This study aimed to evaluate clinical outcomes and the toxicity of intensity-modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) combined with androgen-deprivation therapy for clinically node-positive (cN1) prostate cancer. We retrospectively analyzed 97 patients with cN1 prostate cancer who received SIB-IMRT between June 2008 and October 2017 at our hospital. The prescribed dosages delivered to the prostate and seminal vesicle, elective node area, and residual lymph nodes were 69, 54, and 60 Gy in 30 fractions, respectively. Kaplan–Meier analysis was used to determine 5-year biochemical relapse-free survival (bRFS), relapse-free survival (RFS), overall survival (OS), and prostate cancer-specific survival (PCSS). Toxicity was evaluated using the Common Terminology Criteria for Adverse Events ver. 4.0. Over a median follow-up duration of 60 months, the 5-year bRFS, RFS, OS, and PCSS were 85.1%, 88.1%, 92.7% and 95.0%, respectively. Acute Grade 2 genito-urinary (GU) and gastro-intestinal (GI) toxicities were observed in 10.2% and 2.1%, respectively, with no grade ≥3 toxicities being detected. The cumulative incidence rates of 5-year Grade ≥2 late GU and GI toxicities were 4.7% and 7.4%, respectively, with no Grade 4 toxicities being detected. SIB-IMRT for cN1 prostate cancer demonstrated favorable 5-year outcomes with low incidences of toxicity.

The promising results of the PACIFIC study led to the approval of consolidation durvalumab for coverage by the National Health Insurance (NHI) in 2018 for patients with locally-advanced unresectable non-small cell lung carcinoma (NSCLC) treated with definitive concurrent chemoradiotherapy (CCRT). However, the effect of NHI coverage on the patterns of care for this population remains unclear. Here, we conducted a questionnaire-based survey to determine the patterns of care for patients with stage II–III NSCLC treated with definitive radiotherapy in 2017 (pre-durvalumab era) or in 2019 (post-durvalumab era). Data were obtained from 11 radiotherapy facilities in Gunma prefecture, which has a population of 1.94 million. We identified 80 and 83 patients with stage II–III NSCLC who received definitive radiotherapy in Gunma in 2017 and 2019, respectively. At a given facility, CCRT was the treatment of choice in a significantly greater proportion of patients in 2019 than in 2017 (66% ± 20% vs 51% ± 29%, P = 0.041). Intensity-modulated radiotherapy (IMRT) was more frequent in 2019 than in 2017 (24% vs 1.2%). Carboplatin plus paclitaxel was used for CCRT at higher rate in 2019 than in 2017 (73% vs 44%). Consolidation durvalumab was performed in 73% (40/55) of CCRT-treated patients in 2019, and the treatment was performed for the planned 12 months in 45% (18/40) of patients. These data indicate that NHI coverage of durvalumab might be a possible reason for choosing CCRT in patients with stage II–III NSCLC in the real-world setting.

Despite recognizing the effectiveness of carbon-ion radiotherapy (C-ion RT) in treating head and neck adenoid cystic carcinoma (HN-ACC), the impact of perineural tumor spread (PNTS) on treatment outcomes and the relationship between PNTS and post-treatment marginal recurrences remain unexplored. Therefore, we analyzed the efficacy of C-ion RT in HN-ACC, focusing on PNTS including details of post-treatment marginal recurrence and indicators for future treatment strategies. In this retrospective study, we included 74 patients diagnosed with HN-ACC who underwent C-ion RT between June 2010 and July 2022. Treatment dosages were either 57.6 or 64.0 Gy (relative biological effectiveness) delivered in 16 fractions. Patients undergoing C-ion RT were identified retrospectively from medical records. PNTS was evaluated by magnetic resonance imaging for detecting extratumoral extension to peritumoral nerves. The median duration of follow-up was 46.4 months. Local recurrence developed in 19 patients. Moreover, most marginal recurrences occurred within the irradiated margins. The 5-year rates for local control (LC), progression-free survival (PFS), and overall survival (OS) were 67.6 %, 47.7 %, and 79.0 %, respectively. LC (p = 0.005) and PFS (p = 0.013) demonstrated significant variances on analysis based on PNTS occurrence; however, OS did not exhibit a similar pattern. Our findings highlight the importance for considering disease-specific characteristics and the need for developing targeted strategies that address the complex nature of HN-ACC, particularly in cases involving PNTS, to enhance treatment outcomes and potentially reduce recurrence rates.

Background: Bronchial asthma is a chronic inflammatory disease characterized by airway infiltration of inflammatory cells (eg, eosinophils, lymphocytes), and obstructive changes and hyperresponsiveness of the airways. Chronic inflammation leads to airway remodeling. Matrix metalloproteinase-2 (MMP2) is critical regulator of the extracellular matrix. The role of MMP2 in bronchial asthma is unclear. Aims and Objects: The objective of the present study was to assess the role of the MMP2 in bronchial asthma. Methods: We developed a novel MMP-2 transgenic (TG) mouse that expresses high levels of human MMP-2 in the lung. We sensitized MMP-2 TG and wild type (WT) mice with ovaalbumin eight times for two months. After sensitization, transgenic asthma groups (MMP2/OVA) and wild type asthma groups (WT/OVA) were challenged with ovaalbumin inhalation for seven days before sacrifice. Mice receiving saline instead of ovalbumin (MMP2/SAL; WT/SAL) were used as controls. We compared airway hyperresponsiveness and the levels of cytokines and cell infiltration between TG and WT mice. Results: Hypersensitivity and expression interleukins in MMP2/OVA group decreased significantly than those in WT/OVA group. Conclusion: MMP2 may have protective roles on occurance and progression of bronchial asthma.

In 2021, Japan's medical expenses will exceed 45 trillion yen, and the shortage of doctors, especially in remote and mountainous areas, is becoming serious, making it difficult to maintain the medical system. We have conducted a study of 800 health consultation text data. We developed an on-premise health counseling LLM system by constructing a dialogue flow based on 800 health counseling text data. We conducted a Turing test of this system using 200 test data and verified its effectiveness with three medical professionals. The Turing test was a comparison experiment between this system and a conventional LLM system. The health counseling LLM infrastructure focuses on exercise guidance and analyzes gender, height, weight, body fat percentage, and muscle mass. While the accuracy of the conventional LLM system was 87.5%, this system showed a higher accuracy of 93.1%. Although telemedicine has been slow to spread in Japan, the introduction of a health consultation system using Personal Health Record and Large Language Models has the potential to reduce the burden on physicians. In the future, we aim to improve the accuracy of the system by using Japanese language and medical-specific evaluation scales.