Showing papers in "Japanese Journal of Clinical Oncology in 2011"
TL;DR: The study suggests an improvement in cancer survival in several primary sites in Japan, which is consistent with the development of treatments and early detection.
Abstract: Objective: The purpose of the present study was to collect data from population-based cancer registries and to calculate relative 5-year survival of cancer patients in Japan. We also sought to determine time trends and to compare the results with international studies. Methods: We asked 11 population-based cancer registries to submit individual data for patients diagnosed from 1993 to 1999, together with data on outcome after 5 years. Although all these registries submitted data (491 772 cases), only six met the required standards for the quality of registration data and follow-up investigation. The relative 5-year survival calculated by pooling data from 151 061 cases from six registries was taken as the survival for cancer patients in Japan. Results: Relative 5-year survival (1997 –9 9) was 54.3% for all cancers (males: 50.0%, females: 59.8%). Survival figures for all sites changed slightly over the 7-year period, from 53.2% for the first 4 years of the study (1993 –96) to 54.3% for the last 3 years (1997 –99), however, a major improvement was observed in several primary sites. Some overall survival was lower in Japan than in the USA, but similar to that in European countries. Specifically, survival for uterine cancer, prostate cancer, testis cancer, lymphoma and leukemia was much lower in Japan than in other countries. However, survival was better in Japan mainly for cancers of the esophagus, stomach, colon, liver and gallbladder. Conclusion: The study suggests an improvement in cancer survival in several primary sites in Japan, which is consistent with the development of treatments and early detection.
191 citations
TL;DR: The Japan Cancer Surveillance Research Group estimated the cancer incidence in 2005 as part of the Monitoring of Cancer Incidence in Japan (MCIJ) project, on the basis of data collected from 12 of 30 population-based cancer registries.
Abstract: The Japan Cancer Surveillance Research Group estimated the cancer incidence in 2005 as part of the Monitoring of Cancer Incidence in Japan (MCIJ) project, on the basis of data collected from 12 of 30 population-based cancer registries. The total number of incidences in Japan for 2005 was estimated as 646,802 (C00-C96). The leading cancer site was the stomach for men and the breast for women. Age-standardized incidence rates remained almost the same level as the previous 2 years.
169 citations
TL;DR: Today, liver resection is an established treatment for hepatocellular carcinoma owing to minimal surgical mortality and improved survival, and none of the ablation techniques have been shown to offer a definitive survival advantage.
Abstract: Surgery is the most important therapeutic approach for patients with hepatocellular carcinoma. We have reviewed patients' survival after resection for hepatocellular carcinoma in 17 series since 2000, each including more than 100 patients. Median survival rates were 80% (range 63-97%) at 1 year, 70% (34-78%) at 3 years and 50% (17-69%) at 5 years. Such wide ranges of survival rates are attributed mainly to differences in the hepatocellular carcinoma stage among studies, but the survival rate is obviously much better for early hepatocellular carcinomas. Today, liver resection is an established treatment for hepatocellular carcinoma owing to minimal surgical mortality and improved survival. Liver transplantation is one of the best treatments for hepatocellular carcinoma in patients who meet the selection criteria. Further studies are needed to establish suitable criteria for transplantation in patients with hepatocellular carcinoma. For patients who are not candidates for liver resection or transplantation, percutaneous ablation is the best treatment option. However, no randomized controlled clinical trial has compared the results of ablation with those of surgical therapy for hepatocellular carcinoma, and none of the ablation techniques have been shown to offer a definitive survival advantage. A treatment algorithm based on published evidence is now available, which helps us to select the most suitable therapeutic option for individual patients, depending on tumor characteristics and liver functional reserve. This review paper summarizes the current status of the surgical management of hepatocellular carcinoma.
131 citations
TL;DR: It is confirmed that some subsets of early gastric cancer are very low risk for nodal metastasis and may benefit from resection by endoscopic or laparoscopic techniques and may also be suitable for function-preserving procedures.
Abstract: The type of surgery and the role of adjuvant therapies in the treatment of gastric cancer have changed in recent times. The treatment of gastric cancer with curative intent is moving away from standard D2 or more extensive surgery to a tailored approach depending on the stage of the disease. Data collected from extensive lymphadenectomy for all stages of gastric cancer have confirmed that some subsets of early gastric cancer are very low risk for nodal metastasis. This group of patients may benefit from resection by endoscopic or laparoscopic techniques and may also be suitable for function-preserving procedures. The extent of resection for gastric cancer has always excited debate. D2 gastrectomy was criticized for its higher mortality in the early European Phase III trials, but recent studies from Taiwan and Italy have shown that the procedure is safe when performed by experienced surgeons and has a survival benefit over D1 gastrectomy. The role of para-aortic lymph node dissection for nodes without apparent metastasis in advanced gastric cancer was assessed by a Phase III Japanese trial and showed no additional benefit over D2 resection. Radical gastric resections, involving resection of adjacent organs for direct tumor invasion result in higher rates of complications, and the role of multi-visceral resections has also been reevaluated. Effective adjuvant therapies for gastric cancer have been reported since the early part of 2000. Development of more effective adjuvant therapy combined with D2 resection should continue to improve survival in the future.
89 citations
TL;DR: It is concluded that there is convincing evidence that cigarette smoking strongly increases the risk of esophageal cancer in the Japanese population.
Abstract: Although alcohol drinking is considered as an important risk factor for esophageal cancer, the magnitude of the association might be varied among geographic areas. Therefore, we reviewed epidemiologic studies on the association between alcohol drinking and esophageal cancer among the Japanese population. Original data were obtained from MEDLINE, searched using PubMed or from searches of the Ichushi database, complemented with manual searches. Evaluation of associations was based on the strength of evidence ('convincing', 'probable', 'possible' or 'insufficient') and the magnitude of association ('strong', 'moderate', 'weak' or 'no association'), together with biological plausibility as previously evaluated by the International Agency of Research on Cancer. We identified four cohort studies and nine case-control studies. All cohort studies and case-control studies showed strong positive associations between esophageal cancer and alcohol drinking. All cohort studies and six case-control studies showed that alcohol drinking had the dose- or frequency-response relationships with esophageal cancer. In addition, four case-control studies showed that acetaldehyde dehydrogenase Glu504Lys polymorphism had strong effect modification with alcohol drinking. We conclude that there is convincing evidence that alcohol drinking increases the risk of esophageal cancer in the Japanese population.
88 citations
TL;DR: Psychosocial needs were strongly associated with psychological distress and quality of life andquality of life may be improved if interventions for unmet needs, especially psychological and information needs, are made.
Abstract: Objective: Few studies have investigated the prevalence of the unmet needs among advanced or recurrent breast cancer patients in Asian countries and little is known about the relation between their unmet needs and psychological distress/quality of life. Methods: The participants (n ¼ 87) comprised randomly selected ambulatory female patients with advanced or recurrent breast cancer attending the Outpatient Department of Oncology, Immunology and Surgery of Nagoya City University Hospital. The patients were asked to complete self-administered questionnaires assessing the level of their physical and psychological symptoms, supportive care needs and socio-demographic and biomedical factors. The association between the patients’ perceived needs and psychological distress/quality of life was then analyzed statistically. Results: The patients had am ean+ standard deviation of 11+ 7.7 and a median of 10 unmet needs. The prevalence of the 17 most frequent unmet needs was over 50%, and almost all of these unmet need items belonged to the Psychological or the Health system and information domain. The total Short-form Supportive Care Needs Survey Questionnaire with cancer score was significantly associated with the indices of psychological distress and quality of life. Most of the Short-form Supportive Care Needs Survey Questionnaire with cancer domains except Sexuality domain were also significantly associated with all the indices of psychological distress. Conclusions: Psychosocial needs were strongly associated with psychological distress and quality of life. Quality of life and psychological distress may be improved if interventions for unmet needs, especially psychological and information needs, are made.
80 citations
TL;DR: This regimen appears to be a suitable alternative to three-weekly high-dose cisplatin with concomitant radiotherapy, because patients can be monitored more regularly for toxicity allowing the schedule to be altered if required.
Abstract: Objective: The most common chemoradiotherapy regimen is high-dose (100 mg/m 2 ) threeweekly cisplatin with concomitant radiotherapy; however, this protocol is associated with acute and late toxicities. Here, we reviewed the dose intensity and toxicity for concomitant weekly cisplatin and radiotherapy in patients with head and neck cancer. Methods: Fifty-three patients with untreated head and neck cancer were enrolled and evaluated at our institution from April 2006 to April 2010. Weekly cisplatin (40 mg/m 2 ) was given on weeks 1, 2, 3, 5, 6 and 7 with radiotherapy, which comprised a standard dose of 70 Gy delivered in 35 daily fractions over 7 weeks. Results: Fifty-one patients (96.2%) received the full dose of radiotherapy, while the course was disrupted by adverse events in two. Over the course of the chemotherapy, 31 patients (58.5%) received more than 200 mg/m 2 cisplatin. The toxicity was manageable in all except one patient, who died of sepsis after completing treatment. The 2-year overall survival rate and local progression-free rate for all patients were 93.7% and 88.0%, respectively. The primary site showed a complete response in 52 patients (98.1%) and a partial response in 1 patient (1.9%). The primary disease was well controlled by chemoradiotherapy in 47 patients (88.7%). Conclusions: Weekly cisplatin could be easier to manage than three-weekly cisplatin, because patients can be monitored more regularly for toxicity allowing the schedule to be altered if required. This regimen appears to be a suitable alternative to three-weekly highdose cisplatin with concomitant radiotherapy.
77 citations
TL;DR: It is demonstrated that the primary tumor volume had significantly impacted on the prognosis of patients with nasopharyngeal carcinoma, and it is proposed that thePrimary tumor volume should be considered as an additional stage indicator in the new revision of the clinical stage of nasoph throat carcinoma.
Abstract: Objective The aim of this study was to evaluate the effect of the primary tumor volume on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Methods Between August 2003 and April 2005, 112 patients with Stage I-IVB nasopharyngeal carcinoma treated by intensity-modulated radiation therapy were included. Measurement of the primary tumor volume was based on contrast-enhanced computed tomography scans before treatment. A receiver operating characteristics curve was used to determine the best cut-off point of the primary tumor volume. Results The mean primary tumor volume for 112 patients with nasopharyngeal carcinoma was 33.9 ± 28.7 ml. Within the framework of UICC T-staging, all patients were divided into four groups according to the primary tumor volume. We call it the volume stage (V1 50.55 ml). The 5-year overall survival rates for V1, V2, V3 and V4 were 88.5, 83.3, 82.4 and 54.5% (P = 0.014), respectively. The cumulative survival curves for V1, V2 and V3 were very close, but clearly separated from V4. In addition, Cox proportional hazards regression model analysis showed that a primary tumor volume >50 ml was an independent risk factor for radiotherapy (risk ratio = 3.485, P = 0.025). Conclusions This study demonstrated that the primary tumor volume had significantly impacted on the prognosis of patients with nasopharyngeal carcinoma. We proposed that the primary tumor volume should be considered as an additional stage indicator in the new revision of the clinical stage of nasopharyngeal carcinoma.
75 citations
TL;DR: Cancer incidence growth rates for men exceed the cancer incidence growth rate for women, resulting mainly from lung cancer incidence which is much higher for men, leading to the widening of incidence gap between man and women.
Abstract: Cancer incidence and mortality rates have been increasing in Turkey as most of the developing countries. Besides socioeconomic factors, one of the most prominent attributes of developing countries is the dissimilarity of their age-dependent demographic structure. In Turkey, cancer incidence rates rise due to individual and environmental risk factors as well as due to the improvement in the registry system and to increase in access to health services. According to the data retrieved from the Ministry of Health Department of Cancer Control database cancer incidence rates increased between 2002 and 2005. Incidence rates rose from 133.78 per 100 thousand in 2002 to 173.85 per 100 thousand in 2005. Between 2002 and 2005 the average growth rate of increase for men comes about 9.7%, which is higher than 8.6% for women leading to the widening of incidence gap between man and women. First five frequent cancer types in Turkey are lung (30.13), prostate (24.33), skin (18.91), breast (17.96), stomach (9.92) cancer with an incidence of per 100 thousand. Cancer incidence growth rates for men exceed the cancer incidence growth rate for women. This gap is resulting mainly from lung cancer incidence which is much higher for men. Further extension of the nationwide cancer screening and prevention programs will result in improvement of cancer control.
75 citations
TL;DR: Some baseline conditions including old age, poor performance status, non-epithelioid type, high white blood cell count and high C-reactive protein level were determinants of poor survival of patients with malignant mesothelioma in Japan.
Abstract: Objective: The objective in our study was to examine baseline and other characteristics associated with survival in patients with malignant pleural mesothelioma in Japan. Methods: Three hundred and fourteen patients with an adjudicated diagnosis of mesothelioma were examined. Survival was evaluated by the Kaplan–Meier method with the log-rank test. The Cox model was used to estimate the hazard ratio for the possible prognostic factors. Results: Of 314 patients, 223 (71%) died and only 40 (13%) were still alive at the end of the observation period starting from the day of diagnosis, while 51 (16%) were transferred to other hospitals or had the last health service contact before the end of the study period yielding the median survival of 308 days. In the multivariate analysis, age older than 70 years (hazard ratio ¼ 2.17; 95% confidence interval, 1.36 –3 .46), non-epithelioid type (hazard ratio ¼ 1.58; 95% confidence interval, 1.15–2 .18), poor performance status (hazard ratio ¼ 3.22; 95% confidence interval, 1.19–8.74), high white blood cell count (hazard ratio ¼ 1.49; 95% confidence interval, 0.99– 2.26) and high C-reactive protein level (hazard ratio ¼ 1.80; 95% confidence interval, 1.06 –3 .06) were negatively associated with survival, after adjustment for other factors. Conclusions: Some baseline conditions including old age, poor performance status, nonepithelioid type, high white blood cell count and high C-reactive protein level were determinants of poor survival of patients with malignant mesothelioma.
67 citations
TL;DR: Smoking increases the risk of death from pancreatic cancer in Japanese women, and the number of cigarettes consumed daily in women in a dose-dependent manner.
Abstract: Objective To examine the association of smoking and lifestyle factors with pancreatic cancer death in the prospective design. Methods Mortality from pancreatic cancer in regard to smoking, body mass index, physical activity, and alcohol, coffee and green tea intake, was studied in a prospective cohort of 30,826 inhabitants in Takayama, Japan. In 1992, each subject completed a self-administered questionnaire on demographic information, smoking, drinking habits, diet, exercise and medical histories. The response rate was 85.3%. Results From 1992 to 1999, 33 men and 19 women died due to pancreatic cancer. Hazard ratios and 95% confidence intervals were determined using Cox proportional hazards models. Women who were defined as current smokers at baseline had significant and increased risk of pancreatic cancer death after adjustment for age, body mass index and history of diabetes mellitus (Hazard ratio: 4.77, 95% confidence intervals: 1.58-14.4). There were significant positive associations of pancreatic cancer death with the years of smoking and the number of cigarettes consumed daily in women in a dose-dependent manner. Current smokers indicated a non-significant risk increase in men (Hazard ratio: 3.81, 95% confidence intervals: 0.88-16.6). Body mass index, physical activity, and alcohol, coffee and green tea intake were not significantly associated with pancreatic cancer death. Conclusions These data suggested that smoking increases the risk of death from pancreatic cancer in Japanese women.
TL;DR: The immunohistochemical evaluation of p53 expression may help in taming the currently stormy relationship between pathological and biological breast cancers and in selecting patient subgroups with different biological features providing a potentially powerful prognostic contribution in triple-negative breast cancers.
Abstract: OBJECTIVE Despite the clinical similarities triple-negative and basal-like breast cancer are not synonymous. Indeed, not all basal-like cancers are negative for estrogen receptor, progesterone receptor and HER2 expression while triple-negative also encompasses other cancer types. P53 protein appears heterogeneously expressed in triple-negative breast cancers, suggesting that it may be associated with specific biological subgroups with a different outcome. METHODS We comparatively analyzed p53 expression in triple-negative tumors from two independent breast cancer case series (633 cases from the University of Ferrara and 1076 cases from the University of Nottingham). RESULTS In both case series, p53 protein expression was able to subdivide the triple-negative cases into two distinct subsets consistent with a different outcome. In fact, triple-negative patients with a p53 expressing tumor showed worse overall and event-free survival. CONCLUSIONS The immunohistochemical evaluation of p53 expression may help in taming the currently stormy relationship between pathological (triple-negative tumors) and biological (basal breast cancers) classifications and in selecting patient subgroups with different biological features providing a potentially powerful prognostic contribution in triple-negative breast cancers.
TL;DR: In this paper, the authors conducted a retrospective study using immunohistochemistry and/or fluorescent in situ hybridization to compare human epidermal growth factor receptor 2 and hormone receptor status in primary and metastatic breast cancers.
Abstract: Background: Recent studies have shown that the human epidermal growth factor receptor 2 status of a metastatic site may differ from that of the primary site. This difference may influence patient prognosis and response to therapy. Methods: We conducted a retrospective study using immunohistochemistry and/or fluorescent in situ hybridization to compare human epidermal growth factor receptor 2 and hormone receptor status in primary and metastatic breast cancers. Results: Fifty-six patients were included in this study. Conversion from hormone receptor positive in the primary tumor to hormone receptor negative in the metastasis occurred in 12 patients (21.4%), and hormone receptor negative to hormone receptor positive conversion occurred in two patients (3.6%). Human epidermal growth factor receptor 2 status was discordant between primary and metastatic lesions in seven patients (12.5%). All of the five patients who converted from human epidermal growth factor receptor 2 negative status to human epidermal growth factor receptor positive received trastuzumab-based chemotherapy. Overall response rate and median progression-free survival for concordant human epidermal growth factor receptor 2 positive patients were 69.2% and 16.9 months, whereas that of patients with positive conversion of human epidermal growth factor receptor 2 were 40.0% and 7.6 months, respectively (overall response rate; P ¼ 0.169 and progression-free survival; P ¼ 0.004). Conclusion: Discordance in human epidermal growth factor receptor 2 and hormone receptor status between primary and metastatic tumors was observed, which led to altered treatment decisions. Evaluation of human epidermal growth factor receptor 2 and hormone receptor in metastatic tumors should be considered in patients with breast cancer.
TL;DR: Maximum standardized uptake value of the primary tumor was a powerful prognostic determinant for patients with adenocarcinoma, but not with squamous cell carcinoma of the lung.
Abstract: Objective: This study evaluates the prognostic significance of [18F]-fluoro-2-deoxyglucose positron emission tomography/computed tomography findings according to histological subtypes in patients with completely resected non-small cell lung cancer. Methods: We examined 176 consecutive patients who had undergone preoperative [18F]fluoro-2-deoxyglucose-positron emission tomography/computed tomography imaging and curative surgical resection for adenocarcinoma (n ¼ 132) or squamous cell carcinoma (n ¼ 44). Maximum standardized uptake values for the primary lesions in all patients were calculated as the [18F]-fluoro-2-deoxyglucose uptake and the surgical results were analyzed. Results: The median values of maximum standardized uptake value for the primary tumors were 2.60 in patients with adenocarcinoma and 6.95 in patients with squamous cell carcinoma (P , 0.001). Analyses of receiver operating characteristic curves identified an optimal maximum standardized uptake value cutoff value to predict recurrence of 3.7 for adenocarcinoma, whereas such an indicator could not be identified for squamous cell carcinoma. Although 2-year disease-free survival rates were 70.2% for maximum standardized uptake value 6.95 and 59.3% for maximum standardized uptake value .6.95 (P ¼ 0.83) among patients with squamous cell carcinoma, 2-year disease-free survival rates were 93.9% for maximum standardized uptake value 3.7 and 52.4% for maximum standardized uptake value .3.7 (P , 0.0001) among those with adenocarcinoma, and notably, 100 and 57.2%, respectively, in patients with Stage I adenocarcinoma (P , 0.0001). On the basis of the multivariate Cox analyses of patients with adenocarcinoma, maximum standardized uptake value (P ¼ 0.008) was a significantly independent factor for disease-free survival as well as nodal metastasis (P ¼ 0.001). Conclusions: Maximum standardized uptake value of the primary tumor was a powerful prognostic determinant for patients with adenocarcinoma, but not with squamous cell carcinoma of the lung.
TL;DR: The Indonesian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 can be used as a questionnaire to assess quality of life in Indonesian cancer patients with high-emetogenic treatments.
Abstract: Objective: Quality of life studies in Indonesia are still uncommon. This research was aimed to validate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 in Indonesian version. The standard procedure of forward–backward translation was adhered to in the translation procedures. The validity procedure included reliability, convergent and discriminant validity, known-groups validity, factor analysis and external convergent validity. Methods: Data were collected from cancer patients in the Oncology Department of Sardjito Hospital, Yogyakarta, Indonesia, who were treated with cisplatin at the dosage 50 mg/m 2 as monotherapy or in combinations. The Short Form-36 was used to assess the external convergent validity of our translated questionnaire. Results: One hundred and twenty-eight patients were recruited from March 2009 to November 2009. The internal consistency with values of .0.70 was observed in the Indonesian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 scales. All items in the questionnaire met the criteria of convergent and discriminant validity, except for items 5. Both of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and the Short Form-36 showed that different diagnoses were associated with a similar impact on quality of life. Factor analysis showed that only the role function and social function loaded onto the second factor together. Correlations between the Indonesian versions of both questionnaires were moderate: between 0.18 and 0.48 for the physical, emotional, social, fatigue and pain domains. Conclusions: The Indonesian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 can be used as a questionnaire to assess quality of life in Indonesian cancer patients with high-emetogenic treatments.
TL;DR: Taiwanese patients with end-stage renal disease are found to have a higher risk to develop urinary tract, liver and breast cancer and a lower risk to get lung, prostate and esophageal cancer.
Abstract: Objective: Patients with end-stage renal disease are suggestive to have a higher risk for the development of some kinds of cancer. The aim of this study is to evaluate the possible association between malignancy and end-stage renal disease in Taiwan. Methods: We used the data of the National Health Insurance system of Taiwan to assess this issue. The end-stage renal disease cohort contained 21 817 patients, and each patient was randomly frequency-matched with two people from the general population without endstage renal disease based on their age and sex. The Cox proportional hazard regression analysis was conducted to estimate the effects of end-stage renal disease on the cancer risk. Results: In patients with end-stage renal disease, the risk of developing overall cancer was significantly higher than the normal healthy subjects (adjusted hazard ratio ¼ 1.64, 95% confidence interval ¼ 1.54‐1.74). This was also true when we analyzed males and females separately. For individual cancer, the risks for developing urinary tract cancers, liver cancer and breast cancer among patients with end-stage renal disease were significantly higher. On the contrary, lung, prostate and esophageal cancer risks were significantly lower when compared with the normal healthy subjects. Conclusions: Our study found Taiwanese patients with end-stage renal disease to have a higher risk to develop urinary tract, liver and breast cancer. We unexpectedly discovered these patients to have a lower risk to get lung, prostate and esophageal cancer.
TL;DR: Eight cycles of neoadjuvant chemotherapy-docetaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide-are tolerable and conferred high rates of pathological complete response and breast-conserving surgery, suggesting that selecting appropriate neoadvuvant chemotherapy based on molecular subtype could be possible.
Abstract: Objective: This multicenter, open-label, single-arm, Phase II study assessed the efficacy of a neoadjuvant chemotherapy with docetaxel (75 mg/m 2 q3w) followed by 5-fluorouracil 500 mg/m 2 , epirubicin 100 mg/m 2 and cyclophosphamide 500 mg/m 2 q3w in patients with early-stage breast cancer. Methods: Women with resectable breast cancer (T1c –3 N0 M0 or T1 –3 N1 M0) were enrolled. Before surgery, patients received four cycles of docetaxel followed by four cycles of 5-fluorouracil, epirubicin, and cyclophosphamide. The primary endpoint was the pathological complete response (pCR) rate defined for the breast alone, assessed by a central review committee. Secondary endpoints included clinical response and safety. Results: One hundred and thirty-seven patients were enrolled. Of the 132 patients assessable for pathologic response, 23% (95% confidence interval, 16 –31%) experienced a pathological complete response and 6% (95% confidence interval, 3–12%) had a near pathological complete response (few remaining cancer cells), resulting in a quasi-pathological complete response of 29% (95% confidence interval, 21 –3 7%). Clinical response rate following the initial docetaxel regimen was 64%. The overall clinical response rate after completion of 5-fluorouracil, epirubicin, and cyclophosphamide was 79%; breast-conserving surgery was performed in 79% of patients. More patients with triple-negative disease (estrogen/progesterone receptors negative; human epidermal growth factor 2 negative) experienced a pathological complete response [14/29, (48%); 95% confidence interval, 29 –68%] versus those with other molecular subtypes. The safety profile was acceptable. Conclusions: Eight cycles of neoadjuvant chemotherapy—docetaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide—are tolerable and conferred high rates of pathological complete response and breast-conserving surgery. Patients with triple-negative disease were more likely to achieve pathological complete response versus other subtypes, suggesting that selecting appropriate neoadjuvant chemotherapy based on molecular subtype could be possible.
TL;DR: It is found that further education and practical training will be needed for adequate cancer pain management for young physicians in their early career.
Abstract: Objective: This study is aimed at evaluating the attitude and knowledge about the optimal use of opioids and finding out the barriers to cancer pain management especially for young doctors in South Korea. Methods: A survey through questionnaire form was conducted on 1204 physicians. Physicians were grouped by their medical specialties and personal characteristics. Specialties were grouped into internal medicine and family medicine doctors, surgeons, anesthesiologists, pediatricians, other board holders and general physicians. Personal characteristics were grouped by their past experiences and current surroundings. Results: Though many doctors thought that they were fairly well educated for pain management strategy, a large population of physicians showed a negative attitude and inadequate knowledge status about cancer pain management. The degree of attitude and knowledge status was different as their specialties and personal experiences. The factors that affected doctors’ attitude and knowledge were: (i) medical specialty, (ii) past history of using practical pain assessment tool, (iii) self-perception of knowledge status about pain management, (iv) experience of prescribing opioids, (v) experience of education for cancer pain management. Although many physicians had a passive attitude in prescribing opioid analgesics, they are willingly open to use opioids for cancer pain management in the future. The most important perceived barriers to optimal cancer pain management were the fear for risk of tolerance, drug addiction, side effects of opioid analgesics and knowledge deficit about opioid analgesics. Conclusions: From this study, we found that further education and practical training will be needed for adequate cancer pain management for young physicians in their early career.
TL;DR: In this paper, the efficacy and toxicity of gemcitabine and S-1 combination therapy for metastatic pancreatic cancer were evaluated in a multicenter Phase II study with 55 patients.
Abstract: Objective: The aim of this multicenter Phase II study was to assess the efficacy and toxicity of gemcitabine and S-1 combination therapy for metastatic pancreatic cancer. Methods: Chemotherapy-naive patients with histologically or cytologically proven metastatic pancreatic adenocarcinoma were eligible for this study. Gemcitabine was administered at a dose of 1000 mg/m 2 over 30 min on days 1 and 8, and oral S-1 at a dose of 40 mg/m 2 twice daily from days 1 to 14, repeated every 3 weeks. Results: A total of 55 patients were included and the efficacy and toxicity were analyzed in 54 patients who received at least one dose of gemcitabine and S-1 combination therapy. Although no complete response was seen, a partial response was achieved in 24 patients, resulting in an overall response rate of 44.4% (95% confidence interval: 30.9-58.6%). The median progression-free survival was 5.9 months (95% confidence interval: 4.1-6.9 months) and the median overall survival was 10.1 months (95% confidence interval: 8.5-10.8 months) with a 1-year survival rate of 33.0%. The major Grade 3-4 toxicities were neutro- penia (80%), leucopenia (59%), thrombocytopenia (22%), anorexia (17%) and rash (7%). Hematological toxicity was mostly transient and there was only one episode of febrile neutro- penia Grade 3. Conclusions: Gemcitabine and S-1 combination therapy produced a high response rate with good survival in patients with metastatic pancreatic cancer. A randomized Phase III study to confirm the efficacy of gemcitabine and S-1 combination therapy is ongoing.
TL;DR: FOLFIRI is effective and tolerable for Japanese metastatic colorectal cancer patients and homozygosity for UGT1A1 28 or 6 and heterozygosity For both UGT 1A128 and 6 and 6 are associated with severe neutropenia.
Abstract: OBJECTIVES This is the first phase II study to evaluate the efficacy and tolerability of the first-line FOLFIRI, as well as the influence of uridine diphosphate glucuronosyl transferase 1, family polypeptide A1 gene (UGT1A1) 28/6 polymorphism, in Japanese metastatic colorectal cancer patients. METHODS Fifty-two patients were enrolled in this study and were administrated FOLFIRI (irinotecan; 150 mg/m(2)) as first-line chemotherapy. Thirty-nine patients accepted the evaluation of UGT1A1 genotypes. In patients with UGT1A1 28 homozygosity, the starting dose was reduced (100 mg/m(2)) according to the Food and Drug Administration recommendation and our previous phase I study. RESULTS After a median follow-up period of 22 months, complete response was achieved in 1.9%, partial response in 38.5 %, stable disease in 51.9% and progressive disease in 3.9%. The overall response rate was 40.4%, the disease control rate was 92.3% and the median overall survival time was 22.3 months. The major toxicity was grade 3-4 neutropenia in 44.2%. There was no definite relation between UGT1A1 28, 6 polymorphisms and toxicity. However, homozygosity for UGT1A1 28 or UGT1A1 6 and double heterozygosity for both UGT1A1 28 and UGT1A1 6 were significantly associated with severe neutropenia in metastatic colorectal cancer patients (P< 0.001). CONCLUSIONS FOLFIRI is effective and tolerable for Japanese metastatic colorectal cancer patients. Homozygosity for UGT1A1 28 or 6 and heterozygosity for both UGT1A1 28 and 6 are associated with severe neutropenia.
TL;DR: Treatment with everolimus resulted in dramatic tumor response for the malignant epithelioid variant of angiomyolipoma, and the patient has continued with this treatment on an outpatient basis without signs of disease progression over 7 months.
Abstract: Malignant epithelioid variant of angiomyolipoma has aggressive characteristics, against which conventional cytotoxic agents have been reported to be disappointingly inactive, and the prognosis of unresectable or recurrent disease is dismal poor. A 52-year-old man with a history of left nephrectomy for epithelioid angiomyolipoma was referred to our institution. The computed tomographic scan showed a soft tissue dense mass around the Rex's recess and behind the spleen, and a large pelvic mass. Specimens obtained by percutaneous needle biopsy confirmed the recurrence of malignant epithelioid angiomyolipoma. Everolimus was initiated at 10 mg per day for recurrent disease. Computed tomographic scans 2 months later showed the tumors to be markedly decreased in size. The patient has continued with this treatment on an outpatient basis without signs of disease progression over 7 months, as of February 2011. In this case, treatment with everolimus resulted in dramatic tumor response for the malignant epithelioid variant of angiomyolipoma.
TL;DR: It is concluded that cigarette smoking is a convincing risk factor for bladder cancer among Japanese.
Abstract: Objective Although several epidemiological studies have demonstrated that cigarette smoking is an important risk factor for bladder cancer, no systematic review in the Japanese population has yet been performed. Accurate evaluation of bladder cancer risk in relation to smoking for Japanese populations can provide necessary information for Japanese policy-makers and doctors to enlighten the importance of smoking cessation. We reviewed epidemiologic data to estimate the strength of the association between cigarette smoking and bladder cancer in the Japanese population. Methods We identified previous cohort and case-control studies, extracting data from databases in the MEDLINE (PubMed) and Ichushi. The magnitude of association and strength of evidence were evaluated in each study, and a meta-analysis was conducted to obtain summary estimates for the overall magnitude of association. Results Three cohort and eight case-control studies were identified. Except for one case-control study, all studies showed a strong positive association between cigarette smoking and bladder cancer. The summary relative risk for ever smokers relative to never smokers was 2.14 (95% confidence interval 1.87-2.44) in a fixed-effect model. Conclusions We conclude that cigarette smoking is a convincing risk factor for bladder cancer among Japanese.
TL;DR: A consensus-based guideline defining the clinical target volume primary was developed for external beam radiotherapy for intact uterine cervical cancer and will serve as a template for radiotherapy protocols in future clinical trials.
Abstract: Objective: To develop a consensus-based guideline to define clinical target volume for primary disease (clinical target volume primary) in external beam radiotherapy for intact uterine cervical cancer. Methods: The working subgroup of the JCOG Radiation Therapy Study Group began developing a guideline for primary clinical target volume in November 2009. The group consisted of 10 radiation oncologists and 2 gynecologic oncologists. The process started with comparing the contouring on computed tomographic images of actual cervical cancer cases among the members. This was followed by a comprehensive literature review that included primary research articles and textbooks as well as information on surgical procedures. Extensive discussion occurred in face-to-face meetings (three occasions) and frequent e-mail communications until a consensus was reached. Results: The working subgroup reached a consensus on the definition for the clinical target volume primary. The clinical target volume primary consists of the gross tumor volume, uterine cervix, uterine corpus, parametrium, vagina and ovaries. Definitions for these component structures were determined. Anatomical boundaries in all directions were defined for the parametrium. Examples delineating these boundaries were prepared for the posterior border of the parametrium for various clinical situations (i.e. central tumor bulk, degree of parametrial involvement). Conclusions: A consensus-based guideline defining the clinical target volume primary was developed for external beam radiotherapy for intact uterine cervical cancer. This guideline will serve as a template for radiotherapy protocols in future clinical trials. It may also be used in actual clinical practice in the setting of highly precise external beam radiotherapy, including intensity-modulated radiotherapy.
TL;DR: The results indicate that it seems to be more important not to be pessimistic than to be optimistic, in female cancer patients at risk for higher levels of anxiety and depression in addition to lowered health-related quality of life in the course of the disease.
Abstract: Objective: The aim of this study was to investigate the predictive value of optimism/pessimism for anxiety, depression and health-related quality of life in female cancer patients, quantified with and without controlling the corresponding base level. Methods: A total of 97 women with breast cancer and other gynaecological cancer completed the Life Orientation Test, the Hospital Anxiety and Depression Scale and the Health Survey SF-8 at three time points: during their stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). Results: The degree of self-assessed pessimism at T1 was significantly associated with anxiety, depression and health-related quality of life at T3. After controlling for the base levels of anxiety, depression and health-related quality of life, only the predictive value of pessimism remained significant and substantial. Conclusions: Especially, women with a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered health-related quality of life in the course of the disease. The results indicate that it seems to be more important not to be pessimistic than to be optimistic.
TL;DR: A randomized controlled trial is planned to assess the effectiveness of ultrasonography in women aged 40–49, with a design to study 50 000 women with mammography and ultr Masonography (intervention group), and 50 000 controls with Mammography only (control group).
Abstract: In cancer screening, it is essential to undertake effective screening with appropriate methodology, which should be supported by evidence of a reduced mortality rate. At present, mammography is the only method for breast cancer screening with such evidence. However, mammography does not achieve sufficient accuracy in breasts with high density at ages below 50. Although ultrasonography achieves better accuracy in Breast Cancer detection even in dense breasts, the effectiveness has not been verified. We have planned a randomized controlled trial to assess the effectiveness of ultrasonography in women aged 40–49, with a design to study 50 000 women with mammography and ultrasonography (intervention group), and 50 000 controls with mammography only (control group). The participants are scheduled to take second round screening with the same modality 2 years on. The primary endpoints are sensitivity and specificity, and the secondary endpoint is the rate of advanced breast cancers.
TL;DR: Overall, efficacy and safety were similar when comparing the Japanese and overall populations, and the demonstrated benefits of everolimus in the overall trial population are similar in Japanese patients with metastatic renal cell carcinoma.
Abstract: Objective: To assess the efficacy and safety of everolimus in Japanese patients with metastatic renal cell carcinoma. Methods: A subgroup analysis of the pivotal Phase III, randomized, double-blind, placebocontrolled trial of everolimus 10 mg/day in patients with disease progression after treatment with sorafenib, sunitinib or both assessed outcomes in Japanese participants. Results were compared with those for the overall study population. Results: The final trial analysis included 24 Japanese patients (everolimus, n ¼ 15; placebo, n ¼ 9). Median progression-free survival in the Japanese subpopulation was 5.75 months (95% confidence interval, 4.90 months to not reached) with everolimus and 3.61 months (95% confidence interval, 1.91‐9.03 months) with placebo (hazard ratio, 0.19; 95% confidence interval, 0.05‐0.83). Median overall survival was not reached with everolimus and was 14.9 months (95% confidence interval, 11.0‐16.8 months) with placebo (hazard ratio, 0.30; 95% confidence interval, 0.07‐1.27). Overall, efficacy and safety were similar when comparing the Japanese and overall populations. In the Japanese subpopulation, the most common adverse events with everolimus were stomatitis, infections and rash. Four Japanese subjects (27%) developed Grade 1 (n ¼ 2) or 2 (n ¼ 2) pneumonitis (all reversible and allowing for continuation of therapy, after interruption, steroids and dose reduction for both Grade 2 cases), with a lower pneumonitis incidence of 14% in the overall population (albeit associated with a Grade 3 incidence of 4%). Conclusions: These findings suggest that the demonstrated benefits of everolimus in the overall trial population are similar in Japanese patients with metastatic renal cell carcinoma.
TL;DR: Rec rehabilitation for cancer patients is expected to be an important means of supporting the hopes of patients and their families, and attempting to maintain and improve patients' quality of life.
Abstract: Although rehabilitation for cancer patients is being practiced in clinical settings, it has not been very well recognized in cancer care. However, interest has been turning to cancer rehabilitation in recent years in association with advances in palliative care and the increasing numbers of patients who survive for long periods, while enduring symptoms caused by cancer or adverse effects associated with treatment. The fact that cancer patient rehabilitation fees were newly established in the 2010 revision of the Japanese medical service fees has propelled interest in this topic. Rehabilitation can be applied throughout the entire phase from the time of diagnosis to the terminal stage, and it is an approach that can involve psychosocial aspects as well as physical aspects. Although its effectiveness has not been adequately demonstrated, especially in the area of palliative medicine, rehabilitation for cancer patients is expected to be an important means of supporting the hopes of patients and their families, and attempting to maintain and improve patients' quality of life.
TL;DR: Liver resection is a valid option for the treatment of hepatocellular carcinoma in the elderly; major resections in cirrhotic old patients must be reserved for selected cases.
Abstract: Objective: Hepatocellular carcinoma is often diagnosed in elderly people. Methods: One hundred and seventy-five patients older than 70 years were operated on for hepatocellular carcinoma (Group 1). The results were compared with 276 resected patients younger than 70 (Group 2) and to 108 aged patients with chronic liver disease without hepatocellular carcinoma (Group 3). Results: Hepatocellular carcinoma in the elderly is more frequently associated with hepatitis C virus, less frequently capsulated and less frequently diagnosed by screening programs than in young patients. After resection, no difference was noted in post-operative complications and in mortality rates (3.2%); major hepatic resection in cirrhosis carried a high risk of death (22%). Five years survival was 42%, comparable with the young surgical patients but significantly lower than the medical patients in Group 3. Recurrence of hepatocellular carcinoma was the main reason of death, but it was suitable for a radical treatment in 37.6% of cases, including surgery, with a mean survival of 31 months. Conclusions: Liver resection is a valid option for the treatment of hepatocellular carcinoma in the elderly; major resections in cirrhotic old patients must be reserved for selected cases. Recurrence may be suitable of a radical approach, including surgery.
TL;DR: Oncologists' recognition may not accurately reflect their patients' supportive care needs and symptoms in usual care, and incorporation of a standard assessment system for supportive care Needs and Symptoms in clinical practice must heighten the oncologists’ awareness of their patients’ problems.
Abstract: Objective: The purpose of this study was to investigate the accuracy of oncologists’ recognition of their patients’ supportive care needs and symptoms in breast cancer outpatient consultation in Japan. Methods: The participants included a sample of randomly selected outpatients with breast cancer and two oncologists. The patients responded to validated self-administered questionnaires to assess their supportive care needs and symptoms. The oncologists responded to a questionnaire in which they indicated their perception of level of the same set of needs or symptoms following consultation. The two data sets were compared statistically. Results: Complete data sets were available for 408 patients. Low negative predictive values for the psychological (30%) and information domain (30%) indicated that the patients often have psychological and information needs that the oncologists do not appropriately recognize. The sensitivity and specificity of the physicians’ assessment for all physical symptoms except pain were ,40 and .85%, respectively, indicating that the physicians could not detect, but could rule out the possibility of a patient experiencing physical symptoms. Borderline/clinical depression and anxiety were the only two symptoms that the oncologists reported more frequently than the patients did. As a result, the specificity of the physicians’ assessment for the detection of borderline/clinical depression and anxiety was relatively low (74 and 27%). Conclusions: Oncologists’ recognition may not accurately reflect their patients’ supportive care needs and symptoms in usual care. Incorporation of a standard assessment system for supportive care needs and symptoms in clinical practice must heighten the oncologists’ awareness of their patients’ these problems.
TL;DR: Jagged1 expression may be useful for predicting prognosis in patients with renal cell carcinoma, especially at the early stage, and was found to be an independent prognostic factor for both overall survival and disease-free survival in multivariate analysis.
Abstract: Objective: The pathological roles of Notch pathway in renal cell carcinoma are still unclear, although Notch signaling has been shown to have an effect on many malignant tumors. In this study, Jagged1 was detected to examine its expression pattern and clinical significance in renal cell carcinoma. Methods: Normal and cancerous kidney tissues from three renal cell carcinoma patients were analyzed using western blot and reverse transcriptase – polymerase chain reaction for Jagged1 expression. Subsequently, extensive immunohistochemistry was performed to detect Jagged1 expression in 129 renal cell carcinoma cases. Clinicopathological data for these patients were evaluated. The prognostic significance was assessed using the Kaplan– Meier survival estimates and log-rank tests. A multivariate study with the Cox proportional hazard model was used to evaluate the prognosis-related aspects. Results: Western blot and polymerase chain reaction results showed markedly increased Jagged1 protein and mRNA levels in renal cell carcinoma tissues compared with normal kidney tissues, which was further verified by immunohistochemical analysis. The expression level of Jagged1 was strongly associated with tumor size, nuclear grade and TNM stage. In addition, high Jagged1 expression was statistically linked to reduced overall and disease-free survival, especially at the early stage (P , 0.001 and ,0.001, respectively). Jagged1 expression was found to be an independent prognostic factor for both overall survival and disease-free survival in multivariate analysis (P ¼ 0.035 and 0.028, respectively). Conclusions: Notch signaling may play an important role in the progress of renal cell carcinoma. Jagged1 expression may be useful for predicting prognosis in patients with renal cell carcinoma, especially at the early stage.