Palliative cyberknife therapy successfully controlled lower extremity lymphedema caused by pelvic lymph node metastases after radiation therapy for localized prostate cancer: a case report

This report documents the case of a male in his sixties who developed multiple lymph node metastases after receiving external beam radiation therapy and androgen deprivation therapy for locally advanced prostate cancer. Agglomerated pelvic lymph node metastases caused lower extremity lymphedema, however the patient was administered systemic chemotherapy with docetaxel. Because surrounding normal tissue was already irradiated by the prior therapy, radiation against pelvic lymph nodes by LINAC was in danger of exceeding tolerance dose. Therefore, the patient received stereotactic radiosurgery by cyberknife that has a high degree of accuracy in target identification and localization for pelvic lymph node metastases. The lower extremity lymphedema was declined and his activity of daily living was recovered without obvious side effects. Here we report the case of successfully controlled lymphedema by palliative cyberknife therapy.

Relationship Between the Process of Deciding on a Course at a Medical University and Occupational Identity / 医学教育

Medical university students were divided into 5 types according to the process they used to decide on a course when entering a university, and the relationship between the decision-making process and occupational identity after entering the university was examined. The largest number of students, approximately 50%, were of the “meeting” type, followed in descending order by the “early decision” type, the “changing during 4 years” type, the “deciding at the last moment” type, and the “avoidance” type. There were differences in the frequency of decision-making types among departments, including the nursing department, which showed a large number of students of the “early decision” type. We examined the relationship between the decision-making process and occupational identity after entering the university and found that students of the “early decision” type were stable after entering the university, whereas students of the “avoidance” type had the lowest scores on all 4 subscales of occupational identity. This tendency was seen during the 4 years of university, and the importance of deciding on a course when entering the university was indicated.