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Lattice radiation therapy (LRT) is an innovative type of spatially fractionated radiation therapy. It aims to increase large tumors control probability by administering ablative doses without an increased toxicity. Considering the rising number of positive clinical experiences, the objective of this work is to evaluate LRT safety and efficacy.Reports about LRT clinical experience were identified with a systematic review conducted on four different databases (namely, Medline, Embase, Scopus, and Cochrane Library) through the August 2022. Only LRT clinical reports published in English and with the access to the full manuscript text were considered as eligible. The 2020 update version PRISMA statement was followed.Data extraction was performed from 12 eligible records encompassing 7 case reports, 1 case series, and 4 clinical studies. 81 patients (84 lesions) with a large lesion ranging from 63.2 cc to 3713.5 cc were subjected to exclusive, hybrid, and metabolism guided LRT. Excluding two very severe toxicity with a questionable relation with LRT, available clinical experience seem to confirm LRT safety. When a complete response was not achieved 3-6 months after LRT, a median lesion reduction approximately ≥50 % was registered.This systematic review appear to suggest LRT safety, especially for exclusive LRT. The very low level of evidence and the studies heterogeneity preclude drawing definitive conclusions on LRT efficacy, even though an interesting trend in terms of lesions reduction has been described.

ResumenLos tumores renales voluminosos han disminuido su incidencia por la difusión de estudios radiológicos que permiten un diagnóstico y tratamiento temprano, sin embargo, persisten casos de tumores gigantes que representan verdaderos retos quirúrgicos.Mujer de 47 años, inicia 3años previos con dolor en hemiabdomen derecho y aumento del perímetro abdominal, fiebre y ataque al estado general. Tomografía: tumor renal derecho (30×19×15cm) que ocupa el 80% de la cavidad abdominal. Se realizó nefrectomía radical por línea media, sangrado de 1,800cc y evolución favorable, egresando a las 48h. Reporte histopatológico: carcinoma cromófobo (pT3a) de 31×19×13cm, peso de 4,630g, estadio iii, sin actividad tumoral a los 6meses.Los tumores renales voluminosos representan fases avanzadas, asociándose a mal pronóstico. La embolización prequirúrgica tiene un papel importante al disminuir el sangrado transoperatorio. Si se considera tumor resecable, se prefiere el abordaje abierto sobre el laparoscópico. Se han descrito abordajes por flanco (subcostal, supracostal o transcostal), toracoabdominales, lumbotomía o anteriores (subcostal, Chevron, medios o paramedios). El mejor abordaje debe ajustarse a la anatomía del paciente y las características del tumor.Las masas renales voluminosas constituyen un reto quirúrgico. El éxito terapéutico consiste en la adecuada evaluación perioperatoria del paciente y el tumor, estableciendo el abordaje idóneo.AbstractThe incidence of bulky kidney tumors has decreased thanks to the widespread use of radiographic studies that enable early diagnosis and treatment. However, there are still cases of giant tumors that are true surgical challenges.A 47-year-old woman presented with right hemi-abdominal pain 3 years prior, along with increased abdominal circumference, fever, and poor general status. Tomography scan revealed a right kidney tumor (30×19×15cm) occupying 80% of the abdominal cavity. Radical nephrectomy was performed at the midline with blood loss of 1,800 cc. The patient progressed favorably and was released 48h after the procedure. The histopathologic study reported a stage III chromophobe carcinoma (pT3a) that measured 31×19×13cm and weighed 4,630g There was successful oncologic control at 6 months.Large-volume kidney tumors are advanced stage lesions associated with poor outcome. Preoperative embolization plays an important role in reducing intraoperative blood loss. If the tumor is considered resectable, the open approach is preferred over the laparoscopic one. Flank approaches (subcostal, supracostal, or transcostal), thoracoabdominal, lumbotomy, or anterior approaches (subcostal, Chevron, midline or paramedian) have been described. The best approach should match the anatomy of the patient and the characteristics of the tumor.Bulky renal masses are a surgical challenge. Therapeutic success depends on adequate perioperative evaluation of the patient and the tumor, establishing the ideal approach.

Aminosilanes bearing bulky substituents on nitrogen centers, [(ArNH)(2)SiPhMe] (Ar = 2,6-(Pr2C6H3)-Pr-i (1), 2,4,6-Me3C6H2 (2)) and half-sandwich lithium silylamide [(2,6-Et2C6H3NLi)(2,6-Et2C6H3NH)SiPh2] (3) have been prepared and characterized by elemental analysis, IR, EI mass and NMR (H-1 and Si-29) spectroscopic studies. The solid state structures of 2 and 3 have been determined by single crystal X-ray diffraction studies. The molecule 2 has a C-1 symmetry due to the steric crowding, and the two N-H protons are approximately trans to each other. The amido nitrogen atoms in 2 show significant deviation from trigonal-planar geometry, and as a result, the observed Si-N bonds are marginally longer than those observed in aminosilanes with planar nitrogen atoms. The molecule 3 exists as discrete dimer with an inversion center. The Li ion in 3 forms intramolecular pi-complex with the neighboring aryl (2,6-Et2C6H3) group, to form a half-sandwich lithium silylamide. (c) 2006