FEASIBILITY AND EFFICIENCY OF CONCURRENT CHEMO-RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA PATIENTS / 鼻咽癌杂志

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.

[Atypical presentations of internal mammary chain involvement in breast cancer]

Breast cancer is the first cancer in women. Lymphatic involvement in breast cancer is common, especially in our patients because of the frequency of locally advanced forms. This contrast with a weak rate of diagnosed internal mammary chain invasion. To clarify the atypical presentations of internal mammary chain involvement in breast cancer. We present observations of patients presenting atypical forms of internal mammary chain involvement. The invasion of internal mammary chain is often underestimated. Indeed, this site of lymphatic spread is not accessible to the clinical exam and its radiological exploration is not systematic. Otherwise, different clinical, pathological and radiological presentations have to attract our attention to a potential internal mammary chain invasion. Our misrecognition of this site of spread and its different presentations can partly explain the lack of diagnosis

[Radiation therapy in extra abdominal desmoid tumours]

Desmoid tumours are rare benign tumours that have local 'malignity'. They can be locally aggressive by infiltrating adjacent vascular, nervous and bony structures. To define the role of radiotherapy in the management of desmoid tumours. Retrospective study of six extra-abdominal desmoid tumours treated with surgery and radiation therapy. Median age was 26.8 years [16-35 years]. The tumor was located in the arm [1 case], in the legs [2 cases] and in the body [3 cases]. Median tumoral sizes were 86.6 mm [60-100 min]. Five patients had local recurrence after surgical resection. Radiation therapy included Cobalt 60 in five cases and photons associated to linear acceleration in one case. Total dose was between 54 and 62 Gy. At the end of radiation therapy, tumoral control was obtained in five cases after a median follow-up of 26 months [1-83 months]. Surgery is the main treatment of desmoids tumours but local recurrence rates remain high even after complete resection. The role of adjuvant radiation therapy is controversial

[Tumours of the pineal region: retrospective study about 40 cases]

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

Clear cell carcinoma of the uterus

The aim of this study was to determine the characteristics and outcome of patients presenting with clear cell carcinoma [CCC] of the endometrium treated in a single institution. We reviewed the records of patients treated in the Salah-Azaiz institute for CCC of the endometrium. A histopathological stage was retrospectively assigned to these patients according to the FIGO classification and was compared to the clinical stage. Pathological features were studied in order to determine predictive factors of extrauterine disease extention and failure patterns. 12 patients were included in the study. The mean age at diagnosis was 64 years [50 to 84 yrs]. Upstaging after surgery was found in 9 patients. 9 patients had extrauterine extension. Deap myometrial invasion was not correlated with extrauterine extension. After a median follw up of 32 months, 4 patients presented with recurrences: one vaginal recurrence, two cases of pelvic and abdominal recurrence and abdominal recurrence in one patient. All recurrences occurred during the first year after surgery. Tumor recurrence was located within the radiation field in one case. Two paients with abdomino-pelvic recurrences progressed despite the association of surgery, radiation therapy and chemotherapy. Extrauterine extension is frequent at diagnosis and not correlated to classical risk factors observed in endometrioid carcinoma. A comptlete surgical staging is necessary for adjuvant treatment. Locoregional and distant recurrences are frequent and have a poor outcome

[Internal mammary lymph node invasion in breast cancer: myth or reality]

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

[Prognostic value of the parapharyngeal space involvement in nasopharyngeal carcinoma]

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

[Occupational cancer in Tunisia]

Occupational cancers are cancers due to the exposition of the worker during his daily work to a carcinogenic agent. In Tunisia, the number of declared and compensate cases is still low. The aim of this study is to asses the role of occupational agents in the development of bronchial and pleural cancers and to discuss the causes of this under-assessment. The occupational history of 107 patients with bronchial and pleural cancer was prospectively collected between Jun 2001 and July 2002. A detailed list of the possible occupational activities that would expose the worker to a carcinogenic agent incriminated in the genesis of bronchial or pleural carcinoma was used. Seven cases among 107 bronchial and pleural cancers were thought to have a occupational origin [6.5%]. Two patients had pleural mesothelioma due to an exposition to asbestos in the field of navy constructions and building. The 5 remaining patients had bronchial carcinomas of different histological types [3 squamous cell carcinoma, 1 adenocar-cinoma and 1 small cell carcinoma]. The suspected agents were Arsenic in 4/5 cases in fields of metallurgy [2 cases], mine digging [1 cases], agriculture [1 case]. In 1/5 case the suspected agent was asbestos in brake- plates' maintenance in big engines. The mean duration of the exposition was 22 years and the latency period was 26 years. The role of occupational agents in the development of bronchial and pleural cancer is important but not routinely assessed

[Total body irradiation: techniques and main indications]

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

Metastase cerebrale d'un cancer du sein 49 ans apres le traitement initial

Very late metastases after cancer therapy are not common. We report an exceptional case of breast carcinoma associated with pregnancy that reocurred in the form of brain metastasis 49 years after initial treatment