BACKGROUND:Docetaxel (DTX) is commonly employed in patients with castration-resistant prostate cancer (CRPC) following failure of androgen receptor signaling inhibitors (ARSIs). However, the impact of prior ARSI treatment on the efficacy of subsequent DTX therapy remains unclear. This study aimed to compare oncological outcomes between enzalutamide (ENZ)-DTX and abiraterone acetate plus prednisolone (ABI)-DTX sequential treatment strategies in patients with CRPC. METHODS:The ENABLE study for PCa was an investigator-initiated, multicenter, randomized controlled trial conducted in Japan to compare ENZ and ABI. This subanalysis evaluated the efficacy of subsequent DTX therapy in patients who had received either ENZ or ABI. RESULTS:Between February 2015 and July 2019, 203 patients were enrolled, of whom 184 were randomized to receive ENZ or ABI (92 per arm). Among them, 20 and 21 patients subsequently initiated DTX therapy following ENZ and ABI, respectively. Median prostate cancer-specific survival (PCSS) in the ENZ-DTX and ABI-DTX groups was 22.7 and 32.1 months, respectively (p = 0.1724). Median PCSS from the initiation of DTX was 16.1 months in the ENZ-DTX group and 25.3 months in the ABI-DTX group (p = 0.0966). In the overall cohort (n = 41), patients who received additional ARSIs after ARSI-DTX therapy had significantly longer PCSS from the initiation of DTX compared with those who did not (median 21.6 vs. 13.8 months, p = 0.0157). CONCLUSIONS:ENZ-DTX and ABI-DTX sequential therapies demonstrated comparable survival outcomes in patients with CRPC. Notably, the administration of additional ARSIs following ARSI-DTX therapy may confer a survival benefit, suggesting a potential role for continued ARSI use in this treatment sequence. TRIAL REGISTRATION:The trial was registered with the University Hospital Medical Information Network (UMIN) Center under the identifier UMIN000015529 on November 1, 2014.
Reliable predictors of recurrence after non-operative management (NOM) for pediatric uncomplicated acute appendicitis (UCAA) are lacking. Patients and families often face uncertainty and anxiety about recurrence. We evaluated elective interval appendectomy (E-IA) after NOM, focusing on same-day discharge (SDD). We retrospectively reviewed patients aged ≤ 18 years who underwent laparoscopic E-IA after successful NOM for UCAA between 2017 and 2025. UCAA was defined as ultrasound grade I/IIa appendicitis without perforation, abscess, or diffuse peritonitis. Characteristics, perioperative outcomes, histopathology, and patient/family and staff satisfaction were analyzed. A total of 120 patients underwent E-IA (SDD, n = 40; inpatient management, n = 80). Median age was 13.0 years; fecalith was present in 25 patients (20.8
ABSTRACT Radiofrequency catheter ablation (RFA) effectively treats pediatric arrhythmias, but postoperative nausea and vomiting (PONV) is a common complication impacting patient experience. This study investigated PONV incidence and its contributing factors in pediatric RFA under deep sedation. This retrospective, single‐center cohort study reviewed 70 RFA procedures in 63 pediatric patients (aged ≤ 18 years) performed between January 2013 and December 2025. All procedures were managed under a standardized deep sedation protocol. Data on demographics, arrhythmia type, procedural characteristics (including ablation site: right‐sided vs. left‐sided), anesthetic management, and the occurrence of PONV within 24 h were collected. PONV occurred in 12 of the 70 procedures (17%). The incidence of PONV was significantly higher following left‐sided ablation compared to right‐sided ablation (8/24 [33%] vs. 4/46 [9%]; p = 0.017). Notably, there were no significant differences in procedure time, anesthesia time, number of radiofrequency applications, or the types and dosages of anesthetic agents administered between patients who developed PONV and those who did not. In the majority of these patients, PONV symptoms resolved spontaneously within 24 h without the need for rescue medications. The incidence of PONV was 17% in pediatric patients during RFA under deep sedation. Our findings suggest that most pediatric PONV under deep sedation is transient and clinically manageable without additional medical intervention, although careful observation remains essential during the early postoperative period.
OBJECTIVES:The ENABLE study, an investigator-initiated, multicenter, randomized controlled trial, demonstrated comparable survival benefits between enzalutamide (ENZ) and abiraterone plus prednisolone (ABI) for castration-resistant prostate cancer (CRPC). Because randomized controlled trials typically exclude patients with a history of other cancers (HOCs), we evaluated the efficacy of these agents in this population. METHODS:This sub-analysis was conducted as a post hoc analysis using data from the ENABLE study. Endpoints included time to PSA progression, radiographic progression-free survival, overall survival (OS), prostate cancer-specific survival, and safety. Outcomes were compared between patients with and without a HOC+ versus HOC- and between treatment arms within each group. RESULTS:The HOC+ group included 35 patients (13 ENZ, 22 ABI), whereas the HOC- group included 149 patients (79 ENZ, 70 ABI). The most frequent malignancy was gastric cancer (n = 10, 29%). HOC+ patients had significantly worse OS than HOC- patients (median 24.7 vs. 37.4 months; HR 1.96; 95% CI 1.02-3.77; p = 0.0426), while other survival endpoints did not differ between the groups. Within the HOC+ group, OS was significantly worse with ENZ than with ABI (median 16.0 vs. 30.5 months; HR 3.27; 95% CI 1.08-9.89; p = 0.0354), whereas no significant differences were observed between the arms in the HOC- group. CONCLUSIONS:Although OS was poorer in HOC+ patients, other outcomes were similar, supporting the feasibility of ENZ and ABI regardless of cancer history. The longer OS with ABI in HOC+ patients represents a hypothesis-generating observation and should be interpreted with particular caution.
