- 作者列表："Şentürk S","Ünsal ÜÜ
BACKGROUND:Percutaneous endoscopic surgery is a common technique used for the treatment of disk herniation and spinal stenosis. In this report, we present a patient who underwent percutaneous endoscopic decompression due to spinal metastasis. CASE DESCRIPTION:A 72-year-old female patient with a known diagnosis of lung cancer presented to our clinic with a 10-day history of severe pain in the left leg and a 5-day history of muscle weakness in the left thigh. The patient had a history of multiple organ metastasis and multiple spinal metastasis. On neurologic examination, left hip flexion and extension were graded 2/5. Radiologic workup revealed compression on the left L3 nerve root caused by vertebral metastasis. The patient was planned for a percutaneous full-endoscopic interlaminar decompression due to her clinical condition. The tumor surrounding the left L3 nerve root was removed via endoscopic punch, which resulted in rapid relief of her back pain postoperatively. Adjunct physical therapy was recommended after discharge. CONCLUSIONS:Percutaneous full-endoscopic interlaminar decompression can be an alternative minimally invasive treatment option in selected patients with radicular pain and neurologic deficit caused by spinal metastasis.
背景: 经皮内镜手术是治疗椎间盘突出和椎管狭窄症的常用技术。在本报告中，我们介绍了一例因脊柱转移而接受经皮内镜减压术的患者。 案例描述: 一名 72 岁女性患者，已知诊断为肺癌，就诊于我们的诊所，有 10 天左腿剧烈疼痛史和 5 天肌肉史。左大腿无力。患者既往有多器官转移及多发性脊柱转移病史。神经系统检查，左髋关节屈伸分级为 2/5 级。放射学检查发现椎体转移引起左侧L3 神经根受压。由于患者的临床情况，计划进行经皮全内镜椎板间减压术。通过内镜下打孔术切除左侧L3 神经根周围的肿瘤，术后疼痛迅速缓解。出院后建议辅助物理治疗。 结论: 对于脊柱转移引起的神经根性疼痛和神经功能缺损的选定患者，经皮全内镜椎板间减压术可以成为一种替代的微创治疗选择。
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.