Institute of Oncology Prof. Dr. Ion Chiricuta

Medical oncology is a young specialty in Romania, where early-career oncologists face challenges related to training, mentorship, and research. This study explored their professional status and needs to inform workforce development. An online survey was conducted between February and April 2025 among physicians under 40 years of age who were members of the Romanian National Society of Medical Oncology (SNOMR). The questionnaire (60 items) covered demographics, employment, mentorship, research, and professional development. Descriptive analysis was performed. Of 456 eligible members, 169 responded (response rate: 37%). Most were residents based in oncology institutes or university hospitals. Job insecurity was common, with 57% on temporary contracts. Nearly all respondents (99%) had clinical duties, but only 21% engaged in research and 9% in teaching. Mentorship was inconsistently available (61% had a mentor), yet interest in structured programs was very high (88% for national and 87% for international initiatives). Research involvement was limited: 46% reported no activity, 85% lacked funding, and only 28% published in the past year. While over 80% expressed interest in fellowships or exchanges, only 16% had trained abroad. Most (85%) were ESMO members, but only half considered SNOMR support sufficient. Young oncologists in Romania are motivated but face significant barriers, including job instability, insufficient mentorship, and limited research opportunities. Expanding structured mentorship, ensuring protected research time, and strengthening international mobility are essential. Recent SNOMR initiatives represent important first steps toward addressing these gaps.

Background/Objectives: Artificial intelligence (AI) has shown potential in patient education and integration into clinical decision support systems. However, its performance in counseling patients on breast reconstruction currently remains underexplored. This study's objective is to compare AI-generated answers with expert surgeon responses to common patient questions (derived from clinical scenarios) in domains like oncological justification, reconstructive options, and postoperative care. Methods: We realized an observer-blinded study using five real-world clinical scenarios in the field of oncologic and reconstructive surgery of the breast. Both ChatGPT-5 (October 2025 version) and a senior board-certified plastic surgeon responded to frequently asked questions, which were split into three domains: (1) oncological and surgical justification; (2) reconstruction options and outcomes, respectively; and (3) postoperative period. The answers were evaluated by another senior plastic surgeon using a four-grade ordinal scoring system (1 = unsatisfactory, 4 = excellent), which assessed accuracy, completeness, safety, nuance, and alignment with the current guidelines. Results: Across a total of 40 questions, the average AI response score was 3.1 ± 0.6. Domain-specific items scored lowest values for oncological justification (2.8 ± 0.7) and higher values for reconstruction options/outcomes and postoperative care (both 3.2 ± 0.4). No AI response was graded as unsatisfactory (score 1). Responses graded 4 (15%) were considered comprehensive, accurate, and patient-friendly. Conclusions: Globally, ChatGPT-5 provides satisfactory, readable, and medically accurate answers to basic patient questions on breast reconstruction, with a few limitations in nuanced oncological justification.

Radiotherapy (RT) is essential in pediatric cancer treatment and often requires complete immobility. In younger or noncompliant children, this is typically achieved through sedation or general anesthesia (GA), which raises concerns about acute complications and potential long-term neurodevelopmental effects. Despite widespread use, standardized anesthesia protocols for pediatric RT are lacking. To support the development of practice recommendations, the SIOPE Working Group on Pediatric Anesthesia in Radiation Therapy conducted a systematic literature review. Studies from Medline and Embase were reviewed (March-September 2024) according to PRISMA guidelines, focusing on sedation and GA in pediatric RT. Thirty-nine studies were included, mostly retrospective and of low to moderate quality. Considerable heterogeneity was observed in anesthetic techniques, staffing, and monitoring. Propofol-based sedation was most frequently reported, with favorable safety when delivered by experienced pediatric anesthetists. Complication rates varied widely and were often poorly defined. Additional concerns included long-term neurocognitive impact, vascular access, and procedural burden, especially in resource-limited settings. Evidence supports the safe use of sedation/GA in pediatric RT, but current literature is limited and inconsistent. Standardized protocols and prospective studies are urgently needed to better define safety, long-term outcomes, and staffing requirements.

Reirradiation is increasingly considered for patients with recurrent primary brain tumours, yet clinical practices vary significantly due to limited evidence and a lack of standardized guidelines. This survey aimed to map European practice patterns in brain tumour reirradiation. A 23-item web-based survey was developed by the ESTRO CNS Focus Group to assess institutional characteristics, clinical decision-making, and technical aspects of reirradiation. Distributed via email and social media, the survey collected responses between June-July 2025. Descriptive statistics were applied. Eighty responses from 28 European countries were analysed. High-grade gliomas were the most frequently reirradiated tumours (>80%), followed by meningioma (56%, low-grade glioma (49%), and ependymoma (44%). Conventional photon radiotherapy (RT) was the predominant technique across all tumour types, with varying use of hypofractionation, stereotactic RT, and proton therapy. Target volume definition and margin size varied by histology, with larger margins and inclusion of edema/cavities more frequent in gliomas. MRI-CT fusion was standard for planning. Concurrent systemic treatment was used mainly in high-grade gliomas. Organ at risk dose recovery and cumulative constraints were commonly considered, but threshold values and recovery models differed. Main barriers included fear of toxicities, including radiation necrosis and limited evidence. This survey reveals high heterogeneity in brain tumour reirradiation practices across Europe, especially regarding dose, technique, and target definition. Despite shared principles, consensus is lacking for rarer tumour types. These findings underscore the need for harmonized guidelines and prospective data to optimize patient care.

Homologous recombination deficiency (HRD) is a clinically relevant biomarker that predicts sensitivity to PARP inhibitors and enables personalized cancer therapy. Validated local HRD testing solutions are essential to ensure timely and equitable access, ultimately improving treatment outcomes. We evaluated a shallow whole-genome sequencing (sWGS) approach for genomic instability (GI) assessment combined with a 52-gene targeted panel in ovarian cancer. Validation used reference materials and 24 archival samples with prior HRD characterization, comparing performance with the Myriad myChoice® HRD test. A prospective cohort of 124 newly diagnosed ovarian cancer patients was then analyzed. sWGS-derived GI status showed strong concordance with the reference test (95.8% overall agreement; κ = 0.913; NPV 100%, PPV 93.3%). Pathogenic BRCA1/2 variants were detected in 30 patients (24.19%). An additional 22.76% were BRCA1/2-negative but GI-positive, giving an overall HRD prevalence of 47.15%. Platinum sensitivity occurred in 90.0% (18/20) of HRD-positive patients with follow-up. Among 12 patients assessed for PARP-inhibitor response, the overall response rate was 66.7% (95% CI 39.1–86.2) and disease control rate 83.3% (95% CI 55.2–95.3). TP53 alterations were most frequent (62.90%), followed by BRCA1 (19.35%) and BRCA2 (4.83%). Pathogenic variants in other HR-pathway genes (ATM, CHEK2, BRIP1, RAD51C, BARD1) appeared in 9.57% of BRCA-wild-type cases, with heterogeneous GI impact. Two cases showed concurrent BRCA2 variants and microsatellite instability, indicating possible eligibility for anti-PD-1/PD-L1 therapy in addition to PARPi. This first comprehensive analysis of Romanian ovarian cancer patients suggests that integrating sWGS-based genomic instability assessment with BRCA testing can improve HRD detection and reflects the heterogeneity of HR-pathway variants. Preliminary clinical observations were consistent with known HRD-associated treatment responses, although larger studies are needed to confirm these findings.

ABSTRACTTriple‐negative breast cancer (TNBC) is an aggressive subtype with high heterogeneity, metastasis, and drug resistance, underscoring the need for new therapeutic strategies. Sea buckthorn berries, long used in traditional medicine, are rich in carotenoids with reported anticancer activity. To investigate their transcriptional effects, we treated BT‐549 TNBC cells with a saponified lipophilic sea buckthorn berry extract (LSBE) and performed gene expression profiling using microarray (four independent replicates of treated, respectively, untreated cells). LSBE altered the expression of 330 protein‐coding genes (111 downregulated, 219 upregulated; fold ratio ±1.5, adj. p < 0.05). ingenuity pathway analysis (IPA) revealed activation of cholesterol biosynthesis (z = 3.46, p = 2.7E−15) and ferroptosis (z = 0.78, p = 5.3E−09), while oxidative stress (z = −2.18, p = 3.4E−05) and cholesterol accumulation (z = −2.14, p = 3.4E−06) were inhibited. Gene set enrichment analysis (GSEA) further indicated upregulation of cholesterol homeostasis and mTORC1 signaling. Our findings suggest that carotenoid‐enriched LSBE modulates key pathways related to cellular homeostasis, antioxidant defense, and apoptosis in TNBC. While limited to transcriptional profiling, this exploratory study provides a foundation for future functional validation of LSBE as a complementary TNBC therapeutic approach.

The potential concurrence of uterine leiomyoma and adenomyosis has been mentioned in several studies to date, but as co-existing entities, not as a sequence of pathologic events. This is the case of a young 31-year-old nulliparous patient presenting with unspecific pain and abnormal uterine bleeding (AUB) pattern symptoms, which was clinically diagnosed with FIGO 0 fibroid "in status nascendi". Following removal, the tumor turned out to be a STUMP at the histopathologic workup. After 9 months postoperatively and two unremarkable follow-ups, the patient presented again for pelvic pain and AUB, when ultrasound revealed a heterogeneous endo-uterine tumor of 5 cm, rich in large vessels, with rapid growth at serial ultrasound. MRI established the diagnosis of adenomyosis. In the context of a prior STUMP, nulliparity and rapidly enlarging uterine mass, despite conservative management counseling in a multidisciplinary team, the patient preference was towards radical surgery to prevent any future reproductive organ-related distress, and she opted for total hysterectomy with bilateral adnexectomy. The co-existence of fibroid and adenomyosis has been signaled by several authors, but this is the first report of such a sequence of events (STUMP to large adenomyoma) with swift development, to the best of our knowledge.

Chimeric Antigen Receptor (CAR) T cell therapy, initially developed for hematologic malignancies, has recently emerged as a promising modality for treating autoimmune diseases. This review explores the evolving role of CAR T cells in reprogramming immune tolerance and achieving durable remission in autoimmune disorders. By engineering T cells to target pathogenic B cells or autoreactive T cells, CAR T therapy offers a targeted and potentially curative approach for diseases such as systemic lupus erythematosus, multiple sclerosis, and type 1 diabetes. Early clinical trials and preclinical models have demonstrated the feasibility, safety, and efficacy of CD19-targeted CAR T cells in depleting autoreactive B cells and restoring immune homeostasis. Furthermore, next-generation CAR designs-including regulatory T cell-based CARs and antigen-specific constructs-highlight the growing precision and versatility of this platform. Despite these advances, challenges remain, including potential toxicity, antigen escape, and the need for long-term immune monitoring. This review summarizes current findings, delineates mechanistic insights, and discusses future directions for optimizing CAR T cell therapies in the context of autoimmunity.

Ischemic stroke remains a leading cause of mortality and disability, with proinflammatory, metabolic, and oxidative stress-related factors contributing to outcome variability. We conducted a retrospective cross-sectional study of 124 consecutive patients (53 women, 71 men; median age 71 [62–76]) discharged with ICD-10 code I69.3 from the Neurology Department of the Clinical Rehabilitation Hospital in Cluj-Napoca (January 2023–September 2024). Men were younger (median age of 69 vs. 73 years, p-value = 0.010), more frequently smokers (42% vs. 9%, p < 0.001), and alcohol consumers (21% vs. 4%, p-value = 0.007) than women. In contrast, women were more frequently sedentary (68% vs. 49%, p-value = 0.038) and had higher LDL cholesterol (89 vs. 74 mg/dL, p = 0.026) than men. Patients with at least moderate disability (n = 84) presented higher levels of C-Reactive Protein (CRP), 1.4 vs. 1.1 mg/L, p-value = 0.027) and more frequently low HDL cholesterol serum levels (29.8% vs. 7.5%, p-value = 0.006) compared to those with minor disability. In multivariable regression, low HDL was the sole independent predictor of disability severity (OR = 4.58, 95% CI 1.21–17.41; AUC = 0.78, sensitivity = 88%, specificity = 42%), while CRP and age did not retain the significance obtained in univariable regression. Our findings highlight sex-specific risk profiles and underline the contribution of proinflammatory, metabolic, and oxidative pathways to ischemic stroke severity, underscoring the need for prospective validation in larger cohorts.

Background/Objectives: Sentinel lymph node biopsy (SLNB) is currently the standard approach for axillary staging in breast cancer. Conventional techniques are radioisotope-based (Technetium-99m, Tc99m) and remain widely used, but novel tracers like Indocyanine Green (ICG) fluorescence provide potential advantages regarding feasibility and logistics. Methods: We conducted a prospective, observational study including 476 female patients diagnosed with primary invasive breast cancer who underwent SLNB at the Institute of Oncology “Prof. Dr. I. Chiricuță”, Cluj-Napoca, Romania, between January 2022 and May 2025. Clinical, surgical, and pathological variables were systematically extracted. SLNB was performed using either Tc99m or ICG, according to institutional protocols. Comparative analyses were performed to evaluate sentinel node characteristics, histopathological parameters, and positive surgical margins predictors. Results: The median age was 60 years (IQR: 52–69). Breast-conserving surgery (BCS) was performed in 77.9% of cases, while mastectomy was performed in 22.1%. Sentinel lymph node positivity was reported in 25.6% of cases, with no significant differences in the number of excised or metastatic nodes between Tc99m and ICG (mean nodes: 3.23 vs. 3.20, p = 0.860; mean positive nodes: 0.35 vs. 0.36, p = 0.897). Histologically, invasive carcinoma NST was predominant (90.1%), and surgical margins were negative in 96.8% of patients, with all margin-positive cases occurring following BCS. No pathological markers (grade, Ki67, TILs, DCIS extent) predicted margin status or nodal involvement. Notably, younger age correlated inversely with the extent of ductal carcinoma in situ (r = −0.21, p < 0.00001). Conclusions: Tc99m and ICG provided comparable diagnostic performance in performing SLNB, with equivalent rates of nodal detection and pathological yield. These findings support that ICG is a safe and effective alternative for routine axillary staging in breast cancer.