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- Alkner, Sara, et al.
(author)
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Quality assessment of radiotherapy in the prospective randomized SENOMAC trial
- 2024
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In: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 197
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Journal article (peer-reviewed)abstract
- Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial.Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1–2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015–2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail.Results: CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98–100 %) of the volume. However, even when not an intended target, full dose was delivered to > 80 % of level I (IQR 75–90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head.Conclusion: Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.
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| 2. |
- Alkner, Sara, et al.
(author)
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Quality assessment of radiotherapy in the prospective randomized SENOMAC trial
- 2024
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In: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 197
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Journal article (peer-reviewed)abstract
- Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial. Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1-2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015-2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail.
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| 3. |
- Angiolillo, Fabio, 1994, et al.
(author)
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State of the world 2023: democracy winning and losing at the ballot : State of the world 2023
- 2024
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In: Democratization. - 1351-0347.
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Journal article (peer-reviewed)abstract
- This article presents trends in democracy, autocracy, and regime transformation using the Varieties of Democracy (V-Dem) dataset version 14. We offer five main findings. First, the average level of democracy as measured by the Liberal Democracy Index (LDI) continues to decline and has reached the 1985-level when looking at the population-weighted averages. Second, 42 countries are in ongoing episodes of autocratization, and 18 countries are in ongoing episodes of democratization in 2023. Third, we are the first to show that out of the 42 autocratizing countries, 19 are “Bell-turn” autocratizers, while nine out of the 18 democratizers are “U-turns.” Fourth, we unpack the familiar analysis of the three waves of autocratization and democratization by dividing these into the newly discovered stand-alone episodes of autocratization versus Bell-turn episodes, as well as stand-alone episodes of democratization versus U-turn episodes. This analysis suggests that regime volatility has increased in recent years, as a larger share of both autocratization and democratization are made up of Bell-turns and U-turns, respectively. Fifth, out of the 60 countries holding national elections this year, 31 countries are in some degree of decline in democracy, while only three are improving on democracy.
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| 4. |
- Bengtsson, Kenneth, et al.
(author)
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Så kan Sverige bli ledande nation i resurseffektivitet
- 2016
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In: Dagens Nyheter. - 1101-2447. ; :2016-04-30
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Journal article (pop. science, debate, etc.)abstract
- Ny rapport. Det svenska näringslivet kan bli mer hållbart, resurssmart och därmed internationellt konkurrenskraftigt. Men för det behövs en tydlig politisk avsiktsförklaring och riktlinjer. Vi har listat sex områden där policyutveckling brådskar, skriver företrädare för näringsliv, forskning och myndigheter i en gemensam uppmaning.
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| 5. |
- Boese, Vanessa Alexandra, et al.
(author)
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State of the world 2021: autocratization changing its nature?
- 2022
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In: Democratization. - : Informa UK Limited. - 1351-0347 .- 1743-890X. ; 29:6, s. 983-1013
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Journal article (peer-reviewed)abstract
- This article analyses the state of democracy around the world in 2021. The level of democracy enjoyed by the average global citizen in 2021 was down to 1989 levels. In 2021, autocracies were on the rise, harbouring 70% of the world population, or 5.4 billion people. There was also a record number of countries autocratizing in 2021: 33 countries, home to 36% of the global population. In recent years, the EU seems to be facing its own wave of autocratization, with 20% of its members autocratizing over the last decade. In addition to the continued downturn in global democracy, this article documents several signs that autocratization is changing in nature. Polarization increased substantially and signi?cantly in 40 countries between 2011 and 2021, and our analysis indicates that polarization increasingly damages democracy especially recently and under anti-pluralist governments. Over the past decade, the data also shows that autocratic governments more frequently used misinformation to shape domestic and international opinion. Finally, with ?ve military coups and one self-coup, 2021 featured an unprecedented increase in coups for this century. These coups contributed to the uptick in the number of closed autocracies in 2021 and seem to signal a shift toward emboldened autocratic actors.
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| 8. |
- Kovács, Anikó, 1961, et al.
(author)
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Effect of Radiotherapy After Breast-Conserving Surgery Depending on the Presence of Tumor-Infiltrating Lymphocytes : A Long-Term Follow-Up of the SweBCG91RT Randomized Trial
- 2019
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In: Journal of Clinical Oncology. - 0732-183X. ; 37:14, s. 1179-87
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Journal article (peer-reviewed)abstract
- PURPOSE: The effects of radiotherapy (RT) on the basis of the presence of stromal tumor infiltrating lymphocytes (TILs) have not been studied. The purpose of this study was to analyze the association of TILs with the effect of postoperative RT on ipsilateral breast tumor recurrence (IBTR) in a large randomized trial. METHODS: In the SweBCT91RT (Swedish Breast Cancer Group 91 Radiotherapy) trial, 1,178 patients with breast cancer stage I and II were randomly assigned to breast-conserving surgery plus postoperative RT or breast-conserving surgery only and followed for a median of 15.2 years. Tumor blocks were retrieved from 1,003 patients. Stromal TILs were assessed on whole-section hematoxylin-eosin-stained slides using a dichotomized cutoff of 10%. Subtypes were scored using immunohistochemistry on tissue microarray. In total, 936 patients were evaluated. RESULTS: Altogether, 670 (71%) of patients had TILs less than 10%. In a multivariable regression analysis with IBTR as dependent variable and RT, TILs, subtype, age, and grade as independent variables, RT (hazard ratio [HR], 0.42; 95% CI, 0.29 to 0.61; P < .001), high TILs (HR, 0.61; 95% CI, 0.39 to 0.96, P = .033) grade (3 v 1; HR, 2.17; 95% CI, 1.08 to 4.34; P = .029), and age (≥ 50 v < 50 years; HR, 0.55; 95% CI, 0.38 to 0.80; P = .002) were predictive of IBTR. RT was significantly beneficial in the low TILs group (HR, 0.37; 95% CI, 0.24 to 0.58; P < .001) but not in the high TILs group (HR, 0.58; 95% CI, 0.28 to 1.19; P = .138). The test for interaction between RT and TILs was not statistically significant (P = .317). CONCLUSION: This study shows that high values of TILs in the primary tumor independently seem to reduce the risk for an IBTR. Our findings further suggest that patients with breast cancer with low TILs may derive a larger benefit from RT regarding the risk of IBTR.
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