| 1. |
- Rasmusson, Elisabeth, et al.
(författare)
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Erectile Dysfunction and Absorbed Dose to Penile Base Structures in a Randomized Trial Comparing Ultrahypofractionated and Conventionally Fractionated Radiation Therapy for Prostate Cancer
- 2020
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Ingår i: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier. - 0360-3016 .- 1879-355X. ; 107:1, s. 143-151
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To study the relationships between absorbed dose to penile base structures and erectile dysfunction (ED) in patients treated with ultrahypofractionated (UHF) radiation therapy (RT) or conventionally fractionated (CF) RT for prostate cancer.Methods and Materials: This dose-response study comprises 673 patients (57%) of the 1180 per-protocol patients included in the HYPO-RT-PC trial (median follow-up 5, years), where patients were randomized to CF (39 × 2.0 Gy, 8 weeks) or UHF (7 × 6.1 Gy, 2.5 weeks). No androgen deprivation therapy was allowed. Only patients with erectile function sufficient for intercourse at baseline and complete RT data were included in this study. Erectile function was assessed by physician at regular follow-ups. The main endpoint was severe ED (EDs). The penile bulb (PB) and crus were retrospectively delineated on the treatment planning computed tomography scans. Dose-volume descriptors were derived from EQD2 converted dose matrices (α/β = 3 Gy). Univariable and multivariable Cox proportional hazard regression and logistic regression were used to find predictors for EDS.Results: No significant difference in EDs was found between CF and UHF. During the follow-up period, EDs occurred in 27% of the patients in both treatment groups. Average (median) PB mean dose, Dmean, was 24.5 (20.2) in CF and 18.7 (13.1) Gy3 in UHF. Age was the only significant predictor for EDs in Cox analyses. All dose-volume variables contributed significantly in univariable logistic regression at 2-year follow-up. Age and near maximum dose (D2%) were significant predictors for EDs in multivariable logistic regression analyses at both 1 and 2 years.Conclusions: The frequency of EDS was similar in the CF and UHF treatment groups. Age at radiation therapy was the strongest predictor for EDs, followed by dose to PB, and was most evident for younger patients. We propose D2 % <50 Gy3 and Dmean <20 Gy3 to the PB as the primary objectives to be applied in the treatment planning process.
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| 2. |
- Rasmusson, Elisabeth, et al.
(författare)
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Long-Term Risk of Hip Complications After Radiation Therapy for Prostate Cancer : A Dose-Response Study
- 2021
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Ingår i: Advances in Radiation Oncology. - : Elsevier BV. - 2452-1094. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to analyze the long-term incidence of hip complications after external beam radiation therapy compared with age-matched controls from the general population. We also investigated whether there were any dose−response associations. Methods and materials: A total of 349 patients with prostate cancer treated to curative dose with external beam radiation therapy between 1997 and 2002 were included in the study. Physical and fractionation-corrected dose-volume descriptors were derived for the femoral heads, pubic bone, and sacrum. Information on skeletal events was collected for the patients and 1661 matched controls through the Prostate Cancer database Sweden. Uni- and multivariable Cox proportional hazard regressions were used to analyze the time to event. Results: Data from 346 patients were available for analysis. The median mean physical dose and corresponding equivalent 2-Gy/fraction dose (EQD2) to the femoral heads were 35.5 Gy and 28.7 Gy, respectively. The median follow-up time was 16.0 years. During the follow up, 12 hip fractures occurred. Hip osteoarthritis was diagnosed in 36 cases, with 29 cases leading to replacement surgery. No increased risk of hip fractures was found. Hip osteoarthritis was the only event for which a statistically significant difference was found between the irradiated cohort and the controls (cause-specific hazard ratio: 1.56; 95% confidence interval, 1.07-2.26; P = .02). The cumulative incidence of osteoarthritis at 10 years was 8.1% and 4.9% in the irradiated cohort and the controls, respectively. A significant relationship between osteoarthritis and the volume of the femoral head receiving ≥40 Gy (ie, EQD2) was found. Conclusions: In this study of 346 patients treated with conventional radiation therapy, we found no increased risk of hip fracture but an increased risk of clinically relevant osteoarthritis at long-term follow up. Our results indicate a dose–response relationship between osteoarthritis and the volume of the femoral head receiving an EQD2 dose of ≥40 Gy.
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| 3. |
- Rasmusson, Elisabeth, et al.
(författare)
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Low-dose rate brachytherapy with I-125 seeds has an excellent 5-year outcome with few side effects in patients with low-risk prostate cancer
- 2016
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Ingår i: Acta Oncologica. - Oxon : Taylor & Francis. - 0284-186X .- 1651-226X. ; 55:8, s. 1016-1021
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low-dose rate brachytherapy (LDR-BT) has been used in Sweden for more than a decade for treatment of low-risk prostate cancer. This study presents the outcome for patients treated with LDR-BT at a single institution with focus on the association between dose and biochemical failure-free survival (BFFS).Methods: In total 195 patients were treated with LDR-BT between 2004 and 2008. The patients were followed systematically for side effects for at least one year. PSA levels were followed regularly from three months and for at least five years. Outcome was analyzed in relation to clinical variables at baseline and to radiotherapy data.Results: Kaplan-Meier estimated BFFS at five years was 95.7%. Dose to the prostate in terms of D-90% was significantly associated with BFFS [HR 0.90 (95%CI 0.83-0.96), p=0.002].Conclusion: Out data confirmed that absorbed dose is a predictive factor for BFFS for low-risk patients without androgen deprivation therapy. With our treatment routines and dosimetry, a D-90% in the range of 170-180Gy gives excellent outcomes with acceptable toxicity for patients with low-risk prostate cancer.
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| 4. |
- Rasmusson, Elisabeth, et al.
(författare)
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Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer
- 2013
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Ingår i: Radiation Oncology. - 1748-717X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of the present study was to evaluate the prevalence and severity of lower limb lymphedema after pelvic lymphadenectomy and radiotherapy to the pelvic lymph nodes in patients with prostate cancer. Methods: Twenty-six patients underwent combined treatment for high-risk node-positive prostate cancer at Skane University Hospital between April 2008 and March 2011. The treatment consisted of extended pelvic lymphadenectomy followed by androgen deprivation therapy and radiotherapy. The pelvic lymphnodes, prostate and seminal vesicles were treated with external beam radiotherapy (EBRT) to an absorbed dose of 50 Gy followed by a brachytherapy (BT) boost of 2x10 Gy to the prostate only. Twenty-two patients accepted an invitation to a clinical examination with focus on lower limb swelling. The median time between the end of radiotherapy and examination was 2.2 years (range 1.2-4.1). Results: Six patients (27%) experienced grade 1 lymphedema and two patients (9%) grade 2 while none had grade 3 or 4 according to the CTC Common Toxicity Criteria scale 4.0. Three patients required treatment with compression stockings. Conclusion: Brachytherapy and pelvic EBRT have a low incidence of lymphedema (at median 2.2 y after treatment) in patients with high-risk node-positive prostate cancer that have undergone pelvic lymph node dissection.
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| 5. |
- Gullström, Martin, et al.
(författare)
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Blue Carbon Storage in Tropical Seagrass Meadows Relates to Carbonate Stock Dynamics, Plant–Sediment Processes, and Landscape Context : Insights from the Western Indian Ocean
- 2018
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Ingår i: Ecosystems (New York. Print). - : Springer Science and Business Media LLC. - 1432-9840 .- 1435-0629. ; 21:3, s. 551-566
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Tidskriftsartikel (refereegranskat)abstract
- Globally, seagrass ecosystems are considered major blue carbon sinks and thus indirect contributors to climate change mitigation. Quantitative estimates and multi-scale appraisals of sources that underlie long-term storage of sedimentary carbon are vital for understanding coastal carbon dynamics. Across a tropical–subtropical coastal continuum in the Western Indian Ocean, we estimated organic (Corg) and inorganic (Ccarb) carbon stocks in seagrass sediment. Quantified levels and variability of the two carbon stocks were evaluated with regard to the relative importance of environmental attributes in terms of plant–sediment properties and landscape configuration. The explored seagrass habitats encompassed low to moderate levels of sedimentary Corg (ranging from 0.20 to 1.44% on average depending on species- and site-specific variability) but higher than unvegetated areas (ranging from 0.09 to 0.33% depending on site-specific variability), suggesting that some of the seagrass areas (at tropical Zanzibar in particular) are potentially important as carbon sinks. The amount of sedimentary inorganic carbon as carbonate (Ccarb) clearly corresponded to Corg levels, and as carbonates may represent a carbon source, this could diminish the strength of seagrass sediments as carbon sinks in the region. Partial least squares modelling indicated that variations in sedimentary Corg and Ccarb stocks in seagrass habitats were primarily predicted by sediment density (indicating a negative relationship with the content of carbon stocks) and landscape configuration (indicating a positive effect of seagrass meadow area, relative to the area of other major coastal habitats, on carbon stocks), while seagrass structural complexity also contributed, though to a lesser extent, to model performance. The findings suggest that accurate carbon sink assessments require an understanding of plant–sediment processes as well as better knowledge of how sedimentary carbon dynamics are driven by cross-habitat links and sink–source relationships in a scale-dependent landscape context, which should be a priority for carbon sink conservation.
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| 6. |
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| 7. |
- Rasmusson, Annica J., et al.
(författare)
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Toll-like receptor 4 methylation grade is linked to depressive symptom severity
- 2021
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Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- This study explores potential associations between the methylation of promoter-associated CpG sites of the toll-like receptor (TLR)-family, plasma levels of pro-inflammatory proteins and depressive symptoms in young female psychiatric patients. Ratings of depressive symptoms and blood samples were obtained from 92 young women seeking psychiatric care. Methylation of 32 promoter-associated CpG sites in TLR1 to TLR10 was analysed using the Illumina Infinium Methylation EPIC BeadChip. Expression levels of 91 inflammatory proteins were determined by proximity extension assay. Statistical correlations between depressive state, TLR1-10 methylation and inflammatory proteins were investigated. Four additional cohorts were studied to evaluate the generalizability of the findings. In the discovery cohort, methylation grade of cg05429895 (TLR4) in blood was inversely correlated with depressive symptoms score in young adults. After correction for multiple testing, plasma levels of macrophage inflammatory protein 1 beta (MIP-1 beta/CCL4) were associated with both TLR4 methylation and depressive symptom severity. A similar inverse association between TLR4 methylation in blood and affective symptoms score was also found in a cohort of 148 both males and females (<40 years of age) from the Danish Twin Registry. These findings were not, however, replicated in three other external cohorts; which differed from the first two cohorts by a higher age and mixed ethnicities, thus limiting the generalizability of our findings. However, TLR4 methylation inversely correlated with TLR4 mRNA expression in the Danish Twin Study indicating a functional significance of methylation at this particular CpG. Higher depression scores in young Scandinavian adults was associated with decreased methylation of TLR4 in blood.
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| 8. |
- Rasmusson, Elisabeth
(författare)
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Patient Outcomes after Radiotherapy of Prostate Cancer. Impact of Absorbed Dose and Treated Volume.
- 2020. - 1
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Backgound Prostate cancer is the most common form of cancer in men in Sweden. Radiotherapy, including external beam radiation therapy (EBRT) and brachytherapy (BT), is important treatment alternatives to surgery and active surveillance. Precise delivery of the prescribed absorbed dose to the prostate with minimal irradiation of normal tissue, specifically organs at risk, is crucial for optimal tumour response and limited side effects. The overall aim of this work was to investigate the outcome of radiotherapy for prostate cancer in the clinical settings. A specific aim was to study associations between radiation dose and outcome (tumour response and/or side effects) when applicable. Material and methods The studies were based on clinical patient data.Lymphedema was studied in 22 patients treated with EBRT including large pelvic volumes in combination with high-dose-rate (HDR)-BT and hormonal therapy after lymph-node dissection. Tumour outcome was studied retrospectlively in 195 patients treated with low-dose-rate (LDR)-BT at Skåne University Hospital. Erectile dysfunction (ED) after EBRT was studied in 673 patients, treated in the HYPO-RT-PC randomised phase 3 trial comparing conventional fractionation (CF) with ultrahypofractionation (UHF). Long-term incidence of hip complications after EBRT was studied in 351 patients using outcome data from the National Prostate Cancer Datatbase, PCBaSe. Results: A low rate of lymphedema was found in the group of high-risk node-positive cancer patients, supporting the feasability of this extensive treatment. Excellent outcomes were found in the cohort of low-risk prostate cancer patients treated with LDR-BT showing a biochemical failure-free survival (BFFS) rate of 95.7% at 5 years with few side effects. The dose to the prostate ( D90%) was significantly associated with BFFS. The frequency of ED was similar in the CF and UHF treatment groups. Age was the strongest predictor of severe ED followed by dose to penile bulb (PB) beeing most evident for younger patients. EQD2-corrected doses of D2 % < 50 Gy and Dmean < 20 Gy to PB are suggested as treatement planning objectives in order to minimise ED after EBRT. No increased risk of hip fracture was found after radical radiotherpy but an increased risk of clinically relevant osteoarthritis was observed. These results indicate that osteoarthritis after EBRT is reduced by limiting the volume of the femoral heads receiving more than 40 Gy (EQD2). Conclusions: Toxicity was acceptable after treating pelvic nodes with EBRT. Significant associations were found between dose coverage and tumour-control in LDR-BT, between dose to PB and ED and dose to femoral head and ostearthritis, following EBRT. These findings add valuable information in the design of future radiotherapy regimens.
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