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Objective: To clarify whether routine thoracic duct (TD) resection improves the prognosis of patients with esophageal cancer after radical esophagectomy. Summary Background Data: Although TD resection can cause nutritional disadvantage and immune suppression, it has been performed for the resection of surrounding lymph nodes. Methods: We analyzed 12,237 patients from the Comprehensive Registry of Esophageal Cancer in Japan who underwent esophagectomy between 2007 and 2012. TD resection and preservation groups were compared in terms of prognosis, perioperative outcomes, and initial recurrent patterns using strict propensity score matching. Particularly, the year of esophagectomy and history of primary cancer of other organs were added as covariates. Results: Following propensity score matching, 1638 c-Stage I–IV patients participated in each group. The five-year overall survival and cause-specific survival rates were 57.5% and 55.2% in the TD-resected group and 65.6% and 63.4% in the TD-preserved group, respectively, without significant differences. The TD-resected group had significantly more retrieved mediastinal nodes (30 vs. 21, P < 0.0001) and significantly fewer lymph node recurrence (376 vs. 450, P = 0.0029) compared with the TD-preserved group. However, the total number of distant metastatic organs was significantly greater in TD-resected group than in the TD-preserved group (499 vs. 421, P = 0.0024). Conclusions: TD resection did not improve survival in patients with esophageal cancer. Despite having retrieved more lymph nodes, TD resection caused distant metastases in more organs compared to TD preservation. Hence, prophylactic TD resection should not be recommended in patients with esophageal cancer.

【目的】本研究では、放射線治療症例全国登録(JROD)において、2015～19年に登録された5年分の全国の放射線治療症例の登録状況を明らかにし、全国の放射線治療の実態把握のための基礎資料とすることを目的とする。 【方法】対象施設は、2015～19年に放射線治療を行っている全国の約840の医療機関とした。対象患者は、2014～18年に放射線治療を受け、オプトアウトのない者とした。各医療機関は登録専用のウェブサイトから登録前年の診療情報をもとに登録した。本研究では、①登録施設数と地域別・男女別割合、②調査項目別登録率、③疾患別割合、④生死の状況、⑤治療完遂度について傾向を分析した。なお、本研究は、量子科学技術研究開発機構(QST)とJASTROの共同研究としてQSTのIRBの承認を得て実施されている。 【結果】登録施設数は15年の86施設に対し19年は124施設と44％増、データ数は15年の約4万件に対し19年は約6万件と5割増であった。19年の地域別割合は、北海道、中国、四国では治療施設数全体の10％以下であった。男女別割合は男性55％、女性45％で経年変化はなかった。調査項目別登録率は、患者情報は約50%、疾患情報と治療情報は約30％、予後情報は13％と最も低かったが、有害事象の有無や最終確認日は増加傾向であった。疾患別割合は、乳癌と肺癌・気管･縦隔腫瘍で約20％、泌尿器系腫瘍約15％で経年変化はなかった。生死の状況は、生存が約70％、死亡が約20％で経年変化はなかった。治療完遂度は、疾患全体の予定完遂がX線70％以上、電子線95％以上で経年変化はなかった。 【結語】JRODへの登録施設は年々増加しており、全国の放射線治療症例の傾向を把握することはできた。しかし、登録施設数は治療施設数全体の15%に過ぎないため、学会として登録施設数を増やすための方策を検討する必要がある。, 日本放射線腫瘍学会第33回学術大会

BACKGROUND: The structure of radiation oncology in designated cancer care hospitals in Japan was surveyed in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities and the previous survey. METHODS: The Japanese Society for Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2009. The structures of 365 designated cancer care hospitals and 335 other radiotherapy facilities were compared. RESULTS: Designated cancer care hospitals accounted for 50.0 % of all the radiotherapy facilities in Japan. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were, respectively, as follows: linear accelerators per facility: 1.4 and 1.0; dual-energy function: 78.6 and 61.3 %; three-dimensional conformal radiotherapy function: 88.5 and 70.0 %; intensity-modulated radiotherapy function: 51.6 and 25.3 %; annual number of patients per linear accelerator: 301.3 and 185.2; Ir-192 remote-controlled after-loading systems: 31.8 and 4.2 %; and average number of full-time equivalent radiation oncologists per facility: 1.8 and 0.8. Compared with the previous survey, the ownership ratio of equipment and personnel improved in both designated cancer care hospitals and the other radiotherapy facilities. Annual patient loads per full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 225.5 and 247.6, respectively. These values exceeded the standard guidelines level of 200. CONCLUSIONS: The structure of radiation oncology in designated Japanese cancer care hospitals was more mature than that in the other radiotherapy facilities. There is still a shortage of personnel. The serious understaffing problem in radiation oncology should be corrected in the future.

The ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution was evaluated in order to radiation identify and improve any deficiencies. A questionnaire-based national structure survey was conducted from March 2010 to January 2011 by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study (PCS). The total numbers of new cancer patients and total of cancer patients (new and repeat) treated with radiation in 2009 were estimated at 201,000 and 240,000, respectively. The type and numbers of systems in actual use consisted of Linac (816), telecobalt (9), Gamma Knife (46), (60)Co remote afterloading system (RALS) (29) and (192)Ir RALS systems (130). The Linac systems used dual energy function for 586 (71.8%), 3DCRT for 663 (81.3%) and IMRT for 337 units (41.3%). There were 529 JASTRO-certified radiation oncologists (ROs), 939.4 full-time equivalent (FTE) ROs, 113.1 FTE medical physicists and 1836 FTE radiation therapists. The frequency of interstitial radiation therapy use for prostate and of intensity-modulated radiotherapy increased significantly. PCS stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more radiation therapy tended to be used for cancer patients. In conclusion, the Japanese structure has clearly improved during the past 19 years in terms of equipment and its use, although a shortage of manpower and variations in maturity disclosed by PCS stratification remained problematic in 2009.

To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. METHODS AND MATERIALS: \nEligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size

PURPOSE: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. METHODS AND MATERIALS: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). RESULTS: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). CONCLUSIONS: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.

a b s t r a c t Purpose: To investigate the clinicopathological features and prognosis in patients with adenocarcinoma of the lung with scattered consolidation (ALSC). Materials and methods: Between January 2006 and March 2010, 139 consecutive patients with lung adenocarcinoma of ≤3 cm, who underwent pulmonary resection for lung cancer, were investigated ret- rospectively. Radiologic classification was based on the findings of thin-section CT such as the presence of consolidation or ground-glass opacity (GGO). Type I (n = 15) and Type II (n = 14), showed a pure GGO and a mixed GGO with consolidation