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Introduction: The therapeutic strategy for metastatic colorectal cancer (mCRC) has evolved greatly in the last two decades. This study aimed to compare patients with mCRC treated at the University Hospital of Sousse (Tunisia) through three periods, in terms of treatment strategy; objective response rate (ORR) to chemotherapy; median overall survival (OS) and prognostic factors conditioning OS. Methods: This was a retrospective study covering the period from January 1994 to December 2011. It involved 401 patients with mCRC divided into three groups: group 1 (G1) including patients treated in the period 1994-1998, group 2 (G2) including patients treated in the period 1999-2005 and group 3 (G3) including patients treated in the period 2006-2011. Results: The ORR after 3 cycles of first line chemotherapy was 33%, 50% and 57.8% for G1, G2 and G3 respectively. The median OS was 13.8 months for G1, 19 months for G2 and 23 months for G3. The prognostic factors associated with a better OS for G3 were absence of initial tumor complication, normal initial level of carcinoembryonic antigen, normal liver function tests, surgery of the primary tumor, surgery of liver metastases and the ORR after three cycles of first line chemotherapy. Conclusion: The development of the therapeutic strategy, whatever of medical or surgical nature, has led to improved response rates and survival of patients treated for mCRC.

and 33.3%; p ¼ 0.9). 23.4% of patients received second line treatment. The two most commonly used regimens were FOLFIRI (36.4%) and Capecitabine (27.3%). FOLFIRI seemed to be more effective than Capecitabine (respectively 66.7% of progression vs 100%, p ¼ 0.5). Only 4.3% of patients received a third line chemotherapy based on capecitabine or FOLFIRI. All patients progressed. The median number of received chemotherapy cycles was 4. 41.9% of our patients developed grade 3-4 toxicity during chemotherapy. There was no treatment-related death. Median overall survival (OS) and progression free survival (PFS) were respectively 6 and 5 months. On univariate analysis, factors associated with poor OS were elevated tumor markers (p ¼ 0.001), hepatic metastases (p ¼ 0.003) and radiologic progression after first line treatment (p ¼ 0.03). Those related with a better survival were receiving first (p<0.001) and second line chemotherapy (p ¼ 0.01) and having a surgery (p ¼ 0.01) even with a palliative intent (p ¼ 0.04). Multivariate analysis demonstrated that the only independent factor positively impacting on survival was receiving chemotherapy (p ¼ 0.01). Conclusion: Metastatic spread of gastric cancer is fatal. This study confirms the survival benefit and manageable toxicity of palliative chemotherapy but survival increase remains poor compared to improvements in other gastrointestinal cancers.

Purpose Colon cancer survivors can experience several post-treatment consequences that include fatigue and often report severe psychological illnesses such as depression or anxiety. There is little published quantitative data on the quality of life and psychological well-being associated with the health of Tunisian colon cancer survivors. Methods A total of 60 recovering colon cancer patients underwent a structured interview, which included the Hospital Anxiety and Depression (HADS) scale, the Piper fatigue scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results Patients were 59.26 years old on average. The median length of remission was 33.3 months. Surgery was performed on all patients, followed by 96.7% adjuvant chemotherapy. 15.1% of study participants were in the severe category for the depression score and 10% were in this category for the anxiety score. Ninety-one percent reported pathological fatigue scores on the Piper scale. However, only 8.33% were experiencing severe fatigue. According to the QLQ-C30 assessment, the overall quality of life was slightly impaired with an overall average score of 79.54 ± 16.98. Anxiety, depression and fatigue negatively affect global health outcomes and all their dimensions. Conclusion Even in the recovery phase, colon cancer patients can see their quality of life deteriorate. It comes out of their psychological experience and their physical life. It is, therefore, crucial to provide greater attention to these patients for holistic and multi-disciplinary care.

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Peritoneal mesotheliomas are very rare tumors. Their prognosis is poor, average survival does not exceed 1 year after peritoneal cytoreduction. Systemic chemotherapy is considered to have no proven value in the management of peritoneal mesotheliomas. Objective responses with systemic chemotherapy are very rare. We report here a case of an advanced peritoneal mesothelioma which achieved an unexpected partial response with chemotherapy, allowing the patient to have a right colectomy. The patient was referred to a specialized center on HIPEC, but taking in account the long awaiting interval, the HIPEC was judged to be inefficient and then the poursuit of 6 cycles of systemic chemotherapy was decided. The patient is still alive without any symptom and with a good performance status at 59 months after diagnosis. Throughout our case, we provide an encouraging evidence of the role of initial systemic chemotherapy in the downstaging of initially unresectable primary malignant mesothelioma and in the improvement of overall survival.

Conclusion: Thermal ablation is an effective treatment for colorectal cancer pulmonary metastases. We found no difference in outcome according to the type of thermal ablation used. Small pneumothoraces were common with both types of thermal ablation, but otherwise, both techniques were well-tolerated.Legal entity responsible for the study: The authors.