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The purpose of this article is to report a new case of a probably radio-induced bilateral breast cancer occurred after prophylactic bilateral pulmonary irradiation in the treatment of osteosarcoma. A 42-year-old woman, treated at the age of 12 years for osteosarcoma at the right lower limb with chemotherapy (methotrexate, adriamycin and cisplatin) followed by non-conservative surgery and adjuvant radiotherapy. Eighteen years after, she developed her first breast cancer, and five years later, her second contralateral breast cancer. The patient was treated for her two non-metastatic cancers and is currently in complete remission. This publication adds to several previous publications the very probable effect of ionizing radiation in the occurrence of secondary cancers.

Background Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women. Methods Cross-sectional study was performed on 494 Tunisian women visiting Women’s Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of L1 viral capsid gene. Results The overall HPV prevalence was 34% (95% CI: 30–38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76–92%) and 24.5% (95% CI: 20–29%) respectively. The distribution of HPV prevalence according to women’s age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37–67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22–45%) among women with SIL and 9.2% (95% CI: 6–12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0–5%) among women with SIL and 0.3% (95% CI: 0–1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76–95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64–99%, and 88%, 95% CI: 77–100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1–36% and 6%, 95% CI: 2–14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL. Conclusion HPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.

Introduction In approximately half of patients with breast cancer and lymph node metastases, the sentinel node (SN) is the only involved axillary node. Scoring systems have been developed to predict probability of non-SN metastases among those with a positive SN. The goal of the present study was to determine whether the five models (Memorial Sloan-Kettering Cancer Center (MSKCC), Stanford, Tenon, Cambridge and the Turkish model) accurately predicted non-SN involvement in a North African Tunisian population. Methods During a five years period, we identified 87 cases of invasive breast cancer which had a positive SN biopsy and complete axillary lymph node dissection (CALND). The MSKCC, Stanford, Tenon, Cambridge and Turkish models were tested. Results were compared using the area under the curve (AUC) of the receiver operating characteristics for each model. False negative and false positive rates were also calculated. Results The AUC of the MSKCC, Stanford, Tenon, Cambridge and Turkish models was respectively 0.73 (95% CI 0.6–0.86), 0.76 (95% CI 0.65–0.87), 0.75 (95% CI 0.63–0.87), 0.67 (95% CI 0.53–0.82) and 0.75 (95% CI 0.63–0.88). The threshold for a 10% false negative of non-SN involvement was obtained with a cut off value of 10% for MSKCC, 25% for Stanford, a score of 3 for Tenon, 6% for Cambridge and 15% for the Turkish nomogram. Conclusions Meaningfully applied to our population, although AUC values had overlapping of 95% confidence intervals but combined our data suggest that the Stanford nomogram may be the most accurate. Before prospective trials validate these nomograms, CALND remains the standard for patients who have SN metastases.

Objectifs Analyser les resultats oncologiques de la reconstruction mammaire immediate (RMI) par lambeau abdominal avance (LAA) associe a une prothese et l’impact des traitements adjuvants sur les resultats esthetiques.

Resume L’angiofibrome nasopharyngien est une tumeur vasculaire benigne localement agressive. Il represente 0,05 % des tumeurs de la tete et du cou et touche presque exclusivement les adolescents de sexe masculin. La chirurgie est consideree comme le traitement principal de l’angiofibrome nasopharyngien, les autres modalites therapeutiques telles que radiotherapie et chimiotherapie sont indiquees en cas d’extension intracrânienne avec envahissement du sinus caverneux ou de la carotide interne. Nous rapportons une observation rare d’angiofibrome nasopharyngien, complique d’un syndrome de Kennedy, chez une femme de 34 ans. Le traitement a consiste en une chimiotherapie par doxorubicine et dacarbazine suivie d’une radiotherapie. Nous discutons de l’interet et des resultats de l’association de chimiotherapie et de radiotherapie dans le traitement des angiofibromes nasopharyngiens avec une importante extension intracrânienne (de stade III B de la classification de Arch Otolaryngol Head Neck Surg 122 (2003) 122–129).

El cancer de la nasofaringe, en el que predomina el carcinoma epidermoide, sobre todo de tipo indiferenciado (CNFTI), tiene una incidencia variable, que es intermedia en el Magreb y la cuenca mediterranea, muy elevada en el sudeste asiatico y baja (

I tumori del rinofaringe, in cui spiccano in particolare i carcinomi epidermoidi indifferenziati di tipo undifferentiated carcinoma of nasopharyngeal type (UCNT), hanno un’incidenza variabile, intermedia per il Maghreb e il bacino del Mediterraneo, molto alta per il Sud-Est asiatico e bassa ( early antigen » (EA) e «viral capsid antigen» (VCA). Per il cancro del rinofaringe sono state messe in evidenza alterazioni genetiche a livello dei geni oncosoppressori nelle regioni dei cromosomi 3p, 9p, 11q, 13q, 14q e 16q. I marcatori sierici piu attendibili sono il Cyfra 21 e i livelli dell’acido desossiribonucleico (DNA) sierico. I segni evocatori piu frequenti sono la presenza di adenopatie cervicali, di sintomi otologici oppure rinologici. La valutazione della lesione si basa sulla rinoscopia con biopsia della neoplasia, sulla diagnostica per immagini con tomografia e risonanza magnetica cerebrocervicale e sulla valutazione della ricerca di metastasi. I tumori del rinofaringe sono stadiati secondo la classificazione tumor-nodes-metastases (TNM)-Unione internazionale contro il cancro (UICC) 2002, che ha un valore prognostico e di orientamento terapeutico. La radioterapia resta il trattamento di riferimento locoregionale, con un beneficio in termini di sopravvivenza globale e senza malattia dell’aggiunta della chemioterapia prima o contemporaneamente nelle forme ad alto rischio di metastasi (N3, T3-4). La prognosi dipende soprattutto dal volume della massa locoregionale (T e N) come anche dalla risposta alla chemio- e radioterapia.

Nasopharyngeal carcinoma (NPC) represents an interesting model in the field of head and neck cancers. This cancer is rare in occidental countries (

Objectif Repertorier les seconds cancers observes au niveau de la tete et du cou apres traitement par chimiotherapie et/ou radiotherapie pour un carcinome indifferencie du cavum en Tunisie. Patients et methodes C’est une etude retrospective des dossiers des patients ayant developpe une tumeur secondaire (TS) apres traitement d’un carcinome indifferencie du cavum. Pour etre retenue dans cette etude, la tumeur secondaire doit etre d’histologie differente de l’UCNT initial, localisee dans le champ d’irradiation et survenant apres un delai minimum de 3 ans. Resultats Sur une serie de 2 346 patients traites de 1984 a 2001 a Tunis, Sousse et Sfax, nous avons observe 11 tumeurs secondaires, soit une frequence de 0,46 %. Les patients avaient ete traites pour des UCNT du cavum en majorite etendus T3-T4 (72 %) ou N2-N3 (63 %). L’âge median etait de 20 ans (11 a 48). Le sex-ratio etait de 0,3 (3 H/8 F). Le protocole therapeutique avait comporte une association de chimiotherapie et de radiotherapie dans 8 cas et une radiotherapie seule dans 3 cas. La chimiotherapie etait premiere dans 4 cas combinant adriamycine (40-90 mg/m2)-cisplatine (100 mg/m2) et adjuvante a la radiotherapie dans 4 cas. La dose moyenne de radiotherapie etait de 72 Gy (70 a 75). Le delai median de survenue des TS etait de 9 ans (3 a 17). Il s’agissait de carcinomes epidermoides bien differencies des VADS dans 4 cas, de fibrosarcomes cervico-mandibulaires (2 cas), osteosarcomes du massif facial (2 cas), d’un glioblastome temporal et de deux carcinomes basocellulaires du nez et de la tempe. Le traitement de la tumeur secondaire a comporte une chirurgie seule dans 4 cas et une chimiotherapie seule dans 7 cas. Aucun des patients n’a ete reirradie. La survie mediane etait de 17 mois, 4 patients sont decedes, et 7 sont vivants dont 4 en remission (24+, 36, 36 et 48+ mois) et 3 en evolution tumorale (8, 16 et 18 mois). Conclusion Les tumeurs secondaires apres traitement du cancer du cavum sont rares mais de mauvais pronosticn, justifiant leur detection et leur depistage.

Introduction La radiotherapie cervico-faciale constitue une cause frequente d’insuffisance endocrinienne, volontiers meconnue chez l’adulte. Elle est susceptible d’alterer la qualite de vie et l’etat de sante des patients dont la survie s’est par ailleurs beaucoup amelioree au cours des dernieres annees. Patients et methodes Nous avons mene une etude transversale qui a concerne 55 patients traites par radiotherapie cervico-faciale pour cancer du cavum. Tous patients ont beneficie d’un dosage de la prolactinemie. Resultats L’hyperprolactinemie a ete constatee chez 34,52 % des cas ( n = 19/55) touchant 52,38 % des femmes ( n = 11) et 23,5 % des hommes ( n = 8). Le taux moyen de la prolactinemie etait de 880,8 ± 486,9 mUI/L (440 a 2140 mUI/L). L’intervalle entre la radiotherapie et la decouverte de l’hyperprolactinemie etait en moyenne de 8,4 ± 4,5 ans (extremes :1 et 15 ans). L’hyperprolactinemie etait symptomatique chez 2 patients qui ont presente une galactorrhee. Une amenorrhee secondaire a ete constatee chez 4 femmes. Chez l’homme, nous avons constate une dysfonction erectile chez 4 patients et une gynecomastie chez un seul patient. L’hyperprolactinemie etait associee a une insuffisance gonadique, a une hypothyroidie centrale, une insuffisance somatotrope et une insuffisance corticotrope dans respectivement 5,3 % ( n = 1), 31,6 % ( n = 6), 89,5 % ( n = 17) et 26,3 % des cas ( n = 5). Nous avons egalement trouve que l’hyperprolactinemie etait significativement plus frequente chez les femmes ( p = 0,029) et correle a la dose de radiotherapie totale appliquee ( p = 0,03). Conclusion L’hyperprolactinemie survenant au decours d’une radiotherapie pour cancer du cavum etait frequente et precoce chez nos patientes temoignant de l’atteinte hypothalamique.

More than 95% of cancers of the uterus are carcinomas and uterine sarcomas (US) represent less than 1% of gynecologic cancers and 3% to 8% of all uterine malignancies [17]. Three main types of US are recognized: malignant mixed Mullerian tumour (MMT), recently known as carcinosarcoma, endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS) and a small cohort of unclassifiable high-grade tumours with sarcomatous elements [16]. LMS is observed in women of perimenopausal age, while carcinosarcoma (CS) and ESS occurs in postmenopausal women [4]. CS is associated with a high incidence of lymphatic spread, while LMS is linked with an early metastatic risk to lungs and liver [9,10]. Surgical management of US is based on a minimum of abdominal hysterectomy, bilateral salpingo-oophorectomy, careful inspection of the abdominal and pelvic contents, cytology of peritoneal washings and pelvic and/or para-aortic lymph node dissection [2]. Radiation therapy, chemotherapy, hormonal therapy and recently, biological or molecular targeted anticancer agents are used in the adjuvant or palliative setting (5, 15, 24, 30]). Adjuvant chemotherapy or radiation therapy remains however the subject of controversy, despite some prospective trials in resected stage I or II [15].

Tumor necrosis factor-alpha (TNF-alpha) and stress proteins (heat shock proteins) are determining factors in the immune response to tumor cells. The authors designated a large study to investigate the susceptibility and prognostic implications of the genetic variation in TNF-alpha and hsp70-2 in breast carcinoma.The authors used the polymerase chain reaction and restriction enzyme digestion to characterize the variation of the TNF-alpha promoter region and that of the hsp70-2 gene in 243 unrelated Tunisian patients with breast carcinoma and 174 healthy control subjects. Associations of the clinicopathologic parameters and the genetic markers with the rates of the breast carcinoma specific overall survival and the disease free survival (DFS) were assessed using univariate and multivariate analyses.A highly significant association was found between TNF2 homozygous genotype and breast carcinoma (relative risk [RR], 4.44; P = 0.006). A high relative risk of breast carcinoma was found to be associated with one hsp70-2 homozygous genotype (P2/P2; RR, 7.12; P = 0.0001). The TNF2 homozygous genotype showed a significant association with reduced DFS and/or overall survival by univariate test. Conversely, P2-hsp70-2 homozygous genotype associated with increased overall survival but not with DFS. Multivariate analysis retained significance for TNF2 homozygous genotype as an independent prognostic indicator for both DFS (RR, 2.75; P = 0.01) and overall survival (RR, 4.08; P = 0.01).Genetic variation in TNF-alpha and hsp70-2 may represent not only markers for the increased risk of breast carcinoma but also may predict the clinical outcome.

Objectifs Le but de notre travail est d’evaluer la prevalence et les caracteristiques radiologiques des meatstases osseuses des carcinomes nasopharynges indifferencies (UCNT) initialement localises. Materiels et methodes Etude retrospective de 66 patients traites pour un carcinome nasopharynge indifferencie entre janvier 2001 et decembre 2002. Dix-sept patients ont eu une metastase osseuse explores par une scintigraphie osseuse et un bilan radiologique standard. Six patients ont eu une IRM. Resultats Parmi 66 patients suivis pour un UCNT, 17 ont developpe une ou plusieurs localisations osseuses secondaires donc la prevalence de 25,75 %. Ces metastases osseuses ont complique dans 10 cas des stades T3 ou T4 et N3 et dans 3 cas des stades T3 ou T4 et N2. Uniquement trois patients ayant un stade T4 N0 ont developpe des metastases. Le dernier cas etait un stade T2 N1. L’âge moyen de nos patients a ete de 42,8 ans et le sex ratio a ete de 10 hommes et 7 femmes. Chez les 17 patients, il y avait 41 localisations de metastases osseuses. Cinq patients avaient une localisation unique. Les 41 localisations ont ete reparties en 26 meatstases axiales et 15 peripheriques. Parmi ces metastases il y avait 20 lesions osteocondensantes, 11 osteolytiques et 10 mixtes. Conclusion La survenue des metastases osseuses est relativement frequente au cours des UCNT localises. Elles compliquent surtout les stades N3 qui doivent etre consideres a haut risque imposant une surveillance systematique par une scintigraphie osseuse.

PURPOSE: Fractionated total-body irradiation (HTBI) is considered to induce less toxicity to normal tissues and probably has the same efficacy as single-dose total-body irradiation (STBI) in patients with acute myeloid leukemia. We decided to determine whether this concept can be applied to a large number of patients with various hematologic malignancies using two dissimilar fractionation schedules. PATIENTS AND METHODS: Between December 1986 and October 1994, 160 patients with various hematologic malignancies were randomized to receive either a 10-Gy dose of STBI or 14.85-Gy dose of HTBI. RESULTS: One hundred forty-seven patients were assessable. The 8-year overall survival rate and cause-specific survival rate in the STBI group was 38% and 63.5%, respectively. Overall survival rate and cause-specific survival rate in the HTBI group was 45% and 77%, respectively. The incidence of interstitial pneumonitis was similar in both groups. However, the incidence of veno-occlusive disease (VOD) of the liver was significantly higher in the STBI group. In the multivariate analysis with overall survival as the end point, the female sex was an independent favorable prognostic factor. On the other hand, when cause-specific survival was considered as the end point, the multivariate analysis demonstrated that sex and TBI were independent prognostic factors. CONCLUSION: The efficacy of HTBI is probably higher than that of STBI. Both regimens induce similar toxicity with the exception of VOD of the liver, the incidence of which is significantly more pronounced in the STBI group.