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Rades D, Cremers F, Janssen S, Bartscht T, Kristiansen C, Timke C, Duma MN, Yu NY, Bohnet S. Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients. Anticancer Res 2024; 44:2073-2079. [PMID: 38677766 DOI: 10.21873/anticanres.17011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM Pneumonitis is a serious radiotherapy complication. This study, which is a prerequisite for a prospective trial, aimed to identify the prevalence of pneumonitis and risk factors in elderly patients with lung cancer. PATIENTS AND METHODS Ninety-eight lung cancer patients aged ≥65 years were included. Seventeen factors were investigated regarding grade ≥2 pneumonitis at 24 weeks following radiotherapy. RESULTS The prevalence of grade ≥2 pneumonitis at 24 weeks was 27.3%. On univariate analysis, a significant association was observed for mean (ipsilateral) lung dose (MLD; ≤13.0 vs. 13.1-20.0 vs. >20.0 Gy; 0% vs. 24.9% vs. 48.7%). Results were significant also for ≤13.0 vs. >13.0 Gy (0% vs. 37.1%) or ≤20.0 vs. >20.0 Gy (13.4% vs. 48.7%). MLD achieved significance on multivariate analysis. CONCLUSION Elderly patients receiving MLDs >13.0 Gy, particularly >20.0 Gy, have a high risk of grade ≥2 pneumonitis. These results are important for designing a prospective trial.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Florian Cremers
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical School Hamburg, Schwerin, Germany
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Carmen Timke
- Department of Radiotherapy, Malteser Hospital St. Franziskus, Flensburg, Germany
| | - Marciana N Duma
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Department of Radiotherapy, Medical School Hamburg, Schwerin, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Olloni A, Brink C, Lorenzen EL, Jeppesen SS, Hofmann L, Kristiansen C, Knap MM, Møller DS, Nygård L, Persson GF, Thing RS, Sand HMB, Diederichsen A, Schytte T. Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study. JTO Clin Res Rep 2024; 5:100663. [PMID: 38590728 PMCID: PMC10999485 DOI: 10.1016/j.jtocrr.2024.100663] [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: 09/05/2023] [Revised: 01/21/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction It is an ongoing debate how much lung and heart irradiation impact overall survival (OS) after definitive radiotherapy for lung cancer. This study uses a large national cohort of patients with locally advanced NSCLC to investigate the association between OS and irradiation of lung and heart. Methods Treatment plans were acquired from six Danish radiotherapy centers, and patient characteristics were obtained from national registries. A hybrid segmentation tool automatically delineated the heart and substructures. Dose-volume histograms for all structures were extracted and analyzed using principal component analyses (PCAs). Parameter selection for a multivariable Cox model for OS prediction was performed using cross-validation based on bootstrapping. Results The population consisted of 644 patients with a median survival of 26 months (95% confidence interval [CI]: 24-29). The cross-validation selected two PCA variables to be included in the multivariable model. PCA1 represented irradiation of the heart and affected OS negatively (hazard ratio, 1.14; 95% CI: 1.04-1.26). PCA2 characterized the left-right balance (right atrium and left ventricle) irradiation, showing better survival for tumors near the right side (hazard ratio, 0.92; 95% CI: 0.84-1.00). Besides the two PCA variables, the multivariable model included age, sex, body-mass index, performance status, tumor dose, and tumor volume. Conclusions Besides the classic noncardiac risk factors, lung and heart doses had a negative impact on survival, while it is suggested that the left side of the heart is a more radiation dose-sensitive region. The data indicate that overall heart irradiation should be reduced to improve the OS if possible.
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Affiliation(s)
- Agon Olloni
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ebbe Laugaard Lorenzen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Lone Hofmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Lotte Nygård
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Herlev and Gentofte Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Rune Slot Thing
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Axel Diederichsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Olloni A, Lorenzen EL, Jeppesen SS, Diederichsen A, Finnegan R, Hoffmann L, Kristiansen C, Knap M, Milo MLH, Møller DS, Pøhl M, Persson G, Sand HMB, Sarup N, Thing RS, Brink C, Schytte T. An open source auto-segmentation algorithm for delineating heart and substructures - Development and validation within a multicenter lung cancer cohort. Radiother Oncol 2024; 191:110065. [PMID: 38122851 DOI: 10.1016/j.radonc.2023.110065] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE Irradiation of the heart in thoracic cancers raises toxicity concerns. For accurate dose estimation, automated heart and substructure segmentation is potentially useful. In this study, a hybrid automatic segmentation is developed. The accuracy of delineation and dose predictions were evaluated, testing the method's potential within heart toxicity studies. MATERIALS AND METHODS The hybrid segmentation method delineated the heart, four chambers, three large vessels, and the coronary arteries. The method consisted of a nnU-net heart segmentation and partly atlas- and model-based segmentation of the substructures. The nnU-net training and atlas segmentation was based on lung cancer patients and was validated against a national consensus dataset of 12 patients with breast cancer. The accuracy of dose predictions between manual and auto-segmented heart and substructures was evaluated by transferring the dose distribution of 240 previously treated lung cancer patients to the consensus data set. RESULTS The hybrid auto-segmentation method performed well with a heart dice similarity coefficient (DSC) of 0.95, with no statistically significant difference between the automatic and manual delineations. The DSC for the chambers varied from 0.78-0.86 for the automatic segmentation and was comparable with the inter-observer variability. Most importantly, the automatic segmentation was as precise as the clinical experts in predicting the dose distribution to the heart and all substructures. CONCLUSION The hybrid segmentation method performed well in delineating the heart and substructures. The prediction of dose by the automatic segmentation was aligned with the manual delineations, enabling measurement of heart and substructure dose in large cohorts. The delineation algorithm will be available for download.
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Affiliation(s)
- Agon Olloni
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark.
| | - Ebbe Laugaard Lorenzen
- Department of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Axel Diederichsen
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Cardiology, Odense University Hospital, Denmark
| | - Robert Finnegan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital University Hospital of Southern Denmark, Denmark
| | - Marianne Knap
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
| | - Mette Pøhl
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Gitte Persson
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Hella M B Sand
- Department of Oncology, Aalborg University Hospital, Denmark
| | - Nis Sarup
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
| | - Rune Slot Thing
- Department of Oncology, Vejle Hospital University Hospital of Southern Denmark, Denmark
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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Lindberg S, Grozman V, Karlsson K, Onjukka E, Lindbäck E, Jirf KA, Lax I, Wersäll P, Persson GF, Josipovic M, Khalil AA, Møller DS, Hoffmann L, Knap MM, Nyman J, Drugge N, Bergström P, Olofsson J, Rogg LV, Hagen RK, Frøland AS, Ramberg C, Kristiansen C, Jeppesen SS, Nielsen TB, Lödén B, Rosenbrand HO, Engelholm S, Haraldsson A, Billiet C, Lewensohn R, Lindberg K. Expanded HILUS Trial: A Pooled Analysis of Risk Factors for Toxicity From Stereotactic Body Radiation Therapy of Central and Ultracentral Lung Tumors. Int J Radiat Oncol Biol Phys 2023; 117:1222-1231. [PMID: 37423292 DOI: 10.1016/j.ijrobp.2023.06.246] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/22/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Stereotactic body radiation therapy for tumors near the central airways implies high-grade toxic effects, as concluded from the HILUS trial. However, the small sample size and relatively few events limited the statistical power of the study. We therefore pooled data from the prospective HILUS trial with retrospective data from patients in the Nordic countries treated outside the prospective study to evaluate toxicity and risk factors for high-grade toxic effects. METHODS AND MATERIALS All patients were treated with 56 Gy in 8 fractions. Tumors within 2 cm of the trachea, the mainstem bronchi, the intermediate bronchus, or the lobar bronchi were included. The primary endpoint was toxicity, and the secondary endpoints were local control and overall survival. Clinical and dosimetric risk factors were analyzed for treatment-related fatal toxicity in univariable and multivariable Cox regression analyses. RESULTS Of 230 patients evaluated, grade 5 toxicity developed in 30 patients (13%), of whom 20 patients had fatal bronchopulmonary bleeding. The multivariable analysis revealed tumor compression of the tracheobronchial tree and maximum dose to the mainstem or intermediate bronchus as significant risk factors for grade 5 bleeding and grade 5 toxicity. The 3-year local control and overall survival rates were 84% (95% CI, 80%-90%) and 40% (95% CI, 34%-47%), respectively. CONCLUSIONS Tumor compression of the tracheobronchial tree and high maximum dose to the mainstem or intermediate bronchus increase the risk of fatal toxicity after stereotactic body radiation therapy in 8 fractions for central lung tumors. Similar dose constraints should be applied to the intermediate bronchus as to the mainstem bronchi.
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Affiliation(s)
- Sara Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden.
| | - Vitali Grozman
- Section of Thoracic Radiology, Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Karlsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Onjukka
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Elias Lindbäck
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karam Al Jirf
- Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
| | - Ingmar Lax
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wersäll
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gitte Fredberg Persson
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Herlev-Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mirjana Josipovic
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Azza Ahmed Khalil
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Sloth Møller
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hoffmann
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Marquard Knap
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Jan Nyman
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ninni Drugge
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Bergström
- Department of Oncology, Northern Sweden University Hospital, Umeå, Sweden
| | - Jörgen Olofsson
- Department of Oncology, Northern Sweden University Hospital, Umeå, Sweden
| | | | | | | | - Christina Ramberg
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tine Bjørn Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Britta Lödén
- Oncology Department, Central Hospital in Karlstad, Karlstad, Sweden
| | | | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - André Haraldsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, University of Antwerp, Antwerp, Belgium
| | - Rolf Lewensohn
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden
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Hansen KH, Johansen JS, Urbanska EM, Meldgaard P, Hjorth-Hansen P, Kristiansen C, Stelmach M, Santoni-Rugiu E, Ulhøi MP, Dydensborg AB, Dünweber C, Andersen JL. Clinical outcomes of ALK+ non-small cell lung cancer in Denmark. Acta Oncol 2023; 62:1775-1783. [PMID: 37815923 DOI: 10.1080/0284186x.2023.2263153] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Real-world clinical outcomes of anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer (NSCLC) patients vary. This study aimed to investigate the treatment and clinical outcomes of all ALK+ NSCLC patients in Denmark in the period 2011-2018, regardless of disease stage. MATERIALS AND METHODS A national pathology database with complete coverage was used to identify ALK+ NSCLC patients diagnosed between 2011 and 2018. Clinical data were obtained through retrospective chart reviews. Overall survival (OS) and duration of treatment (DOT) were analyzed using Kaplan-Meier methodologies. RESULTS A total of 209 ALK+ NSCLC patients were included. The cohort had a slight overrepresentation of female patients (56.5%) with a mean age of 61.6 years. Most patients were adenocarcinoma cases (97%) and presented with an ECOG performance status of 0-1 (79%). Stage IIIb-IVb patients comprised 70% of the cohort. The use of ALK-tyrosine kinase inhibitors (TKIs) as first-line treatment increased over time, with the 1st generation ALK-TKI crizotinib being the predominant treatment in the 1st line. In 1st line treatment, 2nd generation ALK-TKIs had a median DOT more than twice the median DOT of crizotinib (25.1 and 9.1 months, respectively). The median OS for the entire cohort was 44.0 months. Patients with stage I-IIIA disease had a median OS that had not been reached, while those with stage IIIb-IVb disease had a median OS of 31.8 months. Patients with stage IIIb-IVb disease receiving an ALK-TKI as 1st line treatment had a median OS of 42.5 months with immature follow-up. Brain metastases at diagnosis or choice of 1st line treatment did not statistically significantly impact OS. CONCLUSION This study gives insights into the treatment and outcome of ALK+ NSCLC patients in Denmark and provides a real-world confirmation of the superior disease control provided by 2nd generation ALK-TKIs as compared to the 1st generation ALK-TKI crizotinib.
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Affiliation(s)
| | | | - Edyta Maria Urbanska
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Eric Santoni-Rugiu
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Rades D, Staackmann C, Lomidze D, Jankarashvili N, Lopez F, Navarro A, Segedin B, Groselj B, Kristiansen C, Dennis K, Schild SE, Fernandez JC. Radiotherapy for Metastatic Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S74. [PMID: 37784567 DOI: 10.1016/j.ijrobp.2023.06.386] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To investigate the outcomes of precision-radiotherapy (RT) with 15 × 2.633 Gy (EQD2 = 41.6 Gy for tumor cell kill, α/β = 10 Gy) or 18 × 2.333 Gy (EQD2 = 43.2 Gy) in patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses (>35 points on a validated survival score). In addition, these patients were compared to a historical control group of patients with favorable prognoses treated with 10 × 3 Gy (EQD2 = 32.5 Gy). MATERIALS/METHODS In a multi-center phase 2 study (RAMSES-01), patients with MSCC and favorable survival prognoses receiving 15 × 2.633 Gy or 18 × 2.333 Gy of precision-RT alone (no upfront surgery) were mainly evaluated for local progression-free survival (LPFS), defined as no deterioration of motor function during RT and no in-field recurrence of MSCC following RT, at 12 months (primary endpoint). Secondary endpoints included improvement of motor and sensory functions, post-RT ambulatory status, relief of pain and distress, toxicity, and survival (OS). The maximum relative doses allowed to the spinal cord were 101.5 % of the prescribed dose for 18 × 2.333 Gy and 101.2% for 15 × 2.633 Gy, respectively (both representing an EQD2 of 46.6 Gy for myelopathy, α/β = 2 Gy). In addition, the RAMSES-cohort was compared to a historical control group (N = 266) irradiated with 10 × 3 Gy (propensity score adjusted Cox regression). RESULTS In the RAMSES-cohort, 50 (of 62 planned) patients were evaluable for LPFS and included in the analyses. Since OS was worse than expected, a new survival score was developed, which was more precise in predicting OS than a previous tool. As a consequence, the RAMSES-trial, which was based on the previous score, was terminated. In the 50 patients included so far, 12-month rates of LPFS and OS were 97.6% and 69.9%, respectively. Improvement of motor function occurred in 28 patients (56.0%), and 47 patients (94.0%) were ambulatory following RT. Within 3 months following RT, 12 of 21 patients (57.2%) with pre-RT sensory deficits improved, 38 of 45 patients (84.4%) with pre-RT pain experienced at least partial relief, and 39 of 50 patients (78.0%) reported relief of distress. Ten of 50 patients (20.0%) experienced grade 2 toxicities (mainly esophagitis/dysphagia) and another two patients (4.0%) grade 3 toxicities (1 diarrhea, 1 esophagitis). After propensity score adjustment, the RAMSES-cohort showed significantly better LPFS than the control group (hazard ratio = 0.125, 95% confidence interval = 0.016 - 0.962, p = 0.046) and a strong trend regarding improvement of motor function (hazard ratio = 1.943, 95% confidence interval = 0.981 - 3.850, p = 0.057). Post-RT ambulatory rates (p = 0.56) and OS rates (p = 0.62) were not significantly different. CONCLUSION Precision-RT with 15 × 2.633 Gy or 18 × 2.333 Gy was sufficiently well tolerated and resulted in significantly better long-term LPFS than 10 × 3 Gy in patients with MSCC and favorable survival prognoses. Thus, the dose-fractionation regimens of the RAMSES-01 trial appear preferable for these patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - C Staackmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Lomidze
- Radiation Oncology Department, Tbilisi State Medical University and Ingorokva High Medical Technology University Clinic, Tbilisi, Georgia
| | - N Jankarashvili
- Department of Radiation Oncology, Acad. F. Todua Medical Center - Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - F Lopez
- Department of Radiation Oncology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Navarro
- Department of Radiation Oncology, Instituto Catalán de Oncología, Barcelona, Spain
| | - B Segedin
- Department of Radiotherapy and Faculty of Medicine, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - B Groselj
- Department of Radiotherapy, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - C Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Veijle, Denmark
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, ON, Canada
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - J Cacicedo Fernandez
- Department of Radiation Oncology, Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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7
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Rimer H, Jensen MS, Dahlsgaard-Wallenius SE, Eckhoff L, Thye-Rønn P, Kristiansen C, Hildebrandt MG, Gerke O. 2-[18F]FDG-PET/CT in Cancer of Unknown Primary Tumor-A Retrospective Register-Based Cohort Study. J Imaging 2023; 9:178. [PMID: 37754942 PMCID: PMC10532746 DOI: 10.3390/jimaging9090178] [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] [Received: 06/28/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
We investigated the impact of 2-[18F]FDG-PET/CT on detection rate (DR) of the primary tumor and survival in patients with suspected cancer of unknown primary tumor (CUP), comparing it to the conventional diagnostic imaging method, CT. Patients who received a tentative CUP diagnosis at Odense University Hospital from 2014-2017 were included. Patients receiving a 2-[18F]FDG-PET/CT were assigned to the 2-[18F]FDG-PET/CT group and patients receiving a CT only to the CT group. DR was calculated as the proportion of true positive findings of 2-[18F]FDG-PET/CT and CT scans, separately, using biopsy of the primary tumor, autopsy, or clinical decision as reference standard. Survival analyses included Kaplan-Meier estimates and Cox proportional hazards regression adjusted for age, sex, treatment, and propensity score. We included 193 patients. Of these, 159 were in the 2-[18F]FDG-PET/CT group and 34 were in the CT group. DR was 36.5% in the 2-[18F]FDG-PET/CT group and 17.6% in the CT group, respectively (p = 0.012). Median survival was 7.4 (95% CI 0.4-98.7) months in the 2-[18F]FDG-PET/CT group and 3.8 (95% CI 0.2-98.1) in the CT group. Survival analysis showed a crude hazard ratio of 0.63 (p = 0.024) and an adjusted hazard ratio of 0.68 (p = 0.087) for the 2-[18F]FDG-PET/CT group compared with CT. This study found a significantly higher DR of the primary tumor in suspected CUP patients using 2-[18F]FDG-PET/CT compared with patients receiving only CT, with possible immense clinical importance. No significant difference in survival was found, although a possible tendency towards longer survival in the 2-[18F]FDG-PET/CT group was observed.
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Affiliation(s)
- Heidi Rimer
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Melina Sofie Jensen
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | | | - Lise Eckhoff
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark
| | - Peter Thye-Rønn
- Department of Medicine, Center of Diagnostics, Odense University Hospital, Svendborg Hospital, 5700 Svendborg, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, University Hospital of Southern Denmark, Lillebælt Hospital, 7100 Vejle, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, 5000 Odense, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
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8
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Bjørnhart B, Mouritzen MT, Kristiansen C, Schytte T, Wedervang K, Pøhl M, Holmskov Hansen K. 5-Year survival in Danish patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy. Acta Oncol 2023; 62:861-870. [PMID: 37534770 DOI: 10.1080/0284186x.2023.2238544] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Convincing results from randomized controlled trials (RCTs) have led to increasing use of immune checkpoint inhibitors (ICI) as part of standard therapies in real-world (RW) scenarios. However, RW patients differ clinically from RCT populations and might have reduced long-term survival. Currently, only sparse data on 3-5-year survival rate for RW patients with advanced non-small cell lung cancer (NSCLC) treated with ICI exist. MATERIALS AND METHODS A multicenter study was performed including 729 patients with advanced NSCLC receiving monotherapy with ICI (retrospective data (n = 566) and prospective data (n = 163)). Detailed baseline clinical characteristics, programmed death-ligand 1 (PD-L1) tumor proportion score (TPS), and baseline haematological count were registered. Kaplan-Meier estimates and log-rank test were used for survival analyses, Cox regression for determination of prognostic factors. RESULTS Median time of follow-up (FU) was 48.7 months (IQR 37.2-54.3). Median overall survival (OS) in first line treatment was 20.4 months (IQR 8.5-45.0) compared to 11.4 months (IQR 4.6-27.1) in ≥2nd line (HR 1.48, 95% CI 1.25-1.75). Estimated probability of OS was 30% at 3 years, 23% at 4 years, and 13% at 5 years in first line compared to 17, 13, and 11% in ≥2nd line, respectively. For those with performance status (PS) 2, the 2-year OS rate was 32% (95% CI 0.22-0.43) compared to 5% (95% CI 0.01-0.15) in patients with PD-L1 ≥ 50% versus <50%, respectively. CONCLUSIONS Compared to RCTs, long-term OS and PFS rates are lower in real-world patients treated with ICI in first line but much improved compared to historic rates on chemotherapy. A promising flattening of both the OS and progression free survival curves illustrates that also a subset of real-world patients obtain long-term remission. Patients with PS 2 and PD-L1 ≥ 50% may obtain clinically meaningful 2-year PFS and OS rates.
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Affiliation(s)
- Birgitte Bjørnhart
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Mette Thune Mouritzen
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg East, Denmark
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Kim Wedervang
- Department of Oncology, Hospital Soenderjylland Soenderborg, Soenderborg, Denmark
| | - Mette Pøhl
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Karin Holmskov Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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9
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Olloni A, Brink C, Lorenzen EL, Jeppesen SS, Hoffmann L, Kristiansen C, Knap MM, Møller DS, Nygård L, Persson GF, Thing RS, Sand HM, Diederichsen A, Schytte T. Does coronary artery calcium score have an impact on overall survival for locally advanced non-small cell lung cancer treated with definitive radiotherapy. Radiother Oncol 2023; 185:109719. [PMID: 37257588 DOI: 10.1016/j.radonc.2023.109719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/17/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND PURPOSE Coronary artery calcium score (CACs) is an excellent marker for survival in non-cancer patients, but its role in locally advanced non-small cell lung cancer (LA-NSCLC) patients remains uncertain. In this study, we hypothesize that CACs is a prognostic marker for survival in a competing risk analysis in LA-NSCLC patients treated with definitive radiotherapy. MATERIALS AND METHODS We included 644 patients with LA-NSCLC treated in 2014-2015 in Denmark. Baseline patient characteristics were derived from the Danish Lung Cancer Registry. Radiotherapy planning CT scans were used for manual CACs measurements, and the patients were divided into four groups, CACs 0, 1-99, 100-399, and ≥400. A multivariable Cox model utilizing bootstrapping for cross-validation modeled overall survival (OS). RESULTS The median follow-up time was seven years, and the median OS was 26 months (95% CI 24-29). Within each CAC group 0, 1-99, 100-399, and ≥400 were 172, 182, 143, and 147 patients, respectively. In the univariable analysis, the survival decreased with increasing CACs. However, after adjustment for age, PS, radiotherapy dose, and logarithmic GTV, CACs did not have a statistically significant impact on OS with hazard ratios of 1.04 (95% CI 0.85-1.28), 1.11 (95%CI 0.89-1.43), and 1.16 (95%CI 0.92-1.47) for CACs 1-99, CACs 100-399 and ≥400, respectively. Elevated CACs was observed in 73 % of the patients suggesting a high risk of cardiac comorbidity before radiotherapy. CONCLUSION CACs did not add prognostic information to our population's classical risk factors, such as tumor volume, performance status, and age; the lung cancer has the highest priority despite the risk of baseline cardiac comorbidity.
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Affiliation(s)
- Agon Olloni
- Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000 Odense C, Denmark.
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark.
| | - Ebbe L Lorenzen
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark.
| | - Stefan S Jeppesen
- Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000 Odense C, Denmark
| | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, 8200 Aarhus N, Denmark.
| | - Charlotte Kristiansen
- Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark.
| | - Marianne M Knap
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Ditte S Møller
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Lotte Nygård
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, 2100 København Ø, Denmark.
| | - Gitte F Persson
- Department of Oncology, Copenhagen University Hospital, , 2730 Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, 2730 Herlev, Denmark.
| | - Rune S Thing
- Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark.
| | - Hella Mb Sand
- Department of Medical Physics, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Axel Diederichsen
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Department of Cardiology, Odense University Hospital, 5000 Odense C, Denmark.
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
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10
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Rades D, Kristiansen C, Schild SE, Janssen S. Short Communication: Results of a Consensus Conference on Radiotherapy for Brain and Bone Metastases Within the Interreg-Project TreaT. In Vivo 2023; 37:894-897. [PMID: 36881061 PMCID: PMC10026661 DOI: 10.21873/invivo.13158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Differences between radiotherapy for metastases in Northern Germany and Southern Denmark were previously identified, which led to a consensus conference. PATIENTS AND METHODS A consensus conference was held between three centers to harmonize radiotherapy regimens for bone and brain metastases. RESULTS Centers agreed on 1×8 Gy for painful bone metastases in patients with poor or intermediate survival prognoses and 10×3 Gy for favorable-prognosis patients. For complicated bone metastases, 5-6×4 Gy was preferred for poor-prognosis, 10×3 Gy for intermediate-prognosis, and longer-course radiotherapy for favorable-prognosis patients. For ≥5 brain metastases, centers agreed on whole-brain irradiation (WBI) with 5×4 Gy in poor-prognosis and longer-course regimens in other patients. For single brain lesions and patients with 2-4 lesions and intermediate/favorable prognoses, fractionated stereotactic radiotherapy (FSRT) or radiosurgery were recommended. No consensus was reached for 2-4 lesions in poor-prognosis patients; two centers preferred FSRT, one center WBI. Preferred radiotherapy regimens were similar for different age groups including elderly and very elderly patients, but age-specific survival scores were recommended. CONCLUSION The consensus conference was successful, since harmonization of radiotherapy regimens was achieved for 32 of 33 possible situations.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
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11
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Rades D, Delikanli C, Schild SE, Kristiansen C, Tvilsted S, Janssen S. Comparison of Three Survival Scores in a Series of Patients ≥80 Years of Age Irradiated for Bone Metastases. Anticancer Res 2023; 43:801-807. [PMID: 36697108 DOI: 10.21873/anticanres.16221] [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] [Received: 12/21/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM Very elderly patients irradiated for bone metastases likely benefit from individualized treatments. A specific survival score was created for this group and compared to existing instruments. PATIENTS AND METHODS Ninety-six patients aged 80+ irradiated for bone metastases were retrospectively evaluated. Dose-fractionation regimen plus twelve characteristics were evaluated for survival. RESULTS In the Cox regression model, performance status and tumor type were significant and used for the score, which included three groups (5-7, 8-12, and 14 points) with 6-month survival rates of 15%, 52%, and 90%. Positive predictive values (PPVs) regarding death ≤6 months were 85% (new score), 100% (previous 65+ score), and 84% (previous score for any age). The new instrument and the 65+ score were also very accurate regarding survival. Since PPV regarding death was calculated from only four patients for the 65+ score, this PPV may be less conclusive than that for the new instrument. CONCLUSION The new score appears useful for patients aged 80+ irradiated for bone metastases.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Odense, Denmark
| | - Soren Tvilsted
- Research Department, Zealand University Hospital, Køge, Denmark
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.,Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
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12
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Bjørnhart B, Kristiansen C, Asmussen J, Hansen KH, Wedervang K, Jørgensen TL, Herrstedt J, Schytte T. Clinical impact of venous thromboembolism in non-small cell lung cancer patients receiving immunotherapy. Thromb Res 2023; 221:164-172. [PMID: 36396518 DOI: 10.1016/j.thromres.2022.10.020] [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] [Received: 08/02/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prospective investigation on cancer-associated venous thromboembolism (VTE) in non-small cell lung cancer (NSCLC) during treatment with immune checkpoint inhibitors (ICIs) is lacking. PATIENTS AND METHODS A prospective real-world study using combined computed tomography venography and pulmonary angiography (CTVPA) to screen patients with NSCLC for VTE (cohort A). A retrospective multicenter cohort without additional screening with CTVPA was included as control (cohort B). A model with VTE as a time-dependent event using competing risk analysis model with death as a competing event was used to evaluate outcomes and differences in cumulative VTE incidences. RESULTS Cohort A (n = 146) and cohort B (n = 426) had median follow-up for VTE of 16.5 months (IQR 6.7-35.6). Cumulative VTE events at 1, 3, 6, and 12 months were 7.5 %, 9.6 %, 13.0 %, 14.4 % for cohort A and 1.9 %, 3.8 %, 4.9 %, 5.6 % for cohort B with SHR 2.42 (CI 95 % 1.37-4.27) p = 0.0024. Recurrent VTE comprised 52 % and 37 %, respectively. In multivariate overall survival analysis, VTE was significantly associated with impaired OS (HR 2.12 CI 95 % [1.49-3.03], p < 0.0001). Risk factors for VTE comprised prior VTE and ICI administered in first line. CONCLUSION Cumulative VTE incidence in NSCLC patients following palliative ICI may be significantly higher than reported in randomised clinical trials and retrospective real-world reports. VTE development during ICI impair OS significantly. Thus, more focus on VTE during ICI is warranted to optimise both prevention and management of VTE. Whether there is a causal relationship between VTE and ICI remains to be explored.
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Affiliation(s)
- Birgitte Bjørnhart
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, J.B.Winsløws Vej 9a, 5000 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
| | | | - Jon Asmussen
- Department of Radiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Karin Holmskov Hansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, J.B.Winsløws Vej 9a, 5000 Odense, Denmark
| | - Kim Wedervang
- Department of Oncology, Hospital Soenderjylland, Sydvang 1, 6400 Soenderborg, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Jørn Herrstedt
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
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13
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Rades D, Al-Salool A, Cremers F, Staackmann C, Cacicedo J, Lomidze D, Segedin B, Groselj B, Jankarashvili N, Moreno AC, Ciervide R, Kristiansen C, Schild S. A New Scoring Tool to Estimate Post-Treatment Ambulatory Status after Radiotherapy of Metastatic Spinal Cord Compression. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.872] [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: 10/31/2022]
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14
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Rades D, Delikanli C, Schild SE, Kristiansen C, Tvilsted S, Janssen S. The First Survival Score for Patients Aged ≥80 Years Irradiated for Brain Metastases. Biology (Basel) 2022; 11:biology11101434. [PMID: 36290338 PMCID: PMC9598105 DOI: 10.3390/biology11101434] [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] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Survival scores facilitate personalized cancer treatment. Due to demographic changes, very elderly patients are more prevalent than in the past. A score was developed in 94 patients aged ≥ 80 years undergoing whole-brain radiotherapy for brain metastases. Dose fractionation, treatment period, age, sex, performance score (ECOG-PS), tumor type, count of lesions, metastases outside the brain, and interval tumor diagnosis to radiotherapy were retrospectively evaluated. Independent predictors of survival were used for the score. Based on individual scoring points obtained from 3-month survival rates, prognostic groups were designed. Additionally, the score was compared to an existing tool developed in patients ≥ 65 years. ECOG-PS, count of lesions, and extra-cranial metastases were independent prognostic factors. Three groups were created (7, 10, and 13−16 points) with 3-month survival of 6%, 25%, and 67% (p < 0.001), respectively. Positive predictive values (PPVs) regarding death ≤ 3 and survival ≥ 3 months were 94% and 67% (new score) vs. 96% and 48% (existing tool), respectively. PPVs for survival ≥1 and ≥2 months were 88% and 79% vs. 63% and 58%, respectively. Both tools were accurate in predicting death ≤2, ≤3, and ≤6 months. The new score was more precise regarding death ≤1 month and survival (all time periods) and appeared preferable. However, it still needs to be validated.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Correspondence: ; Tel.: +49-451-500-45401
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
| | - Søren Tvilsted
- Research Department, Zealand University Hospital, 4600 Køge, Denmark
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, 30161 Hannover, Germany
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15
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Rades D, Delikanli C, Schild SE, Kristiansen C, Tvilsted S, Janssen S. A New Survival Score for Patients ≥65 Years Assigned to Radiotherapy of Bone Metastases. Cancers (Basel) 2022; 14:cancers14194679. [PMID: 36230602 PMCID: PMC9563043 DOI: 10.3390/cancers14194679] [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: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Survival scores are important for personalized treatment of bone metastases. Elderly patients are considered a separate group. Therefore, a specific score was developed for these patients. Elderly patients (≥65 years) irradiated for bone metastases were randomly assigned to the test (n = 174) or validation (n = 174) cohorts. Thirteen factors were retrospectively analyzed for survival. Factors showing significance (p < 0.05) or a trend (p < 0.06) in the multivariate analysis were used for the score. Based on 6-month survival rates, prognostic groups were formed. The score was compared to an existing tool developed in patients of any age. In the multivariate analysis, performance score, tumor type, and visceral metastases showed significance and gender was a trend. Three groups were designed (17, 18−25 and 27−28 points) with 6-month survival rates of 0%, 51%, and 100%. In the validation cohort, these rates were 9%, 55%, and 86%. Comparisons of prognostic groups between both cohorts did not reveal significant differences. In the test cohort, positive predictive values regarding death ≤6 and survival ≥6 months were 100% with the new score vs. 80% and 88% with the existing tool. The new score was more accurate demonstrating the importance of specific scores for elderly patients.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Correspondence: ; Tel.: +49-451-500-45400
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
| | - Søren Tvilsted
- Research Department, Zealand University Hospital, 4600 Køge, Denmark
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, 30161 Hannover, Germany
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Bjornhart B, Mouritzen M, Kristiansen C, Holmskov K, Wedervang K, Jorgensen T, Herrstedt J, Pohl M, Schytte T. 1114P Long-term outcome in Danish real-life patients with advanced non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1239] [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: 11/26/2022] Open
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17
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Rades D, Al-Salool A, Staackmann C, Cremers F, Cacicedo J, Lomidze D, Segedin B, Groselj B, Jankarashvili N, Conde-Moreno AJ, Ciervide R, Kristiansen C, Schild SE. A New Clinical Instrument for Estimating the Ambulatory Status after Irradiation for Malignant Spinal Cord Compression. Cancers (Basel) 2022; 14:cancers14153827. [PMID: 35954490 PMCID: PMC9367288 DOI: 10.3390/cancers14153827] [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: 06/13/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Since 2005, upfront surgery has been increasingly used in addition to radiotherapy for patients with malignant spinal cord compression (MSCC). As spinal surgery includes significant risks, careful patient selection is crucial. Individual risks and benefits should be considered when choosing an optimal treatment strategy. Benefits include preserving or regaining a patient’s ambulatory function. To facilitate the decision pro or contra upfront surgery, a new prognostic score was developed to predict ambulatory status after radiotherapy alone. This clinical score was created from data of patients previously treated in prospective trials. It includes three prognostic groups (17–21, 22–31, and 32–37 points) with post-radiotherapy ambulatory rates of 10%, 65%, and 97%, respectively. Patients of the 32–37 points group may not require upfront surgery. The new instrument achieved very high accuracy in predicting post-radiotherapy ambulatory and non-ambulatory status and was more precise than a previous prognostic score in predicting non-ambulatory status. Abstract Estimating post-treatment ambulatory status can improve treatment personalization of patients irradiated for malignant spinal cord compression (MSCC). A new clinical score was developed from data of 283 patients treated with radiotherapy alone in prospective trials. Radiotherapy regimen, age, gender, tumor type, interval from tumor diagnosis to MSCC, number of affected vertebrae, other bone metastases, visceral metastases, time developing motor deficits, ambulatory status, performance score, sensory deficits, and sphincter dysfunction were evaluated. For factors with prognostic relevance in the multivariable logistic regression model after backward stepwise variable selection, scoring points were calculated (post-radiotherapy ambulatory rate in % divided by 10) and added for each patient. Four factors (primary tumor type, sensory deficits, sphincter dysfunction, ambulatory status) were used for the instrument that includes three prognostic groups (17–21, 22–31, and 32–37 points). Post-radiotherapy ambulatory rates were 10%, 65%, and 97%, respectively, and 2-year local control rates were 100%, 75%, and 88%, respectively. Positive predictive values to predict ambulatory and non-ambulatory status were 97% and 90% using the new score, and 98% and 79% using the previous instrument. The new score appeared more precise in predicting non-ambulatory status. Since patients with 32–37 points had high post-radiotherapy ambulatory and local control rates, they may not require surgery.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Correspondence: ; Tel.: +49-451-500-45400
| | - Ahmed Al-Salool
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | | | - Florian Cremers
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Jon Cacicedo
- Department of Radiation Oncology, Cruces University Hospital/Biocruces Health Research Institute, 48903 Barakaldo, Spain
| | - Darejan Lomidze
- Radiation Oncology Department, Tbilisi State Medical University and Ingorokva High Medical Technology University Clinic, Tbilisi 0177, Georgia
| | - Barbara Segedin
- Department of Radiotherapy, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Blaz Groselj
- Department of Radiotherapy, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Natalia Jankarashvili
- Department of Radiation Oncology, Acad. F. Todua Medical Center—Research Institute of Clinical Medicine, Tbilisi 0112, Georgia
| | - Antonio J. Conde-Moreno
- Department of Radiation Oncology, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
| | - Raquel Ciervide
- Department of Radiation Oncology, University Hospital HM Hospitales, Sanchinarro, 28050 Madrid, Spain
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
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Olloni A, Hansen O, Kristiansen C, Edvardsson L, Nielsen M, Jeppesen S, Schytte T. PO-1140 Survival after stereotactic radiosurgery for brain metastases – A single-institution experience. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03104-8] [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: 11/25/2022]
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Fink T, Kristiansen C, Thing R, Hansen T, Hansen T. PD-0084 Development of a patient decision aid regarding SBRT radiation dose to peripheral tumors in the lung. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02754-2] [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: 11/30/2022]
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Hoffmann L, Persson G, Nygård L, Nielsen T, Borrisova S, Gaard-Petersen F, Josipovic M, Khalil A, Kjeldsen R, Knap M, Kristiansen C, Møller D, Ottosson W, Sand H, Thing R, Pøhl M, Schytte T. Thorough design and pre-trial quality assurance (QA) decrease dosimetric impact of delineation and dose planning variability in the STRICTLUNG and STARLUNG trials for stereotactic body radiotherapy (SBRT) of central and ultra-central lung tumours. Radiother Oncol 2022; 171:53-61. [DOI: 10.1016/j.radonc.2022.04.005] [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] [Received: 07/01/2021] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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Mouritzen MT, Junker KF, Carus A, Ladekarl M, Meldgaard P, Nielsen AWM, Livbjerg A, Larsen JW, Skuladottir H, Kristiansen C, Wedervang K, Schytte T, Hansen KH, Østby AC, Frank MS, Lauritsen J, Sørensen JB, Langer SW, Persson GF, Andersen JL, Homann PH, Kristensen EB, Drivsholm LB, Bøgsted M, Christensen HS, Pøhl M, Bjørnhart B. Clinical features affecting efficacy of immune checkpoint inhibitors in pretreated patients with advanced NSCLC: a Danish nationwide real-world study. Acta Oncol 2022; 61:409-416. [PMID: 35012430 DOI: 10.1080/0284186x.2021.2023213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/26/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are implemented as standard treatment for patients with advanced non-small cell lung cancer (NSCLC) in first-line and subsequent-line treatment. However, certain subgroups such as patients with older age, poor performance status (PS), and severe comorbidity are underrepresented in the randomized controlled trials (RCTs). This study aimed to assess overall survival (OS), treatment data, and clinical features affecting second- or subsequent-line ICI efficacy in an unselected, Danish, nationwide NSCLC population. METHODS Patients with advanced NSCLC who started nivolumab or pembrolizumab as second-line or subsequent-line treatment between 1 September 2015, and 1 October 2018, were identified from institutional records of all Danish oncology departments. Clinical and treatment data were retrospectively collected. Descriptive statistics and survival analyses were performed. RESULTS Data were available for 840 patients; 49% females. The median age was 68 years (19% were ≥75 years), 19% had PS ≥2, and 36% had moderate to severe comorbidity. The median OS (mOS) was 12.2 months; 15.1 months and 10.0 months in females and males, respectively. The median time-to-treatment discontinuation (mTTD) and median progression-free survival (mPFS) was 3.2 and 5.2 months, respectively. Patients with PS ≥2 had a mOS of 4.5 months, mTTD of 1.1 month, and mPFS of 2.0 months. In multivariable Cox regression analysis, male sex (HR = 1.35, 95% CI 1.11-1.62), PS >0 (PS 1, HR = 1.88, 95% CI 1.52-2.33; PS ≥2, HR = 4.15, 95% CI 3.13-5.5), liver metastases (HR = 1.72, 95% CI 1.34-2.22), and bone metastases (HR = 1.27, 95% CI 1.03-1.58) were significant poor prognostic OS factors. CONCLUSIONS Danish real-world patients with advanced NSCLC treated with second- or subsequent-line ICI had an OS comparable to results from RCTs. Women, frail and older patients constituted a higher proportion than in previous RCTs. Clinical features associated with poor OS were male sex, PS ≥1 (in particular PS ≥2), bone-, and liver metastases.
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Affiliation(s)
- Mette T. Mouritzen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Andreas Carus
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Morten Ladekarl
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Anna Livbjerg
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jacob W. Larsen
- Department of Oncology, Region Hospital West Jutland, Herning, Denmark
| | - Halla Skuladottir
- Department of Oncology, Region Hospital West Jutland, Herning, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Kim Wedervang
- Department of Oncology, Hospital Sønderjylland, Sønderborg, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense, Denmark
| | - Karin H. Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense, Denmark
| | - Anne-Cathrine Østby
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Malene S. Frank
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Jakob Lauritsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Jens B. Sørensen
- Department of Oncology, Copenhagen E, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Seppo W. Langer
- Department of Oncology, Copenhagen E, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Gitte F. Persson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
- Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - Jon L. Andersen
- Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | | | | | | | - Martin Bøgsted
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Heidi S. Christensen
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Pøhl
- Department of Oncology, Copenhagen E, Denmark
| | - Birgitte Bjørnhart
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense, Denmark
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Bjoernhart B, Kristiansen C, Hansen K, Wedervang K, Nyhus C, Jørgensen T, Herrstedt J, Schytte T. 54P Impact of comorbidity and venous thromboembolism on outcome in real-life non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibition (ICI). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.541] [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: 10/22/2022] Open
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Mouritzen M, Bjoernhart B, Poehl M, Ladekarl M, Vesteghem C, Boegsted M, Nielsen AM, Meldgaard P, Hansen K, Larsen J, Kristiansen C, Wedervang K, Bareid-Oestby AC, Frank M, Persson G, Kristensen E, Homann P, Carus A. 1334P Real word experience with first-line immunotherapy in advanced non-small cell lung cancer patients in a Danish nationwide cohort. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1648] [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] Open
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Nielsen M, Kristiansen C, Schytte T, Hansen O. Initial experiences with hippocampus-sparing whole-brain radiotherapy for lung cancer patients. Acta Oncol 2019; 58:1540-1542. [PMID: 31303085 DOI: 10.1080/0284186x.2019.1632479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - C. Kristiansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - T. Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - O. Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hansen O, Kristiansen C, Nielsen M, Schytte T, Starup Jeppesen S. Survival after stereotactic radiotherapy in patients with early-stage non-small cell lung cancer. Acta Oncol 2019; 58:1399-1403. [PMID: 31271094 DOI: 10.1080/0284186x.2019.1631476] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Stereotactic radiotherapy (SBRT) is the treatment of choice for inoperable early stage non-small cell lung cancer (NSCLC). We report analyses of the influence of age on survival after SBRT. Methods and material: From 2005 to 2017, 544 previously un-irradiated patients with early stage NSCLC had SBRT. The data were analyzed in four age groups: A: -69 (176 pts), B: 70-74 (115 pts), C: 75-79 (131 pts) and D: 80 years or older (122 pts). Two SBRT dose regimes were used: 45 Gy/3F (N = 103) and 66 Gy/3F (N = 441). Results: All patients had a follow up (time to censoring, FU) of at least 16 months, the median FU being 48.0 months. The median age was 74.4 years. The overall survival (OS) was associated with age. The median OS was 50.7, 45.9, 45.4 and 33.0 months, and the 5-year OS was 45%, 32%, 33% and 18% in groups A, B, C and D, respectively. No difference was found between groups B and C, while OS in group A was significantly better than remaining groups, and the OS in group D significantly poorer. In multivariable analyses, OS was heavily influenced by age, Charlson's comorbidity index (CCI) and performance status (PS). For lung cancer-specific survival (LCSS), only increasing tumor diameter and PS were associated with poor survival. Conclusions: The OS was influenced by age, but the study suggests that a cut point of 75 year is inappropriate in evaluating the effect of old age on survival. Poor PS was associated with poor OS. CCI influenced OS, but not LCSS, which was only affected by PS and tumor size.
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Affiliation(s)
- Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Morten Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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Jelin M, Kristiansen C, Jeppesen S, Nielsen M, Hansen O. EP-1361 Survival after two schedules of SBRT to centrally located lung tumors. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31781-5] [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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Olesrud IC, Schulz MK, Marcovic L, Kristensen BW, Pedersen CB, Kristiansen C, Poulsen FR. Early postoperative MRI after resection of brain metastases-complete tumour resection associated with prolonged survival. Acta Neurochir (Wien) 2019; 161:555-565. [PMID: 30756241 DOI: 10.1007/s00701-019-03829-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 07/12/2018] [Accepted: 01/31/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study aimed to investigate the incidence of residual tumour after resection of brain metastases using early postoperative magnetic resonance imaging (MRI) and the influence of residual tumour on overall patient survival. METHODS Data from 72 consecutive adult patients undergoing surgery for cerebral metastases over an 18-month study period were retrospectively collected. Early postoperative MRI was used to determine the presence of postoperative residual tumour. Patients were divided into three groups according to the presence of tumour remnant on early postoperative MRI: "no residual tumour", "non-measurable residual tumour" and "measurable residual tumour". Survival analysis (mean estimate survival time) was performed using the Kaplan-Meier and log-rank (mantel cox) tests and compared between groups. Surgical reports were evaluated with regard to the surgeon statement about intraoperative extent of resection (EOR) and compared with the presence of tumour remnant found on the early postoperative MRI. RESULTS Sixty-eight procedures were followed by early postoperative MRI. MRI verified the presence of "measurable residual tumour" following 15 procedures (22%). MRI confirmed complete resection in 57%. Gross total resection was described by the operating surgeon in 85% of the procedures. There was a significant difference in survival time after surgery between the group having no residual tumour on MRI and the group with measurable residual tumour (p = 0.025). This difference could not be explained by the differences in postoperative radiation therapy. The longest survival was found in patients with non-measurable and no residual tumour on early postoperative MRI, who also received postoperative radiotherapy. CONCLUSION Residual tumour was seen on MRI after 22% of the procedures. The intraoperative assessment of EOR performed by the surgeon diverged from the early postoperative MRI in 40% of procedures. Correct assessment of residual tumour thus requires early postoperative MRI. Measurable residual tumour on early postoperative MRI was associated with shorter overall survival independent on postoperative radiotherapy.
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Affiliation(s)
- Ida Christine Olesrud
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
| | - Mette Katrine Schulz
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
| | - Ljubo Marcovic
- Department of Neuroradiology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Bjarne Winther Kristensen
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Christian Bonde Pedersen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
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Jeppesen SS, Matzen LE, Brink C, Bliucukiene R, Kasch S, Schytte T, Kristiansen C, Hansen O. Impact of comprehensive geriatric assessment on quality of life, overall survival, and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy. J Geriatr Oncol 2018; 9:575-582. [DOI: 10.1016/j.jgo.2018.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/31/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
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Hansen O, Kristiansen C, Jeppesen S, Nielsen T, Schytte T, Nielsen M. EP-1374: SBRT for new lesions after surgery or curative intended radiotherapy in patients with NSCLC. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31683-9] [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: 10/14/2022]
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Hansen O, Kristiansen C, Jeppesen S, Nielsen T, Schytte T, Nielsen M. OA 01.02 Stereotactic Radiotherapy as Salvage Treatment After Surgery and Curative Intended Radiotherapy for Patients with NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.323] [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: 11/29/2022]
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Ejlsmark MW, Kristiansen C, Eriksen JG, Hansen O, Bastholt L. Recall radiation myelitis after stereotactic radiation and dabrafenib in metastatic melanoma. Acta Oncol 2017; 56:109-110. [PMID: 27830981 DOI: 10.1080/0284186x.2016.1246802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense C, Denmark
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Kristiansen C, Jeppesen S, Nielsen M, Nielsen T, Schytte T, Hansen O. EP-1239: Clinical outcome of SBRT of central, apical or paracostal tumors in the lung, a retrospective study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32489-6] [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: 10/21/2022]
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Abstract
BACKGROUND Lung cancer is an increasing problem in the older patient population due to the improvement in life expectation of the Western population. In this study we examine trends in lung cancer incidence and mortality in Denmark from 1980 to 2012 with special focus on the elderly. MATERIAL AND METHODS Lung cancer was defined as ICD-10 codes C33-34. Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence, and relative survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS In 2012, about 50% of lung cancers were diagnosed among persons aged 70 years or more. For men and women older than 75 years the incidence rates have been increasing and for those aged 80-84 years, the rates have doubled since 1980. Due to the poor survival, similar trends were seen in mortality rates. Over the period, the one-year relative survival rates almost doubled in patients aged 70 years or more, but still only 25% of the patients aged 80-89 years survived their lung cancer for one year. CONCLUSION The incidence of lung cancer is closely linked to the pattern of tobacco smoking with the differences between gender and age groups reflecting smoking behavior in birth cohorts. Elderly patients with lung cancer are a heterogeneous group in whom treatment should be offered according to comorbidity and a geriatric assessment.
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Affiliation(s)
| | - Tine Schytte
- a Department of Oncology , Odense University Hospital , Odense , Denmark
| | | | - Eva Holtved
- a Department of Oncology , Odense University Hospital , Odense , Denmark
| | - Olfred Hansen
- a Department of Oncology , Odense University Hospital , Odense , Denmark
- b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
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Nielsen M, Hansen CR, Brink C, Bertelsen AS, Kristiansen C, Jeppesen SS, Hansen O. Efficient and accurate stereotactic radiotherapy using flattening filter free beams and HexaPOD robotic tables. J Radiosurg SBRT 2016; 4:153-161. [PMID: 29296440 PMCID: PMC5658877] [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] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/16/2016] [Indexed: 06/07/2023]
Abstract
Flattening filter free (FFF) high dose rate beam technique was introduced for brain stereotactic radiosurgery (SRS) and lung Stereotactic Body Radiotherapy (SBRT). Furthermore, a HexaPOD treatment table was introduced for the brain SRS to enable correction of rotational setup errors. 19 filter flattened (FF) and 57 FFF brain SRS treatments, as well as 451 FF and 294 FFF lung SBRT treatments were evaluated to assess differences in intrafractional motion (IFM) between FF and FFF treatments. For brain SRS the accuracy of rotational corrections was assessed as well. For SRS the treatment time was reduced by 21%, and for SBRT the treatment time was reduced by 25%. However, only for SBRT the IFM was significantly reduced, from 1.9 mm to 1.6 mm. For brain SRS, table correction in 6D greatly improves patient setup precision observed as a reduction in mean residual rotational setup error from 0.3° (SD1.2°) to 0.06° (SD 0.3°).
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Affiliation(s)
- Morten Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
| | - Christian R. Hansen
- Laboratory of Radiation Physics, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
| | - Carsten Brink
- Laboratory of Radiation Physics, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, 19 Winsløwparken, DK-5000 Odense C, Denmark
| | - Anders S. Bertelsen
- Laboratory of Radiation Physics, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
| | - Stefan S. Jeppesen
- Department of Clinical Research, University of Southern Denmark, 19 Winsløwparken, DK-5000 Odense C, Denmark
- Department of Oncology, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
| | - Olfred Hansen
- Department of Clinical Research, University of Southern Denmark, 19 Winsløwparken, DK-5000 Odense C, Denmark
- Department of Oncology, Odense University Hospital, 29 Sdr. Boulevard, DK-5000 Odense C, Denmark
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Hofland KF, Hansen S, Sorensen M, Engelholm S, Schultz HP, Muhic A, Grunnet K, Ask A, Costa JC, Kristiansen C, Thomsen C, Poulsen HS, Lassen U. Neoadjuvant bevacizumab and irinotecan versus bevacizumab and temozolomide followed by concomitant chemoradiotherapy in newly diagnosed glioblastoma multiforme: A randomized phase II study. Acta Oncol 2014; 53:939-44. [PMID: 24456504 DOI: 10.3109/0284186x.2013.879607] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 12/25/2022]
Abstract
BACKGROUND Surgery followed by radiotherapy and concomitant and adjuvant temozolomide is standard therapy in newly diagnosed glioblastoma multiforme (GBM). Bevacizumab combined with irinotecan produces impressive response rates in recurrent GBM. In a randomized phase II study, we investigated the efficacy of neoadjuvant bevacizumab combined with irinotecan (Bev-Iri) versus bevacizumab combined with temozolomide (Bev-Tem) before, during and after radiotherapy in newly diagnosed GBM. MATERIAL AND METHODS After surgery, patients were randomized to Bev-Iri or Bev-Tem for eight weeks, followed by standard radiotherapy (60 Gy/30 fractions) and concomitant Bev-Iri or Bev-Tem followed by adjuvant Bev-Iri or Bev-Tem for another eight weeks. Bev-Iri: Bevacizumab and irinotecan were given every 14 days before, during and after radiotherapy. Bev-Tem: Bevacizumab was given as in Bev-Iri and temozolomide was given for five days every four weeks before and after radiotherapy and once daily during radiotherapy. The primary endpoint was response after neoadjuvant chemotherapy and a pre-specified response rate of 30% or more was considered of interest for future studies. Secondary endpoints were progression-free survival (PFS) and toxicity. RESULTS The response rate was 32% (95% CI 17-51%) for Bev-Tem (n = 32) and 23% (95% CI 9-44%) for Bev-Iri (n = 31) (p = 0.56). Median PFS was 7.7 and 7.3 months for Bev-Tem and Bev-Iri, respectively. Hematological toxicity was more frequent with Bev-Tem including one death from febrile neutropenia whereas non-hematological toxicity was manageable. CONCLUSIONS Only the Bev-Tem arm met the pre-specified level of activity of interest. Our results did not indicate any benefit from Bev-Iri in first-line therapy as opposed to Bev-Tem in terms of response and PFS.
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Affiliation(s)
- Kenneth F Hofland
- Department of Oncology and Radiotherapy, Rigshospitalet , Copenhagen , Denmark
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Kristiansen C, Shanmuganathan J, Nørgreen Gustafsson L, Løkke K, Munk-Jørgensen P. EPA-0698 – ADHD in adults: a nationwide study from 1995–2012. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kristiansen C, Olsen KE, Hansen NC, Hansen KH, Hansen O. Epidermal growth factor receptor mutations in synchronous recurrent lung cancer in an 82-year-old woman. A case story. Acta Oncol 2012; 51:948-9. [PMID: 22471746 DOI: 10.3109/0284186x.2011.652739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prithviraj GK, Sommers SR, Jump RL, Halmos B, Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Hunter K, Chamberlain MC, Le EM, Lee ELT, Chamberlain MC, Sadighi ZS, Pearlman ML, Slopis JM, Vats TS, Khatua S, DeVito NC, Yu M, Chen R, Pan E, Cloughesy T, Raizer J, Drappatz J, Gerena-Lewis M, Rogerio J, Yacoub S, Desjardin A, Groves MD, DeGroot J, Loghin M, Conrad CA, Hess K, Ni J, Ictech S, Hunter K, Yung WA, Porter AB, Dueck AC, Karlin NJ, Chamberlain MC, Olson J, Silber J, Reiner AS, Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Shiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Lassman AB, Cachia D, Alderson L, Moser R, Smith T, Yunus S, Saito K, Mukasa A, Narita Y, Tabei Y, Shinoura N, Shibui S, Saito N, Flechl B, Ackerl M, Sax C, Dieckmann K, Crevenna R, Widhalm G, Preusser M, Marosi C, Marosi C, Ay C, Preusser M, Dunkler D, Widhalm G, Pabinger I, Dieckmann K, Zielinski C, Belongia M, Jogal S, Schlingensiepen KH, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine V, Parfenov V, Poverennova I, Hau P, Jachimczak P, Heinrichs H, Mammoser AG, Shonka NA, de Groot JF, Shibahara I, Sonoda Y, Kumabe T, Saito R, Kanamori M, Yamashita Y, Watanabe M, Ishioka C, Tominaga T, Silvani A, Gaviani P, Lamperti E, Botturi A, DiMeco F, Broggi G, Fariselli L, Solero CL, Salmaggi A, Green RM, Woyshner EA, Cloughesy TF, Shu F, Oh YS, Iganej S, Singh G, Vemuri SL, Theeler BJ, Ellezam B, Gilbert MR, Aoki T, Kobayashi H, Takano S, Nishikawa R, Shinoura N, Nagane M, Narita Y, Muragaki Y, Sugiyama K, Kuratsu J, Matsutani M, Sadighi ZS, Khatua S, Langford LA, Puduvalli VK, Shen D, Chen ZP, Zhang JP, Chen ZP, Bedekar D, Rand S, Connelly J, Malkin M, Paulson E, Mueller W, Schmainda K, Gallego O, Benavides M, Segura PP, Balana C, Gil M, Berrocal A, Reynes G, Garcia JL, Murata P, Bague S, Quintana MJ, Vasishta VG, Nagane M, Kobayashi K, Tanaka M, Tsuchiya K, Shiokawa Y, Bavle AA, Ayyanar K, Puduvalli VK, Prado MP, Hess KR, Hunter K, Ictech S, Groves MD, Gilbert MR, Liu V, Conrad CA, de Groot J, Loghin ME, Colman H, Levin VA, Alfred Yung WK, Hackney JR, Palmer CA, Markert JM, Cure J, Riley KO, Fathallah-Shaykh H, Nabors LB, Saria MG, Corle C, Hu J, Rudnick J, Phuphanich S, Mrugala MM, Lee LK, Fu BD, Bota DA, Kim RY, Brown T, Feely H, Hu A, Drappatz J, Wen PY, Lee JW, Carter B, Kesari S, Fu BD, Kong XT, Bota DA, Fu BD, Bota DA, Sparagana S, Belousova E, Jozwiak S, Korf B, Frost M, Kuperman R, Kohrman M, Witt O, Wu J, Flamini R, Jansen A, Curtalolo P, Thiele E, Whittemore V, De Vries P, Ford J, Shah G, Cauwel H, Edrich P, Sahmoud T, Franz D, Khasraw M, Brown C, Ashley DM, Rosenthal MA, Jiang X, Mou YG, Chen ZP, Oh M, kim E, Chang J, Juratli TA, Kirsch M, Schackert G, Krex D, Gilbert MR, Wang M, Aldape KD, Stupp R, Hegi M, Jaeckle KA, Armstrong TS, Wefel JS, Won M, Blumenthal DT, Mahajan A, Schultz CJ, Erridge SC, Brown PD, Chakravarti A, Curran WJ, Mehta MP, Hofland KF, Hansen S, Sorensen M, Schultz H, Muhic A, Engelholm S, Ask A, Kristiansen C, Thomsen C, Poulsen HS, Lassen UN, Zalatimo O, Weston C, Zoccoli C, Glantz M, Rahmanuddin S, Shiroishi MS, Cen SY, Jones J, Chen T, Pagnini P, Go J, Lerner A, Gomez J, Law M, Ram Z, Wong ET, Gutin PH, Bobola MS, Alnoor M, Silbergeld DL, Rostomily RC, Chamberlain MC, Silber JR, Martha N, Jacqueline S, Thaddaus G, Daniel P, Hans M, Armin M, Eugen T, Gunther S, Hutterer M, Tseng HM, Zoccoli CM, Glantz M, Zalatimo O, Patel A, Rizzo K, Sheehan JM, Sumrall AL, Vredenburgh JJ, Desjardins A, Reardon DA, Friiedman HS, Peters KB, Taylor LP, Stewart M, Blondin NA, Baehring JM, Foote T, Laack N, Call J, Hamilton MG, Walling S, Eliasziw M, Easaw J, Shirsat NV, Kundar R, Gokhale A, Goel A, Moiyadi AA, Wang J, Mutlu E, Oyan A, Yan T, Tsinkalovsky O, Jacobsen HK, Talasila KM, Sleire L, Pettersen K, Miletic H, Andersen S, Mitra S, Weissman I, Li X, Kalland KH, Enger PO, Sepulveda J, Belda C, Balana C, Segura PP, Reynes G, Gil M, Gallego O, Berrocal A, Blumenthal DT, Sitt R, Phishniak L, Bokstein F, Philippe M, Carole C, Andre MDP, Marylin B, Olivier C, L'Houcine O, Dominique FB, Philippe M, Isabelle NM, Olivier C, Frederic F, Stephane F, Henry D, Marylin B, L'Houcine O, Dominique FB, Errico MA, Kunschner LJ, Errico MA, Kunschner LJ, Soffietti R, Trevisan E, Ruda R, Bertero L, Bosa C, Fabrini MG, Lolli I, Jalali R, Julka PK, Anand AK, Bhavsar D, Singhal N, Naik R, John S, Mathew BS, Thaipisuttikul I, Graber J, DeAngelis LM, Shirinian M, Fontebasso AM, Jacob K, Gerges N, Montpetit A, Nantel A, Albrecht S, Jabado N, Mammoser AG, Shah K, Conrad CA, Di K, Linskey M, Bota DA, Thon N, Eigenbrod S, Kreth S, Lutz J, Tonn JC, Kretzschmar H, Peraud A, Kreth FW, Muggeri AD, Alderuccio JP, Diez BD, Jiang P, Chao Y, Gallagher M, Kim R, Pastorino S, Fogal V, Kesari S, Rudnick JD, Bresee C, Rogatko A, Sakowsky S, Franco M, Hu J, Lim S, Lopez A, Yu L, Ryback K, Tsang V, Lill M, Steinberg A, Sheth R, Grimm S, Helenowski I, Rademaker A, Raizer J, Nunes FP, Merker V, Jennings D, Caruso P, Muzikansky A, Stemmer-Rachamimov A, Plotkin S, Spalding AC, Vitaz TW, Sun DA, Parsons S, Welch MR, Omuro A, DeAngelis LM, Omuro A, Beal K, Correa D, Chan T, DeAngelis L, Gavrilovic I, Nolan C, Hormigo A, Lassman AB, Kaley T, Mellinghoff I, Grommes C, Panageas K, Reiner A, Barradas R, Abrey L, Gutin P, Lee SY, Slagle-Webb B, Glantz MJ, Sheehan JM, Connor JR, Schlimper CA, Schlag H, Stoffels G, Weber F, Krueger DA, Care MM, Holland K, Agricola K, Tudor C, Byars A, Sahmoud T, Franz DN, Raizer J, Rice L, Rademaker A, Chandler J, Levy R, Muro K, Grimm S, Nayak L, Iwamoto FM, Rudnick JD, Norden AD, Omuro A, Kaley TJ, Thomas AA, Fadul CE, Meyer LP, Lallana EC, Colman H, Gilbert M, Alfred Yung WK, Aldape K, De Groot J, Conrad C, Levin V, Groves M, Loghin M, Chris P, Puduvalli V, Nagpal S, Feroze A, Recht L, Rangarajan HG, Kieran MW, Scott RM, Lew SM, Firat SY, Segura AD, Jogal SA, Kumthekar PU, Grimm SA, Avram M, Patel J, Kaklamani V, McCarthy K, Cianfrocca M, Gradishar W, Mulcahy M, Von Roenn J, Helenowski I, Rademaker A, Raizer J, Galanis E, Anderson SK, Lafky JM, Kaufmann TJ, Uhm JH, Giannini C, Kumar SK, Northfelt DW, Flynn PJ, Jaeckle KA, Buckner JC, Omar AI, Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Schiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Lassman AB, Delios A, Jakubowski A, DeAngelis L, Grommes C, Lassman AB, Theeler BJ, Melguizo-Gavilanes I, Shonka NA, Qiao W, Wang X, Mahajan A, Puduvalli V, Hashemi-Sadraei N, Bawa H, Rahmathulla G, Patel M, Elson P, Stevens G, Peereboom D, Vogelbaum M, Weil R, Barnett G, Ahluwalia MS, Alvord EC, Rockne RC, Rockhill JK, Mrugala MM, Rostomily R, Lai A, Cloughesy T, Wardlaw J, Spence AM, Swanson KR, Zadeh G, Alahmadi H, Wilson J, Gentili F, Lassman AB, Wang M, Gilbert MR, Aldape KD, Beumer JJ, Wright J, Takebe N, Puduvalli VK, Hormigo A, Gaur R, Werner-Wasik M, Mehta MP, Gupta AJ, Campos-Gines A, Le K, Arango C, Richards M, Landeros M, Juan H, Chang JH, Kim JS, Cho JH, Seo CO, Baldock AL, Rockne R, Canoll P, Born D, Yagle K, Swanson KR, Alexandru D, Bota D, Linskey ME, Nabeel S, Raval SN, Raizer J, Grimm S, Rice L, Rosenow J, Levy R, Bredel M, Chandler J, New PZ, Plotkin SR, Supko JG, Curry WT, Chi AS, Gerstner ER, Stemmer-Rachamimov A, Batchelor TT, Ahluwalia MS, Hashemi N, Rahmathulla G, Patel M, Chao ST, Peereboom D, Weil RJ, Suh JH, Vogelbaum MA, Stevens GH, Barnett GH, Corwin D, Holdsworth C, Stewart R, Rockne R, Swanson K, Graber JJ, Kaley T, Rockne RC, Anderson AR, Swanson KR, Jeyapalan S, Goldman M, Boxerman J, Donahue J, Elinzano H, Evans D, O'Connor B, Puthawala MY, Oyelese A, Cielo D, Blitstein M, Dargush M, Santaniello A, Constantinou M, DiPetrillo T, Safran H, Plotkin SR, Halpin C, Merker V, Barker FG, Maher EA, Ganji S, DeBerardinis R, Hatanpaa K, Rakheja D, Yang XL, Mashimo T, Raisanen J, Madden C, Mickey B, Malloy C, Bachoo R, Choi C, Ranjan T, Yono N, Zalatimo O, Zoccoli C, Glantz M, Han SJ, Sun M, Berger MS, Aghi M, Gupta N, Parsa AT. MEDICAL AND NEURO-ONCOLOGY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor152] [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: 11/14/2022] Open
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Hofland KF, Hansen S, Sorensen M, Schultz HP, Muhic A, Engelholm S, Ask A, Kristiansen C, Thomsen C, Skovgaard Poulsen H, Lassen UN. Randomized phase II study of neoadjuvant bevacizumab and irinotecan versus bevacizumab and temozolomide followed by concomitant chemoradiotherapy in newly diagnosed primary glioblastoma multiforme. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kristiansen C, Loft A, Berthelsen AK, Graff J, Lindebjerg J, Bisgaard C, Jakobsen A. PET/CT and histopathologic response to preoperative chemoradiation therapy in locally advanced rectal cancer. Dis Colon Rectum 2008; 51:21-5. [PMID: 17975715 DOI: 10.1007/s10350-007-9095-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Revised: 06/05/2007] [Accepted: 06/30/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE The objective of this study was to investigate the possibility of using positron emission tomography/computer tomography to predict the histopathologic response in locally advanced rectal cancer treated with preoperative chemoradiation. METHODS The study included 30 patients with locally advanced rectal adenocarcinoma treated with a combination of radiotherapy and concurrent Uftoral (uracil, tegafur) and leucovorine. All patients were evaluated by positron emission tomography/computer tomography scan seven weeks after end of chemoradiation, and the results were compared to histopathologic tumor regression as the "standard." The pathologic response was quantified by tumor regression grade. RESULTS Positron emission tomography/computer tomography correctly identified six of eight patients (specificity 75 percent) with complete pathologic response. However, the sensitivity of positron emission tomography/computer tomography was only 45 percent and the accuracy 53 percent. The positive and negative predictive values were 83 and 33 percent, respectively. CONCLUSIONS We conclude that positron emission tomography/computer tomography performed seven weeks after the end of chemoradiation is not able to predict the histopathologic response in locally advanced rectal cancer. There is an obvious need for other complementary methods especially with respect to the low sensitivity of positron emission tomography/computer tomography.
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Affiliation(s)
- Charlotte Kristiansen
- Danish Colorectal Cancer Group South, Vejle Hospital, Kabbeltoft 25, Vejle, Denmark.
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Kristiansen C, Langkjer ST. Treatment and treatment considerations in a patient with advanced breast cancer and acute intermittent porphyria. Acta Oncol 2006; 45:337-9. [PMID: 16644579 DOI: 10.1080/02841860500434697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Molberg O, McAdam S, Lundin KE, Kristiansen C, Arentz-Hansen H, Kett K, Sollid LM. T cells from celiac disease lesions recognize gliadin epitopes deamidated in situ by endogenous tissue transglutaminase. Eur J Immunol 2001; 31:1317-23. [PMID: 11465088 DOI: 10.1002/1521-4141(200105)31:5<1317::aid-immu1317>3.0.co;2-i] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.8] [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: 11/08/2022]
Abstract
Celiac disease is an HLA-DQ2-associated disorder characterized by intestinal T cell responses to ingested wheat gliadins. Initial studies used gliadin that had been subjected to non-enzymatic deamidation during pepsin/trypsin digestion to enrich for the gliadin-specific T cells in small intestinal celiac biopsies. These T cells recognized synthetic gliadin peptides only after their deamidation in vitro by purified tissue transglutaminase (tTG). However, as these studies used a deamidated antigen for re-stimulation prior to testing for antigen specificity, this raised the possibility that T cells specific for native epitopes had not been expanded in vitro and had thus been overlooked. To address this possibility and to look for more direct evidence that endogenous tTG mediates deamidation of gluten in the celiac lesions, we have here used a minimally deamidated chymotrypsin-digest of gliadin to challenge biopsies and then investigated the specificity of the T cell lines derived from them. Interestingly, these T cell lines only barely responded to the chymotrypsin-digested gliadins, but efficiently recognized the in vitro tTG-treated variants of the same gliadins. Moreover, the addition of a tTG-inhibitor during the gliadin challenge often resulted in T cell lines with abolished or reduced responses to deamidated gliadin. These data demonstrate that DQ2-restricted T cells within adult celiac lesions predominantly recognize deamidated gliadin epitopes that are formed in situ by endogenous tTG.
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Affiliation(s)
- O Molberg
- Institute of Immunology, Rikshospitalet, University of Oslo, Norway.
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Abstract
High-dose methotrexate (HD-MTX) is widely used in combination chemotherapy and can be handled without life-threatening toxicity in combination with leucovorin (LV) rescue. However, in an experimental animal model for testing of short-term HD-MTX effects in anesthetized rats, the authors previously demonstrated intolerable toxicity and death within a few hours in some animals. Serum levels were below levels routinely found in patients on HD-MTX treatment. This study was aimed at disclosure of possible mechanisms for acute toxicity of MTX in rats. The previously determined maximum tolerated dose of 5 g/kg MTX was used as the test dose. The animals that died showed sudden reduction in heart rate and blood pressure. LV, 1 g/kg infused immediately prior to MTX, changed MTX elimination kinetics, but did not change the acute toxicity. The data of this study together with additional evidence obtained in the experimental model, suggest that MTX acute toxicity may not be related to its antiproliferative effect, but rather to perturbation of endothelial cell and platelet function.
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Affiliation(s)
- O M Fuskevåg
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Tromsø, Norway
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Kristiansen C, Lund ED, Hey H, Brandslund I. [A clinical evaluation of three different quantitative fibrin D-dimer analyses in the diagnosis of deep venous thrombosis]. Ugeskr Laeger 2000; 162:4927-30. [PMID: 11002741] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The trial included ninety-five consecutive outpatients admitted with symptoms and signs suggesting deep venous thrombosis. Blood samples were collected on admission and analysed when the trial was ended. The three different D-dimer methods were BC D-dimer, Tinaquant D-dimer (both quantitative latex agglutination methods) and VIDAS D-dimer, based on the ELISA principle. Ultrasound was used as the reference method, but the outcome evaluated at three month follow up was the gold standard. The sensitivities of the three different methods were 66% (95% confidence interval 55-75%), 93% (88-98%) and 98% (94-100%) respectively. The negative predictive values were respectively 71% (62-80%), 88% (81-95%) and 95% (91-99%). This trial confirms that VIDAS D-dimer has a high sensitivity and negative predictive value that makes it suitable for clinical use. The same conclusion can be drawn for the Tinaquant D-dimer. The trial also emphasizes the importance of testing new methods under routine clinical conditions.
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Fuskevåg OM, Kristiansen C, Olsen R, Aarbakke J, Lindal S. Microvascular perturbations in rats receiving the maximum tolerated dose of methotrexate or its major metabolite 7-hydroxymethotrexate. Ultrastruct Pathol 2000; 24:325-32. [PMID: 11071571 DOI: 10.1080/019131200750035058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 10/17/2022]
Abstract
Methotrexate (MTX) is a clinically important cytostatic antifolate. The study describes the acute effects of maximum tolerated doses of MTX or its major metabolite 7-hydroxymethotrexate (7-OH-MTX) on the ultrastructure of rat liver and kidneys. The ultrastructural changes in rats receiving MTX or 7-OH-MTX were, in principle, indistinguishable and their severity and extension increased with time of survival or doses of medication. All lesions were focal, microvascular, or parenchymal. Microvascular changes were more severe in nature when blood cells were present. The endothelial cells were swollen with loss of pinocytotic vesicles, their luminal plasma membrane formed blebs or were disrupted. Partly detached endothelial cells or deendothelialized areas, various types of white blood cells, in particular, neutrophil granulocytes, were observed in the microcirculation. Single platelets or small platelet aggregates were found either in the lumen or adhering to deendothelialized areas of injured endothelial cells. Hepatocytes exhibited steatosis, edema, and manifest single cell necrosis. There were also nuclear changes, marked proliferation of smooth endoplasmatic reticulum, increased amounts of intracellular lipid vacuoles, and a decrease in glycogen particles in hepatocytes. The kidney presented the major changes in the tubules and in the interstitial part. MTX and 7-OH-MTX acute toxicity may primarily be related to microvascular perturbation.
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Affiliation(s)
- O M Fuskevåg
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Norway
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Fuskevåg OM, Kristiansen C, Lindal S, Aarbakke J. Maximum tolerated doses of methotrexate and 7-hydroxy-methotrexate in a model of acute toxicity in rats. Cancer Chemother Pharmacol 2000; 46:69-73. [PMID: 10912581 DOI: 10.1007/s002800000111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE After more than 50 years of methotrexate (MTX) treatment of acute lymphoblastic leukaemia (ALL), it is currently believed that as long as dose escalations are followed by adequate leucovorin rescue guided by monitoring MTX serum concentrations, hydration and urinary alkalinization, high-dose MTX (HD-MTX) can be tolerated without life-threatening toxicity. However, our recent experimental animal studies of the major metabolite of MTX, 7-OH-MTX, indicate that this concept may have some limitations. Animals with levels of 7-OH-MTX of 1 mM, which is below the levels routinely found in patients on HD-MTX, demonstrate intolerable toxicity and some animals die within 8 h. Electron microscopy indicates that endothelial cell and platelet functions are perturbed. Since animal data are lacking, and interspecies differences not known, we wanted to investigate the maximum tolerated doses of MTX and 7-OH-MTX in a rat model of short-term effects. The maximum tolerated dose was chosen instead of LD(50) for reasons of animal welfare. METHODS We infused MTX and 7-OH-MTX into anaesthetized male Wistar rats and monitored the animals for 8 h. The drugs were given as a bolus plus continuous infusion. The dose-finding ranges were 1.8 11.3 g/kg MTX and 0.1-1.2 g/kg 7-OH-MTX. RESULTS The maximum tolerated dose was between 3 and 5 g/kg for MTX and lower than 0.1 g/kg for 7-OH-MTX. The mean serum concentrations of MTX and 7-OH-MTX in animals that did not survive the 8-h period were 21.9 and 1.6 mM, respectively. The animals that received the highest MTX or 7-OH-MTX doses and concentrations died after sudden reductions in heart rate and blood pressure. CONCLUSIONS We demonstrated a lower maximum tolerated dose of 7-OH-MTX than of MTX in rats after 8 h. The 7-OH-MTX concentrations were in the therapeutic range after HD-MTX. If the rat/human interspecies differences are not large, our data may indicate that HD-MTX regimens should not be further dose intensified, due not so much to the effects of MTX as to those of 7-OH-MTX.
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Affiliation(s)
- O M Fuskevåg
- Department of Pharmacology, Institute of Medical Biology, University of Tromsø, Norway
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Kristiansen C, Lassen JF, Dahler-Eriksen BS, Dahler-Eriksen K, Larsen TB, Brandslund I. Evaluation of a simple dosage scheme for transition from phenprocoumon to warfarin in oral anticoagulation. Thromb Res 2000; 98:157-63. [PMID: 10713317 DOI: 10.1016/s0049-3848(99)00222-4] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Phenprocoumon, whose elimination half-time is 144 hours, has been the traditional oral anticoagulant of choice in Europe. However, today's most widely used drug is warfarin, whose elimination half-time is 40 hours. This study aims to evaluate a method for safe transition from phenprocoumon to warfarin, which is sometimes required. Hence, the large difference in their elimination rates may on occasion lead to serious overdosage upon transition from one drug to the other. According to average equipotent doses, a stepwise increase in warfarin dose was calculated based on the elimination half-times of the two drugs. The dosage scheme was subsequently tested in a pilot study including 35 patients. The conversion scheme was then adjusted based on the results from the pilot study. The new scheme was tested in 69 patients. The transition factor was 2.3, which implies that equipotency was achieved when the warfarin dose was 2.3 times larger than the phenprocoumon dose (in mg). This scheme proved optimal for 75% of the patients. However, the dose had to be adjusted individually in the remaining 25% of the patients to a level corresponding to the measured international normalised ratios. No patients experienced haemorrhages or thromboembolic complications during the period of changeover. In conclusion, the proposed scheme for changing medication from phenprocoumon to warfarin is safe and convenient.
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Affiliation(s)
- C Kristiansen
- Department of Clinical Biochemistry, Vejle County Central Hospital, DK-7100, Vejle, Denmark.
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Arentz-Hansen EH, McAdam SN, Molberg O, Kristiansen C, Sollid LM. Production of a panel of recombinant gliadins for the characterisation of T cell reactivity in coeliac disease. Gut 2000; 46:46-51. [PMID: 10601054 PMCID: PMC1727782 DOI: 10.1136/gut.46.1.46] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [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: 12/08/2022]
Abstract
BACKGROUND/AIMS Coeliac disease is a chronic intestinal disorder most probably caused by an abnormal immune reaction to wheat gliadin. The identification of the HLA-DQ2 and HLA-DQ8 as the molecules responsible for the HLA association in coeliac disease strongly implicates a role for CD4 T cells in disease pathogenesis. Indeed, CD4 T cells specific for gliadin have been isolated from the small intestine of patients with coeliac disease. However, identification of T cell epitopes within gliadin has been hampered by the heterogeneous nature of the gliadin antigen. To aid the characterisation of gliadin T cell epitopes, multiple recombinant gliadins have been produced from a commercial Nordic wheat cultivar. METHODS The alpha-gliadin and gamma-gliadin genes were amplified by polymerase chain reaction from cDNA and genomic DNA, cloned into a pET expression vector, and sequenced. Genes encoding mature gliadins were expressed in Escherichia coli and tested for recognition by T cells. RESULTS In total, 16 alpha-gliadin genes with complete open reading frames were sequenced. These genes encoded 11 distinct gliadin proteins, only one of which was found in the Swiss-Prot database. Expression of these gliadin genes produced a panel of recombinant alpha-gliadin proteins of purity suitable for use as an antigen for T cell stimulation. CONCLUSION This study provides an insight into the complexity of the gliadin antigen present in a wheat strain and has defined a panel of pure gliadin antigens that should prove invaluable for the future mapping of epitopes recognised by intestinal T cells in coeliac disease.
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Molberg O, Mcadam SN, Körner R, Quarsten H, Kristiansen C, Madsen L, Fugger L, Scott H, Norén O, Roepstorff P, Lundin KE, Sjöström H, Sollid LM. Tissue transglutaminase selectively modifies gliadin peptides that are recognized by gut-derived T cells in celiac disease. Nat Med 1998; 4:713-7. [PMID: 9623982 DOI: 10.1038/nm0698-713] [Citation(s) in RCA: 803] [Impact Index Per Article: 30.9] [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: 02/07/2023]
Abstract
The action of tissue Transglutaminase (TGase) on specific protein-bound glutamine residues plays a critical role in numerous biological processes. Here we provide evidence for a new role of this enzyme in the common, HLA-DQ2 (and DQ8) associated enteropathy, celiac disease (CD). The intestinal inflammation in CD is precipitated by exposure to wheat gliadin in the diet and is associated with increased mucosal activity of TGase. This enzyme has also been identified as the main target for CD-associated anti-endomysium autoantibodies, and is known to accept gliadin as one of its few substrates. We have examined the possibility that TGase could be involved in modulating the reactivity of gliadin specific T cells. This could establish a link between previous reports of the role of TGase in CD and the prevailing view of CD as a T-cell mediated disorder. We found a specific effect of TGase on T-cell recognition of gliadin. This effect was limited to gliadin-specific T cells isolated from intestinal CD lesions. We demonstrate that TGase mediates its effect through an ordered and specific deamidation of gliadins. This deamidation creates an epitope that binds efficiently to DQ2 and is recognized by gut-derived T cells. Generation of epitopes by enzymatic modification is a new mechanism that may be relevant for breaking of tolerance and initiation of autoimmune disease.
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Affiliation(s)
- O Molberg
- Institute of Transplantation Immunology, Rikshospitalet, University of Oslo, Norway
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Björquist P, Brohlin M, Ehnebom J, Ericsson M, Kristiansen C, Pohl G, Deinum J. Plasminogen activator inhibitor type-1 interacts exclusively with the proteinase domain of tissue plasminogen activator. Biochim Biophys Acta 1994; 1209:191-202. [PMID: 7811690 DOI: 10.1016/0167-4838(94)90184-8] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Two different techniques have been used to study the complex formation of recombinant human plasminogen activator inhibitor type-1, PAI-1, with either recombinant human two-chain tissue plasminogen activator, tc tPA (EC 3.4.21.68), or the tPA deletion variants tc K2P, containing the kringle 2 domain and the proteinase domain, and P, containing only the proteinase domain. The same value for Kon, 2.10(7) M-1s-1 for binding of PAI-1 was found for the three tPA forms by direct detection of the complex formation in real time by surface plasmon resonance, BIAcore, or indirectly by monitoring the time course of the inhibition of tPA using the chromogenic substrate N-methylsulfonyl-D-Phe-Gly-Arg-4-pNA-acetate. Apparently, no conformational change is involved in the rate-limiting step, since the kon value was found to be independent of the temperature from 20 to 35 degrees C. By the BIAcore technique, it was found that the complex between PAI-1 and tPA covalently coupled to the surface, was stable at 25 degrees C, since no dissociation was seen in buffer. However, extended treatment with 1 M NH4OH destroyed the complex with t 1/2 = 5 h. The same kon values and complex composition were found by measuring either the binding of tPA to PAI-1 captured on the monoclonal antibody MAI-11 or the binding of PAI-1 to tPA captured on the monoclonal antibody 2:2 B10. Quantification of the complex composition between PAI-1 captured on the monoclonal antibody MAI-11 with either tPA, K2P or P gave a one-to-one ratio with the fraction of active PAI-1, consistent with the results from SDS-PAGE and the specific activity of PAI-1. The complexes of the three tPA forms with PAI-1 captured on a large surface of MAI-11 dissociated more rapidly from MAI-11, with the same apparent koff, kdis, = 2.10(-3) s-1, compared with 0.7-10(-3) s-1 for the dissociation of PAI-1 alone. In consistance, the Kd, calculated from the direct determination of the kon and koff for the association of different form of PAI-1 to a small surface of MAI-11, was found to be higher for PAI-1 in complex with tPA than for free active PAI-1. Apparently, upon complex formation, a change is induced in PAI-1 at the binding epitope for MAI-11.(ABSTRACT TRUNCATED AT 400 WORDS)
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