1.Successful Treatment of Infantile Fibrosarcoma Spinal Metastasis by Chemotherapy and Stereotactic Hypofractionated Radiotherapy.
Cheng Hsiang LO ; Shin Nan CHENG ; Kuen Tze LIN ; Yee Min JEN
Journal of Korean Neurosurgical Society 2013;54(6):528-531
We report a case of infantile fibrosarcoma in an 8-month-old boy manifested as a right-sided lower leg mass. Repeated local recurrence and distant metastasis were noted during the following three-year period. Whole body fluoro-deoxyglucose positron emission tomography scan revealed an asymptomatic metastasis involving the fourth lumbar vertebrae. The patient received chemotherapy (VAC regimen) with Cyberknife(R) stereotactic hypofractionated radiotherapy (26 Gy; 4 fractions). This treatment reduced tumor size by 23% without acute radiation toxicity even after 33 months. This case suggests that combining chemotherapy and this form of radiotherapy may be safe and effective against childhood spinal metastasis.
Drug Therapy*
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Fibrosarcoma*
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Humans
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Infant
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Leg
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Lumbar Vertebrae
;
Male
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Neoplasm Metastasis*
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Positron-Emission Tomography
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Radiotherapy*
;
Recurrence
2.Economic Burden of High-Responding Inhibitors in Patients with Hemophilia A in Taiwan.
Tsu Chiang TU ; Shin Nan CHENG ; Jye Daa CHEN ; Thau Ming CHAM ; Mei Ing CHUNG
Yonsei Medical Journal 2013;54(2):358-365
PURPOSE: Hemophilia A (HA) is the most common X-linked inherited bleeding disorder. In some patients with HA, particularly those with severe HA, replacement therapy results in the production of high-responding clotting factor VIII inhibitors. The economic burden of this complication is the highest reported for a chronic disease. Our aim was to investigate the direct medical expenditure burden of high-responding inhibitors in patients with HA. MATERIALS AND METHODS: A retrospective study was conducted using the National Health Insurance Research Database, utilizing data covering the period of 2004-2007. RESULTS: In total, 638 males with HA, including 37 patients with high-responding inhibitors were evaluated. Over 99% of the annual median medical expenditure was attributable to the cost of clotting factor concentrates (CFCs) in patients with high-responding inhibitors. The annual median expenditure related to CFCs of the total medical care and outpatient care were US$170611 and US$141982, respectively, and were 4.6- and 4.3-fold higher in these patients during the study period, respectively. In patients with high-responding inhibitors, the median hospitalization expenditure and daily hospitalization cost with or without surgical procedures were 3.0- and 2.4-fold higher, respectively, and 4.3 and 5.6-fold higher, respectively. CONCLUSION: Our data reveal higher medical expenditures burden for patients with HA and high-responding inhibitors in Taiwan. Future research is encouraged to evaluate the impact of this burden on patient quality of life.
*Cost of Illness
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*Drug Resistance
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Factor VIII/immunology/therapeutic use
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Hemophilia A/*complications/drug therapy/economics
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Hospitalization/economics
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Humans
;
Male
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*Quality of Life
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Retrospective Studies
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Taiwan