We provide here an outline of adjuvant and neoadjuvant treatment along with surgery from the viewpoint ofthe change in pancreatic cancer survival. Since 2000, gemcitabine and S-1 have been authorized, and gemcitabinehas been chosen for adjuvant treatment. We performed a high-quality RCT of S-1 in the adjuvant setting startingin 2014 and became the leading center for adjuvant treatment. We used resectability criteria that were annuallyreported by the American NCCN, but they were introduced in the 7th edition of the JPS guidelines in this countryand are useful for decision-making orientation. Neoadjuvant chemotherapy is a commonly recognized methodfor the management of patients with resectable and borderline resectable pancreatic tumors. However, there hasnot yet been a consensus on the best regimen choice. A RCT of preoperative chemotherapy including S-1 + GEMtreatment was performed in patients with resectable tumors in 2019, and an improvement in the long-term survivalwas demonstrated. We retrospectively evaluated the cases of patients undergoing pancreatic cancer excision at ourinstitution over the past 24 years. On the basis of resectability (R) criteria classifications, preoperative treatmentwas initiated in 38.4% of patients with UR and 53.8% of patients with BR tumors. The OS was 12.3% for patientswith BR tumors, 28.1% for those with R tumors and 24.9% for patients with UR (P = 0.038) tumors. An improvement in the survival rate was observed with adjuvant treatment. Successful execution of adjuvant treatment withS-1 contributed to long-term survival after surgery without cancer remnants. However, it is essential to preoperatively treat patients with UR tumors to control 20% of recurrences, and there is a high recurrence of cancer inpatients with BR tumors treated with chemotherapy. These treatments performed preoperatively can lead to animprovement in OS.
The efficacy of a novel treatment, combination chemotherapy employing methotrexate, rituximab and otherantineoplastic agents with consolidation therapy via radiation therapy and cytarabine (R-MPV therapy), for primary central nervous system lymphoma has been reported in multiple studies. We introduced R-MPV therapy inJuly 2019 and performed it in 4 patients over a one-year period. We describe here the detailed clinical courses ofthese 4 patients. Although grade 3 or 4 neutropenia was observed in all patients, all elements of R-MPV therapywere performed in all 4 patients without critical side effects. Tumors recurred in 1 patient; however, completeremission has been maintained in 3 patients up until now. Although an additional effect on survival is expectedwith this novel treatment strategy, further long-term observations and evaluations are needed for R-MPV therapyto be established.
The introduction of artificial heart valves improved the surgical outcome of valvular diseases. At the same time, a concept called prosthesis-patient mismatch (PPM) was proposed. There is no consensus on whether PPM affects the long-term mortality rate and cardiovascular event incidence. Moreover, PPM is evaluated by echocardiology at rest but not during exercise. This study investigated the significance of PPM-based echocardiography at rest and dobutamine echocardiography. The study results indicated significant differences in the maximum and mean pressure difference and left ventricular mass index between PPM and non-PPM patients. At the maximum heart rate during dobutamine echocardiography, there was no difference in the maximum and mean pressure differences and METs between non-PPM and PPM patients. For both non-PPM and PPM patients, dobutamine administration significantly increased the maximum and mean pressure differences, which indicates significant stress to the heart during exercise. Long-term follow-up will demonstrate whether the concept of PPM is necessary.
A 16-year-old girl was admitted to our hospital with persistent vomiting and hiccups. She later developed vertigo,nystagmus, diplopia, and limb paresthesia. Brain fluid-attenuated inversion recovery MRI revealed a high-signallesion in the dorsal medulla. The definitive diagnosis of the neuromyelitis optica spectrum disorder (NMOSD)area postrema syndrome (APS) was made based on the positive serum anti-aquaporin-4 antibody test result. Afterthe patient received steroid pulse therapy (methylprednisolone at 1,000 mg/day for five days), her symptomsmarkedly improved. NMOSDs are relatively rare in children, but APS should be considered in the differentialdiagnosis of children with intractable vomiting and hiccups.
An 87-year-old woman diagnosed with acute monoblastic leukemia (M5a) was prescribed oral cytarabineocfosfate and etoposide for 12 days. Subsequently, she developed severe cytopenia. Neutropenia (< 500/μL) persisted for 69 days, during which she developed invasive pulmonary aspergillosis; no other severe adverse eventswere observed. A bone marrow smear 35 days after therapy initiation showed severe hypoplastic findings with noblast cells. The leukocyte count gradually increased as granulocyte colony-stimulating factor injections were administered for 25 days. As an outpatient, she maintained good hematological recovery for more than 1 year, withslight anemia and thrombocytopenia but without an increase in blast cells in the bone marrow 21 months aftertherapy initiation.
A 45-year-old woman visited a primary doctor for cervical lymphadenopathy. She was diagnosed with andtreated for tuberculous lymphadenitis but discontinued treatment because of a skin rash and liver dysfunction.Subsequently, she developed fever and headache and was referred for suspected tuberculous meningitis. She wassuccessfully treated after a diagnosis of miliary tuberculosis and tuberculous meningitis. However, pneumocystispneumonia occurred two months later, and varicella pneumonia occurred three months later. Both diseases improved with medical treatment, but tuberculous meningitis recurred. We report a rare case of consecutive opportunistic infections during the treatment of tuberculosis.
The Novo-TTF 100A system is a novel antitumor treatment modality that demonstrated a survival effect forprimary glioblastoma in a multicenter open-label randomized phase III trial. We used this treatment modality for 3glioblastoma patients in Nihon University Itabashi Hospital. Here, we report the clinical courses of these 3 patients.Patient 1 was a 52-year-old male with left temporal glioblastoma who was treated via the Novo-TTF 100A systemfor 3 months. Patient 2 was a 62-year-old female with right thalamic glioblastoma who was treated via the NovoTTF 100A system for 13 months. Patient 3 was a 38-year-old male with left frontal glioblastoma who was treatedvia the Novo-TTF 100A system for 6 months. Patient 1 died 12 months after surgery, and Patient 2 died 18 monthsafter surgery. Patient 3 is being treated via the Novo-TTF 100A system. The details of the treatment course aredescribed in this article.
The patient was a 66-year-old man. In June 2018, he was found to have elevated serum CEA in a medicalcheckup, and colonoscopy (CF) revealed a type I lesion in the rectum (Rs). He was diagnosed with adenocarcinoma on the basis of biopsy findings and was referred to our hospital. Thoracoabdominal computed tomographyshowed distant lymph node metastases, and Stage IV cancer was diagnosed as unresectable.From August 2018, 12 courses of FOLFOXIRI (5-fluorouracil/leucovorin + oxialiplatin + irinotecan) and Cetuximab therapy were administered, and 12 courses of maintenance therapy were administered. Complete remission (CR) was confirmed in September 2019. The patient was alive without recurrence for 34 months after theinitiation of chemotherapy. The findings from this case suggest that this treatment for unresectable rectal cancercan result in CR.