| 1. |
- Adwall, Linda, et al.
(author)
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Antibiotikaprofylax vid bröstkirurgi? Ja, men inte till alla. Kvalitetsdata fran Uppsala läns landsting ger förslag till riktlinjer
- 2013
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In: Läkartidningen. - Stockholm : Läkartidningen förlag. - 0023-7205 .- 1652-7518. ; 110:5, s. 213-215
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Journal article (other academic/artistic)abstract
- I randomiserade studier har det visats att antibiotikaprofylax minskar infektionsfrekvensen med cirka 30–40 procent vid bröstcancerkirurgi.Statens beredning för medicinsk utvärdering rekommenderar därför sedan 2010 antibiotikaprofylax vid bröstcancerkirurgi.I Uppsala läns landsting fick totalt cirka 10 procent postoperativ infektion efter bröstkirurgi under 2009 och 2010. Ingreppets omfattning relaterar klart till risken för infektion.Vi diskuterar i denna artikel när det kan vara indicerat att ge eller inte ge antibiotikaprofylax vid bröstcancerkirurgi.
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| 2. |
- Jansson, Stefan P. O., 1959-, et al.
(author)
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Interventions for lifestyle changes to promote weight reduction, a randomized controlled trial in primary health care
- 2013
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In: BMC Research Notes. - UK : BioMed Central Ltd.. - 1756-0500. ; 16:1
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Journal article (peer-reviewed)abstract
- Background: Overweight and obesity are growing public health problems in high income countries and is now growing at a dramatic pace in low and middle income countries, particularly in urban settings. The aim of this trial was to examine the effects of a weight reduction program in adults and to determine whether or not a more extensive intervention was superior to ordinary care.Methods: Patients seeking advice for overweight/obesity or illness related to overweight/obesity at eight primary health care centers in Sweden were randomized either to intervention or control care groups with both groups given dietary advice and individualized information on increased regular physical activity. In the intervention group advice was more extensive and follow-up more frequent than in the control group during the study period of two years. Main outcome measure was reduction in body weight of five percent or more from study start.Results: From October 2004 to April 2006, 133 patients, 67 in the intervention group and 66 in the control group, were randomized over a period of 18 months. Target weight was achieved at 12 months by 26.7% of the patients in the intervention group compared with 18.4% in the control group (p = 0.335). There was an average absolute weight loss of 2.5 kg in the intervention group and 0.8 kg in the control group at 12 months as compared with the weight at study entry. There were no significant differences between the groups in quality of life, blood glucose and lipids. At 24 months target weight was achieved in 21.9% versus 15.6%, with an average weight reduction of 1.9 kg and 1.2 kg in the two groups, respectively.Conclusions: Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome.
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| 3. |
- Johansson, Bengt, 1958-, et al.
(author)
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Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1-T2 breast cancer : first long time results from a clinical study
- 2009
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In: Radiotherapy and Oncology. - Amsterdam : Elsevier. - 0167-8140 .- 1879-0887. ; 90:1, s. 30-35
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: To evaluate the long time outcome with regard to local tumour control, cosmetic outcome and side effects of a short (5 days) accelerated interstitial brachytherapy treatment delivered to the surroundings of the operated sector. PATIENTS AND METHODS: Between 1993 and 2003 we treated 50 women with early T1 and T2 breast cancer. Radical sector resection was performed and followed later with an interstitial pulsed dose rate (PDR) brachytherapy of 50Gy in 5 days. The treatment was centred on the tumour with a margin of 30mm. One patient was treated bilaterally. The patients were followed for a median of 86 (32-126) months. RESULTS: Ipsilateral breast cancer recurrence was seen in 3 patients (6%). Two of them occurred outside the treated volume. The 5- and 7-year rates of actuarial local control were 96% and 96%, respectively, overall survival 88% and 85%, disease free survival 88% and 88%, respectively. A dosimetrical analysis showed that the partial breast irradiation covered a median of 31% of the total breast volume. Fat necrosis was seen in 12% and local (moderate-strong) fibrosis in 26% of the patients. Independent cosmetic scoring showed good or excellent result in 56% of the patients. CONCLUSIONS: Local outcome is favourable and very similar to other published studies of accelerated partial breast irradiation. Our long time cosmetic results are lower than other published results.
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| 4. |
- Sackey, H., et al.
(author)
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Arm lymphoedema after axillary surgery in women with invasive breast cancer
- 2014
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In: British Journal of Surgery. - : Wiley-Blackwell. - 0007-1323 .- 1365-2168. ; 101:4, s. 390-397
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Journal article (peer-reviewed)abstract
- Background: The primary aim was to compare arm lymphoedema after sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) in women with node-negative and node-positive breast cancer. The secondary aim was to examine the potential association between self-reported and objectively measured arm lymphoedema.Methods: Women who had surgery during 1999-2004 for invasive breast cancer in four centres in Sweden were included. The study groups were defined by the axillary procedure performed and the presence of axillary metastases: SLNB alone, ALND without axillary metastases, and ALND with axillary metastases. Before surgery, and 1, 2 and 3years after operation, arm volume was measured and a questionnaire regarding symptoms of arm lymphoedema was completed. A mixed model was used to determine the adjusted mean difference in arm volume between the study groups, and generalized estimating equations were employed to determine differences in self-reported arm lymphoedema.Results: One hundred and forty women had SLNB alone, 125 had node-negative ALND and 155 node-positive ALND. Women who underwent SLNB had no increase in postoperative arm volume over time, whereas both ALND groups showed a significant increase. The risk of self-reported arm lymphoedema 1, 2 and 3years after surgery was significantly lower in the SLNB group compared with that in both ALND groups. Three years after surgery there was a significant association between increased arm volume and self-reported symptoms of arm lymphoedema.Conclusion: SLNB is associated with a minimal risk of increased arm volume and few symptoms of arm lymphoedema, significantly less than after ALND, regardless of lymph node status.Minimal after sentinel node biopsy
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| 5. |
- Wickberg, Åsa, 1972-
(author)
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Adjuvant treatments to prevent local reurrence after breast-conserving surgery for early breast cancer : radiation, endocrine- or brachytherapy
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Radiotherapy after breast-conserving surgery due to breast cancer is an established treatment, known to reduce the incidence of recurrence and even death from the disease. However some women are over-treated with sometimes serious adverse effects. De-escalating the treatment and find alternative adjuvant methods are becoming an important issue. In study I, we present the outcomes from a long-term follow-up trial randomising 381 women with breast cancer to surgery alone or to surgery with the addition of radiotherapy. The incidence of any first breast cancer event was significantly higher without radiotherapy but the protecting effect lasted for only the first five years. In study II, we collected the tissue samples from the tumours in study I to construct tissue micro-arrays. Immuno-histochemical analyses were performed and the tumours were classified into the intrinsic subtypes. The luminal B/HER2 negative subtype was found to be prognostic for ipsilateral breast cancer recurrence (IBTR). The intrinsic subtypes did not interact with radiotherapy. Study III was a multicentre prospective cohort study where the 601 study participants with early breast cancer were treated with surgery and endocrine therapy alone without postoperative radiotherapy. The cumulative incidence of IBTR after five years was low -1.2% and only one woman died of breast cancer. In study IV we evaluated the feasibility and treatment complications when introducing a new method for intraoperative brachytherapy (IOBT) using HDR equipment. We designed a pilot study including fifty women where half of them were treated during primary surgery and the others during a second procedure. The treatment was well tolerated and no logistic problems were reported. No acute adverse effects from IOBT were seen.
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