Radiation Therapy for Primary Eyelid Cancers in Tunisia.

Management of eyelid cancers is based on surgery and/or radiotherapy (RT). The treatment objective is to control tumors with acceptable functional and esthetic outcomes. The aim of this study was to evaluate the results of radiation therapy in management of epithelial eyelid cancers, reviewing retrospectively the clinical records of patients treated in our institution from January 1989 to December 2013. We focused on clinical and histological features, treatment characteristics, tolerance and disease control. One hundred and eight patients (62 men and 46 women) were enrolled, with a mean age of 61 years [ranges 1587]. The most frequent tumor location was the inner canthus (42.6%). Median tumor size was 21 mm [ranges 470]. Histological type was basal cell carcinoma in 88 cases (81.5%), squamous cell carcinoma in 16 (14.8%) and sebaceous carcinoma in 4 (3.7%). Radiation therapy was exclusive in 67 cases (62%) and postoperative for positive or close margins in the remaining cases. Kilovoltage external beam radiotherapy (KVRT) was used in 63 patients (58.3%) and lowdoserate interstitial brachytherapy in 37 (34.3%). Eight (7.4%) were treated with cobalt or with a combination of KVRTcobalt, KVRTelectron beams, KVRTbrachytherapy or cobaltelectron beams. The total delivered radiation doses were 70 Gy (2 Gy/fraction) in 62 patients (57.4%), 66 Gy (2 Gy/fraction) in 37 (34.3%) and 61.2 Gy (3.4Gy/fraction) in 9 (8.3%). After a median followup of 64 months, we noted 10 cases of local recurrences(9.2%): 7 after exclusive and 3 after postoperative RT. No local recurrence occurred in patients treated with brachytherapy. Actuarial 5year local recurrencefree rate, diseasefree survival and overall survival were respectively 90%, 90% and 97%. Tstage was found to be a significant factor for recurrence (p=0.047). All acute radiationrelated reactions were scored grade I or II. Delayed effects were eye watering in 24 cases (22.2%), eye dryness in 19 (17.6%), unilateral cataract in 7 (6.4%) and ectropion in 4 (3.7%). Radiation therapy and especially brachytherapy is an efficient treatment of eyelid cancers, allowing eye conservation and functional preservation with good local control rates and acceptable toxicity.

Myeloma after local external beam radiotherapy jet: Is it a new entity?

Multiple myeloma, also known as Kahler's disease, is a cancer of plasma cells that abnormally accumulate in bone marrow. Radiation therapy may be indicated in multiple myeloma to relieve pain, alleviate spinal cord compression or reduce tumor mass. We report the case of a patient presenting a multiple myeloma, treated with radiation therapy for a spinal cord compression, who developed, eleven months later, an in-field subcutaneous relapse. We called this phenomenon myeloma appearance after local external beam radiotherapy jet (MAALEJ). A review of literature was performed trying to explain this uncommon relapse feature.

[Adjuvant radiotherapy in patients with endometrial cancers]. / Place de la radiothérapie dans la prise en charge postopératoire des patientes atteintes de cancer de l'endomètre.

The treatment of patients with endometrial cancer has been extensively modified in recent years. Several randomized studies have redefined the indications for adjuvant therapy in tumours staged 1. In the absence of poor prognostic factors, the management tends to be less aggressive than before, often limited to vaginal brachytherapy. Conversely, for more advanced lesions, for which prognosis is poor, combinations of chemoradiation are currently being evaluated. This literature review aims to provide an update on recent developments in the management of adjuvant radiotherapy for endometrial carcinoma.

[Early breast cancer without axillary lymph node involvement]. / Cancer du sein sans atteinte ganglionnaire axillaire.

Breast cancer is the most common cancer in women. In France, breast cancer incidence was 88.9 per 100,000 women in 2000. Early detection of breast tumours by screening mammography allows a breast conserving treatment, i.e., breast irradiation preceded by a lumpectomy and a sentinel node biopsy. The standard irradiation of early breast cancers consists in delivering 50 Gy to the whole breast in 2 Gy fractions over a five-week period followed by an additional dose targeting the tumour bed of 16 Gy in eight fractions. The 3D-conformal treatment planning optimizes dose distribution to the whole breast and to the tumour bed and lessens the normal tissue irradiation (heart and ipsilateral lung). The aim of this article is to describe epidemiologic, radio anatomic and prognostic features of early stage breast cancer and to propose guidelines for 3D-conformal treatment planning in early breast cancers. This review is illustrated by a case report.

[Breast cancer with axillary lymph node involvement]. / Cancer du sein avec atteinte ganglionnaire axillaire.

Breast cancer is the most frequent cancer of women in western countries. There are one million new cases per year in the world which represents 22% of all female cancers, and more than 370,000 deaths due to breast cancer per year (14% of cancer mortality). More than half of breast cancers are associated with axillary nodal involvement. Post-operative radiation therapy (XRT) is a crucial part of locoregional treatment in axillary nodal involvement breast cancer owing to a 15-years risk reduction of locoregional recurrence of 70% and to a 5.4% risk reduction of specific mortality. In 3D-conformal irradiation in such breast cancers, target volumes are chest wall when mastectomy was performed or breast and boost of tumor bed in case of breast conservative surgery, and supra-clavicular and/or axillary and/or internal mammary node areas. The main organs at risk are ipsilateral lung, heart and brachial plexus. The aim of this article is to describe epidemiologic, radio anatomic and prognostic features of axillary nodal involvement breast cancer and to propose guidelines for 3D-conformal treatment planning in locally advanced breast cancers. This review is illustrated by a case report.

Autophagy and Crohn's disease: at the crossroads of infection, inflammation, immunity, and cancer.

Inflammatory bowel diseases (IBD) are common inflammatory disorders of the gastrointestinal tract that include ulcerative colitis (UC) and Crohn's disease (CD). The incidences of IBD are high in North America and Europe, affecting as many as one in 500 people. These diseases are associated with high morbidity and mortality. Colorectal cancer risk is also increased in IBD, correlating with inflammation severity and duration. IBD are now recognized as complex multigenetic disorders involving at least 32 different risk loci. In 2007, two different autophagy-related genes, ATG16L1 (autophagy-related gene 16-like 1) and IRGM (immunity-related GTPase M) were shown to be specifically involved in CD susceptibility by three independent genome-wide association studies. Soon afterwards, more than forty studies confirmed the involvement of ATG16L1 and IRGM variants in CD susceptibility and gave new information on the importance of macroautophagy (hereafter referred to as autophagy) in the control of infection, inflammation, immunity and cancer. In this review, we discuss how such findings have undoubtedly changed our understanding of CD pathogenesis. A unifying autophagy model then emerges that may help in understanding the development of CD from bacterial infection, to inflammation and finally cancer. The Pandora's box is now open, releasing a wave of hope for new therapeutic strategies in treating Crohn's disease.

[Extramedullary haematopoiesis: report of two cases]. / Hématopoïèse extramédullaire: à propos de deux cas.

Extramedullary haematopoiesis is a physiologic response to chronic anaemia, commonly observed in various haematological disorders. This phenomenon is habitually asymptomatic but it may induce compression of adjacent organs such as the spinal cord. We present the cases of two patients suffering from chronic anaemia, who developed foci of ectopic hematopoiesis, and we discuss through a review of literature, the presentation and the management of this disease, with focus on the role of decompressive radiotherapy.

In vitro antiviral activity of dermaseptins against herpes simplex virus type 1.

The in vitro antiviral activity of dermaseptins (S1-S5) against herpes simplex virus type 1 (HSV1) was investigated. These peptides were incubated with the virus and its target cells under various conditions, and their effects were examined by the cytopathic effect inhibition assay or by reduction in virus yield in Hep-2 cell cultures as well as by direct immunofluorescence. Dermaseptin S4 displayed the strongest antiviral effect against HSV1, at micromolar doses. Experiments including acyclovir as a reference antiviral agent were performed to investigate the mode of action of this dermaseptin. In contrast to acyclovir, dermaseptin S4 showed its inhibitory effect only when applied to the virus before, or during virus adsorption to the target cells. This suggested that the activity of this dermaseptin was exerted at a very early stage of the viral multiplication cycle, most likely at the virus-cell interface.

[Amoebic keratitis caused by Acanthamoeba sp. May HSV1 infection play a role?]. / Kératite amibienne à Acanthamoeba sp. L'infection par HSV1 aurait-elle un rôle?

Many cases of human keratitis with Acanthamoeba sp. have a pseudo-herpetic appearance. The authors therefore evaluated the importance of co-infection with this virus in the onset of amoebic cornean lesions. After herpetic and amoebic co-infection rabbits showed severe cornean lesions, the viral aspect of cornea received a specific treatment. The amoebic co-infection progressed unchecked with severe lesions until day 37 p.i., in which trophozoites and cysts were numerous. The possible favourising role of HSV1 and Acanthamoeba sp. co-infection may exist in humans, just as it certainly exists in the rabbit.

A syntactic approach for handwritten mathematical formula recognition.

Mathematical formulas are good examples of two-dimensional patterns as well as pictures or graphics. The use of syntactic methods is useful for interpreting such complex patterns. In this paper we propose a system for the interpretation of 2-D mathematic formulas based on a syntactic parser. This system is able to recognize a large class of 2-D mathematic formulas written on a graphic tablet. It starts the parsing by localization of the ``principal'' operator in the formula and attempts to partition it into subexpressions which are similarly analyzed by looking for a starting character. The generalized parser used in the system has been developed in our group for continuous speech recognition and picture interpretation.