Particularites du cancer du sein dans le centre tunisien

Il s'agit d'une etude retrospective a propos 1135 cas de cancer du sein colliges dans le centre tunisien sur une periode de 12 ans (janvier 1990 a decembre 2001). L'age moyen des patientes etait de 49;6 ans. La taille tumorale clinique moyenne etait de 49;9 mm; 43des tumeurs etaient classees T2; 50des patientes avaient une adenopathie axillaire homolaterale et 17presentaient une metastase d'emblee. Le taux de survie a 5 ans etait de 66et la survie moyenne de 43;7 mois. Les facteurs pronostiques significatifs etaient : le delai de consultation; la taille tumorale; l'atteinte ganglionnaire; les metastases; le stade T4d; le type histologique de la tumeur primitive; le grade SBR; les embolies vasculaires et lymphatiques; la rupture capsulaire et le traitement conservateur

Outcome of elderly patients with aggressive Non-Hodgkin's lymphoma refractory to or relapsing after first-line CHOP or CHOP-like chemotherapy: a low probability of cure.

We retrospectively evaluated the outcome of 94 consecutive elderly patients treated at our center for an aggressive lymphoma without a low-grade component. Median survival was 26 months and 5-year overall survival was 39% (27-50%). We then evaluated the outcome of patients refractory to or relapsing after CHOP or CHOP-like chemotherapy. Twenty patients were refractory to first-line therapy and only 1/20 is alive with active lymphoma. Eight patients achieved a partial response and only 3 maintained the partial response while the other 5 patients died. Only 2 of the 27 patients who relapsed after a first complete remission achieved a second sustained complete remission. This study suggests that conventional-dose second-line chemotherapy yields disappointing results in elderly patients with aggressive lymphomas.

[Adenoid cystic carcinoma (cylindroma) of the nasopharynx with extension into the cavernous sinus]. / Carcinome adenoïde cystique (cylindrome) du nasopharynx avec extension au sinus caverneux.

INTRODUCTION: The adenoid cystic carcinoma or cylindroma of the nasopharynx is a rare tumour characterised by its slow progression, high risk of local recurrence and prolonged survival, even in the locally advanced and/or metastatic forms. Treatment is pluridisciplinary. OBSERVATION: In a 30 year-old man consulting for right retroauricular pain, hypoacousia and epistaxis, diagnosis of a nasopharyngeal cylindroma was made in 1994. Treatment consisted first line surgery combined with loco-regional radiotherapy. Twenty-six months after complete remission had been obtained, a loco-regional relapse was revealed, combined with pulmonary metastases. The treatment combining radiotherapy, surgery and chemotherapy led to the stabilisation of the disease. COMMENTS: The adenoid cystic carcinoma of the nasopharynx a rare neoplasia of the head and neck, characterised by its slow progression over time, a high risk of relapse and the progression of metastases at distance. The corner stone of its therapeutic management is surgery. Radiotherapy improves the local control of the disease and chemotherapy is helpful in treating the metastatic disease.

[Breast cancer prognosis in Tunisian women: analysis of a hospital series of 729 patients]. / Pronostic du cancer du sein chez les femmes tunisiennes: analyse d'une série hospitalière de 729 patientes.

The objective of this study was to identify the anatomical-clinical aspects and determine the prognostic factors for breast cancer in the central region of Tunisia. This retrospective study involved 729 patients suffering from breast cancer, proven either by histology or cytology, diagnosed and treated between January 1990 and June 1998 at the F. Hached University Hospital in Sousse, Tunisia. The patients' average age was 50 years (ranging from 22-91). The average size of the cancer at the time of diagnosis was 49.1 mm; 90% were invasive duct carcinoma with high histo-prognostic SBR grade (level II-III: 86%). The overall survival rate was 50.5% after five years, and 50% after seven years. Using univariate analysis, significant predictive value was found with the following factors: tumor size, the clinical ganglionic level, metastases at diagnosis, the number of nodes invaded, nodal capsular rupture and lymphatic embolism, SBR grade and the delay in seeking consultation. The multivariate analysis (Cox model) isolated two prognostic factors: the initial size of the tumor (p = 0.001) and metastases at the time of diagnosis (p = 0.01). The study's results indicated that breast cancer prognosis in Tunisia remains poor primarily due to late diagnosis.