Volumetric modulated arctherapy for locally advanced nasopharyngeal carcinoma: Clinical efficacy and late toxicity.

PURPOSE: We report our experience of 86 consecutive patients with locally advanced nasopharyngeal carcinoma who were treated with volumetric modulated arc therapy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 86 patients with histologically proven primary nasopharyngeal carcinoma treated with volumetric modulated arctherapy technique radiotherapy. Primary endpoints were local, regional, distant control, and overall survival, second endpoint was late toxicity. RESULTS: The median age was 47.5 years (range: 13-79 years) with sex ratio 1.09. At diagnosis, rhinologic symptoms represented the most common clinical presentation, reported by 61 patients (70.9%). Almost 88.4% of patients presented non-keratinizing undifferentiated carcinoma histology (n=76). Most of the patients presented a locally advanced disease defined by stage III and IVa (95.3%). Therefore, 31 patients were treated by concurrent chemoradiation (36%), 52 patients received induction chemotherapy followed by concurrent chemoradiotherapy (57%), three patients received induction chemotherapy followed by exclusive radiotherapy (3.5%). and three patients treated with exclusive irradiation (3.5%). With a median follow up of 15.7 months (range: 4-33.3 months), nine patients died (10.4%), three presented local or locoregional relapse (3.4%), while nine patients presented distant recurrences (10.4%). The two years overall and disease-free survival rates were 88.7% and 83.1% respectively, locoregional control was 100% at 12 months and 96.2% at 24 months, and the two years distant failure-free survival was 86.7%. Time to relapse was the only prognostic factor in univariate analysis for overall survival in our study. The therapeutic tolerance was good with 61.7% of grade 3 and 2.3% grade 4 hyposialia respectively, 46.5% of otological disorders and no radionecrosis was noted. CONCLUSION: Volumetric modulated arctherapy technique with concurrent chemoradiotherapy is an effective treatment for nasopharyngeal carcinoma with excellent overall and locoregional control without severe toxicity. Distant metastasis is the major site of failure, so induction chemotherapy added to chemoradiotherapy must be discussed in multidisciplinary consultation meeting because it significantly improved recurrence-free survival and overall survival, as compared with chemoradiotherapy alone.

Childhood cancer: epidemiology in the pediatric oncology department of a university hospital center in Abidjan, Ivory Coast.

Cancer is a major cause of morbidity and mortality in children under the age of 15 years worldwide. To contribute to better knowledge of childhood cancers in Africa. To determine the causes of pediatric cancers and compare them with the results of a previous study and with data available for sub-Saharan Africa. This observational, descriptive study of the data recorded from 2007 to 2015 in the pediatric oncology unit of the University Hospital Center of Treichville in Abidjan analyzes the general and the age- and sex-specific proportions of children under the age of 15 years with neoplasia according to the International Classification of Childhood Cancer, 3rd edition (ICCC.3). This study includes 863 new cases. The sex ratio (M/F) was 1.4, and the mean age 7 years (range: 3 months to 14 years 9 months). The neoplasia rate peaked in the group aged 5-9 years (38.6 %). The most common cancers were: lymphomas (44 %), retinoblastoma (11.7 %), renal tumors (10.1 %), leukemias (6.3 %), and soft tissue sarcomas (5, 9 %). Burkitt lymphoma (85.3 %) and nephroblastoma (90.8 %) were the dominant histological type of lymphoma and renal tumors. This study shows an increase in the annual number of new cases, and an epidemiology close to that reported in other centers in sub-Saharan Africa.