Recurrence In Young Patients Research Articles

Predictive factors for recurrence of differentiated thyroid cancer in patients under 21years of age and a meta-analysis of the current literature.

The influence of predictors for recurrence in relation to recurrence-free survival was analyzed retrospectively in differentiated thyroid cancer (DTC) patients under 21years of age who underwent primary surgical treatment and who had a pathological diagnosis of DTC between 1983 and 2012 at Fudan University Cancer Hospital. Recurrences were retrospectively analyzed using a Cox regression model for the hazard ratio (HR) according to the clinicopathological features. A meta-analysis was performed with respect to the potential predictors for recurrence from current related studies. In the present study, there were 146 young patients aged from 7 to 20years, with a female/male ratio of 2.65/1. Female gender was the only factor significantly associated with recurrence according to univariate (HR = 2.812, P = 0.037) and multivariate (HR = 4.107, P = 0.024) Cox regression analyses. Meta-analyses revealed that multifocality (HR = 1.91, P < 0.05) and presentation at diagnosis (HR = 1.39, P < 0.05) were highly associated with recurrence in young DTC patients. However, female gender and other factors, such as age (≤10 vs. 11-20years), PTC (PTC vs. FTC), extrathyroidal extension, lymph node metastasis, total thyroidectomy (total vs. less than total), radioiodine therapy, and radiation history, were not associated with recurrence in young DTC patients. In conclusion, multifocality and presentation at diagnosis are strong predictive factors of recurrence in relation to recurrence-free survival. We recommend studies with larger sample sizes and longer follow-up to verify the influence of predictors for disease recurrence in young patients.

Reappraisal of upper age limit for adult living-donor liver transplantation using right lobe grafts: an outcome analysis.

Increasingly more elderly recipients are being evaluated for liver transplant nowadays. Reported outcomes of deceased donor liver transplant in elderly recipients have varied in different eras. Little was reported on the outcome of living donor liver transplant (LDLT) in elderly patients, and the upper age limit for consideration for LDLT is variable from center to center. We retrospectively reviewed our database for LDLT procedures performed for recipients 60 years of age or older. Procedures performed for retransplantation or left lobe liver transplants were excluded. Patients were divided into two groups: group A included recipients at least 60 and younger than 65 years old and group B included recipients at least 65 years old. A total of 55 liver transplants were included in our study. Group A included 30 patients, whereas group B included 25 patients. There was a trend toward more vascular complications, more frequent rejections, and hepatitis B virus recurrence in younger patients. This was only significant for hepatitis B virus recurrence. However, there was a trend toward more biliary complications, incisional hernias, and longer ICU/hospital stay in older patients. None of the latter variables reached statistical significance. Older recipients had better patient survival, which was more evident at 3 and 5 years of follow-up. However, graft and disease-free survivals did not differ significantly between both groups. LDLT using right lobe grafts for recipients aged 65 years or older is safe and feasible.

Urothelial cancer of bladder in young versus older adults: Clinical and pathological characteristics and outcomes

Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan–Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5–40 years) for patients less than 40 years old and 61.66 years (range, 41–75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12–65 months) for young patients and 42.57 months (range, 12–72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235–2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416–1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.

Reply to the Letter to the Editor

To the editor, We would like to thank Drs. Rhon and Hando for their interest and insightful comments regarding our recently published study. While we would wholeheartedly agree that a period of immobilization longer than the 3 or 4 weeks employed in our study and others [1–3] would be beneficial to soft tissue healing, the practicalities of doing so may limit its utility. According to our (as well as Professor Itoi’s) observations, compliance with brace wear was a time-limited phenomenon. In fact, only 53% of patients were compliant with full-time sling use for 3 weeks in the Itoi et al. [2] study. The unfortunate reality is that the exact patient group who would potentially benefit from longer immobilization (young, active patients), and who are at highest risk of recurrent instability, is the group that can least tolerate a prolonged period of time away from full participation in studies, family demands, work, or sport. Strategies to improve compliance with immobilization have not been fully explored. An interesting (albeit anecdotal) observation from our own study was that some patients preferred the externally rotated position because it permitted keyboard use and positioned the hand of the affected shoulder in a more functional position in front of the body. One patient even continued to work as a waiter with his tray positioned on his brace during the immobilization period. While the externally rotated position may not considered to confer significant benefit in terms of reducing recurrence versus sling immobilization, there may be some merit to its capacity to allow a more functional position of the ipsilateral hand. We are enthused that our work has generated discussion and thought regarding nonoperative approaches to reduce the relatively high rate of recurrence in young patients following primary dislocation. There are still many questions to be answered — not the least of which are the best position and duration of immobilization. However, any discussion of either question must take into consideration the practical issue of compliance in the target population.

Histopathological correlation of oral squamous cell carcinoma among younger and older patients.

Background:Oral Squamous Cell Carcinoma (OSCC) is commonly noted in elder men, when occurring in younger individuals, its aggression and prognosis is questioned due to biased data in literature. Traditionally, various histopathological grading systems have been used for assessing aggression and prognosis of OSCC. However, multifactorial grading of Anneroth et al., is considered effective.Materials and Methods:In this retro-prospective study, files of 75 OSCC patients were retrieved from Oral Pathology Department; among this 50 patients were >40 years and 25 patients were ≤40 years of age. Archival formalin fixed paraffin embedded tissue blocks of these patients were used to prepare hematoxylin and eosin (H and E) stained sections for grading OSCC based on Broder's and Anneroth et al., criteria. Further, recurrence of OSCC among study subjects within 5 years of treatment was evaluated. Chi-square test was used to compare the disease in patients who were >40 years with ≤40 years.Results:Comparison according to Broder's classification didn’t show any relevant variation. Three of the six parameters and overall grading according to Anneroth et al., criteria showed statistically higher grades of OSCC in the younger age-group; however, there was no significant difference in 5-year recurrence rate.Interpretation and Conclusion:Results of the study are suggestive of aggressive OSCC among young patients when compared to older. Conversely, this aggression didn’t affect the recurrence in younger patients. Further studies on genetics, diet and demographics of patients below 40 years of age affected by OSCC will be of greater value.

Familial history of non‐medullary thyroid cancer is an independent prognostic factor for tumor recurrence in younger patients with conventional papillary thyroid carcinoma

It is not clear whether familial non-medullary thyroid cancer (FNMTC) is more aggressive and has a poorer prognosis, than sporadic carcinoma. Therefore, the optimal clinical approach for FNMTC is yet to be established. In this study, we investigated the biological behavior and prognosis of FNMTC compared with its sporadic counterpart. Between 1996 and 2004, 1,262 patients underwent a total thyroidectomy for conventional PTC at Asan Medical Center and 113 (9.0%) were diagnosed with FNMTC. We compared the clinico-pathologic characteristics, treatment modalities, and prognosis between familial and sporadic NMTC. FNMTC was significantly more multi-centric than sporadic. We also found that family history itself was an independent risk factor for recurrence. Moreover, disease-free survival in the familial group was significantly shorter than in the sporadic group in the subgroups in which age was <45 years, and in which the tumors were multi-centric, bilateral, and of N1b node status. FNMTC may be considered as a separate clinical entity with a higher rate of recurrence and worse DFS than its sporadic counterpart. Furthermore, familial history of NMTC is an independent risk factor for recurrence, especially in younger patients with conventional PTC.

Local excision in early rectal cancer-outcome worse than expected: A population based study

Considering the morbidity and mortality after abdominal surgery for rectal cancer, our aim was to determine whether local excision in Stage I rectal cancer provides long-term survival equivalent to TME surgery, particularly in elderly patients. Data on 3694 consecutive patients with Stage I rectal cancer operated 1995-2006, were collected from the Swedish Rectal Cancer Register, a population-based, prospectively sampled data-base. Risk factors for death within 5 years after surgery, local recurrence rates, cumulative relative and overall survival rates were calculated for patients ≥ and <80 years-of-age. ASA grading related to surgical technique was analysed in a separate sample. Local excision (LE) was associated with an increased mortality risk both ≥80 (HR 1.55) and <80 years-of-age (HR 1.45). After LE the 5-year local recurrence rate was 11.2% and the total and relative cumulative 5-year survival was 0.62 and 0.81 respectively. Hartmann's procedure (HA) showed an increased mortality risk only in younger patients (HR 2.15). The overall local recurrence rate was 7.2% with HA. Male gender (HR 1.70) and age (HR 1.06) were associated with a significantly increased mortality risk in all age groups. The ASA-grade was higher among patients operated with LE compared to Anterior Resection/Abdominoperineal resection. Local excision has a poor outcome in the elderly. A negative selection bias towards old age and high co-morbidity could explain this. Hartmann's procedure has a high risk for mortality and local recurrence in younger patients.

Age as a prognostic factor for recurrence in premenopausal breast cancer patients.

e11036 Background: It remains controversial if young age at diagnosis is an independent prognostic factor for recurrence in breast cancer (BC) patients. Data regarding recurrence with long-term follow-up in premenopausal women are sparse. The aim of the study was to compare the outcome of young patients (&lt;=39 years) with older premenopausal patients. Methods: We collected clinical and pathological data from an inception cohort of 241 premenopausal patients aged &lt;=50 years at diagnosis with stage I-III BC between January 2000 and December 2005 in a single institution. Disease-free survival (DFS) event was defined as time from diagnosis to local or distant recurrence, contralateral invasive BC or death from any cause. Kaplan-Meier curves and Cox model were used to analyze the covariable predictors for recurrence. Results: Median age was 43 years (range: 24-50) and median follow-up was 100 months (range: 72-137). Seventy seven patients (32%) were &lt;=39 and 164 (68%) &gt;39 years of age at diagnosis. Five and 10-year disease-free survival rate was 61 % and 48% respectively for the younger group and 77% and 74% for the older group (p&lt;0.001). In the univariate analysis the hazard ratio (HR) for recurrence in young patients was 2.16 (95%CI: 1.38-3.37) (p&lt; 0.001) Adjusting for T stage (&lt;=2 cm versus &gt;2 cm), N (negative versus positive nodes), Grade (grade 1-2 versus grade 3) and Hormonal Receptor status (positive versus negative), age less than 40 remains and independent prognostic factor for recurrence with an adjusted HR of 2.42 (95%CI: 1.42-4.10) (p&lt;0.001), and was the most important adverse independent predictor among the factors included in the model. Conclusions: BC patients younger than 40 years of age at diagnosis have worse prognosis than older premenopausal patients, and have an independent prognostic value for recurrence after adjusting for known prognostic factors.

The Effect of Age on the Long-term Prognosis of Patients With Hepatocellular Carcinoma After Resection Surgery

The effect of age on the clinicopathologic manifestations of hepatocellular carcinoma (HCC) and on the survival rate in patients with HCC after resection surgery remains controversial. We aim to compare the clinicopathological features and prognoses between younger and older patients with HCC undergoing resection. Retrospective review. A tertiary medical center. We enrolled 1074 consecutive patients with HCC who were undergoing a partial hepatectomy. Patients who were 55 years of age or younger were defined as the younger group (n = 374), and patients who were older than 55 years of age were defined as the older group (n = 700). The postoperative prognoses of the younger and older groups using multivariate analysis and propensity score matching analysis. The younger patients had better liver functional reserve but more aggressive tumor factors than did the older patients. After a median follow-up of 41.0 months, 543 patients died. The cumulative 10-year survival rates were 41.3% in younger patients and 28.8% in the older patients (P = .02). However, using both multivariate analysis and propensity score matching analysis, we failed to demonstrate that age was an independent risk factor associated with overall survival. Besides, there were 643 patients with tumor recurrence after surgery. Using both multivariate analysis and propensity score matching analysis, we found that the incidence of tumor recurrence in younger patients was comparable to that in the older patients. Age is not a risk factor to determine the prognosis of patients with HCC who underwent resection. Older patients with HCC who have good liver functional reserve are encouraged to receive resection surgery.

Application of osteomucoperiosteal flap in large unicystic ameloblastoma to promote early bone healing: An alternative to primary bone grafting

Background:The unicystic variety of ameloblastoma is reported to be significantly less prone to recurrence in young patients than its conventional counterpart, and therefore can be treated conservatively. This paper describes a technique of using an osteoperiosteal flap to allow complete enucleation of a unicystic ameloblastoma. The technique maintains the continuity of the mandible and restores full thickness as well as strength of the mandible to promote early healing. It also maintains blood supply and proper facial contour so that esthetics is unimpaired.Materials and Methods:We describe two cases of unicystic ameloblastoma in which we used an osteoperiosteal flap. This flap was then infractured at the lower border to obliterate the dead space.Results:The sequential radiographs demonstrate early incorporation of the graft and complete filling of the defect by 3 months. At 5 years of follow-up in our first case, complete healing of bone was observed.Conclusions:We believe that these procedures can be the treatment of choice in such cases, especially with larger lesions, as these rapidly restore the patient's facial contour to normal as well as reduce the healing time.

Significant Improvement in Regional Recurrence in Young Patients with Breast Cancer Treated with Comprehensive Nodal Irradiation

Materials/Methods: Clinicopathologic data from 438 patients with early breast cancer (clinical stage: 20 T1N0, 124 T2N0, 60 T1N1, 234 T2N1) who received NeoChemo and Mastx from 1985 to 2004 were retrospectively reviewed. In this cohort, 257 (58.7%) patients received adjuvant radiation (RT) while 181 (41.3%) patients did not. The median number of axillary lymph nodes (LN) dissected was 15. The number of pathologically involved lymph nodes (pLN+) was zero pLN+ in 33.8% of patients, 1-3 pLN+ in 42.2%, and $4 pLN+ in 24%. For clinical N0 (cN0) patients, 47.2% had $1 pLN+ after NeoChemo. For cN1 patients, 24.5%had0pLN+afterNeoChemo.ActuarialrateswerecalculatedusingKaplan-Meiermethodandcomparedusinglog-ranktest. Results: With a median follow-up of 66.3 months, there were 17 LRR in the 438 patients. The 5-year local-regional control (5-yr LRC) and overall survival was 96.1% and 87.7%, respectively. Overall, the patients who received RT had worse tumor features includinghigherproportionsofcN1,LVSI,and $4pLN+comparedtothosewithnoRT(allp\0.003,chi-square).The5-yrLRCfor patientswithnoRTwas96.6%andwithRTwas95.7%(p=0.55).Amongthe80T1/T2patientswithcN1whodidnotreceivepostmastectomy RT, the 5-yr LRC was 100% for those who converted to 0 pLN+, 95.3% for those with 1-3 pLN+,and 75.0% for those with $4pLN+(p= 0.049).Inthetotalcohortofpatientswhodidnotreceive RT(n= 181),thosewithpathologically $4pLN+had the worst 5-yr LRC (0 pLN+ 99.0%, 1-3 pLN+ 94.6%, $4 pLN+ 80.0%, p = 0.034). The presence of lymphovascular invasion (LVSI)wasalsoassociatedwithworse5-yrLRC(LVSI98.0%vs+LVSI84.6%,p=0.006).Patientswith $4pLN+whoreceived RThadanon-statisticalimprovementin5-yrLRCcomparedtothosewithnoRT(NoRT80.0%vs+RT95.5%,p=0.12).Asimilar trend for improved 5-yr LRC was observed for patients with LVSI who received RT (No RT 84.6% vs +RT 97.7%, p = 0.074). Conclusions: Patients with clinical stage T1-2/N0-N1 breast cancer appear to have low risks of recurrence after neoadjuvant chemotherapy and mastectomy, with the exception of those with +LVSI or $4 pLN+. These data warrant a prospective clinical trial to more formally test whether radiation can be avoided in selected patients with stage II breast cancer treated with NeoChemo and Mastx.

OC226: Ultrasonographic detection of recurrence after conservative surgery for borderline ovarian tumors

Borderline ovarian tumor is a tumor of epithelial origin with low malignant potential. Given its good prognosis, conservative surgical treatment can be considered in younger patients of childbearing age. However, the risk of recurrence in conservatively treated patients is well described. In this prospective study we evaluated the effectiveness of transvaginal ultrasound (TVUS) in the early detection of ovarian recurrences. From March 1997 to October 2006, 60 patients underwent fertility-sparing surgery for borderline ovarian tumors and were all followed at our institution by the same two expert sonographers. All women underwent a 4-month follow-up for the first 2 years with clinical evaluation and TVUS, and every 6 months thereafter a measurement of serum biomarkers was requested as well. Fourteen patients at different FIGO stages at onset of the disease (FIGO Stage IA–IIIC) developed a recurrence after a median of 19.8 (range, 6–51) months after primary conservative surgery. All of them were diagnosed as having at least an adnexal cyst (range, 1–4 cysts), mainly unilocular with a mean diameter of 29 (range, 10–53) mm with endoluminal papillae (mean 2.1 (range, 1–4) papillae), except in one case. Ultrasonographic detection of normal ovarian tissue allowed a further conservative surgical approach in 12 cases. Five patients had a third conservative operation and one a fourth procedure. Four patients conceived after their first fertility-sparing surgery, and two after a second and third relapse respectively. Bimanual examination was suspicious in two cases and tumor biomarkers at relapse were positive in three cases. TVUS correctly identified all tumor recurrences and allowed further fertility-sparing surgery in young patients. These data show that TVUS is the most effective diagnostic procedure during follow-up and the early detection of borderline tumor recurrence in young patients treated conservatively.

The safety of breast‐conserving therapy in patients with breast cancer aged ≤40 years

The objectives of this study were to study the probability of local control after breast-conserving therapy (BCT) in a large population of patients with early-stage breast cancer aged < or = 40 years and to determine which factors had prognostic value. All patients (n = 758) aged < or = 40 years with clinical stage I or II breast cancer who underwent BCT in general hospitals in the southern part of the Netherlands between 1988 and 2002 were selected for the current analysis. BCT included local excision of the tumor followed by irradiation of the breast. Of 758 patients, 329 patients (43%) received adjuvant systemic treatment, and 36 patients (5%) underwent a microscopically incomplete excision. The median follow-up was 8.5 years. During follow-up, 95 patients developed a local recurrence without evidence of distant disease at the time the recurrence was diagnosed. Contralateral breast cancer was diagnosed in 59 patients. The 5- and 10-year actuarial local recurrence rates were 9.0% (95% confidence interval [95% CI], 6.6-11.4%) and 17.9% (95% CI, 14.1-21.7%), respectively. In a multivariate analysis, adjuvant systemic treatment reduced the risk of local recurrence (hazards ratio [HR], 0.47; 95% CI, 0.28-0.78) and contralateral breast cancer (HR, 0.46; 95% CI, 0.24-0.87) by >50%. The risk of local recurrence in young patients who underwent BCT was reduced strongly by using adjuvant systemic treatment. This finding may provide an argument if favor of advising the use of systemic treatment for all patients aged < or = 40 years who undergo BCT.

Chronic subdural hematomas—causes of morbidity and mortality

Objective Chronic subdural hematoma is a very common condition seen usually in the later stages of life. Treatment, although apparently simple, is associated with some morbidity and mortality with a potential for recurrence. This is especially important as the average life span of humanity increases all over the world. Methods A retrospective analysis of 647 cases of chronic subdural hematomas treated in NIMHANS was done. The aim of this study was to determine the factors responsible for the morbidity, mortality, and recurrence in patients with chronic subdural hematomas. Results The patients were mostly men in the sixth and seventh decade of life and presented with headache, cognitive decline, or focal deficits. CT scan was done in all cases. 94% of the patients underwent evacuation of the hematoma. There was a mortality rate of 5%, and there was a recurrence of 21%. Statistical analysis for factors both for mortality and morbidity were done. Conclusions It was seen that statistically significant factors determining mortality were age, GCS at presentation, and associated illnesses like cardiac and renal failure. The statistically significant factors for recurrence are the presence of a thick subdural membrane visualized during surgery and brain, remaining at a depth at the end of evacuation of hematoma. Use of a subdural drain significantly reduced recurrences. The chronicity of the hematoma was not a factor determining mortality or morbidity. Drains were seen to significantly reduce recurrence in younger patients with better GCS and when the subdural membrane is seen at surgery and the brain remains at a depth at the end of hematoma evacuation.

Head and neck squamous cell carcinoma in the young patient.

Squamous cell carcinoma of the upper aerodigestive tract most commonly develops in the sixth or seventh decade of life, usually in patients who have significant risk factors from smoking or alcohol use. A subgroup of patients less than 45 years old, however, develops squamous cell carcinoma of the head and neck in whom the role of tobacco or alcohol use is less clear in the etiology of their cancer. Furthermore, there has been considerable debate regarding the tumor biology in this group of patients and its effects on prognosis and overall survival. This paper reviews the current literature and controversies on the etiology and management of squamous cell carcinoma of the head and neck in young patients. Young patients with head and neck squamous cell carcinoma do not have a poorer prognosis or disease-specific survival. Young patients with squamous cell carcinoma of the head and neck have a similar prognosis to older patients. There is a trend, however, towards a higher regional recurrence in young patients with head and neck squamous cell carcinoma, suggesting that prophylactic neck treatment should be considered. Further research is needed to determine whether a subgroup of patients (young nonsmoking women with tongue cancer) have a worse prognosis and warrant more aggressive treatment.

Thyroid Cancers Express CD-40 and CD-40 Ligand: Cancers That Express CD-40 Ligand May Have a Greater Risk of Recurrence in Young Patients

The immune response might suppress thyroid cancer recurrence. Although the factors that control this are unknown, CD-40 and CD-40 ligand might be important. To test this, we stained 36 papillary (PTC) and four follicular (FTC) thyroid carcinomas for CD-40 (n = 37) and CD-40 ligand (n = 36) and graded staining from absent (grade 0) to intense (grade 3). Follicular cells of the majority of thyroid tumors expressed CD-40 (30/37, 81%) and CD-40 ligand (15/24, 69%). Cancers from young patients (< or =21 years of age) that expressed CD-40 contained more numerous lymphocytes/high-power field (36 +/- 11) than cancers that failed to express CD-40 (4 +/- 3, p = 0.01), but there was no correlation with clinical outcome. Among young patients, CD-40 ligand expression was more intense in multifocal (1.1 +/- 0.2 vs. 0.45 +/- 0.2, p = 0.037), aggressive (1.14 +/- 0.14 vs. 0.65 +/- 0.2, p = 0.05) and recurrent tumors (1.2 +/- 0.2 vs. 0.65 +/- 0.2, p = 0.05) and associated with reduced disease-free survival (p = 0.03). We conclude that the majority of thyroid cancers express CD-40 and CD-40 ligand. In patients < or =21 years of age, tumors with intense expression of CD-40 ligand are more often multifocal, aggressive, and recurrent.

Management of shoulder dislocation—are we doing enough to reduce the risk of recurrence?

Young patients with shoulder dislocation are at high risk of recurrence. Traditionally, management has been conservative, but rehabilitative programmes are successful in fewer than 20% of patients. Recent studies suggest that early surgical intervention (arthroscopic lavage or stabilisation) can significantly reduce recurrence in young patients with primary traumatic anterior dislocation. This study demonstrated that in our region, 21% of all patients presenting with shoulder dislocation had already suffered recurrence at 1 year; in the 15–22 years age group this figure was 43%. We propose to offer young patients presenting with primary traumatic anterior dislocations arthroscopic lavage within 10 days of injury. The extra surgical workload is manageable within our current trauma service arrangements, and we believe that this form of treatment would be acceptable to patients.

Solitary unicameral bone cyst

One hundred and forty-four solitary bone cysts were treated by curettage and packing with freeze-dried crushed cortical-bone allograft. One hundred and eight healed primarily. There was a higher rate of recurrence in young patients (less than ten years old), in active cysts, in females, and in incompletely packed cysts. However, of the cysts that were completely packed, 88 per cent healed. These data show that freeze-dried allogeneic crushed cortical bone is superior to similiarly processed cancellous bone and gives results similar to those achieved with fresh autogenous cancellous bone. Orthopaedic surgeons should therefore consider the use of freeze-dried allogeneic crushed cortical bone instead of autogenous grafts to avoid the morbidity and increased risk of complications associated with the procedure to obtain the autogenous bone.