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Résumé: Objectif: Comparer les résultats thérapeutiques de deux groupes de patients, adultes et enfants, traités pour un carcinome du nasopharynx. Patients et méthodes: Trois cents soixante-dix-sept patients atteints d’un carcinome du nasopharynx ont été irradiés entre 1993 et 2007. Parmi eux, 69 étaient âgés de moins de 20ans. Deux cent soixante-huit patients ont reçu une chimiothérapie néoadjuvante ou concomitante. Résultats: Les probabilités de survie globale et de survie sans progression de tout le groupe à cinq ans étaient respectivement de 67 % et 59,4 %. Celles de survie globale à cinq ans étaient respectivement de 66 % et 64 % (p =0,17) dans le groupe enfants et adultes, celles de survie sans progression à cinq ans de 66 % et 57 % (p =0,17). Les rechutes étaient plus fréquentes chez les adultes (1,4 % contre 14 %), mais les rechutes métastatiques étaient plus fréquentes chez les enfants. La toxicité tardive était plus marquée chez les enfants et représentée essentiellement par la xérostomie, sans différence significative. Conclusion: Les résultats thérapeutiques étaient meilleurs dans le groupe des enfants malgré la fréquence des formes localement évoluées, sans atteindre le seuil de signification. L’association de radiothérapie et de chimiothérapie pourrait expliquer nos résultats thérapeutiques. [ABSTRACT FROM AUTHOR]

Abstract: Purpose. – 1/ To evaluate the incidence of hypothyroidism following radiotherapy in the management of breast and nasopharyngeal carcinomas, 2/ to define the role of a systematic post therapeutic screening. Patients and methods. – From January 1996 through March 2001 a systematic evaluation of the clinical and the biological thyroid function was performed on a cohort of 84 patients that received supraclavicular irradiation. Selected patients had either a mammary (37 cases) or a nasopharyngeal (47cases) carcinoma. Initial work up included thyroid inspection and palpation, and biological tests: serum FT4 and TSH levels, radioimmunochemistry, completed by dynamic thyroid stimulation, using TRH, in case of border line low T4 or isolated high TSH levels. Tests were repeated every three months the first year, and then every six months. Replacement therapy with L Thyroxin was administered in case of hypothyroidism. Results. – All selected patients had a normal function initially. With a mean two years follow up (1–5 years), 24 patients (29%) experienced hypothyroidism, half of whom (13 cases) being purely biological. Five patients (11%), with a nasopharyngeal carcinoma, presented also with associated pituitary failure. Clinical symptoms were minor or mild in all cases. Hypothyroidism was detected at a mean 21 months follow up. In 2 patients, hypothyroidism disappeared spontaneously within 6 months. Possible predictive factors were evaluated: age of the time of radiation, gender, percentage of irradiated thyroid, total dose, dose per fraction, tumour type and chemotherapy. Only age appeared significantly correlated with thyroid dysfunction (range: 10-30 years, P =0.002). Conclusion. – Hypothyroidism is a frequent and certainly underestimated complication following radiotherapy of the neck. In such patients, a systematic clinical and biological evaluation every three months the first year, and then every six months until five years is recommended. [Copyright &y& Elsevier]

Standard therapy for nasopharyngeal carcinoma (NPC) in children has generally followed the guidelines established for adults. We report here, the treatment outcomes in 32 children and adolescents with NPC and we discuss treatment approaches. Between 1993 and 1997, 32 NPC patients aged ⩽20 years (mean age 15 years) were treated in our institution; they represented 18% of all NPC cases seen during the same time period. 27 patients had no metastases at diagnosis; 26 of these were treated with primary chemotherapy combining epirubicin and cisplatin. Radiotherapy was then delivered to 22 patients at a mean dose of 70 Gy, either conventionally (6 patients) or bifractionated (16 patients). 5 patients had metastases at diagnosis and were treated with chemotherapy combining epirubicin, bleomycin and cisplatin before definitive radiotherapy. The objective response rate (OR) after chemotherapy was 90.9% at the primary site, with a 13.6% complete response (CR) rate. At nodal sites, the OR was 95.5% and the CR was 31.8%. Local control was obtained in all patients after definitive radiotherapy with a medium follow-up of 43.7 months. Late toxicity affecting quality of life was found in 26% of the children who were irradiated, especially among those under 15 years of age (skin fibrosis, 27%; trismus, 27%; hypothyroidism, 14%). No locoregional relapses were observed. Distant metastases occurred in 33% of cases, with a median delay of 4.7 months from the end of treatment. The 2- and 5-year overall survival (OS) rates were 76 and 56%, respectively. Disease-free survival (DFS) was 65% at 2 and 5 years. Therapeutic outcomes for childhood NPC were similar to those in adults, but with more radiotherapy-induced toxicity. New chemotherapeutic combinations and new radiotherapeutic techniques should be sought to improve both survival and quality of life. [Copyright &y& Elsevier]

Abstract: Pupose. – The aim of this work is to study the epidemiological, clinical and evolutive characteristics of the erysipela in patients treated for nasopharyngeal carcinoma (NPC). Patients and methods. – Between January 1993 and June 2003, 212 patients were treated for NPC in the radiotherapy departement of Sfax hospital. Twenty-two patients among them have presented an erysipela. A neoadjuvant chemotherapy was used for 16 patients with N2–N3 disease. Locoregional radiotherapy was delivred for all of patients. Results. – The mean age was 35 years (range: 10 and 69), sex-ratio was 1.2. The median delay between the appearance of erysipela and the end of the treatment was 16 months. The main localisation was the face. The main clinicals manifestations were fever in 86% of cases and erythema in 77% of cases. Immediate evolution was favorable in all cases after antibiotherapy. Recurrences were observed in 45% in cases. Conclusion. – Erysipela is a common skin infection readly found in patients with venous insufficiency. In our study we found a significant correlation between the frequency of erysipela and dystrophic complications. The incidence of erysipela in the face and cervical region after radiotherapy is unknouwn. [Copyright &y& Elsevier]

Radiation therapy with chemotherapy (CCR) is currently the gold standard treatment for nasopharyngeal carcinoma (NPC). Anatomical changes are mainly due to weight loss. Our prospective study aimed to evaluate the nutritional status and the quality of weight loss in our patients to adapt the subsequent nutritional management of patients during treatment for NPC. A prospective, single-center study of 27 patients with non-metastatic NPC treated in our oncology radiotherapy department between August 2020 and March 2021. Data from interrogation, physical examination, and bioelectrical impedancemetry (weight [W], body mass index [BMI], fat index [GI], fat mass [FM], and fat-free mass (FFM]) were collected at the beginning, the mid, and the end of treatment. Weight loss from mid to end of treatment (median = −4 kg [−9.4; −0.9]) was greater than that from baseline to mid-treatment (median = −2.9 kg [−8.8; 1.8]) (P = 0.016). Weight loss during the entire treatment was −6.2 kg [−15.6; −2.5] (8.4%). The losses of FM were identical between the beginning-mid treatment and the mid-end treatment; they were respectively −1.4 kg [−8.5; 4.2] and −1.4 kg [−8.2; 7.8] (P = 0.4). FFM losses between the mid- and the end of treatment (−2.5 kg [−27.8; 0.5]) were greater than those between baseline and mid-treatment (−1.1 kg [−7.1; 4.7]) (P = 0.014). Median FFM loss during treatment was −3.6 kg [−28.1; 2.6]). The results of our study show that weight loss during CCR for NPC is complex and is not just about loss but about a disruption of body composition. Regular follow-ups by nutritionists are required to prevent denutrition during treatment. [ABSTRACT FROM AUTHOR]

Les volumes tumoraux des carcinomes nasopharyngés avant et après la chimiothérapie d'induction peuvent être des indicateurs pronostiques permettant d'adapter la stratégie thérapeutique. L'objectif de notre étude était d'évaluer l'impact pronostique des volumes initiaux et après chimiothérapie d'induction pour les patients traités pour des carcinomes nasopharyngés localement aévolués. Étude rétrospective colligeant 52 patients atteints d'un carcinome nasopharyngé localement évolué traité par trois cures de chimiothérapie d'induction (TPF, docétaxel, cisplatine et 5-fluoro-uracile) suivis de radiothérapie conformationnelle avec modulation d'intensité associée à une chimiothérapie concomitante. Le volume total initial et celui après la chimiothérapie d'induction médians étaient respectivement de 92,3 et 41,5 mL. À 3 ans, les probabilités de survie sans récidive locorégionale, de survie sans maladie, de survie sans événement et de survie globale étaient respectivement de 85,9 %, 63,5 %, 56,8 % et 67,8 %. En étude multifactorielle, l'association d'un haut volume initial (> 100 mL) et après la chimiothérapie (> 35 mL) était un facteur indépendant pour la survie sans récidive locorégionale, de survie sans maladie, de survie sans événement et de survie globale. Le volume initial total avait une valeur pronostique prédictive pour la survie sans événement et la survie globale meilleure que celle du stade selon la classification TNM (8e édition). Le poids pronostique des volumes tumoral et ganglionnaire était plus important que le stade selon la classification TNM (8e édition). Les volumes tumoraux avant et après chimiothérapie d'induction permettent de sélectionner des sous-groupes de cancers à haut risque « haut volume initial et après la chimiothérapie », chez qui il serait judicieux de proposer des schémas thérapeutiques plus intensifs. The pre- and post-induction chemotherapy tumor volumes of nasopharyngeal carcinomas may be prognostic indicators for adapting the therapeutic strategy. The objective of our study is to assess the prognostic impact of pre- and post-induction chemotherapy volumes in patients treated for locally advanced nasopharyngeal carcinomas. This is a retrospective study including 52 patients with locally advanced nasopharyngeal carcinoma treated with 3 courses of induction chemotherapy (TPF) followed by intensity modulated radiotherapy associated with concomitant chemotherapy. The median initial and post induction chemotherapy total volumes were 92.3 and 41.5 mL, respectively. At 3 years, the LRFS, DMFS, DFS and OS were respectively 85.9%, 63.5%, 56.8% and 67.8%. In multivariate study, the combination of a high initial volume (> 100 mL) and post-chemotherapy volume (> 35 mL) was an independent factor for LRFS, DMFS, DFS and OS. The total baseline volume had a better predictive prognostic value for DFS and OS than the TNM classification (8th edition 2017). The prognostic weight of tumor and nodal volumes was greater than the TNM classification (8th edition). The pre- and post-chemotherapy tumor volumes allow selecting a high-risk patients' subgroup "high initial and post chemotherapy volumes" in which it would be advisable to offer more intensive treatment regimens. [ABSTRACT FROM AUTHOR]

Le carcinome nasopharyngé est souvent diagnostiqué à un stade où il est localement évolué (75 à 90 % des cas) en raison de sa localisation profonde. La chimioradiothérapie concomitante est la pierre angulaire du traitement des formes localement évoluées L'avènement de la radiothérapie avec modulation d'intensité a permis l'amélioration des résultats carcinologiques et la réduction de la toxicité et constitue actuellement la technique d'irradiation de référence. Dans ces formes évoluées, l'ajout d'une chimiothérapie d'induction est devenu un nouveau standard conformément aux dernières recommandations internationales en permettant de réduire les volumes tumoraux et d'agir précocement sur les micros-métastases. Malgré ces progrès thérapeutiques, le taux d'échec local et surtout à distance reste élevé. Cet article passe en revue les stratégies de traitement actuelles dans un premier temps, puis discute les nouvelles approches ainsi que les perspectives dans le traitement locorégional et systémique permettant de réduire les échecs thérapeutiques. Nasopharyngeal carcinoma diagnosis is often made at a locally advanced stage (75 to 90% of cases) due to its deep localization. Concomitant radio-chemotherapy is the cornerstone of the treatment of locally advanced forms. The advent of intensity-modulated radiotherapy has improved oncological outcomes and reduced toxicity and is currently the gold standard for irradiation technique. For the locally advanced stage, the addition of induction chemotherapy has become the new standard care according to the latest international recommendations to reduce tumor volumes and act early on micro-metastases. Despite these therapeutic advances, the local and especially distant failure rate remains high. This article reviews current treatment strategies and discuss new approaches and perspectives of locoregional and systemic treatment to reduce treatment failures. [ABSTRACT FROM AUTHOR]

Abstract: Nasopharyngeal carcinoma affects preferentially young adults and is characterized by a high rate of node and visceral metastases that explains a part of therapeutic failure. We report a case of thyroid metastasis of a nasopharyngeal carcinoma. A 50-year-old patient had been treated of a nasopharyngeal carcinoma (T4 N2M0). Four years after a concomitant chemoradiotherapy, he presented with a compressive mass in the thyroid loge associated to cervical nodes. He underwent a total thyroidectomy and the definitive result concluded to an carcinome indifférencié de type nasopharyngé (UCNT) thyroid metastasis. A new concomitant chemoradiotherapy was delivered and consequently the tumor disappeared. Secondly, several node recurrences occurred. Metastasis of UCNT in thyroid gland is exceptional. Several problems are related to its aetiopathogenesis and to its treatment that is not systematized in the literature. The prognosis like for all metastatic forms of nasopharyngeal cancer is unfavorable. [Copyright &y& Elsevier]

L'objectif de ce travail était d'évaluer les changements anatomiques des structures glandulaires survenus au cours de l'irradiation des carcinomes nasopharyngés et d'étudier leurs impacts dosimétriques. Vingt patients en cours de radiothérapie pour un carcinome nasopharyngé non métastatique ont été inclus dans cette étude. Après la planification dosimétrique initiale, une deuxième scanographie a été faite à 38 Gy dans les mêmes conditions. Il a été relevé les changements volumétriques, positionnels ainsi que dosimétriques, entre les deux scanographies pour les structures glandulaires (parotides, glandes sous-maxillaires, thyroïde et hypophyse). Une diminution moyenne du volume des parotides droites et gauches a été observée (respectivement − 27,9 % et − 27,5 %). Pour les glandes sous-maxillaires, la diminution était de − 36,1 % à droite et − 27,2 % à gauches. Elle était de − 18,01 % pour la glande thyroïde. Une migration supra-millimétrique dans le sens médial de 2 et 1,15 mm a été trouvée pour l'isocentre des glandes parotides droite et gauche respectivement. Elle était corrélée avec la réduction du volume tumoral macroscopique ganglionnaire (GTVN) (r = 0,45 et 0,5). Une augmentation statistiquement significative des doses moyennes a été documentée au niveau des glandes parotides de 1,8 ± 2,3 Gy à droite et de 1,5 ± 2,7 Gy à gauche, de la glande sous-maxillaire droite de 0,35 ± 2 Gy et de la thyroïde de 3,79 ± 5,2 Gy. Les modifications anatomiques et dosimétriques expliquent en partie les toxicités causées par le rayonnement sur les structures glandulaires et constituent une piste pour l'implémentation d'une nouvelle stratégie thérapeutique qui est la radiothérapie adaptative. The aim of this work is to evaluate the anatomical changes of the glandular structures during the NPC IMRT and to study their dosimetric impacts. Twenty patients receiving IMRT for NPC were included. For each patient, a second dosimetric CT was performed at a dose of 38 Gy, which was fused with the initial planning dosimetric CT. We calculated the volume percent change, the positional and dosimetric variation between the 2 scanners for the glandular structures (parotid, submaxillary, thyroid and pituitary). We observed a decrease in the volume of right and left parotids (− 27.9% and − 27.54%). It was correlated with the initial dose planned at its level. For the sub maxillary glands, the decrease was − 36.1% on the right and − 27.28% on the left. The value of reduction of the thyroid gland was − 18.01%. A medial supra-millimeter migration of 2 and 1.15 mm was found for right and left parotid glands respectively, correlated with GTV N reduction volume. We found a significant increase in mean doses for the parotid glands. It was 1.8 ± 2.3 Gy for the right and 1.5 ± 2.7 Gy for the left. For the right sub maxillary gland, the increase was about 0.35 ± 2 Gy and 3.79 ± 5.2 Gy for the thyroid. The modifications observed for glandular structures during NPC IMRT can explain the different toxicities caused by radiation. It seems also that a careful adaptation of the treatment plan should be considered during therapy. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Nous rapportons dans ce travail, les résultats dosimétriques et carcinologiques de la radiothérapie conformationelle avec modulation d'intensité pour la réirradiation des carcinomes nasopharyngés. Patients et méthodes Nous avons repris les dossiers de huit patients qui ont été réirradiés selon une technique conformationnelle avec modulation d'intensité entre janvier 2015 et décembre 2017. Nous avons relevé pour chaque patient : les doses minimale, maximale, moyenne et reçues par 95 % (D95 %), 98 % (D98 %) et 2 % (D2 %) du volume à irradier, les indices d'homogénéité et de conformité et les contraintes de dose au niveau des organes à risque. Résultats La couverture du volume cible était satisfaisante avec une médiane de D95 % supérieure à 57 Gy (soit 95 % de la dose prescrite). La médiane de dose maximale reçue par la moelle épinière et le tronc cérébral étaient respectivement de 8,2 Gy et 18,25 Gy. Avec un recul médian de 14,5 mois [1–29 mois], cinq patients étaient en situation de rémission complète de leur maladie. Le taux de survie globale à 2 ans était de 66,7 %. Une majoration de la toxicité tardive préexistante après la première irradiation (devenue de grade 2 ou plus) a été retrouvée chez quatre patients (50 % des cas). Conclusion La radiothérapie conformationnelle avec modulation d'intensité constitue une technique séduisante en cas de réirradiation du nasopharynx. Elle permet une meilleure conformité de la dose dans le volume tumoral à irradier et une réduction des doses au niveau des organes critiques déjà irradiés, ce qui offre un bon taux de contrôle de la maladie avec moins de toxicité tardive sévère. Abstract Purpose We report in this study, the dosimetric and carcinologic results of intensity-modulated technique for the reirradiation of nasopharyngeal carcinomas. Patients and methods Eight patients reirradiated with intensity-modulation technique between January 2015 and December 2017 were included. We noted for each patient: the minimum, maximum and average doses, the dose received by 95% (D95%), 98% (D98%) and 2% (D2%) of the volume to be irradiated, the homogeneity and conformity indices and doses to the organs at risk. Results Target volume coverage was satisfactory with a median of D95% greater than 57 Gy (95% of the prescribed dose). The median maximum dose received by the spinal cord and brainstem were 8.2 Gy and 18.25 Gy, respectively. After a median follow-up of 14.5 months [1–29 months], five patients were in complete remission of their disease. Overall survival at 2 years was 66.7%. An increase in preexisting late toxicity after the first irradiation (now grade 2 or above) was found in four patients (50% of cases). Conclusion Intensity-modulation is an attractive technique for reirradiation of the nasopharynx. It allows a better conformity of the dose to the target and a reduction of the doses on the already irradiated critical organs. This offers good control of the disease with fewer severe late toxicities. [ABSTRACT FROM AUTHOR]

Purpose We represent in this study the long term results of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by concurrent chemoradiotherapy in Tunisian patients with locally advanced nasopharyngeal carcinoma. The objective of our study is to analyse the efficacy as well as the toxicity of this therapeutic protocol. Patients and methods Between January 2004 and December 2008, 32 patients with locoregional advanced non metastatic disease (T2b or above and/or N1 or above AJCC 2002) were treated in our institution by three cycles of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy every 21 days followed by concurrent chemoradiotherapy. Conventional radiotherapy was delivered using a cobalt 60 machine during 7 weeks with weekly cisplatin (40 mg/m 2 ). Results Twenty-nine patients (90%) had presented an objective clinical response in lymph nodes after neoadjuvant chemotherapy, with a complete response in 28%. Acute toxicity of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy was dominated by vomiting (59%), asthenia (40.6%), diarrhea (34.4%) and febrile neutropenia (15.6%). The complete response rate after the end of treatment was around 80%. The 5 years overall survival and disease-free survival were respectively 68.2% and 67.5%. Conclusion Our results, in this field of study, are encouraging with acceptable toxicity despite the lack of intensity-modulated radiotherapy technique in our institution during the period of study. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: A retrospective analysis of risk factors for late neurological toxicity after nasopharyngeal carcinoma radiotherapy. Patients and methods: Between 1993 and 2004, 239 patients with non metastatic nasopharyngeal carcinoma were treated by radiotherapy associated or not to chemotherapy. Radiotherapy was delivered with two modalities: hyperfractionated for 82 patients and conventional fractionation for 157 patients. We evaluated the impact of tumour stage, age, gender, radiotherapy schedule and chemotherapy on neurological toxicity. Results: After a mean follow-up of 107 months (35–176 months), 21 patients (8.8%) developed neurological complications, such as temporal necrosis in nine cases, brain stem necrosis in five cases, optics nerve atrophy in two cases and myelitis in one case. Five- and ten-year free of toxicity survival was 95 and 84% respectively. Young patients had greater risk of temporal necrosis, and hyperfractionated radiotherapy was associated with a significantly higher risk of neurological complications (14.6% vs 5.7%, p =0.02). On multivariate analysis, hyperfractionation and age were insignificant. Conclusion: Late neurological toxicity after radiotherapy for nasopharyngeal carcinoma was rare. Younger age and hyperfractionation were considered as risk factors of neurological toxicity in our study. [Copyright &y& Elsevier]

Abstract: Background: The current retrospective study aimed to identify some determinants of survival in metastatic NPC. Methods: The study concerned 95 patients with metastatic nasopharyngeal carcinoma treated between 1993 and 2001. Statistical comparison between patients subgroups survival was carried out employing the log-Rank test (statistical significance was defined as p≤0.05). Multivariable analysis was performed using the Cox model (p≤0.05 was used as the cut-off value of statistical significance). Factors that were considered included: age group(≤45 years or>45 years and≤25 years or>25 years), gender, performance status at diagnosis of metastatic disease (PS 0-1 or 2-3), time of metastasis diagnosis(at presentation or later), number of metastatic sites (single or multiple), specific metastatic sites(bone, liver, lung, distant nodes), number of bone metastasis(single or multiple),disease free survival(DFI) (≤or>6 months), prior chemotherapy, radiotherapy of metastatic sites. Results: Negative prognostic factors in univariate analysis were: poor PS (≥1), multiple metastatic sites, multiple bone metastasis, previous chemotherapy, visceral or node metastasis and non irradiated metastasis. Poor PS, multiple metastatic sites, and prior chemotherapy were independently significant negative prognostic factors in multivariable analysis. Conclusions: In this study we identified new prognostic factors in univariate and multivariate analysis. . A regular and careful follow-up of patients treated for NPC is then recommended in order to detect early metastatic dissemination (with minimal localizations) while patients have still a good PS. [Copyright &y& Elsevier]

Abstract: Purpose: To determine the level and prognostic significance of c-kit expression in the two age groups of North African nasopharyngeal carcinomas. Patients and methods: A retrospective study of 99 NPC specimens from Tunisian patients was investigated by immunohistochemistry. Immunohistochemical data were correlated with Epstein-Barr virus LMP1 expression and pathological, clinical and survival parameters. Results: c-kit was detected in 79% of the cases for patients under 30 years of age (juvenile form) but in only 56% of specimens in patients over 30 years (P =0.039) and was significantly over-expressed for patients with lymph node involvement (P =0.015). LMP1 score was 5.78 (±1.84) for c-kit negative tumors compared to 8,23 (±2.39) for c-kit positive tumors (P =0.002). Multivariate analysis including age, lymph nodes involvement and LMP1 expression as co-variables, showed that only age (P =0.027) and LMP1 expression (P =0.005) were significantly correlated to the c-kit expression. Conclusion: c-kit is highly expressed in the juvenile form of North African nasopharyngeal carcinomas. There is a significant association between LMP1 and c-kit expression. The contrasted levels of C-kit expression in the two age groups strengthen the hypothesis that these clinical forms result from distinct oncogenic mechanisms. [Copyright &y& Elsevier]

Abstract: Purpose: The objective of this retrospective study was to discuss the epidemioclinical criteria and the therapeutic results of metastatic nasopharyngeal carcinoma. Patients and methods: The current study concerned 95 patients with histologically proven nasopharyngeal carcinoma who were metastatic at diagnosis or who had developed late metastasis. We reviewed the epidemioclinical records of all the patients. Patients were treated with chemotherapy (BEC regimen: bleomycin, epirubicin and cisplatin or PBF regimen: bleomycin, 5-fluorouacil and cisplatin) and radiotherapy of pauci metastatic localizations (single or double) or bone metastasis with high risk of compression or fracture±associated with locoregional radiotherapy for patients who were metastatic at diagnosis. Response was assessed according to the WHO criteria. Overall survival was calculated according to the Kaplan-Meier method. A long-term disease-free survival was defined from 36 months. Results: There were 34 patients who were metastatic at diagnosis and 61 patients who had developed late metastasis. The mean age was 41.5 years (sex-ratio: 3.1). Bone metastases were the most frequent (83%). Objective and complete response rates were respectively 75% and 70%, and 32% and 16% for BEC and PBF regimens. Twenty-five patients received radiotherapy for pauci metastatic localizations, among whom 19 patients who were metastatic at diagnosis received locoregional irradiation. The overall survival probability was of 15% for three years. Eleven patients were long survivors (extremes: 36 and 134 months). Conclusion: Therapeutic results were comparable to those reported in other series using platin combination chemotherapy. Radiotherapy of metastasis yielded to long-term survival. [Copyright &y& Elsevier]

Résumé: Les métastases cérébrales des carcinomes nasopharyngés sont exceptionnelles. Nous proposons de faire le point sur les aspects anatomocliniques, thérapeutiques et pronostiques de cette entité. Parmi les dossiers de 420 patients pris en charge pour des carcinomes nasopharyngés sur une période de 17ans, le diagnostic de métastases cérébrales a été retenu chez trois patients. Les patients chez qui la tumeur atteignait le cerveau par contiguïté ont été exclus. Un patient était atteint de métastases cérébrales au moment du diagnostic. Les délais de rechute étaient de dix et de 16 mois chez les deux autres patients. Les signes révélateurs étaient le plus souvent oculaires. Le diagnostic de métastase intracrânienne a été retenu après avoir éliminé une extension par contiguïté à travers la base du crâne. Les lésions étaient uniques chez deux patients. Ces métastases étaient accompagnées de lésions secondaires osseuses. Le traitement a comporté une radiothérapie cérébrale et une chimiothérapie palliative. L’évolution était marquée par une progression rapide et le décès des trois patients. Le pronostic des métastases cérébrales est défavorable, dépendant de l’âge, de la possibilité d’une chirurgie complète et de l’existence de métastases extracérébrales. La survie ne dépasse pas en médiane six mois. [ABSTRACT FROM AUTHOR]

Abstract: A 30-year-old woman, with a history of nasopharyngeal carcinoma, which was treated by radiotherapy nine years previously, presented with occasional diplopia and recent headaches. A nasopharyngeal biopsy showed no recurrence. The imaging revealed a sphenoidal sinus mucocele. Endoscopic marsupialization of the mucocele allowed clinical improvement. A 56-year-old woman presented, five years after radiotherapy for nasopharyngeal carcinoma, with a fronto-orbital mass. CT-scan revealed a fronto-ethmoidal mucocele. Nasopharyngeal biopsy showed tumour recurrence. Marsupialization of mucocele was performed. Recurrence of the carcinoma was treated by radiotherapy and chemotherapy. Sphenoidal sinus mucocele developing after radiotherapy for nasopharyngeal carcinoma has rarely been reported. CT scan and MRI are useful tools in making the diagnosis. Biopsy is required to diagnose recurrence or associated radio-induced tumor. Endoscopic approach gives good results. [Copyright &y& Elsevier]

Poster: Clinical track: Head and Neck PO-0847: Quality of life during chemo-radiotherapy for nasopharyngeal carcinoma: A prospective assessment N. Fourati, Z. Fessi, O. Nouri, F. Dhouib, W. Siala, W. Ben Kridis, A. Khanfir, W. Mnejja, J. Daoud. [Extracted from the article]