[Changes in radiotherapy indication for early-stage operated endometrial cancer. Revised staging, predictive factors. Conclusions from our own results]. / Változások a korai stádiumú operált méhtestcarcinoma sugárkezelésének indikációjában. Újabb stádiumbeosztás, prediktív tényezok. Tanulságok saját eredményeink alapján.

Optimal postoperative radiotherapy indications for early-stage operated endometrial cancers have drastically changed with the new imaging generation (magnetic resonance imaging, positron emission tomography/computed tomography) and more detailed pathomorphology. The depth and growth of tumor invasion, presence or absence of the lymph node metastases, grading and lymphovascular invasion are the most important factors to predict the progression and to influence the prognosis. In 2016, on the basis of these, the European Gynecologist Oncology and Radiotherapy Society published a report in which they proposed unanimously indications for postoperative radio- and/or radiochemotherapy. The basis of their work was prospective multilevel randomized investigations which could avoid over- or undertreatment hazards. The results obtained by the authors of this article from 164 operated patients in early-stage endometrium carcinoma seem to be acceptable, in spite of the fact that their earlier radiotherapy indication was different and in the pathological description lymphovascular invasion was not included and the grading was not always applied.

[The need for a paradigm shift in radiotherapy]. / Paradigmaváltás szükségessége a sugárterápiában.

The status and indications of radiotherapy have significantly changed in the past decade because novel techniques, radiobiological research and major advances in informatics have made better local control possible. Using supplemented marking of the target volume with computer tomography based other image-making methods adapted made it possible to define the tumor and intact surrounding tissues more precisely. With novel radiotherapy techniques the dosage of the homogenity and the covering in the target volume can be raised optimally, especially with intensity modulated arc radiotherapy (volumetric modulated arc therapy) without causing radiation injury or damage to intact surrounding tissues. Furthermore, with novel techniques and target volume marking, new indications have appeared in clinical practice and besides stereotactic radiotherapy for intracranial metastases, the extracranial so-called oligometastic conditions can be maintained close to a curative state (or in remission) for many years. Among these, perhaps the most striking is the stereotactic radiotherapy treatment of liver, lung and spinal cord metastases in one or more fractions, for which the indispensable condition is the image or respiratory guided technique.

[Potentiation of 5-fluorouracil efficacy. Molecular mechanisms playing a role in the cytotoxic action of 5-fluorouracil and 5-ethyl-2'-deoxyuridine (EUdR) combination]. / Az 5-fluorouracil (5-FU) hatékonyságának fokozása. Az 5-FU és 5-etil-2'-dezoxiuridin (EUdR) kombináció hatásában szerepet játszó molekuláris tényezôk.

UNLABELLED: Pharmacologic modulation of 5-fluorouracil (5-FU) metabolism provides a possibility for the enhancement of its clinical efficacy. AIM: The purpose of the present work was to study the effect of 5-ethyl-2'-deoxyuridine (EUdR), a potent 5-FU modulator, on different molecular mechanisms, influenced by 5-FU itself, and to obtain further data about the mode of action of the combination. MATERIALS AND METHODS: SW620 cell line was used for the experiments. Cytotoxicity was studied by MTT test, cell kinetic changes by FACStar flow cytometer, apoptosis by fluorescent microscope after staining the cells with acridine orange and ethydium bromide, DNA fragmentation by PAGE electrophoresis after RNase and proteinase-K digestion, thymidine incorporation with 3H-thymidine, p53 and PCNA protein expression by Western blotting. RESULTS: The cytotoxicity of 5-FU was potentiated dose dependently by EUdR. One hundred muM concentration of EUdR resulted in a 40% decrease of the IC50 value of 5-FU. Cell cycle arrest in the G2/M transition phase was most pronounced after combined treatment with 5-FU+EUdR. EUdR potentiated the incorporation of 3Hthymidine into DNA. In addition to the increase of apoptosis rate, the expression of p53 protein, caused by 5-FU was further potentiated by UdR. CONCLUSION: This study demonstrated a potential novel approach to increase the efficacy of 5-FU by EUdR, which incorporated two complementary molecular actions, the selective modulation of TS inhibition and potentiation of the p53 protein expression, consequently leading to an increase in the apoptotic rate.

Prognostic significance of the thymidylate biosynthetic enzymes in human colorectal tumors.

The aim of the present study was to determine the relative intratumoral activity of two pyrimidine biosynthetic enzymes, i.e. thymidylate synthase (TS) and thymidine kinase (TK), in human colorectal cancers to compare their possible relationship with demographic and pathologic characteristics of the patients and their tumors, and moreover to evaluate their predictive significance regarding 5-fluorouracil (5-FU) sensitivity and the overall survival of patients, respectively. TS and TK levels were significantly increased in the tumor compared to peritumoral tissue. However, no significant relationship between TS/TK activity and demographic features of the patients or pathologic characteristics of their tumors could be demonstrated. Kaplan-Meier analysis showed that the overall survival of patients with low TS activity was significantly longer (p < 0.012) compared to those with high TS activity. Such a difference could not be demonstrated between patients with high or low TK activity; however, combined evaluation of the two parameters proved that TK may contribute to the more precise assessment of disease prognosis, and it may further influence treatment decisions, i.e. the selection of patients for adjuvant therapy with 5-FU and folinic acid. Multivariate analysis showed that among the variables tested, beside Dukes' stage, TS and TK activities were significant prognostic factors for the overall survival of colorectal cancer patients.