Radio(chemo)therapy in anaplastic thyroid cancer-high locoregional but low distant control rates-a monocentric analysis of a tertiary referral center.

BACKGROUND: Anaplastic thyroid cancer (ATC) is a lethal disease with highly aggressive disease progression. This study analyses the influence of radio(chemo)therapy, R(C)T, on disease control, survival rates and predictors for survival. PATIENTS AND METHODS: A total of 33 patients with ATC, treated at a tertiary referral center between May 2001 and April 2020 were included. Univariate and multivariate analysis were used to investigate correlates of R(C)T and predictors on disease control and survival rates. RESULTS: Median follow-up was 4 months. In UICC stage IVA and IVB median overall survival (OS) was 8 months, median progression-free survival (PFS) was 6 months. Patients with UICC stage IVA and IVB and patients being irradiated with a radiation dose of more than 60 Gy showed increased OS. Of these patients, 3 were alive and free from disease. All of them receiving cisplatin-based radiochemotherapy and a minimum radiation dose of 66 Gy. UICC stage IVC showed a median OS of 2.5 months and a median PFS of 1 month. Only 2 of 16 patients had local failure. CONCLUSION: Depending on UICC stage, RT with high radiation dose can lead to improved OS or at least higher locoregional control. A limiting factor is the high incidence of distant metastases; therefore modern systemic treatment options should be integrated into multimodal therapy concepts.

Factors affecting infection after calcaneal fracture fixation.

A retrospective study of 178 operatively managed intra-articular calcaneal fractures was undertaken. The primary purpose of the study was to investigate whether delay prior to surgery was related to the prevalence of post-operative deep infection although other factors related to infection were also examined. The deep infection rate was 5.6% but there was no statistical correlation between surgical delay and deep infection. However analysis of the results showed that surgical experience did correlate with deep infection. The infection rate for a group of inexperienced surgeons was 14.3% compared with 2.8% for the most experienced surgeon in the study. Analysis also indicated a trend towards more socially deprived patients having a higher rate of infection but it was only in drug addicts where there was a significantly increased rate of deep infection. Other factors such as smoking, fracture severity and wound closure did not affect the rate of deep infection. Our study shows that delay prior to calcaneal fracture surgery is not associated with a lower infection rate but it is does indicate that surgical experience is important and we believe that these difficult fractures should be treated in specialised centres.

Outcome of hip resurfacing arthroplasty in patients with developmental hip dysplasia.

UNLABELLED: Patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) typically are young and active, which might affect functional ratings or failure rates after resurfacing arthroplasty. We therefore evaluated 24 patients (32 hips; mean age, 44.2 years) after hip resurfacing performed for osteoarthritis secondary to DDH. We used the Harris hip score (HHS), the University of California, Los Angeles (UCLA) activity scale, and a sports and activity questionnaire. A radiographic analysis also was performed. We followed patients a minimum of 28 months (mean, 43 months; range 28-60 months). The HHS improved from a mean of 54.7 to 97.3 and UCLA activity levels increased from a mean of 5.3 to 8.6. All patients returned to sports activity at a mean of 11 weeks after surface replacement. There were no major differences in preoperative and postoperative participation in the most common sports and activities. Two of the 32 replacements (6%) failed. We detected femoral radiolucencies in 10 of the remaining 30 hips. Despite satisfactory outcomes in clinical scores, return to sports, and hip biomechanics, the failure rate of 6% was disappointing. Additional followup is important to assess if failure rates increase in these young, active patients. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.