[Post-prostatectomy radiotherapy: for which patients and when?]. / Radiothérapie post-prostatectomie: pour quels patients et quand?

Biochemical relapse after radical prostatectomy is not exceptional, ranging from 10 to 40% in the literature. To prevent this biochemical failure, adjuvant radiotherapy was proposed to patients with a high risk of relapse. No phase III trial has actually validated this attitude. Best indications for adjuvant irradiation seem to be patients with an extensive extracapsular extension or multiple positive margins. Historical comparisons seems to confer, in these case, a benefit in biochemical control for adjuvant irradiation versus observation. Others authors prefer immediate post-operative irradiation, a delayed treatment, when biochemical relapse has occurred. This attitude has spared some patients irradiation useless. This salvage irradiation lowered the PSA level in 40 to 70% of the cases, but long-term efficiency is obtained only in the case of a low value of the PSA before irradiation. Delayed radiotherapy is, therefore, justified only if a close follow-up is performed, with repeated dosage of PSA. Whatever the case, it is important to differentiate between local and distant relapse: patients with positive nodes at the time of surgery are most likely at risk of distant relapse. It seems that patients with seminal vesicles involvement are also at high risk for distant relapse, but this must be confirmed.

[Pulmonary lesions following bone marrow graft. Study of 35 cases]. / Lésions pulmonaires après greffe de moelle osseuse. Etude de 35 cas.

Lung biopsy of 35 patients with interstitial pneumonitis following bone marrow transplantation (BMT) have been studied histologically, ultrastructurally and by immunofluorescence. Among infectious diseases, cytomegaloviruses (CMV) are the more frequently found, whereas Pneumocystis carinii infections are more frequently found in immunocompromised hosts without BMT. CMV infections are related to severe chronic graft-versus-host disease in allogenic or mismatched BMT. Hemorrhagic pulmonary oedema and vascular damage might be the consequence of high doses of cyclosporin A or of disseminated intravascular coagulation. Granulomatous and fibrosing lesions corresponded in 2 cases to an eosinophilic pneumonitis and in 11 cases to an "idiopathic" diffuse interstitial pneumonitis. 2 patients had concomitant diffuse lung fibrosis, sclerotic plaques of the skin and Sjögren-like syndrome. The pulmonary and cutaneous scleroses had common features in the types of collagen and in the composition of the infiltrate. Both fibroses might result from a common pathogenic mechanism related to an immunologic conflict between the lymphocytes of the graft and the cells from the host tissues.