Focused Microwave Phased Array Thermotherapy for Ablation of Early-Stage Breast Cancer: Results of Thermal Dose Escalation

Background: Tumor ablation as a means of treating breast cancer is being investigated. Microwave energy is promising because it can preferentially heat high-water-content breast carcinomas, compared to adipose and glandular tissues.Methods: This is a prospective, multicenter, nonrandomized dose-escalation study of microwave treatment. Thermal dose was measured as (1) thermal equivalent minutes (cumulative equivalent minutes; CEM) of treatment relative to a temperature of 43°C and (2) peak tumor temperature. Microwaves were guided by an antenna-temperature sensor placed percutaneously into the tumor. Outcomes measured were pathologic response (tumor necrosis) side effects.Results: Twenty-five patients (mean age, 57 years) were enrolled. The mean tumor diameter was 1.8 cm. Tumoricidal temperatures (>43°C) were reached in 23 patients (92%). Tumor size was unchanged after thermotherapy (P = not significant). Pathologic necrosis was achieved in 17 (68%) patients. Complete necrosis of the invasive component was achieved in two patients. One hundred forty CEM is predictive of a 50% tumor response, and 210 CEM is predictive of a 100% tumor response (P = .003). Univariate linear regression predicts that peak tumor temperatures of 47.4°C and 49.7°C cause a 50% tumor response and a 100% tumor response, respectively.Conclusions: Thermotherapy causes tumor necrosis and can be performed safely with minimal morbidity. The degree of tumor necrosis is a function of the thermal dose. Future studies will evaluate the impact of high doses of thermotherapy on margin status and complete tumor ablation.Presented at the 2003 Society of Surgical Oncology Cancer Symposium, Los Angeles, California, March, 5–9, 2003.     

Success of sentinel lymph node mapping after breast cancer ablation with focused microwave phased array thermotherapy

BACKGROUND: Breast cancer tumor ablation as part of a multimodality approach in the treatment of breast cancer is the subject of recent interest. This study was conducted to determine if the ability to perform sentinel node biopsy was impaired after thermal-induced ablation of breast cancer. METHODS: We studied patients who had sentinel node biopsy after preoperative focused microwave phased array for breast cancer ablation. RESULTS: Twenty-one patients with T1-T2 breast cancer and clinically negative axilla underwent wide local excision and sentinel node biopsy guided by blue dye and sulfur colloid. Surgery was done an average of 17 days after microwave ablation. Fifteen of 22 patients (68%) had histologic evidence of tumor necrosis. Sentinel lymph node mapping was successful in 19 of 21 patients (91%). Axillary metastases were detected in 42% of cases. CONCLUSIONS: This study documents successful sentinel lymph node mapping for patients treated with antecedent local tumor ablation using focused microwave phased array ablation.     

A Phase II Trial of Image-Guided Radiofrequency Ablation of Small Invasive Breast Carcinomas: Use of Saline-Cooled Tip Electrode

Background Local ablative therapy of breast cancer represents the next frontier in the evolution of minimally-invasive breast conservation therapy. We performed this Phase II trial to determine the efficacy and safety of Radiofrequency (RF) ablation of small invasive breast carcinomas. Methods Seventeen patients with biopsy-proven invasive breast cancer, ≤ 1.5 cm in diameter were enrolled in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RF electrode followed by surgical resection. Pathologic and immunohistochemical stains were performed to assess tumor viability. We examined whether loss of ER, PR receptor and pancytokeratin expression following RF ablation would correlate with non-viability. Results Fifteen patients completed the treatment. The mean tumor size was 1.28 cm. The mean ablation time was 21 minutes using a mean power of 35.5 watts. During ablation, the tumors became progressively echogenic that corresponded with the region of severe electrocautery injury at pathological examination. Of the 15 treated patients, NADPH viability staining was available for 14 patients and in 13 (92.8%), there was no evidence of viable malignant cells. ER, PR expression and pancytokeratin immunohistochemistry analysis were unreliable surrogates for determining non-viability. Following RF ablation, 2 patients developed skin puckering. Conclusions RF ablation is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further research is necessary to optimize this image-guided technique and evaluate its future role as the sole local therapy.     

Focused Microwave Thermotherapy for Preoperative Treatment of Invasive Breast Cancer: A Review of Clinical Studies

Background  

Preoperative focused microwave thermotherapy (FMT) is a promising method for targeted treatment of breast cancer cells. Results of four multi-institutional clinical studies of preoperative FMT for treating invasive carcinomas in the intact breast are reviewed.     

Radiofrequency Ablation of Invasive Breast Carcinomas: A Phase II Trial

Background Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We conducted a phase II trial to evaluate radiofrequency ablation (RFA) of invasive breast carcinomas. Methods Consecutive patients from two Mexican Institutions with invasive breast cancers < 4 cm, with no multicentric tumors and no previous chemotherapy were included in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RFA electrode followed by surgical resection. Routine pathologic analysis and viability evaluation with NADPH-diaphorase stain were performed to assess tumor ablation. Procedure-associated morbidity was recorded. Results Twenty-five patients were included. Mean patient age was 55.3 years (range 42–89 years). Mean tumor size was 2.08 cm (range 0.9–3.8 cm). Fourteen tumors (56%) were <2 cm. The mean ablation time was 11 minutes using a mean power of 35 W. During ablation, the tumors become progressively echogenic that corresponded with the region of severe RFA injury at pathologic examination. Of the 25 patients treated, NADPH stain showed no evidence of viable malignant cells in 19 patients (76%), with significant difference between tumors <2 cm (complete necrosis in 13 of 14 cases, 92.8%) vs. those >2 cm (complete necrosis 6 of 11 cases, 54.5%) (P < .05). No significant morbidity was recorded. Conclusions RFA is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.     

Transurethral microwave thermotherapy for benign prostatic hyperplasia

The clinical efficacy of transurethral microwave thermotherapy using the PROSTCARE apparatus was evaluated in 60 patients with bladder outlet obstruction associated with benign prostatic hyperplasia. All of the 60 patients received a single thermal session for 60 minutes with an average intraprostatic temperature of 45 degrees C. They were evaluated by analyzing the international prostate symptom score (IPSS), quality of life (QOL) index, maximum urinary flow rate and prostate volume at 2 months after the treatment to estimate criteria for efficacy of treatment in BPH. Both IPSS and QOL index improved significantly. The maximum urinary flow rate improved but there was no significant change. There was no significant change in prostate volume. The rates of improvement in IPSS, QOL index and maximum flow rate were 73%, 78% and 47% of the patients respectively. The rate of overall improvement was 78% of the patients. As a complication after the treatment, 2 patients complained of ejaculation disturbance.     

胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣在乳腺肿瘤切除术后胸壁缺损中的应用

目的探讨对侧胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣修复乳腺肿瘤切除术后胸壁软组织缺损的临床效果。方法回顾性分析大连医科大学附属第一医院2018年1月至2019年5月收治的6例乳腺肿瘤患者的临床资料,均为女性,年龄46~73岁,平均55.5岁,其中5例为局部晚期乳腺癌,1例为晚期乳腺癌。病程4个月至5年,中位时间20.1个月。4例患者行术前化疗。术中切除原发病灶后,局部皮肤软组织缺损范围达10 cm×15 cm^21 cm×31 cm,单独采取对侧胸廓内动脉穿支皮瓣或联合带蒂背阔肌Kiss皮瓣修复胸壁缺损,供区直接拉拢缝合,1例患者对侧乳房体积较大,同期行乳房缩小和乳房成形术。术后进行随访,观察皮瓣情况,以及肿瘤是否复发。结果6例胸廓内动脉穿支皮瓣切取范围为5 cm×12 cm^10 cm×23 cm,其中3例联合带蒂背阔肌Kiss皮瓣进行修复,两叶皮瓣每叶面积范围为5 cm×15 cm^7 cm×18 cm,6例患者皮瓣均成活,其中5例创面一期愈合,1例背部供区因张力稍大,出现皮下积液,经换药、引流后切口延期愈合。术后随访1~17个月,平均7.5个月,术区皮肤平整,皮瓣外观良好,对肩关节及腰部活动无影响,肿瘤均无局部复发,供区仅遗留线状瘢痕。结论应用对侧胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣修复乳腺肿瘤切除后巨大胸壁软组织缺损,无需血管吻合,手术简单,术后恢复快,并发症少,效果较好。     

耳前随意皮瓣转移修复耳廓前侧皮肤缺损的临床探讨

目的：总结评价耳廓前侧皮肤软组织缺损采取耳前随意皮瓣皮下隧道转移修复治疗的临床效果。方法：2008年1月～2009年12月收治9例耳廓前侧体表肿瘤患者。男3例,女6例;年龄16～79岁,平均59岁,病程0.5～16年。其中血管瘤4例,基底细胞癌3例,鳞状细胞癌2例。肿瘤范围0.5cm×0.5cm～3.0cm×2.0cm,形状各异,不规则。根据肿瘤不同性质、大小和范围,选择不同术式完整切除肿瘤,并行耳前随意皮瓣皮下隧道转移修复,术后7～10天拆线。结果：术后患者切口Ⅰ期愈合9例,其中2例愈合过程出现皮瓣远端肿胀、紫红色,皮瓣均成活。9例获随访1年以上,耳廓无变形,瘢痕不明显,患者效果满意。结论：耳前随意皮瓣皮下隧道转移能很好的修复耳廓前侧体表肿瘤切除后的皮肤缺损,具有术后瘢痕小,色泽质地与周围皮肤接近,供区隐蔽的优点,取得满意效果,是治疗的选择方案之一。     

Transurethral hot water balloon thermotherapy for benign prostatic hyperplasia

For many years the transurethral prostatectomy has been the standard therapy for benign prostatic hyperplasia (BPH). In the past 10 to 15 years, a number of competing minimally invasive technologies (MIT) have been used to treat patients with symptomatic BPH. These heat-based treatments include transurethral microwave thermotherapy, interstitial devices (eg, interstitial laser coagulation and transurethral needle ablation), high-intensity focused ultrasound, and water-induced thermotherapy (WIT). This article reviews the evidence supporting the efficacy and safety of transurethral hot water balloon thermotherapy for BPH. Appropriate patient selection factors for WIT versus other MITs are reviewed. A novel combination therapy for adenocarcinoma of the prostate also is proposed.     

INCREASING THE THERMAL DOSE IN TRANSURETHRAL MICROWAVE THERMOTHERAPY PRODUCES NO IMPROVEMENT IN THERAPEUTIC EFFICACY

Background:
Transurethral microwave thermotherapy (TUMT) is a minimally invasive treatment for benign prostatic hyperplasia (BPH). It has been reported that increased thermal dose and higher intraprostatic temperatures resulted in improved clinical response. Recently we treated BPH patients with the prostatron device using a new version of software (Prostasoft 2.5), which was intended to increase thermal delivery by allowing maximum power up to 70W. The safety and clinical results were compared between the patients treated with Prostasoft 2.5 and those treated with the currently available software (Prostasoft 2; maximum power up to 50W).
Methods:
A total of 105 patients were treated successively with two treatment protocols. Sixty-three patients were treated with Prostasoft 2 between September 1992 and July 1993. while 42 were treated with Prostasoft 2.5 between August 1993 and April 1994. Therefore, this investigation was a retrospective nonrandomized study. There was no significant difference in the baseline patient characteristics between the two groups.
Results:
Total thermal dose delivered to the prostate was significantly higher in the Prostasoft 2.5 group than that in the Prostasoft 2 group (137 kJ versus 116 kJ, P < 0.05). No serious complications were encountered in either group. Six months after TUMT, in both the Prostasoft 2.5 and Prostasoft 2 groups there was an improvement in patient condition as measured by the mean I-PSS, OOL, and peak How rate values, as well as the overall therapeutic efficacy. The two groups differed in the amount of posttreatment improvement from between 8% and 22%, but this difference was not statistically significant.
Conclusions:
Our study suggests that higher thermal dose attained by Prostasoft 2.5 does not necessarily result in more pronounced clinical improvement, although clinical response to TUMT has often been reported to be dependent upon thermal dose.     

Nonablative minimally invasive thermal therapies in the treatment of symptomatic benign prostatic hyperplasia

PURPOSE OF REVIEW: As all new treatment modalities nonablative thermal therapy for minimal invasive treatment of benign prostatic hyperplasia should be critically analyzed. This review discusses the literature to identify the merits of these so-called minimally invasive treatments and the place they should take in the armamentarium of benign prostatic hyperplasia therapy options. RECENT FINDINGS: In this review we analyze the different techniques and clinical studies of hot water induced thermotherapy, transurethral microwave thermotherapy, transurethral needle ablation and high intensity focused ultrasound. The high intensity focused ultrasound treatment is noninvasive, but due to the poor clinical results in benign prostatic hyperplasia and its need for anesthesia, this therapeutic option shifted towards the selective ablation of prostate cancer. The transurethral needle ablation treatment can be performed in an outpatient setting although most centers do not. The treatment is not suitable for the bigger prostates and therefore narrows its indication. Water induced thermotherapy is a very promising therapy, although without comparative studies a justified positioning remains difficult. SUMMARY: Of all nonablative thermal therapies, transurethral microwave thermotherapy is the best documented and with several randomized studies comparing transurethral microwave thermotherapy to surgical treatments of the prostate, this therapy definitively found its place as a serious alternative to the ablative surgical treatment options.     

经乳晕入路腔镜下甲状腺手术36例报告

目的探讨经乳晕入路腔镜下甲状腺手术的疗效。方法2004年8月～2008年5月甲状腺〈5cm良性结节或腺瘤,经乳沟1.2cm、乳晕0.5cm三孔入路腔镜下使用超声刀游离胸前区、颈前肌群,超声刀处理血管及腺体,完整腺体摘除或腺叶切除。结果35例腔镜下完成手术,1例因术中快速冰冻提示甲状腺癌中转开放手术。手术时间40～120min,平均80min;术中出血量10～60ml,平均40ml。术后6h下床活动,进流质,颈部引流管术后2d拔除。1例术后皮下淤血,2周后消退。术后住院3～5d,平均4d。术后病理：甲状腺瘤28例,结节性甲状腺肿7例,甲状腺癌1例。35例术后随访3～24个月,平均12个月,均无肿瘤复发,乳晕切口无瘢痕形成,美容效果好。结论经乳晕入路腔镜下甲状腺手术近期疗效满意,安全可靠,手术切口隐蔽,颈部无瘢痕,美容效果好。     

Prostatic and periprostatic interstitial temperature measurements in patients treated with transrectal thermal therapy (local intracavitary microwave hyperthermia).

One of the questions raised regarding the use of transrectal thermal therapy in the treatment of benign prostatic hyperplasia (BPH) is whether there is a uniform and safe temperature distribution within the prostate. Our study represents the first attempt in humans to map the interstitial thermal distribution in the prostate during transrectal thermal therapy. With the patient under local anesthesia and under ultrasound guidance, a transperineal 3-point thermocouple was placed into various areas of the prostate in 15 patients. Prostatic-urethral thermocouple distance ranged from 1 to 3 cm. A urethral catheter containing a 5-point linear array thermocouple was placed and the balloon was inflated so that the proximal point was at the bladder neck and the remaining points were at 1 cm. intervals along the prostatic urethra. Power (25 watts) was delivered via the Primus (Technomatix) transrectal microwave applicator with simultaneous cooling of the rectal mucosa (between 12 and 14C). Treatment was delivered for 60 minutes and temperatures were recorded. In the prostatic substance a maximal temperature of 45C was observed during the heat-up phase and this decreased as the vasoactive response occurred. Temperature along the prostatic urethra varied between 40 and 43C and never exceeded 44C. A similar distribution of temperature was registered in the thermocouple points in the prostatic substance. The anticipated thermal dose of 41.5 +/- 1C for 60 minutes was achieved in the prostatic substance as measured by the sensors in the prostatic urethra and interstitial sensors. The results suggest that transrectal thermal therapy delivers a uniform and safe distribution of heat in the prostatic substance and urethra. Clinical trials are currently underway to ascertain the efficacy of transrectal thermal therapy in the management of BPH.     

Ablative therapies for the treatment of malignant diseases of the breast

BACKGROUND: Because widespread screening for breast cancer is detecting more women at younger ages and earlier stages, the need for minimally invasive, cosmetically preferable approaches to its treatment is growing. Ablative techniques are now being applied to the treatment of primary breast tumors, perhaps offering an alternative to surgical excision. Techniques available for breast cancer treatment include radiofrequency ablation, cryoablation, interstitial laser ablation, microwave thermotherapy, and focused ultrasound ablation. DATA SOURCES: Literature searches for breast and cryoablation, focused ultrasound ablation, interstitial laser ablation, microwave thermotherapy, and radiofrequency ablation were performed. Over 30 articles were identified and analyzed. CONCLUSIONS: It is cautiously optimistic that these therapies can be used as a routine adjunct in the treatment of selected breast cancers. The challenge will lie in the ability to identify multifocal disease and in situ carcinoma as well as to ensure complete and effective eradication of the breast cancer.     

Ultrasound-Guided Laser-Induced Thermal Therapy for Small Palpable Invasive Breast Carcinomas: A Feasibility Study

Background  The next step in breast-conserving surgery for small breast carcinomas could be local ablation. In this study, the feasibility of ultrasound-guided laser-induced thermal therapy (LITT) is evaluated. Methods  Patients with large-core needle biopsy-proven invasive, palpable breast carcinoma (clinically ≤2 cm) underwent ultrasound-guided LITT, followed by surgical excision. Completeness of ablation was determined by both hematoxylin and eosin staining and nicotinamide adenosine diaphorase staining. Results  Fourteen patients completed the treatment. The mean histological tumor size was 17 mm (range, 8–37 mm); 6 of 14 tumors were histologically larger than the clinical entry threshold of 2 cm. The power applied in all patients was 7 W, and the mean treatment time was 21.4 min (range, 15–30 min). In one patient, a skin burn occurred, and one patient had a localized pneumothorax that could be treated conservatively. In 7 (50%) of 14 patients, the tumor was completely ablated, as confirmed by nicotinamide adenosine diaphorase staining. In 11 cases, extensive in-situ carcinoma was present. In one case, the in-situ carcinoma was also completely ablated. A total of seven (88%) of eight tumors <2 cm in size were completely ablated versus one (17%) of six tumors that were ≥2 cm in size (P = .026). Conclusions  Successful LITT of invasive breast cancer seems to be feasible when confined to small (<2 cm) nonlobular carcinomas without surrounding extensive in-situ component and angioinvasion. However, to implement LITT in a curative setting, improvements in imaging to more reliably preoperatively assess tumor size and monitoring of fiber tip placement and treatment affect are essential.     

Development of stereotactically guided laser interstitial thermotherapy of breast cancer: in situ measurement and analysis of the temperature field in ex vivo and in vivo adipose tissue

BACKGROUND AND OBJECTIVE: The size (0.5-1.0 cm) of early nonpalpable breast tumors currently detected by mammography and confirmed by stereotactic core biopsy is of the order of the penetration depth of near infrared photons in breast tissue. In principle, stereotactically biopsied tumors, therefore, could be safely and efficiently treated with laser thermotherapy. The aim of the current study is to confirm the controlled heating produced by clinically relevant power levels delivered with an interstitial laser fiber optic probe adapted for use with stereotactic mammography and biopsy procedures. STUDY DESIGN/MATERIALS AND METHODS: Temperature increases and the resultant thermal field produced by the irradiation of ex vivo (porcine and human) and in vivo (porcine) tissue models appropriate to the treatment of human breast tissue by using cw Nd:YAG laser radiation delivered with a interstitial fiber optic probe with a quartz diffusing tip, were recorded with an array of fifteen 23-gauge needle thermocouple probes connected to a laboratory computer-based data acquisition system. RESULTS: By using a stepwise decreasing power cycle to avoid tissue charring, acceptably symmetric thermal fields of repeatable volumetric dimensions were obtained. Reproducible thermal gradients and predictable tissue necrosis without carbonization could be induced in a 3-cm-diameter region around the fiber probe during a single treatment lasting only 3 minutes. The time-dependences of the temperature rise of the thermocouples surrounding the LITT probe were quantitatively modeled with simple linear functions during the applied laser heating cycles. CONCLUSION: Analysis of our experimental results show that reproducible, symmetric and predictable volumetric temperature increases in time can be reliably produced by interstitial laser thermotherapy.     

Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite Laser

BACKGROUND: Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. OBJECTIVE: To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I-V. METHODS: Eighty-nine untanned patients with skin types I-V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4-6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10-15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm(2), a spot size of 12 mm was used for fluences of 35-40 J/cm(2), and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm(2). Fluences ranging from 20 to 50 J/cm(2) (mean fluence 36 J/cm(2)) were used. RESULTS: The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm(2) (35-50 J/cm(2)) and a 10-12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm(2) (30-40 J/cm2) and a 12-15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm(2) (25-40 J/cm(2)) and a 12-15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25-35 J/cm(2)) and a 12-15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm(2) (20-25 J/cm(2)) and a 12-15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. CONCLUSION: The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.     

Transurethral microwave thermotherapy: from evidence-based medicine to clinical practice

PURPOSE OF REVIEW: The aim of this article is to provide new clinical data on transurethral microwave thermotherapy, evaluate it in the perspective of evidence-based guidelines and daily practice and investigate the driving forces that determine the current position of thermotherapy for the management of benign prostatic obstruction. RECENT FINDINGS: Recent studies have provided significant evidence regarding the efficacy, safety and durability of thermotherapy. Updated evidence-based clinical guidelines on the management of patients with benign prostatic obstruction have been made available. Surveys have evaluated the acceptance of transurethral microwave thermotherapy from the urological community. In addition, several studies have made major contributions to our knowledge of the translation of evidence to daily practice. SUMMARY: The range of therapeutic options for benign prostatic obstruction continues to widen creating the need for clarity in selection and application of these treatments. High-quality data on transurethral microwave thermotherapy have been published and integrated into clinical guidelines. Considerations on the implementation of guidelines to clinical practice, emergence of new treatments, shift of benign prostatic obstruction therapy, economics and the increasing need to treat patients with different clinical profile during the last decade seem to affect the position of transurethral microwave thermotherapy in the armamentarium of a urological centre. Into this frame, transurethral microwave thermotherapy tailored to selective cases seems to remain an attractive option.     

Transurethral microwave thermotherapy in the treatment of benign prostatic hyperplasia: results obtained with the Urologix T3 device

The objective of this study was to assess the efficacy and safety of a new transurethral microwave thermotherapy device, T3, in the treatment of symptomatic benign prostatic hyperplasia. A total of 155 patients were recruited at 3 sites and treated using an identical protocol. The mean AUA symptom score decreased by 58% at 12 months, by 61% at 24 months and by 56% at 36 months. The increase in mean peak flow rates at these time points was 3.9 (47%), 3.4 (44%) and 5.1 ml/s (67%), respectively. Adverse events were minor and the patients' satisfaction with treatment was high. Transurethral microwave thermotherapy with the T3 device provides a safe, effective treatment for symptomatic benign prostatic hyperplasia.     

Laser palliation for colorectal carcinoma.

A review was conducted of 27 patients with colorectal carcinoma treated palliatively with endoscopic neodymium:yttrium-aluminium-garnet (Nd:YAG) laser. There were 25 rectal carcinomas and 2 primary invasive sigmoid colon carcinomas. Of the 25 rectal carcinomas, there was 1 carcinoma in situ, 16 primary cancers, and 8 recurrent rectal carcinomas. The level of the lesions from the anal verge ranged from 0 to 25 cm, with a mean of 7.2 cm. The length of the lesions ranged from 1.5 to 8.5 cm, with a mean of 5 cm. The mean number of Nd:YAG laser treatments was three, with a range from one to nine. The duration of the treatments ranged from 30 to 90 minutes, with a mean of 40 minutes. Four of 27 patients (15%) developed complications. The success rate in terms of the relief of symptoms was established in 23 of the 27 patients.