Details of a Researcher - Sanuki, Naoko

Papers - Sanuki, Naoko

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Postmastectomy radiation therapy for autologous breast reconstruction: a systematic review and meta-analysis for the 2022 Japanese Breast Cancer Society Clinical Practice Guideline

Ogita M., Sawayanagi S., Jinnouchi H., Yoshimura M., Yamauchi C., Sanuki N., Hamamoto Y., Hirata K., Kawamura M., Yamamoto Y., Saji S., Toyama T.

Breast Cancer 33 ( 1 ) 1 - 9 2026.01

ISSN 13406868

Background: The safety of postmastectomy radiation therapy (PMRT) after autologous breast reconstruction remains unclear. Therefore, we conducted a systematic review and meta-analysis to investigate the effects of PMRT on patients with breast cancer who underwent autologous breast reconstruction. Methods: A comprehensive literature search of English and Japanese articles until March 2021 was performed using PubMed/MEDLINE, the Cochrane Library, and Ichushi-Web. We included studies that compared the outcomes of patients with breast cancer who underwent immediate autologous breast reconstruction with and without PMRT. Outcomes including major complications, fat necrosis, and cosmetic results were assessed. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. Results: Ten studies (two retrospective case-controlled and eight retrospective cohort studies) comprising 3,123 cases were included. The rate of major complications was slightly higher in the PMRT group compared to the no PMRT group, but the difference was not statistically significant (13.2% vs. 12.2%, OR 1.58, 95% CI 0.93–2.68, P = 0.09). In contrast, the rate of fat necrosis was significantly increased in the PMRT group (17.2% vs. 8.1%, OR 2.71, 95% CI 1.58–4.65, P = 0.0003). Data on cosmetic outcomes were limited and not pooled for the meta-analysis. Conclusions: PMRT following autologous breast reconstruction was associated with a higher risk of fat necrosis, but not with a significantly increased rate of major complications. With careful patient selection and monitoring, PMRT after autologous breast reconstruction can be considered a safe and acceptable treatment option.

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Postmastectomy radiation therapy for implant-based breast reconstruction: a systematic review and meta-analysis for the 2022 Japanese Breast Cancer Society Clinical Practice Guideline

Ogita M., Sawayanagi S., Jinnouchi H., Yoshimura M., Yamauchi C., Sanuki N., Hamamoto Y., Hirata K., Kawamura M., Yamamoto Y., Saji S., Toyama T.

Breast Cancer Tokyo Japan 32 ( 6 ) 1169 - 1179 2025.11

ISSN 1340-6868

BACKGROUND: Implant-based breast reconstruction is the most commonly performed reconstructive technique following mastectomy. With an increasing number of patients undergoing implant-based breast reconstruction, concerns have arisen regarding the safety of postmastectomy radiation therapy (PMRT) in reconstructed breasts. This study aimed to investigate the safety of PMRT in implant-based breast reconstruction. METHODS: A comprehensive literature search was conducted for articles published up to March 2021. Eligible studies included clinical trials and observational studies comparing outcomes between patients with breast cancer undergoing immediate implant-based breast reconstruction with PMRT and those without PMRT. The primary outcomes included major complications, reconstruction failure, capsular contracture, and cosmetic outcomes. Pooled odds ratio (OR) with 95% confidence interval (CI) were calculated using a random-effects model. RESULTS: A total of 23 studies were identified, comprising one case-control study, one prospective cohort study, and 21 retrospective cohort studies. PMRT was significantly associated with increased rates of major complications (OR 2.62, 95% CI 1.82-3.77, P < 0.00001), reconstruction failure (OR 2.53, 95% CI 2.00-3.20, P < 0.00001), and capsular contracture (OR 9.63, 95% CI 5.77-16.06, P < 0.00001). Furthermore, cosmetic outcomes were significantly poorer in patients undergoing PMRT compared with those not receiving PMRT (OR 3.55, 95% CI 1.80-6.98, P < 0.003). CONCLUSIONS: This meta-analysis demonstrated that PMRT in implant-based breast reconstruction is associated with a significantly increased risk of adverse outcomes. Given these risks, treatment decisions should involve through discussions with patients to ensure that they are fully informed of the potential benefits and complications.

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Timing of postmastectomy radiation therapy in two-stage expander/implant-based breast reconstruction: a systematic review and meta-analysis for the 2022 Japanese breast cancer society clinical practice guideline

Ogita M., Sawayanagi S., Jinnouchi H., Yoshimura M., Yamauchi C., Sanuki N., Hamamoto Y., Hirata K., Kawamura M., Yamamoto Y., Saji S., Toyama T.

Breast Cancer 32 ( 6 ) 1159 - 1168 2025.11

ISSN 13406868

Background: In immediate expander/implant reconstruction, postmastectomy radiation therapy (PMRT) can be administered at two different time points: during tissue expander insertion or after exchange with an implant. The optimal timing for PMRT remains unclear. We conducted a systematic review and meta-analysis to evaluate the impact of PMRT timing on the outcomes of patients with breast cancer undergoing two-stage expander/implant breast reconstruction. Methods: A literature review of articles in English and Japanese up to March 2021 was performed using PubMed/MEDLINE, the Cochrane Library, and Ichushi-Web. Studies comparing the timing of PMRT in patients with breast cancer undergoing immediate two-stage expander/implant breast reconstructions and PMRT were included. The assessed outcomes included major complications, reconstruction failure, cosmesis, capsular contractures, and local recurrence. Results: Eleven studies encompassing 1,628 cases were identified. These included one prospective cohort study, one prospective case–control study, and nine retrospective cohort studies. No significant differences were observed in major complications between PMRT to expander and PMRT to implant (odds ratio [OR] 1.11, 95% confidence intervals [CI] 0.72–1.73, P = 0.64). Reconstruction failure was more prevalent in the expander group (OR 2.33, 95% CI 1.43–3.82, P = 0.0007), while severe capsular contractures occurred less frequently in the expander group (OR 0.33, 95% CI 0.12–0.92, P = 0.03). Conclusions: PMRT to expander was associated with higher reconstruction failure and lower severe capsular contracture rates, with no significant differences in major complications by timing. There is insufficient evidence to favor one approach over the other.

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【Radiation Therapy Today 2025　定位放射線治療の現状と未来】肝細胞がんに対する体幹部定位放射線治療

佐貫直子, 武田篤也

INNERVISION ((株)インナービジョン) 40 ( 11 ) 14 - 17 2025.10

ISSN 0913-8919

肝細胞がん(hepatocellular carcinoma:HCC)は,世界的に主要ながん死因の一つであり,日本においても依然として死亡率の高い疾患である。特に,C型肝炎ウイルス(HCV)やB型肝炎ウイルス(HBV)などの感染に伴う肝硬変を背景として発症することが多いが,近年では飲酒や脂肪肝による慢性肝障害もがん化の原因として増加しており,高齢化とともに治療選択の幅の重要性は増加している。HCCの局所治療は,切除,局所療法[ラジオ波焼灼療法(RFA)やマイクロ波凝固療法(MWA)],肝動脈化学塞栓療法(TACE)など多岐にわたるが,これらが非適応の症例に対する治療として,放射線治療(radiotherapy),特に体幹部定位放射線治療(stereotactic body radiation therapy:SBRT)が注目されている。SBRTは,短期間で高線量を腫瘍に集中的に照射する技術であり,非侵襲性と高い制御率が特徴である。本稿では,HCCに対するSBRTの現状とエビデンス,および今後の展望について論じる。(著者抄録)

Annual report of National Clinical Database-Breast Cancer Registry in 2021: characteristics categorized by body mass index and menopause status

Konishi T., Kumamaru H., Niikura N., Sagara Y., Miyashita M., Iwamoto T., Sanuki N., Tanakura K., Nagahashi M., Yoshida M., Kawashima M., Kinoshita T., Sasada S., Kinukawa N., Saji S., Ishida T., Taira N.

Breast Cancer 32 ( 4 ) 621 - 629 2025.07

ISSN 13406868

The Japanese Breast Cancer Society initiated the breast cancer registry in 1975 and migrated the registry to the National Clinical Database-Breast Cancer Registry (NCD-BCR) in 2012. This annual report presents 2021 data on the NCD-BCR. We analyzed data from 98,540 breast cancer (BC) cases registered in 2021. In 2021, 99.4% of BC cases were females with a median age of 61. Most (57.5%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery was performed in 42.8% of cases. Sentinel lymph node biopsy was performed in 67.8%, followed by radiotherapy in 71.0% of those post-conserving surgery. Regarding postoperative systemic therapy, 63.1% received endocrine therapy, 28.2% received chemotherapy, and 14.9% received molecular-targeted therapy. ER positivity was observed in 75.2%, HER2 in 13.6%, and Ki67 ≥30% in 29.1% of cases. The median age of premenopausal cases was 46 (interquartile range, 42–49) years and the median BMI was 21.5 (19.7–24.2) kg/m<sup>2</sup> whereas the median age of postmenopausal cases was 69 (61–76) years and the median BMI was 23.0 (20.6–25.9) kg/m<sup>2</sup>. In premenopausal cases, cases with normal BMI were more likely to be found at checkups without subjective symptoms and in the early stage than those with high BMI. The tendency of ER, PgR, HER2, and Ki67 status on BMI differed by menopause status; premenopausal cases with a lower BMI showed higher proportions of ER- and PgR-positive cancer and lower proportions of cancer with high Ki67. These nationwide descriptive statistics would help clinical explanation and further research on breast cancer.

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Clinicopathological analysis of the absence of seminal vesicle invasion in prostate cancer patients without radiological evidence on magnetic resonance imaging

Saihara K., Sanuki N., Hashimoto Y., Tochigi K., Hayakawa A., Tomioka S., Nara Y., Maruyama K.

Reports of Practical Oncology and Radiotherapy 30 ( 2 ) 216 - 222 2025.04

ISSN 15071367

Background: In definitive radiotherapy for localized prostate cancer, the seminal vesicle is included in the target volume for intermediate- and high-risk cases, though this increases the risk of toxicity to the bowel and rectum. This study retrospectively examined clinicopathological data to assess the absence of seminal vesicle invasion (SVI) in prostate cancer patients without radiological evidence of SVI using preoperative magnetic resonance imaging (MRI). Materials and methods: Patients with cT1c–cT3a prostate cancer who underwent radical prostatectomy between March 2010 and February 2024 were retrospectively selected, excluding those with distant metastasis, missing MRI data, preoperative systemic therapy, or delayed surgery post-biopsy. Preoperative risk factors [age, initial prostate-specific antigen (PSA), grade group (GG), clinical T stage, positive core ratio] and postoperative pathology were analyzed to assess SVI risk. The impact of GG changes between biopsy and postoperative pathology on risk classification and SVI treatment intensity in radiotherapy was also examined. Results: Of 368 patients, 308 met the inclusion criteria. SVI was observed in 26 patients (8.4%). Significant predictors of SVI included GG, initial PSA ≥ 8.6, and positive core ratio, with a positive core ratio < 0.5 and GG ≤ 3 indicating an SVI risk under 10%. GG discrepancies between biopsy and surgery were noted in 182 cases (59.1%), but had minimal impact on risk classification and SVI risk. Conclusions: Patients with a positive core ratio <0.5 had a low risk of SVI. GG discrepancies did not significantly underestimate prostate cancer risk, minimizing the risk of failing to treat true SVI.

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A Case of a 12-cm Huge Hepatocellular Carcinoma Treated Successfully With Two-Stage CyberKnife Stereotactic Body Radiation Therapy.

Nishimura S, Takeda A, Sanuki N, Kawase T, Tsukamoto N

Cureus 17 ( 4 ) e83094 2025.04

ISSN 2168-8184

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Final Results of a Multicenter Prospective Study of Stereotactic Body Radiation Therapy for Previously Untreated Solitary Primary Hepatocellular Carcinoma (The STRSPH Study)

Sanuki N., Kimura T., Takeda A., Ariyoshi K., Oyamada S., Yamaguchi T., Tsurugai Y., Doi Y., Kokubo M., Imagumbai T., Katoh N., Eriguchi T., Ishikura S.

International Journal of Radiation Oncology Biology Physics 121 ( 4 ) 942 - 950 2025.03

ISSN 03603016

Purpose: To report final results of a prospective study of stereotactic body radiation therapy (SBRT) in patients with previously untreated solitary primary hepatocellular carcinoma (HCC). Methods and Materials: This prospective, single-arm, multicenter phase 2 trial recruited patients with HCC who were unsuitable for, or refused, surgery and radiofrequency ablation, with 3-year overall survival rates as the primary endpoint and survival outcomes and adverse events as secondary endpoints. The prescribed SBRT dose was 40 Gy in 5 fractions. The final data were analyzed in November 2022. Results: Between 2014 and 2018, 36 patients (median age, 73.5 years) were registered; enrollment was closed before full recruitment due to slow accrual. Overall, 34 patients were analyzed for efficacy evaluation after excluding 2 patients. The median tumor size was 2.3 cm. The median follow-up times for all patients and for survivors were 49 and 56 months, respectively. The 3-year overall survival rate was 82% (95% confidence interval, 65%-92%). The 3-year local control rate was 93% (95% confidence interval, 76%-98%). Grade 3 or higher SBRT-related nonlaboratory toxicities were observed in 4 patients (11%). No grade 5 adverse events were observed. Conclusions: Final results of this phase 2 trial suggest the efficacy and safety of SBRT for newly diagnosed early-stage HCC that is unfit for other local therapies. Although this study was underpowered by the small number of registrations, the excellent results indicate that SBRT may be an alternative option for the management of early-stage HCC.

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Breast cancer statistics for Japan in 2022: annual report of the national clinical database-breast cancer registry—clinical implications including chemosensitivity of breast cancer with low estrogen receptor expression

Nagahashi M., Kumamaru H., Kinukawa N., Iwamoto T., Kawashima M., Kinoshita T., Konishi T., Sagara Y., Sasada S., Saji S., Sanuki N., Tanakura K., Niikura N., Miyashita M., Yoshida M., Ishida T., Taira N.

Breast Cancer 32 ( 2 ) 217 - 226 2025.03

ISSN 13406868

This is an annual report by the Japanese Breast Cancer Society, which provides statistics on the clinical data on breast cancer in Japan, extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR). This report includes an update of 102,453 breast cancer cases at 1339 institutions registered in the NCD-BCR in 2022. Among the 101,793 female patients, the median age at cancer diagnosis was 62 years (interquartile range, 50–73 years), and 29.4% of the patients were premenopausal. Of these patients, 15,437 (15.2%) and 42,936 (42.2%) were diagnosed with stage 0 and I disease, respectively. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were positive in 78.7%, 69.4%, and 12.8% of the patients, respectively. Of the 97,154 patients without distant metastasis, 40,521 (41.7%) underwent breast-conserving surgery, and 5780 (5.9%) patients underwent some form of breast reconstruction procedures at the time of mastectomy. A total of 66,894 (68.9%) patients were treated with sentinel lymph node biopsy and 7155 (7.4%) patients were treated with sentinel lymph node biopsy followed by axillary node dissection. In the group of patients treated with breast-conserving surgery (n = 40,521), 29,500 (72.8%) received whole-breast irradiation. In the group of patients who underwent mastectomy (n = 54,476), 6226 (11.4%) received radiation therapy to the chest wall. Of the 13,950 patients receiving preoperative chemotherapy with or without molecular targeted therapy, 4308 (30.9%) achieved a pathological complete response, with the highest rate of 60.5% in patients with the hormone receptor-negative/HER2-positive subtype.

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Design Paper: A Prospective, Multicenter, Single-arm, Phase II Trial of Tailored Axillary Surgery in Patients with Clinically Node-positive Breast Cancer in the Upfront Surgery Setting

Sagara, Y; Terata, K; Sakai, T; Takayama, S; Kitagawa, D; Iwatani, T; Tsukioki, T; Ogita, M; Sanuki, N; Yoshida, M; Tsuda, H; Yamamoto, S; Iwata, H; Shien, T

JMA JOURNAL 8 ( 1 ) 264 - 269 2025.01

ISSN 2433-328X

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高齢者に発症し,放射線治療が奏効した前額部脂腺癌の1例

水野彩加, 渡邊清未, 津田憲志郎, 小幡康範, 佐貫直子, 奈良佳治

日本皮膚科学会雑誌 ((公社)日本皮膚科学会) 135 ( 1 ) 128 - 128 2025.01

ISSN 0021-499X

【薬物療法の進歩における肝細胞癌の診断と治療Update】薬物療法の進歩における放射線治療の役割

佐貫直子, 木村智樹, 斉原和志, 武田篤也

肝臓クリニカルアップデート (医学図書出版(株)) 10 ( 2 ) 186 - 192 2024.10

ISSN 2189-4469

近年の高精度放射線治療技術の進歩により,病変に高線量を照射しつつ肝実質への線量を低減することが可能となった。肝細胞癌のさまざまなステージで有効で安全な治療成績が報告されている。肝細胞癌にはさまざまな治療法があるが,放射線治療はとくに各治療の適応境界において一定の役割を果たし得る。複合免疫療法をはじめとした薬物療法が進歩したいま,改めて放射線治療を含めた局所治療の意義が問われるであろう。(著者抄録)

Tailored Axillary Surgery (TAS) in Patients with Clinically Node-Positive Breast Cancer in the Upfront Surgery Setting: A Prospective, Single-Arm, Multicenter Trial

Terata, K; Sagara, Y; Shien, T; Sakai, T; Takayama, S; Kitagawa, D; Iwatani, T; Tsukioki, T; Ogita, M; Sanuki, N; Yoshida, M; Tsuda, H; Yamamoto, S; Iwata, H

CANCER RESEARCH 84 ( 9 ) 2024.05

ISSN 0008-5472

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The Japanese breast cancer society clinical practice guidelines for radiation treatment of breast cancer, 2022 edition

Yoshimura M., Yamauchi C., Sanuki N., Hamamoto Y., Hirata K., Kawamori J., Kawamura M., Ogita M., Yamamoto Y., Iwata H., Saji S.

Breast Cancer 31 ( 3 ) 347 - 357 2024.05

ISSN 13406868

The Breast Cancer Clinical Practice Guidelines, organized by the Japanese Breast Cancer Society (JBCS), were published in 2022. We present the English version of the Radiation Therapy (RT) section of the guidelines. The JBCS formed a task force to update the 2018 version of the JBCS Clinical Practice Guidelines. The Background Questions (BQs) contain the standard treatments for breast cancer in clinical practice, whereas the Clinical Questions (CQs) address daily clinical questions that remain controversial. Future Research Questions (FRQs) explore the subjects that are considered important issues, despite there being insufficient data for inclusion as CQs. The task force selected the 12 BQs, 8 CQs, and 6 FRQs for the RT section. For each CQ, systematic literature reviews and meta-analyses were conducted according to the Minds Manual for Guideline Development 2020, version 3.0. The recommendations, strength of recommendation, and strength of evidence for each CQ were determined based on systematic reviews and meta-analyses, and finalized by voting at the recommendation decision meeting.

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2020 Annual Report of National Clinical Database-Breast Cancer Registry: 10-year mortality of elderly breast cancer patients in Japan

Sagara Y., Kumamaru H., Niikura N., Miyashita M., Konishi T., Iwamoto T., Sanuki N., Tanakura K., Nagahashi M., Hayashi N., Yoshida M., Kinukawa N., Watanabe C., Toi M., Saji S.

Breast Cancer 31 ( 2 ) 179 - 184 2024.03

ISSN 13406868

The Japanese Breast Cancer Society initiated the breast cancer registry in 1975, which transitioned to the National Clinical Database-Breast Cancer Registry in 2012. This annual report presents data from 2020 and analyzes the ten-year mortality rates for those aged 65 and older. We analyzed data from 93,784 breast cancer (BC) cases registered in 2020 and assessed 10-year mortality rates for 36,279 elderly patients diagnosed between 2008 and 2012. In 2020, 99.4% of BC cases were females with a median age of 61. Most (65%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery rates varied with stages: 58.5% at cStage I, 30.8% at cStage II, and 13.1% at cStage III. Sentinel lymph node biopsy was done in 73.6% of cases, followed by radiotherapy in 70% of those post-conserving surgery and chemotherapy in 21.1% post-surgery. Pathology showed that 63.4% had tumors under 2.0 cm, 11.7% had pTis tumors, and 77.3% had no axillary lymph node metastasis. ER positivity was seen in 75.1%, HER2 in 14.3%, and 30% had a Ki67 positivity rate above 30%. Across all stages and subtypes, there was a trend where the 10-year mortality rates increased for individuals older than 65 years. In Stage I, many deaths were not directly linked to BC and, for those with HER2-type and triple-negative BC, breast cancer-related deaths increased with age. Within Stage II, patients older than 70 years with luminal-type BC often experienced deaths not directly linked to BC, whereas patients below 80 years with HER2-type and triple-negative BC, likely had breast cancer-related deaths. In Stage III, breast cancer-related deaths were more common, particularly in HER2 and triple-negative BC. Our prognostic analysis underscores distinct mortality patterns by stage, subtype, and age in elderly BC patients. It highlights the importance of personalized treatment strategies, considering subtype-specific aggressiveness, age-related factors, and comorbidities.

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Survival trends and patient characteristics between 2004 and 2016 for breast cancer in Japan based on the National Clinical Database-Breast Cancer Registry

Iwamoto T., Kumamaru H., Niikura N., Sagara Y., Miyashita M., Konishi T., Sanuki N., Tanakura K., Nagahashi M., Hayashi N., Yoshida M., Watanabe C., Kinukawa N., Toi M., Saji S.

Breast Cancer 31 ( 2 ) 185 - 194 2024.03

ISSN 13406868

This is a prognostic report by the Japanese Breast Cancer Society on breast cancer extracted from the National Clinical Database-Breast Cancer Registry of Japan. Here, we present a summary of 457,878 breast cancer cases registered between 2004 and 2016. The median follow-up duration was 5.6 years. The median age at the start of treatment was 59 years (5–95%: 38–82 years) and increased from 57 years between 2004 and 2008 to 60 years between 2013 and 2016. The proportion of patients with Stage 0–II disease increased from 74.5% to 78.3%. The number of cases with estrogen and progesterone receptor positivity increased from 74.8% to 77.9% and 60.5% to 68.1%, respectively. Regarding (neo-)adjuvant chemotherapy, the taxane (T) or taxane-cyclophosphamide (C) regimen increased by 2.4% to 8.2%, but the (fluorouracil (F)) adriamycin (A)-C-T/(F) epirubicin (E)C-T and (F)AC/(F)EC regimens decreased by 18.6% to 15.2% and 13.5% to 5.0%, respectively. Regarding (neo-)adjuvant anti-human epidermal growth factor-2 (HER2)-targeted therapy, the use of trastuzumab increased from 4.6% to 10.5%. The rate of sentinel lymph node biopsy increased from 37.1% to 60.7%, while that of axillary dissection decreased from 54.5% to 22.6%. Improvements in disease-free and overall survival were observed in patients with HER2-positive breast cancer, but there was no apparent trend in patients with hormone receptor-positive, HER2-negative, or triple-negative breast cancers.

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Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations

Wong H.C.Y., Wallen M.P., Chan A.W., Dick N., Bonomo P., Bareham M., Wolf J.R., van den Hurk C., Fitch M., Chow E., Chan R.J., AlKhaifi M., Alvarez B.A., Banerjee S., Bloomquist K., Borman P., Borthwick Y., Chan D., Chan S.M., Chan Y., Jean Cheng N.S., Choi J.I., Choy Y.P., Corbin K., Dylke E., Hammond P., Hirakawa S., Hirata K., Lee S.F., Holt M., Johnstone P., Kikawa Y., Kirk D., Kotani H., Kwok C., Lai J., Lim M.Y., Lock M., Lorden B., Mack P., Magno S., Meattini I., Marta G.N., McNeely M., Mondry T., Lopez Montoya L.E., Ogita M., Osaka M., Phan S., Poortmans P., Rafn B.S., Recht A., Rembielak A., Río-González A., Robijns J., Sanuki N., Simone C.B., Spałek M., Tane K., Nevola Teixeira L.F., Terada M., Trombetta M., Wong K.H., Yoshidome K.

Eclinicalmedicine 68 2024.02

ISSN 2589-5370

Background: Developing strategies to prevent breast cancer-related arm lymphoedema (BCRAL) is a critical unmet need because there are no effective interventions to eradicate it once it reaches a chronic state. Certain strategies such as prospective surveillance programs and prophylactic lymphatic reconstruction have been reported to be effective in clinical trials. However, a large variation exists in practice based on clinician preference, organizational standards, and local resources. Methods: A two-round international Delphi consensus process was performed from February 27, 2023 to May 25, 2023 to compile opinions of 55 experts involved in the care and research of breast cancer and lymphoedema on such interventions. Findings: Axillary lymph node dissection, use of post-operative radiotherapy, relative within-arm volume increase one month after surgery, greater number of lymph nodes dissected, and high body mass index were recommended as the most important risk factors to guide selection of patients for interventions to prevent BCRAL. The panel recommended that prospective surveillance programs should be implemented to screen for and reduce risks of BCRAL where feasible and resources allow. Prophylactic compression sleeves, axillary reverse mapping and prophylactic lymphatic reconstruction should be offered for patients who are at risk for developing BCRAL as options where expertise is available and resources allow. Recommendations on axillary management in clinical T1–2, node negative breast cancer patients with 1–2 positive sentinel lymph nodes were also provided by the expert panel. Routine axillary lymph node dissection should not be offered in these patients who receive breast conservation therapy. Axillary radiation instead of axillary lymph node dissection should be considered in the same group of patients undergoing mastectomy. Interpretation: An individualised approach based on patients' preferences, risk factors for BCRAL, availability of treatment options and expertise of the healthcare team is paramount to ensure patients at risk receive preventive interventions for BCRAL, regardless of where they are receiving care. Funding: This study was not supported by any funding. RJC received investigator grant support from the Australian National Health and Medical Research Council (APP1194051).

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Annual report of the Japanese Breast Cancer Registry for 2019

Miyashita M., Kumamaru H., Niikura N., Sagara Y., Konishi T., Iwamoto T., Sanuki N., Tanakura K., Nagahashi M., Hayashi N., Yoshida M., Watanabe C., Kinukawa N., Toi M., Saji S.

Breast Cancer 31 ( 1 ) 16 - 23 2024.01

ISSN 13406868

This is an annual report by the Japanese Breast Cancer Society regarding the clinical data on breast cancer extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR) of Japan. Here, we present an updated summary of 98,300 breast cancer cases registered in 2019. The median age at cancer diagnosis was 61 years (interquartile range 49–72 years), and 30.6% of the breast cancer patients were premenopausal. Of the 93,840 patients without distant metastases, 14,118 (15.0%) and 42,047 (44.8%) were diagnosed with stage 0 and I disease, respectively. Breast-conserving surgery was performed in 42,080 (44.8%) patients. Regarding axillary procedures, 62,677 (66.8%) and 7371 (7.9%) patients underwent sentinel node biopsy and axillary node dissection after biopsy, respectively. Whole breast irradiation was administered to 29,795 (70.8%) of the 42,080 patients undergoing breast-conserving surgery. Chest wall irradiation was administered to 5524 (11.1%) of the 49,637 patients who underwent mastectomy. Of the 6912 clinically lymph node-negative patients who received preoperative therapy, 5250 (76.0%) and 427 (6.2%) underwent sentinel node biopsy and axillary node dissection after biopsy, respectively; however, 602 (8.7%) patients initially underwent axillary node dissection without biopsy.

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Toxicity profile and clinical outcomes of stereotactic body radiotherapy with a focal boost without fiducials or perirectal hydrogel spacer for localized prostate cancer

Tsurugai Y., Takeda A., Sanuki N., Aoki Y., Kimura Y., Oku Y., Eriguchi T., Yamanaka H., Machida M., Matsushita T., Saito S.

Strahlentherapie Und Onkologie 201 ( 8 ) 779 - 787 2024

ISSN 01797158

Purpose: Whole-prostate dose escalation in stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) can improve oncological outcomes, albeit at the cost of increased toxicity. A focal boost to the dominant intraprostatic lesion (DIL) is gaining interest as an alternative approach. Herein, we investigate the safety and efficacy of this approach. Methods: This retrospective study enrolled patients with localized PCa who underwent five-fraction SBRT with a focal boost to the DIL at our institution between May 2016 and August 2021. The prescription doses to the whole prostate were 35 and 36.25 Gy for low- to favorable intermediate-risk PCa and unfavorable intermediate- to high-risk PCa, respectively. The focal boost to the DIL was up to 115–140% of the prescribed dose. None of the patients underwent pretreatment fiducial or perirectal hydrogel spacer placement. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities and oncological outcomes were assessed. Results: Among the 520 patients, 44% were categorized as patients with high-risk PCa. The median follow-up period was 42.9 months. No acute or late grade ≥3 toxicities were observed. Acute and late grade 2 GU toxicities were observed in 22.3 and 6.1%, respectively, while GI toxicities were observed in 2.1 and 0.8% of the patients. The 4‑year relapse-free survival rate was 94.8% among all patients. Conclusion: Our results indicate that SBRT with a focal boost without fiducials or perirectal hydrogel spacer for localized PCa has a promising toxicity profile and oncological outcomes. Longer follow-up studies are necessary to adequately evaluate late toxicities and efficacy.

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A Case of Treatment-resistant Extensive-disease Small-cell Lung Cancer with Multiple Liver Metastases Shrunk by Whole Liver Radiotherapy

Kodama S., Yoshida M., Miki H., Goto H., Masuda K., Fujiwara A., Nanpei Y., Sanuki N., Goto D., Tsuruga T.

Japanese Journal of Lung Cancer 63 ( 7 ) 959 - 964 2023.12

ISSN 03869628

Background. Liver metastases are common in patients with small-cell lung cancer (SCLC) and are associated with a poor prognosis. Recent reports, mainly from abroad, have demonstrated the efficacy of palliative radiotherapy for liver metastases, but this therapy has not been widely used or reported in Japan. Case. Since late June, 20XX−1, a 76-year-old man had been treated with carboplatin, etoposide, and durvalumab for extensive-disease SCLC. After completing six treatment cycles, the patient was undergoing maintenance therapy with durvalumab. Owing to worsening of the primary lesion, liver metastases, and para-aortic lymph node metastases, the patient was admitted to our hospital on late February, 20XX, for treatment modification. Since more than 90 days had passed since the last dose of etoposide, a sensitive relapse was considered, and carboplatin plus etoposide therapy was initiated. However, back pain and jaundice appeared and became severe, requiring the initiation of regular opioid therapy. The symptoms were suggestive of capsular extension due to the rapid growth of multiple liver metastases, prompting whole liver radiotherapy (21 Gy/7 fr) to alleviate pain. There was a temporary increase in pain due to a flare reaction, requiring a temporary increase in opioid and steroid doses, but the symptoms rapidly resolved, and the patient was discharged with independent gait. The patient was subsequently readmitted and switched to amrubicin therapy. Approximately one month after whole liver radiotherapy, all symptoms and multiple liver metastases were under control. Conclusion. SCLC is radiosensitive and responds well to low-dose radiotherapy. Radiation-induced liver disease is unlikely to occur at low doses, and whole liver radiotherapy is considered effective even in patients with treatment-resistant SCLC.

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