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- Ek, Hanna, et al.
(författare)
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Transitioning from conventional photon therapy to proton therapy for primary brain tumors
- 2023
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Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 62:4, s. 391-399
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Proton radiation therapy (PT) has become a treatment option alongside photon therapy (XRT) for lower-grade gliomas (LGG). In this single-institution retrospective study, we investigate the patient characteristics and treatment outcomes, including pseudo-progression (PsP), for LGG patients selected for PT. Method: Adult patients with grade 2–3 glioma consecutively treated with radiotherapy (RT) from May 2012 to December 2019 were retrospectively included in this cohort study. Tumor characteristics and treatment data were collected. The groups treated with PT and XRT were compared regarding treatment characteristics, side effects, occurrence of PsP, and survival outcomes. PsP was defined as new or growing lesions followed by either decrease or stabilization during a 12 month-period with no treatment. Results: Out of 143 patients meeting the inclusion criteria, 44 were treated with PT, 98 with XRT and one with mixed PT + XRT. The patients receiving PT were younger, had a lower tumor grade, more oligodendrogliomas and received a lower mean brain and brainstem dose. PsP was observed in 21 out of 126 patients, with no difference between XRT and PT (p =.38). The rate of fatigue in immediate connection to RT (zero to three months after) was higher for XRT than for PT (p =.016). The PT patients had a significantly better PFS and OS than the XRT patients (p =.025 and.035), but in multivariate analysis radiation modality was non-significant. Higher average dose to both brain and brainstem was associated with inferior PFS and OS (p <.001). Median follow-up time were 69 months and 26 months for XRT and PT patients, respectively. Conclusion: Contrary to previous studies, there was no difference in risk of PsP for XRT and PT. PT was associated with lower rates of fatigue <3 months after RT. The superior survival outcomes for PT indicates that the patients with the best prognosis were referred to PT.
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| 3. |
- Fagerström Kristensen, Ingrid, et al.
(författare)
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Comparative Proton and Photon Treatment Planning in Pediatric Patients with Various Diagnoses
- 2015
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Ingår i: International Journal of Particle Therapy. - 2331-5180. ; 2:2, s. 367-375
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Radiation therapy with protons, owing to its physical properties, can beadvantageous for the treatment of children. This study was conducted in order to quantify the advantages of proton therapy from a treatment planning point of view in a consecutive, realistic, and mixed pediatric/adolescent population with varying diagnoses and target locations.Patients and Methods: Forty-five patients treated with conventional 3 dimensional conformal radiation therapy photon radiation therapy were retrospectively re-planned with scanned proton beams. Treatment sites represented were the central nervous system, head and neck, thorax, and abdomen. Median age was 8 years (range, 2-18 years). All plans were optimized with intensity-modulated proton therapy (multi-field optimization). We analyzed a number of dose-volume descriptors for planned targetvolumes (PTVs). Organ-specific mean doses and relevant DV -values were derived fororgans at risk. In addition, homogeneity index, conformity index, treated volume, and integral dose were calculated for each treatment plan. The Wilcoxon matched-pairs signed rank test was used for studying differences between these variables for the 2 treatment modalities.Results: Planned target volume coverage (V95%) was similar when comparing photons and protons. Conformity and homogeneity indices were similar or better for protons for most cases. In general, doses to organs at risk were lower with protons. In cases with organs at risk in close vicinity to the PTV, the gain with protons is less.Conclusions: The patient cohort benefits from reduced integral dose with protons compared with photons. Patients with tumors in the central nervous system, head and neck, upper mediastinum, and some abdominal locations will gain significantly if treated with protons compared with photons. For 7 of the 45 consecutive patients studied (whole brain, whole lung, whole abdomen, flank treatment), we found no gain with protons (difference in integral dose less than 8%).
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| 4. |
- Fagerström Kristensen, Ingrid, et al.
(författare)
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Rapid Implementation of Telehealth Video Visits in Cancer Care – The Perspectives of Patients and Healthcare Professionals
- 2022
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Ingår i: International Journal of Nursing Health Care Research. - : Gavin Publishers. - 2688-9501. ; 5:04, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Due to the COVID-19 pandemic, physical visits were replaced by video visits. The aim of this study was to evaluatethe rapid implementation of telehealth video visits in cancer care from the perspectives of patients and healthcare professionals togain knowledge about when physical visits can be replaced by video visits and to identify the improvements needed to optimizecancer care.Material and Methods: Questionnaires were designed for the purpose of the study and sent out during March 2021 to adult patients(≥ 18 years) who had participated in video visits, healthcare professionals who had conducted video visits and scheduling staff whohad scheduled video visits from April to December 2020.Results: 99 patients, 17 healthcare professionals and 14 scheduling staff answered the questionnaires. Although high levels ofsatisfaction were reported, a need for improvement was identified. Most of the respondents were positive about continuing with videovisits, which functioned better with a familiar patient in a follow-up situation, especially for those living far from the hospital, frailpatients, and those in need of frequent follow-up. The necessary improvements mainly concerned technical issues pertaining to thedigital platform, training and support.Conclusion: Telehealth video visits are a good complement to physical visits and phone calls. There is a need to optimise theuse of video visits regarding types of visit (i.e., new visits, during treatment, follow-up, etc.) for selected patients with improvedinstructions, guidelines and education as well as a safe and user-friendly digital tool.
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| 5. |
- Lövgren, Nathalie, et al.
(författare)
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Feasibility and constraints of Bragg peak FLASH proton therapy treatment planning
- 2024
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Ingår i: Frontiers in Oncology. - 2234-943X. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: FLASH proton therapy (FLASH-PT) requires ultra-high dose rate (≥ 40 Gy/s) protons to be delivered in a short timescale whilst conforming to a patient-specific target. This study investigates the feasibility and constraints of Bragg peak FLASH-PT treatment planning, and compares the in silico results produced to plans for intensity modulated proton therapy (IMPT). Materials and method: Bragg peak FLASH-PT and IMPT treatment plans were generated for bone (n=3), brain (n=3), and lung (n=4) targets using the MIROpt research treatment planning system and the Conformal FLASH library developed by Applications SA from the open-source version of UCLouvain. FLASH-PT beams were simulated using monoenergetic spot-scanned protons traversing through a conformal energy modulator, a range shifter, and an aperture. A dose rate constraint of ≥ 40 Gy/s was included in each FLASH-PT plan optimisation. Results: Space limitations in the FLASH-PT adapted beam nozzle imposed a maximum target width constraint, excluding 4 cases from the study. FLASH-PT plans did not satisfy the imposed target dose constraints (D95% ≥ 95% and D2%≤ 105%) but achieved clinically acceptable doses to organs at risk (OARs). IMPT plans adhered to all target and OAR dose constraints. FLASH-PT plans showed a reduction in both target homogeneity (p < 0.001) and dose conformity (non-significant) compared to IMPT. Conclusion: Without accounting for a sparing effect, IMPT plans were superior in target coverage, dose conformity, target homogeneity, and OAR sparing compared to FLASH-PT. Further research is warranted in treatment planning optimisation and beam delivery for clinical implementation of Bragg peak FLASH-PT.
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- Nyholm, Tufve, et al.
(författare)
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A national approach for automated collection of standardized and population-based radiation therapy data in Sweden
- 2016
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 119:2, s. 344-350
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To develop an infrastructure for structured and automated collection of interoperable radiation therapy (RT) data into a national clinical quality registry. Materials and methods: The present study was initiated in 2012 with the participation of seven of the 15 hospital departments delivering RT in Sweden. A national RT nomenclature and a database for structured unified storage of RT data at each site (Medical Information Quality Archive, MIQA) have been developed. Aggregated data from the MIQA databases are sent to a national RT registry located on the same IT platform (INCA) as the national clinical cancer registries. Results: The suggested naming convention has to date been integrated into the clinical workflow at 12 of 15 sites, and MIQA is installed at six of these. Involvement of the remaining 3/15 RT departments is ongoing, and they are expected to be part of the infrastructure by 2016. RT data collection from ARIA (R), Mosaiq (R), Eclipse (TM), and Oncentra (R) is supported. Manual curation of RT-structure information is needed for approximately 10% of target volumes, but rarely for normal tissue structures, demonstrating a good compliance to the RT nomenclature. Aggregated dose/volume descriptors are calculated based on the information in MIQA and sent to INCA using a dedicated service (MIQA2INCA). Correct linkage of data for each patient to the clinical cancer registries on the INCA platform is assured by the unique Swedish personal identity number. Conclusions: An infrastructure for structured and automated prospective collection of syntactically inter operable RT data into a national clinical quality registry for RT data is under implementation. Future developments include adapting MIQA to other treatment modalities (e.g. proton therapy and brachytherapy) and finding strategies to harmonize structure delineations. How the RT registry should comply with domain-specific ontologies such as the Radiation Oncology Ontology (ROO) is under discussion.
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| 7. |
- Sharon, Wong, et al.
(författare)
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RTTs-time to prepare for the advent of proton therapy
- 2019
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Ingår i: Technical Innovations and Patient Support in Radiation Oncology. - : Elsevier BV. - 2405-6324. ; 11, s. 26-26
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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