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Abstract

Introduction. The issue of depression in the context of cancer is a very important and complex problem. Suffering from depression and cancer at the same time concerns from 20% to 80% of the patients.

Aim. Assessment of depression occurrence among oncological patients depending on the profile of the disease.

Material and methods. The research group consisted of 63 oncological patients. Diagnostic poll method, survey technique was used. Occurrence and intensity level of depression symptoms were measured according to the Beck Depression Inventory (BDI) which was accompanied by the authorial questionnaire analyzing socio-demographic situation of the surveyed as well as the cancer profile i.e. type of cancer, ailments accompanying the disease and the frequency of their occurrence, undertaken therapies and their results.

Results. The analysis conducted with the help of BDI questionnaire presented the following results: more than half of the surveyed (54%, n=34) suffered from moderate depression and roughly 1/10 (n=7) of the surveyed suffered from severe depression. Only 1/3 (n=22) of the surveyed showed no signs of depression and complained only about low mood. Side effects of the treatment preventing patients from everyday functioning determined the occurrence of depression symptoms. Severity of cancer symptoms, duration of illness, time of diagnosis and number of attempts to fight the disease had no influence on the occurrence of depression symptoms.

Conclusions. Cancer influences every part of a patient’s life. Because of this, a holistic approach should be applied when treating such patients and that approach should be based on cooperation of doctors with clinical psychologists.

4 Romanian Journal of Orthopaedic Surgery and Traumatology 2018; Special Issue 1 ROMSOS, SROA © 2018 MANAGEMENT OF BREAST CANCER PATIENTS AND BONE METASTASES AT THE TIME OF DIAGNOSIS AND DURING ONCOLOGICAL MONITORING doi: 10.2478/rojost-2018-0015 C.B. Coroleucă1,2, C.P. Brătilă2,3, C.A. Coroleucă1,2, D. Comandașu1,2, D. Mihai1,2, A. Nastas1,2, E. Brătilă1,2 1”Prof. Dr. Panait Sârbu” Clinical Hospital of Obstetrics and Gynecology, Bucharest 2“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3Euroclinic Minimally Invasive Surgery Hospital

longer be considered an inevitable side effect of the disease, rather than a foreseeable and reversible occurrence. Consequences of weight loss have a remarkable effect on the patient’s health causing an increased toxicity on healthy cells and making tumoral cells more resistant to the treatment [ 3 ]. At the same time, the immune defense’s weakening increases the frequency of hospital stays and worsens prognosis, elevating the death rate. Malnutrition in oncologic patients is remarkable [ 4 ] because of the multiple and serious consequences associated with the illness

Summary

We aimed to compare results between patients with early- stage prostate cancer who underwent robot-assisted and open radical prostatectomy. We examined preoperative and postoperative data, early and late complications, and analysed oncological and functional outcomes (continence and erectile function) during follow-up.

We studied the data of 123 patients with localized prostate cancer, operated with nerve-sparing retropubic radical prostatectomy, divided into two groups. Group 1 included 70 patients who underwent robot-assisted radical prostatectomy (RARP). Group 2 included 53 patients, on whom open retropubic radical prostatectomy (RRP) was performed. We compared preoperative data, complications rate, oncological, and functional outcome (continence and erectile function) during the follow-up period.

Operative time was significantly lower in the RRP group. Blood loss and earlier removal of the urinary catheter were significantly lower in the RARP group. The percentage of significant postoperative complications (Clavien-Dindo III-IV) was 0% in the first group and 3% in the second group. During follow-up, the improvement in the functional outcome - continence and erectile function was significantly better in the robot-assisted surgery patients.

There were statistically significant better functional outcomes in patients operated on using the robot-assisted technique. The operating time was shorter in the classic radical prostatectomy. The application of robot-assisted radical prostatectomy may help achieve earlier recovery, as compared to open radical prostatectomy.

Problematika Visokih Odmerkov Metotreksata pri Onkoloških Bolnikih

Izhodišča: Metotreksat v visokih odmerkih je edini citostatik v onkologiji, ki mu rutinsko določamo serumske koncentracije, saj je v visokih odmerkih potencialno smrten. Uporablja se za zdravljenje osteosarkomov in ne-Hodgkinovih limfomov. Ker so bile serumske koncentracije metotreksata pri bolnikih na Onkološkem inštitutu pogosto povišane, nas je zanimalo, kateri parametri jih zvišujejo.

Bolniki in metode: V analizo smo vključili vse bolnike, ki so v enem letu prejeli metotreksat v visokih odmerkih, ne glede na to, ali so bile serumske koncentracije metotreksata povišane ali normalne. Gre za 20 bolnikov, ki so skupaj prejeli 55 visokodoznih terapij metotreksata. Pregledali smo, ali na serumske koncentracije metotreksata vplivajo parametri, kot so proizvajalec metotreksata, pripravljalec infuzije, indeks telesne mase, starost pacienta, očistek kreatinina, ocenjeni očistek kreatinina, pH urina, sočasna kemoterapija s prokarbazinom, sočasna terapija z omeprazolom, acetilsalicilno kislino in nesteroidnimi antirevmatiki. Medsebojne vplive smo statistično ovrednotili s X2-testom.

Rezultati: Med 55 visokoodmernimi terapijami smo pri 28 terapijah ugotovili vsaj eno povišano koncentracijo metotreksata. Ugotovili smo, da so bile koncentracije metotreksata v serumu bolnikov z limfomi značilno povišane pri starejših bolnikih, pri bolnikih z višjim indeksom telesne mase, z očistkom kreatinina pod 100ml/min, in v primeru, da so bolniki sočasno z metotreksatom jemali prokarbazin ali omeprazol.

Zaključki: Da bi se izognili neželenim učinkom visokoodmerne kemoterapije, bi bilo treba skrbno prilagoditi visoki odmerek metotreksata glede na pomembnejše dejavnike, ki lahko zvišajo njegovo koncentracijo, in preprečiti interakcije z drugimi zdravili.

Abstract

Cancer is becoming a major public health issue as patients enjoy longer survivals than ever before due to the introduction innovative but expensive drugs in the clinic. In addition, the ageing of the population in Greece is expected to increase the absolute incidence of cancer. The National Health System should rapidly and efficiently adapt to the new challenges, including increased pharmaceutical costs. Resources ought to be allocated rationally and efficiently while maintaining adequate coverage for the insured population. Economising due to large-scale operations should be pursued by the governmental single payor (EOPYY), so that affordable coverage remains feasible. Establishment of mechanisms to deal with new and very costly drugs should be put in place. The major changes in anchor oncologic hospitals are needed in order to play a role as regional leaders in oncologic care, including merging of similar divisions, subspecialisation of services and promotion of clinical research. These major centres could coordinate a host of satellite oncology services in other urban hospitals and in the provinces. In addition, joint operations in training and patient care should be pursued with major private centres, without mutual mistrust or obsolete inflexibilities. The current financial crisis represents an excellent opportunity for revisioning and restructuring oncologic care in Greece, taking into account the societal needs and based on flexibility and efficiency.

training phase is required, which requires sufficient computational power and large datasets. The latter is obtained from radiological images, which is in the domain of radiomics. Radiomics is a process of quantitative extraction of a high number of semantic and agnostic features from diagnostic images. 9 Its approaches, like feature extraction and feature engineering techniques, are essential in the formation of AI applications. 10 Artificial intelligence in cancer imaging (oncologic radiology) Until recently, radiologists’ decisions were based predominantly on his or

Abstract

Introduction. Skin toxicity in patients receiving novel therapeutic cancer agents has become a very important marker in determining drug activity, but it can also severely impact their quality of life. About half of the patients receiving this type of oncologic treatment will develop cutaneous reactions, that is why adequate understanding and management of these side effects is very important for drug adherence and patients’ quality of life.

Materials and methods. We conducted a prospective study of consecutive patients who received oncologic treatment in our institution and presented with dermatologic side effects. The severity of skin toxicity was assessed using the DLQI score and patients were prospectively followed to evaluate response to therapy. Univariate analysis of factors influencing the impact of skin toxicity on patient QOL was conducted.

Results. 52 patients were enrolled in the study. Patients who developed grade 3 and 4 skin toxicity had a higher DLQI score, with a greater impact on quality of life, but with better clinical outcome at 3 months follow-up, based on RECIST. Patients with moderate or severe cutaneous AE were more likely to achieve complete or partial response to therapy than those with mild AE (16/33 vs. 3/19, p = 0.035). Interestingly, female patients had a significantly poorer quality of life than male patients as assessed by the DLQI score (7.28 ± 7 vs. 3.7 ± 3.6, p = 0.038).

Conclusion. Cutaneous side effects are often encountered in cancer patients and their severity can be a surrogate marker for a positive clinical tumor response to therapy.

40 Romanian Journal of Orthopaedic Surgery and Traumatology 2018; Special Issue 1 ROMSOS, SROA © 2018 PERSONALIZED SURGICAL PLANNING – THE USE OF 3D PRINTING IN ONCOLOGICAL PATHOLOGY doi: 10.2478/rojost-2018-0051 E. Liciu1,2, B. Frumuşeanu1,2, B.M. Popescu2, D.C. Florea2, L. Niculescu2, A. Ulici1,2 1“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Emergency Hospital for Children, Bucharest, Romania Introduction. Among the cases of malignant tumors, gathering 30% of them

Abstract

Background. Thrombotic events, arterial or venous in origin, still remain a source of substantial morbidity and mortality in cancer patients. The propensity for their development in oncology patients is partially a consequence of the disease itself and partially a result of our attempts to treat it. One of the rarest and deadliest thromboembolic complications is arterial mesenteric ischemia. The high mortality rate is caused by its rarity and by its non-specific clinical presentation, both of which make early diagnosis and treatment difficult. Hence, most diagnoses and treatments occur late in the course of the disease. The issue survivors of arterial mesenteric ischemia may face is short bowel syndrome, which has become a chronic condition after the introduction of parenteral nutrition at home.

Case report. We present a 73-year-old rectal cancer patient who developed acute arterial mesenteric thrombosis at the beginning of the pre-operative radiochemotherapy. Almost the entire length of his small intestine, except for the proximal 50 cm of it, and the ascending colon had to be resected. After multi-organ failure his condition improved, and he was able to successfully complete radical treatment (preoperative radiotherapy and surgery) for the rectal carcinoma, despite developing short bowel syndrome (SBS) and being dependent upon home-based parenteral nutrition to fully cover his nutritional needs.

Conclusions. Mesenteric ischemia and resultant short bowel syndrome are not absolute contraindications for radical oncological treatment since such patients can still achieve long-term remission.