Novel utility of Vesical Imaging-Reporting and Data System in multimodal treatment for muscle-invasive bladder cancer.

OBJECTIVES: To examine the clinical significance of the Vesical Imaging-Reporting and Data System (VI-RADS) in predicting outcome of multimodal treatment (MMT) in muscle-invasive bladder cancer (MIBC) patients. METHODS: We reviewed 78 pathologically proven MIBC patients who underwent MMT including transurethral resection and chemoradiotherapy, followed by partial or radical cystectomy. Treatment response was assessed through histologic evaluation of cystectomy specimens. Two radiologists categorized the index lesions of pretherapeutic MRI according to the 5-point VI-RADS score. The associations of VI-RADS score with the therapeutic effect of MMT were analyzed. The diagnostic performance of VI-RADS scores with a cut-off VI-RADS scores ≤ 2 or ≤ 3 for predicting pathologic complete response to MMT (MMT-CR) was evaluated. RESULTS: MMT-CR was achieved in 2 (100%) of VI-RADS score 1 (n = 2), 16 (84%) of score 2 (n = 19), 12 (86%) of score 3 (n = 14), 7 (64%) of score 4 (n = 11), and 14 (44%) of score 5 (n = 32). VI-RADS score was inversely associated with the incidence of MMT-CR (p = 0.00049). The cut-off VI-RADS score ≤ 2 and ≤ 3 could predict the favorable therapeutic outcome of MMT with high specificity (0.89 with 95% confidence interval [CI]: 0.71-0.98 and 0.82 with 95% CI: 0.62-0.94, respectively) and high positive predictive value (0.86 with 95% CI: 0.64-0.97 and 0.86 with 95% CI: 0.70-0.95, respectively). CONCLUSION: VI-RADS score may serve as an imaging marker in MIBC patients for predicting the therapeutic outcome of MMT. CLINICAL RELEVANCE STATEMENT: Muscle-invasive bladder cancer patients with a lower Vesical Imaging-Reporting and Data System score can be a good candidate for bladder-sparing treatment incorporating multimodal treatment. KEY POINTS: • Vesical Imaging-Reporting and Data System (VI-RADS) score was potentially valuable for classifying pathologic tumor response in patients with muscle-invasive bladder cancer. • The likelihood of achieving complete response of multimodal treatment (MMT) decreased with increasing VI-RADS score. • VI-RADS score could serve as an imaging marker that optimizes patient selection for MMT.

A Survey of the Current Status of Fentanyl Sublingual Tablets and Evaluation of Problems Associated with Their Proper Use / 日本プライマリ・ケア連合学会誌

<p><b>Objectives: </b>A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.</p><p><b>Methods: </b>Subjects were 18 cancer inpatients who received FST for breakthrough pain in their pharmacological cancer pain management. Changes in the pain score and the occurrence of adverse effects (nausea, vomiting and somnolence) were compared before and after FST administration.</p><p><b>Results: </b>The pain score before FST administration was 6.4±2.4, and this was significantly improved to 3.4±2.8 at 30 min after administration (p<0.01). Somnolence occurred significantly more often 30 min and 2 h after FST administration than immediately before administration (p<0.05). There were no differences in the occurrence of nausea and vomiting before or after FST administration. Nine patients receiving FST therapy developed xerostomia, but there were no significant changes in the pain score or occurrence of adverse effects while they had xerostomia.</p><p><b>Conclusion: </b>It is essential to observe the oral condition to judge whether FST therapy is indicated, and FST should be administered after providing sufficient oral care. The results indicate the possibility of increased occurrence of somnolence as an adverse effect.</p>