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        Early Detection of the Acute Exacerbation of Interstitial Pneumonia after the Surgical Resection of Lung Cancer by Planned Chest Computed Tomography

        Kunihiro Oyama,Masato Kanzaki,Mitsuko Kondo,Hideyuki Maeda,Kei Sakamoto,Tamami Isaka,Jun Tamaoki,Takamasa Onuki 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.3

        Background: To improve postoperative outcomes associated with interstitial pneumonia (IP) in patients with lung c ancer, t he m anagement of t he p ostoperative a cute e xacerbation of I P (PAEIP) was investigated. Methods: Patients with primary lung cancer were considered to be at risk for PAEIP (possible PAEIP) based on a preoperative evaluation. The early phase of this study was from January 2001 to December 2008, and the late phase was from January 2009 to December 2014. In the early phase, chest computed tomography (CT) was performed for patients for whom PAEIP was suspected based on their symptoms, whereas in the late p hase, chest CT w as r outinely p erformed w ithin a few days p ostoperatively. The n umbers o f possible PAEIP cases, actual PAEIP cases, and deaths within 90 days due to PAEIP were compared between both phases. Results: In the early and late phases, surgery was performed in 712 and 617 patients, 31 and 72 possible PAEIP cases were observed, nine and 12 actual PAEIP cases occurred, and the mean interval from the detection of PAEIP to starting treatment was 7.3±2.3 and 5.0±1.8 days, respectively. Five patients died in the early phase, and one patient died in the late phase. Significantly fewer PAEIP-related deaths were observed in the late phase (p<0.05). Conclusion: Identifying patients at risk for PAEIP by routine postoperative CT examinations led to the early diagnosis and treatment of PAEIP, resulting in the reduction of PAEIP-related mortality.

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        Switching to systemic therapy after locoregional treatment failure: Definition and best timing

        Sadahisa Ogasawara,Yoshihiko Ooka,Keisuke Koroki,Susumu Maruta,Hiroaki Kanzaki,Kengo Kanayama,Kazufumi Kobayashi,Soichiro Kiyono,Masato Nakamura,Naoya Kanogawa,Tomoko Saito,Takayuki Kondo,Eiichiro Suz 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.2

        In patients with unresectable hepatocellular carcinoma (HCC) without both macrovascular invasion and extrahepatic metastasis, the initial treatment choice recommended is transarterial chemoembolization (TACE). Before sorafenib came into wide use, TACE had been pointlessly carried out repeatedly. It was in the early 2010s that the concept of TACE refractory was advocated. Two retrospective studies from Japan indicated that conversion from TACE to sorafenib the day after patients were deemed as TACE refractory improved overall survival compared with continued TACE, according to the definition by the Japan Society of Hepatology. Nowadays, phase 3 trials have shown clinical benefits of several novel molecular target agents. Compared with the era of sorafenib, sequential treatments with these molecular target agents have gradually prolonged patients’ survival and have become major strategies in patients with HCC. Taking these together, conversion from TACE to systemic therapies at the time of TACE refractory, compared with before, may have a greater impact on survival and may be considered deeper in the decisions-making process in patients with unresectable HCC who are candidate for TACE. Up-to-date information on the concept of TACE refractory is summarized in this review. We believe that the survival of patients with unresectable HCC without both macrovascular invasion and extrahepatic metastasis may be dramatically improved by optimal timing of TACE refractory and switching to systemic therapies.

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