Percutaneous Endoscopic Excision and Ablation of Osteoid Osteoma of the Lumbar Spine and Sacrum: A Technical Note and Outcomes.
- 作者列表："Xie T","Xiu P","Song Y","Zeng J","Huang S
OBJECTIVE:This study aimed to present a new endoscopic technique for osteoid osteoma (OO) of the lumbar spine and sacrum and to evaluate its safety and effectiveness. METHODS:Eleven consecutive patients with spinal OO underwent percutaneous endoscopic excision and ablation (PEEA) between March 2014 and May 2018. A cannula 0.7 cm in diameter was used for the procedure. According to the size of the nidus, whole-piece removal and piecemeal intralesional resection were used. Afterward, ablation was performed using an endoscopic radiofrequency electrode in the residual osteoma cavities. Clinical outcomes were assessed by Visual Analog Scale (VAS) scores. The efficacy of this technique was assessed using relevant clinical data and postoperative radiographs. RESULTS:The niduses of the 11 patients were all located in the posterior element of the lumbar spine and sacrum (10 in the lumbar spine and 1 in the sacrum). The preoperative VAS score was 7.18 (range, 6-9), the score on postoperative day 1 was 1 (range, 0-2), and the last follow-up VAS score was 0.27 (range, 0-1). All patients were discharged within 24 hours after surgery. The mean follow-up period was 21.8 months (range, 12-36 months). No serious complications were observed during the follow-up period. CONCLUSIONS:PEEA is a safe and effective technique for OO in the lumbar spine and sacrum in which the nidus is located in the posterior element. However, it has a steep learning curve. Further research with a larger and more comprehensive sample population is warranted.
目的: 本研究旨在提出一种新的内窥镜技术治疗腰椎和骶骨骨样骨瘤 (OO)，并评价其安全性和有效性。 方法: 2014 年 3 月至 2018 年 5 月，连续 11 例脊柱OO患者接受了经皮内镜下切除和消融 (PEEA) 治疗。使用直径为 0.7厘米的套管进行手术。根据病灶大小，采用整块切除和零块切除。随后，在残留骨瘤腔中使用内镜下射频电极进行消融。通过视觉模拟评分 (VAS) 评分评估临床结局。使用相关临床数据和术后x线片评估该技术的疗效。 结果: 1 1 例患者的niduses均位于腰椎和骶骨的后部 (1 0 例在腰椎，1 例在骶骨)。术前VAS评分为 7。1 8 (范围，6-9)，术后第 1 天评分为 1 (范围，0-2)，末次随访VAS评分为 0。2 7 (范围，0-1)。所有患者均在术后 24 h内出院。平均随访时间为 21.8 个月 (范围 12-36 个月)。随访期间未观察到严重并发症。 结论: PEEA是一种安全有效的治疗腰椎和骶骨后部病灶的技术。然而，它有一个陡峭的学习曲线。需要进行更大、更全面的样本人群的进一步研究。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.