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Background: Japan has recently begun introducing educational programmes on cancer as part of health and physical education (HPE) classes in schools. In support of this work, the Japanese Society for Radiation Oncology has developed an educational video to enhance children's understanding of cancer and radiotherapy. Objectives: This study examined the perceived effectiveness of this video among teachers and clarified whether their specialisation played a role in their responses. Methods: An online survey was administered to junior and senior high school teachers without a history of cancer. Respondents' demographic characteristics, healthy lifestyle habits, anxiety about cancer treatment and knowledge about cancer and radiotherapy were surveyed pre- and post-video. We compared the data from science teachers, HPE teachers and teachers of other specialties. Subsequently, we performed a multiple logistic regression analysis to estimate significant factors that predicted post-watch correct-answer rates. Results: Science teachers were less anxious about radiotherapy and surgery than the other-specialty teachers. They were also the most knowledgeable about cancer and radiotherapy. Post-viewing correct-answer rates improved, except for questions about the work of medical physicists and damage to normal cells. The multiple regression analysis identified age ([beta] = 0.07), sex ([beta] = 0.08), anxiety about radiotherapy ([beta] = -0.09) and pre-video correct-answer rates ([beta] = 0.46) as significant factors predicting post-watch correct-answer rates. Conclusion: The video was beneficial in enhancing teachers' understanding of cancer and radiotherapy. Compared with HPE and other-specialty teachers, science teachers were superior in terms of cancer and radiotherapy comprehension. There may be value in exploring possibilities for cross-disciplinary instruction involving not only HPE but also science teachers in cancer education, especially radiotherapy education.

Cancer education programs are regularly conducted in schools in Japan. Previous reports on their effectiveness were based on surveys conducted several months after the education. We aimed to evaluate whether cancer education for children influenced their behavioral changes in adulthood. We targeted schools where the Japan Cancer Society has conducted the programs since 2011 and the program participants are older than 21 years currently. Invitations were sent to the participants and controls who graduated one year before or after the participants, and answers were obtained using an online questionnaire. Data were collected on the willingness to undergo cancer screening, sociodemographic characteristics, healthy behaviors, and health literacy. We compared the data from the program participants with those from controls. We requested cooperation from 13 schools; however, only one agreed. The common reason for refusal was privacy concerns. In the all-boys participating school in Tokyo, there was no significant difference in background information between the cancer education (38 participants) and control (55 participants) groups. Multiple linear regression showed that healthcare or welfare education background (β = 0.25, p = 0.01) and health literacy (β = 0.24, p = 0.02) were significant predictors of cancer screening intention, while the presence of cancer education (p = 0.25) was not. Despite severe selection bias, this is the first study to examine the long-term impacts of cancer education. We found no significant impacts on the measured outcome. However, the educational content at that time differed from that of today, and the program's efficacy should not be negated. [ABSTRACT FROM AUTHOR]

Objective: Japan has recently implemented screening and support to balance cancer treatment and work. The present study evaluated whether the interest of employers in small and medium‐sized enterprises (SMEs) affects cancer control in the workplace. Methods: Cancer preparedness at work was examined by a Japanese life insurance company contracting 370 000 SMEs. The analysis targeted SMEs hiring ≤50 employees whose employer was aged ≥40 years. The endpoints were performing one or more screening for stomach, colon, or lung cancer recommended for both sexes in Japan and implementing three or more supportive measures from the nine systems listed in a questionnaire. Logistic regression analysis was performed to predict these endpoints using other factors. Results: The survey was completed from January 5 to 28, 2022 and included 5268 eligible companies. Around half were small enterprises with up to five employees. Screenings were performed for stomach (32%), colorectal (27%), and lung (26%) cancers. Sick leave (36%) was the most common support for balancing cancer treatment and work. Logistic regression analysis revealed that employer's concern was a significant predictor of screening (odds ratio [OR] = 3.59, P <.001) and support (OR = 2.55, P <.01) compared with "not concerned at all," along with industry type, annual sales, experience of employees with cancer, and employer's participation in screening. Conclusion: Our findings suggested that employers' interest was a powerful predictor of implementing cancer control in SMEs. Educational intervention targeted toward the employer could play a critical role in improving SMEs. [ABSTRACT FROM AUTHOR]

Men with localized prostate cancers are insured for undergoing radical radiotherapy or prostatectomy. However, limited information is available on the influence of cancer treatments on patients' employment status in Japan. Therefore, in this web-based survey, we aimed to compare the effects of post-treatment changes on the annual income of patients with prostate cancer after undergoing radical radiotherapy and prostatectomy and to identify the risk factors associated with the decrease in annual income. We investigated the clinical characteristics and demographics including pre-treatment working status, self-employment, non-regular employment, working for wage or salary, and joblessness of patients with localized prostate cancer. Multivariable logistic regression was performed to analyze the effects of various factors on the change in the annual income of self-employed and non-regularly employed workers. Seventy-eight eligible patients with localized prostate cancer had undergone radiotherapy, and 128 patients had undergone prostatectomy. Among self-employed and non-regularly employed workers, post-treatment income decline rates in those who underwent radiotherapy were smaller but not significant (12% vs. 42%, P = 0.074). Multivariable logistic regression analysis revealed that initial treatment for prostate cancer was the only significant risk factor for the post-treatment income decline among self-employed and non-regularly employed workers. Radiotherapy was associated with a smaller decrease in income (odds ratio, 0.22; 95% confidence interval, 0.052–0.95; P = 0.042). Our novel results implied the effectiveness of radiotherapy in preventing post-treatment income decline among patients with prostate cancer based on specific employment status: self-employed or non-regularly employed. [ABSTRACT FROM AUTHOR]

Since 2018, the Japanese Ministry of the Environment (MoE) has worked on the "Recycling Demonstration Project for the Soil Generated from Decontamination Activities" (the Project), which aims to offer empirical evidence for the final disposal of radiation‐contaminated substances. To offer practical suggestions for the Project, this study aimed to explore determinants of its support. More specifically, building on previous studies on trust, this study proposed a hypothetical model in which support for the Project was determined by trust in the MoE, which in turn was determined by salient value similarity, ability, and motivation. Additionally, it was hypothesised that the relationships between trust and its different determinants differed: Salient value similarity showed a stronger relationship with trust in those who lived near the place where the Project is taking place whereas ability and motivation showed stronger relationships with trust in those who did not. Questionnaire‐based research was conducted in both Iitate village (n = 106), Fukushima, where the Project had been taking place, and Tokyo (n = 163), located approximately 220 km from Fukushima. Multilevel structural equation modelling supported the hypothesis. These results suggest that emphasising the similarity of values between the MoE and the public would help obtain the public's support for the Project. [ABSTRACT FROM AUTHOR]

Cell‐free and concentrated ascites reinfusion therapy (CART) is now attracting rising attention as one of the strategies against cancer‐related malignant ascites in Japan. Several studies report the safety, effectiveness, and complications of CART applied to patients with malignancies. However, its mechanism reflecting these effects still remains unclear. We evaluated concentration of inflammatory cytokines including interleukin (IL)‐1β, IL‐6, IL‐8, IL‐12, tumor necrosis factor (TNF)‐α, and immunosuppressive cytokine IL‐10 in ascites before CART procedures. We investigated their impacts on survival. IL‐1β, IL‐6, IL‐8, TNF‐α, and IL‐10 were detected in ascites of the patients undergoing CART. Significant body temperature elevation, one potential complication of CART, was observed among the patients although it was not clinically important. There were no significant correlations between changes in body temperature and the concentration of IL‐6, IL‐8, and IL‐10. The presence of IL‐10 in ascites significantly related to longer survival after the first session of CART procedures. However, we observed no other clinically important correlation between cytokine concentrations and changes in WBC and CRP. Concentration of inflammatory cytokines in ascites did not relate to body temperature change, the chief complication of CART. Surprisingly, the presence of IL‐10 in ascites related to longer survival after CART. Immunological environment of cancer‐related ascites may reflect the outcome of CART and improve survival in those with malignancy. [ABSTRACT FROM AUTHOR]

Background/Aims: We aimed to investigate incidence, characteristics, and possible risk factors of pancreatic cancer in patients under observation for hepatocellular carcinoma (HCC) because the association of hepatitis virus B infection and pancreatic cancer has been reported. Patients and Methods: We performed a retrospective cohort study in the Gastroenterology Department of a University Hospital in Japan between 2004 and 2012. A total of 1848 patients who underwent treatment for HCC were included at the initiation of treatment for HCC (mean follow-up period, 33.6 months). The patients received trimonthly radiological follow-ups. Newly developed cases of pancreatic cancer during follow-up for HCC were compared with that of an age- and sex-matched theoretical cohort from national statistics. Possible predisposing factors for pancreatic cancer related to HCC were assessed. Cumulative probabilities of developing a pancreatic cancer were compared using log-rank test. Results: About 13 of 1848 patients developed pancreatic cancer (mean follow-up period, 45.2 months). The risk ratio for all patients was 3.02 (log-rank test: P =0.01). Statistical analyses showed no effects of the following factors on the development of pancreatic cancer: age, sex, follow-up period, alcohol intake, laboratory data, presence of hepatitis virus, characteristics of HCC, type of treatment, number of radiological examinations, and cumulative effective dose. Conclusions: Increased incidence of pancreatic cancer was found in patients under observation for HCC in a relatively small cohort. HCC or other common underlying conditions might be a risk factor for development of pancreatic cancer. [ABSTRACT FROM AUTHOR]

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Background: The objectives of this study were to compare the importance of components of a good death among cancer patients, the general population, oncologists, and oncology nurses, and explore which patients preferred 'fighting against cancer.' Methods: We conducted a cross-sectional anonymous self-reported survey of cancer patients who visited a radiation oncology outpatient clinic, oncologists, and oncology nurses at the Tokyo University Hospital and a random sample of the general population in the Tokyo metropolitan area. The outcomes were 18 previously developed components of a good death in Japanese cancer care consisting of 57 attributes. Results: Three hundred ten patients, 353 subjects from the general population, 109 oncologists, and 366 oncology nurses participated. The desire to 'fight against cancer' was highly significantly different between patients and oncologists (effect size [ES] = −1.40; P = 0.001) and patients and oncology nurses (ES = −1.12; P = 0.001). 'Physical and cognitive control' was, similarly, highly significantly different between patients and oncologists (ES = −1.30; P = 0.001) and patients and oncology nurses (ES = −1.06; P = 0.001). Patients who emphasized 'maintaining hope and pleasure' ( P = 0.0001), 'unawareness of death' ( P = 0.0001), and 'good relationship with family' ( P = 0.004) favored 'fighting against cancer.' The patients, however, who emphasized 'physical and psychological comfort' did not significantly favor 'fighting against cancer' ( P = 0.004). Conclusion: The importance of good death components differed between groups. Medical professionals should be aware of the diversity of values surrounding death and assess the patient's values and discuss them to support his or her quality of life. In addition, the development of care and a medical/social system to maintain hope and pleasure after failure of anticancer treatment is necessary. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to pilot test the effectiveness of using recently developed clinical guidelines from Australia for conducting palliative care family meetings in Japan. Methods: Palliative care family meetings were conducted using clinical guidelines with 15 primary family carers of cancer patients who were admitted to an acute care hospital in Japan. Using the pre-family meeting questionnaire, the primary carers were asked to write key concerns to discuss during the family meetings and rate their concerns via a numerical rating scale: how upset/worried they were about the problem, frequency in which problem occurs, life interference with the problem, and the confidence to deal with the problem. Within 3 days after the meeting, the primary carers were asked to complete the post-meeting questionnaire to evaluate the effectiveness of the family meeting. Results: There was a significant improvement in family carers' psychological well-being in the post-meeting questionnaires compared to the pre-meeting questionnaires as follows: how upset/worried they were about the problem, t(14) = 3.1071, p < 0.000011; frequency in which problem occurs, t(14) = 3.2857, p < 0.000013; life interference with the problem, t(14) = 2.7857, p < 0.000008; and the confidence to deal with the problem, t(13) = −2.3007, p < 0.005480. Conclusions: In accordance with the study aims, we were able to demonstrate the utility of a questionnaire as an essential tool to plan and conduct effective communication between health professionals and primary family carers in Japanese cancer patients. This pilot test should be followed up with a larger sample and a controlled trial. [ABSTRACT FROM AUTHOR]

Background. There is no current consensus regarding the optimal bladder volumes in definitive radiotherapy for localized prostate cancer. The aim of this study was to clarify the relationship between the bladder volume and optimal treatment planning in radiotherapy for localized prostate cancer. Material and methods. Two hundred and forty-three patients underwent definitive radiotherapy with helical tomotherapy for intermediate- and high-risk localized prostate cancer. The prescribed dose defined as 95% of the planning target volume (PTV) receiving &geqq; 100% of the prescription dose was 76 Gy in 38 fractions. The clinical target volume (CTV) was defined as the prostate with a 5-mm margin and 2 cm of the proximal seminal vesicle. The PTV was defined as the CTV with a 5-mm margin. Treatment plans were optimized to satisfy the dose constraints defined by in-house protocols for PTV and organs at risk (rectum wall, bladder wall, sigmoid colon and small intestine). If all dose constraints were satisfied, the plan was defined as an optimal plan (OP). Results. An OP was achieved with 203 patients (84%). Mean bladder volume (± 1 SD) was 266 ml (± 130 ml) among those with an OP and 214 ml (±130 ml) among those without an OP (p = 0.02). Logistic regression analysis also showed that bladder volumes below 150 ml decreased the possibility of achieving an OP. However, the percentage of patients with an OP showed a plateau effect at bladder volumes above 150 ml. Conclusions. Bladder volume is a significant factor affecting OP rates. However, our results suggest that bladder volumes exceeding 150 ml may not help meet planning dose constraints. [ABSTRACT FROM AUTHOR]

Background. Taste loss is a major cause of morbidity in patients undergoing head and neck irradiation. Methods. In a prospective study, 51 patients undergoing radical head and neck irradiation at the Tokyo University Hospital were assessed for taste loss. Taste ability was measured by the taste threshold for the four basic tastes (sweet, sour, salt, and bitter qualities) plus another taste of “umami” quality using a filter-paper-disc method in patients before, during, and after radiotherapy (RT). Results. All tastes declined on the fifth week after the start of RT and improved on the 11th week. Anatomic pathologic analyses in rats revealed that taste buds diminished completely on the sixth day after irradiation of 15 Gy in a single fraction, and the appearance of taste buds returned almost to the preirradiation state on the 28th day. Conclusions. The main cause of taste disorder resulting from RT was believed to be a disappearance of taste buds and not damage to the taste nerves. © 2006 Wiley Periodicals, Inc. Head Neck 28:508–516, 2006 [ABSTRACT FROM AUTHOR]

Aim: We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer. Methods and Materials: A database consisting of 95 Japanese women with stage 0–4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation. Results: The median age at the time of perforation was 72.5 years (range 62–78). The median time from completion of radiotherapy to perforation was 6 months (range 2–58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract. Conclusions: The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate, in Japan Clinical Oncology Group study 0403, the safety and efficacy of stereotactic body radiation therapy (SBRT) in patients with T1N0M0 non-small cell lung cancer (NSCLC).Methods and Materials: Eligibility criteria included histologically or cytologically proven NSCLC, clinical T1N0M0. Prescribed dose was 48 Gy at the isocenter in 4 fractions. The primary endpoint was the percent (%) 3-year overall survival. The threshold % 3-year survival to be rejected was set at 35% for inoperable patients, whereas the expected % 3-year survival was 80% for operable patients.Results: Between July 2004 and November 2008, 169 patients from 15 institutions were registered. One hundred inoperable and 64 operable patients (total 164) were eligible. Patients' characteristics were 122 male, 47 female; median age 78 years (range, 50-91 years); adenocarcinomas, 90; squamous cell carcinomas, 61; others, 18. Of the 100 inoperable patients, the % 3-year OS was 59.9% (95% confidence interval 49.6%-68.8%). Grade 3 and 4 toxicities were observed in 10 and 2 patients, respectively. No grade 5 toxicity was observed. Of the 64 operable patients, the % 3-year OS was 76.5% (95% confidence interval 64.0%-85.1%). Grade 3 toxicities were observed in 5 patients. No grade 4 and 5 toxicities were observed.Conclusions: Stereotactic body radiation therapy for stage I NSCLC is effective, with low incidences of severe toxicity. This treatment can be considered a standard treatment for inoperable stage I NSCLC. This treatment is promising as an alternative to surgery for operable stage I NSCLC. [ABSTRACT FROM AUTHOR]

Health literacy (HL) plays a vital role in an individual's ability to make informed health decisions. Japan faces several challenges in cervical cancer control, including low human papillomavirus (HPV) vaccination and screening rates, underutilization of radiotherapy, and limited HL. This study explored the association between HL and knowledge of cervical cancer and radiotherapy, particularly among young Japanese women. We conducted a web-based survey among users of LunaLuna, a popular women's healthcare application, to assess their HL and knowledge about cervical cancer and radiotherapy through a 46-question survey. We compared three groups in terms of HL (inadequate, problematic, and sufficient & excellent). Multiple regression analysis was used to identify factors associated with knowledge. In total, 1468 respondents were included in this study. HL was positively correlated with knowledge scores (inadequate: 51.8%; problematic: 56.3%; sufficient & excellent: 60%). Participants displayed relatively low accuracy for treatment-related questions. Higher HL (β = 0.15, p < 0.01), education (β =  - 0.11, p < 0.01), cervical cancer screening (β =  - 0.11, p < 0.01), income (β = 0.09, p < 0.01), and employment (β =  - 0.06, p = 0.04) were significant factors affecting knowledge of cervical cancer and radiotherapy. Our findings underscore the pivotal role of HL in promoting cervical cancer prevention and providing a better understanding of radiotherapy. Despite factors such as age, education, and history of cervical cancer screening, HL showed the strongest association with knowledge of cervical cancer and radiotherapy. The enhancement of HL and knowledge dissemination may be critical for promoting cervical cancer prevention and radiotherapy in Japan., (© 2024. The Author(s).)

Background: Workplace cancer screening programs are determined as part of an employee's benefits package and health checkups are perceived positively. However, the current status of workplace cancer screening programs in Japan is unavailable. This study aimed to assess the adherence to national guidelines for colorectal, breast, and cervical cancer screenings in the workplace among Japanese enterprises and identify factors associated with excessive or inadequate screenings., Methods: A cross-sectional study design was employed. Data were obtained from a survey conducted by the "Corporate Action to Promote Cancer Control" between November and December 2022 among registered partner enterprises in Japan. The survey included questions on background characteristics, cancer screening practices, and intervention approaches. The analysis included 432 enterprises that provided complete responses regarding colorectal, breast, and cervical cancer screenings., Results: The guideline-adherence rates for colorectal, breast, and cervical cancer screenings in the workplace were 12.7%, 3.0%, and 8.8%, respectively. Enterprises had lower adherence to screening guidelines than local governments. Colorectal (70.8%) and breast (67.1%) cancer screenings were predominantly categorized as "overscreening" and cervical (60.6%) cancer screening, as "underscreening." Factors such as enterprise scale, health insurance associations, and the number of interventional approaches were significantly associated with increased "overscreening" (101-1000: β = 0.13, p = 0.01; ≥ 1000: β = 0.17, p < 0.01; health insurance association: β = 0.23, p < 0.01; and approaches: β = 0.42, p < 0.01) and reduced "underscreening" (101-1000: β = -0.13, p = 0.01; ≥ 1000: β = -0.17, p < 0.01; health insurance association: β = -0.18, p < 0.01; and approaches: β = -0.48, p < 0.01)., Conclusion: Adherence to national guidelines for colorectal, breast, and cervical cancer screenings in the workplace was suboptimal among Japanese enterprises. Therefore, appropriate cancer screening measures and interventions to ensure guideline adherence and optimization of screening benefits while minimizing potential harms should be expeditiously implemented., (© 2024. The Author(s).)

Purpose: This study focused on identifying the factors influencing the decision-making process in patients with localized prostate and cervical cancer in Japan and specifically examining the choice between surgery and radiotherapy., Methods: Patients with specific cancer stages registered with a healthcare research company for whom radical surgery or radiotherapy was equally effective and recommended participated in this cross-sectional online survey., Results: The responses of 206 and 231 patients with prostate and cervical cancer, respectively, revealed that both groups relied heavily on the physicians' recommendations (prostate: odds ratio (OR) = 40.3, p < 0.001; cervical: OR = 5.59, p < 0.001) and their impression of radiotherapy (prostate: OR = 9.22, p < 0.001; cervical: OR = 2.31, p < 0.001). Factors such as hypertension (OR = 6.48, p < 0.05), diabetes mellitus (OR = 9.68, p < 0.05), employment status (OR = 0.08, p < 0.01), and impressions of surgery (OR = 0.14, p < 0.01) also played a significant role in patients with prostate cancer. In contrast, the specialty of the physician (OR = 4.55, p < 0.05) proposing the treatment influenced the decision-making process of patients with cervical cancer. Information sources varied between the two groups: patients with prostate cancer were more inclined towards printed materials, whereas patients with cervical cancer were more inclined towards interpersonal relationships., Conclusion: Although several limitations, such as the sample and recall bias, were noted, this study emphasizes the role of psychosocial factors in the decision-making process and the requirement for tailored information sources., (© 2024. The Author(s).)

Objective: The radiotherapy utilization rate in Japan is lower than that in other developed countries. This study identified factors associated with the low rate, by conducting an online survey of Japanese cancer survivors., Methods: We reviewed the web survey results of Japanese cancer patients. The survey examined the process of choosing treatments and the actual treatment received. We included respondents whose most engaged-in treatment was either radiotherapy or surgery, dividing them into two groups. We used the chi-square test to compare the patients in the both groups for their impression of the therapy, decision-making approach, and decision to seek second medical opinions (SMOs). To assess the relationship between seeking SMOs, being most engaged in radiotherapy, and feeling satisfied, we used the structural equation modeling (SEM) approach., Results: We included 139 patients in the radiotherapy group and 681 patients in the surgery group. Compared with patients in the surgery group, more patients in the radiotherapy group sought SMOs (19% vs. 28%), shared opinions with their doctor (27% vs. 42%), and were satisfied with their treatment (69% vs. 78%). SEM analysis showed that seeking SMOs contributed to radiotherapy being the most-engaged-in therapy (β = 0.23; P < 0.01), and the treatment contributed to the satisfaction (β = 0.15; P < 0.01)., Conclusion: Patients who underwent radiotherapy felt more satisfied with the treatment than patients who underwent surgery. Perceptions about radiotherapy and SMOs may be a reason for the low utilization of radiotherapy in Japan.

Objective: This study investigates the views on death among cancer patients in Japan and examines how these views are related to age, sex, and physical condition. We also investigate how these views are related to where patients would like to spend their final days and whether or not they would like to be told how long they have left to live., Method: We targeted 450 cancer patients receiving outpatient treatment in the radiology department at the University of Tokyo Hospital. We used the Death Attitudes Inventory (DAI) developed by Hirai to measure attitudes about death., Results: Of the 450 patients approached, we received responses from 310 (69% collection rate). The results of the t test and one-way ANOVA showed that, in terms of "death anxiety/fear," the under-65 group (17.73 ± 6.69) scored significantly higher than the 65-and-over group (15.43 ± 7.69, t = 2.685, df = 280, p < 0.01); the group with KPS scores 70 or above (16.88 ± 7.21) scored higher than the group with KPS scores below 70 (12.73 ± 7.09, t = 2.168, df = 280, p = 0.03); and no significant difference was found for sex, metastasis, or treatment stage., Significance of Results: Our results demonstrate that, although views on death among cancer patients may differ according to sex, age, and physical condition, taking these factors into account when understanding such views can be useful in predicting where patients may wish to spend their final days.

Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. Outcomes of SBRT for liver tumors unsuitable for ablation or surgical resection were evaluated. A total of 79 patients treated with SBRT for primary hepatocellular carcinoma (HCC) between 2004 and 2012 in six Japanese institutions were studied retrospectively. Patients treated with SBRT preceded by trans-arterial chemoembolization were eligible. Their median age was 73 years, 76% were males, and their Child-Pugh scores were Grades A (85%) and B (11%) before SBRT. The median biologically effective dose (α/β = 10 Gy) was 96.3 Gy. The median follow-up time was 21.0 months for surviving patients. The 2-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival were 53%, 40% and 76%, respectively. Sex and serum PIVKA-II values were significant predictive factors for OS. Hypovascular or hypervascular types of HCC, sex and clinical stage were significant predictive factors for PFS. The 2-year PFS was 66% in Stage I vs 18% in Stages II-III. Multivariate analysis indicated that clinical stage was the only significant predictive factor for PFS. No Grade 3 laboratory toxicities in the acute, sub-acute, and chronic phases were observed. PFS after SBRT for liver tumor was satisfactory, especially for Stage I HCC, even though these patients were unsuitable for resection and ablation. SBRT is safe and might be an alternative to resection and ablation., (© The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.)

Objective: Outcomes were examined for the cases that received radiotherapy (RT) for esophageal cancer with metastasis to supraclavicular lymph nodes (ScLN) in a single institutional retrospective study., Materials and Methods: Cases examined were 53 consecutive patients with pathologically confirmed esophageal cancer enrolled from our institution who received semi-radical RT from 2001 to 2013. Radiotherapy consisted of a total dose of from 50-50.4 Gy given in 25-28 fractions of 1.8-2.0 Gy with five fractions per week. The chemotherapy regimen included nedaplatin and 5-fluorouracil. All had ScLN metastasis, and all diseases were included in the RT field., Results: The median follow up time was 42 months for survival patients. Overall survival (OS) and progression free survival (PFS) for 1-, 2-, and 3 years were 39%, 19%, and 12% and 14%, 9%, and 6%, respectively. Acute grade 3-5 esophagitis and neutropenia was seen in 11% and 81%, respectively. Late grade 3-5 toxicity in esophagus, lung, and heart was seen in 4%, 0%, and 0%. Five patients (9%) survived more than 4 year., Conclusion: Although the 2-year PFS was less than 10% and very poor, long term survival for over 4 year was seen in 9% cases. In other words, despite the poor results, the fact remains that some patients were cured with CRT.

Our work on stereotactic body radiation therapy (SBRT) for primary and metastatic lung tumors will be described. The eligibility criteria for SBRT, our previous SBRT method, the definition of target volume, heterogeneity correction, the position adjustment using four-dimensional cone-beam computed tomography (4D CBCT) immediately before SBRT, volumetric modulated arc therapy (VMAT) method for SBRT, verifying of tumor position within internal target volume (ITV) using in-treatment 4D-CBCT during VMAT-SBRT, shortening of treatment time using flattening-filter-free (FFF) techniques, delivery of 4D dose calculation for lung-VMAT patients using in-treatment CBCT and LINAC log data with agility multileaf collimator, and SBRT method for centrally located lung tumors in our institution will be shown. In our institution, these efforts have been made with the goal of raising the local control rate and decreasing adverse effects after SBRT.

Respiratory motion management (RMM) systems in external and stereotactic radiotherapies have been developed in the past two decades. Japanese medical service fee regulations introduced reimbursement for RMM from April 2012. Based on thorough discussions among the four academic societies concerned, these Guidelines have been developed to enable staff (radiation oncologists, radiological technologists, medical physicists, radiotherapy quality managers, radiation oncology nurses, and others) to apply RMM to radiation therapy for tumors subject to respiratory motion, safely and appropriately.

Medical radiation exposures are increasing world-wide and especially in Japan, because of the progress in medical care. In order to keep the patients safe from medical exposure, we should know not only possible radiation injuries through the radiological interventions provided to the patients, but also the factors which increase or decrease medical exposure. In addition, we have to keep aware of the radiation dose level exposed to the patients, every time we use medical radiation to our patients. Continuing educations and guidelines on medical exposure and consciousness of the dose level are helpful in decreasing the patients' medical exposures, and in consequences, also in protecting ourselves from occupational exposures.

Gastrointestinal syndrome after high-dose acute radiation whole body exposure is difficult to treat, although it is a well-known complication. In this report, we describe the clinical and pathological features of a patient who died after the criticality accident which occurred in Japan on 30 September 1999. The patient was estimated to have been exposed to 16-25 Gy equivalent of gamma ray, and died of multiple organ failure after acute radiation syndrome, especially gastrointestinal syndrome, on day 82. The stomach and small intestine contained a large amount of blood clots and the gastrointestinal epithelial cells were almost totally depleted at autopsy. In addition, the degree of the mucosal damage was dependent on the segment of the gastrointestinal tract; the mucosa of stomach, ileum and ascending colon was entirely depleted, but the esophagus, descending and sigmoid colon and rectum retained a small portion of the epithelial cells. From the posture of the patient at the time of exposure, the absorbed dose was presumed to be highest in the right-anterior abdomen. This agreed with the pathological differences in the mucosal damage by the position in the abdomen, which depended presumably on the radiation dose. This is the first report documenting the relationship between the absorbed dose and the severity of gastrointestinal damages in vivo.

Mouse 3T3-Swiss albino cells are widely used as feeder cells to culture the human epidermis for the treatment of burns. To minimize the risk of xenoinfection, quality control of the feeder cells is required in the Japanese guidelines on regenerative medicine using feeder cells. We characterized three lots of 3T3-Swiss albino cells that are publicly or commercially available in Japan. One lot, which propagated more rapidly than the other two without showing typical contact inhibition, was found to release endogenous murine leukemia virus upon iododeoxyuridine-treatment. Southern blotting of restriction fragments showed that the rapidly growing lot consisted of genetically altered cells that had probably emerged during the passages. The data support the guidelines that recommend the quality control of each lot of 3T3-Swiss albino cells if they are to be used clinically.

Purpose: To determine how the omission of whole brain radiotherapy (WBRT) affects the neurocognitive function of patients with one to four brain metastases who have been treated with stereotactic radiosurgery (SRS)., Methods and Materials: In a prospective randomized trial between WBRT+SRS and SRS alone for patients with one to four brain metastases, we assessed the neurocognitive function using the Mini-Mental State Examination (MMSE). Of the 132 enrolled patients, MMSE scores were available for 110., Results: In the baseline MMSE analyses, statistically significant differences were observed for total tumor volume, extent of tumor edema, age, and Karnofsky performance status. Of the 92 patients who underwent the follow-up MMSE, 39 had a baseline MMSE score of < or =27 (17 in the WBRT+SRS group and 22 in the SRS-alone group). Improvements of > or =3 points in the MMSEs of 9 WBRT+SRS patients and 11 SRS-alone patients (p = 0.85) were observed. Of the 82 patients with a baseline MMSE score of > or =27 or whose baseline MMSE score was < or =26 but had improved to > or =27 after the initial brain treatment, the 12-, 24-, and 36-month actuarial free rate of the 3-point drop in the MMSE was 76.1%, 68.5%, and 14.7% in the WBRT+SRS group and 59.3%, 51.9%, and 51.9% in the SRS-alone group, respectively. The average duration until deterioration was 16.5 months in the WBRT+SRS group and 7.6 months in the SRS-alone group (p = 0.05)., Conclusion: The results of the present study have revealed that, for most brain metastatic patients, control of the brain tumor is the most important factor for stabilizing neurocognitive function. However, the long-term adverse effects of WBRT on neurocognitive function might not be negligible.

The effectiveness of intervention by the palliative care team at the University of Tokyo Hospital was assessed using the Support Team Assessment Schedule. During the study, 316 consecutive patients with malignant tumor disease were referred to the palliative care team, which assessed 11 physical symptoms. Results were tested by paired t test to calculate 95% confidence intervals comparing the mean Support Team Assessment Schedule scores for each symptom from the first time to the last time after palliative care intervention. The study concluded that (1) intervention by a palliative care team in general inpatient units can effectively control pain, nausea, and vomiting in patients up until the terminal stage; (2) it is likely that cough is controllable in the terminal stage with intervention by a palliative care team; (3) mouth dryness, anorexia, constipation, diarrhea, fatigue, and ascites are difficult to alleviate in the long term even with palliative intervention.

Background/aims: To evaluate outcome of the U.S. RTOG/Intergroup Protocol 85-01 for 44 Japanese esophageal cancer patients., Methodology: Between 1996 and 2004, patients with esophageal cancer received the Intergroup concurrent chemoradiation therapy regimen for the primary treatment (n=44, group A). We compared the data with those of patients receiving radiotherapy (RT) combined with the weekly chemotherapy regimen (n=12, group B) and with those of patients receiving RT combined with the daily low-dose chemotherapy regimen (n=24, group C)., Results: The median survival period was 14.9 months in group A, 5.7 months in group B, and 6.3 months in group C. The survival rates at 1 and 3 years were 56% and 26% in group A, 42% and 21% in group B (p=0.3307), and 27% and 18% in group C (p=0.0462), respectively., Conclusions: The prognosis of patients who received the Intergroup regimen for esophageal cancer was significantly better than that of patients who received the daily low-dose chemotherapy regimen. The Intergroup regimen is well tolerable for the Japanese patients too.

Purpose: To evaluate the treatment outcome of concurrent chemoradiation therapy (cCRT) for 13 clinically confirmed T1 esophageal cancer patients., Methods: Between June 2000 and February 2004, patients with T1 esophageal cancer (tumor invading lamina propria or submucosa) received cCRT (50.4 Gy; CDDP: 75 mg/m2, day 1, bolus; 5-FU: 1000 mg/m2, days 1 to 4, continuous) (n = 13, T1 group). This treatment regimen was compared with the following 2 other groups treated during the same period: one was treated with radiation therapy alone for T1 disease (n = 5, RT-alone group); and the other group of patients consisted of those with T2 disease (tumor invading muscularis propria) who received the same cCRT regimen as the first T1 group (n = 9, T2 group)., Results: The overall survival rates at 1 and 3 years were in the T1 group, 75% and 75%; in the T2 group, 75% and 45% (P =0.2890); and in the RT-alone group, 60% and 40% (P = 0.2978). No treatment-related mortalities occurred in the T1 and RT-alone groups, but one patient in the T2 group died of radiation-induced pneumonitis., Conclusions: Although this study was not randomized, the results showed that cCRT is a safe and effective method for treating patients with superficial esophageal cancer.

A survey was conducted to determine the antimicrobial activity of fluoroquinolones and other antimicrobial agents against 8,474 clinical isolates obtained from 37 Japanese medical institutions in 2000. A total of 25 antimicrobial agents were used, comprising 4 fluoroquinolones, 13 beta-lactams, minocycline, chloramphenicol, clarithromycin, azithromycin, gentamicin, amikacin, sulfamethoxazole-trimethoprim, and vancomycin. A high resistance rate of over 85% against fluoroquinolones was exhibited by methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium. Isolates showing resistance to fluoroquinolones among methicillin-resistant coagulase-negative Staphylococci, Enterococcus faecalis, and Pseudomonas aeruginosa from UTI accounted for 30-60%. However, many of the common pathogens were still susceptible to fluoroquinolones, such as Streptococcus pneumoniae (including penicillin-resistant isolates), Streptococcus pyogenes, methicillin-susceptible S. aureus (MSSA), methicillin-susceptible coagulase-negative Staphylococci, Moraxella catarrhalis, the Enterobacteriaceae family, and Haemophilus influenzae (including ampicillin-resistant isolates). About 85% of P. aeruginosa isolated from RTI were susceptible to fluoroquinolones. In conclusion, this survey of sensitivity to antimicrobial agents clearly indicated trend for increasing resistance to fluoroquinolones among MRSA, Enterococci, and P. aeruginosa isolated from UTI, although fluoroquinolones are still effective against other organisms and P. aeruginosa from RTI as has been demonstrated in previous studies.