Japanese Journal of Cancer and Chemotherapy最新文献

A 59-year-old man presented with abdominal mass and weight loss. Computed tomography revealed a 20 cm mass in the vicinity of the left kidney. A tumor biopsy was performed and diagnosed with leiomyosarcoma. We performed tumor resection. The tumor invaded the surrounding tissues, and a lumpectomy with resection of the left kidney and left adrenal gland was performed. Pathologically, there was a slight suspicion of tumor exposure, so radiotherapy was administered to the dissected surface. There was no evidence of local recurrence or metastasis after 12 months.

We report a case of ectopic goiter that developed during administration of rheumatrex and in which we had difficulty in differentiating it. A 46-year-old woman had been diagnosed with rheumatoid arthritis(RA) and had been taking rheumatrex(12.5 mg/week)for the past 2 years. When she visited a local doctor, she was diagnosed with a thyroid tumor and was referred to our hospital. A plain chest X-ray showed compression of the trachea. A neck ultrasound showed an 8 cm tumor extending from the lower pole of the left thyroid lobe into the mediastinum. A contrast-enhanced CT scan showed tracheal deviation and an 8 cm tumor extending from the left thyroid lobe toward the mediastinum. Fine-needle aspiration biopsy was performed on the tumors in both thyroid lobes, but the diagnosis was benign. Surgery was performed to relieve the pressure on the trachea. A left lobectomy and removal of the left cervical tumor were performed. Histopathological diagnosis was adenomatous goiter in both cases. There was no continuity between the left thyroid lobe and the left anterior cervical tumor, so the tumor was diagnosed as ectopic goiter.

A 66-year-old man underwent endoscopic mucosal resection(EMR)for a polyp located in the rectosigmoid(RS)region. The pathological findings was tub1, T1a, ly0, v0, HM0 and VM0, and there were no factors indicating the need for additional treatment. Four years following the EMR procedure, a contrast-enhanced CT scan revealed an enlarged lymph node exhibiting contrast enhancement in the area of #252 lymph nodes. The patient was diagnosed with recurrent cancer, and laparoscopic high anterior resection with D3 dissection was performed. The patient had a good postoperative course and was discharged from the hospital on the seventh day after the surgery. The pathological diagnosis was a recurrence of rectal cancer characterized by an extramural tumor nodule without involvement of lymph node structures. Four courses of CAPOX were administered as adjuvant chemotherapy, and there has been no recurrence observed 2 years and 6 months after the surgery. The recurrence rate for endoscopically resected pT1a rectal cancer with no additional treatment considerations is relatively high, at 6.3%. Therefore, we consider that it is important to follow up the patient closely.

An 82-year-old woman, who underwent a mastectomy for right breast cancer 35 years ago, presented to our hospital with a chief complaint of general malaise and dyspnea. A chest CT scan revealed a right pleural effusion and multiple bone metastases. Upper gastrointestinal endoscopy revealed a small bulge in the mid gastric fold, which was diagnosed as a metastatic breast cancer lesion, based on pathological diagnosis and immunostaining findings. The patient had triple-negative breast cancer and was started on docetaxel therapy despite her advanced age. The pleural effusion disappeared, tumor marker levels normalized, and treatment was continued. Here, we report a case of late recurrence of breast cancer with gastric metastasis 35 years postoperatively.

An 80-year-old man underwent laparoscopic distal gastrectomy, D2 lymphadenectomy, and Billroth Ⅰ reconstruction for gastric cancer. The short gastric artery and vein were completely preserved. The patient developed a fever on the second postoperative day, and a blood test on the third day showed high inflammation findings, and contrast-enhanced CT scan revealed decreased gastric wall blood flow of the anal side of the remnant stomach. When contrast-enhanced CT was performed again 7 days after the surgery to re-evaluate the condition, there was no improvement in the decreased blood flow in the remnant stomach, so the diagnosis of remnant gastric necrosis was made. Total remnant gastrectomy, Roux-en-Y reconstruction were performed. Histopathologically, the remnant stomach was found to have full-thickness necrosis on the anal side. The stomach has a well-developed intramural blood flow network, so blood flow disorders in the remnant stomach is rare. However, there are individual differences in the blood flow network within the gastric wall, and if decreased blood flow is suspected, ICG fluorescence imaging should be performed and consideration should be given to changing the surgical method to additional gastrectomy or total gastrectomy.

The widespread adoption of smartphones due to advances in information and communication technology(ICT)has enabled the use of software for data collection in clinical trials. In March 2021, revisions to the"Ethical Guidelines for Medical and Biological Research Involving Human Subjects"expanded the methods for obtaining consent using electronic means, further broadening the approaches to conducting clinical trials. However, nutrition impact symptoms in cancer patients remain inadequately defined. The authors aim to define these symptoms through the WASHOKU trial, utilizing smartphones for data collection related to nutrition. Through the WASHOKU trial, many challenges such as patient awareness, recruitment for research, smartphone ownership rates, and the technical proficiency of patients and users utilizing digital devices have come to light. Such trials serve as litmus tests, raising expectations for further clinical trials leveraging ICT.

In 2001, a robotic remote cholecystectomy was conducted between France and the United States, showing the world that telesurgery is a realistic procedure. In Japan, research on telesurgery has been started since 2002. Several attempts have been made, including an international telesurgery. At that time, high-speed telecommunications had not yet been developed, and robotic surgery itself was not yet well accepted by the general public, therefore telesurgery was not successfully implemented. In recent years, however, the number of robot-assisted surgeries has increased rapidly in Japan. In addition, the shortage of physicians in rural areas and an aging society are rapidly increasing the need for online medical services (other than surgery). The Japan Surgical Society(JSS)has taken the lead in conducting many feasibility studies for the clinical introduction of telesurgery, and moves toward its realization are now in progress. In addition to Japan, China, India, and the United States are also conducting clinical studies to realize telesurgery, and it is expected that telesurgery will be introduced in earnest in many countries in the near future.

Due to supply difficulties and other factors associated with COVID-19, oral dexamethasone became less readily available. To address this limitation, we investigated the effect of adjusting prophylactic antiemetic therapy on the efficacy of anticancer drug treatment. This study included patients in the gastrointestinal oncology unit of our hospital who received a regimen containing moderately emetogenic risk anticancer drugs between September 2021 and August 2022. We retrospectively analyzed medical records to assess the treatment regimen, prophylactic antiemetic therapy, oral dexamethasone dose reduction, presence of emetic events during the first course, use of additional antiemetic agents for prominent nausea and vomiting, and the complete response(CR)rate. The study included 98 patients with a median age of 71 years. The overall CR rate was 95% in the standard-dose dexamethasone group and 92.3% in the dexamethasone-reduced group(p=0.68). The CR rates for oxaliplatin- and irinotecan-based regimens were 92.9% and 100% in the dexamethasone-reduced group and 91.5% and 94.7% in the standard-dose dexamethasone group. In this study, the CR rates were not significantly different between the dexamethasone reduction and standard-dose groups. This may be due to the use of steroid-sparing or triple therapy by physicians, depending on the patient's risk factors. Therefore, the prophylactic antiemetic therapies for individual patients must be continued to examine.

Background: In terminal cancer patients, the nutritional status deteriorates due to cachexia. In this study, we performed a nutritional assessment of terminal gastrointestinal cancer patients and examined the relationship with prognosis.

Subjects and methods: Fifty-eight patients with terminal gastrointestinal cancer who were hospitalized and treated from January 2019 to June 2022 were included. Patients with terminal cancer were defined as those who were refractory to active treatment, and hospitalization was defined for treatment of distress due to cancer progression. Body mass index(BMI)and prognostic nutritional index(PNI)were calculated as nutritional indices. Neutrophil/lymphocyte ratio(NLR)was calculated as an immune index, and platelet/lymphocyte ratio(PLR)and modified Glasgow prognostic score(mGPS)as prognostic indices.

Results: The median values for all cancers were BMI 18.9(16.6-22.9)kg/m2, PNI 33.9(29.2-39.6), NLR 7.9(5.0-16.4), PLR 381.6(181.6-1,025.9) and mGPS 0/1/2 in 10/4/42 cases. Patients were divided into 2 groups by median values of each index(0, 1 and 2 for mGPS), and survival after hospitalization was examined: BMI≥18.9/<18.9: 27(15-35)/27 (16-50)days, p=0.3427, PNI≥33.9/<33.9: 40(25-54)/19.5(9-27)days, p=0.0036, NLR≥7.9/<7.9: 22(12-29)/50 (21-67)days, p=0.0035, PLR≥381/<381: 27(18-36)/24(15-52)days, p=0.2250, mGPS≥2/<2: 25(15-30)/57.5 (20-80)days, p=0.0023.

Conclusion: The present study suggests that PNI may be related to prognosis in nutritional assessment in patients with terminal gastrointestinal cancer.

Dual human epidermal growth factor receptor 2(HER2)blockade with trastuzumab(H)and pertuzumab(P)combined with docetaxel and carboplatin(TCb)is a standard neoadjuvant therapy for HER2-positive breast cancer patients. We conducted this sub-study using data from the investigator-initiated randomized phase 2 JBCRG-20(Neo-peaks)study to evaluate the safety of simultaneous mixed HP infusion in Japanese patients, as there have been no data to date. A total of 204 patients in groups A-C received TCbHP, TCbHP followed by trastuzumab emtansine(T-DM1)+P, and T-DM1+P, respectively. Of the 103 patients in groups A and B who received H and P by sequential infusion in cycle 1, the 17(median age 59; range 29-69 years)who did not experience an infusion reaction(IF)received these agents as a mixed, single-bag infusion from cycle 2 onwards. No cases of IF were observed, thus 71 mixed doses were safely administered. Administration time was reduced to 60 min from cycle 3 onwards. Furthermore, in the group B patients, mixed HP infusion did not affect their subsequent treatment(i. e. 4 cycles of T-DM1+P). Simultaneous administration of H and P enables a reduced administration time, which would benefit both patients and healthcare providers.