No abstract

Primarypapillaryserouscarcinoma of the uterine cervix is an extremely rare anatomopathologicalentity. Itsdiagnosisis one of exclusion, requiring the elimination of an ovarian or endometrialprimary. Known for having a poorprognosis, no consensus wasreachedregarding a specifictherapeuticapproach for thishistological type, both in localized and advanced stages. We report a case of locallyadvancedpapillaryserouscarcinoma of the uterine cervix treatedwith exclusive cisplatin-basedradiochemotherapyfollowed by brachytherapy, with a good post-therapeuticclinicalevolution.

Soft-tissue sarcomas (STS) are a rare, and comprise a relatively heterogeneous group of malignant tumors arising from mesenchymal tissue. STS can affect any age group. In order to provide patients suffering from STS, with a functional extremity without local tumor relapse, treatment decisions must involve a multidisciplinary team decision-making approach. We conducted a retrospective, descriptive study, of 43 cases of soft tissue sarcoma, collected between January 2013 and December 2018, in the department of Radiation-Oncology of the Oncology and hematology hospital of Mohammed VI University Teaching Hospital. With this study we aimed to report the epidemiological, clinical, histological, therapeutic and evolutionary characteristics of soft tissue sarcomas in the Radiation-Oncology department, and to define the factors influencing patient survival in order to improve the quality of care. The items collected were: epidemiological, clinical, histological, radiological, and therapeutic. Univariate and then multivariate analyzes were performed looking for factors influencing 2-year survival. During the study period, we collected 43 cases, 22 Men and 21 Women, the average age was 45.23 years (Extreme = 11-78 years). The tumor was deep in 73% percent of the cases, and the lower limbs were the most affected (65%) especially in the thigh. The predominant histological type was Liposarcoma in 16 cases (37.20%). The tumor stage was localized in 35 cases (81.39%), metastatic in 8 cases (18.60%). Thirty-five tumors were treated with surgery, including 31 cases (88.57%) of conservative surgery and 4 cases (11.42%) of radical surgery. Radiotherapy was performed in 33 patients, and chemotherapy in 24 patients. Follow-up monitoring has detected 5 cases (28%) of local recurrence, and 13 other cases (72%) of distant metastases. In univariate analysis the prognostic factors were age (p = 0.03) and tumor stage (p = 0.09). In our study, radiation therapy is an integral part of the ......

he treatment of locally advanced non-metastatic laryngeal squamous cell carcinoma is very controversial. Total laryngectomy associated with lymph node dissection and adjuvant radiotherapy with or without chemotherapy is considered the gold standard treatment. The functional impairment on voice and breathing that result from this approach called for discussion of preservation of this organ. Since the publication of the Veterans' Study in 1991 on laryngeal cancer and the confirmation by subsequent randomized trials of an equivalent survival, treatment strategies for advanced laryngeal carcinoma have shown significant changes in favour of an organ-sparing approach by chemoradiotherapy. Purpose: We aim to assess the outcome of locally advanced non-metastatic laryngeal cancer classified as (T3NxM0 -T4NxM0) by comparing the carcinological results and the survival at one and three years between two cohorts of patients, one treated by surgery and the other by organ preservation protocols. Between the two series, we will analyze the carcinological outcomes, local control, local and lymph node recurrence, distant metastases, overall survival, and recurrence-free survival, lymph Node-free survival, and metastatic evolution. Results: 106 patients were treated for locally advanced squamous cell laryngeal carcinoma of the ENT department and radiation Oncology department of Mohamed VI University hospital between January 2014 and December 2018; Sixty-three patients in surgery group I and forty-three patients in group II went on organ sparing approach by radiochemotherapy. The two groups were compared according to local tumor control, local recurrence, lymph node recurrence, and distant metastasis. Early deaths and patients who were lost to follow-up were excluded from this analysis. The average age was 61 years in the surgery group versus 60 years in the RCC. The male predominance was marked in both treatment groups, 102 were male (96.23%) and only 4 female (3.77 %.).88.7% were smokers with an average consumption of 26.4 package-years. Only 15% of our smoking patients reported a withdrawal period estimated at two months on average. Alcohol-smoking synergy was observed in 19% of cases. In the surgery group, 47 patients or 83.9% had local tumor control compared to 12 patients or 41.4% in the radio-chemotherapy group with a statistically significant difference p<0.0001. Local recurrence was observed in 8 patients (14.5%) in the surgery group against 6 patients (46.2%) in the radio-chemotherapy cohort with a p= 0.02. We noted that there was a large number of missing data (30 patients) in the radio-chemotherapy group due to the large number of patients who were lost to follow-up, early deaths, and patients who did not progress well after treatment. There was no statistically significant difference between the two groups in terms of lymph node recurrence and metastatic progression. At 1 year, Overall survival was 87.9% of patients were alive (n=51 out of 58) in the surgery arm versus 60.6% (n=20 out of 33) in the radio-chemotherapy arm. At 3 years overall survival was 77.5% for surgery versus 48.4% for radiotherapy (p= 0.005).Lymph node free recurrence and metastatic free progression at 1 year was 94.5% in the surgery group compared with 84.6% for radio-chemotherapy. Survival at 3 years was 85.4% versus 53.8% respectively (p=0.05).In the chemoradiation therapy group, there were 30 missing data due to a large number of deaths and loss of the follow-up during the first year without any indication of the presence or absence of recurrence, compared to 8 missing data for the radio-chemotherapy group. Conclusion: The optimal treatment for advanced squamous cell carcinoma of the larynx is highly controversial. Total laryngectomy associated with cervical lymph node dissection remains the gold standard of treatment but organ-sparing protocols are as effective as surgical therapy. However, in our study, total laryngectomy plus lymph node dissection showed better survival outcomes in terms of locoregional control and significantly increased overall survival and recurrence-free survival. This makes surgery the treatment of choice in the management of locally advanced non-metastatic laryngeal cancer in our single institutional Moroccan setting. Possible reasons for these results may be poor patient selection, inadequate follow-up, incomplete treatment, and interrupted treatment sessions but also the long delay in consultation. Patients and professionals should be made aware of the small but significant disadvantage of the non-surgical therapy approach as part of the shared decision-making process when selecting treatment. Both surgery and radio-chemotherapy can be effective if the treatment indications are well directed. These indications depend on several many several parameters and should be considered at the multidisciplinary consultation meetings and adapted on a case-by-case basis.