Journal d'oncologie intégrative

Introduction and objective: The aim of the study was to evaluate usefulness of 3-D models utilizing generated incremental techniques from thermoplastic materials in mandibular reconstruction with utilization of free osteocutaneous fibular and scapular flaps. Methods: 12 patients were treated due to an advanced oral cavity squamous cell carcinoma (T4b). In four patients with a mandibular defect a physical 3-D model consisting of the reconstructed and unaffected sites was prepared for a reconstruction protocol. The 3-D models were designed based to high resolution CT scans. Results: Assessment of comparative functionality (stability of junction, mobility, mastication ability), and cosmetics was examined in both groups, following an 8- week healing period. Conclusion: Applying 3-D models for mandibular manufacturing using a three dimensional printing technologies allows for obtainment of better functionality of restored mandible in comparison to the traditional method. Utilization of mandibular and fibular model significantly decreases time of the operation and allows for achievement of desired shape and esthetic effect within the 1/3 of the lower face.

Objective: Malignant melanoma with brain metastases is associated with a higher risk of death. No specific treatments were demonstrated to be useful in a such situation. Drugs as temozolomide orally or new targeted treatments showed significant objective response rates, even complete regression. Such responses could be obtained using new strategies based on dynamic changes over time of some molecular markers. Elements of ethics should be taken into account in order to adapt treatment and avoid resistance. Methods: The case of a 59-year old male with a primary cutaneous melanoma of the trunk, treated at Cancer Institute “Ion Chiricuta” from August 2001 is presented. After multiple loco-regional relapses, the patient developed brain metastases and started temozolomide 150 mg once daily, five days, every 4 weeks, 6 cycles with concurrent whole brain external radiotherapy. Comparative immunostaining including proliferation and pro-apoptotic molecular markers between the initial diagnosis (2001), before (2005) and after (2008) temozolomide treatment was performed. Result: Nine months after the start of temozolomide treatment, complete response was confirmed by magnetic resonance imaging. Overall cancer specific survival was 41 months. Ki-67, cyclin E, HMB-45 expression and Bax/ Bcl-2 ratio increased during almost 10 years of treatment and follow-up. Bcl-2 staining was absent at the last analysis. Only p53 and Bax expression doesn't changed during treatment. Conclusion: It seems that metastatic melanoma cells lost some of pro-apoptotic markers and overexpressed markers of proliferation. Predictive markers of response and resistance were actively identified; their combination and dynamic over time could help the oncologist to select those metastatic patients with highest chances of response. Dynamic changes of these molecular markers would guide treatment and the overall core strategy. Serial biopsies and tissue analyses become a challenging ethical issue. Empiric treatments based on a unique tumor signature should be modified using an adaptive approach.

Objective: The accurate estimation of outcome in postoperative breast cancer patients is an essential component of the individualized treatment, decision-making, and patient counseling processes. The disease outcome and prognosis of breast cancer patients may vary according to geographic and ethnic factors. To clarify this topic, we created a new prognostic and predictive model for breast cancer patients, based on clinical and pathological variables. Study design and setting: Clinical and pathological data were collected from 1587 patients with breast cancer who underwent surgical intervention. A survival prediction model was used to allow the analysis of the optimal combination of variables. The area under the receiver operating characteristic (ROC) curve, as applied to an independent validation data set, was used as the measure of accuracy. Results were assessed by comparing the area under the ROC curve with the SEER database. Results: Our predictive model of survival predicted disease outcome for individual patients with breast cancer. The comparison between our predictive model and SEER databases showed that our model underestimated outcome in the SEER cohort and that the SEER model overestimated outcome in our breast cancer patients. Conclusion: Our model may present an alternative as personalized prognostic tool for breast cancer patients. Decision regarding the survival prediction should take every consideration about regional and racial factors into account.

Background: Quality of life (QoL) is an important factor for the cancer patients after treatment. The study aimed to investigate QoL and sexual activity in patients who had undergone stereotactic hypofractionated radiotherapy (HRT). Methods: The analysis included 82 prostate cancer patients: 40 patients treated by HRT (33.5 Gy in 5 fractions) and 42 patients treated by standard three-dimensional conformal radiation treatment 3DCRT (70-82 Gy in 35-41 fractions); and 50 healthy men without any type of cancer. The subjects filled out the questionnaires: EORTC QLQC30 (version 3.0.) and the prostate cancer-specific EORTC QLQ-PR25. The median follow-up was 21 months for HRT patients and 28 months for 3DCRT patients. Results: The tolerance for stereotactic HRT was shown to be good. The QoL and the general health status of HRT patients were higher than of 3DCRT patients and even of healthy men. Most patients treated by HRT felt that they had lost their masculinity. However, they were still interested in having sex; one third of them were sexually active, most reported satisfaction with their sex life. Conclusions: HRT for prostate cancer patients was an attractive treatment in relation to patients' QoL assessment in the short term analysis.