Niigata Prefectural Central Hospital

Concurrent chemoradiotherapy (CCRT) with docetaxel, cisplatin (CDDP), and fluorouracil (5-FU) (i.e. TPF regimen) has yielded favourable outcomes in treating advanced external auditory canal squamous cell carcinoma (EACSCC). However, safety and efficacy have not been compared across TPF-CCRT and CDDP-based regimens. This study thus aimed to assess the feasibility, safety, and efficacy of TPF-CCRT versus CDDP-CCRT. This retrospective study evaluated 20 patients with T3/T4 EACSCC who underwent CCRT between 2007 and 2023. During radiotherapy, the TPF group (n = 10) received two cycles of 50 mg/m2 docetaxel and 60 mg/m2 CDDP on day 1, plus 600 mg/m2 5-FU on days 1-4. Meanwhile, the CDDP group (n = 10) received three cycles of CDDP (80 mg/m2) triweekly or two cycles of CDDP (60 mg/m2) on day 1 and 5-FU (600 mg/m2/day) on days 1-4 during RT. Treatment compliance, incidence of adverse events, progression-free survival (PFS), and overall survival (OS) were compared between the groups. All patients completed radiotherapy. The incidence of grade ≥ 3 adverse events was not significantly different between the TPF and CDDP groups, but leukopenia (any grade) and alopecia occurred more frequently in the TPF group. Two-year PFS (80% vs. 20%, p < 0.01) and OS rates (100% vs. 40%, p < 0.01) were significantly higher in the TPF group. Compared with CDDP-CCRT, TPF-CCRT has excellent feasibility and efficacy and acceptable toxicity for advanced EACSCC, making it a promising treatment option for this malignancy.

We evaluated the outcomes of canalplasty for external auditory canal cholesteatoma (EACC) using an inferior-pedicled periosteal flap to cover the eradicated diseased bone. Retrospective chart review. Tertiary referral center. Thirty-one ears in 30 patients surgically treated for stages III and IV primary EACC. Canalplasty using an inferior-pedicled periosteal flap with or without tympanoplasty. Disease recurrence, hearing, and clinical factors influencing the time taken to achieve complete epithelization of the external auditory canal. The 31 ears with EACC required 2 to 40 weeks (mean, 7.8 wk; median, 4 wk) to achieve complete epithelization. After epithelization, 84% of the ears became self-cleaning ear canals without any local treatment. Two patients with renal dysfunction experienced recurrence of EACC in the anterior-superior bony canal wall and needed additional treatment. Younger patients took a significantly shorter time to achieve epithelization than older patients ( p < 0.001). Patients with renal dysfunction tended to need longer periods for epithelization than those without renal dysfunction ( p = 0.092). Canalplasty for stages III and IV EACC using an inferior-pedicled periosteal flap achieved good postoperative results, with 86% of ears becoming self-cleaning ear canals in a short healing time. Special attention must be paid to the patients with renal dysfunction to create a pedicled flap of sufficient size to cover the bone and maintain a good blood supply.

This study aimed to survey the efficacy of chemotherapy regimens in the real world setting and explore the most promising regimen for patients experiencing early recurrence for gastric cancer. We retrospectively reviewed the clinical course of 207 patients with gastric cancer, who developed early recurrence during or within 6 months after completing S-1 adjuvant therapy at 19 Japanese institutions between 2012 and 2016. The treatment regimens after recurrence were fluoropyrimidines plus platinum-based regimens (FP) in 91 (44%) patients, paclitaxel-based regimens (PTX) in 102 (49%), and irinotecan-based regimens (IRI) in 14 (7%). The overall response and disease control rates were 28.7% and 54.1%. Median progression-free survival (PFS) and overall survival (OS) were 5.1 and 12.9 months, respectively. In the FP, PTX, and IRI regimens, the median PFS and OS were 5.9, 4.1, 4.1 months and 12.8, 12.9, and 11.8 months, respectively. The combination of PTX and ramucirumab showed survival comparable to capecitabine plus platinum. Multivariate analyses for OS showed that recurrence during adjuvant chemotherapy and undifferentiated histological type were independent poor prognostic factors. Although the prognosis of patients with early recurrence even with adjuvant S-1 was poor, PTX plus ramucirumab therapy could be a potential treatment option.

The successful installation of linear accelerators (LINACs) depends on operator skill and experience, and its optimization can be further improved using vendor commissioning support. To facilitate the introduction of LINAC, Elekta provides commissioning support through Accelerated Go Live (AGL) using representative beam data. This study aimed to evaluate the effective commissioning of LINAC-assisted AGL complemented by additional measurements conducted by a user. Materials and Methods: Output doses were measured within a field size of > 3 cm2 using a single chamber with AGL and within a field size of > 2 cm 2 using three types of optimal chambers based on the field size adopted by the user. In all cases, the differences between the measured and calculated output doses were maintained at < 2%. Results: The accuracy of couch modeling was evaluated by measuring arc irradiation for three different field sizes, with the electron density value assigned as a dose difference of <2% between the measured and calculated values at 2% for all energies and field size of >3 cm2. Additionally, imaging scan parameters for cone beam computed tomography were optimized to reduce the radiation dose, in comparison to the initial vendor settings, by referencing IEC 60601-2-44 standards and examining results from neighboring facilities. Conclusions: AGL proved to be effective as a temporary check, but additional commissioning efforts by the user were necessary for a more thorough evaluation and more appropriate initiation, aligning with established clinical practices.

Tofacitinib is one of the Janus kinase inhibitors approved for the treatment of rheumatoid arthritis. The major adverse event of this drug is herpes zoster, which can lead to death in severe cases. The risk of herpes zoster has been studied at 10 mg/day of tofacitinib; however, 5 mg/day, which is recommended in patients with chronic kidney disease, is unclear. To investigate whether 5 mg/day of tofacitinib reduced the risk of herpes zoster compared with 10 mg/day in rheumatoid arthritis patients. We analyzed the Japanese Adverse Drug Event Report Data (JADER) database and compared the frequency of herpes zoster in rheumatoid arthritis patients treated with tofacitinib 5 mg/day and 10 mg/day. Multivariable logistic regression analysis was performed to identify the risk factors for herpes zoster in tofacitinib users. A total of 812 tofacitinib users with rheumatoid arthritis were identified, including 131 with herpes zoster. Disproportionality for herpes zoster was observed between 5 mg/day and 10 mg/day (reporting odds ratio (OR): 0.68, 95% confidence interval (CI): 0.47-0.98, P = 0.045). Multivariable logistic regression analysisshowed that the risk of herpes zoster was significantly increased in female patients (OR: 1.87, 95% CI: 1.12-3.12, P = 0.016) and methotrexate users (OR: 1.69, 95% CI: 1.12-2.54, P = 0.013) and significantly decreased with tofacitinib 5 mg/day compared with 10 mg/day (OR: 0.62, 95% CI: 0.40-0.96, P = 0.032). We suggest that tofacitinib 5 mg/day may decrease the risk of herpes zoster compared with 10 mg/day in rheumatoid arthritis patients.

A 72-year-old woman presented with obstructive jaundice. Computed tomography revealed a 12-mm low-density mass in the head of the pancreas. She was diagnosed as having pancreatic cancer by endoscopic ultrasound-guided fine-needle aspiration. She received gemcitabine plus nab-paclitaxel as preoperative chemotherapy. After 2 courses, hepatoduodenal lymph node metastasis appeared and was accompanied by increased tumor marker levels. The regimen was changed to modified FOLFIRINOX. After 5 courses, the lymph node metastasis was reduced in size and the tumor marker levels were decreased, so subtotal stomach-preserving pancreaticoduodenectomy was performed. Adjuvant chemotherapy was administered postoperatively. The patient was alive and well without recurrence 2 years and 9 months after the surgery, but died of sepsis. Nevertheless, this case highlights that when preoperative chemotherapy for resectable pancreatic cancer appears to be ineffective, a change in regimen may be useful.

To evaluate the radiological differences between diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole spine computed tomography (CT), including the spine and sacroiliac joint (SIJ). The ossification and bridging of spinal ligament and fusion of the facet joint and SIJ were evaluated in 111 patients who were diagnosed with DISH and 27 patients with AS on the whole spine CT. The number of anterior bridging and shape of bridging (candle-wax-type/ smooth-type) were also evaluated. We further evaluated patients with DISH and AS by matching their age and sex. Complete SIJ fusion was more common in AS, whereas anterior and posterior bony bridging around SIJ was more common in DISH. However, 63% of patients with DISH had a partial or complete fusion. In spinal anterior bony bridging, the majority of patients with AS had the smooth-type, whereas those with DISH had the candle-wax-type. However, some of the patients with DISH (11%) had smooth-type. Intervertebral facet joint fusion is more common in AS. The number of anterior spinal bony bridging was greater in AS than in DISH, especially in the lumbar spine. These results are useful in differentiating DISH from AS and should therefore be considered when making a diagnosis.

Cardiopulmonary arrest (CPA) due to drowning has an extremely high mortality rate, and very few cases have good neurological outcomes. Severe respiratory failure can occur even after resuscitation. A 66 year old woman with a history of refractory epilepsy had a CPA due to drowning. Approximately 20 min after drowning, she was resuscitated and transported to the hospital, and extracorporeal membrane oxygenation (ECMO) was introduced on day two due to continued severe respiratory failure caused by acute respiratory distress syndrome (ARDS). After the introduction of ECMO, her respiratory status gradually improved and ECMO was discontinued on day 12. Approximately 6 months after drowning, she visited our hospital for a follow‐up with a cerebral performance category of 1. Since cases of CPA due to drowning with a short drowning time or hypothermia are expected to have good neurological outcomes, the introduction of ECMO should be considered as a treatment for ARDS after resuscitation.