Purpose : To evaluate the dosimetric differences between volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiation therapy (3D-CRT) for locally advanced non-small cell lung cancer (NSCLC). Materials and methods : A planning study was performed with the data of 17 patients with inoperable NSCLC who actually underwent definitive radiotherapy. VMAT and 3D-CRT plans were created for each patient. The primary objectives of these plans were to prescribe 60 Gy in 30 fractions to 95% of the planning target volume and to limit the dose delivered to the spinal cord to less than 50 Gy. The secondary objectives were to keep the doses delivered to other risk organs as low as possible. Results : The 3D-CRT plans for two patients did not achieve the primary objectives, although they were achieved by the VMAT plans for these patients. In a comparison of the acceptable plans, the VMAT plans improved the dose conformity, V20 and mean dose of the lung, and V35 of the oesophagus. There were no significant differences in V10 or V5 of the lung, or the maximum dose and mean dose of the oesophagus. Conclusion : The advantage of VMAT compared to 3D-CRT may facilitate appropriate use of VMAT for patients with locally advanced NSCLC.
Objective : This phase 2, single-arm trial aimed to evaluate the efficacy and safety of gemcitabine in the adjuvant setting for patients with biliary tract carcinoma (BTC). Method : Patients undergoing surgery subsequently received 6 cycles of adjuvant gemcitabine (1000mg/m2) intravenously over 30 minutes on days 1, 8, and 15 every 4 weeks. The primary end point was a two-year disease-free survival (DFS) rate and secondary end points were a two-year overall survival (OS) rate, tolerability, and the frequency of grade 3 or 4 toxicity. Results : A total of 55 patients were enrolled. Primary tumor sites were intrahepatic bile duct in 14, extrahepatic bile duct in 34, gallbladder in 3, and ampulla of Vater in 4. During median follow-up of 40 months, 34 patients developed disease recurrence. Two-year DFS and OS rates were 47.7% and 78.2%, and median DFS and OS were 23 months and 46 months, respectively. The long-term outcomes in patients with extrahepatic bile duct carcinoma were similar compared with a historical cohort who underwent surgery alone. The completion rate and total dose intensity were 61.8% and 70.3%, respectively. Twenty-six patients (47.3%) had grade 3 or 4 toxicity, none of which culminated in a fatal event. Conclusion : The present study failed to show significant benefits of gemcitabine in the adjuvant setting for patients with resected BTC, although the regimen was well tolerated.
Yokenella regensburgei rarely causes human infections, and there is no strong evidence to support its clinical importance. We report the first case in Japan of bacteremia caused by Y. regensburgei in a patient with diabetic gangrene. A 74-year-old man was admitted to our hospital. He had type 2 diabetes mellitus, and underwent surgical amputation of both lower limbs due to gangrene. Y. regensburgei was isolated from swabbing of the wounds on the limbs and the blood samples. The case was successfully treated by intravenous administration of ampicillin-sulbactam and ceftazidime.
The patient was a 61-year-old man. Ten years after eradication of H. pylori (HP) in the stomach, esophagogastroduodenoscopy showed an ulcerative lesion in the great curvature against the gastric angle, and the tumor was diagnosed as gastric cancer using the biopsy specimens. The patient underwent a distal gastrectomy with D2-node dissection. Pathologically, the large tumor cells infiltrated the subserosa of the gastric wall, and these tumor cells immunohistochemically showed a positive reaction for chromogranin A and synaptophysin. Therefore, the tumor was diagnosed as large cell-neuroendocrine carcinoma of the stomach. Metastasis was observed in 4 regional lymph nodes, and the TNM classification was defined as pStage IIIA. After surgery, adjuvant chemotherapy consisting of 4 cycles of S-1 therapy following 6 courses of cisplatin (CDDP)/irinotecan (CPT-11) therapy was performed. The patient is well without any recurrence over 4 years after surgery. Adjuvant chemotherapy using CDDP/CPT-11 followed by S-1 is a treatment option for a possible therapeutic regimen. Furthermore, it is necessary to check the HP-eradicated stomach for detection of neuroendocrine carcinoma in the long term.
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