[Results of a retrospective study on radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma]. / Place de la radiothérapie pour les lymphomes du mucosa-associated lymphoid tissue gastriques : résultats d'une étude rétrospective.

PURPOSE: We aimed to evaluate therapeutic results of radiotherapy for gastric mucosa-associated lymphoid tissue (MALT) lymphomas. PATIENTS AND METHODS: We reviewed retrospectively the records of 11 patients presenting with gastric MALT lymphoma treated between 1993 and 2014. Patients with low-grade lymphoma in failure after helicobacter eradication had exclusive gastric external radiotherapy. Chemotherapy followed by radiotherapy were indicated in case of high grade lymphoma. Radiotherapy doses range between 30 and 40Gy (2Gy per fraction, five fractions per week). RESULTS: All tumours were IE stage. Seven patients with low-grade lymphoma had radiotherapy. Four patients with high-grade lymphoma received chemotherapy then radiotherapy. Ten patients are in complete remission after treatment achievement. Five and 10 years disease-free survival are 100%. No severe toxicity was seen. CONCLUSION: Eradication of Helicobacter pylori is the mainstay of treatment of gastric MALT. External irradiation is an effective and well-tolerated treatment modality in case of resistance to helicobacter eradication.

[Role of postoperative chemoradiotherapy in the therapeutic management of adenocarcinomas of the stomach and oesogastric junction]. / Quelle place pour la chimioradiothérapie postopératoire dans la prise en charge thérapeutique des adénocarcinomes de l'estomac et de la jonction œsogastrique ?

The available data in the literature show that for gastric adenocarcinoma or gastroesophageal junction adenocarcinoma, postoperative chemoradiotherapy improves disease-free survival after surgery with D0 or D1 lymph node dissection (and perhaps D2) as well as in case of positive node or R1 resection. With the publications of perioperative chemotherapy trials, the role of postoperative radiotherapy in the therapeutic arsenal of gastric adenocarcinoma or gastroesophageal junction adenocarcinoma becomes difficult to define. Postoperative radiotherapy is indicated in case of R1 resection.

[Small cell carcinoma of the ovary]. / Carcinome à petites cellules de l'ovaire.

Small cell carcinoma of the ovary of the hypercalcemic type is a rare tumor. We report a case in a 34-year-old patient, revealed by a pelvic pain. The imaging found a large mass of the right ovary. The patient had right oophorectomy and total hysterectomy, a left oophorectomy, pelvic and a para-aortic lymphadenectomy. She subsequently received 6 cycles of adjuvant chemotherapy followed by pelvic radiation therapy. The hypercalcemic small cell carcinoma of the ovary is a rare disease of poor prognosis. Treatment approaches include surgery, chemotherapy with the addition of radiotherapy.

[Localized primary bone lymphoma: about four cases]. / Lymphome osseux primitif localisé : à propos de quatre cas.

PURPOSE: To study epidemiological, clinical, pathological anatomy and therapeutic results of localized primary bone lymphoma. PATIENTS AND METHODS: Between February 1993 and February 2013, four patients were treated for localized primary bone lymphoma in Sfax's hospitals (Tunisia). Treatment was decided regarding to the age of the patient, his performance status, stage of the disease, lactate dehydrogenase (LDH) and socio-economical conditions of the patient. The therapeutic evaluation was done after chemotherapy and after radiotherapy. There was a clinical, biological and radiological follow-up. RESULTS: The mean age was 59.5 years. The sex-ratio was 3. Bone localizations were clavicula, femur, humerus and mandibula. All patients had stage I large cell B lymphoma. In 3 cases, imaging showed osteolytic lesions with cortical destruction and extension to soft tissues. One patient had a fracture of the humerus. The treatment consisted in chemotherapy followed by radiotherapy. Three patients were alive with complete remission after a mean follow-up of 76 months. CONCLUSION: The treatment of primary bone lymphoma is based on a combination of chemotherapy (with or without anti-CD20) and radiotherapy. The prognosis is excellent when it is localized.

[Treatment of primary bone lymphomas]. / Traitement des lymphomes osseux primitifs.

Primary bone lymphoma constitutes a rare entity. They are often localized. The studies published are retrospective, using definitions and different classifications. The populations of the studied patients are often heterogeneous. The therapeutic modalities used are also different. Consequently, the prognostic stratification and the analysis of the therapeutic results are difficult. We review the literature and discuss the therapeutic modalities and the results as well as the prognosis of the primary bone lymphomas.

[A long survival after the treatment of a squamous cell carcinoma of the gallbladder]. / Une longue survie après traitement d'un carcinome épidermoïde de la vésicule biliaire.

We report the case of a long survival after the treatment of a squamous cell carcinoma of the gallbladder. The patient is a 58-year-old man, who was treated by cholecystectomy, followed by postoperative radiotherapy of the tumour bed at a dose of 45Gy, combined with 5-fluoro-uracil chemotherapy. After 18 years, the patient is alive in complete remission. The end point of this work was to study the clinical and therapeutic characteristics of squamous cell carcinoma of the gallbladder and its prognosis through this case and a review of literature.

[Extramedullary plasmocytomas]. / Plasmocytomes extraosseux.

PURPOSE: To study the localization, treatment and prognosis of extramedullary plasmocytoma through a series of eight patients and a literature review. PATIENTS AND METHODS: Eight patients with extramedullary plasmocytoma were treated in the university's hospital of Sfax in Tunisia. The average age was 57.3 years. Female represented 75% of patients. The diagnosis of plasmocytoma was based on anatomo-pathology and immunohistochemistry of a biopsy or resected tumour. Extramedullary location was confirmed if biological and radiological exams and medullary biopsy were normal. The therapeutic decision was made after multidisciplinary meetings regarding tumour location and anterior treatment. RESULTS: Solitary extramedullary plasmocytoma was located in nasal cavity, cervical node, testis, ovary, bladder and the tongue. One patient was treated for three simultaneous locations of extramedullary plamocytoma (node, bowel, pleura) without evidence of myeloma. Radiotherapy was proposed in six cases but refused in one case (plasmocytoma of the bladder is currently receiving radiotherapy). Treatment consisted in chemotherapy in two cases. Evaluation after treatment revealed complete remission in 86% of the cases. Nodal recurrence was noted in two cases. These two patients were lost to follow up. The five other patients were in complete remission after a mean follow up of 5.7 years. No local recurrence or myeloma was noted. CONCLUSION: Extramedullary plasmocytoma is a rare affection. It can occur in any region of the body. Head and neck is most frequent localization. The treatment is irradiation or surgery in some localization. Progression to myeloma is the most important factor that influences the prognosis of the disease.

[Upper limb lymphedema after breast cancer treatment]. / Lymphœdème du membre supérieur après traitement du cancer du sein.

PURPOSE: To study the frequency and risk factors for upper limb lymphedema through a series of patients treated for breast cancer. PATIENTS AND METHODS: It is a retrospective study about 222 patients treated for breast cancer during the period between February 1993 and December 2003 in Sfax hospitals. Average age was 51 years (27-92 years). Tumour was T2 in 59% of cases. All patients had surgery with lymph node dissection. Infiltrating ductal carcinoma was the most frequent histological type (80% of cases), with predominant SBR II grade (62%). The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node metastasis was detected in 124 patients. Radiotherapy was delivered in 200 patients, including axillary irradiation in 30 cases. The mean follow-up was 68 months (12-120). RESULTS: Lymphedema appeared in 23% of cases (51 patients), 14 months after surgery (mean period). Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases and all upper limb in 71% of cases. Fifty percent of patients had rehabilitation. However, improvement of lymphedema was obtained in 18 cases. Parameters predicting lymphedema were studied. Significant risk factors were obesity, infection and a number of removed lymph node above 10. The type of surgery, axillary irradiation and shoulder abduction deficit did not predict lymphedema. CONCLUSION: Lymphedema of the arm is a frequent consequence of breast cancer treatment. The risk of lymphedema is correlated with obesity, infection and a number of removed lymph node above 10.

[Radiotherapy for cutaneous cancers with xeroderma pigmentosum]. / Radiothérapie des cancers cutanés au cours du xeroderma pigmentosum.

PURPOSE: To analyze the therapeutic results of cutaneous cancers on xeroderma pigmentosum through a series of 15 patients treated by radiotherapy. PATIENTS AND METHODS: Between 1993 and 2006, 15 patients with xeroderma pigmentosum and having cutaneous cancers were treated in the Radiotherapy Department of university hospital Habib-Bourguiba of Sfax in Tunisia. Seventy-three percent of the cases occurred in male patients and the mean age of appearance of the first tumour was 18.2 years. Tumour histology was squamous cell carcinoma in 74% of the cases. The total number of cutaneous tumours was 84. Ten patients had a surgical resection. Four patients did not respond to chemotherapy. The modality of irradiation was decided according to the size, thickness and localization of the tumour. The dose of radiotherapy was 60Gy or equivalent with classic irradiation. RESULTS: The total number of lesions treated with radiotherapy was 64. Forty-three lesions were treated with contact therapy, ten with brachytherapy and 11 with cobalt therapy. The following acute complications were observed: cutaneous infection (53.3% of patients), radioepithelite (80% of patients) and necroses (33.3% of patients). Evaluation after treatment showed a clinical complete remission in 73% of the cases. Late effects were noted in seven cases: telangiectasy and cutaneous atrophy. A recurrence in the irradiated zone was observed in one case. A nodal metastasis was observed in two cases. Another patient presented lung metastases. After a median follow up of 37.2 months, four patients died, seven are alive with cutaneous cancer and four are alive with complete remission. CONCLUSION: Radiotherapy is a possible and effective therapeutic alternative. Dose and methods are not defined for xeroderma pigmentosum.

[Pediatric nasopharyngeal carcinoma: Anatomoclinic aspects, therapeutic results and evolutive particularities]. / Le cancer du cavum de l'enfant et l'adulte jeune : aspects anatomocliniques, thérapeutiques et particularités évolutives.

PURPOSE: We retrospectively analyzed anatomoclinic, therapeutic and evolutive particularities of 74 young patients (< or =20 years) with nasopharyngeal carcinoma treated between 1993 and 2005. PATIENTS AND METHODS: Initial work-up included a fiberoptic nasofibroscopy with biopsy, tomodensitometry and/or MRI of nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. Patients were treated with either primary chemotherapy (epirubicin and cisplatin) followed by radiotherapy or concomitant radiochemotherapy (five fluorouracil and cisplatin). Radiotherapy was delivered to a total dose of 70 to 75 Gy to nasopharynx and involved cervical lymph nodes and 50 Gy to the remainder cervical areas. RESULTS: The median age was 16 years. Sixty-three percent of patients had undifferentiated tumors. Sixty-six percent had locally advanced tumor. With a median follow-up of 107 months, one patient presented a local relapse, 24 patients developed distant metastases with a median delay of 7 months. The 5 years overall survival and disease-free survival were 66 and 65 %. Late complications were dominated by dry mouth and endocrine disorders. COMMENTS: Pediatric nasopharyngeal carcinoma is characterized by an early metastatic diffusion. Local control is excellent but with severe late toxicities. New techniques of radiotherapy and new molecules of chemotherapy could improve these results.

[The value of radiotherapy in the treatment of aggressive and localised gastric lymphomas]. / Intérêt de la radiothérapie dans le traitement des lymphomes gastriques agressifs localisés.

PURPOSE: To evaluate the treatment results of localised aggressive gastric lymphomas with favourable prognosis using chemotherapy and radiotherapy. PATIENTS AND METHODS: Between February 1993 and December 2004, nine patients with primary gastric high-grade lymphoma have been treated by the Lymphoma Committee of Sfax (Tunisia). The sex ratio was 1.5. The mean age was 44.9 years. Histological type was the large cell B lymphoma in 100% of the cases. Disease was stage I in eight cases and stage II in one case (Ann Arbor Classification). The treatment consisted in primary chemotherapy followed by radiotherapy of the stomach with or without regional nodes (40 Gy). RESULTS: After treatment, all patients had complete remission. With a mean follow-up of 55.7 months, one patient was lost to follow-up; the other patients were alive with complete remission. No major acute toxicities or late effects were found. Overall survival was 100% at five years. CONCLUSION: Chemotherapy associated with radiotherapy can be proposed to patients having localised and aggressive primary gastric lymphoma with favourable prognosis, since this treatment is well tolerated and provides satisfactory control of the disease.

[Primary cervical epidural low-grade non-hodgkin's lymphoma: a case report and review of the literature]. / Le lymphome non-hodgkinien de bas grade épidural cervical primitif: à propos d'un cas et revue de la littérature.

Primary epidural cervical non-hodgkin's low-grade lymphomas is exceptional. We report a 43-year-old woman admitted for a total functional disability of the four limbs. Magnetic resonance imaging revealed a cervical epidural mass C2-C3. A laminectomy was performed. The histological study revealed a small cells lymphoma. The patient underwent chemotherapy and radiotherapy. There was a favourable evolution. She is in complete remission with a follow-up of two years. We review literature to describe epidemiological, clinical and therapeutic features with evolutive aspects in primary epidural non-hodgkin's lymphomas.

[Infectious complications postengrafment in the first year after autologous stem cell transplantation in children]. / Autogreffes de cellules souches hématopoïétiques en oncologie pédiatrique; étude des complications infectieuses survenant au cours de la première année après sortie d'aplasie.

BACKGROUND: Studies on the infectious complications postengrafment in pediatric stem cell transplantation patients are rare. The aim of this study was to assess the incidence, types, outcome and factors affecting late infections. PATIENTS AND METHODS: A single-institution retrospective analysis was done of infections recorded in the first year following engrafment in children who underwent autologous stem cell transplantation for solid tumors from January 1991 to December 2000. A systematic antimicrobial chemoprophylaxis of TMP/SMX was administered. Patients who were at high risk for varicella-zona virus infection received prophylactic acyclovir. RESULTS: Eighty-four assessable patients were enrolled. Fifty-four patients (64%) underwent autologous peripheral blood stem cell transplantation and 30 patients (36%) underwent bone marrow transplantation. Forty-nine episodes of infections were documented in 39 patients (46%) of whom 27 patients (32%) developed infections after the first 100 days post transplantation. Bacterial septicemia occurred in nine patients of whom four patients had a catheter-related septicemia. Twelve patients (14%) developed localized herpes zoster infection. Local fungal infection occurred in five patients. Infection-related death occurred in one patient with non-documented pneumonitis. Univariable analysis showed a correlation between the CD34(+) cell dose <7.5 10(6)/kg and the development of infections (P =0.04). Patients who did not go into remission after transplantation where at high risk for septicemia (P =0.007). Multivariate analysis showed that a history of varicella or pretransplant varicella-zona positivity was the only significant factor for development zoster infection (P =0.01). CONCLUSION: Our study shows that infections in the first year postengrafment following autologous stem cell transplantation for solid tumors have a good prognosis and that the use of TMP/SMX should be the single systematic antimicrobial prophylaxis. The CD34(+) cell dose seems to play a role in preventing late infections.

[Erysipelas after breast cancer treatment]. / Erysipele apres traitement du cancer du sein.

BACKGROUND: Study of the epidemiological, clinical and evolutive characteristics of the erysipelas of patients treated for breast cancer. PATIENTS AND METHODS: Between February 93 and December 99, 20 patients among 700 (2.85%) treated for breast cancer in the radiotherapy department of sfax have presented an erysipelas. All of these patients had undergone a chirurgical treatment containing an axillary lymph node dissection with radiotherapy in 95% and adjuvent chemotherapy in 80% of cases. RESULTS: The medium delay between the appearance of the eryslpelas and the end of treatment was 23 months. The preferential localisation was the homolateral upper limb to the treated breast (95%). The immediate evolution was favourable in 85% after antibiotherapy. Recurrence of erysipelas was seen in 20% in cases. DISCUSSION: Erysipelas after treatment of breast cancer is known but rarely reported. The secondary lymphedema of the upper limb is the major favouring factor. CONCLUSION: Appearance of erysipelas among women treated for breast cancer is frequent, his recurrent character must always lead to antibiotic prophylaxis.

[Infantile fibrosarcoma: a clinicopathological and molecular study of five cases]. / Fibrosarcome infantile: étude anatomo-clinique et moléculaire de cinq cas.

We report 5 cases of infantile fibrosarcoma (4 boys and 1 girl) whose average age was 5, 7 months (range 0 days to 14 months). The tumor was congenital in 4 cases. All tumors presented in the extremities (forearm, hand, thigh: 1 case, lower leg: 2 cases). Treatment was based on surgery (3 cases: amputation, 2 cases: local excision) with a favorable course in all cases, even those with marginal excision (follow-up ranging from 5 to 21 years). The lesions were characterized by dense monotonous cells growing in a fascicular pattern, with small necrotic areas and scattered lymphocytes. The mitotic index was high (average 8/10 high-power fields). ETV6-NK3 chimeric RNA was detected by reverse transcriptase polymerase chain reaction in two cases out four cases from paraffin-embedded tissue blocks. The infantile fibrosarcoma is a good prognosis tumor characterized by particular histological features and ETV6-NK3 gene fusion.

[Radiation-induced glioblastoma and myxoma after treatment for undifferentiated carcinoma of the naspharynx]. / Glioblastome et myxome radio-induits après traitement d'un carcinome indiffencié du nasopharynx.

Radio-induced tumor have been known for a long time to occur after treatment of cancer during childhood. This entity is exceptional following radiotherapy of the cavum. Skull and facial osteosarcoma were described after treatment of UCNT. We report two observations of radio-induced tumors arising, respectively three and seven years after treatment of UCNT. The first one is a temporoparietal glioblastoma and the second is a rhino- and pharyngeal myxoma. The two patients are alive after treatment of the second tumor. The delay of appearance of these tumors, their situation in the field's irradiated and dose received suggests their radio-induced nature. However, the cytogenetic study is necessary to confirm the implication of radiotherapy in the genesis of these cancers.

[Stomatococcus mucilaginosus meningitis in immunocompromised child]. / Méningite à Stomatococcus mucilaginosus chez un enfant immunodéprimé.

BACKGROUND: Opportunistic infections are responsible for significant morbidity and mortality in patients with malignancy developing granulocytopenia as a result of therapy. A case of Stomatococcus mucilaginosus meningitis is reported. CASE REPORT: A 2 year-old boy was admitted because he had developed fever and neutropenia during chemotherapy given for neuroectodermal tumor. He was previously treated for a Stomatococcus mucilaginosus septicemia with vancomycin given for 15 days through an intravenous catheter which has subsequently been left in place. At admission, fever was associated with severe degree of aplasia (70 WBC/mm3). The patient was given IV ceftazidime plus amikacin. Two days later, the boy developed acute meningitis due to Stomatococcus mucilaginosus; he was then given IV vancomycin (40 mg/kg/d) and imipenem (100 mg/kg/d). Persistence of abnormal clinical and bacteriological findings required subsequent intrathecal administration of vancomycin (1.5 mg/d) for 5 days. CSF cultures were negative 2 days later, leading to stop IV antibiotics after 3 weeks. The catheter was removed 1 week later. CONCLUSION: This patient represents the third reported case of Stomatococcus mucilaginosus meningitis. Combined intrathecal and systemic administration of vancomycin seems to have been useful in our case.

[Autologous bone marrow graft in solid tumors in childhood]. / Greffe de moelle autologue dans les tumeurs solides des enfants.

Curability in children suffering from malignant solid tumor is 50%. Thus, high dose chemotherapy with or without total body irradiation followed by autologous bone marrow transplantation (ABMT) has been proposed to patients suffering from cancer either at initial diagnosis (poor prognosis tumor) or at relapse. Thanks to these studies, drugs having dose effects properties have been selected. In some tumors, ABMT has significantly improved patients median survival. It remains to be determined if: 1. high dose chemotherapy protocols with ABMT are superior to new aggressive chemotherapeutic protocol without ABMT. 2. ABMT increases the curability of high risk patients.