Background Roles of induction chemotherapy (ICT) and chemoradiotherapy (CRT) for laryngeal preservation in patients with locally advanced laryngeal cancer (LC) remain unclear. Patients and methods We enrolled 834 patients with T3N0-2M0 and T4aN0-2M0 LC registered in the Head and Neck Cancer Registry of Japan between 2011 and 2015. Oncological outcomes of total laryngectomy (TL), CRT, and ICT were evaluated. Propensity score-matching analyses (PSMA) were performed between TL and CRT, excluding ICT. Results No significant differences were observed in overall survival (OS) and disease-specific survival (DSS) among patients treated by TL, CRT, and ICT followed by TL or CRT, and among patients treated by TL and CRT in PSMA. Of note, no significant difference was observed in LCR and LRFS between TL and ICT groups. Conclusions ICT and CRT did not yield survival benefits but might contribute to laryngeal preservation without compromising survival in patients with T3-4aN0-2M0.
BACKGROUND: Japan Clinical Oncology Group (JCOG) defined gastric cancer (GC) with bulky lymph node (Bulky N) and/or para-aortic lymph node (PAN) as extensive lymph node metastasis (ELM), and has developed neoadjuvant chemotherapy followed by D2 gastrectomy with PAN dissection (PAND) through three phase II trials using different regimens (JCOG0001: irinotecan/cisplatin, JCOG0405: cisplatin/S-1, JCOG1002: docetaxel/cisplatin/S-1). However, whether PAND provides survival benefit remains uncertain. METHODS: The therapeutic value index was investigated using integrated data from JCOG0001, JCOG0405, and JCOG1002. Patients were classified into Bulky N group (only bulky N without PAN) and PAN group (PAN regardless of bulky N) based on the clinical diagnosis. The index was calculated by multiplication of incidence of metastasis and percentage 5-year relapse-free survival (5yRFS) of patients with metastasis for each lymph node area. RESULTS: A total of 122 patients were analyzed (Bulky N group: 68, PAN group: 54). In Bulky N group, the proportion of metastasis/5yRFS/index in the PAN area was 15.2%/30.0%/4.5 (JCOG0001: 27.8%/20.0%/5.6, JCOG0405: 13.6%/33.3%/4.5, JCOG1002: 7.7%/50.0%/3.8). The proportion of metastasis decreased across trials. In PAN group, the proportion of metastasis/5yRFS/index in the PAN area was 44.4%/4.2%/1.9 (JCOG0001: 81.3%/7.7%/6.3, JCOG0405: 30.0%/0.0%/0.0, JCOG1002: 27.8%/0.0%/0.0). Notably, the indices of the recent two trials were zero. CONCLUSIONS: PAND may retain a potential role in the Bulky N group, whereas its benefit appears limited in the PAN group. Decreasing trends in PAN metastasis and therapeutic value were observed in both groups. Given the distinct characteristics of these subgroups, the omission of PAND should be determined through separate future validation.
Pediatric radiotherapy (RT) plays a key role in childhood cancer care, yet regional disparities in its utilization and delivery persist. We aimed to quantify prefecture-level disparities in pediatric RT utilization and examine associations with workforce and facility factors. Using the Ministry of Health, Labour and Welfare National Database Open Data, we extracted counts of pediatric RT add-on claims (fractions) for fiscal year 2023. Utilization was calculated as claims per 100,000 children (< 15 years). Explanatory variables were the number of board-certified pediatricians and the presence of a designated pediatric cancer hub hospital in each prefecture. We conducted Pearson/Spearman correlation analyses and Welch’s t-test, reporting Cohen’s d. Supplementary analyses summarized prefecture-level distributions and 5-year trends (2019–2023). The national mean utilization was 58.7 fractions per 100,000 children (range, 0.0–161.0), with marked inter-prefectural variability. Pediatrician numbers strongly correlated with claim counts (r = 0.94, p < 0.001) but not with claims per 100,000 children (r = 0.18, p = 0.22). Prefectures with a pediatric cancer hub hospital had significantly higher utilization than those without (80.9 vs. 50.2 per 100,000; p = 0.046), with Cohen’s d = 0.66. In a multi-year view, several prefectures (e.g., Mie, Miyagi, Tokyo) repeatedly maintained higher utilization. This study examined prefecture-level disparities in pediatric radiotherapy across Japan. The number of board-certified pediatricians was associated with crude treatment counts but not with population-normalized rates, whereas prefectures with a designated pediatric cancer hub hospital showed significantly higher rates. These findings can inform policy making and healthcare resource allocation, particularly efforts to strengthen hub hospitals and cross-prefectural referral networks.
Nivolumab plus chemotherapy has shown efficacy in clinical trials for advanced or recurrent gastric cancer (GC). However, real-world utilization data are limited. In this study, we aimed to assess the effectiveness, safety, and treatment status of first line nivolumab plus chemotherapy in Japanese patients with treatment-naïve advanced or recurrent GC. Untreated patients with advanced or recurrent GC who initiated nivolumab plus chemotherapy as first line treatment from November 2021 to June 2023 across 23 Japanese sites were enrolled in this observational study (G-KNIGHT). This report focused on the objective response rate (ORR), real-world progression-free survival (rwPFS), and the treatment-related adverse event (TRAE) incidence. Furthermore, subgroup analyses for ORR and rwPFS were conducted for patients stratified by various factors including age and the programmed cell death ligand 1 (PD-L1) combined positive score (CPS). Among 527 patients (median age, 70.3 years; 25.2
The JCOG1806 trial (jRCTs031190129) is underway to evaluate the omission of surgery in patients with human epidermal growth factor receptor (HER2)-positive early breast cancer who have a clinical complete response (cCR) after primary systemic therapy (PST). We aimed to assess the cCR rate in this trial and identify predictive factors. HER2-positivity was defined as an immunohistochemistry (IHC) score of 3 + or in situ hybridization-positivity. A cCR was defined as the absence of detectable lesions upon palpation, contrast-enhanced magnetic resonance imaging, and ultrasonography; biopsy-based confirmation was optional in hormone receptor (HR)-negative cases and mandatory in HR-positive cases. Multivariate logistic regression analyses were used to identify predictors of a cCR. The cCR rate was 57.6
