Management of bone painful metastases

Bone is the thirdmost common site of metastatic cancer after lung and liver. It becomes painful in 70% and may significantly impair the cancer patient's quality of life. The pathophysiology of pain due to bone metastasis in now better understood. The character of painful bone includes both inflammatory and neuropathic features.Different and many therapeutic options are available. It is important to know the different options of treatment in order to select the appropriate treatment for the individual patient. However multimodal approach is often necessary and includes medical treatment [analgesics, bisphosphonates anddenosumab] and non-medicalsuch us radiotherapy and cementoplasty Analgesics include three levels of WHO and will be indicated depending on the pain intensity. Bisphosphonates and denosumab decrease bone resorption by acting on osteoclasts and have demonstrated analgesic effect particularly in prostate cancer with bone metastases. Radiotherapy provides an analgesic effect resulting from the radiotoxic effect directly on tumor cells and inflammatory reaction of the boneenvironment. While external beam radiotherapy is the treatment of choice to treat pain from localized bone metastases, Radiopharmaceuticals by their systemic action is better suited in case of extensive metastases. Cementoplasty consist in injecting cement into the injured vertebral body injured but its analgesic role remains unproven. Anti-cancer therapy should be reviewed when the tumor is responsive. The therapeutic approach should be individualized for each patient and requires an understanding of the mechanisms of cancer pain. At present, there is no algorithm of choice between the different therapeutic modalities. The treatment must be discussed within a multidisciplinary working team with specialists of cancer, a nuclear physician, an intensivist, a surgeon and a palliative care physician

[Primary osteosarcoma of the breast]

The primary osteosarcoma of the breast is a rare tumor representing only 0.25% of malignant breast tumors. Its diagnosis is based on the exclusive presence in the breast of an ostrogenic sarcomatous component, and the absence of any epithelial component confirmed by immunohistochemical and ultra-structural study. For localized stages, the treatment is mainly based on surgery. The place of adjuvant treatments [radiotherapy and chemotherapy] remains to be defined. For metastatic palliative chemotherapy is recommended. A woman of 45 years old, without particular pathological history, presenting a primary osteosarcoma of the left breast, confirmed by immunohistochemical study and a correct staging, metastatic from the outset, treated by a palliative chemotherapy with a fatal outcome. We will discuss the risk factors for primary breast osteosarcoma of diagnostic, its diagnostic criteria treatment and outcome, with a review of the literature. We will discuss also its histological aspects, treatment and outcome, with a review of the literature It is an aggressive disease that requires early diagnosis, adequate and early therapeutic management to ensure good locoregional and general control and improve better outcome. His prognosis is still very pejorative

[Adjuvant treatment of early endometrial carcinomas]

Endometrial carcinoma is the most common gynaecological malignant disease in developed countries. About 80% of patients present with early stage disease can be diagnosed [limited uterine tumour stage I or II]. The surgery of first intention allows to individualize decisional prognosis factors of adjuvant therapy. Postoperative radiation therapy plays a major role in the management of stage I and II endometrial carcinoma, but the respective place of external beam radiotherapy and vaginal brachytherapy remains controversial. Several randomized studies have shown that adjuvant external beam radiotherapy reduces locoregional recurrences, but carries a risk of toxicity without overall survival benefits. This technique is restricted to patients with high risk endometrial cancer. For those with intermediate risk, exclusive vaginal brachytherapy ensure an excellent local control with less toxicity. The indication for adjuvant chemotherapy should be discussed in the group of patients with high risk endometrial cancer. But adjuvant hormone therapy is not recommended for early stage disease

[Desmoplastic small round cell tumor]

Desmoplastic small round cell tumor is a recently recognized and rare clinicopathologic entity with distinctive morphologic and immuno histochemical features .Moreover, specific cytogenetics abnormalities and molecular characteristics have been described and confirmed its identity. It is often located at the abdominal cavity, but can exceptionally be located at the cerebral level or some soft tissue and the bones of the members. We report a case of Desmoplastic small round cell involving gluteal muscle and iliac bone at a 25-year-old girl. Our patient had been treated by chemotherapy based on ifosfamide, doxorubicine, etoposide and cis platine. The evolution was marked by the tumoral progress and the death of the patient 18 months after the discovery of the disease. The second case is a 27-year old man .He had a retro peritoneal desmoplastic small round cell tumor treated by surgery alone. The evolution was marked by metastasis and the patient died 10 months after diagnosis. The prognosis of these tumors remains unclear in spite of the mulitidisciplinary treatment. Hence the necessity of new lines of therapeutic research

[Preoperative radiochemotherapy for resectable esophageal cancer]

It is the third most frequent cancer of the digestive system, its treatment for respectable stage [T3-T4a, No-N1] based on surgery. Preoperative radiochemotherapy remains a controversial strategy for both squamous cell carcinoma then for adenocarcinoma. Until recently, randomized studies combine the two histological types, often without any distinction. In randomized studied involving mainly or exclusively respectable localized squamous cell carcinoma, the preoperative radiochemotherapy increases the rate of complete resection, the pathological response, the rate of local control, and disease-free survival. The absence of any impact on overall survival may be linked to the toxic effects of this treatment. Meta-analyses have revealed a survival benefit of approximately 13% at 2 years. However, the methodology used was perhaps questionable. Two randomized trials [French and German] compared surgery or additional radiochemotherapy after a first phase of radiochemotherapy in locally advanced respectable squamous cell carcinomas [T3-T4, N0-N1]. Both drew the same that is surgery did not improve survival benefit for patients in complete response, which remains difficult to predict and highlight. Five randomized trials focusing on patients with adenocarcinoma of the esophagus or gastro esophageal junction, the results are contradictory with insufficient statistical power in some positive studies. The recently CROSS randomized trial in fact except to answer this question once and for all: preoperative radiochemotherapy has been beneficial in this Dutch trial in terms of rates of complete resection and overall survival, without postoperative mortality

[Radiotherapy in rectal cancer: standards and actualities]

The treatment of rectal cancer has been profoundly modified during last years. In less than one decade we evolved from a situation where the surgery is used to be the only standard treatment for cancer rectum to a situation where radiation therapy associated with surgery is recommended by several authors. The radiotherapy is well established as a major component in treatment cancer rectum. As it reduced the local recurrence to about 50% and improves global survival rate. Even if some points related to timing and technical modalities are still discussed, the association of radiotherapy and surgery nowadays is the standard treatment for rectal cancer. Meanwhile, some tuning still interesting trials will provide assessment of association of radiation therapy and chemotherapy by using new drugs

Paratesticular rhabdomyosarcoma

Paratesticular rhabdomyosarcoma occurs predominantly in children and adolescents. is a rare tumor and It's developped proximal to the tesicle. Clinical signs are like any intrascrotal tumor. Scrotal ultrasound, CT scan and tumor markers are necessary for the diagnostic and stadification of this cancer. Orchidectomy followed by chemotherapy and radiotherapy is the usual treatment. We report 3 cases of paratesticular rhabdomyosarcoma. We discuss the diagnosis and therapeutic attitudes, evolutionary aspects and prognostic factors of these tumors re also discussed

News drugs of chemotherapy in advanced colon cancer

Almost 40 years after it's development Fluouracil [5FU] remains the chemotherapeutic mainstay of management for patients with advanced colon cancer. Recently alternative treatment strategies have been developed which offer the promise of greater convenience and enhanced efficacy. Several forms of oral Fluropyrimidines have been introduced and are promising as an alternative to parenteral 5FU based treatment. More importantly, irinotecan and oxaliplatine, cytotoxic drugs that act through mechanisms other than inhibition of thymidylate synthetase have shown to be effective in the treatment of this disease