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PurposeTo study the influence of Monaco 5.4 treatment planning system (TPS) on the dosimetry of radiotherapy for nasopharynx carcinoma (NPC) under the condition of different segment shape optimization (SSO) times.MethodsFifteen patients with T3-4N0-2M0 stage nasopharyngeal carcinoma were enrolled, and each case was designed with SSO of 3, 5, 7 and 10 times respectively. The dose results of the target area and the major organs at risk (OAR) were statistically analyzed by DVH statistics; moreover, the isodose lines of 70Gy, 60Gy and 54Gy were intercepted at the same plane in the transverse, coronal and sagittal views and the segment shapes were compared at the angle of 30°, 120°, 240° and 330° in beam eye view (BEV); In addition, optimization time (OT), delivery time (DT), segments# and MU# were obtained and analyzed by optimization console; the plans were verified and analyzed by using ArcCheck phantom.ResultsFor target area D2, the results of the SSO7 group and the SSO10 group were similar and both better than those of SSO3 and SSO5 groups, and the D2 results of the SSO3 group were notable higher than those of the other three groups; for the major OARs, the results of the maximum dose of spinal cord, brain stem, and lens and the mean dose and V30 of parotid glands showed the same trend. It showed that SSO7 and SSO10 share similar dose results, too which are notable better than the similar dose results shared by SSO3 and SSO5; in the dose deprogram distribution of 70Gy, 60Gy and 54Gy, partial 70Gy dose spillover occurred in both groups SSO3 and SSO5 and it was more obvious in group SSO3. While there was a no significant dose spillover in group SSO7 and group SSO10; in the sub-field alignment comparison under the same angle, the alignment became more complicated and the sub-fields were smaller as the number of SSO increased; the results of segment#, MU# and plan delivery time between different SSO groups were slightly different, while the plan optimization time changed significantly. The difference between group SSO3 and group SSO10 was more than 500s; the results were compared in ArcCheck, there was no significant difference between the groups.ConclusionsThe user-defined SSO function of Monaco 5.4 TPS effectively balances the relationship between plan design efficiency and plan quality. When SSO is 7, it is better value for efficiency and quality in clinical radiotherapy for nasopharyngeal carcinoma.

Introduction: Nasopharyngeal carcinoma (NPC) is closely associated to viral infection, i.e. Epstein-Barr virus (EBV), about 90 % of the worldwide are infected with EBV at same point of their lives. This virus is highly oncogenic and easily transmitted via saliva. The high level of biomarker for EBV infection can become a risk factor for NPC in relative’s NPC patients. Therefore, EBV related biomarkers is needed to enable screening and detecting early diagnosis of NPC in endemic area. Objective: This study aims to analyze the role of IgA (VCA-p18+EBNA1) levels and viral load (VL) as screening tools for early detection in relatives of positive EBV NPC patients. Therefore, it can be used as predicted risk factor for NPC. Method: The method used in this study is cross-sectional with consecutive sampling of 50 relatives of NPC patients treated at the Dr. Wahidin Sudirohusodo Hospital from August 2012 to May 2013. Univariate and bivariate analysis and t-test are used to measure and to show the correlation of Ig A (VCA-p18+EBNA1) level and VL. Result: Results showed that 28 % of the NPC patients are female with an average age of 31.12±11.91. Sixty-eight percent of the relatives are siblings, and most of them are Buginese tribe (58%). According to the risk distribution of NPC, the sampling is grouped in 3 categories i.e. high risk, intermediate risk, and low risk to NPC. There is 50% of the relatives of the NPC patients categorized to the intermediate risk. The IgA (VCA-p18+EBNA1) level is significant (p=0.000) compared with the VL level (p=0.337). Sixteen percent of the high-risk group have a normal pattern, but it still needs high awareness. Statistically, the Pearson correlation analysis showed a relationship but not significant. Conclusion: It could be concluded that IgA (VCA-p18+EBNA1) and VL level could be used as a screening method and early detection in relatives of NPC patients and become a predicted risk factor for NPC

Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p

Aim: To investigate the relationship between PI3K/Akt/NF-κB cellular signal pathway and the expression of P-gp and LRP in multidrug resistance (MDR) cell of nasopharyngeal carcinoma. Method: The PI3K, p-Akt and NF-κB/p65 as the activity of PI3K/Akt/NF-κB were detected by Western blot. The expressions of LRP and P-gp were detected by Western blot and real-time PCR. Result: The RIs of CNE/DDP group to DDP, 5-Fu, VCR, ADR and PTX were 35.04, 18.14, 24.13, 12.00 and 10.18, respectively. The RIs of LY-294002 group were 11.77, 5.83, 3.07, 3.86 and 3.34, and PDTC group were 11.08, 6.55, 7.66, 2.18 and 4.05. The expressions of PI3K, p-Akt and NF-κBp65, LRP and P-gp were increased and mRNA of LRP and P-gp were up-regulated in CNE/DDP. The expression of p-Akt in LY-294002 group was down-regulated. The expression of NF-κB p65 in PDTC group was decreased. The mRNA of LRP and P-gp in LY-294002 group and PDTC group were decreased. Conclusion: MDR of nasopharyngeal carcinoma cell can be regulated by activating PI3K/Akt/NF-κB signal pathway and then increase the expression of P-gp and LRP. The MDR of nasopharyngeal carcinoma cell can be reversed by inhibiting PI3K/Akt/NF-κB signal pathway.

EgeUn###, A 62-year-old man was admitted to our clinic with a two-week history of double vision. Neuro-ophthalmological examination showed a left abducens nerve palsy with an ipsilateral Horner’s syndrome. Neuro-imaging identified recurrent nasopharyngeal carcinoma explaining the clinical findings. Co-existence of unilateral abducens nerve palsy and ipsilateral Horner’s syndrome is very rare and localises to the posterior cavernous sinus. Therefore, clinicians should be aware of this rare co-existence and perform appropriate neuro-imaging to clarify the underlying aetiology. © 2019, © 2019 Taylor & Francis Group, LLC.

Bu yazıda, nazofarenks karsinomu nedeniyle radyoterapi ile tedavi edilen ve radyoterapiden dört yıl sonra iki taraflı dış kulak yolu kolesteatomu saptanan 55 yaşında bir kadın olgu sunuldu. Hastada inatçı otore vardı ve tanı otoskopik bulguların yanı sıra, temporal kemik tomografisinde dış kulak yolu ön duvarını aşındıran yumuşak doku kitlesinin görülmesi ile konuldu. Cerrahi tedavi olarak kanaloplasti ve kolesteatom eksizyonu yapıldı. In this article, we report a 55-year-old female case was treated with radiotherapy due to nasopharynx carcinoma and diagnosed with bilateral external auditory canal cholesteatoma four years after radiotherapy. Persistent otorrhea was present in the patient and the diagnosis was established through noticing a soft tissue mass eroding external auditory canal anterior wall in temporal bone tomography as well as the otoscopic findings. Canaloplasty and cholesteatoma excision were administered as the surgical treatment.

Background: Nasopharyngeal carcinoma (NPC) is a malignancy originated from nasopharyngeal epithelial cells. NPC therapy response could be predicted from histopathological type, but some patients with the same histopathological type, showed a different therapy response. Interleukin (IL)-10 expression is expected to be able to predict a better response of therapy in NPC patients. Purpose: To find out the correlation between IL-10 expression and histopathological type in NPC patients. Method: An analytic observational study with cross sectional approach towards 33 samples taken from the Oncology Polyclinic of Outpatient Unit of Otorhinolaryngology Head and Neck Surgery Department, Dr. Soetomo General Hospital. Formalin-fixed paraffin-embedded biopsy specimens were obtained. The IL-10 expression was studied with immunohistochemistry using rabbit polyclonal antibody Anti IL-10. Assessment of the staining used Allred scale. The Fisher exact test was utilized to determine the correlation of IL-10 expression and histopathological type of NPC, with p value = 0.05. Result: The result of IL-10 expression in NPC patients with histopathological WHO type I NPC obtained 1 sample (8.3%) with strong positive expression and 2 samples (9.5%) with weak positive expression. In patients with histopathological WHO type II NPC obtained 2 samples (16.7%) with strong positive expression and 12 samples (57.1%) with weak positive expression. In patients with histopathological WHO type III NPC obtained 9 samples (75%) with strong expression and 7 samples (33.3%) with weak positive expression. Conclusion: There was moderate positive correlation between IL-10 expression and histopathological type in NPC patients.Keywords: nasopharyngeal carcinoma, IL-10 expression, histopathological type ABSTRAK Latar belakang: Karsinoma nasofaring (KNF) adalah suatu keganasan yang berasal dari epitel nasofaring. Respon terapi KNF selama ini dapat dinilai berdasarkan tipe histopatologi, namun pada kenyataannya penderita KNF dengan tipe histopatologi sama dapat menunjukkan respon terapi berbeda. Pemeriksaan ekspresi interleukin (IL)-10 diharapkan dapat memberikan prediksi lebih baik mengenai respon terapi pada penderita KNF. Tujuan: Mengetahui hubungan antara ekspresi IL-10 dengan tipe histopatologi pada penderita KNF. Metode: Penelitian observasional analitik dengan pendekatan cross sectional pada 33 sampel yang diperoleh dari Poliklinik Onkologi Unit Rawat Jalan, Departemen THTBedah Kepala Leher, RSUD Dr Soetomo. Ekspresi IL-10 diperiksa dari blok parafin dengan teknik pemulasan imunohistokimia menggunakan rabbit polyclonal antibody Anti IL-10. Ekspresi IL-10 dinilai dengan menggunakan skala Allred. Uji Fisher exact digunakan untuk menentukan korelasi antara ekspresi IL-10 dan tipe histopatologi KNF, dengan p = 0,05. Hasil: Ekspresi IL-10 pada KNF WHO tipe I didapatkan ekspresi positif kuat 1 penderita (8,3%) dan ekspresi positif lemah 2 penderita (9,5%). Hasil ekspresi IL-10 pada KNF WHO tipe II didapatkan ekspresi positif kuat 2 penderita (16,7%) dan ekspresi positif lemah 12 penderita (57,1%). Hasil ekspresi IL-10 pada KNF WHO tipe III 9 penderita (75%) dengan ekspresi positif kuat dan 7 penderita (33,3%) dengan ekspresi positif lemah. Kesimpulan: Didapatkan korelasi positif sedang antara ekspresi IL-10 dan tipe histopatologi pada penderita KNF

Nasopharyngeal carcinoma is the highest malignancy in the head and neck regio. The cause of nasopharyngeal carcinoma is unknown, but there are several risk factors that can trigger nasopharyngeal carcinoma which include age, gender, genetics, occupation, geographical location, consumption of salted fish, consumption of grilled fish / grilled meat, consumption of canned foods and smoking. This study aims to determine the risk factors that influence the incidence of nasopharyngeal carcinoma. The type of this study is a obervasional analysis with a case control design carried out on 40 samples that fulfilled the inclusion and exclusion criteria. The instrument of this research is in the form of medical record recapitulation and structured interviews. The bivariate test results were age (p=0.043), sex (p=1,000), genetics (p=0.044), occupation (p=0.740), geographical location (p= 1,000), consumption of salted fish (p = 0.004) , consumption of grilled fish / grilled meat (p=0.007), consumption of canned foods (p = 0.106) and smoking (p = 0.527). The multivariate test results were the consumption of salted fish with a value (p = 0.004), consumption of salted fish / grilled meat (p = 0.023), genetic (p = 0.062), and age (p = 0.264). The conclusion of this study is the consumption of salted fish, consumption of grilled fish / grilled meat, genetics and age have a significant relationship with the event of nasopharyngeal carcinoma and the most influential relationship is the consumption of salted fish. Keywords: nasopharyngeal carcinoma, risk factor, dr. Soebandi hospital

Oncogenes are mutated form of normal cellular genes called as proto-oncogenes and conduce to the cancer development process. Despite the fact that so many genes have been described, new genes with oncogenic characteristic and potential or tumor supressoring activity are still being defined. Recently, Up-regulated gene 4/Upregulator of cell proliferation (URG4/URGCP), a novel gene, induced by hepatitis-Bvirus-encoded X antigen (HBxAg), has been identified. URG4/URGCP gene was registered to the National Center for Biotechnology Information-GenBank (NCBI-GenBank, Entrez GeneID: 55665 and Entrez Nucleotide ID NM_017920). URG4/URGCP is located on the short arm of chromosome 7 (7p13) and synthesizes a protein containing 922 amino acids in the cytoplas. Relationship between URG4/URGCP expression and clinicopathologic characteristics were evaluated and significant results were in various cancer types such as hepatocellular carcinoma, osteosarcoma, nasopharyngeal carcinoma, bladder cancer, gastric cancer and glioma. Although, biological activity of URG4/URGCP and its effect mechanism in malignant cells is not fully understood, all interesting and promising results shows that URG4/URGCP may be a putative oncogene that contributes to multistep carcinogenesis, cell cycle regulation and other important biological process in the cell. © 2018 Elsevier B.V.

Background The Epstein-Barr virus (EBV) is the causative agent of infectious mononucleosis. EBV is highly prevalent lymphotropic herpesvirus and has been linked to several malignancies. Transmission is generally by oral secretions, but can be through blood transfusions and organ transplantations. This study aimed to determine the seroprevalence, viremia rates, and circulating genotypes of EBV in healthy blood donors in Qatar. Methods Blood samples from 673 blood donors of different nationalities residing in Qatar (mainly Qatar, Egypt, Syria, Jordan, Pakistan, and India) were collected and tested for anti-EBV capsid (VCA; IgG & IgM), nuclear (EBNA; IgG), and early (EA-D; IgG) antigens. Avidity testing was determined when active infection was suspected. DNA was extracted from the buffy coat and subjected to EBV-DNA quantification using qRT-PCR. Genotyping was performed using nested-PCR targeting EBV-EBNA2 gene, and phylogeny by sequence analysis of the LMP-1 gene. Results 97.9% (673/659) of the samples were seropositive as indicated by the presence VCA-IgG, while 52.6% (354/673) had detectible EBV-DNA. EBV seroprevalence and viremia rates increased significantly with age. Genotyping of 51 randomly selected samples showed predominance of Genotype 1 (72.5%, 37/51) as compared to genotype 2 (3.5%), and mixed infections were detected in 4% of the samples. Sub-genotyping for these samples revealed that the Mediterranean strain was predominant (65.3%), followed by B95.8 prototype and North Carolina strains (12.2% each), and China1 strain (6%). Conclusion As a first study to evaluate EBV infection in highly diverse population in Qatar, where expatriates represent more than 85% of the population, our results indicated high seroprevalence and viremia rate of EBV in different nationalities, with genotype 1 and Mediterranean strain being predominant. Clinical significance of these finding have not been investigated and shall be evaluated in future studies. 1 2017 Smatti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This work was made possible by UREP grant # (UREP18-001-3-001) from the Qatar National Research Fund (a member of Qatar Foundation). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We are grateful to: Ms. Enas Al Absi, Mr. Mohamed El Zowalaty and Mrs. Nadima Ali, and the following students: Mariam Nofal, Rana Al Disi and Soumaya Harche for their technical support. This work was made possible by UREP grant # (UREP18-001-3-001) from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the author(s). This sample collection was approved by the Hamad Medical Center Research Committee (Protocol #13422/13). Scopus

Nasopharyngeal tuberculosis is indeed a rare manifestation of extrapulmonary tuberculosis. The general symptoms of nasopharyngeal tuberculosis are nasal obstruction, neck mass, epitaxis, rhinorrhoea, otalgia and hearing loss. Constitutional symptoms may present in almost 12-30% of nasopharyngeal tuberculosis cases, hence it often disguise as nasopharyngeal carcinoma in patients. Apart from that, most cases of nasopharyngeal tuberculosis usually occur with combined active pulmonary tuberculosis or systemic infection. Hereby presenting a case of nasopharyngeal tuberculosis in a lady who is otherwise healthy presented with neck mass for duration of two months with no obstructive symptoms. Upon proceeding with rigid nasal endoscopy, obliteration of fossa of rossenmuller was noted and biopsy confirmed tuberculosis. Patient was immediately started on antituberculosis therapy. Upon subsequent follow ups, resolution of the neck mass was noted. Hence, it is crucial to have a high index of suspiciousness to rule out nasopharyngeal tuberculosis as this is a curable disease and failure to do so can pave way for the deathly pathogen to disseminate in its host and cause mortality.

In 2003, a non-replicating adenoviral gene therapy product received the world`s first government licence for the treatment of head and neck cancer. Two years later approval was granted to a replication-selective adenovirus for the treatment of nasopharyngeal carcinoma in combination with chemotherapy. This review introduces the reader to gene therapy as an emerging treatment modality, and outlines its application to the management of nasopharyngeal carcinoma by examining recent pre-clinical and clinical research.

Resume La dermatomyosite (DM) est une pathologie inflammatoire multi-organe dont les manifestations cutanees et musculaires sont au premier plan. La physiopathologie est encore tres mal comprise, mais il s’agit d’un dereglement de l’immunite humorale et cellulaire. Le diagnostic de DM est base sur cinq criteres : une faiblesse des muscles proximaux des membres, une elevation des enzymes musculaires seriques, des anomalies musculaires histopathologiques visibles sur la biopsie musculaire, des anomalies electromyographiques, et des manifestations cliniques inflammatoires dermatologiques (eruption heliotrope, poikilodermie et lesions inflammatoires au niveau des mains et en regard des articulations). La DM s’observe frequemment au cours de certains cancers, et peut apparaitre avant le cancer, en meme temps que le cancer ou apres le diagnostic de cancer. L’incidence de DM associee avec les carcinomes nasopharynges est de l’ordre d’un pour 1000 cas de cancer nasopharynge. Le traitement est fonde sur les immunosuppresseurs non selectifs meme en cas de cancer, et en particulier sur les corticoides par voie generale a long cours. Cependant, le developpement de therapies ciblees pourra modifier cette approche therapeutique dans un avenir proche. Malgre l’immunosuppression iatrogene, le pronostic des cancers nasopharynges associes a la DM paraneoplasique n’est pas modifie. Notre rapport a pour objectif de rapporter un cas a titre d’illustration d’une evolution paraneoplasique (evoluant en meme temps que le cancer) et de faire une mise au point des connaissances actuelles concernant la DM paraneoplasique dans ces cancers.

Resume Les carcinomes nasopharynges representent une entite specifique differente des cancers de la tete et du cou. L’incidence est plus elevee en Asie du Sud-Est et en Afrique du Nord. Le pronostic reste sombre pour les stades localement avances (IIB–IVB) et metastatiques, plus d’un tiers des cas presenteront une recidive locale et/ou metastatique, la survie globale a cinq ans tous stades confondus est estimee a 50–70 %. En situation metastatique, le role de la chimiotherapie est bien etabli et demeure un traitement palliatif important, bien qu’aucune etude randomisee n’a compare les differents protocoles de chimiotherapie. Pour la premiere ligne, une chimiotherapie a base de sels de platines semble optimale et pour la seconde ligne et apres progression sous sels de platine, il n’existe pas de consensus : une monotherapie avec des substances comme la gemcitabine, la capecitabine ou les taxanes a ete la plus testee avec des resultats acceptables. Les futurs essais devront integrer les therapeutiques ciblees, devant la surexpression de l’EGFR1 et du C-kit par les carcinomes nasopharynges. Dans ce travail, nous proposons une revue de la litterature s’interessant aux differentes etudes portant sur les carcinomes nasopharynges en situation metastatique.

Resume Objectif Analyser retrospectivement les facteurs de risque de survenue de toxicite thyroidienne apres radiotherapie pour cancer du nasopharynx et montrer l’interet d’une surveillance a long terme apres irradiation cervicale. Patients et methodes Entre 1993 et 2004, 239 patients atteints d’un carcinome nasopharynge non metastatique ont ete traites par radiotherapie conventionnelle associee ou non a une chimiotherapie. La radiotherapie a ete delivree selon une modalite classique (2 Gy/seance, cinq seances par semaine) pour 157 patients et hyperfractionnee (1,6 Gy/seance, deux seances par jour, cinq jours par semaine) pour 82 patients. Une evaluation de la toxicite thyroidienne tardive en fonction du stade tumoral, de l’âge, du sexe, du recul, de la modalite d’irradiation et de l’association ou non de chimiotherapie a ete realisee. Resultats Apres un recul median de 111 mois, 72 patients (30 %) ont presente un dysfonctionnement hormonal thyroidien, primitif et/ou hypophysaire. Il s’agissait essentiellement d’une hypothyroidie post-radique revelee chez 57 patients (24 %). Elle etait d’origine peripherique dans 92 % des cas (biologique 73 %, clinique 19 %) et centrale dans 8 % des cas. Le delai moyen d’apparition de l’hypothyroidie etait de 37 mois. Tous les patients ont recu un traitement substitutif par l -thyroxine. Le taux actuariel d’hypothyroidie etait de 18,1 % a trois ans ; 24,3 % a cinq ans et 35 % a dix ans. Seul le sexe feminin a ete retrouve comme facteur de risque de survenue d’hypothyroidie en analyse univariee. Cependant l’âge jeune et le stade tumoral avance ont ete associes a un risque plus eleve d’hypothyroidie mais la difference etait non significative (p = 0,08 pour chacun). La difference etait non significative pour les autres facteurs a savoir le stade ganglionnaire, la modalite d’irradiation et l’association ou non de chimiotherapie. L’analyse multivariee n’a retenu aucun facteur de risque particulier. Conclusion Le dysfonctionnement thyroidien apres radiotherapie pour carcinomes nasopharynges est frequent, ce qui incite a un depistage precoce pour instaurer une prise en charge plus rapide et adequate. Seul, le sexe feminin est retrouve comme facteur de risque en analyse univariee dans cette etude.

Background : The use of Slice thickness examination of nasopharyngeal CT based on theory (Seeram, 2001) using 3 mm and according (Ballinger, 2010) using 5 mm, while in hospital Dr. Moewardi Surakarta the slice thickness used is 5 mm according to theory and 7 mm based on the radiographer. The purpose of this research is to know the difference of anatomical information and image quality of CT scan of nasopharynx of carcinoma case and to know the slice thickness that produces anatomical information and the best image quality CT Scan nasopharynx case carcinoma. Method : The type of research is a quantitative with experimental approach. The data were obtained from 10 nasopharynx CT patients with carcinoma using variations of slice thickness 3 mm, 5 mm, and 7 mm. The assesment of anatomical information and image quality by spreading questionnaire at 3 doctor radiolog. Data were tested with Shapiro Wilk for normality data, then friedman test. To determine the optimal slice thickness using descriptive mean rank test. Results : The results showed that there were differences in anatomical information and image quality of nasopharyngeal CT scan of axial slice using slice thickness. The probability value of this study is p value = 0,000 (

Resume Objectif Analyser retrospectivement les facteurs de risque de survenue de toxicite neurologique apres radiotherapie pour cancer du nasopharynx. Patients et methodes Entre 1993 et 2004, 239 patients atteints d’un carcinome nasopharynge non metastatique ont ete traites par irradiation associee ou non a une chimiotherapie. La radiotherapie a ete delivree selon une modalite classique (cinq seances de 2 Gy par semaine) pour 157 patients et hyperfractionnee pour 82 patients. Une evaluation de la toxicite neurologique tardive a ete faite en fonction du stade tumoral, de l’âge, du sexe, des modalites d’irradiation et de l’association ou non de chimiotherapie. Resultats Avec un recul moyen de 107 mois (35–176 mois), 21 patients (8,8 %) ont ete atteints de complications neurologiques, a type de necrose temporale dans neuf cas, necrose du tronc dans cinq cas, myelite dans un cas et atrophie du nerf optique dans deux cas. Les taux de survie a cinq et dix ans sans complication neurologique etaient respectivement de 95 et 84 %. La jeunesse du patient a ete retrouvee comme facteur de risque de necrose temporale (p = 0,04) et l’irradiation hyperfractionnee a ete associee a un risque plus eleve de complications neurologiques (14,6 % contre 5,7 %, p = 0,02). La difference n’etait pas significative pour les autres facteurs. L’analyse multifactorille n’a retenu aucun facteur. Conclusion La toxicite neurologique est rare et tardive. La jeunesse du patient et l’hyper fractionnement ont ete retenus dans notre etude comme facteurs de risque.

Our aim was to evaluate the feasibility and efficacy of intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) technique following neoadjuvant chemotherapy for locoregionally advanced nasopharyngeal cancer (NPC).Between April 2004 and December 2006, 25 patients with stage IIB to IVB NPC underwent 3 cycles of neoadjuvant chemotherapy followed by IMRT using SIB technique. Neoadjuvant chemotherapeutic regimens were 5-fluorouracil and cisplatin in 11 patients; docetaxel, 5-fluorouracil, and cisplatin in 8; and paclitaxel and cisplatin in 6. Dose prescription of IMRT was as follows: 67.5 Gy at 2.25 Gy/fraction to postchemotherapy gross tumor, 54 to 60 Gy at 1.8 to 2 Gy/fraction to subclinical disease, and 48 Gy at 1.6 Gy/fraction to elective neck. Seventeen patients received weekly cisplatin during the course of radiation therapy as well.With a median follow-up of 29 months for survivors (range, 14-39), the 3-year local progression-free, regional progression-free, and distant metastasis-free survival rates were 89.6%, 87.2%, and 80.4%, respectively. Treatment was well tolerated despite the grade 3 mucositis (16%) and/or pharyngitis (16%). With follow-up, the frequency of xerostomia decreased. At 3 months after IMRT, the proportions of Radiation Therapy Oncology Group grades 0, 1, and 2 xerostomia were 13%, 38%, and 50%, respectively. At 24 months, the corresponding figures were 36%, 46%, and 18%, respectively.IMRT with SIB technique for locoregionally advanced NPC was feasible and effective regarding locoregional control and development of xerostomia, even after neoadjuvant chemotherapy. Definition of gross tumor volume by postchemotherapy extent of disease was also feasible.

Le carcinome du nasopharynx (NPC) constitue le premier cancer ORL en Algerie. Les composantes genetiques et virales sont essentielles dans l’etiopathogenie de cette tumeur par la frequence de cas familiaux et sa liaison constante avec le virus d’Epstein-Barr dont l’utilisation des marqueurs serologiques pour le depistage precoce du NPC a donne des resultats prometteurs. L’objectif de notre etude est de definir les indications et les limites du depistage du NPC chez les populations nord-africaines. Il s’agit d’une enquete epidemiologique portant sur 102 cas de NPC et comprenant trois etapes. Les deux premieres portent sur l’etude des cas familiaux de cancer par l’etude de la genealogie du groupe familial chez 30 familles ayant un cas vivant de NPC, suivie d’une enquete comparative entre 72 cas de NPC appariees a 72 temoins selon l’âge, le sexe et la localite de residence. La troisieme etape est une etude de la faisabilite du depistage serologique du NPC portant sur 600 sujets de l’entourage familial des malades. Les resultats montrent une frequence de cas familiaux de cancer elevee notamment la localisation nasopharyngee et qui sont associes significativement a un risque eleve de NPC. Concernant l’enquete de depistage, le taux de participation est faible a cause d’une perception du NPC comme fatalite et maladie systematiquement letale. Si ces elements devraient etre en faveur d’un depistage precoce du NPC, l’endemicite moderee dans les pays d’Afrique du Nord faisant que cette affection ne constitue pas une priorite sanitaire, la perception culturelle de la maladie et la mauvaise acceptabilite des tests constituent, pour ce type d’actions, des limites considerables.

Acrometastases are rare and often misdiagnosed or overlooked. We report the case of an 80-year-old patient in whom an acrometastasis in the right long finger from a nasopharyngeal carcinoma was diagnosed. The treatment consisted of amputation through the proximal phalanx and resulted in a good recovery. To our knowledge, no case of acrometastasis from this origin has been reported in the literature to date. A literature review is also presented regarding acrometastasis diagnosis and treatment.

Nasopharyngeal carcinoma Nasopharyngeal carcinoma is relatively common. Undifferentiated Carcinomas of Nasopharyngeal Type (UNCT) are endemic Epstein-Barr virus (EBV)-related tumors. They are mainly radiosensitive. The role of imaging is to assess locoregional extension, TNM classification and adjust the radiation fields. MRI is essential to determine the initial extension. CT is useful to confirm the presence of bone involvement and evaluate nodal status. MRI and CT are necessary for the post-treatment follow-up.

In the design of randomised trials in rare cancers, a Bayesian approach has been advocated, which allows for external and subjective information to be formally incorporated. We explore whether this can be extended more generally to allow for smaller trials to be conducted using a case study involving a trial of nasopharyngeal carcinoma. The external information available at various points during the trial is first summarised in the form of 'prior distributions'. Each of these is then combined with the accumulated data from the trial at that point in time to form 'posterior distributions', from which conclusions are drawn. We have argued that such a framework for the design, analysis and interpretation of a randomised trial in the light of external evidence is particularly useful in situations such as trials in rare cancers. But more generally, it may potentially also allow for smaller trials to be conducted. Although, at this point in time, we are hesitant to recommend the full implementation of the Bayesian methodology to modify the (conventionally) planned trial size we submit that a formal synthesis of the external evidence bearing on the question of concern is a valuable exercise in itself.

Resume Objectif Preciser le niveau et la signification pronostique de l'expression immunohistochimique de c-kit dans les deux groupes d'âge de patients nord africains atteints de carcinome nasopharynge. Patients et methodes Il s'agit d'une etude retrospective de l'expression immunohistochimique de c-kit dans une serie de 99 cas de carcinomes nasopharynges nord africains. Les resultats immunohistochimiques etaient correles aux differents parametres anatomocliniques et evolutifs et au niveau d'expression de la proteine LMP1. Resultats Il y avait une expression plus frequente de c-kit dans la forme juvenile des carcinomes nasopharynges (79 % des biopsies des patients âges de moins de 30 ans [forme juvenile] contre 56 % pour les patients âges de plus de 30 ans [p = 0,039]) et une correlation entre la surexpression de c-kit et l'atteinte ganglionnaire (p = 0,015). Le score d'expression de la proteine LMP1 etait de 8,23 (± 2,39) pour les tumeurs c-kit positives et de 5,78 (± 1,84) pour les tumeurs c-kit negatives (p = 0,002). Dans l'etude multifactorielle, incluant l'âge, l'atteinte ganglionnaire et l'expression de la LMP1 comme covariables, seuls l'âge (p = 0,027) et l'expression de la LMP1 (p = 0,005) etaient correles significativement avec l'expression de c-kit. Conclusion c-kit est fortement exprime dans la forme juvenile des carcinomes nasopharynges nord africains. Il y a une correlation entre cette surexpression et celle de la LMP1. La difference d'expression de c-kit suggere fortement que la carcinogenese des carcinomes nasopharynges serait differente entre les deux groupes d'âge.

Resume Objectif Analyser les aspects cliniques, radiologiques, therapeutiques et evolutifs de la radionecrose cerebrale apres traitement pour cancer du nasopharynx. Patients et methodes Les dossiers de sept hommes et deux femmes d’âge moyen 47,7 ans (extremes : 18–57 ans), traites par irradiation pour un cancer du nasopharynx entre 1989 et 2003 et atteints d’une radionecrose cerebrale, ont ete etudies. Le traitement a consiste en une radiotherapie externe a la dose moyenne de 73,5 Gy (70–75 Gy) par fractions de 2 a 2,5 Gy, completee chez un seul patient par une curietherapie de 8 Gy. Une chimiotherapie a ete associee dans quatre cas. Resultats La radionecrose cerebrale a ete authentifiee par l’imagerie (scanographie ± IRM) demandee devant des signes neurologiques non specifiques dans sept cas, fortuitement chez deux malades. Le delai d’apparition etait de 40,3 mois (10–108 mois). Le siege etait temporal dans six cas, parieto-occipital dans un cas et bulbomedullaire dans deux cas. Avec un recul moyen de 30,6 mois (12–84 mois), l’evolution clinique a ete favorable dans tous les cas sous traitement medical (corticoides) avec une stabilisation des lesions radiologiques dans huit cas et une regression complete des lesions radiologiques chez un malade. Conclusion La radionecrose cerebrale represente une complication tardive et rare chez les patients irradies pour cancers du nasopharynx. L’imagerie (scanographie et surtout IRM) a un role majeur dans le diagnostic. Le traitement par corticoides a permis une reponse objective durable chez tous les patients avec, dans la plupart des cas, une stabilisation radiologique.

Nasopharyngeal carcinoma ( N PC) is an epithelial malignancy originating from the surface of the lateral and posterior wall of the nasopharynx. Bcl-2 is an oncoprotein that plays an important role in disrupting the process of apoptosis. Expression of Bcl-2 in biopsy samples of undifferentiated NPC also related to the nature of more aggressive tumor mass and unfavorable clinical radiotherapy response. The purpose of this study was to assess the relationship of Bcl-2 expression with radiotherapy response in undifferentiated NPC. The method of this study areusing 40 samples of paraffin blocks were diagnosed as undifferentiated NPC by histopathologic examination with H&E staining. The samples were divided into 2 groups who respond and do not respond to radiotherapy. All samples examined by Bcl-2 immunohistochemistry and the expression willanalyzed and assess therelationship to radiotherapy response. Of the 40 cases of undifferentiated NPC show imunoekspresi Bcl-2 positive in 39 cases (97.5%) and 1 case (2.5%) negative from response group. The results of statistical analysis of the Bcl-2 obtained significant results with p value

Resume Objectif Le but de cette etude retrospective etait de discuter les aspects epidemiocliniques et les resultats therapeutiques des cancers du cavum metastatiques. Patients et methodes Cette etude a concerne 95 patients atteints d'un cancer du cavum histologiquement prouve avec des metastases synchrones ou metachrones, pour lesquels nous avons recueilli les differentes donnees epidemiocliniques. Ils ont ete traites par l'association d'une chimiotherapie [protocole BEC (bleomycine–epirubicine–cisplatine) ou PBF (bleomycine–5-fluoro-uracile–cisplatine)], d'une radiotherapie locale en cas de metastase solitaire, double ou menacante de compression ou de fracture, et inconstamment d'une irradiation locoregionale en cas de tumeur d'emblee metastatique. La reponse a ete evaluee selon les criteres de l'OMS. La probabilite de survie globale a ete calculee selon la methode de Kaplan–Meier. Une longue survie a ete definie a partir de 36 mois. Resultats Il s'agissait de 34 cancers d'emblee metastatiques et de 61 secondairement metastatiques. L'âge moyen etait de 41,5 ans (sex-ratio : 3, 1). Les metastases osseuses etaient les plus frequentes (83 %). Les taux respectifs de reponse objective et de reponse complete etaient de 75 et 70 % et de 32 et 16 % avec les protocoles BEC et PBF. Vingt-cinq patients ont ete irradies pour des localisations metastatiques et 19 ont recu en plus une radiotherapie locoregionale pour une tumeur d'emblee metastatique. La probabilite de survie globale etait de 15 % a trois ans. Onze patients ont vecu au-dela de 36 mois (extremes : 36 et 134 mois). Conclusion Les resultats therapeutiques etaient comparables a ceux des differentes series ayant utilise une polychimiotherapie a base de sels de platine. L'irradiation des metastases a permis l'obtention de longues survies.

Le carcinome nasopharynge, en particulier le type indifferencie, est une affection maligne rare qui se caracterise par une prevalence elevee en Asie du sud-est et en Afrique du nord. Objectif Definir la place de la chimiotherapie dans le traitement des cancers du cavum, quel que soit leur stade. Materiel et methodes Une recherche a ete effectuee dans la banque de donnees Medline, entre 1970 et 2005. Les mots cles : carcinome nasopharynge, chimiotherapie et radiochimiotherapie concomitante ont ete utilises pour avoir acces aux principaux essais de chimiotherapie dans les cancers du cavum. Resultats Neuf essais randomises de phase III testant l’association chimiotherapie et radiotherapie ont ete retrouves. Il existe de plus en plus de preuves attestant le benefice de l’adjonction de la chimiotherapie a la radiotherapie dans le traitement des formes localement avancees (stade III et IV), en particuliers de facon concomitante, vu le benefice apporte en survie globale. Les associations a base de cisplatine se sont revelees etre les plus efficaces. De nouvelles molecules (capecitabine, taxanes, gemcitabine…) sont actuellement en cours d’essai, dans des etudes de phase II, dans les formes recidivantes et metastatiques, pour lesquelles il n’existe toujours pas de standard therapeutique. Conclusion La consultation de la banque Medline revele que la radio-chimiotherapie concomitante, a base de cisplatine, est le traitement standard des carcinomes nasopharynges localement avances. Les formes metastatiques sont traitees par une chimiotherapie palliative.

Cyclooxygenase-2 (COX-2) has been shown to be involved in multiple steps of carcinogenesis. In this study, we examined COX-2 expression in nasopharyngeal carcinoma (NPC). COX-2 mRNA analyzed by reverse-transcription polymerase chain reaction (RT-PCR) was detected in 66% (16 of 24) of tumor tissues. Western blot analysis demonstrated that COX-2 protein level was increased in tumor tissues and was correlated with the expression level of mRNA. Immunohistochemical study showed that COX-2 was predominantly detected in cancer cells, and the staining pattern was cytoplasmic. Ten histologically normal nasopharyngeal tissues obtained from nasopharyngeal hyperplasia were also investigated. We found that COX-2 mRNA was detectable in three tissues and the COX-2 protein level was very low. The frequency of COX-2 overexpression was significantly higher in patients of the N1-N3 group than in patients of the N0 group (P=0.006). Taken together, these data suggest that COX-2 is overexpressed and is associated with increased lymphatic invasion in NPC.

The objective of this paper is to give some practical landmarks for the delineation of target volumes and organs at risk in Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma. This delineation, drawn from anatomo-clinical data, natural history of the disease and radiological pre-treatment evaluation, seems to be easier to define than the delineation of other head and neck cancer localisations (oropharynx and oral cavity for example). Experience inside national and international cooperative groups should tend to standardize this initial and fundamental step of Nasopharyngeal Conformal Radiotherapy.

Background: : Radiogenic malignancies require cure of the primary disease and a prolonged survival. The introduction of high-volt technology in the 1950s and 1960s made radical radiotherapy feasible and successful in terms of higher cure rates and longer survival. We are already in a time when a higher number of patients with radiogenic secondary malignancies must be expected. Case Report: : A 12-year-old boy is reported who suffered from an advanced nasopharynx carcinoma and was treated with radical irradiation in 1983. 15 years later he developed a rare microcystic adnexal carcinoma of the auditory canal inside the volume of the target dose. The secondary malignant neoplasm was resected and required another radiation treatment (1 Gy b.i.d.) due to involved margins. Discussion and Literature Review: : The entity of microcystic carcinoma is discussed with a review of the literature on biology, diagnosis, and treatment