[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

[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

[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