Japanese Journal of Cancer and Chemotherapy最新文献

A 53-year-old male patient presented with dyspnea and was admitted with the diagnosis of bacterial pneumonia.His respiratory condition did not improve despite the resolution of fever with antibiotic therapy, and he was eventually diagnosed with thymoma associated with myasthenia gravis.The patient underwent robot-assisted thoracoscopic extended thymectomy under general anesthesia.The anterior mediastinal tissue was resected en bloc using 5 ports and the port-hopping function of the robotic system.The operation time was 264 min, and the blood loss was 55 g.Histopathologic examination led to the definitive diagnosis of type B2 thymoma.Postoperatively, muscle strength improved, oral intake resumed after extubation, and the patient was transferred to rehabilitation on day 35.Achieving adequate dissection without approaching from both the right and left sides is generally challenging in resecting mediastinal tissue via thoracoscopic extended thymectomy.The subxiphoid approach may pose similar limitations.However, in the present case, the use of the port-hopping function during robot-assisted surgery allowed scope insertion from various positions, enabling excellent visualization.

A 62-year-old woman was admitted and underwent endoscopic mucosal resection for sigmoid colon cancer.Histopathological examination revealed submucosal invasion of 3,000 μm with positive tumor budding(Grade 2).Subsequently, she underwent laparoscopic sigmoidectomy with D2 lymphadenectomy.Postoperative pathology showed no regional lymph node metastasis, and the disease was staged as pStage Ⅰ.Chest CT scans revealed small nodules in the right middle lobe and left lower lobe that had been noted preoperatively and demonstrated gradual enlargement.Twenty four months after the initial surgery, these were diagnosed as synchronous pulmonary metastases, and she underwent thoracoscopic partial resections of both lungs.Nonetheless, the patient remains alive, with no recurrence 10 years after the resection of the pulmonary metastases.

We investigated the outcomes of robot-assisted surgery for elderly patients with colorectal cancer at a municipal hospital after its introduction.

Subjects and methods: From February 2024 to April 2025, we underwent 78 cases of robot-assisted colorectal cancer surgery.We divided these cases into cases over 80 years old and cases under 80 years old, and compared the short-term surgical outcomes to examine whether robot-assisted surgery could be safely introduced for elderly patients with colorectal cancer.

Results: There were 25 patients over 80 years old(Group A)and 53 patients under 80 years old(Group B).Age was significantly higher in Group A, and there were more women.Robot-assisted surgery was completed in all patients, and there were no differences in the degree or number of lymph nodes dissected.There was no difference in operative time or blood loss, but console time tended to be longer in Group A.Postoperative complications and postoperative length of hospital stay were significantly higher in Group A, but there were no in-hospital deaths.

Conclusions: Robot-assisted surgery for elderly patients with colorectal cancer can be safely implemented even in municipal hospitals, but careful attention to postoperative progress is required.

Radiotherapy plays a central role in the management of esophageal cancer, encompassing definitive, neoadjuvant, and palliative indications.Recent advances in linear accelerator-based technologies, such as intensity-modulated radiotherapy(IMRT)and volumetric-modulated arc therapy(VMAT), have enabled improved target coverage and significant reductions in cardiac and pulmonary doses, resulting in better treatment outcomes.Dynamic trajectory radiotherapy(DTRT), which synchronously controls gantry and couch motion, represents an innovative approach that allows three-dimensional beam trajectory optimization and further sparing of critical organs.Particle beam therapy using protons or carbon ions achieves highly conformal dose distributions with reduced cardiopulmonary toxicity and may enhance therapeutic efficacy when combined with systemic therapy or through the preservation of host immunity.Artificial intelligence(AI)is transforming radiotherapy workflows by enabling automatic contouring, adaptive replanning, and predictive modeling through radiomics.These technologies contribute to the standardization and individualization of treatment by improving prognostic and toxicity predictions.Concurrently, combined modality strategies integrating radiotherapy with immune checkpoint inhibitors and oncolytic viral therapies are under active clinical investigation.Early-phase trials have demonstrated favorable safety profiles and promising local control rates.Ongoing prospective multi-institutional trials and large-scale data analyses are essential to validate the clinical benefits and long-term safety of these novel modalities.The integration of technological innovations and biological insights is expected to drive further improvements in local control, toxicity reduction, and survival outcomes, establishing radiotherapy as an increasingly precise and biologically guided treatment modality for esophageal cancer.

Although systemic chemotherapy is the mainstay of treatment for metastatic recurrence of pancreatic cancer, in recent years, with the improvement of chemotherapy, some cases have been reported as long-term survival by multidisciplinary.We report a case of pancreatic cancer with superior mesenteric artery invasion treated with chemotherapy and carbon-ion radiotherapy(CIRT)followed by conversion surgery(CS).CIRT was successfully re-introduced for hepatic oligometastatic recurrence that appeared 1 year after CS.Disease control was obtained and continued at 6 months after CIRT for the liver, suggesting that multidisciplinary treatment including CIRT might be promising strategy for hepatic oligometastases if the primary tumor is under control.

84-year-old male was diagnosed with diffuse large B-cell lymphoma.He had Stage Ⅳ, performance status was 2, and 'high risk' according to the International Prognostic Index.He was started on Pola-R-mini-CHP.The day after completion of the 4 cycle, he developed shortness of breath, and we diagnosed he as having exacerbation of interstitial lung disease by CT.We started steroid pulse therapy.However, his condition failed to improve, and he died.An autopsy was performed.The pathological diagnosis was pulmonary fibrosis with acute diffuse alveolar damage.It is necessary to carefully monitor patients receiving Pola-R-CHP.

We report 2 cases in which skin grafting was avoided by utilizing thoracoepigastric following mastectomy with extensive skin defects due to advanced breast cancer extensively involving the breast.Case 1: A 53-year-old woman was diagnosed with right breast cancer extending to the midline of the chest.She underwent total mastectomy of the right breast, resection of the midline chest skin, and sentinel lymph node biopsy.Intraoperative frozen section analysis revealed positive sentinel nodes, prompting additional axillary lymph node dissection.Due to the extensive skin defect caused by resection of the midline chest skin, a thoracoepigastric flap was created to achieve wound closure.The postoperative course was uneventful.Case 2: A 64-year-old woman developed an intramammary recurrence of right breast cancer during follow-up after prior surgery.The recurrent tumor had extensively spread throughout the breast, with widespread erythema noted on the overlying skin.Multiple axillary lymph node metastases were also present, and neoadjuvant chemotherapy was initiated.Following chemotherapy, she underwent right total mastectomy and axillary lymph node dissection.A thoracoepigastric flap was used for wound closure.Her postoperative course was free of complications.

The purpose of this study was to clarify the prognostic factors of locally advanced colorectal cancer cases without distant metastasis successfully resected after chemotherapy.We investigated the association between prognosis and clinicopathological factors in 25 cases of locally advanced colorectal cancer without distance metastasis that underwent curative resection after chemotherapy between 2008 and 2021.The association between clinicopathological factors and DFS showed no difference in the use of molecular targeted drugs, response criteria, depth of tumor invasion, lymph node metastasis, but the prognosis was better in cases with a histological response Grade 1b or higher(p=0.039)and the cases underwent postoperative adjuvant chemotherapy(p=0.021), and both of these factors were extracted as independent prognostic factors for DFS in multivariate analysis.These results suggest that the histological response grade may be a useful prognostic factor in locally advanced colorectal cancer cases without distant metastasis successfully resected after chemotherapy.

A 61-year-old man experienced cardiopulmonary arrest twice during treatment for diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome.He was successfully resuscitated with intensive treatment.Subsequently, anemia progressed and a fecal occult blood test was positive.Ischemic enteritis with multiple small ulcers in the cecum and deep ulcers in the ileum were observed with lower gastrointestinal endoscopy.Approximately 1 week after the examination, melena and intestinal obstruction developed.Fever and abdominal pain were intensified, and blood test findings markedly worsened and abdominal CT showed that the small intestine was dilated, the wall of the terminal ileum was thickened, and a small amount of ascites in the pelvis.Laparotomy was performed 32 days later.The wall of the terminal ileum was markedly thickened.Intestinal necrosis and perforation were observed in a segment of approximately 10 cm that was 5 cm proximal to the terminal ileum.Ileocecal resection and ileostomy were performed.We encountered a patient who experienced cardiac arrest during treatment for hyperosmolar hyperglycemic syndrome and diabetic ketoacidosis, developed necrotic ischemic enteritis with circumferential perforation, and required surgical treatment.

Adrenal metastasis from gastric cancer is often found as part of systemic metastasis, and is rarely an isolated tumor that requires resection.The patient was a 73-year-old man.Contrast CT scan performed to investigate anemia and positive stool for occult blood revealed a 5 cm mass in the left adrenal gland.Upper gastrointestinal endoscopy revealed gastric cancer in the lesser curvature of the gastric angle, and lower gastrointestinal endoscopy revealed rectal cancer.Laparoscopic left adrenalectomy was performed for the left adrenal mass, and a histopathological examination revealed that the tumor was adrenal metastasis from gastric cancer.After 3 courses of SOX therapy, robot-assisted distal gastrectomy, with D2 lymph node dissection, and Roux-en-Y reconstruction were performed.Postoperative pathological diagnosis was M, Less, ypType 4, 48×43 mm, por2>tub2>sig, ypT3(SS), INF c, Ly0, V0, ypPM0, ypDM0, ypN0, P0, CY0, H0, M1(ADR), ypStage Ⅳ.By appropriately combining systemic therapy(chemotherapy)and local therapy(surgical resection), it is expected that the prognosis can be improved even for isolated adrenal metastasis of gastric cancer.