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Summary Introduction We aimed to explore the use of complementary and alternative medicine (CAM) and to identify their side effects, when used in cancer patients. We also assessed the communication of the patients and families with the oncologist about this issue. Methods A cross-sectional survey of 120 adult patients treated for cancer in our medical oncology department between January and April 2019, using an anonymous questionnaire to assess complementary and alternative medicine use. Results One hundred twenty patients participated in the survey, among them 102 used CAM (85%). A majority of users were female patients (n = 72, 70.6%), and mean age was 52.4 years ± 11.6. Patients had breast cancer in 48% of cases. Wild herbs were the most commonly used alternative therapy (67.7%), particularly Ephedra foeminea (Alanda) in 52% of cases. Patients’ families incited them to use CAM in 64.7% of cases. Internet and social network (Facebook) were the major sources of information on CAM (79.4%), followed by family and friends (72.5%). Fourteen patients (13.7%) reported nausea and vomiting secondary to CAM use. We reported disruption of liver function in 9.8% of cases, and renal failure in 1.96%, with fatal issue in one patient using Ephedra. Nineteen patients (18.6%) informed their oncologist about the alternative therapy they received. Conclusion The oncologist has to explore the use of alternative therapies with their patients. Communication about CAM should be a part of cancer care. It may protect patients from some dangerous side effects and improve efficacy of conventional therapy. more...

The use of regimens with adjuvant taxanes reduces the risk of recurrence and improves survival in patients with node-positive breast cancer, but the use of taxanes in node-negative breast cancer is still to be defined. The aim of this study is to evaluate the role of taxanes in high-risk node-negative breast cancer. Two categories of studies were reviewed: studies that evaluated both node-positive and node-negative breast cancers, and studies that included only high-risk node-negative breast cancers. Three phase-III studies that evaluated both negative and positive nodes did not show any benefit of the use of taxanes according to the node-negative subgroup analyses, versus two studies (European Cooperative Trial in Operable Breast Cancer [ECTO] et Grupo Espanol de Investigacion del Cancer de Mama [GEICAM]) that showed a significant difference in disease-free survival. In view of these studies, the role of taxanes in node-negative breast cancer is still controversial and the results of the ongoing trials may respond to this subject. more...

Resume Introduction Le lymphome primitif du grele (LPG) est le deuxieme lymphome malin non hodgkinien (LMNH) digestif apres celui de l’estomac. Objectif Evaluer l’evolution epidemiologique, anatomoclinique et therapeutique des LPG en Tunisie sur une experience acquise durant plus d’un quart de siecle. Patients et methodes Notre etude retrospective a collige les patients, chez qui le diagnostic de LPG a ete prouve histologiquement entre 1981 et 2008, inclus a l’institut Salah Azaiz. La cohorte de 210 patients a ete divisee en deux groupes : le premier groupe de 152 patients traites de 1981 a 1992 (A) et le second (B) de 58 cas traites de 1993 a 2008. Nous avons etudie les donnees epidemiologiques, anatomocliniques, histologiques et les resultats therapeutiques. Resultats Outre la baisse de l’incidence annuelle des LPG, nous avons observe une nette transition, d’une predominance des lymphomes de type immunoproliferative small intestinal disease (IPSID) encore appeles « Mediterraneen » diffus du grele vers une frequence relative plus importante des formes « occidentales ». La chirurgie exploratrice et/ou de reduction tumorale, largement pratiquee dans le groupe A, a disparu au profit de la chimiotherapie premiere ( p Conclusion Les LPG en Tunisie ont subi une triple transition : epidemiologique, histologique et therapeutique. more...

Resume Les carcinomes epidermoides (NPC) sont frequemment indifferencies de type UCNT (undifferentiated carcinoma of nasopharyngeal type) et ont une incidence variable, intermediaire pour le Maghreb et le Bassin mediterraneen, tres elevee pour l’Asie du Sud-Est et faible ( more...

The use of regimens with adjuvant taxanes reduces the risk of recurrence and improves survival in patients with node-positive breast cancer, but the use of taxanes in node-negative breast cancer is still to be defined. The aim of this study is to evaluate the role of taxanes in high-risk node-negative breast cancer. Two categories of studies were reviewed: studies that evaluated both node-positive and node-negative breast cancers, and studies that included only high-risk node-negative breast cancers. Three phase-III studies that evaluated both negative and positive nodes did not show any benefit of the use of taxanes according to the node-negative subgroup analyses, versus two studies (European Cooperative Trial in Operable Breast Cancer [ECTO] et Grupo Español de Investigación del Cáncer de Mama [GEICAM]) that showed a significant difference in disease-free survival. In view of these studies, the role of taxanes in node-negative breast cancer is still controversial and the results of the ongoing trials may respond to this subject. more...

Primary small intestinal lymphoma (PSIL) is the second Non-Hodgkin lymphoma (NHL) of the digestive tract (after gastric NHL).To evaluate during the past 28 years the epidemiological, anatomoclinical and therapeutic changes of PSIL in Tunisia through an acquired experience of more than a quarter of a century.Our retrospective study included patients with histologically confirmed small intestinal lymphoma from 1981 to 2008 in Tunisia at Salah Azaiz Institute. The cohort of 210 patients was divided into two groups: A group from 1981 to 1992 (152 patients) and B group from 1993 to 2008 (58 patients). We analysed the epidemiological, anatomoclinical, histological, and therapeutic characteristics.We observed a significant decrease in the annual incidence of PSIL but also a significant transition of diffuse immunoproliferative small intestinal disease (IPSID) also known as "Mediterranean" PSIL, which were progressively replaced by "Western" lymphomas. Laparotomy with or without a debulking surgery, largely performed in group A, has disappeared at the cost of a primary chemotherapy (p0.001). Five-year actuarial global and relapse free survivals were respectively 60.5 and 57.3%.PSIL in Tunisia were subjected to a triple transition: epidemiological, histological and therapeutic. more...

Nasopharyngeal carcinomas (NPC) are predominantly of undifferentiated type (UCNT or undifferentiated carcinoma of nasopharyngeal type), rare (1/100,000) and sporadic in occidental countries, but endemic in the Mediterranean area of intermediate incidence (2 to 10/100,000) and highly frequent (10/100,000) in South East Asia. NPC staging is based on TNM UICC 2002 that has a prognostic and therapeutic orientation impact. Irradiation of the primitive tumor and its extensions remains the standard loco-regional treatment. The recent introduction of primary and concomitant chemotherapy leads to an improvement in terms of overall and disease-free survival, specially for for high-risk-patients (T3-4 and N2-3 disease). Prognosis remain linked to T, N, histologic type and quality of response to chemotherapy and radiotherapy. more...

Cyfra 21-1 is a recognised marker for epidermoid lung and head and neck carcinomas oriented to the cytokeratin 19 that is expressed particularly in malignant epithelial cells. The aims of this study were to evaluate the importance of the use of this marker in nasopharyngeal carcinoma (NPC). Our prospective study interested 41 patients (33M/8F) with a mean age of 44 years (13 to 70) with 8 of them aged less than 30 years, presenting a nasopharyngeal carcinoma histologically confirmed from September 1999 to March 2000 and 45 healthy controls without evidence neoplasm. Undifferentiated forms represent 90.2% of cases and lesions are staged T2, T3 and T4 in 2.4%, 36.6% and 61% of cases, while N1, N2 and N3 represent 9.8%, 26.8% and 41.5% of cases. A blood sample was collected from each patient and control before any treatment, as well as controls to measure Cyfra 21-1 by immunoenzymatic assay, 2 groups of patients were selected after a period varying from 4 to 37 months with a median of 29 months: 27 patients with favourable evolution (without evidence of disease after initial treatment), 12 patients with non favourable evolution (1 death, 2 cases of loco-regional relapse and 9 patients with metastatic disease). 2 patients were lost to follow-up. The results showed that the mean serum Cyfra 21-1 values were significantly higher in patients with NPC than those in controls (p = 0.001). A significant correlation was found between the serum Cyfra 21-1 level before treatment and the clinical outcome of patients (p = 0.0009). Patients having a favourable evolution have the lowest level. Seric level of Cyfra 21-1 at diagnosis of NPC may play a predictive role to evaluate the risk of metastatic disease and prognosis. more...