Japanese journal of clinical oncology最新文献

Background: The mainstay of treatment for soft-tissue sarcomas is complete resection with negative surgical margins. However, treatment strategies for local control including the frequency of adjuvant radiotherapy (RT) and surgical margin differ greatly between Japan and other countries, and the optimal strategy of local control remains controversial.

Methods: A total of 70 patients with high-grade sarcoma who underwent surgery of the 72 patients enrolled in JCOG0304, were included. The primary endpoint was the proportion of local recurrence, and we investigated the clinicopathological background of local recurrence cases, including the surgical margins according to the Japanese Orthopedic Association (JOA) margin classification or histological margin, and use of adjuvant RT.

Results: Local recurrence occurred in five patients, with a 5-year local recurrence proportion of 7.1% (95% confidence interval, 2.6%-14.8%) in 70 patients. The histological subtype were four cases of undifferentiated pleomorphic sarcoma (UPS) and 1 case of liposarcoma. The 5-year local recurrence proportions for UPS and non-UPS were 19.0% and 2.0%, respectively. Two of the five recurrent cases (40%) had adjuvant RT. The recurrent cases were four males and one female, median age 54 years (range: 33-66), JOA margin classification showed wide resection in four cases and marginal resection in one case, and histological margin showed negative in all five cases.

Conclusion: Despite the low proportion of adjuvant RT, local control of high-grade soft tissue sarcoma with preoperative chemotherapy in JCOG0304 was good. However, more detailed surgical margin evaluation and the use of adjuvant RT should be further investigated in the future for UPS.

Background: This study aimed to elucidate the significance of the maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) by radiological ground glass opacity (GGO) tumors of non-small cell lung cancer (NSCLC), particularly in tumors assumed to be pathologically non-invasive.

Methods: Overall, 709 consecutive patients with GGO-dominant NSCLC who underwent complete resections at three institutions between 2017 and 2022 were included. GGO-dominant tumors and pure GGO tumors were evaluated based on the SUVmax. The adenocarcinoma subtypes were categorized into low, medium, and high grade. The correlation between the SUVmax, pathological malignant grade, and pathological invasive diameter was examined.

Results: In GGO-dominant lung adenocarcinoma, the SUVmax correlated positively with the pathological malignant grade and the pathological invasive diameters (respectively, (P = .0001), (P < .0001)). Similarly, in pure GGO lung adenocarcinoma, the SUVmax correlated positively with the pathological malignant grade. The median pathological invasive diameter was higher in patients with SUVmax ≥ 1.0 compared to those with SUVmax < 1.0 [10 mm vs 0 mm, respectively, (P = .017)].

Conclusions: A higher accumulation of FDG than in the background lung reflects invasive components even in pure GGO areas where only non-invasive components are expected. An FDG-PET/CT can complement the qualitative diagnosis in predicting invasive components with limitations in high-resolution computed tomography alone.

Stomatitis, which is a common side effect of chemotherapy, currently lacks a standardized approach for its prevention. Therefore, this multicenter, randomized, open-label, controlled phase III trial aims to assess the efficacy and safety of a dexamethasone-based mouthwash for preventing chemotherapy-induced stomatitis in patients with early breast cancer. We will randomly assign 230 patients with early breast cancer scheduled to receive chemotherapy in a 1:1 ratio to either the dexamethasone-based mouthwash group (10 ml, 0.1 mg/ml; swish for 2 min and spit 4 times daily for 8 weeks) or the mouthwash-with-tap-water group. The incidence of stomatitis, measured using electronic patient-reported outcomes, is the primary endpoint.

Bone metastases are often associated with pain and can occur in various types of cancer, significantly affecting patients' quality of life. Despite the high response rates to initial conventional radiotherapy in patients with painful spinal metastases, recurrence and inadequate response still occur. Thus, the development of a highly effective strategy for pain recurrence is crucial to improving the quality of life in patients with advanced metastatic cancer. This randomized phase III trial aims to confirm the superiority of re-irradiation with stereotactic body radiotherapy (24 Gy in 2 fractions) over conventional radiotherapy (8 Gy in a single fraction) in achieving a complete pain response at 12 weeks in patients with previously irradiated painful spinal metastases. A total of 158 patients from 33 hospitals will be enrolled in Japan over 3.5 years. This trial has been registered in the Japan Registry of Clinical Trials as jRCTs1030240172 (https://jrct.niph.go.jp/latest-detail/jRCT1030240172).

Background: Malignant primary cardiac tumors require multimodal approaches including surgery, chemotherapy and radiotherapy, but these treatments can be associated with cardiovascular complications. However, few reports have described the cardiovascular complications related to primary cardiac tumor treatment because of their rarity.

Methods: Clinical records of patients with primary cardiac tumors treated at Kyushu University Hospital from January 2010 to August 2021 were retrospectively examined.

Results: Of the 47 primary cardiac tumor patients, 13 (28%) were diagnosed with malignancy, including 5 angiosarcomas, 3 intimal sarcomas, 3 diffuse large B-cell lymphomas, 1 Ewing's sarcoma and 1 fibrosarcoma. Cardiovascular events were observed in 10 patients (77%), including cardiac dysfunction in 6 patients, arrhythmias in 5 patients, right heart failure in 2 patients, and excessively prolonged prothrombin time due to the combination of warfarin and chemotherapy in 1 patient. Two patients who showed notable cardiac complications are described. Case A involved a 69-year-old woman who underwent surgery for a left atrial intimal sarcoma, followed by postoperative chemotherapy with doxorubicin plus ifosfamide and radiotherapy. After three cycles of chemotherapy and sequential radiotherapy, her left ventricular ejection fraction decreased to 34%, and ongoing heart failure therapy was required. Case B involved a 66-year-old man who received chemotherapy for primary cardiac lymphoma, resulting in tumor shrinkage. However, due to tumor involvement of the intraventricular septum, atrioventricular block developed, requiring cardiac pacemaker implantation.

Conclusion: High incidences of cardiac failure and arrhythmias were observed during multimodal treatments for malignant primary cardiac tumors. Proper management of complications may lead to a favorable prognosis in patients with malignant primary cardiac tumors.

Objective: The aim of this study was to compare prognostic outcomes of administering first- or second-generation androgen receptor signaling inhibitors in non-metastatic castration-resistant prostate cancer and to find prognostic indicators.

Methods: This retrospective study included 198 patients with non-metastatic castration-resistant prostate cancer from 14 institutions associated with Tokai Urologic Oncology Research Seminar. Forty-two patients were treated with combined androgen blockade using first-generation inhibitors (bicalutamide or flutamide), and 156 were treated with second-generation inhibitors (abiraterone/enzalutamide or apalutamide/darolutamide) after primary androgen deprivation therapy failure. We compared survival outcomes of combined androgen blockade using first-generation inhibitors and second-generation inhibitor treatments, and analyzed clinicopathological or serum parameters and survival outcome.

Results: Combined androgen blockade and second-generation androgen receptor signaling inhibitor groups demonstrated median progression-free survival of 10.2 (95% confidence interval: 5.5-12.3) and 26.0 (95% confidence interval: 21.9-38.4; P < 0.001) months, respectively. Cut-off levels for clinical biomarkers were targeted to <0.2 ng/ml prostate-specific antigen levels 3 months after treatment initiation for non-metastatic castration-resistant prostate cancer; the patient group that achieved this showed better progression-free survival (median 14.7 months, 95% confidence interval: 10.3-23.9 not achieved, median not applicable, 95% confidence interval: 24.6-not applicable achieved; P < 0.00001). Multivariate analysis revealed significant prognostic factors: second-generation androgen receptor signaling inhibitor as first-line treatment (odds ratio: 5.05, 95% confidence interval: 1.54-16.6) and a high hemoglobin level (odds ratio: 2.92, 95% confidence interval: 1.26-6.76).

Conclusions: Our findings suggested prostate-specific antigen < 0.2 ng/ml after 3 months may be a practical prognostic indicator of survival outcomes in non-metastatic castration-resistant prostate cancer. Patients showing a high hemoglobin level should be intensively treated with second-generation androgen receptor signaling inhibitors rather than combined androgen blockade using first-generation inhibitors.

Biliary tract cancer, carcinoma of the extrahepatic bile ducts, carcinoma of the gallbladder, ampullary carcinoma, and intrahepatic cholangiocarcinoma are often identified at advanced stages. The standard therapy for advanced biliary tract cancer has been a combination of cytotoxic agents. Globally, gemcitabine plus cisplatin has been the standard first-line regimen, whereas gemcitabine plus cisplatin plus S-1 and gemcitabine plus S-1 have also been the standard regimens in Japan. Recently, treatment strategies have been updated. As first-line systemic therapy, the addition of an immune checkpoint inhibitor, such as durvalumab or pembrolizumab, to gemcitabine plus cisplatin has been shown to prolong overall survival compared with gemcitabine plus cisplatin. These combined immunotherapies are widely used in clinical practice as internationally standard first-line regimens. Regarding second-line treatment after a gemcitabine-based regimen, fluorouracil and folinic acid plus oxaliplatin have been the standard regimen. Additionally, FGFR2 fusion gene/rearrangement, mutations of IDH1/2, KRAS, and BRAF, and overexpression of HER2 are promising therapeutic targets for which the effectiveness of each targeted therapy has been reported, at this time, as a second-line or later treatment.