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Schuster A, Randrianasolo BS, Rabozakandraina OO, Ramarokoto CE, Brønnum D, Feldmeier H. Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: A qualitative study on disease perception, health impairment and social impact. PLoS Negl Trop Dis 2022; 16:e0010901. [PMID: 36342912 PMCID: PMC9639808 DOI: 10.1371/journal.pntd.0010901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Background Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS. Methods We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis. Results Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking. Conclusions Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas. Trial registration The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072). Female genital schistosomiasis is a parasitic disease, acquired by humans when exposed to infested water. Patients can develop severe gynaecologic symptoms and face psychological and social problems. Although urogenital schistosomiasis is very common in many communities in Sub-Sahara Africa, knowledge on FGS among community members and health care workers is poor. Knowledge and experiences of women affected by FGS have never been explored but need to be understood to provide effective health care and to promote adequate interventions. In this study, waterborne and sexual transmission were the most recurrently mentioned pathways for FGS acquisition. Most women perceived the risk for FGS as immutable and related to the precarious living conditions. The women were able to differentiate between urinary and female genital schistosomiasis. FGS caused partnership conflicts and affected women’s position in the community. Stigma within the community and mistrust in health care resulted in delayed seeking health care. In view of these results, we propose including health education and structural interventions to improve living conditions, in order to reduce the burden of FGS. Further, improved access to correct diagnosis and treatment should be provided.
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Affiliation(s)
- Angela Schuster
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
- * E-mail:
| | | | | | | | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Hermann Feldmeier
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
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Nielsen SW, Ruhlmann CHB, Eckhoff L, Brønnum D, Herrstedt J, Dalton SO. Response to Vitetta et al. Support Care Cancer 2022; 30:8623-8624. [PMID: 36100727 DOI: 10.1007/s00520-022-07356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/06/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Sebastian Werngreen Nielsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.
| | - Christina H Bruvik Ruhlmann
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.,Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Lise Eckhoff
- Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, 9800, Hjoerring, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark.,Survivorship & Inequality in Cancer, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark
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Nielsen SW, Ruhlmann CH, Eckhoff L, Brønnum D, Herrstedt J, Dalton SO. Cannabis use among Danish patients with cancer: a cross-sectional survey of sociodemographic traits, quality of life, and patient experiences. Support Care Cancer 2021; 30:1181-1190. [PMID: 34453567 DOI: 10.1007/s00520-021-06515-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with cancer are using cannabis for self-treatment. The reasons, experienced effects, and prevalence of use are unknown in the European general oncological population. METHODS Adult patients with cancer attending outpatient oncology clinics were invited to participate in a cross-sectional survey. The questionnaire consisted of sociodemographic questions, validated scales on quality of life, neuropathy, anxiety and depression as well as questions regarding use of cannabis. RESULTS The overall response rate was 83% (2839 patients) and 13% of patients were using or had used cannabis during their treatment. Rate of use was higher in smokers (19% vs 11%, p adjusted 0.002), in patients in active cancer treatment (14% vs 10%, p adjusted = 0.02), and in patients with depression (19% vs 11%, adjusted p = 0.002). Cannabis use was also correlated with lower quality of life (EORTC C30 SumScore mean diff. = - 7.61, 95% CI = [- 9.69; - 5.53]). In total, 77% of users experienced at least one positive effect of cannabis, 18% experienced no effect, and 5% experienced other effects. At least one side effect was experienced by 33% of users. Management of pain and nausea were the primary reasons for initiating cannabis use (39% for both). Less nausea and better sleep were the most common effects experienced (26% for both). Oils for oral use were the most common route of administration (88%). CONCLUSION Cannabis use among patients with cancer is prevalent and correlated with worse quality of life. Patients report using cannabis for symptom management and many experience relief of their symptoms. However, one third of patients experienced side effects.
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Affiliation(s)
- Sebastian W Nielsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.
| | - Christina H Ruhlmann
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.,Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Lise Eckhoff
- Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, 9800, Hjoerring, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark
| | - Susanne O Dalton
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark.,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark
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Gunst JD, Staerke NB, Pahus MH, Kristensen LH, Bodilsen J, Lohse N, Dalgaard LS, Brønnum D, Fröbert O, Hønge B, Johansen IS, Monrad I, Erikstrup C, Rosendal R, Vilstrup E, Mariager T, Bove DG, Offersen R, Shakar S, Cajander S, Jørgensen NP, Sritharan SS, Breining P, Jespersen S, Mortensen KL, Jensen ML, Kolte L, Frattari GS, Larsen CS, Storgaard M, Nielsen LP, Tolstrup M, Sædder EA, Østergaard LJ, Ngo HT, Jensen MH, Højen JF, Kjolby M, Søgaard OS. Efficacy of the TMPRSS2 inhibitor camostat mesilate in patients hospitalized with Covid-19-a double-blind randomized controlled trial. EClinicalMedicine 2021; 35:100849. [PMID: 33903855 PMCID: PMC8060682 DOI: 10.1016/j.eclinm.2021.100849] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The trans-membrane protease serine 2 (TMPRSS2) is essential for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cell entry and infection. Efficacy and safety of TMPRSS2 inhibitors in patients with coronavirus disease 2019 (Covid-19) have not been evaluated in randomized trials. METHODS We conducted an investigator-initiated, double-blind, randomized, placebo-controlled multicenter trial in patients hospitalized with confirmed SARS-CoV-2 infection from April 4, to December 31, 2020. Within 48 h of admission, participants were randomly assigned in a 2:1 ratio to receive the TMPRSS2 inhibitor camostat mesilate 200 mg three times daily for 5 days or placebo. The primary outcome was time to discharge or clinical improvement measured as ≥2 points improvement on a 7-point ordinal scale. Other outcomes included 30-day mortality, safety and change in oropharyngeal viral load. FINDINGS 137 patients were assigned to receive camostat mesilate and 68 to placebo. Median time to clinical improvement was 5 days (interquartile range [IQR], 3 to 7) in the camostat group and 5 days (IQR, 2 to 10) in the placebo group (P = 0·31). The hazard ratio for 30-day mortality in the camostat compared with the placebo group was 0·82 (95% confidence interval [CI], 0·24 to 2·79; P = 0·75). The frequency of adverse events was similar in the two groups. Median change in viral load from baseline to day 5 in the camostat group was -0·22 log10 copies/mL (p <0·05) and -0·82 log10 in the placebo group (P <0·05). INTERPRETATION Under this protocol, camostat mesilate treatment was not associated with increased adverse events during hospitalization for Covid-19 and did not affect time to clinical improvement, progression to ICU admission or mortality. ClinicalTrials.gov Identifier: NCT04321096. EudraCT Number: 2020-001200-42.
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Affiliation(s)
- Jesper D. Gunst
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Nina B. Staerke
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Marie H. Pahus
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Nicolai Lohse
- Department of Emergency Medicine, Copenhagen University Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Lars S. Dalgaard
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Ole Fröbert
- Faculty of Health, Dept. of Cardiology, Örebro University, Sweden
| | - Bo Hønge
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Isik S. Johansen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark
| | - Ida Monrad
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Regitze Rosendal
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Emil Vilstrup
- Department of Medicine, Viborg Regional Hospital, Denmark
| | - Theis Mariager
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Dorthe G. Bove
- Department of Emergency Medicine, Copenhagen University Hospital, Hillerød, Denmark
| | - Rasmus Offersen
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Shakil Shakar
- Department of Internal Medicine, North Denmark Regional Hospital, Denmark
- Department of Emergency Medicine, North Denmark Regional Hospital, Denmark
| | - Sara Cajander
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nis P. Jørgensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | | | - Peter Breining
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Jespersen
- Department of Emergency Medicine, Copenhagen University Hospital, Hillerød, Denmark
| | - Klaus L. Mortensen
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Mads L. Jensen
- Department of Medicine, Viborg Regional Hospital, Denmark
| | - Lilian Kolte
- Department of Lung and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
| | - Giacomo S. Frattari
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten S. Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P. Nielsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva A. Sædder
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lars J. Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hien T.T. Ngo
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Morten H. Jensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper F. Højen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Kjolby
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- DANDRITE, Deptarment of Biomedicine, Aarhus University, Aarhus Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- University of Dundee, Scotland, United Kingdom
| | - Ole S. Søgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Tigerholm J, Hoberg TN, Brønnum D, Vittinghus M, Frahm KS, Mørch CD. Small and large cutaneous fibers display different excitability properties to slowly increasing ramp pulses. J Neurophysiol 2020; 124:883-894. [PMID: 32783585 DOI: 10.1152/jn.00629.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The excitability of large nerve fibers is reduced when their membrane potential is slowly depolarizing, i.e., the fibers display accommodation. The aim of this study was to assess accommodation in small (mainly Aδ) and large (Aβ) cutaneous sensory nerve fibers using the perception threshold tracking (PTT) technique. Linearly increasing ramp currents (1 ms-200 ms) were used to assess the excitability of the nerve fibers by cutaneous electrical stimulation. To investigate the PPT technique's ability to preferentially activate different fiber types, topical application of lidocaine/prilocaine (EMLA) or a placebo cream was applied. By means of computational modeling, the underlying mechanisms governing the perception threshold in the two fiber types was studied. The axon models included the voltage-gated ion channels: transient TTX-sensitive sodium current, transient TTX-resistant sodium current (NaTTXr), persistent sodium current, delayed rectifier potassium channel (KDr), slow potassium channel, and hyperpolarization-activated current. Large fibers displayed accommodation, whereas small fibers did not display accommodation (P < 0.05). For the pin electrode, a significant interaction was observed between cream (EMLA or placebo) and pulse duration (P < 0.05); for the patch electrode, there was no significant interaction between cream and duration, which supports the pin electrode's preferential activation of small fibers. The results from the computational model suggested that differences in accommodation between the two fiber types may originate from selective expression of voltage-gated ion channels, particularly the transient NaTTXr and/or KDr. The PTT technique could assess the excitability changes during accommodation in different nerve fibers. Therefore, the PTT technique may be a useful tool for studying excitability in nerve fibers in both healthy and pathological conditions.NEW & NOTEWORTHY When large nerve fibers are stimulated by long, slowly increasing electrical pulses, interactive mechanisms counteract the stimulation, which is called accommodation. The perception threshold tracking technique was able to assess accommodation in both small and large fibers. The novelty of this study is that large fibers displayed accommodation, whereas small fibers did not. Additionally, the difference in accommodation between the fiber could be linked to expression of voltage-gated ion channels by means of computational modeling.
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Affiliation(s)
- Jenny Tigerholm
- Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Tatiana Nielson Hoberg
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dorthe Brønnum
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Mette Vittinghus
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,It-center for Telemedicin, Region Midtjylland, Aarhus N, Denmark
| | - Ken Steffen Frahm
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Carsten Dahl Mørch
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Integrative Neuroscience Group, Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Duane FK, McGale P, Brønnum D, Cutter DJ, Darby SC, Ewertz M, Hackett S, Hall P, Lorenzen EL, Rahimi K, Wang Z, Warren S, Taylor CW. Cardiac Structure Doses in Women Irradiated for Breast Cancer in the Past and Their Use in Epidemiological Studies. Pract Radiat Oncol 2019; 9:158-171. [PMID: 30690085 PMCID: PMC6493043 DOI: 10.1016/j.prro.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/09/2018] [Accepted: 01/04/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Incidental cardiac exposure during radiation therapy may cause heart disease. Dose-response relationships for cardiac structures (segments) may show which ones are most sensitive to radiation. Radiation-related cardiac injury can take years to develop; thus, studies need to involve women treated using 2-dimensional planning, with segment doses estimated using a typical computed tomography (CT) scan. We assessed whether such segment doses are accurate enough to use in dose-response relationships using the radiation therapy charts of women with known segment injury. We estimated interregimen and interpatient segment dose variability and segment dose correlations. METHODS AND MATERIALS The radiation therapy charts of 470 women with cardiac segment injury after breast cancer radiation therapy were examined, and 41 regimens were identified. Regimens were reconstructed on a typical CT scan. Doses were estimated for 5 left ventricle (LV) and 10 coronary artery segments. Correlations between cardiac segments were estimated. Interpatient dose variation was assessed in 10 randomly selected CT scans for left regimens and in 5 for right regimens. RESULTS For the typical CT scan, interregimen segment dose variation was substantial (range, LV segments <1-39 Gy; coronary artery segments <1-48 Gy). In 10 CT scans, interpatient segment dose variation was higher for segments near field borders (range, 3-47 Gy) than other segments (range, <2 Gy). Doses to different left-anterior descending coronary artery (LADCA) segments were highly correlated with each other, as were doses to different LV segments. Also, LADCA segment doses were highly correlated with doses to LV segments usually supplied by the LADCA. For individual regimens there was consistency in hotspot location and segment ranking of higher-versus-lower dose. CONCLUSIONS The scope for developing quantitative cardiac segment dose-response relationships in patients who had 2-dimensional planning is limited because different segment doses are often highly correlated, and segment-specific dose uncertainties are not independent of each other. However, segment-specific doses may be reliably used to rank segments according to higher-versus-lower doses.
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Affiliation(s)
- Frances K Duane
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
| | - Paul McGale
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital/Department of Clinical Medicine, Aalborg University, Hjørring, Denmark
| | - David J Cutter
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Sarah C Darby
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Denmark
| | - Sara Hackett
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, United Kingdom
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Oncology, South General Hospital, Stockholm, Sweden
| | - Ebbe L Lorenzen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Kazem Rahimi
- George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Zhe Wang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Samantha Warren
- University of Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Carolyn W Taylor
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
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Taylor C, McGale P, Brønnum D, Correa C, Cutter D, Duane FK, Gigante B, Jensen MB, Lorenzen E, Rahimi K, Wang Z, Darby SC, Hall P, Ewertz M. Cardiac Structure Injury After Radiotherapy for Breast Cancer: Cross-Sectional Study With Individual Patient Data. J Clin Oncol 2018; 36:2288-2296. [PMID: 29791285 PMCID: PMC6067799 DOI: 10.1200/jco.2017.77.6351] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Incidental cardiac irradiation can cause cardiac injury, but little is known about the effect of radiation on specific cardiac segments. Methods For 456 women who received breast cancer radiotherapy between 1958 and 2001 and then later experienced a major coronary event, information was obtained on the radiotherapy regimen they received and on the location of their cardiac injury. For 414 women, all with documented location of left ventricular (LV) injury, doses to five LV segments were estimated. For 133 women, all with documented location of coronary artery disease with ≥ 70% stenosis, doses to six coronary artery segments were estimated. For each segment, numbers of women with left-sided and right-sided breast cancer were compared. Results Of women with LV injury, 243 had left-sided breast cancer and 171 had right-sided breast cancer (ratio of left v right, 1.42; 95% CI, 1.17 to 1.73), reflecting the higher typical LV radiation doses in left-sided cancer (average dose left-sided, 8.3 Gy; average dose right-sided, 0.6 Gy; left minus right dose difference, 7.7 Gy). For individual LV segments, the ratios of women with left- versus right-sided radiotherapy were as follows: inferior, 0.94 (95% CI, 0.70 to 1.25); lateral, 1.42 (95% CI, 1.04 to 1.95); septal, 2.09 (95% CI, 1.37 to 3.19); anterior, 1.85 (95% CI, 1.39 to 2.46); and apex, 4.64 (95% CI, 2.42 to 8.90); corresponding left-minus-right dose differences for these segments were 2.7, 4.9, 7.2, 10.4, and 21.6 Gy, respectively ( Ptrend < .001). For women with coronary artery disease, the ratios of women with left- versus right-radiotherapy for individual coronary artery segments were as follows: right coronary artery proximal, 0.48 (95% CI, 0.26 to 0.91); right coronary artery mid or distal, 1.69 (95% CI, 0.85 to 3.36); circumflex proximal, 1.46 (95% CI, 0.72 to 2.96); circumflex distal, 1.11 (95% CI, 0.45 to 2.73); left anterior descending proximal, 1.89 (95% CI, 1.07 to 3.34); and left anterior descending mid or distal, 2.33 (95% CI, 1.19 to 4.59); corresponding left-minus-right dose differences for these segements were -5.0, -2.5, 1.6, 3.5, 9.5, and 38.8 Gy ( Ptrend = .002). Conclusion For individual LV and coronary artery segments, higher radiation doses were strongly associated with more frequent injury, suggesting that all segments are sensitive to radiation and that doses to all segments should be minimized.
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Affiliation(s)
- Carolyn Taylor
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Paul McGale
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Dorthe Brønnum
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Candace Correa
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - David Cutter
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Frances K. Duane
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Maj-Britt Jensen
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Ebbe Lorenzen
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Kazem Rahimi
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Zhe Wang
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Sarah C. Darby
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Per Hall
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Marianne Ewertz
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
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Brønnum D, Højen AR, Gøeg KR, Elberg PB. Terminology-Based Recording of Clinical Data for Multiple Purposes Within Oncology. Stud Health Technol Inform 2016; 228:267-271. [PMID: 27577385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Collecting clinical data once for the use in both electronic health record (EHR) and registries requires semantic interoperability. This paper presents the results of a systematic semantic analysis of similarities and differences in clinical documentation across regional EHR and a national oncology registry to assess options for an integration of recording templates. METHODS A comparison of current clinical information in EHR and the national registry was carried out, using SNOMED CT as frame of reference to find exact-, similar- and non-match. RESULTS Exact match was found for 9 out of 19 items from the registry and EHR, relating to clinical history, observations and findings at the examination and tumor control. Similar match concerned clinical findings of more common side effects to therapy whether present or absent. Both EHR and the registry had information with no compared match. CONCLUSION Clinical documentation during a follow-up in head and neck cancer contains a core set of items recorded in both EHR and registry, representing clinical history, observations and more common side effects and tumor evaluation. These core items could be the point of departure for integration or re-design of EHR-systems.
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Affiliation(s)
- Dorthe Brønnum
- Department of Oncology, Aalborg University Hospital, Denmark
| | | | | | - Pia Britt Elberg
- Department of Health Science and Technology, Aalborg University, Denmark
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Højen AR, Brønnum D, Gøeg KR, Elberg PB. Applying the SNOMED CT Concept Model to Represent Value Sets for Head and Neck Cancer Documentation. Stud Health Technol Inform 2016; 228:436-440. [PMID: 27577420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper presents an analysis of the extent to which SNOMED CT is suitable for representing data within the domain of head and neck cancer. In this analysis we assess whether the concept model of SNOMED CT comply with the documentation needed within this clinical domain. Attributes from the follow-up template of the clinical quality registry for Danish Head and Neck Cancer, and their respective value sets were mapped to SNOMED CT using existing mapping guidelines. Results show that post-coordination is important to represent specific types of value sets, such as absence of findings and severities. The concept model of SNOMED CT was found suitable for representing the value sets of this material. We argue for the development of further mapping guidelines for consistent post-coordination and for initiatives that demonstrate use of this important terminological feature in actual SNOMED CT implementations.
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Affiliation(s)
| | - Dorthe Brønnum
- Department of Oncology, Aalborg University Hospital, Denmark
| | | | - Pia Britt Elberg
- Department of Health Science and Technology, Aalborg University, Denmark
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Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, Correa C, Cutter D, Gagliardi G, Gigante B, Jensen MB, Nisbet A, Peto R, Rahimi K, Taylor C, Hall P. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368:987-98. [PMID: 23484825 DOI: 10.1056/nejmoa1209825] [Citation(s) in RCA: 2522] [Impact Index Per Article: 229.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain. METHODS We conducted a population-based case-control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart. RESULTS The overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy. CONCLUSIONS Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women. (Funded by Cancer Research UK and others.).
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Affiliation(s)
- Sarah C Darby
- Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom.
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Taylor CW, Brønnum D, Darby SC, Gagliardi G, Hall P, Jensen MB, McGale P, Nisbet A, Ewertz M. Cardiac dose estimates from Danish and Swedish breast cancer radiotherapy during 1977-2001. Radiother Oncol 2011; 100:176-83. [PMID: 21376412 PMCID: PMC3168733 DOI: 10.1016/j.radonc.2011.01.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 11/27/2022]
Abstract
Background and purpose To estimate target and cardiac doses from breast cancer radiotherapy in Denmark and in the Stockholm and Umeå areas of Sweden during 1977–2001. Methods Representative samples of irradiated women were identified from the databases of the Danish Breast Cancer Cooperative Group and the Swedish Nationwide Cancer Registry. Virtual simulation, computed tomography planning and manual planning were used to reconstruct radiotherapy regimens on a typical woman. Estimates of target dose and various measures of cardiac dose were derived from individual radiotherapy charts. Results Doses were estimated in 681 Danish and 130 Swedish women. Mean heart dose for individual women varied from 1.6 to 14.9 Gray in Denmark and from 1.2 to 22.1 Gray in Sweden. In Denmark, mean target doses averaged across women increased from 40.6 to 53.8 Gray during 1977–2001 but, despite this, mean heart dose averaged across women remained around 6 Gy for left-sided and 2–3 Gray for right-sided radiotherapy. In Sweden mean target dose averaged across women increased from 38.7 to 46.6 Gray during 1977–2001, while mean heart dose averaged across women decreased from 12.0 to 7.3 Gray for left-sided and from 3.6 to 3.2 Gray for right-sided radiotherapy. Temporal trends for mean biologically effective dose [BED] to the heart, mean dose to the left anterior descending coronary artery, the right coronary artery and the circumflex coronary artery were broadly similar. Conclusions Cardiac doses in Denmark were low relative to those in Sweden. In both countries, target dose increased during 1977–2001. Despite this, cardiac doses remained constant in Denmark and decreased in Sweden.
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Darby S, Brønnum D, Correa C, Ewertz M, Gagliardi G, Gigante B, McGale P, Nisbet A, Taylor C, Hall P. A Dose-response Relationship for the Incidence of Radiation-related Heart Disease. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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