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Träfflista för sökning "AMNE:(MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi) srt2:(1995-1999)"

Sökning: AMNE:(MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi) > (1995-1999)

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  • Isacsson, Ulf (författare)
  • Comparative treatment planning in external radiotherapy of malignant tumours : Potential gains using protons
  • 1998
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>It is well known that protons have physical characteristics superior to conventional radiation qualities in external beam radiotherapy. The primary aim of this work is to determine if the physical advantages also may lead to clinical advantages. A second aim is to evaluate the treatment planning algorithms incorporated into a 3D treatment planning system, used in the prediction, Helax-TMS<sup>TM</sup>. The potential benefits of using protons instead of conventional radiation qualities is evaluated by comparing treatment plans. Dose-response models of tumour control probability (TCP) and normal tissue complication probability (NTCP) were used to predict the treatment outcome for the different plans. Uncertainties in the results were studied in sensitivity analyses.</p><p>Comparative studies were performed in four different tumour types, locally advanced rectal cancer, a paraspinal tumour, oesophageal cancer and left-sided node-positive breast cancer. Advantages with protons were seen in all cases, but the advantages were of different size.</p><p>Proton therapy in patients with oesophageal carcinoma increases the TCP from 6 to 49% if a risk of 1% in the spinal cord and a total NTCP for the two lungs equivalent to a one-sided pulmectomy is allowed. This gain is relatively insensitive to variations, within reasonable limits, in the dose-response parameters.</p><p>Proton therapy reduces the risk for cardiac mortality and radiation pneumonitis to almost zero when treating node-positive left-sided breast cancer after breast-conserving surgery.</p><p>The evaluation of the treatment planning algorithms shows that pencil kernel algorithms are required in order to accurately calculate dose distributions in heterogeneous patient volumes. The scattering phenomenon in the vicinity of interfaces between different materials is modelled. The magnitude of the effect is underestimated (less than 1%) due to the inherent approximations.</p>
  • Sjöholm, H, et al. (författare)
  • Necrosis of malignant gliomas after intratumoral injection of 201Tl in vivo in the rat
  • 1995
  • Ingår i: Anti-Cancer Drugs. - Rapid Communications. - 0959-4973. ; 6:1, s. 109-114
  • Tidskriftsartikel (refereegranskat)abstract
    • Fourteen adult Fischer 344 rats were inoculated in vivo unilaterally in the caudate nucleus in the brain with malignant RG 2 glioma cells. By 3 weeks a tumor with a diameter of 3-6 mm normally develops. Ten animals which survived the repeated periods of anesthesia and thallium (Tl) injections (intratumorally three times of 201Tl, 15-23 days after inoculation) showed a prolonged retention of radioactivity at the site of injection with no uptake in other organs except for the kidneys. Singular circumscribed necroses were found post-mortem at the site of injection, comprising malignant glioma tumor tissue, which in six animals was absent, in three animals was markedly reduced in size compared with controls and in one animal had the expected size. In four animals metastases were found in distant locations in the brain; in three of these cases there was a retention of radioactivity in the tumor. The selective necrotizing effect on the tumor cells is interpreted as mainly due to emission of Auger electrons from intracellularly accumulated 201Tl, giving rise to very high energy deposition in the vicinity of the cell nucleus. The results should also have implications for the treatment of human malignant gliomas.
  • Carlsson, Maria (författare)
  • Informational support for patients with gynaecological cancer and their families
  • 1997
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The main purpose of the present thesis was to gain a deeper knowledge and understanding of the informational need by women with gynaecological cancer and their families. The studies evaluate the experience of different kind of information giving; a telephone-help line; a 3 years educational group support programme; and information givings in ordinary care.</p><p>There was a significant correlation to interest in an educational supportive group in the prestudy depending on age, legal status, educational level. Younger individuals, couples and people with a higher formal education were generally more interesting in participating (p&lt;0.05). Patients who actively chose to participate m a an educational support group differed from the unselected control group even prior the intervention, they with a higher formal education were generally more interesting in participating, they felt more confused and angry than the control group. After intervention, the patients in the interventional group reported a significant improved level of knowledge about cancer.</p><p>Both patients and next-of-kin request information about medical- and psychological aspects of the disease and its treatment. The evaluation of the questions in the educational supportive group show that patients and their relatives asked questions of a general nature, related to basic knowledge of cancer and treatment principles, and not directly related to their own illness. There was no general difference in knowledge level between cancer patients and the controls of healthy women. The length of formal education was the most important determinator of correct answers (p&lt;0.01).</p><p>Two main themes were revealed at the interviews about the patients informations preferences. These were to actively address questions and the right to receive honest information;</p><p>It is concluded that differential information giving techniques are required to satisfy the patients' different preferences. The patients express an active role in the information giving process. They preferred information with numerous opportunities to address questions, that the staff have time for questions and that the questions are honestly answered.</p>
  • Jansson, Tomas (författare)
  • Methods for selection and optimisation of radiotherapy and early therapy evaluation in breast cancer
  • 1998
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Adjuvant systemic therapy for breast cancer, the most common malignancy in females, increases survival and this has recently also been demonstrated for postoperative radiotherapy. The aims of this study were to develop an optimised radiotherapeutic technique for postoperative treatment, to analyse the association between p53 status in node-negative patients and radiotherapy, to investigate the incidence of in-breast relapses after conservative surgery and radiotherapy and to determine if positron emissiontomography could be useful for early evaluation of polychemotherapy.</p><p>A technique with mixed photon and electron beams from an accelerator equipped with a multileaf collimator was developed for irradiation of the breast parenchyma and regional lymph nodes after breast-conserving surgery.</p><p>Lymph node negative patients with p53 mutated cancers treated with radiotherapy to either the ipsilateral breast parenchyma after sector resection, or the parasternal and supraclavicular fossa after modified radical mastectomy due to medial or central tumours had a statistically significant longer relapse-free, breast cancer-corrected, and overall survival (<i>p</i>=0.0007, <i>p</i>=0.001, <i>p</i>=0.02, respectively) compared with non-irradiated patients.</p><p>In 672 patients with pT1N0M0 cancers treated with radiotherapy (54 Gy) after breast-conserving surgery 2.5% in-breast relapses appeared after a mean follow-up of 6.8 years.</p><p>Positron emission tomography with <sup>18</sup>FDG and <sup>11</sup>C-methionine revealed a decrease in tumour metabolism one to two weeks after the first course of polychemotherapy in 11 of 12 clinically responding patients.</p>
  • Nordin, Karin (författare)
  • Psychological responses to gastrointestinal cancer
  • 1998
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The overall aim of the present thesis is to gain knowledge about psychological distress and adjustment in gastrointestinal cancer patients (colon, rectum, gastric, pancreatic or biliary) at various phases of their disease.</p><p>Reactions to the diagnosis, anxiety, depression and coping were investigated in newly diagnosed patients (n=139). Repeated assessments were performed throughout the fast year after the diagnosis. Only a limited group reported high levels of anxiety (17%) and depression (21%) close to the diagnosis. Patients with colon or rectal cancer, most of whom were potentially cured, had a more confronting attitude to their diagnosis and reported more 'Fighting Spirit' than patients with gastric and pancreatic/biliary cancer. These responses were associated with better emotional well-being. The former group also reported less `Hopeless/helplessness' and 'Anxious preoccupation', which were related to higher levels of psychological distress. There were no changes over time in mean levels of anxiety and depression and virtually no changes in mean values of the coping subscales. In a separate group (n=141), overall levels of anxiety, depression and worry were low in conjunction to a medical follow-up control visit approximately two years after diagnosis.</p><p>Levels of anxiety and depression at diagnosis predicted a similar status six months later. A model based on standardised cut-off scores of moderate or high levels of anxiety or depression and intrusive thoughts close to the diagnosis was used to identity patients with prolonged psychological distress.</p><p>A psychometric analysis was performed of the Mental Adjustment to Cancer (MAC) scale (n=868 patients with various cancers). The reliability of the original subscales was satisfying. A confirmatory factor analysis revealed a factor structure including 28 of the original 40 items in four factors. Both versions of the MAC confound coping efforts and emotional outcomes, preventing analyses of coping-outcome relations.</p><p>The main conclusion is that a majority of gastrointestinal cancer patients cope well with their disease in the short as well as in the long run.</p>
  • Hugosson, Claes (författare)
  • Diagnosis of solid abdomino-pelvic tumours in children : A retrospective radiological study
  • 1999
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><i>Problems and Aims</i>: Solid abdomino-pelvic tumours (APTs) in children constitute a heterogeneous group of masses which may originate from the retroperitoneum, the abdominal or pelvic cavities or any adjacent structure. They have different histological features, growth patterns and prognoses.</p><p>The aim of the present investigation was to study the potential of modern imaging to assess the location, size and type of tumour, the extent of the disease and, if possible, the tumour stage in order to provide information to guide therapy.</p><p><i>Materials and Methods</i>: Imaging was performed in 92 children and adolescents with a primary APT using conventional radiography, radionuclide scintigraphy, US, CT and MR imaging for pre-treatment assessment, US-guided biopsies were performed in 61 children: the results were analysed retrospectively for yield and complications.</p><p><i>Results</i>: In pelvic bone tumours, all imaging modalities contributed to the evaluation of the primary tumour. Conventional radiography and bone scintigraphy were necessary for an initial diagnosis and CT for further evaluation. MR imaging and/or dynamic contrast-enhanced CT were mandatory prior to surgical resection.</p><p>In primary kidney tumours contrast-enhanced CT and non-enhanced MR imaging were equally accurate in determining the size and origin of the tumours but were inadequate in assessment of tumour staging. MR imaging findings varied somewhat between Wilms' tumours and non-Wilms' tumours.</p><p>In solid pelvic tumours compartmental localization was equally assessed with CT and MR and, together with gender, was found to correlate with the type of tumour.</p><p>In abdominal neuroplastoma, evaluation of the local disease was equally accurate with CT and MR imaging, while assessment of invasion and lymphadenopathy was not possible regardless of imaging modality. Metastatic disease needed imaging with CT, MR, scintigraphy and bone marrow aspiration for assessment. Staging accuracy improved if an increased number of imaging methods were used.</p><p>Needle core biopsy provided significantly better results than fine needle aspiration biopsy without an increase in complications.</p><p><i>Conclusions</i>: Assessment of APT in children requires the use of several different yet complementary imaging modalities in defining location, extent and tissue characteristics of the tumour. The choice of imaging modality depends on history, clinical findings, presumed location and available techniques. Pre-treatment assessment with imaging constitutes the basis for presentation of a staging protocol.</p>
  • Knutson, Folke (författare)
  • The quality of red blood cells and platelets intended for transfusion : Opportunities for improvements
  • 1999
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>A new, automated technique for collection and instant preparation of blood components has been developed. The device enables the combined collection of red cells (250 mL) and plasma (475 mL). No adverse effects were seen in the donors. The blood components were of good quality. The impact of the pre-separation temperature on whole blood was studied in two studies. In the first study blood was collected and put into stoppered test tubes. The test tubes were then put into water bath at 15,20,25 and 30 °C. Samples were taken at intervals during 24 hours. The lactate concentration increased and 2,3-DPG concentrations decreased during storage and at a higher rate with higher temperature. In the second study blood was collected and dived into half units. One half unit was actively cooled to 20 °C the other half kept at 28 °C. Blood component preparation was done after 6 hours. There were a significant change in 2,3-DPG, pH and lactate already after two hours hold of the whole blood. The differences were maintained for one week and for 2,3-DPG throughout 28 days storage. Myeloperoxidase levels in plasma were lower in the cooled units. The leucocytes reduction properties of BAT procedure were improved by addition of mannitol in the anticoagulant. The contents of leucocytes in RBC units were in the test group 32x10<sup>6</sup> and in the control group 573x10<sup>6</sup>. In vitro storage data showed no significant difference between the two groups during 42 days of storage of the red cells. A photochemical treatment (PCT) process has been used in decontamination of buffy-coat derived platelets (BC-PCs). Different strains of bacteria known to be associated with bacterial contamination's of blood components were added to two pooled ABO matched BC-PCs. After mixing the BC-PCs were divided. One BC-PC underwent PCT and the other did not. All bacterial experiments were made in duplicates. In all experiments, the bacteria were killed except in one with <em>Bacillus cereus</em>, a known spore former. PCT conditions similar to those used in the bacterial inactivation experiment were efficacious to inactivate HIV-1. In a second study a number of in vitro parameters known to be related to viability or function of stored platelets were tested. No physiologically relevant differences were found between the test and the control BC-PCs during 7 days of storage.</p>
  • Tisell, Lars-Eric, 1931-, et al. (författare)
  • Somatostatin receptor scintigraphy in medullary thyroid carcinoma.
  • 1997
  • Ingår i: The British journal of surgery. - 0007-1323. ; 84:4, s. 543-7
  • Tidskriftsartikel (refereegranskat)abstract
    • 111In-radiolabelled (DTPA-D-Phe1)-octreotide scintigraphy can be used to localize neuroendocrine tumours expressing somatostatin receptors (SSTRs). The aim of this paper was to analyse the importance of tumour volume and growth for the visualization by SSTR scintigraphy of metastases from medullary thyroid carcinoma (MTC).
  • Jernström, Helena (författare)
  • Effects of Oral Contraceptives on Endogenous Hormones, Body Constitution, and Breast Epithelium in Healthy, Young Women
  • 1996
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • This thesis concerns the effects of low-dose oral contraceptives (OCs) on endogenous hormones, insulin-like growth-factor-1 (IGF-1), sexual hormone binding globulin (SHBG), and body constitution in two groups of healthy women aged 19­25 who had never been pregnant. Prolactin concentrations were elevated in a subgroup of present and former users. IGF-1 concentrations were significantly decreased during menstrual cycle days 18­23 in present OC users compared with never users, while no effect was seen during cycle days 5­10. Former users had significantly higher follicle-stimulating hormone (FSH) concentrations than never users. This rebound-like phenomenon peaked one year after cessation of use. High FSH concentrations could increase the number of ovulations and thereby the ovarian cancer risk, especially among intermittent users who may experience repeated rebound peaks. Among present and former users SHBG concentrations were significantly correlated with reported weight gain in connection with OC start. SHBG was not related to the same hormonal and constitutional parameters in former users as in never users. Breast size was significantly larger in present users than in former and never users, and approximately half of the ever users reported breast tenderness or enlargement in connection with OC start. Breast epithelial proliferation rate was studied by means of a new monoclonal antibody, Ki-S5, in 58 women who had undergone reduction mammoplasties and who were born 1940 or later. There was no significant difference in breast tissue proliferation between present, former and never users. Women who had used OCs before the first full-term pregnancy had a significantly higher proliferation rate in the breast tissue than other women, regardless of present OC status. Women who used exogenous hormones and who had a first and/or second degree relative relative with breast cancer had a significantly higher proliferation rate in the breast tissue than other women. A high proliferation rate may increase the risk of developing breast cancer.
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