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Introduction: To determine the proportion and the reasons which lead to palliative treatment in patients initially a candidate for concomitant chemoradiotherapy (CCRT). Methods: A retrospective study including patients followed for locally advanced lung cancer newly diagnosed from April 1, 2016, to 12/31/2017 in the radiotherapy department of the National Oncology Institute who received palliative treatment. Results: We collected 52 patients out of a total of 225 stage III patients (23%) followed by lung cancer candidates for CCRT who had undergone palliative treatment. The mean age in our series was 61.23 years [22 - 81] with 86% male. The majority of patients (71%) had Performance Status (PS) ≤ 2. Histological confirmation was obtained by pathological examination in all our patients. It was an adenocarcinoma (ADK) in 54% of cases; squamous cell carcinoma in 46% of cases. The reasons for palliative treatment were mainly due to dosimetric constraints: large tumor volume 22/52 (42%); the tumor location close to the bone marrow in 15 of 52 (29%) patients; and general Performance Status impairment (29%) in 15 of 52 patients. Palliative treatment consisted of palliative chemotherapy in 37 of 52 patients (71%), among whom 19 (51%) were stable after 2 months of chemotherapy, in palliative dose chest radiotherapy on the pulmonary parenchyma and/or mediastinum in 10 of 52 (19%) patients, and supportive care in 5 (10 %) patients. We observed 40/52 (77%) cases of stationary course, 04/52 (8%) cases of progress to metastases, and 08/52 (15%) deaths before radiotherapy. Conclusion: A large proportion of patients followed for locally advanced non-metastatic lung cancer are not eligible for curative treatment. The reasons for the palliative treatment of patients followed for lung cancer candidates for CCRT are variable but for a large proportion of patients due to the deterioration of their state of health during their diagnostic journey. Hence, there is the need to improve the early diagnosis and early management of patients with lung cancer to avoid delayed care.

Purpose To develop the results of concomitant radiochemotherapy in management of nasopharyngeal carcinoma (NPC) to the National Institute of Oncology at Rabat. Materials and methods Retrospective study of 81 patients with nasopharyngeal carcinoma and who were treated with concomitant radiochemotherapy to the National Institute of Oncology at Rabat in radiotherapy department, for a period of January to December 2012. Results Median age was 43 years old with male dominance to 78,8 %. According to TNM classification passed by AJCC 2010, 43,2% were classified stage IV, 37 % stage III and 19,8 % stage II. Neoadjuvant chemotherapy was indicated in 20 patients (24,7%) or 95% in N2-N3. The Therapeutic result after the neoadjuvant chemotherapy for lymph node was complete in 31,2 %. The concomitant radiochemotherapy treatment consisted in a conformal therapy treatment with lateral 6 MV photon beams dose of 70 Gy in conventional fractioning, and in two series by excluding spinal cord after dose of 40 Gy. We used electrons treatment in addition to treat the lymph nodes. The concomitant chemotherapy consisted of a weekly cisplatin treatment 40 mg/m2. The mean spread was 57,3 days. During the concomitant chemotherapy treatment 60 % of radiomucitis and 30 % nephrotoxicity were observed in patients receiving neoadjuvant chemotherapy. Late toxicities were dominated by hyposcialie (90,1%) and otological disorders (67,9%). After an average follow-up of 30,6 months, we were able to follow the progress of 69 patients (85,2%). Forty-nine patients (75,3%) were in good locoregional control. We observed 20 relapses (24,7 %) including 14 metastatic relapses. The main prognostic factors of metastasis were lymph node involvement in 92,2% (p = 0,04) and T3-T4 stages in 64,2% (p = 0,013). At three years, overall survival at all stages were to 81,9%, survival without recurrence to 71% and local control to 79,2%. Conclusion The nasopharyngeal carcinoma are radiosensitive and radiocurable tumors. Concomitant radiochemotherapy is the therapeutic standard for locally advanced nasopharyngeal carcinoma, and allow to obtain carcinological good results at toxicity notable disadvantage.

It’s a 24 years old female patient who presented with rhinological burning pain evolving since 1 year. She didn’t consult until a blistering lesion filled half of the oral cavity. The initial biopsy of the tumor was interpreted as a round cell tumor process. It’s a 24 years old female patient who presented with rhinological burning pain evolving since 1 year. She didn’t consult until a blistering lesion filled half of the oral cavity. The initial biopsy of the tumor was interpreted as a round cell tumor process. An immuno-histochemical complement showed a poorly differentiated neuroendocrine carcinoma (Pancytokeratine+, Ki67 at 30%, Chromogranine+, Synaptophysine-). CT scan showed a locally advanced maxillary nasal sinus tumor of 74 mm in the greatest diameter. The remainder of the staging didn’t reveal any metastases. The patient received 3 courses of chemotherapy with Etoposod-cisplatin. The clinical and radiological evaluations showed a progression of disease [Figure 1].

Background Leiomyosarcoma of the rectum is a rare entity that comprises less than 0.1 % of all rectal malignancies. Given the uncommon nature of this tumor and the controversy about its treatment we report one case and review the literature in an attempt to report a particular evolution and to discuss the most appropriate treatment. Case presentation This case report describes the presentation of leiomyosarcoma of the rectum. A 30-year-old man from the north of Morocco presented with rectorrhagia and constipation. On physical examination we found a mass in his rectum approximately 6 cm from his anal margin. Pelvic magnetic resonance imaging showed a rectal mass with a parietal attachment that invaded the fascia and his perirectal tissue. Before any treatment he defecated spontaneously the tumor. On histopathological examination a diagnosis of leiomyosarcoma was made. An anterior resection of his rectum was performed with adjuvant radiotherapy at a dose of 50 Gy. After 1 year of surveillance, he has not presented any clinical symptoms and pelvic magnetic resonance imaging was normal. Unfortunately, histological analysis of a superficial biopsy of a rectal leiomyosarcoma may not be reflective of the entire tumor mass, and a diagnosis is based essentially on postoperative pathological examination. The optimal treatment modality in patients with rectal leiomyosarcomas is controversial. Prognosis is also poor; tumor size, histological grade, mitotic index, and local staging are the most known prognosis factors. Conclusion The prognosis of rectal leiomyosarcoma is poor; more investigations are necessary to understand the progression of these tumors and to define an optimal treatment modality.

Introduction: In Morocco, cervical cancer is the second most common cancer, and proximally half of the cases are diagnosed at an advanced stage. The standard treatment approach is concurrent chemoradiation followed by intracavitary brachytherapy (BT) boost to the cervix. Patients and methods: 293 patients diagnosed with cervical cancer and treated with concurrent chemoradiotherapy between January 2011 and December 2011 at our department was retrieved. We analyzed defined prognostic factors influencing outcomes. The aim of our study is to analyze the effect of the use of brachytherapy on treatment outcomes (overall survival and local control) and to report the toxicities for each treatment approach. Results: At 3 years, the use of brachytherapy as boost was found to be a significant factor impacting both OS (P=0.0001)), and LC (P=0.001). Also in the multivariate analysis, brachytherapy was an independent prognosis factor affecting both OS (hazard ratio [HR], 3.29; 95% CI, 1.50-7.21, P=0.03) and LC (hazard ratio [HR], 2.33; 95% CI, 1.30-7.21, P=0.005). Conclusion: At present, brachytherapy is still the standard approach to boost the cervix in patients with locally advanced cervical cancer.

Introduction: Treatment duration has always been related to treatment outcomes in cervical cancer. Our study is aiming to evaluate this parameter and its effect on treatments’ results in patients with locally advanced cervical cancer treated with concurrent chemo radiation. Patients and methods: Between January 2011 and December 2011, all patients diagnosed with cervical cancer and treated with concurrent chemo radiotherapy were retrieved. Treatment duration was calculated from the first day of EBRT to the last day of brachytherapy or EBRT, whichever was last to complete, Fifty-six days (8 weeks) was used as a limit, we analyzed the impact of treatment duration on the overall survival and local control. Results: The median time to complete pelvis RT was 37 days (34-42 days). A median of 15 days (13-26 days) between the last day of Pelvic RT and the start of the first Brachytherapy fraction (Pelvis RT-BT interval) was noted. The median time to complete EBRT in association with BT was55 days (50-69 days) while the median total treatment duration was 61 days (53-71 days). At 3 years the overall survival (OS) rate of the studied cohort was 89.8% and local control (LC) rate was 80.8%. In the univariate analysis, total treatment duration (>56 days) was found to be a significant factor impacting both OS (P=0.014)), and LC (P=0.014). Also in the multivariate analysis, total treatment duration was associated independently with prognosis, and affected both OS (hazard ratio [HR], 2.8; 95% CI, 1.07-7.54, P=0.035) and LC (hazard ratio [HR] 3.2; 95% CI, 1.57-6.64, P=0.001). Conclusion: Extended treatment duration significantly affects treatment outcomes in cervical cancer, efforts should be made to shorten it in a way to improve cancer prognosis.

Introduction Cancer metastasis to the thyroid is extremely rare. The most common sites that have been reported to metastasize to the thyroid gland are breast and kidney. As to primary lung cancer metastasizing to the thyroid gland, only a few cases have been described in the literature. Case presentation We report a case of a 37-year-old white Arabian woman who had never smoked tobacco products for whom a malignant thyroid mass revealed a primary lung tumor. She had a surgical excision for both the thyroid and the pulmonary tumors, and received adjuvant chemotherapy. At 1 year, she is still in remission. Conclusions Our case is rare as it describes a case where the thyroid lesion was the revealing sign of an unknown lung carcinoma. Management of thyroid metastases should depend on the individual situation and surgical excision should be proposed whenever a patient’s condition is favorable.

Background Sebaceous carcinoma is a rare malignancy primarily with aggressive growth affecting the cutaneous tissues of the periocular region. Sebaceous carcinoma of the parotid gland is exceedingly rare, with only 32 cases reported in the literature. Our case brings this total to 33. Case presentation We present a case of a 57-year-old Moroccan woman with a firm, painless, slowly enlarging swelling at her left parotid area, with normal overlying skin and no palpable neck nodes. Parotidectomy with facial nerve preservation was performed, and microscopic examination showed sebaceous carcinoma. Then, she underwent adjuvant radiotherapy. With a follow up of 20 months, head and neck computed tomography revealed no recurrence. Conclusions The optimal treatment is unclear. With more cases reported, clinicopathological characteristics and histogenesis are increasingly understood. Therefore the treatment for this rare tumor continues to evolve.