H. Ben Salah

Glioblastome et myxome radio-induits après traitement d’un carcinome indiffencié du nasopharynx

Resume La survenue de tumeurs radio-induites est une eventualite connue depuis longtemps. Elle a surtout ete decrite apres le traitement de cancers pendant l’enfance. Les tumeurs secondaires a une irradiation d’un cancer cavum sont exceptionnelles. Des osteosarcomes craniofaciaux ont ete decrits apres traitement d’un carcinome indifferencie du nasopharynx. Nous rapportons deux observations de tumeurs radio-induites survenues respectivement trois et sept ans apres le traitement d’un carcinome indifferencie du nasopharynx. La premiere est celle d’un glioblastome temporoparietal et la deuxieme, celle d’un myxome rhino- et oropharynge. Les deux malades sont en vie apres le traitement de la seconde tumeur. Le delai d’apparition de ces tumeurs, leur situation dans le volume irradie et la dose recue a ce niveau suggerent leur nature radio-induite, mais l’etude cytogenetique serait necessaire pour confirmer l’implication de la radiotherapie dans la genese de ces cancers.

Le cancer du cavum de l’enfant et l’adulte jeune : aspects anatomocliniques, thérapeutiques et particularités évolutives

PURPOSE We retrospectively analyzed anatomoclinic, therapeutic and evolutive particularities of 74 young patients (< or =20 years) with nasopharyngeal carcinoma treated between 1993 and 2005. PATIENTS AND METHODS Initial work-up included a fiberoptic nasofibroscopy with biopsy, tomodensitometry and/or MRI of nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. Patients were treated with either primary chemotherapy (epirubicin and cisplatin) followed by radiotherapy or concomitant radiochemotherapy (five fluorouracil and cisplatin). Radiotherapy was delivered to a total dose of 70 to 75 Gy to nasopharynx and involved cervical lymph nodes and 50 Gy to the remainder cervical areas. RESULTS The median age was 16 years. Sixty-three percent of patients had undifferentiated tumors. Sixty-six percent had locally advanced tumor. With a median follow-up of 107 months, one patient presented a local relapse, 24 patients developed distant metastases with a median delay of 7 months. The 5 years overall survival and disease-free survival were 66 and 65 %. Late complications were dominated by dry mouth and endocrine disorders. COMMENTS Pediatric nasopharyngeal carcinoma is characterized by an early metastatic diffusion. Local control is excellent but with severe late toxicities. New techniques of radiotherapy and new molecules of chemotherapy could improve these results.

Carcinome à petites cellules de l’ovaire

Small cell carcinoma of the ovary of the hypercalcemic type is a rare tumor. We report a case in a 34-year-old patient, revealed by a pelvic pain. The imaging found a large mass of the right ovary. The patient had right oophorectomy and total hysterectomy, a left oophorectomy, pelvic and a para-aortic lymphadenectomy. She subsequently received 6 cycles of adjuvant chemotherapy followed by pelvic radiation therapy. The hypercalcemic small cell carcinoma of the ovary is a rare disease of poor prognosis. Treatment approaches include surgery, chemotherapy with the addition of radiotherapy.