Tokyo National Hospital

Palliative interventional radiology (IR) procedures are effective for managing refractory cancer pain, but their real-world utilization—including procedural volume, physicians’ perceptions, and barriers to implementation—remains unclear. This study aimed to assess the current implementation of these procedures in Japan and to explore IR physicians’ perceptions and barriers. A nationwide cross-sectional survey was conducted among 1,087 board-certified IR physicians in Japan from February to March 2020. A self-administered questionnaire assessed current practice for three procedures (celiac plexus/splanchnic nerve block [nerve block], percutaneous vertebroplasty/osteoplasty [bone augmentation], and transcatheter arterial embolization [TAE]), perceived effectiveness, willingness to perform in the future, and demographics. Barriers to implementation, which were predefined as questionnaire items, were evaluated using univariable and multivariable logistic regression analyses. A total of 554 valid responses were obtained (response rate: 51.1%). Although all respondents were board-certified IR physicians, 52.5% reported diagnostic imaging as their primary practice, and 35.0% were dedicated to IR. Implementation rates were 18.1% for nerve block, 22.6% for bone augmentation, and 51.4% for TAE. Lack of adequate training was the most consistent barrier across all procedures, along with delayed referrals, lack of confidence, limited case volume, time constraints, institutional resource limitations, and insufficient evidence. Perceived effectiveness was high (81.2% for nerve block, 83.1% for bone augmentation, and 62.1% for TAE), whereas willingness to perform was lower (50.2%, 48.4%, and 66.0%). Implementation of palliative IR procedures in Japan remains limited, despite the high perceived effectiveness among IR physicians. Lack of adequate training was the most consistent barrier across all procedures, suggesting that greater availability of training opportunities may help narrow the gap between perceived benefit and actual practice. These findings highlight a clinically important mismatch: procedures viewed as effective for refractory cancer pain are not reaching patients who might benefit from them.

ABSTRACTA 52‐year‐old man with a history of Philadelphia chromosome‐positive acute lymphoblastic leukaemia underwent peripheral blood stem cell transplantation (PBSCT) 10 years earlier. Five years after transplantation, he developed a persistent dry cough and exertional dyspnea. High‐resolution CT revealed upper lobe‐predominant subpleural fibrosis compatible with pleuroparenchymal fibroelastosis (PPFE) and lower lobe reticulation with ground‐glass opacities. Video‐assisted thoracoscopic lung biopsy showed subpleural fibroelastosis and bronchocentric lesions, along with intra‐alveolar accumulation of foamy macrophages containing cholesterol crystals and periodic acid–Schiff‐positive material, with surfactant protein A immunoreactivity—consistent with pulmonary alveolar proteinosis (PAP). Despite corticosteroids, tacrolimus, and subsequent antifibrotic therapy with nintedanib, the disease gradually progressed, and the patient ultimately died of acute exacerbation triggered by SARS‐CoV‐2 infection. This case highlights a rare coexistence of PPFE and PAP after PBSCT and underscores the potential role of chronic graft‐versus‐host disease and immune dysregulation in their pathogenesis.

Cholangiocarcinoma (CCA) is a highly heterogeneous malignancy originating from biliary epithelial cells. Due to challenges in early diagnosis and the limited efficacy of traditional treatments, the prognosis for patients remains poor. Recent advances in molecular profiling and immunology have significantly altered the therapeutic landscape of CCA. Genomic studies have shown that approximately 40% of CCA cases carry targetable driver mutations, including FGFR2 fusions and IDH1/2 mutations. Targeted therapies directed at these alterations have notably improved survival outcomes in patients with specific molecular subtypes. Additionally, immunotherapies targeting the immunosuppressive tumor microenvironment (TME) of CCA have made substantial progress. The combination of immune checkpoint inhibitors (ICIs) with chemotherapy has become the new standard first-line treatment, and emerging strategies involving dual immunotherapy, ICIs with targeted therapies, and ICIs with local-regional treatments have demonstrated promising synergy. Nevertheless, challenges such as resistance to targeted therapies, barriers posed by the immunosuppressive TME, and the absence of universal biomarkers continue to pose significant obstacles.

Long-term follow-up (LTFU) outpatient clinics play a primary role in screening, preventing, and addressing late effects after hematopoietic cell transplantation (HCT). Following the 2018 nationwide survey, which led to the development of standardized nationwide tools to deliver information to HCT survivors, we re-evaluated changes in the current status of LTFU clinics. We targeted 267 HCT centers certified by the Japanese society for transplantation and cellular therapy. Several questionnaire categories were retained from the 2018 survey to compare results (e.g., LTFU clinic establishment and institutional practices for late-effect screening). The response rate was high in both adult (90%) and pediatric HCT centers (88%), and the establishment rate of post-HCT LTFU clinics increased to 82% (adult, 90%; pediatric, 64%). Pediatric centers were more likely to continue follow-up of patients who received HCT beyond 5 years post-HCT. Regarding transitional medical care for long-term survivors at non-HCT institutions, only a few HCT centers conducted routine transitions to specific referral facilities. We observed significant changes in recommendations for secondary cancer screenings compared to 2018, with a substantial decrease in the proportions of "not routinely included as a screening issue." In the future, it is essential to create a sustainable follow-up system, establish networks with non-HCT facilities, and educate patients to encourage behavioral changes for lifelong health screenings.

CD20-negative large B-cell lymphomas exhibit aggressive behavior and are ineligible for rituximab-containing therapy. To identify antigens targeted by treatment, we analyzed CD79B and CD19 expression in 108 samples from 75 patients with CD20-negative large B-cell lymphomas using H-score. Diffuse-strong (H-score 300) CD79B and CD19 expression was observed in 51% and 57% of samples, and low/negative (H-score ≤ 100) in 35% and 30%, respectively. CD79B expression was significantly lower in de novo CD20-negative diffuse large B-cell lymphoma (DLBCL) than in CD20-negative DLBCL changed from CD20-positive DLBCL after rituximab-containing therapy and in CD20-negative DLBCL transformed from CD20-positive low-grade B-cell lymphoma after rituximab-containing therapy (H-score ≤ 100 in 79% vs. 27% vs. 10%, p<0.001). CD19 expression was lower in de novo CD20-negative DLBCL than in transformed DLBCL (H-score ≤ 100 in 43% vs. 3%, p=0.006). Of 12 patients with plasmablastic lymphoma, CD79B and CD19 were negative in 83% and 66% of cases, respectively. Among 46 CD20-negative large B-cell lymphomas with low CD79B and/or CD19 expression, the tumor proportion score for programmed death-ligand 1 was positive (≥ 1%) in 33% of cases. The combined positive score for programmed death-ligand 1 was positive in 52% of programmed death-ligand 1 tumor proportion score-negative samples. In conclusion, CD79B and CD19 were variably expressed in CD20-negative large B-cell lymphomas, but lower in de novo DLBCL, and especially in plasmablastic lymphoma. Programmed cell death protein 1/programmed death-ligand one inhibitors may represent a treatment option.

The paramount challenge in precision oncology lies in further improving quality of life and response rates for individual patients. Efforts toward these goals are steadily expanding the scope of clinical implementation, despite ongoing challenges such as standardization, cost-effectiveness, and data harmonization. Building upon this maturing foundation, generative AI—which has evolved dramatically in recent years—is particularly valuable at this stage of advancing efficiency and adoption as an auxiliary technology linking literature, guidelines, trial protocols, and patient data. Specifically, through mutation interpretation, trial eligibility matching, and tumor board support, it is expected to contribute to advancing standardization, improving cost-effectiveness, accelerating data harmonization, and further accelerating human-centered decision-making. Accordingly, this review surveys the development history of generative AI and its current healthcare applications, organizing its implementation potential for precision oncology along three axes: (1) generative AI–based interpretation of genetic mutations and estimation of their pathological significance; (2) generative AI–driven verification of clinical trial eligibility; and (3) multimodal foundation models for imaging and pathology that compute “tumor phenotypes” using real-world data, contributing to report drafting and molecular surrogate estimation. In response, we propose a strategy centered on retrieval-augmented generation (RAG) and human-in-the-loop (HITL) workflows, encompassing data preparation based on OMOP, mCODE, and FHIR; multicenter prospective evaluation; auditable logs and governance aligned with Good Manufacturing Practice (GMP) and the EU AI Act; and a synthetic data strategy including differential privacy. Ultimately, this approach validates value through real-world outcomes and charts a path toward “learning oncology,” accelerating patient-centered decision-making and clinical trial development.

This study aimed to examine the effects of concomitant use of proton-pump inhibitors (PPIs) on the survival outcomes in patients with endocrine-sensitive chemotherapy-naïve advanced breast cancer (BC) treated with palbociclib or abemaciclib. This multicenter, retrospective study was conducted at five hospitals in Japan. Data were collected from consecutive patients treated with palbociclib or abemaciclib in combination with endocrine therapy as first-line treatment for endocrine-sensitive chemotherapy-naïve advanced BC between December 2017 and August 2022. Associations between concomitant PPI use and survival outcomes were analyzed. Among 202 patients, 38 (19%) were concomitant PPI users. In the palbociclib population (n = 123), concomitant PPI use was associated with a trend toward decreased progression-free survival (PFS) and a significant reduction in overall survival (OS; crude hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.86–3.00 and crude HR, 3.51; 95% CI, 1.53–7.64, respectively). In multivariable analyses, consistent results were obtained (adjusted HR, 1.29; 95% CI, 0.66–2.53 and adjusted HR, 3.23; 95% CI, 1.28–7.67, respectively). In contrast, concomitant PPI use did not significantly affect either PFS or OS in the abemaciclib group (n = 79). Concomitant PPI use decreased the efficacy of palbociclib regardless of the formulation, with no such impact observed with abemaciclib.

ABSTRACTWe report a rare case of a BRAF V600E‐mutated laterally spreading tumor, granular type (LST‐G), with a neuroendocrine carcinoma (NEC) component in a patient with stage IV colorectal cancer. The patient presented with multiple lymph nodes and liver metastases. Following systemic chemotherapy, significant regression of both the primary lesion and metastases was achieved, enabling successful conversion surgery. Postoperative pathological analysis post‐surgery revealed only well‐differentiated tubular adenocarcinoma, with complete disappearance of the NEC component. Molecular testing confirmed the persistence of the BRAF V600E mutation. The patient remains recurrence‐free two years after surgery. This case highlights the potential for conversion surgery in stage IV BRAF‐mutated colorectal cancer with NEC.

Abstract Introduction The Japanese Ministry of Health, Labour, and Welfare proposed increased copayments for over-the-counter (OTC)-like drugs, with possible special consideration for certain chronic diseases, although the specific diseases to be included were not clarified as of January 2026. The costs attributable to OTC-like drugs indicated for chronic diseases in adults remain unclear. Methods Using the DeSC database (individual-level claims data) in fiscal year 2023, we estimated the average per-person annual costs of the study OTC-like drugs indicated for adults with representative chronic diseases. The estimates were stratified by sex and age. We also computed the national estimates of the numbers of adults with representative chronic diseases who would need OTC-like drugs and the costs attributable to these drugs by applying stratum-specific estimates from the DeSC database to national population counts and aggregated claims data from the National Database of Health Insurance Claims Open Data. The study OTC-like drugs included oral acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical anti-inflammatory patches, oral second-generation antihistamines, and heparinoid-containing topical preparations. Results The average per-person annual costs were several hundred yen for acetaminophen and several thousand yen for the other drug categories, with marked variation by drug category, chronic disease, age, and sex. In the national estimates, the proportion of OTC-like drug users with representative chronic diseases was &lt;10% in every disease–age–sex stratum; nevertheless, the maximum stratum-specific shares of total OTC-like drug costs attributable to these groups were high (up to 50–60% for osteoarthritis for acetaminophen/NSAIDs/patches and up to ∼60% for atopic dermatitis/asteatosis for heparinoids). Conclusions The average per-person annual costs for OTC-like drugs varied substantially across drug categories and patient subgroups. Indicated chronic diseases in adults may account for substantial OTC-like drug costs within some strata, despite representing a small fraction of users.