[Medical treatment of nasopharyngeal cancers]

Nasopharyngeal cancers are essentially epidermoids [NPC] and dominated by the undifferentiated type [UCNT] in endemic areas. The standard treatment of NPC remain external beam radiotherapy but the results are poor in T3-4 lesions locally advanced [30-40% on event-free survival vs 80-90% in T1-T2] explained by a higher rate of relapse and metastases. Improvement of therapeutic results occurs with addition of chemotherapy to radiotherapy, specially with the concomitant scheme [weekly cisplatin], with an increase of overall and diseasefree survivals for the advanced stages [Meta-analysis data]. Despite these progresses, we have to evaluate the risk of long term sequelae of combined therapies in children and adolescents. We are observing however an epidemiologic transition with the increase of more localized cases in term of T and N disease

[Conserving surgery for breast cancer]

Breast cancer is the first women's cancer. Conserving surgery associated with radiotherapy, is in progress. Her indications are frequent. The result local control and global survival am the same as radical surgery

Local Regional Recurrance of Breast cancer in Tunisian Center

To evaluate locoregional recurrence rate of breast cancer, determine its anatomoclinical characteristics and discuss the available therapeutic alternatives. Patients and methods A retrospective study including 41 patients with LRR following modified radical mastectomy or conservative surgery of invasive breast carcinoma without metastasis, between January 1993 and December 2002. 38 cases of LRR occurred after mastectomy and 3 cases after conservative surgery. LRR rate was 4.84%. mean follow-up 44.7 months. Mean age of patients was 45 years and LRR mean occurrence time-interval 22.4 months. Recurrence was parietal in 25 cases, mammary in 2 cases, and nodal in 14 cases. 18 patients had to be operated on. Conclusion Prognosis of breast cancer depends on distant metastasis. LRR constitutes the second major risk liable to influence the overall prognosis

[Pronostic factors in squamous cell carcinoma of the vulva. about 35 cases]

To evaluate the pronostic factors of the vulvar cancer. This is a retrospective study, of 35 cases of squamous cell carcinoma of the vulva diagnosed and treated at Farhat Hached Hospital [Sousse] between January 1991 and December 2002. The study of the pronostic factors is based on analysis of the following parameters obtained after a period varying from 6 months to 5 years: clinical data, pre-therapeutique and therapeutic evaluation, pathologic data, outcome and survival rate. The diagnostis was often late with a delay for consultation superior to 6 months in 60% of cases. 80% of the patient were in stages III and IV of FIGO with an average tumorous size of 3.8 cm and palpable lymph node in 74.2% of the cases. 22 patient underwent vulvectomy with bilateral inguinal node dissection. Adjuvant therapy was carried out in 8 cases. The rate of relapses was 22.7%. The global survival at 5 years of the operated patients was of 40%. The main prognostic factors were: the size tumorale, the degrees of stromal invasion and the lymph node invasion. Early detection fo vulvar cancer by regular gynecologic examinations and a biopsy of all suspect lesions, allows an early treatment consequenlly a better prognosis

Adult acute lymphoblastic leukemia. Report of 42 cases

Between 1989 and 1995, 42 cases with acute lymphoblastic leukemia [18 males and 24 females] were diagnosed in our institution. Median age was 38.5 years [range, 16-88 years]. Leukocyte count was more than 30.10 9/l in 54 percent of cases. According to the French-American-British [FAB] criteria, 67 percent were classified L1 and 33 percent L2. Sixteen patients were treated with 12LA80 protocol, 14 patients with LALA 85 protocol, 6 patients with LALA 87 protocol and 6 patients with EORTC protocol. Complete remission was achieved in 22 cases [52 percent], 8 cases [20 percent] failed to respond and 12 [28 percent] died during induction. Relapse was observed in 10 cases. The 4-year survival rate was 28 percent confirming the worse prognosis of this leukemia when treated with standard chemotherapy

Elderly acute leukemia: report of 40 cases

Between 1989 and 1996, 40 cases with acute leukemia [16 males and 24 females] were diagnosed in out institution. Median age was 65 years [range, 56- 88 years]. Leukocyte count was more than 30.109/1 in 42 percent of cases. According to the French-American-British [FAB] criteria, 11 cases were classified lymphoblastic and 29 myeloblastic. Sixteen patients have received palliative treatment because of there age and there bad performance status. Only 24 patients have received curative treatment. Complete remission was achieved in 12 cases [50 percent], 5 cases [20 percent] failed to respond and 7 [30 percent] died during induction. Relapse was observed in 8 cases. The 2-year survival rate was 10 percent confirming the worse prognosis of the acute leukemia in elderly