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Purpose@#This multicenter retrospective study aimed to investigate clinical, radiologic, and treatment-related factors affecting survival in patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG) treated with radiotherapy. @*Materials and Methods@#Patients aged <30 years who underwent radiotherapy as an initial treatment for DIPG between 2000 and 2018 were included; patients who did not undergo magnetic resonance imaging at diagnosis and those with pathologically diagnosed grade I glioma were excluded. We examined medical records of 162 patients collected from 10 participating centers in Korea. The patients’ clinical, radiological, molecular, and histopathologic characteristics, and treatment responses were evaluated to identify the prognosticators for DIPG and estimate survival outcomes. @*Results@#The median follow-up period was 10.8 months (interquartile range, 7.5 to 18.1). The 1- and 2-year overall survival (OS) rates were 53.5% and 19.0%, respectively, with a median OS of 13.1 months. Long-term survival rate (≥ 2 years) was 16.7%, and median OS was 43.6 months. Age (< 10 years), poor performance status, treatment before 2010, and post-radiotherapy necrosis were independently associated with poor OS in multivariate analysis. In patients with increased post-radiotherapy necrosis, the median OS estimates were 13.3 months and 11.4 months with and without bevacizumab, respectively (p=0.138). @*Conclusion@#Therapeutic strategy for DIPG has remained unchanged over time, and the associated prognosis remains poor. Our findings suggest that appropriate efforts are needed to reduce the occurrence of post-radiotherapy necrosis. Further well-designed clinical trials are recommended to improve the poor prognosis observed in DIPG patients.
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Objective@#This study aimed to evaluate the oncologic outcomes according to disease burden in uterine cervical cancer patients with metachronous distant metastases. @*Methods@#Between 2005 and 2015, 163 patients with metachronous distant metastases from uterine cervical cancer after receiving a definitive therapy were evaluated at seven institutions in Korea. Low metastatic burden was defined as less than 5 metastatic sites, whereas high metastatic burden was others. Each metastasis site was divided based on the lymph node (LN) and organs affected. The overall survival (OS) and progression-free survival (PFS) were assessed. Cox proportional hazards models, including other clinical variables, were used to evaluate the survival outcomes. @*Results@#The median follow-up duration was 22.2 months (range: 0.3–174.8 months). Para-aortic LNs (56.4%), lungs (26.4%), supraclavicular LNs (18.4%), and peritoneum (13.5%) were found to be the common metastasis sites. Among 37 patients with a single metastasis, 17 (45.9%) had LN metastases and 20 (54.1%) had organ metastases. The 1- and 2-year OS rates were 73.9% and 55.0%, respectively, whereas the PFS rates were 67.2% and 42.9%, respectively. SCC Ag after recurrence and high metastatic burden were significant factors affecting the OS (p=0.004 and p<0.001, respectively). Distant organ recurrence, short disease-free interval (≤2 years), and high metastatic burden were unfavorable factors for PFS (p=0.003, p=0.011, and p=0.002, respectively). @*Conclusion@#A favorable oncologic outcome can be expected by performing salvage treatments in selected patients with a long disease-free interval, low metastatic burden, and/or lymphatic-only metastasis.
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Purpose@#To evaluate the role of postmastectomy radiation therapy (PMRT) in patients with node-negative breast cancer of 5cm or larger tumors undergoing mastectomy @*Materials and Methods@#Medical records of 274 patients from 18 institutions treated with mastectomy between January 2000 and December 2016 were retrospectively reviewed. Among these, 202 patients underwent PMRT, while 72 did not. Two hundred and forty-one patients (88.0%) received systemic chemotherapy, and 172 (62.8%) received hormonal therapy. Patients receiving PMRT were younger, more likely to have progesterone receptor-positive tumors, and received adjuvant chemotherapy more frequently compared with those without PMRT (p <0.001, 0.018, and <0.001, respectively). Other characteristics were not significantly different between the two groups. @*Results@#With a median follow-up of 95 months (range, 1-249), there were 9 locoregional recurrences, and 20 distant metastases. The 8-year locoregional recurrence-free survival rates were 98.0% with PMRT and 91.3% without PMRT (p=0.133), and the 8-year disease-free survival (DFS) rates were 91.8% with PMRT and 73.9% without PMRT (p=0.008). On multivariate analysis incorporating age, histologic grade, lymphovascular invasion, hormonal therapy, chemotherapy, and PMRT, the absence of lymphovascular invasion and the receipt of PMRT were associated with improved DFS (p=0.025 and 0.009, respectively). @*Conclusion@#Locoregional recurrence rate was very low in node-negative breast cancer of 5cm or larger tumors treated with mastectomy regardless of the receipt of PMRT. However, PMRT was significantly associated with improved DFS. Further investigation is needed to confirm these findings.
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Purpose@#To evaluate the necessity of regional nodal irradiation (RNI) for pT1-2N1 breast cancer patients treated with breast-conserving surgery and radiotherapy, we compared clinical outcomes of patients treated with and without RNI. @*Materials and Methods@#We retrospectively analyzed the data of 214 pT1-2N1 breast cancer patients treated with breast-conserving surgery and whole breast irradiation from 2009–2016. There were 142 (66.4%), 51 (23.85%), and 21 (9.8%) patients with one, two, and three positive lymph nodes, respectively. Thirty-six patients (16.8%) underwent RNI. Adjuvant chemotherapy, endocrine therapy, and anti-HER2 therapy were given to 91.6%, 79.0%, and 15.0% patients, respectively. The most common chemotherapy regimen was anthracycline + cyclophosphamide, followed by taxane (76.5%). The median follow-up was 64 months (range, 6 to 147 months). Patients were propensity matched 1:2 into RNI and no-RNI groups. @*Results@#Two patients experienced locoregional recurrences simultaneously with distant metastases, ten patients developed distant metastases, and one patient died. Before matching, the 5-year actuarial locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates in the RNI and no-RNI groups were 100.0% and 99.4% (p = 0.629), 94.1% and 96.0% (p = 0.676), and 100.0% and 99.4% (p = 0.658), respectively. After matching, the 5-year LRC, DMFS, and OS were 98.3% and 100.0% (p = 0.455), 96.6% and 93.9% (p = 0.557), and 100.0% and 100.0% (p > 0.999) in the RNI and no-RNI groups, respectively. No clinicopathologic or treatment-related factors were significantly associated with LRC, DMFS, or OS. @*Conclusion@#Adding RNI did not show superior LRC, DMFS, or OS in pT1-2N1 breast cancer patients.
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BACKGROUND/OBJECTIVES@#Morusin, a marker component of Morus alba L., possesses anticancer activity. The objective of this study was to determine autophagy-inducing effect of morusin in non-small cell lung cancer (NSCLC) cells and investigate the underlying mechanism. @*SUBJECTS/METHODS@#Autophagy induction and the expression of autophagy-related proteins were analyzed by LC3 immunofluorescence and western blot, respectively. The role of autophagy and AMP-activated protein kinase (AMPK) was determined by treating NSCLC cells with bafilomycin A1, an autophagy inhibitor, and compound C, an AMPK inhibitor.Cytotoxicity and apoptosis induction were determined by MTT assay, trypan blue exclusion assay, annexin V-propidium iodide (PI) double staining assay, and cell cycle analysis. @*RESULTS@#Morusin increased the formation of LC3 puncta in the cytoplasm and upregulated the expression of autophagy-related 5 (Atg5), Atg12, beclin-1, and LC3II in NSCLC cells, demonstrating that morusin could induce autophagy. Treatment with bafilomycin A1 markedly reduced cell viability but increased proportions of sub-G1 phase cells and annexin V-positive cells in H460 cells. These results indicate that morusin can trigger autophagy in NSCLC cells as a defense mechanism against morusin-induced apoptosis. Furthermore, we found that AMPK and its downstream acetyl-CoA carboxylase (ACC) were phosphorylated, while mammalian target of rapamycin (mTOR) and its downstream p70S6 kinase (p70S6K) were dephosphorylated by morusin. Morusin-induced apoptosis was significantly increased by treatment with compound C in H460 cells. These results suggest that morusin-induced AMPK activation could protect NSCLC cells from apoptosis probably by inducing autophagy. @*CONCLUSIONS@#Our findings suggest that combination treatment with morusin and autophagy inhibitor or AMPK inhibitor might enhance the clinical efficacy of morusin for NSCLC.
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The thioredoxin (Trx) system plays critical roles in regulating intracellular redox levels and defending organisms against oxidative stress. Recent studies indicated that Trx reductase (TrxR) was overexpressed in various types of human cancer cells indicating that the Trx-TrxR system may be a potential target for anti-cancer drug development. This study investigated the synergistic effect of auranofin, a TrxR-specific inhibitor, on sulforaphane-mediated apoptotic cell death using Hep3B cells. The results showed that sulforaphane significantly enhanced auranofin-induced apoptosis by inhibiting TrxR activity and cell proliferation compared to either single treatment. The synergistic effect of sulforaphane and auranofin on apoptosis was evidenced by an increased annexin-V-positive cells and Sub-G1 cells. The induction of apoptosis by the combined treatment caused the loss of mitochondrial membrane potential (ΔΨm) and upregulation of Bax. In addition, the proteolytic activities of caspases (-3, -8, and -9) and the degradation of poly (ADP-ribose) polymerase, a substrate protein of activated caspase-3, were also higher in the combined treatment. Moreover, combined treatment induced excessive generation of reactive oxygen species (ROS). However, treatment with N-acetyl-L-cysteine, a ROS scavenger, reduced combined treatment-induced ROS production and apoptosis. Thereby, these results deduce that ROS played a pivotal role in apoptosis induced by auranofin and sulforaphane. Furthermore, apoptosis induced by auranofin and sulforaphane was significantly increased through inhibition of the phosphoinositide 3-kinase (PI3K)/Akt pathway. Taken together, the present study demonstrated that down-regulation of TrxR activity contributed to the synergistic effect of auranofin and sulforaphane on apoptosis through ROS production and inhibition of PI3K/Akt signaling pathway.
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PURPOSE: To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1–3 positive nodes and a tumor size of <5 cm. MATERIALS AND METHODS: We retrospectively analyzed data of 133 female breast cancer patients with 1–3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%). RESULTS: Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. CONCLUSION: Our study showed a very low local recurrence in patients with 1–3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient’s given risk for local and regional recurrence, and possible radiation-related toxicities.
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Female , Humans , Breast Neoplasms , Breast , Chemotherapy, Adjuvant , Cyclophosphamide , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lymph Node Excision , Mastectomy , Neoplasm Metastasis , Radiotherapy , Recurrence , Retrospective Studies , TrastuzumabABSTRACT
PURPOSE: A hybrid-dynamic conformal arc therapy (HDCAT) technique consisting of a single half-rotated dynamic conformal arc beam and static field-in-field beams in two directions was designed and evaluated in terms of dosimetric benefits for radiotherapy of lung cancer. MATERIALS AND METHODS: This planning study was performed in 20 lung cancer cases treated with the VERO system (BrainLAB AG, Feldkirchen, Germany). Dosimetric parameters of HDCAT plans were compared with those of three-dimensional conformal radiotherapy (3D-CRT) plans in terms of target volume coverage, dose conformity, and sparing of organs at risk. RESULTS: HDCAT showed better dose conformity compared with 3D-CRT (conformity index: 0.74 ± 0.06 vs. 0.62 ± 0.06, p < 0.001). HDCAT significantly reduced the lung volume receiving more than 20 Gy (V20: 21.4% ± 8.2% vs. 24.5% ± 8.8%, p < 0.001; V30: 14.2% ± 6.1% vs. 15.1% ± 6.4%, p = 0.02; V40: 8.8% ± 3.9% vs. 10.3% ± 4.5%, p < 0.001; and V50: 5.7% ± 2.7% vs. 7.1% ± 3.2%, p < 0.001), V40 and V50 of the heart (V40: 5.2 ± 3.9 Gy vs. 7.6 ± 5.5 Gy, p < 0.001; V50: 1.8 ± 1.6 Gy vs. 3.1 ± 2.8 Gy, p = 0.001), and the maximum spinal cord dose (34.8 ± 9.4 Gy vs. 42.5 ± 7.8 Gy, p < 0.001) compared with 3D-CRT. CONCLUSIONS: HDCAT could achieve highly conformal target coverage and reduce the doses to critical organs such as the lung, heart, and spinal cord compared to 3D-CRT for the treatment of lung cancer patients.
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Humans , Heart , Lung Neoplasms , Lung , Organs at Risk , Radiotherapy , Radiotherapy, Conformal , Spinal CordABSTRACT
Radiotherapy is used to treat not only malignant tumors but also benign inflammatory and hypertrophic diseases. Because of concerns about the potential hazards of irradiation, physicians in many countries, especially in North America, ruled radiotherapy out of medical practice for non-malignant diseases. Low-dose radiotherapy modulates the inflammatory response, providing an anti-inflammatory effect. Many researchers have reported low-dose radiotherapy efficacious for degenerative and inflammatory diseases. There are broad potential clinical indications for radiotherapy of non-malignant diseases. The general indications for radiotherapy for non-malignant disorders are acute/chronic painful degenerative diseases, such as chronic or acute painful osteoarthritic diseases of various joints; hypertrophic (hyperproliferative) disorders of soft tissues, such as early stages of Morbus Dupuytren and Ledderhose, keloids and pterygium; functional diseases, such as dysthyroid ophthalmopathy and arteriovenous malformations; and others, such as prophylaxis of heterotopic ossification. Radiotherapy for non-malignant disorders may be safely and effectively used, especially in older patients who suffered from these disorders and those who are reluctant to use other treatment options.
Subject(s)
Humans , Acute Pain , Arteriovenous Malformations , Dupuytren Contracture , Graves Ophthalmopathy , Joints , Keloid , North America , Ossification, Heterotopic , Osteoarthritis , Pterygium , Radiotherapy , TendinopathyABSTRACT
Radiotherapy is used to treat not only malignant tumors but also benign inflammatory and hypertrophic diseases. Because of concerns about the potential hazards of irradiation, physicians in many countries, especially in North America, ruled radiotherapy out of medical practice for non-malignant diseases. Low-dose radiotherapy modulates the inflammatory response, providing an anti-inflammatory effect. Many researchers have reported low-dose radiotherapy efficacious for degenerative and inflammatory diseases. There are broad potential clinical indications for radiotherapy of non-malignant diseases. The general indications for radiotherapy for non-malignant disorders are acute/chronic painful degenerative diseases, such as chronic or acute painful osteoarthritic diseases of various joints; hypertrophic (hyperproliferative) disorders of soft tissues, such as early stages of Morbus Dupuytren and Ledderhose, keloids and pterygium; functional diseases, such as dysthyroid ophthalmopathy and arteriovenous malformations; and others, such as prophylaxis of heterotopic ossification. Radiotherapy for non-malignant disorders may be safely and effectively used, especially in older patients who suffered from these disorders and those who are reluctant to use other treatment options.
Subject(s)
Humans , Acute Pain , Arteriovenous Malformations , Dupuytren Contracture , Graves Ophthalmopathy , Joints , Keloid , North America , Ossification, Heterotopic , Osteoarthritis , Pterygium , Radiotherapy , TendinopathyABSTRACT
PURPOSE: The standard radiation dose for patients with locally rectal cancer treated with preoperative chemoradiotherapy is 45-50 Gy in 25-28 fractions. We aimed to assess whether a difference exists within this dose fractionation range. MATERIALS AND METHODS: A retrospective analysis was performed to compare three dose fractionation schedules. Patients received 50 Gy in 25 fractions (group A), 50.4 Gy in 28 fractions (group B), or 45 Gy in 25 fractions (group C) to the whole pelvis, as well as concurrent 5-fluorouracil. Radical resection was scheduled for 8 weeks after concurrent chemoradiotherapy. RESULTS: Between September 2010 and August 2013, 175 patients were treated with preoperative chemoradiotherapy at our institution. Among those patients, 154 were eligible for analysis (55, 50, and 49 patients in groups A, B, and C, respectively). After the median follow-up period of 29 months (range, 5 to 48 months), no differences were found between the 3 groups regarding pathologic complete remission rate, tumor regression grade, treatment-related toxicity, 2-year locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, or overall survival. The circumferential resection margin width was a prognostic factor for 2-year locoregional recurrence-free survival, whereas ypN category was associated with distant metastasis-free survival, disease-free survival, and overall survival. High tumor regression grading score was correlated with 2-year distant metastasis-free survival and disease-free survival in univariate analysis. CONCLUSION: Three different radiation dose fractionation schedules, within the dose range recommended by the National Comprehensive Cancer Network, had no impact on pathologic tumor regression and early clinical outcome for locally advanced rectal cancer.
Subject(s)
Humans , Appointments and Schedules , Chemoradiotherapy , Disease-Free Survival , Dose Fractionation, Radiation , Fluorouracil , Follow-Up Studies , Neoadjuvant Therapy , Pelvis , Radiotherapy , Rectal Neoplasms , Retrospective StudiesABSTRACT
PURPOSE: To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. MATERIALS AND METHODS: Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. RESULTS: The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. CONCLUSION: The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.
Subject(s)
Female , Humans , Axilla , Body Mass Index , Breast Neoplasms , Breast , Electrons , Lymph Nodes , Mastectomy, Segmental , Radiotherapy , Tomography, X-Ray ComputedABSTRACT
PURPOSE: This study aimed to compare the dosimetric profiles of electron beams (EB) and X-ray beams (XB) for boosting irradiation in breast cancer patients who underwent breast-conserving surgery and postoperative radiotherapy. METHODS: For 131 breast cancer patients who underwent breast-conserving surgery, we compared plans for EB and XB boost irradiation after whole-breast irradiation. The organs at risk (OAR) included the cardiac chambers, coronary arteries, ipsilateral lung, and skin. The conformity index (CI), inhomogeneity index (IHI), and dose-volume parameters for the planning target volume (PTV), and OAR were calculated. Postradiotherapy chest computed tomography scans were performed to detect radiation pneumonitis. RESULTS: XB plans showed a significantly better CI and IHI for the PTVs, compared to the EB plans. Regarding OAR sparing, the XB reduced the high-dose volume at the expense of an increased low-dose volume. In 33 patients whose radiation fields included nipples, IHI was higher in the EB plans, whereas the presence of a nipple in the radiation field did not interfere with the XB. EB-treated patients developed more subclinical radiation pneumonitis. CONCLUSION: XB plans were superior to EB plans in terms of PTV coverage (homogeneity and conformity) and high-dose volume sparing in OAR when used as boost irradiation after breast-conserving surgery. A disadvantage of the XB plan was an increased low-dose volume in the OAR, but this was offset by the increased electron energy. Consequently, tailored plans with either XB or EB are necessary to adapt to patient anatomic variance and tumor bed geometric properties.
Subject(s)
Humans , Breast Neoplasms , Coronary Vessels , Electrons , Lung , Mastectomy, Segmental , Nipples , Organs at Risk , Radiotherapy, Adjuvant , Skin , Thorax , X-Ray TherapyABSTRACT
PURPOSE: To determine the incidence, risk factors, and clinical characteristics of pelvic insufficiency fracture (PIF) in patients with cervical cancer. MATERIALS AND METHODS: Between July 2004 and August 2009, 235 patients with non-metastatic cervical cancer were treated with definitive chemoradiation or postoperative radiotherapy. Among 235 patients, 117 (49.8%) underwent the first positron emission tomography/computed tomography (PET/CT) within 1 year after radiotherapy. The median radiation dose was 55 Gy (range, 45 to 60 Gy). Medical charts and imaging studies, including PET/CT, magnetic resonance imaging (MRI), CT, bone scintigraphy were reviewed to evaluate the patients with PIF. RESULTS: Among 235 patients, 16 developed PIF. The 5-year detection rate of PIF was 9.5%. The 5-year detection rate of PIF in patients who underwent the first PET/CT within a year was 15.6%. The median time to development of PIF was 12.5 months (range, 5 to 30 months). The sites of fracture included 12 sacroiliac joints, 3 pubic rami, 3 iliac bones, and 1 femoral neck. Eleven of 16 patients having PIF complained of hip pain requiring medications. One patient required hospitalization for pain control. The significant risk factors of PIF were old age, body mass index less than 23, bone mineral density less than -3.5 SD, and the first PET/CT within a year after radiotherapy. Radiation dose and concurrent chemotherapy had no impact on PIF rate. CONCLUSION: PIFs were not rare after pelvic radiotherapy in cervical cancer patients in the era of PET/CT. Timely diagnosis and management of PIF can improve quality of life in patients with cervical cancer, in addition to reducing unnecessary medical expenses.
Subject(s)
Humans , Body Mass Index , Bone Density , Electrons , Femur Neck , Fractures, Stress , Hip , Hospitalization , Incidence , Magnetic Resonance Imaging , Quality of Life , Risk Factors , Sacroiliac Joint , Uterine Cervical NeoplasmsABSTRACT
PURPOSE: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. MATERIALS AND METHODS: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. RESULTS: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. CONCLUSION: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.
Subject(s)
Animals , Female , Humans , Male , Ankle , Arthritis , Arthritis, Rheumatoid , Arthrodesis , Arthropathy, Neurogenic , Congenital Abnormalities , Follow-Up Studies , Fractures, Stress , Leg , Osteoarthritis , Poliomyelitis , Retrospective Studies , TibiaABSTRACT
BACKGROUND: The elderly is known to have many different clinical laboratory data compared with the young adults. There have been rare studies comparing tumor markers and rheumatoid factors between young adults and the elderly in Korea. This study was conducted to evaluate the differences in tumor markers and rheumatoid factor between elderly and young adults. METHODS: We gathered 94 healthy elderly cases and 91 healthy young adults who have taken periodic health examination from November 1996 to February 1997 at one hospital. We compared the mean of rheumatoid factor and tumor markers between two groups and took multiple regression analysis. RESULTS: In the elderly, the mean of CEA and AFP are significantly higher than young adults. The number of abnormally elevated rheumatoid factor is significantly higher in elderly group, but in case of CEA the number of abnormal data is not significantly different. The CEA level is significantly high in smoker group than non smoker group. The factors that increase the CEA level are old age, smoking amount, albumin level. The factors that increase the AFP level are old age, hemoglobin level. The factor that increase the rheumatoid factor is old age only. CONCLUSION: When we interpretate the level of tumor markers and rheumatoid factor, we must consider the patient's age. Aging is a factor that is associated with CEA, AFP, rheumatoid factor.