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.
The ONCO DVT study demonstrated the benefit of extended anticoagulation therapy with edoxaban in patients with cancer-associated isolated distal deep vein thrombosis (DVT). However, it remains unclear whether these results can be applied regardless of the number of thrombosed venous segments. In this post-hoc subgroup analysis of the ONCO DVT study, 601 patients were stratified into the single-site (N=268) and multiple-sites (N=333) DVT subgroups based on the number of thrombosed venous segments at diagnosis. We compared 12-month and 3-month edoxaban treatment groups in each subgroup for the primary endpoint of symptomatic recurrent venous thromboembolism (VTE) or VTE-related death and the major secondary endpoint of major bleeding at 12 months. The cumulative 12-month incidence of the primary endpoint was significantly lower in the 12-month edoxaban group than in the 3-month edoxaban group both in the single-site (0.8
Very high acute pacing thresholds (VHPT) during AVEIR-AR atrial leadless pacemaker (ALP) implantation often prompt device repositioning, although excessive manipulation may increase procedural risk. To evaluate the safety and early electrical performance of ALP release despite VHPT using a current-of-injury (COI)-guided strategy. We retrospectively analyzed 28 consecutive patients who underwent AVEIR-AR ALP implantation at two centers in Japan and compared procedural safety and short-term electrical performance between patients with normal PTs (NPT <5.5 V at 0.4 ms) and those with VHPT (≥5.5 V at 0.4 ms). In the VHPT group, ALP device release was permitted when pre-screw COI was adequate (≥1 mV). The mean age was 85±6 years, body weight was 54±8 kg, and 11 patients were female. Single-site pre-mapping successful implantation was achieved in 36
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 purpose of this study was to validate the accuracy of a method for determining the iodine contrast dose using effective diameter (Deff) when performing dynamic computed tomography (CT) scans of the upper abdomen in patients with unknown body weight (BW). Deff was measured at the heart, at the right diaphragm upper edge, and at the right pulmonary rib diaphragm levels in the localizer radiograph and axial images. Correlation coefficients between Deff and BW were determined for each cross section. Deff_axial and BW showed the highest correlation at the right diaphragm upper edge level in men (rS = 0.862) and at the right pulmonary rib diaphragm level in women (rS = 0.890). The BW estimated from Deff showed a strong correlation with measured BW and may serve as a practical alternative in cases where BW is unknown.
