OBJECTIVE:This study aims to examine the prognostic value of synchronous cancer diagnosis following an initial diagnosis of breast cancer, with a focus on site-specific survival rates and the correlation between primary breast cancer and secondary cancers. METHODS:We conducted a retrospective analysis of patients treated at Saint Nicholas Hospital in Pitesti, Romania, from January 2016 to January 2024. The inclusion criteria were a confirmed diagnosis of primary breast cancer and a secondary synchronous cancer diagnosed within two months. Data collection included demographic, clinical, and pathological characteristics, as well as treatment details and follow-up outcomes. Statistical analyses were performed using SPSS software version 26.0 (IBM Corp., Armonk, New York, USA), employing Kaplan-Meier survival curves, Cox regression models, and other relevant statistical tests. RESULTS:Out of 73 initially identified patients, 49 met the inclusion criteria. The mean age was 59.6 years, with most patients being postmenopausal. Synchronous cancers were primarily contralateral breast cancer (44.9%) and female genital organ cancer (12.24%). Patients with synchronous bilateral breast cancer had significantly better overall survival (33 months) compared to those with other synchronous cancers (23.5 months). Multivariate analysis indicated that synchronous non-breast cancers were associated with a higher risk of death (hazard ratio (HR)=1.6, 95% CI: 1.22-2.10, p=0.003). CONCLUSION:Synchronous cancer diagnosis following an initial breast cancer diagnosis significantly impacts prognosis, with synchronous bilateral breast cancer associated with better survival outcomes compared to other synchronous cancers. These findings underscore the importance of vigilant screening and personalized treatment strategies for patients with synchronous malignancies.

Background/Objectives: Tumor biology—particularly HER2 expression, Ki-67 proliferation index, and triple-negative phenotype—has traditionally influenced the timing of breast reconstruction after mastectomy. However, real-world data from Eastern Europe remain limited, and variability in access and clinical practice persists. This study aimed to determine whether tumor biology independently predicts the likelihood of immediate breast reconstruction (IBR) in a multidisciplinary tertiary center. Methods: We performed a retrospective cross-sectional analysis of 208 consecutive patients who underwent mastectomy with or without IBR between January 2023 and January 2024. Associations between tumor biology (HER2 status, Ki-67 index, and triple-negative subtype) and IBR were examined using χ2 tests, independent samples t-tests, and multivariate logistic regression adjusting for age, BMI, smoking status, comorbidities, neoadjuvant chemotherapy, pathological tumor size (pT), nodal stage (pN), and surgery type. Statistical significance was set at p < 0.05. Results: IBR was performed in 41.4% of HER2-positive and 41.2% of HER2-negative patients (p = 1.00). Reconstruction rates across Ki-67 quartiles (≤10%, 11–20%, 21–40%, ≥41%) were 50.0%, 37.5%, 34.4%, and 37.5%, respectively (p = 0.58). Triple-negative status was not associated with IBR in multivariate analysis (OR = 0.44, 95% CI 0.08–2.18, p = 0.32). Significant predictors of IBR included younger age (OR = 0.87, 95% CI 0.80–0.93, p < 0.001) and less extensive surgery (OR = 0.23, 95% CI 0.09–0.59, p = 0.002). The mean interval to adjuvant therapy was comparable between IBR (28.7 ± 6.2 days) and non-IBR (27.9 ± 5.8 days) groups (p = 0.34), indicating that reconstruction did not delay systemic treatment. Conclusions: In this real-world Romanian cohort, tumor biology did not significantly influence immediate reconstruction decisions. Age and surgical extent were the main determinants of IBR, suggesting that reconstructive access was guided more by clinical than molecular factors. These findings support the shift toward multidisciplinary, biology-informed, and patient-centered surgical decision-making, in line with current ESMO and NCCN recommendations. Despite limitations—including the retrospective design, single-center setting, incomplete BRCA data, and absence of long-term oncologic outcomes—the study provides novel regional perioperative evidence supporting safe and equitable access to immediate reconstruction across biologic subtypes.

Preoperative parathyroid evaluation through nuclear medicine and intraoperative hormone monitoring has significantly increased the success of the surgical intervention. Material and method: Our study is descriptive, the database is retrospective but it is maintained prospectively. The preoperative protocol included single photon emission computed tomography (SPECT) with the use of technetium-99 sestamibi tracer. We preferred this approach as it allowed 3-D localization of the adenomas. PTH values were obtained from blood drawn from the ipsilateral jugular vein at the regular intervals of 5, 10 and 15 minutes post excision. Results: We had 6 cases with false negative which led to the necessary dissection of the contralateral neck. Two had previous surgery and 4 had tumors in other locations which were observed after the surgical intervention through methodical investigations. We encountered 3 patients with false positive results. 2 had intrathyroidal adenomas and 1 was diagnosed with thyroid papillary carcinoma. Causes of a misinterpretation are related to thyroid disease in association with hyperparathyroidism, a history of parathyroid surgery or multiple locations of hyperproductive parathyroid glands.

BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic outbreak forced cancer care providers to face different challenges in terms of prevention and treatment management due to specific precautions implemented for oncological patients. We aimed to describe the level of knowledge, attitude and practices (KAP) among cancer patients, with the purpose to provide an image of the impact of COVID-19 and evaluate the effectiveness of pandemic response measures.PATIENTS AND METHODS:We developed a cross-sectional multicentric study that targeted adults with active cancer during the COVID-19 outbreak, aiming to describe KAP related to COVID-19 among Romanian oncological patients. A questionnaire investigating 64 items on KAP related to the novel coronavirus was designed and applied in seven Romanian hospitals. The group of participants consisted of 1585 oncological patients who completed the questionnaire during the outbreak (April-May 2020).RESULTS:Only 172 patients (10.8%) had very good knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection symptoms, treatment options and incubation period. Only 44.3% of patients identified diarrhoea as a sign of COVID-19. About one-third of patients (32.6%) declared that they are 'very worried' about getting infected with the novel coronavirus. More than two-thirds of participants (68%) considered that having cancer represents an additional risk for infection with SARS-CoV-2, but 27.8% would rather not vaccinate against SARS-CoV-2 should a vaccine be available. A small percentage (8.8%) believed that the risk of infection justifies delaying/stopping oncological treatment until after the pandemic. Around half of the participants (55.5%) declared being compliant with all the protective measures against coronavirus infection listed in the questionnaire.CONCLUSION:Romanian oncological patients have a less than expected knowledge about SARS-CoV-2, appropriate prevention behaviours, with limited trust in their efficacy, optimistic attitudes towards COVID-19 and low level of trust in information sources. Good COVID-19 knowledge was associated with appropriate practices towards COVID-19 and optimistic attitudes.

1.In autumn 2013 a new surgical oncology was created in Saint John Hospital Bucharest, with the main purpose to treat abdominal malignancies.

Introduction: The number of elders affected by rectal cancer is high and will continue to grow because life expectancy is constantly increasing. Preoperative chemoradiotherapy tends to became the new standard treatment for locally advanced rectal cancer, with better local control and minimal or no survival advantages. We conducted a prospective single arm study to evaluate the efficacy of preoperative capecitabine based chemoradiotherapy in elderly patients with rectal cancer. The primary objectives of our study were evaluation of the efficacy of the treatment regarding response rate and sphincter preservation rate and the safety profile. The secondary objectives were progression free survival and overall survival rates at 2 year. Methods: Seventy two selected patients over 65 years with stage II or stage III confirmed rectal adenocarcinoma were treated between 2001 and 2010. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Frail patients according to CGA (category III) were excluded. The treatment schedule consisted in concomitant radio-chemotherapy. At the end of chemoradiation the patients were evaluated for surgery. The fit patients underwent surgery and the others received definitive radiation. None of the patients received adjuvant therapy. All patients received external beam radiation therapy up to a total dose of 50-54 Gy, in daily 180-200 cGy fractions, 5 days/week, using 4 fields technique. In 31 cases external radiotherapy was followed by endocavitary HDR brachytherapy with a total dose of 10 Gy on the tumor volume, 500 cGy/fraction– 2 fractions, 1 fraction/week. Chemotherapy schedule was based on Capecitabine 825mg/m2 twice daily, at 30 min after the meals, 7 days per week. Results: All patients were evaluable for safety profile. Gastrointestinal toxicities were diarrhea that occurred in 63 patients (87.5%) with grade 3 - 4 only in 10 patients (13.8%); vomiting and nausea 47 patients (65.3%) with grade 3 – 4 in 5 patients (6.9%). Hematological toxicity occurred in 23 patients (31.9%), but grade 3-4 in 6 patients (8.3%). Hand-foot syndrome was present in 2 patients (2.77%). The other primary objective was to identify the response rate in our series. Overall response rate was 76.3%, with complete response obtained in 4 patients (5.6%), partial response in 51 patients (70.8%). Eight patients (11.1%) were evaluated with stable disease. Progressive disease was found in 9 patients (12.5%). In 16 cases (22.2%) sphincter preservation surgery was performed and in 4 cases (5.6%) complete pathological response was obtained. Progression free survival was 48.6% (35/72), local relapse (LR) was 20.8% (15/72), and distant recurrence rate was 11.1% (8/72) at 2 years. Mortality was 19.5% (14 patients) at 2 years. There were 9 cancer related deaths (12.5%), and 5 deaths (6.9%) due to comorbidities. Conclusion: Concomitant preoperative chemoradiation in locally advanced rectal cancer could be an option for the treatment of elderly patients as in younger ones. Our data offer comparable results with published clinical trials which did not include age-selected patients.

Purpose: The combination of Gemcitabine (GEM)/carboplatin (CBDCA) has demonstrated activity in the treatment of stage III and IV non-small-cell lung cancer (NSCLC). This phase III randomized trial compared the response rate, survival rate, and toxicity of the combination of GEM plus CBDCA with the combination of VLB plus CDDP. Methods: Chemonaı̈ve patients with advanced or metastatic NSCLC were enrolled in the study. Pts were randomized by coin method to receive either cisplatin (CDDP) 70 mg/m2 on day 1 plus vinblastine (VLB) 6 mg/m2 on days 1 and 8 (arm A) or gemcitabine 1000 mg/m2 on days 1 and 8 plus carboplatin 300 mg/m2 on day 1 (arm B). Both regimens were administered on a 21-day course. Results: A total of 198 patients (99 pts each in arms A and B) were enrolled in the study between July 1997 and April 2000. All pts had an ECOG performance status ≤2. Patients had a median age of 58 years (range, 49–67) in arm A and 59 years (range, 49–69) in arm B. In arm A, there were 15 partial responders (PR), for an overall response rate (ORR) of 15%, compared with three complete responders (CR) and 24 PR, for an ORR of 27% (P<0.05), in arm B. Mean survival times were 7.9 months (95% CI, 7.1–8.0) in arm A and 11.6 months (95% CI, 10.0–13.0) in arm B. One-year survival rates for arms A and B, respectively, were 13 and 36%. Numbers of pts with WHO grad 3/4 hematologic and non-hematologic toxicity in arms A/B were leukopenia 0/2, thrombocytopenia 0/2, alopecia 46/33, neurotoxicity 2/1, and asthenia 35/42. Conclusion: The GEM/CBDCA combination showed a higher therapeutic response, an improved 1-year survival, and a similar toxicity profile compared with the VLB/CDDP combination.