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Chemotherapy and targeted therapy remain the cornerstone of treatment of locally advanced and metastatic non-small cells lung cancer (NSCLC). Given the intrinsic chemoresistance of tumor cells, new treatment options have been developped. The knowledge of the molecular mechanisms of tumor biology, and signal transduction pathways activating cancer cells led to the identification of a new targeted therapy such as Crizotinib. The small molecule Crizotinib is a selective inhibitor of the receptor tyrosine kinase ALK (anaplastic lymphoma kinase) and its oncogenic variants (ALK fusion gene and some mutations of ALK). Phases I and II trials showed the efficacy of Crizotinib in the treatment of locally advanced and metastatic NSCLC expressing ALK. Thereafter, randomized Phase III trial confirmed the significant superiority of Crizotinib versus standard chemotherapy in terms of progression free survival and objective response with good tolerance; therefore, it has been approved by the Food and Drug Administration (FDA) as the standard treatment for locally advanced and metastatic ALK-positive NSCLC.

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GIST are rare during pregnancy. We report here the case of a patient who was admitted in our university hospital for GIST discovered during the second trimester of pregnancy. She was 42 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain with vomiting. On abdominal examination, we objectified a distended abdomen with uterine height of 18 cm and epigastric mass of 10 cm. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a hepatic, tissue and cystic mass, developing at the expense of the left liver. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. A cesarean was scheduled at the 35th month of pregnancy for fetal extraction and rescue. Exploration of the peritoneal cavity during surgery has objectified a hepatic highly vascularised mass reaching up to the umbilicus. This mass was unresectable. A postoperative CT scan revealed a large bilobed epigastric mass adhering to the stomach and the left liver. Histological and immunohistochemical study of hepatic process showed a gastrointestinal stromal tumor of high risk of malignancy. Conclusion: few cases have been reported in the literature on GIST during pregnancy showing the rarity of the condition that requires multidisciplinary care.

Objective. To determine the current shortfall of medical oncologists (MOs) and the projected supply. Background. Morocco, the medical oncology (MO) is a relatively new specialty. Medical oncology was recognized as a separate specialty in 1994 but the real taking-off was done only since the 2000s after the creation of the chair of medical oncology in the University of Rabat. The GRIOMM (Moroccan group of trialist in medical oncology) was created in 2011 and conducted its first study, EVA-onco, concerning the practice of medical oncology in Morocco in 2011. Design. EVA-onco is a prospective study concerning the practice of medical oncology in Morocco in 2011. Results. The entire public cancer centers completed the survey. There were no missing data. The number of medical oncologist per 100000/habitants in Morocco was 0.09. The average number of new patients seen per medical oncologist was 718 patients (ranging by state from 97 to 1875). The shortfall of MOs was estimated at 26 at least in 2011 according to the national recommendations. Conclusions. Since 2010, a national strategy to increase the capacity of MO workforce existed. The current shortfall of MO is expected to disappear in the future.

Introduction: Malignant melanoma, which has a highly malignant potential, is a tumor of the skin and mucosal membranes. Malignant melanomas of the female genital tract, including the vulva and vagina, are rare. Their overall prognosis is poor and is worse than that for cutaneous melanomas. Cases presentation: Clinical data for 3 patients with primary malignant melanoma are presented. Diagnosis was based on histologic and immunohistochemical examinations. Case 1 was a 45 year-old women with cervical polyp and excision revealed malignant melanoma. Case 2 was 46-year-old woman with cervical and vaginal melanoma and the third was a 64 year-old women with lentiginous melanoma of the clitoris. One patient was treated with surgery and adjuvant chemotherapy, and two patients received systemic chemotherapy. Conclusion: Although malignant melanoma of the female genital tract is uncommon, literature review shows that prognosis is poor than at other sites, most probably due to more advanced disease at diagnosis. This presentation highlights that early diagnosis by physicians at this relatively rare site is of crucial importance since it may result in improved outcome, similar to that of melanoma at more common sites.

Background A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21–88). The male–female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.

"Classic" Kaposi's sarcoma (CKS) not related to HIV is a multifocal angioproliferative neoplasm that is linked to human herpesvirus. CKS is a cutaneous cancer frequently occurring with an indolent course. However, it can compromise the quality of life by causing pain, disfigurement and functional disability. For this reason, the main treatment goals are not only to reduce the cutaneous lesions but also to alleviate organ involvement and psychological stress by delaying disease progression and ultimately cure. This report summarizes systemic treatment options of CKS, including chemotherapy, immunotherapy and anti-HHV8 therapy. In addition, this review will focus on the recent understanding of carcinogenesis and consequently highlight potential "targeted" therapeutic interventions.

Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive variety of sarcoma arising typically from abdominal or pelvic peritoneum. Diagnosis and treatment approaches of this entity are complex and require a skilled, experienced, multidisciplinary team. Authors report their experience with a case of an intraabdominal DSRCT arising in a 37-year-old young man in order to discuss the clinico-pathological and radiological behavior of this tumor and underline diagnostic and therapeutic difficulties.

Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

Angiogenesis is crucial for the growth and metastasis of many cancers. A series of new inhibitors of angiogenesis are now in intensive development. Recent preclinical studies suggest that frequent administration of certain conventional cytotoxic agents at low doses increases their putative antiangiogenic activity. Moreover, many clinical trials confirm efficacy of this metronomic chemotherapy in terms of clinical benefice and survival prolongation. Combining metronomic chemotherapy with hormonotherapy, angiogenesis inhibitors and radiotherapy increases efficacy. Many biomarkers are used to predict optimal drugs and appropriate use of them. This review describes experimental and clinical studies published and discuss its potential uses and limits.

We report the case of a patient of 30 years with primary choriocarcinoma of the ovary. This patient referred for abdomino-pelvic mass suspected clinically and sonographically. Exploratory laparotomy was performed with the presence of two latero-uterine mass adherents to the highly vascularised uterus and difficult to resects deep plane with a mass left hepatic bleeding. A biopsy of both masses was performed and histological examination with immunehistochemical study returned for a primary ovarian non-gestational choriocarcinoma and the patient received 4 cycles of chemotherapy after hepatic artery embolization with good clinical, biological and radiological evaluation.

PURPOSE: Leiomyosarcoma of the breast is extremely rare. To date, the factors that are predictive of patient prognosis have not been identified. To clarify the nature of leiomyosarcoma of the breast, and also to establish the proper treatment strategy, we report this case We report this case while discussing The Clinical presentation, diagnosis, therapy and pathologic feature. INTRODUCION: Sarcomas comprise less than 1% of all primary breast neoplasms and only a minority of these are leiomyosarcomas. There were only 35 cases being reported in English literature. The mainstay of treatment is surgical excision with clear margins and longterm followup is essential. Its prognosis is better compared to other breast sarcoma. CASE PRESENTATION: We report a case of primary leiomyosarcoma of the breast occurring in young female patient which was successfully treated by surgery and radiotherapy. CONCLUSION: According to literature data, primary leiomyosarcoma is characterized by a better prognosis compared with other breast sarcomas, To date, the factors that are predictive of patient prognosis have not been identified. .The rarity and diagnostic difficulty imposed a multidisciplinary approach.

Le dermatofibrosarcome de Darier et Ferrand (DFS) est une tumeur mesenchymateuse cutanee de malignite intermediaire. C'est une tumeur rare mais non exceptionnelle, representant 0,1% des tumeurs cutanees malignes. Les auteurs presentent une etude retrospective de 27 cas de DFS diagnostiques sur une duree de 7 ans (2004 a 2010) et la comparent aux donnees de la litterature. Cette etude permet d’etablir en plus des caracteristiques anatomopathologiques et immunohistochimiques, une etude epidemiologique, clinique et evolutive de ce sarcome. l’âge moyen de nos patients est de 41 ans avec une predominance masculine. Le tronc est la localisation preferentielle touche dans 52% des cas. La taille tumorale a atteint 30cm et mesure en moyenne 6,1 cm. Le diagnostic etait evoque a l'examen histologique standard et confirme par l'expression intense et diffuse du CD34. Le traitement etait chirurgical, associe a une radiotherapie dans 2 cas. L’evolution etait marquee par la transformation en un sarcome pleomorphe de haut grade dans un cas et par la survenue de recidives locales dans 2 cas. Nos resultats sont classiques et comparables aux autres series de la litterature. L'examen histologique est indispensable pour le diagnostic. L'exerese chirurgicale large est le traitement de reference. Le pronostic est conditionne par une malignite surtout locale et un fort potentiel de recidive. La transformation sarcomateuse franchement maligne metastasiante est exceptionnelle.

In 2013, at the congress of the European CanCer Organization and the European Society for Medical Oncology, colorectal cancer was the subject of various oral presentations and posters. In this article, we have selected the most innovative studies that are likely to change our daily practice.

Background: Non-small cell lung cancer (NSCLC) in young patients is uncommon and is thought to constitute a distinct oncological entity with characteristic clinicopathological patterns. The objective of our work is to analyze presentation, management and outcome data of NSCLC patients aged less than 45 years and compare them with those of patients over 45 years old. Materials and methods: We retrospectively reviewed all patients treated for metastatic NSCLC over the period of 5 years (2007–2012) at the Medical Oncology Department of Hassan II University Hospital. The clinicopathological characteristics of patients aged less than and over 45 years old were compared and evaluated for prognostic significance regarding outcome. Results: The data for NSCLC patients (116), of whom 15 were aged

Background: The study aims to determine the impact of cancer on Moroccan patients of Moslem faith. Method: Patients included a convenience sample with histological confirmed cancer. Cases with cerebral metastasis or lacking capacity were excluded. Participants were assessed prospectively using a questionnaire covering epidemiological and socio-economic characteristics, religious affiliation, repercussions of disease on religious beliefs and practices. Results and conclusions: One thousand and six hundred patients (median age 49 years) were approached; 41% females and 74% from rural areas. There was a high rate of illiteracy (38%) and only 7% had higher education. Seventeen per cent were divorced, among whom 41% were divorced after diagnosis of cancer. Eighty-seven per cent had no medical insurance. All were Muslims; 49% practising believers and 51% non-practising. In the first group cancer represented a divine test that permitted acceptance of the disease. In the second group of ‘non-practising believers’, patients reported a feeling of culpability and 95% of them started taking up religious practices, often with extremism and sometimes in contradiction of medical advice. In both groups new behaviours were noticed; 450 women now wore the ‘Hijab’ (scarf), 19% used popular medicine and plants in their diet recommended by the Koran. While these results require replication they indicate changes in behaviour by those within the Moslem faith following a cancer diagnosis. Copyright © 2007 John Wiley & Sons, Ltd.

Classic Kaposi’s sarcoma (CKS) is a subtype that traditionally occurs in elderly HIV-negative males of Mediterranean origin. Patients with CKS characteristically present with skin lesions in the distal extremities. Involvement of the viscera is uncommon but may occur in the late stages of the disease. Patients with extensive KS can be treated with systemic chemotherapy. A number of drugs approved for treatment of AIDS-associated KS, especially Paclitaxel, have activity against CKS after failure of prior therapy. We report a patient treated with weekly Paclitaxel, as initial chemotherapy, for CKS presenting with multiple visceral involvement and having a contraindication for Bleomycin. The patient had quasi-complete response after three months of chemotherapy suggesting that weekly Paclitaxel might be effective as a first-line therapy for classical type KS with visceral involvement.

INTRODUCTION: La classification moléculaire des cancers du sein basée sur l'expression génique puis sur le profil protéique a permis de distinguer cinq groupes moléculaires: luminal A, luminal B, Her2/neu, basal-like et non-classées. L'objectif de cette étude réalisée au CHU Hassan II de Fès est de classer 335 cancers du sein infiltrant en groupes moléculaires, puis de les corréler avec les caractéristiques clinicopathologiques. METHODES: Etude rétrospective étalée sur 45 mois, comportant 335 patientes colligées au CHU pour le diagnostic et le suivi. Les tumeurs sont analysées histologiquement et classées après une étude immunohistochimique en groupes: luminal A, luminal B, Her2+, basal-like et non-classées. RESULTATS: 54.3% des tumeurs sont du groupe luminal A, 16% luminal B, 11.3% Her2+, 11.3% basal-like et 7% non-classées. Le groupe luminal A renferme le plus faible taux de grade III, d'emboles vasculaires ainsi que de métastases ; alors que le groupe des non-classées et basal-like représentent un taux élevé de grade III, une faible proportion d'emboles vasculaires et d'envahissement ganglionnaire. Ces facteurs sont significativement élevés dans les groupes luminal B et Her2+ avec un taux de survie globale de 78% et 76% respectivement. Dans le groupe luminal A, la survie globale des patientes est élevée (87%) alors qu'elle n'est que de 49% dans le groupe des triples négatifs (basal-like et non-classés). CONCLUSION: Le groupe luminal B est différent du luminal A et il est de pronostic péjoratif vis à vis du groupe Her2+. Les caractéristiques clinicopathologiques concordent avec le profil moléculaire donc devraient être pris en considération comme facteurs pronostiques.

Background Breast carcinoma is known as a heterogeneous disease because gene expression analyses identify several subtypes and the molecular profiles are prognostic and predictive for patients. Our aim, in this study, is to estimate the prevalence of breast cancer subtypes and to determine the relationship between clinico-pathological characteristics, overall survival (OS) and disease free survival (DFS) for patients coming from north-east of Morocco. Methods We reviewed 366 cases of breast cancer diagnosed between January 2007 to June 2010 at the Department of pathology. Age, size tumor, metastatic profile, node involvement profile, OS and DFS were analyzed on 181 patients. These last parameters were estimated by Kaplan-Meier analysis and log-rank test to estimate outcome differences among subgroups. Results The average age was 45 years, our patients were diagnosed late (57% stage III, 17.5% stage IV) with a high average tumor size. Luminal A subtype was more prevalent (53.6%) associated with favorable clinic-pathological characteristics, followed by luminal B (16.4%), Her2-overexpressing (12.6%), basal-like (12.6%) and unclassified subtype (4.9%). Survival analysis showed a significant difference between subtypes. The triple negative tumors were associated with poor prognosis (49% OS, 39% DFS), whereas the luminal A were associated with a better prognosis (88% OS, 59% DFS). The luminal B and the Her2-overexpressing subtypes were associated with an intermediate prognosis (77% and 75% OS, and 41% and 38% DFS respectively). Conclusion This study showed that molecular classification by immunohistochemistry was necessary for therapeutic decision and prognosis of breast carcinoma. The luminal A subtype was associated with favorable biological characteristics and a better prognosis than triple negative tumors that were associated with a poor prognosis and unfavorable clinic-pathological characteristics.

This paper discusses a rare case of renal metastatic osteosarcoma. A 25-year-old man with a history of metastatic osteosarcoma involving his right kidney was referred to our institution for treatment. He was managed with chemotherapy. An exhaustive review of the English literature pertaining to this disease was performed. To our knowledge, this case represents only the sixteenth. The literature suggests that the incidence of renal involvement in osteosarcoma is significant and that the treatment should be multidisciplinary in such patients.

Angiogenesis is crucial for the growth and metastasis of many cancers. A series of new inhibitors of angiogenesis are now in intensive development. Recent preclinical studies suggest that frequent administration of certain conventional cytotoxic agents at low doses increases their putative antiangiogenic activity. Moreover, many clinical trials confirm efficacy of this metronomic chemotherapy in terms of clinical benefice and survival prolongation. Combining metronomic chemotherapy with hormonotherapy, angiogenesis inhibitors and radiotherapy increases efficacy. Many biomarkers are used to predict optimal drugs and appropriate use of them. This review describes experimental and clinical studies published and discuss its potential uses and limits.

Introduction Triple-negative breast cancer (TNBC) is defined as a group of breast carcinomas that are negative for expression of hormone receptors (ER, PR) and Her2, we can distinguish between two groups: basal-like (ER-, PR-, Her2-, cytokeratin (CK) 5/6+ and/or Her1+) and unclassified subtype (ER-, PR-, Her2-, Her1- and CK5/6-). The aim of this study is to determine the clinicopathological, histological, therapeutic and prognostic features associated with this type of breast cancer. Methods This is a retrospective study of 366 female breast cancer patients, diagnosed between January 2007 and June 2010 at the Department of Pathology. Epidemiological, clinical, histological, therapeutic and evolutive data were analyzed. OS and DFS rates were estimated by Kaplan-Meier analysis and a log-rank test to estimate outcome. Results A total of 64 women were identified as having TNBC (17.5% of all female breast cancer patients), 12.6% were basal-like, 4.9% were unclassified subtype, with a median age of 45 years. The median histological tumor diameter was 4.3 cm. TNBC were most often associated with a high grade, 49.2% grade III (53% for unclassified subtype, 47.6% for basal-like). Vascular invasion was found in 26.6% of cases (22% for unclassified subtype and 28.3% for basal-like). For the lymph node involvement: 51% had positive lymph nodes, and 22.4% had distant metastases. Neoadjuvant chemotherapy was administered to 18% patients with 26% of complete pathologic response; therefore adjuvant chemotherapy was given to 82%. 98% received anthracycline based regimen and only 30% received taxanes. The Kaplan-Meier curves based showed the lowest survival probability at 3-years (49% of OS, and 39% of DFS). Conclusion TNBC is associated with young age, high grade tumors, advanced stage at diagnosis, difference chemo response compared to other subtypes, and shortest survival. Critical to optimal future management is accurate identification of truly triple negative disease, and adequately powered prospective TNBC trials to establish treatment efficacy and define predictive biomarkers.

Background: Gastric signet ring cell carcinoma (SRC) is a poorly differentiated adenocarcinoma in which the tumour cells invade singly or in small groups. The incidence of SRC has been reported in china as 13.9% (662 patients of 4,759) [1]. It is reported to occur more frequent among women and young patients. A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. Case presentation: A 38-year-old female presented with a 3 weeks history of epigastralgia. Her medical history was unremarkable. The endoscopic findings of the stomach revealed an infiltrative lesion, which the guided biopsy yielded a positive pathologic diagnosis of signet ring cell carcinoma. Diagnostic imaging with an abdominal computed tomography (CT) scan revealed a gastric thickening, with lymph nodes. Induction chemotherapy was recommended, based on 6 cycles of ECX (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2). The total gastrectomy specimen showed a pathological complete response. The patient, who is always followed in consultation, is in complete remission 19 months after the diagnosis Conclusion: SRC is a distinctive histological type of gastric cancer. The ECX or EOX (epirubicin, oxaliplatine, capecitabine) remains the standard treatment of advanced primary gastric signet-ring cell carcinoma. Our case illustrates a complete pathologic response to ECX, which confirmed the effectiveness of this protocol on this histology.

Tamoxifen-induced skin reactions are uncommon. We report a case of a delayed maculopapular eruption induced by tamoxifen. A 57-year-old Moroccan woman developed a diffuse maculopapulous eruption one month after beginning a tamoxifen regimen instituted as adjuvant therapy. The eruption resolved rapidly after withdrawal of tamoxifen. The late onset in this case is intriguing and prompted us to look for another cause which could not be found. Patch tests performed later with Nolvadex® tablets crushed in vaseline were negative. The most common adverse effect on skin, with an incidence of 17–67%, is vasomotor instability with hot flushes, but more severe types of skin reactions caused by tamoxifen are rare. A search of the published medical literature identified occasional reports of skin reactions.

Liver damage is further characterized into hepatocellular (predominantly initial Alanine transferase elevation) and cholestatic (initial alkaline phosphatase rise) types. However they are not mutually exclusive and mixed type of injuries are often encountered. Serious drug-induced hepatotoxicity is an infrequent but life-threatening complication often identified through post marketing drug safety surveillance. The main toxicities of Tyrosine Kinase Inhibitors (TKI) therapy are fatigue, rash, diarrhea, hypertension, stomatitis, hand-foot syndrome, hypothyroidism and cardiac toxicity. Whilst most multitargeted TKI exhibit most of the side-effects noted above, each TKI has its particular profile. Sunitinib is an oral multikinase inhibitor that blocks the activity of VEGFR-2 and PDGFR, as well as Src, Abl, insulin-like growth factor receptor-1 and fibroblast growth factor receptor-1 tyrosine kinases, approved by the United States Food and Drug Administration (FDA) in January 2006 for treatment of renal cell carcinoma and gastrointestinal stromal tumor after disease progression or intolerance of Imatinib mesylate. In preapproval clinical trials, two patients reportedly experienced hepatotoxicity during treatment with sunitinib. Although both patients had evidence of liver metastasis before receiving sunitinib, the FDA deemed the suggestion of hepatotoxicity equivocal. We report the case of a patient treated for metastatic renal carcinoma who presented a hepatic cytolysis after introduction the sunitinib: 50mg/day, this is a second report case in the English literature in our knowledge. Clinicians should be aware of this possible adverse effect of sunitinib, and continued pharmacovigilance is imperative to accurately quantify the possible risk of sunitinib-related hepatotoxicity.

Cancer is a major risk factor for thromboembolic disease. This risk is increased by the therapies applied including hormone therapy. We report a case of a 54 years old patient, postmenopausal, treated for breast cancer who presented an intracranial hypertension syndrome 15 months after starting Tamoxifen. A brain scan with injection of contrast was performed and revealed a left lateral sinus thrombophlebitis extended to the ipsilateral jugular vein. Curative anticoagulation was started the same day of diagnosis with low molecular weight heparin. Symptoms were improved 5 days after starting anticoagulation.

Background Concurrent chemoradiotherapy (CCRT) after breast surgery was investigated by few authors and remains controversial, because of concerns of toxicity with taxanes/anthracyclines and radiation. This treatment is not standard and is more commonly used for locally advanced breast cancer. The aim of our study was to evaluate the efficacy and safety of the concomitant use of anthracycline with radiotherapy (RT). Findings Four hundred women having operable breast cancer, treated by adjuvant chemotherapy (CT) and RT in concomitant way between January 2001 and December 2003, were included in this retrospective cohort study. The study compares 2 adjuvant treatments using CCRT, the first with anthracycline (group A) and the second with CMF (group B). The CT treatment was repeated every 21 days for 6 courses and the total delivered dose of RT was 50 Gy, divided as 2 Gy daily fractions. Locoregional recurrence free (LRFS), event free (EFS), and overall survivals (OS) were estimated by the Kaplan-Meier method. The log-rank test was used to compare survival events. Multivariate Cox-regression was used to evaluate the relationship between patient characteristics, treatment and survival. In the 2 groups (A+B) (n = 400; 249 in group A and 151 in group B), the median follow-up period was 74.5 months. At 5 years, the isolated LRFS was significantly higher in group A compared to group B (98.7% vs 95.3%; hazard ratio [HR] = 0.258; 95% CI, 0.067 to 0.997; log-rank P = .034). In addition, the use of anthracycline regimens was associated with a higher rate of 5 years EFS (80.4% vs 75.1%; HR = 0.665; 95% CI, 0.455 to 1.016; log-rank P = .057). The 5 years OS was 83.2% and 79.2% in the anthracycline and CMF groups, respectively (HR = 0.708; 95% CI, 0.455 to 1.128; log-rank P = .143). Multivariate analysis confirmed the positive effect of anthracycline regimens on LRFS (HR = 0.347; 95% CI, 0.114 to 1.053; log-rank P = .062), EFS (HR = 0.539; 95% CI, 0.344 to 0.846; P = 0.012), and OS (HR = 0.63; 95% CI, 0.401 to 0.991; P = .046). LRFS, EFS and OS were significantly higher in the anthracycline group where the patients (n = 288) received more than 1 cycle of concurrent CT (P = .038, P = .026 and P = .038, respectively). LRFS and EFS were significantly higher in the anthracycline group within the BCT subgroup (P = .049 and P = .04, respectively). There were more hematologic, and more grade 2/3/4 skin toxicity in the anthracycline group. Conclusions After mastectomy or BCT, the adjuvant treatment based on anthracycline and concurrent RT reduced breast cancer relapse rate, and significantly improved LRFS, EFS and OS in the patients receiving more than 1 cycle of concurrent CT. There were more hematologic and non hematologic toxicities in the anthracycline group.

Fibrosarcomas (FS) of bone are a rare malignancy accounting for less than 5% of all primary malignant bone neoplasms. Diagnosis and treatment approaches of this entity are complex and require a skilled and experienced multidisciplinary team. Authors report their experience with a case of FS of humerus showing a pathologic complete response to neo-adjuvant chemotherapy based on adriamycin, cisplatin and ifosfamid. This approach allowed limb-sparing surgery with an excellent functional and psychological result.

Background Breast cancer is uncommon in young women and induces more aggressive biologic characteristics. Survival in young women has been widely studied in developed countries. Less favorable prognosis and low survival were found. In Morocco, this study is the first investigation of clinical features, treatment and prognosis associated with breast cancer in young women. Findings Four hundred and nine women aged 35 years or less were included in this study. All these women were diagnosed as having breast cancer at the National Institute of Oncology in Rabat, Morocco between 2003 and 2007. The relation between clinical and therapeutic characteristics and event-free survival (EFS) and overall survival (OS) were assessed by Cox regression analysis. The median age of the patients was 32 years. Fifty three patients (13%) have metastatic disease at diagnosis and 356 patients (87%) had localised disease. In 57.9% of the cases, the estrogen receptors status was positive. The median follow-up was 32.2 months. After 3 years the survival rate was 80.6%. In the case of localised disease, OS and EFS at 3 years were 83.2% and 62.5%, respectively. OS and EFS at 3 years was higher in patients with stage I than patients with stage II and stage III (p = 0.001). Positive estrogen receptors was significantly associated to OS and EFS at 3 years compared to negative estrogen receptors (p = 0.001). Adjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy were associated with net benefit in OS and EFS at 3 years. Cox regression analysis showed that negative ER was significantly associated with poorer OS (HR = 2.42, 95% CI = 1.25 - 4.66, p < 0.009) and poorer EFS (HR = 1.73, 95%CI = 1.05 - 2.86, p = 0.03). Stage III disease were associated to poorer EFS (HR = 5.35, 95%CI = 1.60 -17.84, p = 0.006). Conclusions In Morocco, young women with breast cancer had less favorable prognosis. Multivariate analysis showed that negative hormone receptor status was associated with lower EFS and OS. Clinical trials should be launched to improve the survival of these young women with breast cancer.

Wilm’s tumor is rare in adulthood. The prognosis is poor when compared with children. Adults more frequently present with advanced disease stages, and chemotherapy has a moderate effect. The various protocols of chemotherapy and indications for surgery and radiotherapy are not yet precisely defined, mainly due to the rarity of the disease. The Society of Pediatric Oncology (SIOP) guidelines suggest that both pediatric and adult patients should have initial chemotherapy followed by surgery. However, the National Wilms’ Tumor Stage Group (NWTSG) recommends surgery followed by chemotherapy. The authors present 2 cases of adult nephroblastoma that were highly resistant to presurgical chemotherapy. Nephrectomy was not completed because of rapid disease progression. The poor response of these 2 patients indicates that the alternate NTWSG approach of initial surgery followed by systemic treatment might have better results for this population. The authors review related reports and discuss the diagnosis and management of adult Wilms’ tumor.

Background The optimal sequencing of chemotherapy and radiotherapy after breast surgery was largely studied but remains controversial. Concurrent chemo-radiotherapy is a valuable method for adjuvant treatment of breast cancer which is under ongoing research program in our hospital. We are evaluating the feasibility of the concomitant use of chemotherapy retrospectively. Methods Two hundred forty four women having breast cancer were investigated in a retrospective study. All patients were either treated by radical surgery or breast conservative surgery. The study compares two adjuvant treatments associating concomitant chemotherapy and radiotherapy. In the first group (group A) the patients were treated by chemotherapy and radiotherapy in concomitant way using anthracycline (n = 110). In the second group (group B) the patients were treated by chemotherapy and radiotherapy in concomitant way using CMF treatment (n = 134). Chemotherapy was administered in six cycles, one each 3 weeks. Radiotherapy delivered a radiation dose of 50 Gy on the whole breast (or on the external wall) and/or on the lymphatic region. The Kaplan-Meier method was used to estimate the rates of disease free survival, loco-regional recurrence-free survival and overall survival. The Pearson Khi2 test was used to analyse the homogeneity between the two groups. The log-rank test was used to evaluate the differences between the two groups A and B. Results After 76.4 months median follow-up (65.3 months mean follow up), only one patient relapsed to loco-regional breast cancer when the treatment was based on anthracycline. However, 8 patients relapsed to loco-regional breast cancer when the treatment was based on CMF. In the anthracycline group, the disease free survival after 5 years, was 80.4% compared to 76.4% in the CMF group (Log-rank test: p = 0.136). The overall survival after 5 years was 82.5% and 81.1% in the anthracycline and CMF groups respectively (Log-rank test: p = 0.428). The loco-regional free survival at 5 years was equal to 98.6% in group A and 94% in group B (Log-rank test: p = 0,033). The rate of grade II and grade III anaemia was 13.9% and 6.7% in anthracycline group and CMF group respectively (Khi2-test: p = 0.009). The rate of grade II and grade III skin dermatitis toxicity was 4.5% in the group A and 0% in the group B (Khi2-test: p = 0.013). Conclusion From the 5 years retrospective investigation we showed similar disease free survival and overall survival in the two concurrent chemo-radiotherapy treatments based on anthracycline and CMF. However in the loco-regional breast cancer the treatment based on anthracycline was significantly better than that of the treatment based on CMF. There was more haematological and skin dermatitis toxicity in the anthracycline group.

Objective Germ-cell tumours (GCTs) with a non-GCT malignant component are a unique and rare phenomenon called teratoma with malignant transformation (TMT). The only published series of patients with TMT treated with chemotherapy comprised 10 patients. We report here our experience in treating 14 patients with TMT. Patients and methods Sarcoma was identified in 10 of 14 patients, with rhabdomyosarcoma ranking first ( n =4). Other histological types included adenocarcinoma ( n =3) and bronchoalveolar carcinoma ( n =1). Immunohistochemistry was performed to help in identifying the malignant non-GCT component. Results Primary treatment consisted of surgery alone in 4 patients. The remaining 10 patients received first-line cisplatin-based chemotherapy with resection of residual masses ( n =5): 4 patients had a complete response and 5 had a partial response. Overall, 9 patients developed a relapse with a median time of 84 mo (range: 6–168). At relapse, 8 patients received a chemotherapy regimen directed to the non-GCT component. Four of these patients achieved a partial response. With a median follow-up of 59 mo (range: 3–180), 4 of 14 patients are alive, including 3 who are disease-free. Conclusion To our knowledge, this is by far the largest reported European series of chemotherapy in TMT. Although TMT has a poor prognosis compared to GCT, its management may be improved by adapted chemotherapy associated with surgical resection of residual masses.

Introduction Biliary tract cancers (BTC) are relatively rare (3% of digestive cancers), they mainly affect older women and are located in the gallbladder in about 70% of the cases. Methods In this retrospective study, we reviewed 70 cases of BTC admitted in the medical oncology unit of HASSAN II university hospital between January 2008 and January 2012. The aim of this study is to define epidemiologic, diagnostic and therapeutic aspects of this disease in a Moroccan population. Results In our study, BTC account for 4.8 % of digestive cancers. The mean age of our patients was 62.4 years ranged from 32 to 81 years, female gender represent 71 %. The tumors were located in the gallbladder (GB) in 72 % of the cases divided into adenocarcinoma (77 %) and squamous cell carcinoma (23 %). The other locations were hilar cholangiocarcinoma (21 %) and intrahepatic cholangiocarcinoma (7 %). Concerning the radiological finding, abdominal ultrasonography was performed in all of the patients but it allowed to suspect cancer in only 47% of the cases. Magnetic resonance cholangiographic was performed (n=16) and allowed to suspect cancer in all of these patients. Incidental finding of gallbladder cancer at surgery was recorded in 24 patients: intraoperatively in 10 cases or after pathological study in 14 cases. For all the cases of BTC, Staging of the disease was based on the thoraco-abdomino-pelvic scan and divided into localized stage (7 %), locally advanced stage (14 %) and metastatic stage (79 %). The site of metastases was as following: liver (85 %), lymph nodes (43 %), lung (35 %), peritoneum (25 %), bone (7.5 %), and soft subcutaneous metastasis (5 %). An initial complete surgery in gallbladder cancer (extended cholecystectomy including en bloc hepatic resection and lymphadenectomy with or without bile duct excision) was performed in 7 patients. A second curative surgery was performed in 8 patients. A complete surgery in cholangiocarcinoma cases (n=20) was performed in 6 patients. A palliative surgery was done in 24 patients of all BTC: cholecystectomy (n=9) and biliary drainage (n=15). In all the BTC metastatic patients (n=55), a palliative chemotherapy was administered as following: combination of cisplatin and gemcitabine (n=22), gemcitabine alone (n=10), combination of oxaliplatin and gemcitabine (GEMOX) (n=5), combination of cisplatin and 5 fluorouracil (n=4), capecitabine alone (n=4), combination of capecitabine and oxaliplatin (XELOX) (n=2), and FUFOL Mayo clinic (n=2). While 9% of the patients received supportive care because of their comorbidities and the deterioration of the performans status and liver blood tests. Conclusion Because of the silent evolution of BTC, the diagnosis is therefore delayed, the prognosis is poor and treatment is usually palliative. Our results are consistent with those of the literature concerning the epidemiological finding and diagnosis aspects. A multidisciplinary approach including methods for early diagnosis, oncologic surgery and chemotherapy is recommended to improve the prognosis of patients with biliary tract cancers.

Introduction Gastric linitis plastica is a very particular malignant gastric tumor different from the usual gastric carcinoma. It refers to the diffuse proliferation of connective tissue, resulting in tissue thickening so that the stomach is constricted and rigid. Methods In this retrospective study, we reviewed the records of 34 patients diagnosed with gastric linitis between January 2008 and January 2012. The aim of this study is to identify the clinical, diagnostic and therapeutic features of this type of gastric cancer in Moroccan patients. Results The mean age at the diagnosis was 42.6 years ranged from 25 to 69 years, 22 patients were female. The clinical symptoms were mainly vomiting (73 %), epigastric pain (79 %) and deterioration of Performance Status (94 %). In all of the cases, endoscopy has revealed rigid and thickening stomach. 68 % (n=23) of the patients were metastatic at the diagnosis, sites of metastasis were: peritoneum (71 %), lymphatic nodes (53 %), lung (32 %), liver (24 %) and the ovary (6 %). Among the 34 patients, 32 % (n=11) were treated with curative strategy by total gastrectomy followed by adjuvant concomitant chemo radiotherapy (n=5), adjuvant chemotherapy (n=4) or perioperative chemotherapy (n=2). For the metastatic patients chemotherapy regimens were distributed as following: ECC (Epirubicin 50 mg/m2, Cisplatin 60 mg/m2, Capecitabine 625 mg/m2/12h) was administered to 56 % of the cases, combination of cisplatin and 5 fluorouracil (cisplatin at the dose of 75 mg/m2 and 5 fluorouracil at 300 mg/m2 for 3 days) to 22 % of the cases, capecitabine as monotherapy for 14 %, and FUFOL Mayo Clinic regimen for 4 % of metastatic patients. While 4 % of the cases received supportive care because of deterioration of the performance status and liver blood tests. Download : Download full-size image Figure 1 . Expression of AEG-1 in gastric cancer tissues by immunohistochemical staining AEG-1 expression is not detected in normal gastric mucosa (left). AEG-1 positive expression in intestinal metaplasia (middle). AEG-1 strong positive expression in gastric cancer (right). Download : Download full-size image Figure 2 . Expression of AEG-1-mRNA in gastric cancer cells by RT-PCR. Conclusion The gastric linitis plastica represent an entity with specific characteristics, which tends more toward tumor invasion depth, with nodal and peritoneal metastases. A multidisciplinary approach including cancer surgery and chemotherapy is recommended to improve the prognosis of patients with this disease.