Résumé
Objective:To analyze the correlation between the volume of irradiated pelvic bone marrow and acute hematologic toxicity (HT), in order to provide clinical data to reduce the risk of acute HT and optimize the radiotherapy plan.Methods:From October 2017 to May 2019, 41 LARC patients who received neoadjuvant concurrent chemoradiotherapy (CCRT) were retrospectively reviewed in our center. All patients were treated with 5-field intensity-modulated radiotherapy (IMRT), and the prescription dose delivered to PTV was 45-50.4 Gy in 25-28 fractions. Capecitabine or 5-fluorouracil (5-FU) wasadministered daily 5 days a week during radiotherapy. Different HTswere recorded according to National Cancer Institute Common Toxicity Criteria Version 5.0 (NCI-CTC.V5.0) based on laboratory tests. The volume of PBM or each site (coxal, sacrum, femoral) receiving more than x Gy refers to as TVx, CVx, SVx, and FVx, respectively. Logistic regression was performed to evaluate the association between the volume of irradiated pelvic bone marrow and different HT. Generalized additive model (GAM) and piecewise regression were used to further analyze the possible nonlinear relationship and threshold effect between them. Results:Multivariate logistic regression analysis showed that low-dose of irradiated total pelvic bone marrow volume ( TV5) and coxal bone marrow volume ( CV5, CV10) were significantly correlated with Grade ≥2 leukopenia( P<0.05). There was a significant negative correlation between the sacrum bone marrow volume ( SV5, SV10) and Grade ≥2 leukopenia ( P<0.05). A thresholdeffect has been observed between CV10 and Grade ≥2 leukopenia by Generalized additive model (GAM) and piecewise linear regression. The threshold between CV10 and Grade ≥2 leukopenia was 575 ml, OR (95% CI) was 1.85 (1.08, 3.16). Conclusions:In neoadjuvant IMRT of rectal cancer, CV is a better predictor of acute HT induced by CCRT than TV. The irradiated volume of CV associated with acute HT was mainly low-dose levels ( CV5, CV10). The thresholds of our study ( CV10= 575 ml) could be a good reference for the optimization of the radiotherapy plan.
Résumé
Introducción El uso de aloinjerto óseo irradiado en las revisiones de cadera es controvertido por las alteraciones que genera este tratamiento en el hueso. Se realizó una evaluación de una serie consecutiva de pacientes con revisión en que se utilizó este tipo de tejido. Materiales y métodos Se realizó una evaluación retrospectiva de una serie de casos consecutivos (2005-2013) de 54 pacientes (55 caderas) intervenidos por un solo cirujano. Resultados Dos pacientes requirieron una nueva revisión y tres pacientes terminaron sin prótesis por infección profunda. Se realizó el seguimiento de 39 caderas, en el cual se destaca una mejoría de la puntuación de Merle d'Aubigné-Postel, con un promedio de 9 a 14; se encontró que 11 de los 27 acetábulos (40,7%) presentaron una migración en algún plano mayor o igual a 5 mm y todos los restantes, menos uno, tuvieron alguna migración. La media de hundimiento del tallo femoral fue 4,9 mm. La incorporación del injerto se constató en el 14,8% (4/27) en el acetábulo y el 50% (8/16) en el fémur. Discusión Esta serie muestra excelentes resultados clínicos en general, pero, mientras el injerto irradiado en forma de chapas para el fémur y estructural para el acetábulo tiene buen resultado clínico y radiológico, y un buen índice de incorporación, el tejido que llega en chips para técnica de injerto compactado provoca fallas radiológicas muy frecuentes (con relación a lo publicado) y, a pesar de los buenos resultados clínicos y de la seguridad biológica ofrecida, debe indicarse con precaución y nunca debe ser la primera opción. Nivel de evidencia clínica Nivel IV.
Background The use of irradiated bone allograft in hip revision is controversial because of the alterations caused by this treatment in the allograft bone. A report is presented on a consecutive series of patients undergoing revision hip replacement using this type of tissue. Materials and methods A retrospective evaluation was performed on a series of consecutive cases (2005-2013) of 54 patients (55 hips) operated on by a single surgeon. Results Two patients required a new revision and three patients completed without prosthesis due to deep infection. Follow-up of 39 hips was performed, with an improvement in the Merle d'Aubigné-Postel score from 9 to 14. It was found that 11 (40.7%) of the 27 sockets had a migration in some plane greater or equal to 5 mm, and in the remainder all had some migration minus one. The mean subsidence of the femoral stem was 4.9 mm. The incorporation of the graft was in the acetabulum in 14.8% (4/27), and 50% (8/16) in the femur. Discussion This series shows excellent clinical results in general, but the irradiated graft in the form of plates for the femur, and structural for the acetabulum has good clinical and radiological results, and good incorporation index. Although the impaction bone grafting had good clinical outcomes and a biological safety, it should be indicated with caution and should never be the first option. Evidence level IV.
Sujets)
Allogreffes , Arthroplastie , Revue de la littérature , Prothèse de hancheRésumé
The purpose of this study was to evaluate and compare the influence of Steroid topical irrigation and implant surface on bone healing in the irradiated rabbit tibia. Implant to bone contact surface ratio and the pattern of bone healing around hydroxyapatite(HA) coated implant and pure titanium (Ti) implant which were inserted into the irradiated rabbit tibia were compared. 16 Korean house mature male rabbits were used as experimental animal. Each rabbit received 15 Gy of irradiation. 4 weeks after the irradiation, two holes were prepared in the irradiated tibia of each rabbits, where two surface type of implants were inserted :1) HA coated type and 2) pure Ti type. Right before placing implants, one group of rabbit received steroid irrigation and the other group did saline. After the irrigation, two implants of HA coated type and pure Ti type were inserted into the tibia of each rabbits. Each rabbit were sacrificed at 2nd, 4th, and 8th week after the implantation and the specimens were observed by the light microscope. The pattern of bone healing and histomorphometric analysis of the implant-bone interface were done. The results were as follows. 1. All implants inserted into the irradiated tibia of rabbit did not show any sign of clinical mobility and the bone around implants inserted into the irradiated tibia of rabbit did not show any resorption. 2. The bone to implant contact surface ratio around HA coated implants that received steroid irrigation got more bone to implant contact surface ratio than that of the saline irrigation. This result showed statistically significant(p<0.05). There was no statistically significant difference in 8th week group. 3. Though there was no statistically significant difference HA coated implants had more bone to implant contact surface ratio than pure Ti implant in 2nd and 4th groups, and there was no difference in 8th week group. 4. All implants inserted into the irradiated tibia of rabbit had exhibited successful osseointegraion.