Lung cancer is one of the malignancies for which new clinical evidence has accumulated most rapidly in recent years. In parallel with advances in systemic therapy, radiotherapy has also evolved substantially with the development of high-precision techniques such as stereotactic body radiotherapy (SBRT), intensity-modulated radiotherapy, and particle therapy. These technological innovations, together with the introduction of immunotherapy and targeted therapies, have reshaped the role of radiotherapy within multidisciplinary treatment strategies for non-small cell lung cancer (NSCLC). This review summarizes current clinical practice and emerging perspectives in radiotherapy for NSCLC across disease stages. In early-stage disease, the established role of SBRT and the potential advantages of particle therapy as curative strategies for medically inoperable patients and for operable patients who refuse surgery are outlined. For locally advanced NSCLC, evolving treatment paradigms in the era of immunotherapy are reviewed, including concurrent chemoradiotherapy followed by consolidation immunotherapy, as well as ongoing efforts to reduce treatment-related toxicity through advances in radiotherapy techniques. In addition, the emerging role of radiotherapy as local consolidative therapy for oligometastatic stage IV NSCLC is highlighted, with attention to recent randomized trials and the challenges of patient selection. As treatment strategies for NSCLC continue to evolve rapidly, radiotherapy is expected to play an increasingly important role in multidisciplinary management. Further research is required to optimize treatment sequencing, identify patients most likely to benefit from radiotherapy, and refine its integration with modern systemic therapies. Radiotherapy remains a key component of multidisciplinary management for non-small cell lung cancer (NSCLC). This review summarizes current clinical evidence and the evolving roles of radiotherapy across disease stages, including early-stage, locally advanced, and oligometastatic NSCLC.
This study examined changes in practice patterns and outcomes of allogeneic hematopoietic cell transplantation (HCT) over the past 20 years. Data were analyzed from a Japanese nationwide registry of consecutive adult patients with acute myeloid leukemia who underwent allogeneic HCT between 2001 and 2020. The study population included 17,553 patients, of whom 6653 underwent allogeneic HCT in 2001–2010 and 10,900 in 2011–2020. Patients in the later period were older, were more likely to be in first complete remission, and more frequently received umbilical cord blood transplantation. After adjusting for major covariates, the 2011–2020 cohort had lower risks of overall mortality (hazard ratio [HR], 0.84; 95
BACKGROUND:To evaluate the dissemination and real-world implementation of recommendations from the 5th Edition of the Japanese Esophageal Cancer Practice Guidelines and to inform development of the upcoming 6th Edition, the Guideline Committee of the Japanese Esophageal Society conducted a nationwide Quality Indicator (QI) survey in Japan. METHODS:A nationwide, cross-sectional, web-based questionnaire survey was distributed to 381 certified institutions participating in the 2023 National Registry of Esophageal Cancer in Japan. Conducted in November 2024, the survey covered six domains-epidemiology, surgery, endoscopy, chemotherapy, radiation therapy, and pathology-reflecting key recommendations of the 5th Edition. Responses were summarized descriptively at the institutional level. RESULTS:Valid responses were obtained from 190 institutions (49.9%). Smoking cessation guidance was implemented in more than 90% of institutions, and over 90% also provided guidance on alcohol abstinence or moderation, although complete alcohol abstinence was less uniformly recommended. Minimally invasive, including robot-assisted, esophagectomy was adopted by over 90% of institutions. The proportion of institutions performing prophylactic cervical lymph node dissection varied by tumor location and stage, reflecting contemporary staging concepts. The DCF regimen was the predominant neoadjuvant therapy for stage II/III disease (94.7%), and immune checkpoint inhibitor-based chemotherapy was widely used for unresectable or recurrent disease. Advanced endoscopic diagnostic modalities, including magnifying and image-enhanced endoscopy, were widely adopted. CONCLUSIONS:This nationwide QI survey demonstrates broad adherence to guideline-based multidisciplinary management of esophageal cancer in Japan and provides an evidence base for refining recommendations in the 6th Edition of the Japanese Esophageal Cancer Practice Guidelines.
Wnt/β-catenin-activated rosette-forming carcinoma (WARFC) is a recently proposed cutaneous tumor entity characterized by rosette formation, CDX2 expression, RB1 loss, and Wnt/β-catenin pathway activation. Extracutaneous counterparts of WARFC have not been documented to date. We report a distinctive case of lung carcinoma closely resembling WARFC. An 80-year-old man with a smoking history presented with a rapidly enlarging lung nodule. The resected tumor consisted of a rosette-forming large cell carcinoma with a trabecular pattern and lacking neuroendocrine marker expression, combined with squamous cell carcinoma. The rosette-forming component showed aberrant nuclear β-catenin expression, diffuse CDX2 expression, and RB1 loss. Targeted sequencing identified a pathogenic APC splice-site mutation. This case likely represents the pulmonary counterpart of cutaneous WARFC. Pulmonary WARFC should be considered in the differential diagnosis of large cell lung carcinoma with neuroendocrine morphology.
A 67-year-old man presented with bilateral diplopia and gait instability. Brain magnetic resonance imaging revealed two adjacent lesions in the right middle cerebellar peduncle: a 2.7-cm cystic lesion with an enhancing mural nodule and a 1.7-cm ring-enhancing nodule with surrounding edema and associated brainstem compression. Biopsy followed by surgical resection demonstrated a biphasic tumor composed of glioma-like and epithelial-like components. Immunohistochemically, the glioma-like component expressed GFAP and OLIG2, whereas the epithelial-like component lacked glial and epithelial lineage markers and exhibited a high proliferative index (Ki-67 labeling index, 50%). Aberrant calponin-1 expression was observed in both components but was not associated with definitive smooth muscle or myoepithelial differentiation. DNA methylation profiling did not yield a definitive classification and demonstrated borderline similarity to established high-grade glioma classes, clustering near the glioblastoma, IDH-wild-type, midline subtype. Molecular analysis of the epithelial-like component was not feasible due to limited tissue availability, preventing assessment of clonal relatedness between components. This case illustrates the diagnostic challenges posed by intratumoral heterogeneity and sampling limitations in adult cerebellar high-grade gliomas. This report highlights the interpretive constraints of current histopathological and molecular classification frameworks when confronted with spatially heterogeneous tumors and incomplete sampling, rather than defining a novel tumor entity.
