Faculty Profiles - NAGANAWA, Shinji

High-dose-rate intracavitary brachytherapy for recurrent cervical cancer in the vaginal stump after hysterectomy Reviewed Open Access

Kozai Yuka, Itoh Yoshiyuki, Kawamura Mariko, Nakahara Rie, Ito Junji, Okada Tohru, Kikkawa Fumitaka, Ikeda Mitsuru, Naganawa Shinji

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 81 ( 3 ) page： 351 - 358 2019.8

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

This study aimed to evaluate the treatment outcomes of patients who received high-dose-rate intracavitary brachytherapy (HDR-BT) using Iridium-192 with or without external beam radiotherapy as definitive treatment for recurrent cervical cancer after hysterectomy. Thirty-six patients with local recurrence after hysterectomy received radiotherapy including HDR-BT from 2005 to 2013. Overall survival, local control rate, and progression-free survival were estimated retrospectively via the Kaplan-Meier method. Late adverse events were also scored using the Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time was 38 (range, 7.4-101.3) months. The 3-year estimates of overall survival, local control rate, and progression-free survival were 100.0%, 82.8%, and 76.8%, respectively. Two patients (5.6%) had grade 2 lymphedema, but no other adverse events greater than grade 2 were reported. In conclusion, HDR-BT was an effective treatment modality for patients with cervical cancer recurrence in the vaginal stump.

DOI： 10.18999/nagjms.81.3.351

Whole abdominopelvic intensity-modulated radiation therapy for peritoneal disseminated rhabdomyosarcoma with three-year follow-up: a case report. Reviewed International journal Open Access

Mariko Kawamura, Kuniyasu Okudaira, Yoshiyuki Itoh, Takeshi Kamomae, Eri Nishikawa, Hideki Muramatsu, Yoshiyuki Takahashi, Kazuki Yokota, Shinji Naganawa

Radiation oncology (London, England) Vol. 14 ( 1 ) page： 127 - 127 2019.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The role of local radiotherapy in the treatment of metastatic rhabdomyosarcoma is important. However, with peritoneal dissemination, the application of local therapy is challenging. Although there are few reports addressing the efficacy of the whole abdominopelvic irradiation to peritoneal disseminated rhabdomyosarcoma patients, no precise curse of treatment nor the follow up result is explained in paper nor in the text. CASE PRESENTATION: Six years old rhabdomyosarcoma boy with peritoneal dissemination was treated at our facility under COG D9803 protocol (vincristine, dactinomycin, and cyclophosphamide (VAC)). He underwent tumor resection on the 14th week according to the protocol. During surgery, the 2-cm residual tumor was completely resected, but in the pelvis, numerous nodules that were suspected as peritoneal disseminated tumors were observed. We administered 30 Gy/20fr whole abdominopelvic radiotherapy using volumetric modulated arc therapy (VMAT) technique and a 6 Gy sequential boost to pelvis after the surgery and completed the protocol treatment. During the course of treatment, the patient experienced G4 hematological toxicity and received multiple transfusions, particularly after whole abdominopelvic irradiation. He has achieved complete remission and is alive without evidence of recurrence and severe late adverse effect for 3 years. In terms of growth, his height and weight are within the average values for Japanese boys at the same age. CONCLUSION: By using the VMAT technique, a patient with peritoneal disseminated rhabdomyosarcoma can be treated, and a dose of 30 Gy to the whole abdominopelvis with concurrent chemotherapy may be tolerable.

DOI： 10.1186/s13014-019-1333-x

2.胸部領域　胸部画像診断におけるAIと臨床研究について Reviewed

伊藤倫太郎、岩野信吾、長縄慎二

INNERVISION Vol. 34 ( 7 ) page： 25 - 28 2019.7

Postoperative recurrence of clinical early-stage non-small cell lung cancers: a comparison between solid and subsolid nodules. Reviewed International journal Open Access

Shingo Iwano, Hiroyasu Umakoshi, Shinichiro Kamiya, Kohei Yokoi, Koji Kawaguchi, Takayuki Fukui, Shinji Naganawa

Cancer imaging : the official publication of the International Cancer Imaging Society Vol. 19 ( 1 ) page： 33 - 33 2019.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: For subsolid non-small cell lung cancers (NSCLCs), solid size (SS), which is the maximal diameter of the solid component, correlates more accurately with tumor prognosis than the total size, which is the maximal diameter of the entire tumor, including ground-glass opacity. We reviewed the propriety of the TNM staging based on the SS for early-stage NSCLCs. METHODS: We retrospectively reviewed the preoperative radiological reports, clinical records, and pathological reports of NSCLC cases in our hospital between 2010 and 2013, and clinical stage (c-Stage) 0 and I tumors were selected. Disease-free survival (DFS), based on survival analysis, was used to assess the tumor characteristics that predicted the prognosis. RESULTS: A total of 247 NSCLC diagnoses in 231 patients (88 women and 143 men; age, 67 ± 7 years) were included in our cohort. They were classified into solid (n = 131) and subsolid (n = 116) nodules. The DFS curves indicated that prognosis was significantly worse in the following order: c-Stage 0, c-Stage IA, and c-Stage IB tumors (p = 0.016). Patients with solid nodules showed a significantly worse prognosis than patients with subsolid nodules (p < 0.001). A multivariate Cox proportional hazards model showed that the significant predictive factors for DFS were c-Stage (hazard ratio, 1.600; p = 0.020) and solid nodules (hazard ratio, 3.077; p = 0.031). CONCLUSIONS: For early-stage NSCLCs, the c-Stage based on the SS in subsolid nodules was useful for predicting postoperative DFS. In addition, whether nodules were solid or subsolid was another independent prognostic factor.

DOI： 10.1186/s40644-019-0219-3

Monitoring of fatigue in radiologists during prolonged image interpretation using fNIRS. Reviewed

Takashi Nihashi, Takeo Ishigaki, Hiroko Satake, Shinji Ito, Osamu Kaii, Yoshine Mori, Kazuhiro Shimamoto, Hiromichi Fukushima, Kojiro Suzuki, Hiroyasu Umakoshi, Mitsuo Ohashi, Fumio Kawaguchi, Shinji Naganawa

Japanese journal of radiology Vol. 37 ( 6 ) page： 437 - 448 2019.6

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: To determine whether functional near-infrared spectroscopy (fNIRS) allows monitoring fatigue in radiologists during prolonged image interpretation. MATERIALS AND METHODS: Nine radiologists participated as subjects in the present study and continuously interpreted medical images and generated reports for cases for more than 4 h under real clinical work conditions. We measured changes in oxygenated hemoglobin concentrations [oxy-Hb] in the prefrontal cortex using 16-channel fNIRS (OEG16ME, Spectratech) every hour during the Stroop task to evaluate fatigue of radiologists and recorded fatigue scale (FS) as a behavior data. RESULTS: Two subjects showed a subjective feeling of fatigue and an apparent decrease in brain activity after 4 h, so the experiment was completed in 4 h. The remaining seven subjects continued the experiment up to 5 h. FS decreased with time, and a significant reduction was observed between before and the end of image interpretation. Seven out of nine subjects showed a minimum [oxy-Hb] change at the end of prolonged image interpretation. The mean change of [oxy-Hb] at the end of all nine subjects was significantly less than the maximum during image interpretation. CONCLUSION: fNIRS using the change of [oxy-Hb] may be useful for monitoring fatigue in radiologists during image interpretation.

DOI： 10.1007/s11604-019-00826-2

【人工知能が医療を変える!医療分野におけるAI研究開発最前線2019】領域別・画像診断におけるAI研究開発の最前線胸部領域胸部画像診断におけるAIと臨床研究について Reviewed

食道平滑筋腫 Reviewed

兵藤良太、岩野信吾、長縄慎二

画像診断 Vol. 39 ( 7 ) page： 662 - 663 2019.6

伊藤倫太郎, 岩野信吾, 長縄慎二

INNERVISION Vol. 34 ( 7 ) page： 25 - 28 2019.6

Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)インナービジョン

2006年から始まった第三次AIブームによりAIの研究が加速度的に進み、現在ではスマートフォンのカメラや音声入力など身近なものに活用されている。放射線医学においては古くから人工知能(AI)を用いた研究が行われ、臨床にも応用されていた。最近では、さらに発展したAIを用いたCADの開発が盛んであり、世界中の研究者が開発を競っている。本稿では、加速度的に進歩するAIと放射線医学とのかかわりについて、主に胸部画像診断の観点から現在の状況と問題点についてまとめ、実際の研究例について提示する。(著者抄録)

Increased signal intensity of low-concentration gadolinium contrast agent by longer repetition time in heavily T<sub>2</sub>-weighted-3D-FLAIR.

Kato Y, Bokura K, Taoka T, Naganawa S

Japanese journal of radiology Vol. 37 ( 5 ) page： 431-435 2019.5

Phase II study of chemoradiotherapy combined with gemcitabine plus nab-paclitaxel for unresectable locally advanced pancreatic ductal adenocarcinoma (NUPAT 05 Trial): study protocol for a single arm phase II study. Reviewed Open Access

Nao Takano, Suguru Yamada, Akihiro Hirakawa, Yukihiro Yokoyama, Hiroki Kawashima, Osamu Maeda, Tohru Okada, Eizaburo Ohno, Junpei Yamaguchi, Takuya Ishikawa, Fuminori Sonohara, Masaya Suenaga, Hideki Takami, Masamichi Hayashi, Yukiko Niwa, Yoshiki Hirooka, Yoshiyuki Ito, Shinji Naganawa, Yuichi Ando, Masato Nagino, Hidemi Goto, Tsutomu Fujii, Yasuhiro Kodera

Nagoya journal of medical science Vol. 81 ( 2 ) page： 233 - 239 2019.5

Language：English Publishing type：Research paper (scientific journal)

The efficacy of nab-paclitaxel combined with gemcitabine (GnP) and of chemoradiotherapy (CRT) for unresectable locally advanced pancreatic ductal adenocarcinoma (UR-LA PDAC) is still unclear. We previously conducted a phase I study of CRT using GnP and determined the recommended dose and have now designed a phase II trial to evaluate the efficacy of CRT incorporating GnP for UR-LA PDAC. Eligibility criteria are chemotherapy-naïve patients with UR-LA PDAC as defined by the NCCN guidelines version 2. 2016. Study patients will receive 100 mg/m2 nab-paclitaxel and 800 mg/m2 gemcitabine on Days 1, 8, and 15 per 4-week cycle with concurrent radiation therapy (total dose of 50.4 Gy in 28 fractions of 1.8 Gy per day, 5 days per week). Treatment will be continued until disease progression or surgery, which is to be performed only for patients in whom the disease is well-controlled at 8 months from beginning the protocol treatment. Primary endpoint is 2-year overall survival rate and co-primary endpoint is resection rate. Secondary endpoints are overall survival, progression free survival, time to treatment failure, response rate, disease control rate, early tumor shrinkage, depth of response, reduction of SUV-max on PET-CT, serum tumor markers, relative dose intensity, safety, and Quality of life. This study will show the efficacy and safety of chemoradiotherapy combined with GnP.

DOI： 10.18999/nagjms.81.2.233

子宮平滑筋肉腫 Reviewed

櫻井悠介、岩野信吾、長縄慎二、下山芳江、新美　薫

画像診断 Vol. 39 ( 6 ) page： 512 - 513 2019.5

画像診断と病理食道平滑筋腫

兵藤良太, 岩野信吾, 長縄慎二, 宮田一志, 島田聡子

画像診断 Vol. 39 ( 7 ) page： 662 - 663 2019.5

Utility of Metabolic Parameters on FDG PET/CT in the Classification of Early-Stage Lung Adenocarcinoma: Prediction of Pathological Invasive Size.

Iwano S, Ito S, Kamiya S, Ito R, Kato K, Naganawa S

Clinical nuclear medicine 2019.4

A case of human pancreatic eurytremiasis. Reviewed International journal Open Access

Hiroshi Ogawa, Yasuo Takehara, Shinji Naganawa, Junpei Yamaguchi, Masato Nakaguro

Abdominal radiology (New York) Vol. 44 ( 4 ) page： 1213 - 1216 2019.4

Language：English Publishing type：Research paper (scientific journal)

This study provides the first comprehensive imaging report of human pancreatic eurytremiasis. A 43-year-old man with obstructive jaundice and a pancreatic tumor was referred for diagnosis and treatment. Serum aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase were elevated. Computed tomography (CT) revealed a multilocular cystic lesion with delayed enhanced area in the pancreas head. On magnetic resonance imaging, the tumor was hyperintense on diffusion-weighted image, and the apparent diffusion coefficient value of the tumor was lower than that of the normal pancreatic parenchyma. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) revealed abnormally increased uptake of 18F-FDG in the tumor. A subtotal stomach-preserving pancreaticoduodenectomy was performed on the preoperative diagnosis of pancreatic carcinoma accompanied by branch duct-type intraductal papillary mucinous neoplasm. Multifocal granulomatous lesions with necrotic areas including many parasite eggs were seen on the histology. The final diagnosis was pancreatic eurytremiasis.

DOI： 10.1007/s00261-019-01925-4