[Extracorporeal high-intensity focused ultrasound: therapeutic alternative for renal tumors]. / Ultrasonidos extracorpóreos de alta intensidad: alternativa terapéutica del tumor renal.

OBJECTIVES: High intensity focused ultrasound (HIFU) is known to be used for the treatment of solid tumors in minimally invasive procedures. Transducers allowing for application of ultrasound from an extracorporeal focus have recently been developed. A review is provided of the development, physical principles, and current status of this therapy, and our early experience with it for the treatment of renal tumors is reported. MATERIALS AND METHODS: Extracorporeal HIFU is currently being used for the treatment of tumors (mainly hepatic, gynecological, and bone tumors), and has been started to be used for renal tumors with good results. A literature review (structured search in the online MEDLINE electronic base) of the physical principles of this treatment and its biological action is provided. The therapeutic procedure used in the first few patients with renal carcinoma successfully treated with HIFU at our hospital is reported. RESULTS: This therapy has been successfully used to treat solid tumors at several centers in Europe, America, and Asia. Our center has a wide experience in treatment of gynecological tumors using extracorporeal HIFU, and has already treated renal tumors with no complications, although follow-up is still short. CONCLUSIONS: Extracorporeal use of this energy appears as a new option among non-invasive therapies for renal cancer in selected cases. A low complication rate has been noted, but much longer follow-up times are required for assessment of oncological results.

Ultrasonidos extracorpóreos de alta intensidad: alternativa terapéutica del tumor renal / Extracorporeal high-intensity focused ultrasound: Therapeutic alternative for renal tumors

Objetivos: Es conocida la aplicación de los ultrasonidos focalizados de alta intensidad (HIFU) en el tratamiento de los tumores sólidos dentro de las terapias mínimamente invasivas, habiéndose desarrollado en los últimos años transductores que permiten la aplicación de ultrasonidos desde un foco extracorpóreo. Presentamos una revisión del desarrollo, los principios físicos, el estado actual y la experiencia inicial propia de esta terapia en el tratamiento de los tumores renales. Material y métodos: Actualmente el HIFU extracorpóreo está siendo utilizado en el tratamiento de tumores, principalmente hepáticos, ginecológicos y óseos, y se ha iniciado su uso en la terapia para las neoplasias renales con buenos resultados. Presentamos una revisión bibliográfica (búsqueda estructurada en la base electrónica MEDLINE online) de los principios físicos de este tratamiento y su acción biológica. Describimos la metodología de tratamiento de los primeros casos de carcinoma renal tratados en nuestro hospital con éxito mediante HIFU. Resultados: Esta terapia ha sido empleada con éxito para tratar tumores sólidos en varios centros de Europa, América y Asia. En nuestro centro tenemos una amplia experiencia en el tratamiento mediante HIFU extracorpóreo de tumores ginecológicos, y ya hemos tratado tumores renales sin complicaciones, si bien el seguimiento es todavía corto. Conclusiones: El uso de esta energía de forma extracorpórea aparece como una nueva opción dentro de las terapias no invasivas del cáncer renal en casos seleccionados, con un escaso índice de complicaciones, aunque hace falta mucho más tiempo de seguimiento para valorar sus resultados desde el punto de vista oncológico (AU)

Objectives: High intensity focused ultrasound (HIFU) is known to be used for the treatment of solid tumors in minimally invasive procedures. Transducers allowing for application of ultrasound from an extracorporeal focus have recently been developed. A review is provided of the development, physical principles, and current status of this therapy, and our early experience with it for the treatment of renal tumors is reported. Materials and methods: Extracorporeal HIFU is currently being used for the treatment of tumors (mainly hepatic, gynecological, and bone tumors), and has been started to be used for renal tumors with good results. A literature review (structured search in the online MEDLINE electronic base) of the physical principles of this treatment and its biological action is provided. The therapeutic procedure used in the first few patients with renal carcinoma successfully treated with HIFU at our hospital is reported. Results: This therapy has been successfully used to treat solid tumors at several centers in Europe, America, and Asia. Our center has a wide experience in treatment of gynecological tumors using extracorporeal HIFU, and has already treated renal tumors with no complications, although follow-up is still short. Conclusions: Extracorporeal use of this energy appears as a new option among non-invasive therapies for renal cancer in selected cases. A low complication rate has been noted, but much longer follow-up times are required for assessment of oncological results (AU)

Small cell carcinoma of the urinary bladder treated with chemotherapy and radiotherapy: results in five cases.

Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol was the one used with small cell lung cancer patients at our hospital: six cycles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide, doxorubicin, vincristine). Cystoscopy was performed after the third cycle. Four out of 5 patients were free of macroscopic disease. The fifth patient had persistent lesions and was treated by cystectomy. This patient developed a local-regional recurrence 4 months later and died shortly afterwards. Four patients completed the planned six cycles. Cystoscopy with bladder biopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One patient had invasive bladder recurrence 12 months later and cystectomy was performed. At the last follow-up 42 months later, he was alive and well. The other 3 patients were alive and free of disease 60, 48 and 27 months after diagnosis, respectively. These results are clearly more favorable than previous reports. Cystectomy might, therefore, be unnecessary in some patients.

[Malignant rhabdoid tumor of the kidney in the adult]. / Tumor rabdoide maligno de riñón en el adulto.

Presentation of a malignant rhabdoid renal tumour. This type of sarcoma which occurs commonly during the paediatric age is exceptional in the adult, this being the reason for reviewing this clinical case and its management. The term rhabdoid includes several types of morphologically similar tumours which make analysis and pathological categorization difficult. A description of the classification criteria and likely origin of the tumour is included.

[Intraluminal crystalloids in prostatic carcinoma: morphologic and histochemical study]. / Cristaloides intraluminales en el carcinoma de próstata: estudio morfológico e histoquímico.

The histological sections of 302 diagnosed cases of prostate carcinoma were analyzed for intraluminal crystalloids, correlating their presence, number and characteristics with other morphological parameters used for the diagnosis of prostate carcinoma. Evidence of these structures was found in 65 cases (21.5%). The majority developed in malignant glands though they were also found in benign glands adjacent to cancerous foci. Their presence indicates good tumoral differentiation and both their number and shape are dependent on the tumour's histological grade.