1
|
Stelwagen J, Meuleman AT, Lubberts S, Steursma G, Kruyt LM, Donkerbroek JW, Meijer C, Walenkamp AME, Lefrandt JD, Rakers SE, Huitema RB, de Jong MAA, Wiegman EM, van den Bergh ACM, de Jong IJ, van Rentergem JAA, Schagen SB, Nuver J, Gietema JA. Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment. Cancers (Basel) 2021; 13:5675. [PMID: 34830829 PMCID: PMC8616311 DOI: 10.3390/cancers13225675] [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: 10/30/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. METHODS In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)-with a follow-up duration ≥ 20 years-and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). RESULTS We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20-42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score -0.85; 95% CI -1.39 to -0.33) compared to controls (mean 0.67; 95% CI -0.21 to 1.57, p < 0.01). In univariate analysis, the presence of hypogonadism (β -1.50, p < 0.01), high c-PWV (β -0.35, p = 0.09), and high AGEs (β -1.27, p = 0.02) were associated with lower cognitive scores, while only AGEs (β -1.17, p = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, p < 0.01). CONCLUSIONS Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. TRIAL REGISTRATION NCT02572934.
Collapse
Affiliation(s)
- Johannes Stelwagen
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Andrea T. Meuleman
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Gerrie Steursma
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Lara M. Kruyt
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Jan W. Donkerbroek
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Coby Meijer
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Annemiek M. E. Walenkamp
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Joop D. Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Sandra E. Rakers
- Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (S.E.R.); (R.B.H.)
| | - Rients B. Huitema
- Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (S.E.R.); (R.B.H.)
| | - Marianne A. A. de Jong
- Department of Radiotherapy, Radiotherapeutic Institute Friesland, 8900 CC Leeuwarden, The Netherlands;
| | - Erwin M. Wiegman
- Department of Radiotherapy, Isala Hospital, 8025 AB Zwolle, The Netherlands;
| | - Alfons C. M. van den Bergh
- Department of Radiotherapy, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Igle J. de Jong
- Department of Urology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Joost A. Agelink van Rentergem
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands; (J.A.A.v.R.); (S.B.S.)
| | - Sanne B. Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands; (J.A.A.v.R.); (S.B.S.)
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| |
Collapse
|
2
|
Postma MR, Kuijlen JMA, Korsten AGW, Westerlaan HE, van den Bergh ACM, Nuver J, den Dunnen WFA, van den Berg G. An aggressive poorly differentiated plurihormonal Pit-1-positive adenoma. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200166. [PMID: 34673544 PMCID: PMC8558894 DOI: 10.1530/edm-20-0166] [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: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 11/14/2022] Open
Abstract
SUMMARY In July 2017, a 35-year-old woman was referred to our care for treatment of a large pituitary mass with an unusually high growth rate. She presented with right-sided ptosis and diplopia (n. III palsy), increasing retrobulbar pain and vertigo. Although laboratory investigations were consistent with acromegaly, she exhibited no clear phenotypic traits. During transsphenoidal surgery aimed at biopsy, typical adenomatous tissue was encountered, upon which it was decided to proceed to debulking. Histopathological analysis demonstrated a poorly differentiated plurihormonal Pit-1-positive adenoma with focal growth hormone (GH) and prolactin positivity, positive SSTR2 staining and a Ki-67 of 20-30%. Postoperative magnetic resonance imaging (MRI) examination revealed a large tumour remnant within the sella invading the right cavernous sinus with total encasement of the internal carotid artery and displacement of the right temporal lobe. As a consequence, she was treated additionally with radiotherapy, and a long-acting first-generation somatostatin analogue was prescribed. Subsequently, the patient developed secondary hypocortisolism and diabetes mellitus despite adequate suppression of GH levels. In September 2019, her symptoms recurred. Laboratory evaluations indicated a notable loss of biochemical control, and MRI revealed tumour progression. Lanreotide was switched to pasireotide, and successful removal of the tumour remnant and decompression of the right optic nerve was performed. She received adjuvant treatment with temozolomide resulting in excellent biochemical and radiological response after three and six courses. Symptoms of right-sided ptosis and diplopia remained. Evidence for systemic therapy in case of tumour progression after temozolomide is currently limited, although various potential targets can be identified in tumour tissue. LEARNING POINTS Poorly differentiated plurihormonal Pit-1-positive adenoma is a potentially aggressive subtype of pituitary tumours. This subtype can express somatostatin receptors, allowing treatment with somatostatin analogues. A multidisciplinary approach involving an endocrinologist, neurosurgeon, pituitary pathologist, neuroradiologist, radiation oncologist and medical oncologist is key for the management of patients with aggressive pituitary tumours, allowing the successful application of multimodality treatment. Temozolomide is first-line chemotherapy for aggressive pituitary tumours and carcinomas. Further development of novel targeted therapies, such as peptide receptor radionuclide therapy (PRRT), vascular endothelial growth factor (VEGF) receptor-targeted therapy, tyrosine kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors and immune checkpoint inhibitors, is needed.
Collapse
Affiliation(s)
| | | | - Astrid G W Korsten
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Imaging Center
| | | | - Alfons C M van den Bergh
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Wilfred F A den Dunnen
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | | |
Collapse
|
3
|
Postma MR, Wolters TLC, van den Berg G, van Herwaarden AE, Muller Kobold AC, Sluiter WJ, Wagenmakers MA, van den Bergh ACM, Wolffenbuttel BHR, Hermus ARMM, Netea-Maier RT, van Beek AP. Postoperative use of somatostatin analogs and mortality in patients with acromegaly. Eur J Endocrinol 2019; 180:1-9. [PMID: 30400068 DOI: 10.1530/eje-18-0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/08/2018] [Indexed: 11/08/2022]
Abstract
Objective To assess the effect of somatostatin analogs (SSAs) on mortality in relation to disease control of acromegaly after pituitary surgery. Design A retrospective study in two large tertiary referral centers in The Netherlands. Methods Overall, 319 patients with acromegaly in whom pituitary surgery was performed as primary therapy between January 1980 and July 2017 were included. Postoperative treatment with SSA was prescribed to 174 (55%) patients because of persistent or recurrent disease. Disease control at last visit was assessed by IGF1 standard deviation score (SDS). Adequate disease control was defined as IGF1 SDS ≤2. Univariate determinants of mortality and standardized mortality ratios (SMRs) were calculated for groups with and without SSA at any moment postoperatively and at last visit. Results In total, 27 deaths were observed. In univariate analysis, determinants of mortality were inadequate disease control (relative risk (RR): 3.41, P = 0.005), surgery by craniotomy (RR: 3.53, P = 0.013) and glucocorticoid substitution (RR: 2.11, P = 0.047). There was a strong trend toward increased mortality for patients who used SSA (RR: 2.01, P = 0.067) and/or dopamine agonists (RR: 2.54, P = 0.052) at last visit. The SMR of patients with adequate disease control who used SSA at any moment postoperatively (1.07, P = 0.785) and at last visit (1.19; P = 0.600) was not increased. Insufficiently controlled patients had a significantly raised SMR (3.92, P = 0.006). Conclusions Postoperative use of SSA is not associated with increased mortality in patients with acromegaly who attain adequate disease control. In contrast, inadequate disease control, primary surgery by craniotomy and glucocorticoid substitution are associated with increased mortality.
Collapse
Affiliation(s)
- Mark R Postma
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thalijn L C Wolters
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerrit van den Berg
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margreet A Wagenmakers
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Centre for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Alfons C M van den Bergh
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ad R M M Hermus
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
Schaake W, van der Schaaf A, van Dijk LV, Bongaerts AHH, van den Bergh ACM, Langendijk JA. Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients. Radiother Oncol 2016; 119:381-7. [PMID: 27157889 DOI: 10.1016/j.radonc.2016.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/28/2016] [Accepted: 04/03/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Curative radiotherapy for prostate cancer may lead to anorectal side effects, including rectal bleeding, fecal incontinence, increased stool frequency and rectal pain. The main objective of this study was to develop multivariable NTCP models for these side effects. MATERIAL AND METHODS The study sample was composed of 262 patients with localized or locally advanced prostate cancer (stage T1-3). Anorectal toxicity was prospectively assessed using a standardized follow-up program. Different anatomical subregions within and around the anorectum were delineated. A LASSO logistic regression analysis was used to analyze dose volume effects on toxicity. RESULTS In the univariable analysis, rectal bleeding, increase in stool frequency and fecal incontinence were significantly associated with a large number of dosimetric parameters. The collinearity between these predictors was high (VIF>5). In the multivariable model, rectal bleeding was associated with the anorectum (V70) and anticoagulant use, fecal incontinence was associated with the external sphincter (V15) and the iliococcygeal muscle (V55). Finally, increase in stool frequency was associated with the iliococcygeal muscle (V45) and the levator ani (V40). No significant associations were found for rectal pain. CONCLUSIONS Different anorectal side effects are associated with different anatomical substructures within and around the anorectum. The dosimetric variables associated with these side effects can be used to optimize radiotherapy treatment planning aiming at prevention of specific side effects and to estimate the benefit of new radiation technologies.
Collapse
Affiliation(s)
- Wouter Schaake
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Alfons H H Bongaerts
- Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Alfons C M van den Bergh
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| |
Collapse
|
5
|
Schaake W, de Groot M, Krijnen WP, Langendijk JA, van den Bergh ACM. Quality of life among prostate cancer patients: a prospective longitudinal population-based study. Radiother Oncol 2013; 108:299-305. [PMID: 23932157 DOI: 10.1016/j.radonc.2013.06.039] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the course of quality of life (QoL) among prostate cancer patients treated with external beam radiotherapy and to compare the results with QoL of a normal age-matched reference population. PATIENTS AND METHODS The study population was composed of 227 prostate cancer patients, treated with radiotherapy. The EORTC QLQ-C30 was used to assess QoL before radiotherapy and six months, one year, two years and three years after completion of radiotherapy. Mixed model analyses were used to investigate longitudinal changes in QoL. QoL of prostate cancer patients was compared to that of a normative cohort using a multivariate analysis of covariance. RESULTS A significant decline in QoL was observed after radiotherapy (p<0.001). The addition of hormonal therapy to radiotherapy was associated with a lower level of role functioning. Patients with coronary heart disease and or chronic obstructive pulmonary disease or asthma had a significantly worse course in QoL. Although statistically significant, all differences were classified as small or trivial. CONCLUSION Prostate cancer patients experience a small worsening of QoL as compared with baseline and as compared with a normal reference population. As co-morbidity modulates patients' post-treatment QoL, a proper assessment of co-morbidity should be included in future longitudinal analyses on QoL.
Collapse
Affiliation(s)
- Wouter Schaake
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands; Hanze University of Applied Sciences, Professorship in Health Care and Nursing, Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|
6
|
Postma MR, Netea-Maier RT, van den Berg G, Homan J, Sluiter WJ, Wagenmakers MA, van den Bergh ACM, Wolffenbuttel BHR, Hermus ARMM, van Beek AP. Quality of life is impaired in association with the need for prolonged postoperative therapy by somatostatin analogs in patients with acromegaly. Eur J Endocrinol 2012; 166:585-92. [PMID: 22250074 DOI: 10.1530/eje-11-0853] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 11/08/2022]
Abstract
OBJECTIVE To assess the influence of long-acting somatostatin analogs (SSTA) after initial pituitary surgery on long-term health-related quality of life (HR-QoL) in relation to disease control in patients with acromegaly. DESIGN This is a cross-sectional study in two tertiary referral centers in The Netherlands. PATIENTS AND METHODS One hundred and eight patients with acromegaly, in whom transsphenoidal (n=101, 94%) or transcranial (n=7, 6%) surgery was performed. Subsequently, 46 (43%) received additional radiotherapy and 41 (38%) were on postoperative treatment with SSTA because of persistent or recurrent disease at the time of study. All subjects filled in standardized questionnaires measuring HR-QoL. Disease control at the time of study was assessed by local IGF1 SDS. RESULTS IGF1 SDS were slightly higher in patients treated with SSTA in comparison with patients without use of SSTA (0.85±1.52 vs 0.25±1.21, P=0.026), but the percentage of patients with insufficient control (IGF1 SDS >2) was not different (17 vs 9%, P=0.208). Patients using SSTA reported poorer scores on most subscales of the RAND-36 and the acromegaly QoL and on all subscales of the multidimensional fatigue inventory-20. A subgroup analysis in patients with similar IGF1 levels (SSTA+, n=26, IGF1 SDS 0.44±0.72 vs SSTA-, n=44, IGF1 SDS 0.41±0.65) revealed worse scores on physical functioning, physical fatigue, reduced activity, vitality, and general health perception across all HR-QoL questionnaires in patients treated with SSTA. CONCLUSION QoL is impaired in association with the need for prolonged postoperative therapy by SSTA in patients with acromegaly despite similar IGF1 levels.
Collapse
Affiliation(s)
- Mark R Postma
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Buunk AP, Bennenbroek FTC, Stiegelis HE, van den Bergh ACM, Sanderman R, Hagedoorn M. Follow-up effects of social comparison information on the quality of life of cancer patients: the moderating role of social comparison orientation. Psychol Health 2011; 27:641-54. [PMID: 21895459 DOI: 10.1080/08870446.2011.613994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine how social comparison orientation (SCO) moderates the effects of three types of social comparison information on the global quality of life of cancer patients 2 weeks and 3 months later. DESIGN Cancer patients (n=226) were provided with social comparison information just prior to undergoing radiation therapy, using audiotapes. Each participant was confronted with one of three tapes: (1) focusing on procedural aspects, (2) focusing on emotional reactions and (3) focusing on coping strategies. MAIN OUTCOME MEASURES Quality of life as measured with the Cantril self-anchoring scale [Cantril, H. (1965). The pattern of human concerns. New Brunswick, NJ: Rutgers University Press]. RESULTS With increasing SCO, a lower quality of life was reported after listening to the emotion tape, while a higher quality of life was reported after listening to the coping tape. These effects were found 2 weeks as well as 3 months after the radiation therapy had ended. CONCLUSION Social comparison information may have longitudinal effects on quality of life, but these effects are to an important extent dependent on the nature of the information and individual differences in SCO.
Collapse
Affiliation(s)
- Abraham P Buunk
- Royal Netherlands Academy of Arts and Sciences, Department of Psychology, University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
8
|
Brummelman P, Elderson MF, Dullaart RPF, van den Bergh ACM, Timmer CA, van den Berg G, Koerts J, Tucha O, Wolffenbuttel BHR, van Beek AP. Cognitive functioning in patients treated for nonfunctioning pituitary macroadenoma and the effects of pituitary radiotherapy. Clin Endocrinol (Oxf) 2011; 74:481-7. [PMID: 21133979 DOI: 10.1111/j.1365-2265.2010.03947.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [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: 11/27/2022]
Abstract
CONTEXT AND OBJECTIVE Cognitive deterioration is reported in patients with a nonfunctioning pituitary macroadenoma (NFA) and after pituitary radiotherapy. However, reported results are inconsistent and are potentially confounded by different underlying pituitary disorders. The aim of this study was to examine cognitive functions in patients previously treated for NFA with or without radiotherapy. DESIGN Verbal memory was assessed with the Dutch equivalent to the Rey Auditory Verbal Learning Test (15 Words Test, 15 WT). Executive functioning was examined using the Ruff Figural Fluency Test (RFFT). We compared our patient cohort with large reference populations representative of the Dutch population. PATIENTS Eighty-four patients (62±10 years) who underwent transsphenoidal surgery 8.6±6.3 years earlier participated. Patients who underwent radiotherapy (n=39) were compared to those who received surgery alone (n=45). All patients were on stable hormonal replacement therapy. RESULTS The total patient group scored significantly below the reference sample on all 15 WT z-scores (95%CI): short-term memory, -0.3 (-0.5 to -0.1); total memory, -0.8 (-1.1 to -0.5); learning score, -0.3 (-0.5 to -0.1); delayed memory, -0.8 (-1.1 to -0.5), all P<0.01. The total patient group scored significantly below the reference sample on RFFT z-scores (95%CI): unique designs, -0.7 (-0.9 to -0.5) and perseverative errors, -0.5 (-0.8 to -0.2), both P<0.001. Patients who underwent radiotherapy showed no significant differences on cognition when compared to those who received surgery alone. CONCLUSION Patients with NFA score significantly worse on cognition compared to reference populations. Radiotherapy does not appear to have a major influence on cognition.
Collapse
Affiliation(s)
- Pauline Brummelman
- Department of Endocrinology, University Medical Center Groningen, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Stiegelis HE, Hagedoorn M, Sanderman R, van der Zee KI, Buunk BP, van den Bergh ACM. Cognitive adaptation: A comparison of cancer patients and healthy references. Br J Health Psychol 2010; 8:303-18. [PMID: 14606975 DOI: 10.1348/135910703322370879] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Taylor's theory of cognitive adaptation proposes that adjustment depends on the ability to sustain and modify illusions (i.e. unrealistic optimism, exaggerated perceptions of control, and self-aggrandizement) that buffer against threats but also against possible future setbacks. Because the question of whether cancer patients show these illusions has received little attention, the present study compared patients' perceptions of optimism, control, and self-esteem at different stages of the cancer process with that of healthy references. The effects of these perceptions on psychological distress were also assessed. DESIGN The present study has a longitudinal design. Including a group of healthy references enabled us to draw more firm conclusions about the effect of cancer upon cognitive perceptions. METHODS The participants were 67 cancer patients and 50 healthy references. Patients filled out questionnaires prior to their first radiotherapy (T1), at 2 weeks (T2), and at 3 months (T3) after completing radiotherapy. Healthy references were assessed at similar intervals. RESULTS T tests revealed that patients experienced significantly higher levels of optimism and self-esteem than the healthy reference group. Concerning control, no group differences were found. Importantly, regression analyses showed that lower levels of optimism and control at T1 were predictive of feelings of anxiety at T3. Lower perceived control also predicted depressive symptoms. CONCLUSION Results support the theory of cognitive adaptation in that patients are indeed able to respond to cancer with high levels of optimism and self-esteem and that lower levels of optimism and control are predictive of psychological distress.
Collapse
Affiliation(s)
- Heidi E Stiegelis
- Department of Public Health and Health Psychology, University of Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
10
|
Sijtsema NM, van den Bergh ACM, Burlage FR, Bijl HP, Langendijk JA, Meertens H. Patient position verification with oblique radiation beams. Radiother Oncol 2007; 85:126-31. [PMID: 17306395 DOI: 10.1016/j.radonc.2007.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/10/2007] [Accepted: 01/24/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE In this study we investigated whether the position of head and neck cancer patients during radiotherapy could be determined from portal images of oblique radiation beams. Currently applied additional anterior posterior (AP) and lateral verification beams could then be abandoned. METHOD The patient position was determined from portal images of the oblique radiation beams and compared with that determined from AP and lateral verification beams. Seven hundred and fifty-one portal images of 18 different patients were analyzed. RESULTS The set-up errors of patients that were treated with oblique gantry angles could be determined with the same accuracy from the oblique beams as from the AP and lateral verification beams in the ventrodorsal and craniocaudal direction. An additional AP beam was necessary to obtain the same accuracy in the lateral direction, because the used beam directions were relatively close to lateral. The position verification of patients treated with both oblique gantry angles and isocentric table rotations was more accurate if AP and lateral verification beams were used. CONCLUSIONS For patients treated with an irradiation technique with oblique gantry angles (and no isocentric table rotations) position verification can be performed by using these oblique radiation beams.
Collapse
Affiliation(s)
- Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
11
|
Poortmans P, Bossi A, Vandeputte K, Bosset M, Miralbell R, Maingon P, Boehmer D, Budiharto T, Symon Z, van den Bergh ACM, Scrase C, Van Poppel H, Bolla M. Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group. Radiother Oncol 2007; 84:121-7. [PMID: 17706307 DOI: 10.1016/j.radonc.2007.07.017] [Citation(s) in RCA: 227] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 07/07/2007] [Accepted: 07/14/2007] [Indexed: 01/03/2023]
Abstract
The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing post-operative radiotherapy for prostate cancer requires a standardisation of the target volume definition and delineation as well as standardisation of the clinical quality assurance procedures. Recommendations for this are presented on behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group and in addition to the already published guidelines for radiotherapy as the primary treatment.
Collapse
Affiliation(s)
- Philip Poortmans
- Department of Radiotherapy, Dr. B. Verbeeten Institute, Tilburg, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
van den Bergh ACM, van den Berg G, Schoorl MA, Sluiter WJ, van der Vliet AM, Hoving EW, Szabó BG, Langendijk JA, Wolffenbuttel BHR, Dullaart RPF. Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma: Beneficial effect on local control without additional negative impact on pituitary function and life expectancy. Int J Radiat Oncol Biol Phys 2007; 67:863-9. [PMID: 17197121 DOI: 10.1016/j.ijrobp.2006.09.049] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 09/29/2006] [Accepted: 09/29/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To demonstrate the benefit of immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma (NFA) in perspective to the need for hormonal substitution and life expectancy. METHODS AND MATERIALS Retrospective cohort analysis of 122 patients, operated for NFA between 1979 and 1998. Recurrence was defined as regrowth on computed tomography or magnetic resonance imaging. The occurrence of hormonal deficiencies was defined as the starting date of hormonal substitution therapy. RESULTS Seventy-six patients had residual NFA after surgery and received immediate postoperative radiotherapy (Group 1); three patients developed a recurrence, resulting in a 95% local control rate at 10 years. Twenty-eight patients had residual NFA after surgery, but were followed by a wait-and-see policy (Group 2). Sixteen developed a recurrence, resulting in a local control rate of 49% at 5 years and 22% at 10 years (p < 0.001 compared with Group 1). There were no differences between Group 1 and 2 regarding the need for substitution with thyroid hormone, glucocorticoids, and sex hormones before first surgery, directly after surgery and at end of follow-up. There were no differences in hormone substitution free survival between Group 1 and Group 2 during the study period after first surgery. Life expectancy was similar in Group 1 and 2, and their median life expectancy did not differ from median life expectancy in the general population. CONCLUSIONS Immediate postoperative radiotherapy provides a marked improvement of local control among patients with residual NFA compared with surgery alone, without an additional deleterious effect on pituitary function and life expectancy.
Collapse
Affiliation(s)
- Alfons C M van den Bergh
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
van den Bergh ACM, Schoorl MA, Dullaart RPF, van der Vliet AM, Szabó BG, ter Weeme CA, Pott JWR. Lack of Radiation Optic Neuropathy in 72 Patients Treated for Pituitary Adenoma. J Neuroophthalmol 2004; 24:200-5. [PMID: 15348984 DOI: 10.1097/00041327-200409000-00003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of radiation optic neuropathy (RON) after external photon beam radiation therapy for nonfunctioning pituitary adenoma (NFA) is not well-studied. Retrospective review of ophthalmological and imaging data in 72 patients with NFA treated between 1985 and 1998 with external beam radiation therapy after surgery Clinical follow-up after radiation therapy had to be at least 18 months. RON was defined as a sudden and profound irreversible visual loss affecting the optic nerve or chiasm A review of previously published cases of RON was then performed. In our cohort, no patient had RON. A total of 11 adequately documented series reports of RON were found in the medical literature on radiation-treated NFAs. The incidence of RON in NFA from these series is 0.53% (95% CI, 0.26%-0.96%). An additional 14 single RON cases have been reported, bringing the total of adequately documented RON cases to 25. RON is a rare complication after external beam radiation therapy for NFA.
Collapse
Affiliation(s)
- Alfons C M van den Bergh
- Department of Radiation Oncology, University Hospital Groningen, PPO Box 30.001, 9700 RB Groningen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
14
|
Creutzberg CL, van Putten WLJ, Wárlám-Rodenhuis CC, van den Bergh ACM, de Winter KAJ, Koper PCM, Lybeert MLM, Slot A, Lutgens LCHW, Stenfert Kroese MC, Beerman H, van Lent M. Outcome of High-Risk Stage IC, Grade 3, Compared With Stage I Endometrial Carcinoma Patients: The Postoperative Radiation Therapy in Endometrial Carcinoma Trial. J Clin Oncol 2004; 22:1234-41. [PMID: 15051771 DOI: 10.1200/jco.2004.08.159] [Citation(s) in RCA: 227] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Stage IC, grade 3 endometrial cancer is regarded as a high-risk category. Stage IC, grade 3 patients were not eligible for the randomized Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial, but were registered and received postoperative radiotherapy. Patients and Methods The PORTEC trial included 715 patients with stage IC, grade 1 or 2, and stage IB, grade 2 or 3 endometrial cancer. Patients were randomly assigned after surgery to receive pelvic radiotherapy (RT) or no further treatment. A total of 104 patients with stage IC, grade 3 endometrial cancer were registered, of whom 99 could be evaluated. Patterns of relapse and survival were compared with PORTEC patients receiving RT. Median follow-up was 83 months. Results The actuarial 5-year rates of locoregional relapse were 1% to 3% for PORTEC patients who received RT, compared with 14% for stage IC, grade 3 patients. Five-year distant metastases rates were 3% to 8% for grade 1 and 2 tumors; 20% for stage IB, grade 3 tumors; and 31% for stage IC, grade 3 tumors. Overall survival rates were 83% to 85% for grades 1 and 2; 74% for stage IB, grade 3; and 58% for stage IC, grade 3 patients (P < .001). In multivariate analysis grade 3 was the most important adverse prognostic factor for relapse and death as a result of endometrial cancer (hazard ratios, 5.4 and 5.5; P < .0001). Conclusion Patients with stage IC, grade 3 endometrial carcinoma are at high risk of early distant spread and endometrial carcinoma-related death. Novel strategies for adjuvant therapy should be explored to improve survival for this patient group.
Collapse
Affiliation(s)
- Carien L Creutzberg
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Stiegelis HE, Hagedoorn M, Sanderman R, Bennenbroek FTC, Buunk BP, van den Bergh ACM, Botke G, Ranchor AV. The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy. Psychooncology 2004; 13:248-59. [PMID: 15054729 DOI: 10.1002/pon.738] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many studies have reported that cancer patients who show difficulties maintaining perceptions of control report more psychological distress than patients who are higher in control. Besides perceptions of control, feelings of illness uncertainty have also been regarded as a predictor of psychological distress. Given these strong relationships between perceptions of low control and high illness uncertainty and psychological distress, the present study examined whether an informational self-management intervention (booklet) could moderate this relationship. The booklet contained general and specific information about cancer and cancer treatment, information about possible coping strategies, and social comparison information, which consisted of short stories of other patients. Prior to radiotherapy, 209 patients with cancer completed baseline measures, including control and illness uncertainty. After completing radiotherapy, patients were randomly allocated to receive either a booklet (experimental group; N=103) or no booklet (control group; N=106). Three months after the intervention, aspects of psychological distress were assessed, including tension, anger, depression, fatigue and vigour. The results supported our hypotheses and suggested that a self-management intervention is relevant in reducing the relationship between control and illness uncertainty before radiotherapy and psychological distress after radiotherapy. This seems important, especially for high-risk patients who perceive little control and much illness uncertainty.
Collapse
Affiliation(s)
- Heidi E Stiegelis
- Northern Centre for Healthcare Research, University of Groningen, Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
van den Bergh ACM, Dullaart RPF, Hoving MA, Links TP, ter Weeme CA, Szabó BG, Pott JWR. Radiation optic neuropathy after external beam radiation therapy for acromegaly. Radiother Oncol 2003; 68:95-100. [PMID: 12972302 DOI: 10.1016/s0167-8140(03)00202-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Alfons C M van den Bergh
- Department of Radiation Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
17
|
van den Bergh ACM, Hoving MA, Links TP, Dullaart RPF, Ranchor AV, ter Weeme CA, Canrinus AA, Szabó BG, Pott JWR. Radiation optic neuropathy after external beam radiation therapy for acromegaly: report of two cases. Radiother Oncol 2003; 68:101-3. [PMID: 12972303 DOI: 10.1016/s0167-8140(03)00201-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For diagnosing radiation optic neuropathy (RON) ophthalmological and imaging data were evaluated from 63 acromegalic patients, irradiated between 1967 and 1998. Two patients developed RON: one patient in one optic nerve 10 years and another patient in both optic nerves 5 months after radiation therapy. RON is a rare complication after external beam radiation therapy for acromegaly, which can occur after a considerable latency period.
Collapse
Affiliation(s)
- Alfons C M van den Bergh
- Department of Radiation Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Creutzberg CL, van Putten WLJ, Koper PC, Lybeert MLM, Jobsen JJ, Wárlám-Rodenhuis CC, De Winter KAJ, Lutgens LCHW, van den Bergh ACM, van der Steen-Banasik E, Beerman H, van Lent M. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 2003; 89:201-9. [PMID: 12713981 DOI: 10.1016/s0090-8258(03)00126-4] [Citation(s) in RCA: 235] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine the rates of local control and survival after relapse in patients with stage I endometrial cancer treated in the multicenter randomized PORTEC trial. METHODS The PORTEC trial included 715 patients with stage 1 endometrial cancer, either grade 1 or 2 with deep (>50%) myometrial invasion or grade 2 or 3 with <50% invasion. In all cases an abdominal hysterectomy was performed, without lymphadenectomy. After surgery, patients were randomized to receive pelvic RT (46 Gy) or no further treatment. RESULTS The analysis was done by intention-to-treat. A total of 714 patients were evaluated. At a median follow-up of 73 months, 8-year actuarial locoregional recurrence rates were 4% in the RT group and 15% in the control group (P < 0.0001). The 8-year actuarial overall survival rates were 71 (RT group) and 77% (control group, P = 0.18). Eight-year rates of distant metastases were 10 and 6% (P = 0.20). The majority of the locoregional relapses were located in the vagina, mainly in the vaginal vault. Of the 39 patients with isolated vaginal relapse, 35 (87%) were treated with curative intent, usually with external RT and brachytherapy, and surgery in some. A complete remission (CR) was obtained in 31 of the 35 patients (89%), and 24 patients (77%) were still in CR after further follow-up. Five patients subsequently developed distant metastases, and 2 had a second vaginal recurrence. The 3-year survival after first relapse was 51% for patients in the control group and 19% in the RT group (P = 0.004). The 3-year survival after vaginal relapse was 73%, in contrast to 8 and 14% after pelvic and distant relapse (P < 0.001). At 5 years, the survival after vaginal relapse was 65% in the control group compared to 43% in the RT group. CONCLUSION Survival after relapse was significantly better in the patient group without previous RT. Treatment for vaginal relapse was effective, with 89% CR and 65% 5-year survival in the control group, while there was no difference in survival between patients with pelvic relapse and those with distant metastases. As pelvic RT was shown to improve locoregional control significantly, but without a survival benefit, its use should be limited to those patients at sufficiently high risk (15% or over) for recurrence in order to maximize local control and relapse-free survival.
Collapse
Affiliation(s)
- Carien L Creutzberg
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|