Background:To improve the quality of radiation oncology in Japan, Patterns of Care Study (PCS), a widelyknown qualityassurance (QA) program inthe USA, wasintroduced. The feasibility was tested by collecting nationwide data by extramural audit for cervix cancer. Methods: From July 1996through February 1997, PCSaudits were performed for 29 institutions nationwide. On the basisof the facility surveyby Tsunemoto, 13 institutions were classified as A1 (university hospital/cancer center), 10 as 81 (other institutions treating ;:::120 patients/year) and six as 82 (other institutions treating <120 patients/year). Medical charts for the patients treated for cervixcancerbetween 1992and 1994were reviewed based onthe dataformatof the USPCS. The total numberof patients surveyed was 432. Results: Simulation was used for >90% of the patients in both A1 and 81-2 institutions. However, in 81-2, planning for 5% of thepatients wasperformed with only a clinical set-up (p = 0.0287). A daily fraction with a size of 200cGywasgiven to >65% of patients inA1 andto <47% in 81-2. Ontheother hand, >50% of those in 81-2 were treated with daily fractions of 180cGy and less compared with 25%in A1 institutions (p < 0.0001). 8rachytherapy was utilized more frequently for patients in Stages II (p= 0.0365), III (p = 0.0015) andIV(p =0.0483) inA1 than in 81-2. Asforexternal beam equipment, linear accelerators with 10 MV or more were used for 83% of the patients in A1. However, in 81-2 institutions, machines with lower energy were used for 38% of thepatients (p < 0.0001). The median number of full-time-equivalent (FTE) radiation oncologists was 2.7 in A1, 0.65 in 81 and 0.2 in 82. Conclusions: Institutional stratification, including equipment and personnel, was found to affect significantly the patterns of care for cervix cancer. Therefore, to improve the quality of radiation therapy nationwide, improvements in equipment and in supply of FTE personnel are extremely important. pes was found to have great potential for a practical evaluation of how much improvement will be required in Japan.

Although pathological diagnosis is essential for managing malignant lymphoma, intraabdominal lesions are generally difficult to approach due to the invasiveness of abdominal surgery. Here, we report the use of percutaneous image-guided coaxial core-needle biopsy (CNB) to obtain intraabdominal specimens for diagnosing intraabdominal lymphomas, which typically requires histopathological and immunohistochemical evaluation. We retrospectively reviewed consecutive cases involving computed tomography (CT)- or ultrasonography (US)-guided CNB to obtain pathological specimens for intraabdominal lesions from 1999 to 2011. Liver, spleen, kidney, and inguinal node biopsies were excluded. We compared CNBs with laparotomic biopsies. A total of 66 CNBs were performed for 59 patients (32 males, 27 females; median age, 63.5), including second or third repeat procedures. Overall diagnostic rate was 88.5%. None of the patients required additional surgical biopsies. Notably, the median interval between recognition of an intraabdominal mass and biopsy was only 1 day. Forty-five procedures were performed for hematological malignancies. Adequate specimens were obtained for histopathological diagnosis in 86% of cases. Flow cytometry detected lymphoma cells in 79.5% of cases. Twelve patients (nine males, three females; median age, 60) were eligible for surgical biopsy. While every postoperative course was satisfactory, median duration from lesion recognition to therapy initiation for lymphoma cases was significantly shorter for CNB than for surgical biopsy (14 vs. 35 days). While one-fourth of the patients were not eligible for the procedures, CNB is safe and highly effective for diagnosis of intraabdominal lymphomas. This method significantly improves sampling and potentially helps attain immunohistological distinction, allowing for more timely therapy initiation.

We report a patient who presented with colicky abdominal pain, hematemesis, and melena following a blunt abdominal injury sustained in an automobile accident. Serologic tests suggested liver dysfunction and computed tomography (CT) revealed dilatation of the intrahepatic bile duct. Duodenoscopy demonstrated hemobilia originating from the duodenal papilla of Vater. Angiography revealed a pseudoaneurysm of the hepatic artery and angiographic embolization sucessfully stopped the hemorrhaging. However, even following the angiographic embolization, the patient remained symptomatic and repeat CT demonstrated thickening of the gallbladder wall and a lesion resembling a blood clot. We strongly suspected cholecystitis and performed a laparoscopic cholecystectomy. Grossly, the resected specimen revealed wall thickening with a congested mucosa and three blood clots; histologically, these changes were consistent with a diagnosis of chronic cholecystitis. The clinical message of this paper is that patients should be observed for this usual complication of hemobilia after liver injury.

PCS extramural audits were performed for 29 institutions nationwide. Medical charts for 432 patients with uterine cervix cancer treated between 1992 and 1994 were reviewed based on the PCS data format used in the US. The processes of radiation therapy for these patients were compared in two age groups -those aged Ն75 years (n ϭ 132) and those aged Ͻ75 years (n ϭ 300). Results. There were significant differences by age group in medical background, indicating the fragility of the elderly and a relatively higher incidence of early-stage disease in the elderly by patient selection. Lower pelvic radiation doses were used for the elderly with advanced stage disease. There were no significant differences in unplanned breaks in external irradiation between the two age groups. Brachytherapy was used less commonly in the elderly group than in younger group (P ϭ 0.0187). The dose range for brachytherapy did not show any significant difference between the two groups. Preliminary survival rates for the elderly were similar to those for the younger group. Conclusion. Radiation therapy was found to play an important role in the treatment of uterine cervix cancer in elderly as well as younger patients. Abstract Background.To improve the quality of radiation oncology in Japan, a Patterns of Care Study (PCS), a quality assurance program widely known in the United States, was introduced to Japan. In this study, the process, including work-up and treatment for uterine cervix cancer patients, was investigated to show nationwide variation by age.T. Teshima ( ) · T. Inoue

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