[The surgical opportunity in metastatic lesions of renal-cell carcinoma after a response to adjuvant immunotherapy]. / Oportunidad de la cirugía en las lesiones metastáticas del carcinoma de células renales tras respuesta a la inmunoterapia adyuvante.

Surgical resection of primary lesions and single metastasis can be curative, but surgery, used as the only therapeutic option, is not unanimously accepted in patients with multiple metastasis and, apart from other considerations, there are no established clinical criteria to allow us to predict which patients will benefit from a metastectomy. This study evaluates four patients with advanced RCC. Three had multiple pulmonary metastasis at the time of diagnosis and one presented retroperitoneal mass at 36 months of follow-up. All patients were nephrectomized and received adjuvant immunotherapy with an association of IL-2 and 2b alpha-IFN subcutaneously, obtaining partial response of the disease after two treatment courses. Later, the patients underwent debulking surgery. Two patients are still alive and have no evidence of disease progression at 28 months and 8 months of follow-up. This data and that contrasted with other authors, suggests that surgical management would be a reasonable option in patients who have partially responded to immunotherapy, even though the selection of both candidates and surgical strategy should be considered on an individual basis.

[Clinical experience with the treatment of metastatic renal cell carcinoma with subcutaneous interleukin-2r (IL-2r) and interferon Alpha-2b (IFN Alfa-2b)]. / Experiencia clínica en el tratamiento del carcinoma de células renales metastático con interleucina-2r (IL-2r) e interferón alfa 2b (IFN alfa 2b) por vía subcutánea.

This work presents our recent clinic experience in the treatment of advanced RCC with IL-2 in association to alpha IFN given subcutaneously. Fifteen patient with histologically confirmed advanced RCC and measurable lesions were entered in the study. Patients were treated in cycles of 7 weeks at a IL-2 dose of 4.8 million IU/m2 (induction phase)-2.4 million IU/m2 (maintenance phase) every 12h five days a week and alpha IFN: 6 million IU/m2 every 24h three days a week, and were afterwards evaluated for response. Responders with localized residual bulk underwent rescue surgery. Seven patient has objective response (3 complete, 2 partial and 2 stable responses). The complete responses were stable and lasted 36 m, 14 m and 8 m, and global survival was of 14.6 m (3-36 m). All patients had toxicity at various degrees but WHO grade II was not exceeded at any time. The association of IL-2 and alpha IFN 2b given subcutaneously, appears to have antitumoral activity against advanced RCC with durable responses and in a proportion similar to other associations in intravenous administration, but with lower systemic toxicity. Surgical resection of residual bulk can be beneficial in selected patient with partial response.

[Metastasis of prostatic origin in periorbital soft tissues]. / Metástasis de origen prostático en tejidos blandos periorbitarios.

Appearance of orbital metastatic (OM) neoplasia is the most frequent cause of eye tumour; however, its incidence related to prostatic carcinoma (PC) is rare, primarily when there is sole infiltration of the periorbital soft tissue (STOM). The paper describes the case of a patient diagnosed with PC presenting proptosis and diplodia as first spread symptoms. The rarity of STOM of the prostatic carcinoma prompted the diagnosis to be seen sceptically until immunohistochemical confirmation was obtained. An analysis is made of various features of interest regarding the grading of OM, clinical incidence and diagnostic methods. The singularity of the present case, affecting only the periocular soft tissues is illustrated. Finally, the situations requiring orbital biopsy in order to avoid a second neoplasia are analyzed.

[Bladder carcinosarcoma with osteosarcomatous differentiation]. / Carcinosarcoma vesical con diferenciación osteosarcomatosa.

Osteoid tissue can eventually be identified outside the bone skeleton adopting the form of metastasis, osteoid metaplasia or primitive osteosarcoma. This latter presentation is most frequently located in soft tissues and exceptionally at the visceral level. The term used for any of these forms is extra-bone osteogenic sarcoma. This paper reports the case of a 62 year-old female patient diagnosed with vesical urothelial carcinosarcoma treated with external radiotherapy. After a disease-free period of 20 years the patient developed osteosarcomatous-differentiated vesical carcinosarcoma. A literature review is made to analyze, from a clinical and histopathological perspective, several items of interest presented by this pathology. The role of sarcomatous radio-induction is also highlighted. Finally, we emphasize the relevance of using radical treatments from the start, so as to restrain the highly malignant potential of this condition.