Noureddine Benjaafar

Cancer incidence in Rabat, Morocco: 2006–2008

Introduction No population-based data of cancer incidence from Morocco have been published before. This is the first report of cancer incidence in Rabat from a population-based cancer registry for the period 2006–2008. Materials and methods The cancer registry collects data on all new cases of cancer diagnosed in the resident population of the Rabat area. Data collection is an active process involving visits by registry staff to all data sources, essentially hospitals, pathological laboratories, and private clinics in Rabat. Results A total of 2,473 new cases of cancer were registered among residents in Rabat during the period 2006–2008. The overall world age-standardised rate (ASR) for all sites combined was 136.6/100,000 for men and 114.5/100,000 for women. The most frequently diagnosed malignancies in males were lung cancer (19.0%, ASR 24.8/105), followed by prostate cancer (15.5%, ASR 22.9/105), colorectal cancer (8.8%, ASR 12.0/105), bladder cancer (6.9%, ASR 9.7/105), and non-Hodgkin’s lymphoma (NHL) (6.0%, ASR 8.2/105). In females, the most frequently reported malignancies were breast cancer (39.9%, ASR 43.4/105), followed by cervix uteri cancer (11.4%, ASR 13.0/105), colorectal cancer (7.5%, ASR 9.0/105), NHL (3.4, ASR 4.2/105), and thyroid cancer (3.4%, ASR 3.9/105). Of all cancers, 2% are observed in childhood (0–14 years), and ~43% of them are malignant haemopathies. Conclusion The data reported by Rabat Cancer Registry indicate that cancers of the breast, cervix, uteri, and colon and rectum in females and the lung, prostate, and colon and rectum in men are major cancers in the population of Rabat. The Incidences observed are sometimes different from those observed in the neighbouring North African countries.

Concurrent chemoradiotherapy in adjuvant treatment of breast cancer

BackgroundThe 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.MethodsTwo 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.ResultsAfter 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).ConclusionFrom 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.

Pediatric rhabdomyosarcoma in Morocco.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. There is, however, a paucity of reports on the pattern of its occurrence in Africa. This study analyses the epidemiological pattern, clinical features, histology, and outcome in Moroccan children presenting with RMS.

Associated factors with psychological distress in Moroccan breast cancer patients: A cross-sectional study

OBJECTIVESnTo estimate the prevalence of psychological distress (PD) in Moroccan breast cancer patients, and to determine clinical and social demographic factors associated with PD.nnnMETHODSnIt was a cross-sectional study where we included all female breast cancer patients that did not have other malignancies. Judgment criteria were based on the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). Threshold values of 15 and 3 were fixed to detect patients on PD by the HADS and the DT, respectively. We analyzed data by calculation of Cronbachs alpha coefficient for the reliability of measurements, and by simple and multiple logistic regressions.nnnRESULTSn446 women were enrolled. Cronbachs alpha coefficient was 0.801, 0.669 and 0.639 respectively for the HADS, HAD-A and HAD-D questionnaires. 120 patients (26.9%) had a HADS global score ≥15. HAD-A and HAD-D sub-scores were ≥11 in 25 (5.6%) and 30 (6.7%) patients respectively. In multivariate analysis, adjusted for the education level, marital status, taking analgesic and/or anxiolytic treatment, and current treatment type; we found that the occurrence of a distant metastasis [ORxa0=xa014.427 pxa0<xa00.001], lack of social family support [ORxa0=xa04.631 pxa0<xa00.001], living a difficult emotional [ORxa0=xa02533 pxa0=xa00.034] and/or financial [ORxa0=xa02.09 pxa0=xa00.037] situation, and younger (<50 years) age [ORxa0=xa02.398 pxa0=xa00.002], were independent associated factors with PD as assessed by the HADS.nnnCONCLUSIONSnSocial family support, emotional and financial difficulties should be investigated in all Moroccan breast cancer patients, especially among younger ones, in order to detect those at risk of PD and offer them appropriate support.

Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer

PURPOSEnTo evaluate the effect of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes on overall survival (OS), disease-free survival (DFS), locoregional control and on treatment-related toxicity in patients with breast cancer and nodal involvement.nnnMETHODS AND MATERIALSnTwo hundred fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiation therapy (42xa0Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast-conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or interstitial high-dose-rate brachytherapy). Two hundred fifty-six (99.6%) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment, and 65 (25.3%) had anti-HER2 targeted therapy.nnnRESULTSnThe median follow-up time was 64xa0months (range, 11-88xa0months). The rates of 5-year OS, DFS, locoregional recurrence (LRR)-free survival, and distant metastasis (DM)-free survival were 86.6%, 84.4%, 93.9%, and 83.1%, respectively. In multivariate analysis (MVA), lymph node ratio >65%, lymphovascular invasion, and negative hormone receptor status predicted for OS, DSF, and DM. T3 to 4 stage was also associated with worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2 to 3 stage and grade 3. Hyperpigmentation was observed in 19.2% of patients, telangiectasia in 12.3%, and fibrosis in 30.7%. Grade ≥2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis was observed, nor were plexopathy or rib fractures.nnnCONCLUSIONnAccording to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.

Skin metastases of cervical cancer: two case reports and review of the literature

BackgroundAlthough cervix carcinoma is one of the most common malignancies in women, hematogenous metastases are relatively not common. Cutaneous metastases, in particular, are unusual even at an advanced stage of disease. Their presence is a predictor of poor prognosis.Case presentationCase 1: A 63-year-old postmenopausal Moroccan woman was diagnosed as having cervical squamous cell carcinoma. She was treated with radical concurrent chemotherapy and radiation therapy followed by low-dose brachytherapy. Six months after finishing the therapy, multiple skin nodules appeared on her abdomen and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. Her disease progressed and she died before completing her fourth course of palliative chemotherapy.Case 2: A 48-year-old Moroccan woman was diagnosed as having cervical squamous cell carcinoma; she was treated with concurrent chemoradiation. Before a planned high-dose brachytherapy, she noticed many nodular lesions on her arms, thighs, and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. She then underwent a series of imaging examinations, including computed tomography of her chest, abdomen, and pelvis, and a whole body bone scan that showed disseminated disease involving her lungs and bones. She died after two courses of palliative chemotherapy, 2xa0months after the appearance of the skin lesions.ConclusionWe report two cases to illustrate a rare localization of metastasis from cervical carcinoma that is highly aggressive requiring early detection and aggressive management.

Epidemiology and outcome of cervical cancer in national institute of Morocco

BackgroundOn behalf of the medical staff of the National Institute of Oncology of Rabat, we conducted a retrospective study to report epidemiology and 5-year outcomes of cervical carcinoma in Moroccan women.MethodsWe reviewed all women diagnosed with invasive cervical carcinoma in our institute between January 2006 and December 2006. Outcomes and prognoses are analyzed in patients who received at least one treatment.ResultsThe analysis included 646 women. Median age was 50xa0years (23–85 years). Bleeding was the most frequent symptom (95xa0%). The most predominant histology was squamous cell carcinoma (94xa0%). The majority of patients were diagnosed at locally advanced stages (88xa0%). Among patients who received treatment (nu2009=u2009550), the management was based on concurrent chemoradiotherapy in 69.7xa0% of cases. The median duration of follow-up was 60xa0months (range 2–78 months). Overall survival, progression free survival, and locoregional recurrence free survival were 63.2, 60.7 and 79.1xa0% respectively. Significant poor prognostic factors in univariate analysis included stage, tumor size, lymph node involvement, anemia and absence of response to radiotherapy. The prognostic significance of response to radiotherapy and stage were retained in multivariate analysis.ConclusionCervical cancer in our Institute is diagnosed at locally advanced stages. Two third of patients were treated by concurrent chemoradiotherapy. Outcome of Moroccan patients are comparable to that of western countries. Significant prognostic factors were stage, tumor size, lymph node involvement, anemia, and response to radiotherapy. The way to reduce the global burden of cervical cancer in our country continues to be the development of vaccination and screening programs.

Factors influencing diagnosis delay of advanced breast cancer in Moroccan women

BackgroundDelay in the diagnosis of breast cancer in symptomatic women of 3xa0months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women.MethodsA group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records.ResultsIn all, 137 patients were interviewed. The mean age of women was 48.3u2009±u200910.4xa0years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1xa0%) patients and to a medical reason in 19 (13.9xa0%) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9xa0%) patients; traditional therapy was applied in 15 (12.7xa0%) patients and fear of cancer diagnosis and/or treatment in 14 (11.9xa0%) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (pu2009=u20090.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (pu2009<u20090.001). Also, a significantly higher risk of more than 6xa0months delay was found among rural women (Pu2009=u20090.035) and women who live far away from specialized care center (Pu2009=u20090.001).ConclusionsDiagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection.

Radical Mastectomy Increases Psychological Distress in Young Breast Cancer Patients: Results of A Cross-sectional Study

Micro‐Abstract The present cross‐sectional study aimed to detect the effect of breast cancer surgery on the psychological state of 122 young women aged < 45 years. We found that mastectomy was an independent factor associated with greater rates of psychological distress, increasing the interest of early detection in third world countries to allow for more breast conservative procedures. Introduction: The present study aimed to detect the factors associated with psychological distress (PD) in young Moroccan patients with breast cancer, with a special focus on the type of surgical procedure. Patients and Methods: We collected social, demographic, and clinical data from female patients, aged < 45 years, with localized stage breast cancer who had undergone either radical mastectomy or conservative surgery and for whom adjuvant chemotherapy was indicated. We used the Hospital Anxiety and Depression Scale (HADS) to assess the psychological status. The relationship between the variables and PD was analyzed using simple and multiple logistic regression analyses. Results: A total of 122 women were enrolled, of whom 41 (33.6%) had a HADS global score ≥ 15. The HAD anxiety and depression subscores were ≥ 11 for 10 (8.2%) and 8 (6.6%) patients, respectively. On multivariate analysis, adjusted for marital status and receipt of analgesic and/or anxiolytic treatment, we found that radical mastectomy (odds ratio [OR], 5.747; 95% confidence interval [CI], 1.342‐24.608), living in a difficult emotional (OR, 7.366; 95% CI, 1.727‐31.41) and/or financial (OR, 16.521; 95% CI, 3.574‐76.36) situation, and a lack of social and/or family support (OR, 19.617; 95% CI, 3.549‐108.43) were independent factors associated with PD. Conclusion: Breast‐conserving surgery should be performed whenever possible for young women to avoid the psychological repercussions of radical procedures.

Extranodal NK/T-Cell Lymphoma, Nasal Type, Presenting as Facial Cellulitis

Background: Checkpoint kinase 1 (CHK1) is a serine/threonine-protein kinase which plays a major role during checkpoint-mediated cell cycle arrest and activation of DNA repair in response to DNA damage. Ultraviolet (UV) irradiation induces DNA damage triggering the cell cycle arrest and the cell may be forced into apoptosis if damage is not repaired. Through phosphorylation mediated activation CHK1, as an effector kinase, responds to this damage by targeting downstream effector proteins. nObjective: The objective of the present study was to demonstrate CHK1 methylation in response to UV induced DNA damage. nMethods: Expression of CHK1 was detected in a cancer cell line Hct-116. Hct-116 cells, cultured in RPMI-1640 medium supplemented with serum and antibiotics, were transfected with HA-Chk1 plasmid, exposed to UV radiation and incubated for different time intervals. Cell lysis followed by immunoblotting was performed to visualize the signals of methylated CHK1. nResult: Methylated CHK1 signals were observed in response to UV induced DNA damage in a cancer cell line Hct-116. Expectedly, it was found that with the increased duration of post UV exposure, methylation level of CHK1 was also amplified. nDiscussion and Conclusion: Here, for the first time, it is reported that DNA damage induced by UV radiation was associated with elevated methylation of CHK1. This new finding might indicate that cells may have evolved mechanisms to promote CHK1 methylation for reasons not yet known. This study reveals novel modification of CHK1 as a component of the cellular response to DNA damage which may help us understand the importance of such modifications.Background: Checkpoint kinase 1 (CHK1) is a serine/threonine-protein kinase which plays a major role during checkpoint-mediated cell cycle arrest and activation of DNA repair in response to DNA damage. Ultraviolet (UV) irradiation induces DNA damage triggering the cell cycle arrest and the cell may be forced into apoptosis if damage is not repaired. Through phosphorylation mediated activation CHK1, as an effector kinase, responds to this damage by targeting downstream effector proteins. nObjective: The objective of the present study was to demonstrate CHK1 methylation in response to UV induced DNA damage. nMethods: Expression of CHK1 was detected in a cancer cell line Hct-116. Hct-116 cells, cultured in RPMI-1640 medium supplemented with serum and antibiotics, were transfected with HA-Chk1 plasmid, exposed to UV radiation and incubated for different time intervals. Cell lysis followed by immunoblotting was performed to visualize the signals of methylated CHK1. nResult: Methylated CHK1 signals were observed in response to UV induced DNA damage in a cancer cell line Hct-116. Expectedly, it was found that with the increased duration of post UV exposure, methylation level of CHK1 was also amplified. nDiscussion and Conclusion: Here, for the first time, it is reported that DNA damage induced by UV radiation was associated with elevated methylation of CHK1. This new finding might indicate that cells may have evolved mechanisms to promote CHK1 methylation for reasons not yet known. This study reveals novel modification of CHK1 as a component of the cellular response to DNA damage which may help us understand the importance of such modifications.