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

[Primary osteosarcoma of the breast]

The primary osteosarcoma of the breast is a rare tumor representing only 0.25% of malignant breast tumors. Its diagnosis is based on the exclusive presence in the breast of an ostrogenic sarcomatous component, and the absence of any epithelial component confirmed by immunohistochemical and ultra-structural study. For localized stages, the treatment is mainly based on surgery. The place of adjuvant treatments [radiotherapy and chemotherapy] remains to be defined. For metastatic palliative chemotherapy is recommended. A woman of 45 years old, without particular pathological history, presenting a primary osteosarcoma of the left breast, confirmed by immunohistochemical study and a correct staging, metastatic from the outset, treated by a palliative chemotherapy with a fatal outcome. We will discuss the risk factors for primary breast osteosarcoma of diagnostic, its diagnostic criteria treatment and outcome, with a review of the literature. We will discuss also its histological aspects, treatment and outcome, with a review of the literature It is an aggressive disease that requires early diagnosis, adequate and early therapeutic management to ensure good locoregional and general control and improve better outcome. His prognosis is still very pejorative

[Adjuvant treatment of early endometrial carcinomas]

Endometrial carcinoma is the most common gynaecological malignant disease in developed countries. About 80% of patients present with early stage disease can be diagnosed [limited uterine tumour stage I or II]. The surgery of first intention allows to individualize decisional prognosis factors of adjuvant therapy. Postoperative radiation therapy plays a major role in the management of stage I and II endometrial carcinoma, but the respective place of external beam radiotherapy and vaginal brachytherapy remains controversial. Several randomized studies have shown that adjuvant external beam radiotherapy reduces locoregional recurrences, but carries a risk of toxicity without overall survival benefits. This technique is restricted to patients with high risk endometrial cancer. For those with intermediate risk, exclusive vaginal brachytherapy ensure an excellent local control with less toxicity. The indication for adjuvant chemotherapy should be discussed in the group of patients with high risk endometrial cancer. But adjuvant hormone therapy is not recommended for early stage disease

[Desmoplastic small round cell tumor]

Desmoplastic small round cell tumor is a recently recognized and rare clinicopathologic entity with distinctive morphologic and immuno histochemical features .Moreover, specific cytogenetics abnormalities and molecular characteristics have been described and confirmed its identity. It is often located at the abdominal cavity, but can exceptionally be located at the cerebral level or some soft tissue and the bones of the members. We report a case of Desmoplastic small round cell involving gluteal muscle and iliac bone at a 25-year-old girl. Our patient had been treated by chemotherapy based on ifosfamide, doxorubicine, etoposide and cis platine. The evolution was marked by the tumoral progress and the death of the patient 18 months after the discovery of the disease. The second case is a 27-year old man .He had a retro peritoneal desmoplastic small round cell tumor treated by surgery alone. The evolution was marked by metastasis and the patient died 10 months after diagnosis. The prognosis of these tumors remains unclear in spite of the mulitidisciplinary treatment. Hence the necessity of new lines of therapeutic research

[Preoperative radiochemotherapy for resectable esophageal cancer]

It is the third most frequent cancer of the digestive system, its treatment for respectable stage [T3-T4a, No-N1] based on surgery. Preoperative radiochemotherapy remains a controversial strategy for both squamous cell carcinoma then for adenocarcinoma. Until recently, randomized studies combine the two histological types, often without any distinction. In randomized studied involving mainly or exclusively respectable localized squamous cell carcinoma, the preoperative radiochemotherapy increases the rate of complete resection, the pathological response, the rate of local control, and disease-free survival. The absence of any impact on overall survival may be linked to the toxic effects of this treatment. Meta-analyses have revealed a survival benefit of approximately 13% at 2 years. However, the methodology used was perhaps questionable. Two randomized trials [French and German] compared surgery or additional radiochemotherapy after a first phase of radiochemotherapy in locally advanced respectable squamous cell carcinomas [T3-T4, N0-N1]. Both drew the same that is surgery did not improve survival benefit for patients in complete response, which remains difficult to predict and highlight. Five randomized trials focusing on patients with adenocarcinoma of the esophagus or gastro esophageal junction, the results are contradictory with insufficient statistical power in some positive studies. The recently CROSS randomized trial in fact except to answer this question once and for all: preoperative radiochemotherapy has been beneficial in this Dutch trial in terms of rates of complete resection and overall survival, without postoperative mortality

[Radiotherapy in rectal cancer: standards and actualities]

The treatment of rectal cancer has been profoundly modified during last years. In less than one decade we evolved from a situation where the surgery is used to be the only standard treatment for cancer rectum to a situation where radiation therapy associated with surgery is recommended by several authors. The radiotherapy is well established as a major component in treatment cancer rectum. As it reduced the local recurrence to about 50% and improves global survival rate. Even if some points related to timing and technical modalities are still discussed, the association of radiotherapy and surgery nowadays is the standard treatment for rectal cancer. Meanwhile, some tuning still interesting trials will provide assessment of association of radiation therapy and chemotherapy by using new drugs

Treatment of keloids by immediat post-operatoire interstitial brachytherapy

Clinically considered as a pathologic scar remaining beyond 12 to 18 months, the keloid is characterised by a high recurrance rate after excision alone [50% - 100%]. Many therapeutic methods were used [Corticotherapy, pressotherapy], with disappointing results. The aim of this paper is to identify that post operative interstitial radiotherapy by iridium 192 [low dose rate] is effective for improving local control of keloids and preventing recurrence. From 1995 to 1998, 14 patients [18 keloids] were treated at the National Institute of Oncology - Rabat - Morocco. The average age is 27 years. The keloid was located on ear lobes in half of the cases. All patients had previously a trauma [injured, surgery]. 3 patients had multiple keloids. 10 patients [70% of cases] had keloid relapse after surgical excision. The treatment consisted of surgical excision followed immediately by brachytherapy with iridium 192. After 41 months of follow-up, we had obtained a good esthetic results in 7 cases [8 keloids]. 4 patients [5 keloids] recurred after an average delay of 14 months. 4 patients [5 keloids] were lost to follow-up

Paratesticular rhabdomyosarcoma

Paratesticular rhabdomyosarcoma occurs predominantly in children and adolescents. is a rare tumor and It's developped proximal to the tesicle. Clinical signs are like any intrascrotal tumor. Scrotal ultrasound, CT scan and tumor markers are necessary for the diagnostic and stadification of this cancer. Orchidectomy followed by chemotherapy and radiotherapy is the usual treatment. We report 3 cases of paratesticular rhabdomyosarcoma. We discuss the diagnosis and therapeutic attitudes, evolutionary aspects and prognostic factors of these tumors re also discussed