Cutaneous squamous cell carcinomas of the nose in a child treated with external radiation therapy: a case report.

Cutaneous squamous cell carcinomas are very rare in children. The recommended treatment for localized cancers is surgery with sufficient margins which can sometimes be mutilating especially for facial localizations. We report a rare case of facial skin carcinoma in a 13-year-old girl measuring 3 cm in diameter infiltrating the tip of the nose. The treatment was an exclusive external radiation therapy with a dose of 70 Gy in 35 fractions in standard fractionation. The technique used was intensity-modulated conformational radiotherapy. It was proposed as an alternative to surgery which could be mutilating. A complete tumour response was obtained with a good aesthetic result and without major toxicity.

Management of Esthesioneuroblastoma: A Retrospective Study of 6 Cases and Literature Review.

The esthesioneuroblastoma (ENB) is a rare malignant sinonasal tumor of neuroectodermal origin. This study aimed to improve the understanding of the clinical features by reviewing the literature and analyzing the medical records of patients diagnosed with ENB in our institution between 2012 and 2019. A total of 6 cases of ENB were available for analysis. The mean age at the time of diagnosis was 36 years. The main complaints at presentation were the rhinologic signs. Tumors were classified as stage C of Kadisk in 3 cases and stage D in the others. According to TNM (modified by Dulguerov), 2 patients were T3N0M0, one T4N0M0, one T3N1M0, and two T4N1M0. The diagnosis of ENB was based on pathological examination. According to Hyams histological grading, low-grade lesions (Hyams I and II) were seen in 2 cases, high-grade undifferentiated lesions (Hyams III and IV) were seen in 4. Of the 6 patients, 4 received surgery. The surgical approaches mainly included an endoscopic endonasal resection in 2 cases, a cranial-facial resection surgery in 1 case, and an expanded endoscopic endonasal approach in combination with craniotomy in 1 case. Four patients received adjuvant radiotherapy (RT). RT dose ranged from 60 to 70 Gy. A total of 3 patients had lymph node metastasis and received RT of the neck. Chemotherapy was delivered in 2 patients. After a mean follow-up of 4.5 years, 4 patients were free of recurrence. Unfortunately, 1 patient died from a progressive disease 6 months after RT. ENB is a rare locally aggressive tumor of the nasosinusal cavities. The first-line treatment for resectable tumors should include primary surgical resection with adjuvant RT. However, this tumor remains of poor prognosis. Therefore, long-term close follow-up based on symptoms, endoscopy, and imaging is essential.

Burnout among physicians and caregivers in oncology: the Moroccan experience.

Purpose: Caregivers in radiation oncology are exposed to a high risk of burnout which sometimes causes serious consequences for their health, which can in turn affect patient care. In this study, we investigated the prevalence of burnout and its psychological impact on health professionals and determined the factors that predispose to the risk of burnout. Methods and materials: A cross-sectional survey was conducted with descriptive and analytical purposes among the different teams within the oncology and radiotherapy departments in different hospitals (CHU and regional hospitals) in Morocco, through an online self-questionnaire composed of sociodemographic data, professional data, working conditions, an assessment of interfering factors, the Maslach Burnout Inventory (MBI), the Generalised Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) scale. Results: One hundred and eighteen caregivers participated in this evaluation. 62.7% were physicians, 75.4% worked in university hospitals and 53.4% were in radiotherapy departments. Analysis of the three dimensions of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) score found high scores in the dimensions of emotional exhaustion (81.4%) and depersonalisation (79.7%), and low scores in decreased personal accomplishment (46.6%). The evaluation of the impacts of burnout in the latter found a mean of the Patient Health Questionnaire-9 (PHQ-9) at 12.45 + 7.84 and the mean of the GAD-7 at 9.73 + 5.98. Conclusion: Our results are in line with those found in the literature, hence the need for screening and active prevention of burnout among radiation oncology caregivers.

[Therapeutic approach against malignant Hodgkin's lymphoma during pregnancy: about a case and literature review]. / Le lymphome malin Hodgkinien au cours de la grossesse; quelle modalité thérapeutique: à propos d'un cas et une revue de la littérature.

Malignant Hodgkin's lymphoma or (Hodgkin's disease) accounts for only 10% of all lymphomas but it is one of the most commonly diagnosed sub-types of lymphoma during pregnancy. This is due, in large part, to the maximum of disease incidence which coincides with reproductive age. The management of a pregnant patient with Hodgkin's disease requires multidisciplinary approach as well as effective communication with the patient and her family. The aim is to optimize mother's chances of being cured while ensuring the delivery of a healthy baby. We here report the rare case of a pregnant patient with Hodgkin's disease at 17 weeks of amenorrhea.

[Radiation therapy in inflammatory breast cancer]. / Radiothérapie des cancers du sein inflammatoires.

BACKGROUND: Inflammatory breast cancer accounts for 1-5% of all breast cancers. It is associated with a poor prognosis, because of an increased risk to develop metastases in comparison with all breast malignancies. The treatment is multimodal. We have evaluated the role of radiotherapy: indications, techniques and impact for local control and overall survival. METHOD: The series of the literature with more than 40 patients irradiated for inflammatory breast cancer published since 1995 were analyzed. RESULTS: Chemotherapy was always delivered first. Adjuvant radiotherapy was associated with local control and overall survival at 10 years of 63-92% and 51-64 respectively. Without surgery, local control was 65% and overal survival 38% at 10years. Results of concomitant radiochemotherapy were reported: the studies were heterogenous. Modalities of radiotherapy were detailed with respect to dose and fractionation, target-volumes and technical considerations (including bolus). CONCLUSION: The multimodal strategy comprises systematically radiotherapy with an evaluation of tumor response to maximise resecability.

[Contribution of concomitant radiochemotherapy in the management of undifferentiated carcinoma of the nasopharynx in adults]. / L'apport de la radio-chimiothérapie concomittante dans la prise en charge du carcinome indifférencié du nasopharynx de l'adulte.

This study aimed to investigate the epidemiological, clinical, therapeutic and evolutionary features of undifferentiated carcinoma of the nasopharynx in adults. We conducted a retrospective cohort study of 163 patients aged 17 years old and over, treated for non metastatic undifferentiated carcinoma of the nasopharynx. The average age of our patients was 46,5 years, with a sex-ratio of 1.7; 35.57% of patients had locally advanced tumors (T3-T4) and 52.27% had advanced regional lymph nodes involvement (N2-N3). Neoadjuvante chemotherapy was performed in 77% of patients and 93.8% of patients underwent concomitant radiochemotherapy. After a mean follow-up interval of 40.8 months overall survival was 92.9% and relapse-free survival (RFS) was 78.9%. Relapse-free survival was caculated according to different prognostic factors, revealing a statistically significant difference based on lymph nodes involvement; three-year RFS rates were 88%, 82.6%, 80.8% and 61.5% in patients with tumor classified as N0, N1, N2 and N3, respectively (p = 0.02). Nasopharyngeal cancer is a complex disease, but progress has been made thanks to advances in radiotherapy and molecular biology. Concomitant radiochemotherapy is the therapeutic standard for patients with clinical stage greater than or equal to T2, or greater than or equal to N1. The innovative techniques in radiation therapy appear promising and they could reduce late toxicity while ensuring an excellent local control rate.