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Introduction and Literature Review: Pancreatic cancer is often diagnosed in an advanced/metastatic stage, as it is a very aggressive type of cancer. The prognosis of pancreatic cancer is extremely unfavorable. The mean survival rate for patients with metastatic pancreatic adenocarcinoma is 3–6 months. Stage IV pancreatic cancer has a five-year survival rate of 1.3% to 13%. This article presents recent data regarding the oncologic management of metastatic pancreatic cancer. Case presentation: We present the case of a female patient who was 49 years old at the time of diagnosis, in June 2021. The patient was diagnosed with stage IV pancreatic neoplasm (due to liver metastases). The diagnosis was made by histopathological and immunohistochemical examination, which corroborated imaging investigations. The patient underwent four lines of chemotherapy between July 2021 and July 2024, undergoing partial response to the disease. The patient is a long-term survivor of metastatic pancreatic cancer (3 years in July 2024). Discussions: the peculiarity of this case is long-term survival (3 years and a month at the date when this article is being written) in a patient with pancreatic cancer and liver metastases. Conclusions: histopathological type, good performance status, CEA, and CA tumor markers 19.9 within normal limits may be favorable prognostic factors for long-term survival in metastatic pancreatic carcinoma. [ABSTRACT FROM AUTHOR]

Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these psychoemotional symptoms affect the patients' quality of life. Objective: This research seeks to identify correlations both between anxiety and depression and the patients' performance statuses, as well as between anxiety and depression and the type of treatment: radiotherapy, chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy and palliative care. Materials and Methods: The study evaluated 105 patients with lung cancer from two oncologic centers. Patients were assessed for anxiety and depression using the questionnaire Hospital Anxiety and Depression Scale (HADS). The HADS is a self-report rating scale of 14 items. It measures anxiety and depression, and has two subscales. There are seven items for each subscale. There are 4-point Likert scale ranging from 0 to 3. For each subscale, the score is the sum of the seven items, ranging from 0 to 21. Results: The most powerful correlation with statistical significance was observed between the IT type of treatment (immunotherapy) and the normal level of anxiety, PC = 0.82 (p < 0.001) as well as the normal level of depression. Palliative treatment was correlated with anxiety and depression, both borderline and abnormal. For ECOG 3–4 performance status and abnormal anxiety, respectively, abnormal depression was significantly associated. Also, continuous hospitalization was associated with abnormal anxiety and depression. Conclusions: Early assessments of anxiety and depression are necessary in patients with advanced and metastatic lung cancer, with unfavorable performance status, who have been admitted to continuous hospitalization, and who require palliative care. [ABSTRACT FROM AUTHOR]

Introduction: Patients with non-small cell lung cancer (NSCLC) and brain metastatic disease have an unfavorable prognosis. The goal of the treatment in stage IV NSCLC is to increase the survival rate and to improve the quality of life. Case report: We present the case of a young male patient (47 years old at the time of diagnosis in 2021) with NSCLC stage IV with the onset of the disease through neurological symptoms determined by brain metastasis. The immunohistochemical result raised problems of differential diagnosis. The complete favorable response was obtained 20 months after the initiation of second-line immunotherapy, maintaining this response 6 months later. Discussion: The therapeutic approach for the second-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) without mutations has been revolutionized by the approval of immune-checkpoint inhibitors (ICIs). The combination of radiotherapy and immunotherapy can increase the abscopal phenomenon by the stimulation of an immune response against tumors at distant sites, outside the radiation field, as recent studies suggest. Conclusions: Second-line immunotherapy is beneficial to the survival of patients with NSCLC with disease progression beyond initial chemotherapy. The combination of radiotherapy and immunotherapy has the potential to play an important role in metastatic NSCLC. [ABSTRACT FROM AUTHOR]

This article, published in the Romanian Journal of Oral Rehabilitation, discusses the principles of specific treatment and palliative care in advanced head and neck cancer. It emphasizes the challenges faced by medical teams in managing advanced cases and highlights the importance of a multidisciplinary approach and empathic connection between the medical team, patients, and their families. The article also addresses the impact of late diagnosis and the complexity of multimodal oncological treatment. It provides a case study of a patient with pharyngolaryngeal squamous cell carcinoma and reviews recent articles on chemotherapy, radiotherapy, immunotherapy, and palliative care for head and neck cancers. The text concludes by emphasizing the need for collaboration between clinicians and addressing both the scientific and emotional aspects of treatment. This comprehensive article offers valuable insights for researchers and healthcare professionals interested in head and neck cancer management. [Extracted from the article]

We present the case of a patient who was diagnosed in 2018 with nodular Malignant Melanoma (MM) without BRAF V 600 mutations stage 3 C (pT4b pN1a M0), and who underwent adjuvant citokines treatment with Interferon alpha 2b-48 weeks. Immunotherapy was initiated in January 2021 for lung and lymph node metastases. In June 2021, there was a partial response of the lung and lymph node metastases, but there was also progression to brain metastases. Immunotherapy was continued and Whole Brain Radiotherapy (WBRT) was performed. In September 2023, the imaging investigations revealed a favorable response, with no lesions suggestive of secondary determinations. The combination of Radiotherapy (RT) and Immunotherapy (IT) with Immune Checkpoint Inhibitors (ICI) has an abscopal effect. There is a coordinated action in the combination of RT and IT in order to obtain a common result, with the antitumor effect being greater than if RT or IT acted separately. [ABSTRACT FROM AUTHOR]

Endometrial stromal sarcoma (ESS) is a rare tumor, predominantly occurring as a primary tumor of the uterus. Rare cases of primary extrauterine ESS (EESS) have been reported. Low-grade ESS (LG-ESS) is more common than high-grade ESS (HG-ESS). We present five cases of ESS and one case of EESS. All cases received external radiotherapy (EBRT) at the Radiotherapy Department of the Emergency Clinical Hospital 'Sfantul Apostol Andrei' Galati, during 2004-2020. Five cases underwent EBRT in two-dimensional (2D) technique and only one patient received EBRT with three-dimensinal conformational radiotherapy (3DCRT) technique with a linear accelerator, Elekta Synergy. Five patients were referred to postoperative radiotherapy after hysterectomy. The median age of the patients was 57.4 years. One patient was referred to radiotherapy with palliative intent. EESS localized in the retroperitoneum, in the para-aortic region, was identified in one 64-year-old patient with a personal history of hysterectomy and bilateral salpingo-oophorectomy in 1997; EESS was complicated with vertebral extension at the L1-L2 level and spinal cord compression syndrome. ESS represents a rare diagnosis and a high- or low-grade tumor profile is distinguished by immunohistochemistry (IHC) tests. Up to 30% of patients have EESS at presentation. The treatment of ESS is multimodal, its management requiring a multidisciplinary team, and it is different according to the primary tumor location and tumor staging. The role of adjuvant radiotherapy remains controversial in high-grade EESS and due to the rarity of these cases there are limited data concerning the efficacy of adjuvant EBRT available from prospective randomized control clinical trials. [ABSTRACT FROM AUTHOR]

Cervical cancer still represents an important cause of morbidity and mortality, with all the progress achieved in screening, prevention, diagnostic and treatment. Concomitant chemoradiotherapy brings a benefit in the survival of cervical cancer patients. The standard treatment in stages IB2 – IVA consist in concomitant platinum chemotherapy and radiotherapy followed by brachytherapy, preferable image­guided (IGBT). The poor prognostic is correlated with tumor characteristics (dimensions more than 4 cm), histology, lymphovascular space invasion, and regional lymph node invasion. We present the case of a 42­year­old woman diagnosed with cervical cancer, stage IB3 FIGO; we also present the discussion about the first therapeutic intent within multidisciplinary committee for diagnostic and therapeutic course. We are trying to answer some questions regarding whether it is necessary and when is recommended hysterectomy after external radiotherapy, regarding the role of induction chemotherapy followed by surgical intervention in stage IB2 – IIB, and regarding the aspects related to fertility preservation in early stages. The discussions in the tumor board allow the recommendation of the most adequate treatment, the therapies’ sequentiality is decided by tumor’s and patient’s characteristics, the potential treatment’s late effects, the technical available resources and, last but not least, by patient’s opinion and the opinion of medical team who manages the case. [ABSTRACT FROM AUTHOR]

The scope of the study was to identify the associated risk factors of lower limb lymphedema development in cervical and endometrial cancer patients. We retrospectively analysed 326 patients: 186 cases (57.06%) with cervical cancer and 140 cases (42.94%) with endometrial cancer were treated in Surgery, Radiotherapy, Oncology and Gynaecology Clinics of 'St. Apostle Andrew' Emergency Clinical Hospital Galati over 9 years. Adjuvant radiotherapy was performed in 83.57% of endometrial cancer cases. Adjuvant chemotherapy was performed in 45.16% of cervical cancer cases. Over 10 lymph nodes were removed in 74.73% of cervical cancer patients. Incidence of lymphedema was 15.05% in cervical cancer patients and 10% in endometrial cancer patients, P=0.06. Analysed risk factors for lower limb lymphedema occurrence were: Age, disease stage, radiotherapy, number of invaded lymph nodes (for cervical cancer patients), number of removed lymph nodes (for cervical cancer patients) and obesity. Multivariate analysis for associated risk factors of lower limb lymphedema development in cervical cancer showed that number of removed lymph nodes, OR=2.109 (0.907-4.903), P<0.0001, number of lymph nodes with metastasis, OR=1.903 (0.253-4.332), P=0.004 and obesity, OR=1.713 (0.226-2.967), P=0.006 were found as statistically significant risk factors for lower limb lymphedema onset. For endometrial cancer patients, obesity, OR=1.518 (0.721-2.75), P=0.0003, was the only associated risk factor with statistical significance for the lower limb lymphedema development. Lower limb lymphedema represents one of the adverse reactions of multimodal treatment in gynaecological cancers which affects patient's quality of life. Lower limb lymphedema occurrence is related with number of risk factors, the most important being removed lymph nodes, obesity and radiotherapy. [ABSTRACT FROM AUTHOR]

Background: With the oropharynx as a key part of the upper aerodigestive tract, tumours at this site and even the treatment itself can impair speech, swallowing and the airway. The stratified squamous epithelium of the palatine tonsil can undergo malignant transformation, causing a neoplasm whose management can be quite challenging. Objective: Our aim is to present the approach taken in the case of a now 71-year-old woman diagnosed with tonsil cancer five years ago. Material and methods: In January 2014, a 65-year old non-smoking woman is admitted to the Otorhinolaryngology section of the General County Hospital in Gala?i due to persistent odynophagia. A standard nasopharyngeal rigid rod examination reveals an infected, ulcerated formation in the right tonsil, which a biopsy confirms is squamous cell carcinoma, for which polychemotherapy and radiotherapy is started. In 2017, laterocervical metastatic adenopathy is detected but deemed inoperable because of its proximity to the internal jugular vein, which prompts the initiation of chemotherapy and biological treatment. Although an increase in size was reported at first, MRI scans in October 2018 and July 2019 both reveal a mass of quasi-identical dimensions. Along the way, the patient acquires and grade III radiodermitis, which requires a temporary cessation of radiotherapy. She has experienced alopecia and edentulism and suffers from permanent dysphonia. Results: After the initial course of treatment, the patient was in remission. The laterocervical metastatic recurrence demanded cytostatic treatment and biological therapy with Cetuximab, the latter of which was not tolerated. The patient is now to undergo IMRT radiotherapy, a more focused approach aimed at reducing the dose of radiation to the nearby organs and the cervical medulla. Conclusions: At least moderate improvements are expected in the near future of the patient, whose long-term prospects are, within reason, promising. [ABSTRACT FROM AUTHOR]