Gastric Adenocarcinoma at the Joliot Curie Institute in Dakar: Epidemiological, Diagnostic and Therapeutic Aspects about 54 Cases

Objectives: To study the epidemiological, diagnostic, therapeutic and prognostic aspects of gastric adenocarcinoma at the Joliot Curie Institute in Dakar. Materials and Methods: We conducted a retrospective study over a seven-year period from January 2010 to December 2017 at the Joliot Curie Institute in Dakar. All cases of gastric adenocarcinoma proven by fibroscopy followed by histology or proven on the histological analysis of a surgical specimen were taken into account. The parameters studied were age, risk factors, stages of the disease, treatment and prognosis. Results: There were 54 cases of gastric adenocarcinoma over a period of 7 years. The average age was 54.74 years with extremes of 25 and 84 years. A male predominance was noted (35/54). The main risk factors found were alcohol (5/54), tobacco (13/54), Helicobacter pilori (4/54), gastric ulcer (12/54). Epigastralgia was the most frequent clinical manifestation. FOGD was carried out in 77.8% of patients. Histology was obtained before surgery in 40 patients (74.1% of cases) and on the operating room in 14 patients (25.9%). Patients were classified as stage II in 2/54 cases, stage III in 5/54 cases and stage IV in 47/54 cases. Gastro-entero-anastomosis was the main surgical procedure performed. External radiotherapy was performed in 1/54 patients. Chemotherapy was done in 52/54 patients, 96.3% of the cases. It was palliative in 66.7% of cases, neoadjuvant in 1.9% of cases, adjuvant in 24.1% of cases, perioperative in 3.7% of cases. Mortality was 79.6%. Patient survival times were relatively short: in less than 6 months 24/54 cases, 13/54 cases between 6 - 12 months, 5/54 cases between 13 - 24 months and 6/54 cases beyond 24 months. 6/54 patients were lost from view. Conclusion: Gastric adenocarcinoma is diagnosed lately in our conditions. It is responsible for a high mortality rate. Palliative treatment is often the only option because of the delay in diagnosis.

Management of Phylloid Sarcomas: A Retrospective Study of 12 Cases

Background: Phylloid sarcomas are rare. There is not enough data to codify the management. Objectives: The objective was to study the clinical and therapeutic aspects and the fate of patients after a follow-up of at least 4 years. Thus contributing to the limited body of knowledge on these tumors. Methods: a retrospective analysis of the files from 2013 to 2017 was carried out and patients were followed up until 2021at Hassan II Hospital. Epidemiological, clinical and therapeutic aspects were studied. Survival was calculated using the Kaplan-Meier method. Results: We collected 12 charts of patients treated for phyllodeal sarcoma from 2013 to 2017. The median age was 43 years. The circumstance of discovery was marked by the presence of nodule in all patients. The coupled echo-mammography examination classified the nodules, ACR 4 in 7 patients and ACR 3 in 3 and ACR 5 in 2 patients. Histological examination revealed a phylloid sarcoma in 11 patients and a borderline phylloid tumor in 1 patient. All patients had radical surgery with positive margins in 2 patients, 16.66%. One patient had revision surgery. Histological examination of the surgical specimens showed phylloid sarcoma on all specimens. All patients had adjuvant radiotherapy with doses of 50 Gy in 25 fractions of 2 Gy and a boost of 10 Gy was done in one patient. The median spread of radiotherapy was 37 days. Grade 1 and 2 skin toxicities were noted in 5 and 3 patients respectively. The median time from surgery to radiotherapy was 2.95 months. 3 patients relapsed after 13.6 months of follow-up. The recurrence-free survival at 1 and 3 years was 83% and 75% respectively. Overall survival at 3 and 5 years was 83% and 75% respectively. Conclusion: This is a rare entity which requires randomized trials to codify its management. It would seem that the multidisciplinary approach, associating surgery ± radiotherapy, is a good option.