ABSTRACT
Exocrine pancreatic carcinoma [EPC] occurs in the majority of cases with early locoregional spread and distant metastasis at diagnosis, leading to dismal prognosis and limited treatment options. Traditional cytotoxic chemotherapy provide only modest benefit to patients with EPC. Identification of different molecular pathways, overexpressed in pancreatic cancer cells, has provided the opportunity to develop targeted therapies with a crucial therapeutic role in this cancer setting. Our aim is to study the epidemiological, clinico-pathological characteristics, treatment modality and clinical outcome of pancreatic adenocarcinoma in Tunisian patients treated in the department of medical oncology Abderrahmane Mami Ariana. This retrospective study concerned patients with exocrine pancreatic carcinoma treated between 2009 and 2012. We analysed the following data: Anamnesis, age, sex, delay to diagnosis[DD], symptoms, clinical exam, performance status, stage, therapeutic protocol and results. We collected 158 patients [113 males/45 females, SR 2.5] with a median age of 64 years [20-93]. The median DD was 2 months [1-12]. Abdominal pain, jaundice and weight loss were the most frequent symptoms, 88.6%, 43% and 55.1% of cases respectively. Performance status was < 2 in 56.9% [90 pts]. Seric CA19-9 was increased in 86.6% of cases. Tumor was at stage III in 24.7% and stage IV in 58.2%. Surgery was done in 24.7% of cases [39pts], curative in 21 patients. Neoadjuvant chemotherapy[NACT] was administrated to 10.8% of patients, adjuvant to 13.9% [22 pts] and palliative chemotherapy[PCT] concerned 58.8% of patients. We used weekly Gemcitabine, Gemcitabine-CDDP, Gemcitabine-Oxaliplatine and LV5-FU2-CDDP in palliative setting respectively in 20%, 31.1%, 2.2 and 36.7% of cases. Median survival was 6 months [2-60] and the 1year overall survival at 38.8%. EPC remains a rare cancer in Tunisia. The prognosis is still grim worldwide and so does in our country. In this retrospective serie, we noted the predominance of locally advanced and metastatic cases with a long delay to diagnosis. Awareness campaigns have to be programmed to improve early diagnosis in EPC and improve outcomes
ABSTRACT
Background: Background: Non-small cell lung cancer [NSCLC] is the most common histologic form, leading causes of cancer death among masculine population. Half of CNPC was metastatic at diagnosis
Aim: To report the epidemiologic, anatomoclinic profile, therapeutic protocols and results of a retrospective study of non-small cell lung cancer [NSCLC] initially metastatic
Methods: our retrospective study include patients with NSCLC histologically confirmed with inaugural metastasis collected from January 1999 to december 2012. We had analysed epidemiologic, anatomopathologic data [TNM 2009], therapeutic protocols and results in term of overall survival, median survival and event free survival
Results: 100 case of NSCLC have been collected, mea nage was 57 years [22 to 81] and sex -ratio was 4,6. The majority of cases [74%] had a good performance statut [PS
Conclusion: Despite therapeutic progress in management of NSCLC, the prognosis of metastatic forms still reserved with a poor mean survival reported in litterature [12 years] valideted in our study. This push us to improve research mainly since advent of targeted therapy which still a promising way in the management of these tumors
ABSTRACT
Lung cancer is the first cause of death by cancer worldwide. In Tunisia, its incidence has increased from 17.6 cases per 100.000 persons in 1997 to 27.6 cases per 100.000 persons in 2003. Its prognosis has been improving thanks to the emergence of molecular targets. The first one is represented by EGFR [Epidermal growth factor receptor], which marks this year [2014] its tenth anniversary. Many other targets have been identified. The most famous and useful of them is the fusion gene ALK-EML4 but other oncogenic pathways have been implicated and are under investigations including HER2, BRAF, MET, RET . The most relevant challenges encountered are represented by the difficulty to achieve a consensual decisional and therapeutic algorithm, the absence of standardized diagnostic techniques and the unavoidable occurrence of secondary resistance due to the activation of other oncogenic pathways that must be explored and targeted. In this update, we tried to present the major pathways implicated and the most relevant practice routine strategies
ABSTRACT
Background: Glioblastoma [GB] is the most common and lethal primary brain tumor in adults representing 25% of primary brain tumors in adults. The objective of our study was to report the epidemiologic, clinical and therapeutic features of GB in Tunisia.
Methods:Our retrospective study included 41 patients with histologically confirmed GB treated between 2006 and 2012 at the medical oncology departments of Abderrahmane Mami hospital in Ariana and the military hospital in Tunis
Results: Median age was 54 years [13 to 72 years] and sex-ratio was 2.3. Karnofsky performance status [KPS] was <70% in 31.7% of cases, while Recursive partitioning analysis radiation therapy oncology group [RTOG-RPA] classification was III in 11 [26.8%], IV in 19 [46.3%], V in 10 [24.3%] and VI in 1 [2.4%] cases. Complete resection [CR] was achieved in 29 patients [70.7%], partial resection [PR] or tumor debulking in 5 patients [12.2%] and biopsy alone [BA] in 7 patients [17.1%]. All patients received brain radiotherapy [RT] at a dose of 60 Gy combined with concurrent temozolomide [TMZ]. Nineteen patients [46.3%] received adjuvant TMZ, 8 of them completed 6 cycles. Median overall survival [OS] was 12 months [2 to 56 months]. Six, 12, 18 and 24-months OS rates were 84.6%, 57.6%, 35.4% and 20.7%, OS being correlated to age, KPS, RPA and quality of resection
Conclusion: Our retrospective study is the first African GB series. Despite it included predominantly poor prognosis patients with impaired neurocognitive function and adjuvant treatment discontinuation, our median OS was comparable to Stupp data
ABSTRACT
To analyze the literature data concerning the results of the main international randomized trials of adjuvant Aromarase Inhibitors [AI] in adjuvant setting for early breast cancer and the impact on daily practice in the management of breast cancer. We selected through a literature review 30 publications concerned the topic of AI They concerned the large ATAC, BIG, MA17 and IES concerning anastrozole, letrozole and exemestane . AI have been compared to tamoxifen in upfront of swich intents and showed a superiority to reduce, mortality rate, controlateral breast cancer risk, a better tolerance profile compared to tamoxifen and a significant benefit in term of disease-free survival. These results made a revolution in the adjuvant BC treatment, leading to the systematic use of upfront AI in menopaused patients. Adjuvant hormonotherapy in menopaused patients is now based on AI and proved its superiority to tamoxifen in term of distant, controlateral risks reduction and disease-free survival, less for overall survival
Subject(s)
Humans , Female , Breast Neoplasms/drug therapy , Tamoxifen , MenopauseABSTRACT
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