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.

Merkel cell carcinoma occurring in a black woman: a case report.

BACKGROUND: Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years. CASE PRESENTATION: We report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature. CONCLUSIONS: The Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.

Skin metastases of cervical cancer: two case reports and review of the literature.

BACKGROUND: Although cervix carcinoma is one of the most common malignancies in women, hematogenous metastases are relatively not common. Cutaneous metastases, in particular, are unusual even at an advanced stage of disease. Their presence is a predictor of poor prognosis. CASE PRESENTATION: Case 1: A 63-year-old postmenopausal Moroccan woman was diagnosed as having cervical squamous cell carcinoma. She was treated with radical concurrent chemotherapy and radiation therapy followed by low-dose brachytherapy. Six months after finishing the therapy, multiple skin nodules appeared on her abdomen and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. Her disease progressed and she died before completing her fourth course of palliative chemotherapy. Case 2: A 48-year-old Moroccan woman was diagnosed as having cervical squamous cell carcinoma; she was treated with concurrent chemoradiation. Before a planned high-dose brachytherapy, she noticed many nodular lesions on her arms, thighs, and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. She then underwent a series of imaging examinations, including computed tomography of her chest, abdomen, and pelvis, and a whole body bone scan that showed disseminated disease involving her lungs and bones. She died after two courses of palliative chemotherapy, 2 months after the appearance of the skin lesions. CONCLUSION: We report two cases to illustrate a rare localization of metastasis from cervical carcinoma that is highly aggressive requiring early detection and aggressive management.

[Radiotherapy for endometrial cancer: experience of the national institute of oncology with 52 cases]. / La radiothérapie du cancer de l'endomètre: expérience de l'institut national d'oncologie à propos de 52 cas.

Endometrial cancer is the most common gynecological cancer in the Western world. It affects mainly postmenopausal women. The aim of our study is to report the experience of the radiotherapy department of the National Oncology Institute (INO) in the treatment of endometrial cancer. We retrospectively analyzed 52 cases of endometrial cancer treated in the INO radiotherapy department between 2007-2009. Data obtained from the patient medical records were related to the epidemiologic, clinical, therapeutic and evolutionary aspects of this cancer. The median age of the patients was 57 years, 87% were postmenopausal. The median of consultation time was six months. The main symptom was metrorrhagia (51 patients). Histological diagnosis was based on biopsic curettage of uterine endometrium in 51% of the cases. Anatomo-pathological examination showed an endometrioid adenocarcinoma in 92% of the cases. After the assessment, 27% of the patients were stage I, 30% stage II, 20% stage III and 1% stage IVA, according to the International Federation of Gynecological and Obstetrics (FIGO) stage classification. After surgery, 51% of the patients received postoperative external radiotherapy. The delivered dose was 46 Gray (Gy). All patients received internal vaginal brachytherapy. From an evolutionary perspective, 83% of the patients had no recurrences during the follow-up period, 8% of patients had a local recurrence and 4% of patients had distant metastases. Therefore, surgery is the main treatment for endometrial cancer. Radiotherapy is the primary adjuvant treatment.

[Role of radiotherapy in stage I testicular seminomas: about 25 cases]. / Place de la radiothérapie dans les séminomes testiculaires de stade I: à propos de 25 cas.

We conducted a retrospective, descriptive study of 25 stage I testicular seminomas to clarify the role of radiotherapy in the management of this disease. Between January 2001 and December 2009, 25 patients with stage I testicular seminoma were treated in the Radiotherapy Department at the National Institute of Oncology in Rabat. Primary orchidectomy was performed via the inguinal route. Initial staging was based on total beta-hCG dosage, alpha-fetoprotein dosage and exploration of superior diaphragmatic and sub-diaphragmatic lymph nodes using tomodensitometry. Adjuvant radiotherapy was delivered using linear accelerator. The median age was 33 years (18-52 years). Testicular tumor involved the right side in 16 patients and the left side in 9 patients. Radiotherapy was delivered to lombo-aortic lymph nodes in 18 patients, lombo-aortic and ipsilateral iliac lymph nodes in 7 patients, using 2 anterior-posterior beams, with delivery of 20-25 Gy in 10-14 fractions. Immediate tolerance was excellent. The average monitoring period was 73 months. Twenty three patients are currently alive in complete remission. One patient developed a pulmonary relapse 22 months after the end of the radiotherapy. One patient was lost to follow-up. Long-term toxicity, especially gastrointestinal toxicity, was not observed. No tumor or secondary hematologic disease was reported. Prophylactic radiotherapy remains the standard adjuvant treatment of stage I seminomas. Immediate tolerance is satisfactory and an increased risk for secondary cancer is negligible compared to the therapeutic benefit. However, strict monitoring and one cycle of carboplatin-based adjuvant chemotherapy are also effective.

[What nutritional management in patients with head and neck cancers undergoing radiotherapy? An overview]. / Quelle prise en charge nutritionnelle des patients atteints du cancer de la sphère oto-rhino-laryngée traités par la radiothérapie ? Une mise au point.

Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects, which lead to malnutrition. Morbidity related to weight loss during treatment may include dehydration, hospitalization, compromised treatment efficacy, and reduced quality of life and may impact survival hence the importance of early nutritional management prior to radiotherapy. Multiple interventions have been implemented to help ameliorate the impact of treatment on weight loss and nutritional status, including the use of percutaneous endoscopic gastrostomy tubes. The goal of this overview is to search the predictive factors of malnutrition and an overview of the different types of nutritional interventions and their impact on the local control of the disease, mortality and quality of life of patients treated with radiotherapy or concomitant chemoradiotherapy.

Oral verrucous carcinoma complicating a repetitive injury by the dental prosthesis: a case report.

Verrucous carcinoma (VC) is an unusual, well differentiated, and low-grade type of squamous cell carcinoma, characterized by benign histology and cytology but markedly invasive clinical behavior. They have a predilection for squamous mucosae, particularly those of the head and neck region. Many factors have been associated with its pathogenesis, including the presence of previous skin lesions; VC arising from a prosthesis injury is rare. Here we reported a case of VC of oral cavity a particularly very aggressive, arising from prosthesis injury. Regardless of the treatment modality, given new insights into the possible aggressivity of this tumor, radiotherapy associated to chemotherapy may be a more appropriate primary treatment compared with the significant local morbidity associated with surgery.

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.

Breast cancer associated with neurofibromatosis type 1: a case series and review of the literature.

INTRODUCTION: Neurofibromatosis type 1, also known as Von Recklinghausen's disease, is a rare neuroectodermal disease that mainly affects the skin and the nervous system. Patients with neurofibromatosis type 1 have a higher risk of developing various types of cancers, especially tumors derived from the embryogenic neural crest. However, its association with breast cancer has seldom been reported. CASE PRESENTATION: We report the cases of three white Arabic women diagnosed with neurofibromatosis type 1, with a median age of 40-years-old (range: 39 to 43), who sought treatment at our centre for breast cancer. CONCLUSIONS: The association between neurofibromatosis type 1 and breast cancer is uncommon. In our case series we readdress this association through a literature review.

Solitary intraosseous schwannoma of the base and vault of the skull: a summary review of such unusual location.

Intra-osseous schwannoma is a rare mesenchymal tumor. Although, the head and neck region is one of the most common sites for schwannomas, its location at the skull bone is uncommon and accounted for less than 0.2% in the largest series of bone tumors ever reported. Furthermore, it is most often a benign tumor, malignant transformation is exceedingly rare. Clinical presentation is non-specific, most often symptoms are associated with compression and invasion of adjacent organs. Neuro-imaging features are non-specific and the diagnosis is based on histological examination with immunohistochemical study. Surgery remains the aim of treatment. However, radiation therapy could be an interesting therapeutic option in unresectable tumors. This systemic review offers new clinicopathological data useful for better defining the diagnosis and clinicopathological behavior of schwannoma. The purpose of this work is to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a mass of skull bone is identified.