小久保 雅樹

BACKGROUND: Postoperative regional nodal irradiation (RNI) is a standard treatment for breast cancer at high risk of regional recurrence; however, the necessity of including the internal mammary node (IMN) region in the radiation field remains unclear. This study aimed to evaluate treatment outcomes in a large cohort of patients who received postoperative radiotherapy with RNI excluding the IMN region. METHODS: This study included patients with breast cancer who underwent surgery followed by RNI without IMN irradiation between 2007 and 2018. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), breast cancer-specific mortality (BCM), distant metastasis-free survival (DMFS), recurrence patterns, and treatment-related adverse events. RESULTS: In total, 799 patients were included. The 5-year DFS, OS, BCM, and DMFS rates were 75.9, 88.3, 9.7, and 77.1%, respectively. Worse outcomes were associated with a higher number of positive lymph nodes and estrogen receptor (ER)-negative disease. Medial/central tumor location and younger age were each significantly associated with poorer outcomes, being associated with worse DFS and DMFS. Bone was the most common recurrence site. ER-negative disease, a higher number of positive lymph nodes, medial/central location, and younger age were significant risk factors for recurrence, particularly distant metastasis. IMN recurrence was rare. CONCLUSIONS: In this cohort, medial/central tumor location, ER-negative disease, and extensive nodal involvement were associated with poorer outcomes, suggesting that these factors may identify patients who can benefit from IMN irradiation. These findings may serve as important reference data when determining the indication for IMN irradiation on an individual patient basis.

This survey examined the real-world practice of radiotherapy for small-cell lung cancer (SCLC) in Japan, focusing on treatment strategies for limited-disease SCLC (LD-SCLC) and extensive-disease SCLC (ED-SCLC). This study aimed to identify inter-institutional differences, optimize treatment strategies and explore opportunities for standardization. A questionnaire was distributed to members of the Japanese Radiation Oncology Study Group, and responses were collected from 15 December 2023 to 14 March 2024. Responses to 11 questions specifically related to SCLC treatment strategies were analyzed. Among the 112 institutions, 38.3% did not set an upper age limit for concurrent chemoradiotherapy in LD-SCLC, whereas 31.3% set the limit at 80 years. The most commonly used chemotherapy regimen was cisplatin plus etoposide (79.5%), and the predominant radiotherapy fractionation schedule was twice-daily 45 Gy in 30 fractions (97.3%). Elective nodal irradiation (ENI) was ommited in 30.4% of institutions, while 17.9% reported performing ENI in all cases. Intensity-modulated radiation therapy (IMRT) was introduced in 71.4% of institutions, with D50% as the most frequently used dose-prescription method (47.5%). After achieving complete response, 16.1% of institutions routinely perform prophylactic cranial irradiation (PCI) in all patients. Hippocampus-sparing PCI was not widely used at the time of the survey (13.3%). In conclusion, this Japanese nationwide survey highlighted the SCLC treatment patterns and differences compared with non-small lung cancer (NSCLC). ENI omissions and IMRT have become increasingly adopted for SCLC, whereas clinical target volume margin definitions show some variation compared with NSCLC. Regular surveys are essential to monitor the evolution of treatment strategies.

This survey was conducted to examine the real-world practice of definitive chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (LA-NSCLC) in Japan, aiming to standardize treatment, reduce inter-institutional disparities and identify areas for future research. A questionnaire was sent to members of the Japanese Radiation Oncology Study Group through a mailing list, with responses collected between December 15, 2023, and March 14, 2024. Responses from 112 institutions revealed that 81.2% either did not set general upper age limits or established limits at 80 years or older for definitive CRT in LA-NSCLC. The most common absolute contraindications were active interstitial pneumonia (60.7%) and contralateral hilar lymph node metastasis (42.0%). Relative contraindications involved dose-volume indices of the normal lung (70.5%). The most commonly adopted dose-volume indices were lung V20Gy < 30%, lung V5Gy < 60% and mean lung dose <20 Gy, while no definite indices were established for heart V50Gy and mean heart dose in half of the institutions. Additionally, 88.4% of institutions reported using IMRT for LA-NSCLC. Involved-field radiotherapy (IFRT) was adopted regardless of institutional size, and institutions with higher IMRT usage for LA-NSCLC also had higher IFRT adoption rates. In conclusion, this nationwide survey revealed the expanded use of definitive CRT and a growing emphasis on reducing lung dose to mitigate pulmonary toxicities, facilitated by advancements in IMRT and IFRT. Regularly conducting these surveys is essential to monitor evolving treatment strategies.

Fungating lesions in advanced breast cancer often affect the quality of life. Fractionated radiation therapy is the preferred treatment over single-fraction radiation therapy because of the relatively favorable prognosis for breast cancer. Therefore, limited literature is available regarding the effectiveness of short-course radiation therapy, especially 8-Gy single-fraction radiation therapy. Herein, we describe the case of an 85-year-old patient diagnosed with locally advanced breast cancer for several years who underwent two sessions of 8-Gy single-fraction radiation therapy performed approximately one year apart. This therapy resulted in prolonged control of bleeding without severe side effects. The patient experienced bleeding from a fungating lesion and was referred to the Department of Radiation Oncology for palliative therapy to relieve the bleeding. Owing to limited support from her family and nursing care workers, she faced transportation challenges making frequent hospital visits infeasible, so 8-Gy single-fraction radiation therapy was performed. Radiation therapy was well tolerated, and hemostasis was achieved. Eleven months later, tumor regrowth and recurrent bleeding occurred, which necessitated another 8-Gy therapy. Re-irradiation was tolerated with only mild dermatitis noted, and the symptoms were relieved. Twelve months after re-irradiation, the breast cancer remained controlled, with no further bleeding. These findings indicate that 8-Gy single-fraction radiation therapy effectively controls bleeding from fungating breast cancer, and hemostasis may last longer than previously reported. Moreover, this method may be a valuable way to provide symptomatic relief, especially for elderly patients needing nursing care, even when their prognosis is relatively good.

PURPOSE: This multi-institutional prospective cohort trial aimed to demonstrate the changes in physician-evaluated dysphagia and patient-reported outcomes (PROs) after palliative external beam radiotherapy (EBRT) in patients with incurable esophageal cancer presenting with dysphagia. MATERIALS AND METHODS: We evaluated the rates of freedom from physician-evaluated dysphagia progression and improvement along with longitudinal changes in PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life-Core 30 Questionnaire [QLQ-C30] and OES-18) after palliative EBRT. Multivariate analysis was used to identify the factors associated with freedom from physician-evaluated dysphagia progression at week 13. RESULTS: A total of 519 patients with esophageal cancer were screened; the full analysis set comprised 93 patients with a baseline median dysphagia score of 2 (IQR, 1-3) whose possible range was 1-4. Squamous cell carcinoma accounted for 94% of the full analysis set. The median prescribed dose of palliative EBRT was 40 Gy (IQR, 37.5-50). The rates of freedom from physician-evaluated dysphagia progression and improvement at 13 weeks were 76% (95% CI, 66 to 85) and 50% (95% CI, 39 to 60), respectively. Multivariate analysis suggested that high-dose palliative EBRT was more effective in preventing deterioration of physician-evaluated dysphagia than the low-dose one. Role functioning, fatigue, dyspnea, and appetite were worsened at week 4 but recovered at week 13. Patient-reported dysphagia, as represented in EORTC OES-18, demonstrated clinically significant improvement from weeks 13 through 52, relieving dysphagia-associated symptoms and enhancing global health. CONCLUSION: Palliative EBRT could relieve physician-evaluated and patient-reported dysphagia and dysphagia-associated symptoms and enhance global health in patients with incurable esophageal cancer, especially for squamous cell carcinoma despite transient dysfunction and aggravations of symptoms attributable to acute toxicity from palliative EBRT.