scholarly journals Survival Benefit of Transarterial Chemoembolization for Hepatocellular Carcinoma

2020 ◽  
Vol 5 (2) ◽  
pp. 43-47
Author(s):  
Waqas Ahmad ◽  
Iffat Rehman ◽  
Osama Majeed ◽  
Imran Khalid Niazi ◽  
Khurram Aftab Mufti ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatorenal Syndrome ◽  
Clinical Status ◽  
Lesion Size ◽  
Target Lesion ◽  
Clinical Notes ◽  
Kaplan Meier ◽  
Lost To Follow Up ◽  
Tace Procedure

Objective: Transarterial chemo-embolization (TACE) is a palliative treatment option for hepatocellular carcinoma (HCC) with improved patient survival. The aim of the study was to see the outcome of our patients at our institution 2 years post TACE. Patients and Methods: Electronic records were retrospectively reviewed for patients who had TACE from 1st November 2009 – 31st October 2012. Baseline imaging, multidisciplinary team (MDT) and clinical notes, pathology labs, TACE angiograms and follow up imaging were reviewed for 2 years after first TACE. Procedure complications, clinical status and findings at follow up CT were reviewed and analyzed in SPSS version 19. Survival was assessed using Kaplan Meier curves. Results: A total of 104 patients had TACE for HCC. Amongst these 21 patients were lost to follow up and could not be contacted to reconfirm the outcome and had to be excluded to minimize bias. Amongst the included 83 patients, 57 (68.7%) were male and 65 (78.4%) were 51-70 years of age at time of first TACE. The commonest cause for HCC was HCV in 74 (89.2%) patients. Target lesion size at baseline CT was < 5 cm in 38 (45.8%) patients, 5-10 cm in 37 (44.6%) patients and >10 cm in 8 (9.6%) patients. A total of 25 (30%) patients needed more than 1 session of TACE. On post TACE CT, 46 (55.4%) patients had good packing of lipoidol in the lesion. A total of 18 (21.7%) patients progressed in TACED lesions while another 21 (25%) progressed with new lesions. One patient had metastasis to adrenal gland. Only 8 (9.6%) patients had liver failure after TACE and 1 patient had hepatorenal syndrome. Only 1 patient died within 30 days after TACE. Two years post TACE, 47 (56.6%) patients were alive indicating good outcome. Conclusion: TACE improves survival in HCC; 1 year survival was 80% and 2 year survival was 56.6%.

scholarly journals Lymphopenia Is Associated with Gross Target Volumes and Fractions in Hepatocellular Carcinoma Patients Treated with External Beam Radiation Therapy and Also Indicates Worse Overall Survival

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Hai-Ge Zhang ◽  
Ping Yang ◽  
Tao Jiang ◽  
Jian-Ying Zhang ◽  
Xue-Juan Jin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cox Regression ◽  
External Beam Radiation ◽  
Rank Test ◽  
Beam Radiation ◽  
Kaplan Meier ◽  
Target Volumes ◽  
The Relationship

Purpose. To investigate whether lymphocyte nadir induced by radiation is associated with survival and explore its underlying risk factors in patients with hepatocellular carcinoma (HCC). Methods. Total lymphocyte counts were collected from 184 HCC patients treated by radiotherapy (RT) with complete follow-up. Associations between gross tumor volumes (GTVs) and radiation-associated parameters with lymphocyte nadir were evaluated by Pearson/Spearman correlation analysis and multiple linear regression. Kaplan–Meier analysis, log-rank test, as well as univariate and multivariate Cox regression were performed to assess the relationship between lymphocyte nadir and overall survival (OS). Results. GTVs and fractions were negatively related with lymphocyte nadir (p<0.001 and p=0.001, respectively). Lymphocyte nadir and Barcelona Clinic Liver Cancer (BCLC) stage were independent prognostic factors predicting OS of HCC patients (all p<0.001). Patients in the GTV ≤55.0 cc and fractions ≤16 groups were stratified by lymphocyte nadir, and the group with the higher lymphocyte counts (LCs) showed longer survival than the group with lower LCs (p<0.001 and p=0.006, respectively). Patient distribution significantly differed among the RT fraction groups according to BCLC stage (p<0.001). However, stratification of patients in the same BCLC stage by RT fractionation showed that the stereotactic body RT (SBRT) group achieved the best survival. Furthermore, there were significant differences in lymphocyte nadir among patients in the SBRT group. Conclusions. A lower lymphocyte nadir during RT was associated with worse survival among HCC patients. Smaller GTVs and fractions reduced the risk of lymphopenia.

scholarly journals Exercise testing of patients after a period of prolonged mechanical ventilation

2004 ◽  
Vol 60 (2) ◽  
Author(s):  
R. Roos ◽  
H. Van Aswegen ◽  
C. J. Eales ◽  
P. J. Becker
Keyword(s):  
Mechanical Ventilation ◽  
Exercise Test ◽  
Statistical Tests ◽  
Prolonged Mechanical Ventilation ◽  
Correlation Study ◽  
Perceived Effort ◽  
Kaplan Meier ◽  
Functional Exercise ◽  
Lost To Follow Up

In this study, physical recovery of patients who received prolonged mechanical ventilation (PMV) was assessed with a six-phase functional exercise test after the period of ventilation. A prospective correlation study using a consecutive sampling method was carried out over a six-month period. Thirty-one patients were tested but five were lost to follow-up Statistical tests included the Pearson’s correlation coefficient, student’s paired t-test and Kaplan-Meier survival estimate. Subjective perceived effort changed significantly from phase to phase in the exercise test and over time (p < 0.00) Heart rate and respiratory rate responses indicated increased cardio-respiratory effort during the test. No correlation existed between subjective perceived

Autologous Transplantation in De Novo Non-Promyelocytic Acute Myeloid Leukemia (AML) Patients in First Complete Remission (CR1) with Peripheral Blood Stem Cell (PBSC) Collection Following Consolidation with High-Dose Cytarabine and Etoposide: A Single Institution Experience

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4461-4461
Author(s):  
Eugene Choi ◽  
Lingyi Chen ◽  
Srikanth Nagalla ◽  
Vamshi Kaveti ◽  
Regina Mullaney ◽  
...  
Keyword(s):  
De Novo ◽  
Disease Free Survival ◽  
High Dose ◽  
Free Survival ◽  
Kaplan Meier ◽  
Cd34 Cells ◽  
High Dose Cytarabine ◽  
Lost To Follow Up ◽  
Disease Free

Abstract INTRODUCTION: Autologous PBSC transplant is an important yet evolving treatment modality for patients with AML. However, the ideal mobilization regimen from which to collect PBSC remains in question. Previous reports have indicated that highdose cytarabine with etoposide is both safe and effective in terms of successful PBSC procurement, subsequent engraftment, and disease outcome. METHODS: At our institution from 1994 to 2007, 38 consecutive patients with de novo non-promyelocytic AML in first complete remission following conventional induction chemotherapy were consolidated with high-dose cytarabine (2000mg/m2 IV q12h × 8 doses, days 1–4) and etoposide (40mg/kg IV over 96h) followed by G-CSF 5 mg/kg subcutaneously starting d14 until completion of PBSC collection. Patients underwent myeloablative therapy with busulfan (1mg/kg po q6h × 16 doses, days –7 to -4) and etoposide (60 mg/kg IV over 10h, day -3) with PBSC infusion occurring on day 0 with daily G-CSF 5 mg/kg. Data regarding stem cell yield, engraftment and patient outcome was collected retrospectively. RESULTS: The average patient age was 44 years (range 19–70). Following consolidation, at least 2×106 CD34 cells/kg were isolated from all 38 patients with a median of 9.4×106 (range 2.2–43) CD34 cells/kg over a mean of 4 collections (range 1–11). Overall, 36 of 38 (95%) remained in CR and went onto PBSC transplant (one died from infectious complications during consolidation, one relapsed before transplant). The median number of stem cells infused was 8.8×106 CD 34 cells/kg (range 2.2–47). All 36 patients engrafted with the mean number of days to neutrophil recovery (ANC&gt;500) being 11 (range 8–17) and the mean number of days to platelet recovery (&gt;20,000) being 12 (range 8–19). Disease-free outcomes in patients undergoing PBSC transplant while in CR1 are presented in Figure 1. The 3y overall survival in all pts was 66%, and 56% at 5y. For good-risk cytogenetic patients, 3y OS was 78% and the 5y OS was 75%. For intermediate-risk cytogenetic patients, OS was 47% and 36% at 3y and 5y respectively. Three patients with poor cytogenetics were autulogously transplanted. One patient relapsed at day 111 and expired at day 450. The second patient remains in CR at day 246. The third patient relapsed at day 104 and expired at day 322. CONCLUSION: In patients with de novo non-promyelocytic AML in CR1, consolidation with high-dose cytarabine plus etoposide is safe and provides excellent yield of PBSCs upon growth factor accelerated hematological recovery. Subsequent engraftment after autologous transplanation is rapid. Our outcomes support the viability of this regimen in patients with good and intermediate-risk cytogenetics. Figure 1: Kaplan-Meier analysis of disease-free survival following autologous PBSC transplant. Cytogenetic analysis was unavailable in 5 patients, and 1 patient was lost to follow-up. Figure 1:. Kaplan-Meier analysis of disease-free survival following autologous PBSC transplant. Cytogenetic analysis was unavailable in 5 patients, and 1 patient was lost to follow-up.

Embolization versus embolization and systemic therapy in patients with hepatocellular carcinoma and metastatic disease: A retrospective analysis.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 363-363 ◽  
Author(s):  
Sunnie Kim ◽  
Karen T. Brown ◽  
Yuman Fong ◽  
Stephen Barnett Solomon ◽  
Joanne F. Chou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Analysis ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
Combined Modality ◽  
Kaplan Meier

363 Background: Transarterial chemoembolization (TACE) provides a survival benefit in a subset of patients with unresectable hepatocellular carcinoma (HCC). Even though data are lacking, patients with metastatic HCC (mHCC) are sometimes treated with transarterial therapies to address the hepatic disease. Sorafenib is a standard treatment for patients with mHCC. Methods: A retrospective analysis was conducted on patients diagnosed with HCC who had undergone hepatic arterial embolization (HAE) between 2006 and until 2013. Overall survival (OS) was calculated from date of HAE to date of death and estimated by Kaplan Meier Methods. Patients alive at their last follow up date were censored. Results: Of 243 patients who had undergone HAE at MSKCC during the study period, 36 patients had mHCC on initial diagnosis. Of these, 22 received HAE only, while 14 received HAE plus systemic therapy at some time during their whole treatment course. Conclusions: Patients with mHCC who underwent HAE alone had a poor OS. These data suggest that there maybe a survival benefit in patients with mHCC treated with transarterial therapies add to systemic therapy that is given at some time during their whole treatment course. These results contrast with recent data on the use of combined modality in locally advanced disease. Further studies of combined modality therapy in the setting of mHCC may be warranted. [Table: see text]

scholarly journals RADI-32. INTRACRANIAL CONTROL AND RADIONECROSIS IN MELANOMA PATIENTS WITH BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i28-i28
Author(s):  
Michael Tjong ◽  
Fabio Moraes ◽  
David Shultz
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Brain Mri ◽  
Lesion Size ◽  
Kaplan Meier ◽  
Prescription Dose ◽  
Melanoma Patients ◽  
The Brain

Abstract PURPOSE/OBJECTIVE(S): Melanoma commonly metastasizes to the brain and is radioresistant. Stereotactic radiosurgery (SRS) confers durable local control of brain metastases (BM) while maintaining neurocognitive function. These advantages are increasingly important as survival among these patients improves secondary to advances in systemic therapies. This study investigated the local control (LC), intracranial PFS (iPFS), freedom from radionecrosis (FFRN), and overall survival (OS) among melanoma patients receiving SRS for BM. MATERIALS/METHODS: We retrospectively reviewed clinical outcomes of melanoma patients with brain metastases treated with SRS between October 2008 and January 2017 in a large academic centre. Post-SRS, patients were followed in a multidisciplinary clinic with clinical examination and brain MRI every 3 months. Survival outcomes were estimated using the Kaplan-Meier method. RESULTS: In total, 97 patients with 283 brain metastases (including 12 surgical cavities) treated with SRS were identified. Median age was 60.5 (24.4–90.7). Median follow-up was 9.6 (2.2–74.7) months after first SRS. Median prescription dose was 21 (10–24) Gy delivered in a single fraction. Thirty (30.9%) patients had WBRT post-SRS, 36 (37.1%) patients had BRAF-positive disease. Per lesion (N=283), 1-year LC and FFRN were 84.4%, and 90.1%, respectively; medians were not achieved for either LC or FFRN. Radionecrosis (RN) occurred in 20 (7.1%) lesions. Per patient (N=97), median OS and iPFS were 16.0 and 5.3 months, respectively; 1-year OS and iPFS rates were 62.0%, and 30.1%, respectively. CONCLUSION: SRS resulted in excellent rates of LC, with a low risk of RN. However, most patients developed intracranial progression within 1 year. Further analyses to establish correlates (lesion size, SRS dose, and molecular status) to LC, FFRN, OS, and iPFS will be performed prior to the final presentation.

Comparative effectiveness of combination TACE/ablation vs. monotherapy in hepatocellular carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 350-350
Author(s):  
Arthur Winer ◽  
Yohei Rosen ◽  
Frederick Lu ◽  
Russell S. Berman ◽  
Marcovalerio Melis ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Therapy Group ◽  
Dual Therapy ◽  
Treatment Modalities ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Treatment Type ◽  
Significant Difference ◽  
Arterial Chemoembolization

350 Background: Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related death worldwide. Loco-regional treatment modalities for HCC include Trans-Arterial Chemoembolization (TACE) and Radiofrequency/Microwave Ablation (RFA/MWA). Studies have shown that dual therapy with both TACE and ablation is beneficial, though data is limited. We retrospectively studied all HCC patients treated with either TACE, ablation, or dual therapy at a tertiary referral public hospital to determine differences in survival. Methods: Following IRB approval, all patients diagnosed with HCC (1998-2013) at our institution were retrospectively analyzed for date of diagnosis, treatment-type, length of follow-up, and survival. Patients were excluded if they did not undergo TACE or RFA/MWA, or underwent other treatments, such as surgery. The primary outcome was all-cause mortality 5 years after diagnosis. Kaplan Meier curves were created and statistics with Log-rank testing and hazard ratios (HR) were performed. Results: Of 509 patients diagnosed with HCC, 109 (21.4%) met inclusion criteria. 60 were treated with TACE alone, 30 with ablation alone, and 19 were treated with both, either concomitantly or in sequence. Median follow-up and overall median survival was 15.5, 19, and 52 months for TACE, ablation, and dual therapy, respectively. Survival at 5 years was 11.9%, 13.3% and 42.1% for TACE, ablation, and combination groups respectively. Kaplan Meier analysis revealed a significant increase in survival in the combination therapy group vs. RFA or TACE alone at 5 years (p = 0.0006). However, there was no significant difference in survival when comparing TACE vs. RFA/MWA at 5 years (HR = 1.18, p = 0.48). Conclusions: Our study suggests a greater survival benefit for patients treated with TACE and RFA/MWA versus either modality alone.

Compliance with McDonald criteria and red flag recognition in a general neurology practice in Ireland

2010 ◽  
Vol 16 (6) ◽  
pp. 678-684 ◽  
Author(s):  
Christine Albertyn ◽  
Sean O'Dowd ◽  
John McHugh ◽  
Raymond Murphy
Keyword(s):  
Consensus Statement ◽  
Clinical Presentation ◽  
Red Flags ◽  
Clinical Notes ◽  
Important Principle ◽  
Mcdonald Criteria ◽  
Red Flag ◽  
Lost To Follow Up ◽  
Over Time

Background: The revised McDonald criteria aim to simplify and speed the diagnosis of multiple sclerosis (MS). An important principle of the criteria holds there should be no better explanation for the clinical presentation. In Miller et al.’s consensus statement on the differential diagnosis of MS, red flags are identified that may suggest a non-MS diagnosis. Objective: All new patients with a practice diagnosis of MS were assessed for compliance with McDonald criteria. The group of patients not fulfilling criteria was followed up to assess compliance over time. At the end of the follow-up period, red flags were sought in the group of patients who remained McDonald criteria negative. Methods: Clinical notes and paraclinical tests were examined retrospectively for compliance with McDonald criteria and for the presence of red flags. Results: Sixty-two patients were identified, with two lost to follow-up. Twenty-six (42%) patients fulfilled criteria at diagnosis. After 53 months follow-up, 47 (78%) patients fulfilled criteria. In the 13 (22%) patients who remain McDonald criteria negative, a total of 20 red flags were identified, ranging from one to six per patient. Alternative diagnoses were considered and further investigations performed in 10 patients with no significantly abnormal results. Conclusion: Twenty-two percent of patients still do not fulfill McDonald criteria after 53 months. Dissemination in time was not proven in the majority of patients and the lack of follow-up neuroimaging was an important factor in this. Red flags may be useful in identifying alternative diagnoses, but the yield was low in our cohort.

A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy

1995 ◽  
Vol 83 (6) ◽  
pp. 989-993 ◽  
Author(s):  
Jamal M. Taha ◽  
John M. Tew ◽  
C. Ralph Buncher
Keyword(s):  
Trigeminal Neuralgia ◽  
Target Lesion ◽  
Long Term Results ◽  
Sensory Loss ◽  
Content Type ◽  
Kaplan Meier ◽  
Corneal Reflex ◽  
Trigger Zone

✓ There is a lack of prospective studies for the long-term results of percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of patients with trigeminal neuralgia. The authors present results in 154 consecutive patients with trigeminal neuralgia treated by PSR and prospectively followed for 15 years. Ninety-nine percent of the patients obtained initial pain relief after one PSR. Dysesthesia occurred in 31 patients (23%): in 7% with mild initial hypalgesia; in 15% with dense hypalgesia; and in 36% with analgesia. Dysesthesia was mild and did not require treatment in most patients. The corneal reflex was absent or depressed in 29 patients, and keratitis developed in three patients. In 19 of 22 patients with trigeminal motor weakness, the paresis resolved within 1 year. Of 33 patients who had pain recurrence, 10 patients had pain that was mild or controlled with medications, and 23 patients required additional surgical treatment. The authors estimated using Kaplan—Meier analysis that the 14-year recurrence rate was 25% in the total group: 60% in patients with mild hypalgesia, 25% in those with dense hypalgesia, and 20% in those with analgesia. Timing of pain recurrence varied according to the degree of sensory loss. All pain recurrences in patients with mild hypalgesia occurred within 4 years after surgery; 10% more of the patients with dense hypalgesia had pain recurrences within the first 10 years compared with patients with analgesia. The median pain-free survival rate was 32 months for patients with mild hypalgesia and more than 15 years for patients with either analgesia or dense hypalgesia. Of the 100 patients followed for 15 years after one or two PSR procedures, 95 patients (95%) rated the procedure excellent (77 patients) or good (18 patients). The authors conclude that PSR is an effective, safe treatment for trigeminal neuralgia. Dense hypalgesia in the painful trigger zone, rather than analgesia, should be the target lesion.

scholarly journals Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases: The MD Anderson experience

2015 ◽  
Vol 2 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Khinh Ranh Voong ◽  
Benjamin Farnia ◽  
Qianghu Wang ◽  
Dershan Luo ◽  
Mary F. McAleer ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Progression Free Survival ◽  
Lesion Size ◽  
Significant Treatment ◽  
Kaplan Meier ◽  
Treatment Dose ◽  
Md Anderson ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract Background Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS). Methods The records of 1962 patients with brain metastases treated with GK_SRS between 2009 and 2013 were retrospectively reviewed. Seventy-four patients with 77 BSMs and follow-up brain imaging were identified. Local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were assessed. Results Median follow-up was 5.5 months (range, 0.2–48.5 months). Median tumor volume was 0.13 cm3 (range, 0.003–5.58 cm3). Median treatment dose was 16 Gy (range, 10–20 Gy) prescribed to 50% isodose line (range, 40%–86%). Crude LC was 94% (72/77). Kaplan-Meier estimate of median OS was 8.5 months (95% CI, 5.6–9.4 months). Symptomatic lesions and larger lesions, especially size ≥2 cm3, were associated with worse LC (HR = 8.70, P = .05; HR = 14.55, P = .02; HR = 62.81, P &lt; .001) and worse OS (HR = 2.00, P = .02; HR = 2.14, P = .03; HR = 2.81, P = .008). Thirty-six percent of BSMs were symptomatic, of which 36% (10/28) resolved after SRS and 50% (14/28) had stable or improved symptoms. Actuarial median PFS was 3.9 months (95% CI, 2.7–4.9 months). Midbrain location was significant for worse PFS (HR = 2.29, P = .03). Toxicity was low (8%, 6/74), with size and midbrain location associated with increased toxicity (HR 1.57, P = .05; HR = 5.25, P = .045). Conclusions GK_SRS is associated with high LC (94%) and low toxicity (8%) for BSMs. Presence of symptoms or lesion size ≥ 2 cm3 was predictive of worse LC and OS.

scholarly journals CLINICAL RESPONSE OF A BRAND OF ARTEMETHER- LUMEFANTRINE IN CHILDREN BELOW FIVE YEARS OLD

2021 ◽  
Vol 19 (1) ◽  
pp. 123-132
Author(s):  
JOHN EDJOPHE ARUTE ◽  
VALENTINE UCHE ODILI ◽  
EMMANUEL AGBAMU ◽  
WINIFRED AITALEGBE OJIEABU
Keyword(s):  
Clinical Response ◽  
Falciparum Malaria ◽  
Failure Rate ◽  
Health Concern ◽  
Major Health ◽  
Kaplan Meier ◽  
A Prospective Study ◽  
Lost To Follow Up ◽  
Parasitological Response

Malaria is a major health concern in children aged less than five years old, globally. In Nigeria, it was estimated that 300,000 children die annually from malaria. Thus, this study aims to evaluate the clinical response of a brand of arthemether-lumefantrine (AL) for clearing parasitaemia in children aged less than five years old. This was a prospective study of the clinical and parasitological responses to the treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria using a popular dispersible brand of AL 20/120 mg. A hundred participants within 6–59 months with P. falciparum malaria were enrolled in the study and participants who could not complete the follow-ups were excluded. The drug was administered to participants following same dosage regimen on days 0, 1, 2 and followed-up on days 3, 7, 14, 21 and 28 in which the participants were assessed clinically and parasitologically. Data was analysed using MS-Excel 2010 and SPSS version 18. Kaplan-Meier survival analysis was used to assess clinical outcomes. The study showed that 73 participants completed the 28 days follow-up while 27 participants were lost to follow-up. Clinical outcome revealed no early treatment failure (ETF), one late clinical failure (LCF), 10 parasitological failures and 62 adequate clinical and parasitological response (ACPF). Clinical response was 84.9%, cumulative success and failure rate was 93.6% and 6.4%, respectively, on day 28. The clinical response of AL was efficacious. The failure rate of 6.4% could likely be as a result of reinfection within the period of follow-up.

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