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Recent discovery showing the presence of microRNAs (miRNAs) in the circulation sparked interest in their use as potential biomarkers. Our previous studies showed the diagnostic potential of miR-451 as a serological marker for inflammatory breast cancer (IBC), miR-337- 5p and miR-30b for non-inflammatory breast cancer (non-IBC). The aim of this study is to investigate the prognostic values of circulating miRNAs by comparing the amounts of 12 circulating miRNAs in the serum of IBC and non-IBC from Tunisian breast cancer patients, and by determinating whether correlated pairs of miRNAs could provide useful information in the diagnosis of IBC and non-IBC patients. TaqMan qPCR was performed to detect circulating expression of miRNAs in serum of 20 IBC, 20 non-IBC and 20 healthy controls. Nonparametric rank Spearman rho correlation coefficient was used to examine the prognostic value of miRNAs and to assess the correlation profile between miRNAs expression. Further, a large number of miRNAs were highly correlated (rho>0.5) in both patients groups and controls. Also, the correlations profiles were different between IBC, non-IBC and healthy controls indicating important changes in molecular pathways in cancer cells. Our results showed that miR-335 was significantly overexpressed in premenopausal non-IBC patients; miR-24 was significantly overexpressed in non-IBC postmenopausal patients. Patients with previous parity had higher serum of miR-342-5p levels than those without. Furthermore, patients with HER2+ IBC present lower serum levels of miR-15a than patients with HER2- disease. Together, these results underline the potential of miRNAs to function as diagnostic and prognostic markers for IBC and non-IBC, with links to the menopausal state, Her2 status and parity.

This study aimed to identify prognostic factors for outcome in Tunisian patients with nonmetastatic inflammatory breast cancer (IBC) receiving multimodality therapy.From 1994 to 2000, 100 patients with nonmetastatic IBC were reviewed. Patients underwent neo-adjuvant chemotherapy including anthracyclines (99%), then mastectomy (93%) when feasible, radiotherapy (83%) and adjuvant chemotherapy (84%). Sixty patients (60%) had hormone therapy.Median age at diagnosis was 44 years (range 23-71). Seventy patients had premenopausal status (70%). Ten cases occurred during pregnancy (10%). Body mass index indicated overweight or obesity in 76 patients (76%). After neo-adjuvant chemotherapy, pathologic complete response (pCR) rate was 20%. Median time of follow-up for surviving patients was 44 months. Median progression-free survival (PFS) was 19 months and overall survival (OS) 30 months. Factors associated with improved survival were no pregnancy (P = 0.0095), estrogen receptor positivity (P = 0.028), tumor size5 cm (P = 0.021), clinical complete response (cCR) (P = 0.022), pCR (P = 0.011), negative nodes (P = 0.053) and hormone therapy (P0.001). In multivariate analysis, cCR, negative nodes and hormone therapy were independently associated with better OS and PFS. Factors predictive to pCR were age45 years, negative nodes and cCR.Tunisian patients with IBC have particular epidemiologic characteristics, with earlier disease and context of overweight and obesity, but prognostic factors are similar to those reported in the literature. Hormone therapy seems to improve patient outcome.

Breast cancer, the most commonly diagnosed cancer in women, is the second leading cause of cancer death in women worldwide. To investigate the contribution of BRCA1 gene mutations to familial breast cancer in Tunisia, 32 unrelated patients who had at least one first degree relative affected with breast and/or ovarian cancer were analysed. BRCA1 mutation analysis was performed by DNA sequencing of all BRCA1 exons. We identified four different BRCA1 frameshift mutations: c. 4041delAG, c. 2551delG and c. 5266dupC already been described and one novel mutation, c. 211dupA, observed in two unrelated families. C. 5266dupC has previously been found among Jewish Ashkenazi and Eastern European populations. Our study describes it in Arabic/Berber population. Five out of thirty two familial cases had deleterious BRCA1 mutations. Fifteen additional cases carried unclassified variants (UV) or single nucleotide polymorphisms (SNPs). Our study is the first molecular investigation on the role of BRCA1 in hereditary breast cancer in North Tunisia.

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry (NTCR) and from the Salah AZAIZ Institute (SAI) Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases/100,000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years (11%) could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia.

To evaluate the insertion and use of implantable central venous accesses in medical oncology at the Institute Salah Azaïz.From January 1992 to June 2000, 205 patients including 179 adults (118F/61M) and 26 children aged 7 months to 72 years (mean 37 years) required the insertion of an implantable port (IP). Tumoral pathology was dominated by metastatic breast carcinoma (93/179), digestive cancer (42/179) and paediatric cancer (26 cases).Excluding 3 initial failures, we inserted 205 IP for 202 patients. The supraclavicular anatomic way (Yoffa) was used in 156/205 cases and the subclavicular (Aubaniac) for the resting 32 cases with a jugular conversion in 17 cases. Initial complications were represented by 6 arterial puncture (2.9%), 3 pneumothorax (1.5%) and 1 catheter migration in the right pulmonary artery. Median life duration of the material was 210 days (3 to 1460 days) for adults and 185 days (3 to 1460 ays) for children. Mean life duration for the 205 IP was 240 days +/- 239 (3 to 1460 days) with a total of 49,200 IP-days. We explanted 17 IP for infection (8 cases), cutaneous ulceration (8 cases) and actinomycin extravasation (1 case). We observed 6 cases (2.9%) of subclavian and jugular thrombosis treated by anticoagulants and conservation management of the port. Presently, 58 patients are alive with IP in place.Implantable ports represent a useful option in medical oncology for patients treated with prolonged chemotherapy and adjuvant treatments such as antibiotics, transfusion. This method allows a good comfort for the patients and also the treating team but requires a prealable training for the nursing team.

Within a multifactorial etiology of cancers and a bio-psycho-social approach of patients, considering, among the risk factors, those related to personality in a preventive view, the authors investigate, by an epidemiologic methodology, for a correlation between break-down phenomena and the development of a cancer. The study was carried out at the Salah Azaïez Institute in 1992 and included 707 patients aged from 15 to 82 years, 44% presenting a malignant tumour. For a retrospective evaluation of break-down semiology, the study is based on DSM-III criteria of break-down diagnostic. Search for a clinic/psychic diagnostic relation reveals the difficulty of coexistence between break-down signs and the development of a cancer. That difficulty increases in case of an organised break-down.

The aim of the present study is to investigate the clinical features and the risk factors characteristic of choroidal metastasis, which is known as the most common malignant neoplasm of the adult eye.A systematic ophthalmologic examination together with angiography and echography were performed in 106 patients with carcinoma.10% of patients showed choroïdal metastasis. Breast and bronchogenic carcinoma were the most common primary tumor. 82% of cases died within a mean 6.5 months. Clinical, angiographic, echographic and histopathologic features of such metastasis were described.The importance of an early diagnosis of such metastasis are raised.

From May 1983 to June 1985 the authors performed a thoracoscopy as a diagnostic and therapeutic objective in 83 patients with chronic recurrent pleurisy; amongst these patients, 69 had know intra or extra thoracic cancer and the other 14 presented with an isolated pleurisy. Eight other patients had pleural carcinomatosis proven by needle biopsy and had pleural talc introduced by thoracoscopy. The examination was performed under local anaesthesia with neuroleptanalgesia; a rigid 7 mm diameter thoracoscope was used; the biopsies were performed uniquely on the parietal pleura using tropical forceps. The outcome was uncomplicated with no deaths nor any serious complications due to the method. The sensitivity of the pleural biopsy was 91.5% or 76 positive biopsies out of 83. 73 biopsies were metastatic and 3 were tuberculous pleurisies. The macroscopic appearance was strongly suggestive of malignancy in 78 patients and appeared inflammatory in 13, of whom 9 cases were positive on biopsy. The authors performed a pleural talcage in every case; a lasting pleural adhesion was obtained in 66 patients but regrettably there were 14 failures, the effusion recurring after removal of the drain. The authors stress the reduced number of incidents of pleural effusion, which confirms the good tolerance of pleural endoscopy.

The authors report the results of their experience using tale pleurodesis under thoracoscopic control in the treatment of 218 cases of malignant pleural involvement. Although this technique is well tolerated it is necessary to note certain factors which prevent a successful pleurodesis (12% of cases). Thus, huge effusions greater than 12 litres, pleural involvement with large tumour masses, a very long history and patients aged more than 70 years were all factors contributing to a poor outcome. The success of pleural talc also depends on the nature of the primary cancer, for example in our series broncho-pulmonary cancers yielded better results than those effusions which were secondary to ovarian cancers.

The authors report the preliminary results of attempts at treatment using radiotherapy and chemotherapy for inoperable carcinoma of the bladder. Chemotherapy alone (cis diamine dichloropalatinum : CDDP) used twice for metastases gave 1 regression of more than 50 % and 1 failure, used twice for non-irradiated pelvic tumours gave 1 regression of more than 50 % and finally was associated with no improvement in 7 patients already irradiated. Chemotherapy (CDDP) associated with a series of flash doses of radiotherapy was used in 6 cases and gave one regression of more than 50 % and one of less than 50 %. Bleomycin in continuous infusion associated with flash radiotherapy was used in 3 cases and gave a regression of more than 50 % of pelvic tumours in two. These poor though not completely nil results have lead the authors to develop a cooperative treatment programme involving the urologist, radiotherapist and chemotherapist.

Chemotherapy for carcinoma of the kidney using the sequence VM 26 (or vincristine), CCNU gave 12 per cent of objective results (complete remission or regression of more than 50 per cent in metastatic tumours and did not alter the actuarial survival curve of these patients. The same type of chemotherapy given on a routine basis and early did not alter the actuarial curves of the first remission after nephrectomy for carcinoma of the kidney at Robson stage III or II. Early chemotherapy would thus not appear to be justified before trials in cases of metastatic carcinoma have led to the discovery of a more effective form.