The aim of this retrospective study is to detennine prognostic factors for response to CT and survival, in patients (pts) treated with neoadjuvant CT and radiotherapy (RT) for locoregionally advanced non-metastatic NPC. From February 1988 to December 1992, 100 untreated pts received 3 courses of CT regimen with Cisplatin 100mg/m2 Day l and Adriamycin 30 to 50mg/m2 Day l for group I (36 pts), 50 to 75mg/m2 for group II (39 pts) and 75 to 90mg/m2 for group III (25 pts), repeated every 3 weeks, followed by locoregional RT. Response was assessed after 1 cycle of CT, before and after RT, by the measurement of node areas. Pts characteristics: 70% were men, median age 36.6 years (11–66 yrs); T1T2=26 pts, T3=25, T4=49, N2=39, N3=61; histology; UCNT=64, non-UCNT=36. All characteristics were well balanced in the 3 groups. The mean response rate after I cycle was 54.9%, after 3 cycles 78.8%. After RT, we observed 83% of CR, 14% PR and 3% of failure. Twenty seven pts relapsed. With a mean follow up of 27 month, the 3-yrs overall survival (OS) was 73.5% and disease free survival (DFS) 64.2%. Age, sex, node area, histology, T, N, Adriamycin dose-intensity, clinical response to CT, duration of RT and delay between CT and RT were variables studied in univariate and multivariate analysis (Cow model). In univariate study, the factors influencing significatively as and DFS were response after 3 cycles of CT (P<0.05) and response after RT (P<0.02), the age was significant only for DFS (P<0.03). The only variable influencing the response rate to CT was Adriamycin dose-intensity (P<0.05). In multivariate study, only the response rate to CT influence the survival (P<0.02).

Within a multifactorial etiology of cancers and a bio-psycho-social approach of patients, considering, among the risk factors, those related to personality in a preventive view, the authors investigate, by an epidemiologic methodology, for a correlation between break-down phenomena and the development of a cancer. The study was carried out at the Salah Azaiez Institute in 1992 and included 707 patients aged from 15 to 82 years, 44% presenting a malignant tumour. For a retrospective evaluation of break-down semiology, the study is based on DSM-III criteria of break-down diagnostic. Search for a clinic/psychic diagnostic relation reveals the difficulty of coexisence between break-down signs and the development of a cancer. That difficulty increases in case of an organised break-down.

Although GTD is uncommon, it is extremely important because of the high degree of curability with adapted treatment. It is becoming important to preserve young patients (pts) fertility. We reviewed the productive history ofall pts who received chemotherapy (CT) for a GTD at ISA, between January 1982 and December 1993. Only 34 pts had subsequent pregnancies: 19 had molar pregnancies (MP) and 15 choriocarcinomas (CC). The mean age was 27 years (range 17–38). Pts with CC received a combined regimen of CT with Vincristin and Methotrexate 9 pts and Etoposide and Actinomycin 6 pts. All those with MP were treated by a CT associating (Methotrexate and Vincristin). All of them entered a complete remission, 7 after a salvage CT.MP n=15CC n=19Number of pregnancies2829Normal term pregnancies1823Spontaneous abortion31Ectopic pregnancy01Placenta Acreta00Premature birth11Congenital malformations33

CT is the mainstay of treatment in UCNT but the chronologic order of administration should be discussed (adjuvant or neoadjuvant). In this study, we report 61 cases of non-metastatic UCNT registered in ISA from 1981 to 1987. All patients (pts) had a locoregional radiotherapy followed by a CT with different combined regimen: Adriamycin + Bleomycin + Cisplatin = 19% of pts, Vincristin + Bleomycin + Cisplatin = 32%, Vincristin + Cyclophosphamide + Bleomycin = 19% and 30% had regimen containing nitrosourea. Pts characteristics: median age = 18.8 years (range 9–41); 36 males and 25 females; staging: T1T2 = 19 pts, T3 = 4, T4 = 38, N0 = 4, N1 = 6, N2 = 36, N3 = 13, Nx = 2. Survival: 5-years overall survival = 85.3% and disease free survival = 71.7%. An univariate analysis of prognostic factors has been made (age, sex, T, N, CT with or without Cisplatin and duration of CT more or less 6 months). Only one variable has found to be nearly statistically significant (P = 0.07), it is the duration of CT. CT is the mainstay of treatment in UCNT but the chronologic order of administration should be discussed (adjuvant or neoadjuvant). In this study, we report 61 cases of non-metastatic UCNT registered in ISA from 1981 to 1987. All patients (pts) had a locoregional radiotherapy followed by a CT with different combined regimen: Adriamycin + Bleomycin + Cisplatin = 19% of pts, Vincristin + Bleomycin + Cisplatin = 32%, Vincristin + Cyclophosphamide + Bleomycin = 19% and 30% had regimen containing nitrosourea. Pts characteristics: median age = 18.8 years (range 9–41); 36 males and 25 females; staging: T1T2 = 19 pts, T3 = 4, T4 = 38, N0 = 4, N1 = 6, N2 = 36, N3 = 13, Nx = 2. Survival: 5-years overall survival = 85.3% and disease free survival = 71.7%. An univariate analysis of prognostic factors has been made (age, sex, T, N, CT with or without Cisplatin and duration of CT more or less 6 months). Only one variable has found to be nearly statistically significant (P = 0.07), it is the duration of CT.

The authors report their experience of pleural talcage under thoracoscopy in 21 cases of lymphomatous pleurisy. This represents 9.6% of the total number of cancerous pleurisies treated with talc over four years. A successful result with talcage was achieved in 84% of cases.The success or failure of talage seems to depend on the macroscopic appearance (the existence of masses or nodules) as well as an abundance of pleural liquid, all constitute unfavorable factors. On the other hand the lymphoma (Hodgkins or non Hodgkins) does not seem to have any unfavourable effect.

Between 1981 and 1985, the authors studied 21 Tunisian patients with alpha chain disease. Twenty of 21 underwent laparotomy. According to Galian et al. six patients were classified Stage A, two Stage B, and 13 Stage C. The therapeutic regimen included the following: (1) Antibiotics: In the case of intestinal bacterial overgrowth (IBO), antibiotics selected by their antibiograms were delivered; in absence of IBO, metronidazole plus ampicillin were first given. The antibiotic treatment was changed in case of therapeutic failure. (2) Chemotherapy: From 1981 to 1983 a cyclophosphamide, Adriamycin (doxorubicin), teniposide (VM-26), prednisone (CHVP) protocol (Adriamycin 35 mg/m2, teniposide 50 mg/m2 day 2, cyclophosphamide 300 mg/m2 days 2 through 4, prednisone 40 mg/m2 days 1 through 10) was used. After 1983 bleomycin 15 mg, Adriamycin 30 mg, vinblastine 10 mg were given on day 15. Serum immunoelectrophoresis and immunohistochemical study of duodenojejunal specimens were made on a 3-month and 6-month basis, respectively. Survival curve analysis was made according to Kaplan and Meier. Results were as follows: (1) Stage A: Six patients were first treated by antibiotics alone; two complete responses (CR) persisting 42 and 55 months later were observed, respectively. The four antibiotic failures were submitted to further chemotherapy with four subsequent failures and two deaths. (2) Stage B-C: Chemotherapy led to nine CR with one precocious relapse, a salvage chemotherapy allowing to one more CR. (3) All stages mixed, percentage of survival reached 90 +/- 12% at 2 years and 67 +/- 25% at 3 years, all patients alive beyond 3.5 years being disease-free.