Objective of the Study: The objective of this study is to evaluate the side effects related to body image in men undergoing anti-androgenic treatment. Materials and Methods: This is a prospective study conducted over a six-month period between January and June 2023, including 150 patients followed for prostate cancer and still under anti-androgenic hormone therapy, with post-therapeutic monitoring consultations every three months. We asked the patients to report all side effects related to body image and to rate each effect on a scale from 0 to 10, with 0 being no discomfort and 10 being extreme discomfort. Correlations were analyzed using Pearsons correlation coefficient. Results: The age of the patients ranged from 49 to 75 years, with a median age of 68 years. The diagnosis of high-risk prostate cancer was made in all patients based on PSA levels, histopathological study, and/or clinical and radiological TNM classification. Hormone therapy (Triptorelin 11.25 mg or Goserelin 10.8 mg every three months) was started six months prior as neoadjuvant to local radiotherapy. The total duration of hormone therapy was 2 years for all patients. Seventeen patients, or 11.33%, reported the occurrence of gynecomastia between 8 and 14 months after the start of hormone therapy, with an average discomfort of 5.9/10. Sixty-five patients, or 43.33%, noted weight gain starting from the 6th month of hormone therapy, with an average discomfort of 6.3/10. Fifty patients, or 33.33%, reported a reduction in penis size, with an average discomfort of 9.5/10. All patients were informed about these side effects before starting treatment. None of the patients received any medical or other treatment besides the ongoing hormone therapy. The reduction in penis size was correlated with the discomfort felt. No other significant correlation was found. Conclusion: Managing the side effects of hormone therapy is crucial to improving the quality of life for patients and optimizing therapeutic adherence. It is essential to inform these men about these potential effects, especially since there is no treatment available to mitigate some of these effects.

The occurrence of brain metastases from endometrial cancer is a rare phenomenon. Despite the poor prognosis of this presentation, offering the patient curative ablative treatment, when possible, improves significantly the prognosis and quality of life. We report in this work the case of a 61-year-old female patient, treated in 2024 for endometrial cancer initially considered to be endometrioid type classified at stage II according to the FIGO 2023 classification, with a grade 3 and presence of vascular emboli. 8 months after her diagnosis, she developed an isolated brain metastasis, without other secondary distant locations. The revelation of this metastasis made it possible to adjust the initial histological diagnosis of endometrial cancer to carcinosarcoma. Our patient was treated by total surgical excision followed by stereotaxic irradiation of the surgical bed at a dose of 27 GY in 3 fractions, with good clinical tolerance. A summary of previous studies and recommendations on the treatment of brain metastases from endometrial cancer was presented.

Introduction:Endometrial cancer is the third gyneco-mammary cancer in the radiotherapy-brachytherapy department of the RABAT national oncology institute.Brachytherapy has an important place in the therapeutic strategy. The objective of the study:Is to analyze the coverage of target volumes as well as the dose to organs at risk with three-dimensional dosimetric planning and toxicity assessment. Material and methods:This is a retrospective study of 60 cases of operated endometrial cancers treated by high dose rate brachytherapy without external radiotherapy or chemotherapy collected in the radiotherapy department of the National Institute of Oncology RABAT between January 2018 and December 2020. A dosimetric scan without injection was performed at the first session and was used to delineate the clinical anatomic target volume (CTV). We evaluated the D100 of the clinical target volume and the D2 cm3 of the bladder, rectum and small intestine. We also analyzed acute genitourinary and gastrointestinal toxicity. Results:The average age of the patients was 49 years. Endometrioid carcinoma accounted for 98.5%, with one case of mucinous carcinoma. All patients underwent surgery.The brachytherapy protocol used was 3 × 7 Gy (75%) or 4 × 5.5 Gy (17%) in weekly sessions A single patient received a reduced total dose of 19.8 Gy in 3 fractions of 5.5 Gy due to a high rectal dose.The average target volume coverage (D100) was 96.50%.The average D2 cm3 per session received by the bladder, rectum and small intestine were 4.06 Gy, 4.9 Gy and 2.8 Gy, respectively.Regarding genitourinary toxicity, we noted two grade 1 cystitis, one grade 2, two grade 1 mucositis and one grade 2.For gastrointestinal toxicity, no cases of grade greater than 1 were noted.No grade 3 or 4 toxicities were recorded. Conclusion:High dose rate brachytherapy has an important place in the therapeutic strategy for endometrial cancer.The very low toxicity recalls the good tolerance of this treatment whichapplies to the entire population.

Introduction Patients diagnosed with head and neck cancers (HNC) are highly susceptible to malnutrition, with initial rates ranging from 35% to 60%, which can further worsen during treatment, leading to significant weight loss in up to 80% of patients. Malnutrition often remains undetected, contributing to increased morbidity, mortality, and healthcare expenses. This study sought to evaluate the nutritional status of patients with head and neck cancer receiving radiotherapy and investigate its relationship with factors related to the disease and treatment.  Materials and Methods The study is a longitudinal observational research involving 31 patients who were treated at the Radiation Oncology Unit of the National Institute of Oncology in Rabat, Morocco, between October 2023 and March 2024. Patients underwent radiation therapy using the Volumetric Modulated Arc Therapy (VMAT) technique, either alone or in combination with chemotherapy. Data, including anthropometric measurements, PG- SGA assessments, and RTOG criteria evaluations, were gathered at the start of treatment, at the end of treatment, and three months after the treatment ended.  Results The cohort consisted of 28 males and 3 females, with a mean age of 56 ± 8 years. The majority of tumors were located in the larynx (32%) and nasopharynx (30%), with 78% of patients presenting with stage III or IV cancer. Initially, 88% of patients were well- nourished; however, by the end of treatment, 79% were malnourished. The average PG-SGA score rose from 2.8 to 11.3. There was a marked decrease in food intake, with only 40.2% of patients consuming more than half of their meal portions by the end of treatment. Weight loss occurred in 85% of patients, with 27% experiencing a loss of over 10% of their initial body weight. Patients with advanced-stage cancer, oral cavity and pharyngeal cancers, and those undergoing chemo-radiotherapy were more likely to be malnourished. Higher radiation doses were associated with increased pain and swallowing difficulties.  Conclusion Radiotherapy significantly worsens the nutritional status of HNC patients, particularly by the end of treatment. The most severe nutritional declines were observed in patients with oral cavity and pharyngeal cancers, advanced-stage disease, concurrent chemotherapy, and higher radiation toxicity. Incorporating routine nutritional assessments into clinical practice and assigning dedicated staff for these evaluations could enable timely nutritional interventions.

The prognosis of breast cancer has significantly improved in recent years thanks to advances in therapeutic options. Quality of life is increasingly recognized as a fundamental criterion in evaluating treatment outcomes. This highlights the particular impact on sexuality. Our objective is to evaluate the sexual well-being of Moroccan individuals undergoing treatment for non-metastatic breast cancer. This is a retrospective study involving a series of 230 sexually active patients treated for breast cancer at the Radiotherapy Department of the National Institute of Oncology in Rabat between January 1, 2022, and July 31, 2022. Sexual function was assessed during the end-of- treatment consultation using the Relationship and Sexuality Scale (RSS).The mean age of the patients was 47.24 years with a range from 32 to 65 years .Surgical treatment was radical mastectomy in 44% of instances, conservative lumpectomy was performed along with axillary lymph node dissection in 56% of cases.. The majority of patients (85.2%) received chemotherapy. More than half of the participants (71%) received adjuvant hormone therapy. Hormone therapy consisted of tamoxifen in 67.3% of cases and aromatase inhibitors in 32.7%. In terms of sexual dysfunction, more than half of the patients (61%) reported impaired sexual functioning. Specifically, the frequency of sexual intercourse and sexual desire (RSS 3 and RSS 4) decreased in 54% and 43% of our patients, respectively. In 65% of patients (measured by RSS 8 and RSS 13), dissatisfaction was noted concerning the emotional relationship dynamics within the couple. Regarding apprehension regarding sexual intercourse, 23% of patients reported experiencing such fear. Therapeutic management appears to have an impact on sexual function in patients with breast cancer. It is important to consider these disorders during management given their frequency and their impact on quality of life, even remotely from treatment and in the absence of any signs of disease progression.

Introduction Brain tumors, defined by the abnormal proliferation of anaplastic cells within the brain meninges or cranial nerves, remain significant contributors to morbidity and mortality despite advances in imaging techniques like MRI, PET, and SPECT, and neuro-oncological therapies. Histological types of these tumors vary by age. This study aims to outline the epidemiological and histological profiles of central nervous system (CNS) tumors at the National Institute of Oncology in Rabat, Morocco.  Materials and Methods A retrospective descriptive study was conducted on patients treated at the radiotherapy department from November 2018 to October 2021. Parameters such as age, sex, primary clinical signs, tumor origin for secondary lesions, tumor location, and histological types were analyzed.  Results 182 cases of CNS tumors were recorded, with a median patient age of 43 years (range 8-73 years). Women represented 73.2% of the cases, and children made up 8.5% of the study population. The most common symptoms at diagnosis were headaches (68.3%), decreased visual acuity (28%), and nausea/vomiting (24.4%). Tumors were mostly located above the tentorium (80%). Of the tumors, 49% were secondary, primarily originating from the breast (58.6%) and lungs (46%). Glioblastoma was the most common primary tumor (39.1%), with a mortality rate of 55%. Multidisciplinary care is crucial for addressing the challenges posed by this serious prognosis.  Conclusion CNS tumors are uncommon in Morocco and are generally observed in adults, mainly secondary to breast cancer. Glioblastoma is the most frequent primary tumor. Effective multidisciplinary approaches are necessary to manage these complex cases.

The objective of the study: The aim of our study was to highlight the anatomical and physiological changes of the vagina after external radiotherapy and brachytherapy in cervical cancer. Materials and Methods: This was a prospective descriptive study conducted over a period of 6 months, from March to August 2022. A total of 123 women with cervical cancer, treated with concurrent radiochemotherapy and uterovaginal brachytherapy, who reported having had sexual intercourse in the six months prior, were included in the study. Patients were interviewed and examined during post-therapeutic follow-up consultations. Results and Statistical Analysis: The age of the patients (n=123) ranged from 33 to 67 years, with a mean of 49.35 ± 9.84 years. The post-therapeutic follow-up duration ranged from 6 months to 7 years. The most common histological type was squamous cell carcinoma, and the most common FIGO stage was stage II. Treatment consisted of concurrent radiochemotherapy and uterovaginal brachytherapy. Interviews revealed several changes related to the vagina after treatment. More than 65% of patients (n=81) reported the onset or worsening of vaginal dryness, over 50% (n=63) reported the onset or worsening of dyspareunia. Nearly 70% (n=83) reported a decrease in sexual desire frequency or dissatisfaction, and over 60% (n=78) became indifferent to sexual life. Gynecological examination revealed a vaginal length ranging from 2 to 10 cm with a mean of 5.66 ± 2.09 cm, the presence of synechiae and/or stenosis in nearly 43% (n=53), and bleeding in nearly 40% (n=47). In univariate analysis, vaginal dryness and dyspareunia significantly increased with age. Resumption of sexual activity was slower in younger and older women. Among patients followed for two years or less, there was a significant increase in synechiae or stenosis, as well as bleeding. Conversely, the prevalence of vaginal dryness and dyspareunia increased with follow-up duration, especially in those exceeding two years. In groups with vaginal dryness or dyspareunia, a large proportion of patients reported a decrease in sexual desire and indifference to their sexual life. Conclusion: This study revealed that patients with cervical cancer experienced significant anatomical and physiological changes in the vagina after treatment with concurrent radiochemotherapy and uterovaginal brachytherapy, leading to chronic sequelae and sexual disorders. It is therefore essential to implement measures to prevent or limit certain side effects associated with these treatments.

Introduction and Aim of the Study:When a child or adolescent is diagnosed with cancer, it represents a challenging ordeal that often brings significant changes to their daily life. School is an important concern for young patients, but a cancer diagnosis usually leads to school disruptions. The aim of our study is to evaluate the impact of radiotherapy treatment on the schooling of children and adolescents affected by cancer. Materials and Methods:This is a prospective study conducted in the Radiotherapy Department of the National Institute of Oncology in Rabat from January 2022 to December 2022, including 40 children and adolescents aged between 6 and 16 years undergoing radiotherapy or concurrent radiochemotherapy treatment for cancer. Results:The median age of our patients was 10 years, with a predominance of males (sex ratio = 2). The most common neoplasms were malignant hemopathies (35%), nasopharyngeal carcinoma (20%), soft tissue sarcoma (17.5%), brain neoplasms (15%), and others (nephroblastoma , neuroblastoma 12.5%).42.5% of the patients had previously received chemotherapy alone, 30% had chemotherapy plus surgery, and 27.5% had surgery alone.During our study, all patients received either radiotherapy alone (80%) or concurrent radiochemotherapy (20%). The average number of sessions was 22, held daily from Monday to Friday.All our patients were attending school before their diagnosis. However, 96% discontinued school at the start of their treatment, with only 4% continuing to attend school. The heaviness of the treatments received and their side effects are the main cause of school discontinuation. The distance between the treatment location and the patients home was also factor for patients undergoing radiotherapy. Conclusion:The discontinuation of schooling for children and adolescents represents a significant disruption in their daily lives, potentially impacting their psychological well-being. Furthermore, feeling different from other children their age can be challenging for them. Therefore, it is important to offer an adaptation of their schooling with specialized education to enable their social development and well-being.

The coexistence of cervical carcinoma and pelvic kidney is uncommon. Given that the pelvic kidney occupies the traditional radiation field for cervical carcinoma, treating these patients with radiation poses a therapeutic dilemma. We report the case of a 72 years old patient with stage IIIB cervical carcinoma with an incidental diagnosis of pelvic kidney was treated with radical chemoradiotherapy using volumetric-modulated arctherapy with concurrent weekly cisplatin.. At the 12-month follow-up, the patient was disease free and had no deterioration in kidney function. Volumetric-modulated arc therapy (VMAT) allowed for the precise delivery of high radiation doses in this particular case, while effectively sparing the kidney.

Introduction: Cerebral radionecrosis is a rare but a serious complication induced by radiotherapy of the nasopharyngeal cancer. Since nasopharyngeal cancer is common to have skull base infiltration, radiation fields cover inevitably the temporal lobes despite the use of the more advanced intensity-modulated radiotherapy (IMRT). Even though the development of imaging means and the systematic practice of CT and MRI in post-therapeutic monitoring, the diagnosis and treatment of cerebral remain challenging. Materiel and Method:A retrospective study including fifteen cases of cerebral radionecrosis occurring after radiotherapy of cavum cancer, based on data from 382 irradiated for cavum cancer during the period from January 2017 to January 2022 and who were regularly followed in post-therapeutic monitoring. Results: The incidence of cerebral radionecrosis in our patients was 3,9%. The average age of patients was 47.5 years (range 28 - 62 years), with a female predominance (sex ratio: 4M/11F = 0.36). All our patients were followed for locally advanced UCNT of the cavum (73% stage IVA and 27 % stage III). 80% of cases have benefited from conformal radiotherapy technique by intensity modulation (VMAT archtherapy). And all cases have had concomitant chemotherapy. Cerebral radionecrosis occurred after an average delay of 31.6 months (11-77 months) from the end of irradiation. The location of the cerebral radionecrosis lesions was temporal in all our patients. Exploring dosimetric data of our patients, we noted that in 58% of cases the dose constraint at the level of the temporal lobe affected by radionecrosis was not respected. Cerebral radionecrosis was initially discovered on MRI of the cavum, a brain MRI was subsequently requested to show areas of cerebral radionecrosis. Spectroscopy was carried out in 33% of patients. Cerebral radionecrosis was treated with corticosteroid therapy in 53% of cases. After a mean follow-up of 19.8 months (2-63 months) the evolution of cerebral radionecrosis in patients irradiated fornasopharyngeal cancer, was marked by radiological stability without the appearance of clinical symptoms in 53% of cases. Conclusion: Cerebral radionecrosis of radiation-treated cavum patients could be a devastating complication. Furthermore, the differential diagnosis remains challenging and may require the use of advanced imaging modalities. The intricate relationship between dose parameters and radionecrosis incidence requires large-scale longitudinal studies. Despite the fact that there is no definitive treatment for cerebral radionecrosis, bevacizumab has proven to be an encouraging treatment option.

Ewing's sarcoma of the prostate is a rare tumor. Treatment must be multimodal and involves surgery, chemotherapy and radiotherapy. We report an observation of an Ewing sarcoma of the prostatic compartment that was immediately metastatic in a 33- year-old patient and will discuss the diagnostic and therapeutic modalities.

Ledderhose’s disease, or plantar fibromatosis, is a rare benign condition characterized by the excessive proliferation of connective tissue in the plantar aponeurosis, leading to slow-growing nodules. Although it usually presents unilaterally, bilateral involvement occurs in about 25% of cases. The exact cause is unknown, but associations with diabetes mellitus, liver disease, and repeated trauma have been noted. Treatment options are diverse, with surgery often being the primary approach, but radiation therapy has emerged as a promising alternative. We present the case of a 70-year-old Moroccan man with a painful plantar nodule, diagnosed with Ledderhose’s disease. Initial measures were insufficient, leading to the use of radiation therapy. The patient received Three-Dimensional Conformal Radiotherapy (3D-CRT) at a dose of 30.0 Gy, administered in two courses. Following treatment, the patient experienced significant symptom relief and a notable reduction in nodule size. Although surgery was eventually required due to disease progression, it is noteworthy that radiation therapy effectively delayed the need for surgical intervention.

This study compares the dosimetric parameters of Volumetric Modulated Arc Therapy (VMAT) and Three-Dimensional Conformal Radiotherapy (3DCRT) in patients with synchronous bilateral breast cancer (SBBC). Five patients who underwent modified radical mastectomy and axillary lymph node dissection were included in the study. The plans for VMAT and 3DCRT were evaluated based on dose distribution and protection of critical organs at risk (OARs). The results indicate that VMAT provides superior target volume coverage and better protection of OARs compared to 3DCRT.

Study object : To report the experience of the external radiotherapy department of the RABAT National Institute of Oncology in the conformal irradiation of prostate cancers with intensity modulation of the volumetric modulated arc therapy (VMAT). Materials and methods: This is a retrospective study conducted in the external radiotherapy department between January 2017 and December 2021. All patients with prostate cancer were included. Those with immediate metastatic disease at the time of diagnosis were excluded. For 441 patients, respecting dose constraints in organs at risk of toxicity. VMAT was the technique used in all our patients. Results and statistical analysis: A total of 441 prostate cancer patients were treated in our department. The median age at diagnosis was 72 years, with an average consultation time of 8 months. Mean PSA: 59 ng/ml (range 5.03 to 403 ng/ml). Pelvic MRI was performed in 94% of patients. Three of our patients were classified as oligo-metastatic. The predominant histological type was ADK in 100% of cases. Tumors were classified according to the current Amico and NCCN classifications. Treatment consisted of a combination of external radiotherapy and hormone therapy in 97% of cases, and exclusive radiotherapy in 3% of cases. In terms of therapeutic tolerance, 66% of patients experienced acute toxicities of all kinds, and 45% of patients experienced late toxicities. Complete remission was achieved in 100% of patients, with a mean PSA Nadir of 0.09 ng/ml. Overall recurrence-free survival was 94%, with a relapse rate of 6%. Conclusion : VMAT is an effective technique for treating prostate cancer, with a better rate of locoregional control and reduced toxicity than 3D conformal radiotherapy.

Oral mucosal melanoma is a rare malignancy with the tendency to metastasize and locally invade tissues more readily than other malignant tumor of the oral cavity. It occurs approximately four times more frequently in the oral mucosa of the upper jaw usually on the palate or alveolar gingiva. The chameleonic presentation of malignant melanoma, its asymptomatic condition, rarity of the lesion, poor prognosis and the necessity of a highly specialized treatment are factors that should be seriously considered by the involved health care provider. We report a rare and interesting case of oral malignant melanoma of the upper gum, which was clinically and histopathologically diagnosed with a brief review of literature, has been discussed.

Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare yet clinically significant malignancy Originating from the Bartholin's gland, situated in the vulvar region, ACC exhibits unique histopathological features and clinical behaviors. In our article, we describe a clinical case involving a 28-year-old female patient who initially presented with a painful swelling on the left labia majora. Initially misdiagnosed as simple Bartholin's gland inflammation, biopsy revealed cystic adenoid carcinoma of the Bartholin gland upon histopathological examination. Radiological evaluation revealed a locally advanced left vulvar lesion with no evidence of distant metastasis. Given the impracticability of surgical intervention, concurrent chemoradiation therapy was administered, resulting in favorable outcomes. ACC has been a diagnostic therapeutic challenge, there is currently no established therapeutic standard. Despite its infrequent occurrence, ACC warrants attention due to its potential for aggressive local invasion, distant metastasis, and propensity for recurrence.

Cervical cancer poses a significant health challenge in Morocco, and uterovaginal brachytherapy is essential for treating advanced cases. This study evaluates the use of hypnosedation as an alternative to traditional anesthesia methods during brachytherapy. Conducted over two months at the National Oncology Institute in Rabat, Morocco, the study included five patients previously treated with external radiotherapy and chemotherapy. Hypnosedation was used in the 3rd and 4th brachytherapy sessions, replacing spinal analgesia. Patients reported a reduction in pain and expressed high satisfaction with hypnosedation compared to traditional methods. This approach offers a promising alternative to conventional anesthesia, providing effective pain management and improved patient comfort.

The aim of this analysis is to assess radiotherapy's role and technical aspects in an array of rare gastrointestinal (GI) cancers for adult patients. Collection data pertaining to radiotherapy and digestive rare cancers were sourced from Medline, EMBASE, and Cochrane Library. Preoperative chemoradiotherapy improved outcomes for patients with esophageal undifferentiated carcinoma compared with esophageal salivary gland types of carcinomas. For rare gastric epithelial carcinoma, perioperative chemotherapy is the common treatment. Adjuvant chemoradiotherapy showed no benefice compared with adjuvant chemotherapy for duodenal adenocarcinoma. Small bowel sarcomas respond well to radiotherapy. By analogy to anal squamous cell carcinoma, exclusive chemoradiotherapy provided better outcomes for patients with rectal squamous cell carcinoma. For anal adenocarcinoma, neoadjuvant chemoradiotherapy, followed by radical surgery, was the most effective regimen. For pancreatic neuroendocrine tumors, chemoradiotherapy can be a suitable option as postoperative or exclusive for unresectable/borderline disease. The stereotactic body radiotherapy (SBRT) is a promising approach for hepatobiliary malignancy. Radiotherapy is a valuable option in gastrointestinal stromal tumors (GIST) for palliative intent, tyrosine kinase inhibitors (TKIs) resistant disease, and unresectable or residual disease. Involved field (IF) radiotherapy for digestive lymphoma provides good results, especially for gastric extranodal marginal zone lymphoma (MALT). In conclusion, radiotherapy is not an uncommon indication in this context. A multidisciplinary approach is needed for better management of digestive rare cancers.