Radiotherapy for parotid cancer: 10 years of experience in a single center.

<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>.

Evaluation of tumor response three months after concomitant chemoradiotherapy with high dose rate brachytherapy as a definitive treatment modality for locally advanced cervical cancer.

OBJECTIVE: Radiotherapy remains an essential part of the management of locally advanced cervical cancer. Post-treatment surveillance allows for tumor response assessment and early detection of progressive prosecutions or local recurrences that may benefit from salvage treatment. The objective of this work is to assess the effectiveness of this therapeutic modality. MATERIALS METHODS: This is a retrospective study of 69 patients treated with concomitant radiation chemotherapy followed by high dose rate intracavitary brachytherapy. The tumor response was assessed by gynecologic physical examination at three months after the end of treatment. RESULTS: Median age of patients is 54.9 years (33-78 years). The most common histological type is squamous cell carcinoma (89.9%). The average dose received during external radiotherapy is 52.2Gy (46-60Gy). The average dose received during brachytherapy is 27.5Gy (18-28Gy). Three months after completion of treatment, 95.6% of patients had complete tumor remission, and only 4.4% had a tumor residue of 1cm. CONCLUSION: Radiation chemotherapy with brachytherapy allows for improved short-term local control in cervical cancer.

Lacrimal gland adenoid cystic carcinoma: report of an unusual case with literature review.

Lacrimal gland adenoid cystic carcinomas are rare, aggressive orbital tumors characterized by poor overall prognosis, tendency for local recurrence and metastasis despite aggressive treatment. Treatment continues to be controversial. Many authorities today will often initiate surgery (orbital exenteration with or without bone removal vs. globe-sparing resection) and adjuvant radiotherapy (external beam or proton beam therapy). We introduce a case of lacrimal gland adenoid cystic carcinoma treated with orbital exenteration and adjuvant volumetric modulated arc therapy, and discuss the related literature.

Intrathyroidal parathyroid carcinoma: a case report and literature review.

Parathyroid carcinoma is an uncommon endocrine malignancy comprising 0.5%-2% of patients with primary hyperparathyroidism. The probability of an intrathyroidal location is low (0.2%) and make preoperative suspicion and diagnosis challenging. Less than 20 cases of intrathyroidal parathyroid carcinoma have been reported. We introduce a case of intrathyroidal parathyroid carcinoma mimicking a suspicious thyroid nodule, and review the literature, with a focus on the role of adjuvant radiotherapy.

Radical Mastectomy Increases Psychological Distress in Young Breast Cancer Patients: Results of A Cross-sectional Study.

INTRODUCTION: The present study aimed to detect the factors associated with psychological distress (PD) in young Moroccan patients with breast cancer, with a special focus on the type of surgical procedure. PATIENTS AND METHODS: We collected social, demographic, and clinical data from female patients, aged < 45 years, with localized stage breast cancer who had undergone either radical mastectomy or conservative surgery and for whom adjuvant chemotherapy was indicated. We used the Hospital Anxiety and Depression Scale (HADS) to assess the psychological status. The relationship between the variables and PD was analyzed using simple and multiple logistic regression analyses. RESULTS: A total of 122 women were enrolled, of whom 41 (33.6%) had a HADS global score ≥ 15. The HAD anxiety and depression subscores were ≥ 11 for 10 (8.2%) and 8 (6.6%) patients, respectively. On multivariate analysis, adjusted for marital status and receipt of analgesic and/or anxiolytic treatment, we found that radical mastectomy (odds ratio [OR], 5.747; 95% confidence interval [CI], 1.342-24.608), living in a difficult emotional (OR, 7.366; 95% CI, 1.727-31.41) and/or financial (OR, 16.521; 95% CI, 3.574-76.36) situation, and a lack of social and/or family support (OR, 19.617; 95% CI, 3.549-108.43) were independent factors associated with PD. CONCLUSION: Breast-conserving surgery should be performed whenever possible for young women to avoid the psychological repercussions of radical procedures.

Adenocarcinoma of the lacrimal gland: a case report.

BACKGROUND: Primary ductal adenocarcinomas of the lacrimal gland are very rare. This neoplasm shares some histological and immunohistochemical similarities with salivary duct carcinoma. CASE PRESENTATION: Here, we present a case of a 55-year-old Moroccan man with lacrimal gland adenocarcinoma. He underwent orbital exenteration with lymph nodes dissection and ipsilateral parotidectomy. After surgery, he was lost to follow-up and died 13 months later. CONCLUSIONS: Lacrimal gland tumors are rare but highly aggressive salivary gland tumors. Complete excision with adjuvant radiotherapy is recommended.

Merkel cell carcinoma occurring in a black woman: a case report.

BACKGROUND: Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years. CASE PRESENTATION: We report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature. CONCLUSIONS: The Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.

Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer.

PURPOSE: To evaluate the effect of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes on overall survival (OS), disease-free survival (DFS), locoregional control and on treatment-related toxicity in patients with breast cancer and nodal involvement. METHODS AND MATERIALS: Two hundred fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiation therapy (42 Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast-conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or interstitial high-dose-rate brachytherapy). Two hundred fifty-six (99.6%) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment, and 65 (25.3%) had anti-HER2 targeted therapy. RESULTS: The median follow-up time was 64 months (range, 11-88 months). The rates of 5-year OS, DFS, locoregional recurrence (LRR)-free survival, and distant metastasis (DM)-free survival were 86.6%, 84.4%, 93.9%, and 83.1%, respectively. In multivariate analysis (MVA), lymph node ratio >65%, lymphovascular invasion, and negative hormone receptor status predicted for OS, DSF, and DM. T3 to 4 stage was also associated with worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2 to 3 stage and grade 3. Hyperpigmentation was observed in 19.2% of patients, telangiectasia in 12.3%, and fibrosis in 30.7%. Grade ≥2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis was observed, nor were plexopathy or rib fractures. CONCLUSION: According to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.

Extra-axial ependymoma of the cerebral convexity: A very rare intracranial adult tumor.

Background Ependymomas are rare adult tumors that originate from the ventricular system or the ependymal surface of the central canal. Extra-axial supratentorial ependymomas are extremely rare, and only five cases have been reported to date in the English literature. Case presentation A 46-year-old previously healthy male presented with a gradual painless loss of vision in the right eye. Cerebral MRI showed a right parietal-occipital lesion resembling an atypical meningioma. Surgical resection was performed, and immunohistochemical staining results concluded that it was a very uncommon location of a grade 3 ependymoma. Favorable outcome was observed one year after completion of postoperative radiotherapy. Conclusion Clinical and imaging aspects are misleading in rare brain tumors, and immunohistochemistry is essential to re-address diagnosis.

Associated factors with psychological distress in Moroccan breast cancer patients: A cross-sectional study.

OBJECTIVES: To estimate the prevalence of psychological distress (PD) in Moroccan breast cancer patients, and to determine clinical and social demographic factors associated with PD. METHODS: It was a cross-sectional study where we included all female breast cancer patients that did not have other malignancies. Judgment criteria were based on the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). Threshold values of 15 and 3 were fixed to detect patients on PD by the HADS and the DT, respectively. We analyzed data by calculation of Cronbach's alpha coefficient for the reliability of measurements, and by simple and multiple logistic regressions. RESULTS: 446 women were enrolled. Cronbach's alpha coefficient was 0.801, 0.669 and 0.639 respectively for the HADS, HAD-A and HAD-D questionnaires. 120 patients (26.9%) had a HADS global score ≥15. HAD-A and HAD-D sub-scores were ≥11 in 25 (5.6%) and 30 (6.7%) patients respectively. In multivariate analysis, adjusted for the education level, marital status, taking analgesic and/or anxiolytic treatment, and current treatment type; we found that the occurrence of a distant metastasis [OR = 14.427 p < 0.001], lack of social family support [OR = 4.631 p < 0.001], living a difficult emotional [OR = 2533 p = 0.034] and/or financial [OR = 2.09 p = 0.037] situation, and younger (<50 years) age [OR = 2.398 p = 0.002], were independent associated factors with PD as assessed by the HADS. CONCLUSIONS: Social family support, emotional and financial difficulties should be investigated in all Moroccan breast cancer patients, especially among younger ones, in order to detect those at risk of PD and offer them appropriate support.

Radiation-induced osteosarcoma of the skull base after radiation therapy in a patient with nasopharyngeal carcinoma: a case report and review of the literature.

BACKGROUND: Radiation-induced osteosarcomas are a recognized complication of radiation therapy. Owing to the fact that it is rare, publications on radiation-induced osteosarcoma of the skull base are limited to a small series and some case reports. CASE PRESENTATION: We describe a rare case of a patient with a skull base radiation-induced osteosarcoma treated 11 years before with ionizing radiation for an undifferentiated carcinoma of the nasopharynx. The patient was treated with chemotherapy alone, but he died after the third cycle. CONCLUSIONS: Radiation-induced osteosarcoma of the skull base after treatment of nasopharyngeal carcinoma is a very rare but very aggressive complication with a poor prognosis. Chemotherapy gives bad results, and regular follow-up of treated patients should be considered.

Epidemiology and outcome of cervical cancer in national institute of Morocco.

BACKGROUND: On behalf of the medical staff of the National Institute of Oncology of Rabat, we conducted a retrospective study to report epidemiology and 5-year outcomes of cervical carcinoma in Moroccan women. METHODS: We reviewed all women diagnosed with invasive cervical carcinoma in our institute between January 2006 and December 2006. Outcomes and prognoses are analyzed in patients who received at least one treatment. RESULTS: The analysis included 646 women. Median age was 50 years (23-85 years). Bleeding was the most frequent symptom (95 %). The most predominant histology was squamous cell carcinoma (94 %). The majority of patients were diagnosed at locally advanced stages (88 %). Among patients who received treatment (n = 550), the management was based on concurrent chemoradiotherapy in 69.7 % of cases. The median duration of follow-up was 60 months (range 2-78 months). Overall survival, progression free survival, and locoregional recurrence free survival were 63.2, 60.7 and 79.1 % respectively. Significant poor prognostic factors in univariate analysis included stage, tumor size, lymph node involvement, anemia and absence of response to radiotherapy. The prognostic significance of response to radiotherapy and stage were retained in multivariate analysis. CONCLUSION: Cervical cancer in our Institute is diagnosed at locally advanced stages. Two third of patients were treated by concurrent chemoradiotherapy. Outcome of Moroccan patients are comparable to that of western countries. Significant prognostic factors were stage, tumor size, lymph node involvement, anemia, and response to radiotherapy. The way to reduce the global burden of cervical cancer in our country continues to be the development of vaccination and screening programs.

Skin metastases of cervical cancer: two case reports and review of the literature.

BACKGROUND: Although cervix carcinoma is one of the most common malignancies in women, hematogenous metastases are relatively not common. Cutaneous metastases, in particular, are unusual even at an advanced stage of disease. Their presence is a predictor of poor prognosis. CASE PRESENTATION: Case 1: A 63-year-old postmenopausal Moroccan woman was diagnosed as having cervical squamous cell carcinoma. She was treated with radical concurrent chemotherapy and radiation therapy followed by low-dose brachytherapy. Six months after finishing the therapy, multiple skin nodules appeared on her abdomen and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. Her disease progressed and she died before completing her fourth course of palliative chemotherapy. Case 2: A 48-year-old Moroccan woman was diagnosed as having cervical squamous cell carcinoma; she was treated with concurrent chemoradiation. Before a planned high-dose brachytherapy, she noticed many nodular lesions on her arms, thighs, and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. She then underwent a series of imaging examinations, including computed tomography of her chest, abdomen, and pelvis, and a whole body bone scan that showed disseminated disease involving her lungs and bones. She died after two courses of palliative chemotherapy, 2 months after the appearance of the skin lesions. CONCLUSION: We report two cases to illustrate a rare localization of metastasis from cervical carcinoma that is highly aggressive requiring early detection and aggressive management.

Sebaceous carcinoma of the parotid gland: a case report and review of the literature.

BACKGROUND: Sebaceous carcinoma is a rare malignancy primarily with aggressive growth affecting the cutaneous tissues of the periocular region. Sebaceous carcinoma of the parotid gland is exceedingly rare, with only 32 cases reported in the literature. Our case brings this total to 33. CASE PRESENTATION: We present a case of a 57-year-old Moroccan woman with a firm, painless, slowly enlarging swelling at her left parotid area, with normal overlying skin and no palpable neck nodes. Parotidectomy with facial nerve preservation was performed, and microscopic examination showed sebaceous carcinoma. Then, she underwent adjuvant radiotherapy. With a follow up of 20 months, head and neck computed tomography revealed no recurrence. CONCLUSIONS: The optimal treatment is unclear. With more cases reported, clinicopathological characteristics and histogenesis are increasingly understood. Therefore the treatment for this rare tumor continues to evolve.

[Radiotherapy for endometrial cancer: experience of the national institute of oncology with 52 cases]. / La radiothérapie du cancer de l'endomètre: expérience de l'institut national d'oncologie à propos de 52 cas.

Endometrial cancer is the most common gynecological cancer in the Western world. It affects mainly postmenopausal women. The aim of our study is to report the experience of the radiotherapy department of the National Oncology Institute (INO) in the treatment of endometrial cancer. We retrospectively analyzed 52 cases of endometrial cancer treated in the INO radiotherapy department between 2007-2009. Data obtained from the patient medical records were related to the epidemiologic, clinical, therapeutic and evolutionary aspects of this cancer. The median age of the patients was 57 years, 87% were postmenopausal. The median of consultation time was six months. The main symptom was metrorrhagia (51 patients). Histological diagnosis was based on biopsic curettage of uterine endometrium in 51% of the cases. Anatomo-pathological examination showed an endometrioid adenocarcinoma in 92% of the cases. After the assessment, 27% of the patients were stage I, 30% stage II, 20% stage III and 1% stage IVA, according to the International Federation of Gynecological and Obstetrics (FIGO) stage classification. After surgery, 51% of the patients received postoperative external radiotherapy. The delivered dose was 46 Gray (Gy). All patients received internal vaginal brachytherapy. From an evolutionary perspective, 83% of the patients had no recurrences during the follow-up period, 8% of patients had a local recurrence and 4% of patients had distant metastases. Therefore, surgery is the main treatment for endometrial cancer. Radiotherapy is the primary adjuvant treatment.

Primary Kaposi's sarcoma of the nasal cavity: a case report and review of the literature.

BACKGROUND: Kaposi sarcoma is a neoplastic vascular disorder. It usually present on the skin of the upper and lower extremities, rarely in the mucosa of the head and neck. The most common sites reported are within the oral cavity, particularly on the palate. Other mucosal sites are rare. We present an unusual case where the primary manifestation of the Kaposi's sarcoma was in the nasal mucosa. CASE PRESENTATION: A 56-year-old female of Mediterranean descent presented with a 1 year history of swelling on the left side of her nose, nasal obstruction and occasional minor epistaxes. Physical examination showed a firm and bulging polypoid mass which filled the left nasal cavity without cutaneous lesions. Computed tomography (CT) demonstrated a tumor, measuring 77 mm in diameter, occupying the left nasal cavity causing erosion of nasal septum and extending posteriorly to the left choana and nasopharynx. There was bilateral cervical lymphadenopathy. Patient treated with chemotherapy alone. She was in a complete response after the first cycle. The patient received no further treatment. She needs a regular medical checkups that include a review of a patient's medical history and a complete physical exam. She is in excellent local control over 12 months. CONCLUSIONS: A review of the literature revealed that only seven cases of primary Kaposi sarcoma of the nasal cavity have previously been published and only two of them presented in a patient not associated with the acquired immunodeficiency syndrome. Here, we report the third case where the primary manifestation of the Kaposi sarcoma was in the nasal cavity in a patient with an adequate immune system.

[Role of radiotherapy in stage I testicular seminomas: about 25 cases]. / Place de la radiothérapie dans les séminomes testiculaires de stade I: à propos de 25 cas.

We conducted a retrospective, descriptive study of 25 stage I testicular seminomas to clarify the role of radiotherapy in the management of this disease. Between January 2001 and December 2009, 25 patients with stage I testicular seminoma were treated in the Radiotherapy Department at the National Institute of Oncology in Rabat. Primary orchidectomy was performed via the inguinal route. Initial staging was based on total beta-hCG dosage, alpha-fetoprotein dosage and exploration of superior diaphragmatic and sub-diaphragmatic lymph nodes using tomodensitometry. Adjuvant radiotherapy was delivered using linear accelerator. The median age was 33 years (18-52 years). Testicular tumor involved the right side in 16 patients and the left side in 9 patients. Radiotherapy was delivered to lombo-aortic lymph nodes in 18 patients, lombo-aortic and ipsilateral iliac lymph nodes in 7 patients, using 2 anterior-posterior beams, with delivery of 20-25 Gy in 10-14 fractions. Immediate tolerance was excellent. The average monitoring period was 73 months. Twenty three patients are currently alive in complete remission. One patient developed a pulmonary relapse 22 months after the end of the radiotherapy. One patient was lost to follow-up. Long-term toxicity, especially gastrointestinal toxicity, was not observed. No tumor or secondary hematologic disease was reported. Prophylactic radiotherapy remains the standard adjuvant treatment of stage I seminomas. Immediate tolerance is satisfactory and an increased risk for secondary cancer is negligible compared to the therapeutic benefit. However, strict monitoring and one cycle of carboplatin-based adjuvant chemotherapy are also effective.