Selected meeting abstracts of 2nd International Conference on Contemporary Oncology

close contact with the external anal sphincter. Biopsy was performed for histological and immunohistochemical study. The results were in favour of a perineal embryonic RMS expressing desmin and myogenin. Conclusions: Early diagnosis of perineal rhabdomyosarcoma in adolescents and children is crucial. Management during a multidisciplinary meeting is one of the challenges facing oncologists and surgeons.

07 Radiation oncology outpatient satisfaction with cancer care: the quality of care from patient's perspective Zeineb Naimi, Meriem ElBessi, Meriem Bohli, Raouia Ben Amor, Awatef Hamdoun, Ghada Bouguerra, Rihab Haddad, Lotfi Kochbati Radiation Oncology Department, Abderrahmen Mami Hospital Ariana, Ariana 2080, Tunisia Aim: The aim of this study was to evaluate patient's satisfaction with cancer care in the setting of outpatient radiotherapy.

Methods:
We conducted a cross-sectional study including all patients undergoing radiotherapy during April 2023.Patients were treated with either 3D conformal radiotherapy (3DCRT) or volumetric modulated arc therapy (VMAT).They were asked to fill in the EORTC OUT-PATSAT35 RT questionnaire.Patients coming for their first session were excluded.Domain's scores were calculated and statistically analyzed.
Results: A total of 70 patients were included in this study.Forty-seven (67%) patients were treated with 3DCRT and 23 (33%) with VMAT.Mean age was 56 (12-98) years old.Sixty-nine percent of the patients were female.The mean overall satisfaction (OS) score was 84.3.All domains' scores statistically correlated with the OS mean scores in the different domains regarding doctors, radiation therapists and services/organization are reported in Table 1.A "poor" cotation was reported in 11.6% of cases in item n° 32 (accessibility), 6% of the cases in item n° 29 (waiting time) and in 3% of the cases in items n° 28 and 33 (information about other services and ease in finding the different units).Fourteen patients didn't answer item n° 25 (exchange of information with services outside of the hospital).Eight patients added comments to the questionnaire (acknowledgments in seven cases and a recommendation in one case).

Conclusions:
Mediastinal radiotherapy for thymic tumors yielded substantially high doses to all coronary arteries (Dmax > 30 Gy). High point doses were reported to coronary arteries' proximal segments, suggesting a high risk of potentially harmful radiation induced coronary disease.Heart sparing radiotherapy techniques should be routinely used in thymic tumors irradiation.The study was approved by the Ethics Committee of Abderrahmen Mami Hospital Ariana.Informed consent to participate in the study was obtained from all participants.

Therapeutic and prognostic aspects of ovarian cancer: the experience of the Main Instructional Military Hospital (MIMH) in Tunis
Ghammem Nour, Ayari Jihen, Ben Naser Sonia, Balti Mehdi, Haddaoui Abderrazek Department of Medical Oncology, The Military Hospital of Tunis, Tunis 1008, Tunisia Aim: Ovarian cancer (OC) ranks fifth among cancers and fourth as a leading cause of cancer-related deaths in women.This study aims to update the therapeutic and prognostic data on OC in Tunisia.
Methods: A retrospective observational study was conducted at MIMH's Medical Oncology Department, using records of primary OC patients receiving treatment between 2010 and 2016.Descriptive and analytical univariate analyses (Kaplan-Meier method and log rank test at P < 0.05) and multivariate analyses (linear regression at P < 0.15) were performed.
Results: Thirty OC cases were analyzed.The time from diagnosis to treatment initiation averaged 28 days (range: 3-48 days).Radical surgery was done early in seven cases, while 11 had incomplete surgery.First-line CT was indicated for all patients, administered adjuvantly in 73.3%, mainly at early stages (77.8%), with an average of 5 cycles.Carboplatin and paclitaxel-based regimens were given to 96.7% with average doses of 266 mg (range: 130-560 mg) and 523 mg (range: 250-500 mg), respectively.CT-related toxicity affected 26 patients, most commonly fatigue (20 cases), followed by gastrointestinal (12 cases), hematologic (11 cases), and neurological (10 cases) toxicities.Eighteen out of 26 cases achieved complete remission, and CA125 normalized in 12 out of 15 patients.Recurrence occurred in four patients, with two local and two distant cases.The mean time to the first recurrence was 28 months (range: 3-48 months).Average progressionfree survival was 8.5 months (range: 0-51 months), and overall survival was 63.3 months (range: 39.6-87 months).Follow-up was limited; only 56.7% of patients were followed over a period of 1 year and 13.3% over a period of 3 years.No statistically significant predictive factors for treatment response were identified.
Conclusions: Despite therapeutic advancements in Tunisia, OC still faces high recurrence and mortality rates.Targeted therapies like bevacizumab and PARP inhibitors show promise for improving the prognosis.
The study is exempt from ethical approval.Informed consent to participate in the study was obtained from all participants.Informed consent to publication was obtained from relevant participants.Aim: Recent data have shown that lymphopenia, a common complication of radiotherapy, has a detrimental impact on survival.Studies have also suggested that there is a correlation between the dose received by the spleen and the risk of lymphopenia.However, there are no validated dosimetric constraints for the spleen.
The purpose of this study was to evaluate the dose received by the spleen during external beam radiotherapy of lower lobe lung tumors and to investigate the association between the delivered dose to the spleen and the risk of lymphopenia.
Methods: A retrospective analysis of the medical records of 15 patients undergoing sequential chemoradiotherapy between 2018 and 2022 for lower lobe lung cancer was performed.The mean dose prescribed to the planning target volume (PTV) was 57.8 Gy (45-64 Gy).The spleen was not considered as an organ at risk (OAR) during treatment planning and was delineated retrospectively.Complete blood counts were done and collected before and after the end of radiotherapy (RT).The delta lymphocyte (delta lymph), corresponding to the variation in the absolute number of lymphocytes before and after the completion of radiotherapy, was calculated.The dosimetric variables analyzed were the mean dose (Dmean), the maximum dose (Dmax), the V20 Gy, and the V30 Gy.

Results:
The mean volume of the spleen was 165.6 cc (59.6-484.8cc).For left lower lobe tumors, the mean Dmean and Dmax received by the spleen were respectively 5.34 Gy (0.37-28.75 Gy) and 19 Gy (0.64-67.7 Gy).For right lower lobe tumors, the mean Dmean and Dmax received by the spleen were respectively 0.49 Gy (0.06-0.8 Gy) and 1.30 Gy (0.17-2.23 Gy).The mean V20 Gy and V30 Gy were respectively 4.5 cc and 3.71 cc.Lymphopenia was noted after the end of treatment in 60% of cases (n = 9/15).This lymphopenia was of grade 2 in 78% of cases.The delta lymph calculated was correlated with the Dmean and the V30 Gy of the spleen with Pearson coefficients of 0.57 (P = 0.02) and 0.53 (P = 0.03), respectively.No correlation was noted between the other dosimetric variables analyzed and the risk of lymphopenia.

Conclusions:
Our results showed a significant correlation between the Dmean and the V30 Gy of the spleen and the risk of lymphopenia during radiotherapy treatment for left lower lobe lung cancers.Given the impact of lymphopenia on survival, we suggest considering the spleen as an OAR with the following dose constraints: Dmean < 6 Gy and V30 Gy < 4 cc to limit the risk of lymphopenia.Prospective studies are, however, necessary to confirm these results.

Aim: Trastuzumab emtansine (T-DM1
) is an antibody-drug conjugate incorporating the human epidermal growth factor receptor 2 (HER2) targeted antitumor properties of trastuzumab with the cytotoxic activity of the microtubule-inhibitory agent DM1.It is indicated as monotherapy for the treatment of adult patients, with HER2-positive unresectable metastatic or locally advanced breast-cancer, who have previously received trastuzumab and a taxane separately or in combination.

Methods:
We have included all breast-cancer patients who received their first T-DM1 treatment from the National Health Insurance Fund between 01/06/2021 and 30/06/2022.
Results: Our study included 18 patients with a mean age of 54 years.Cancer was initially non-metastatic in 10 cases of whom 8 were receiving adjuvant trastuzumab.One patient had non-metastatic cancer and was treated with T-DM1 postoperatively for an incomplete histological response.The first-line T-DM1 was prescribed for 2 patients who had metastatic relapse during adjuvant trastuzumab and second-line therapy in 6 patients after relapse or progression under trastuzumab and/or dual HER2 blockade.T-DM1 was prescribed for the remaining after at least one line of chemotherapy and trastuzumab and/or dual HER2 blockade.The average delivery time of the treatment by the polyclinic of the national social security fund was 47 days.The average number of cures received was 9. T-DM1 was well tolerated in all patients.Seven patients are still stable on T-DM1 with an average duration of stability of 11 months versus 11 patients who had progressed with an average time to progress of 9 months.Five patients died.Progression-free survival was 10 months and the overall survival was 3 years.

Conclusions:
T-DM1 has already proven to be effective and safe in several studies.It appears as an effective treatment option in the treatment of HER2-positive breast cancer.This is a descriptive and retrospective study that does not require an ethical approval.

Cytokines in nasopharyngeal carcinoma and prognostic correlations
Khemissi Faten, Ayari Jihen, Zribi Aref, Lagha Awatef, Fehri Rania, Ghazouani Ezzedine, Haddaoui Abderazek Medical Oncology Department, Military Hospital of Tunis, Tunis 1089, Tunisia Aim: Nasopharyngeal carcinoma (NPC) is characterized by distinct geographical distribution and is particularly prevalent in East and Southeast Asia.Its incidence is increasing in Tunisian population.Chronic inflammation can promote tumor progression, invasion, and metastasis.This investigation aims to assess the serum concentrations of cytokines (IL-1, IL-6, IL-8, and TNF) and their associations with the prognosis of patients with NPC.
Methods: Serum samples were collected in a prospective cohort of 25 patients with NPC treated in the Department of Medical Oncology of Jendouba before treatment, 7 weeks, 3 months, and 6 months after treatment.The TNF-, IL-1 beta, IL-6, and IL-8 were measured by a solid-phase.

Results:
The average age of our patients was 47.8 years (14-80 years) with a sex ratio of 2.57 (18 men and 7 women).We observed a correlation between the highest level of cytokines and the age group between 31-40.
The study also found that the levels of IL-6 and IL-1 beta were higher in patients with stage T1-T2, while IL-8 was higher in patients with advanced stages.Our research demonstrated that by the seventh week following the end of treatment the cytokine levels had increased, these signs indicated a positive response to treatment and a favorable prognosis.Additionally, we observed a significant increase in the cytokines in metastatic patients; IL-8 (P = 0.01), IL-6 (P = 0.001), and TNF alpha (P = 0.038).These are often associated with disease spread.
Conclusions: TNF alpha, IL-1 beta, IL-6, and IL-8 have the potential to be considered as prognostic biomarkers in NPC.These biomarkers identify a reserved prognosis group of patients that require aggressive treatment and closer monitoring.Other clinical studies are needed to better understand the inflammatory profile, its correlation with the NPC, the particularity of Tunisian patients and to validate the prognostic value of these serum biomarkers.In addition, subsequent molecular biology studies would be possible to determine the secretory origin of these cytokines; the body's immune cells or tumor cells.Aim: Curative surgery after neoadjuvant treatment is the gold standard treatment for patients with locally advanced rectal cancer (LARC).Pathologic complete response (pCR) after resection has been described as an important prognostic factor of low rate of recurrence and a long-term overall survival.Neoadjuvant radiochemotherapy has long been the gold standard but in recent years total neoadjuvant therapy (TNT) is being adopted worldwide as a promising means to improve outcomes for patients with LARC.We aimed to study the clinical and pathological features and the treatment outcomes related to both strategies in a center of Tunisia.
Methods: This is a retrospective, monocentric observational study including patients diagnosed with LARC and treated in the Oncology Department of Abderrahmane Mami Hospital, Ariana, Tunisia between 2014 and 2022.Data regarding epidemiologic characteristics, diagnosis and staging, preoperative treatment received, surgical outcomes, including treatment response, and pathological stage were collected.

Results:
We collected 61 patients, 47.5% were female and the mean age was 58 years old.The main cT stage was T3 with 70.5% of cases and 31% N2.Tumor location distribution was 1.6% upper, 52.5% medium, and 45.9% lower rectum.The 54.1% patients had good differentiation grade and 4 patients had signet ring cell carcinoma.We have 2 groups: 33 patients were treated with TNT with short course radiotherapy and 28 patients with neoadjuvant chemoradiotherapy.For the first group, all patients received short course radiotherapy which was well tolerated.Radiological response was seen in 79% of patients (48.5% complete, 30.5% partial).Twenty-four patients had radical surgery, with 66.6% achieving an R0 resection and 24.2% had a pCR.Two patients have progressed on chemotherapy with the appearance of bone metastases and both patients had signet ring cell carcinoma.Three sudden deaths after chemotherapy were reported in this group although there were no grade 3-4 chemotherapy toxicity reported and 1 postoperative death; respectively aged of 75, 70, 71 and 40 years old.For the second group, all patient received long course radiotherapy with concomitant chemotherapy; 25 capecitabine, 2 capox, and 1 folfox.Radiological evaluation with MRI

Table 1 .
Means scores of the EORTC OUT-PATSAT35 RT questionnaire We found globally high satisfaction scores with cancer care in our department.The lowest scores were mainly in the organization domain, suggesting that an extra effort should be made to improve radiotherapy outpatient experience.The EORTC OUT-PATSAT35 RT seems to be a reliable and valid instrument to identify which aspect of care should be improved.The study was approved by the Ethics Committee of Abderrahmen Mami Hospital Ariana.Informed consent to participate in the study was obtained from all participants. Conclusions:

08 Mediastinal irradiation for thymic epithelial tumors: a deep focus on coronary arteries' exposure
The mean Dmean/Dmax for coronary arteries were as follow: 35.6 Gy/40.4Gy for LM, 21.39 Gy/38.5 Gy for LAD, 14.73 Gy/39 Gy for Cx, and 12.61 Gy/32.04Gy for RCA.Strong positive correlation was found between usual heart dose constraints (Dmean heart/V30 Gy) and doses delivered to coronary arteries, with Pearson coefficient ranging between 0.57 and 0.82.Exclusive irradiation radiotherapy yielded higher point doses to proximal coronary arteries' segments when compared to postoperative radiotherapy (P = 0.03).

13 A retrospective comparison between chemoradiotherapy and total neoadjuvant treatment in locally advanced rectal cancer: real world data
The study was approved by the committee for the protection of people of the Tunis Military Hospital, Decision number 73:55/2023/CLPP/ Military Hospital of Tunis.Informed consent to participate in the study was obtained from all participants.