Pat Laupattarakasem

Cholangiocarcinoma with spinal metastasis: Single center survival analysis.

The aim of this study was to perform a survival analysis of Cholangiocarcinoma (CCA) with spinal metastases. 55 cases of CCA with spinal metastases were retrospectively reviewed. We recorded age, sex, Kanofsky performance score, Frankel scale, number and region of affected vertebrae, presence of appendicular bone metastases, treatment received, and survival time; then performed a survival analysis. Overall median survival was 4months (95%CI, 2.89-5.11). Frankel A had the poorest survival (2months-95%CI, 1.15-2.85) compared to Frankel C and D (P=0.004 and <0.001, respectively). One-level spinal metastasis had the longest survival (8months-95%CI, 5.98-10.02) compared to two-level and more than two-level involvement (P=0.036 and 0.001, respectively). The higher Kanofsky score had the longer survival (11months-95%CI, 9.61-12.39) compared with the low and moderate score groups (P<0.001 and 0.012, respectively). Radiation therapy had a survival of 6months (95%CI, 3.41-8.59), significantly longer than the 3months for palliative spine surgery and 2months for palliative treatment alone. CCA resection and palliative spine surgery-when performed together and/or combined with other adjuvant treatment(s)-had a survival time of longer than 9months. In conclusion, CCA with spinal metastases had a poor median survival. A single level of affected spine, a Frankel scale of C or better, a moderate to high Kanofsky score, and radiation therapy were associated with significantly longer median survival. CCA resection and spinal surgery may play an important role in prolonging survival when used in conjunction with other adjuvant treatment modalities.

SAT0476 Efficacy of 14% Plai vs. Placebo Creams for Symptomatic Control of Patients with Knee Osteoarthritis

Background Non-operative treatments for mild to moderate knee osteoarthritic (OA) is recommended. Plai (Zingibercassumunar Roxb.) belongs to the ginger family. It is a Thai herb used in Thai traditional medicine for relieving muscle and joint pain (1–2). Plai has anti-inflammatory activities due to compounds found in its extracts (1–4). These findings suggest that topical plai cream is a potentially useful drug for the treatment of painful OA of the joints. Since there have not been any studies on the efficacy of plai cream alone for relieving symptoms of OA knee joint, we aimed to test its value. Objectives To assess the efficacy of topical plai cream for the treatment of primary osteoarthritis (OA) knee. Methods This was a 9-week (4 weeks treatment + 1 week wash-out + 4 weeks placebo) phase III randomized, double-blind, controlled, cross-over, community trial of Plai vs. placebo, in adults with OA of the knee. This study aimed to determine whether Plai cream was more effective at reducing pain than a placebo cream, as measured using a visual analog scale (VAS) plus the Western Ontario McMaster (WOMAC) score. Results A total of 120 pairs of subjects were enrolled. The mean different VAS favoring Plai varied between 0.46 and 1.4 (p<0.05). The respective percentage of patients in the Plai group who reached MCII of VAS, WOMAC pain, stiffness and function was 37.9%, 40.10%, 26.45% and 54.58%. The respective percentage of patients in the Plai group who experienced 50% improvement of VAS, WOMAC pain, stiffness and function was 33.33%, 31.77%, 41.66% and 24.68%. The respective number of cases needed to treat to reduce pain of Plai based on MCII and 50% improvement of VAS was 2.63 (95% CI; 2.44, 2.84) and 3 (95% CI; 2.75, 3.29). Four cases in the Plai group had a mild skin reaction. Conclusions This cross-over, randomized, controlled, communit, trial demonstrated that Plai cream is an effective topical agent for relieving the symptoms of mild to moderate OA knee. References Panthong A, Kanjanaponthi D, Niwatananun V, Tuntiwachwuttikul P, Reutrakul V. Anti-inflammatory activity of compounds isolated from Zingiber cassumunar. Planta Med. 1990;56:655. Han AR, Kim MS, Jeong YH, Lee SK, Seo EK. Cyclooxygenase-2 inhibitory phenylbutenoids from the rhizomes of Zingiber cassumunar. Chem Pharm Bull (Tokyo). 2005;53(11):1466–8. Chaiwongsa R OS, Tangyuenyong S, Kongtawelert P, Panthong A, Reutrakul V. Chondroprotective potential of bioactive compounds of Zingiber cassumunar Roxb. Against cytokine-induced cartilage degeneration in explant culture. J Med Plants Res. 2012;6 (39):5204–13. Leelarungravub D SM. Potential antioxidant and anti-inflammatory activity of Thai plai (Zingiber cassumunar Roxb.) essential oil. International Journal of Essential Oil Therapeutics. 2009;3(1):25–30. Disclosure of Interest None declared