You have accessJournal of UrologyBladder Cancer: Invasive III (PD34)1 May 2024PD34-07 LONG-TERM ONCOLOGIC OUTCOMES OF TETRAMODAL BLADDER-PRESERVATION THERAPY INCORPORATING INDUCTION CHEMORADIOTHERAPY AND CONSOLIDATIVE PARTIAL CYSTECTOMY WITH PELVIC LYMPHNODE DISSECTION FOR MUSCLE-INVASIVE BLADDER CANCER Hajime Tanaka, Motohiro Fujiwara, Akira Hasegawa, Hiroki Tanaka, Kotaro Suzuki, Tomoki Kimura, Rikuto Yasujima, Tsubasa Ito, Riko Ikeda, Shunya Matsumoto, Kasumi Yoshitomi, Masaki Kobayashi, Yuki Nakamura, Bo Fan, Wei Chen, Yudai Ishikawa, Shohei Fukuda, Yuma Waseda, Soichiro Yoshida, Ryoichi Yoshimura, Kazunori Kihara, and Yasuhisa Fujii Hajime TanakaHajime Tanaka , Motohiro FujiwaraMotohiro Fujiwara , Akira HasegawaAkira Hasegawa , Hiroki TanakaHiroki Tanaka , Kotaro SuzukiKotaro Suzuki , Tomoki KimuraTomoki Kimura , Rikuto YasujimaRikuto Yasujima , Tsubasa ItoTsubasa Ito , Riko IkedaRiko Ikeda , Shunya MatsumotoShunya Matsumoto , Kasumi YoshitomiKasumi Yoshitomi , Masaki KobayashiMasaki Kobayashi , Yuki NakamuraYuki Nakamura , Bo FanBo Fan , Wei ChenWei Chen , Yudai IshikawaYudai Ishikawa , Shohei FukudaShohei Fukuda , Yuma WasedaYuma Waseda , Soichiro YoshidaSoichiro Yoshida , Ryoichi YoshimuraRyoichi Yoshimura , Kazunori KiharaKazunori Kihara , and Yasuhisa FujiiYasuhisa Fujii View All Author Informationhttps://doi.org/10.1097/01.JU.0001008768.36634.79.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemoradiation (CRT)-based bladder-preservation therapy is currently acknowledged as a curative treatment option for muscle-invasive bladder cancer (MIBC). However, one of the major concerns is the risk of MIBC recurrence, which may be originated from latent cancer cells remaining after CRT. We developed tetramodal bladder-preservation therapy (TeMT) incorporating induction CRT and consolidative partial cystectomy (PC) with pelvic lymphnode dissection (PLND). This study assessed the long-term oncologic outcomes of MIBC patients treated with TeMT. METHODS: Following the institutional review board approval (# M2000-453), we prospectively enrolled 201 patients with N0M0 MIBC between 1997 and 2020. All the patients met the inclusion criteria for the enrollment (Figure 1). After maximal transurethral resection and induction CRT, patients who had complete remission of cancer or small amount of microscopic Ta/is cancer remaining at the original tumor site underwent consolidative PC with PLND and achieved bladder preservation; salvage radical cystectomy was offered to the other patients. RESULTS: The median age was 69, and 157 patients (78%) were male. Overall 171 patients (85%) sufficiently responded to induction CRT. Among them, 148 (74%) underwent consolidative PC according to the protocol. Pathological examination of the PC specimens revealed that residual bladder cancer in 15 patients (10%) including 3 (2.0%)/2 (1.4%)/10 (6.8%) showing ypTis/T1/T2-3, respectively and lymphnode metastasis in 4 (2.7%) were surgically removed in this surgery. During the median follow up of 6.2 years (IQR: 4.1-9.8), 31 (15%) in the intent-to-treat (ITT) patients and 13 (8.8%) in those who underwent PC died of bladder cancer. 5/10 year-cancer-specific survival was 85%/82% in ITT patients, respectively, and 92%/90% in patients undergoing PC, respectively. The cumulative incidences of MIBC recurrence after PC were 6.0% at 5 years and 8.8% at 10 years. CONCLUSIONS: TeMT protocol incorporating induction CRT and consolidative PC with PLND yielded favorable long-term oncologic outcomes for optimally selected patients with MIBC. Consolidative PC may contribute to decreasing the risk of MIBC recurrence. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e721 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Hajime Tanaka More articles by this author Motohiro Fujiwara More articles by this author Akira Hasegawa More articles by this author Hiroki Tanaka More articles by this author Kotaro Suzuki More articles by this author Tomoki Kimura More articles by this author Rikuto Yasujima More articles by this author Tsubasa Ito More articles by this author Riko Ikeda More articles by this author Shunya Matsumoto More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Yuki Nakamura More articles by this author Bo Fan More articles by this author Wei Chen More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Yuma Waseda More articles by this author Soichiro Yoshida More articles by this author Ryoichi Yoshimura More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Therapeutic strategies in patients with interstitial pneumonia with autoim-mune features (IPAF) and histological usual interstitial pneumonia (UIP) pattern (IPAF-UIP) have not been thoroughly evaluated. We compared the therapeutic efficacy of anti-fibrotic therapy with that of immunosuppressive treatment for patients with IPAF-UIP.Methods: In this retrospective case series, we identified consecutive IPAF-UIP patients treated with anti-fibrotic therapy or immunosuppressive therapy. Clinical characteristics, one-year treatment response, acute exacerbation, and survival were studied. We per-formed a stratified analysis by the pathological presence or absence of inflammatory cell infiltration.Results: Twenty-seven patients with anti-fibrotic therapy and 29 with immunosuppressive treatment were included. There was a significant difference in one-year forced vital ca-pacity (FVC) change between patients with anti-fibrotic treatment (4 in 27 improved, 12 stable, and 11 worsened) and those with immunosuppressive treatment (16 in 29 improved, eight stable, and five worsened) (p 1/4 0.006). There was also a significant difference in one-year St George's Respiratory Questionnaire (SGRQ) change between patients with anti -fibrotic therapy (2 in 27 improved, ten stable, and 15 worsened) and those with immuno-suppressive treatment (14 in 29 improved, 12 stable, and worsened) (p < 0.001). There was no significant difference in survival between the groups (p = 0.32). However, in the sub-group with histological inflammatory cell infiltration, survival was significantly better with immunosuppressive therapy (p = 0.02).Conclusion: In IPAF-UIP, immunosuppressive therapy seemed to be superior to anti-fibrotic treatment in terms of therapeutic response, and provided better outcomes in the histo-logical inflammatory subgroup. Further prospective studies are needed to clarify the therapeutic strategy in IPAF-UIP.(c) 2023 Published by Elsevier B.V. on behalf of The Japanese Respiratory Society.

Introduction: Interstitial lung diseases (ILDs) are associated with the onset of lung cancer (LC). Aims and objectives: We aimed to investigate the incidence rate, time to onset, and risk of the onset of LC in ILD patients. Methods: We retrospectively evaluated consecutive ILD patients in 2008-2015. We investigated whether they developed LC until May 2021. Results: Among 1070 ILD patients, 42 were excluded (patients diagnosed with LC by the time of the diagnosis of ILDs, 23; others, 19) and 1028 were included in the final analysis. Male was 671, median age was 68 years, smoking history was found in 551 (current, 94; former, 457) and 452 were diagnosed as idiopathic pulmonary fibrosis (IPF). The median observation period was 4.88 years (IQR: 2.07-7.49). Sixty-four cases had LC (adenocarcinoma, 25; squamous cell carcinoma, 19; small cell carcinoma, 11; others, 9) and the median time to onset was 3.52 years (95% CI: 2.77-4.32). The incidences of LC were 1.27 cases per 100 person-years (IPF was 1.83 and non-IPF ILDs was 0.94, respectively). Univariable analysis showed male, age, smoking history and IPF were associated with the onset of LC. Multivariable analysis showed male and age were associated. Conclusions: The incidences of LC in ILD patients were 1.27 cases per 100 person-years and the median time to onset was about 3.5 years. Male and age were significantly associated with the onset of LC.

Although mass and energy in Jupiter's magnetosphere mostly come from the innermost Galilean moon Io's volcanic activities, solar wind perturbations can play crucial roles in releasing the magnetospheric energy and powering aurorae in Jupiter's polar regions. The systematic response of aurora to solar wind compression remains poorly understood. Here we report the analysis of a set of auroral images with contemporaneous in situ magnetopause detections. We distinguish two types of auroral enhancements: a transient localized one and a long-lasting global one. We show that only the latter systematically appears under a compressed magnetopause, while the localized auroral expansion could occur during an expanded magnetopause. Moreover, we directly examine previous theories on how solar wind compressions enhance auroral emissions. Our results demonstrate that auroral morphologies can be diagnostic of solar wind conditions at planets when in situ measurements are not possible.

Anagrelide, a phospholipase A2 inhibitor, is widely used in the management of essential thrombocythemia. To date, anagrelide has only rarely been reported to be associated with the development of drug-induced interstitial pneumonitis. We herein report two cases of anagrelide-associated interstitial pneumonitis. The patients were a 67-year-old woman and a 75-year-old man, both with essential thrombocythemia. Both cases developed interstitial pneumonitis at 8 weeks after administration of anagrelide. Because anagrelide-induced interstitial pneumonitis was suspected from CT scan and bronchoalveolar lavage fluid findings, anagrelide-therapy was discontinued and corticosteroid administration was initiated. Anagrelide withdrawal and corticosteroid administration resulted in marked symptom amelioration. A lymphocyte stimulation test using anagrelide was positive in both cases. As interstitial pneumonitis is a rare adverse event during anagrelide-therapy administration, physicians must be vigilant in identifying drug-induced interstitial pneumonitis in patients treated with anagrelide because early detection can decrease the severity and prevent mortality.

The safety and efficacy of stereotactic body radiotherapy (SBRT) for small hepatocellular carcinoma (HCC) is well established. However, the effect of repeated SBRT for intra-hepatic recurrent HCC is unclear. This study aimed to retrospectively evaluate the safety and efficacy of repeated SBRT for intra-hepatic recurrent HCC. We enrolled 24 patients with 53 tumors who had undergone ≥ 2 two courses (median 2 times; range 2- 4 times). Sixteen patients (66.7%) had previously undergone surgery or ablation therapy, and 45 lesions (84.9%) underwent trans-arterial chemo-embolization using lipiodol before SBRT. Median tumor size was 17 mm (range 5- 47 mm). Child-Pugh (CP) scoring system was used to classify 20 and 4 patients (first course), and 18 and 6 patients (second course or beyond) into classes A and B, respectively. SBRT was performed using a 3-dimensional conformal method which delivered a single high dose radiation to the tumor. Prescribed dose was evaluated at the isocenter in 27 lesions (median dose: 48 Gy in 4 fractions) and at D95% prescription in 26 lesions (median dose: 40 G y in 4 fractions) for the first and rest of the courses. Local progression was defined as growth of the irradiated tumor and early arterial enhancement remaining for more than 6 months on follow-up with dynamic CT. Treatment-related toxicities were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) Version. The median follow-up duration was 42 months (range, 9- 79 months). The median interval between the first and the repeated SBRT was 21 months (range 4 - 61 months). Three- year overall survival rates, and local control rates for patients were 75.0 % (95 % CI: 56.0 - 94.0 %) and 97.4 % (95 % CI: 92.5 – 100 %), respectively. Grade 3 toxicities such as AST/ALT elevation, decreased platelet count, and ascites were observed in 4 patients (16.7 %) in the first course and 5 patients (20.8 %) in the second course or beyond. Seven patients developed grade 3 during all the courses, which was significantly higher in CP class B than in CP class A (p=0.0196). All sessions were fused using deformable registration software (Velosity, Varian) to evaluate the median mean liver dose (MLD), 13.1 Gy (range, 5.5- 24.6 Gy) and the percentage of the uninvolved liver (liver volume other than GTV) volume exceeding 20 Gy (V20Gy), 20.7 % (range, 6.2- 48.3 %). There was no significant difference in MLD and V20Gy between patients with or without grade 3 toxicities. Repeated SBRT can be used safely and effectively for patients with intra-hepatic recurrent HCC. However, caution should be exercised in repeated SBRT usage for CP class B patients due to high rates of severe liver toxicities.

Advanced lung cancer frequently causes bone metastasis which can be associated with skeletal-related events (SREs) that may cause significant deterioration of the patient’s quality of life (QoL). The Spinal Instability Neoplastic Score (SINS) can be used to assist in standardizing evaluations of neoplastic spinal instability between spinal and non-spine surgeons. This research investigated the association between SREs and SINS for patients with non-small cell lung cancer (NSCLC).

．近年，LVAD 患者における出血の背景として， 後天性フォンウィルブランド症候群 (acquired von Willebrand syndrome: AVWS) の重大な関与が注目さ れている 7) ．AVWS はフォンウィルブランド因子

Many researchers have proposed ultrasound imaging techniques for product inspection; however, most of these techniques are aimed at detecting the existence of flaws in products. The acquisition of an accurate three-dimensional image using ultrasound has the potential to be a useful product inspection tool. In this paper we apply the Envelope algorithm, which was originally proposed for accurate UWB (Ultra Wide-Band) radar imaging systems, to ultrasound imaging. We show that the Envelope algorithm results in image deterioration, because it is difficult for ultrasound measurements to achieve high signal to noise (S/N) ratio values as a result of a high level of noise and interference from the environment. To reduce errors, we propose two adaptive smoothing techniques that effectively stabilize the estimated image produced by the Envelope algorithm. An experimental study verifies that the proposed imaging algorithm has accurate 3-D imaging capability with a mean error of 6.1 mu m, where the transmit center frequency is 2.0 MHz and the S/N ratio is 23 dB. These results demonstrate the robustness of the proposed imaging algorithm compared with a conventional Envelope algorithm.

Ultrasound imaging is an important technique with great potential for accurate nondestructive testing. Previously, we proposed a high-resolution 3-D imaging algorithm for UWB radar, the Envelope algorithm with adaptive smoothing techniques. The Envelope imaging algorithm utilizes the principle that the target boundary is expressed as an envelope of spheres determined by observed ranges, while the range smoothing techniques stabilize the estimated image produced by the Envelope algorithm by adaptively changing the range smoothing method. Numerical simulations confirm that the maximum error of this algorithm is less than 0.015 center wavelength. In this study, we apply the Envelope algorithm with adaptive smoothing techniques to high resolution 3-D acoustic imaging, which is a promising form of accurate nondestructive testing, and evaluate the performance of this algorithm with experimental data. The results verify that the proposed method achieves high-resolution 3-D acoustic imaging. The mean error of the estimated image is 6.1μm which corresponds to 8.2 ×10−3 center wavelength.