This case illustrates the variegated clinical presentation of indeterminate cell tumor and the necessity of appropriate immunohistochemical workup for its diagnosis.
Background90-day mortality (90 DM) has been proposed as a clinical indicator in radiotherapy delivered in a curative setting. No large scale assessment has been made. Its value in allowing robust comparisons between centres and facilitating service improvement is unknown.MethodsAll radiotherapy treatments delivered in a curative setting over seven years were extracted from the local electronic health record and linked to cancer registry data. 90 DM rates were assessed and factors associated with this outcome were investigated using logistic regression. Cause of death was identified retrospectively further characterising the cause of 90 DM.ResultsOverall 90 DM was 1.25%. Levels varied widely with diagnosis (0.20–5.45%). Age (OR 1.066, 1.043–1.073), year of treatment (OR 0.900, 0.841–0.969) and diagnosis were significantly associated with 90 DM on multi-variable logistic regression. Cause of death varied with diagnosis; 50.0% post-operative in rectal cancer, 40.4% treatment-related in head and neck cancer, 59.4% disease progression in lung cancer.ConclusionDespite the drive to report centre level comparative outcomes, this study demonstrates that 90 DM cannot be adopted routinely as a clinical indicator due to significant population heterogeneity and low event rates. Further national investigation is needed to develop a meaningful robust indicator to deliver appropriate comparisons and drive improvements in care.
Background:
Promising results have been reported with indication-specific partially threaded screws and variable-pitched headless compression screws. Our objective was to compare clinical and radiographic results of Jones fractures treated with these two screw types. We also evaluated the association of patient and fracture characteristics with surgical failure.
Methods:
Retrospective review identified all Jones fractures treated with primary intramedullary screw fixation from 1995 through 2015. Chart review yielded patient and fracture characteristics, implants, postoperative course, and serial radiographs for fracture classification (Torg and anatomic zone) and radiographic union. The primary endpoint was surgical failure (delayed union, nonunion, or refracture). Secondary endpoints included time to radiographic union, weight bearing, and pain resolution.
Results:
Fifty-nine consecutive patients (47 with partially threaded screws and 12 with headless compression screws) with a mean age of 30 yr and follow-up of 9.6 mo were included. The group with partially threaded screws showed more failures (10/47, 21.3% vs. 1/12, 8.3%; P=0.31) and longer time to full weight bearing (4.2 vs. 3.3 wk, P=0.06), without differences in time to radiographic union or pain resolution. Pooled union rate was 96.6%.
Conclusions:
Factors significantly correlated with failure were age, diabetes, and body mass index, without significant correlation with tobacco or gender. No differences were found between zone II and III fractures. The two groups had similar clinical and radiographic results, both with high union rates. The 21% failure rate with partially threaded screws is concerning and may warrant further investigation. This supports the headless compression screw as a viable Jones fracture treatment.
Level of Clinical Evidence:
Level III.
Introduction: Definitive chemoradiotherapy (dCRT) and radical radiotherapy are central to the management of distal oesophageal carcinoma. This study sought to establish whether the spleen receives a significant incidental radiation dose when treating distal oesophageal carcinoma with the standardised dCRT or radical radiotherapy doses. Methods: In this single-centre retrospective study, all patients (n = 34) with distal oesophageal cancer, treated with either dCRT or radical radiotherapy over an 18-month period using a volumetric modulated arc therapy (VMAT) planning technique, were included. The median age was 74 years old: 56% were male; 50% (n = 17) had adenocarcinoma and 41% (n = 14) had squamous carcinoma. The majority (79%) received dCRT with a prescribed dose of 50 Gy in 25 fractions while the other 21% of patients were treated with radical radiotherapy alone (55 Gy in 20 fractions). The spleen was retrospectively contoured by one physician, and the V 10 Gy and mean splenic dose (MSD) were calculated using Eclipse planning software. Results: The median MSD was 14.4 Gy with a range of 0.75-28.3 Gy. The median V 10 Gy was 62.7%. Of the cohort, 67.6% received an MSD of more than 10 Gy. Conclusions: Two-thirds of the patients received a dose of more than the 10 Gy. A review of the literature suggests that higher splenic radiation doses may increase the long-term risk of infection and impact on other outcomes. This study provides important evidence that the spleen receives a significant dose of radiation when treating distal oesophageal cancer and should be considered as an organ at risk.
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