HPV and cofactors for invasive cervical cancer in Morocco: a multicentre case-control study.

BACKGROUND: Limited national information is available in Morocco on the prevalence and distribution of HPV-sub-types of cervical cancer and the role of other risk factors. The aim was to determine the frequency of HPV-sub-types of cervical cancer in Morocco and investigate risk factors for this disease. METHODS: Between November 2009 and April 2012 a multicentre case-control study was carried out. A total of 144 cases of cervical cancer and 288 age-matched controls were included. Odds-ratios and corresponding confidence-intervals were computed by conditional logistic regression models. RESULTS: Current HPV infection was detected in 92.5% of cases and 13.9% of controls. HPV16 was the most common type for both cases and controls. Very strong associations between HPV-sub-types and cervical cancer were observed: total-HPV (OR = 39), HPV16 (OR = 49), HPV18 (OR = 31), and multiple infections (OR = 13). Education, high parity, sexual intercourse during menstruation, history of sexually transmitted infections, and husband's multiple sexual partners were also significantly associated with cervical cancer in the multivariate analysis. CONCLUSIONS: Our results could be used to establish a primary prevention program and to prioritize limited screening to women who have specific characteristics that may put them at an increased risk of cervical cancer.

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.

A Rare Case of a Massive Carotid Body Tumor in a 3-Year-Old Infant: Case Presentation and a Literature Review.

BACKGROUND: Paragangliomas are neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Only 3% of all paragangliomas are reported to occur in the head and neck region. The most common paraganglioma of the head and neck is the carotid body tumor. Only few cases have been described in the literature regarding the pediatric age group less than aged 14 years, mostly as case reports. CASE REPORT: Our case describes a massive paraganglioma in the head and neck region occurring in a 3-year-old Arabic boy, for which surgical excision was not possible and radiotherapy resulted in a good clinical and radiologic response. CONCLUSIONS: Paragangliomas a rare in children and mostly diagnosed in a locally advanced stage. Surgery in most cases is difficult especially because of the proximity of the vessels; radiotherapy is still a good alternative for those cases.

Venous thromboembolism in cancer patients: an underestimated major health problem.

Venous thromboembolism (VTE) is a major health problem among patients with cancer, its incidence in this particular population is widely increasing. Although VTE is associated with high rates of mortality and morbidity in cancer patients, its severity is still underestimated by many oncologists. Thromboprophylaxis of VTE now considered as a standard of care is still not prescribed in many institutions; the appropriate treatment of an established VTE is not yet well known by many physicians and nurses in the cancer field. Patients are also not well informed about VTE and its consequences. Many studies and meta-analyses have addressed this question so have many guidelines that dedicated a whole chapter to clarify and expose different treatment strategies adapted to this particular population. There is a general belief that the prevention and treatment of VTE cannot be optimized without a complete awareness by oncologists and patients. The aim of this article is to make VTE a more clear and understood subject.

[Radiotherapy in the management of painful bone metastases at The National Institute of Oncology in Morocco: data from one year follow-up of 86 patients]. / Traiment antalgique des metastases osseuses par radiothérapir externe à l'lnstitut National d'Oncologie du Maroc: Donnnées d'une année de suive86 patients.

BACKGROUND: Radiation therapy plays an essential role in the management of pain caused by bone metastases Objectives: Evaluate the effect of radiation for the relief of pain caused by bone metastases. METHODS: We conducted a prospective study of 86 patients suffering from pain associated with bone metastases treated at our department by external radiotherapy between September 2010 and December 2011. Patients recorded pain severity in the numeric rating scale and analgesic requirements before, at the end of irradiation, then weekly for a month, and every month for a year. RESULTS: The median age of patients was 54 years (28-75 years). There were 45 (52.3%) women and 41 (47.7%) men. Radiotherapy was delivered in a multifraction schedule to a total dose of 30 Gy in 72% of patients or in a single fraction of 8 Gy in 28% of patients. A favorable analgesic response was observed in 59 (68.6%) patients with 8 (9.3%) complete responses and 51 (59.3%) partial responses. The median time-to-response was 2 weeks (0-7 weeks), and the median duration of pain relief was 22 weeks (9-46 weeks). CONCLUSION: Radiotherapy is effective in relieving pain associated with bone metastases in the majority of patients.

Analysis of mutations in the E6 oncogene of human papillomavirus 16 in cervical cancer isolates from Moroccan women.

BACKGROUND: Worldwide, cervical cancer is the second most common cancer in women. High-risk human papillomavirus (HPV) play a crucial role in the etiology of cervical cancer and the most prevalent genotype is HPV16. HPV 16 intratypic variants have been reported to differ in their prevalence, biological and biochemical properties. The present study was designed to analyze and identify HPV type 16 E6 variants among patients with cervical cancer in Morocco. METHODS: A total of 103 HPV16 positive samples were isolated from 129 cervical cancer cases, and variant status was subsequently determined by DNA sequencing of the E6 gene. RESULTS: Isolates from patients were grouped into the European (E), African (Af) and North-American (NA1) phylogenetic clusters with a high prevalence of E lineage (58.3%). The Af and NA1 variants were detected in 31.1% and 11.6% of the HPV16 positive specimens, respectively, whereas, only 3% of cases were prototype E350T. No European-Asian (EA), Asian (As) or Asian-American (AA) variants were observed in our HPV16-positive specimens. At the amino acid level, the most prevalent non-synonymous variants were L83V (T350G), H78Y (C335T), E113D (A442C), Q14D (C143G/G145T) and R10I (G132T), and were observed respectively in 65%, 41.8%, 38.8%, 30.1% and 23.3% of total samples.Moreover, HPV16 European variants were mostly identified in younger women at early clinical diagnosis stages. Whereas, HPV16 Af variants were most likely associated with cervical cancer development in older women with pronounced aggressiveness. CONCLUSION: This study suggests a predominance of E lineage strains among Moroccan HPV 16 isolates and raises the possibility that HPV16 variants have a preferential role in progression to malignancy and could be associated with the more aggressive nature of cervical cancer.

Extragonadal mixed germ cell tumor of the right arm: description of the first case in the literature.

BACKGROUND: Extragonadal localization of germ cell tumors (GCTs) is rare; to the best of our knowledge, a location in the soft tissue of the arm has never been previously reported in the literature. CASE PRESENTATION: We report the case of a 37-year-old man who presented with a primary malignant mixed non-seminomatous GCT (teratocarcinoma variety) in the right arm, treated by a combination of cisplatin-based chemotherapy and surgery. After 18 months of close follow-up, no locoregional recurrence or distant metastases have been detected. CONCLUSIONS: A combination of chemotherapy and surgery is the most appropriate treatment strategy for extragonadal GCTs, to ensure both local and systemic control.

Evaluation of tumor response three months after concomitant chemoradiotherapy with high dose rate brachytherapy as a definitive treatment modality for locally advanced cervical cancer.

OBJECTIVE: Radiotherapy remains an essential part of the management of locally advanced cervical cancer. Post-treatment surveillance allows for tumor response assessment and early detection of progressive prosecutions or local recurrences that may benefit from salvage treatment. The objective of this work is to assess the effectiveness of this therapeutic modality. MATERIALS METHODS: This is a retrospective study of 69 patients treated with concomitant radiation chemotherapy followed by high dose rate intracavitary brachytherapy. The tumor response was assessed by gynecologic physical examination at three months after the end of treatment. RESULTS: Median age of patients is 54.9 years (33-78 years). The most common histological type is squamous cell carcinoma (89.9%). The average dose received during external radiotherapy is 52.2Gy (46-60Gy). The average dose received during brachytherapy is 27.5Gy (18-28Gy). Three months after completion of treatment, 95.6% of patients had complete tumor remission, and only 4.4% had a tumor residue of 1cm. CONCLUSION: Radiation chemotherapy with brachytherapy allows for improved short-term local control in cervical cancer.

Intrathyroidal parathyroid carcinoma: a case report and literature review.

Parathyroid carcinoma is an uncommon endocrine malignancy comprising 0.5%-2% of patients with primary hyperparathyroidism. The probability of an intrathyroidal location is low (0.2%) and make preoperative suspicion and diagnosis challenging. Less than 20 cases of intrathyroidal parathyroid carcinoma have been reported. We introduce a case of intrathyroidal parathyroid carcinoma mimicking a suspicious thyroid nodule, and review the literature, with a focus on the role of adjuvant radiotherapy.

Lacrimal gland adenoid cystic carcinoma: report of an unusual case with literature review.

Lacrimal gland adenoid cystic carcinomas are rare, aggressive orbital tumors characterized by poor overall prognosis, tendency for local recurrence and metastasis despite aggressive treatment. Treatment continues to be controversial. Many authorities today will often initiate surgery (orbital exenteration with or without bone removal vs. globe-sparing resection) and adjuvant radiotherapy (external beam or proton beam therapy). We introduce a case of lacrimal gland adenoid cystic carcinoma treated with orbital exenteration and adjuvant volumetric modulated arc therapy, and discuss the related literature.

Can Radiation Therapy Quality Assurance Improve Nasopharyngeal Cancer Outcomes in Low- and Middle-Income Countries: Reporting the First Phase of a Prospective International Atomic Energy Agency Study.

PURPOSE: Most new nasopharyngeal cancer cases occur in low-income and middle-income countries, and these patients experience poorer overall survival than that of new nasopharyngeal cancer cases in high-income countries. The goal of this research project is to determine whether the introduction of a radiation therapy quality assurance program can ultimately improve outcomes for nasopharyngeal cancer patients in lower-income and middle-income countries. This study reports the results of the first phase of the International Atomic Energy Agency Coordinated Research Project (325-E3-TM-47712). METHODS AND MATERIALS: This prospective study has 2 phases. Phase 1 is a survey of radiation therapy resources, patient characteristics and treatment, and results of radiation therapy quality assurance performed by the expert panel. An educational workshop reviewing phase 1 results for each center was completed before accrual of patients for phase 2. The ultimate aim of the study is to compare the first and second cohort of patients to see if quality assurance can result in fewer major protocol deviations and a 15% improvement in patients' 3-year progression-free survival. RESULTS: Of 14 participating centers, 13 (93%) had computed tomography simulators and linear accelerators (LINAC) with intensity modulated radiation therapy (IMRT) capacity, median 3 LINAC (range, 1-13), and median 10 radiation oncologists (range, 5-51). The annual number of nasopharyngeal cancer cases irradiated was median 54 (range, 10-627). Five of 14 centers (36%) had no local radiation therapy quality assurance. For the current phase 1 study, 134 patients were evaluated, 82.1% had MRI staging, 99.3% had metastatic workup, 65.6% undifferentiated histology, 51% stage 3 and 49% stage 4. Radiation therapy quality assurance revealed 81 (60.4%) of 134 patients had major protocol violations in gross tumor volume and high dose planning target volume contours and/or dosimetry, 28.4% patients had borderline plans, 15 (11.2%) acceptable, and only 6 (4.2%) had inevitable compromise due to tumor extent. CONCLUSIONS: This is the first International Atomic Energy Agency study to address the fundamental issue of treatment quality rather than altered treatment regimens. The high rate of unacceptable radiation therapy plans is a major concern, and we hope phase 2 will show a significant reduction and improved patient outcomes.

Pediatric rhabdomyosarcoma in Morocco.

BACKGROUND: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. There is, however, a paucity of reports on the pattern of its occurrence in Africa. This study analyses the epidemiological pattern, clinical features, histology, and outcome in Moroccan children presenting with RMS. METHODS: We retrospectively studied 100 consecutive cases of histologically proven RMS in previously untreated children <15 years old followed at the Pediatric Oncology Unit of the Children's Hospital of Rabat from January 1995 to December 2004. RESULTS: RMS represented 5% of all the patients treated for cancer during this period. The male/female ratio was 2:1 with a mean age at diagnosis of 5 years. The embryonal subtype was the most frequent (73%) and the head and neck was the most common site of disease, followed by the genito-urinary tract and limbs. Chemotherapy was used in all patients; 44% also had a radical surgery and 23% radiation therapy. The event-free survival (EFS) at 10 years was 39% with relapse as the first cause of treatment failure. The overall survival at 10 years was 70%. The rate of treatment abandonment was 37%. CONCLUSION: Epidemiology and clinical features of RMS in Moroccan children does not differ from others countries. However, EFS is lower than that reported elsewhere due to occasional lack of availability of drugs, inadequate local control, and abandonment.

Epidemiologic profile of pediatric brain tumors in Morocco.

INTRODUCTION: Brain tumors are the most common solid tumors diagnosed among children below 15 years worldwide. However, little is known about the profile of pediatric brain tumors in Africa. The purpose of this study was to further elaborate the epidemiological profile of pediatric brain tumors in Africa, specifically Morocco. METHODS: A retrospective review was conducted of all patients with primary brain tumors in the age group 0-19 years, from 2003 to 2007, from multiple centers in two cities of Rabat and Casablanca, Morocco. Only patients with histopathological confirmation were included (n = 542). Descriptive epidemiologic profiles were created for the patients by age, sex, and histological subtypes of brain tumors. RESULTS: Overall medulloblastoma was the most common brain tumor (34.5%), followed by pilocytic astrocytoma (17.3%) and diffuse astrocytoma grade 2 (12.5%). Brain tumors occurred most commonly in 5-9-year age group followed by 10-14-year age group with the former being more common among males and the latter being more common among females. We also found medulloblastoma to be the most common brain tumor in the 0-14-year-olds. CONCLUSIONS: In this rare study focused on pediatric brain tumors in Morocco, most of the findings were consistent with past studies from other parts of the world. However, we found medulloblastoma to be the most common pediatric brain tumor followed by astrocytoma.

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.

Radical Mastectomy Increases Psychological Distress in Young Breast Cancer Patients: Results of A Cross-sectional Study.

INTRODUCTION: The present study aimed to detect the factors associated with psychological distress (PD) in young Moroccan patients with breast cancer, with a special focus on the type of surgical procedure. PATIENTS AND METHODS: We collected social, demographic, and clinical data from female patients, aged < 45 years, with localized stage breast cancer who had undergone either radical mastectomy or conservative surgery and for whom adjuvant chemotherapy was indicated. We used the Hospital Anxiety and Depression Scale (HADS) to assess the psychological status. The relationship between the variables and PD was analyzed using simple and multiple logistic regression analyses. RESULTS: A total of 122 women were enrolled, of whom 41 (33.6%) had a HADS global score ≥ 15. The HAD anxiety and depression subscores were ≥ 11 for 10 (8.2%) and 8 (6.6%) patients, respectively. On multivariate analysis, adjusted for marital status and receipt of analgesic and/or anxiolytic treatment, we found that radical mastectomy (odds ratio [OR], 5.747; 95% confidence interval [CI], 1.342-24.608), living in a difficult emotional (OR, 7.366; 95% CI, 1.727-31.41) and/or financial (OR, 16.521; 95% CI, 3.574-76.36) situation, and a lack of social and/or family support (OR, 19.617; 95% CI, 3.549-108.43) were independent factors associated with PD. CONCLUSION: Breast-conserving surgery should be performed whenever possible for young women to avoid the psychological repercussions of radical procedures.

[An analysis of breast cancer treatment waiting times: Experience of a tertiary referral center in Morocco]. / Analyse des délais de traitement du cancer du sein : expérience d'un centre de référence tertiaire au Maroc.

Measuring waiting times is a good indicator of quality and performance of cancer care. However, no detailed evaluation of these deadlines has been carried out in Morocco. The aim of this study was to determine the waiting times of medical care of breast cancer in a national tertiary referral center. The study was carried out by retrospective analysis of 373 cases of patients randomly selected among the cases recruited during the year 2015. Twelve delays of the care pathway were evaluated. The mean age was of 50,7 years. The deadline of access to this center was 9±8days. The deadline of access to the diagnosis was 33.5±21.2 days. The deadlines of access to multidisciplinary team meeting pre-therapeutic was 20.4±16.9 days. The access to the first treatment was 51.1±34.3 days for the neoadjuvant chemotherapy and 75.5±34.8 days for surgery. The deadline of access to the postoperative therapeutic proposal was on average 49.2±25.2 days. The deadline of access to the postoperative chemotherapy was 83.7±28.8 days and 284±43.8 days for postoperative radiotherapy in case of adjuvant chemotherapy. The global deadline mammography-radiotherapy was 372±66.5 days. Many of our deadlines were long compared to international recommendations. The factors associated with these delays must be analyzed in order to introduce improvement measures to control these indicators.

[Evaluation of multidisciplinary team meeting; the example of gynecological mammary cancers in a tertiary referral center in Morocco]. / Évaluation des réunions de concertation pluridisciplinaire ; l'exemple des cancers gynéco-mammaires dans un centre de référence tertiaire au Maroc.

The multidisciplinary team meeting has become a standard medical practice in oncology. However, no evaluation of this activity was carried out in Morocco. The aim of this study was to evaluate the multidisciplinary team meeting of gynecological mammary cancers in a National Tertiary Referral Center. The study was carried out by retrospective analysis of 207 cases of patients randomly selected among the 1190 cases recruited during the year 2015. Completeness and quality criteria were evaluated. The global completeness rate of passage in multidisciplinary team meeting is 38%. According to the therapeutic specialities, the completeness of passage in multidisciplinary team meeting is 68% of surgery, 35% of medical oncology and 19% of radiotherapy. As far as localizations are concerned, the completeness of passage in multidisciplinary team meeting is 43% for the breast and only 19% for the cervix. A quorum was met 100% of the cases. In 96% of cases the treatment performed is in accordance with the decision of the multidisciplinary team meeting. Eighty-four percent of cases performed multidisciplinary team meeting within less than one month. This analysis shows that the completeness of the transition to multidisciplinary team meeting has not reached the 100% planned by our institution. However, the requirements for conducting the multidisciplinary team meeting were generally met. This study shows an organizational evolution of our structure based on collective and multidisciplinary medical decision. The national obligation measure of multidisciplinary team meeting is necessary.

Extra-axial ependymoma of the cerebral convexity: A very rare intracranial adult tumor.

Background Ependymomas are rare adult tumors that originate from the ventricular system or the ependymal surface of the central canal. Extra-axial supratentorial ependymomas are extremely rare, and only five cases have been reported to date in the English literature. Case presentation A 46-year-old previously healthy male presented with a gradual painless loss of vision in the right eye. Cerebral MRI showed a right parietal-occipital lesion resembling an atypical meningioma. Surgical resection was performed, and immunohistochemical staining results concluded that it was a very uncommon location of a grade 3 ependymoma. Favorable outcome was observed one year after completion of postoperative radiotherapy. Conclusion Clinical and imaging aspects are misleading in rare brain tumors, and immunohistochemistry is essential to re-address diagnosis.