Reversible posterior leukoencephalopathy syndrome following carboplatin and paclitaxel in cervical cancer: Case report.

Posterior reversible leukoencephalopathy is a rare radio-clinical entity that has gained increasing recognition over the last two decades. It is associated with various etiologies: arterial hypertension, autoimmune diseases, chemotherapy, and immunosuppressive drugs. Several cases have already been reported following cancer therapy. Posterior reversible leukoencephalopathy is characterized by capital clinical signs (headache, seizures, confusional syndrome, and visual disorders) and radiological abnormalities (cerebral edema predominantly in the posterior regions). We report the case of a 38-year-old female patient diagnosed with posterior reversible leukoencephalopathy after receiving Carboplatin and Paclitaxel chemotherapy for recurrent cervical cancer, which was revealed by a generalized seizure. Brain magnetic resonance imaging showed T2 Flair hyper signals in the parieto-occipital regions. This complication is rare but is probably underdiagnosed due to a lack of awareness and limited hindsight. Rapid diagnosis is essential to prevent acute neurological complications, which can be life-threatening or functionally crippling regardless of neoplasia.

Patterns of practice survey for cervical cancer brachytherapy in Morocco.

PURPOSE: This study surveyed radiation oncologists in Morocco to explore current practices and perspectives on brachytherapy for cervix cancer. METHODS AND MATERIALS: A 37-question survey was conducted in April 2023 among 165 Moroccan radiation oncologists using Google Forms. RESULTS: Of the 93 respondents, 39% treated over 20 patients in 2022 using 3D image-guided brachytherapy (BT) through the HDR technique; 2D techniques were not reported in the last five years. Intracavitary BT is uniformly applied with a tandem and ovoid applicator. Only 14% utilized interstitial needles for hybrid BT. Iridium-192 was the primary radioactive source (63%), followed by cobalt (37%). Ultrasound-guided 47% of applicator insertions. All used CT scans for planning, but only 6% used MRI fusion due to limited availability. Guidelines for target volume and dose prescription were mostly based on GEC-ESTRO recommendations (74%), followed by Manchester Point A (30.4%) and ABS (11%). Over 90% delineated CTV-HR and CTV-IR; 30% delineated GTV. All marked the bladder and rectum, while 52% marked the sigmoid, 5% the small bowel, and 3% the recto-vaginal point. For dosimetry, 12% used ICRU 89 points, 54% used dose-volume histograms (DVH), and 36% used both. Most reported EQD2cc for OARs for the rectum and bladder, with nine still using ICRU point doses. The most common fractionation schema was 7 Gy in four fractions (60%) and 7 Gy in three fractions (55%). CONCLUSIONS: Brachytherapy remains essential for treating cervical cancer in Morocco. Key areas for improvement include MRI fusion-guided brachytherapy, access to advanced applicators, expanding interstitial techniques, and professional training and national referential.

Metachronous ureteral metastasis of a gastric adenocarcinoma: a case report and review of literature.

BACKGROUND: Ureteral metastasis from gastric cancers are rare and can be a cause of ureteral obstruction. There have been few published case reports in the literature. In this paper, we report an additional case and a review of the literature of all the previous reported cases. CASE PRESENTATION: A 67 years old North African women who was treated four years before for a gastric adenocarcinoma, presented with abdominal pain. Imaging and endoscopy showed a mural stenosis of the left ureter, without any other abnormality. Histopathology confirmed the gastric origin of the metastasis. A palliative chemotherapy was foreseen, but due to the deterioration of the general condition of the patient, she received palliative care. We have also reviewed the literature and reported the previously published cases of ureteral metastasis from gastric cancer. CONCLUSIONS: It is worth recalling that in a context of neoplasia and with the presence of signs of ureteral obstruction, it is important to keep in mind the possibility of a ureteral metastasis.

Prevalence of Polyomaviruses and Herpesviruses in Moroccan Breast Cancer.

Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer death in women worldwide, accounting for 24.5% of total new cancer cases and 15.5% of total cancer deaths. Similarly, BC is the most common cancer among Moroccan women, comprising a noteworthy percentage of 40% of all cancers in women. Globally, 15% of cancers are attributable to infections; among them, viruses play a significant role. The present study aimed to explore the presence of a wide range of viral DNA in samples recovered from 76 Moroccan patients with BC and 12 controls using Luminex technology. The explored viruses were as follows: 10 polyomaviruses (PyVs): BKV, KIV, JCV, MCV, WUV, TSV, HPyV6, HPyV7, HPyV9, and SV40; and 5 Herpesviruses (HHVs): CMV, EBV1, EBV2, HSV1, and HSV2. Our results revealed the presence of PyVs DNA in both control (16.7%) and BC tissues (18.4%). Nonetheless, HHV DNA was detected exclusively in BC tissues (23.7%), with a predominance of Epstein-Barr virus (EBV) (21%). In conclusion, our study highlights the presence of EBV in human BC tissues, which may play an important role in its development and/or progression. Further investigations are needed to confirm the presence/co-presence of these viruses in BC.

Epidemiological, Clinicopathological and Prognosis Features of Moroccan Patients with Nasopharyngeal Carcinoma.

PROPOSAL: A distinct epidemiology, etiology, clinical characteristics, and therapeutic outcomes characterize nasopharyngeal carcinoma (NPC) from other head and neck cancers. An actualized analysis of NPC patients' features enables a global view of NPC management. Accordingly, the current study investigated the epidemiological and clinical characteristics of Moroccan patients with NPC, as well as their 4-years survival outcomes and influencing prognostic factors. METHODS: We prospectively analyzed data of 142 histologically confirmed Moroccan patients with NPC between October 2016 and February 2019. Kaplan-Meier and Cox regression analyses were used to assess predictive prognostic factors related to NPC. All analyses were conducted using SPSS version 21 statistical software. RESULTS: In the present study, a net male predominance was found, with a mean age of 44±16.3 years old. Advanced stages of NPC were observed in 64.1% of patients, and 32.4% of patients presented with distant metastasis at diagnosis. The 4-years overall survival, locoregional relapse-free survival, distant metastasis-free survival and progression-free survival were 68.0%, 63.0%, 53.9%, and 39.9%, respectively. Age, N category and distant metastasis were identified as the most important independent prognosis factors for NPC in this cohort (p<0.05). CONCLUSION: In conclusion, NPC affects young adults and is frequently diagnosed at advanced disease stages, impacting therefore negatively patients survival; which is in line with data from endemic areas for NPC. The current study clearly highlights that a greater attention should be directed to improving the management of this aggressive malignancy.

FETAL DOSE ESTIMATION DURING PREGNANCY USING GATE MONTE CARLO SIMULATION: APPLICATION OF HODGKIN'S LYMPHOMA RADIOTHERAPY.

The aim of this study is to estimate the fetal radiation dose for a pregnant patient treated for Hodgkin's lymphoma. Due to the supradiaphragmatic extensions, two plans are used for this treatment, one for supra-clavicular and the other for cervical lymph nodes, with beam energies of 18 and 6 MV, respectively. We model the ELEKTA accelerator (Versa HD Ltd, Crawly, UK) and the pregnant patient using GATE code. The accelerator is modelled based on the vendor-supplied data and the pregnant patient is modeled with a voxelized pregnant woman phantom (Katja, 29 years old) at the 24th week of pregnancy. In each plan, we estimate the absorbed dose of each fetus organ by delivering a 2 Gy for one fraction and then multiplying the result by 15 fractions to get the total prescribed dose, then we calculate the mean fetal absorbed dose. The results indicate that the mean absorbed fetal dose was 26.18 mGy.

Situation of pediatric radiotherapy in Morocco: First national survey.

INTRODUCTION: Pediatric radiotherapy (PR) faces several issues in middle- and low-income countries. AIM: Our study is a cross-sectional observation which aimed to describe the current situation of PR in Morocco in order to identify the needs and to propose an organizational shema for this discipline. METHODS: The collection of data used two surveys, one of which was intended to the heads of the radiotherapy department of all university hospital centers (UHC) in Morocco concerning the hospital's infrastructure, human resources, technical and the course of radiotherapy. A second survey was intended for all radiation oncologists trained and working in Morocco with data related to the practice of PR. RESULTS: In 2021, 295 children were treated in the radiotherapy departments of the seven university hospitals in Morocco. One hundred and two radiation oncologists responded to our survey. The multidisciplinary consultation board is held in five university hospitals, four of which have a complete multidisciplinary team. The children are sent to another structure by default of anesthesia according to 21% of the radiotherapists questioned. The three-dimensional technique is available in all university hospitals. Intensity modulated radiotherapy is available in 5 UHC. Additional training in radiotherapy after residency was necessary according to 60% of the radiotherapists questioned. CONCLUSION: Despite the progress that Morocco has made in terms of infrastructure and radiotherapy equipment, this first national survey has identified some weaknesses and developed some recommendations for the organization of PR.

[Which chemotherapy regimen in patients with metastatic phyllodes tumors of the breast? case report]. / Quelle chimiothérapie dans les tumeurs phyllodes métastatiques du sein? rapport de cas.

Phyllodes tumors (PT) of the breast are rare. They can be benign, borderline or malignant. Malignant forms account for 20-30% of PTs, with distant metastases in 10-26% of cases. Chemotherapy is one of the main therapeutic weapons for metastatic phyllodes tumors (MPTs). We here report four cases of MPTs of the breast managed at The Mohammed VI Center For Cancers Treatment in Casablanca from January 2015 to December 2017. The average age of patients ranged from 25 to 45 years. The mode of revelation was represented, in the majority of cases, by the occurrence of a huge breast mass and in all patients the histological diagnosis was based on the examination of mastectomy specimen. Three patients had lung metastases, two had axillary lymph-node metastases, two had bone metastases and only one had liver metastases. All patients received chemotherapy. Doxorubicin monotherapy and doxorubicin-ifosfamide (AI) were used. Only one patient had a very favorable outcome, with radiologic complete response after 3 AI regimens. MPTs of the breast have a poor prognosis. The role of systemic chemotherapy is to be defined, especially since there are no data available on optimal chemotherapy regimen.

BTN3A: A Promising Immune Checkpoint for Cancer Prognosis and Treatment.

Butyrophilin-3A (BTN3A) subfamily members are a group of immunoglobulins present on the surface of different cell types, including innate and cancer cells. Due to their high similarity with the B7 family members, different studies have been conducted and revealed the involvement of BTN3A molecules in modulating T cell activity within the tumor microenvironment (TME). However, a great part of this research focused on γδ T cells and how BTN3A contributes to their functions. In this review, we will depict the roles and various aspects of BTN3A molecules in distinct tumor microenvironments and review how BTN3A receptors modulate diverse immune effector functions including those of CD4+ (Th1), cytotoxic CD8+ T cells, and NK cells. We will also highlight the potential of BTN3A molecules as therapeutic targets for effective immunotherapy and successful cancer control, which could represent a bright future for patient treatment.

Glioblastoma Following Treated Medulloblastoma After 29 Years in the Posterior Fossa: Case Report and Review of Literature.

Glioblastoma multiforme (GBM) is a high-grade glioma that may be a rare complication of radiotherapy. We report a case of a patient who was treated for medulloblastoma (MB) of the posterior fossa at the age of 27 years. Twenty-nine years later, at the age of 56 years, he presented with a double-location tumor: supratentorial and in the posterior fossa. Imaging features of the supratentorial location were very suggestive of a meningioma. We operated on the posterior fossa location, which revealed a glioblastoma. Histologically, the tumor cells exhibited characteristics of both GBM and rhabdoid tumor cells. Literature reports of cases of GBM following MB at the same place are very rare, and presenting rhabdoid characteristics is even rarer. This is the first case of MB and GBM at ages 27 and 56 years, respectively. The double-location supratentorial probable meningioma and GBM of the posterior fossa 32 years after MB is the only case reported in the literature. What to do in this case remains a topic of debate, and there are no clear recommendations in the literature.

Prognostic Gene Expression Signature in Patients With Distinct Glioma Grades.

Background: Glioma is the most common type of primary brain tumor in adults. Patients with the most malignant form have an overall survival time of <16 months. Although considerable progress has been made in defining the adapted therapeutic strategies, measures to counteract tumor escape have not kept pace, due to the developed resistance of malignant glioma. In fact, identifying the nature and role of distinct tumor-infiltrating immune cells in glioma patients would decipher potential mechanisms behind therapy failure. Methods: We integrated into our study glioma transcriptomic datasets from the Cancer Genome Atlas (TCGA) cohort (154 GBM and 516 LGG patients). LM22 immune signature was built using CIBERSORT. Hierarchical clustering and UMAP dimensional reduction algorithms were applied to identify clusters among glioma patients either in an unsupervised or supervised way. Furthermore, differential gene expression (DGE) has been performed to unravel the top expressed genes among the identified clusters. Besides, we used the least absolute shrinkage and selection operator (LASSO) and Cox regression algorithm to set up the most valuable prognostic factor. Results: Our study revealed, following gene enrichment analysis, the presence of two distinct groups of patients. The first group, defined as cluster 1, was characterized by the presence of immune cells known to exert efficient antitumoral immune response and was associated with better patient survival, whereas the second group, cluster 2, which exhibited a poor survival, was enriched with cells and molecules, known to set an immunosuppressive pro-tumoral microenvironment. Interestingly, we revealed that gene expression signatures were also consistent with each immune cluster function. A strong presence of activated NK cells was revealed in cluster 1. In contrast, potent immunosuppressive components such as regulatory T cells, neutrophils, and M0/M1/M2 macrophages were detected in cluster 2, where, in addition, inhibitory immune checkpoints, such as PD-1, CTLA-4, and TIM-3, were also significantly upregulated. Finally, Cox regression analysis further corroborated that tumor-infiltrating cells from cluster 2 exerted a significant impact on patient prognosis. Conclusion: Our work brings to light the tight implication of immune components on glioma patient prognosis. This would contribute to potentially developing better immune-based therapeutic approaches.

Evaluation of cardiac toxicity of systemic treatments in Moroccan patients followed for localized breast cancer: Prospective observational study of 549 cases.

BACKGROUND: Breast cancer is the most common cancer in women in the world and in Morocco. Anthracyclines and anti-HER2 therapy are major drugs in the therapeutic management of localized breast cancer. The most serious toxicity of these drugs is cardiotoxicity. Our work aims to assess the prevalence of this toxicity in the Moroccan population. PATIENTS AND METHODS: We conducted a prospective longitudinal observational study between January 2017 and June 2018. All our patients were followed in The Cardio-Oncology Unit, 1st unit of its kind in Morocco, created thanks to the collaboration between the Mohammed VI Cancer Treatment Center and The Cardiology Departement of Ibn Rochd University Hospital in Casablanca. Eligible patients (n=549) had Stage I-III localized breast cancer, verified histologically, and a pre-treatment adequate cardiac function with a LVEF = 50%, measured with echocardiography, and received systemic cardiotoxic treatment (anthracycines, anti-her2 drugs). All patients received regular monitoring of cardiac function mainly by echocardiography. Cardiotoxicity was defined as a decrease in LVEF of 10 points and / or <50%. RESULTS: A decrease in LVEF was observed in 8.4% of our patients, with 4% symptomatic heart failure. The baseline average LVEF in the cardiotoxicity group was 63.5% (50-77) versus 60.5% (60-74) in the group without cardiotoxicity. 97.1% of these patients received anthracyclines, 98% received trastuzumab against 97% and 65% in the group without cardiotoxicity respectively. Cardiotoxicity was reversible in 6.4% of patients, permanent discontinuation of cardiotoxic treatment was observed in 2.2%. A statistically significant relationship was found between cardiotoxicity and arterial hypertension (HTA) (p = 0.002), trastuzumab (p = 0.0001) and radiotherapy for left breast cancer (p = 0.023). CONCLUSION: This is one of the first observational studies in Morocco with a large number of patients, which gives us an idea of the cardiotoxicity of systemic treatments in Moroccan localized breast cancer patients. Our results join those of the literature, but are still worrying and invite us, oncologists and cardiologists, to be more vigilant with this toxicity, which influences the oncological and cardiac prognosis of our patients, especially cancer survivors.

A review of the international early recommendations for departments organization and cancer management priorities during the global COVID-19 pandemic: applicability in low- and middle-income countries.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer. Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints.

Cancer management challenge in a developing country in COVID-19 pandemic: reflection of a group of Moroccan oncologists.

Management of cancer patients during the COVID-19 pandemic is a worldwide challenge - in particular in developing countries where the risk of saturation of health facilities and intensive care beds must be minimized. The first case of COVID-19 was declared in Morocco on 2 March 2020, after which a panel of Moroccan experts, consisting of medical oncologists from universities and regional and private oncology centers, was promptly assembled to conduct a group reflection on cancer patient's management. The main objective is to protect the immunocompromised population from the risk of COVID-19, while maintaining an adequate management of cancer, which can quickly compromise their prognosis. Recommendations are provided according to each clinical situation: patients undergoing treatment, new cases, hospitalized patients, palliative care and surveillance.

Radiation therapy in mycosis fungoid patient.

Mycosis fungoid (MF) is a non-Hodgkin's T-cell lymphoma determined by primary cutaneous involvement. It is a slow-progressing chronic indolent disease characterized by atypical T-cells with a cerebral nucleus. Management of this disease depends on the stage and is based essentially on the systemic treatment. Radiotherapy intervenes in case of localized or extended tumor, indeed, the radiosensibility of this tumor, like any other hematological affection, makes it possible to obtain a high rate of response. Clinical case: we report the observation of a 46-year-old patient followed since 2012 for mycosis fungoid revealed by a papullo-squamous lesion located at the level of the right lumbar fossa. The diagnosis was confirmed by cutaneous biopsy, showing the presence of T lymphocytes expressing CD2, CD3, CD4, CCR4, CD45RO markers. Initial assessment included a thoraco-abdominal pelvic CT, which was normal, an accelerated sedimentation rate at the 1st hour, a high C reactive protein (CRP), the electrolytic, renal, hepatic status and the hemogram were normal. Patient received 6 courses of chemotherapy according to the COPP protocol with a decrease in the size of the lesion estimated at 40%. A norm fractionated radiation therapy was delivered at the dose of 36Gy. The evolution was marked by a complete remission, maintained after 6 months of the treatment. Mycosis fungoid is a rare disease, whose management must be discussed in a multidisciplinary team. Radiotherapy remains an interesting option for all stages, but has to be validated in largest studies.

Prevalence of mucosal and cutaneous human papillomavirus in Moroccan breast cancer.

BACKGROUND: Due to recent technical improvements and some encouraging new results, there has been a resurgence of interest in the possibility that a substantial proportion of breast cancers (BCs) may be caused by viral infections, including Human papillomavirus (HPV). The aim of this study was to determine the prevalence of mucosal and cutaneous HPV in tumours from Moroccan BC patients. MATERIALS AND METHODS: Frozen tumours from 76 BC cases and 12 controls were evaluated for the presence of 62 HPV-types using highly sensitive assays that combine multiplex polymerase chain reaction and bead-based Luminex technology. RESULTS: HPV DNA was found in 25.0% of BC tumours and only 8.3% of controls. Beta and gamma HPV types were found in 10.5% and 6.6% of BC tumours, respectively. High-risk mucosal types HPV16 and 18 were not detected in the subjects, but other probable/possible high-risk or high-risk -HPV types (HPV51, 52, 58, 59, and 66) were found in 5.3% of BC tumours. Statistical analysis showed no significant difference between, controls, BC cases and the inflammatory status (p > 0.05). CONCLUSION: HPV DNA was found 3 times as frequently in the BC tumours as in the controls. However, this difference requires confirmation in a larger sample.

[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.

Adult-type granulosa cell tumor of the testis: report of a case and review of literature.

Granulosa cell tumors is classified into juvenile and adult types and comprise less than 5% of ovarian tumors in women and are much rarer in men which only 45 have been previously reported. We report here a 40-year young man with a left testicular adult type granulosa cell tumor. The tumor measured 5.5X5X4cm; Immunohistochemical stains showed the tumor diffusely positive for inhibin and vimentin. Post operative CT scans shows a lomboaortic lymphnodes treated by four cycles of chemotherapy type BEP (bleomycin, etoposide, cisplatin). The thoraco abdominal CT scans post chemotherapy shows the disappearance of the right testicular nodule and the lomboaortic lymphnodes. 2 years after treatment, the patient is alive and well with no signs of recurrence. Our report highlights one more case of this very rare tumor of the testis, which is quite problematic In terms of prognosis and management, and for this reason seems to have attracted the interest of many researchers recently.

[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.

[Brain metastasis from rectal adenocarcinoma: about a case and review of the literature]. / Métastase crânienne d'un adénocarcinome rectal: à propos d'un cas avec revue de la littérature.

The most common primary sites for bone metastases in men are lung, prostate, kidney, thyroid or bladder. Colorectal origin is rare. Few studies have described this type of metastases; the axial skeleton or the pelvis are the most common metastasis locations. Craniofacial location is exceptional. We here report the case of a 38 years old man treated for metastatic rectal cancer metastasized to temporal bone. He initially had undergone surgical procedure for low anterior resection, tumor was classified as pT3N0M0; 24 months after the patient had left exophthalmos revealing a temporal tumoral process. Evolution and context favoured metastasis. In conclusion, this study reporting an exceptional case of craniofacial bone metastasis from multi-metastatic colorectal cancer will enrich the scarce data reported in the literature related to bone metastases from primary colorectal cancer.