Immunotherapy and stereotactic body radiotherapy for older patients with non-metastatic renal cancer unfit for surgery or decline nephrectomy: practical proposal by the International Geriatric Radiotherapy Group.

The standard of care for non-metastatic renal cancer is surgical resection followed by adjuvant therapy for those at high risk for recurrences. However, for older patients, surgery may not be an option due to the high risk of complications which may result in death. In the past renal cancer was considered to be radio-resistant, and required a higher dose of radiation leading to excessive complications secondary to damage of the normal organs surrounding the cancer. Advances in radiotherapy technique such as stereotactic body radiotherapy (SBRT) has led to the delivery of a tumoricidal dose of radiation with minimal damage to the normal tissue. Excellent local control and survival have been reported for selective patients with small tumors following SBRT. However, for patients with poor prognostic factors such as large tumor size and aggressive histology, there was a higher rate of loco-regional recurrences and distant metastases. Those tumors frequently carry program death ligand 1 (PD-L1) which makes them an ideal target for immunotherapy with check point inhibitors (CPI). Given the synergy between radiotherapy and immunotherapy, we propose an algorithm combining CPI and SBRT for older patients with non-metastatic renal cancer who are not candidates for surgical resection or decline nephrectomy.

Immunotherapy and radiotherapy for older patients with locally advanced rectal cancer unfit for surgery or decline surgery: a practical proposal by the International Geriatric Radiotherapy Group.

The standard of care for locally advanced rectal cancer is total neoadjuvant therapy followed by surgical resection. Current evidence suggests that selected patients may be able to delay or avoid surgery without affecting survival rates if they achieve a complete clinical response (CCR). However, for older cancer patients who are too frail for surgery or decline the surgical procedure, local recurrence may lead to a deterioration of patient quality of life. Thus, for clinicians, a treatment algorithm which is well tolerated and may improve CCR in older and frail patients with rectal cancer may improve the potential for prolonged remission and potential cure. Recently, immunotherapy with check point inhibitors (CPI) is a promising treatment in selected patients with high expression of program death ligands receptor 1 (PD- L1). Radiotherapy may enhance PD-L1 expression in rectal cancer and may improve response rate to immunotherapy. We propose an algorithm combining immunotherapy and radiotherapy for older patients with locally advanced rectal cancer who are too frail for surgery or who decline surgery.

Synergizing Expertise and Technology: The Artificial intelligence Revolution in Radiotherapy for Personalized and Precise Cancer Treatment.

Artificial intelligence (AI) has truly revolutionized many fields, including healthcare. In radiation oncology, AI has emerged as a powerful tool for improving the speed, accuracy and overall quality of radiotherapy treatments. The radiotherapy workflow involves complex processes that require coordination between healthcare professionals with diverse skills. AI and deep learning methods offer unprecedented potential to transform this workflow by leveraging imaging modalities, digital data processing and advanced software algorithms. Despite the revolutionary potential, challenges remain in seamlessly integrating AI into clinical workflows. Ethical considerations, data privacy, and algorithm interpretability necessitate cautious implementation. Additionally, fostering interdisciplinary collaboration between AI experts and radiation oncologists is imperative to harness the technology's full potential. This paper explores the impact of AI in four key areas of radiotherapy: automated segmentation, dosimetric and machine quality assurance, adaptive radiation therapy, and clinical outcome prediction. Key words: Artificial intelligence, Radiotherapy, Workflow, Accuracy, cancer ,machine-learning.

Overcoming Chemotherapy Resistance in Cutaneous T-Cell Lymphoma: A Successful Case of High-Dose Radiotherapy Management.

The management of refractory cutaneous T-cell lymphoma (CTCL) is challenging and requires a multimodal approach. Radiotherapy is one of the treatment options used in managing CTCL, particularly for localized disease or as a palliative measure to control symptoms in advanced cases. The rarity of the disease makes it difficult to conduct extensive clinical trials and gather sufficient data on the most effective treatment approaches. Lymphocytes are among the most sensitive cells to radiation's damaging effects. Because of this sensitivity, radiation therapy can be an effective treatment. This case illustrates the efficacy of radiotherapy and its potential as an effective treatment alternative for a severe and resistant CTCL to systemic therapy in a 61-year-old Moroccan patient. The patient underwent curative high-dose radiation therapy, utilizing three-dimensional conformal radiation therapy. At the 19-month follow-up post-radiotherapy, no evidence of local recurrence, either clinically or radiologically, was observed, and the patient maintained a good quality of life with unrestricted mobility of his arm.

Bladder carcinosarcoma treated by cystectomy and adjuvant chemotherapy with good outcomes: a case report.

BACKGROUND: Primary carcinosarcoma of the bladder is a rare and highly aggressive tumor, representing less than 1% of all bladder neoplasms. There is no specific treatment guideline has for carcinosarcoma of the bladder, and majority of published patients was treated exclusively by surgery. CASE PRESENTATION: We report a case of 65-year-old Moroccan man, presented with macroscopic hematuria, pollakiuria and painful urination. Histological analysis showed a biphasic epithelial and mesenchymal proliferation, with invasion of lamina propria and muscularis, compatible with diagnosis of bladder carcinosarcoma. The patient was treated with cystectomy and adjuvant chemotherapy based on gemcitabin-cisplatin, 18 months after treatment, patient still free of recurrence. CONCLUSION: Carcinosarcoma of the urinary bladder is a rare and aggressive tumor regardless treatment. A multidisciplinary management based on radical cystectomy and combined adjuvant treatments can improve prognosis. In this work, we suggest to propose adjuvant chemotherapy whenever possible.

A closer look at nasopharyngeal cancer: A typical case report.

Nasopharyngeal cancer is a relatively rare cancer type, it is most common in southeast Asia and north Africa, it can be presented with nonspecific symptoms, making it challenging to diagnose. However, it remains a significant cancer to diagnose and treat early, as it can be aggressive and difficult to manage in its advanced stages. We report the case of a 48-year-old man who presented with isolated neck swelling, which was later found to be caused by multiple lymphadenopathies and suspected nasopharyngeal neoplasm. Imaging confirmed a large mass in the nasopharynx and bilateral cervical adenopathy. The patient underwent neoadjuvant chemotherapy and concomitant chemo-radiation, which resulted in a partial response. However, residual tumor persisted in the nasopharynx and cervical lymph nodes, and the patient requires cervical dissection. This case highlights the importance of early diagnosis and prompt treatment of nasopharyngeal cancer.

Testicular Radiotherapy: A Challenging Irradiation Site.

Testicular radiation therapy is a crucial component of the overall treatment of certain neoplasms. Yet, it remains challenging due to the unique anatomic location of the testicles, their specific radiation tolerance, and the lack of a standardized treatment workflow. In this article, we present the case of a 78-year-old patient with primary testicular lymphoma and describe the technical aspects of his radiation therapy. The challenge was to achieve a comfortable, reproducible, and effective treatment position while protecting the penis and covering the superficial layers of the scrotum. We used a total body restraint system and performed a second simulated CT scan with a bolus. The entire scrotum was delineated as the clinical target volume, with an additional 1 cm margin to obtain the planning target volume. This case highlights the importance of careful planning and personalized treatment approaches in testicular irradiation and underscores the need for further research and standardization in this complex irradiation site.

Brachytherapy Versus Stereotactic Body Radiotherapy for Cervical Cancer Boost: A Dosimetric Comparison.

BACKGROUND: The standard treatment for locally advanced cervical cancer involves chemo-radiation followed by brachytherapy. However, some patients are unable to undergo brachytherapy intensification. Recent advancements in radiation technology have provided several techniques, with stereotactic body radiation therapy (SBRT) theoretically able to mimic the dose distribution of brachytherapy with a high dose gradient. METHODS: We analyzed 20 high-dose-rate intra-cavity brachytherapy plans for women with cervical cancer and simulated an adjunctive stereotactic radiotherapy plan at the same doses used for brachytherapy (21 Gray [Gy] in three fractions). No planning tumoral volume (PTV) margin was added for SBRT dosimetry. We used the dose constraints for brachytherapy from the EMBRACE trial and the dose constraints for SBRT in three fractions. Dose distribution, maximum dose points on target volumes, bladder, rectum, and dose-volume histograms were compared between the two techniques. RESULTS: The mean volume of the high-risk clinical tumoral volume (CTV) was 64 cm3, and the mean volume of the intermediate-risk CTV was 93 cm3. The mean minimum dose received by 90% of the high-risk CTV (D90 CTV HR) was 17 Gy for brachytherapy versus 8.3 Gy for SBRT. The average minimum dose received by 90% of the intermediate-risk CTV (D90 CTV IR) was 7.5 Gy for brachytherapy versus 8.9 Gy for SBRT. The mean minimum dose delivered to 2cc of the bladder was 74.6 Gy for brachytherapy versus 84.7 Gy for SBRT. The mean minimum dose delivered to 2cc of the rectum was 71.8 Gy for brachytherapy versus 74.7 Gy for SBRT. CONCLUSION: We confirmed the dosimetric superiority of brachytherapy over SBRT in terms of target volume coverage and organ-at-risk sparing. Therefore, pending the results of further clinical studies, no current radiotherapy technique can replace brachytherapy for cervical cancer boost after external radiotherapy.

A giant primary vaginal sarcoma: A report case and literature review.

Primary vaginal sarcoma is a rare disease entity, reported in less than 3% of cases of vaginal cancers. We report the observation of a patient treated at the regional oncology center of Oujda in Morocco who is presented with a non-metastatic primary vaginal leiomyosarcoma of 20 cm. The treatment consisted of neoadjuvant chemotherapy, followed by hemostatic surgery with tumor resection limits, reinforced by radiotherapy and then a surgical resection with a tumor resection taking away the infiltrated part of the anterior face of the lower rectum and the realization of a left iliac colostomy whose resected tumor part limits were healthy. At present, the patient is 4 years of follow-up without locoregional or distant recurrence.

Primary urachal adenocarcinoma treated effectively with surgery and post operative chemoradiation therapy: Case Report with review of the literature.

Urachal carcinomas is a rare and aggressive tumor, accounting for less than 1% of all bladder cancers. We report a case of a 32-year-old man, with no past medical history, complaining of a total hematuria. The abdominal computed tomography scan revealed an exophytic mass of 3 cm on the dome of the bladder, extending to the urachus. The computed tomography scan of chest, abdomen and pelvis did not show neither regional or distant metastasis. Partial Cystectomy with umbilectomy was performed. Histopathology was in favor of urachal adenocarcinoma, classed pT3a, based on Sheldon's staging system, pT2b based on Mayo system, and pT2 based on Ontario system.

[Six-year disease-free survival after chemotherapy treatment for metastatic renal peripheral neuroectodermal tumor]. / Six ans de survie sans progression après chimiothérapie pour une tumeur neuro-ectodermique périphérique rénale métastatique.

Peripheral neuroectodermal tumors (PNET) of the kidney are extremely rare. They are often diagnosed at a late stage due to their nonspecific clinical presentation. Treatment of patients with metastases is based on palliative chemotherapy. We here report a case of PNET of the kidney with sudden onset of metastases to the lymph nodes and to the skin. The patient showed good clinical and radiological response and experienced progression-free survival at 6 years after polychemotherapy with vincristine, doxorubicin and cyclophosphamide.

Sexuality of Moroccan Survivors of Cervical Cancer: A Prospective Data

Introduction: This is a prospective study aiming to describe how cervical cancer and its treatment can affect the sexuality of a specific population of Moroccan women survivors of this disease. Materiels and Methods: It is a comparison of clinical features and Female Sexual Function Index (FSFI) of 3 balanced groups of women, made up of 100 survivors of cervical cancer, 100 survivors of non-gynecological cancer and a group of 100 healthy women. Results: 97% of the patients stopped their full sexual activity at the time of treatment; the time interval between treatment and regular sexual activity was 8 months for the cervical cancer group, and 5.8 months for non-gynecologic cancer (P =0.001). Vaginal length assessed by pelvic examination during follow up visits was estimated at about 6.2 cm, 9.2 cm and 9.5 cm respectively for the cervical cancer group, non-gynecologic cancer group and the control group (p=0.04). On the basis of the FSFI questionnaire, the analysis of the 6 main sexuality parameter scores did attest worse results for the variables related to sexual function for cervical cancer group, but not in a statistically significant way. Conclusion: In order to preserve an optimal quality of life after cervical cancer, the sexual dimension is a crucial parameter to take into consideration throughout treatment phases, especially radiation (by encouraging sexual intercourses, and using vaginal dilators during the treatment). Moroccan survivors of this disease must be treated according to a multidisciplinary approach, that includs the psychological component.

[Vulvar cancer treatment options: experience in the Oncology Center in Oujda]. / Les traitements du cancer de la vulve: expérience du Centre d'Oncologie d'Oujda.

Vulvar cancer is a rare neoplastic disorder accounting for less than 5% of female genital cancers. This study aims to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of vulvar cancer in the population of the eastern region of Morocco. We conducted a retrospective study of all patients treated for vulvar cancer in the Oncology Center, University Hospital Mohammed VI in Oujda, Morocco from June 2007 to January 2014. The study included 34 patients with an average age of 65.7 years, of whom 52.9% were multiparous. The most frequent reason for consultation was pruritus (94.1% of cases). The median of consultation time was 16 months, ranging from 2 months to 8 years. Ignorance and modesty were the major causes of diagnostic delay, since 73.5% of patients already had locally advanced disease at diagnosis. Surgical treatment was proposed to 61.4% of cases and was based on radical vulvectomy associated with bilateral inguinal lymphadenectomy in 68.5% of cases. Adjuvant radiotherapy was indicated in 41.2% of cases, 5.9% of patients underwent neo-adjuvant radiotherapy while 20.6% underwent exclusive radiotherapy associated with concomitant chemotherapy. Palliative chemotherapy was proposed to 8.8% of patients. The overall survival rate at 3 years was 65%, locoregional or distant recurrence rate was 17.3%. Cultural and social characteristics of patients of the eastern region of Morocco treated for vulvar cancer are factors influencing treatment and outcomes. Additional prevention and awareness efforts should be made in order to reduce the rates of locally advanced tumors and to enable curative treatment for this population.