Predictors of a placebo response in patients with hand osteoarthritis: post-hoc analysis of two randomized controlled trials.

BACKGROUND: Placebo can have a significant therapeutic effect in patients with hand osteoarthritis (OA). This aim of the study is to identify factors associated with a clinically meaningful placebo response in patients with hand OA. METHODS: This post-hoc analysis of two double-blind, placebo-controlled, randomized trials (RCTs) investigating the efficacy of GCSB-5 or diacerein as treatments for hand OA analyzed the efficacy of a placebo. Clinical and laboratory factors associated with a clinically meaningful response, defined as an improvement in the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain score > 10 at 4 weeks relative to baseline, were identified. RESULTS: The mean improvement in the AUSCAN pain score was - 6.0 ± 20.3, with marked variation between 143 hand OA patients (range: - 76.4 to 33.2). A clinically meaningful improvement was observed in 54 (37.8%) patients. Placebo responders had worse AUSCAN pain scores (55.7 ± 19.7 vs. 43.6 ± 21.6, p = 0.001) and a worse AUSCAN stiffness (68.2 ± 20.5 vs. 57.5 ± 24.5, p = 0.008) at baseline than non-responders. Improvements in pain correlated with the baseline pain level (Pearson r = - 427, p < 0.001). Structural joint changes such as tender, swollen, enlarged, or deformed joint counts did not differ between placebo responders and non-responders. In a multivariable analysis, only baseline AUSCAN pain was associated with a clinically meaningful placebo response (OR: 1.054, 95% CI [1.019-1.089], p = 0.002). CONCLUSIONS: High levels of pain at baseline are predictive of a clinically meaningful placebo response in patients with hand OA. Further studies are needed to optimize and utilize the benefit of placebo responses in patients with hand OA.

Treatment of stage I non-small cell lung cancer with CyberKnife, image-guided robotic stereotactic radiosurgery.

The object of our study was to evaluate the clinical characteristics and outcomes of patients with stage I non-small cell lung cancer (NSCLC) who underwent radiosurgery using the CyberKnife, a newly developed technology to deliver radiation from multiple angles with a real-time target tracking system. A retrospective analysis of eight patients with stage I NSCLC who were treated with curative intent using the CyberKnife between 2002 and 2007 at a cancer center in Korea was performed. Among eight patients (seven men and one woman), three patients were ineligible for surgery due to poor lung function while four patients refused surgical treatment. Tumor size ranged from 19 to 50 mm in the maximal diameter (12 to 113 ml in volume). The administered radiation dose varied from 36 to 54 Gy in three fractions. All of the patients tolerated the treatment very well without any significant side effects. Complete response was achieved and was sustained for almost two years in one male patient until the patient died from a cerebrovascular accident. Seven patients showed radiographic partial response at 1-3 months. Re-growth of tumor at the treated site was observed in only one patient demonstrating an excellent local control rate, although systemic spread or regional lymph node metastasis of disease occurred in six patients during follow-up. CyberKnife treatment is very safe and is able to achieve a high local control rate, suggesting its role as a reasonable alternative therapeutic modality in early lung cancer.

Esophageal and laryngeal cancer incidentally found on [18F]fluorodeoxyglucose positron emission tomography/computed tomography during the staging workup for lung cancer.

During staging workup for lung cancer of a 74-year-old man, 2 more incidental tumors were found on [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). The 3 sites with cancer in this patient involved organs in which field cancerization has often been described, suggesting that triple primary tumors were more probable than metastasis. After treating them separately, complete response was achieved and sustained for > 2 years. The use of FDG-PET/CT seems necessary to evaluate patients with cancer, especially when there is a reasonable chance for cure. Incidentally identified lesions on FDG-PET/CT should be thoroughly explored to rule out the presence of hidden malignancy and the possibility of synchronous multiple primary tumors.

Gastrointestinal metastasis of lung cancer with special emphasis on a long-term survivor after operation.

PURPOSE: The aim of this study was to report the clinical characteristics and outcomes of gastrointestinal metastasis from lung cancer, with special emphasis on a long-term survivor after surgery. METHODS: We retrospectively reviewed all patients diagnosed with lung cancer between 2000 and 2007 at a tertiary referral center for cancer. RESULTS: Gastrointestinal metastases were detected in 10 (0.19%) of 5,239 lung cancer patients. Small bowel metastases occurred in one-half of the patients, making it the most common metastatic site. One patient underwent emergency surgery because of an intestinal perforation. Although a perforation developed only in this patient, surgical intervention was required for five other patients to relieve intestinal obstruction or control bleeding. The prognosis was poor, with a median survival of 96.5 days after diagnosis. However, one patient remains alive >5 years post-operatively, without a recurrence, suggesting that surgical resection is an option for cure in properly selected patients. CONCLUSIONS: Physicians should be familiar with unique features of lung cancer with metastasis to the gastrointestinal tract so as to render early and optimal management.

Primary gastric choriocarcinoma: two case reports and review of the literatures.

Primary gastric choriocarcinoma (PGC) is a rare tumor, and its pathogenesis is still uncertain. Most PGCs have been reported to possess an adenocarcinoma component of variable extent, and pure PGC is especially rare. The diagnosis of PGC is confirmed by exhibition of choriocarcinomatous components on biopsy and exhibition of beta-hCG positive cell on immunohistochemical stain and elevation of the serum beta-hCG. Moreover it must be confirmed that no other site including gonads displays any tumor masses. The PGC tends to be more invasive and to have early metastasis. The median survival is known to be less than several months. We report two cases. The first case was a 62 year-old man who was diagnosed as advanced gastric cancer (AGC) by endoscopic biopsy with hepatic metastasis and received palliative chemotherapy with modified FOLFOX regimen and Genexol plus cisplatin regimen. He underwent subtotal gastrectomy due to perforation of the stomach during chemotherapy. On post-operative biopsy, He was re-diagnosed as PGC and received another palliative chemotherapy modified FOLFIRI, BEP, EMACO, VIP. However, multiple liver metastases were aggravated, and also serum AFP level increased. Ultimately, the patient died 10 months after initial diagnosis. Another case was a 45 year-old man. On endoscopic biopsy, he was diagnosed as AGC of adenocarcinoma. On Chest and Abdomen CT, multiple pulmonary and hepatic metastasis were also confirmed. On liver biopsy, He was diagnosed as PGC. The immunohistochemical stains were performed and the results were cytokeratin positive, EMA negative and beta-hCG weak positive. The serum beta-hCG level was highly elevated. BEP, VIP and EMA/CO combination therapy were administered, but he died at 12th months after the initial diagnosis.