Expected and paradoxical effects of obesity on cancer treatment response

Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. Furthermore, epidemiological studies have shown that obesity is a negative independent prognostic factor for several oncological outcomes, including overall and cancer-specific survival, for several site-specific cancers as well as for all cancers combined. Yet, a recently growing body of evidence suggests that sometimes overweight and obesity may associate with better outcomes, and that immunotherapy may show improved response among obese patients compared with patients with a normal weight. The so-called 'obesity paradox' has been reported in several advanced cancer as well as in other diseases, albeit the mechanisms behind this unexpected relationship are still not clear. Aim of this review is to explore the expected as well as the paradoxical relationship between obesity and cancer prognosis, with a particular emphasis on the effects of cancer therapies in obese people.

Osteoid osteoma treated with radiofrequency ablation in non-operating room anesthesia. A different way of approaching ablative therapy on osteoid osteoma

OBJECTIVE

The purpose of this study is to verify the effectiveness and complications occurrence of radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in non-operating room anesthesia (N.O.R.A.).

PATIENTS AND METHODS

From 2014 to 2017, 61 patients affected by OO (40 men and 21 women) with an age of 20.7 years on average (range, 4-51 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency ablation (RFA) in N.O.R.A. (Non-Operating Room Anesthesia). Lesion sites treated were: femur (27), tibia (22), pelvis (2), talar bone (3), distal radius (1), and humerus (6). Mean follow-up time was 36 months. In each case, anesthesiologic support followed a new protocol (N.O.R.A. protocol), approved by our Institute. Primary success rate, complications, symptom-free intervals, and follow-up results were evaluated.

RESULTS

Pain relief (evaluated with Visual Analogue Scale - VAS) was significant in 97% of patients; it disappeared within 24 hours of the procedure in 44 patients, within 3 days in 10 patients, and within 7 days in 7 patients. After 6 months of observation time, 60 of 61 patients were successfully treated and had no more complaints. In 2 patients, two major complications were found: infection of the site treated, healed with antibiotics, and a nerve lesion, healed with steroid therapy. No other complications were observed.

CONCLUSIONS

RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO following N.O.R.A.

PROTOCOL

The effectiveness of a standard drill connected to a core biopsy needle: How to obtain specimens in very strong bone tumors

INTRODUCTION

Core biopsy is today recognized as the gold standard for the diagnosis of bone lesions; unfortunately, when the bone is too solid it can be very difficult to penetrate it; in case of failure, open biopsy is indicated but it is associated with greater contamination and complications. A possible solution is to connect a common orthopedic drill to the core biopsy needle. The aim of the presenting study was to present a technique useful for performing biopsies in case of very strong bone lesions and to evaluate the adequacy and quality of the obtained specimen.

MATERIALS AND METHODS

A standard bone biopsy set was connected to a commercial drill to perform bone biopsies. Data was collected over a 2-year period (2015-2016). Information regarding technical success, diagnostic data and complication rates was all collated to assess the technical feasibility of this technique.

RESULTS

Out of 357 bone biopsies, 34 patients underwent the procedure using a common orthopedic drill connected to a core biopsy needle. Diagnostic material was obtained in each patient and the artifacts were considered irrelevant. No major complications occurred in any patient.

DISCUSSION

The use of a core biopsy needle connected to a common orthopedic drill facilitates the penetration of thick cortical bone by simply applying continuous speed and pressure; nevertheless, the biopsy needle we use is not designed for a drilling procedure and for this reason it can be damaged, but if the biopsy is performed with particular attention, the mechanical failure can be avoided CONCLUSIONS: Bone biopsy using a commercial hand drill has a technically high success rate with minimal complications. Further studies with more cases are necessary to verify our results.

[Prosthetic hip revision: relationship between bone stock and quality of life in aseptic loosening of the femoral component]

OBJECTIVES

We evaluated the clinical and radiographic results in the medium and long term in patients undergoing revision surgery for aseptic loosening with different bone quality at the time of the operation. We investigated how different bone quality shapes for a good clinical result.

MATERIALS AND METHODS

A total of 33 patients who underwent revision surgery of the hip (for aseptic loosening of the stem) evaluated radiographically and clinically at 1,6,12 and 18 months. The evaluation of clinical status preoperatively and at the end of follow-up was be made as questionnaires SF-36, Harris Hip Score and WOMAC; radiographic assessment was made using the scale of Paprosky. The data thus obtained have been related to complications arising and the status of femoral bone-loss before the surgery time.

RESULTS

The groups PI and PII (Paprosky) showed a high level of satisfaction with an average value of reference for the postoperative rated as excellent, the absence of complications and good functional recovery at the end of follow-up. The groups PIII and PIV showed increased incidence of complications and difficulties with rehabilitation clinics and SF-36 scores and HHS inferior to other classes.

CONCLUSIONS

Our dates confirm that bone quality at the time of surgery affects the therapeutic target. All patients with good bone quality at the time of the revision surgery (groups PI and PII) showed a distinct advantage from surgical treatment. Revision surgery had not much effect in patients with high bone loss. Preservation of bone stock should be considered a good foundation for the success of a prosthetic reimplantation with better functional and radiographic out-come associated with greater satisfaction for the patient.

[Proximal femur fractures in elderly patients: the influence of comorbidity on prognosis in the short, medium and long term]

INTRODUCTION

Our study aims to assess post-intervention and pre-operative mortality in patients admitted to our institute diagnosed with a fractured proximal femur. The influence of comorbidity on prognosis in the short (1 month), medium (3 month) and long term (6 month) was assessed between July 2006 and July 2009.

MATERIALS AND METHODS

The 238 patients (85 men and 153 women), between 65- and 99-year-old, were followed-up as outpatients and by telephone for 1 year to monitor the state of persistence in life or eventually the date of death. The comorbidity parameters considered were: sex, age, ASA class of anesthetic risk, fracture location and type of surgical treatment used, the number of previous associated diseases and the presence/absence of cognitive impairment on admission.

RESULTS

The data obtained, in comparison with that of the general population in the Lazio region (ISTAT table), showed. Higher mortality rate in men than women, high mortality rate for patients with cognitive impairment at admission (50%), mortality over twice as high in patients belonging to ASA classes III and IV than in patients belonging to the lower categories. By observing the time between surgery and death it was also evident that the first 6-month period was the most critical; furthermore, 45.45% of deaths occurred within the first 60 days.

CONCLUSIONS

Identifying the causes that influence the mortality of our patients and being able to quantify the relevance in subsequent death enables us to improve the care for the risk, strengthen the therapeutic choices based on new evidence, and especially lay the groundwork for the development of new treatment protocols, useful for clinical and forensing decision-making.