Unusual location of myxopapillary ependymoma in the sacrum: Case report and review of the literature.

Myxopapillary ependymoma, a rare variant of ependymoma, commonly occurs in the conus medullaris or filum terminale. The rarity of these tumors can make their diagnosis and treatment challenging. This case report presents an atypical occurrence of myxopapillary ependymoma within the sacrum in a 68-year-old patient presented with a 3-month history of persistent left-sided low back pain radiating to the legs and fecal dysfunction. The patient underwent a sacral laminectomy and subtotal excision of the tumor, followed by adjuvant radiotherapy with favorable outcomes. This report highlights the significance of tailored approaches for unconventional tumor locations emphasizes the potential benefits of multimodal treatment strategies and provides insights from a comprehensive literature review on similar cases.

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.

Paradigm change in urological, gynaecological and breast cancer management: A new practice-changing data from ASCO 2022 annual meeting.

Changing medical practice has been a constant process based on many scientific findings for years. In the oncology community, the American Society of Clinical Oncology (ASCO), one of the major annual conferences, presented the latest updates on practice-changing in cancer. At the recent meeting of 2022, held this year on June 2-6, researchers presented essential findings in urological, gynecological, and breast cancer management. In urological cancer, olaparib + abiraterone was demonstrated thru the PROpel trial to benefit in first-line treatment mCRPC regardless of the HRR stratification factor, along with the adjuvant therapy everolimus, for fully resected RCC in the EVEREST trial. In gynecological cancer, tisotumab vedotin demonstrated a potential role in improving clinical outcomes in 1st line r/mCC thru InnovaTV-205. In breast cancer, trastuzumab deruxtecan showed significant benefit for redefined human epidermal growth factors receptor 2 status in HER2 low BC patients, where current targeted-HER2 therapies are ineffective in the DESTINY-BREAST 04 study. The use of Immuno-based combinations in the medical management of TNBC patients has been supported thru several recent studies, showing positive results and outcomes, as demonstrated by the expert's opinions in Rizzo et al. research papers. In this article, we resumed the different renowned and what we considered intriguing to review studies presented during these three long sessions at the ASCO 2022 meeting.

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.

Advances in the management of non-small cell lung cancer (NSCLC): A new practice changing data from asco 2020 annual meeting.

At the meeting of the American Society of Clinical Oncology (ASCO 2020), held this year virtually on May 29-31, investigators presented important practice changing findings in non-small cell lung cancer (NSCLC). In the early-stage resectable NSCLC, the key presentation was ADAURA study. This phase III clinical trial showed that the use of adjuvant osimertinib in stage IB-IIIA NSCLC patients harboring EGFR mutations had a clinically meaningful benefit. In locally advanced NSCLC, the recent studies investigated the role of immune checkpoint inhibitors (ICIs) administred early with or before concurrent chemoradiotherapy. In advanced-stage NSCLC with driver mutations, new targets and drugs were explored. The major step forward was the approval of personalized treatment in very uncommon genomic alterations, as RET fusions or MET mutations. In advanced NSCLC without targetable mutations, some new immunotherapy combination strategies have been presented. One of such combination was tiragolumab, an immune checkpoint inhibitor binding to TIGIT, evaluated with atezolizumab. There were also data from the Checkmate 227 and Checkmate 9LA trials that led to recent approvals.

Primary intrapulmonary malignant peripheral nerve sheath tumor: A rare case.

A rare case of malignant peripheral nerve sheath tumor (MPNST) was found in the lungs of a 68-year-old male patient. He was referred to our hospital because of visual disturbances, confusion, and headaches. Upon admission, a chest-Abdomen-Pelvis CT scan (CT scan of CAP) showed a right posterobasal pulmonary lesion process associated with liver metastases and a lytic lesion of the vertebral body of D3. Brain MRI (Magnetic Resonance Imaging) revealed secondary brain lesions above and below the tentorium. Image guided liver biopsy showed a suspicious site of malignancy. In the histopathological examination, a diagnosis of MPNST was established. A biological agent, Imatinib, was administered and the patient underwent cerebral radiotherapy. CT scan of CAP showed a partial tumor response according to Chun's criteria. Pre-existing literature indicates that MPNSTs with metastases to the brain are very rare and have a poor prognosis - survival after brain metastases would be about 10 months. Our case report agrees with the literature, as the disease stabilized with treatment up to 7 months, after which the patient was unreachable and our team lost track of him. Our case report appears to be one of the first cases of primary MPNST in the lungs with brain metastases.

COVID-19 and Gynecological Cancers: A Summary of International Recommendations.

Morocco and the rest of the world are experiencing a pandemic of a new coronavirus known as COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). On August 24, 2020, the spread of the virus in Morocco had caused more than 52,000 cases and 880 deaths. Cancer patients are more susceptible to develop an infection than people without cancer because of their immunosuppression caused by the disease and treatments (surgery and chemotherapy). Therefore, these patients are at higher risk of infection with COVID-19 and a much higher risk of developing more serious forms. Given this epidemiological context, the establishment of guidelines for patients with gynecological cancers, requiring multidisciplinary management during the global COVID-19 pandemic, is crucial to limit their infection while maintaining their chances for a cure. In this paper, we summarize the international COVID-19 recommendations on the prioritization of surgical cases, the perioperative protective measures, the precautions to be taken in the brachytherapy unit, the COVID-19 screening, and finally the therapeutic indications of gynecological cancers by tumor location.

COVID-19, Brachytherapy, and Gynecologic Cancers: a Moroccan Experience.

The treatment of gynecological cancers is the main activity of brachytherapy units. However, during COVID-19 pandemic, precautions should be done in order to reduce the spread of the virus while maintaining all chances to recovery for all patients (Radiother Oncol 148, 227-228, 2020). Despite the extent of the pandemic in our country, limited data are available to establish recommendations with a sufficient level of evidence (Radiother Oncol 148, 227-228, 2020). More recently, the American Brachytherapy Society published some clarifications in this regard and international expert consensus recommendations of radiation therapy for gynecologic malignancies during the COVID-19 pandemic were published (https://www.americanbrachytherapy.org/about-abs/abs-news/abs-statement-on-coronavirus/, Gynecol Oncol 15, 2020). In this commentary, we sought to share the procedures adopted for the management of gynecological cancer patients during COVID-19 pandemic in our brachytherapy unit.

COVID-19 Recommendations for Patients with Cancer: The post-COVID-19 Era.

Despite the extent of the COVID-19 infection worldwide, the impact of the pandemic in our country remains low thanks to containment measures. On July 11, 2020, the spread of the virus in Morocco has caused more than 15,000 cases and 243 deaths. It is important to note that cancer patients are at high risk of developing COVID-19 disease. However, little changes have been made in our clinical practice in cancer management. Medical care aims are to ensure optimal treatment while minimizing the risk of COVID-19 transmission. Management should be discussed in a multidisciplinary team meeting, and any decision made, particularly influenced by the context of the COVID-19 pandemic, should be discussed and shared with the patient. In this article, we summarize our practical recommendations and how we prioritize cancer patient care during the post-COVID-19 phase.

[Skin metastasis from undifferentiated carcinoma of the nasopharynx: about a case]. / Métastase cutanée d'un carcinome indifférencié du cavum: à propos d'un cas.

Skin metastases from undifferentiated carcinoma of the nasopharynx are a rare clinical entity with unfavorable prognosis. We here report the case of a 16-year-old patient with single scalp metastasis with rapid evolution. This occurred 6 months after the end of concomitant radiotherapy and chemotherapy for the treatment of undifferentiated carcinoma of the nasopharynx. The patient died a month after the diagnosis of the metastasis. Given their poor prognosis, skin metastases should always be suspected in patients with skin lesions after a cancer.

Metastasis to the pancreas: a rare site for secondary malignancy of breast cancer (a case report).

Breast cancer is the most frequent invasive cancer in women and the second cause of death by cancer in women after lung cancer. It causes metastases especially to bones, liver and lungs. Pancreatic metastases from a primary breast neoplasm are rare and unusual, occurring in less than 3% of the cases. There have been only 28 cases described in the literature. This paper adds one more case to the published literature. We present a case of pancreatic metastasis of the breast in a 64-year-old female and a discussion based on a review of the literature.

Neoadjuvant Chemotherapy: A New Standard for Muscle Invasive Bladder Cancer?

Bladder cancer is the seventh most common cancer and the ninth most common cause of cancer deaths for men worldwide. Cystectomy with pelvic lymph nodes dissection is the standard local treatment of muscle invasive bladder cancer (MIBC) (T2-T4). In the last decade, the management of MIBC had become multidisciplinary involving peri-operative chemotherapy (neo- or adjuvant chemotherapy). Randomized trials and meta-analyses confirmed the survival benefit of neoadjuvant chemotherapy before local treatment (surgery and/or radiotherapy). Consequently, this sequence should be considered as standard treatment of choice, for patients with good performance status (0-1) and good renal function. The benefit of adjuvant chemotherapy is not clear for patients treated with primary surgery.

Epidemiology and outcome of cervical cancer in national institute of Morocco.

BACKGROUND: On behalf of the medical staff of the National Institute of Oncology of Rabat, we conducted a retrospective study to report epidemiology and 5-year outcomes of cervical carcinoma in Moroccan women. METHODS: We reviewed all women diagnosed with invasive cervical carcinoma in our institute between January 2006 and December 2006. Outcomes and prognoses are analyzed in patients who received at least one treatment. RESULTS: The analysis included 646 women. Median age was 50 years (23-85 years). Bleeding was the most frequent symptom (95 %). The most predominant histology was squamous cell carcinoma (94 %). The majority of patients were diagnosed at locally advanced stages (88 %). Among patients who received treatment (n = 550), the management was based on concurrent chemoradiotherapy in 69.7 % of cases. The median duration of follow-up was 60 months (range 2-78 months). Overall survival, progression free survival, and locoregional recurrence free survival were 63.2, 60.7 and 79.1 % respectively. Significant poor prognostic factors in univariate analysis included stage, tumor size, lymph node involvement, anemia and absence of response to radiotherapy. The prognostic significance of response to radiotherapy and stage were retained in multivariate analysis. CONCLUSION: Cervical cancer in our Institute is diagnosed at locally advanced stages. Two third of patients were treated by concurrent chemoradiotherapy. Outcome of Moroccan patients are comparable to that of western countries. Significant prognostic factors were stage, tumor size, lymph node involvement, anemia, and response to radiotherapy. The way to reduce the global burden of cervical cancer in our country continues to be the development of vaccination and screening programs.

Evaluation of the cost of cervical cancer at the National Institute of Oncology, Rabat.

INTRODUCTION: The Cervical Cancer (CC) is one of the heavy and costly diseases for the population and the health system. We want to know through this study, the first in Morocco, the annual cost of the treatment of this disease at the National Institute of Oncology (NIO) in Rabat, we also want to explore the possibility of flat-rate management of this disease in order to standardize medical practices and improve reimbursement by health insurance funds. METHODS: 550 patients were treated for their cervical cancer in the Rabat's NIO. Data of all of medical and surgical services offered to patients were collected from the NIO registry. The cost of care was assessed using the method of micro-costing. We will focus to the total direct cost of all the services lavished to patients in NIO. RESULTS: The global cost was about US$ 1,429,673 with an average estimated at US$ 2,599 ± US$ 839. Radiotherapy accounts for 55% of total costs, followed by brachytherapy (27%) and surgery (7%). This three services plus chemotherapy influence the overall cost of care (p <0.001). Other services (radiology, laboratory tests and consultations) represent only 10%. The overall cost is influenced by the stage of the disease, this cost decreased significantly evolving in the stage of CC (p <0.001). CONCLUSION: The standardization of medical practices is essential to the equity and efficiency in access to care. The flat-rate or lump sum by stage of disease is possible and interesting for standardizing medical practices and improving the services of the health insurance plan.