We investigated the factors predicting radiation-induced organizing pneumonia (RIOP) relapse after tangential breast irradiation. The participants included 23 patients diagnosed with RIOP at the St. Marianna University School of Medicine Hospital between January 2008 and March 2015. Relapse was defined as the appearance of new lesions on diagnostic images during follow-up or after commencing treatment. The relapse-free survival rate and the following 9 parameters were compared between patients with and without RIOP relapse: 1) age (less than vs. equal to or more than the median); 2) white blood cell count (less than vs. equal to or more than the median); 3) C-reactive protein (CRP) level at the time of RIOP diagnosis (less than normal, more than normal/ less than borderline, and more than borderline); 4) boost irradiation (yes vs. no); 5) maximum lung depth on linacgraphy (less than vs. equal to or more than the median); 6) hormone therapy (yes vs. no); 7) chemotherapy (yes vs. no); 8) RIOP ratio in the whole lung (less than vs. equal to or more than the median) at the time of RIOP diagnosis; and 9) use of corticosteroids (yes vs. no). The Kaplan-Meier method was used for statistical analysis, with relapse as the cutoff. The follow-up period spanned the date of RIOP onset to May 30, 2015. The level of significance for 2-sided tests was p < 0.05. Relapse was evident in 14 patients (60.8%). The relapse-free survival rate was significantly greater in the normal CRP group (less than 0.30 mg/dl) than in the abnormal CRP group (more than 0.36 mg/dl) (p = 0.044) and in the normal/borderline CRP group (less than 0.36 mg/dl) than in the high CRP group (more than 0.70 mg/dl) (p < 0.01). The CRP level at RIOP onset may be a useful predictor of relapse after breast-conserving therapy. Y. Okada et al.
Background: Small-cell lung cancer (SCLC) has poor prognosis owing to the high risk of distant metastasis. Purpose: To identify the prognosticators of brain metastasis from SCLC treated by whole-brain radiotherapy. Material and methods: We evaluated patients diagnosed with primary brain metastasis from SCLC between 1 January 2010 and 30 September 2019. Age, sex, disease stage at the first examination, time to the diagnosis of brain metastasis, state of other lesions at the diagnosis of brain metastasis, haematological parameters, neurologic symptoms, whole-brain radiotherapy dose, imaging findings of the brain metastasis (single or multiple), and chemotherapy and radiotherapy status were investigated for correlations with survival from the diagnosis of brain metastasis. Results: A total of 24 participants were evaluated. After radiotherapy, the median survival period was 118·5 (22–998) days, and 21 patients died during the follow-up period. Multivariate stepwise analysis of the four parameters of lactate dehydrogenase (LDH) level (within vs. above the reference value), platelet level (continuous variable), neurologic symptoms (with versus. without), and NSE (neuron-specific enolase) level (continuous variable) identified the following significant differences: neurologic symptoms were 3·81 (95% CI 1·07–13·5, p = 0·04), and NSE was 1·01 (95% CI 1·00–1·01, p = 0·04). Conclusion: NSE and neurologic symptoms are prognosticators of brain metastasis from SCLC treated by whole-brain radiotherapy.
In this study, we evaluate the analgesic effect of strontium-89 (Sr-89) for patients with breast cancer having multiple bone metastases and identify positive predictive factors. We retrospectively evaluated 15 patients who were administered Sr-89 for painful bone metastases from breast cancer at St. Marianna University Hospital between January 2010 and April 2014. For patients receiving multiple doses, only the first dose was evaluated. Pain relief was defined as a decrease in the score of the Numeric Rating Scale (NRS) or requirement of reduced doses of pain medication 1-2 months after being on Sr-89 administration. The associations between pain relief owing to Sr-89 and that owing to bone scan index, interval from bone metastasis onset to Sr-89 administration, zoledronate and denosumab treatment history, hormone therapy/aromatase inhibitor history, and chemotherapy history were assessed. A logistic model was used for statistical analysis. Pain relief was observed in 11 (73.3%) of 15 patients. No statistically significant value was observed between pain relief and bone scan index, interval from bone metastasis onset to Sr-89 administration, zoledronate and denosumab treatment history, hormone therapy/aromatase inhibitor history, and chemotherapy. Thus, Sr-89 was effective for 70% of patients with breast cancer bone metastases, although positive predictive factors for pain relief could not be determined.
This study aimed to evaluate the imaging findings and prognostic factors after whole-brain radiotherapy in patients with carcinomatous meningitis from breast cancer. A retrospective analysis of imaging data and prognostic factors was performed in patients treated with whole-brain radiotherapy or whole-brain/spine radiotherapy immediately after the first diagnosis of carcinomatous meningitis from breast cancer at our hospital from January 1, 2010 to December 31, 2018. Statistical significance was set at P < .05 (two-tailed).All patients (n = 31) were females with the mean age of 58.0 ± 11.0 years. The breast cancer subtypes were luminal (n = 14, 45.1%), human epidermal growth factor receptor 2 (HER2)-positive (n = 9, 29.0%), and triple-negative (n = 8, 26.0%) breast cancer. Brain metastasis and abnormal contrast enhancement in the sulci were observed in 21 (67.7%) and 24 (80.6%) patients, respectively. The median survival time after cancerous meningitis diagnosis was 62 (range, 6–657) days. Log-rank test showed significant differences in median survival time after cancerous meningitis diagnosis: 18.0 days for subjects treated with 30 Gy in < 10 fractions (n = 7) vs 78.5 days for subjects treated with 30 Gy in ≥10 fractions (n = 24) ( P < .01) and 23.0 days for the triple-negative subtype vs 78.5 days for the other subtype ( P < .01) groups. Univariate analysis using the Cox regression model showed significant differences in median survival time after cancerous meningitis diagnosis between the group treated with 30 Gy in <10 fractions and the group treated in ≥10 fractions (hazard ratio [HR] 0.08, 95% confidence interval [CI], 0.03–0.26; P < .01), and between the triple-negative subtype and the other subtypes (HR = 5.48; 95% CI, 1.88–16.0; P < .01) groups. Discontinuation of whole-brain radiotherapy and the presence of triple-negative breast cancer were indicators of poor prognosis.
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