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Sökning: WFRF:(Derwinger Kristoffer 1969)

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1.
  • Corin, Irina, 1969, et al. (författare)
  • A study of the expression of Cyclin E and its isoforms in tumor and adjacent mucosa, correlated to patient outcome in early colon cancer.
  • 2010
  • Ingår i: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 49:1, s. 63-69
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Cyclin E, a key regulator in the cell cycle, is often over-expressed in malignant disease. It can present as full length (FL) and low-molecular-weight (LMW) isoforms. The purpose of this study was to characterize the expression pattern of cyclin E in colon cancer, both in tumor and in macroscopically normal adjacent mucosa. A secondary aim was to study the possible correlation to clinical factors and patient outcome. MATERIAL AND METHOD: Tumor and mucosa tissue from 114 patients with radically operated, non-metastatic colon tumors were analyzed. The cyclin E expression was measured by Western Blot in the tumor and adjacent mucosa using the antibody targeting C-terminal. The cyclin E expression was correlated to both pathology factors as differentiation grade and to the patient outcome. RESULTS: Cyclin E was detected in both tumor and adjacent mucosa and in both FL and LMW-forms. FL was present in 29 (25.4%) tumors and only in three (2.6%) mucosa samples, the corresponding figures for the LMW-isoforms were 80 (70.2%) and 67 (58.8%). There was no correlation between the cyclin E expression and gender, age, tumor location or tumor pathology. Patients with a high expression of LMW isoforms (p < 0.03) or a high total expression (FL+LMW) (p < 0.006) had higher risks of recurrence and thus a worse survival. CONCLUSION: Cyclin E is expressed in FL- and LMW-forms in both colon tumors and the macroscopically normal adjacent mucosa. A high expression of cyclin E in tumor was associated with an increased risk of tumor recurrence and a worse outcome. It could be a possible prognostic marker in non-metastatic colon cancer.
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2.
  • Angenete, Eva, 1972, et al. (författare)
  • The Surgical Teams' Perception of the Effects of a Routine Intraoperative Pause.
  • 2016
  • Ingår i: World journal of surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 40:12, s. 2875-2880
  • Tidskriftsartikel (refereegranskat)abstract
    • A pause routine may reduce stress and errors during surgery. The aim of this study was to explore how the team, divided into the different professional groups, perceived the implementation of a pause routine and its possible impact on safety.A pause routine was introduced at a University hospital operating theatre in Sweden in 2013. Questionnaires were distributed about 1year later to all members of the operating theatre team. The questions included different perspectives of possible effects of the pause routine.A majority were positive to scheduled pauses. The surgeons often felt refreshed and at times changed their view on both anatomy and their surgical strategy. They were also perceived by other team members as improved regarding communication. All groups felt that patient safety was promoted. There were differences by profession in perception of team communication.The pause routine was well perceived by the surgical team. A majority believed that scheduled and regular pauses contribute to improved patient safety and better team communication. There were also findings of differences in communication and experience of team coherence between personnel categories that could benefit from further acknowledgement and exploration.
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3.
  • Bexe-Lindskog, Elinor, et al. (författare)
  • A population-based cohort study on adherence to practice guidelines for adjuvant chemotherapy in colorectal cancer
  • 2014
  • Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 14, s. 948-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The value of adjuvant chemotherapy in colorectal cancer is well studied, and guidelines have been established. Little is known about how treatment guidelines are implemented in the everyday clinical setting. Methods: This national population-based study on nearly 34,000 patients with colorectal cancer evaluates the adherence to present clinical guidelines for adjuvant chemotherapy. Virtually all patients with colorectal cancer in Sweden during the years 2007-2012 and data from the Swedish Colorectal Cancer Registry were included. Results: In colon cancer stage III, adherence to national guidelines was associated with lower age, presence of multidisciplinary team (MDT) conference, low co-morbidity, and worse N stage. The MDT forum also affected whether or not high-risk stage II colon cancer patients were considered for adjuvant chemotherapy. Rectal cancer patients both in stage II and III were considered for adjuvant chemotherapy less often than colon cancer patients, but the same factors influenced the decision. Adjuvant chemotherapy was started later than eight weeks after surgery in 30% of colon cancer patients and in 38% of rectal cancer patients. Conclusions: In Sweden, the adherence to national guidelines for adjuvant chemotherapy in colon cancer stage III is acceptable in younger and healthier patients. MDT conferences are of major importance and affect whether patients are recommended for adjuvant chemotherapy. Special consideration needs to be given to certain subgroups of patients, particularly older patients and patients with poorly differentiated tumors. There is a need to shorten the waiting time until start of chemotherapy.
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4.
  • Bexe-Lindskog, Elinor, et al. (författare)
  • Thymidine phosphorylase expression is associated with time to progression in patients with metastatic colorectal cancer.
  • 2014
  • Ingår i: BMC clinical pathology. - : Springer Science and Business Media LLC. - 1472-6890. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • 5-Fluorouracil (5-FU) is the cornerstone of chemotherapeutic treatment for patients with colorectal cancer. The enzyme thymidine phosphorylase (TP) catalyzes the conversion of 5-FU to its active metabolite, 5-fluoro-2'-deoxyuridine. TP is expressed in tumour epithelial cells and stromal cells, particularly in tumour-associated macrophages. These macrophages may affect sensitivity to chemotherapy. Previously, we identified TP as a predictive factor in microdissected tumour samples of patients with advanced colorectal cancer. In the present study, we analysed TP expression in tissues and associated stromal cells from patients with advanced colorectal cancer and associated TP levels to tumour response and time-to-event variables during first-line chemotherapy treatment. We also investigated the association between serum TP levels at the time of surgery and gene expression in primary tumour tissues.
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5.
  • Bexe-Lindskog, Elinor, et al. (författare)
  • Thymidine Phosphorylase Gene Expression in Stage III Colorectal Cancer.
  • 2012
  • Ingår i: Clinical Medicine Insights. Oncology. - 1179-5549. ; 6, s. 347-53
  • Tidskriftsartikel (refereegranskat)abstract
    • The thymidine phosphorylase (TP) enzyme has several tumor-promoting functions. The aim of this study was to explore TP gene expression in relation to clinical and histopathological data obtained from patients with stage III colorectal cancer.
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6.
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7.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • A phase I/II study of neoadjuvant chemotherapy with Pemetrexed (Alimta) in rectal cancer.
  • 2011
  • Ingår i: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. - : Elsevier BV. - 1532-2157. ; 37:7, s. 583-8
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to assess the feasibility of preoperative chemotherapy and possible tumour response using Pemetrexed (Alimta) in rectal cancer.
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8.
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9.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • A study of lymph node ratio as a prognostic marker in colon cancer.
  • 2008
  • Ingår i: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. - : Elsevier BV. - 1532-2157. ; 34:7, s. 771-5
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The aim of this study was to evaluate and describe the lymph node ratio (LNR) as a prognostic parameter for patients with colon cancer. As lymphatic involvement is the key, focus was set at stage III disease. Interest was directed at the possibility of identifying high-risk groups and the clinical implementation and consequence. METHOD: The study was retrospective using a database of clinical data of all cancer patients treated at our unit. It has been continuous in registration, inclusion and update since 1999 including survival and clinical features. All patients (n=265) diagnosed with stage III colon cancer during 1999-2003 were included for the study. LNR was calculated and quartile groups were created. LNR and associated parameters were analysed towards 3-year disease-free survival (DFS). Basic patient data as well as surgery, pathology and postoperative treatment were taken into consideration. RESULTS: Significant differences in disease-free survival were found for TNM N-status, tumour differentiation grade and LNR quartile group. There was a difference in 3-year DFS from 80% in LNR group 1 compared with less than 30% in group 4. These results were of prognostic interest both independently and in interaction with each other. High-risk groups could be identified and in the worst prognosis LNR group we also found a tendency towards more side effects with adjuvant chemotherapy. CONCLUSION: The lymph node ratio, the quota between the number of lymph node metastasis and assessed lymph nodes, is a highly significant (p<0.001) prognostic factor in stage III colon cancer. It can be an aid in identifying risk groups that could benefit from a more intense postoperative surveillance and possibly bring changes in adjuvant treatment strategy. More studies of clinical data, genetic and biochemical markers are needed in this patient group to understand the possible difference in tumour behaviour and tailor the treatment.
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10.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • A study of lymph node ratio in stage IV colorectal cancer.
  • 2008
  • Ingår i: World journal of surgical oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT: BACKGROUND: The finding of metastasis in colorectal cancer, stage IV disease, has a major impact on prognosis and treatment strategy. Known important factors include the extent of the metastasis and the patients' performance status. The lymph node factors are of known importance in earlier cancer stages but less described in metastatic disease. The aim of the study was to evaluate lymph node status and ratio as prognostic markers in stage IV colorectal cancer. METHOD: The study was retrospective and assessing all patients operated, with bowel resection, for an initial stage IV colorectal cancer during 1999-2003 (n=136). Basic demographic data as well as given treatment was assessed. The Lymph node ratio (LNR), the quota between the number of lymph node metastasis and assessed lymph nodes, was calculated. LNR groups were created by ratio thirds, 3 equally sized groups. The analysis was made by LNR group and by eligibility for chemotherapy with cancer specific survival as outcome parameter. RESULTS: The median survival (CSS) for the entire group was 431 days with great variability. For the patients eligible for chemotherapy it ranged from 791 days in LNR-group 1 to 433 days for the patients in group 3. For patients ineligible for chemotherapy the corresponding figures were 209 and 91 days. The eligibility for chemotherapy was a major prognostic factor which also takes co-morbidity, age and performance status into consideration. The LNR (p<0.01) and the tumour differentiation grade were also significant (p<0.05) factors regarding survival. The LNR group 3 was also associated with a higher frequency of multiple metastasis locations (p<0.05) and of more side effects with chemotherapy and thus of reductions in dosage or pre-emptive treatment ending (p<0.05). CONCLUSION: Stage IV colorectal cancer is a heterogeneous group regarding the survival prognosis. The lymph node ratio was found to be a significant marker for the survival prognosis (p<0.0049). High and low risk groups could be identified with a survival difference of up to one year. It could be of importance when planning a treatment strategy or evaluating clinical data materials. A pathology report should include a node assessment even at presence of synchronous metastasis.
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11.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • A study of the MTHFR gene polymorphism C677T in colorectal cancer.
  • 2009
  • Ingår i: Clinical colorectal cancer. - 1533-0028. ; 8:1, s. 43-8
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of this study was to examine the clinical significance of the methylenetetrahydrofolate reductase (MTHFR) gene polymorphism C677T in colorectal cancer (CRC). The hypothesis was that the genotype could affect the risk of cancer development and the results of cancer treatment. PATIENTS AND METHODS: Genotyping was made for a random 30% (n = 544) of all patients treated for CRC at our unit from 1999 to 2006 (n = 1812). Basic clinical and pathologic factors were analyzed by genotype group and also compared with those of the entire cohort. Tolerability of chemotherapy and possible side effects were analyzed by genotype. Survival was analyzed by genotype for all stages for patients treated between 1999 and 2003. The genotype prevalence was also compared with a control material of healthy blood donors. RESULTS: No genotype was associated with an increased risk of CRC or higher cancer stage. The patients with CT/TT genotype had significantly greater risk of suffering side effects from fluoropyrimidine (5-fluorouracil) treatment (P < .05). In stage III colon cancer, the patients with CT/TT genotype had a poorer prognosis than those with the CC genotype. The difference was significant in univariate (P < .003) and multivariate (P < .040) analysis. Though the genotype-associated side effect risks remained in stage IV, the effect on survival was not significant (P < .1). CONCLUSION: The MTHFR polymorphism C677T does, in our material, not affect the risk of CRC; however, it can affect the sensitivity to chemotherapy and the risk of side-effects and therefore survival in stage III and possibly stage IV colon cancer. It could be a future predictive factor in the choice of a treatment regimen.
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12.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • Age Aspects of Demography, Pathology and Survival Assessment in Colorectal Cancer
  • 2010
  • Ingår i: ANTICANCER RESEARCH. - : International Institute of Anticancer Research. - 0250-7005 .- 1791-7530. ; 30:12, s. 5227-5231
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this study was to assess how age is related to differences in stage, tumour differentiation and treatment in colorectal cancer. Patients and Methods: A retrospective study in a consecutive series of colorectal cancer patients (n=2220) where age was related to demography, stage, tumour characteristics, treatment and outcome (OS/CSS) both as a continuous variable and grouped by high/low 10th percentiles, as young/old groups, with a third median reference group. Results: Young patients had more advanced cancer stages (p=0.012), higher N-status (p=0.011) and more frequent T4/G4 tumours. Old patients had higher postoperative mortality and were less likely to receive chemotherapy. The proportion of cancer-related deaths was stage-dependent and decreased with age. Conclusion: Cancer stage, tumour characteristics, treatment and outcome can vary with age in colorectal cancer. The increasing proportion of non-cancer deaths at a higher age can affect the use of overall survival as an outcome parameter, which may be of importance in evaluating clinical and translational research.
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13.
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14.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • Defining stage III disease in colorectal cancer--aspects on treatment and evaluation of survival.
  • 2010
  • Ingår i: Journal of surgical oncology. - : Wiley. - 1096-9098 .- 0022-4790. ; 102:5, s. 424-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Stage III in colorectal cancer is defined by presence of node metastasis, whereas distant growth constitutes stage IV. The aim was to describe prognosis in high risk groups of stage III in relation to survival in stage IV, along with possible effect on research and treatment.
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15.
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16.
  • Derwinger, Kristoffer, 1969 (författare)
  • Prognostic and predictive factors in colorectal cancer
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The aim of the thesis was to study prognostic and predictive factors in patients treated for colorectal cancer (CRC). Method: In paper I, a retrospective comparison was made between the patients treated in 1999 (n=180) with those treated in 2004 (n=175). During the period, a multidisciplinary team conference and an improved cooperation with the pathologists had been initiated. The focus of interest was the lymph node assessment, its’ development and how this affected clinical staging and treatment. In paper II, the lymph node diagnostics were studied in patients with stage III colon cancer 1999-2003 (n=265). Prognostic markers were evaluated along with the use of the lymph node ratio as a prognostic indicator to differentiate the risk assessment within the stage group. In paper III, single nucleotide pair (SNP) gene analyses was made for the metylentetrahydrofolate reduktase (MTHFR) gene polymorphism C677T in patients treated for colorectal cancer 1999-2006 (n=544). The functional polymorphisms were then correlated to pathology, stage, outcome and side effects of chemotherapy. Comparisons of genotype prevalence were made against a cohort of 299 blood donors as well as the pathology data of the other 1256 patients treated during this period. In paper IV, the presence of cyclin E in both tumour and mucosa was studied in 114 patients with stage I/II colon cancer treated 2003-2007. The expression was analyzed in both tumour and adjacent mucosa and the results were correlated to pathology, staging and prognosis. Results: In paper I, an improved lymph node assessment was shown to lead to stage migration and thus an increase of patients with stage III disease. A highly variable outcome in stage II associated to an inadequate assessment was also found. In paper II, stage III disease was found to have heterogeneous survival prognosis and the lymph node ratio was a significant marker for the outcome (p<0.001). In paper III, no correlations between polymorphism genotype and the risk of cancer or cancer stage were found. There was a significant correlation to the risk of suffering side-effects (p<0,05) and to the outcome in stage III colon cancer (p<0,003). In paper IV, cyclin E was found to be expressed in both full length form and shorter isoform in both tumour and adjacent mucosa. A high total expression of cyclin E correlated significantly to the risk of tumour recurrence (p<0,0063). Conclusion: The lymph node assessment is a key factor in CRC pathology and of importance for both clinics and research. Additional prognostic information can be gained in stage III colon cancer by use of the lymph node ratio. The function of the folic acid metabolism can affect the risks associated with 5-fluorouracil treatment and also the outcome in stage III colon cancer. Cyclin E is expressed in both tumour and mucosa and could be an independent prognostic factor in stage I/II colon cancer.
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17.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • Stage migration in colorectal cancer related to improved lymph node assessment
  • 2007
  • Ingår i: Eur J Surg Oncol. - 0748-7983. ; 33:7, s. 849-53
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The aim of the study was to evaluate the clinical impact of improved cooperation between the treating surgeons and pathologists in a high volume surgical unit. As a measure we used the staging process with special focus on lymph node assessment. FINDINGS: Comparing two periods 5years apart, we found a significant increase in the number of nodes examined and also an increase in the number of metastasis-positive nodes. Concurrently, we observed a trend in stage migration from stage I/II towards stage III, whilst stage IV remained unchanged. This was one factor that contributed to an increase in the number of patients treated with adjuvant chemotherapy. We also found that the number of assessed nodes had an impact on survival in stage II. The major change in practise was the implementation of a multidisciplinary team conference and the associated possibility of reciprocal feedback. CONCLUSION: Lymph node status has a key role in cancer staging and in the selection of further therapy. The quality and the standard of the assessment can be improved through multidisciplinary cooperation and it has an impact on the clinical decisions and can affect long-term survival. A correct node status should be mandatory in the evaluation of prognostic factors.
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18.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • Tumour differentiation grade is associated with TNM staging and the risk of node metastasis in colorectal cancer.
  • 2010
  • Ingår i: Acta oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 49:1, s. 57-62
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The tumour differentiation grade has been shown by numerous multivariate analyses to be a stage-independent prognostic factor in colorectal cancer. The aim of this study was to explore the importance of differentiation grading for the staging of colorectal cancer and how it relates to the components of the TNM system. MATERIAL AND METHODS: The study was a retrospective single-centre analysis of all patients undergoing surgical resection for colorectal cancer during the period 2002-2007 (n = 1239). The clinical parameters and pathology data of overall stage, differentiation grade, local tumour (T)-stage and metastasis status (M-stage) were included as well as the lymph node count of both assessed and metastatic nodes. The differentiation grade was correlated with demography, overall stage and each component of the TNM staging system. The correlation between differentiation grade and N-stage was also explored for the separate T-stages. RESULTS: The tumour differentiation grade correlated significantly with the overall TNM stage (p < 0.0001). The grade significantly correlated with the T-stage and the risk of having lymph node metastasis (p < 0.0001). A high grade was associated with a higher positive lymph node count in stage III disease (p < 0.0002). For the T-stages, the risk of node metastasis was significantly linked to the tumour grade. A low grade (G1) T2 had a 17% risk of lymph node metastasis compared to a 44% risk for a high grade (G4) T2. CONCLUSION: Tumour differentiation is an important prognostic factor. It correlates significantly with the overall stage of the TNM system and also to each of its components. The risk of having lymph node metastasis for each T-stage also correlates with the tumour grade. The findings can be of importance in postoperative risk assessment or when considering local resection procedures like TEM.
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19.
  • Derwinger, Kristoffer, 1969, et al. (författare)
  • Variations in demography and prognosis by colon cancer location.
  • 2011
  • Ingår i: Anticancer research. - 0250-7005. ; 31:6, s. 2347-50
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: Tumours of the right and left colon are suggested to be different entities with different prognosis. The aim was to explore differences related to the location of a colonic tumour. PATIENTS AND METHODS: A single-centre retrospective analysis of all patients treated for colon cancer during 1999-2008 (n=1558) was carried out. Assessed data included demography, pathology and survival by cancer location, with left colon also sub-divided into left and sigmoid colon. RESULTS: Right colon carcinoma was associated with female gender, higher age and poor grade of differentiation; left colon carcinoma had characteristics of worse stages and requiring emergency surgery. Sigmoid tumours were of better grade and stage. Survival was related the staging, which varied with location. Right colon carcinoma conferred a worse overall survival (OS) (p<0.037) but not cancer-specific survival (CSS) or disease-free survival compared to the entire left colon, whilst sigmoid tumours conferred a better OS and CSS (p<0.001) when the left colon was sub-divided. CONCLUSION: There are differences in demography and pathology related to the location of colon cancer. Sigmoid location carries the best prognosis.
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20.
  • Erestam, Sofia, et al. (författare)
  • A survey of surgeons' perception and awareness of intraoperative time utilization.
  • 2014
  • Ingår i: Patient safety in surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 8
  • Tidskriftsartikel (refereegranskat)abstract
    • Surgical teams' awareness of the time needed to perform specific phases of a surgical procedure is likely to improve communication in the operating theatre and benefit patient safety. The aim of this study was to assess surgeons' awareness of time utilization and the actual time needed to perform specific phases of an operation.
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22.
  • Gustavsson, Bengt, 1947, et al. (författare)
  • Phase 1 dose de-escalation trial of the endogenous folate [6R]-5,10-methylene tetrahydrofolate in combination with fixed-dose pemetrexed as neoadjuvant therapy in patients with resectable rectal cancer.
  • 2015
  • Ingår i: Investigational new drugs. - : Springer Science and Business Media LLC. - 1573-0646 .- 0167-6997. ; 33:5, s. 1078-1085
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Modufolin® ([6R]-5,10-methylene tetrahydrofolate; [6R]-MTHF) is an endogenous biomodulator that is being developed as an alternative to leucovorin, a folate prodrug used in the treatment of colorectal cancer. The objective of this phase 1 dose de-escalation trial was to estimate the minimum tolerated dose of [6R]-MTHF to be used in combination with pemetrexed 500mg/m(2) in the neoadjuvant treatment of patients with rectal cancer. Methods Adult patients (≥18years) with resectable rectal adenocarcinoma were allocated to [6R]-MTHF doses of 500, 100, 50, and 10mg/m(2) in combination with pemetrexed 500mg/m(2). [6R]-MTHF was administered as an intravenous (i.v.) bolus injection 1week prior to the first dose of pemetrexed and then once weekly for 9weeks; pemetrexed was administered by i.v. infusion once every 21days for three cycles. Results Twenty-four patients (mean [SD] age, 63.1 [12.9] years) were enrolled in the study. A total of 72 treatment-related adverse events (AEs) were reported, of which the most common were fatigue (n=17; 23.6%), nausea (n=10; 13.9%), and diarrhea (n=5; 6.9%). The incidence of treatment-related AEs by [6R]-MTHF dose level (500, 100, 50, 10mg/m(2)) was 11.1% (n=8), 13.9% (n=10), 45.8% (n=33), and 29.2% (n=21), respectively. There were no dose-limiting toxicities, and only two (2.8%) treatment-related AEs were grade 3 in severity. Of the 11 serious AEs reported, none were considered to be related to [6R]-MTHF treatment. Conclusions The results of this phase 1 study indicate that the estimated minimum tolerated dose of [6R]-MTHF was 100mg/m(2) once weekly in combination with pemetrexed 500mg/m(2). The low toxicity profile of [6R]-MTHF supports its further evaluation as a component of systemic chemotherapy in the management of colon and rectal cancer.
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23.
  • Kodeda, Karl, et al. (författare)
  • Genomic CGH-assessed structural DNA alterations in rectal carcinoma as related to local recurrence following primary operation for cure.
  • 2012
  • Ingår i: International journal of oncology. - : Spandidos Publications. - 1791-2423 .- 1019-6439. ; 41:4, s. 1397-1404
  • Tidskriftsartikel (refereegranskat)abstract
    • Several factors determine overall outcome and possible local recurrence after curative surgery for rectal carcinoma. Surgical performance is usually believed to be the most pertinent factor, followed by adjuvant oncological treatment and tumor histopathology. However, chromosomal instability is common in colorectal cancer and tumor clones are assumed to differ in aggressiveness and potential of causing local recurrence. The aim of this study was, therefore, to evaluate if genetic alterations in primary rectal carcinoma are predictive of local recurrences. A large clinical database with linked bio-bank allowed for careful matching of two patient groups (R0) resected for rectal carcinoma. One group had developed early, isolated local recurrences and the other group seemed cured after 93months follow-up. DNA from the primary tumors was analysed with array-CGH (comparative genomic hybridization) including 55,000 genomic probes. DNA from all primary tumors in both groups displayed previously reported and well-recognised DNA aberrations in colorectal carcinoma. Significant copy number gains were confirmed in the 4q31.1-31.22 region in DNA from tumors with subsequent local recurrence. Twenty-two affected genes in this region code for products with high relevance in tumor biology (p53 regulation, cell cycle activity, transcription). DNA from rectal carcinoma displayed well-known aberrations as described for colon carcinoma with no obvious prediction of local rectal recurrence. Gains in the 4q31.1-31.22 DNA region are highly potential for local recurrence despite R0 resection to be confirmed in larger patient materials.
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24.
  • Kodeda, Karl, et al. (författare)
  • Local recurrence of rectal cancer: a population based cohort study of diagnosis, treatment and outcome.
  • 2012
  • Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1463-1318. ; 14:5, s. 230-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: Local recurrence is an important endpoint of rectal cancer treatment, but details of this form of treatment failure are less well described. The aim of this study was to acquire deeper knowledge of local recurrence regarding symptoms, diagnostic work-up, clinical management, health-care utilization and outcome. Method: Of 671 patients with rectal cancer, 57 were diagnosed with local recurrence within 5 years after surgery. Their records were analysed. Results: At diagnosis of local recurrence 49(86%) of 57 patients were symptomatic and 40 (70%) were diagnosed between scheduled follow-up visits. The predominant symptom was pain. Forty five of the 57 (79%) had a palpable tumour. Most were deemed incurable at presentation and less than 10 (18%) were operated on with curative intent. Five years after the initial rectal cancer surgery, two patients were alive, with one free of disease. Despite the need for multiple interventions, including surgery, only 4 out of 40 patients were classified as being well palliated in the terminal stage. Conclusion: Follow-up after rectal cancer surgery by annual clinical examination is not sufficient to detect local recurrence when it is asymptomatic. Local recurrence of rectal cancer is often associated with intractable symptoms. These patients require frequent interventions and can rarely be cured if diagnosed at an advanced stage. Strategies for early detection of local recurrence and the management thereof require improvement.
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25.
  • Ljungman, David, et al. (författare)
  • Case Mix Difference Can Affect Evaluation of Outcome of Treatment for Colorectal Cancer
  • 2015
  • Ingår i: Anticancer Research. - 0250-7005. ; 35:7, s. 4073-4076
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To explore the potential effects of patient selection, for example by organization, on survival as outcome parameter in colorectal cancer treatment. Patients and Methods: The main cohort was identified in a Hospital-based registry and outcome data of all 2,717 patients operated on for colorectal cancer between 2000-2011 were evaluated. A simulation of different center settings was performed using several potential selection criteria, including emergency cases, referral surgery and palliative resection, and used for comparison of outcome data. Results: Overall survival and cancer-specific survival can be significantly affected in both short-term (30-/90-day) mortality and long-term survival by factors of organizational level. Conclusion: Survival data as an outcome parameter can be affected by the composition of the patient cohort and thus reflect possible selection bias for example due to organization, referral patterns and practice customs. This potential bias should be acknowledged when making inter-hospital comparisons of outcome.
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26.
  • Sterner, Anton, et al. (författare)
  • Quality of life in patients treated for anal carcinoma-a systematic literature review
  • 2019
  • Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 34:9, s. 1517-1528
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose Anal cancer is a mainly treated with chemoradiotherapy. A small number of patients undergo salvage surgery. There are few published studies investigating quality of life and functional outcome after treatment for anal cancer. The aim of this review was to explore the literature and identify areas for further research. Methods A search was conducted in Medline using MESH terms related to anal cancer and quality of life. Two investigators selected and reviewed articles based on titles and abstracts. Three investigators read and reviewed the included articles and collected relevant data. The included articles were evaluated using the minimum standard checklist, and key findings were summarised in a chart. Results Some 15 articles, and a total of 802 patients, were deemed eligible. The results differed slightly among the studies. The incidence of symptoms such as fatigue, nausea, insomnia and appetite loss was higher than among healthy volunteers. Bowel function, urinary function and sexual function were negatively affected. Some studies found that, compared with the normal population, anal cancer survivors scored clinically significant worse in the functional scales in QLQ-C30. Conclusion In conclusion, it is apparent that several functional problems affect the quality of life of patients with anal cancer. There are few studies which have investigated quality of life after treatment for anal cancer. Interventions to address issues related to anal cancer treatment may improve long-term quality of life in this patient group.
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27.
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28.
  • Swartling, Torbjörn, et al. (författare)
  • Stage and size using magnetic resonance imaging and endosonography in neoadjuvantly-treated rectal cancer.
  • 2013
  • Ingår i: World journal of gastroenterology : WJG. - : Baishideng Publishing Group Inc.. - 1007-9327. ; 19:21, s. 3263-71
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To assess the stage and size of rectal tumours using 1.5 Tesla (1.5T) magnetic resonance imaging (MRI) and three-dimensional (3D) endosonography (ERUS). METHODS: In this study, patients were recruited in a phaseI/II trial of neoadjuvant chemotherapy for biopsy-proven rectal cancer planned for surgical resection with or without preoperative radiotherapy. The feasibility and accuracy of 1.5T MRI and 3D ERUS were compared with the histopathology of the fixed surgical specimen (pathology) to determine the stage and size of the rectal cancer before and after neoadjuvant chemotherapy. A Philips Intera 1.5T with a cardiac 5-channel synergy surface coil was used for the MRI, and a B-K Medical Falcon 2101 EXL 3D-Probe was used at 13 MHz for the ERUS. Our hypothesis was that the staging accuracy would be the same when using MRI, ERUS and a combination of MRI and ERUS. For the combination, MRI was chosen for the assessment of the lymph nodes, and ERUS was chosen for the assessment of perirectal tissue penetration. The stage was dichotomised into stage. and stage. or greater. The size was measured as the supero-inferior length and the maximal transaxial area of the tumour. RESULTS: The staging feasibility was 37 of 37 for the MRI and 29 of 36 for the ERUS, with stenosis as a limiting factor. Complete sets of investigations were available in 18 patients for size and 23 patients for stage. The stage accuracy by MRI, ERUS and the combination of MRI and ERUS was 0.65, 0.70 and 0.74, respectively, before chemotherapy and 0.65, 0.78 and 0.83, respectively, after chemotherapy. The improvement of the post-chemotherapy staging using the combination of MRI and ERUS compared with the staging using MRI alone was significant (P = 0.046). The post-chemotherapy understaging frequency by MRI, ERUS and the combination of MRI and ERUS was 0.18, 0.14 and 0.045, respectively, and these differences were non-significant. The measurements of the supero-inferior length by ERUS compared with MRI were within 1.96 standard deviations of the difference between the methods (18 mm) for tumours smaller than 50 mm. The agreement with pathology was within 1.96 standard deviations of the difference between imaging and pathology for all tumours with MRI (15 mm) and for tumours that did not exceed 50 mm with ERUS (22 mm). Tumours exceeding 50 mm in length could not be reliably measured by ERUS due to the limit in the length of each recording. CONCLUSION: MRI is preferable to use when assessing the size of large or stenotic rectal tumours. However, staging accuracy is improved by combining MRI with ERUS. (C) 2013 Baishideng. All rights reserved.
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29.
  • Taflin, Helena, et al. (författare)
  • Folate Levels and Polymorphisms in the Genes MTHFR, MTR, and TS in Colorectal Cancer.
  • 2014
  • Ingår i: Clinical Medicine Insights. Oncology. - 1179-5549. ; 8, s. 15-20
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to explore and describe the effect of polymorphisms in folate-associated genes regarding the levels of different folate forms and their distribution in tumors and mucosa in patients with colorectal cancer.
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30.
  • Taflin, Helena, et al. (författare)
  • Folate levels measured by LC-MS/MS in patients with colorectal cancer treated with different leucovorin dosages.
  • 2014
  • Ingår i: Cancer chemotherapy and pharmacology. - : Springer Science and Business Media LLC. - 1432-0843 .- 0344-5704. ; 74:6, s. 1167-1174
  • Tidskriftsartikel (refereegranskat)abstract
    • Calcium folinate (leucovorin), which is converted in vivo into biologically active folate, enhances the potency of 5-fluorouracil (5-FU)-based chemotherapy in colorectal cancer. A common dosage of leucovorin in adjuvant and palliative settings is 60mg/m(2). The aim was to determine the levels of tetrahydrofolate (THF), 5,10-methylenetetrahydrofolate (methyleneTHF), and 5-methyltetrahydrofolate (methylTHF) in tumour and mucosa of colorectal cancer patients who received different dosages of leucovorin intravenously at time of surgery.
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31.
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32.
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33.
  • Taflin, Helena, et al. (författare)
  • Relationship between folate concentration and expression of folate-associated genes in tissue and plasma after intraoperative administration of leucovorin in patients with colorectal cancer
  • 2018
  • Ingår i: Cancer Chemotherapy and Pharmacology. - : Springer Science and Business Media LLC. - 0344-5704 .- 1432-0843. ; 82:6, s. 987-997
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of study was to investigate the relationship between folate concentration and expression of folate-associated genes in tumour, mucosa and plasma of patients with colorectal cancer, after intraoperative administration of bolus leucovorin (LV). METHODS: Eighty patients were randomized into four groups to receive 0, 60, 200, or 500 mg/m(2) LV, respectively. Tissue and plasma folate concentrations were assessed by LC-MS/MS. Gene expression of ABCC3/MRP3, FPGS, GGH, MTHFD1L, SLC46A1/PCFT, and SLC19A1/RFC-1 was determined using quantitative PCR. RESULTS: The folate concentration in tumour increased with increasing dosage of LV. Half of the patients treated with 60 mg/m(2) did not reach a level above the levels of untreated patients. A significant correlation between folate concentration in tumour and mucosa was found in untreated patients, and in the group treated with 60 mg/m(2) LV. The 5-MTHF/LV ratio correlated negatively with folate concentration in mucosa, whereas a positive correlation was found in tumour of patients who received 200 or 500 mg/m(2) LV. A positive correlation was found between folate concentration and expression of all genes, except MTHFD1L, in patients who received LV. There was a negative correlation between 5-MTHF concentration in plasma of untreated patients and expression of GGH and SLC46A1/PCFT in tumour. CONCLUSIONS: The results indicate the possibility of using the individual plasma 5-MTHF/LV ratio after LV injection as a surrogate marker for tissue folate concentration. Expression of several folate-associated genes is associated with folate concentration in tissue and plasma and may become useful when predicting response to LV treatment.
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