| 1. |
- Baumann, Pia, et al.
(author)
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Stereotactic body radiotherapy for medically inoperable patients with stage I non-small cell lung cancer - a first report of toxicity related to COPD/CVD in a non-randomized prospective phase II study.
- 2008
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In: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 88:3, s. 359-67
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: In a retrospective study using stereotactic body radiotherapy (SBRT) in medically inoperable patients with stage I NSCLC we previously reported a local control rate of 88% utilizing a median dose of 15Gyx3. This report records the toxicity encountered in a prospective phase II trial, and its relation to coexisting chronic obstructive pulmonary disease (COPD) and cardio vascular disease (CVD). MATERIAL AND METHODS: Sixty patients were entered in the study between August 2003 and September 2005. Fifty-seven patients (T1 65%, T2 35%) with a median age of 75 years (59-87 years) were evaluable. The baseline mean FEV1% was 64% and median Karnofsky index was 80. A total dose of 45Gy was delivered in three fractions at the 67% isodose of the PTV. Clinical, pulmonary and radiological evaluations were made at 6 weeks, 3, 6, 9, 12, 18, and 36 months post-SBRT. Toxicity was graded according to CTC v2.0 and performance status was graded according to the Karnofsky scale. RESULTS: At a median follow-up of 23 months, 2 patients had relapsed locally. No grade 4 or 5 toxicity was reported. Grade 3 toxicity was seen in 12 patients (21%). There was no significant decline of FEV1% during follow-up. Low grade pneumonitis developed to the same extent in the CVD 3/17 (18%) and COPD 7/40 (18%) groups. The incidence of fibrosis was 9/17 (53%) and pleural effusions was 8/17 (47%) in the CVD group compared with 13/40 (33%) and 5/40 (13%) in the COPD group. CONCLUSION: SBRT for stage I NSCLC patients who are medically inoperable because of COPD and CVD results in a favourable local control rate with a low incidence of grade 3 and no grade 4 or 5 toxicity.
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| 2. |
- Adolfsson, Emelie, 1985-, et al.
(author)
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Response of Lithium Formate EPR Dosimeters at Photon Energies Relelvant to Brachytherapy
- 2009
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In: IFMBE Proceedings. - Heidelberg : Springer Berlin Heidelberg. - 9783642034725 - 9783642034749 ; , s. 236-239
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Conference paper (other academic/artistic)abstract
- After development of sensitive dosimeter materials Electron Paramagnetic Resonance EPR dosimetry has been successfully used also in radiation therapy. The intensity of the EPR-signal is a measure of the amount of free radicals created by ionizing radiation which is proportional to the absorbed dose in the dosimeter. Lithium formate monohydrate is a dosimeter material with 2-6 times higher sensitivity than alanine, a linear dose response over a wide dose range and mass-energy absorption properties similar to water. These properties make lithium formate promising for verification of absorbed doses around high dose rate brachytherapy sources where the dose gradient is steep and the photon energy distribution changing with distance from the source. Calibration of the dosimeters is performed in 60Co or MV photon beams where high dosimetric accuracy is feasible. The use in brachytherapy field relies on the assumption that the production of free radicals per mean absorbed dose in the dosimeter is similar at the lower photon energies present there. The aim of this work was to test that assumption. The response of the dosimeters as a function of photon energy was determined by irradiations with four x-ray qualities in the range 100-250 kV and 137Cs, relative to the response when irradiated with 60Co, all photon beams with well-known air kerma rates at the Swedish Secondary Standards Dosimetry Laboratory. Monte Carlo simulations were used to convert air kerma free in air to mean absorbed dose to the dosimeter. The measured response relative 60Co as a function of photon energy was below unity for all qualities. The maximum deviation from unity was 2.5% (100 kV, 135 kV) with a relative standard deviation of 1.5% (k = 1).
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| 3. |
- Axelsson, Susanna, et al.
(author)
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Disseminating evidence from health technology assessment : the case of tobacco prevention
- 2006
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In: International Journal of Technology Assessment in Health Care. - Stockholm : Karolinska Institutet, Dept of Public Health Sciences. - 0266-4623.
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Journal article (peer-reviewed)abstract
- OBJECTIVES: The aims of the present study were to investigate the awareness among dentists and dental hygienists of evidence-based reports and guidelines on tobacco cessation activities and the impact these publications had on clinical practice. METHODS: A questionnaire was mailed to dental hygienists and dentists in Stockholm County, Sweden, and the results were compared with a previous investigation. RESULTS: Among the respondents, awareness of a popular science version of a systematic review on smoking and its effect on oral health was reported by 90 percent of the hygienists and 66 percent of the dentists. The information was used in clinical work by 34 percent of the dentists and 54 percent of the hygienists. Reported changes in patterns of practice were more frequent recommendations to use nicotine replacement therapy and a more widespread use of setting quit dates. Approximately one quarter of the dental professionals reported that they had increased tobacco cessation consultation because of the results from the reports. CONCLUSIONS: Changes in patterns of practice were observed after dissemination of evidence-based information on tobacco cessation. Methods that were proven to be effective in the evidence-based report such as discussing quit dates and recommending nicotine replacement therapy were more commonly used after the publication of the report. Short, popular versions of extensive systematic reviews seem to be useful for implementing evidence-based knowledge and changing clinical practice.
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| 4. |
- Baumann, Pia, et al.
(author)
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Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy.
- 2009
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In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. - 1527-7755 .- 0732-183X. ; 27:20, s. 3290-6
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Journal article (peer-reviewed)abstract
- PURPOSE: The impact of stereotactic body radiotherapy (SBRT) on 3-year progression-free survival of medically inoperable patients with stage I non-small-cell lung cancer (NSCLC) was analyzed in a prospective phase II study. PATIENTS AND METHODS: Fifty-seven patients with T1NOMO (70%) and T2N0M0 (30%) were included between August 2003 and September 2005 at seven different centers in Sweden, Norway, and Denmark and observed up to 36 months. SBRT was delivered with 15 Gy times three at the 67% isodose of the planning target volume. RESULTS: Progression-free survival at 3 years was 52%. Overall- and cancer-specific survival at 1, 2, and 3 years was 86%, 65%, 60%, and 93%, 88%, 88%, respectively. There was no statistically significant difference in survival between patients with T1 or T2 tumors. At a median follow-up of 35 months (range, 4 to 47 months), 27 patients (47%) were deceased, seven as a result of lung cancer and 20 as a result of concurrent disease. Kaplan-Meier estimated local control at 3 years was 92%. Local relapse was observed in four patients (7%). Regional relapse was observed in three patients (5%). Nine patients (16%) developed distant metastases. The estimated risk of all failure (local, regional, or distant metastases) was increased in patients with T2 (41%) compared with those with T1 (18%) tumors (P = .027). CONCLUSION: With a 3-year local tumor control rate higher than 90% with limited toxicity, SBRT emerges as state-of-the-art treatment for medically inoperable stage I NSCLC and may even challenge surgery in operable instances.
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| 5. |
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| 6. |
- Crooks, Lucy, et al.
(author)
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Comparison of analyses of the QTLMAS XII common dataset. II : genome-wide association and fine mapping.
- 2009
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In: BMC Proceedings. - 1753-6561. ; 3 Suppl 1
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Journal article (peer-reviewed)abstract
- As part of the QTLMAS XII workshop, a simulated dataset was distributed and participants were invited to submit analyses of the data based on genome-wide association, fine mapping and genomic selection. We have evaluated the findings from the groups that reported fine mapping and genome-wide association (GWA) efforts to map quantitative trait loci (QTL). Generally the power to detect QTL was high and the Type 1 error was low. Estimates of QTL locations were generally very accurate. Some methods were much better than others at estimating QTL effects, and with some the accuracy depended on simulated effect size or minor allele frequency. There were also indications of bias in the effect estimates. No epistasis was simulated, but the two studies that included searches for epistasis reported several interacting loci, indicating a problem with controlling the Type I error rate in these analyses. Although this study is based on a single dataset, it indicates that there is a need to improve fine mapping and GWA methods with respect to estimation of genetic effects, appropriate choice of significance thresholds and analysis of epistasis.
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| 7. |
- Djärv, Emma, et al.
(author)
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Dummy run for a phase II study of stereotactic body radiotherapy of T1-T2 N0M0 medical inoperable non-small cell lung cancer.
- 2006
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In: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 45:7, s. 973-7
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Journal article (peer-reviewed)abstract
- In forthcoming multicentre studies on stereotactic body radiotherapy (SBRT) compliance with volume and dose prescriptions will be mandatory to avoid unnecessary heterogeneity bias. To evaluate compliance in a multicentre setting we used two cases from an ongoing phase II study of SBRT of T1-T2N0M0 inoperable NSCLC in a dummy run oriented on volumes and doses. Six Scandinavian centres participated. Each centre received CT-scans covering the whole lung volumes of two patients with instructions to follow the study protocol when outlining tumour and target volumes, prescribing doses and creating dose plans. Volumes and doses of the 12 dose plans were evaluated according to the study protocol. For the two patients the GTV volume range was 24 to 39 cm3 and 26 to 41 cm3, respectively. The PTV volume range was 90 to 116 cm3, and 112 to 155 cm3, respectively. For all plans the margin between CTV and PTV in all directions followed in detail the protocol. The prescribed dose was for all centres 45 Gy/3 fractions (isocentre dose about 66 Gy). The mean GTV doses ranged from 63 to 67 Gy and from 63 to 68 Gy, respectively. The minimum doses for GTV were between 50-64 Gy and between 55-65 Gy, respectively. The dose distribution was conformed to PTV for 10 of 12 plans and 2 of 12 plans from one centre had sub-optimal dose distribution. Most of the volume and dose parameters for the participating centres showed fully acceptable compliance with the study protocol.
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| 8. |
- Fransson, Per, et al.
(author)
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Quality of life in patients with locally advanced prostate cancer given endocrine treatment with or without radiotherapy: 4-year follow-up of SPCG-7/SFUO-3, an open-label, randomised, phase III trial.
- 2009
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In: The lancet oncology. - : Elsevier. - 1474-5488 .- 1470-2045. ; 10:4, s. 370-80
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Journal article (peer-reviewed)abstract
- BACKGROUND: Androgen treatment for prostate cancer can adversely affect functional domains of quality of life. We aimed to assess quality of life in men with locally advanced prostate cancer in an open-label phase III randomised comparison between lifelong endocrine treatment with and without radiotherapy. METHODS: We obtained quality-of-life information from 872 (99%) of 875 eligible men with locally advanced prostate cancer (T3; 78%) who were randomly assigned, between 1996 and 2002, to 3 months of total androgen blockade followed by continuous endocrine treatment (439 patients) or the same hormonal treatment with radiotherapy 3 months after randomisation (436 patients). Prospective outcomes included patient-reported symptoms and quality of life assessed with questionnaires from baseline to 4 years after randomisation. Analysis was by intention to treat. This study is registered as an international standard randomised controlled trial, number ISRCTN01534787. FINDINGS: 438 of 439 men assigned endocrine treatment and 434 of 436 assigned endocrine plus radiotherapy completed at least one questionnaire. Missing data at baseline and during follow-up was equally distributed between groups. At 4 years, 64 (18%) of 353 patients on combined therapy and 39 (12%) of 337 on endocrine-alone therapy had moderate to severe urinary bother (p=0.005), and 16 (4%) of 355 on combined therapy and five (2%) of 338 on endocrine treatment alone had pain while urinating (p=0.024). 37 (11%) of 350 in the combined group and 23 (7%) of 35 in the endocrine-only group had overall bother from all bowel symptoms (p=0.022). 281 (85%) of 332 in the combined-treatment group and 227 (72%) of 313 in the endocrine-only group had erectile dysfunction (p=0.0002). Quality of life at 4 years was similar, with the exception of decreased social function in patients receiving endocrine treatment plus radiotherapy. INTERPRETATION: Although addition of radiotherapy to endocrine treatment significantly increased some treatment-related symptoms, none were serious. Given the substantial survival benefit of combined treatment, the increase of symptoms seems acceptable and has little extra effect on quality of life after 4 years compared with endocrine treatment alone.
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| 9. |
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| 10. |
- Larsson-Lund, Maria, et al.
(author)
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Associations between perceptions of environmental barriers and participation in persons with late effects of polio
- 2009
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 16:4, s. 194-204
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Journal article (peer-reviewed)abstract
- The aim of this pilot study was to assess the association between perceived environmental barriers and perceived participation in everyday life situations encountered by people with late effects of polio. A sample of 45 persons with clinically verified late effects of polio answered the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and the Craig Hospital Inventory of Environmental Factors (CHIEF-S). The relationships between the perceived occurrence of a broad range of environmental barriers and perception of participation in life situations and problems with participation were explored. The majority of the respondents perceived that they encountered environmental barriers, but their occurrence was generally infrequent and their magnitude tended to be low. The barriers identified in the physical/structural subscale were generally most strongly related to problems with participation, compared with the four other environmental subscales. A high frequency of never encountering environmental barriers in the three subscales physical/structural, work and education, and policies in CHIEF-S were significantly related to more reports of good participation in IPA-S. These associations indicate that the participation of those with late effects of polio is influenced by their perception of the barriers they encounter. Further studies of these concepts can provide a greater understanding of disabilities and help us to promote participation in life situations for people with late effects of polio.
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