Vibrant soundbridge in aural atresia: does severity matter?

Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone anchored hearing aids (BAHA) and the Vibrant Soundbridge (VSB) have been considered as alternatives or adjuncts to conventional atresiaplasty. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. More recent publications suggest that patients with Jahrsdoerfer scores between three and seven may benefit from VSB implantation. The purpose of this study was to further investigate the outcomes of VSB implantation in CAA. The study was a multi-center, retrospective review. A retrospective review of data (patient's demographic, clinical, implant and audiological information) from four collaborating centers that have performed VSB implantation in CAA was performed. Outcomes based on severity of the atresia using the Jahrsdoerfer and Yellon-Branstetter scoring systems were also evaluated. Data from 28 patients from the four centers revealed no iatrogenic facial nerve injuries or change in bone thresholds. Post-operative speech threshold and speech recognition was, respectively, 39 dB and 94%. Jahrsdoerfer and Yellon scores ranged from 4 to 9 and 4 to 12, respectively. The scores did not correlate to or predict outcomes. Three individual elements of the scores did correlate to initial, but not long-term outcomes. Atresiaplasty and BAHA in the management of CAA are not complete solutions. VSB may offer an alternative in these surgically complex patients for achieving amplification, though better metrics for patient selection need to be developed. LEVEL OF EVIDENCE : IV.

Evaluation of efectiveness of palliative radiotherapy alone or combined with surgery in patients with bone metastases

Material and methods. The retrospective analysis results of palliative radiotherapy alone or combined with surgery of 200 patients with bone metastases are presented. All patient were irradiatated, 47 of them were operated before or after radiotherapy. General performance status, pain relief, movement efficiency, analgetic drugs and bisphosphonates administration, disease progress and bone reossification were assesed 1, 2, 3, 6, 12 months after the treatment and durning the last examination.<br /> Results. The complete or partial pain relief were observed in 47% of patients 1 month, 56% two months 41% in 3, 38% 6 months after the treatment. 26% reported pain relief 1 year after irradiation and 33% at the last visit<br /> The Kaplan Maier survival analysis shows ststistically significant longer survival for patient treated by combined treatment, women, patients with multiple bone metastases and patients with metastases located in long bones and patients without symptoms of spine compression. Spearman analysis reveals correlation beetween performance status and follow up. There are no correlations between radiation dose, bisphosphonates administration and pain relief, pathology of tumor and follow up. <br /> Conclusions. The obtained results suggests that radiotherapy is effective method of analgetic treatment in bone metastases and that radiotherapy associated with surgery improves survival.

[Use of radiotherapy in treatment of painful scapula-humeral periarthritis]

In 10 cases of painful scapulo-humeral periarthritis radiotherapy was used. In all cases conventional anti-inflammatory treatment was unsuccessful or impossible to deliver. Patients were treated using gamma 60Co radiation and 6 Gy was delivered in 1 Gy fractions over 8 days. The average degree of pain relief and improvement of limb mobility was assessed after radiotherapy completion, 1 week, 7 weeks after treatment and at final-up. The degree of pain relief was respectively 27%, 72%, 85% and 93%. Significant improvement of limb mobility was noted in all cases. Obtained results allow to conclude that anti-inflammatory radiotherapy is an effective treatment of painful scapulo-humeral periarthritis.

The efficacy of radiotherapy for vertebral hemangiomas

Vertebral hemangiomas are benign, slowly growing tumors sometimes causing local pain in the spine and/or neurologic disorders. The present paper includes 14 cases of painful vertebral hemangiomas treated by radiotherapy. All patients were irradiated using standard fractionation scheme with a total dose 20-30 Gy. One month after the treatment complete pain relief was noted in 36% of cases, five months later in 67% of cases, but in the remaining cases partial pain relief was noted. No correlation between treatment outcome and different biological and technical factors was found. No dose-response relationship was noted. The results suggest that anti-inflamatory effect of radiation plays the major role in this kind of treatment and that radiotherapy for vertebral hemangiomas is easy, short and highly effective analgetic treatment modality.

Efficacy of radiotherapy for giant cell tumor of bone: given either postoperatively or as sole treatment

PURPOSE

The aim of this paper is to evaluate efficacy of radiotherapy for giant cell tumor of bone given either postoperatively or as sole treatment, and to assess prognostic factors for treatment outcome.

METHODS AND MATERIALS

The study includes 37 patients. In 9 cases, soft tissue involvement was noted. Nonradical operation followed by radiotherapy was given to 23 patients, and 14 patients received irradiation only. Total dose of 39--64 Gy was delivered. The average follow-up was 5 years. Probability of local tumor control (LTC) depending on the treatment strategy was calculated, and prognostic factors were assessed.

RESULTS

LTC was noted in 31 cases. Ten-year LTC for surgery with irradiation was 83% and 69% for radiotherapy alone; however, this difference was not statistically significant. For tumors smaller than 4 cm LTC probability was above 90%, and it decreased to less than 60% for tumors larger than 8.5 cm. No dose-response relationship has been found. In 7 cases, late normal tissue effect occurred.

CONCLUSIONS

Giant cell tumors of bone can be considered as radiosensitive and radiotherapy with total dose of 40--45 Gy seems to be an effective sole treatment especially for tumors smaller than 4 cm in diameter. For larger tumors, surgery combined with postoperative radiotherapy should be considered.

[Radiotherapy of vertebral hemangiomas]

The paper presents the analysis of results of treatment with radiotherapy of 14 cases of vertebral hemangiomas. All patients were irradiated in accordance with conventional schedule fractionated doses, using 2 Gy per fraction. The total radiation dose amounted to 20 Gy (1 case), 24 Gy (4 cases) and 30 Gy (9 cases). The degree of pain relief and lesion reossification was assessed 1 months and 6 months after completion of radiotherapy. Complete pain relief 1 month post radiotherapy was noted in 5 cases (on average patients claimed that radiotherapy resulted in a 70% decrease of pain syndromes). Six months post radiotherapy complete pain relief was noted in 8 cases (on average patients reported a 90% decrease in pain). Signs of reossification were observed in cases 6 months after treatment. No correlation was noted neither between the degree of pain relief and reossification, nor between the total delivered dose and the degree of pain relief. The obtained results allow to conclude that conventionally fractionated radiotherapy (using 20-24 Gy as total dose) is a good method of analgetic treatment of vertebral hemangiomas probably based on the anti-inflammatory effect of radiation.

[Treatment of giant cell tumor of bone: surgery or radiotherapy?]

The results of treatment for giant cell tumor of bone in 41 patients subdivided into 4 groups have been assessed. In group treated with radical surgery (amputations, extensive excision) 100% patients were cured. In group treated with curettage alone success rate was 33.3% and in radiotherapy group--72.3%. Curettage and radiotherapy combined rendered 95% success rate and this mode of treatment should be recommended.