Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Background: The therapeutic standard for oligoprogressive prostate cancer resistant to castration is second-generation hormone therapy. This systemic treatment is expensive. There are oligoprogressive lesions accessible to radiotherapy. Objectives: To study the impact of radiotherapy of oligoprogressive lesions on the implementation of second generation hormone therapy. Patients and Methods: A retrospective study from 2012 to 2020 was carried out. All patients with oligoprogressive prostate cancer who had received radiotherapy on one or more lesions in progression were collated. Survival was calculated using the Kaplan-Meier method. Results: 8 patients were treated with stereotactic and conformational radiotherapy between August 2012 and August 2020 in the context of oligoprogressive prostate cancer resistant to castration. The median age at diagnosis of oligoprogression was 73 years with a median PSA level of 3.11 ng/ml. Nine lesions were diagnosed with PET scan PSMA. All the lesions were treated by radiotherapy with different regimens. After a median follow-up of 12.5 months, 7 patients showed a biochemical response to treatment with a median decrease in PSA of 67%. The median survival without clinical or biochemical progression was 7 months. The median survival without the need for further systemic treatment was 9 months. During the follow-up period, six patients received second-generation hormone therapy to treat their relapse, and the other two showed no clinical or biochemical relapse. Conclusion: Radiotherapy may be an alternative to delay the introduction of difficult-to-access second-generation hormone therapy in developing countries. A prospective study could validate this therapeutic approach.

Radio-Chemotherapy in Pre-Operative Rectal Adenocarcinoma at Dalal Jamm Hospital, Senegal

Background: Radiation therapy is an essential treatment for rectal cancer. In 2018, Senegal experienced a transition from two-dimensional to three-dimensional radiotherapy (RC3D). We are evaluating for the first time the impact of this RC3D in the treatment of rectal cancer in Senegal. Objective: To describe the epidemiological, clinical and diagnostic profile of rectum cancer in Senegal, to list the different radiotherapy techniques used, to evaluate the response as well as the outcome of patients. Method: We conducted a retrospective descriptive study on preoperative radio-chemotherapy of rectal adenocarcinoma at the Dalal Jamm University Hospital in Dakar from July 2018 to June 2020. Results: The 42 patients included, including 18 men and 24 women (Sex Ratio: 0.75), had an average age of 55.9 years. We found a family history of CRC (Colorectal cancer) in 7 cases and smoking in 5 cases. The clinical signs were dominated by rectal bleeding, noted in 92.8% of cases, with or without pain, and changes in transit in 57.1% and 50% respectively. The tumor was perceptible on digital rectal examination (DRE) in 76.1%. All patients had undergone endoscopy, which revealed a budding aspect in 69% of cases. The preferred location was the lower rectum (59.5%). The predominant histological type was liberkhunian adenocarcinoma (85.7%). T3 and T4 tumors accounted for 30.9% and 21.4% of cases respectively and stage III was predominant, 69%. The aim of radiotherapy was curative in 33 patients and palliative in 9 patients. Curative radiotherapy was preoperative in 29 patients and adjuvant in 2 patients. RC3D was the technique used in all our patients and the total dose of 50.4 Gy in 28 sessions of 5 days per week was the most used (69%). The incidents noted during radiotherapy were 12 cases of radiodermatitis, 15 cases of diarrhea, and no severe toxicity was noted. Thirty-one patients underwent surgery, 16 with anterior resection of the rectum and 3 with total proctectomy;the sphincter preservation rate was 61.2%. The surgical resection was carcinological (R0) in 26 patients and microscopically incomplete (R1) in 5 patients. Post-operative evaluation of the pathological specimen showed a complete histological response in 21% of cases. The evolution was marked by a progressive disease in 4 cases, local recurrence in 3 cases, metastatic recurrence in 4 cases, death in 8 cases and remission in 23 cases. The average follow-up of our patients was 17.3 months. Conclusion: Rectal cancer is diagnosed late in Senegal;surgery remains the cornerstone of treatment. Radiotherapy increases the resectability and local control.

Conformational Radiotherapy of Prostatic Adenocarcinoma at the Dalal Jamm Hospital, Senegal—(Retrospective Analysis of a Series of 62 Cases)

Aim: We endeavored to describe the epidemiological profile of prostatic cancer, and to evaluate its diagnostic and therapeutic aspects. Method: We conducted a descriptive retrospective study on the conformational radiotherapy of prostatic adenocarcinoma at the Dalal Jamm University Hospital, Senegal from June 2018 to December 2019. We included 62 consecutive patients. The average age of the patients was 68.9 years. The average consultation time was 7.6 months. Results: Symptom manifestation and high PSA triggered the diagnosis of cancer in 74.2% and 25.8% of patients, respectively. Symptoms: pollakiuria (72.3%), bone pain (8%) and erectile dysfunction (4.8%). The digital rectal examination: normal (33.8%), nodular (30.6%), induration (24.1%), and shielding (11.3%). The mean PSA level was 90.6 ng/ml. Histology: adenocarcinoma was the most common (98.6%). The Gleason score: <7 (45.1%), =7 (35.5%), and >7 (19.4%). The majority of patients were in the high-risk group (70.9%) and 7 patients (11.2%) were metastatic at diagnosis. Therapy: first radical prostatectomy (20.9%), first-line curative radiotherapy (67.8%), adjuvant (21%) and palliative radiotherapy in 7 patients (11.2%): patients having received palliative radiotherapy had an estimated decline in symptoms of 80%. Hormone therapy was performed in 88.8% of patients, with average duration of 12.5 months. After a mean follow-up of 15 months, 59 patients were alive, including 45 cases (81.8%) in complete remission;3 patients with metastasis at the first visit (having received palliative radiotherapy) died. Conclusion: The collected data show a profile of prostate cancer that is specific to the sub-Saharan context in which the discovery is still late. Also in comparison to developed countries, the therapeutic means necessary to fight against this cancer are limited, even though three-dimensional conformational radiotherapy remains an effective and essential treatment;this study provided fundamental data in the area of insufficient data/tools.

Nasosinus Metastases from Breast Cancer: A Review of Two Cases

Context: Breast cancer affects more than 2 million women a year worldwide. Improved treatments have made it possible to increase survival rates with more and more patients having time to develop secondary locations. Nasosinus metastases from this cancer are rare. Two recently treated breast cancer patients developed metastases to the sphenoidal and maxillary sinuses. These cases gave rise to an examination of the incidence of this disease, its diagnosis, the therapeutic means envisaged and the fate of these patients. Method: We report the diagnostic and therapeutic data of two patients suffering from breast cancer and presenting metastases at the nasosinus level, with a focus on the interest of radiotherapy in palliative care. Results: The two patients aged 56 and 60 presented in the course of their breast cancer secondary localizations in the sphenoidal and maxillary sinus confirmed by endoscopy and histology. All the cases presented massive lesions associated with other secondary bone locations in particular. After local radiotherapy and systemic chemotherapy treatment, one patient died 5 months after her diagnosis and the other was alive 16 months later. Conclusion: Nasal and sinus metastases from breast cancer are rare and have a poor prognosis as disseminated disease, they do not respond well to conventional systemic therapies even if palliative radiotherapy allows local control.

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.

Sexual and Urinary Disorders after Treatment of Rectal Cancer by Radiotherapy and Surgery at the Dantec University Hospital of Dakar

We performed a descriptive retrospective study of sexual and urinary disorders after treatment of rectal cancer by radiotherapy and/or surgery at the Dantec University Hospital in Dakar from 2008 to 2015. The objective of the study was to evaluate these sexual and urinary complications and the factors influencing it. We have collected 50 patients. The average age of is 55.7 years with a sex ratio of 0.78. The dominant clinical signs are rectorrhagia (66.0%). Endoscopy (94.0% of patients) showed an ulcerative-budding appearance in 84.0% of cases. The preferred location was the lower rectum 66.0%). The predominant histologic type is adenocarcinoma lieberkunien (82.0%). Computed tomography is performed in 78% of cases and MRI in 30%. Stage III accounts for 70.0% of cases. Thirty-two patients (64.0%) were treated with conventional 2-beam 2D radiation therapy with or without chemotherapy. The total dose of 46 Gy in 23 sessions was the most used, found in 22 patients;30 Gy in 10 sessions in 9 cases. And 16 Gy in 10 sessions, found in 1 case. Surgery performed was abdominoperineal amputation (58.0%) and conservative surgery (42.0%). We note a complete response in 28.0% of patients;8.0%, an increase of 16.0% and a stabilization of 4.0%. The sexual disorders are more important after radiotherapy compared to non-irradiated patients: 31.3% vs 5.6% (p = 0.035). We observe respectively that 2%, 6% and 8% of our patients had urinary disorders in the form of acute retention, urinary incontinence, and urinary burning. Patient follow-up time was between 0 and 42.83 months with an estimated average of 34.9 ± 3.37. The evolution is marked at 6 months by a persistence of sexual disorders in 63.8% of cases and urinary dysfunction in 4% of cases.

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.