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Kågedal Å, Margolin G, Held C, da Silva PFN, Piersiala K, Munck-Wikland E, Jacobsson H, Häyry V, Cardell LO. A Novel Sentinel Lymph Node Approach in Oral Squamous Cell Carcinoma. Curr Pharm Des 2021; 26:3834-3839. [PMID: 32053068 DOI: 10.2174/1381612826666200213100750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Occult metastases are common in patients with oral squamous cell carcinoma (OSCC) which is why elective neck dissection, adjuvant radiotherapy or watchful waiting have been treatment options after surgical removal of the primary tumour. Sentinel lymph node biopsy (SLNB) has lately emerged as a novel possibility in treatment planning. OBJECTIVES To establish a reliable and clinically useful protocol for SLNB in staging/elective neck dissection in oral cancer. METHODS Fourteen consecutive patients with T1-T2 N0 oral cancer were enrolled when scheduled for elective neck dissection. RESULTS This study outlines various techniques for improving SLNB in head and neck cancer. After evaluation, a combination of techniques was found to constitute a reliable, clinically adaptable work concept. The suggested procedure starts with the pre-surgical injection of radioactive technetium 99Tcm carried on tilmanocept (Lymphoseek ®) at the tumour site. The radioactivity in the lymph node is then visualized preoperatively with Single Photon Emission Computed Tomography (SPECT/CT). Intraoperatively, indocyanine green (ICG) is injected and a sentinel node is visualized with near-infrared light. To support the sentinel node detection, the surgeon uses a hand-held gamma detection probe. This approach results in a reproducible and reliable detection of sentinel nodes. CONCLUSION This paper presents a novel protocol for the identification of the sentinel node in the head and neck region. The protocol additionally enables the use of flow cytometry analysis of resected lymph nodes.
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Affiliation(s)
- Åsa Kågedal
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Gregori Margolin
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Cornelia Held
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pedro F N da Silva
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Krzysztof Piersiala
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Munck-Wikland
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hans Jacobsson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Valtteri Häyry
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars O Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Lövgren T, Wolodarski M, Wickström S, Edbäck U, Wallin M, Martell E, Markland K, Blomberg P, Nyström M, Lundqvist A, Jacobsson H, Ullenhag G, Ljungman P, Hansson J, Masucci G, Tell R, Poschke I, Adamson L, Mattsson J, Kiessling R. Complete and long-lasting clinical responses in immune checkpoint inhibitor-resistant, metastasized melanoma treated with adoptive T cell transfer combined with DC vaccination. Oncoimmunology 2020; 9:1792058. [PMID: 32923156 PMCID: PMC7458624 DOI: 10.1080/2162402x.2020.1792058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Development of T cell-directed immune checkpoint inhibitors (ICI) has revolutionized metastatic melanoma (MM) therapy, but <50% of treated patients experience durable responses. This phase I trial (NCT01946373) investigates the safety/feasibility of tumor-infiltrating lymphocyte (TIL) adoptive cell therapy (ACT) combined with dendritic cell (DC) vaccination in MM patients progressing on ICI. An initial cohort (5 patients) received TIL therapy alone to evaluate safety and allow for optimization of TIL expansion protocols. A second cohort (first-in-man, 5 patients) received TIL combined with autologous tumor lysate-loaded DC vaccination. All patients received cyclophosphamide/fludarabine preconditioning prior to, and intravenous (i.v.) IL-2 after, TIL transfer. The DC vaccine was given as five intradermal injections after TIL and IL-2 administration. [18F]-FDG PET/CT radiology was performed to evaluate clinical response, according to RECIST 1.1 (on the CT part). Immunological monitoring was performed by flow cytometry and T-cell receptor (TCR) sequencing. In the safety/optimization cohort, all patients had a mixed response or stable disease, but none durable. In the combination cohort, two patients experienced complete responses (CR) that are still ongoing (>36 and >18 months, respectively). In addition, two patients had partial responses (PR), one still ongoing (>42 months) with only a small bone-lesion remaining, and one of short duration (<4 months). One patient died early during treatment and did not receive DC. Long-lasting persistency of the injected TILs was demonstrated in blood. In summary, we report clinical responses by TIL therapy combined with DC vaccination in 4 out of 4 treated MM patients who previously failed ICI.
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Affiliation(s)
- Tanja Lövgren
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Maria Wolodarski
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stina Wickström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Edbäck
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mette Wallin
- Center for Clinical Cancer Studies, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Eva Martell
- Center for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Katrin Markland
- Vecura, Karolinska Cell Therapy Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Pontus Blomberg
- Vecura, Karolinska Cell Therapy Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Maria Nyström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hans Jacobsson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Gustav Ullenhag
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Per Ljungman
- Center for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Division of Hematology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Masucci
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Roger Tell
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Isabel Poschke
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,DKTK Immune Monitoring Unit, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Lars Adamson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre University Health Network, University of Toronto, Toronto, Canada
| | - Rolf Kiessling
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Fernström A, Hylander B, Moritz A, Jacobsson H, Rössner S. Increase of Intra-Abdominal Fat in Patients Treated with Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089801800204] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate changes in amount and distribution of body fat in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Prospective study. Computed tomography (CT) and dual energy x-ray absorptiometry (DEXA) were used for determination of body composition at commencement of CAPD, and after a mean of 7.2 months of dialysis treatment. Setting CAPD unit at an academic teaching hospital. Patients The study included 19 consecutive patients who started CAPD during a 15-month time frame. Of these 19 patients, 12 (8 males) with a mean initial age of 60 years completed the study. Main Outcome Measures Siemens Somatom HiQ (Erlangen, Germany) was used for CT of the abdomen and of the right thigh. Fat and muscle areas were expressed as square centimeters. The proportion of total fat mass was determined by body composition analysis using DEXA (DPX-L densitometer) (Lunar, Madison, WI, U.S.A.) and expressed as percentage of total body weight (FAT%). Results Body weight changed from 67.1 to 68.4 kg (p = 0.20), and the intra-abdominal fat area increased 22.8% (p = 0.02). This increase was predominantly seen in male patients (p = 0.007). The FAT% changed from 27.8% to 30.9% (p = 0.25), without difference between sexes. Conclusion The increase of intra-abdominal fat found in this study may suggest a mechanism by which the established risk for CAPD patients to develop cardiovascular morbidity and mortality may be at least partially explained.
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Affiliation(s)
- Anders Fernström
- Department of Internal Medicine, Division of Nephrology, 40besity Unit, Karolinska Hospital, Stockholm, Sweden
| | - Britta Hylander
- Department of Internal Medicine, Division of Nephrology, 40besity Unit, Karolinska Hospital, Stockholm, Sweden
| | - Ake Moritz
- Departments of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden
| | - Hans Jacobsson
- Departments of Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden
- Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
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Abstract
Objective To evaluate if impaired gastric emptying of digestible solids can explain the disturbed eating behavior in continuous ambulatory peritoneal dialysis (CAPD) patients, and if predialytic and dialytic (CAPD and hemodialysis) patients with impaired gastric emptying have a higher prevalence of electrogastrographic (EGG) abnormalities. Design Cross-sectional study. After ingestion of a 99mTc-labeled test meal, anterior and posterior 1-minute scintigraphic acquisitions were collected every 5 minutes during the first 50 minutes and thereafter every 10 minutes until 2 hours had elapsed. Simultaneously, cutaneous EGG recorded gastric myoelectric activity. Setting The Division of Nephrology and the Department of Nuclear Medicine at the same academic teaching hospital. Participants Thirty outpatients participated in both the gastric emptying and the EGG studies. Dialysis patients should have been on dialysis for more than 3 months. For comparison, 160 healthy control subjects participated in the gastric emptying study. Main Outcome Measures The following parameters were used to describe gastric emptying: lag phase 90%, half-emptying time ( T50), gastric retention at 90 and 120 minutes (Ret 90/120) and gastric emptying rate (GER, %/min). Electrogastrographic measurements were expressed as percentages of normal slow waves [2.4 – 3.6 cycles/min (cpm)], bradygastria (1.5 – 2.4 cpm), and tachygastria (3.6 – 10 cpm). Results T50 was prolonged, Ret 90 and Ret 120 were higher, and GER was slower in male CAPD patients compared to male controls. No significant differences were found in postprandial EGG. Conclusion Gastric emptying is impaired in male non-diabetic CAPD patients. However, abnormalities in postprandial EGG cannot explain this finding.
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Affiliation(s)
- Anders Fernström
- Divisions of Nephrology, Department of Internal Medicine, Stockholm, Sweden
| | - Britta Hylander
- Divisions of Nephrology, Department of Internal Medicine, Stockholm, Sweden
| | - Per Grybäck
- Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden
| | - Hans Jacobsson
- Departments of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
- Diagnostic Radiology, Karolinska Hospital, Stockholm, Sweden
| | - Per M. Hellström
- Divisions of Gastroenterology, Department of Internal Medicine, Stockholm, Sweden
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Abstract
Gastroparesis often presents a challenge to the practicing gastroenterologist. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also significant disruption of social activities that often center around food. The treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic and idiosyncratic nature of the illness, often with some common psychiatric co-morbidity, parallels other functional disorders of the gastrointestinal tract. These parallels have provided the rationale for studies investigating alternative diagnostic features of the gastric emptying test as employed in the clinical setting. Hence, not only the regular cut-offs of 60% or 10% gastric retention of a meal at 2 and 4 h, but also a new concept, the intragastric meal distribution at time 0 (IMD0) is now introduced as a plausible diagnostic feature that should be more aligned with the patients' symptoms as they appear in close connection with the meal. Impaired gastric accommodation with absence of fundic relaxation followed by dumping of the meal into antrum is suggested to be diagnostic for functional dyspepsia and gastroparesis. The diagnostic cut-off is considered when more than 57% of the meal is distributed to the distal part of the stomach immediately on food intake. This new diagnostic feature of the gastric emptying profile lend support to better understanding of the patients' symptoms and provides a new basis for pharmacological treatment options in gastroparesis that may provide an improved quality of life in affected individuals.
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Affiliation(s)
- Per Grybäck
- Department of Hospital Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Jacobsson
- Department of Hospital Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lucyna Neuger
- Department of Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Berger K, Rhost S, Hughes E, Harrison H, Rafnsdottir S, Jacobsson H, Gregersson P, Magnusson Y, Fitzpatrick P, Andersson D, Ståhlberg A, Landberg G. Abstract P2-06-11: Sortilin targeted therapy in breast cancer with elevated progranulin expression. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-06-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A major challenge concerning breast cancer therapy is the occasional lack of effects using drugs that target cancer cells unspecifically. One possible explanation for this treatment failure is the existence of the small subpopulation of breast cancer stem cells that are believed to be more resistant towards conventional therapy and possesses the ability to drive tumor formation and disease progression. Cytokines secreted by nearby cells and other factors in the surrounding tumor microenvironment further stimulate the cancer cells, contributing to a heterogeneous and potentially more treatment resistant tumor. Thus, a more specific treatment approach targeting the breast cancer stem cell niche is crucial in preventing disease recurrences. In a cytokine screen, we identified progranulin as one of the main compounds secreted from cells exposed to hypoxia, leading to cancer stem cell propagation. Progranulin is involved in biological processes such as wound healing, inflammation and cancer progression. Progranulin and its receptor sortilin are known to be highly expressed in subgroups of breast cancer and are further associated with a clinically aggressive phenotype.
Methods/Results: By carrying out a number of in vitro and in vivo like screening assays, we demonstrate that progranulin influences the stem cell population in breast cancer and is responsible for spreading a cancer stem cell promoting signal to normoxic tumor areas. In breast cancer, progranulin induces a dedifferentiation process in the receiving cancer cells and expression of cancer stem cell markers together with an EMT-associated gene expression profile, leading to cancer stem cell expansion. By using siRNA and pharmacological inhibition of sortilin, we show that sortilin is a functional receptor of progranulin and is responsible for driving progranulin induced breast cancer stem cell propagation. Supporting the role of progranulin in cancer progression, administration of progranulin in immunocompromised mice induce lung metastasis in our breast cancer xenograft models. The use of different approaches for blocking sortilin, such as sortilin inhibitors, down-modulators or sortilin-targeted antibodies can prevent this dedifferentiation process, both in vitro and in vivo, making the tumor cells less aggressive and metastatic.
Conclusion: Targeting progranulin through its associated receptors is a potential therapeutic strategy for the treatment of patients with breast tumors having elevated progranulin or sortilin expression. By inhibiting the secretion based breast cancer progression, we could possibly block the formation of metastasis and cancer cell infiltration.
Citation Format: Berger K, Rhost S, Hughes E, Harrison H, Rafnsdottir S, Jacobsson H, Gregersson P, Magnusson Y, Fitzpatrick P, Andersson D, Ståhlberg A, Landberg G. Sortilin targeted therapy in breast cancer with elevated progranulin expression [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-11.
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Affiliation(s)
- K Berger
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - S Rhost
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - E Hughes
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - H Harrison
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - S Rafnsdottir
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - H Jacobsson
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - P Gregersson
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - Y Magnusson
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - P Fitzpatrick
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - D Andersson
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - A Ståhlberg
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
| | - G Landberg
- Institute of Biomedicine, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden; Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, United Kingdom; Shore Lab, Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, United Kingdom; Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academ, Göteborg, Sweden
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7
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Eskian M, Alavi A, Khorasanizadeh M, Viglianti BL, Jacobsson H, Barwick TD, Meysamie A, Yi SK, Iwano S, Bybel B, Caobelli F, Lococo F, Gea J, Sancho-Muñoz A, Schildt J, Tatcı E, Lapa C, Keramida G, Peters M, Boktor RR, John J, Pitman AG, Mazurek T, Rezaei N. Effect of blood glucose level on standardized uptake value (SUV) in 18F- FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements. Eur J Nucl Med Mol Imaging 2018; 46:224-237. [DOI: 10.1007/s00259-018-4194-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/10/2018] [Indexed: 01/24/2023]
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Guan J, Fransson S, Siaw JT, Treis D, Van den Eynden J, Chand D, Umapathy G, Ruuth K, Svenberg P, Wessman S, Shamikh A, Jacobsson H, Gordon L, Stenman J, Svensson PJ, Hansson M, Larsson E, Martinsson T, Palmer RH, Kogner P, Hallberg B. Clinical response of the novel activating ALK-I1171T mutation in neuroblastoma to the ALK inhibitor ceritinib. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a002550. [PMID: 29907598 PMCID: PMC6071567 DOI: 10.1101/mcs.a002550] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/13/2018] [Indexed: 12/12/2022] Open
Abstract
Tumors with anaplastic lymphoma kinase (ALK) fusion rearrangements, including non-small-cell lung cancer and anaplastic large cell lymphoma, are highly sensitive to ALK tyrosine kinase inhibitors (TKIs), underscoring the notion that such cancers are addicted to ALK activity. Although mutations in ALK are heavily implicated in childhood neuroblastoma, response to the ALK TKI crizotinib has been disappointing. Embryonal tumors in patients with DNA repair defects such as Fanconi anemia (FA) often have a poor prognosis, because of lack of therapeutic options. Here we report a child with underlying FA and ALK mutant high-risk neuroblastoma responding strongly to precision therapy with the ALK TKI ceritinib. Conventional chemotherapy treatment caused severe, life-threatening toxicity. Genomic analysis of the initial biopsy identified germline FANCA mutations as well as a novel ALK-I1171T variant. ALK-I1171T generates a potent gain-of-function mutant, as measured in PC12 cell neurite outgrowth and NIH3T3 transformation. Pharmacological inhibition profiling of ALK-I1171T in response to various ALK TKIs identified an 11-fold improved inhibition of ALK-I1171T with ceritinib when compared with crizotinib. Immunoaffinity-coupled LC-MS/MS phosphoproteomics analysis indicated a decrease in ALK signaling in response to ceritinib. Ceritinib was therefore selected for treatment in this child. Monotherapy with ceritinib was well tolerated and resulted in normalized catecholamine markers and tumor shrinkage. After 7.5 mo treatment, the residual primary tumor shrunk, was surgically removed, and exhibited hallmarks of differentiation together with reduced Ki67 levels. Clinical follow-up after 21 mo treatment revealed complete clinical remission including all metastatic sites. Therefore, ceritinib presents a viable therapeutic option for ALK-positive neuroblastoma.
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Affiliation(s)
- Jikui Guan
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden.,Children's Hospital Affiliated to Zhengzhou University, 450018 Zhengzhou, China
| | - Susanne Fransson
- Department of Pathology and Genetics, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Joachim Tetteh Siaw
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Diana Treis
- Childhood Cancer Research Unit, Department of Women's and Children's Health, and Pediatric Oncology Program Karolinska University Hospital, Stockholm 17176, Sweden
| | - Jimmy Van den Eynden
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Damini Chand
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Ganesh Umapathy
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Kristina Ruuth
- Institute of Molecular Biology, Umeå University, Umeå 90187, Sweden
| | - Petter Svenberg
- Childhood Cancer Research Unit, Department of Women's and Children's Health, and Pediatric Oncology Program Karolinska University Hospital, Stockholm 17176, Sweden
| | - Sandra Wessman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Alia Shamikh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Hans Jacobsson
- Department of Radiology, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Lena Gordon
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Jakob Stenman
- Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Pär-Johan Svensson
- Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Magnus Hansson
- Department of Pediatrics and Pathology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Erik Larsson
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Tommy Martinsson
- Department of Pathology and Genetics, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Ruth H Palmer
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Per Kogner
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Bengt Hallberg
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
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wickström SL, Lövgren T, Wolodarski M, Edbäck U, Martell E, Markland K, Nyström M, Lundqvist A, Jacobsson H, Hansson J, Masucci G, Tell R, Poschke I, Adamson L, Mattsson J, Kiessling R. Abstract CT032: Adoptive T cell transfer combined with DC vaccination in patients with metastatic melanoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and aim: Although several drugs have been approved that improve overall survival in patients with metastatic melanoma, there is still a need for additional treatments when the approved ones are exhausted. Adoptive T-cell therapy (ACT) has been reported to induce clinical responses in up to 70% of stage IV melanoma patients. The aim of the MAT02 trial is to investigate the toxicity and feasibility of a combined treatment with adoptive transfer of autologous, tumor-derived T cells with or without autologous dendritic cell (DC) vaccination in patients with stage III/IV melanoma.
Method: This study is a single centre, open-label, two-armed, phase I trial. Five patients are assigned to each cohort (A or B) and receive ACT of autologous tumor infiltrating lymphocytes (TIL) without (A) or with (B) autologous tumor loaded DC i.c. Prior to TIL cell transfer, all patients are pre-treated with a precondition regimen. Administration of TIL cells is followed by IL-2 administration (100000 U/Kg q8hx14). Radiological evaluation is performed four weeks after the last DC administration. The primary objective is to evaluate the toxicity and feasibility. The secondary objectives are to generate large numbers of T cells, boost tumor-reactive T cells by DC vaccination, characterize the T cell population used for adoptive transfer with regard to phenotype and functionality, and generate an objective anti-tumour response.
Results: Cohort A in which patients received only TIL has been completed and the treatment was feasible with limited expected toxicity. All treated patients showed a mixed response or stable disease. However, these responses were not durable. The overall survival ranged between 4-17 months. For cohort B which received the combined treatment of TIL and DC vaccine, three patients have completed the treatment that has been feasible with limited expected toxicity. The number of cells transfused in this cohort ranged between 29 and 33 billion and all patients have been administered five DC-vaccinations. All 3 patients responded; one with a complete response which is still ongoing (> 12 mo). Two patients showed a partial response, one with a long lasting response (> 18 mo) and one with a short response (< 4 mo). The accrual continues and we expect to include another two patients before the summer of 2018.
Conclusions: Adoptive T cell therapy combined with DC vaccination is safe with tolerable toxicity profiles and can result in complete clinical response in patients who have failed on checkpoint therapy.
Citation Format: stina L. wickström, Tanja Lövgren, Maria Wolodarski, Ulrika Edbäck, Eva Martell, Karin Markland, Maria Nyström, Andreas Lundqvist, Hans Jacobsson, Johan Hansson, Giuseppe Masucci, Roger Tell, Isabel Poschke, Lars Adamson, Jonas Mattsson, Rolf Kiessling. Adoptive T cell transfer combined with DC vaccination in patients with metastatic melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT032.
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Affiliation(s)
- stina L. wickström
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Lövgren
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Wolodarski
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Edbäck
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Martell
- 2Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Markland
- 3Vecura, Clinical Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Nyström
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundqvist
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hans Jacobsson
- 4Department of Radiology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Johan Hansson
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Masucci
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Roger Tell
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Isabel Poschke
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Adamson
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Mattsson
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Kiessling
- 1Cancer Center Karolinska (CCK), Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Jacobsson H. Book Review: Combined Scintigraphic and Radiographic Diagnosis of Bone and Joint Diseases. Acta Radiol 2016. [DOI: 10.1177/02841851960371p149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alanko Blomé M, Björkman P, Flamholc L, Jacobsson H, Widell A. Vaccination against hepatitis B virus among people who inject drugs - A 20year experience from a Swedish needle exchange program. Vaccine 2016; 35:84-90. [PMID: 27894721 DOI: 10.1016/j.vaccine.2016.11.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at particular risk of hepatitis B virus (HBV) acquisition, but often have poor access or adherence to HBV vaccination. Vaccination against HBV has been offered at a major Swedish needle exchange program (NEP) since 1994. The aim of this study was to evaluate vaccine completion and response rates, and the effect of sequential booster doses to non-responders to the standard vaccination schedule. METHODS PWID enrolled in the NEP 1994-2013, without serological markers for HBV at baseline (negative for HBsAg/anti-HBc/anti-HBs), were offered a three-dose standard intramuscular vaccination schedule (Engerix®-B, GSK, 20μg/mL, intended to be received at months 0, 1 and 6). Vaccination response was defined as protective levels of anti-HBs (⩾10mIU/mL). Up to three booster doses were then offered for non-responders, each followed by anti-HBs testing. RESULTS HBV data was available for 2352 identifiable individuals at NEP enrolment, of whom 1516 (64.5%) had no markers for previous HBV exposure or vaccination. Vaccination was initiated for 1142 (75.3%) individuals and 898 (59.2%) completed the standard vaccination schedule. Post-vaccination anti-HBs levels were available from 800 individuals, with 598 (74.8%) responding to the basic vaccination schedule. After up to three booster doses a total of 676 (84.5%) individuals achieved protective anti-HBs levels. Non-response to vaccination was associated with higher age and anti-HCV positivity (p<0.001). Eighteen incident cases of HBV infection were observed among vaccine non-responders, as well as 30 cases among those who had not completed vaccination. CONCLUSION We demonstrate the feasibility of including HBV vaccination in the services offered by a NEP, with completion of vaccination in a majority of HBV-susceptible PWID. The response to HBV vaccination among PWID was relatively low; however, the addition of up to three booster doses improved the response rate from 74.8 to 84.5%.
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Affiliation(s)
- M Alanko Blomé
- Department of Clinical Sciences, Infectious Disease Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - P Björkman
- Department of Clinical Sciences, Infectious Disease Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - L Flamholc
- Department of Clinical Sciences, Infectious Disease Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - H Jacobsson
- Research and Development Center Skåne, Skåne University Hospital, Lund, Sweden
| | - A Widell
- Department of Medical Microbiology, Lund University, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Clinical Virology, Lund University, Lund, Sweden.
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Wilczek B, von Schoultz E, Bergh J, Eriksson E, Larsson SA, Jacobsson H. Early assessment of neoadjuvant chemotherapy by FEC-courses of locally advanced breast cancer using 99mTc-MIBI. Acta Radiol 2016; 44:284-7. [PMID: 12751999 DOI: 10.1080/j.1600-0455.2003.00066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: Response assessment at neoadjuvant (preoperative) chemotherapy of locally advanced breast cancer using clinical examination and mammography is insensitive. Mammoscintigraphy with 99mTc-MIBI was studied for the prediction of response at such therapy before finishing the chemotherapy cycles. Material and Methods: Chemotherapy was given as repeated courses of 5-fluorouracil, epirubicin and cyclophosphamide (FEC). In 1 patient group ( n = 23), the tumor uptake relative to surrounding breast tissue and lung tissue at SPECT examination after finishing neoadjuvant chemotherapy was compared with the examination made before chemotherapy. In another group ( n = 30), a similar comparison after the first therapy cycle (mean 19 days) with a baseline examination was made. Histologic examination of the resected tumors was made. Results: After finishing chemotherapy, there was a strong reduction of the relative tumor activity, while there was no correlation with therapy effect as assessed by histology. After one therapy course, there was no significant reduction of the relative tumor uptake. Conclusion: Scintigraphy with 99mTc-MIBI demonstrated the response after finished neoadjuvant chemotherapy of breast cancer using FEC-courses. It cannot be used to predict a therapy response after one therapy course.
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Affiliation(s)
- B Wilczek
- Department of Radiology, Karolinska Hospital, Stockholm, Sweden.
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Abstract
The bone scintigrams of 52 women with radiographically proven hyperostosis cranii were examined specifically with regard to the endosteal lesions. It was confirmed that hyperostosis cranii exhibits a characteristic appearance at bone scintigraphy that is usually easy to recognize. By scoring the degree of hyperostotic changes and their scintigraphic activity according to a semiquantitative scale, an inverse relation between radiographic changes and scintigraphic activity was observed but could not be statistically proven. A tendency of more pronounced radiographic changes and a tendency of decreasing activity at bone scintigraphy with increasing age were also found. It is suggested that hyperostosis cranii starts in younger women and that the initial osseous turnover of the lesions is high. Successively, the metabolic activity decreases while the endosteal lesions increase, tending towards a stabilization of the process with increasing age.
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Abstract
Purpose: To explore the diagnostic value of immunoscintigraphy compared to CT and/or MR imaging in the diagnosis of local recurrence (LR) of rectal cancer. Material and Methods: Forty-six patients suspected of having LR of rectal cancer were retrospectively studied. Carcinoembryonic antigen (CEA) scintigraphy findings were compared to CT and/or MR in all patients, and with data from surgery and morphology (31 patients), biopsy (7 cases) and follow-up (8 patients). Results: CEA scintigraphy was not complementary to CT and/or MR in the detection of LR. Two false-positive and 14 false-negative diagnoses of LR occurred with CEA scintigraphy. Distant metastases including metastatic lymph nodes were found by this method in only 7 of 27 patients with proven metastases. CT/MR were able to demonstrate these metastases in 21 of 27 patients. Conclusion: Accuracy and sensitivity of CEA scintigraphy in the detection of LR and distant metastases is lower than that of CT and/or MR. However, CEA scintigraphy seems to have a high specificity and could therefore be used in patients with a strong clinical suspicion of LR but negative CT/MR investigations. Available diagnostic methods have limitations in differentiating between benign, post-treatment changes and LR of rectal cancer and in staging of malignant disease.
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Affiliation(s)
- V. Järv
- Department of Radiology, Karolinska Hospital, Stockholm, Sweden
| | - L. Blomqvist
- Department of Radiology, Karolinska Hospital, Stockholm, Sweden
| | - T. Holm
- Department of Surgery, Karolinska Hospital, Stockholm, Sweden
| | - H. Ringertz
- Department of Radiology, Karolinska Hospital, Stockholm, Sweden
| | - H. Jacobsson
- Department of Radiology, Karolinska Hospital, Stockholm, Sweden
- Department of Hospital Physics, Karolinska Hospital, Stockholm, Sweden
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Wang Y, Jacobsson H, Jacobson SH, Kimiaei S, Larsson SA. A 3-D Method for Delineation of Activity Distributions and Assessment of Functional Organ Volumes with Spect. Acta Radiol 2016. [DOI: 10.1177/028418519503600443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The distribution volume of an organ may have a clinical impact in many cases and various methods have been designed to make volume assessments. In this paper, we describe a new method for delineation of the distribution outline and volume determination. The method is based on smoothing, differentiation, image relaxation and voxel counting of single photon emission computer tomography (SPECT) image sets with 3-D operators. A special routine corrects for the inherent thickness of the voxel-based outline. Phantom experiments, using a SPECT system with LEGP-collimator and a 64×64 acquisition matrix with 6.3×6.3 mm2 pixel size, demonstrated good correlation between the measured and the true volumes. For volumes larger than 120 cc the correlation coefficient was 0.9999 with SE 1.0 cc and an average relative deviation of 0.49%. For volumes below 120 cc, the accuracy was impaired due to low resolution power. By improving the system spatial resolution with an LEHR-collimator and a smaller pixel-size (4.1×4.1 mm2), good accuracy was achieved also for volumes in the range from 3 to 120 cc. Measurements of 15 differently shaped phantoms of volumes between 3 and 104 cc demonstrated high correlation between measured and true volumes: R=0.9921 and SE=0.74 cc (5.3%). For volumes as small as 3 and 5 cc, the difference between the true and the assessed volume was 0.6 cc. The reproducibility of the method was within 3% for volumes above 120 cc and within 7% for volumes below. Due to this accuracy, we conclude that the method can be applied for various clinical routine and research applications using SPECT.
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Affiliation(s)
- Y. Wang
- Department of Hospital Physics, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
- Department of Diagnostic Radiology, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - H. Jacobsson
- Department of Diagnostic Radiology, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - S. H. Jacobson
- Department of Medicine, Division of Nephrology, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - S. Kimiaei
- Department of Hospital Physics, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - S. A. Larsson
- Department of Hospital Physics, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
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Axelsson B, Jacobsson H. Quantitative Single Photon Emission Computed Tomography Applied to a Comparison of Propanetetraphosphonate and Albumin Colloid for Liver and Spleen Scintigraphy. Acta Radiol 2016. [DOI: 10.1177/028418518802900312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A clinical application of a previously developed technique for absolute quantitation of organ uptake of radioactivity is presented. The method, which is based on single photon emission computed tomography involving correction for scattering and attenuation of photons, enables an accurate in vivo determination of the amount of administered activity taken up in a specific organ. The technique was applied to a comparative clinical trial between propanetetraphosphonate and albumin colloid for liver and spleen scintigraphy. The mean uptake of the liver was 73±9 per cent using propanetetraphosphonate and 63±10 per cent using albumin colloid. The corresponding figures for the spleen were 6±3 and 9±4 per cent, respectively. The activity concentration of the different lobes of the liver, bone marrow and soft tissue was also estimated. Phantom studies showed that the total uptake in the liver could be determined with an accuracy of about 6 per cent. The accuracy of the clinical examinations was estimated to about 10 per cent.
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Bergenfelz A, Salem AF, Jacobsson H, Nordenström E, Almquist M. Risk of recurrent laryngeal nerve palsy in patients undergoing thyroidectomy with and without intraoperative nerve monitoring. Br J Surg 2016; 103:1828-1838. [PMID: 27538052 DOI: 10.1002/bjs.10276] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/09/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Vocal cord palsy occurs in 3-5 per cent of patients after thyroidectomy. To reduce this complication, intraoperative nerve monitoring (IONM) has been introduced, although its use remains controversial. This study investigated the risk of postoperative vocal cord palsy with and without the use of intermittent IONM. METHODS Patients registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery, 2009-2013, were included. Early palsy of the recurrent laryngeal nerve was diagnosed within 6 weeks after surgery. Permanent palsy was defined as that persisting after 6 months. Univariable and multivariable logistic regression analyses were used to examine risk factors for vocal cord palsy. RESULTS The cohort consisted of 5252 patients undergoing thyroidectomy. IONM was used in 3277 operations (62·4 per cent); postoperative laryngoscopy was performed in 1757 patients (33·5 per cent). Early vocal cord palsy occurred in 217 patients (4·1 per cent), of which three were bilateral, all in the group without IONM. Permanent vocal cord palsy occurred in 62 patients (1·2 per cent). In the multivariable analysis of 1757 patients who had postoperative laryngoscopy, the use of IONM was not associated with a decreased risk of early vocal cord palsy (odds ratio (OR) 0·67, 95 per cent c.i. 0·44 to 1·01), but decreased the risk of permanent vocal cord palsy (OR 0·43, 0·19 to 0·93). [Correction added on 11 November 2016 after first publication: the word 'routine' has been removed from this section.] CONCLUSION: IONM reduced the risk of permanent vocal cord palsy. No bilateral recurrent laryngeal nerve injury occurred following IONM.
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Affiliation(s)
- A Bergenfelz
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A F Salem
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - H Jacobsson
- Research and Development Centre, Skåne University Hospital, Skåne, Sweden
| | - E Nordenström
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M Almquist
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Farnebo J, Wadelius A, Sandström P, Nilsson S, Jacobsson H, Blomqvist L, Ullén A. Progression-free and overall survival in metastatic castration-resistant prostate cancer treated with abiraterone acetate can be predicted with serial C11-acetate PET/CT. Medicine (Baltimore) 2016; 95:e4308. [PMID: 27495034 PMCID: PMC4979788 DOI: 10.1097/md.0000000000004308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In this retrospective study, we evaluated the benefit of repeated carbon 11 (C11)-acetate positron emission tomography/computed tomography (PET/CT) to assess response in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate (AA).A total of 30 patients with mCRPC were monitored with C11-acetate PET/CT and PSA levels during their treatment with AA. Retrospective evaluation of their response was made after 102 days (median; range 70-155) of treatment. Statistical analyses were employed to detect predictors of progression-free survival (PFS) and overall survival (OS), and potential correlation between serum levels of PSA, standardized uptake values (SUVpeak), and bone lesion index measured from PET were investigated.At follow-up 10 patients exhibited partial response (PR), 10 progressive disease (PD), and 10 stable disease (SD), as assessed by PET/CT. In survival analysis, both PR and PD were significantly associated with PFS and OS. CT response was also associated with OS, but only 19/30 patients demonstrated a lesion meeting target lesion criteria according to RECIST 1.1. No PET/CT baseline characteristic was significantly associated with PFS or OS. A PSA response (reduction in the level by >50%) could also predict PFS and OS. In the subgroup lacking a PSA response, those with PD had significantly shorter OS than those with PR or SD.PFS and OS in patients with mCRPC treated with AA can be predicted from repeated C11-acetate PET/CT. This may be of particular clinical value in patients who do not exhibit a PSA response to treatment.
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Affiliation(s)
- Jacob Farnebo
- Department of Diagnostic Radiology and Nuclear Medicine, Karolinska University Hospital and Department of Molecular Medicine and Surgery
- Correspondence: Jacob Farnebo, Stavgårdsgatan, Bromma, Sweden (e-mail: )
| | - Agnes Wadelius
- Department of Oncology, Karolinska University Hospital and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Per Sandström
- Department of Oncology, Karolinska University Hospital and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Sten Nilsson
- Department of Oncology, Karolinska University Hospital and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hans Jacobsson
- Department of Diagnostic Radiology and Nuclear Medicine, Karolinska University Hospital and Department of Molecular Medicine and Surgery
| | - Lennart Blomqvist
- Department of Diagnostic Radiology and Nuclear Medicine, Karolinska University Hospital and Department of Molecular Medicine and Surgery
| | - Anders Ullén
- Department of Oncology, Karolinska University Hospital and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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Brodin O, Eksborg S, Wallenberg M, Asker-Hagelberg C, Larsen EH, Mohlkert D, Lenneby-Helleday C, Jacobsson H, Linder S, Misra S, Björnstedt M. Pharmacokinetics and Toxicity of Sodium Selenite in the Treatment of Patients with Carcinoma in a Phase I Clinical Trial: The SECAR Study. Nutrients 2015; 7:4978-94. [PMID: 26102212 PMCID: PMC4488827 DOI: 10.3390/nu7064978] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Sodium selenite at high dose exerts antitumor effects and increases efficacy of cytostatic drugs in multiple preclinical malignancy models. We assessed the safety and efficacy of intravenous administered sodium selenite in cancer patients’ refractory to cytostatic drugs in a phase I trial. Patients received first line of chemotherapy following selenite treatment to investigate altered sensitivity to these drugs and preliminary assessment of any clinical benefits. Materials and Methods: Thirty-four patients with different therapy resistant tumors received iv sodium selenite daily for consecutive five days either for two weeks or four weeks. Each cohort consisted of at least three patients who received the same daily dose of selenite throughout the whole treatment. If 0/3 patients had dose-limiting toxicities (DLTs), the study proceeded to the next dose-level. If 2/3 had DLT, the dose was considered too high and if 1/3 had DLT, three more patients were included. Dose-escalation continued until the maximum tolerated dose (MTD) was reached. MTD was defined as the highest dose-level on which 0/3 or 1/6 patients experienced DLT. The primary endpoint was safety, dose-limiting toxic effects and the MTD of sodium selenite. The secondary endpoint was primary response evaluation. Results and Conclusion: MTD was defined as 10.2 mg/m2, with a calculated median plasma half-life of 18.25 h. The maximum plasma concentration of selenium from a single dose of selenite increased in a nonlinear pattern. The most common adverse events were fatigue, nausea, and cramps in fingers and legs. DLTs were acute, of short duration and reversible. Biomarkers for organ functions indicated no major systemic toxicity. In conclusion, sodium selenite is safe and tolerable when administered up to 10.2 mg/m2 under current protocol. Further development of the study is underway to determine if prolonged infusions might be a more effective treatment strategy.
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Affiliation(s)
- Ola Brodin
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Södersjukhuset, SE-118 83 Stockholm, Sweden.
| | - Staffan Eksborg
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden.
| | - Marita Wallenberg
- Department of Laboratory Medicine, Division of Pathology F46, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
| | - Charlotte Asker-Hagelberg
- Medical Products Agency, P.O. Box 26, SE-751 03 Uppsala, Sweden.
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Solna, SE-171 76 Stockholm, Sweden.
| | - Erik H Larsen
- National Food Institute, Technical University of Denmark, DK-2860 Søborg, Denmark.
| | - Dag Mohlkert
- Department of Radiology, Karolinska University Hospital Södersjukhuset, SE-171 76 Stockholm, Sweden.
| | - Clara Lenneby-Helleday
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Södersjukhuset, SE-118 83 Stockholm, Sweden.
| | - Hans Jacobsson
- Department of Radiology, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
| | - Stig Linder
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm SE-171 76, Sweden.
- Department of Medicine and Health, Linköping University, Linköping SE-581 83, Linköping, Sweden.
| | - Sougat Misra
- Department of Laboratory Medicine, Division of Pathology F46, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
| | - Mikael Björnstedt
- Department of Laboratory Medicine, Division of Pathology F46, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
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Foukakis T, Lövrot J, Sandqvist P, Xie H, Lindström LS, Giorgetti C, Jacobsson H, Hedayati E, Bergh J. Gene expression profiling of sequential metastatic biopsies for biomarker discovery in breast cancer. Mol Oncol 2015; 9:1384-91. [PMID: 25888067 DOI: 10.1016/j.molonc.2015.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/10/2015] [Accepted: 03/23/2015] [Indexed: 11/17/2022] Open
Abstract
The feasibility of longitudinal metastatic biopsies for gene expression profiling in breast cancer is unexplored. Dynamic changes in gene expression can potentially predict efficacy of targeted cancer drugs. Patients enrolled in a phase III trial of metastatic breast cancer with docetaxel monotherapy versus combination of docetaxel + sunitinib were offered to participate in a translational substudy comprising longitudinal fine needle aspiration biopsies and Positron Emission Tomography imaging before (T1) and two weeks after start of treatment (T2). Aspirated tumor material was used for microarray analysis, and treatment-induced changes (T2 versus T1) in gene expression and standardized uptake values (SUV) were investigated and correlated to clinical outcome measures. Gene expression profiling yielded high-quality data at both time points in 14/18 patients. Unsupervised clustering revealed specific patterns of changes caused by monotherapy vs. combination therapy (p = 0.021, Fisher's exact test). A therapy-induced reduction of known proliferation and hypoxia metagene scores was prominent in the combination arm. Changes in a previously reported hypoxia metagene score were strongly correlated to the objective responses seen by conventional radiology assessments after 6 weeks in the combination arm, Spearman's ρ = 1 (p = 0.017) but not in monotherapy, ρ = -0.029 (p = 1). Similarly, the Predictor Analysis of Microarrays 50 (PAM50) proliferation metagene correlated to tumor changes merely in the combination arm at 6 and 12 weeks (ρ = 0.900, p = 0.083 and ρ = 1, p = 0.017 respectively). Reductions in mean SUV were a reliable early predictor of objective response in monotherapy, ρ = 0.833 (p = 0.008), but not in the combination arm ρ = -0.029 (p = 1). Gene expression profiling of longitudinal metastatic aspiration biopsies was feasible, demonstrated biological validity and provided predictive information.
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.
| | - John Lövrot
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Patricia Sandqvist
- Department of Radiology and Nuclear Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Hanjing Xie
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Linda S Lindström
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, University of California at San Francisco, USA
| | | | - Hans Jacobsson
- Department of Radiology and Nuclear Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Nardo D, Högberg G, Jonsson C, Jacobsson H, Hällström T, Pagani M. Neurobiology of Sleep Disturbances in PTSD Patients and Traumatized Controls: MRI and SPECT Findings. Front Psychiatry 2015; 6:134. [PMID: 26441695 PMCID: PMC4585117 DOI: 10.3389/fpsyt.2015.00134] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/11/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Sleep disturbances such as insomnia and nightmares are core components of post-traumatic stress disorder (PTSD), yet their neurobiological relationship is still largely unknown. We investigated brain alterations related to sleep disturbances in PTSD patients and controls by using both structural and functional neuroimaging techniques. METHOD Thirty-nine subjects either developing (n = 21) or not developing (n = 18) PTSD underwent magnetic resonance imaging and a symptom-provocation protocol followed by the injection of 99mTc-hexamethylpropyleneamineoxime. Subjects were also tested with diagnostic and self-rating scales on the basis of which a Sleep Disturbances Score (SDS; i.e., amount of insomnia/nightmares) was computed. RESULTS Correlations between SDS and gray matter volume (GMV)/regional cerebral blood flow (rCBF) were computed in the whole sample and separately in the PTSD and control groups. In the whole sample, higher sleep disturbances were associated with significantly reduced GMV in amygdala, hippocampus, anterior cingulate, and insula; increased rCBF in midbrain, precuneus, and insula; and decreased rCBF in anterior cingulate. This pattern was substantially confirmed in the PTSD group, but not in controls. CONCLUSION Sleep disturbances are associated with GMV loss in anterior limbic/paralimbic, PTSD-sensitive structures and with functional alterations in regions implicated in rapid eye movement-sleep control, supporting the existence of a link between PTSD and sleep disturbance.
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Affiliation(s)
- Davide Nardo
- Neuroimaging Laboratory, Santa Lucia Foundation , Rome , Italy
| | - Göran Högberg
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Cathrine Jonsson
- Department of Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden
| | - Hans Jacobsson
- Department of Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden
| | - Tore Hällström
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden ; Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Marco Pagani
- Department of Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden ; Institute of Cognitive Sciences and Technologies, National Research Council , Rome , Italy
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Lindholm H, Brolin F, Jonsson C, Jacobsson H. Effects on the FDG distribution by a high uptake of brown adipose tissue at PET examination. EJNMMI Res 2014; 4:72. [PMID: 26116129 PMCID: PMC4452657 DOI: 10.1186/s13550-014-0072-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/28/2014] [Indexed: 11/17/2022] Open
Abstract
Background At fluorodeoxyglucose/positron emission tomography (FDG/PET) examinations, a generally increased uptake of the skeletal muscles is sometimes encountered. As the tracer distribution constitutes a ‘zero-sum-game’, the uptake of lesions as well as of normal tissues is reduced in these patients. This has to be considered at calculation of standardised uptake values (SUVs), especially at longitudinal examinations in the same patient. In the current study, a possible similar influence on the FDG distribution by a high uptake of brown adipose tissue (BAT) was studied. Methods Twelve patients with strongly increased BAT uptake were examined twice with a mean of 5 days (study group). In six of these patients, there was at least one pathological lesion with increased uptake. The BAT uptake was normalised at the second examination after pretreatment with propranolol. SUVs of the pathological lesions and of the liver, spleen, lung, blood, skeletal muscles, bone marrow, gluteal fat, abdomen and heart were assessed. In order to control the effects of propranolol on normal organs/tissues, which could interfere with the findings, 25 age and gender matched normal controls were also studied (control subjects). Results In the study group, there was only a lower bone marrow uptake after propranolol administration. Comparing the study group with the control subjects, the bone marrow activity was higher at examination before propranolol treatment compared to the control subjects. There was also a higher uptake of the spleen in the study group before propranolol treatment compared to the control subjects. There were no differences between the study group after propranolol administration and the control subjects. Conclusions The differences found are small and cannot be explained, why they could be random phenomena. Together with, there were no differences between the study group after propranolol administration and the control subjects; it is concluded that an effect on the FDG distribution in patients with a strong BAT uptake by can be disregarded in clinical praxis. This is important at longitudinal examinations of patients undergoing tailored tumour therapy and in contrast to examinations in patients with a generally increased uptake of the skeletal muscles which significantly affects the distribution of the radiopharmaceutical.
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Affiliation(s)
- Henry Lindholm
- Department of Radiology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden,
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Gardner A, Åstrand D, Öberg J, Jacobsson H, Jonsson C, Larsson S, Pagani M. Towards mapping the brain connectome in depression: functional connectivity by perfusion SPECT. Psychiatry Res 2014; 223:171-7. [PMID: 24931481 DOI: 10.1016/j.pscychresns.2014.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/08/2014] [Accepted: 05/14/2014] [Indexed: 12/29/2022]
Abstract
Several studies have demonstrated altered brain functional connectivity in the resting state in depression. However, no study has investigated interregional networking in patients with persistent depressive disorder (PDD). The aim of this study was to assess differences in brain perfusion distribution and connectivity between large groups of patients and healthy controls. Participants comprised 91 patients with PDD and 65 age- and sex-matched healthy controls. Resting state perfusion was investigated by single photon emission computed tomography, and group differences were assessed by Statistical Parametric Mapping. Brain connectivity was explored through a voxel-wise interregional correlation analysis using as covariate of interest the normalized values of clusters of voxels in which perfusion differences were found in group analysis. Significantly increased regional brain perfusion distribution covering a large part of the cerebellum was observed in patients as compared with controls. Patients showed a significant negative functional connectivity between the cerebellar cluster and caudate, bilaterally. This study demonstrated inverse relative perfusion between the cerebellum and the caudate in PDD. Functional uncoupling may be associated with a dysregulation between the role of the cerebellum in action control and of the caudate in action selection, initiation and decision making in the patients. The potential impact of the resting state condition and the possibility of mitochondrial impairment are discussed.
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Affiliation(s)
- Ann Gardner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Järva Psychiatric Out-patient Clinic, Stockholm, Sweden
| | - Disa Åstrand
- Section of Imaging Physics, Solna Nuclear Medicine, Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Öberg
- Section of Imaging Physics, Department of Hospital Physics, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Jacobsson
- Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Cathrine Jonsson
- Section of Imaging Physics, Solna Nuclear Medicine, Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden
| | - Stig Larsson
- Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Marco Pagani
- Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden; Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy.
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Schumacher MC, Radecka E, Hellström M, Jacobsson H, Sundin A. [11C]Acetate positron emission tomography-computed tomography imaging of prostate cancer lymph-node metastases correlated with histopathological findings after extended lymphadenectomy. Scand J Urol 2014; 49:35-42. [PMID: 25001948 DOI: 10.3109/21681805.2014.932840] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy of combined [(11)C]acetate positron emission tomography and computed tomography ([(11)C]acetate-PET/CT) in regional lymph-node staging in patients with prostate cancer (PCa). MATERIAL AND METHODS [(11)C]Acetate-PET/CT was performed in 19 PCa patients who subsequently underwent extended pelvic lymph-node dissection (ePLND). The [(11)C]acetate-PET/CT results were compared with the surgical and histopathological findings from 13 defined lymph-node regions. RESULTS [(11)C]Acetate-PET/CT was true-positive for lymph-node metastases in nine patients, false-positive in three, false-negative in one patient and true-negative in six. The patient-by-patient-based sensitivity was 90% and the specificity 67%, the positive predictive value (PPV) was 75% and the negative predictive value (NPV) 86%. From a total of 114 nodal regions (mean 5.9 regions per patient), 484 lymph nodes (mean 25.5 nodes per patient) were removed and evaluated histopathologically. Forty-six lymph nodes from 24 out of 114 (21%) nodal regions were positive for PCa metastasis. The nodal-region-based sensitivity of [(11)C]acetate-PET/CT was 62%, specificity was 89%, PPV 62% and NPV 89%. CONCLUSION [(11)C]Acetate-PET/CT detects PCa lymph-node metastases with high patient-by-patient-based sensitivity but low specificity, and low nodal-region-based sensitivity but high specificity. Its limited ability to detect microscopic lymph-node involvement makes ePLND essential in all patients diagnosed with positive nodes on [(11)C]acetate-PET/CT.
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Affiliation(s)
- Martin C Schumacher
- Department of Urology, Molecular Medicine and Surgery, Karolinska Institutet, Section of Urology, Karolinska University Hospital , Stockholm , Sweden
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Foukakis T, Lovrot J, Sandqvist P, Xie H, Lindström LS, Giorgetti C, Jacobsson H, Hedayati E, Bergh JCS. Sequential metastatic biopsies and functional imaging in breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e22120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - John Lovrot
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | | | - Hanjing Xie
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | | | | | - Hans Jacobsson
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | - Elham Hedayati
- Karolinska Institutet, University Hospital, Stockholm, Sweden
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Lindholm H, Staaf J, Jacobsson H, Brolin F, Hatherly R, Sânchez-Crespo A. Repeatability of the Maximum Standard Uptake Value (SUVmax) in FDG PET. Mol Imaging Radionucl Ther 2014; 23:16-20. [PMID: 24653930 PMCID: PMC3957966 DOI: 10.4274/mirt.76376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/23/2013] [Indexed: 12/01/2022] Open
Abstract
Objective: SUVmax is often calculated at FDG PET examinations in systematic studies as well as at clinical examinations. Since SUVmax represents a very small portion of a lesion it may be questioned how statistically reliable the figure is. This was studied by assessing the repeatability of SUVmax between two FDG acquisitions acquired immediately upon each other in patients with chest lesions. Methods: In 100 clinical patients with a known chest lesion, two identical 3 min PET registrations (PET1 and PET2, respectively) were initiated within 224±31 sec of each other. The difference in SUVmax between the lesion for the two PET scans (ΔSUVmax) was calculated and the uncertainty expressed as the coefficient of variation, CV (%). The correlation between ΔSUVmax and the lowest SUVmax from PET1 or PET2, the approximate metabolic lesion volume, the time from FDG injection to PET1 and the time between PET1 and PET2, respectively, was also assessed. Results: In 56 patients SUVmax increased at the second acquisition and in 44 patients it decreased. Mean of SUVmax was 7.8±6.1 and 7.8±6.2 for PET1 and PET2, respectively. The mean percentage difference was 0.9±7.8. The difference was not significant (p=0.20). CV gave an uncertainty of 4.3% between the two measurements which is a strong indicator of equivalence. There was no correlation between ΔSUVmax and any of the assessed four parameters. The difference between the acquisitions, 0.9%, was much lower compared to the 3 previous published similar, but more restricted studies where the difference was 2.5-8.2%. Conclusion: From camera and computational perspectives, SUVmax is a stable parameter Conflict of interest:None declared.
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Affiliation(s)
- Henry Lindholm
- Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Johan Staaf
- Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden
| | - Hans Jacobsson
- Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Fredrik Brolin
- Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden
| | - Robert Hatherly
- Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden
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Hatherly R, Brolin F, Oldner Å, Sundin A, Lundblad H, Maguire GQ, Jonsson C, Jacobsson H, Noz ME. Technical requirements for Na¹⁸F PET bone imaging of patients being treated using a Taylor spatial frame. J Nucl Med Technol 2014; 42:33-6. [PMID: 24436472 DOI: 10.2967/jnmt.113.133082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Diagnosis of new bone growth in patients with compound tibia fractures or deformities treated using a Taylor spatial frame is difficult with conventional radiography because the frame obstructs the images and creates artifacts. The use of Na(18)F PET studies may help to eliminate this difficulty. METHODS Patients were positioned on the pallet of a clinical PET/CT scanner and made as comfortable as possible with their legs immobilized. One bed position covering the site of the fracture, including the Taylor spatial frame, was chosen for the study. A topogram was performed, as well as diagnostic and attenuation correction CT. The patients were given 2 MBq of Na(18)F per kilogram of body weight. A 45-min list-mode acquisition was performed starting at the time of injection, followed by a 5-min static acquisition 60 min after injection. The patients were examined 6 wk after the Taylor spatial frame had been applied and again at 3 mo to assess new bone growth. RESULTS A list-mode reconstruction sequence of 1 × 1,800 and 1 × 2,700 s, as well as the 5-min static scan, allowed visualization of regional bone turnover. CONCLUSION With Na(18)F PET/CT, it was possible to confirm regional bone turnover as a means of visualizing bone remodeling without the interference of artifacts from the Taylor spatial frame. Furthermore, dynamic list-mode acquisition allowed different sequences to be performed, enabling, for example, visualization of tracer transport from blood to the fracture site.
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Affiliation(s)
- Robert Hatherly
- Department of Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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Foukakis T, Hartman J, Stone-Elander S, Jacobsson H, Bergh J. Abstract OT1-2-03: A prospective randomized phase II study to identify predictive biomarkers and mechanisms of resistance in patients with HER2-negative metastatic breast cancer treated with the combination of bevacizumab and paclitaxel. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot1-2-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Several phase III trials have evaluated the combination of bevacizumab and chemotherapy in patients with metastatic breast cancer (MBC). These individual studies as well as a meta-analysis indicate high response rates (RR) and increased progression-free survival (PFS), however no significant gain of overall survival (OS) by the addition of bevacizumab to chemotherapy. To date, there are no methods to reliably select patients with MBC that benefit from treatment with bevacizumab.
Trial design
This project is a prospective, randomized, 2-arm, open-label, single-center, phase II trial aiming to identify predictive markers and mechanisms of resistance to bevacizumab in MBC by longitudinal biopsies and functional imaging. The study will be initiated with a non-randomized, feasibility stage including ten patients who will be treated with bevacizumab and paclitaxel, in order to determine the safety of metastatic tumor biopsies during therapy with bevacizumab. In a second phase, 20 patients will be randomized (1:1) between two treatment arms: Paclitaxel 80 mg / m2 weekly with or without bevacizumab 15 mg / kg every 3 weeks.
Mandatory, repeated peripheral blood sampling and fine needle aspiration biopsies (FNAB) will be collected at baseline, at day 4 after the first cycle and at progression. At baseline, a core biopsy will be obtained as well. Patients will also undergo two 18F]-fluoro-L-thymidine (FLT) Positron Emission Tomography (PET)/CT scans (18F-FLT PET/CT), at baseline and at day 4 after the first cycle.
Eligibility criteria
Eligible are patients aged 18-70 years, with newly diagnosed HER2-negative MBC (stage IV or recurrent) that are candidates for chemotherapy (ECOG 0-2), with measurable disease and at least one lesion that is accessible for biopsy. Adequate bone marrow, hepatic and renal function are required, as well as absence of thromboembolic disease, bleeding diathesis or second concurrent malignancy. No previous systemic treatment for MBC is allowed.
Specific aims
1. To assess early therapeutic response to bevacizumab in MBC by whole-exome sequencing and gene expression of serial metastatic biopsies and functional imaging.
2. To identify potential biomarkers present in plasma that can be used for patient selection or for monitoring therapy with bevacizumab in MBC.
3. To explore mutations and gene expression alterations as mechanisms of resistance to bevacizumab in MBC.
Statistical methods
The main objective of the study is exploratory. For most of the planned analyses, each patient will serve as her own control and baseline values of potential biomarkers will be compared in pairs with intra-patient, longitudinal samples, which significantly increases the statistical power.
For the identification of biomarkers, the results of the molecular analyses will be correlated with clinical outcome measurements including RR, PFS, and OS.
Present accrual and target accrual.
The trial was opened for inclusion in May 2013 and one patient has been accrued by June 1st 2013. A total of 30 patients will be included during a period of 2 years.
Contact:
Principal Investigator: Theodoros.Foukakis@ki.se; Study Director: Jonas.Bergh@ki.se.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-2-03.
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Affiliation(s)
- T Foukakis
- Karolinska Institutet, Stockholm, Sweden
| | - J Hartman
- Karolinska Institutet, Stockholm, Sweden
| | | | | | - J Bergh
- Karolinska Institutet, Stockholm, Sweden
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Nilsson H, Blomqvist L, Douglas L, Nordell A, Jacobsson H, Hagen K, Bergquist A, Jonas E. Dynamic gadoxetate-enhanced MRI for the assessment of total and segmental liver function and volume in primary sclerosing cholangitis. J Magn Reson Imaging 2013; 39:879-86. [PMID: 24123427 DOI: 10.1002/jmri.24250] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/09/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) for the assessment of global and segmental liver volume and function in patients with primary sclerosing cholangitis (PSC), and to explore the heterogeneous distribution of liver function in this patient group. MATERIALS AND METHODS Twelve patients with primary sclerosing cholangitis (PSC) and 20 healthy volunteers were examined using DHCE-MRI with Gd-EOB-DTPA. Segmental and total liver volume were calculated, and functional parameters (hepatic extraction fraction [HEF], input relative blood-flow [irBF], and mean transit time [MTT]) were calculated in each liver voxel using deconvolutional analysis. In each study subject, and incongruence score (IS) was constructed to describe the mismatch between segmental function and volume. Among patients, the liver function parameters were correlated to bile duct obstruction and to established scoring models for liver disease. RESULTS Liver function was significantly more heterogeneously distributed in the patient group (IS 1.0 versus 0.4). There were significant correlations between biliary obstruction and segmental functional parameters (HEF rho -0.24; irBF rho -0.45), and the Mayo risk score correlated significantly with the total liver extraction capacity of Gd-EOB-DTPA (rho -0.85). CONCLUSION The study demonstrates a new method to quantify total and segmental liver function using DHCE-MRI in patients with PSC.
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Affiliation(s)
- Henrik Nilsson
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Micarelli A, Jacobsson H, Larsson SA, Jonsson C, Pagani M. Neurobiological insight into hyperbaric hyperoxia. Acta Physiol (Oxf) 2013; 209:69-76. [PMID: 23692702 DOI: 10.1111/apha.12116] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/02/2013] [Accepted: 05/15/2013] [Indexed: 11/29/2022]
Abstract
AIM Hyperbaric hyperoxia (HBO) is known to modulate aerobic metabolism, vasoreactivity and blood flow in the brain. Nevertheless, mechanisms underlying its therapeutic effects, especially in traumatic brain injury (TBI) and stroke patients, are debated. The present study aimed at investigating regional cerebral blood flow (rCBF) distribution during acute HBO exposure. METHODS Regional cerebral blood flow response was investigated in seven healthy subjects exposed to either normobaric normoxia or HBO with ambient pressure/inspired oxygen pressure of 101/21 and 250/250 kPa respectively. After 40 min at the desired pressure, they were injected a perfusion tracer and subsequently underwent brain single photon emission computed tomography. rCBF distribution changes in the whole brain were assessed by Statistical Parametric Mapping. RESULTS During HBO, an increased relative rCBF distribution was found in sensory-motor, premotor, visual and posterior cingulate cortices as well as in superior frontal gyrus, middle/inferior temporal and angular gyrus and cerebellum, mainly in the dominant hemisphere. During normobaric normoxia, a higher (99m) Tc-HMPAO distribution in the right insula and subcortical structures as well as in bilateral hippocampi and anterior cingulated cortex was found. CONCLUSIONS The present study firstly confirmed the rCBF distribution increase during HBO in sensory-motor and visual cortices, and it showed for the first time a higher perfusion tracer distribution in areas encompassed in dorsal attention system and in default mode network. These findings unfold both the externally directed cognition performance improvement related to the HBO and the internally directed cognition states during resting-state conditions, suggesting possible beneficial effects in TBI and stroke patients.
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Affiliation(s)
- A. Micarelli
- Department of Medical Sciences and Translational Medicine; ‘Tor Vergata’ University; Rome; Italy
| | - H. Jacobsson
- Department of Nuclear Medicine; Karolinska University Hospital; Stockholm; Sweden
| | - S. A. Larsson
- Department of Nuclear Medicine; Karolinska University Hospital; Stockholm; Sweden
| | - C. Jonsson
- Department of Nuclear Medicine; Karolinska University Hospital; Stockholm; Sweden
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Nardo D, Högberg G, Lanius RA, Jacobsson H, Jonsson C, Hällström T, Pagani M. Gray matter volume alterations related to trait dissociation in PTSD and traumatized controls. Acta Psychiatr Scand 2013; 128:222-33. [PMID: 23113800 DOI: 10.1111/acps.12026] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study used voxel-based morphometry (VBM) to investigate brain structural alterations related to trait dissociation and its relationship with post-traumatic stress disorder (PTSD). METHOD Thirty-two subjects either developing (N = 15) or non-developing (N = 17) PTSD underwent MRI scanning and were assessed with the Dissociative Experience Scale (DES), subscales for pathological (DES-T) and non-pathological trait (DES-A) dissociation, and other clinical measures. Gray matter volume (GMV) was analyzed using VBM as implemented in SPM. PTSD and non-PTSD subjects were compared to assess brain alterations related to PTSD pathology, whereas correlation analyses between dissociation measures and GMV were performed on the whole sample (N = 32), irrespective of PTSD diagnosis, to identify alterations related to trait dissociation. RESULTS As compared to traumatized controls, PTSD subjects showed reduced GMV in the prefrontal cortex, hippocampus and lingual gyrus. Correlations with dissociation measures (DES, DES-T, and DES-A) consistently showed increased GMV in the medial and lateral prefrontal, orbitofrontal, parahippocampal, temporal polar, and inferior parietal cortices. CONCLUSION PTSD and dissociation seem to be associated with opposite volumetric patterns in the prefrontal cortex. Trait dissociation appears to involve increased GMV in prefrontal, paralimbic, and parietal cortices, with negligible differences between pathological and non-pathological dissociation.
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Affiliation(s)
- D Nardo
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.
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Kölbeck KG, Kamareji S, Jacobsson H, Hillerdal G. [Fast track assessment of lung cancer cut the investigation time in half]. Lakartidningen 2013; 110:1474-1476. [PMID: 24044184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Engstrand T, Kihlström L, Neovius E, Skogh ACD, Lundgren TK, Jacobsson H, Bohlin J, Åberg J, Engqvist H. Development of a bioactive implant for repair and potential healing of cranial defects. J Neurosurg 2013; 120:273-7. [PMID: 23909245 DOI: 10.3171/2013.6.jns1360] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The repair of complex craniofacial bone defects is challenging and a successful result is dependent on the size of the defect, quality of the soft tissue covering the defect, and choice of reconstruction method. The objective of this study was to develop a bioactive cranial implant that could provide a permanent reconstructive solution to the patient by stimulating bone healing of the defect. In this paper the authors report on the feasibility and clinical results of using such a newly developed device for the repair of a large traumatic and therapy-resistant cranial bone defect. The patient had undergone numerous attempts at repair, in which established methods had been tried without success. A mosaic-designed device was manufactured and implanted, comprising interconnected ceramic tiles with a defined calcium phosphate composition. The clinical outcome 30 months after surgery revealed a restored cranial vault without postoperative complications. Computed tomography demonstrated signs of bone ingrowth. Examination with combined (18)F-fluoride PET and CT provided further evidence of bone healing of the cranial defect.
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Affiliation(s)
- Thomas Engstrand
- Stockholm Craniofacial Centre, Department of Molecular Medicine and Surgery, Plastic Surgery Section
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Gabrielsen A, Darlington P, Sorensson P, Cederlund K, Jacobsson H, Eklund A, Grunewald J. Cardiac involvement in Caucasian patients with pulmonary sarcoidosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lindholm H, Brolin F, Jonsson C, Jacobsson H. The relation between the blood glucose level and the FDG uptake of tissues at normal PET examinations. EJNMMI Res 2013; 3:50. [PMID: 23829959 PMCID: PMC3717131 DOI: 10.1186/2191-219x-3-50] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/25/2013] [Indexed: 11/20/2022] Open
Abstract
Background The influence of the blood glucose level on the tracer uptake of normal tissues at [18F]-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) was retrospectively studied in examinations in clinical patients. Methods Five hundred examinations were evaluated in retrospect. The inclusion criteria were studies with a normal or near-normal FDG distribution. Patients who had been subjected to chemotherapy (including GSF treatment) or radiotherapy <4 weeks prior to the examination were excluded; we cannot exclude, however, that in a very few patients the available information might have been incomplete. Otherwise, patients were included regardless of concurrent diseases and/or therapy. In one evaluation, the mean standardized uptake value of the liver, spleen, lungs, peripheral blood, selected muscles and bone marrow of all 500 individuals was correlated to the blood glucose level. In another evaluation, a subgroup of 62 patients with increased blood glucose levels (≥7.0 mmol/l) was compared with another subgroup of 62 patients paired with regard to age and gender with blood glucose levels within normal range (≤6.0 mmol/l). Results There was a weak positive correlation between the blood glucose level and the muscular uptake of FDG, while there was no correlation with the tracer uptake of the liver, spleen, lungs, peripheral blood or bone marrow. The patient group with increased blood glucose levels showed a slightly, but significantly, higher muscular FDG uptake compared with the matched subgroup of patients with normal blood glucose levels. When comparing the other assessed tissues/organs, there were no differences between these two patient groups. Conclusions The effect of hyperglycaemia at FDG PET on the studied normal tissues is restricted to a slightly increased muscular uptake. The effect of the blood glucose level on the blood activity at the time of examination is negligible.
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Affiliation(s)
- Henry Lindholm
- Department of Radiology, Karolinska University Hospital Solna, Stockholm, SE 171 76, Sweden.
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Hillerdal G, Kölbeck K, Jacobsson H. [Pulmonary tularemia: rare disease that can be interpreted as lung cancer. Serology provides the correct diagnosis, as shown by case reports]. Lakartidningen 2013; 110:1280-1281. [PMID: 23951881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Janek Strååt S, Jacobsson H, Noz ME, Andreassen B, Näslund I, Jonsson C. Dynamic PET/CT measurements of induced positron activity in a prostate cancer patient after 50-MV photon radiation therapy. EJNMMI Res 2013; 3:6. [PMID: 23343347 PMCID: PMC3557183 DOI: 10.1186/2191-219x-3-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/14/2013] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this work was to reveal the research interest value of positron emission tomography (PET) imaging in visualizing the induced tissue activity post high-energy photon radiation treatment. More specifically, the focus was on the possibility of retrieving data such as tissue composition and physical half-lives from dynamic PET acquisitions, as positron-emitting radionuclides such as 15O, 11C, and 13N are produced in vivo during radiation treatment with high-energy photons (>15 MeV). The type, amount, and distribution of induced positron-emitting radionuclides depend on the irradiated tissue cross section, the photon spectrum, and the possible perfusion-driven washout. Methods A 62-year-old man diagnosed with prostate cancer was referred for palliative radiation treatment of the pelvis minor. A total dose of 8 Gy was given using high-energy photon beams (50 MV) with a racetrack microtron, and 7 min after the end of irradiation, the patient was positioned in a PET/computed tomography (CT) camera, and a list-mode acquisition was performed for 30 min. Two volumes of interests (VOIs) were positioned on the dynamic PET/CT images, one in the urinary bladder and the other in the subcutaneous fat. Analysis of the measured relative count rate was performed in order to compute the tissue compositions and physical half-lives in the two regions. Results Dynamic analysis from the two VOIs showed that the decay constants of activated oxygen and carbon could be deduced. Calculation of tissue composition from analyzing the VOI containing subcutaneous fat only moderately agreed with that of the tabulated International Commission on Radiation Units & Measurements (ICRU) data of the adipose tissue. However, the same analysis for the bladder showed a good agreement with that of the tabulated ICRU data. Conclusions PET can be used in visualizing the induced activity post high-energy photon radiation treatment. Despite the very low count rate in this specific application, wherein 7 min after treatment was about 5% of that of a standard 18F-FDG PET scan, the distribution of activated tissue elements (15O and 11C) could be calculated from the dynamic PET data. One possible future application of this method could possibly be to measure and determine the tumor tissue composition in order to identify any hypoxic or necrotic region, which is information that can be used in the ongoing therapy planning process. Trial registration The official name of the trial committee of this study is ‘Regionala etikprövningsnämnden i Stockholm’ (FE 289, Stockholm, SE-17177, Sweden). The unique identifying number is 2011/1789-31/2.
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Affiliation(s)
- Sara Janek Strååt
- Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Stockholm, PO Box 260, SE-171 76, Sweden.
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Scherf DB, Sarkisyan N, Jacobsson H, Claus R, Bermejo JL, Peil B, Gu L, Muley T, Meister M, Dienemann H, Plass C, Risch A. Epigenetic screen identifies genotype-specific promoter DNA methylation and oncogenic potential of CHRNB4. Oncogene 2012; 32:3329-38. [PMID: 22945651 PMCID: PMC3710305 DOI: 10.1038/onc.2012.344] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/21/2012] [Accepted: 06/20/2012] [Indexed: 12/11/2022]
Abstract
Genome-wide association studies have highlighted three major lung cancer susceptibility regions at 15q25.1, 5p15.33 and 6p21.33. To gain insight into the possible mechanistic relevance of the genes in these regions, we investigated the regulation of candidate susceptibility gene expression by epigenetic alterations in healthy and lung tumor tissues. For genes up- or downregulated in lung tumors the influence of genetic variants on DNA methylation was investigated and in vitro studies were performed. We analyzed 394 CpG units within 19 CpG islands in the susceptibility regions in a screening set of 34 patients. Significant findings were validated in an independent patient set (n=50) with available DNA and RNA. The most consistent overall DNA methylation difference between tumor and adjacent normal tissue on 15q25 was tumor hypomethylation in the promoter region of CHRNB4 with a median difference of 8% (p<0.001) which resulted in overexpression of the transcript in tumors (p<0.001). Confirming previous studies we also found hypermethylation in CHRNA3 and TERT with significant expression changes. Decitabine treatment of H1299 cells resulted in reduced methylation levels in gene promoters, elevated transcript levels of CHRNB4 and CHRNA3 and a slight downregulation of TERT demonstrating epigenetic regulation of lung cancer cells. SNPs rs421629 on 5p15.33 and rs1948, rs660652, rs8040868 and rs2036527 on 15q25.1, previously identified as lung cancer risk or nicotine addiction modifiers were associated with tumor DNA methylation levels in the promoters of TERT and CHRNB4 (p<0.001) respectively in two independent sample sets (n=82; n=150). In addition, CHRNB4 knock down in two different cell lines (A549 and H1299) resulted in reduced proliferation (pA549<0.05;pH1299L<0.001) and propensity to form colonies in H1299 cells. These results suggest epigenetic deregulation of nicotinic acetylcholinereceptor subunit (nAChR) genes which in the case of CHRNB4 is strongly associated with genetic lung cancer susceptibility variants and a functional impact on tumorigenic potential.
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Affiliation(s)
- D B Scherf
- Division of Epigenomics and Cancer Risk Factors (C010), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Lindholm H, Johansson O, Jonsson C, Jacobsson H. The distribution of FDG at PET examinations constitutes a relative mechanism: significant effects at activity quantification in patients with a high muscular uptake. Eur J Nucl Med Mol Imaging 2012; 39:1685-90. [DOI: 10.1007/s00259-012-2202-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
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Staaf J, Jacobsson H, Sanchez-Crespo A. A revision of the organ radiation doses from 2-fluoro-2-deoxy-D-glucose with reference to tumour presence. Radiat Prot Dosimetry 2012; 151:43-50. [PMID: 22247523 DOI: 10.1093/rpd/ncr471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Absorbed radiation doses to major human organs after intravenous bolus administration of 2-[(18)F]fluoro-2-deoxy-d-glucose (FDG) were reviewed. Absorbed doses were calculated using the medical internal radiation dose (MIRD) formalism from experimental activity-time curves. Thirty patients (22 with macroscopic lung tumour and 8 without observable disease) were investigated using a state-of-the-art combined positron emission tomography/computer tomography system (Siemens Biograph 64). Each patient underwent a series of 10 consecutive whole-body PET scans during the first 60-min post-FDG administration. Differences were observed between organ radiation doses in this work and those reported in International Commission for Radiation Protection 106 (21 % in effective dose). The presence of tumour did not affect the FDG biodistribution. Large inter-individual variations in organ-absorbed doses were observed. This in combination with the lack of a model for bladder voiding suitable for all patients suggests the need for a more precise estimate of normal-organ radiation doses. This will be beneficial in optimising FDG administration in clinical routine.
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Affiliation(s)
- Johan Staaf
- Department of Physics, Stockholm University, Stockholm, Sweden
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Larsson P, Arvidsson D, Björnstedt M, Isaksson B, Jersenius U, Motarjemi H, Jacobsson H. Adding 11C-acetate to 18F-FDG at PET Examination Has an Incremental Value in the Diagnosis of Hepatocellular Carcinoma. Mol Imaging Radionucl Ther 2012; 21:6-12. [PMID: 23487415 PMCID: PMC3590959 DOI: 10.4274/mirt.87] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 01/02/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The sensitivity of FDG at PET examination of Hepatocellular Carcinoma (HCC) is restricted. In a few studies, all done in Oriental patients, PET-examination with (11)C-acetate has shown a higher accuracy than with FDG. In the current study, the uptake of (11)C-acetate has been compared with the uptake of FDG in the primary HCC in a cohort of Occidental patients. MATERIAL AND METHODS 44 patients underwent PET-examination with both tracers with a mean of 9 days between the examinations. 26 patients had a microscopical diagnosis and 18 were diagnosed with multimodal radiological methods. At least one relevant radiological examination was available for comparison. RESULTS At visual evaluation, 13 of the HCC's were positive at PET-examination using FDG and 34 were positive using (11)C-acetate (p<0.001). Median tumor SUVmean of (11)C-acetate was 4.7 and of FDG was 1.9 (p<0.001). There was also a higher uptake of (11)C-acetate by the surrounding liver tissue than of FDG. Median liver SUVmean of [u]11[/u]C-acetate was 3.2 and of FDG it was 1.7 (p<0.001). This corresponded to a median tumour/liver tissue ratio for (11)C-acetate of 1.4 and for FDG of 1.0 (p<0.05). Previous reports of a negative correlation between the uptake of the tracers were weakly supported. In 4 large tumors some portions being hot using one of the tracers were cold using the other tracer and vice versa. CONCLUSION Adding registration with (11)C-acetate to registration with FDG at PET-examination has an incremental value in the diagnosis of HCC. A higher tumor uptake of (11)C-acetate cannot be taken full advantage of because of a higher uptake also by the surrounding liver tissue. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Patricia Larsson
- Karolinska University Hospital Solna, Departments of Radiology and Nuclear Medicine, Solna, Sweden
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Jacobsson H. Single-photon-emission computed tomography (SPECT) with 99 technetium sestamibi in the diagnosis of small breast cancer and axillary node involvement. World J Surg 2012; 35:2673-4. [PMID: 21913133 DOI: 10.1007/s00268-011-1271-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hans Jacobsson
- Department of Radiology and Nuclear Medicine, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden.
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Pagani M, Nardo D, Hogberg G, Lanius R, Bravo T, Jacobsson H, Jonsson C, Hallstrom T. P-973 - Gray matter volume alterations associated with dissociative traits in PTSD and traumatized controls. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Blomé MA, Björkman P, Flamholc L, Jacobsson H, Molnegren V, Widell A. Minimal transmission of HIV despite persistently high transmission of hepatitis C virus in a Swedish needle exchange program. J Viral Hepat 2011; 18:831-9. [PMID: 21114587 DOI: 10.1111/j.1365-2893.2010.01400.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The aim of this study was to examine the prevalence and incidence of HIV and hepatitis B and C (HBV and HCV) among injecting drug users in a Swedish needle exchange programme (NEP) and to identify risk factors for blood-borne transmission. A series of serum samples from NEP participants enrolled from 1997 to 2005 were tested for markers of HIV, HBV and HCV (including retrospective testing for HCV RNA in the last anti-HCV-negative sample from each anti-HCV seroconverter). Prevalence and incidence were correlated with self-reported baseline characteristics. Among 831 participants available for follow-up, one was HIV positive at baseline and two seroconverted to anti-HIV during the follow-up of 2433 HIV-negative person-years [incidence 0.08 per 100 person-years at risk (pyr); compared to 0.0 in a previous assessment of the same NEP covering 1990-1993]. The corresponding values for HBV were 3.4/100 pyr (1990-1993: 11.7) and for HCV 38.3/100 pyr (1990-1993: 27.3). HCV seroconversions occurred mostly during the first year after NEP enrolment. Of the 332 cases testing anti-HCV negative at enrolment, 37 were positive for HCV RNA in the same baseline sample (adjusted HCV incidence 31.5/100 pyr). HCV seroconversion during follow-up was significantly associated with mixed injection use of amphetamine and heroin, and a history of incarceration at baseline. In this NEP setting, HIV prevalence and incidence remained low and HBV incidence declined because of vaccination, but transmission of HCV was persistently high. HCV RNA testing in anti-HCV-negative NEP participants led to more accurate identification of timepoints for transmission.
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Affiliation(s)
- M Alanko Blomé
- Department of Infectious Diseases, Division of Clinical Sciences, Lund University, Malmö, Sweden
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Nardo D, Högberg G, Flumeri F, Jacobsson H, Larsson SA, Hällström T, Pagani M. Self-rating scales assessing subjective well-being and distress correlate with rCBF in PTSD-sensitive regions. Psychol Med 2011; 41:2549-2561. [PMID: 21672299 DOI: 10.1017/s0033291711000912] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational-related post-traumatic stress disorder (PTSD) subjects and to seek possible correlations between brain perfusion and self-rating scales (SRS) in order to cross-check their diagnostic value and to look for their neural correlates. METHOD A total of 13 traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD who had experienced a 'person under train' accident or who had been assaulted at work underwent clinical assessment and 99mTc-HMPAO SPECT imaging during autobiographical trauma scripts. Statistical parametric mapping was applied to analyse rCBF changes in S as compared with NS and to search for correlations between rCBF and the administered SRS scores, modelling age, months to SPECT and the ratio 'grey matter/intra-cranial volume' as nuisance variables. RESULTS Significantly higher activity was observed during trauma script in left posterior and anterior insula, posterior cingulate, inferior parietal lobule, precuneus, caudate and putamen in PTSD subjects as compared with the trauma-exposed control group. Impact of Event Scale and World Health Organisation (10) Well-Being Index scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found. CONCLUSIONS These findings support the involvement of insular, cingulate and parietal cortices (as well as the basal ganglia) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress.
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Affiliation(s)
- D Nardo
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.
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Suzuki C, Blomqvist L, Sundin A, Jacobsson H, Byström P, Berglund Å, Nygren P, Glimelius B. The initial change in tumor size predicts response and survival in patients with metastatic colorectal cancer treated with combination chemotherapy. Ann Oncol 2011; 23:948-54. [PMID: 21832285 DOI: 10.1093/annonc/mdr350] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To determine whether the change in tumor diameters at the first follow-up computed tomography (CT) examination after baseline examination (first change) correlates with outcome in patients with metastatic colorectal cancer (mCRC) treated with combination chemotherapy. PATIENTS AND METHODS The first change was analyzed in a multicenter randomized phase III trial (Nordic VI, N = 567) comparing first-line irinotecan with either bolus or infused 5-fluorouracil. Cox proportional hazards multiple regression model and Kaplan-Meier survival analyses after correction for guarantee-time bias were carried out to evaluate correlations between first change, objective response according to RECIST 1.0, progression-free survival (PFS), and overall survival (OS). RESULTS The hazard ratios for PFS and OS decreased along with first change. A decrease between 10% and <30%, albeit RECIST does not regard this as a partial response, was a positive prognostic factor for PFS and OS. Patients who had new lesions or unequivocal progression of nonmeasurable lesions had a worse prognosis than those with only an increase in size of >20%. CONCLUSIONS The change in tumor size at the first follow-up CT is strongly prognostic for PFS and OS in mCRC.
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Affiliation(s)
- C Suzuki
- Department of Diagnostic Radiology, Institution for Molecular Medicine and Surgery, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
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Abstract
AIM Acute hypobaric hypoxia is well known to alter brain circulation and to cause neuropsychological impairment. However, very few studies have examined the regional changes occurring in the brain during acute exposure to extreme hypoxic conditions. METHODS Regional cerebral blood flow (rCBF) response to hypoxia was investigated in six healthy subjects exposed to either normobaric normoxia or hypobaric hypoxia with ambient pressure/inspired oxygen pressure of 101/21 kPa and 50/11 kPa respectively. After 40 min at the desired pressure they were injected (99m)Tc-HMPAO and subsequently underwent single photon emission computed tomography. Regional cerebral blood flow distribution changes in the whole brain were assessed by Statistical Parametric Mapping, a well established voxel-based analysis method. RESULTS Hypobaric hypoxia increased rCBF distribution in sensorymotor and prefrontal cortices and in central structures. PCO(2) correlated positively and SatO(2) negatively with rCBF in several temporal, parahippocampal, parietal and central structures. CONCLUSIONS These findings underscore the specific sensitivity of the frontal lobe to acute hypobaric hypoxia and of limbic and central structures to blood gas changes emphasizing the involvement of these brain areas in acute hypoxia.
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Affiliation(s)
- M Pagani
- Institute of Cognitive Sciences and Technologies, CNR, Rome & Padua, Italy.
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Suzuki C, Blomqvist L, Sundin A, Bystrom P, Berglund A, Jacobsson H, Nygren P, Glimelius B. Initial change in tumor size as an imaging surrogate of outcomes in patients with metastatic colorectal cancer (mCRC) treated with first-line irinotecan and 5-FU combination chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Holte H, Bogsrud T, Leppa S, Laukka M, Bjorkholm M, Jacobsson H, Jyrkkio S, Seppanen M, Jerkeman M, Brun E, Fluge O, Pedersen LM, Eriksson M. 18FDG PET/CT after intensified chemo-immunotherapy in diffuse large B-cell lymphoma (DLBCL), aged 18-65 with aaIPI 2-3 positive or indeterminate lesions are often false-positive: A Nordic phase II substudy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Witte AB, Grybäck P, Jacobsson H, Näslund E, Hellström PM, Holst JJ, Hilsted L, Schmidt PT. Involvement of endogenous glucagon-like peptide-1 in regulation of gastric motility and pancreatic endocrine secretion. Scand J Gastroenterol 2011; 46:428-35. [PMID: 21114428 DOI: 10.3109/00365521.2010.537680] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To study the role of endogenous glucagon-like peptide-1 (GLP-1) on gastric emptying rates of a solid meal as well as postprandial hormone secretion and glucose disposal. MATERIAL AND METHODS In nine healthy subjects, gastric emptying of a 310-kcal radio-labelled solid meal and plasma concentrations of insulin, glucagon and glucose were measured during infusion of saline or the GLP-1 receptor antagonist exendin(9-39)amide (Ex(9-39)) at 300 pmol·kg(-1)·min(-1). RESULTS Ex(9-39) infusion had no effect on the total gastric emptying curve, but changed the intra-gastric distribution of the meal. During infusion of Ex(9-39), more content stayed in the upper stomach (79.1 ± 2.5% of total during Ex(9-39) compared to 66.6 ± 5.7% during saline at 5 min). During Ex(9-39) infusion, higher concentrations of plasma glucagon were measured both before (after 40 min of Ex(9-39) infusion the glucagon level was 15.1 ± 0.7 pmol·L(-1) compared to 5.4 ± 1.4 during saline) and after the meal, and postprandial GLP-1 levels increased. Basal insulin and glucose levels were not affected by Ex(9-39), but the postprandial rise of insulin and glucose enhanced during Ex(9-39). CONCLUSIONS Endogenous GLP-1 is involved in the regulation of gastric motility in relation to meal intake and also in the regulation of postprandial insulin and glucose levels. Furthermore, endogenous GLP-1 seems to tonically restrain glucagon secretion.
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Affiliation(s)
- Anne-Barbara Witte
- Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
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