ABSTRACT
Purpose: To evaluate the feasibility and efficiency of concurrent chemo-radiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients. Patients and Methods: We reviewed data of 33 non-metastatic NPC patients who had been treated with CCRT between January 2004 and December 2006. The Median age of patients was 41 year-old and the male/female ratio was 3. According to the 2002 TNM staging system, T3-T4 locally advanced tumors and N2-N3 nodal status rates were 67% and 46%, respectively. All patients had undifferentiated carcinoma and received conventional fractionated 2D conventional radiotherapy (RT) with a total dose of 70-74 Gy and concurrent weekly intravenous cisplatin (40 mg/m2). Results: The acute toxicities were all manageable. Grade 3-4 mucositis and skin reaction were seen in 6 patients (18%). RT interruption for a week occurred in 1 patient because of a Grade 3 dysphagia. All patients finished their planned RT. Four patients (12%) refused to complete the concurrent chemotherapy (CT) and 5 other patients (15%) did not receive the planned cycles of CT because of renal and/or hematologic toxicities. After a median follow-up of 58 months, 6 patients (18%) developed loco-regional relapse associated with distant metastasis in 4 cases (12%), and 6 patients (18%) developed distant metastases alone. Five-year overall survival and disease-free survival rates were 70 and 63%, respectively. A univariate analysis for prognostic factors was also performed. Overall survive was affected by Stage T4, Stage N3, age >40 years, and cycles of CT ≤ 5. Patients who received more than 5 cycles of cisplatin had also significantly better disease free survival and metastasis free survival. Conclusion: The results of our study have shown that CCRT for locoregionally advanced NPC is both feasible and effective, with acceptable toxic effects. On univariate analysis, the age >40 years, Stage T4, Stage N3, and cycles of CT ≤ 5 had a significantly poor outcome.
ABSTRACT
Sternal arch is a nonspecific clinical signs wich may arise during following of breast cancer, this sign reveals an involvement of internal mammary nodes secondary to breast cancer. To report a rare event such as a loco-regional sternal or parasternal invasion secondary to locally advanced cases of breast cancer [BC] about a Tunisian series. We collected retrospectively from 1988 to 2012, 11 cases of BC treated at the Institut Salah Azaiez [ISA] of Tunis, with presence during the disease evolution [initial or at relapse] of a sternal or parasternal swelling. We analyzed their clinical history, clinical and imaging data [CT-scan and/or MRI], stage, time of occurrence, treatment and evolution. All patients were females and their mean age was 46 years varying from 24 to 75 years. The sternal or parasternal swelling was found at diagnosis in 5 cases and on recurrence in 6 patients after a mean free interval of 24 months, > 12 months in 5 cases. The mean clinical tumor size of the primitive BC was 38 mm [24-75 mm] and lesions located in external quadrants in 3 cases and internal or central in 6 cases. Sternal involvement related to large Intrammmary Chain [IMC] adenopathies was diagnosed by CT-scan. 7 patients had synchronous metastases. 9 out of the 11 patients received a locoregional RT and two received chemotherapy [CT]. Sternal or parasternal swelling is a clinical apparent symptom of advanced internal mammary lymph nodes in breast cancer. The first etiologic diagnosis in this context is an advanced internal mammary chain [IMC] node involvement from breast cancer
Subject(s)
Humans , Female , Sternum/pathology , Retrospective StudiesABSTRACT
The tumours of the pineal region are rare brain tumours, most common in children and characterized by a large clinical and histologic polymorphism. To assess the outcome and prognostic factors of 40 patients with primitive pineal region tumours treated at the department of radiotherapy of Salah Azaiz institute. Between January 19977 and December 2000, 40 patient received radiotherapy. There were 22 adults and 18 children [age <16 years]. The mean age was 20.4 years and sex ratio was 2.07. Histologic diagnosis was confirmed in 11 cases; 16 patients had a CT evaluation after 20 Gy radiotherapy and in 13 cases diagnosis was performed with CT aspects +/- germinal tumour markers. Target volume varied: 10 had craniospinal irradiation, 16 had local irradiation and 14 had whole brain irradiation with a boost at the tumour bed. Chemotherapy was proposed for metastases and recurrent diseases. Survival rates were 87% at 2 years and 74, 5% at 5 years. For children, survival rates were 88% at 2 and 4 years. Eight patients [20%] failed locally and 5 patients [12.5%] had metastasis. Age, performance status and large fields of radiotherapy seem to be associated with prognosis and survival. Pineal tumors and especially germinal tumours are chemosensitive and radiosensitive, care of these tumours is multidisciplinary involving surgery, chemotherapy and radiotherapy. From our study and a review of the literature, we tried to find a therapeutic strategy for tumours of the pineal region
ABSTRACT
The internal mammary nodes are often underestimated as breast cancer lymphatic pathway spread. It is yet the first site of lymphatic invasion in central or internal tumors and the second site in external tumors. The intra-thoracic situation of internal mammary nodes explains partly, the difficulty of its exploration. To evaluate the risk of internal mammary node invasion, some predictive factors are established [tumor size, internal or central tumor location, axillary node invasion and young age]. Prognostic and therapeutic impact of invasion justifies its systematic research. Without exploring internal mammary nodes status, TNM classification remains, incomplete. CT scanner, magnetic resonnance imaging, positron emission tomography scanner and sentinel node exploration technique are helpful to explore this region and to adapt its irradiation
Subject(s)
Humans , Lymph Nodes , Breast Neoplasms/classification , Breast Neoplasms/therapyABSTRACT
This study evaluated the prognostic value of the Para pharyngeal space involvement in nasopharyngeal carcinoma T 2 disease [UICC 1997 classification]. From January 1997 and December 20G1 32 patients with nasopharyngeal carcinoma were examined by CT scan and according to the 1997 International Union Against Cancer [UICC] staging system 15 had stage T2a MO [G1] and 17 T2hMO[G2]. The median age was 47 years .The male to female ratio was 1.81 [G1]; 4.3[G2] All patients were pathologically confirmed by biopsy from the nasopharynx as having UCNT in 100%[G1] and 94%[G2].The node involvement was 52%for the GI[N2: 26%, N3: 26%] and 80%for the G2[N2: 47%, N3: 41%]. Both neoadjuvant chemotherapy and radiotherapy were performed for advanced N disease and only radiotherapy for NO. Examination and CT scan were performed for the evaluation of the treatment. The completely clinical remission after chemotherapy was 12.5%[G1] and 53%[G2], partial remission was 25%[G1] and 35%[G2]. The CT scan control wasn't performed for all patients. The complete response was 69%[G1] and 53%[G2]: partial response was 6%for both two groups. The median follow op was 79 months. Disease free survival rates were 70%for G1 [T2a] and 48%for G2 T2b]. Distant metastasis rates were 26%[G1] vs 6%[G2] and more likely in the presence of advanced N disease. Five years overall survival was 78%[G1] T2a vs 55%[G2] T2b.The N disease was correlated to metastasis as overall survival was 66.7%for N3 disease vs 85.7%for NO. Parapharyngeal tumor involvement affects local and regional tumor failure. Subclassification of T2 disease into T2a112b should have an impact on treatment strategies
Subject(s)
Humans , Male , Female , Nasopharyngeal Neoplasms/pathology , Pharynx , Retrospective Studies , Tomography, X-Ray Computed , CarcinomaABSTRACT
The radiotherapy department at Salah Azaiz institute had started, in March 2000, a new sophisticated technique of irradiation consisting in total body irradiation [TBI]. TBI is used in many preparative regimens before bone marrow transplantation in the treatment of haematological malignancies. TBI aims to destroy immunocompetent tissues in order to avoid graft rejection and to eradicate residual tumor cells. In this article, we review different TBI techniques and its main indications. We also describe the acute and late effects of TBI
Subject(s)
Humans , Bone Marrow Transplantation , Hematologic NeoplasmsABSTRACT
This is a retrospective study of patients treated for cancer cervix staged IB2, IIA or lIB with bulky tumor [>4cm]. Treatment was concurrent radiotherapy [45Gy with I,8Gy daily fraction] and chemotherapy [5 cycles of Platinum 40mg/m2/week]. All patients. underwent Brachytherapy [l5Gy on the reference isodose according to Paris system] followed by surgery [radical abdominal hysterectomy and bilateral pelvic lymphadenectomy: Piver 3]. Between October 1999 and December 2002, forty five patients were treated in this protocol. Median age was 46 years [21- 68]. Histology was squamous cell carcinoma in 93% and glandular carcinoma in 7%. Average external radiation dose was 44Gy [20-50]. Ninety three% of patients had at least 3 cycles of chemotherapy and 46,5% received the planned 5 cycles. On the operative specimens, there was 62,5% complete response and only 7 pelvic node involvement [17,5%]. Four postoperative complications were noted [one vascular injury, one urinary fistula, one phlebitis and one lymph collection]. Preoperative combined radiotherapy and chemotherapy in the early bulky stages of uterine cervix cancer is well tolerated and "gives" a high rate of sterilisation. There was no increase in surgical morbidity