| 1. |
- Elliot, Anders H., et al.
(författare)
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Pretreatment MRI in Primary Rectal Cancer as a Predictor for Oncological Outcomes After Surgery for Local Recurrence
- 2021
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Ingår i: Anticancer Research. - : Anticancer Research USA Inc.. - 0250-7005 .- 1791-7530. ; 41:5, s. 2459-2465
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: For patients with locally recurrent rectal cancer (LRRC) extensive surgery is often the only curative option and patient selection is crucial. This study aimed to investigate whether magnetic resonance imaging (MRI) characteristics of the primary tumour can predict oncological outcome after surgery for locally recurrent rectal cancer (LRRC). Patients andMethods: All patients undergoing surgery for LRRC with a curative intent at the Karolinska University Hospital 2003-2013 were included. MRI examinations of the primary tumour were re-evaluated.Results: In total, 54 patients were included. A tumour volume decrease of <70% after preoperative radiotherapy or chemoradiotherapy (C)RT for the primary tumour was correlated with a lower proportion of R0 resection of the LRRC (OR=0.07, 95% CI=0.01-0.84). No association between MRI characteristics of the primary tumour and prognosis after LRRC surgery was found.Conclusion: Long-term outcomes after surgery for LRRC were not significantly associated with MRI characteristics of the index tumour. However, factors associated with increased risk of R1 resection of LRRC were identified.
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| 2. |
- Foukakis, Theodoros, et al.
(författare)
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Immune gene expression and response to chemotherapy in advanced breast cancer
- 2018
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 118:4, s. 480-488
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Tidskriftsartikel (refereegranskat)abstract
- Background:Transcriptomic profiles have shown promise as predictors of response to neoadjuvant chemotherapy in breast cancer (BC). This study aimed to explore their predictive value in the advanced BC (ABC) setting.Methods:In a Phase 3 trial of first-line chemotherapy in ABC, a fine needle aspiration biopsy (FNAB) was obtained at baseline. Intrinsic molecular subtypes and gene modules related to immune response, proliferation, oestrogen receptor (ER) signalling and recurring genetic alterations were analysed for association with objective response to chemotherapy. Gene-set enrichment analysis (GSEA) of responders vs non-responders was performed independently. Lymphocytes were enumerated in FNAB smears and the absolute abundance of immune cell types was calculated using the Microenvironment Cell Populations counter method.Results:Gene expression data were available for 109 patients. Objective response to chemotherapy was statistically significantly associated with an immune module score (odds ratio (OR)=1.62; 95% confidence interval (CI), 1.03-2.64; P=0.04). Subgroup analysis showed that this association was restricted to patients with ER-positive or luminal tumours (OR=3.54; 95%, 1.43-10.86; P=0.012 and P for interaction=0.04). Gene-set enrichment analysis confirmed that in these subgroups, immune-related gene sets were enriched in responders.Conclusions:Immune-related transcriptional signatures may predict response to chemotherapy in ER-positive and luminal ABC.
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| 3. |
- Salehi, Sahar, et al.
(författare)
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Cardiophrenic lymph node resection in advanced ovarian cancer : surgical outcomes, pre- and postoperative imaging
- 2018
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Ingår i: Acta Oncologica. - 0284-186X. ; 57:6, s. 820-824
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the accuracy of preoperative imaging in the diagnosis of cardiophrenic lymph node (CPLN) metastases and to report perioperative outcomes after resection of CPLN at the time of cytoreductive surgery for advanced epithelial ovarian cancer (EOC). Furthermore, to assess clearance of CPLN by postoperative imaging. Methods: All women with stage IIIC/IV EOC subjected to surgery at our institution from January 2014 to October 2016 were retrospectively identified from a database. Among these, women subjected to CPLN resection during surgery were identified. Pre- and postoperative computed tomography (CT) scans, pathology reports, surgical approach and outcomes were reviewed. Results: One hundred and eighty women with stage IIIC/IV EOC subjected to surgery with curative intent were identified. Twenty-four (13%) of these women underwent CPLN resection. All had CT imaging suggestive of CPLN metastases. 20/24 (83%) had confirmed metastases upon final pathology. CPLN resection was associated with longer operation time, more often advanced upper abdominal surgery and more postoperative complications but there was no difference in days from surgery to initiation of chemotherapy. Postoperative CT was still indicative of CPLN metastases in 13/22 (59%) women despite resection with confirmative pathology. Conclusions: Resection of CPLN metastases is highly feasible without considerable added morbidity. Concern regarding surgical clearance is raised since postoperative imaging was indicative of metastases in the majority of women. The prognostic significance of stage IV disease based exclusively on CPLN metastases is unclear and any survival benefit from the procedure is yet to be determined.
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| 4. |
- Salehi, Sahar, et al.
(författare)
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Long-term quality of life after comprehensive surgical staging of high-risk endometrial cancer - results from the RASHEC trial
- 2018
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Ingår i: Acta Oncologica. - : TAYLOR & FRANCIS LTD. - 0284-186X .- 1651-226X. ; 57:12, s. 1671-1676
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The health-related quality of life (HRQoL) outcomes after comprehensive surgical staging including infrarenal paraaortic lymphadenectomy in women with high-risk endometrial cancer (EC) are unknown. Our aim was to investigate the long-term HRQoL between robot-assisted laparoscopic surgery (RALS) and laparotomy (LT). Patients and Methods: A total of 120 women with high-risk stage I-II EC were randomised to RALS or LT for hysterectomy, bilateral salpingoophorectomy, pelvic and infrarenal paraaortic lymphadenectomy in the previously reported Robot-Assisted Surgery for High-Risk Endometrial Cancer trial. The HRQoL was measured with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-30) and its supplementary questionnaire module for endometrial cancer (QLQ-EN24) questionnaire. Women were assessed before and 12 months after surgery. In addition, the EuroQol Eq5D non-disease specific questionnaire was used for descriptive analysis. Results: There was no difference in the functional scales (including global health status) in the intention to treat analysis, though LT conferred a small clinically important difference (CID) over RALS in cognitive functioning albeit not statistically significant -6 (95% CI-14 to 0, p = .06). LT conferred a significantly better outcome for the nausea and vomiting item though it did not reach a CID, 4 (95% CI 1 to 7, p = .01). In the EORTC-QLQ/QLQ-EN24, no significant differences were observed. Eq5D-3L questionnaire demonstrated a higher proportion of women reporting any extent of mobility impairment 12 months after surgery in the LT arm (p = .03). Conclusion: Overall, laparotomy and robot-assisted surgery conferred similar HRQoL 12 months after comprehensive staging for high-risk EC.
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| 5. |
- Suzuki, Chikako, et al.
(författare)
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Assessing polyp size by improved digitalized computed tomography (CT)
- 2008
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Ingår i: Anticancer Research. - 0250-7005 .- 1791-7530. ; 28:3B, s. 1911-1915
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Tidskriftsartikel (refereegranskat)abstract
- Background: The size of colorectal polyps is important in the clinical management of these lesions. When using a conventional ruler (the tool of pathologists worldwide), we have previously found unacceptably high intra- and inter-observer variations in assessing the size of phantom polyps. The aim of this study was to assess the size of 12 phantom polyps by computed tomography (CT). Materials and Methods: The size of phantom polyps as assessed by CT was compared to the gold standard size (GSS) measured at The Royal Institute of Technology, Stockholm, Sweden. Results: In 33.3% (n=4) of the 12 polyps and in 41.7% (n=25) of the 60 measurements, the mean CT size under- or overestimated the GSS by more than 1 mm. In 15%, or in 9 of the 60 measurements, the CT size was under- or overestimated by more than 2 mm. In polyp #5 the GSS size was 8.41 mm where the expected cancer-risk in adenomas is 1%. But 3 out of 5 CT measurements were >10 mm, where the expected cancer-risk in adenomas is 10%. In polyp #10 the GSS size was 10.20 mm where the expected cancer-risk is 10%. But 2 out of 5 CT measurements were <10 mm where the expected risk is only 1%. Conclusion: The size assessed by CT was more reliable than that obtained with a millimetre ruler using the same devices, inasmuch as the disparate individual deviation-values found with the latter method were avoided. The volume and the shape of the devices influenced size assessment of phantom polyps by CT.
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| 6. |
- Suzuki, Chikako
(författare)
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Computed tomography based assessment of treatment response in solid tumors
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A “substantial evidence” of effectiveness is required for new cancer treatment regimens to be approved. Objective tumor shrinkage/enlargement has been adopted as an indicator of drugs efficacy. The change of tumor size is assessed and quantified by various radiological techniques; most commonly computed tomography (CT). A high accuracy and reproducibility is, for obvious reasons, necessary in order to achieve a meaningful evaluation of such studies. For that purpose, the World Health Organization criteria (WHO-criteria) were launched in 1979 followed by the Response Evaluation Criteria In Solid Tumors (RECIST) in 2000 and the updated version RECIST 1.1 in 2009. There are, however, still several steps that may deteriorate consistencies. The purpose of this thesis was to investigate causes that may affect inconsistency in evaluation procedure according to RECIST (study I and II) and to explore the percentage of tumor size change at the first follow-up CT as the potential new surrogate indicators for OS in patient with metastatic colorectal cancer (mCRC) (study III) and in patient with metastatic breast cancer (MBC) (study IV). The number of discordant cases increased gradually when assessing fewer target lesions. Measuring fewer than four target lesions might cause discrepancies when more than five target lesions were present (study I). Interobserver variation using RECIST and WHO-criteria were moderate: 0.53 (95%CI 0.33 - 0.72) and 0.60 (0.39 – 0.80), respectively. Intraobserver variation using RECIST and WHO-criteria were substantial to perfect that ranged between 0.76 – 0.96 and 0.86 – 0.91, respectively (study II). The initial change in tumor size 8 weeks after initiation of chemotherapy was prognostic for PFS: Hazard Ratio (HR) 2.21, 95%CI 1.97 – 2.49, and OS: HR2.01, 95%CI 1.75 – 2.31, in mCRC (study III). The initial change in tumor size also correlated with OS in MBC (study IV). A marked difference in OS between patients with or without new lesion was demonstrated in mCRC: HR 3.77, 95%CI 2.08 – 6.83 (study III) and in MBC: HR 4.29, 95%CI 2.44 – 7.53 (study IV). In conclusion, the current tumor response evaluation criteria are associated with several subjective steps that may cause inconsistent results. The initial change in tumor size at the first follow-up CT may provide an alternative surrogate outcome. The findings obtained in this thesis may improve the development of future response evaluation criteria.
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| 7. |
- Suzuki, Chikako, et al.
(författare)
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Impact of the first tumor response at eight weeks on overall survival in metastatic breast cancer patients treated with first-line combination chemotherapy
- 2013
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Ingår i: Medical Oncology. - : Humana Press. - 1357-0560 .- 1559-131X. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this was to determine whether the change of size observed at the first response evaluation after initiation of first-line combination chemotherapy correlates with overall survival (OS) in patients with metastatic breast cancer (MBC). The change in size of tumors derived from measurements according to Response Evaluation Criteria In Solid Tumors (RECIST) at the first evaluation on computed tomography (CT) was obtained from a multicenter, randomized phase III trial ("TEX trial," n = 287) comparing treatment with a combination of epirubicin and paclitaxel alone or with capecitabine (TEX). Cox regression and Kaplan-Meier analyses were performed to evaluate the correlations between the first change in tumor size, response according to RECIST and OS. Data from CT evaluations of 233 patients were available. Appearance of new lesions or progression of non-target lesions (new/non-target) indicated short OS by univariable regression analysis (HR 3.76, 95 % CI 1.90-7.42, p andlt; 0.001). A decrease by andgt;30 % at this early time point was prognostic favorable (HR 0.69, 95 % CI 0.49-0.98, p = 0.04) and not significantly less than the best overall response according to RECIST. After adjustment for previous adjuvant treatment and the treatment given within the frame of the randomized trial, OS was still significantly shorter in patients with new/non-target lesions after a median 8 weeks of treatment (HR 4.41, 95 % CI 2.74-7.11, p andlt; 0.001). Disease progression at the first evaluation correlates with OS in patients with MBC treated with first-line combination chemotherapy. The main reason for early disease progression was the appearance of new lesions or progression of non-target lesions. These patients had poor OS even though more lines of treatment were available. Thus, these factors should be focused on in the response evaluations besides tumor size changes.
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| 8. |
- Suzuki, Chikako, et al.
(författare)
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Interobserver and intraobserver variability in the response evaluation of cancer therapy according to RECIST and WHO-criteria
- 2010
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 49:4, s. 509-514
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Response Evaluation Criteria In Solid Tumors (RECIST) and WHO-criteria are used to evaluate treatment effects in clinical trials. The purpose of this study was to examine interobserver and intraobserver variations in radiological response assessment using these criteria.MATERIAL AND METHODS: Thirty-nine patients were eligible. Each patient's series of CT images were reviewed. Each patient was classified into one of four categories according RECIST and WHO-criteria. To examine interobserver variation, response classifications were independently obtained by two radiologists. One radiologist repeated the procedure on two additional different occasions to examine intraobserver variation. Kappa statistics was applied to examine agreement.RESULTS: Interobserver variation using RECIST and WHO-criteria were 0.53 (95% CI 0.33-0.72) and 0.60 (0.39-0.80), respectively. Response rates (RR) according to RECIST obtained by reader A and reader B were 33% and 21%, respectively. RR according to WHO-criteria obtained by reader A and reader B were 33% and 23% respectively. Intraobserver variation using RECIST and WHO-criteria ranged between 0.76-0.96 and 0.86-0.91, respectively.CONCLUSION: Radiological tumor response evaluation according to RECIST and WHO-criteria are subject to considerable inter- and intraobserver variability. Efforts are necessary to reduce inconsistencies from current response evaluation criteria.
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| 9. |
- Suzuki, Chikako, et al.
(författare)
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Radiologic measurements of tumor response to treatment : practical approaches and limitations
- 2008
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Ingår i: Radiographics. - : Radiological Society of North America (RSNA). - 0271-5333 .- 1527-1323. ; 28:2, s. 329-44
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Tidskriftsartikel (refereegranskat)abstract
- Objective response assessment is important to describe the treatment effect of anticancer drugs. Standardization by using a "common language" is also important for comparison of results from different trials. In contrast to clinical results, which can be subjective, diagnostic imaging provides a greater opportunity for objectivity and standardization. It was generally accepted that a decrease in tumor size correlated with treatment effect; as a result, imaging was adopted for lesion measurement in the World Health Organization (WHO) criteria in 1979. However, because of some limitations of the WHO criteria, the Response Evaluation Criteria in Solid Tumors (RECIST) were introduced in 2000. In RECIST, imaging was recognized as indispensable for response evaluation of solid tumors. Nevertheless, the widespread use of multidetector computed tomography and other imaging innovations have made RECIST outdated, with a concomitant need for modifications. Meanwhile, newer anticancer agents with targeted mechanisms of action have demonstrated an inherent limitation and unsuitability of anatomic tumor evaluation that assesses only lesion size. In addition, the effect of these new drugs changes the paradigm according to which tumor response or response rate is measured. Complete and partial responses cannot be the end points in all clinical trials; in some cases, disease control or progression-free survival may be the more relevant end point.
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| 10. |
- Suzuki, Chikako, et al.
(författare)
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The importance of rectal cancer MRI protocols on interpretation accuracy
- 2008
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Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 6, s. 89-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Magnetic resonance imaging (MRI) is used for preoperative local staging in patients with rectal cancer. Our aim was to retrospectively study the effects of the imaging protocol on the staging accuracy. PATIENTS AND METHODS: MR-examinations of 37 patients with locally advanced disease were divided into two groups; compliant and noncompliant, based on the imaging protocol, without knowledge of the histopathological results. A compliant rectal cancer imaging protocol was defined as including T2-weighted imaging in the sagittal and axial planes with supplementary coronal in low rectal tumors, alongside a high-resolution plane perpendicular to the rectum at the level of the primary tumor. Protocols not complying with these criteria were defined as noncompliant. Histopathological results were used as gold standard. RESULTS: Compliant rectal imaging protocols showed significantly better correlation with histopathological results regarding assessment of anterior organ involvement (sensitivity and specificity rates in compliant group were 86% and 94%, respectively vs. 50% and 33% in the noncompliant group). Compliant imaging protocols also used statistically significantly smaller voxel sizes and fewer number of MR sequences than the noncompliant protocols CONCLUSION: Appropriate MR imaging protocols enable more accurate local staging of locally advanced rectal tumors with less number of sequences and without intravenous gadolinium contrast agents.
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