Curative 3D Conformal Radiotherapy of Non-Operated Prostate Adenocarcinoma at Pointe-a-Pitre University Hospital (Guadeloupe): About 29 Cases

Context: Technological advances have improved the toxicities of radiotherapy. We are evaluating the 3D technique in prostate cancer. Materials and Methods: Retrospective study from January 2015 to December 2015 with 29 files. Survival was calculated by Kaplan-Meier method. Results: We collected 29 patient records over the study period. The median age was 75 years with the following extremes: 54 years and 83 years. The median PSA level was 12 ng/ml with a range of 3.05 to 79 ng/ml. Gleason score analysis showed 6 patients (20.69%) with a score of 6 (3 + 3), 23 patients (79.31%) with a score of 7 including 12 patients (41.38%) with grade 3 and 11 patients (37.93%) with grade 4. The median dose delivered was 74 Gy, with a mean dose of 73.79 Gy and extremes of 70 Gy for the minimum and 76 Gy for the maximum. Hormone therapy was combined with radiotherapy in 17 patients (58.62%). Seven patients (24.14%) had grade 1 acute bladder toxicity and one patient (3.45%) had grade 2 acute toxicity. Late bladder toxicity was grade 1 in 5 patients (17.24%), grade 2 in 3 patients (10.34%) and grade 3 in 1 patient (3.45%). Late rectal toxicity, grade 2 in 3 patients (10.34%), grade 3 in 1 patient, was noted. Overall survival at 2 years was 100% and 89.65% at 5 years. Relapse-free survival at 2 years was 82.76% and 62.07% at 5 years. There were 3 deaths (10.34%) of which only one was related to prostate cancer. Conclusion: Radiotherapy, like surgery, is a fundamental option for the treatment of prostate cancers, particularly those that are locally advanced. It is gaining in importance with the improvement of techniques (IMRT, VMAT…) and new fractionations which contribute to the reduction of toxicities and the comfort of patients (shorter spread).

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.

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.

A Shoulder Mass Revealing a Metastatic Prostate Cancer

Introduction: A shoulder mass revealing metastatic prostate cancer is very rare. We report a case of metastatic prostate cancer diagnosed on a shoulder mass and treated with analgesic radiotherapy and chemotherapy and androgen deprivation therapy (ADT). Observations: A 66 years old patient was referred for a painful right shoulder mass whose biopsy and pathological examination found a Gleason 8 (4 + 4) moderately differentiated adenocarcinoma. The PSA level was 508.52 ng/ml. The patient was treated with analgesic radiotherapy on the right shoulder and chemo-hormonal therapy. At 2 years follow-up, the disease was well controlled. Conclusion: A shoulder mass revealing metastatic prostate cancer is not common. Local treatment of the symptomatic metastasis while continuing chemotherapy and ADT improves the quality of life.

Epidemiological, Diagnosis, Therapeutic and Evolving Profile of Triple Negative Breast Cancer in Senegal

Objective: Describe the epidemiological, diagnostic, therapeutic and evolutionary profile of triple negative breast cancer at the Dakar Cancer Institute in Senegal. Patients and Methods: This was a retrospective study between January 1, 2011 and December 31, 2014. All patients with a triple negative molecular profile were included. The data were collected from the medical records of the patients. The data were entered and analyzed with SPSS edition 16 software under Windows 7. Results: Two hundred and twenty-five patients were selected. The mean age was 47.9 ± 12.5 years with extremes of 25 and 90 years. The main reason for consultation was dominated by the finding of a breast lump. The mean clinical tumor size was 8, 54 cm with a large majority of T3-T4 tumors 26% and 63% respectively, lymph node involvement in one hundred and seventy-two cases (76.4%);twenty eight patients (12.4%) were metastatic from the outset. Non-specific invasive carcinoma was the most common histologic type (78.2%), and more than half of the patients (53.3%) had an aggressive tumor (Scarff-Bloom-Richardson grading III). Neoadjuvant chemotherapy was performed in 65.78% of cases. We noted 27.7% total response and 41.7% partial response in patients who have received this neoadjuvant chemotherapy. The surgery was radical in 77% of cases, conservative in 14% and cleanliness surgery for palliative purposes in 9% of cases. Adjuvant radiotherapy is performed in 58.6% of operated patients. The mean time to follow-up was 20.63 months with extremes of 1 and 53 months. Overall survival was 69.8% at one year, 41.6% at two years and 25.6% at three years. Conclusion: The descriptive analysis of these results confirms the high frequency of triple-negative breast cancer in Senegal and its poor prognosis.

Radiotherapy of Esophageal Carcinomas at the Dantec University Hospital of Dakar from 2010 to 2015

We performed a descriptive retrospective study of radiotherapy of esophageal carcinomas at the Dantec University Hospital in Dakar from 2010 to 2015. The aim was to describe the type of patient, and to evaluate the indication and the results of the irradiation. We consulted 117 cases and selected 26 cases. The average age of patients is 46.1 years (Extremes 17 - 83 years and peaks 30-39 and 50 - 59 years). The sex ratio is 1.67. Smoking was reported in 38.4% of cases and alcoholism in 15.3%. Dysphagia is the predominant sign (100% of patients). The general condition is classified WHO 1 for 42.3% of cases. The tumor was localized in 61.5% in the lower third and is stenosing in 84.6% of our patients. Squamous cell carcinoma is the most common type (88.5% of cases). The size of the tumor, specified in 50% of cases, varies from 2.6 to 11.2 cm. Computed tomography is performed in more than 50% of cases. Endoscopic ultrasonography is not performed and surgical exploration has contributed to the staging of 7.7% of irradiated patients. The tumor is localized in 47.8% of cases;at an advanced stage in 52% and is metastatic in 4.3%. We note a transhiatal excision and a gastrostomy in 15% and 69% of the cases and no surgery of excision in healthy margin. Chemotherapy or neoadjuvant radiotherapy is not performed. The radiotherapy was: exclusive (11%), adjuvant after surgery in margin R2 (15%), palliative in 3 × 5 Gy per 3 week (4%) and concomitant with chemotherapy cisplatyl 5FU (70%). The spread ranges from 2 to 6 weeks. The partial and complete response rate is 38.4% and 11.5%. The stabilization is 30.7% and the progression is 19.4%. Grade I-2 toxicity was noted in 46.1% (asthenia, radiodermatitis, cough) and grade 3 radiodermite in 4%. The average follow-up time is 198.19 days with extremes of 2 days and 32 months.

Prognosis of Breast Cancer Patients Underwent Surgery in a Developing Country

Background: We aim to review different factors associated with the relapse and the mortality in breast cancer patients in restricted-resource settings over a five-year period. Method: A retrospective cohort study including 133 women underwent breast cancer surgery was performed at the Surgical Oncology Unit of the Conakry University Hospital in Guinea. Socio-demographical characteristics, clinical information, treatment and data on relapse and survival were retrieved from medical files. Predictor factors of relapse were analyzed by using univariate and multivariate logistic regression. Factors associated with mortality were analyzed by Kaplan Meier survival and Cox models. Results: Breast cancer surgery was conservative in 13 cases (9.8%) and radical in 120 cases (90.2%). Five-year relapse was 33.8% ± 8.0% and the predictor factors of this relapse were age and stage III (p = 0.005). The overall 5-year mortality was 42.1% and the risk factors independently associated with death were body mass index (p = 0.01), origin of patients (p = 0.02), radiotherapy (p = 0.01) and cancer relapse (p = 0.001). Conclusion: The proportions of relapse and death were higher in breast cancer patients. The age and the stage of cancer at the time of surgery were the predictor factors of relapse. Body mass index, origin of patients, radiotherapy and cancer relapse were associated with death.

Establishment of Local Diagnostic Reference Levels in Conventional Radiography: A Pilot Study in Dakar, Senegal

Diagnostic Reference Levels (DRLs) are indicators that allow assessing the quality of equipment and procedures from the point of view of the doses delivered to patients and subsequently initiate corrective actions if necessary. The purpose of this study is to encourage health professionals to investigate patient radiation doses and to determine whether those doses comply with the principles of radiation protection in medical fields so as to improve practices by reducing patient exposure without reducing clinical effectiveness. To perform this work, we have investigated patient doses for different radiological examinations from six (6) medical centers in Dakar, including the following nine routine types: chest (PA), abdomen (AP), pelvis (AP), cervical spine (AP), lumbar spine (AP, Lat), hip (AP), thoracic spine (AP, Lat). Three types of data were collected, i.e., X-ray tube machine data, patient data and output measurements. The data were analyzed statistically and the median, minimum, maximum, and third quartile values were calculated and displayed throughout boxplots graphs for all exams and medical centers. The two sigma range (95% confidence interval) was also checked. Comparison of third quartiles of Entrance Surface Dose (ESD) and Dose Area Product (DAP) by type of examination with recommended international DRLs was performed. The third quartile of ESD for pelvis (AP) and thoracic spine (AP) was up to 16% and 38% higher, respectively than their corresponding DRLs in the European Commission Report RP 180 Part 2. For all exams, except thoracic spine (lat), the third quartiles of the dose area product were higher than the corresponding DRLs in the above report. The source of dose variability between medical centers was related to many parameters such as poor radiographic techniques, lack of modern X-ray machines and adequately documented radiation protection practices. The results show the need to develop protocols for dose measurement as well as to carry out quality assurance programs and dose optimization in Senegal.