Respuesta biológica en las pacientes con cáncer de mama tratadas con radioterapia intraoperatoria / Biological response in breast cancer patients using intraoperative radiotherapy

Introducción: el tratamiento conservador de la mama junto con la radioterapia es de elección en las pacientes con cáncer de mama precoz. Gracias a un mayor conocimiento de la radiobiología tumoral, la tendencia actual consiste en utilizar técnicas de irradiación parcial acelerada, entre las que destaca la radioterapia intraoperatoria (RIO). Métodos: estudio prospectivo multicéntrico dividido en 2 grupos comparativos con casos consecutivos de las pacientes a que han recibido una cirugía conservadora por cáncer de mama asociada o no a RIO. Se valora la relación de esta terapia con los valores de las proteínas involucradas en la respuesta biológica (IL6, IL8, CXCL10, IL1β y TNF- α) en muestras de suero preoperatorio y a las 24 h desde la cirugía, y de drenaje quirúrgico a las 6 y 24 h desde la cirugía. Resultados: se ha objetivado en las pacientes tratadas con RIO una disminución significativa de IL6 e IL8, así como un aumento de CXCL10 favorable para la lucha contra la progresión del tumor (p valor < 0,05). Las alteraciones del sistema inmunológico se manifiestan tanto en suero como en débito del drenaje quirúrgico a las 6 y 24 h desde la cirugía. Conclusiones: la RIO modifica la respuesta biológica en las pacientes con cáncer de mama. A pesar de que se deben desarrollar más líneas de investigación, la comprensión de los mecanismos de desarrollo del tumor, abre una nueva etapa en el desarrollo de tratamientos perioperatorios dirigidos a dianas concretas que compensen las consecuencias dañinas de la cirugía. (AU)

Introduction: Breast conserving surgery with radiotherapy is the treatment of choice in patients with early breast cancer. Due to a better understanding of tumour radiobiology, the current trend is to use accelerated partial irradiation techniques, among which intraoperative radiotherapy (RIO) stands out. Methods: Prospective multicentre study divided into two comparative groups with consecutive cases of patients who have undergone conservative surgery for breast cancer associated or not with RIO. The relation of this therapy with the values of proteins involved in the biological response (IL6, IL8, CXCL10, IL1β y TNF- α) is assessed in serum samples preoperative and 24 hours after surgery, and surgical drainage samples at 6 and 24 hours after surgery. Results: A significant decrease in IL6 and IL8, as well as an increase in CXCL10 favourable for the fight against tumour progression (p-value < 0.05) was observed in patients treated with RIO. Immune system alterations are manifested in both serum and surgical drainage debit at 6 and 24 hours after surgery. Conclusions: RIO modifies the biological response in breast cancer patients. Although more lines of research need to be developed, the understanding of the mechanisms of tumour development opens a new stage in the development of perioperative treatments directed at specific targets that compensate for the harmful consequences of surgery. (AU)

Cirugía conservadora de cáncer de mama y radioterapia intraoperatoria. ¿Podemos predecir la fibrosis? / Breast-conserving surgery in breast cancer and intraoperative radiotherapy. Can we predict the fibrosis?

Introducción: Las técnicas de radioterapia asociadas a la cirugía conservadora del cáncer de mama precoz han evolucionado gracias a un mayor conocimiento de la radiobiología tumoral, destacando entre ellas la radioterapia intraoperatoria (RIO). Sin embargo, se han documentado complicaciones con dicha técnica, principalmente la fibrosis. El factor de crecimiento transformante beta (TGF-β) es una citocina relacionada con la fibrosis inducida después de la radiación que podría servir como marcador temprano del riesgo de desarrollo de la misma. Métodos: Estudio prospectivo multicéntrico de 60 pacientes a las que se les ha sometido a cirugía conservadora por cáncer de mama, asociada a RIO en 30 de ellas. Se evalúan los valores de TGF-β en muestras de suero preoperatorio y a las 24 h desde la cirugía, y de muestras de drenaje a las 6 y 24 h desde la cirugía. Resultados: Los valores de TGF-β objetivados en el suero y en el débito de drenaje a las 24 h desde la cirugía de las pacientes que recibieron RIO fueron significativamente mayores que los de aquellas que no la recibieron (p < 0,0001). De entre ellas, 8 pacientes presentaron valores superiores a 1.000 pg/ml. Estas diferencias entre los grupos no se modifican por el tipo de muestra utilizada, bien sea suero, bien débito de drenaje (p = 0,5881). Conclusiones: Aunque deben realizarse más estudios, valores elevados de TGF-β en las pacientes con cáncer de mama a las que se les realiza cirugía conservadora asociada a RIO pueden predecir el riesgo de fibrosis

Introduction: Radiotherapy techniques associated with breast-conserving surgery have evolved in early breast cancer thanks to a better knowledge of tumor radiobiology, highlighting intraoperative radiotherapy (IORT). However, complications have been documented with this procedure, mainly fibrosis. Transforming growth factor beta (TGF-β) is a cytokine with an active role in radiation-induced fibrosis, which could be used as an early biomarker for the development of fibrosis. Methods: Multicentric prospective analysis of 60 patients with breast cancer who underwent breast-conserving surgery, 30 of whom had received additional IORT. TGF-β values were evaluated in serum pre-surgery and in serum collected 24 h after surgery. In addition, we evaluated surgical wound fluids collected 6 h and 24 h following surgery. Results: Serum and surgical wound fluids TGF-β values collected over 24 h following surgery were significantly higher in patients who received additional IORT (P < .0001). Notably, 8 of these patients showed values above 1,000 pg/ml. There were no differences between the samples (serum or surgical wound fluids) (P = .5881). Conclusions: Although further investigation is needed, higher TGF-β values in IORT during breast-conserving surgery can be used as an early biomarker for the development of fibrosis

Breast-conserving surgery in breast cancer and intraoperative radiotherapy. Can we predict the fibrosis? / Cirugía conservadora de cáncer de mama y radioterapia intraoperatoria. ¿Podemos predecir la fibrosis?

INTRODUCTION: Radiotherapy techniques associated with breast-conserving surgery have evolved in early breast cancer thanks to a better knowledge of tumor radiobiology, highlighting intraoperative radiotherapy (IORT). However, complications have been documented with this procedure, mainly fibrosis. Transforming growth factor beta (TGF-ß) is a cytokine with an active role in radiation-induced fibrosis, which could be used as an early biomarker for the development of fibrosis. METHODS: Multicentric prospective analysis of 60 patients with breast cancer who underwent breast-conserving surgery, 30 of whom had received additional IORT. TGF-ß values were evaluated in serum pre-surgery and in serum collected 24h after surgery. In addition, we evaluated surgical wound fluids collected 6h and 24h following surgery. RESULTS: Serum and surgical wound fluids TGF-ß values collected over 24h following surgery were significantly higher in patients who received additional IORT (P<.0001). Notably, 8 of these patients showed values above 1,000pg/ml. There were no differences between the samples (serum or surgical wound fluids) (P=.5881). CONCLUSIONS: Although further investigation is needed, higher TGF-ß values in IORT during breast-conserving surgery can be used as an early biomarker for the development of fibrosis.

Factores de morbimortalidad postoperatoria tras cirugía laparoscópica por cáncer de colon en pacientes octogenarios / Postoperative morbidity and mortality factors after laparoscopic resection for colon cancer in octogenarians

Introducción: Dado el aumento del diagnóstico de cáncer de colon y el acceso al tratamiento en pacientes mayores de 80 años, nuestro objetivo es valorar si el abordaje laparoscópico sigue aportando las ventajas demostradas en la recuperación postoperatoria, al tiempo que analizamos los factores que pueden influir en dichos resultados. Material y método Se han analizado retrospectivamente 593 pacientes, intervenidos de cáncer de colon por laparoscopia de forma electiva entre enero de 1999 y diciembre de 2010. Se dividieron en 33 grupos: A) menores de 70 años (n = 230), B) 70-79 años (n = 209), C) mayores o igual a 80 años (n=154). Las variables independientes: sexo, enfermedades asociadas, cirugía abdominal previa, índice de Karnosfky, índice de masa corporal (IMC), nivel de hemoglobina, proteínas y albúmina, CEA, grado de ASA, localización y estadificación tumoral. Variables dependientes perioperatoria: conversión, tiempo operatorio y pérdidas hemáticas; y postoperatorias: complicaciones locales y generales, requerimiento de unidad de cuidados intensivos, reintervenciones, estancia hospitalaria y éxitus. Resultados El grupo C presentó una mayor incidencia (p<0,001) de hipertensión arterial, diabetes mellitus, cardiopatía, neumopatía y ASA grado 3, así como valores inferiores de índice de Karnofsky, IMC, hemoglobina, albúmina y proteínas totales. Durante el postoperatorio se observó (p>0,001), mayor incidencia de complicaciones generales (respiratorias y urinarias), reintervenciones, ingresos en unidad de cuidados intensivos, éxitus y mayor estancia hospitalaria. Conclusión Aunque la cirugía laparoscópica ofrece ventajas a los pacientes mayores de 80 años con cáncer de colon, este grupo de pacientes presenta un mayor riesgo de complicaciones que la población más joven y, en consecuencia, debemos ser cuidadosos en su manejo (AU)

Introduction: Given the increase in the diagnosis in colon cancer and the access to treatment in patients over 80 years old, our aim is to assess whether laparoscopic surgery still has the demonstrated advantages in post-operative recovery, as well as to analyse the factors that may influence these results. Material and method: A retrospective analysis was made on a total of 593 patients subjected to elective laparoscopy surgery due to cancer of the colon between January 1999 and December 2010. They were divided into three age groups: A) less than 70 years (n = 230),B) 70-79 years (n = 209), C) 80 years or over (n = 154). The independent variables were: gender, concomitant diseases, previous abdominal surgery, Karnosfky index, BMI, level of, haemoglobin, proteins and albumin, CEA, and ASA grade, location (..) (AU)

[Postoperative morbidity and mortality factors after laparoscopic resection for colon cancer in octogenarians]. / Factores de morbimortalidad postoperatoria tras cirugía laparoscópica por cáncer de colon en pacientes octogenarios.

INTRODUCTION: Given the increase in the diagnosis in colon cancer and the access to treatment in patients over 80 years old, our aim is to assess whether laparoscopic surgery still has the demonstrated advantages in post-operative recovery, as well as to analyse the factors that may influence these results. MATERIAL AND METHOD: A retrospective analysis was made on a total of 593 patients subjected to elective laparoscopy surgery due to cancer of the colon between January 1999 and December 2010. They were divided into three age groups: A) less than 70 years (n = 230), B) 70-79 years (n = 209), C) 80 years or over (n=154). The independent variables were: gender, concomitant diseases, previous abdominal surgery, Karnosfky index, BMI, level of, haemoglobin, proteins and albumin, CEA, and ASA grade, location and stage of tumour. The peri-operative dependent variables were: conversion, operating time and blood loss; and post-operative: local and general complications, need for intensive care, further surgery, hospital stay, and death. RESULTS: Group C had a higher incidence (P<.001) of arterial hypertension, diabetes mellitus, heart disease, chest disease and grade 3 ASA, as well as lower values for the Karnofsky Index, body mass index (BMI), haemoglobin, albumin and total protein. A higher incidence (P>.001) of general complications (respiratory and urinary), further surgery, admission to intensive care unit, longer hospital stay and death, was also observed in the post-operative period in this group. CONCLUSION: Although laparoscopic surgery offers advantages to patients over 80 years-old, this group has a higher risk of complications than the younger population and, as a result, we must take great care in their management.