Therapeutic Biopsy

The classical concept of biopsy, i.e. obtaining a sample only for diagnostic information, is much broader at the present time. A sample of the tumour, normally tissue or blood from a patient can be useful either to determine certain characteristics of the tumor which can be the basis for a new treatment, or to obtain a vaccine. In this aspect, the selection of some particular tumours is remarkable in order to assess genetic aspects of interest in the treatment (molecular biology) such as lymphomas for the study of apoptosis, head and neck cancers in order to study sensitivity to different drugs of anti-neoplastic treatment, lung cancers for studies of genes related with targeted drugs, and kidney cancer or melanoma for anti-tumour vaccines.

Integrated approach to oligo-metastatic cancer

This is a very important approach, in which specific techniques are developed in order to eradicate metastatic tumours when its location and the number of metastases enable a combined radical treatment. At our centre we have developed new approaches to treat liver, lung and brain metastases as well as peritoneal or pleural implants.

Intra-arterial chemotherapy

This consists in administering the treatment directly in the tumour blood vessels (regional and local treatment), in order to better exploit of the properties of the drug or of the tumour circulation itself. Thus, the therapeutic effect is strengthened on the affected organ due to the drug first pass through the tumour, reducing its harmful effects on the rest of the body.

Sugarbaker Coliseum Technique

This surgical technique was developed 20 years ago by Dr. Sugarbaker in Washington DC, and has been applied successfully in the U.S. and Europe ever since. It is used in the treatment of advanced abdominal and thoracic tumours, which are difficult to manage because of their dissemination over the pleural or peritoneal cavities. This treatment, initiated in Spain at our centre, consists in removing the tumour as much as possible in previously selected in patients, administering intra-cavity chemotherapy under hyperthermia conditions (reaching temperatures of 40-43ºC), thus strengthening its effectiveness.

Antineoplastic drug pharmacokinetics

This enables the administration of drugs at the most accurate dosage adjusted to the characteristics of the patient's metabolism and the properties of the tumour, in order to reduce those unwanted effects resulting from overdose in very sensitive patients. It is also useful to administer the necessary dosage in those cases in which the regular dosage can be increased to achieve higher effectiveness.

Radiofrequency

Ablation through radiofrequency consists of inducing heat by introducing an electrode inside the tumour. This generates a high frequency alternate current that, through molecular friction, increases the temperature in the surrounding tissue until it is destroyed. During the treatment, temperatures of 100ºC are reached and maintained for several minutes, with the purpose of attaining the total necrosis of tumour tissues, with enough safety margin to reach the highest possibility of local tumour control. Whenever possible, the procedure is carried out with percutaneous anaesthesia (through the skin), which is simple and comfortable for the patient. Should localization be more precise, the organ to be treated is previously exposed through surgery in the operating room.

Ablation through radiofrequency is used to treat both primary tumours and metastases in different organs (lung, liver, suprarenal glands, lymph nodes, bone, skin, muscle). It can be the only treatment used or it can be combined with chemotherapy, radiation therapy or as surgical complement.

Immunophenotype and Molecular Genetics

At the laboratory of pathology and molecular biology, immunohistochemical studies of immunophenotype and prognostic factors of tumours are automated. PCR and hybrid "in-situ" techniques are also applied for the study of chromosome translocations and gene fusion proteins in tumours. The study of the immunophenotype in certain tumours, such as lymphomas, is completed with the assessment of flow cytometry.

Cancer immunotherapy

It consists of stimulating the immune mechanisms of the patient's organism so that tumour cells can be detected and consequently destroyed. The two best developed modalities in our centre are: obtaining, activating and administering TIL (Tumour Infiltrating Lymphocytes) and dendritic cells incubated with tumor cells, which have the highest immune stimulating capacity known so far.

Photodynamic Therapy

Treatment of tumours through an innovative system that combines the action of a photosesitizing drug, with high tumor uptake, and a laser beam therapy which activates a letahl reaction in the tumour cell. It permits local control of the disease - outdoing conventional techniques - with fewer aesthetic sequels. It can be combined with surgery, radiation therapy or chemotherapy and, unlike other techniques, it can be repeated should the tumour progress.

This treatment is being used successfully in patients with head and neck tumours, brain tumours and skin cancer, among others. Its indication in such cases is highly approved by scientists (Lancet Oncol 2000;1:212-19).

Isolated Perfusion of the Limb with TNF and Melphalan

This is a technique in which, after isolating the circulation of a limb from the rest of the organism through an extra-corporeal circulation circuit, the isolated limb is treated with a chemotherapeutic agent (melphalan) together with another powerful anti-tumour agent (TNF, Tumopur Necrosis Factor). The temperature of the perfusion fluid is higher than that of the body (hyperthermia), which increases its effect. It is indicated in cases of locally advanced or relapsing sarcoma or melanoma. In a high percentage of patients, improvement of symptoms and function is attained, thus avoiding the amputation of the limb.

Owing to its special characteristics, the centres performing the procedure require a previous accreditation of the multi-disciplinary team. Hospital San Jaime is one of two centres in Spain and among the twenty European centres which have such accreditation.

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Identification of the Sentinel Node

This surgical procedure is used in melanoma and breast cancer along with surgery of the tumour. It permits an accurate assessment of the regional nodal affection of these tumours, thus avoiding broader surgery, in which all the nodes in the area are removed - whether affected or not - and therefore the sequels derived from it. This procedure is being developed successfully in patients with other tumours, such as head and neck cancer and colon cancer.

Radioimmunotherapy

This is the selective treatment of tumours through radioactive drugs that, target-oriented and selectively, deliver a dose of radiation to the tumour cell that destroys the cell together with a few neighbouring cells, preserving the rest of the adjacent tissues. These highly specialized treatments, integrated in a multi-discipline approach, are carried out in neuroendocrinal and thyroid tumours, treatment of bone metastases, hepatocarcinomas and lymphomas.

Intraoperative Radiation Therapy and Modulated Intensity

These techniques allow the administration of a very selective dosage of radiation therapy to patients. They reach high rates of cure or local control in locally advanced solid tumours or in patients with oligometastatic tumours, reducing the dose to critical organs close to the tumour and minimizing secondary adverse effects.

In order to increase the precision of some conventional treatments of radiation therapy, there is also a program of implanting fiducial markers close to the tumour which improve the daily location of the area to be treated.