W. Siala

Toxicité neurologique tardive après traitement des carcinomes nasopharyngés

PURPOSE A retrospective analysis of risk factors for late neurological toxicity after nasopharyngeal carcinoma radiotherapy. PATIENTS AND METHODS Between 1993 and 2004, 239 patients with non metastatic nasopharyngeal carcinoma were treated by radiotherapy associated or not to chemotherapy. Radiotherapy was delivered with two modalities: hyperfractionated for 82 patients and conventional fractionation for 157 patients. We evaluated the impact of tumour stage, age, gender, radiotherapy schedule and chemotherapy on neurological toxicity. RESULTS After a mean follow-up of 107 months (35-176 months), 21 patients (8.8%) developed neurological complications, such as temporal necrosis in nine cases, brain stem necrosis in five cases, optics nerve atrophy in two cases and myelitis in one case. Five- and ten-year free of toxicity survival was 95 and 84% respectively. Young patients had greater risk of temporal necrosis, and hyperfractionated radiotherapy was associated with a significantly higher risk of neurological complications (14.6% vs 5.7%, p=0.02). On multivariate analysis, hyperfractionation and age were insignificant. CONCLUSION Late neurological toxicity after radiotherapy for nasopharyngeal carcinoma was rare. Younger age and hyperfractionation were considered as risk factors of neurological toxicity in our study.

Résultats thérapeutiques du cancer du cavum : y a-t-il une différence entre enfants et adultes ?

PURPOSE To compare therapeutic results of nasopharyngeal carcinoma between adults and children. PATIENTS AND METHODS Three hundred and seventy seven patients with nasopharyngeal carcinoma received a radiotherapy between 1993 and 2007. Sixty-nine of them were 20years old or less. Two hundred and sixty eight patients received a chemotherapy (neoadjuvant or concomitant). RESULTS Overall survival and disease-free survival at 5 years were 67 % and 59.4 % in all patients, respectively. Overall survival rates at 5 years in children and adults were 66 % and 64 %, respectively (P=0.17), disease-free survival rates at 5 years were 66 % and 57 %, respectively (P=0.17). Local failures occurred more frequently in adults than in children (1.4 % versus 14 %). However, metastatic events were frequently seen in children. Late toxicities were important in children, xerostomia was the most common one. CONCLUSION Despite locally advanced disease in children, therapeutic results were better than in adults but not statistically significant. The use of treatment combination (chemotherapy and radiotherapy) in juvenile nasopharyngeal carcinoma may explain our findings.

Place de la radiotherapie dans le traitement des tumeurs cutanees chez huit patients atteints de xeroderma pigmentosum

RésuméLe xeroderma pigmentosum (XP) est une génodermatose caractérisée par l’apparition, à un â ge précoce, de tumeurs cutanées et oculaires posant souvent des difficultés thérapeutiques. Le but de notre travail était de décrire notre expérience dans le traitement de ces tumeurs par radiothérapie (RT). Nos huit malades présentaient 24 tumeurs (un à sept par patient) qui siégeaient surtout au niveau des lèvres (sept cas), du nez (cinq cas) et des paupières (cinq cas). La RT était réalisée dans un but curatif dans sept cas et dans un but palliatif, dans un cas. Le traitement était basé sur la contacthérapie dans 16 cas (à la dose de 3,4 grays/séance, au rythme de trois séances/semaine, avec des doses totales allant de 30 à 62 grays), la RT transcutanée dans quatre cas (deux grays/séance, cinq séances/semaine) et la curiethérapie dans quatre cas. Une régression clinique des tumeurs était obtenue dans 18 cas sans aucune récidive, trois malades étaient perdus de vue et un malade était décédé. Les effets secondaires étaient à type de surinfections (quatre cas) et d’atrophie cutanée (deux cas). La RT parait satisfaisante (75 % de guérison), les effets secondaires étaient rares. L’exérèse chirurgicale reste le traitement de première intention, la RT constitue une alternative thérapeutique possible chaque fois que la tumeur est inopérable. La contacthérapie permet de réduire la surface irradiée. Les effets secondaires à long terme sont mal connus notamment chez des enfants.AbstractXeroderma pigmentosum (XP) is a rare genodermatosis characterised by the occurrence of cutaneous and tumors in the young age that arise therapeutic challenge. The aim of the study is to report an experience in the management of these cases by radiotherapy (RT). Eight patients with 24 tumors (one to seven by patient), located to the lips (seven cases), nose (five cases) and eyelids (five cases). RT was undertaken in seven cases as curative method and in one case as palliative one. Treatment was based on contact therapy in 16 cases (3.4 gy/session with a weekly three sessions, total doses were between 30 to 62 gy), transcutaneous RT in four cases (2 gy/session, five sessions/week) and curitherapy in four cases. Resolution of the tumors was obtained in 18 cases, without recurrence, three patients being last and one deceased. RT side effects were skin infection (four cases) and skin atrophy (two cases). RT is a satisfactory method (healing of 75% of cases), side effects being rare. Surgery remains the treatment of choice. However RT is an alternative method when surgery could not be used. Contact therapy allows reduction of irradiated area. Long term side effects are not known, notable in RT treated children.

Métastase intradurale extramédullaire lombosacrée d’un sarcome d’Ewing cervical: présentation d’un cas clinique et revue de la littérature

Spinal Ewing’s sarcoma is rare. It can be located in the vertebrae, epidural space or, very occasionally, in the intradural extramedullary space, which makes diagnosis, treatment and prognosis difficult. Since 1999, nine cases have been reported in the literature. We describe a case of cervical Ewing’s sarcoma presenting intradural, extramedullary distant metastasis seven years after initial treatment. To our knowledge, no intradural extramedullary Ewing’s sarcoma metastasis has been reported before. Diagnosis was established by surgery with histological and immunohistochemical examinations. The multidisciplinary treatment includes complete excision if possible, radiotherapy and chemotherapy. Prognosis is generally severe with a poor survival rate.RésuméLa localisation rachidienne du sarcome d’Ewing est rare. Elle peut être vertébrale, épidurale ou exceptionnellement intradurale extramédullaire. Cette dernière localisation pose des problèmesdiagnostique, thérapeutique et pronostique. Depuis 1999, neuf cas ont été rapportés dans la littérature. Nous présentons un cas de sarcome d’Ewing cervical avec localisation secondaire lombosacrée intradurale extramédullaire, sept ans après le traitement initial. Il s’agit, à notre connaissance, du premier cas de localisation métastatique rapporté dans la littérature. La confirmation histologique et immunohistochimique a été faite sur pièce d’exérèse chirurgicale. La prise en charge thérapeutique est multidisciplinaire, associant la chirurgie qui doit être la plus complète possible, la radiothérapie et la chimiothérapie. Le pronostic est souvent sévère avec des taux de survie bas.