Primary thyroid lymphoma: clinicopathologic characteristics and therapeutic outcomes of six cases in morocco

Background: Primary non-Hodgkin lymphomas of the thyroid are uncommon and account for 1-5% of all thyroid malignancies and less than 2% of extranodal lymphomas. The aim of the present study was to review our experience and management of primary thyroid lymphoma and to discuss the diagnostic and therapeutic considerations

Methods: All non-Hodgkin lymphoma diagnosed at our institution between 2007 and 2011 were reviewed, six cases of primary thyroid lymphoma were identified. The clinical and pathological features of these patients were analyzed

Results: There were five females and one male and their mean age was 67.5 years. All patients presented with an enlarging anterior neck mass and two patients also have compressive symptoms. Five patients have a history of pre-existing goiter, four have 'B' symptoms and one was hypothyroid. All patients have B-cell Non Hodgkin Lymphoma. Four patients have stage II disease, while two patients have disseminated disease. All patients underwent thyroid resection. One patient died after surgery. The five others were treated postoperatively with 3-weekly cycles of combination chemotherapy. One patient in stage II received consolidation radiotherapy after chemotherapy. Complete remission was achieved in four patients and one patient had partial response to the treatment. After a median follow-up of 26 months [2-51], three patients are still alive without any relapse, one died and the last was lost to follow up

Conclusion: Primary thyroid lymphomas are rare. Treatment depends on the histological subtype and stage of the disease, including radiotherapy and chemotherapy. The prognosis usually is favorable with proper treatment

Pain and cancer: a systematic review

Pain is the most common symptoms in patients with cancer, a significant number of cases it is undiagnosed and under treated. It is important to understand the nature of the pain experienced by patients, to distinguish between nociceptive and neuropathic pain. Successful management of cancer pain requires a good knowledge of the causes of pain and various treatment available and information to manage their side effects. Pain has a significant negative impact on the patient and his family, therefore it needs to be managed urgently and appropriately

Bevacizumab in clinical practice

The development of targeted therapies and especially angiogenesis inhibitor drugs is undoubtedly a major advancement in the treatment of cancer in the 21st century. Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor that was approved for the treatment of multiple solid tumors, we have reviewed the side effects cited in clinical trials of bevacizumab and the guidelines for their management and we can conclude that bevacizumab, is generally well tolerated but is associated with increase in some adverse side effects for which monitoring is required particularly vascular and renal side effects including hypertension, proteinuria, thromboembolic events and hemorrhage. The better understanding of bevacizumab toxicity profile and the guidelines for their optimal management as well as the education of patients may allow prolonged therapy and thus improved clinical outcomes

Clinical prognostic factors in locally advanced nasopharyngeal carcinoma in Moroccan population

Nasopharyngeal carcinoma is a distinct cancer of head and neck by its pathology, etiology, epidemiology and clinical behavior. Morocco is considered an endemic region with intermediate incidence. The aim of our report is to underline some clinical determinants of survival in locally advanced disease. We conducted a retrospective study from January 2003 to December 2005. All patients with undifferentiated nasopharyngeal carcinoma treated in the National Institute of Oncology of Rabat, Morocco were recorded. Classified stage II to IVB disease according to TNM classification adopted by the AJCC [American Joint Committee of Cancer] 6th edition. The study included 339 patients, 122 women and 217 men [sex-ratio: 1.7]. Mean age was 43 years old [range: 6-91years]. Median duration to diagnosis was 6 months [range: 1-72] presenting symptoms at diagnosis were predominantly cervical lymph node in 79%. Forty- two patients have T1 tumors, 159 = T2 tumors, 64 = T3 tumors and 69 = T4 tumors. Sixty-five patients do not have lymph-node involvement, 49 have N1, 128 have N2 and 95 have N3. Three patients were at stage IIA, 57 patients were at stage IIB, 40 patients were at stage III, and 57 patients were at stage IVA and the remaining 96 patients were at stage IVB. Eighty-seven percent of patients underwent sequential chemoradiation and 17% underwent concurrent chemo-radiation [CTR]. Response to induction chemotherapy was assessed in 235 patients. There were 31 patients with complete response and 59 patients have partial response. Complete response to radiotherapy was reached in 235 patients. Mean overall survival [OS] was 66.2%. Gender was a prognostic factor of OS [p=0.045] and DFS favoring women. Age wasn't a prognostic factors determining the outcome with no difference between patients aged more than 40 years old and patients younger. Tumor size was not a determinant of survival with a non-significant p in OS and DFS [0.27 and 0.46 respectively] but T4 stage patients appear to have a worse prognosis. Lymph node involvement was significantly determining the outcome either in OS and DFS [p=0.001 and 0.009 respectively]. TNM stage was also a significant prognostic factor in OS but not in DFS favoring those with early stage [p= 0, 004 and p= 0, 13 respectively]. The treatment strategy was not a significant prognostic factor with no difference between patients who underwent sequential or concurrent chemoradiation [OS p= 0, 48 and DFS p= 0, 9]. In multivariate analysis, lymph-node involvement is the most significant factor. Our findings were mostly concordant with the literature data in endemic areas for TNM staging; however we are limited by the bias of retrospective studies. Prospective studies would be more accurate to define those prognostic factors in our population