination with endocrine therapy and osteoclast inhibitors, followed by targeted therapy combinations within a clinical trial (gedatolisib + palbociclib + fulvestrant). Under this regimen, disease progression occurred with new bone and brain lesions, requiring a therapeutic switch. Consequently, treatment with capivasertib + fulvestrant was initiated in June 2025, concomitantly with denosumab. Periorbital and leptomeningeal brain metastases were treated with stereotactic radiotherapy. Results. Over more than four years of multimodal treatment, the patient experienced alternating periods of clinical and imaging stability, along with metastatic progression, managed through therapeutic adjustments and stereotactic radiotherapy. The current evaluation shows partial stability of cerebral and bone lesions, improved tumor markers, and maintenance of a moderate general condition. Conclusions. This case highlights the importance of molecular testing and personalized therapeutic guidance in advanced ER+/HER2- breast cancer with PIK3CA mutation. Sequential therapeutic strategies and multidisciplinary collaboration play a pivotal role in achieving disease control and in preserving the quality of life.

Keywords: invasive breast carcinoma, bone metastases, brain metastases, PIK3CA mutation, targeted therapy, radiotherapy

 

 

The visible victory: depigmentation highlighting the efficacy of immunotherapy

Ioana-Diana Plai, Larisa Popovici, Mihaela-Andreea Matei, Cristina Pruteanu

Medical Oncology, Regional Institute of Oncology Iași, Romania
 

Introduction. Malignant melanoma is the most lethal form of skin cancer. Immunotherapy has become a cornerstone in its treatment, achieving meaningful antitumor response. However, these therapeutic benefits are frequently ac­com­panied by immune-related adverse effects, which may be striking in presentation and challenging to manage. Case report. A 41-year-old patient was diagnosed in October 2019 with lymph node metastases from a BRAF-negative, unspecified malignant melanoma. Clinically, he presented with left axillary adenopathy (3-5 cm) that had been present for five months. Surgical consultation and biopsy confirmed the diagnosis. PET-CT (November 2019) revealed multiple hypermetabolic adenopathic blocks, some partially necrotic, located at the left cervical level III (72×24 mm), level IV (32×50 mm), left subclavicular, left interpectoral, and left axillary (50×68×99 mm). In December 2019, combined immunotherapy with nivolumab and ipilimumab was initiated for four cycles, followed by maintenance nivolumab monotherapy, which continues to date. After three months of treatment, the patient developed complete skin depigmentation (biopsy: CD3+ inflammatory infiltrate, with immunohistochemistry confirming a predominance of CD8+ T lymphocytes), along with mild joint pain and conjunctivitis. In August 2024, the course was further complicated by biopsy-confirmed autoimmune colitis, successfully managed with medical therapy. The patient continues the treatment with immunotherapy, presenting partial remission of disease, with an ECOG performance status of 0. Conclusions. Oncology patients require a holistic approach after diagnosis, a multidisciplinary team playing a pivotal role in their care. Immunotherapy has become an essential component in the management of malignant melanoma, although it is not without adverse effects. Notably, the development of cutaneous toxicity has been shown to correlate with improved treatment response and overall survival.

Keywords: melanoma, immunotherapy, depigmentation, colitis

 

 

HER2-positivity spectrum in patients with breast cancer: results of the 2024 cohort
from the real-world evidence national study SPECTRUM

O. Pop^1,2, Maria Olinca³, M. Stoicea⁴, Corina Voinea⁵, Alis-Liliana-Carmen Dema⁶

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

2. Resident Laboratory Medicine, Oradea, Romania

3. Oncoteam Diagnostic, Bucharest, Romania

4. “Regina Maria” Private Health Network, Bucharest, Romania

5. Medical Department, AstraZeneca, Bucharest, Romania

6. Morphopathology Department, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
 

Introduction. This study aimed to describe the real-world HER2 testing practices and immunohistochemistry (IHC) positivity rate of the human epidermal growth factor receptor 2 (HER2) in patients with breast carcinoma (BC) in Romania. The study was conducted in two phases (2023 and 2024). We present here the results of the 2024 phase. Materials and method. SPECTRUM was a chart review conducted by pathologists from 23 public and private pathology laboratories. The results of the HER2 IHC testing performed over two three-month periods (August-October 2023 and August-October 2024) on formalin fixed paraffin embedded tissue were extracted. Data were collected consecutively, in a reverse order, until the site’s quota was met. Statistics were descriptive. Results. IHC testing practice (n=23 laboratories): median number of BC cases per year – 350, median number of IHC HER2 tests per month – 25, 74% performed “in-house” and 26% externalized; 83% performed reflex HER2 IHC, and 70% reflex in situ hybridization (ISH) only on cases with IHC=2+score. Overall, 57% of the laboratories used VENTANA anti-HER2/neu (4B5) clone, 52% Ultraview detection kit, and 78% reported quality assurance programs in place. Patient characteristics (n=161): the median age was 64 years old, with 99% females, 96% samples from primary tumor, 69% obtained by core needle biopsy, 66.5% estrogen and progesterone receptor positive, 95% invasive BC, median ki67 was 25%, and median fixation time was 24 hours. HER2 testing results: 40% IHC=0 (35% IHC=0; 5% IHC=0-1), 26% IHC=1+; 24% IHC=2+; 10% IHC=3+; 41% IHC=2+ISH-/IHC=1+(HER2-low), 5% IHC=0-1 (HER2-ultralow) and 14% IHC=3+/IHC=2+ISH+ (HER2-positive). For 4% IHC=2+ cases, the ISH results were unavailable. Sensitivity analyses revealed that, in the 2024 cohort, the probability of accurately classifying as HER2-low increased (p=0.074). Conclusions. The 2024 cohort analysis provided additional insights into the HER2 IHC testing practices and changes over one year. The accuracy of identifying the HER2-low status improved, an essential finding for patients who could benefit from the innovative antibody-drug conjugates.

Keywords: breast cancer, HER2 testing, HER2 low, immunohistochemistry, real world

Funding: AstraZeneca

 

Dual undifferentiated malignancies in a BRCA1 carrier: immunohistochemical pitfalls
and limitations of risk-reducing surgery 

Luiza Purcari

Gynecological Oncology Department, Filantropia Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania
 

Objective. To illustrate the diagnostic challenges of two undifferentiated malignancies with overlapping morphology and immunoprofiles in a BRCA1 mutation carrier, emphasizing the interpretative pitfalls of immunohistochemistry (IHC) and the implications of comprehensive pathological assessment during risk-reducing surgery. Materials and method. A 51-year-old woman with a germline BRCA1 (c.5266dupC) mutation was diagnosed at 41 with metaplastic triple-negative breast carcinoma (CK5+, GATA3+, p63+, PAX8-). Five years after the prophylactic hysterectomy and bilateral salpingo-oophorectomy, performed without SEE-FIM protocol, she developed peritoneal carcinomatosis. Serial biopsies underwent histopathologic and IHC evaluation, including CK7, CK5/6, GATA3, PAX8, WT1, ER, PR, HER2, p53, SOX10 and mammaglobin. Results. The initial breast carcinoma was a poorly differentiated, CK5+, triple-negative metaplastic carcinoma (GATA3+, p63+, PAX8-). The peritoneal lesions displayed PAX8+, WT1+, p53-null, ER 45%, and faint focal GATA3 positivity, consistent with high-grade serous carcinoma. Discordant IHC results in later biopsies alternately supported a mammary or serous origin. The overlap between marker expression – loss of GATA3/mammaglobin in metaplastic carcinoma and aberrant GATA3 expression in serous carcinoma – contributed to diagnostic uncertainty. The absence of SEE-FIM at risk-reducing surgery limited the evaluation of the fimbrial epithelium, potentially precluding identification of an occult serous tubal intraepithelial carcinoma (STIC). Conclusions. In BRCA1 mutation carriers, both metaplastic triple-negative breast carcinoma and high-grade serous carcinoma may present as undifferentiated, high-proliferation malignancies with overlapping IHC profiles. Accurate diagnosis requires integration of morphology, IHC and clinical context. The case underscores the relevance of SEE-FIM in risk-reducing surgery, as its systematic application enhances the early detection of STIC and may prevent the development of a later peritoneal malignancy.

Keywords: BRCA1 mutation, metaplastic breast carcinoma, high-grade serous carcinoma, SEE-FIM, differential diagnosis

 

 

Multimodal treatment in the management of colorectal cancer – a clinical case. From adjuvant
to palliative treatment

Claudia-Florina Radu¹, Adina-Emilia Croitoru^1,2

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

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

Circulating tumor DNA (ctDNA) is a noninvasive biomarker that accurately reflects tumor dynamics and offers greater sensitivity than traditional markers such as carcinoembryonic antigen (CEA). In metastatic colorectal cancer, rapid and significant reductions in ctDNA levels following treatment have been correlated with clinical response and improvements in both progression-free survival (PFS) and overall survival (OS). We report the case of a 52-year-old man with no significant medical history who presented with nonspecific abdominal bloating. Colonoscopy revealed a partially obstructing tumor approximately 50 cm from the anal verge. Biopsy confirmed moderately differentiated adenocarcinoma. Staging CT showed no distant metastases. In January 2023, he underwent curative resection; pathology demonstrated stage III disease, with high-risk features and microsatellite stable status. He completed six months of adjuvant mFOLFOX6 chemotherapy. Post-treatment imaging revealed no recurrence. In September 2023, Signatera ctDNA testing was positive (2.02 MTM/mL). By February 2024, CT chest and MRI abdomen/pelvis identified two liver lesions (segment IVa), initially suspected as hemangiomas. However, rising ctDNA levels in March 2024 (5.51 MTM/mL versus 0.59 in December 2023) and subsequent imaging increased the suspicion for hepatic metastases. Atypical hepatectomies confirmed liver metastases histologically. The patient received adjuvant FOLFIRI. In September 2024, a new hepatic lesion in segment VI was treated with stereotactic body radiotherapy (60 Gy in three fractions). In April 2025, a further lesion in segment III was confirmed by PET-CT. Molecular profiling showed RAS wild-type status, and systemic therapy with anti-EGFR therapy plus mFOLFOX6 was initiated. By July 2025, marked regression of the segment III lesion was observed. In conclusion, this case highlights the critical role of serial ctDNA monitoring in detecting early molecular relapse and in guiding timely interventions in stage III colorectal cancer. Multimodal management, including surgery, systemic chemotherapy, targeted therapy and stereotactic radiotherapy, achieved meaningful disease control in a patient with liver-limited metastases and RAS wild-type status.

Keywords: colorectal cancer, ctDNA, biomarker, oligometastatic disease, local treatment

 

 

Where fire once touched: malignant degeneration in post-burn skin

Mara Răzniceanu¹, Ioana-Maria Calancea¹, Ana-Maria-Cecilia Păuleț², Monica Buzemurgă¹

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

2. Oncology Department, Regional Institute of Oncology Iaşi, Romania
 

Introduction. Marjolin ulcer is a rare malignancy arising in chronic burn scars, usually decades after the initial injury. Compared to primary cutaneous squamous cell carcinoma, it demonstrates more aggressive behavior, with higher rates of lymph node metastasis. The treatment is complicated by burn-related fibrosis that distorts normal anatomy, limits reconstructive options, and creates a compromised tissue bed for adjuvant radiotherapy. Case presentation. A 69-year-old female with extensive childhood post-burn sequelae affecting the right axilla, lateral thorax and upper limb presented with a Marjolin ulcer in the right axillary region. Preoperative biopsy (July 2022) confirmed a moderately differentiated squamous cell carcinoma in an axillary lymph node. The surgical treatment consisted of wide local excision with axillary lymph node clearance and reconstruction with a pectoralis major myocutaneous flap and split-thickness skin grafting. Shoulder abduction of 90 degrees was achieved. The postoperative course was complicated by cardiorespiratory arrest on day 2, successfully resuscitated. Histopathology revealed moderately differentiated squamous cell carcinoma (G2) with one of 21 lymph nodes showing metastasis with extranodal extension (pT3N1). The deep margin measured 1.2 mm at the superior aspect. Follow-up imaging demonstrated no axillary recurrence, with stable indeterminate pulmonary nodules. Adjuvant radiotherapy (November-December 2022) delivered 50 Gy in 25 fractions to the surgical bed and regional nodes (axillary levels I-II, Rotter’s, infraclavicular), with a boost to 60 Gy in 30 fractions to the close margin region. The treatment was complicated by grade III radioepithelitis. Conclusions. Metastatic Marjolin ulcer management demonstrates cumulative therapeutic burden, where marginal resection clearance necessitates escalated radiation doses, resulting in severe radioepithelitis. Preexisting scar tissue compromise intensifies treatment-related toxicity, necessitating meticulous patient evaluation and comprehensive supportive management.

Keywords: Marjolin ulcer, squamous cell carcinoma, post-burn scar, adjuvant radiotherapy

 

 

Advanced jejunal GIST: sequential therapies, multimodal interventions and personalized therapeutic approaches

Andreea-Elena Robu, Adina Croitoru

Medical Oncology Department, Fundeni Clinical Institute, Bucharest, Romania
 

Introduction. Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the digestive tract, characterized by c-KIT (CD117) expression and by the dependence on KIT or PDGFRA mutations. Although standard therapy with tyrosine kinase inhibitors (TKIs) has significantly improved patient outcomes, treatment resistance remains a major challenge, requiring therapeutic strategies defined within a multidisciplinary framework. Case presentation. The case study presents a 56-year-old male patient with no significant past medical history, diagnosed with a perforated jejunal GIST. The patient underwent segmental enterectomy, and the histopathological exam confirmed the diagnosis of GIST, stage pT3N0M1PER. Afterwards, the clinical course was marked by intraperitoneal recurrence and multiple liver metastases which prompted initiation of imatinib 400 mg/day. Despite therapy, disease progression was noted, leading to dose escalation. Due to further progression of hepatic and peritoneal metastases, treatment was switched to sunitinib, followed by regorafenib. Four years after the diagnosis, next-generation sequencing (NGS) identified mutations with potential resistance to imati­nib and sunitinib. The patient also required multiple surgical and interventional radiology procedures. A chemotherapy regimen with gemcitabine and oxaliplatin was initiated, guided by Onconomics testing. However, the tolerance was poor, and the patient subsequently developed severe bacterial pneumonia. The overall course was unfavorable, with progressive deterioration and death five years after the diagnosis. Discussion. This case highlights the therapeutic complexity of an advanced case of GIST, characterized by the development of resistance to standard treatments and the necessity of integrated multidisciplinary, and even personalized approaches. Conclusions. The management of patients with advanced, treatment-refractory GIST requires a multidisciplinary approach combining targeted therapy, surgery and interventional techniques. Primary or acquired resistance to TKIs necessitates exploration of novel therapeutic strategies, including genetic testing, in vitro chemosensitivity assays such as Onconomics and clinical trial enrollment in order to improve patient outcomes.

Keywords: multidisciplinary approach, multimodal therapy, personalized oncology, GIST

 

 

Balancing efficacy and safety: immunotherapy in stage IV non-small cell lung cancer: case report

Ana-Maria Sandu

Medical Oncology Resident, “Elias” University Emergency Hospital, Bucharest, Romania
 

Materials and method. Mrs. S.A., a 76-year-old female, with a history of hypertension and Mayer-Rokitansky-Küster-Hauser syndrome, was diagnosed in July 2023 with stage IV pulmonary adenocarcinoma (CK7+, TTF-1-, PD-L1 1%, EGFR-, ALK-). In addition, a PET-scan and a brain MRI confirmed stage IV pulmonary adenocarcinoma. The treatment was initiated according to the 9LA protocol (nivolumab + ipilimumab + pemetrexed + carboplatin). Clinical evolution, imaging results and immune-related adverse events were monitored throughout therapy. Results. During treatment, several immune-mediated complications occurred. After the first cycle of pemetrexed + carboplatin + nivolumab + ipilimumab, the patient developed an erythematous maculopapular rash, leading to a 25% chemotherapy dose reduction. Imaging in November showed a partial response, and the therapy continued with nivolumab and ipilimumab. A recurrent cutaneous toxicity required allergy reassessment and a 16-step desensitization protocol. In April 2024, Crohn’s-like lesions induced by checkpoint inhibitors were identified, and maintenance therapy proceeded with nivolumab alone. Due to recurrent immune-mediated hematologic toxicity, nivolumab was discontinued in September 2025. The patient remains under follow-up. Conclusions. This case underlines the dual nature of immunotherapy in advanced NSCLC – effective in disease control, yet capable of inducing serious immune-mediated toxicities that may limit treatment continuation.

Keywords: immunotherapy, checkpoint inhibitors, immune-related adverse events (irAEs), toxicity management, desensitization protocol

 

 

Adjuvant contact brachytherapy for cutaneous cancers: from implementation to outcomes –
a single-centre experience

Daniela-Lidia Sandu^1,2, Ana Dulan^1,2, Ile Bogdan¹

1. OncoHelp Oncology Center, Timişoara, Romania

2. “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
 

The incidence of basal cell and squamous cell skin cancers is rising worldwide, posing an increasingly important clinical challenge, particularly in elderly and frail patients. Although surgery remains the therapeutic standard, it is not always feasible due to tumor location, comorbidities or functional and cosmetic considerations. In such situations, brachytherapy is an effective, minimally invasive alternative that can be used both as adjuvant therapy and as a curative option. GEC-ESTRO ACROP recommendations and ABS consensus underscore that brachytherapy may be delivered using superficial techniques with contact applicators, customized molds or interstitial approaches, depending on lesion thickness, morphology and location. Clinical data show excellent local control rates (above 90-95%), favorable cosmetic outcomes and acceptable toxicity. Moreover, hypofractionated regimens allow shorter overall treatment time and improved adherence, particularly important in elderly patients. In our centre, we have used brachytherapy for patients in whom surgery was no longer a viable option. These cases included positive surgical margins, with involvement at the bone interface or situations where reintervention would have resulted in unacceptable cosmetic or functional defects. In such contexts, brachytherapy provided effective local control while preserving satisfactory cosmetic results, with minimal impact on quality of life. The cases presented will derive from our centre’s clinical experience and demonstrate the practical applicability of international guidelines, confirming the role of brachytherapy as a personalized alternative in the adjuvant treatment of cutaneous cancers. The effectiveness of treatment depends on individualized patient selection, rigorous planning and multidisciplinary collaboration to optimize oncologic and cosmetic outcomes.

Keywords: contact brachytherapy, cutaneous cancers, adjuvant therapy, local control, cosmetic outcomes

 

 

Atypical late metastatic recurrence of endometrial cancer with jejunal and axillary involvement

O.D. Schreiner, V. Huțanu, C. Tiron, D. Petroiu

Oncology Department, Regional Institute of Oncology Iași, Romania
 

Introduction and objective. Endometrial cancer (EC) typically metastasizes to the lungs, liver and lymph nodes. Gastrointestinal (GI) involvement, particularly jejunal me­ta­­stases, is exceedingly rare. We present a unique case of a patient with a 12-year disease-free interval before recurrence with isolated jejunal metastasis and subsequent atypical progression. The aim is to highlight the importance of long-term surveillance and the role of hormonal therapy in chemoresistant, comorbid patients. Materials and method. We report the case of a 72-year-old woman with a history of stage III endometrioid endometrial adenocarcinoma (ER/PR-positive, G2), initially treated in 2010 with total hysterectomy and bilateral salpingo-oophorectomy, who declined adjuvant therapy and was lost to follow-up. In 2022, she presented with nonspecific GI symptoms, being diagnosed with jejunal metastasis from poorly differentiated carcinoma. Disease progression, treatments and outcomes were tracked retrospectively. Results. The patient underwent segmental enterectomy and received first-line chemotherapy (carboplatin-paclitaxel). She achieved initial disease control. In 2023, pulmonary and axillary metastases developed. Despite multiple chemotherapy regimens (including gemcitabine and doxorubicin), the disease progressed. Due to declining performance status (ECOG 2), comorbidities (multiple strokes) and refusal of further chemotherapy, hormonal treatment with megestrol acetate was initiated. Imaging in March 2025 showed stable disease, and the patient remained on maintenance hormonal therapy, with clinical benefit. Conclusions. This case illustrates an exceptionally late and atypical recurrence of endometrial cancer, with isolated jejunal metastasis as the first sign of disease relapse after a 12-year interval. It highlights the critical need for long-term oncological surveillance, even in patients with previously localized disease. Furthermore, in the context of chemoresistant, hormone receptor-positive tumors and comorbid conditions, hormonal therapy can provide meaningful disease control and symptom relief.

Keywords: endometrial cancer, jejunal metastasis, late recurrence, hormonal therapy, long-term follow-up

 

 

Immunotherapy-induced autoimmune pneumonitis mimicking pulmonary carcinomatous lymphangitis: a diagnostic challenge

Dana Semen¹, Cătălin Lulciuc² 

1. Oncologist, Nord Clinic – Provita Medical Group, Suceava, Romania

2. Oncological Interventional Radiology, Nord Clinic – Provita Medical Group, Suceava, Romania
 

Introduction. Pulmonary carcinomatous lymphangitis is a severe metastatic complication characterized by progressive dyspnea and diffuse pulmonary infiltrates with interlobular septal thickening. The diagnosis is supported by CT and PET-CT imaging; however, certain immunotherapy-related adverse reactions can closely mimic this pattern, creating major diagnostic dilemmas. Case presentation. We report the case of a 51-year-old male patient with a history of malignant melanoma treated with immunotherapy. Follow-up imaging revealed diffuse pulmonary infiltrates, ground-glass opacities and interlobular septal thickening – findings suggestive of carcinomatous lymphangitis. PET-CT showed diffuse FDG uptake along the interlobular and peribronchovascular septa, raising suspicion of metastatic spread. Clinically, the patient presented with severe dyspnea and dry cough, consistent with the suspicion of lymphangitic carcinomatosis. However, based on the oncologist’s and radiologist’s assessment, correlation with the therapeutic history and the absence of other metastatic lesions, the diagnosis was shifted toward autoimmune pneumonitis induced by immunotherapy. The evolution under corticosteroid therapy was slowly favorable, with gradual resolution of symptoms and imaging abnormalities after approximately three months, confirming the diagnosis of immune-related toxicity and ruling out carcinomatous lymphangitis. Discussion. This case demonstrates that autoimmune pneumonitis can clinically and radiologically mimic carcinomatous lymphangitis, including on PET-CT, where diffuse inflammatory infiltrates can lead to false-positive FDG uptake. Accurate differential diagnosis is crucial, as the therapeutic implications differ radically, changing the oncologic treatment versus initiating immunosuppressive therapy. Conclusions. Immunotherapy-induced autoimmune pneumonitis can faithfully reproduce the clinical and imaging features of pulmonary carcinomatous lymphangitis. Recognizing this entity and confirming it through a favorable response to corticosteroid therapy are essential to avoid a false diagnosis of tumor progression and to ensure optimal continuation of oncologic treatment.

Keywords: autoimun pneumonitis, immunotherapy, diagnostic

 

 

The importance of multidisciplinary approach in the treatment of gastric adenocarcinoma

Andreea-Voichița Slevoacă-Grigore, M.I. Drozd, Cornelia Nițipir

Medical Oncology Department, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
 

This paper presents the case of a 64-year-old female patient diagnosed with antral gastric adenocarcinoma of intestinal type, HER2 negative (1+), MSI-H, Ki67 85%, PD-L1 wt, with peritoneal carcinomatosis, who received oncological treatment with chemotherapy and immunotherapy. The patient presented in November 2024 at the gastroenterology department for pyrosis, fatigue and weight loss. Following imagistic investigations, the suspicion of a gastric tumor was raised. An upper gastrointestinal endoscopy was performed, and biopsies were obtained. Imaging evaluation by CT and PET-CT revealed a gastric tumor with serosal infiltration, perigastric lymphadenopathy and peritoneal dissemination. ECOG performance status was 0-1 at diagnosis. The patient underwent the therapeutic protocol with FOLFOX + pembrolizumab, administered for six cycles, currently receiving maintenance treatment with pembrolizumab. The treatment was relatively well tolerated, but with neurological toxicity. Periodic evaluations were performed by CT and PET-CT for monitoring therapeutic response and evolution of peritoneal carcinomatosis. Under systemic treatment, the patient showed favorable evolution, with treatment response, the disease currently being in regression. The patient was evaluated in a multidisciplinary oncological and surgical setting, maintaining good performance status, with the patient even returning to work. In conclusion, this case illustrates the importance of multidisciplinary approach in the management of MSI-H gastric adenocarcinoma with peritoneal carcinomatosis. The chemotherapy-immunotherapy combination (FOLFOX + pembrolizumab) represents a valuable therapeutic option for selected patients with favorable molecular profile, offering disease control and acceptable quality of life. Careful monitoring through imaging and multidisciplinary evaluation are essential for optimizing the long-term therapeutic strategy in the context of advanced peritoneal disease.

Keywords: gastric adenocarcinoma, peritoneal carcinomatosis, immunotherapy, pembrolizumab, tumor response

 

 

Oncofertility knowledge among physicians in young breast cancer patients

Mihaela Stana^1,2, Daniel Sur^2,3, Cristian Lungulescu^4,5, Flaviu Andreicovici¹, Gabriel Kacso^6,7, Alexandru Eniu^8,9, Luca Arecco¹⁰, Matteo Lambertini^11,12

1. Department of Medical Oncology, Amethyst Radiotherapy Satu Mare, Romania

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

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

4. Department of Oncology, University of Medicine and Pharmacy of Craiova, Romania

5. Oncolab Craiova, Romania

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

7. Department of Medical Oncology, Emergency County Hospital Cluj-Napoca, Romania

8. Department of Medical Oncology, Genolier Cancer Center, Genolier, Switzerland

9. European School of Oncology
10. Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Bruxelles, Belgium

11. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Italy

12. Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
 

Objective. This study aimed to evaluate the level of knowledge and awareness of oncofertility among physicians treating young breast cancer patients, and to emphasize the necessity of structured training and oncofertility counseling to ultimately improve the quality of life for these patients. Materials and method. Between 2023 and 2025, we conducted an online survey involving 102 physicians from Romania, Italy, France, Belgium, Portugal, Cyprus, Switzerland, Russia, Sweden, the Netherlands and Mexico. Eligible participants were physicians working in medical oncology, radiation oncology, obstetrics-gynecology, or oncologic surgery who manage young women diagnosed with breast cancer. We used a structured questionnaire designed to assess their awareness, attitudes and practices concerning oncofertility, including counseling habits, referral behavior, perceived barriers and interest in further education. Results. Of the 102 respondents from 11 countries, 61.8% identified as medical oncologists, 17.6% as radiation oncologists, 10.8% as obstetrics-gynecology specialists, 2.9% as oncologic surgeons, and 6.9% held dual training in medical and radiation oncology. More than half (54.9%) were aged 31-40, and 62.7% had under five years of professional experience. Forty-nine percent worked in university hospitals, and 45.1% reported managing 41-50 young breast cancer patients annually. A majority (70.6%) provide oncofertility counseling prior to oncologic treatment; nonetheless, 85.3% had received no formal oncofertility training during residency. Nearly all (96.1%) believed oncofertility deserved greater attention within clinical care. Ethical considerations were recognized by 64.7% of respondents, and 75.5% indicated that patients expressed fear about pregnancy after therapy. Only 52.9% offered psychological counseling in the fertility preservation context. Furthermore, 83.3% of physicians expressed willingness to pay for continuing education on oncofertility, and 91.2% believed that better physician preparation would enhance patient access to fertility counseling. Discussion and conclusions. Although general awareness of oncofertility is high among breast cancer specialists, significant deficiencies remain regarding detailed knowledge, standardized referral practices, and educational preparation. Our findings underscore the need for formalized training programs, institution-wide protocols, and integration of psychological and ethical support elements within cancer care. Limitations such as voluntary response bias and potential overrepresentation of academic center physicians must be acknowledged. Nevertheless, this work highlights the urgency of embedding fertility preservation as a standard component of breast cancer management, and future research should explore patient perspectives, regional disparities and practical barriers in underserved settings.

Keywords: oncofertility, breast cancer, young patients, premonopausal, BRCA carriers

 

 

Exploring targetable biomarkers in pancreatic ductal adenocarcinoma: an immunohistochemical study of p16, p53, HER2 and MMR proteins

Laura-Elena Stanciu¹, Luciana Nichita^1,4, T. Voiosu^3,4, B. Mastalier^2,4, Anastasia-Ioana Cibotariu¹, Cristiana Popp¹

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

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

3. Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania

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

Introduction and objective. Pancreatic cancer has a dismal prognosis, with a five-year survival rate of approximately 10%, most often diagnosed at advanced stages. Tumor cell hetero­geneity and chemoresistance necessitate the exploration of targeted therapies. This study aims to outline the immunohistochemical profile of pancreatic ductal adenocarcinomas, providing a future perspective on targeted treatment. Materials and method. A retrospective observational study was performed on paraffin blocks from patients who underwent cepha­lic duodenopancreatectomy and were diagnosed with pancreatic ductal adenocarcinoma between 2021 and 2025. Representative tumor blocks were selected and subjected to immunohistochemi­cal testing for p16, p53, MLH1, MSH2, MSH6, PMS2 and HER2 (c-erbB-2). Fisher’s exact test (p<0.05) was used to assess correlations between nominal variables. Results. The study included 12 patients (five men and seven women, aged 47-78 years old). Tumor extension was pT3 in 50% of cases, pT2 in 41.7%, and pT1 in 8.3%. Nine patients (75%) had nodal metastases, with one also presenting hepatic metastases. Lymphovascular invasion was identified in 91.7% of cases, and perineural invasion in 83.3%. Most tumors were moderately differentiated (11 cases), with one poorly differentia­ted. p16 expression was absent in all cases, while p53 showed a mutant pattern in seven cases (three negative, four overexpressed). No microsatellite instability was detected. HER2 expression was negative in nine cases and equivocal in three cases. Conclusions. The analysis of HER2, microsatellite instability markers, p16 and p53 revealed a hete­ro­geneous immunohistochemical profile, with frequent p53 alterations, loss of p16 expression and variable HER2 expression. Future studies are required to clarify the prognostic and therapeutic significance of HER2, p16 and p53 in pancreatic ductal adenocarcinoma.

Keywords: pancreatic ductal adenocarcinoma, HER2, p16, p53, targetable biomarkers

 

 

The clinical utility of genetic testing in brain tumors: insights from a case presentation

Monica Stoian^1,2, Anca Bardan¹, Florin Iordache¹, Alexandra Şerban¹, Diana Pasov¹

1. Personal Genetics – Medical Genetics Center, Bucharest, Romania

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

Introduction. Brain tumors are relatively rare, accounting for approximately 1-2% of all cancers, yet they represent a major cause of morbidity and mortality worldwide. Advances in molecular diagnostics and the updated WHO 2021 classification have highlighted the critical role of genetic and epigenetic markers in refining diagnosis, prognosis and therapeutic decision-making in gliomas and other central nervous system (CNS) tumors. Case presentation. We present the case of a 44-year-old male with a left frontal lobe neoplasm, on histopathological examination with hematoxylin and eosin staining initially classified as an anaplastic oligodendroglioma. Histopathology revealed a diffuse glial proliferation with high cellularity, mitotic activity, microvascular proliferation and necrosis, diffuse infiltrative high-grade glioma. Immunohistochemistry showed ATRX nuclear positivity, Olig2 positivity, Ki67 approximately 20% and negative p53. Genetic testing was performed using FISH, MS-MLPA and NGS panels. The results demonstrated the absence of 1p/19q codeletion, MGMT promoter methylation and two significant somatic mutations: a TERT promoter mutation (c.124C>T) and PIK3CA mutation (p.Gly118Asp). Discussion. The molecular profile confirmed glioblastoma, IDH-wild-type, WHO grade 4, a clinically aggressive entity. TERT promoter mutation, frequent in glioblastoma and oligodendroglioma, drives telomerase reactivation and correlates with poor prognosis, but it may indicate survival benefit with adjuvant chemoradiotherapy. MGMT promoter methylation predicted sensitivity to temozolomide. PIK3CA mutation suggested activation of the PI3K/AKT/mTOR pathway, conferring therapy resistance, yet offering opportunities for targeted inhibition in clinical trials. These findings emphasize the importance of integrating molecular markers in brain tumor diagnostics. Conclusions. Genetic testing is indispensable for accurate classification, prognostic assessment and therapeutic stratification in brain tumors. It refines WHO classification, supports precision oncology, and identifies eligibility for targeted or experimental therapies. This case illustrates how the integration of molecular profiling into routine practice transforms the management and improves the individualized patient care.

Keywords:brain tumors, genetic testigs, case presentation

 

 

HER2 dynamics and therapeutic sequencing in a premenopausal woman with metastatic breast cancer: a case report

Anca Stolojanu¹, Elena Iovanescu^1,2, Crina Siminiceanu¹, Loredana Ciontea¹, Radu Matei¹, Adelina-Silvana 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
 

Introduction. HER2-positive breast cancer represents an aggressive subtype, yet targeted therapies have improved outcomes. HER2 expression, however, may change over time, raising therapeutic and biological challenges. We report a case where sequential strategies and molecular re-profiling prolonged survival in a de novo metastatic setting. Materials and method. A 41-year-old premenopausal woman was diagnosed in 2020 with de novo stage IV ER+/HER2- breast cancer (liver, bone, lymph nodes). After neoadjuvant chemotherapy and surgery, pathology revealed ER/PR positivity and HER2 3+. Results. She received docetaxel plus trastuzumab/pertuzumab, then stereotactic radiosurgery for a solitary brain metastasis, followed by T-DM1 with 15 months of stability. Hepatic progression in March 2024 prompted the initiation of trastuzumab deruxtecan until January 2025, when further liver lesions and rising tumor markers indicated progression. She was then started on tucatinib in combination with capecitabine and trastuzumab, according to guideline-based sequencing. Due to lack of biochemical response, liver re-biopsy (June 2025) revealed HR+, HER2-low (1+) status. Treatment was switched to palbociclib plus fulvestrant and LHRH analogue, achieving favorable tumor marker evolution. Conclusions. Despite de novo metastatic disease, a multidisciplinary approach, sequential lines of HER2-targeted therapy and molecular re-profiling have contributed to extended survival. The conversion from HER2-positive to HER2-low invites reflection: is this a biological evolution of the tumor, treatment-induced selection, or sampling variability? The case emphasizes the importance of reassessing biomarkers to guide optimal therapy.

Keywords: HER2 conversion, breast cancer, multidisciplinary approach, sequencing

 

 

Ultrasound-guided thermal ablation for metastatic liver tumors – a single-center experience

Daniela Tabacelia^1,2, Patricia Nicolae², Mihaela Piţurcă², Andrei Ioan², Florin Bejinaru², Alexandra Dumitrescu², Oana-Lucia Andrei²,
Alina Mehedinţeanu^2,3, Nicoleta Gidea², Ana-Maria Ciurea^2,3, Ioana Irimie², Adina Mihalache², Ciprian Berisha^2,3, Michael Schenker^2,3

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

2. “Sf. Nectarie” Oncology Center, Craiova, Romania

3. University of Medicine and Pharmacy of Craiova, Romania
 

Introduction. Local thermal ablation is a well-known alternative to surgical resection for the treatment of liver metastases from colorectal cancer. Our study pursues clinical experience of percutaneous ultrasound-guided microwave ablation (MWA) and endoscopic ultrasound (EUS) radiofrequency ablation (RFA) as a regional treatment for different secondary liver tumors in terms of progression-free survival (PFS) and overall survival (OS), and the identification of predictors that may influence these. Materials and method. Patients with liver metastases secondary to neoplasms with different primary sites were included in the study. MWA system was used for the percutaneous approach, and RFA system was used for the EUS approach. Power and time were set for every lesion depending on the size. Results. Baseline data from 23 patients, including nine men (37.1%), attended at the “Sf. Nectarie” Oncology Center, Craiova, Romania, from January 2023 to September 2025, were recovered and analyzed in a retrospective, observational and interventional nonrandomized study. Indications were represented by one or multiple metastases from: colorectal cancer (six patients), genital neoplasm (three patients), neuroendocrine tumor (one patient), breast cancer (five patients), melanoma (one patient), sarcoma (one patient), gallbladder adenocarcinoma (one patient), urothelial carcinoma (one patient) and pancreatic adenocarcinoma (four patients). Combined approach, EUS and percutaneous, was performed in five cases (21.7%) and EUS approach only was performed in one case with a solitary lesion in the left liver lobe (4.5%). The median tumor size was 23.9 mm, with a median number of nodules 2.87. PFS rates were better in patients treated by percutaneous approach. Mean value of OS was 11 months. Conclusions. Thermal ablation is safe and effective for liver metastases, with PFS and OS rates similar in patients who undergo surgery. Expanding the indication for secondary lesions from different types of neoplasms requires a larger cohort of patients and longer follow-up.

Keywords: microwave ablation, radiofrequency ablation, liver metastases, percutaneous ultrasound, endoscopic ultrasound

 

 

Endoscopic ultrasound-guided radiofrequency ablation for pancreatic tumors –
a center experience

Daniela Tabacelia^1,2, Patricia Nicolae², Mihaela Piţurcă², Andrei Ioan², Florin Bejinaru², Alexandra Dumitrescu², Oana-Lucia Andrei²,
Alina Mehedinţeanu^2,3, Nicoleta Gidea², Ana-Maria Ciurea^2,3, Ioana Irimie², Adina Mihalache², Ciprian Berisha^2,3, Michael Schenker^2,3

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

2. “Sf. Nectarie” Oncology Center, Craiova, Romania

3. University of Medicine and Pharmacy of Craiova, Romania
 

Introduction. Locoregional ablative treatments are presenting an increasing interest and broader use in oncologic diseases. Inoperable pancreatic tumors, refractory to neoadjuvant therapy, are calling for new approaches. Endoscopic ultrasound (EUS) guided radiofrequency ablation (RFA) showed some benefits in terms of local control and symptoms relief over recent years. The aim of this paper is to underscore the benefits of performing EUS-guided RFA of pancreatic tumors in a multimodality approach. Materials and method. We have retrospectively reviewed patients with inoperable pancreatic lesions treated with EUS-guided RFA between January 2023 and August 2025 at the “Sf. Nectarie” Oncology Center, Craiova, Romania. We used the VIVA Combo ablation system coupled with a 19-Gauge electrode, with a 10-mm active tip. Results. Twelve patients were treated, including four females (33.3%). All subjects had histology proven for malignancy before procedure. Nine patients had adenocarcinoma of the pancreas, two had pancreatic neuroendocrine tumor (PNET), and one patient had five metastases from renal cell carcinoma located in the uncinate process (one), head (one), body (one) and tail (two) of the pancreas. The mean diameter of the tumor was 27.9 mm. Major complications encountered were duodenal stenosis and a choledochoduodenal fistula, both treated with endoscopic intervention. One patient died one month after the procedure in a different medical unit, without information about the cause. The median follow-up was 6.75 months from the moment of the procedure. Biopsy performed from the ablation area in one patient revealed the absence of tumor cells. Conclusions. EUS-guided RFA in advanced stage or in inoperable patients with pancreatic tumors is a safe and feasible procedure. Multimodality approaches combining systemic chemotherapy and locoregional radiotherapy may offer better results in local tumor control and for overall survival. Further studies should be supported in this direction.

Keywords: pancreatic tumor, radiofrequency ablation, endoscopic ultrasound

 

 

Alectinib in ALK-positive lung cancer: balancing efficacy and cardiac safety

Smaranda-Iuliana Tabarcea, Cristina-Alexandra Cotovanu, Elena-Rodica Gafton

Oncology Department, Regional Institute of Oncology Iași, Romania
 

Studies have shown that alectinib is the antineoplastic drug with the highest risk of cardiac toxicity among those used in non-small cell lung cancer (NSCLC), making cardiovascular monitoring essential during its administration. An 81-year-old female patient, with an ECOG performance status of 1, was diagnosed in February 2022 with stage IV non-small cell lung cancer (adenocarcinoma), with pleural and hepatic metastases and mixed bone lesions highly suspicious for malignancy. Immunohistochemical testing revealed the presence of an ALK mutation. A bone scintigraphy was also performed, confirming the presence of secondary bone lesions. Comorbidities inclu­ded grade 2 mitral and tricuspid valve insufficiency, moderate pulmonary hypertension, aortic atheromatosis, and varicose veins in the lower limbs. Targeted therapy with alectinib was initiated, along with regular cardiology evaluations. In January 2023, a cardiology consultation revealed bradycardia likely related to alectinib therapy, leading to dose reduction while continuing treatment. Imaging studies showed a partial response, despite the reduced dose of alectinib. Given the efficacy of alectinib in ALK-positive tumors and the necessity of its use in metastatic stages with confirmed mutations, it remains the preferred treatment option, despite potential adverse effects with appropriate cardiovascular monitoring and dose adjustment when needed. To conclude, even with dose reduction, alectinib targeted therapy maintains its antitumor benefits, with a progression-free survival of approximately 39 months.

Keywords: alectinib, cardiotoxicity, ALK mutations, lung cancer

 

 

Personalized management of a young patient diagnosed with MEN2A: transition from vandetanib to selpercatinib

Roxana-Cosmina Tailup¹, F.C. Amurăriți-Proca¹, C. Volovăț^1,2

1. Medical Oncology Department, Victoria Hospital – Euroclinic Oncology Center, Iaşi, Romania

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

Objective. To present the complex management of multiple endocrine neoplasia type 2A (MEN2A), highlighting the role of sequencing RET inhibitors according to molecular profile and treatment tolerability. Materials and method. A 41-year-old male patient was diagnosed with MEN2A, confirmed by a RET exon 11 (codon 634) germline mutation. Clinical course, imaging, pathology and systemic therapies were retrospectively reviewed. Results. In 2021, the patient was diagnosed with medullary thyroid carcinoma (pT3bN1M0, stage III) and underwent total thyroidectomy with bilateral lymphadenectomy, followed by radiotherapy. Subsequent imaging revealed lymph node, adrenal and bone metastases. Vandetanib combined with denosumab were initiated in October 2022. In February 2023, bilateral adrenalectomy confirmed pheochromocytomas. Bone scintigraphy demonstrated metastatic spread, but also partial treatment response. Disease evolution was complicated by cutaneous toxicity and the detection of a parathyroid adenoma. In April 2025, PET-CT documented pulmonary, paratracheal and bone progression, prompting a switch to selpercatinib, a selective RET inhibitor, in line with the patient’s molecular profile. Conclusions. This case illustrates the dynamic and multifaceted management required in MEN2A. Sequential use of RET inhibitors, tailored to molecular findings and toxicity profiles, may provide durable disease control and improve the quality of life in patients with advanced medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2A.

Keywords: multiple endocrine neoplasia type 2A, me­dul­lary thyroid carcinoma, pheochromocytoma, metastatic di­sease, surgery, selective RET inhibitors

 

 

Lung adenocarcinoma with EGFR exon 20 insertion mutation: clinical-molecular characteristics and therapeutic approach. Case report

Angi Tatarici¹, Cornelia Nițipir^1,2

1. Department of Medical Oncology, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania

2: Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

The pathogenic insertion variant of EGFR exon 20 accounts for 12% of all EGFR mutations and 0.8-1.2% of all molecular alterations identified in patients with non-small cell lung cancer (NSCLC). These mutations are reported more frequently in females, in never-smokers, and are predominantly associated with adenocarcinoma histology. From a therapeutic standpoint, most exon 20 mutations, with the exception of the S768I mutation, do not respond to tyrosine kinase inhibitors commonly used for classical EGFR mutations. In this context, amivantamab, a bispecific monoclonal antibody, represents a therapeutic option for patients who experience disease progression during or after platinum-based chemotherapy. We present the case of a 40-year-old female patient with ankylosing spondylitis diagnosed in December 2024 with invasive non-mucinous lung adenocarcinoma, T2N1M0. Extended molecular testing revealed a pathogenic insertion variant (A767_V769dup) in exon 20 of the EGFR gene, along with PD-L1 positivity (2-3%). In January 2025, the patient underwent a left upper lobectomy with mediastinal lymphadenectomy, followed by four cycles of chemotherapy with pemetrexed and cisplatin, and subsequent immunotherapy with pembrolizumab. In August 2025, the patient presented with follow-up CT findings showing nodular thickening of the left mediastinal pleura, a newly developed left pulmonary nodule (approximately 9 mm), and mediastinal lymphadenopathy, suggestive of secondary lesions. Consequently, a PET-CT was performed, confirming these findings and additionally identifying a bone lesion in the 6^th rib, consistent with disease progression. In this context, a new biopsy was performed, and the necessary steps were initiated to obtain amivantamab, as the patient met the eligibility criteria: the presence of an EGFR exon 20 mutation and disease progression following platinum-based chemotherapy. In conclusion, this case highlights the importance of extended molecular testing for individualized therapeutic management and underscores the need for access to modern targeted therapies.

Keywords: amivantamab, exon 20, pemetrexed, EGFR (epidermal growth factor receptor), tyrosine kinase inhibitors (TKIs)

 

 

Appendiceal mucinous adenocarcinoma with pulmonary lesion: a diagnostic dilemma

Bristena-Octavia Terţan

Regina Maria Health Network, Cluj-Napoca, Romania
 

Introduction. Appendiceal mucinous adenocarcinoma is a rare gastrointestinal malignancy with a tendency for peritoneal dissemination. The pattern of recurrence is often peritoneal, though rare distant sites (lung, bone, lymph nodes) have been reported even after long disease-free intervals. Metastatic spread may mimic a second primary tumor, posing significant diagnostic and therapeutic challenges. Case presentation. A 58-year-old female with a history of Crohn’s disease and appendiceal mucinous adenocarcinoma with peritoneal metastases and pseudomyxoma peritonei, treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) using cisplatin and mitomycin C in 2014, presented for routine follow-up. She reported dyspnea, and PET-CT demonstrated a 2-cm right upper lobe pulmonary nodule with mediastinal lymphadenopathy. Video-assisted mediastinoscopy and biopsy revealed adenocarcinoma negative for ALK rearrangement and EGFR mutation. The disease was staged as T1bN2M0, corresponding to stage IIB lung adenocarcinoma. She received four cycles of neoadjuvant cisplatin and pemetrexed, followed by right upper lobectomy. Follow-up imaging at six and 12 months showed no recurrence. However, two years postoperatively, PET-CT revealed peritoneal nodularity with increased metabolic activity along the right hemidiaphragm. Diagnostic laparoscopy confirmed recurrent mucinous adenocarcinoma consistent with the previous appendiceal primary. A multidisciplinary tumor board recommended systemic palliative chemotherapy with FOLFOX, resulting in stable disease and symptomatic improvement after six cycles. Conclusions. This case highlights the diagnostic difficulty in distinguishing metastatic appendiceal mucinous adenocarcinoma from primary pulmonary adenocarcinoma. Late metastases can closely resemble new primary tumors both radiologically and histologically. Molecular profiling, including assessment for KRAS, GNAS and TP53 mutations, combined with immunohistochemistry for CK7, CK20, CDX2 and TTF-1, can help clarify the tumor origin. Identification of shared molecular alterations can guide therapeutic decisions and avoid overtreatment. This case emphasizes the importance of integrating molecular pathology with imaging and multidisciplinary evaluation in managing complex metastatic mucinous neoplasms.

Keywords: appendiceal mucinous adenocarcinoma, lung adenocarcinoma, pseudomyxoma peritonei

 

 

Cemiplimab in advanced squamous cell carcinoma: from an ulcerated vegetant mass to sustained long-term remission

M.V. Timoftei, I. Andrei, M. Schenker

Medical Oncology Department, “Sf. Nectarie” Oncology Center, Craiova; University of Medicine and Pharmacy of Craiova, Romania
 

Objective. Advanced squamous cell carcinoma represents a major therapeutic challenge, particularly in patients with disease progression after conventional chemotherapy. We present a case, illustrating the long-term efficacy of cemiplimab immunotherapy. Materials and method. The patient, diagnosed with advanced squamous cell carcinoma, initially received standard chemotherapy, with documented disease progression during treatment. Subsequently, immunotherapy with cemiplimab was initiated in association with external radiotherapy. Clinical and imaging evolution was monitored through computed tomography (CT) and periodic clinical evaluations. Results. Baseline CT performed before the first administration of immunotherapy revealed a necrotic left submandibular mass measuring 3.2×2.5 cm, with minimal mandibular osteolysis and extension to the overlying skin and adjacent soft tissues, suggestive of an adenopathic block. After 12 months of immunotherapy combined with radiotherapy, imaging demonstrated the complete disappearance of the tumor mass, with persistence of fibrotic changes and residual edematous infiltration, but no evidence of progression. At 26 months after therapy initiation, the response remained sustained, with both clinical and radiological remission. The patient’s general condition improved significantly, with resolution of vertigo, ear pain and tinnitus during the past six months. Conclusions. This case highlights the remarkable potential of cemiplimab in achieving long-term remission in patients with advanced cutaneous squamous cell carcinoma refractory to chemotherapy. Anti-PD-1 immunotherapy can significantly alter the prognosis of such patients, providing durable clinical benefits and improved quality of life.

Keywords: squamous cell carcinoma, cemiplimab, immunotherapy, long-term remission

 

 

PD-L1 blockade and durable disease control in metastatic urothelial carcinoma

C.A. Tiron, Valentina Huțanu, O.D. Schreiner, Diana Petroiu

Medical Oncology Department, Regional Institute of Oncology Iași, Romania
 

Introduction. Urothelial carcinoma of the bladder is the most common form of bladder cancer, characterized by a high risk of recurrence and progression. In de novo metastatic disease, the prognosis remains poor, with a median overall survival of less than 15 months in the chemotherapy era. Anti-PD-L1 immunotherapy (atezolizumab) is approved in patients ineligible for cisplatin or after progression on platinum-based chemotherapy, representing a modern therapeutic option. We present a case with a sustained response and stable disease for more than five years under atezolizumab, in the context of cardiovascular comorbidities and complex urological impairment. Case presentation. A 71-year-old female, diagnosed in November 2019 with high-grade, infiltrative urothelial carcinoma (cT4aN2M1a, stage IVa due to retroperitoneal lymph node involvement), initiated first-line chemotherapy with carboplatin-gemcitabine. During treatment, she developed macroscopic hematuria, requiring hemostatic radiotherapy. The first imaging assessment revealed partial response at the bladder level, but progression in lymph nodes, prompting a treatment change. According to guidelines at that time, anti-PD-L1 therapy with atezolizumab was initiated. Under immunotherapy, the patient achieved a complete and durable response, maintained to date (approximately 62 months), with ECOG performance status 1. Multidisciplinary monitoring (oncology, urology, cardiology, endocrinology) allowed the continuation of treatment without major interruptions and with good quality of life, despite cardiovascular comorbidities and grade V left ureterohydronephrosis. Conclusions. This case illustrates the exceptional benefit of PD-L1 blockade in metastatic urothelial carcinoma, with survival significantly exceeding historical data. Moreover, it raises several clinically relevant points: the potential role of platinum rechallenge after a long treatment-free interval, the importance of monitoring and managing late toxicities of prolonged immunotherapy, and the availability of novel targeted agents such as enfortumab vedotin as valuable options in case of relapse.

Keywords: bladder cancer, immunotherapy, complete response

 

 

Symptomatic bone marrow metastasis in breast cancer: the experience of “Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca

R. Todea¹, T. Vancea², O. Bochiș¹

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

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

No clinical guidelines exist for the management of symptomatic bone marrow invasion due to breast cancer. The published data on the topic is scarce: only five retrospective studies have been published to date, between 22 to 67 patients being included. We designed a retrospective observational, single-center study that evaluates the clinical-pathological features and treatment efficacy for symptomatic bone marrow invasion in patients with breast carcinoma treated at the “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania. We included all patients with a histologically confirmed breast carcinoma diagnosis and bone marrow invasion which was demonstrated by bone marrow aspirate or bone marrow biopsy. Kaplan-Meier plots as well as univariate and multivariate Cox regression analysis were performed using SPSS version 20. A total of 19 patients fulfilled the inclusion criteria. Fifteen patients were hormone receptor positive, three had HER2 3+, and one had triple negative breast cancer. Eighteen patients presented with bone metastases. Median time to bone marrow invasion (TTI) was 14 months, the median survival since bone marrow invasion (SSI) was seven months (3-12), and the median overall survival (OS) was 27 months (23-31). Chemotherapy (CHT) treated patients had an SSI median of five months (1-11); hormone therapy – seven months (5-9); targeted therapy – 21 months. While the SSI difference between patients with early invasion versus late invasion was not significantly different (13 months versus 6 months; p=0.406), it had an impact on median OS (13 months versus 35 months; p=0.0001). Median OS for targeted therapy was 26 months, for chemotherapy – 30 months, and for hormone therapy – 27 months, although not statistically significant. While our study was too small to properly identify the best specific treatment, we show that survival is improved when patients are treated with targeted therapy when that is an option. We also show that bone marrow invasion carries the same negative prognosis, independently of TTI.

Keywords: breast cancer, bone marrow metastasis, time to invasion, survival since invasion, treatment efficacy

 

 

Long-term management of advanced melanoma in a young patient: from immunotherapy rechallenge to local control of brain metastasis

Diana-Elena Tomescu

“Sf. Nectarie” Oncology Center, Craiova, Romania
 

Introduction. Melanoma in young adults often presents with aggressive features and therapeutic challenges. This case portraits unique biological and therapeutic implications. For patients lacking actionable mutations, immune checkpoint inhibitors (ICIs) remain the cornerstone of systemic ther­apy, though optimal sequencing remains under investigation. Objective. To present the long-term management challenges of a young patient with advanced malignant melanoma, focusing on immunotherapy rechallenge and local control of brain metastasis. Materials and method. We describe the case of a 23-year-old male, diagnosed in 2017 with ulcerated cutaneous melanoma of the left arm (Clark III, Breslow 2.03 mm), surgically treated with axillary lymph node dissection. The patient subsequently received adjuvant nivolumab plus ipilimumab for one year in a clinical trial, achieving long-term disease control, with remission maintained for seven years. In 2025, the patient developed an isolated left frontoparietal brain metastasis, successfully resected neurosurgically. Molecular testing showed no BRAF, NRAS or C-KIT mutations. Restaging demonstrated mediastinal and hilar lymph node involvement, and the patient was included in a clinical trial with pembrolizumab. Results. The patient achieved durable clinical and biological disease control without significant immune-related adverse events. The combination of neurosurgical intervention with sequential immunotherapy contributed to prolonged survival and preservation of quality of life. Discussion. The combination of nivolumab and ipilimumab, administered within CheckMate 915 clinical trial, achieved long-lasting disease control, with remission maintained for nearly seven years, providing valuable insights into the potential of dual immune checkpoint blockade and durable response. The late relapse, manifested as an isolated brain metastasis, occurred seven years after treatment completion, illustrating the phenomenon of late progression in melanoma. The favorable response to subsequent and ongoing pembrolizumab therapy demonstrates the feasibility and clinical relevance of immunotherapy rechallenge, and reinforces the importance of clinical trials and individualized strategies in selected patients. Conclusions. This case highlights the therapeutic challenges of managing advanced melanoma in young patients lacking actionable mutations, underlining the role of immunotherapy rechallenge in association with local metastasis control.

Keywords: early-onset melanoma, advanced melanoma, brain metastasis, immunotherapy sequencing, multimodal management

 

 

Long-term response to nivolumab in recurrent nasopharyngeal carcinoma – clinical case

Nicoleta-Andreea Tudose

Oncology Department, Colțea Clinical Hospital, Bucharest, Romania
 

A 65-year-old woman with a medical history of hypertension and NYHA II heart failure was diagnosed in 2019 with non-keratinizing nasopharyngeal squamous cell carcinoma, stage T2N0M0 (stage II). She received concurrent chemoradiotherapy with cisplatin for six weeks, achieving a complete response on follow-up imaging. In 2022, she developed local recurrence and pulmonary metastases. Four cycles of gemcitabine plus cispla­tin were administered, but the disease progressed locally with invasion of the right orbit and frontal lobe, causing partial right-sided visual loss. The multidisciplinary tumor board recommended palliative radiotherapy for rapid local control, followed by systemic immunotherapy. Nivolumab 240 mg every two weeks was started, leading to a remarkable response, with major regression of the primary tumor and complete resolution of lung lesions, maintained for over two years. During treatment, she developed immune-related hypothyroidism and autoimmune diabetes, both well controlled. The patient continued nivolumab with a sustained partial response and preserved quality of life. In conclusion, this case illustrates that nivolumab can provide long-term benefit in recurrent nasopharyngeal carcinoma, a setting where data remain limited, emphasizing the value of multidisciplinary and individualized management.

Keywords: immunotherapy, nasopharyngeal carcinoma, immune-related toxicities

 

 

The effects of physical exercise in decongestive complex therapy in patients with secondary lymphedema after breast cancer

A.M.G. Țăranu^1,2, M.A. Chivu¹, I.B. Goga¹, C.A. Gogoreanu¹

1. Therapy for Movement Clinic, Bucharest, Romania

2. National University of Physical Education and Sports, Bucharest, Romania
 

Lymphedema is a frequent complication following breast cancer treatment, resulting from surgical lymph node removal or radiotherapy, and it has often a negative impact on patients’ physical and psychological well-being. Complex decongestive therapy (CDT), consisting of manual lymphatic drainage, compression, skin care and physical exercise, is currently regarded as the gold standard in lymphedema management. Among these components, physical exercise plays a crucial role in enhancing lymphatic circulation, reducing swelling and improving functional capacity. The aim of this paper is to highlight the importance of physical exercise following surgical intervention for breast neoplasm. The case study presents a 76-year-old patient who underwent a left breast mastectomy with lymphadenectomy in 2023. During the surgery, 17 lymph nodes were removed from the left axilla. The patient underwent eight preoperative chemotherapy sessions and 28 postoperative radiotherapy sessions. Based on the clinical examination and anamnesis, a management plan was established, involving the maintenance phase of complex decongestive therapy over a period of six months. The statistical analysis, correlated with a comparative analysis of data from the literature, highlighted that complex decongestive therapy has a significant impact on improving the quality of life of patients diagnosed with secondary lymphedema after breast cancer. By applying the original medical recovery protocol, a significant reduction in the circumference of the affected limb and an improvement in the range of motion were achieved. These results contribute to optimizing daily activities and increasing personal autonomy, thereby improving the quality of life.

Keywords: breast neoplasm, physiotherapy, decongestive therapy, physical exercise

 

 

Cardiotoxicity in oncology: classification, mechanisms, updated guidelines and integrated cardiological intervention

Petruța-Raluca Țui¹, Raluca-Alexandra Popescu^2,3, Elisabeta Bădilă^2,3

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

2. Cardiology Clinical Department, Colentina Clinical Hospital, Bucharest, Romania

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

Introduction. Cardiotoxicity has emerged as a pressing challenge in oncology, reflecting the growing use of anticancer agents with the potential to impair cardiovascular function. The spectrum ranges from biomarker elevation and subclinical dysfunction to overt heart failure, arrhythmias, ischemia, and hypertension. Classification considers timing, reversibility and pathophysiology. Novel agents, such as immune checkpoint inhibitors, introduce distinct immune-mediated and vascular mechanisms, underscoring the need for updated and nuanced definitions. Discussion. This paper synthesizes current knowledge by systematically categorizing major anticancer therapies and mapping mechanisms that underlie cardiotoxicity. For each drug class, complications, red-flag clinical features, and strategies for early recognition are detailed. Special focus is given to anthracyclines, the prototype of type I irreversible cardiotoxicity, with updated recommendations on baseline assessment, longitudinal surveillance, and cardioprotective strategies. Equally emphasized are non-anthracycline regimens (HER2-targeted therapies, tyrosine kinase inhibitors, immune checkpoint inhibitors), where rapidly evolving evidence has refined risk stratification, monitoring, and intervention. Integration of recent international guidelines highlights structured surveillance through imaging modalities, circulating biomarkers, and personalized preventive therapies. Beyond drug-specific recommendations, this work advocates for a proactive cardio-oncology model, fostering seamless collaboration between oncologists and cardiologists to balance therapeutic efficacy with cardiovascular safety. Conclusions. Advances in mechanistic insights, predictive biomarkers, and novel interventions are reshaping strategies to mitigate cardiotoxicity. Early identification, adherence to evidence-based guidelines and integrated cardiological care support a paradigm shift from late recognition to proactive prevention. Such an approach is pivotal to improving survival, long-term cardiovascular health, and quality of life in patients navigating cancer treatment.

Keywords: cardio-oncology, cardiotoxicity, chemotherapeutic agents, risk stratification, imaging

 

 

Surgical management of suspected isolated ipsilateral axillary recurrence in a patient
with invasive breast carcinoma and adjuvant chemoradiotherapy: a case report

C. Vîjîiac, A. Anica, Cătălina Bezărău

General Surgery Department, Oncofort Hospital, Bucharest; Radiotherapy Department, Amethyst Radiotherapy, Bucharest; Medical Oncology Department, Municipal Hospital Ploiești, Romania
 

Introduction. Isolated axillary recurrence of invasive ductal carcinoma after primary surgery with negative sentinel lymph nodes and adjuvant chemoradiotherapy is a rare event, occurring in fewer than 1% of cases. It is generally associated with an unfavorable prognosis, and there is currently no consensus regarding the optimal surgical management of the axilla. Materials and method. We present the case of a 52-year-old female patient previously diagnosed with left-sided invasive mucinous breast carcinoma. The initial diagnosis was established following a primary sector resection, with sentinel lymph node biopsy (SLNB) which was negative (three lymph nodes examined). Histopathology revealed a hypercellular, poorly differentiated tumor (G3), estrogen receptor-positive (ER 8/8), progesterone receptor-negative (PR 0/8), HER2 equivocal (2+), with a negative DISH test, Ki67 index of 20-25%, and an Oncotype DX score of 30. The patient underwent adjuvant radio-chemotherapy. During follow-up, a CT scan revealed a single left axillary lymph node measuring 20×16 mm. Axillary ultrasound confirmed a solitary lymph node without definitive signs of malignant invasion. Results. The multidisciplinary tumor board concluded that axillary lymph node dissection would be indicated only if axillary tumor recurrence was confirmed. Consequently, a magnetic marker (Magseed) was placed within the suspicious lymph node under ultrasound guidance, allowing for straightforward intraoperative detection. Targeted lymph node excision was performed using a magnetic detection system (Sentimag). Mammographic imaging of the excised specimen was obtained, followed by intraoperative frozen section examination, which revealed reactive lymphadenitis. Conclusions. This case illustrates the use of Magseed-guided targeted axillary dissection in a patient with invasive breast carcinoma and suspected isolated ipsilateral axillary recurrence. The technique successfully avoided unnecessary axillary lymph node dissection.

Keywords: isolated axillary recurrence, Magseed, targeted axillary dissection

 

 

Laparoscopic surgical treatment accompanied by sentinel lymph node biopsy for early-stage endometrial cancer – case series

C. Vîjîiac¹, Amedeia Niță², Pompilia Moțatu², Gabriela Niculai², Cătălina Bezărău²

1. Surgery II Department, “Dr. Constantin Andreoiu” County Emergency Hospital, Ploiești;

2. Medical Oncology, Municipal Hospital Ploiești, Romania
 

Introduction. Endometrial cancers are the most common type of gynecological cancer in Western countries. Total hysterectomy with bilateral salpingo-oophorectomy (THBSO) via laparoscopy, accompanied by pelvic sentinel lymph node biopsy (SLNB), has been the standard treatment for early uterine neoplasms since 2021, according to the NCCN guidelines and the 2022 ESMO guidelines. Materials and method. We analyzed a series of 16 consecutive personal cases, with patients aged between 55 and 78 years old, during the period of January 2025 to September 2025, diagnosed with early-stage endometrial cancers. The technical means employed included a laparoscope with a near-infrared light camera. One milliliter of indocyanine green (ICG) double dilution was injected at the 3 o’clock and 9 o’clock positions of the cervix. Results. Bilateral mapping was successful in 14 out of 16 cases, while in the other two cases, mapping was unilateral, accompanied by contralateral lymphadenectomy. The average duration of surgery was 85 minutes, with two cases requiring conversion due to the large size of the uterus. The average number of lymph nodes retrieved was 7.4. All lymph nodes were sent for frozen section examination, and no lymph node was found to be invaded. The average postoperative hospitalization duration was 2.4 days. No notable complications were observed. Conclusions. This refers to a small group of 14 out of 16 patients who underwent THBSO via laparoscopy with SLNB. The results are consistent with current guidelines and the specialized literature. This procedure is safe and effective in the treatment and staging of early-stage endometrial neoplasms.

Keywords: sentinel lymph node, laparoscopy, early-stage endometrial cancer

 

 

Local fasciocutaneous flaps and therapeutic mammoplasties – the end of the mastectomy era. Literature review and personal experience

C. Vîjîiac¹, Amedeia Niță², Pompilia Moțatu², Gabriela Niculai², Cătălina Bezărău²

1. Surgery II Department, “Dr. Constantin Andreoiu” County Emergency Hospital, Ploiești;

2. Medical Oncology, Municipal Hospital Ploiești, Romania
 

Introduction. Oncoplastic breast surgery has evolved considerably since the early 2000s, combining oncologic safety with esthetic outcomes. The adoption of therapeutic mammoplasties (TM) and, more recently, local fasciocutaneous chest wall perforator flaps (CWPF) has led to a significant global reduction in mastectomy rates, now below 20% in many centers. In Romania, however, mastectomy rates remain above 80%. Materials and method. We conducted a retrospective analysis of 52 consecutive patients diagnosed with invasive ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS), stages cT1-T4, cN0-N3 and cM0-M1, treated between October 2024 and September 2025. All patients were female, aged 36-84 years old, and underwent either primary or post-neoadjuvant surgery. Near-infrared (NIR) imaging was used for sentinel lymph node biopsy (SLNB) and flap perfusion assessment, while a magnetic detection system utilizing superparamagnetic iron oxide (SPIO) was used for SLNB, intraoperative localization of non-palpable lesions, and targeted axillary dissection (TAD). Results. A total of 32 therapeutic mammoplasties (30 IDCs and two DCISs), 12 local fasciocutaneous flaps (CWPF), and eight mastectomies (six IDCs and two DCISs) were performed. Two mastectomy patients underwent immediate reconstruction, one with a silicone implant and acellular dermal matrix (ADM) and one with a tissue expander. Axillary procedures included 35 SLNBs, two delayed SLNBs, one TAD and 17 axillary lymph node dissections. Overall, 84% of procedures were oncoplastic. Conclusions. Our results demonstrate that the majority of breast cancer surgeries can now be safely managed through oncoplastic approaches, with excellent oncologic control and esthetic outcomes. The integration of therapeutic mammoplasty and local fasciocutaneous flaps significantly reduces the need for mastectomy, supporting the global shift toward breast conservation.

Keywords: oncoplastic surgery, therapeutic mammoplasty, fasciocutaneous flaps, mastectomy, breast cancer

 

 

Delayed sentinel lymph node biopsy using superparamagnetic iron oxide in ductal carcinoma
in situ surgery – case report

C. Vîjîiac¹, Cătălina Bezărău²

1. Surgery II Department, “Dr. Constantin Andreoiu” County Emergency Hospital, Ploiești, Romania

2. Department of Medical Oncology, Municipal Clinical Hospital Ploiești, Romania
 

Introduction. Sentinel lymph node biopsy (SLNB) is the most commonly used method for axillary evaluation in cases of invasive ductal carcinoma, but it is often unnecessary (in 80% of cases, according to literature) in patients with ductal carcinoma in situ (DCIS), suspicious radiologic lesions with multiple negative biopsies, or those undergoing prophylactic mastectomy (e.g., BRCA carriers). Delayed sentinel lymph node biopsy (dSLNB) – performed 30 days after injection (concomitant with the breast surgery, SPIO persists for at least 30 days in the sentinel node) – allows for axillary staging only when the presence of invasive ductal carcinoma is confirmed histopathologically. Materials and method. A 46-year-old female patient presented with a tumor in the right breast, involving the upper quadrants, with a mixed content (3/2/4 cm), radiologic features (MRI, mammography and breast ultrasound) classified as BIRADS 4, with ultrasound-guided breast biopsy positive for DCIS. Surgical excision with clear margins was decided, along with injection of superparamagnetic iron oxide (SPIO). On 4 August 2025, 0.5 ml of SPIO was injected peritumorally. On 8 August 2025, surgery was performed, including tumor resection with “batwing” type therapeutic mammoplasty. Results. Histopathological result: besides DCIS, an area of invasive ductal carcinoma measuring 0.7/0.9 cm, grade G1, was detected, with immunohistochemistry in progress. On 28 August 2025, dSLNB was performed using a magnetic probe and indocyanine green (ICG). Three axillary lymph nodes were identified (two both tracers, one only with SPIO), with histopathological examination in progress. Conclusions. Numerous studies confirm that delayed sentinel lymph node biopsy with SPIO is a safe and effective method that reduces unnecessary axillary interventions and associated morbidity. Furthermore, superparamagnetic iron oxide may persist inside the lymph node for more than six months, making it ideal to inject before neoadjuvant treatment.

Keywords: sentinel lymph node biopsy, ductal carcinoma in situ, superparamagnetic iron oxide

 

 

Borderline ovarian tumors: diagnosis and proposal of an optimized algorithm

Mariana Vîrlan

Department of Oncology, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău; Institute of Oncology Chișinău, Republic of Moldova
 

Borderline ovarian tumors (BOTs) represent a distinct pathological entity, situated between benign and malignant ovarian neoplasms. They are characterized by epithelial proliferation with nuclear atypia in the absence of stromal invasion. Accurate diagnosis is essential to avoid overtreatment and to preserve fertility, especially in young women. This retrospective-prospective study included 78 patients diagnosed with BOTs, investigated between 2015 and 2021 at the Institute of Oncology Chişinău and the “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova. Clinical, imaging (ultrasound, MRI), histopathological and immunohistochemical (Ki67, p53, ER, PR, CA-125) data were analyzed. Serous tumors predominated (70.5%), followed by mucinous (25.6%) and mixed forms (3.9%). Correct MRI diagnosis was established in 82% of cases, while CA-125 levels were elevated in 64.7% of patients. Ki67 expression above 15% was associated with an increased risk of recurrence (p<0.05). Based on the correlation of these data, a differential diagnostic algorithm was developed, adapted to patient age and immunohistochemical profile. The diagnosis of BOTs requires a multidisciplinary approach, combining clinical, imaging and morphological data. The proposed algorithm may contribute to accurate staging, personalized treatment and fertility preservation in selected patients.

Keywords: borderline ovarian tumors, differential diagnosis, imaging, immunohistochemistry, fertility

 

 

Solitary colon metastasis of renal cell carcinoma: an unusual site of metastasis

C. Volovăţ, A. Hordilă, Diana-Alexandra Sava

Victoria Hospital – Euroclinic Oncology Center, Iaşi; Regional Institute of Oncology Iaşi, Romania
 

Objective. Renal cell carcinoma (RCC) is a rare tumor that comprises only 3% of adult cancers, while renal parenchymal tumors constitute 85% of all RCC cases. RCC frequently metastasizes to the lungs, bones, brain or liver; however, the gastrointestinal tract, particularly the colon, is an unusual location for metastasis. There are few cases reported in literature involving RCC metastasis to the colon. The commonly affected areas within the colon include the rectosigmoid colon, the splenic flexure and the transverse colon. Materials and method. We present the case of a 65-year-old patient, nonsmoker, who presented in October 2019 for macroscopic hematuria for which he underwent CT examination, that showed a left kidney mass. Left radical nephrectomy was performed, with the result of clear cell renal carcinoma. CT examination revealed no signs of local tumor recurrence, tumor remnant or distant secondary determinations. After three years, the patient had digestive symptoms, with intestinal transit disturbances. Colonoscopy showed narrowing of the lumen, and suggested extrinsic infiltration. He underwent surgery for the colonic tumoral formation, that confirmed metastasis of renal cell carcinoma. In October 2022, a CT scan revealed pulmonary nodules. Treatment was initiated with avelumab and axitinib in 2022, and for the moment, in 2025, the patient has stable disease with avelumab monotherapy. Results. Cases of colonic metastasis following resection of a renal cell carcinoma are uncommon in the literature, and their location can be very varied. Recurrence of RCC is frequently seen during the first three postoperative years. Conclusions. This case is a good example for young oncologists and not only, because, although very rare, metastatic renal cell carcinoma should be kept in the differential diagnosis of patients with lower gastrointestinal symptomatology, with a prior history of kidney mass or nephrectomy.

Keywords: colon, metastasis, renal cell carcinoma, ne­phrectomy

 

 

When signs mislead: leptomeningeal metastasis with equivocal imaging – a case series

Rareș Vrîncianu¹, Raluca Pătru¹, Florian Antonescu², Teodora Micu¹, Ivona Măriuță¹

1. Colțea Clinical Hospital, Bucharest, Romania

2. National Institute of Neurology and Neurovascular Disease, Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

Introduction. Leptomeningeal metastasis (LM) is a rare but severe complication of solid malignancies, most frequently from breast and lung cancers. Its heterogeneous clinical presentation, limited sensitivity of even advanced neuroimaging, and lack of randomized trials guiding therapy make LM a major diagnostic and therapeutic challenge. This case series illustrates the diverse clinical manifestations and management difficulties encountered in leptomeningeal metastasis. Case presentations. We report three patients with LM confirmed by positive cerebrospinal fluid (CSF) cytology and elevated opening pressure on lumbar puncture, but with equivocal or normal neuroimaging. Case 1. A 38-year-old woman with HR-positive, HER2-low metastatic breast cancer, with multiple previous lines of systemic treatment, developed progressive visual disturbances, leading to complete blindness. A normal 1.5T MRI was followed by a 3T MRI, suggesting leptomeningeal metastasis, confirmed cytologically. The disease was controlled by radiotherapy and systemic treatment. Case 2. A 74-year-old patient with HR-positive, HER2-negative metastatic breast cancer presented with sudden dysphonia progressing to complete vocal cord paresis, speech impairment and dysphagia. Both 1.5T and 3T MRI scans were normal. The disease rapidly progressed with cranial nerves palsies. Case 3. A 52-year-old patient with non-squamous NSCLC (PD-L1 70%; KRAS G12C) and multiple comorbidities presented with meningeal irritation (photophobia, neck stiffness) and intracranial hypertension (headache, jet vomiting). The symptoms initially improved with corticosteroids, then relapsed with seizures, including opisthotonus. Symptomatic relive was achieved with radiotherapy. Conclusions. These cases highlight the diagnostic and therapeutic complexity and variability of leptomeningeal metastasis, where neurological symptoms may precede or contradict imaging findings. All patients showed elevated cerebrospinal fluid pressure, without ventricular dilatation or cerebral edema, underscoring the central role of CSF cytology in diagnosis and the limitations of neuroimaging in detecting leptomeningeal metastasis.

Keywords: leptomeningeal carcinomatosis, neuroimaging limitations, clinical-paraclinical discordance, CSF cytology

 

 

Chemotherapy-induced cardiotoxicity in colorectal cancer: a dual case report

A. Zaiț¹, O.C. Voinea², C.M. Orlov-Slavu¹, C. Nițipir¹

1. Oncology Department, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania

2. “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
 

Objective. Cardio-oncology is an emerging discipline, aiming to identify and manage cardiovascular complications associated with oncological therapies. We present two clinical cases of chemotherapy-induced (bevacizumab, 5-fluorouracil) cardiovascular complications in patients with colorectal cancer, the most common cancer in both sexes in Romania. Materials and method. We present two clinical cases of cardiovascular complications induced by chemotherapy in colon cancer patients. Clinical and paraclinical aspects were evaluated, as well as disease evolution under multidisciplinary treatment, both oncological and cardiological. Results. A 72-year-old female with metastatic invasive right colon adenocarcinoma (cT4b, cN2b, cM1c) and controlled grade II hypertension was treated at the “Agrippa Ionescu” Hospital, Bucharest, Romania, with mFOLFOX6 and bevacizumab (5 mg/kg every two weeks). After five cycles of treatment, the patient developed severe hypertension (>180/100 mmHg) attributed to bevacizumab’s inhibition of vascular endothelial growth factor (VEGF), leading to reduced nitric oxide production and increased vascular resistance. Due to uncontrolled hypertension, bevacizumab was temporarily discontinued to stabilize blood pressure. Central antiadrenergic therapy controlled her blood pressure, allowing continued oncological treatment. The second case refers to a 63-year-old male with rectosigmoid adenocarcinoma (ypT3, ypN1a, R1), previously treated with neoadjuvant radiotherapy (2019), surgery (2020) and mFOLFOX6 (2022), who presented with local recurrence and metastases (M1 LYM, M1HEP, M1 OTH-intestinal) by December 2024. After palliative radiotherapy (25 Gy, May 2025), he received FOLFIRI + panitumumab. During the third cycle, he suffered a syncopal episode, diagnosed as anteroseptal STEMI with severe systolic dysfunction (ejection fraction 30%) and valvular regurgitation, likely due to 5-fluorouracil-induced coronary vasospasm. He required intensive care, with mechanical ventilation and transfer to the “Carol Davila” Cardiology Center, where angiography identified normal coronary arteries. Conclusions. These cases highlight the challenges of cardio-oncology in daily practice, where cardiotoxicity may jeopardize the oncological treatment of colorectal cancer. A multidisciplinary approach ensures risk reduction, treatment continuity and improved overall outcomes.

Keywords: cardio-oncology, colorectal cancer, cardiotoxi­city, bevacizumab, STEMI