[A Case of Advanced Squamous Cell Carcinoma of the Lung 19 Years after Chemoradiotherapy of Limited-Disease Small-Cell Lung Cancer].

A 65-year-old man was referred to our hospital because of a fever and cough 19 years after chemoradiotherapy for small-cell lung cancer(SCLC)in the right middle lobe. Computed tomography(CT)revealed a normal right middle lobe, but found pneumonia and a tumor at the bronchial entrance of the right upper lobe. After treating the pneumonia with antibiotics and prednisolone, transbronchial biopsies(TBBs)revealed the tumor to be squamous cell carcinoma(SCC). Eight lines of chemotherapy including immune checkpoint inhibitors(ICIs)were completed with a 42-month survival following the initiation of chemotherapy for SCC, after which he ultimately died of hemoptysis. Survival of over 10 years from small- cell cancer is rare. We herein report the prognosis of SCLC and the treatment of subsequent primary lung cancer.

[A case of squamous cell carcinoma of the esophagogastric junction with bulky no.7-metastatic node successfully treatedby chemoradiation followed by surgery].

The patient was a 59-year-old man showing an ulcerative tumor. He had squamous cell carcinoma diagnosed by biopsy specimens, found in the esophagogastric junction by esophagogastroduodenoscopy. Abdominal CT showed a No.7 nodeswelling( 40mm in diameter), and the metastatic tumor directly invaded the pancreas(cStage IVa). We scheduled surgery followed by chemoradiotherapy, because it was difficult to remove the metastatic node completely. Two courses of chemotherapy consisting of 5-FU and CDDP were performed, and 2 Gy/day-irradiation(total amount of 40 Gy)was performed over 20 days. After chemoradiation, the tumor changed to a superficially depressed lesion, and the metastatic huge node was shrunk. Thirty-five days after chemoradiation, transhiatal a lower esophagectomy with proximal gastrectomy was performed. Histopathologic findings after surgery showed no cancer remnant in the primary site and the node(pCR). Three years later, the patient is well without recurrence. Although there was no evidence of preoperative chemoradiation limited in squamous cell carcinoma of the esophagogastric junction, surgery followed by chemoradiotherapy may be an effective treatment in advanced cases, such as the present one.

Patterns of radiotherapy practice for patients with cervical cancer in Japan, 2003-2005: changing trends in the pattern of care process.

PURPOSE: The patterns of care study (PCS) of radiotherapy for cervical cancer in Japan over the last 10 years was reviewed. METHODS AND MATERIALS: The Japanese PCS working group analyzed data from 1,200 patients (1995-1997, 591 patients; 1999-2001, 324 patients; 2003-2005, 285 patients) with cervical cancer treated with definitive radiotherapy in Japan. RESULTS: Patients in the 2001-2003 survey were significantly younger than those in the 1999-2001 study (p < 0.0001). Histology, performance status, and International Federation of Gynecology and Obstetrics stage were not significantly different among the three survey periods. Use of combinations of chemotherapy has increased significantly during those periods (1995-1997, 24%; 1999-2001, 33%; 2003-2005, 54%; p < 0.0001). The ratio of patients receiving concurrent chemotherapy has also dramatically increased (1995-1997, 20%; 1999-2001, 54%; 2003-2005, 83%; p < 0.0001). As for external beam radiotherapy (EBRT), the application rate of four-field portals has greatly increased over the three survey periods (1995-1997, 2%; 1999-2001, 7%; 2003-2005, 21%; p < 0.0001). In addition, the use of an appropriate beam energy for EBRT has shown an increase (1995-1997, 67%; 1999-2001, 74%; 2003-2005, 81%; p = 0.064). As for intracavitary brachytherapy (ICBT), an iridium source has become increasingly popular (1995-1997, 27%; 1999-2001, 42%; 2003-2005, 84%; p < 0.0001). Among the three surveys, the ratio of patients receiving ICBT (1995-1997, 77%; 1999-2001, 82%; 2003-2005, 78%) has not changed. Although follow-up was inadequate in each survey, no significant survival differences were observed (p = 0.36), and rates of late Grade 3 or higher toxicity were significantly different (p = 0.016). CONCLUSIONS: The Japanese PCS has monitored consistent improvements over the past 10 years in the application of chemotherapy, timing of chemotherapy, and EBRT methods. However, there is still room for improvement, especially in the clinical practice of ICBT.

Treatment outcome of elderly patients with glioblastoma who received combination therapy.

OBJECTIVES: Large population-based registries in Western countries show that the treatment strategy for glioblastoma multiforme (GBM) in elderly patients is likely less intensive. The purpose of this study was to clarify the treatment outcome of elderly patients with GBM and to explore appropriate treatment strategies. METHODS: We analyzed records from 86 patients (median age, 59 y; range, 9 to 77 y) diagnosed and histologically confirmed to have GBM, between January 1991 and June 2006 at our institutions; 14 elderly patients (range, 71 to 77 y) and 72 younger patients (range, 9 to 70 y). Fifty-two patients underwent total or subtotal resection and 34 patients underwent partial resection or biopsy. The median radiation dose was 54 Gy and 79 patients (92%) received anticancer agents. RESULTS: Among the 51 patients in recursive partitioning analysis (RPA) classes 5 and 6, the median survival time of the 12 elderly and 39 younger patients were 10.5 months [95% confidence interval, 5.8-12.8] and 11.7 months (95% confidence interval, 9.3-13.0), respectively (P = 0.32). Multivariate analysis showed only RPA class as an independent prognostic factor for overall survival rate (P = 0.009), whereas age (P = 0.85), total radiation dose (P = 0.052), and treatment with anticancer agents (P = 0.32) were not. CONCLUSIONS: After adjustment for RPA class, the treatment outcome of patients aged >70 years was equal to that of younger patients. Definitive treatment should not be withheld based on age alone.

Changing trend in the patterns of pretreatment diagnostic assessment for patients with cervical cancer in Japan.

OBJECTIVE: Cancer staging systems should be responsive to the development of diagnostic tools. The International Federation of Gynecology and Obstetrics (FIGO) cervical cancer guidelines were modified in 2009 regarding the pretreatment assessment. We report the recent Japanese patterns of pretreatment workup for cervical cancer. METHODS: The Japanese Patterns of Care Study (PCS) working group analyzed the pretreatment diagnostic assessment data of 609 patients with cervical cancer treated with definitive radiotherapy in the two survey periods (1999-2001, 324; 2003-2005, 285) in Japan. Sixty-one of 640 institutions were selected for this survey using a stratified two-staged cluster sampling method. RESULTS: The use of optional examinations in the latest FIGO guidelines such as intravenous urography, cystoscopy, and proctoscopy was gradually decreasing. Surgical staging was rarely performed in either survey period. Computed tomography (CT) and magnetic resonance imaging (MRI) were widely used, and MRI has become increasingly prevalent even between the two survey periods. Primary lesion size and pelvic lymph node status was evaluated by CT/MRI for most patients in both surveys. CONCLUSIONS: The use of CT/MRI that is encouraged in the latest FIGO staging guidelines already replaced intravenous urography, cystoscopy, and proctoscopy in Japan. Japanese patients received the potential benefit of CT/MRI because prognostic factors such as primary lesion size and pelvic lymph node status were evaluated by these modalities. The use of cystoscopy and proctoscopy should be continuously monitored in the future PCS survey because only CT/MRI could lead to the stage migration for patients on suspicion of bladder/rectum involvement on CT/MRI.

Validation of the Total Dysphagia Risk Score (TDRS) as a predictive measure for acute swallowing dysfunction induced by chemoradiotherapy for head and neck cancers.

BACKGROUND AND PURPOSE: Methods for predicting acute swallowing dysfunction in patients with head and neck cancers undergoing definitive chemoradiotherapy have not been established. We investigated the validity of the Total Dysphagia Risk Score (TDRS) as a predictive measure for this morbidity. MATERIALS AND METHODS: Forty-seven patients with head and neck cancers who underwent definitive chemoradiotherapy between December 1998 and March 2006 were reviewed retrospectively. Median age was 63 years (range, 16-81). Almost all patients underwent platinum-based concomitant chemoradiotherapy. Factors of the TDRS were as follows: T-classification, neck irradiation, weight loss, primary tumour site and treatment modality. Patients were classified into three risk groups according to the TDRS. RESULTS: Swallowing dysfunction was observed in 27 patients (57%) as RTOG grade 2 or higher acute morbidity. This classification was significantly associated with grade 2 or higher acute swallowing dysfunction (P<0.001). In ROC (receiver operator characteristic) analysis, the cut-off value of TDRS was set at 18 (sensitivity=0.81; specificity=0.85). Prediction of severe (grade ≥ 3) acute swallowing dysfunction was similarly obtained. CONCLUSION: The TDRS is a useful tool to predict acute swallowing dysfunction induced by chemoradiotherapy for head and neck cancers.

Risk factors for severe Dysphagia after concurrent chemoradiotherapy for head and neck cancers.

OBJECTIVE: The aim of this study was to investigate the risk factors for dysphagia induced by chemoradiotherapy for head and neck cancers. METHODS: Forty-seven patients with head and neck cancers who underwent definitive chemoradiotherapy from December 1998 to March 2006 were reviewed retrospectively. Median age was 63 years (range, 16-81). The locations of the primary lesion were as follows: larynx in 18 patients, oropharynx in 11, nasopharynx in 7, hypopharynx in 7 and others in 4. Clinical stages were as follows: Stage II in 20 and Stages III-IV in 27. Almost all patients underwent platinum-based concomitant chemoradiotherapy. The median cumulative dose of cisplatin was 100 mg/m(2) (range, 80-300) and median radiation dose was 70 Gy (range, 50-70). RESULTS: Severe dysphagia (Grade 3-4) was observed in 22 patients (47%) as an acute toxic event. One patient required tube feeding even at 12-month follow-up. In univariate analysis, clinical stage (III-IV) (P = 0.017), primary site (oro-hypopharynx) (P = 0.041) and radiation portal size (>11 cm) (P < 0.001) were found to be associated with severe dysphagia. In multivariate analysis, only radiation portal size was found to have a significant relationship with severe dysphagia (P = 0.048). CONCLUSIONS: Larger radiation portal field was associated with severe dysphagia induced by chemoradiotherapy.

Patterns of radiotherapy practice for patients with cervical cancer (1999-2001): patterns of care study in Japan.

PURPOSE: To describe the patterns of definitive radiotherapy practice for patients with uterine cervical cancer from 1999 to 2001 in Japan. METHODS AND MATERIALS: The Japanese Patterns of Care Study (JPCS) working group conducted a third extramural audit survey of 68 institutions and collected specific information on 324 cervical cancer patients treated with definitive radiotherapy. RESULTS: Almost all patients (96%) were treated with whole pelvic radiotherapy using opposing anteroposterior fields (87%). A midline block was used in 70% of the patients. Intracavitary brachytherapy (ICBT) was applied in 82% of cases. Most patients (89%) were treated with high-dose rate (HDR) ICBT. Calculation of doses to organs at risk (ICRU 38) was performed for rectum in 25% of cases and for bladder in 18% of cases. Only 3% of patients were given intravenous conscious sedation during ICBT applicator insertions. The median total biologically effective dose at point A (EBRT+ICBT) was 74 Gy(10) in cases treated with HDR-ICBT. There was no significant difference in total biologically effective dose between stages. The median overall treatment time was 47 days. Concurrent chemoradiation was applied in 17% of patients. CONCLUSIONS: This study describes the general patterns of radiotherapy practice for uterine cervical cancer in Japan. Although methods of external radiotherapy seemed to be appropriate, there was room for improvement in ICBT practice, such as pretreatment. A substantial difference in total radiotherapy dose between Japan and the United States was observed.

Patterns of pretreatment diagnostic assessment and staging for patients with cervical cancer (1999-2001): patterns of care study in Japan.

OBJECTIVE: To evaluate the patterns of pretreatment diagnostic assessment in uterine cervical cancer patients treated with definitive radiotherapy in Japan. METHODS: The Japanese Patterns of Care Study working group conducted a second extramural audit survey of 68 institutions and collected specific information on 631 patients with cervical cancer. All patients were treated with radiotherapy in 1999-2001. Of these, 324 patients treated without surgery were the subjects of this study. RESULTS: International Federation of Gynecology and Obstetrics-prescribed diagnostic procedures were performed at moderate rates in our study cohort. The performance rates of chest X-ray, intravenous urography, cystoscopy, and proctoscopy were 74, 54, 53, and 33%, respectively. Cross sectional imaging studies were frequently performed. Pelvic CT, abdominal CT, and pelvic MRI were performed in 88, 80, and 76%, respectively. Lymphangiography (1%) and surgical evaluation (1%) were rarely done. Only one patient underwent PET scans in this survey period. CONCLUSIONS: This study demonstrated the patterns of pretreatment diagnostic assessment in cervical cancer patients treated with definitive radiotherapy in Japan.

Radiotherapy for uterine cervical cancer: results of the 1995-1997 patterns of care process survey in Japan.

OBJECTIVE: The aim of this study is to establish Japanese national practice patterns for uterine cervical cancer patients who received radiotherapy without surgery. METHODS: The Japanese Patterns of Care Study (JPCS) conducted a national survey of 73 institutions using two-stage cluster sampling, and collected specific information on 591 patients with uterine cervical cancer treated by radiotherapy without planned surgery between 1995 and 1997. RESULTS: The median age of the patients was 70 years. Karnofsky performance status (KPS) was >/=90 for 37%. Most patients (95%) had histology of squamous cell carcinoma. Ten percent were stage I, 29% stage II, 48% stage III and 13% stage IVA. Photon beams of 10-14 MV were the most used for external beam radiotherapy (EBRT). The beam energy utilized varied significantly by institution strata. Midline block was used in approximately 70% of institutions. Intracavitary brachytherapy (ICBT) was performed in 77%. Institution strata correlated significantly with the ICBT application. The majority of patients (89%) were treated with high-dose-rate (HDR) ICBT. The median single point A dose of HDR-ICBT was 600 cGy. The median summated point A dose from EBRT and HDR-ICBT was 5800 cGy (range: 1196-8600). The median overall treatment time including ICBT was 49 days. Twenty-four percent of the patients received chemotherapy. Concurrent chemoradiation was performed in 5%. CONCLUSIONS: The JPCS established the Japanese national practice patterns of care for uterine cervical cancer patients treated with radiotherapy without planned surgery between 1995 and 1997. This survey demonstrated that the institutional strata significantly affected several practice patterns.

[Impact of treatment extending to 60 Gy on the outcome of radiotherapy for nasopharyngeal carcinoma].

PURPOSE: To clarify the impact of treatment duration on the outcome of nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Forty-three patients with NPC were treated with definitive radiotherapy from January 1980 through May 1996. The male-to-female ratio was 32:11, and median age was 58 years (10-78 years). According to the fifth UICC classification, 4 patients were stage I, 12 were stage II, 6 were stage III, and 21 were stage IV. Twenty-nine patients received chemotherapy. Each patient was treated to various doses according to their disease extension. Thus, treatment duration was defined as the duration from the start of radiotherapy to the end of 60 Gy. The median follow-up period was 63 months (2-164 months). RESULTS: The 5-year overall and disease-free survival rates of all patients were 66% and 59%, respectively. The 5-year disease-free survival rates of the patients treated with the short treatment duration (< or = 8 weeks) and those treated with the long treatment duration (> 8 weeks) were 76% and 38%, respectively (p = 0.008). CONCLUSION: Long treatment duration may lead to poor treatment outcome in NPC.