Journal of Oncology Medicine & Practice

Thyroid cancer represents a spectrum of biological and molecular activity. As such it can behave in a variety of ways. This makes metastatic thyroid cancer challenging to manage. In advanced rapidly progressive thyroid cancer new agents and multimodality care represent promising therapeutic options for patients. However, these agents are not without risk and clinicians must be judicious with their use, weighing toxicities, quality of life and likely benefits. We review the presentation, treatment and prognosis of thyroid cancer subtypes as well as the recent developments in targeted therapy for medullary thyroid cancer. We discuss the role of cytotoxic therapy in thyroid cancer and review recent trials of novel agents and currently recruiting trials.

Background

Cancer affects all human beings. However, the type and patterns of occurrence vary depending on geographical location, socio-economic status, life style, genetic variation and other risk factors. Like other sub-Saharan countries, the incidence of cancer is rising in Ethiopia. The number of patients with a diagnosis of cancer is alarmingly rising in University of Gondar Hospital. Here, we describe the pattern of cancer diagnosed with their socio demography.

Methodology

Study design: This was a retrospective record analysis of pathology service results, biopsy and FNAC.

Population: All patients with a record of diagnosis as cancer according to the pathology (FNAC and biopsy) from Sept 2014 to Aug 2015 were included.

Data collection and handling: Data was collected from the pathology department record books by physicians working in the department. It was documented in an excel sheet and cross checked for consistency by the investigator. It was transferred to SPSS version 20 and descriptive analysis was done.

Result

Out of 3231 samples (1263 biopsies and 1968 FNAC) evaluated in university of Gondar hospital in 2014 – 2015, 540 (16.7%) were malignant cancer cases. Among this 346 (64%) were females and the rest 194 (36%) were males. The age pattern shows, 499 (92%) were occur in adults and 41 (8%) are occurred in children. Lymphomas, cervical cancer and breast cancer are the three top common cancers of all age groups.

In adult population cervical cancer, breast cancer and lymphoma are most common. In children of age less than 14 years lymphomas, wilm’s tumor and retinoblastoma were the three top cancers. Cervical cancer, breast cancer and lymphomas are found to be the commonest cancers in females. On the other hand, lymphomas, head and neck squamous cell carcinomas (HNSCC), and colorectal cancer are the three top commonest cancers in males.

Conclusion

This first study on cancer pattern in North-west Ethiopia indicates cancer is one of the common finding from cytology and histology samples analyzed in the pathology department. Comprehensive demographic and clinical data using population or facility based registry is required to get better information and for planning and monitoring cancer pattern in the region. Additionally, it will help in resource prioritization and decision making in the treatment strategies of cancer in the country.

Background: Completion surgery after chemoradiotherapy (CRT) in management of locally advanced cervical cancers (LACC) still controversial. The aim of this study was to compare disease-free and overall survival rates in patients who had completion surgery and who were therefore treated conservatively by exclusive concomitant chemoradiotherapy (CCRT).

Materials and methods: This is a retrospective study from January 2005 to December 2014 included 130 patients with LACC, managed by standard CCRT followed by brachytherapy at the radiotherapy department of Military Hospital Mohamed V of Rabat in Morocco.

Inclusion criteria were the following: Biopsy-proven carcinoma of the cervix, FIGO stage IB2 to IVA and treatment with CCRT followed by brachytherapy. All patients had good response to standard CCRT, with a clinical decrease in tumor volume of more than 50%. Patients were divided into two groups depending on the authors practice: Group 1 consisted of patients without completion surgery who had theoretically a good response to standard treatment and Group 2 consisted of patients treated by completion surgery with pelvic control on final pathology.

One hundred and two patients are included in Group 1 and 28 in Group 2. The mean age of the patients was 50.9 years (range 29–82). Squamous cell carcinoma 115 (89.8%) was the leading histological type. Tumor size was 4.77 ± 1.44 cm clinically and 46.72 ± 15.42 mm in MRI. The parametrial was invaded in 113 (87.6%) of cases and the pelvic lymph nodes were suspected in 29 (23%) of cases.

Major of patients whom underwent a completion surgery showed a complete response on final pathology. Overall, 20.8% (27/130) of patients had a recurrence, with a median time to recurrence of 8 months [2-55]. With a mean follow-up of 44 months (2 to 118), the local control rate was 68.5% (n=89) and 20 (15.4%) patients were lost to follow-up.

The overall survival (OS) at 5 years in Group 1 and 2 was respectively 59.8% and 88.9% and the relapse-free survival (RFS) was respectively 73.3% and 88.9%. A significant benefit of completion surgery was seen only in OS (p=0.011).

Conclusion: completion surgery after CCRT has a place in the multimodality management of locally advanced cervical cancer with significant benefice in local control and OS.