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.
A 70-year-old woman presented with hemoptysis due to a right upper lobe mass. Bronchial artery embolization (BAE) using gelatin sponge was successful in controlling bleeding. Two weeks later, chest computed tomography (CT) revealed that the solid tumour had been replaced by a 5.6 cm thin-walled cavity without fluorodeoxyglucose uptake on positron emission tomography-computed tomography, although fluorodeoxyglucose accumulation was observed in the right hilar lymph node. Right upper lobectomy confirmed adenocarcinoma. The patient, confirmed with a pathological stage of IIIA, received adjuvant chemotherapy and has remained recurrence-free for more than 5 years. This case suggests that BAE induced tumour necrosis and cavitation; however, viable tumour tissue remained. Further accumulation of similar cases is needed to clarify the therapeutic significance of BAE in lung cancer.
Background:In this retrospective study, we analyzed postoperative cervical and lumbar symptoms following cervical laminoplasty (CLP) for degenerative cervical myelopathy (DCM). Methods:Patients with DCM (2013-2022) were evaluated using the Japanese Orthopedic Association (JOA) score, the back pain evaluation questionnaire (BPEQ), the cervical myelopathy evaluation questionnaire (CMEQ), the neck disability index (NDI), the Oswestry Disability Index (ODI), and the visual analog scale (VAS). Preoperative and postoperative scores were compared at 1 postoperative year. Results:The study included 155 males and 55 females with an average age of 62.66 years. Patients from both groups demonstrated significant improvement in cervical and lumbar JOAs, BPEQ (ambulation, social life, and mental status), CMEQ (cervical, upper and lower extremities, and quality of life), NDI, ODI, and VAS (neck, shoulder, and upper extremities) using the Wilcoxon signed-rank test. Conclusion:CLP proved to be an effective treatment for alleviating cervical and lumbar symptoms associated with DCM.
BACKGROUND:Patients with lumbar isthmic spondylolisthesis (LIS) and spinal stenosis (SS) are commonly treated with decompression and fusion. OBSERVATIONS:A 78-year-old male presented with radicular pain, numbness in the posterolateral aspect of both legs, and intermittent claudication. No obvious neurological abnormality was detected. Lumbar radiography and CT showed mild scoliosis and almost grade 2 L4-5 LIS with instability. MRI revealed severe SS at L3-5 and bilateral intervertebral foramen stenosis at L4-5. Combined extreme lateral interbody fusion (XLIF) with percutaneous pedicle screw (PPS) fixation at L4-5 and full endoscopic laminectomy (FEL) at L3-5 were performed under general anesthesia. Postoperative MRI and CT revealed an expanded lumbar canal at L3-5 and decompression of the bilateral L4 and L5 nerve roots. The patient's symptoms resolved postoperatively, and the patient was discharged without perioperative complications. LESSONS:The combined XLIF with PPS and FEL technique may represent a minimally invasive and effective treatment for patients with SS due to LIS. https://thejns.org/doi/10.3171/CASE251027.
