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Edvardsson A, Gorgisyan J, Andersson KM, Vallhagen Dahlgren C, Dasu A, Gram D, Björk-Eriksson T, Munck af Rosenschöld P. Robustness and dosimetric verification of hippocampal-sparing craniospinal pencil beam scanning proton plans for pediatric medulloblastoma. Phys Imaging Radiat Oncol 2024; 29:100555. [PMID: 38405431 PMCID: PMC10891325 DOI: 10.1016/j.phro.2024.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Background and Purpose Hippocampal-sparing (HS) is a method that can potentially reduce late cognitive complications for pediatric medulloblastoma (MB) patients treated with craniospinal proton therapy (PT). The aim of this study was to investigate robustness and dosimetric plan verification of pencil beam scanning HS PT. Materials and Methods HS and non-HS PT plans for the whole brain part of craniospinal treatment were created for 15 pediatric MB patients. A robust evaluation of the plans was performed. Plans were recalculated in a water phantom and measured field-by-field using an ion chamber detector at depths corresponding to the central part of hippocampi. All HS and non-HS fields were measured with the standard resolution of the detector and in addition 16 HS fields were measured with high resolution. Measured and planned dose distributions were compared using gamma evaluation. Results The median mean hippocampus dose was reduced from 22.9 Gy (RBE) to 8.9 Gy (RBE), while keeping CTV V95% above 95 % for all nominal HS plans. HS plans were relatively robust regarding hippocampus mean dose, however, less robust regarding target coverage and maximum dose compared to non-HS plans. For standard resolution measurements, median pass rates were 99.7 % for HS and 99.5 % for non-HS plans (p < 0.001). For high-resolution measurements, median pass rates were 100 % in the hippocampus region and 98.2 % in the surrounding region. Conclusions A substantial reduction of dose in the hippocampus region appeared feasible. Dosimetric accuracy of HS plans was comparable to non-HS plans and agreed well with planned dose distribution in the hippocampus region.
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Affiliation(s)
- Anneli Edvardsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jenny Gorgisyan
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | | | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden
- Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Daniel Gram
- Department of Clinical Oncology and Palliative Care, Radiotherapy, Zealand University Hospital, Næstved, Denmark
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology – Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Per Munck af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Gram D, Brodin NP, Björk-Eriksson T, Nysom K, Munck Af Rosenschöld P. The risk of radiation-induced neurocognitive impairment and the impact of sparing the hippocampus during pediatric proton cranial irradiation. Acta Oncol 2023; 62:134-140. [PMID: 36847433 DOI: 10.1080/0284186x.2023.2176253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/01/2023]
Abstract
BACKGROUND AND PURPOSE Hippocampus is a central component for neurocognitive function and memory. We investigated the predicted risk of neurocognitive impairment of craniospinal irradiation (CSI) and the deliverability and effects of hippocampal sparing. The risk estimates were derived from published NTCP models. Specifically, we leveraged the estimated benefit of reduced neurocognitive impairment with the risk of reduced tumor control. MATERIAL AND METHODS For this dose planning study, a total of 504 hippocampal sparing intensity modulated proton therapy (HS-IMPT) plans were generated for 24 pediatric patients whom had previously received CSI. Plans were evaluated with respect to target coverage and homogeneity index to target volumes, maximum and mean dose to OARs. Paired t-tests were used to compare hippocampal mean doses and normal tissue complication probability estimates. RESULTS The median mean dose to the hippocampus could be reduced from 31.3 GyRBE to 7.3 GyRBE (p < .001), though 20% of these plans were not considered clinically acceptable as they failed one or more acceptance criterion. Reducing the median mean hippocampus dose to 10.6 GyRBE was possible with all plans considered as clinically acceptable treatment plans. By sparing the hippocampus to the lowest dose level, the risk estimation of neurocognitive impairment could be reduced from 89.6%, 62.1% and 51.1% to 41.0% (p < .001), 20.1% (p < .001) and 29.9% (p < .001) for task efficiency, organization and memory, respectively. Estimated tumor control probability was not adversely affected by HS-IMPT, ranging from 78.5 to 80.5% for all plans. CONCLUSIONS We present estimates of potential clinical benefit in terms of neurocognitive impairment and demonstrate the possibility of considerably reducing neurocognitive adverse effects, minimally compromising target coverage locally using HS-IMPT.
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Affiliation(s)
- Daniel Gram
- Department of Oncology - Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Radiotherapy, Zealand University Hospital, Næstved, Denmark
| | - N Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.,Regional Cancer Centre West, Gothenburg, Sweden
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark.,Radiation Physics - Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
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Gurjar M, Lindberg J, Björk-Eriksson T, Olsson C. Automated data extraction tool (DET) for external applications in radiotherapy. Tech Innov Patient Support Radiat Oncol 2022; 25:100194. [PMID: 36659909 PMCID: PMC9842687 DOI: 10.1016/j.tipsro.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023] Open
Abstract
Oncological Information Systems (OIS) manage information in radiotherapy (RT) departments. Due to database structure limitations, stored information can rarely be directly used except for vendor-specific purposes. Our aim is to enable the use of such data in various external applications by creating a tool for automatic data extraction, cleaning and formatting. METHODS AND MATERIALS We used OIS data from a nine-linac RT department in Sweden (70 weeks, 2015-16). Extracted data included patients' referrals and appointments with details for RT sub-tasks. The data extraction tool to prepare the data for external use was built in C# programming language. It used excel-automation queries to remove unassigned/duplicated values, substitute missing data and perform application-specific calculations. Descriptive statistics were used to verify the output with the manually prepared dataset from the corresponding time period. RESULTS From the initial raw data, 2030 (51 %)/907 (23 %) patients had known curative and palliative treatment intent for 84 different cancer diagnoses. After removal of incomplete entries, 373 (10 %) patients had unknown treatment intents which were substituted based on the known curative/palliative ratio. Automatically- and manuallyprepared datasets differed < 1 % for Mould, Treatment planning, Quality assurance and ± 5 % for Fractions and Magnetic resonance imaging with overestimations in 80/140 (57 %) entries by the tool. CONCLUSION We successfully implemented a software tool to prepare ready-to-use OIS datasets for external applications. Our evaluations showed overall results close to the manually-prepared dataset. The time taken to prepare the dataset using our automated strategy can reduce the time for manual preparation from weeks to seconds.
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Affiliation(s)
- Mruga Gurjar
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Corresponding author
| | - Jesper Lindberg
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden,Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Caroline Olsson
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
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Björk-Eriksson T, Boström M, Bryngelsson IL, Lähteenmäki PM, Jarfelt M, Kalm M, Olsson DS. Mortality Among Pediatric Patients With Acute Lymphoblastic Leukemia in Sweden From 1988 to 2017. JAMA Netw Open 2022; 5:e2243857. [PMID: 36441552 PMCID: PMC9706364 DOI: 10.1001/jamanetworkopen.2022.43857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/29/2022] Open
Abstract
IMPORTANCE Acute lymphoblastic leukemia (ALL) constitutes 20% to 30% of all pediatric cancers. The 5-year overall survival among pediatric patients with ALL in high-income countries such as Sweden is currently more than 90%, but long-term unselected nationwide mortality data and mortality data in relation to the general population are lacking. OBJECTIVE To compare mortality between pediatric patients with ALL and the general population during a 30-year period in Sweden and to assess the incidence of ALL in Sweden. DESIGN, SETTING, AND PARTICIPANTS This cohort study included pediatric patients (aged <18 years) with a morphologically verified ALL diagnosis in the Swedish Cancer Register and/or at least 2 ALL diagnoses in the Swedish National Patient Register between January 1, 1988, and December 31, 2017. Data were cross-linked to the Swedish Cause of Death Register. Data were analyzed from May 2019 to January 2022. MAIN OUTCOMES AND MEASURES The main outcomes were mortality among patients with ALL compared with that in the general population and mortality in different subgroups within the cohort. Standardized mortality ratios (SMRs) were calculated using the general Swedish population as a reference. Within-cohort survival analyses were performed. RESULTS A total of 2397 patients (1354 [56%] male; mean [SD] age at diagnosis, 6.1 [4.7] years) were included in the study. The mean (SD) incidence of pediatric ALL during the study period was 4.11 (0.60) cases per 100 000 persons per year (females, 3.68 [0.65] cases per 100 000 persons per year; males, 4.52 [0.81] cases per 100 000 persons per year; P < .001). The observed number of deaths among pediatric patients with ALL was 409 vs the 9.5 deaths expected in the general population, resulting in an overall SMR of 43.1 (95% CI, 39.0-47.5); females had a higher SMR than males (57.8 [95% CI, 49.5-67.2] vs 34.5 [95% CI, 32.0-41.4]; P < .001). Analysis within the cohort showed a continued decrease in survival throughout the 30-year follow-up. The association between calendar year of ALL diagnosis, corresponding with different ALL treatment protocols, and mortality showed the lowest survival for the 1988-1991 group and the highest for the 2008-2017 group (χ2 = 20.3; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, a consistently high SMR was seen among pediatric patients with ALL. Within the ALL cohort, survival evolved to a similar extent as in the young general population of Sweden. Furthermore, survival among patients with ALL decreased throughout the whole follow-up period without any trend difference after the 5-year follow-up time point. The changes in ALL treatment protocols were associated with overall improved absolute survival over time.
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Affiliation(s)
- Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Martina Boström
- Medical Affairs, Neurology, Go North Medical AB, Gothenburg, Sweden
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Marianne Jarfelt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Kalm
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Daniel S. Olsson
- Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden
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Gram D, Brodin P, Björk-Eriksson T, Nysom K, Munck af Rosenschöld P. PD-0165 The risk of neurocognitive impairment and the impact of sparing the hippocampus during pediatric CSI. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02770-0] [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: 11/27/2022]
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Rydén I, Fernström E, Lannering B, Kalm M, Blomstrand M, Hellström P, Björk-Eriksson T, Jarfelt M. Neuropsychological functioning in childhood cancer survivors following cranial radiotherapy - results from a long-term follow-up clinic. Neurocase 2022; 28:163-172. [PMID: 35549827 DOI: 10.1080/13554794.2022.2049825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 10/18/2022]
Abstract
Treatment of malignant childhood posterior fossa tumors (CPFT) often includes surgical resection and craniospinal radiotherapy (CSI). Nasopharyngeal tumors in childhood (CNPHT) are often treated with surgery and radiotherapy (RT), leading to incidental brain irradiation. RT to the developing brain is associated with risks for cognitive impairments. We studied cognitive functioning, health-related quality of life (HRQOL), fatigue, and psychological distress, in adult survivors of CPFT and CNPHT, representing two groups, which had received high and low radiation dose-exposure to the brain, respectively. Cognitive tests were used to compare CPFT (n = 12) and CNPHT (n = 7) survivors to matched healthy controls (n = 28). HRQOL data was compared to the general population (GP) (n = 1415-1459). Average follow-up was 23 (CPFT) and 19 years (CNPHT). CPFT survivors had significant deficits in all cognitive domains. CNPHT survivors showed results below the control group but differed statistically only on one executive test. HRQOL-ratings indicated that both groups had similar self-reported cognitive problems. CPFT survivors reported more emotional problems and fatigue. Anxiety was seen in both CPFT and CNPHT survivors. This study confirmed long-term cognitive sequelae after RT in adult survivors of CPFT,and possible RT-induced cognitive deficits in adult CNPHT survivors.
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Affiliation(s)
- Isabelle Rydén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Erik Fernström
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Birgitta Lannering
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Marie Kalm
- Department of Pharmacology, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Blomstrand
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Per Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Marianne Jarfelt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Abel E, Silander E, Nordström F, Olsson C, Brodin NP, Nyman J, Björk-Eriksson T, Hammerlid E. Fatigue in head and neck cancer patients treated with radiotherapy: a prospective study of patient-reported outcomes and their association with radiation dose to the cerebellum. Adv Radiat Oncol 2022; 7:100960. [PMID: 35847551 PMCID: PMC9280038 DOI: 10.1016/j.adro.2022.100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Although fatigue is a known side effect in patients with head and neck cancer (HNC) receiving radiation therapy, knowledge regarding long-term fatigue and dose-response relationships to organs at risk is scarce. The aim of this prospective study was to analyze patient-reported fatigue in patients with HNC receiving radiation therapy and to explore any possible association with organ-at-risk doses. Methods and Materials Patients with HNC referred for curative radiation therapy were eligible for inclusion in the study. To assess patient-reported fatigue, quality of life questionnaires (European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-FA12) were distributed before treatment and 1, 3, 6, 12, 24, and 60 months after the start of treatment. Mean dose (Dmean) and near maximum dose (D2%) of the cerebellum and brain stem were evaluated in relation to baseline-adjusted fatigue scores at 3 months. Results One hundred twenty-six patients treated with intensity modulated radiation therapy between 2008 and 2010 were available for final analysis. Female sex and age <60 years were associated with higher fatigue at baseline, whereas patients also treated with chemotherapy had reduced physical and emotional fatigue at 6 months. Physical fatigue (QLQ-FA12 scale) increased from baseline up to 3 months (29 vs 59; P < .0001) but showed no difference compared with baseline from 1 to 5 years. Emotional fatigue was significantly lower at 5 years compared with baseline (14 vs 28; P < .0001). Patients with cerebellum Dmean > 3.5 Gy had higher mean physical fatigue scores at 3 months (38 vs 27; P = .036). Conclusions Although there is a significant increase in fatigue scores for patients with HNC up to 1 year after radiation therapy, this study showed a return to baseline levels at 5 years. A possible association was found between physical fatigue and a higher mean dose to the cerebellum.
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Rasmussen M, Larsson M, Gilljam H, Adami J, Wärjerstam S, Post A, Björk-Eriksson T, Helgason AR, Tønnesen H. Effectiveness of tobacco cessation interventions for different groups of tobacco users in Sweden: a study protocol for a national prospective cohort study. BMJ Open 2022; 12:e053090. [PMID: 35078840 PMCID: PMC8796232 DOI: 10.1136/bmjopen-2021-053090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users. METHODS AND ANALYSIS This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders. ETHICS AND DISSEMINATION The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders. TRIAL REGISTRATION NUMBER NCT04819152.
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Affiliation(s)
- Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Matz Larsson
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- The Cardiology-Lung Clinic, Örebro University Hospital, Örebro, Sweden
| | - Hans Gilljam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sanne Wärjerstam
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
| | - Ann Post
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
- Department of Oncology, University of Gothenburg, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
| | | | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Frederiksberg University Hospital, Frederiksberg, Denmark
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Lindberg J, Gurjar M, Holmström P, Hallberg S, Björk-Eriksson T, Olsson CE. Resource planning principles for the radiotherapy process using simulations applied to a longer vacation period use case. Tech Innov Patient Support Radiat Oncol 2021; 20:17-22. [PMID: 34703909 PMCID: PMC8524937 DOI: 10.1016/j.tipsro.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/05/2021] [Revised: 09/02/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Radiotherapy (RT) resources need to be used wisely to balance workload and patient throughput. There are no known strategies on how to plan resource use around longer vacation periods to avoid patient waiting times. We created a simulation model over the RT workflow to evaluate different scenarios for this purpose. MATERIALS AND METHODS The simulation model mimics a large modern RT department in Sweden. It was based on real data on patient referral patterns and resource use extracted from clinical systems (3666 treatment courses). Workshops with managers and staff were held to investigate nine different scenarios for the summer vacation period including one scenario to validate the model. Different capacity reductions, vacation period lengths and timing of the vacation periods between the preparatory part of the RT workflow and the treatment part were evaluated. RESULTS For an eight-week period, resource utilization was predicted to be high both before and after the vacation period regardless of timing. However, more patients would be waiting with completed preparations with simultaneous vacation periods than when the preparatory part started one-two weeks prior to the treatment part. With shorter vacation periods, treatment would require overtime during the vacation period with higher levels of patients waiting compared to an eight-week scenario. CONCLUSIONS Our proposed strategy aided managers to identify a preferred scenario for the summer vacation period with the preparatory part starting one-two weeks prior to the treatment part for an eight-week vacation period. This can help other RT departments to plan for similar situations.
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Affiliation(s)
- Jesper Lindberg
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Mrugaja Gurjar
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Paul Holmström
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Stefan Hallberg
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Caroline E Olsson
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
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Lindberg J, Björk-Eriksson T, Olsson CE. Linear accelerator utilization: Concept and tool to aid the scheduling of patients for radiotherapy. Tech Innov Patient Support Radiat Oncol 2021; 20:10-16. [PMID: 34722940 PMCID: PMC8531843 DOI: 10.1016/j.tipsro.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/05/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 10/31/2022] Open
Abstract
Background and purpose Resources in radiotherapy (RT) need to be used effectively to meet the current clinical demand. The aim of this data-driven study is to identify temporal trends in the scheduling of patients for RT and to develop a tool for a visual overview of future scheduling levels. Material and methods Scheduling data at an eight-linac modern RT department in Sweden were collected twice daily for planned and observed linac use in 2018-2020. Information was retrieved each day for the present (Day 0) and the forthcoming 100 weekdays with total linac utilization rates (LURs) calculated for two activity categories: treatment and non-treatment. An in-house tool based on the LUR concept, database queries from the oncology information system (OIS)/automatic calculations was developed and evaluated by RT managers and scheduling staff (n = 10). Results Overall median LURs were 87%/89% (planned/observed; p < 0.01) with more frequent and larger daily increase for non-treatment activities compared with treatment activities. LUR increased with shorter planning horizons and reached 100% for fully-operating linacs ≈3 weeks before Day 0. The tool was reported by 88% to ease the work and to contribute towards an even scheduling of patients (responses: 8/10). Conclusion Alterations from a planned RT schedule occurs frequently. Having a tool that helps to reduce the abundance of booking information into clinically relevant overviews promise to increase the understanding of present and future scheduling levels. Our proposed concept and tool suggest that this is a feasible approach to schedule patients for RT more evenly.
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Affiliation(s)
- Jesper Lindberg
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45 Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45 Gothenburg, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Caroline E Olsson
- Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45 Gothenburg, Sweden
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Smith F, Hellström A, Gunnarsdóttir KÁ, Genell A, Eriksson E, Mannefred C, Björk-Eriksson T, Vaughn L. Exploring the meaning, role and experiences of a patient-led social innovation for people affected by cancer: a new collaborative care model complementing traditional cancer rehabilitation in Sweden. BMJ Open Qual 2021; 10:bmjoq-2021-001400. [PMID: 34686486 PMCID: PMC8543647 DOI: 10.1136/bmjoq-2021-001400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/11/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Kraftens Hus is the first support centre in Sweden designed by and for people affected by cancer, including patients, family, friends, staff members and local community representatives (collectively ‘stakeholders’). The purpose of this study was to explore the meaning, role and experiences of Kraftens Hus stakeholders using a patient and public involved methodology. Methods To understand and map the experiences of visitors to Kraftens Hus, we applied concept mapping (CM), a mixed methods approach where data are collected and analysed in four structured steps designed to capture the diverse perspectives of multiple stakeholders. Qualitative interviews with relevant stakeholders supplemented the CM findings. Results The final concept map contained six clusters of ideas. Within the clusters, there was a recurring theme that cancer-affected people value accessible and long-term psychosocial support (PSS). The intended emotional, social and practical needs identified in a previous design process seem to have been addressed and appreciated by Kraftens Hus visitors. Conclusion Kraftens Hus is an example of a new patient-led social innovation based on a life-event perspective and integration of resources from different sectors in society. By focusing on life, not the disease, the care continuum expands, and long-term PSS is provided alongside cancer treatment. The evaluation confirms that PSS should focus on health and well-being in the broadest sense.
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Affiliation(s)
- Frida Smith
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden .,Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Andreas Hellström
- Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden.,Centre for Healthcare Improvement, Center for Healthcare Improvement, Gothenburg, Sweden
| | | | - Anna Genell
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
| | - Erik Eriksson
- Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Carina Mannefred
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden.,Department of Oncology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lisa Vaughn
- Collage of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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12
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson CE. An analytical approach to aggregate patient inflows to a simulation model over the radiotherapy process. BMC Health Serv Res 2021; 21:207. [PMID: 33685475 PMCID: PMC7938525 DOI: 10.1186/s12913-021-06162-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background In meeting input data requirements for a system dynamics (SD) model simulating the radiotherapy (RT) process, the number of patient care pathways (RT workflows) needs to be kept low to simplify the model without affecting the overall performance. A large RT department can have more than 100 workflows, which results in a complex model structure if each is to be handled separately. Here we investigated effects on model performance by reducing the number of workflows for a model of the preparatory steps of the RT process. Methods We created a SD model sub-structure capturing the preparatory RT process. Real data for patients treated in 2015-2016 at a modern RT department in Sweden were used. RT workflow similarity was quantified by averaged pairwise utilization rate differences (%) and the size of corresponding correlation coefficients (r). Grouping of RT workflows was determined using two accepted strategies (80/20 Pareto rule; merging all data into one group) and a customized algorithm with r≥0.75:0.05:0.95 as criteria for group inclusion by two strategies (A1 and A2). Number of waiting patients for each grouping strategy were compared to the reference of all workflows handled separately. Results There were 128 RT workflows for 3209 patients during the studied period. The 80/20 Pareto rule resulted in 14/8/21 groups for curative/palliative/disregarding treatment intent. Correspondingly, A1 and A2 resulted in 7-40/≤4-36/7-82 groups depending on r cutoff. Results for the Pareto rule and A2 at r≥85 were comparable to the reference. Conclusions The performance of a simulation model over the RT process will depend on the grouping strategy of patient input data. Either the Pareto rule or the grouping of patients by resource use can be expected to better reflect overall departmental effects to various changes than when merging all data into one group. Our proposed approach to identify groups based on similarity in resource use can potentially be used in any setting with variable incoming flows of objects which go through a multi-step process comparable to RT where the aim is to reduce the complexity of associated model structures without compromising with overall performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06162-4.
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Affiliation(s)
- Jesper Lindberg
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden. .,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden. .,Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45, Gothenburg, Sweden.
| | - Paul Holmström
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Stefan Hallberg
- Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45, Gothenburg, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Caroline E Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, 413 45, Gothenburg, Sweden
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13
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Johansson G, Olsson C, Smith F, Edegran M, Björk-Eriksson T. AI-aided detection of malignant lesions in mammography screening - evaluation of a program in clinical practice. BJR Open 2021; 3:20200063. [PMID: 33598603 PMCID: PMC7880231 DOI: 10.1259/bjro.20200063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives: Evaluation of the degree of concordance between an artificial intelligence (AI) program and radiologists in assessing malignant lesions in screening mammograms. Methods: The study population consisted of all consecutive cases of screening-detected histopathologically confirmed breast cancer in females who had undergone mammography at the NU Hospital Group (Region Västra Götaland, Sweden) in 2018 to 2019. Data were retrospectively collected from the AI program (lesion risk score in percent and overall malignancy risk score ranging from 1 to 10) and from medical records (independent assessments by two radiologists). Ethical approval was obtained. Results: Altogether, 120 females with screening-detected histopathologically confirmed breast cancer were included in this study. The AI program assigned the highest overall malignancy risk score 10 to 86% of the mammograms. Five cases (4%) were assigned an overall malignancy risk score ≤5. Lack of consensus between the two radiologists involved in the initial assessment was associated with lower overall malignancy risk scores (p = 0,002). Conclusion: The AI program detected a majority of the cancerous lesions in the mammograms. The investigated version of the program has, however, limited use as an aid for radiologists, due to the pre-calibrated risk distribution and its tendency to miss the same lesions as the radiologists. A potential future use for the program, aimed at reducing radiologists’ workload, might be to preselect and exclude low-risk mammograms. Although, depending on cut-off score, a small percentage of the malignant lesions can be missed using this procedure, which thus requires a thorough risk–benefit analysis. Advances in knowledge: This study conducts an independent evaluation of an AI program’s detection capacity under screening-like conditions which has not previously been done for this program.
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Affiliation(s)
- Greta Johansson
- Department of Radiology, NU Hospital Group, Trollhättan/Uddevalla, Region Västra Götaland, Sweden
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14
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson CE. A national perspective about the current work situation at modern radiotherapy departments. Clin Transl Radiat Oncol 2020; 24:127-134. [PMID: 32875126 PMCID: PMC7451821 DOI: 10.1016/j.ctro.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 05/11/2020] [Revised: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 10/27/2022] Open
Abstract
Background The radiotherapy (RT) community faces great challenges to meet the growing cancer incidence, especially regarding workload and recruitment of personnel. Workflow-related issues affect involved professions differently since they have specific expertise and various roles in the workflow. To obtain an objective understanding of the current working situation and identify workflow bottle necks in RT, we conducted a national survey on this topic in 2018. Materials and Methods All 17 (photon-based) RT departments in Sweden were invited to participate in the study, which targeted both managers and employees in RT. Descriptive statistics were calculated for each profession and for small, medium and large departments (2/3-4/≥5 linacs). Results Altogether, 364 filled-in questionnaires were returned (32/332 managers/employees; 94% response rate). Managers reported a general need for more staff (all professions). Small departments reported no problems with waiting times (0/3); whereas 2/3 of medium and large departments did (medium: 5/8, large: 2/3). All professions had a positive attitude towards working in RT (mean = 86%, 0/100%=negative/positive attitude). Organizational issues were ranked highest among reoccurring events that were most frustrating/had most negative effect on the work environment. The most severe workflow-related problems were reported to originate at contouring. Conclusion Future efforts to improve the modern RT workflow need to focus on how to make positive mechanisms at small departments useful in larger settings. Our data also reveal that strong leadership and improved routines at contouring are warranted by all RT professions to reduce frustration related to organizational issues and to increase work effectivity.
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Affiliation(s)
- Jesper Lindberg
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Paul Holmström
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Hallberg
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden.,Department of Oncology, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline E Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
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15
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Olsson CE, Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Johansson KA. Radiation Therapy in Sweden: Past, Present, and Future Perspectives. Int J Radiat Oncol Biol Phys 2020; 107:6-11. [PMID: 32277922 DOI: 10.1016/j.ijrobp.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/19/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline E Olsson
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Jesper Lindberg
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paul Holmström
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Stefan Hallberg
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Health Care Region, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Karl-Axel Johansson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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16
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Smith F, Gunnarsdóttir KÁ, Genell A, McLinden D, Vaughn L, Garelius H, Nilsson-Ehle H, Lönqvist U, Björk-Eriksson T. Evaluating the implementation and use of the regional cancer plan in Western Sweden through concept mapping. Int J Qual Health Care 2020; 31:44-52. [PMID: 30576515 DOI: 10.1093/intqhc/mzy241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/30/2018] [Revised: 12/09/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE Within healthcare, policy documents are often used to strategically standardize, streamline or change how general health issues are managed for a specific patient group or treatment. Despite significant effort in developing policy and strategic planning documents, these may not have the intended impact and their value has long been questioned by practitioners. CHOICE OF SOLUTION To identify barriers and affordances for the implementation and use of a strategic plan for cancer care in the Western Sweden Healthcare Region, we used Concept Mapping; a participatory mixed method approach to inquiry consisting of both qualitative and quantitative tasks intended to elicit and integrate the diverse perspectives of multiple stakeholders. IMPLEMENTATION The study was carried out between April and October 2017 and consisted of several sequential data collection steps: idea generation, sorting and rating ideas for importance and feasibility. Stakeholders from different levels and professions in cancercare participated, but the number varied in the separate steps of data collection: idea generation (n = 112), sorting (n = 16) and rating (n = 38). EVALUATION A concept map visualized seven areas that stakeholders throughout the cancer-care process considered necessary to address in order to enable the implementation of the plan. Skills provision was considered the most important cluster but also rated as least feasible. A consistent theme emerged that information, or lack thereof, might be a barrier for the plan being put into action to a greater extent in the cancer-care units. Nine actionable ideas rated highly on both importance and feasibility were presented as a go-zone. LESSONS LEARNED Our results suggest that efforts might be better spent on ensuring information about and accessibility to strategic documents throughout the organization, rather than frequently updating them or producing new ones. Having sufficient skills provision seems to be the prerequisite for successful implementation.
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Affiliation(s)
- Frida Smith
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Chalmers University of Technology, Chalmersplatsen 4, Gothenburg, Sweden
| | | | - Anna Genell
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel McLinden
- University of Cincinnati College of Medicine, 3230 Eden Ave Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Division of General & Community Pediatrics, 3333 Burnet Ave Cincinnati, OH, USA
| | - Lisa Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA.,Educational Studies, University of Cincinnati College of Education, Criminal Justice, and Human Services, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA
| | - Hege Garelius
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Herman Nilsson-Ehle
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ulf Lönqvist
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson C. Simulating the Radiation Therapy Process: An Analytical Approach to Enable Quantification of Patient Inflows. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.083] [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: 10/26/2022]
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18
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson C. Healthcare Professionals’ Views on Work Related Issues at Swedish Radiotherapy Departments. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Abel E, Silander E, Nyman J, Björk-Eriksson T, Hammerlid E. Long-Term Aspects of Quality of Life in Head and Neck Cancer Patients Treated With Intensity Modulated Radiation Therapy: A 5-Year Longitudinal Follow-up and Comparison with a Normal Population Cohort. Adv Radiat Oncol 2019; 5:101-110. [PMID: 32051896 PMCID: PMC7004944 DOI: 10.1016/j.adro.2019.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/04/2018] [Revised: 04/11/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Knowledge of long-term health-related quality of life (HRQOL) in patients with advanced head and neck cancer treated with intensity modulated radiation therapy is scarce. Methods and Materials HRQOL in 126 patients with advanced head and neck cancer treated with intensity modulated radiation therapy was followed longitudinally from diagnosis to 5 years after treatment with the European Organization for Research and Treatment of Cancer's QLQ-C30, the European Organization for Research and Treatment of Cancer's Head and Neck Cancer Module, and the M.D. Anderson Dysphagia Inventory. The survivors' HRQOL was compared with an age- and sex-matched normal population cohort. Results At 5 years, 73 of the 95 surviving patients had completed the study. Significant reductions in general pain (29 vs 12), head and neck (HN) pain (22 vs 14), and feeling ill (20 vs 10) were found, and emotional functioning (70 vs 83) and global quality of life (67 vs 74) improved, compared with baseline values. Conversely, dry mouth (19 vs 56), senses (8 vs 27), teeth problems (10 vs 22), opening mouth (19 vs 56), and sticky saliva (15 vs 40) were markedly worse, although significant improvements had occurred over time after treatment. Anderson Dysphagia Inventory scores >80 at 5 years indicated good swallowing function. In a subgroup analysis, dry mouth and senses were significantly better in patients treated with chemoradiotherapy. Comparison to a normal population cohort's HRQOL shows that the study group experienced a wide array of symptoms affecting their quality of life. Conclusions The results of this large, long-term follow-up study show that a majority of patients report a reasonable quality of life 5 years after treatment and that there seems to be continuous improvement over time. Comparison with a normal population cohort, however, underlines the fact that classical side effects remain, even with improved radiation techniques. Additional emphasis on normal-tissue-sparing radiation therapy is warranted, with close attention devoted to HRQOL outcomes.
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Affiliation(s)
- Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Silander
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.,Regional Cancer Centre West, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
Background: Patients treated for breast cancer with breast conserving surgery and radiotherapy (RT) often complain about swelling, heaviness, and pain in the treated breast. This pilot study was undertaken to examine if compression therapy was effective as an early treatment to reduce breast edema and symptoms assessed by Visual Analogue Scale (VAS). Methods and Results: Fifty-six breast cancer-treated women with breast edema, diagnosed by the measurement of tissue water content by tissue dielectric constant (TDC) technique 3 months post-RT, were randomized to either an intervention group, wearing a sports bra of compression type, or a control group, wearing a standard bra daily for 9 months when tissue water content in breast, upper arm, and lateral thorax of the operated side, and symptoms assessed by VAS were evaluated. No differences were found between the groups at start or end of study concerning tissue water content or VAS. However, within both groups, a significant reduction in tissue water content and experience of heaviness was found. Conclusion: Breast edema as well as experience of heaviness in the affected breast found at 3 months post-RT decreased after 9 months independent of whether a sports bra of compression type or a standard bra was used.
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Affiliation(s)
- Karin Johansson
- Department of Health Sciences, Lund University, Lund, Sweden
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21
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson C. PO-1129 An analytical approach to aggregate patient workflows for system dynamics modelling of radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31549-x] [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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Gasic D, Haraldsson A, Brodin N, Nysom K, Björk-Eriksson T, Rosenschöld PM. PO-0990 Positioning uncertainties for pediatric craniospinal irradiation and the impact of image guidance. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31410-0] [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: 11/28/2022]
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23
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Pettersson E, Bäck A, Björk-Eriksson T, Lindencrona U, Petruson K, Thilander-Klang A. Structure delineation in the presence of metal - A comparative phantom study using single and dual-energy computed tomography with and without metal artefact reduction. Phys Imaging Radiat Oncol 2019; 9:43-49. [PMID: 33458424 PMCID: PMC7807554 DOI: 10.1016/j.phro.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/04/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022]
Abstract
Background and purpose Metal artefacts in computed tomography (CT) images impairs structure delineation. These artefacts can potentially be reduced with dual-energy CT (DECT) with or without using metal artefact reduction (MAR). The purpose was to investigate how structure delineation in DECT with or without MAR and single-energy CT (SECT) images were affected by metals. Materials and methods A phantom with known irregular structures was developed. Reference structures were determined from a low-noise scan without metal. Bilateral hip prostheses were simulated with steel or titanium inserts. The phantom was scanned with SECT and fast-kV switching DECT with optional MAR. Four radiation oncologists delineated the structures in two phantom set-ups. Delineated structures were evaluated with Dice similarity coefficient (DSC) and Hausdorff distance relative to the reference structures. Results With titanium inserts, more structures were detected for non-MAR DECT compared to SECT while the same or less were detected with steel inserts. MAR improved delineation in DECT images. For steel inserts, three structures in the region of artefacts, were delineated by at least two oncologists with MAR-DECT compared to none with non-MAR DECT or SECT. The highest values of DSC for MAR-DECT were 0.69, 0.81 and 0.77 for those structures. Conclusions Delineation was improved with non-MAR DECT compared to SECT, especially for titanium inserts. A larger improvement was seen with the use of MAR for both steel and titanium inserts. The improvement was dependent on the location of the structure relative to the inserts, and the structure contrast relative to the background.
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Affiliation(s)
- Erik Pettersson
- Department of Diagnostic Radiation Physics, Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.,Department of Therapeutic Radiation Physics, Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden
| | - Anna Bäck
- Department of Therapeutic Radiation Physics, Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden.,Regional Cancer Center West, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - Ulrika Lindencrona
- Department of Therapeutic Radiation Physics, Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden
| | - Karin Petruson
- Department of Oncology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - Anne Thilander-Klang
- Department of Diagnostic Radiation Physics, Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden
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Gasic D, Rosenschöld PMA, Vogelius IR, Maraldo MV, Aznar MC, Nysom K, Björk-Eriksson T, Bentzen SM, Brodin NP. Retrospective estimation of heart and lung doses in pediatric patients treated with spinal irradiation. Radiother Oncol 2018; 128:209-213. [PMID: 29859753 PMCID: PMC6261493 DOI: 10.1016/j.radonc.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate whether treatment information from medical records can be used to estimate radiation doses to heart and lungs retrospectively in pediatric patients receiving spinal irradiation with conventional posterior fields. MATERIAL AND METHODS An algorithm for retrospective dosimetry in children treated with spinal irradiation was developed in a cohort of 21 pediatric patients with available CT-scans and treatment plans. We developed a multivariable linear regression model with explanatory variables identifiable in case note review for retrospective estimation of minimum, maximum, mean and V10%-V80% doses to the heart and lungs. Doses were estimated for both linear accelerator (Linac) and 60Co radiation therapy modalities. RESULTS Age and spinal field width were identified as statistically significant predictors of heart and lung doses in multivariable analyses (p < 0.01 in all models). Models showed excellent predictive performance with R2 = 0.70 for mean heart dose and 0.79 for mean lung dose, for Linac plans. In leave-one-out cross-validation analysis the average difference between predicted and actual mean heart dose was 6.7% and 7.6% of the prescription dose for Linac and 60Co plans, respectively, and 5.2% and 4.9% for mean lung dose. Due to the small sample size and large inter-patient variation in heart and lung dose, prospective studies validating these findings are highly warranted. CONCLUSIONS The models presented here provide retrospective estimates of heart and lung doses for historical cohorts of pediatric patients, thus facilitating studies of long-term adverse effects of radiation.
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Affiliation(s)
- Daniel Gasic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark.
| | - Per Munck Af Rosenschöld
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden; Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ivan R Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja V Maraldo
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Marianne C Aznar
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Karsten Nysom
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Regional Cancer Centre West, Gothenburg, Sweden
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Nils Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, USA
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Boström M, Kalm M, Eriksson Y, Bull C, Ståhlberg A, Björk-Eriksson T, Hellström Erkenstam N, Blomgren K. A role for endothelial cells in radiation-induced inflammation. Int J Radiat Biol 2018; 94:259-271. [PMID: 29359989 DOI: 10.1080/09553002.2018.1431699] [Citation(s) in RCA: 14] [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] [Indexed: 01/11/2023]
Abstract
PURPOSE To unravel the role of the vasculature in radiation-induced brain tissue damage. MATERIALS AND METHODS Postnatal day 14 mice received a single dose of 10 Gy cranial irradiation and were sacrificed 6 h, 24 h or 7 days post-irradiation. Endothelial cells were isolated from the hippocampus and cerebellum using fluorescence-activated cell sorting, followed by cell cycle analysis and gene expression profiling. RESULTS Flow cytometric analysis revealed that irradiation increased the percentage of endothelial cells, relative to the whole cell population in both the hippocampus and the cerebellum. This change in cell distribution indicates that other cell types are more susceptible to irradiation-induced cell death, compared to endothelial cells. This was supported by data showing that genes involved in endothelial cell-specific apoptosis (e.g. Smpd1) were not induced at any time point investigated but that genes involved in cell-cycle arrest (e.g. Cdkn1a) were upregulated at all investigated time points, indicating endothelial cell repair. Inflammation-related genes, on the other hand, were strongly induced, such as Ccl2, Ccl11 and Il6. CONCLUSIONS We conclude that endothelial cells are relatively resistant to ionizing radiation but that they play an active, hitherto unknown, role in the inflammatory response after irradiation. In the current study, this was shown in both the hippocampus, where neurogenesis and extensive cell death after irradiation occurs, and in the cerebellum, where neurogenesis no longer occurs at this developmental age.
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Affiliation(s)
- Martina Boström
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden.,b Department of Oncology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden.,c Department of Pharmacology , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Marie Kalm
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden.,c Department of Pharmacology , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Yohanna Eriksson
- c Department of Pharmacology , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Cecilia Bull
- b Department of Oncology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - Anders Ståhlberg
- d Department of Pathology and Genetics , Sahlgrenska Cancer Centre, Institute of Biomedicine, University of Gothenburg , Gothenburg , Sweden
| | - Thomas Björk-Eriksson
- b Department of Oncology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - Nina Hellström Erkenstam
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Klas Blomgren
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden.,e Department of Pediatric Oncology , Karolinska University Hospital , Stockholm , Sweden.,f Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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26
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Fernström E, Nyman J, Hammerlid E, Holmberg E, Haugen-Cange H, Petruson K, Abel E, Björk-Eriksson T. Results of preoperative chemoradiotherapy for patients with advanced cancer of the nasal cavity and paranasal sinuses. Acta Otolaryngol 2017; 137:1292-1300. [PMID: 28749194 DOI: 10.1080/00016489.2017.1357081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/19/2022]
Abstract
OBJECTIVES Curative treatment of nasal cavity and paranasal sinus cancer is challenging due to the proximity to critical anatomical structures. The purpose of this study was to analyze the impact of trimodality therapy with preoperative chemotherapy and reduced-dose radiotherapy followed by organ-preserving surgery for treating patients with nasal cavity and paranasal sinus cancer. METHODS This retrospective study included all 156 patients diagnosed with sinonasal cancer in western Sweden between 1986 and 2009. We determined the treatment selection pattern and treatment outcomes for 79 patients treated with preoperative chemoradiotherapy. RESULTS Squamous cell carcinoma was the most common histology. The five-year overall survival was 54%, and 85% of these patients had T3 or T4 tumors. The five-year cumulative incidence rate of local recurrence was 32%. The five-year overall survival in patients with squamous cell carcinoma and adenocarcinoma was 45% and 76%, respectively. The median preoperative radiation dose was 48 Gy. Orbital exenteration was performed in 7% of patients. CONCLUSIONS Preoperative chemoradiotherapy may be beneficial for patients with advanced sinonasal cancer when primary radical surgery is challenging. Survival outcomes were comparable to outcomes reported in the literature despite conservative surgery and relatively low radiation doses in patients with locally advanced tumors.
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Affiliation(s)
- Erik Fernström
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology and Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hedda Haugen-Cange
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Petruson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kalm M, Andreasson U, Björk-Eriksson T, Zetterberg H, Pekny M, Blennow K, Pekna M, Blomgren K. C3 deficiency ameliorates the negative effects of irradiation of the young brain on hippocampal development and learning. Oncotarget 2017; 7:19382-94. [PMID: 27029069 PMCID: PMC4991390 DOI: 10.18632/oncotarget.8400] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/13/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy in the treatment of pediatric brain tumors is often associated with debilitating late-appearing adverse effects, such as intellectual impairment. Areas in the brain harboring stem cells are particularly sensitive to irradiation (IR) and loss of these cells may contribute to cognitive deficits. It has been demonstrated that IR-induced inflammation negatively affects neural progenitor differentiation. In this study, we used mice lacking the third complement component (C3−/−) to investigate the role of complement in a mouse model of IR-induced injury to the granule cell layer (GCL) of the hippocampus. C3−/− and wild type (WT) mice received a single, moderate dose of 8 Gy to the brain on postnatal day 10. The C3−/− mice displayed 55 % more microglia (Iba-1+) and a trend towards increase in proliferating cells in the GCL compared to WT mice 7 days after IR. Importantly, months after IR C3−/− mice made fewer errors than WT mice in a reversal learning test indicating better learning capacity in C3−/− mice after IR. Notably, months after IR C3−/− and WT mice had similar GCL volumes, survival of newborn cells (BrdU), microglia (Iba-1) and astrocyte (S100β) numbers in the GCL. In summary, our data show that the complement system contributes to IR-induced loss of proliferating cells and maladaptive inflammatory responses in the acute phase after IR, leading to impaired learning capacity in adulthood. Targeting the complement system is hence promising for future strategies to reduce the long-term adverse consequences of IR in the young brain.
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Affiliation(s)
- Marie Kalm
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Andreasson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | | | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Milos Pekny
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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28
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Bull C, Malipatlolla D, Kalm M, Sjöberg F, Alevronta E, Grandér R, Sultanian P, Persson L, Boström M, Eriksson Y, Swanpalmer J, Wold AE, Blomgren K, Björk-Eriksson T, Steineck G. A novel mouse model of radiation-induced cancer survivorship diseases of the gut. Am J Physiol Gastrointest Liver Physiol 2017; 313:G456-G466. [PMID: 28729245 DOI: 10.1152/ajpgi.00113.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Received: 05/08/2017] [Revised: 07/06/2017] [Accepted: 07/16/2017] [Indexed: 01/31/2023]
Abstract
A deeper understanding of the radiation-induced pathophysiological processes that develop in the gut is imperative to prevent, alleviate, or eliminate cancer survivorship diseases after radiotherapy to the pelvic area. Most rodent models of high-dose gastrointestinal radiation injury are limited by high mortality. We therefore established a model that allows for the delivering of radiation in fractions at high doses while maintaining long-term survival. Adult male C57/BL6 mice were exposed to small-field irradiation, restricted to 1.5 cm of the colorectum using a linear accelerator. Each mouse received 6 or 8 Gy, two times daily in 12-h intervals in two, three, or four fractions. Acute cell death was examined at 4.5 h postirradiation and histological changes at 6 wk postirradiation. Another group was given four fractions of 8 Gy and followed over time for development of visible symptoms. Irradiation caused immediate cell death, mainly limited to the colorectum. At 6 wk postirradiation, several crypts displayed signs of radiation-induced degeneration. The degenerating crypts were seen alongside crypts that appeared perfectly healthy. Crypt survival was reduced after the fourth fraction regardless of dose, whereas the number of macrophages increased. Angiogenesis was induced, likely as a compensatory mechanism for hypoxia. Four months postirradiation, mice began to show radiation-induced symptoms, and histological examination revealed an extensive crypt loss and fibrosis. Our model is uniquely suitable for studying the long-term trajectory and underlying mechanisms of radiation-induced gastrointestinal injury.NEW & NOTEWORTHY A novel mouse model for studying the long-term trajectory of radiation-induced gut injury. The method allows for the use of high doses and multiple fractions, with minor impact on animal health for at least 3 mo. Crypt loss and a slow progression of fibrosis is observed. Crypt degeneration is a process restricted to isolated crypts. Crypt degeneration is presented as a convenient proxy endpoint for long-term radiation-induced gut injury.
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Affiliation(s)
- Cecilia Bull
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dilip Malipatlolla
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kalm
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fei Sjöberg
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleftheria Alevronta
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rita Grandér
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pedram Sultanian
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linda Persson
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martina Boström
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yohanna Eriksson
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Swanpalmer
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Agnes E Wold
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
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29
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Steineck G, Bull C, Kalm M, Sjöberg F, Alevronta E, Malipatlolla DK, Bergmark K, Jeppsson B, Wilderäng U, Björk-Eriksson T. Radiation physiology - evidence for a higher biological effect of 24 Gy in four fractions as compared to three. Acta Oncol 2017; 56:1240-1243. [PMID: 28379720 DOI: 10.1080/0284186x.2017.1309062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Bull
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Marie Kalm
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Fei Sjöberg
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Eleftheria Alevronta
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Dilip Kumar Malipatlolla
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Karin Bergmark
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Bengt Jeppsson
- Department of Surgery, Lund University, SUS Malmö, Malmö, Sweden
| | - Ulrica Wilderäng
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Bull C, Cooper C, Lindahl V, Fitting S, Persson AI, Grandér R, Alborn AM, Björk-Eriksson T, Kuhn HG, Blomgren K. Exercise in Adulthood after Irradiation of the Juvenile Brain Ameliorates Long-Term Depletion of Oligodendroglial Cells. Radiat Res 2017; 188:443-454. [PMID: 28777696 DOI: 10.1667/rr14737.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cranial radiation severely affects brain health and function, including glial cell production and myelination. Recent studies indicate that voluntary exercise has beneficial effects on oligodendrogenesis and myelination. Here, we hypothesized that voluntary running would increase oligodendrocyte numbers in the corpus callosum after irradiation of the juvenile mouse brain. The brains of C57Bl/6J male mice were 6 Gy irradiated on postnatal day 9 during the main gliogenic developmental phase, resulting in a loss of oligodendrocyte precursor cells. Upon adulthood, the mice were injected with bromodeoxyuridine and allowed to exercise on a running wheel for four weeks. Cell proliferation and survival, Ascl1+ oligodendrocyte precursor and Olig2+ oligodendrocyte cell numbers as well as CC1+ mature oligodendrocytes were quantified using immunohistology. Radiation induced a reduction in the number of Olig2+ oligodendrocytes by nearly 50% without affecting production or survival of new Olig2+ cells. Ascl1+ cells earlier in the oligodendroglial cell lineage were also profoundly affected, with numbers reduced by half. By three weeks of age, Olig2+ cell numbers had not recovered, and this was paralleled by a volumetric loss in the corpus callosum. The deficiency of Olig2+ oligodendrocytes persisted into adulthood. Additionally, the depletion of Ascl1+ progenitor cells was irreversible, and was even more pronounced at 12 weeks postirradiation compared to day 2 postirradiation. Furthermore, the overall number of CC1+ mature oligodendrocytes decreased by 28%. The depletion of Olig2+ cells in irradiated animals was reversed by 4 weeks of voluntary exercise. Moreover, voluntary exercise also increased the number of Ascl1+ progenitor cells in irradiated animals. Taken together, these results demonstrate that exercise in adulthood significantly ameliorates the profound and long-lasting effects of moderate exposure to immature oligodendrocytes during postnatal development.
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Affiliation(s)
- Cecilia Bull
- a Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christiana Cooper
- b Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Veronica Lindahl
- b Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sylvia Fitting
- c Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anders I Persson
- d Department of Neurology, University of California, San Francisco, California
| | - Rita Grandér
- a Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Alborn
- b Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- a Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Georg Kuhn
- b Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Klas Blomgren
- e Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden.,f Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
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31
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Sabel M, Kalm M, Björk-Eriksson T, Lannering B, Blomgren K. Hypothermia after cranial irradiation protects neural progenitor cells in the subventricular zone but not in the hippocampus. Int J Radiat Biol 2017; 93:771-783. [PMID: 28452566 DOI: 10.1080/09553002.2017.1321810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To explore if hypothermia can reduce the harmful effects of ionizing radiation on the neurogenic regions of the brain in young rats. MATERIALS AND METHODS Postnatal day 9 rats were randomized into two treatment groups, hypo- and normothermia, or a control group. Treatment groups were placed in chambers submerged in temperature-controlled water baths (30 °C and 36 °C) for 8 h, after receiving a single fraction of 8 Gy to the left hemisphere. Seven days' post-irradiation, we measured the sizes of the subventricular zone (SVZ) and the granule cell layer (GCL) of the hippocampus, and counted the number of proliferating (phospho-histone H3+) cells and microglia (Iba1 + cells). RESULTS Irradiation caused a 53% reduction in SVZ size in the normothermia group compared to controls, as well as a reduction of proliferating cell numbers by >50%. These effects were abrogated in the hypothermia group. Irradiation reduced the number of microglia in both treatment groups, but resulted in a lower cell density of Iba1 + cells in the SVZs of the hypothermia group. In the GCL, irradiation decreased both GCL size and the proliferating cell numbers, but with no difference between the treatment groups. The number of microglia in the GCL did not change. CONCLUSIONS Hypothermia immediately after irradiation protects the SVZ and its proliferative cell population but the GCL is not protected, one week post-irradiation.
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Affiliation(s)
- Magnus Sabel
- a Department of Pediatrics , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,b Childhood Cancer Centre , Queen Silvia Children's Hospital , Gothenburg , Sweden
| | - Marie Kalm
- c Department of Pharmacology , Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Thomas Björk-Eriksson
- d Regional Cancer Centre west , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Birgitta Lannering
- a Department of Pediatrics , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,b Childhood Cancer Centre , Queen Silvia Children's Hospital , Gothenburg , Sweden
| | - Klas Blomgren
- e Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden.,f Department of Pediatric Oncology , Karolinska University Hospital , Stockholm , Sweden
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32
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Kalm M, Boström M, Sandelius Å, Eriksson Y, Ek CJ, Blennow K, Björk-Eriksson T, Zetterberg H. Serum concentrations of the axonal injury marker neurofilament light protein are not influenced by blood-brain barrier permeability. Brain Res 2017; 1668:12-19. [PMID: 28522263 DOI: 10.1016/j.brainres.2017.05.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 01/31/2017] [Revised: 03/31/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
Abstract
A blood biomarker to monitor individual susceptibility to neuronal injury from cranial radiotherapy could potentially help to individualize radiation treatment and thereby reduce the incidence and severity of late effects. An important feature of such a blood biomarker is that its concentration is not confounded by varying degrees of release from the brain into the blood across the blood-brain barrier (BBB). In this study, we investigated serum neurofilament light protein (NFL) concentrations in 21-day old mice following a single dose of cranial irradiation (8Gy). Cranial irradiation resulted in acute cell injury measured as a 12.9-fold increase in caspase activity 6h after irradiation; activation of inflammation measured by levels of CCL2 and increased BBB permeability measured by 14C-sucrose concentration ratios in brain and cerebrospinal fluid (CSF). Serum levels of NFL peaked at 6h after both anesthesia and cranial irradiation, but no timely correlation of serum NFL concentration with BBB permeability was found. Further, three groups of patients with different degrees of BBB impairment (measured as the CSF/serum albumin ratio) were investigated. There was no correlation between serum NFL concentration and CSF/serum albumin ratio (r=0.139, p=0.3513), however a strong correlation was found for NFL concentration in serum and NFL concentration in CSF (r=0.6303, p<0.0001). In conclusion, serum NFL appears to be a reliable blood biomarker for neuronal injury, and its concentration is not confounded by BBB permeability.
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Affiliation(s)
- Marie Kalm
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Martina Boström
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Åsa Sandelius
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Yohanna Eriksson
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - C Joakim Ek
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
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Abel E, Silander E, Nyman J, Bove M, Johansson L, Björk-Eriksson T, Hammerlid E. Impact on quality of life of IMRT versus 3-D conformal radiation therapy in head and neck cancer patients: A case control study. Adv Radiat Oncol 2017; 2:346-353. [PMID: 29114602 PMCID: PMC5605311 DOI: 10.1016/j.adro.2017.05.002] [Citation(s) in RCA: 21] [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: 01/09/2017] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to prospectively and longitudinally compare the health-related quality of life (HRQOL) outcomes between head and neck (HN) cancer patients treated with parotid-sparing intensity modulated radiation therapy (IMRT) and patients treated with 3-dimensional conventional radiation therapy (3D-CRT). Methods and materials Before and up to 12 months after treatment, HRQOL was recorded in patients with HN cancer who were referred to the Department of Oncology at Sahlgrenska University Hospital for curative IMRT. The study group's HRQOL was compared with a matched group of patients from previous descriptive HRQOL studies treated with 3D-CRT. Both groups' HRQOL was measured by the European Organization for Research and Treatment for Cancer QLQ-C30 and European Organization for Research and Treatment for Cancer QLQ-HN35 at 6 time points in the first year after diagnosis. Results Two hundred and seven patients were included, 111 treated with IMRT and 96 matched controls treated with 3D-CRT. Both groups' HRQOL deteriorated during and after treatment. Just after treatment, worse HRQOL scores were observed in the IMRT group regarding insomnia (38 vs 27; P = .032), appetite loss (64 vs 50; P = .019), senses (54 vs 41; P = .017), and coughing (39 vs 26, P = .009). At 12 months, however, significantly better HRQOL scores were observed in the IMRT group regarding problems with dry mouth (72 vs 62; P = .018), pain (28 vs 20; P = .018), sexuality (37 vs 23; P = .016), social contacts (10 vs 6; P = .026), cognitive functioning (79 vs 87; P = .0057), and financial difficulties (12 vs 20; P = .0019). Conclusions This study further supports the hypothesis that the introduction of IMRT has improved the long-term quality of life of HN cancer patients who have been treated with radiation therapy, but might cause more acute side effects. Longer follow-up is needed to study late complications.
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Affiliation(s)
- Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Silander
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mogens Bove
- Department of Otorhinolaryngology, Norra Älvsborgs Hospital, Trollhättan, Sweden
| | - Leif Johansson
- Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Indelicato DJ, Merchant T, Laperriere N, Lassen Y, Vennarini S, Wolden S, Hartsell W, Pankuch M, Brandal P, Law CCK, Taylor R, Laskar S, Okcu MF, Bouffet E, Mandeville H, Björk-Eriksson T, Nilsson K, Nyström H, Constine LS, Story M, Timmermann B, Roberts K, Kortmann RD. Consensus Report From the Stockholm Pediatric Proton Therapy Conference. Int J Radiat Oncol Biol Phys 2016; 96:387-392. [DOI: 10.1016/j.ijrobp.2016.06.2446] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022]
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Nyholm T, Olsson C, Agrup M, Björk P, Björk-Eriksson T, Gagliardi G, Grinaker H, Gunnlaugsson A, Gustafsson A, Gustafsson M, Johansson B, Johnsson S, Karlsson M, Kristensen I, Nilsson P, Nyström L, Onjukka E, Reizenstein J, Skönevik J, Söderström K, Valdman A, Zackrisson B, Montelius A. A national approach for automated collection of standardized and population-based radiation therapy data in Sweden. Radiother Oncol 2016; 119:344-50. [DOI: 10.1016/j.radonc.2016.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
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Nyqvist J, Fransson P, Laurell G, Hammerlid E, Kjellén E, Franzén L, Söderström K, Wickart-Johansson G, Friesland S, Sjödin H, Brun E, Ask A, Nilsson P, Ekberg L, Björk-Eriksson T, Nyman J, Lödén B, Lewin F, Reizenstein J, Lundin E, Zackrisson B. Differences in health related quality of life in the randomised ARTSCAN study; accelerated vs. conventional radiotherapy for head and neck cancer. A five year follow up. Radiother Oncol 2016; 118:335-41. [PMID: 26777124 DOI: 10.1016/j.radonc.2015.12.024] [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: 04/29/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Health related quality of life (HRQoL) was assessed in the randomised, prospective ARTSCAN study comparing conventional radiotherapy (CF) with accelerated radiotherapy (AF) for head and neck cancer. MATERIAL AND METHODS 750 patients with squamous cell carcinoma (of any grade and stage) in the oral cavity, oro-, or hypopharynx or larynx (except T1-2, N0 glottic carcinoma) without distant metastases were randomised to either conventional fractionation (2 Gy/day, 5 days/week in 49 days, total dose 68 Gy) or accelerated fractionation (1.1+2.0 Gy/day, 5 days/week in 35 days, total dose 68 Gy). HRQoL was assessed with EORTC QLQ-C30, QLQ-H&N35 and HADS at baseline, at end of radiotherapy (eRT) and at 3 and 6 months and 1, 2 and 5 years after start of treatment. RESULTS The AF group reported HRQoL was significantly lower at eRT and at 3 months for most symptoms, scales and functions. Few significant differences were noted between the groups at 6 months and 5 years. Scores related to functional oral intake never reached baseline. CONCLUSION In comparison to CF, AF has a stronger adverse effect on HRQoL in the acute phase.
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Affiliation(s)
- Johanna Nyqvist
- Department of Otolaryngology and Head and Neck Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Science Otolaryngology and Head and Neck Surgery, Umeå University, Sweden.
| | | | - Göran Laurell
- Department of Clinical Science Otolaryngology and Head and Neck Surgery, Umeå University, Sweden; Department of Otolaryngology and Head and Neck Surgery, Uppsala University Hospital, Sweden
| | - Eva Hammerlid
- Department of Otolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Kjellén
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Lars Franzén
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Karin Söderström
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | | | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Sjödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Brun
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Anders Ask
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Per Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Lars Ekberg
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | | | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Britta Lödén
- Department of Clinical Oncology, Karlstad Central Hospital, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | | | - Erik Lundin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
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Kornerup JS, Brodin P, Birk Christensen C, Björk-Eriksson T, Kiil-Berthelsen A, Borgwardt L, Munck Af Rosenschöld P. Use of PET/CT instead of CT-only when planning for radiation therapy does not notably increase life years lost in children being treated for cancer. Pediatr Radiol 2015; 45:570-81. [PMID: 25378209 DOI: 10.1007/s00247-014-3197-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/03/2014] [Accepted: 08/13/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND PET/CT may be more helpful than CT alone for radiation therapy planning, but the added risk due to higher doses of ionizing radiation is unknown. OBJECTIVE To estimate the risk of cancer induction and mortality attributable to the [F-18]2-fluoro-2-deoxyglucose (FDG) PET and CT scans used for radiation therapy planning in children with cancer, and compare to the risks attributable to the cancer treatment. MATERIALS AND METHODS Organ doses and effective doses were estimated for 40 children (2-18 years old) who had been scanned using PET/CT as part of radiation therapy planning. The risk of inducing secondary cancer was estimated using the models in BEIR VII. The prognosis of an induced cancer was taken into account and the reduction in life expectancy, in terms of life years lost, was estimated for the diagnostics and compared to the life years lost attributable to the therapy. Multivariate linear regression was performed to find predictors for a high contribution to life years lost from the radiation therapy planning diagnostics. RESULTS The mean contribution from PET to the effective dose from one PET/CT scan was 24% (range: 7-64%). The average proportion of life years lost attributable to the nuclear medicine dose component from one PET/CT scan was 15% (range: 3-41%). The ratio of life years lost from the radiation therapy planning PET/CT scans and that of the cancer treatment was on average 0.02 (range: 0.01-0.09). Female gender was associated with increased life years lost from the scans (P < 0.001). CONCLUSION Using FDG-PET/CT instead of CT only when defining the target volumes for radiation therapy of children with cancer does not notably increase the number of life years lost attributable to diagnostic examinations.
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Affiliation(s)
- Josefine S Kornerup
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark,
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Kornerup JS, Brodin NP, Björk-Eriksson T, Birk Christensen C, Kiil-Berthelsen A, Aznar MC, Hollensen C, Markova E, Munck Af Rosenschöld P. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy. Br J Radiol 2014; 88:20140586. [PMID: 25494657 DOI: 10.1259/bjr.20140586] [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: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). METHODS Target volumes were first delineated without and subsequently re-delineated with access to (18)F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). RESULTS Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. CONCLUSION Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. ADVANCES IN KNOWLEDGE (18)F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT.
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Affiliation(s)
- J S Kornerup
- 1 Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Stahl Kornerup J, Brodin P, Björk-Eriksson T, Kiil-Berthelsen A, Birk-Christensen C, Loft A, Pettersson N, Scherman J, Munck af Rosenschöld P. The Impact of Different PTV Margins in VMAT and IMPT for Adolescents With Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2132] [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: 10/24/2022]
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Blomstrand M, Holmberg E, Aberg MAI, Lundell M, Björk-Eriksson T, Karlsson P, Blomgren K. No clinically relevant effect on cognitive outcomes after low-dose radiation to the infant brain: a population-based cohort study in Sweden. Acta Oncol 2014; 53:1143-50. [PMID: 24697746 PMCID: PMC4219853 DOI: 10.3109/0284186x.2014.899434] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While the detrimental effects of cranial radiotherapy on the developing brain are well known, the effects on cognitive performance of low doses of ionizing radiation is less studied. We performed a population-based cohort study to determine whether low doses of ionizing radiation to the brain in infancy affects cognitive function later in life. Further we hypothesized that the dose to the hippocampus predicts cognitive late side effects better than the anterior or the posterior brain doses. Material and methods During 1950–1960 3860 boys were treated with radiation in Sweden for cutaneous hemangiomas before the age of 18 months. Of these, 3030 were analyzed for military test scores at the age of 18 years and 2559 for the highest obtained educational level. Results Logical, spatial and technical test scores were not affected by increasing irradiation doses. The verbal test scores displayed a significant trend for decreasing scores with increasing doses to the hippocampus (p = 0.005). However, the absolute mean difference between the zero dose and the highest dose category (median 680 mGy) was very small, only 0.64 stanine points, and the significance was dependent on the highest dose category, containing few subjects. The educational level was not affected by brain irradiation. Overall, the hippocampal dose was a better predictor of late cognitive side effects than the doses to the anterior or the posterior brain. In conclusion, there was no decrease in logical, spatial and technical verbal or global test scores after ionizing radiation doses up to 250 mGy, but a subtle decrease in verbal test scores if the highest dose category was included (median 680 mGy). However, the clinical relevance of this decline in the highest dose group is questionable, since we could not find any effect on the highest obtained educational level.
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Affiliation(s)
- Malin Blomstrand
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg , Sweden
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Abstract
PURPOSE Cranial radiotherapy is an important tool in the cure of primary brain tumors. Unfortunately, it is associated with late-appearing toxicity to the normal brain tissue, including cognitive impairment, particularly in children. The underlying mechanisms are not fully understood but involve changes in hippocampal neurogenesis. Recent studies report essentially different responses in the juvenile and the adult brain after irradiation, but this has never been verified in a comparative study. MATERIALS AND METHODS We subjected juvenile (9-day-old) and adult (6-month-old) male rats to a single dose of 6 Gray (Gy) whole brain irradiation and euthanized them 6 hours, 7 days or 4 weeks later. Hippocampal lysates were analyzed for caspase-3 activity (apoptosis) and the expression of cytokines, chemokines and growth factors. Four weeks after irradiation, the number of microglia (expressing ionized calcium-binding adapter molecule 1, Iba-1), activated microglia (expressing cluster of differentiation 68 [CD68]), bromodeoxyuridine (BrdU) incorporation and granule cell layer (GCL) volume were assessed. RESULTS The major findings were (i) higher baseline BrdU incorporation (cell proliferation) in juvenile than in adult controls, which explains the increased susceptibility to irradiation and higher level of acute cell death (caspase activity) in juvenile rats, leading to impaired growth and subsequently a smaller dentate gyrus volume 4 weeks after irradiation, (ii) more activated (CD68-positive) microglia in adult compared to juvenile rats, regardless of irradiation, and (iii) differently expressed cytokines and chemokines after cranial irradiation in the juvenile compared to the adult rat hippocampus, indicating a more pro-inflammatory response in adult brains. CONCLUSION We found essentially diverse irradiation reactions in the juvenile compared to the adult hippocampus, indicating different mechanisms involved in degeneration and regeneration after injury. Strategies to ameliorate the cognitive deficits after cranial radiotherapy should therefore likely be adapted to the developmental level of the brain.
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Affiliation(s)
- Malin Blomstrand
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology , Gothenburg , Sweden
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Kalm M, Abel E, Wasling P, Nyman J, Hietala MA, Bremell D, Hagberg L, Elam M, Blennow K, Björk-Eriksson T, Zetterberg H. Neurochemical evidence of potential neurotoxicity after prophylactic cranial irradiation. Int J Radiat Oncol Biol Phys 2014; 89:607-14. [PMID: 24803034 DOI: 10.1016/j.ijrobp.2014.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 02/21/2014] [Accepted: 03/12/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine whether cerebrospinal fluid biomarkers for neuroaxonal damage, neuroglial activation, and amyloid β-related processes could characterize the neurochemical response to cranial radiation. METHODS AND MATERIALS Before prophylactic cranial irradiation (PCI) of patients with small cell lung cancer, each patient underwent magnetic resonance imaging of the brain, lumbar puncture, and Mini-Mental State Examination of cognitive function. These examinations were repeated at approximately 3 and 12 months after radiation. RESULTS The major findings were as follows. (1) Cerebrospinal fluid markers for neuronal and neuroglial injury were elevated during the subacute phase after PCI. Neurofilament and T-tau increased 120% and 50%, respectively, after PCI (P<.05). The same was seen for the neuroglial markers YKL-40 and glial fibrillary acidic protein, which increased 144% and 106%, respectively, after PCI (P<.05). (2) The levels of secreted amyloid precursor protein-α and -β were reduced 44% and 46%, respectively, 3 months after PCI, and the levels continued to decrease as long as 1 year after treatment (P<.05). (3) Mini-Mental State Examination did not reveal any cognitive decline, indicating that a more sensitive test should be used in future studies. CONCLUSION In conclusion, we were able to detect radiation therapy-induced changes in several markers reflecting neuronal injury, inflammatory/astroglial activation, and altered amyloid precursor protein/amyloid β metabolism, despite the low number of patients and quite moderate radiation doses (20-30 Gy). These changes are hypothesis generating and could potentially be used to assess the individual risk of developing long-term symptoms of chronic encephalopathy after PCI. This has to be evaluated in large studies with extended clinical follow-up and more detailed neurocognitive assessments.
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Affiliation(s)
- Marie Kalm
- Department of Clinical Neuroscience and Rehabilitation, Insitute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Pontus Wasling
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Max Albert Hietala
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Bremell
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lars Hagberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Mikael Elam
- Department of Clinical Neuroscience and Rehabilitation, Insitute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; UCL Institute of Neurology, London, United Kingdom
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Brodin NP, Vogelius IR, Björk-Eriksson T, Munck af Rosenschöld P, Maraldo MV, Aznar MC, Specht L, Bentzen SM. Optimizing the radiation therapy dose prescription for pediatric medulloblastoma: minimizing the life years lost attributable to failure to control the disease and late complication risk. Acta Oncol 2014; 53:462-70. [PMID: 24274390 DOI: 10.3109/0284186x.2013.858824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A mathematical framework is presented for simultaneously quantifying and evaluating the trade-off between tumor control and late complications for risk-based radiation therapy (RT) decision-support. To demonstrate this, we estimate life years lost (LYL) attributable to tumor recurrence, late cardiac toxicity and secondary cancers for standard-risk pediatric medulloblastoma (MB) patients and compare the effect of dose re-distribution on a common scale. METHODS Total LYL were derived, based on the LYL attributable to radiation-induced late complications and the LYL from not controlling the primary disease. We compared the estimated LYL for three different treatments in 10 patients: 1) standard 3D conformal RT; 2) proton therapy; 3) risk-adaptive photon treatment lowering the dose to part of the craniospinal (CS) target volume situated close to critical risk organs. RESULTS Late toxicity is important, with 0.75 LYL (95% CI 0.60-7.2 years) for standard uniform 24 Gy CS irradiation. However, recurrence risk dominates the total LYL with 14.2 years (95% CI 13.4-16.6 years). Compared to standard treatment, a risk-adapted strategy prescribing 12 Gy to the spinal volume encompassing the 1st-10th thoracic vertebrae (Th1-Th10), and 36 Gy to the remaining CS volume, estimated a LYL reduction of 0.90 years (95% CI -0.18-2.41 years). Proton therapy with 36 Gy to the whole CS volume was associated with significantly fewer LYL compared to the risk-adapted photon strategies, with a mean LYL difference of 0.50 years (95% CI 0.25-2.60 years). CONCLUSIONS Optimization of RT prescription strategies considering both late complications and the risk of recurrence, an all-cause mortality dose painting approach, was demonstrated. The risk-adapted techniques compared favorably to the standard, and although in this context, the gain is small compared to estimated uncertainty, this study demonstrates a framework for all-cause mortality risk estimation, rather than evaluates direct clinical applicability of risk-adapted strategies.
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Affiliation(s)
- N. Patrik Brodin
- Department of Radiation Oncology, Radiation Medicine Research Center, Rigshospitalet,
Copenhagen, Denmark
- Niels Bohr Institute, University of Copenhagen,
Copenhagen, Denmark
| | - Ivan R. Vogelius
- Department of Radiation Oncology, Radiation Medicine Research Center, Rigshospitalet,
Copenhagen, Denmark
| | - Thomas Björk-Eriksson
- Department of Radiation Oncology, Sahlgrenska University Hospital,
Gothenburg, Sweden
| | - Per Munck af Rosenschöld
- Department of Radiation Oncology, Radiation Medicine Research Center, Rigshospitalet,
Copenhagen, Denmark
- Niels Bohr Institute, University of Copenhagen,
Copenhagen, Denmark
| | - Maja V. Maraldo
- Department of Radiation Oncology, Rigshospitalet,
Copenhagen, Denmark
| | - Marianne C. Aznar
- Niels Bohr Institute, University of Copenhagen,
Copenhagen, Denmark
- Department of Radiation Oncology, Rigshospitalet,
Copenhagen, Denmark
| | - Lena Specht
- Department of Radiation Oncology, Rigshospitalet,
Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Søren M. Bentzen
- Department of Human Oncology, University of Wisconsin Medical School,
Madison, Wisconsin, USA
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Brodin NP, Munck af Rosenschöld P, Blomstrand M, Kiil-Berthlesen A, Hollensen C, Vogelius IR, Lannering B, Bentzen SM, Björk-Eriksson T. Hippocampal sparing radiotherapy for pediatric medulloblastoma: impact of treatment margins and treatment technique. Neuro Oncol 2013; 16:594-602. [PMID: 24327585 DOI: 10.1093/neuonc/not225] [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] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND We investigated how varying the treatment margin and applying hippocampal sparing and proton therapy impact the risk of neurocognitive impairment in pediatric medulloblastoma patients compared with current standard 3D conformal radiotherapy. METHODS We included 17 pediatric medulloblastoma patients to represent the variability in tumor location relative to the hippocampal region. Treatment plans were generated using 3D conformal radiotherapy, hippocampal sparing intensity-modulated radiotherapy, and spot-scanned proton therapy, using 3 different treatment margins for the conformal tumor boost. Neurocognitive impairment risk was estimated based on dose-response models from pediatric CNS malignancy survivors and compared among different margins and treatment techniques. RESULTS Mean hippocampal dose and corresponding risk of cognitive impairment were decreased with decreasing treatment margins (P < .05). The largest risk reduction, however, was seen when applying hippocampal sparing proton therapy-the estimated risk of impaired task efficiency (95% confidence interval) was 92% (66%-98%), 81% (51%-95%), and 50% (30%-70%) for 3D conformal radiotherapy, intensity-modulated radiotherapy, and proton therapy, respectively, for the smallest boost margin and 98% (78%-100%), 90% (60%-98%), and 70% (39%-90%) if boosting the whole posterior fossa. Also, the distance between the closest point of the planning target volume and the center of the hippocampus can be used to predict mean hippocampal dose for a given treatment technique. CONCLUSIONS We estimate a considerable clinical benefit of hippocampal sparing radiotherapy. In choosing treatment margins, the tradeoff between margin size and risk of neurocognitive impairment quantified here should be considered.
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Affiliation(s)
- N Patrik Brodin
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden (M.B.); Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (M.B.); Radiation Medicine Research Center, Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark (N.P.B., P.M.R., A.K.-B., C.H., I.R.V., S.M.B.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (N.P.B., P.M.R.); Department of Clinical Physiology and Nuclear Medicine, Centre of Diagnostic Investigations, Copenhagen, Denmark (A.K.-B.); Department of Pediatric Oncology, the Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.); Department of Human Oncology, University of Wisconsin Medical School, Madison, Wisconsin (S.M.B.); Department of Radiation Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.B.-E.)
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Rasmusson E, Gunnlaugsson A, Blom R, Björk-Eriksson T, Nilsson P, Ahlgen G, Jönsson C, Johansson K, Kjellén E. Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer. Radiat Oncol 2013; 8:271. [PMID: 24252686 PMCID: PMC3842657 DOI: 10.1186/1748-717x-8-271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 06/16/2013] [Accepted: 11/13/2013] [Indexed: 12/25/2022] Open
Abstract
Background The aim of the present study was to evaluate the prevalence and severity of lower limb lymphedema after pelvic lymphadenectomy and radiotherapy to the pelvic lymph nodes in patients with prostate cancer. Methods Twenty-six patients underwent combined treatment for high-risk node-positive prostate cancer at Skåne University Hospital between April 2008 and March 2011. The treatment consisted of extended pelvic lymphadenectomy followed by androgen deprivation therapy and radiotherapy. The pelvic lymphnodes, prostate and seminal vesicles were treated with external beam radiotherapy (EBRT) to an absorbed dose of 50 Gy followed by a brachytherapy (BT) boost of 2x10 Gy to the prostate only. Twenty-two patients accepted an invitation to a clinical examination with focus on lower limb swelling. The median time between the end of radiotherapy and examination was 2.2 years (range 1.2–4.1). Results Six patients (27%) experienced grade 1 lymphedema and two patients (9%) grade 2 while none had grade 3 or 4 according to the CTC Common Toxicity Criteria scale 4.0. Three patients required treatment with compression stockings. Conclusion Brachytherapy and pelvic EBRT have a low incidence of lymphedema (at median 2.2 y after treatment) in patients with high-risk node-positive prostate cancer that have undergone pelvic lymph node dissection.
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Brodin NP, Vogelius IR, Björk-Eriksson T, Munck af Rosenschöld P, Bentzen SM. Modeling Freedom From Progression for Standard-Risk Medulloblastoma: A Mathematical Tumor Control Model With Multiple Modes of Failure. Int J Radiat Oncol Biol Phys 2013; 87:422-9. [DOI: 10.1016/j.ijrobp.2013.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/23/2013] [Accepted: 06/09/2013] [Indexed: 11/29/2022]
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Brodin P, Munck af Rosenschöld P, Kiil-Berthelsen A, Vogelius I, Hollensen C, Blomstrand M, Bentzen S, Björk-Eriksson T. Impact of Treatment Margins and Treatment Technique in Hippocampal Sparing Radiation Therapy for Pediatric Medulloblastoma. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
During the last 20 years a tremendous improvement in the care of patients with pituitary tumors and of hypopituitarism has been achieved. If we resolve most of the possible causes of the increased cardiovascular disease and stroke mortality a normal survival is expected in these patients. Recently, a large population based study showed a decline in the risk of non-fatal stroke and of non-fatal cardiac events in GH deficient patients. This improvement was achieved by complete hormone replacement, including long term GH replacement, together with prescription of cardio protective drugs. If we follow the latest achievements in pituitary imaging, surgery techniques, hormone substitutions, cardio protective medications, we would expect a normal longevity in these patients. This review will focus on; (1) pituitary insufficiencies and hormone substitutions, (2) modes of cranial radiotherapy, and (3) new techniques in the surgery of a pituitary adenoma.
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Affiliation(s)
- Eva Marie Erfurth
- Department of Endocrinology, Skånes University Hospital, 221 85, Lund, Sweden.
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Hedman M, Björk-Eriksson T, Brodin O, Toma-Dasu I. Predictive value of modelled tumour control probability based on individual measurements of in vitro radiosensitivity and potential doubling time. Br J Radiol 2013; 86:20130015. [PMID: 23479396 DOI: 10.1259/bjr.20130015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare patient-specific radiobiological parameters with population averages in predicting the clinical outcome after radiotherapy (RT) using a tumour control probability (TCP) model based on the biological effective dose (BED). METHODS A previously published study of 46 head and neck carcinomas with individually identified radiobiological parameters, radiosensitivity and potential doubling time (Tpot), and known tumour size was investigated. These patients had all been treated with external beam RT, and the majority had also received brachytherapy. The TCP for each individual based on the BED using patient-specific radiobiological parameters was compared with the TCP based on the BED using average radiobiological parameters (α=0.3 Gy(-1), Tpot=3 days). RESULTS 43 patients remained in the final analysis. There was only a weak trend for increasing local tumour control with increasing BED in both groups. However, when the TCP was calculated, the use of patient-specific parameters was better for identifying local control correctly. The sensitivity and specificity for tumour-specific parameters were 63% and 80%, respectively. The corresponding values for population-based averages were 0% and 91%, respectively. The positive predictive value was 92% when tumour-specific parameters were used compared with 0% for population-based averages. A receiver operating characteristic curve confirmed the superiority of patient-specific parameters over population averages in predicting local control. CONCLUSION Individual radiobiological parameters are better than population-derived averages when used in a mathematical model to predict TCP after curative RT in head and neck carcinomas. ADVANCES IN KNOWLEDGE TCP based on individual radiobiological parameters is better than TCP based on population-based averages for identifying local control correctly.
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Affiliation(s)
- M Hedman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
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Brodin N, Vogelius I, Björk-Eriksson T, Munck af Rosenschöld P, Bentzen S. PD-0471: Freedom from progression for standard-risk medulloblastoma: A model for incorporating multiple modes of failure. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32777-8] [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: 10/23/2022]
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