Combinación de 2 técnicas de transposición ovárica laparoscópica previa al tratamiento radioterápico de neoplasias pélvicas / Combination of 2 techniques of laparoscopic ovarian transposition prior to radiotherapy for pelvic neoplasms

El tratamiento con radioterapia de masas pélvicas en mujeres jóvenes causa una alta incidencia de fallos ováricos precoces. Para evitarlo, existe la opción de transponer los ovarios fuera del campo de radiación. Exponemos el caso de 2 mujeres tratadas de un sarcoma de Ewing y de una recidiva de enfermedad de Hodgkin, respectivamente, que se sometieron a una transposición ovárica laparoscópica bilateral a las correderas cólicas, el ovario izquierdo a un nivel algo inferior para mantenerlo unido a su trompa. Esta técnica permite preservar la función ovárica a la vez que mantiene la posibilidad de futuros embarazos espontáneos (AU)

Glutamine potentiates TNF-alpha-induced tumor cytotoxicity.

L-glutamine (Gln) sensitizes tumor cells to tumor necrosis factor (TNF)-alpha-induced cytotoxicity. The type and mechanism of cell death induced by TNF-alpha was studied in Ehrlich ascites tumor (EAT)-bearing mice fed a Gln-enriched diet (GED; where 30% of the total dietary nitrogen was from Gln). A high rate of Gln oxidation promotes a selective depletion of mitochondrial glutathione (mtGSH) content to approximately 58% of the level found in tumor mitochondria of mice fed a nutritionally complete elemental diet (standard diet, SD). The mechanism of mtGSH depletion involves a glutamate-induced inhibition of GSH transport from the cytosol into mitochondria. The increase in reactive oxygen intermediates (ROIs) production induced by TNF-alpha further depletes mtGSH to approximately 35% of control values, which associates with a decrease in the mitochondrial transmembrane potential (MMP), and elicits mitochondrial membrane permeabilization and release of cytochrome c. Mitochondrial membrane permeabilization was also found in intact tumor cells cultured with a Gln-enriched medium under conditions of buthionine sulfoximine (BSO)-induced selective GSH synthesis inhibition. Enforced expression of the bcl-2 gene in tumor cells could not avoid the glutamine- and TNF-alpha-induced cell death under conditions of mtGSH depletion. However, addition of GSH ester, which delivers free intracellular GSH and increases mtGSH levels, preserved cell viability. These findings show that glutamine oxidation and TNF-alpha, by causing a change in the glutathione redox status within tumor mitochondria, activates the molecular mechanism of apoptotic cell death.

[Pre-operative radiotherapy, conventional or accelerated, for invasive bladder cancer. Objectives and radiation modalities. Results and complications]. / Radioterapia pre-operatoria, convencional o acelerada, en el cáncer vesical invasor. Objectivos y modalidades de irradiación. Resultados y complicaciones.

OBJECTIVE: To present the experience of La Fe Hospital and the Institute of Oncology of Valencia with preoperative radiotherapy for bladder cancer and review the literature. METHODS: The principles of radiotherapy are discussed and the most important series reported in the English literature (Memorial Sloan Kettering, M.D. Anderson, London Institute of Urology and Rotterdam Radiotherapy Institute) and the largest published Spanish series (Ramón y Cajal Hospital) are reviewed. Furthermore, the results achieved in 123 patients treated between 1982 and 1989 at the Urology and Radiotherapeutic Oncology services of La Fe Hospital and the IVO experience with accelerated radiotherapy (20 Gy in 5 fractions) immediately followed by radical cystectomy are presented. RESULTS: The five-year survival ranged from 39% to 66%. Distant metastasis, which occurred in more than 50% of the patients, was the most common cause of failure. Comparison of the complication rates of the different series is difficult to perform. The operative mortality ranged from 2.4% to 10% and was 8% in our series. Preoperative radiotherapy does not appear to increase the number of postoperative complications. By multivariate analysis, lymph node involvement was the only significant factor that influenced survival in our series. CONCLUSIONS: It cannot be concluded from the analysis of the prospective and randomized studies that preoperative radiotherapy improves survival in patients with invasive bladder cancer. However, some authors have reported that patients with T3b tumor might benefit from this therapeutic modality.

Changes in glutathione status and the antioxidant system in blood and in cancer cells associate with tumour growth in vivo.

The relationship among cancer growth, the glutathione redox cycle and the antioxidant system was studied in blood and in tumour cells. During cancer growth, the glutathione redox status (GSH/GSSG) decreases in blood of Ehrlich ascites tumour-bearing mice. This effect is mainly due to an increase in GSSG levels. Two reasons may explain the increase in blood GSSG: (a) the increase in peroxide production by the tumour that, in addition to changes affecting the glutathione-related and the antioxidant enzyme activities, can lead to GSH oxidation within the red blood cells; and (b) an increase of GSSG release from different tissues into the blood. GSH and peroxide levels are higher in the tumour cells when they proliferate actively, however GSSG levels remain constant during tumour growth in mice. These changes associate with low levels of lipid peroxidation in plasma, blood and the tumour cells. The GSH/GSSG ratio in blood also decreases in patients bearing breast or colon cancers and, as it occurs in tumour-bearing mice, this change associates with higher GSSG levels, especially in advanced stages of cancer progression. Our results indicate that determination of glutathione status and oxidative stress-related parameters in blood may help to orientate cancer therapy in humans.

[Radiotherapy of early glottic carcinoma. Experience at the "La Fe" Hospital]. / Radioterapia del carcinoma glótico precoz. Experiencia del Hospital "La Fe".

The paper deals with the experience gained by the AA (Hospital "La Fe", Valencia) through 49 glottic cancers treated with x-ray therapy. The results are very gratifying since the percentage of survivals and cures at 10 years accounts for 96 and 92 per cent, respectively. Five failures (10%) underwent salvage surgery (T. laryngectomy), 3 with good outcome. With regard to the prognostic factors it is important to recall the great number of recurrences among the cordectomy patients (preceding the x-ray therapy) with seeded borders (4 among 10) than in the rest of the group (1 among 39).

[Treatment of Ewing's sarcoma with special reference to radiotherapy]. / Terapeútica del sarcoma de Ewing con especial referencia a la radioterapia.

The authors study 31 cases of Ewing's sarcoma. The survival after 5 years in only 25% for the initially localized tumors because lung and bone metastases finally develop in spite of any treatment. Polychemotherapy defers the appearance of metastases and increases the number of survivors. Patients being less than 15 years old offer a worst prognosis. The tumor localization, existence of general symptoms and their duration, and the alterations of the blood picture were not related with significant variations in the evolution of the Ewing's sarcoma in the studied cases. Probably the prophylactic irradiation of the lungs delays the appearance of metastases.