Radiation Therapy for Bone Metastasis from Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIM: Recent advances in both diagnosis and treatment have markedly improved the prognosis in patients with hepatocellular carcinoma (HCC). Bone metastasis has become a clinical problem in the treatment of HCC patients. The purpose of this study was to evaluate the palliative effect of radiotherapy for painful bone metastasis from HCC. METHODS: From January 1991 to June 2000, 51 patients (77 sites) with painful bone metastasis from HCC were retrospectively analyzed. Ages ranged from 21 to 80 years (median 55 years). The male:female ratio was 7.5:1. Synchronous or metachronous bone metastasis was seen in 20 (39%) and 31 patients (61%), respectively. The most common symptom of bone metastasis was pain (45 patients, 88%). Twenty-one patients (41%) had a solitary bone metastasis while 30 (59%) had multiple ones. The sites of bone metastasis, in order of frequency, were the vertebra (38), rib (20), and pelvis (19). The total radiation dose ranged from 12.5 to 50 Gy (median 30 Gy). The Wisconsin Brief Pain Questionnaire was used to evaluate pain response. RESULTS: The overall 1 and 2 year survival rates from the time of bone metastasis were 15% and 4%, respectively. The median survival time was 5 months. Intrahepatic stage(p=0.014), and metastasis to other organs(p=0.019) were significant prognostic factor for survival by univariate analysis. There was, however, no independent prognostic factor on multivariate analysis. Pain relief after radiotherapy was achieved for 56 sites (73%). CONCLUSION: The expected life span (median 5 months) in this group of patients suggests a strong necessity for effective treatment for symptomatic palliation. Radiation therapy was effective in pain palliation for bone metastasis from HCC, and this could improve patients' quality of life.

Percutaneous Epiphysiodesis / 대한정형외과학회잡지

Leg length discrepancy in the growing children was developed by multiple causes; such as congenital, infection, traumatic, and mechanical facotrs etc. The discrepancy have been treated by several methods including bony lengthening which is preferable method, but epiphysiodesis also has been one of the valuable methods in which was applied to the treatment of mild to moderate leg length discrepancy in the growing children. We report on patients(15 cases) with leg length discrepancy treated by percutaneous epiphysiodesis since July 1986. There were 8 males and 7 females and the average age of them was 12.6 years old. And we also performed an experimental study which was to find out the effectiveness of the pereutaneous physeal destruction comparing the techningues between curette and drill in the bony models. The causes of leg length discrepancy were trauma in 8 cases and osteomyelitis in 2 cases, congenital dislocation of the hip in 2 cases, poliomyelitis, Legg-Galve-Perthes disease, congenital hemihypertropy in each 1 case. The average preoperative leg length discrepancy was 2.6cm(range:1.9-3.7cm), and average anticipated discrepancy without operation have been 3.7cm(range:2.2-6.3cm) at maturity. The final discrepancy was 0.9cm after 43 months follow-up. According to the result by experimental study, percutaneous epiphysiodesis with curette technique would be more effective and safe than drill thchnique. Percutaneous epiphysiodesis might be one of the useful methods for the treatment of mild to moderate degree of leg length discrepancy in the growing children, and also could be applied combining with bony lengthening for treatment of severe degree of leg length discrepancy.