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Introduction: - The induction of malignant diseases is one of the most concerning late effects of ionizing radiation. The topic of this study deals with skin tumors developed in the irradiated areas in children given X-ray therapy for tinea capitis., Material and Methods: - All patients with malignant tumors of the scalp referred to Salah Azaiz Institute between 1970 and 2001 have been questioned in order to determine if there had been a prior X-ray irradiation for tinea capitis, its modality, and its consequences. The first scalp irradiation goes back to 1922 and the last was performed in 1963., Results: - Ninety-eight patients with 150 radio-induced cancers of the scalp following irradiation for tinea capitis are reported (1.5 lesion per patient). The patients were irradiated in various hospitals and dispensaries throughout the country. Eighty-one patients (82%) had only one session of radiation. The average age at irradiation was 12 (+/-6) years, the latent period for radiation-induced skin cancers was 36 (+/-14) years. In 61 patients (62%), the scalp appeared normal and in 38% radiodermatitis was noted. Patient age at diagnosis of malignancy varied from 20 to 83 years with an average of 47 years. Basal cell carcinomas (125 cases) and spinocellular carcinomas (16 cases) were the most common, three other cases of annexial tumors, two malignant non-Hodgkin's lymphomas and four melanoma lesions are also present. Radiotherapy was used for the treatment of 74 patients (alone in 42 and associated with surgery in 32 patients); 14 patients had exclusive surgical excision., Conclusions: - Basal cell carcinomas are the most frequent tumors arising on chronic radiodermatitis. In spite of the long latency period, patients' young age at irradiation explained the occurrence of these cancers at a relatively young age. Literature review is suggesting recessive mutation of tumor-suppressor genes as the characteristic abnormality in radio-induced cancer.

A better knowledge of the radiobiological effects and the control of the techniques of dosimetry led to a renewed interest for the radiotherapy of the benign lesions. The doses used for these indications are weaker than those recommended for treatment of cancer and the radiobiological mechanisms implied are different. The aim of this review of the literature is to specify the radiobiological mechanisms, the risks and the place of ionizing radiations during the processing of the benign lesions. Although the risk of radiation induced neoplasms remains a limiting factor of the indications, those are very varied. Some indications are well accepted such as keloid, cerebral arteriovenous malformations, graves' ophtalmopathy, prevention of postoperative heterotopic bone formations; and some others remain still controversial such as the prevention of the post angioplasty restenosis and age-related macular degeneration.

Hypothyroidism frequency is estimated to be between 10 and 45% after radiotherapy alone, and 40 to 67% after radiotherapy associated with thyroidectomy. This hypothyroidism is infraclinical in 60% of the cases. Our study concerned 15 cases of hypothyroidism after external radiotherapy delivered between and 1991 and 1999. An irradiation of the cervical, cerebral and thorax regions was indicated for different types of cancers. Larynx carcinoma epidermoid was the most frequent cancer (seven cases); the radiation treatment used cobalt 60 with conventional fractionation, i.e., 2 Gy per treatment, five treatments a week. In nine cases, the hypothyroidism was discovered during a systematic examination; it was clinically evident in the six remaining cases. Hypothyroidism appeared after an irradiation dose average of 50 Gy (extremes 30-65 Gy). The average duration of the irradiation was about 7 weeks and the hypothyroidism appeared in a mean 22 months. In all cases, the substituting treatment was initiated with a favorable progression. Faced with the risk of hypothyroidism, it is necessary to check patients who have undergone external irradiation of the neck.

Purpose: This is a retrospective study to evaluate the efficacy and safety of routine use of electronic portal imaging device (EPID) in intensity-modulated radiation therapy for localised prostate cancer. Materials and methods: Data from 20 patients with localised prostate cancer treated by radical radiotherapy using intensity-modulated technique in Habib Bourguiba Hospital were analysed to define the action levels for pretreatment planer dose distribution of 100 treatment fields and the set-up errors of 418 portal imaging. Pretreatment planar dose distribution was measured with the EPID. The additional dose from repeated portal imaging was determined with treatment planning system. Results: For all 100 fields, the predicted and the measured planar dose distribution agrees well with mean±standard deviation value for γ max=2·31±0·57, γ avg=0·36±0·07 and γ %≤1=98·94%±0·71%, respectively. For the evaluation of set-up errors, the mean total errors with 1 SD in the lateral, longitudinal and vertical directions were 0·11±0·44 cm; 0·02±0·37 cm and −0·02±0·21 cm, respectively. The imaging additional dose was evaluated as 1 cGy per monitor unit. Conclusion: EPID is a useful tool to verify pretreatment dose distribution and to assess the correct field position without a significant increase in the absorbed dose due to the repetition of portal imaging. [ABSTRACT FROM AUTHOR]

Abstract: Primary epidural cervical non-hodgkin''s low-grade lymphomas is exceptional. We report a 43-year-old woman admitted for a total functional disability of the four limbs. Magnetic resonance imaging revealed a cervical epidural mass C2–C3. A laminectomy was performed. The histological study revealed a small cells lymphoma. The patient underwent chemotherapy and radiotherapy. There was a favourable evolution. She is in complete remission with a follow-up of two years. We review literature to describe epidemiological, clinical and therapeutic features with evolutive aspects in primary epidural non-hodgkin''s lymphomas. [Copyright &y& Elsevier]

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]

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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]

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]

Cardiotoxicity following breast cancer radiotherapy (RT) represents one of the most redoubtable toxicities. The Global longitudinal strain measurement (GLS) based on 2D speckle tracking imaging (STI) allows detection of left ventricular (LV) dysfunction at a subclinical stage. The aim of this prospective study was to detect patients at risk of cardiotoxicity using echocardiographic parameters and to determine the association between segmental RT doses and early cardiac toxicity. The STI was performed prior to RT and at 3 , 6 and 12 months after. The association between subclinical LV dysfunction, defined as a reduction of GLS more than 10% from the initial value, radiation doses to different LV segments and non-radiation factors were performed based on multivariate analyses. From June 2017 to August 2018, a total of 103 female patients were included. Sixty patients had left sided RT. Seven patients (7.8%) developed a GSL impairment. The segmental alterations predominated in the anteroseptal and apical LV segments. The mean Dmean in altered segments was significantly higher than in non-altered segments (6.7 ± 8.8 Gy -7.8 ± 8.9 Gy vs 4.9 ± 7.9–5.4 ± 8.2Gy ; p < 0.05). Age > 55 years and obesity were important confounding factors that should be considered during radiotherapy planning. The results of our study show that radiation dose is correlated with the subclinical LV segments' alteration. Global heart delineation seems to be insufficient during the breast radiotherapy planning. Segmental delineation of the LV may be an interesting alternative to limit segmental doses and to reduce the risk of subclinical alterations. A mean dose of 5 Gy could be proposed in exposed heart segment. • Global heart delineation for radiotherapy planning is insufficient. • Segmental Left Ventricle delineation is recommended especially for left breast radiotherapy. • A-seven segment delineation instead of 17 seems to be sufficient and help to save delineation time. • Sub clinical segment alterations detected by longitudinal strain reduction are significantly associated with radiotherapy doses in univariate and multivariate analysis. • A limit of 5Gy in left ventricle segments may be used during radiotherapy planning. [ABSTRACT FROM AUTHOR]

Résumé L’adénocarcinome sinonasal de bas grade est une entité rare de description récente. Son diagnostic histologique est difficile. C’est une tumeur à développement locorégional qui donne exceptionnellement des métastases. Bien traitée, son pronostic est très favorable. Nous présentons le cas d’une patiente qui était atteinte d’un adénocarcinome bien différencié de bas grade des fosses nasales, pour discuter les particularités cliniques, anatomopathologiques et évolutives de cette tumeur particulière. La patiente, âgée de 54 ans, s’est présentée avec une obstruction nasale et une épistaxis droites évoluant depuis dix ans. L’examen a mis en évidence une formation charnue qui comblait toute la fosse nasale droite, qui a été opérée par voie endonasale. L’étude histologique a conclu à un adénocarcinome bien différencié de bas grade de la fosse nasale droite. Il n’a pas été observé de signe de poursuite évolutive avec un recul de quatre ans. Les adénocarcinomes représentent de 4 à 20 % des tumeurs malignes primitives nasosinusiennes. L’adénocarcinome de bas grade est une entité encore mal individualisée, qui se localise le plus souvent au niveau des fosses nasales. Son diagnostic est purement histologique et il est souvent difficile de différencier l’adénocarcinome de bas grade d’une simple tumeur bénigne. Son traitement est chirurgical et donne d’excellents résultats. Low-grade sinonasal adenocarcinomas are uncommon and recently described entities. Its histologic diagnosis is challenging. This tumour is characterized by a tendency to local invasion, and rare distant metastases. Well treated, the prognosis is excellent. We describe a case of low-grade nasal cavity adenocarcinoma and discuss the anatomoclinical, therapeutic and evolutionary characteristics of this malignant tumour. A 54-year-old female patient presented with a 10 years history of right-sided nasal obstruction and recurrent epistaxis. On examination the patient had a large, firm mass in the right nasal cavity. Endoscopic sinonasal surgery was performed. The lesion was found to originate from the posteriolateral wall of the right nasal cavity. Histopathology analysis identified a low-grade sinonasal adenocarcinoma. Upon follow-up 4 years after surgery, the patient exhibited no clinical evidence of recurrence. Low-grade sinonasal adenocarcinomas are poorly defined neoplasms, accounting for 4 to 20% of all sinonasal malignancies. The nasal cavity is the most frequently involved site. Low-grade sinonasal adenocarcinomas pose a diagnostic challenge for the pathologist because they must be distinguished from benign tumours, especially adenomas. The primary treatment of sinonasal adenocarcinoma is complete surgical excision. [ABSTRACT FROM AUTHOR]

Rapporter les particularités épidémiocliniques, thérapeutiques et évolutives des carcinomes canalaires de la parotide. Étude rétrospective portant sur cinq cas de carcinome canalaire de la parotide primitive ou secondaire, pris en charge à notre service de 2007 à 2019. Il s'agissait de quatre hommes et une femme d'âge moyen de 61,4 ans. Une patiente avait été traitée pour un carcinome canalaire infiltrant mammaire. Le motif de consultation était une tuméfaction parotidienne dans quatre cas et une asymétrie faciale dans un cas. Une perméation cutanée a été trouvée dans un cas. Quatre patients ont eu une parotidectomie totale avec sacrifice du nerf facial dans trois cas et étendue à la peau dans un cas. Un évidement ganglionnaire a été réalisé dans quatre cas. Une patiente a eu une biopsie parotidienne diagnostique. Le carcinome canalaire était primitif dans quatre cas et métastatique d'un cancer mammaire dans un cas. Une radiothérapie postopératoire a été réalisée pour les quatre patients opérés. Le contrôle local et à distance a été obtenu dans trois cas. Une récidive locale et méningée a été observée dans un cas. Pour la patiente ayant un carcinome mammaire, elle avait une progression polymétastatique pulmonaire, osseuse, hépatique et cérébrale. Le carcinome canalaire est une forme rare et agressive des cancers parotidiens de haut grade. Il peut être primitif ou secondaire. Le traitement se base sur la chirurgie et la radiothérapie. Le pronostic est réservé. To describe the clinical, therapeutic and prognostic features of ductal carcinomas of the parotid gland. Five patients with ductal carcinoma of the parotid gland (primary and secondary carcinoma) treated, between 2007 and 2019, in our ENT department, were reviewed. Four men and one woman were included. The mean age was 61,4 years. One patient had a history of an invasive ductal carcinoma of the breast. Four patients consulted for swelling in the parotid region. One patient referred to our department for dysfunction of facial nerve. Skin invasion was found in one case. Four patients underwent total parotidectomy with sacrifice of the facial nerve (three cases). One patient underwent extended parotidectomy involving the skin. An ipsilateral selective neck dissection was performed in four cases. One patient had a parotid gland biopsy. Ductal carcinoma was primary in four cases and metastatic from breast origin in one case. Four patients were treated with postoperative radiotherapy. Remission was obtained in three cases. One patient had a local and meningeal recurrence. The patient with metastatic carcinoma had pulmonary, bone, hepatic and brain progression. Ductal carcinoma is a rare and aggressive tumor of the parotid gland. It can be primary or secondary. The treatment is based on surgery and radiotherapy. The prognosis is poor. [ABSTRACT FROM AUTHOR]

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 Objectif de l'étude Étude rétrospective des résultats thérapeutiques de la radiothérapie pour les lymphomes du mucosa-associated lymphoid tissue (MALT) gastriques. Patients et méthodes Entre février 1993 et décembre 2014, 11 patients atteints d'un lymphome primitif gastrique de type MALT ont été pris en charge. Les patients atteints d'un lymphome de bas grade avec échec de la trithérapie ont reçu exclusivement une radiothérapie externe. En cas de transformation en un lymphome de haut grade, la prise en charge a associé une chimiothérapie à une radiothérapie externe. La radiothérapie a été délivrée à la dose de 30 à 40 Gy selon un étalement et un fractionnement classiques. Résultats Toutes les tumeurs étaient de stade IE. Sept étaient de bas grade et ont été prises en charge par une radiothérapie externe, quatre étaient transformées en haut grade et ont été prise en charge par une chimiothérapie suivie d'une radiothérapie externe. Dix patients étaient en situation de rémission complète. Le suivi moyen était de 127 mois. Le taux de survie sans récidive à 5 et à 10 ans était de 100 %. Aucune toxicité sévère n'a été observée le long du suivi. Conclusion Le traitement du lymphome du MALT gastrique repose sur l'éradication d' Helicobacter pylori. La radiothérapie externe est une modalité thérapeutique efficace et sûre assurant un excellent contrôle sans toxicité. Abstract Purpose We aimed to evaluate therapeutic results of radiotherapy for gastric mucosa-associated lymphoid tissue (MALT) lymphomas. Patients and methods We reviewed retrospectively the records of 11 patients presenting with gastric MALT lymphoma treated between 1993 and 2014. Patients with low-grade lymphoma in failure after helicobacter eradication had exclusive gastric external radiotherapy. Chemotherapy followed by radiotherapy were indicated in case of high grade lymphoma. Radiotherapy doses range between 30 and 40 Gy (2 Gy per fraction, five fractions per week). Results All tumours were IE stage. Seven patients with low-grade lymphoma had radiotherapy. Four patients with high-grade lymphoma received chemotherapy then radiotherapy. Ten patients are in complete remission after treatment achievement. Five and 10 years disease-free survival are 100%. No severe toxicity was seen. Conclusion Eradication of Helicobacter pylori is the mainstay of treatment of gastric MALT. External irradiation is an effective and well-tolerated treatment modality in case of resistance to helicobacter eradication. [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]

Résumé: Objectif: Étudier les caractéristiques épidémiologiques, cliniques et anatomopathologiques, ainsi que les résultats thérapeutiques des lymphomes osseux primitifs localisés. Patients et méthodes: Entre février 1993 et février 2013, quatre patients atteints de lymphome osseux primitif localisé, ont été pris en charge par le comité des hémopathies malignes des centres hospitaliers universitaires de Sfax en Tunisie. Les décisions thérapeutiques étaient prises en réunion de concertation pluridisciplinaire prenant en considération l’âge du patient, son état général, le stade de sa maladie, la concentration de lactate déshydrogénase (LDH) et ses conditions socioéconomiques. Une évaluation de la réponse au traitement était faite après la chimiothérapie et après la fin de la radiothérapie. La surveillance après traitement était clinique, biologique et radiologique Résultats: L’âge moyen des malades était de 59,5ans. Le sex-ratio était de 3. Les localisations osseuses étaient la clavicule, le fémur, l’humérus et la mandibule. Tous les malades étaient atteints d’un lymphome B à grandes cellules de stade I. Le lymphome osseux se traduisait par une lésion ostéolytique avec rupture corticale et extension aux parties molles dans trois cas. Il y avait chez un patient un aspect de fracture déplacé instable de l’extrémité inférieure de l’humérus droit. Le traitement a consisté en une chimiothérapie suivie d’une radiothérapie. Trois patients étaient en situation de rémission complète avec un recul moyen de 76mois. Conclusion: Le traitement du lymphome osseux primitif repose sur l’association chimiothérapie (avec ou sans anti-CD20) et de radiothérapie, son pronostic est excellent quand il est localisé. [ABSTRACT FROM AUTHOR]

Résumé: Les lymphomes osseux primitifs constituent une entité rare. Ils sont souvent localisés. Les études publiées à ce propos sont rétrospectives utilisant des définitions et des classifications différentes. Les populations des malades étudiées sont souvent hétérogènes. Les modalités thérapeutiques utilisées sont aussi différentes. Par conséquent, la stratification pronostique et l’analyse des résultats thérapeutiques sont difficiles. Nous avons fait une revue de la littérature et nous discutons les modalités thérapeutiques et les résultats, ainsi que le pronostic des lymphomes osseux primitifs. [ABSTRACT FROM AUTHOR]

Résumé: Les lymphomes non-hodgkiniens extraganglionnaires des tissus mous maxillofaciaux sont très rares. Nous rapportons deux cas de lymphome non-hodgkinien des parties molles maxillofaciales en rémission complète avec un recul de six et trois mois après une chimiothérapie suivie d’une radiothérapie localisée. Nous avons étudié les caractéristiques cliniques, radiologiques et histopathologiques ainsi que le traitement et le pronostic des lymphomes non-hodgkiniens extraganglionnaire des muscles maxillofaciaux. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To study the localization, treatment and prognosis of extramedullary plasmocytoma through a series of eight patients and a literature review. Patients and methods: Eight patients with extramedullary plasmocytoma were treated in the university''s hospital of Sfax in Tunisia. The average age was 57.3 years. Female represented 75% of patients. The diagnosis of plasmocytoma was based on anatomo-pathology and immunohistochemistry of a biopsy or resected tumour. Extramedullary location was confirmed if biological and radiological exams and medullary biopsy were normal. The therapeutic decision was made after multidisciplinary meetings regarding tumour location and anterior treatment. Results: Solitary extramedullary plasmocytoma was located in nasal cavity, cervical node, testis, ovary, bladder and the tongue. One patient was treated for three simultaneous locations of extramedullary plamocytoma (node, bowel, pleura) without evidence of myeloma. Radiotherapy was proposed in six cases but refused in one case (plasmocytoma of the bladder is currently receiving radiotherapy). Treatment consisted in chemotherapy in two cases. Evaluation after treatment revealed complete remission in 86% of the cases. Nodal recurrence was noted in two cases. These two patients were lost to follow up. The five other patients were in complete remission after a mean follow up of 5.7 years. No local recurrence or myeloma was noted. Conclusion: Extramedullary plasmocytoma is a rare affection. It can occur in any region of the body. Head and neck is most frequent localization. The treatment is irradiation or surgery in some localization. Progression to myeloma is the most important factor that influences the prognosis of the disease. [Copyright &y& Elsevier]

Abstract: Purpose: To analyze the therapeutic results of cutaneous cancers on xeroderma pigmentosum through a series of 15 patients treated by radiotherapy. Patients and methods: Between 1993 and 2006, 15 patients with xeroderma pigmentosum and having cutaneous cancers were treated in the Radiotherapy Department of university hospital Habib-Bourguiba of Sfax in Tunisia. Seventy-three percent of the cases occurred in male patients and the mean age of appearance of the first tumour was 18.2 years. Tumour histology was squamous cell carcinoma in 74% of the cases. The total number of cutaneous tumours was 84. Ten patients had a surgical resection. Four patients did not respond to chemotherapy. The modality of irradiation was decided according to the size, thickness and localization of the tumour. The dose of radiotherapy was 60Gy or equivalent with classic irradiation. Results: The total number of lesions treated with radiotherapy was 64. Forty-three lesions were treated with contactherapy, ten with brachytherapy and 11 with cobaltherapy. The following acute complications were observed: cutaneous infection (53.3% of patients), radioepithelite (80% of patients) and necroses (33.3% of patients). Evaluation after treatment showed a clinical complete remission in 73% of the cases. Late effects were noted in seven cases: telangiectasy and cutaneous atrophy. A recurrence in the irradiated zone was observed in one case. A nodal metastasis was observed in two cases. Another patient presented lung metastases. After a median follow up of 37.2 months, four patients died, seven are alive with cutaneous cancer and four are alive with complete remission. Conclusion: Radiotherapy is a possible and effective therapeutic alternative. Dose and methods are not defined for xeroderma pigmentosum. [Copyright &y& Elsevier]

Abstract: Purpose: We retrospectively analyzed anatomoclinic, therapeutic and evolutive particularities of 74 young patients (≤20 years) with nasopharyngeal carcinoma treated between 1993 and 2005. Patients and methods: Initial work-up included a fiberoptic nasofibroscopy with biopsy, tomodensitometry and/or MRI of nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. Patients were treated with either primary chemotherapy (epirubicin and cisplatin) followed by radiotherapy or concomitant radiochemotherapy (five fluorouracil and cisplatin). Radiotherapy was delivered to a total dose of 70 to 75 Gy to nasopharynx and involved cervical lymph nodes and 50 Gy to the remainder cervical areas. Results: The median age was 16 years. Sixty-three percent of patients had undifferentiated tumors. Sixty-six percent had locally advanced tumor. With a median follow-up of 107 months, one patient presented a local relapse, 24 patients developed distant metastases with a median delay of 7 months. The 5 years overall survival and disease-free survival were 66 and 65 %. Late complications were dominated by dry mouth and endocrine disorders. Comments: Pediatric nasopharyngeal carcinoma is characterized by an early metastatic diffusion. Local control is excellent but with severe late toxicities. New techniques of radiotherapy and new molecules of chemotherapy could improve these results. [Copyright &y& Elsevier]

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: The mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, skin and breast. However, colorectal involvement is extremely rare. To our knowledge, only ten cases of primary rectal MALT lymphoma have been reported in the literature. We report a 46-year-old woman with rectal MALT lymphoma, which regressed after radiotherapy. The patient had rectal bleeding. Colonoscopy showed a pseudonodular and ulcerated big fold in the rectum. Microscopic and immunohistologic studies of the biopsy specimen showed typical features of low grade MALT lymphoma. Upper endoscopy showed chronic gastritis with lymphoid follicles but without any infiltration of lymphoma cells. Helicobacter pylori infection was confirmed by histology. No extra-intestinal involvement was found on the staging evaluation, which included computed tomography (CT) of the abdomen, chest, pelvis and a bone marrow biopsy. We attempted to eradicate H. pylori with a 7-day course of omeprazole, amoxycillin, and metronidazole. Eradication was proved successful by endoscopy. Repeated colonoscopy 4months after the end of treatment showed that the rectal tumor had not regressed. Biopsy specimens confirmed the persistent infiltration of lymphoma cells. The patient was considered to be a non-responder to eradication therapy and was indicated for radiotherapy. He underwent a total of 34Gy. Complete regression was confirmed by colonoscopic and histologic examination at 2months after the end of treatment. He was followed up closely with colonoscopy, but no relapse of these lesions was detected after 12 months. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the treatment results of localised aggressive gastric lymphomas with favourable prognosis using chemotherapy and radiotherapy. Patients and methods: Between February 1993 and December 2004, nine patients with primary gastric high-grade lymphoma have been treated by the Lymphoma Committee of Sfax (Tunisia). The sex ratio was 1.5. The mean age was 44.9 years. Histological type was the large cell B lymphoma in 100% of the cases. Disease was stage I in eight cases and stage II in one case (Ann Arbor Classification). The treatment consisted in primary chemotherapy followed by radiotherapy of the stomach with or without regional nodes (40Gy). Results: After treatment, all patients had complete remission. With a mean follow-up of 55.7 months, one patient was lost to follow-up; the other patients were alive with complete remission. No major acute toxicities or late effects were found. Overall survival was 100% at five years. Conclusion: Chemotherapy associated with radiotherapy can be proposed to patients having localised and aggressive primary gastric lymphoma with favourable prognosis, since this treatment is well tolerated and provides satisfactory control of the disease. [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: 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]

Purpose. – To review the radiotherapy department experience in treating primitive spinal cord ependymomas (PSCE), analyse prognostic factors and provide treatment recommendations regarding literature review.Methods and material. – Sixteen patients with PSCE received postoperative radiotherapy between 1972 and 1997. There were 10 male and 6 female patients with a mean age of 34 years (range 2–63). Surgery was gross total resection in 2 cases, subtotal resection in 9, biopsy in 4 and of unknown type in one patient. All patients were treated with radiotherapy to the craniospinal axis (4 cases), spinal cord (1 case) and to the site of primary tumour in 11 cases.Results. – Five year-survival rate was 73%. Two patients had recurrent tumours within the primary site. Gender, extent of surgery and treatment field extent were not prognostic factors. Histologic type was the only variable predictive of outcome. Patients with myxopapillary type had a 5-year survival rate of 100% compared with 47% for those with other histology types.Conclusion. – We conclude that aggressive surgery is not necessary in the management of PSCE, localised field radiotherapy is associated with favourable outcome, and tumour grade is an important prognostic factor. [Copyright &y& Elsevier]

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: Physics track: Intra-fraction motion management PO-1668: Can we use cascade deep learning for GTV delineation in adaptive radiotherapy for NPC? B. Daoud, K. Morooka, R. Kurazume, N. Fourati, W. Mnejja, L. Farhat, J. Daoud. [Extracted from the article]

Abstract: Primary signet ring cell carcinoma of urinary bladder is a rare tumor; accounting for approximately 0,24% of all bladder malignancies. In this study, we report a case of a 58-year old man who consulted for complaints of gross hematuria, the bladder biopsie showed signet ring cell carcinoma; the exploration of gastrointestinal tract did not reveal any other tumor localizations. A total cystoprostatectomy was performed followed by radiotherapy. The aim of this study is to determine the anatomoclinical, therapy and evolution characteristics of this rare tumor. [Copyright &y& Elsevier]