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  • 1
    Online Resource
    Online Resource
    Minimally Invasive Salvage Operations for Esophageal Cancer after Definitive Chemoradiotherapy
    S. Karger AG ; 2018
    In:  Digestion Vol. 97, No. 1 ( 2018), p. 64-69
    Details
    In: Digestion, S. Karger AG, Vol. 97, No. 1 ( 2018), p. 64-69
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 Because salvage surgery after definitive chemoradiotherapy for esophageal cancer is associated with high postoperative mortality and morbidity, minimally invasive methods are desirable. We analyzed the validity of minimally invasive salvage operations (MISO). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Twenty-five patients underwent salvage operation between 2010 and 2016 in our institution, 10 having undergone right transthoracic salvage esophagectomy (TTSE group), 6 transhiatal salvage esophagectomy (THSE), 6 salvage lymphadenectomy (SLA), and 3 salvage endoscopic submucosal dissection (SESD). Patients who had undergone THSE, SLA, or SESD were categorized as the MISO group. Short- and long-term outcomes were assessed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The mean duration of surgery was significantly shorter in the SLA groups than in the TTSE group ( 〈 i 〉 p 〈 /i 〉  = 0.0248). Blood loss was significantly less in the SLA than the TTSE group ( 〈 i 〉 p 〈 /i 〉  = 0.0340). Intensive care unit stay was shorter in the THSE than the TTSE group ( 〈 i 〉 p 〈 /i 〉  = 0.0412). There was no significant difference in postoperative mortality between the MISO and THSE groups. Postoperative hospital stay was significantly shorter in the SLA than the TTSE group ( 〈 i 〉 p 〈 /i 〉  = 0.0061). Patients’ survivals did not differ significantly between the MISO and TTSE groups ( 〈 i 〉 p 〈 /i 〉  = 0.752). Multivariate analysis revealed that residual disease (R0; HR 4.872, 95% CI 1.387–17.110, 〈 i 〉 p 〈 /i 〉  = 0.013) was the only independent factor influencing overall survival. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 MISO is preferable because short-term outcomes are better and long-term outcomes do not differ from those of TTSE.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000484034
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482218-0
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  • 2
    Online Resource
    Online Resource
    Progressive Supranuclear Palsy with Wall-Eyed Bilateral Internuclear Ophthalmoplegia Syndrome: Authors’ Second Case
    S. Karger AG ; 2019
    In:  Case Reports in Neurology Vol. 11, No. 2 ( 2019-7-10), p. 205-208
    Details
    In: Case Reports in Neurology, S. Karger AG, Vol. 11, No. 2 ( 2019-7-10), p. 205-208
    Abstract: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome has previously been reported in only 2 patients with progressive supranuclear palsy (PSP). Herein, we report a third case of WEBINO syndrome with PSP. The patient was an 81-year-old man who had experienced gradually increasing gait disturbance and occasional falls since the age of 78 years. At 80 years of age, he presented with cognitive impairment, parkinsonism, and oculomotor abnormalities. The oculomotor abnormalities consisted of vertical gaze palsy and loss of eye convergence. Brain magnetic resonance imaging demonstrated marked atrophy of the midbrain. He was diagnosed with PSP. At the age of 81 years, he presented with alternating extropia in his forward gaze and adduction paresis and outward nystagmus of the abducted eye in his horizontal gaze, both of which were compatible with WEBINO syndrome. Previously, we reported the first case of PSP with WEBINO syndrome, and another group recently reported a second case. In light of the previous cases and the present case, WEBINO syndrome in PSP should not be considered extremely rare. Furthermore, WEBINO syndrome has not been reported in other neurodegenerative disorders, which suggests that it might be a useful and specific diagnostic finding in PSP.
    Type of Medium: Online Resource
    ISSN: 1662-680X
    URL: Article
    DOI: 10.1159/000501394
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 2505302-4
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  • 3
    Online Resource
    Online Resource
    Liver Cancer Study Group of Japan Clinical Practice Guidelines for Intrahepatic Cholangiocarcinoma
    S. Karger AG ; 2022
    In:  Liver Cancer Vol. 11, No. 4 ( 2022), p. 290-314
    Details
    In: Liver Cancer, S. Karger AG, Vol. 11, No. 4 ( 2022), p. 290-314
    Abstract: This paper presents the first version of clinical practice guidelines for intrahepatic cholangiocarcinoma (ICC) established by the Liver Cancer Study Group of Japan. These guidelines consist of 1 treatment algorithm, 5 background statements, 16 clinical questions, and 1 clinical topic, including etiology, staging, pathology, diagnosis, and treatments. Globally, a high incidence of ICC has been reported in East and Southeast Asian countries, and the incidence has been gradually increasing in Japan and also in Western countries. Reported risk factors for ICC include cirrhosis, hepatitis B/C, alcohol consumption, diabetes, obesity, smoking, nonalcoholic steatohepatitis, and liver fluke infestation, as well as biliary diseases, such as primary sclerosing cholangitis, hepatolithiasis, congenital cholangiectasis, and Caroli disease. Chemical risk factors include thorium-232, 1,2-dichloropropane, and dichloromethane. CA19-9 and CEA are recommended as tumor markers for early detection and diagnostic of ICC. Abdominal ultrasonography, CT, and MRI are effective imaging modalities for diagnosing ICC. If bile duct invasion is suspected, imaging modalities for examining the bile ducts may be useful. In unresectable cases, tumor biopsy should be considered when deemed necessary for the differential diagnosis and drug therapy selection. The mainstay of treatment for patients with Child-Pugh class A or B liver function is surgical resection and drug therapy. If the patient has no regional lymph node metastasis (LNM) and has a single tumor, resection is the treatment of choice. If both regional LNM and multiple tumors are present, drug therapy is the first treatment of choice. If the patient has either regional LNM or multiple tumors, resection or drug therapy is selected, depending on the extent of metastasis or the number of tumors. If distant metastasis is present, drug therapy is the treatment of choice. Percutaneous ablation therapy may be considered for patients who are ineligible for surgical resection or drug therapy due to decreased hepatic functional reserve or comorbidities. For unresectable ICC without extrahepatic metastasis, stereotactic radiotherapy (tumor size ≤5 cm) or particle radiotherapy (no size restriction) may be considered. ICC is generally not indicated for liver transplantation, and palliative care is recommended for patients with Child-Pugh class C liver function.
    Type of Medium: Online Resource
    ISSN: 2235-1795 , 1664-5553
    URL: Article
    DOI: 10.1159/000522403
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 2666925-0
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  • 4
    Online Resource
    Online Resource
    Proton Beam Therapy versus Radiofrequency Ablation for Patients with Treatment-Naïve Single Hepatocellular Carcinoma: A Propensity Score Analysis
    S. Karger AG ; 2023
    In:  Liver Cancer Vol. 12, No. 4 ( 2023), p. 297-308
    Details
    In: Liver Cancer, S. Karger AG, Vol. 12, No. 4 ( 2023), p. 297-308
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Proton beam therapy (PBT) is known to be an effective locoregional treatment for hepatocellular carcinoma (HCC). However, few comparative studies in treatment-naïve cases have been reported. The aim of this study was to compare the survival outcomes of PBT with those of radiofrequency ablation (RFA) in patients with treatment-naïve solitary HCC. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Ninety-five consecutive patients with treatment-naïve HCC, a single nodule measuring ≤5 cm in diameter, and a Child-Pugh score of ≤8 who were treated with PBT at the University of Tsukuba Hospital between 2001 and 2013 were enrolled in the study. In addition, 836 patients with treatment-naïve HCC treated by RFA at the University of Tokyo Hospital during the same period were analyzed as controls. Recurrence-free survival (RFS) and overall survival (OS) were compared in 83 patient pairs after propensity score matching. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The 1-year, 3-year, and 5-year RFS rates were 86.6%, 49.5%, and 35.5%, respectively, in the PBT group and 59.5%, 34.0%, and 20.9% in the RFA group ( 〈 i 〉 p 〈 /i 〉 = 0.058); the respective OS rates were 97.6%, 77.8%, and 57.1% in the PBT group and 95.1%, 81.7%, and 67.7% in the RFA group ( 〈 i 〉 p 〈 /i 〉 = 0.16). Regarding adverse effects, no grade 3 or higher adverse events were noted in the PBT; however, two grade 3 adverse events occurred within 30 days of RFA in the RFA group: one hemoperitoneum and one hemothorax. 〈 b 〉 〈 i 〉 Discussion: 〈 /i 〉 〈 /b 〉 After propensity score matching, PBT showed no significant difference in RFS and OS compared to RFA. PBT can be an alternative for patients with solitary treatment-naïve HCC.
    Type of Medium: Online Resource
    ISSN: 2235-1795 , 1664-5553
    URL: Article
    DOI: 10.1159/000528537
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
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  • 5
    Online Resource
    Online Resource
    Proton Beam Therapy for Intrahepatic Cholangiocarcinoma: A Multicenter Prospective Registry Study in Japan
    S. Karger AG ; 2023
    In:  Liver Cancer
    Details
    In: Liver Cancer, S. Karger AG
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Intrahepatic cholangiocarcinoma (ICC) can be treated with chemotherapy in unresectable cases, but outcomes are poor. Proton beam therapy (PBT) may provide an alternative treatment and has good dose concentration that may improve local control. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Fifty-nine patients who received initial PBT for ICC from May 2016 to June 2018 at nine centers were included in the study. The treatment protocol was based on the policy of the Japanese Society for Radiation Oncology. Forty patients received 72.6–76 Gy (RBE) in 20–22 fr, 13 received 74.0–76.0 Gy (RBE) in 37–38 fr, and 6 received 60–70.2 Gy (RBE) in 20–30 fr. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The 59 patients (35 men, 24 women; median age: 71 years; range: 41–91 years) had PS of 0 ( 〈 i 〉 n 〈 /i 〉 = 47), 1 ( 〈 i 〉 n 〈 /i 〉 = 10), and 2 ( 〈 i 〉 n 〈 /i 〉 = 2). Nine patients had hepatitis and all 59 cases were considered inoperable. The Child-Pugh class was A ( 〈 i 〉 n 〈 /i 〉 = 46), B ( 〈 i 〉 n 〈 /i 〉 = 7), and unknown ( 〈 i 〉 n 〈 /i 〉 = 6); the median maximum tumor diameter was 5.0 cm (range 2.0–15.2 cm); and the clinical stage was I ( 〈 i 〉 n 〈 /i 〉 = 12), II ( 〈 i 〉 n 〈 /i 〉 = 19), III ( 〈 i 〉 n 〈 /i 〉 = 10), and IV ( 〈 i 〉 n 〈 /i 〉 = 18). At the last follow-up, 17 patients were alive (median follow-up: 36.7 months; range: 24.1–49.9 months) and 42 had died. The median OS was 21.7 months (95% CI: 14.8–34.4 months). At the last follow-up, 37 cases had recurrence, including 10 with local recurrence. The median PFS was 7.5 months (95% CI: 6.1–11.3 months). In multivariable analyses, Child-Pugh class was significantly associated with OS and PFS, and Child-Pugh class and hepatitis were significantly associated with local recurrence. Four patients (6.8%) had late adverse events of grade 3 or higher. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 PBT gives favorable treatment outcomes for unresectable ICC without distant metastasis and may be particularly effective in cases with large tumors.
    Type of Medium: Online Resource
    ISSN: 2235-1795 , 1664-5553
    URL: Article
    DOI: 10.1159/000531376
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 2666925-0
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