Gan to kagaku ryoho. Cancer & chemotherapy
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There are many things that we can learn from the clinical trials conducted in the U. S. They move ahead based on explicit basic principles regarding various matters such as the method for setting up the clinical trial system, selection of CRO, selection of investigators, monitoring activities that are mainly based on their direct access to source documents and sponsor's action when a lack of compliance with GCP occurs. ⋯ It is evident that compliance with these standards is ensured in the U. S. by the activities of study coordinators who take greater part in the clinical studies themselves. In order to expedite introduction of the study coordinator system in Japan even just a little, sponsors should consider providing medical institutions with relevant information as well as a chance to educate and train their study coordinators to optimize the function.
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Gan To Kagaku Ryoho · Jul 1998
Review[Prediction of survival of terminally ill cancer patients--a prospective study].
Planning effective palliative care requires accurate estimation of survival. A prospective study was performed on 150 hospice inpatients to identify prognostic factors in terminally ill cancer patients. ⋯ Multiple regression analysis showed that five factors were independent predictors of survival: performance status, dyspnea at rest, appetite loss, edema, and delirium. We discussed current problems and future directions of survival prediction for terminally ill cancer patients.
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Gan To Kagaku Ryoho · Jul 1998
Review Comparative Study[Differences between Japan and the west in treatment strategy for gastrointestinal cancer--gastric cancer].
Diagnosis, staging, and treatment strategies for gastric cancer were reviewed with regard to differences between Japan and the West. In Japan, detection of early gastric cancer is common due to mass screening and widespread use of endoscopy. Treatment options for gastric cancer vary from endoscopic mucosal resection to the super-extended lymphadenectomy. ⋯ In Japan, D2 lymphadenectomy is the standard, and now a more extended surgery (D4) is being evaluated in a randomized controlled study, while D2 lymphadenectomy has been reported to be associated with high morbidity and mortality in European studies. Adjuvant chemotherapy is more commonly used in Japan, mostly with oral fluorouracil. However, no regimen has been shown effective in the adjuvant setting in either Japanese and Western studies.
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Endocrine therapy for prostate cancer has been changing rapidly. While LH-RH agonists have been popularly used in medication, their long-acting sustained release formulation is about to be introduced to clinics in Japan. ⋯ In addition, a broader range of endocrine therapies is being studied for treatment of prostate cancer. In terms of treatment methods, a number of attempts are made in selection of subject patients, treatment timing, combination treatment and so on.
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This is a review of the recent progress in chemoradiotherapy of locally advanced lung cancer. In the limited disease stage of small cell lung cancer, a meta-analysis showed patients treated with a combination of chemotherapy and radiotherapy have a statistically significantly longer survival than those with chemotherapy alone. However, the timing of the combination of radiation and chemotherapy has not been clarified. ⋯ Our randomized study indicated the addition of radiotherapy after chemotherapy is superior in long-term survival to chemotherapy alone. The West Japan Lung Cancer Group conduct a phase III randomized study comparing concurrent and sequential chemoradiotherapy, and the determination of survival is now in the follow-up stage. The role of induction chemoradiotherapy before surgical resection, comparison of chemoradiotherapy with induction chemoradiotherapy followed by surgery, and the effects and safety of the combination of new drugs and radiotherapy are now under investigation.