Three weekly irinotecan and bolus 5-fluorouracil combination in the first line treatment of advanced gastric cancer - a single institution experience

Background: The goal of this study is to determine the efficacy and toxicity of a non-platinum based chemotherapy combination using irinotecan associated to bolus 5-FU as first line treatment in advanced gastric cancer. Materiel and methods: Retrospective analysis of a population of patients treated for metastatic and locally advanced gastric cancer with irinotecan and 5-FU as upfront chemotherapy. Results: Thirteen patients were enrolled. The median age was 56 years. Seven patients were males and six were of females. Ten patients had a metastatic disease and three patients had a locally advanced disease. Patients received a total number of 43 cycles of chemotherapy. Overall response rate was 38,4%, median time to progression (TTP) was 3 months, and median overall survival was 4 months. Three patients (23,1%) presented grade 3 /4 neutropenia complicated with an infectious episode with fever in two cases, three patients (23,1%) required blood transfusion for a grade 4 anemia, and one patient (7,6%) was hospitalized for a severe episode of diarrhea. Conclusion: Three weekly irinotecan and bolus 5-FU is an interesting combination as first line treatment of advanced gastric cancer; designed clinical trials are needed to confirm the activity of this combination

Biphasic Pulmonary Blastoma: a Case Report and Literature Review.

Introduction: Biphasic Pulmonary blastoma (BPB) is classified as one of the rare primary lung malignancies. It is composed of a mixture of epithelial and mesenchymal tissues resembling embryonic lung tissue. BPB is considered to be distinct from other lung tumors based on pathological features, clinical course and prognosis. Presentation of Case: The authors report an atypical case of BPB in a 27 -year-old man presented with complaints of dyspnea and left-sided chest pain for the previous four months. A chest radiograph showed the presence of an opaque left hemithorax, and the mediastinum was pushed toward the left. Computed tomography (CT) of the chest revealed a mixed solid and cystic process with variable contrast enhancement measuring 15,4 x 13,7 cm occupying the totality of the left hemithorax, pleural effusion, and a collapsed left lung, with contralateral mediastinal shift. A transthoracic needle pleural biopsy yielded a diagnosis of BPB.A general examination shows a peritoneal effusion. One month after diagnosis, the tumor grew rapidly, and therefore he was treated only by palliative care. He died from respiratory failure one month later. Although BPB is rare, this entity is increasingly described. Conclusion: The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when a pleural mass is identified. Histological examination is the most reliable and conclusive method of diagnosing BPB and differentiating it from other primary or metastatic lung malignancies.

Le traitement chirurgical des adenocarcinomes de la jonction osogastrique: Experience marocaine a travers une serie de 149 cas

Introduction: L'incidence du cancer de la Jonction oesogastrique (JOG) ne cesse d'augmenter depuis les deux dernieres decades aussi bien dans les pays industrialises que dans les pays en voie dedeveloppement notamment le Maroc. Le rapprochement sur le plan etiopathogenique desadenocarcinomes (ADK) du cardia et ceux du bas oesophage reste un sujet de controverse posant leprobleme du choix therapeutique chirurgical; notamment l'etendu de la resection. Le but de ce travail est de dresser le profil epidemiologique des patients operes pour un ADK du cardia et analyser les gesteschirurgicaux realises par l'equipe chirurgicale A du centre hospitalier universitaire IBN SINA a Rabat atravers une serie de 149 cas. Methodes: Il s'agit d'une etude retrospective ayant interesse les malades operes pour un ADK de la JOG sur une periode de 15 annees (1990-2004) en chirurgie A du CHU IBNSINA a Rabat. Resultats: 149 cas d'ADK de la JOG ont ete retenus. L'age moyen etait de 55 ans; 76etaient de sexe masculin avec un sex-ratio de 3/1. Les signes cliniques les plus frequemment observessont la dysphagie (70); les douleurs epigastriques (67) et le reflux gastro-oesophagien (15.5). La notion de tabagisme n'a ete rapportee que chez 20des cas et l'oesophage de barret chez 10des patients. Le type I de Siewert a concerne 65 cas (43.5); le type II 40 cas (27); et le type III 44 cas (29.5). Dans le type I une oesophagectomie transhiatale a ete proposee; alors que les type II et III ont ete traite comme un cancer de l'estomac par une gastrectomie totale. Les suites operatoires etaient simples chez 80des patients; la mortalite globale etait de 8.5. Conclusion: L'oesophagectomie par voie transhiatale chez les patients fragiles avec un ADK de la JOG de type I permet des resultats carcinologiques satisfaisants avec reduction de la morbidite postoperatoire par rapport a la voie transthoracique. La gastrectomie totale est le traitement de choix pour les types III; alors que le debat est toujours ouvert quant a la meilleure strategie chirurgicale pour la prise en charge des tumeurs de type II

Concurrent chemoradiotherapy in the management of advanced nasopharyngeal carcinoma: current status.

Nasopharyngeal carcinoma (NPC) differs from other head and neck cancers in its epidemiology, natural behavior and, particularly, in the therapeutic considerations. In addition, NPC is responsive to both chemotherapy and radiotherapy (RT). This article reviews the recent advances in concurrent chemoradiotherapy (CCRT) for NPC. To identify the studies mentioned in this article, we searched the MEDLINE database, and abstracts of selected conference proceedings (up to 2008) using the key words 'nasopharyngeal carcinoma,' 'advanced,' 'radiotherapy,' and 'concurrent chemotherapy.' Eight randomized clinical trials of CCRT in NPC have been reported in the English literature. These trials can be classified according to the timing of the chemotherapy, which was given either concurrently with RT (in three trials) or concurrently with radiotherapy and adjuvant after the and of concurrent chemoradiotherapy (in five trials). There have also been four meta-analyses addressing the value and scheduling of chemotherapy in the curative treatment of NPC. This article reviews the recent literature and the pertinent issues concerning the role of CCRT in the treatment of patients with locoregionally advanced NPC.

Primary lymphoma of the ovary.

Involvement of the ovary by malignant lymphoma is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma is rare. We report a case of primary ovarian non-Hodgkin's lymphoma with bilateral involvement which was managed by surgery and chemotherapy. A 29-year-old woman was admitted with signs and symptoms suggestive of an ovarian cancer. Computed tomography revealed an abdominal tumor measuring 20 cm in diameter, without enlarged lymph nodes. The diagnosis of malignant lymphoma was established after bilateral adnexectomy and histological study of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient has been advised 8 cycles of standard CHOP regimen and is presently on treatment. She has now been without disease for 7 months after the surgery. According to previous reports the treatment principles and prognosis of primary ovarian lymphoma is the same as that of other nodal lymphomas.