| 1. |
|
|
| 2. |
- Dijkstra, Esmee A., et al.
(författare)
-
Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer - The RAPIDO trial
- 2022
-
Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 171, s. 69-76
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: The RAPIDO trial demonstrated a decrease in disease-related treatment failure (DrTF) and an increase in pathological complete responses (pCR) in locally advanced rectal cancer (LARC) patients receiving total neoadjuvant treatment (TNT) compared to conventional chemoradiotherapy. This study examines health-related quality of life (HRQL), bowel function, and late toxicity in patients in the trial.Materials and methods: Patients were randomized between short-course radiotherapy followed by pre-operative chemotherapy (EXP), or chemoradiotherapy and optional post-operative chemotherapy (STD). The STD group was divided into patients who did (STD+) and did not (STD-) receive post-operative chemotherapy. Three years after surgery patients received HRQL (EORTC QLQ-C30, QLQ-CR29 and QLQ-CIPN20) and LARS questionnaires. Patients who experienced a DrTF event before the toxicity assessments (6, 12, 24, or 36 months) were excluded from analyses.Results: Of 574 eligible patients, 495 questionnaires were returned (86%) and 453 analyzed (79% com-pleted within time limits). No significant differences were observed between the groups regarding QLQ-C30, QLQ-CR29 or LARS scores. Sensory-related symptoms occurred significantly more often in the EXP group compared to all STD patients, but not compared to STD+ patients. Any toxicity of any grade and grade > 3 toxicity was comparable between the EXP and STD groups at all time-points. Neurotoxicity grade 1-2 occurred significantly more often in the EXP and STD+ group at all time-points compared to the STD-group.Conclusion: The results demonstrate that TNT for LARC, yielding improved DrTF and pCRs, does not com-promise HRQL, bowel functional or results in more grade >3 toxicity compared to standard chemoradio-therapy at three years after surgery in DrTF-free patients.(c) 2022 The Authors. Published by Elsevier B.V. Radiotherapy and Oncology 171 (2022) 69-76 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
|
|
| 3. |
|
|
| 4. |
- Henriksson, Anna
(författare)
-
Physical activity and exercise during curative oncological treatment : exploring the effects of exercise intensity and behaviour change support, safety, and patients’ and exercise professionals’ experiences
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: This thesis aimed to explore the effects of exercise intensity and behaviour change support (BCS), the safety of exercise, and experiences of exercise for both patients and exercise professionals during oncological treatment (e.g. neo/adjuvant chemotherapy, endocrine treatment, radiotherapy). This thesis is based on data from the Phys-Can (Physical training and Cancer) multicentre research program, consisting of a feasibility study, an observation study, and a randomised controlled trial (RCT). Methods: Paper I and II were quantitative studies. Paper I was a RCT with a 2x2 factorial design. Patients newly diagnosed with breast, prostate, or colorectal cancer about to start oncological treatment were randomised to six months of high intensity (HI) or low-moderate intensity (LMI) supervised group based resistance- and home-based endurance training, with or without additional BCS. The primary outcome, cancer related fatigue (CRF), was assessed by the Multidimensional Fatigue Inventory. Multiple linear regression and additional responder analysis for primary outcomes were performed. Paper II was a descriptive and comparative study based on secondary data from the observation study and RCT. Data were presented descriptively, and related factors to adverse events (AEs) were analysed with logistic regressions. Paper III and IV were qualitative studies. Participants were patients with breast, prostate, or colorectal cancer undergoing oncological treatment (Paper III) or coaches supervising exercise for participants in the RCT (Paper IV). Data were collected through semi-structured individual- (Paper III and IV) and focus group interviews (Paper III) and analysed with qualitative content analysis (Paper III) and thematic analysis (Paper IV). Main results and conclusions: The results from this thesis indicate that exercise at HI may not improve CRF in comparison with exercise at LMI in patients undergoing treatment, thus patients can be advised to exercise at either preferred intensity. Also, additional BCS did not improve CRF in relatively motivated patients receiving supervised exercise (Paper I). Furthermore, exercise-related AEs in persons undergoing oncological treatment are minor, of musculoskeletal origin, and with a similar incidence as in healthy populations. However, a higher risk of minor exercise-related AEs was reported in HI groups than in LMI groups. More serious AEs were rare, thus it seems safe to exercise even at HI for these patient groups (Paper II). The results also indicated that patients could experience side effects and concerns regarding the safety of exercising during oncological treatment as barriers to engage in physical activity. Therefore, engaging in physical activity before the onset of side effects from treatment and providing information regarding physical activity to patients could be beneficial (Paper III). Professionals supervising exercise for patients may find it highly rewarding, which is promising for implementation in cancer rehabilitation. However, patients may still receive contradictory information regarding the safety of exercise from health care staff, which can be difficult for exercise professionals to counteract (Paper IV).
|
|
| 5. |
- Heyman, Sofia, et al.
(författare)
-
Reduction of elective lymph node volume in radiotherapy of early anal squamous cell cancer : a comparative study between two Swedish university hospitals
- 2024
-
Ingår i: Acta Oncologica. - : Medical Journals Sweden. - 0284-186X .- 1651-226X. ; 63:1, s. 118-124
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Anal squamous cell cancer (ASCC) in early stages (T1–2N0M0) is treated with chemoradiotherapy with a 3-year overall survival (OS) exceeding 90%. In Swedish guidelines, it has been optional to include the external iliac and presacral lymph node (LN) stations in radiotherapy (RT) treatment fields in early ASCC. Two Swedish hospitals treating ASCC (SU: Sahlgrenska University Hospital; UU: Uppsala University Hospital) have chosen different approaches since 2010.Material and methods: This study included consecutive patients with early ASCC (T1–2N0M0) treated between 2010 and 2017 at both sites (SU n = 70; UU n = 46). Data were retrieved from medical records and RT charts.Results: At SU, the external iliac and presacral LN stations were included in elective LN irradiation in 96.8% (n = 60) and 95.2% (n = 59) patients compared to 2.4% (n = 1) and 29.3% (n = 12) at UU. The mean elective LN volume was 2,313 cc (interquartile range [IQR] 1,951–2,627) in the SU cohort compared to 1,317 cc (IQR 1,192–1,528) in the UU cohort, p < 0.0001. No case of regional LN recurrence was seen in either cohort. Disease specific survival (DSS) at 5 years was 95.7% (confidence interval [CI] 90.1–100.0) in the SU cohort and 97.8% (CI 93.2–100.0) in the UU cohort (p 0.55). OS at 5 years was 84.5% (CI 76.1–93.0) in the SU cohort and 82.6% (CI 69.6–89.1) in the UU cohort (p 0.8).Interpretation: We found no differences in regional recurrence, DSS or OS between the cohorts treated with different elective LN volumes. In this population-based study, reduction of RT volume in early ASCC did not lead to inferior outcome.
|
|
| 6. |
- Johnsson, Anders, et al.
(författare)
-
Anal cancer in Sweden 2015-2019. Implementation of guidelines, structural changes, national registry and early results
- 2022
-
Ingår i: Acta Oncologica. - : Taylor & Francis Group. - 0284-186X .- 1651-226X. ; 61:5, s. 575-582
-
Tidskriftsartikel (refereegranskat)abstract
- Background Squamous cell cancer of the anus is an uncommon malignancy, usually caused by human papilloma virus (HPV). Chemoradiotherapy (CRT) is the recommended treatment in localized disease with cure rates of 60-80%. Local failures should be considered for salvage surgery. With the purpose of improving and equalizing the anal cancer care in Sweden, a number of actions were taken between 2015 and 2017. The aim of this study was to describe the implementation of guidelines and organizational changes and to present early results from the first 5 years of the Swedish anal cancer registry (SACR). Methods The following were implemented: (1) the first national care program with treatment guidelines, (2) standardized care process, (3) centralization of CRT to four centers and salvage surgery to two centers, (4) weekly national multidisciplinary team meetings where all new cases are discussed, (5) the Swedish anal cancer registry (SACR) was started in 2015. Results The SACR included 912 patients with a diagnosis of anal cancer from 2015 to 2019, reaching a national coverage of 95%. We could show that guidelines issued in 2017 regarding staging procedures and radiotherapy dose modifications were rapidly implemented. At baseline 52% of patients had lymph node metastases and 9% had distant metastases. Out of all patients in the SACR 89% were treated with curative intent, most of them with CRT, after which 92% achieved a local complete remission and the estimated overall 3-year survival was 85%. Conclusions This is the first report from the SACR, demonstrating rapid nation-wide implementation of guidelines and apparently good treatment outcome in patients with anal cancer in Sweden. The SACR will hopefully be a valuable source for future research.
|
|
| 7. |
- Nilsson, Martin P., et al.
(författare)
-
Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer
- 2023
-
Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 62:8, s. 897-906
-
Tidskriftsartikel (refereegranskat)abstract
- Background: To date, anal cancer patients are treated with radiotherapy to similar volumes despite a marked difference in risk profile based on tumor location and stage. A more individualized approach to delineation of the elective clinical target volume (CTVe) could potentially provide better oncological outcomes as well as improved quality of life. The aim of the present work was to establish Nordic Anal Cancer (NOAC) group guidelines for delineation of the CTVe in anal cancer.Methods: First, 12 radiation oncologists reviewed the literature in one of the following four areas: (1) previous delineation guidelines; (2) patterns of recurrence; (3) anatomical studies; (4) common iliac and para-aortic recurrences and delineation guidelines. Second, areas of controversy were identified and discussed with the aim of reaching consensus.Results: We present consensus-based recommendations for CTVe delineation in anal cancer regarding (a) which regions to include, and (b) how the regions should be delineated. Some of our recommendations deviate from current international guidelines. For instance, the posterolateral part of the inguinal region is excluded, decreasing the volume of irradiated normal tissue. For the external iliac region and the cranial border of the CTVe, we agreed on specifying two different recommendations, both considered acceptable. One of these recommendations is novel and risk-adapted; the external iliac region is omitted for low-risk patients, and several different cranial borders are used depending on the individual level of risk.Conclusion: We present NOAC consensus guidelines for delineation of the CTVe in anal cancer, including a risk-adapted strategy.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Radu, Calin, 1969-, et al.
(författare)
-
Integrated peripheral boost in preoperative radiotherapy for the locally most advanced non-resectable rectal cancer patients
- 2013
-
Ingår i: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 52:3, s. 528-537
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose.Few studies have explored the potential clinical advantages of dose escalation and integrated boosts for patients with non-resectable locally advanced rectal cancer. The possibility of escalating dose to non-resectable regions in these patients was the aim of this study.Patients and methods.Seven patients with locally very advanced rectal tumours (sacrum overgrowth or growth into pelvic side walls) were evaluated. Intensity modulated photon and pencil beam scanning proton plans with simultaneously integrated boosts (45 Gy to elective lymph nodes, 50 Gy to tumour and 62.5 Gy to boost area in 25 fractions) were compared.Results.Target coverage was achieved with both photon and proton plans. Estimated risks of acute side effects put the two patients with the largest tumours at unacceptable risk for intestinal toxicity, regardless of modality. The remaining five patients had beneficial sparing of dose to the small intestine with protons.Conclusions.Adding boost to areas where rectal tumours infiltrate adjacent non-resectable organs is an attractive option which appears possible using both photon and proton irradiation. Proton plans reduced dose to organs at risk. Integrated peripheral boosts should be considered more frequently in these very advanced tumours.
|
|
