Revolutionizing localized prostate cancer treatment: Stereotactic radiotherapy "Moroccan experience".

INTRODUCTION: Prostate cancer is the most common urological cancer, and its incidence  is increasing. Radical prostatectomy and radiotherapy are theprimary treatments for localized forms. Stereotactic Body RadioTherapy (SBRT), a new and innovative therapy, has been validated for some cancer localizations but not yet for localized prostate cancer. Our study aims to report the efficacy and tolerance results of SBRT for localized prostate cancer. MATERIALS AND METHODS: This is a retrospective study of 27 patients with localized prostate cancer (CaP) who were treated with SBRT in our department from 2017 to 2021 using transponders for tumor tracking. The dose was 36.25 Gy delivered in five fractions of 7.25 Gy. The delineation and doses of organs at risk were determined based on the recommendations of the SFRO and the TG101 report of medical physics. All patients were treated using a latest-generation linear accelerator (True Beam STXÒ). RESULTS: Acute toxicities were observed in 33.3% of cases, with 22.2% grade 1 or 2 genitourinary (GU) and no grade 3 while 11.1% gastrointestinal (GI) toxicities were reported as grade 1-2 (7.4%) and one case grade 3 (3.7%). Late grade 1 or 2 GU toxicity was observed in 14.84% of cases, with no reports of late GI toxicity. After a 26-month follow-up period, the biochemical failure-free survival rate was 92.6%. CONCLUSIONS: The results of our study are consistent with the existing literature and support the safety and effectiveness of SBRT as a treatment option for localized prostate cancer (CaP). In the United States, both ASTRO and the NCCN recognize SBRT as a valid treatment option for localized CaP. Ongoing phase III trials are being conducted to further substantiate these long-term results and to establish SBRT as the future standard of care for localized CaP.

Stereotactic Body Radiation Therapy (SBRT) for prostate cancer: Preliminary results of toxicity.

To the Editor, Prostate cancer is the second most common cancer in men in Morocco after lung cancer. External radiotherapy (RTE) is a curative therapeutic option for localized prostate cancer, However the conventional RTE remains a long treatment (7- 8 weeks, 5 days a week) which is demanding for patients and make difficult to manage the waiting lists. The development of imaging and irradiation techniques over the last decades has allowed a high precision in the delivery of the dose to the target organ and a better protection of the organs at risk (OAR), which has encouraged the hypo fractionated irradiation of localized prostate cancer, especially after the results of radiobiology studies that suggested a low report a/b for the prostate.

Anal Cancer with Atypical Brain and Cranial Bones Metastasis: About 2 Cases and Literature Review.

Canal anal cancer is a rare tumor that accounts for 2% of all colorectal neoplasms, with a low propensity for metastasis. The spread of anal squamous cell carcinoma to the brain is exceedingly rare and has been previously reported only 5 times in the medical literature. However, the first and only case of cranial bone metastasis from anal canal carcinoma was described in 2019. The purpose of this article is to add our cases to the limited literature for the management of metastatic anal cancer. The current study presents 2 cases of patients diagnosed with squamous cell carcinoma of the anal canal how underwent chemo and radiotherapy. Despite the treatment our patients developed neurological symptoms, cerebral magnetic resonance imaging showed brain lesions for the first case, and cranial bones metastasis for the second one, histopathology confirmed these lesions to be a poorly differentiated squamous cell carcinoma, consistent with the known primary tumor of the anal canal. Unfortunately, both patients succumbed quickly to systemic complications of the disease during these treatments. Despite its rarity, brain metastasis should be considered in any patient with a history of anal cancer presented neurological symptoms.

Chondrosarcoma of the parapharyngeal space: Case report and literature review of an extremely rare location.

Chondrosarcoma of the head and neck region is a rare disease, representing approximately 0.1% of all head and neck neoplasms. Parapharyngeal location is extremely rare and low-grade ones are even rarer. Surgery alone or followed by adjuvant radiotherapy is the treatment of choice. In this article, we report a case of a 67-year-old male with low-grade parapharyngeal chondrosarcoma who presented with a 3-month history of dysphagia. A cervical magnetic resonance imaging was performed that shows a well-defined mass located at the right parapharyngeal space, causing medial deviation of the mucosal space. Surgical resection of the tumor without neck dissection followed by adjuvant radiotherapy was undertaken with a favorable response. The purpose of this article is to add our case to the limited literature for good management of parapharyngeal chondrosarcomas.

Rare location of head and neck adenoid cystic carcinoma.

Adenoid Cystic Carcinoma of larynx is extremely rare location. We herein describe an unusual clinical and radiological presentation of ACCL and review recent literature. We report a case of a 38-year-old woman with history of asthma, presented to our department with acute inspiratory dyspnea that required an emergency tracheotomy. Physical examination revealed a large anterior cervical mass without any lymphadenopathy suspecting thyroid origin. Cervical Computed Scan showed a tumor process between the thyroid lobe, the left edge of the subglottic area and first tracheal rings filling all the lumen, discussing either a laryngo-tracheal or thyroid origin. The patient underwent a panendoscopy under general anesthesia that confirmed a subglottic extension of the tumor and multiples biopsies showed a malignant salivary origin of the mass. After multidisciplinary discussion, the patient underwent total laryngectomy and thyroidectomy with bilateral selective neck dissections (levels II- IV). Anatomopathological examination confirmed the laryngeal location of Adenoid Cystic Carcinoma classified pT4aN0R0. Adjuvant radiation therapy was indicated. In our knowledge, only 10 cases were reported in the literature with this unusual presentation. Moreover, the case we report is in the subglottic floor without invasion of neither vocal cords nor trachea. Total laryngectomy with neck dissection remains the recommended therapeutic procedure for locally advanced ACCL. Adverse features such as close or positive margins, T3-4, intermediate or high grade neural and perineural spread, lymphatic or vascular invasion or lymph node metastases should indicate adjuvant treatment to improve the outcome. The lack of randomized multicentric study, implies the management of ACCL by skilled multidisciplinary team, to suggest adequate personalized treatment.

T lymphocyte subsets in cancer immunity: Friends or foes.

Although immune-based therapy is proving to be a success in several cancer types, only a set of patients appear to respond to immune checkpoint blockade including PD-1 and CTLA-4. A better understanding of the crucial components of cancer immunity is therefore necessary. T lymphocytes, a key element, are found within the tumor microenvironment and seem to be critical in determining the efficacy of immune surveillance. In this review, we will depict the pro- and antitumor roles of major T cell subsets in distinct cancer tissues. The central role of the mainly antitumor subsets, cytotoxic T cells and Th1 cells, will be delineated. Subsequently, we will indicate how other subsets including Th2, Th17, and T regulatory cells exhibit ambivalent roles. We will also describe the emerging and favorable role of Th9 cells in cancer immunity. In parallel, we will go through main mechanisms by which these cells operate, and will pinpoint pathways, which could be used as potential therapeutic targets in order to positively impact the immune response and ameliorate patients' clinical outcome.

[Gastrointestinal Stromal Tumors "GIST": status and news through our experience on 54 cases and review of literature]. / Tumeurs Stromales Gastro-Intestinales «GIST¼: état des lieux et actualités à travers notre expérience portant sur 54 cas et une Revue de littérature.

Tumors Gastrointestinal Stromal "GIST" are a very rare form of digestive tract cancers belonging to the family of sarcomas. The aim of this study is to establish the epidemiological profile, the diagnostic and therapeutic difficulties of this malignancy supported in a developing country. A retrospective study spread over 8 years from January 2002 to March 2010, was conducted at the Department of Radiotherapy and Oncology of Casablanca (Morocco) have collated 54 cases of Gastrointestinal Stromal tumors. The average age of our patients was 55 years. The average time of evolution was 11 months (0-72 months). The biopsy confirmed the diagnosis in 14 cases and surgery in 40 cases. The main histological form was fusiform (92.6%). GIST in our series had an average tumor size of 12.5 cm with a positive C-Kit in 52 cases. The risk of progression was established in 47 cases of which 39 were high risk. Surgery was the main treatment of patients in our study. After a mean fellow of 31 months, half of evaluable patients in our series (n = 19) is maintained complete remission, one third (n= 13) died while a quarter (n= 8) has a local recurrence and / or metastatic. Although the recommendations are published for the treatment of these tumors, these still present many problems both diagnostic and therapeutic in our context.

[Ameloblastoma of the maxillary sinus treated with radiation therapy]. / Améloblastome du sinus maxillaire traité par radiothérapie.

Ameloblastoma is a benign aggressive odontogenic tumor which requires early diagnosis and appropriate treatment. It commonly affects the mandible and radical surgery is the gold standard treatment. We report the case of a patient with ameloblastoma in extremely advanced phase affecting the maxillary sinus who was treated with intensity modulated conformal radiation therapy. Patient's evolution was marked by complete remission maintained after 24 months follow-up. Maxillary ameloblastoma is not well documented in the literature. It is usually diagnosed at the later stage when optimal surgery cannot be performed. This case study aimed to demonstrate that radiation therapy is a real therapeutic alternative in the treatment of advanced and inoperable forms of ameloblastoma.

[Subcutaneous myxoid liposarcoma]. / Liposarcome myxoide sous cutané.

Although myxoid liposarcomas (MLS) are the most common type of soft-tissue sarcomas in adults, their primary location in the superficial tissues is rare. So sarcomas are classified as superficial and deep-seated. They are distinct based on their location and their frequency as well as their prognosis which is relatively better in superficial sarcomas. We here report the case of a patient with subcutaneous liposarcoma in the right thigh. The diagnosis was confirmed by histology after clinical symptoms had evolved over 1 year. Treatment involved wide surgical resection followed by locoregional radiation therapy. Patient's evolution was marked by complete remission maintained after 32 months follow-up. This study highlights that superficial sarcomas are rare and this can cause a delay in diagnosis compromising their prognosis.

Clinical and pathological features of BRCA1/2 tumors in a sample of high-risk Moroccan breast cancer patients.

BACKGROUND: BRCA1 and BRCA2 genes explain a large part of hereditary breast cancer. Several studies have shown that BRCA1 and BRCA2 tumors exhibit some specific morphological and immunohistochemical characteristics. The aim of our study is to compare the clinicopathological characteristics between Moroccan breast cancers associated or not with BRCA1 and BRCA2 mutations. Previously, we had identified 11 BRCA carriers in a series of 40 selected breast cancer patients at increased risk for carrying a mutation in the BRCA1 and BRCA2 genes. The clinical and pathological features of patients carrying BRCA1 or BRCA2 mutation (n = 11) were evaluated and compared to those of non-mutated patients (n = 29). RESULTS: In comparison with non carriers, women with BRCA1/2 mutation present younger mean age at diagnosis (37.90 vs. 44.48 years, p = 0.05), younger mean age of 1st menarche (13.08 vs. 14.24 years, p = 0.05) and shorter duration of breastfeeding (8.71 vs. 19.35 months, p = 0.05). Moreover, 63.6 and 62.5% of BRCA1/2 carriers present SBR grade III and triple negative tumors respectively (p = 0.02). CONCLUSIONS: In this first Moroccan study comparing clinical and pathological characteristics of women carrying or not BRCA1/2 mutation, patients with BRCA mutation tend to develop early breast cancer with high-grade and triple negative tumors. However, further large scale research including more data is needed to better characterize BRCA1/2 cases and to evaluate the survival rate associated with these mutations in our population tumors. Moreover, it would be more interesting to study women with BRCA1 and BRCA2 mutations separately in order to determine if they exhibit distinct characteristics.

Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast cancer after conservative surgery.

BACKGROUND: Breast cancers are becoming more frequently diagnosed at early stages with improved long term outcomes. Late normal tissue complications induced by radiotherapy must be avoided with new breast radiotherapy techniques being developed. The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk between conformal (CRT) and intensity-modulated radiation therapy (IMRT) after breast-conserving surgery. MATERIALS AND METHODS: A total of 20 patients with early stage left breast cancer received adjuvant radiotherapy after conservative surgery, 10 by 3D-CRT and 10 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram analyses in terms of PTV homogeneity and conformity indices as well as organs at risk dose and volume parameters. RESULTS: The HI and CI of PTV showed no difference between 3D-CRT and IMRT, V95 gave 9.8% coverage for 3D-CRT versus 99% for IMRT, V107 volumes were recorded 11% and 1.3%, respectively. Tangential beam IMRT increased volume of ipsilateral lung V5 average of 90%, ipsilateral V20 lung volume was 13%, 19% with IMRT and 3D-CRT respectively. Patients treated with IMRT, heart volume encompassed by 60% isodose (30 Gy) reduced by average 42% (4% versus 7% with 3D-CRT), mean heart dose by average 35% (495 cGy versus 1400 cGy with 3D-CRT). In IMRT minimal heart dose average is 356 cGy versus 90 cGy in 3D-CRT. CONCLUSIONS: IMRT reduces irradiated volumes of heart and ipsilateral lung in high-dose areas but increases irradiated volumes in low-dose areas in breast cancer patients treated on the left side.