Exact(3)
In a prospective randomised study of preoperative versus postoperative RTX by O'Sullivan et al. (2002) [ 25] regional and distal failure rates were identical but in this study low grade (17%) and superficial (16 21%) tumours were included.
Results of induction chemotherapy followed by CRT are encouraging (Hainsworth et al, 2002; Machtay et al, 2002; Haraf et al, 2003; Vokes et al, 2003) (Table 4b) and suggest a reasonable toxicity profile, lower distal failure rates, and improved survival in comparison with historical controls using the same CRT regimen (Vokes et al, 2003).
Still induction chemotherapy cannot be considered standard of care due to the lack of convincing phase III evidence, but lower level evidence suggests that it is reasonably safe and may benefit patients at high risk for distal failure as indicated by advanced nodal involvement.
Similar(57)
Interestingly, distal failures were decreased presumably due to the higher doses of systemic chemotherapy compared with concomitant CRT.
Induction chemotherapy attempts to decrease distal failures has been advocated now that local control is achieved in most patients (see below).
This has been illustrated by a study showing a higher incidence of distal screw failure in unreamed intramedullary nails when used for distal metaphyseal tibial fractures [63].
Although, laparoscopic assistance has been shown to reduce malposition rates and distal shunt failure, many centers still employ an open technique for inserting the abdominal end intraperitoneally [1].
Mechanical ventilation, which is commonly used in the management of these critically ill patients, can induce an inflammatory response, which may be involved in distal organ failure.
Many factors contribute to the development of CVS: distal microcirculatory failure, poor collateral anatomy, genetic or physiological variations, cortical spread of depolarization, and remodeling [ 11].
However, that study did not investigate whether mechanical ventilation could enhance the development of distal organ failure in the absence of acute lung injury.
Shaft alignment was normal in both coronal and sagittal planes except from one case of implant failure (distal screw breakage).
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