Pleomorphic adenoma of the trachea is a rare tumor, with fewer than 50 cases reported. Its nonspecific symptoms can delay diagnosis. We describe the case of a 48-year-old woman with recurrent obstructive pleomorphic adenoma of the trachea. She was initially treated with endoscopic resection in 2019. In 2024, she developed increasing respiratory distress due to an inoperable recurrence. The patient received volumetric modulated arc therapy (VMAT) with a dose of 20 Gy in five treatments of 4 Gy each. This provided rapid symptom relief, and significant regression was observed on radiological imaging at three and 12 months. Although complete surgical removal remains the best option, this case shows that radiation therapy can be an effective choice for inoperable or recurrent tumors. The positive clinical and radiological results we observed underscore the role of radiotherapy in achieving durable local control and symptom relief. This highlights the need for thorough evaluation by multiple specialists and long-term follow-up.

Introduction: Pulmonary metastases occur in 10% to 15% of patients with colorectal cancer and represent a frequent site of recurrence for rectal cancer. In the context of oligometastatic disease, local ablative treatment via surgery or stereotactic body radiotherapy (SBRT) is central to the therapeutic strategy. While surgical metastasectomy remains the historical gold standard, SBRT is emerging as an effective, non-invasive alternative, particularly for central lesions or patients at high surgical risk. This study reports our experience in managing pulmonary metastases of rectal origin and defines criteria for selecting between these two modalities. Materials and Methods: We conducted a retrospective study over a 4-year period, including six patients with histologically confirmed rectal adenocarcinoma whose cases were discussed during a multidisciplinary tumor board (MTB). Data collected included primary tumor characteristics, neoadjuvant and systemic treatments received, and the profile of the metastatic disease (number and location of lesions). Selection criteria between surgical resection and SBRT were based on anatomical (central or peripheral location), functional (respiratory reserve), and oncological parameters. Primary endpoints were local control, progression-free survival, and toxicity. Results: At initial diagnosis, disease was locally advanced in 83% of patients (T3N1, n=5) and T2N1 in 17% (n=1). The majority (83%) received short-course neoadjuvant radiotherapy (5×5 Gy) followed by primary tumor excision and systemic chemotherapy (XELOX/FOLFOX). At the metastatic stage, disease involved the lungs (50%, n=3) or liver (50%, n=3), with 1 to 3 lesions per patient. Three patients were treated with surgery (peripheral lesions) and three with SBRT (central lesions or surgical contraindication). The local control rate with SBRT was 100%, documented by morphological imaging and PET-CT, with doses ranging from 30 to 54 Gy in 4 to 6 fractions. No grade ≥3 toxicit

Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the salivary glands, characterized by slow growth, marked local aggressiveness, and a strong tendency for perineural invasion. Due to nonspecific symptoms, diagnosis is often delayed, and tumors are frequently locally advanced at presentation. While surgery is the standard treatment for resectable disease, definitive radiotherapy is a valid alternative for inoperable cases. We report a case of ACC of the maxillary sinus, staged T4bN2bM0, treated with definitive volumetric modulated arc therapy (VMAT) radiotherapy, with sustained locoregional control at one year. A 56-year-old chronic smoker was diagnosed with ACC of the right maxillary sinus, staged T4bN2bM0, and considered inoperable. The patient was treated with definitive radiotherapy (69.96 Gy; VMAT technique). A partial response was observed on early post-treatment assessment, with sustained locoregional control after one year of follow-up. Definitive radiotherapy can provide effective locoregional control in inoperable cases of ACC, although long-term follow-up remains essential because of the risk of late recurrence.

BACKGROUND:Laryngeal squamous cell carcinoma (SCC) requires rigorous post-operative imaging surveillance to detect early recurrence, yet benign post-surgical changes may mimic malignancy and create diagnostic uncertainty. CASE PRESENTATION:We report a case of a 65-year-old male with well-differentiated laryngeal SCC who developed a suspicious lesion in the oropharynx on planning CT for adjuvant radiotherapy, 2 months after total laryngectomy, raising concern for early local recurrence. Clinical Discussion: Further assessment using multiplanar MRI demonstrated a well-defined elongated uvula with homogeneous enhancement, slightly hyperintense on T2 and without diffusion restriction, consistent with postoperative inflammatory change. Comparison with pre-treatment imaging confirmed its benign nature, preventing unnecessary biopsy or PET-CT. CONCLUSION:This case highlights the importance of distinguishing benign anatomical variants from malignant recurrence during post-operative surveillance imaging in head and neck oncology.

Nutritional status is a critical determinant in the management of oncology patients, as malnutrition can significantly impair treatment tolerance and exacerbate therapy-related toxicities. This prospective observational study, involving 140 patients at the Department of Radiotherapy, evaluated the impact of baseline nutritional status on the clinical tolerance of radiotherapy or concurrent chemoradiotherapy. Nutritional status was assessed prior to treatment using body mass index (BMI), recent weight loss, and serum albumin levels. Tolerance was monitored throughout therapy by recording adverse events according to CTCAE v5.0, treatment interruptions, protocol modifications, and unplanned hospitalizations. The cohort had a mean age of 57 years, with a predominance of head and neck (47.85%), cervical (30.71%), and prostate (21.43%) cancers. At the initiation of treatment, 45% of patients presented with impaired nutritional status. Among them, 65% experienced reduced treatment tolerance, compared to only 25% in the well-nourished group (p < 0.001). Malnourished patients exhibited significantly higher rates of severe fatigue (40% vs. 18%, p = 0.02), treatment interruptions or modifications (30% vs. 10%, p = 0.01), and unplanned hospitalizations (22% vs. 8%, p = 0.02). These findings demonstrate that baseline malnutrition is a strong predictor of poor tolerance and increased toxicity. This highlights the necessity for systematic early nutritional screening and proactive intervention to optimize therapeutic adherence and clinical outcomes for patients undergoing radiotherapy.

Neurofibromatosis type 1 (NF1) is a multisystemic disorder predisposing to various neoplasms and vasculopathies. While optic pathway gliomas (OPGs) are hallmarks of pediatric NF1, their incidental discovery in adults, especially when associated with persistent unidentified bright objects (UBOs), mesenchymal malignancies, and rare venous anomalies, is exceptional. A 49-year-old female with NF1 and a history of cervical synovial sarcoma underwent routine oncological surveillance. Brain MRI incidentally revealed a WHO Grade 1 OPG, multiple persistent UBOs in the brainstem and cerebellar peduncles, and a focal parietal venous aneurysm. Despite being asymptomatic, multimodal ophthalmological imaging was performed. Optical coherence tomography (OCT) showed significant asymmetric axonal loss. The left eye (OS) exhibited marked peripapillary retinal nerve fiber layer (pRNFL) thinning (69 µm, p < 0.01). Notably, while the right eye (OD) had normal pRNFL thickness (83 µm), macular ganglion cell layer (GCL) analysis detected early focal neuro-retinal suffering (54 µm minimum thickness). Automated perimetry confirmed functional correlation in both eyes. This case highlights the "multi-tumor challenge" in NF1, suggesting a high-penetrance phenotype driven by RAS/MAPK hyperactivation. The persistence of UBOs into the fifth decade and the discovery of a rare venous aneurysm likely due to medial dysplasia underscore a unique systemic vasculopathy. Unlike sporadic adult OPGs, NF1-associated forms often follow an indolent course, justifying a "watch-and-wait" strategy. Managing complex adult NF1 phenotypes requires a multidisciplinary approach. This case demonstrates that GCL-OCT can serve as a sensitive "early warning system" for axonal loss before clinical symptoms arise, facilitating non-invasive surveillance in genetically vulnerable individuals.

Background: This study aimed to evaluate the impact of patient positioning on dose distribution to the bowel and bladder in rectal cancer patients in a setting without access to a belly board or advanced techniques such as Intensity-Modulated Radiotherapy (IMRT). Methods: Between July and October 2014, 20 consecutive rectal cancer patients were prospectively enrolled. Computed Tomography (CT) simulations were performed with a full bladder in two positions: prone (without a belly board) and supine. Three-dimensional conformal radiotherapy (3D-CRT) plans delivering 46 Gy in 23 fractions were generated. Bowel volumes receiving 5-Gy increments (V5–V45) and bladder dose parameters were compared between positions. Results: The mean Planning Target Volume (PTV), bowel, and bladder volumes were similar between prone and supine positions (PTV: 1000.78 vs 1006.21 cm³, p=0.84; bowel: 752.04 vs 750.32 cm³, p=0.97; bladder: 225.48 vs 244.16 cm³, p=0.26). Across all dose levels (V5–V45), no statistically significant differences were observed in bowel or bladder irradiation. Conclusion: Although these findings do not introduce new dosimetric concepts, they provide practical evidence supporting the use of the supine position with a full bladder in preoperative 3D-CRT for rectal cancer, particularly in centers lacking a belly board or access to IMRT. Supine positioning offers comparable bowel sparing, improved patient comfort, and better reproducibility, making it a feasible alternative in resource-limited settings.

Introduction:The simultaneous presentation of multiple primary urological malignancies in a single patient is exceedingly rare and poses significant diagnostic and therapeutic challenges. We report the case of a 48-year-old man presenting two histologically confirmed synchronous urological malignancies and one radiologically suspected contralateral renal mass. Case presentation:The patient had undergone right radical nephrectomy for pT1 ISUP grade 2 ccRCC fourteen years prior. Surveillance imaging revealed a recurrence at the right nephrectomy bed (12 cm) and an incidentally discovered left renal mass (4 cm). CT imaging additionally identified extensive abdominal dissemination of indeterminate origin. Histological confirmation was obtained for the right renal recurrence by CT-guided biopsy and for the prostate cancer by systematic biopsy; the contralateral left renal mass fulfilled imaging criteria for ccRCC but could not be biopsied prior to the patient's death, representing a diagnostic limitation acknowledged throughout this report. Biochemical workup simultaneously revealed a markedly elevated PSA of 50 ng/ml. Prostate biopsy confirmed Gleason 9 (5 + 4) adenocarcinoma with bone scintigraphy demonstrating four skeletal metastatic foci. The patient died at home one month after diagnosis, before initiation of treatment. Conclusion:This case illustrates the exceptional convergence of three synchronous urological conditions-two histologically confirmed and one radiologically suspected-with a fatal outcome, highlighting the importance of extended post-nephrectomy surveillance, integrated PSA monitoring in ccRCC survivors, and early germline evaluation in young patients with multiple urological primaries. synchronous multiple primary malignancies, ultra-late renal cell carcinoma recurrence, metastatic prostate cancer, post-nephrectomy surveillance, hereditary cancer predisposition.

Pineoblastoma is a rare and highly aggressive embryonal tumor of the pineal region, predominantly affecting children and adolescents. It is classified as a CNS WHO grade 4 tumor and is characterized by a high risk of cerebrospinal fluid dissemination. Although leptomeningeal spread is a recognized feature of this tumor, spinal metastatic involvement at diagnosis remains uncommon and indicates high-risk disease. We report the case of a 16-year-old girl with no relevant past medical history who presented with a two-week history of sleep disturbances, right-sided strabismus, and projectile vomiting. Brain MRI demonstrated a heterogeneous pineal region mass measuring approximately 28 × 26 mm, associated with triventricular hydrocephalus. The patient underwent endoscopic ventriculocisternostomy and stereotactic biopsy. Histopathological and immunohistochemical findings confirmed the diagnosis of pineoblastoma. Staging spinal MRI revealed multiple dorsal spinal leptomeningeal nodules, consistent with CSF dissemination and spinal drop metastases. Given the rarity of pineoblastoma and the absence of a universally established pineoblastoma-specific therapeutic protocol, the case was discussed with an international pediatric neuro-oncology expert. Based on this expert recommendation, the patient was treated using a high-risk medulloblastoma-derived regimen. She received craniospinal irradiation with weekly vincristine, followed by adjuvant chemotherapy with cisplatin, cyclophosphamide, and vincristine according to an ACNS0332-based approach. At three months after completion of treatment, follow-up MRI showed complete regression of the spinal metastatic lesions and a small residual cystic lesion in the pineal region. Clinically, the patient showed marked improvement, particularly in oculomotor function. This case highlights the importance of systematic craniospinal staging at diagnosis in pineoblastoma and illustrates the potential value of early multidisciplinary and multimodal management in metastatic disease. At nine months of follow-up, the patient remained clinically stable, without evidence of spinal disease progression on serial imaging. However, this follow-up remains limited, and long-term clinical and radiological surveillance is essential because of the high risk of recurrence.

Background:Erectile dysfunction (ED) is a frequent and impactful side effect of prostate cancer radiotherapy. Data on the relationship between radiation dose to the penile bulb (PB) and ED severity in North African populations remain limited. This study aimed to assess ED prevalence and severity in Moroccan men treated with volumetric modulated arc therapy (VMAT) and identify associated clinical and dosimetric predictors. Materials and methods:A retrospective analysis was performed on 52 Moroccan patients treated with VMAT for localized or locally advanced prostate cancer (2021-2024). Erectile function was evaluated using the Sexual Health Inventory for Men (SHIM) score. Analyzed dosimetric variables included PB mean dose, PB V30, PB V50, PB V60, and doses to 25-90% of the PB volume (PB D25, PB D50, PB D75, PB D90). Statistical methods included ANOVA, Pearson correlation, ROC curve analysis, and multivariate logistic regression. Results:Moderate to severe ED was found in 65.4% of patients. Strongest correlations with SHIM score were seen for PB D25 (r = -0.47), PB mean dose (r = -0.45), PB V30 (r = -0.41), and PB D50 (r = -0.41). ROC analysis identified PB V30 > 64.9% and PB D50 > 38.7 Gy as optimal cutoffs for predicting ED. ISUP grade was significantly associated with ED severity (p = 0.007), while TNM stage and D'Amico classification were not. No significant association was observed with hypertension, diabetes, or smoking. Conclusions:This study highlights the importance of PB dosimetry in predicting post-radiotherapy ED. PB V30 and PB D50 emerged as reliable predictors, underscoring the need to integrate PB constraints in VMAT planning to preserve erectile function in prostate cancer survivors.

Introduction Treatment of locally advanced nasopharyngeal carcinoma with neoadjuvant chemotherapy followed by concomitant chemoradiotherapy has shown an overall survival advantage over concomitant chemoradiotherapy alone in several clinical trials. However, data on its efficacy in low- and intermediate incidence regions remains limited. The aim of this study is to assess the efficacy and toxicity of this approach in a Moroccan cohort. Methods We conducted a retrospective analysis involving 95 patients with stage III-IVA nasopharyngeal carcinoma treated at the National Institute of Oncology in Rabat, Morocco, from January 2018 to December 2021. Eligible patients received at least one cycle of neoadjuvant chemotherapy prior to concomitant chemoradiotherapy. The collected data included patient characteristics, treatment regimens, and therapeutic outcomes, including overall survival, locoregional recurrence-free survival, distant metastasis-free survival, as well as acute toxicity. Results Median follow-up was 41.5 months. The 5-year overall survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 67%, 81.3%, and 75.7%, respectively. Independent prognostic factors for overall survival included age (P<0.002), body mass index (P=0.002), and nodal stage (P=0.005). Grade≥3 acute toxicities occurred in 30.9% during neoadjuvant chemotherapy and 62.8% during concomitant chemoradiotherapy. Five treatment-related deaths occurred. Conclusion Neoadjuvant chemotherapy followed by concomitant chemoradiotherapy for locally advanced nasopharyngeal carcinoma yields acceptable outcomes in real-world settings. However, the high rate of acute toxicities highlights the need for rigorous patient selection and appropriate management of side effects.

Locoregional and regional nodal recurrence remains a major therapeutic challenge in cervical cancer, particularly in patients previously treated with pelvic radiotherapy, where salvage options are limited by cumulative toxicity to surrounding organs at risk. In selected patients with limited-volume recurrent disease, stereotactic body radiotherapy (SBRT) has emerged as a highly conformal salvage approach capable of delivering ablative radiation doses while minimizing exposure to adjacent normal tissues. We report two cases of limited-volume regional nodal recurrence from cervical squamous cell carcinoma successfully managed with SBRT. The first patient, a 32-year-old woman initially diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC1 disease, developed multifocal pelvic and para-aortic lymph node recurrence 12 months after completion of definitive treatment. The second patient, a 48-year-old woman with FIGO 2018 stage IIB disease, presented with isolated para-aortic nodal recurrence after a 33-month disease-free interval. In both cases, recurrence was identified by fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) and discussed in a multidisciplinary tumor board. Histological confirmation was not obtained because of the deep location of the lesions, their proximity to major vascular structures, the procedural risks of biopsy, and the highly suggestive PET-CT findings in patients with previous cervical squamous cell carcinoma. Salvage surgery was considered technically challenging because of previous irradiation and fibrosis. SBRT was delivered using volumetric modulated arc therapy (VMAT) with daily image guidance. The first patient received 40 Gy in five fractions for pelvic and para-aortic nodal recurrence, whereas the second received 30 Gy in three fractions for isolated para-aortic nodal recurrence. Treatment was well tolerated, with no acute grade ≥2 toxicity and no late grade ≥3 toxicity observed. Follow-up PET-CT demonstrated a complete metabolic response in both patients. At the last follow-up, the first patient remained disease-free 38 months after SBRT, and the second patient remained disease-free 40 months after SBRT, without evidence of progression or significant late toxicity. SBRT appears to be a feasible and well-tolerated salvage option for selected patients with limited-volume regional nodal recurrence of cervical cancer after prior definitive chemoradiotherapy. PET-CT-guided SBRT allows delivery of ablative doses with durable local control while limiting toxicity to previously irradiated normal tissues. These findings support further prospective evaluation of curative-intent local treatment strategies in this setting.

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.

Breast cancer, a serious diagnosis for women, can cause major alterations in their physical and psychological state and, consequently, lead to changes in their commitment to spiritual and religious practices. Despite the crucial role played by these spiritual aspects in stress management, psychological support and the overall well-being of patients, they remain underexplored in the scientific literature. The present study aims to provide a comprehensive analysis of the impact of cancer on religious beliefs and practices among patients, with a particular focus on its effect on their quality of life. A descriptive cross-sectional study was conducted among 50 patients diagnosed with breast cancer and undergoing irradiation in the Radiotherapy Department at the National Institute of Oncology during the period from January 2025 to May 2025. A multifaceted assessment was conducted, encompassing the degree of religiosity, spiritual well-being, quality of life, the presence of physical and psychological symptoms, the extent of acceptance of the disease, and therapeutic strategies. This assessment was complemented by an interview conducted during weekly monitoring consultations, which addressed various factors. The educational and economic levels of the participants were also evaluated.

Patient-Specific Quality Assurance is usually performed using phantoms made of homogeneous materials with regular shapes and small sizes, which does not simulate real world considerations. This work aims to establish and implement an efficient end-to-end quality assurance protocol for Volumetric Modulated Arc Therapy treatment plans for Head-and-Neck (H&N) cancers using adult RANDO anthropomorphic phantom to assess the overall treatment chain uncertainty and accuracy. Four VMAT treatment plans of H&N cancers (Brain metastases, Parotid glands, Nasopharynx, and Larynx) were selected based on their clinical incidence frequency. The phantom passed through the same treatment process as patient to simulate a real world scenario. These plans were applied to the phantom as QA-plans. The mean dose discrepancies describing the entire plan deliverability and acceptability were 0.76% +/- 2.22%, 0.68% +/- 4.51%, 1.56% +/- 2.85%, and 2.04% +/- 3.53% for Brain metastases, parotid glands, nasopharyngeal, and laryngeal cancers respectively. Plans standard deviations (SDTPS-OSLD) tend to increase with mean differences (Max-min) over bar because of dose heterogeneity at the measurement positions. Over all plans, a lower difference of about 0.72% was shown between the highest and the lowest in-field standard deviation SDin (%). Out-of-field standard deviations SDout (%) indicated a highest dose discrepancy due to organ at risk to be spared. VMAT treatment plans for Head-and-Neck cancers are extremely complex processes, involving many uncertainties that could affect the desired plan administration accuracy. Therefore, it is essential to implement such an end-to-end test, in order to verify system ability to reach therapeutic goals and spare organs at risk, taking into account all the related uncertainties.