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Bak ME, Jensen NKG, Nøttrup TJ, Mathiesen HF, Roed H, Sjölin M, Kjær-Kristoffersen F, Hansen VN, Vogelius IR. Clinical experiences with online adaptive radiotherapy of vulvar carcinoma. Acta Oncol 2023; 62:1230-1238. [PMID: 37713179 DOI: 10.1080/0284186x.2023.2257377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND PURPOSE Radiotherapy for vulvar carcinoma is challenging due to relatively high risk of locoregional disease recurrence, a technically challenging target, and postoperative lymphocele, and a high risk radiation sequelae. We aim to explore, if it is possible to reduce dose to normal tissue, while maintaining CTV coverage for this patient group with online adaptive radiotherapy. MATERIALS AND METHODS 20 patients with vulvar carcinoma (527 fractions) were treated with online adaptation on a Varian Ethos accelerator. Setup CBCTs were acquired daily for adaptive planning. Verification CBCTs were acquired immediately prior to dose delivery. CTV dose coverage and dose to bladder and rectum were extracted from the scheduled and adapted plans as well as from adapted plans recalculated based on verification CBCTs. In addition, analysis of the decision of the adaptive procedure was performed for 17 patients (465 fractions). RESULTS Mean CTV D95% and standard deviation was 98% ± 5% for the scheduled plan compared to 100.0 ± 0.3% and 100.0 ± 0.8% for the adapted plan on the setup and verification CBCT respectively. Dose to OARs varied substantially and did not show any benefit from adaption itself, however a margin reduction was implemented after the first patients treated. The adapted plan was chosen for 63.5% of the fractions and dominant reasons for not adapting were 'no significant dosimetric gain' (75 fractions, 14%) and 'Medical doctor (MD) not available for treatment' (50 fractions, 9.5%). The median adaption time was 15 min and the 25th and 75th percentile was 12 and 17 min, respectively. CONCLUSION CTVs and PTVs dose coverage were significantly improved with adaptation compared to image-guided RT. This gain was robust during the treatment time.
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Affiliation(s)
- Malene E Bak
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Henrik Roed
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Maria Sjölin
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Ivan R Vogelius
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bak M, Jensen N, Jakobi Nøttrup T, From Mathiesen H, Roed H, Sjölin M, Kjær-Kristoffersen F, Nordmark Hansen V, Richter Vogelius I. PD-0904 Clinical experiences with online adaptive radiotherapy of vulvar carcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mirza M, Bjørge L, Marmé F, DePont Christensen R, Gil-Martin M, Auranen A, Ataseven B, Rubio M, Salutari V, Lund B, Runnebaum I, Redondo A, Lindemann K, Trillsch F, Barretina Ginesta M, Roed H, Løhndorf J, Nyvang GB, Sehouli J. LBA28 A randomised double-blind placebo-controlled phase II trial of palbociclib combined with letrozole (L) in patients (pts) with oestrogen receptor-positive (ER+) advanced/recurrent endometrial cancer (EC): NSGO-PALEO / ENGOT-EN3 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2258] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Berg T, Nøttrup TJ, Peen UBS, Roed H. Treatment and outcomes of a Danish ovarian cancer population. Dan Med J 2020; 67:A06190346. [PMID: 31908253] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Ovarian cancer has the highest mortality rate among gynaecological cancers and is the tenth most frequent cancer among women. 80% of patients with advanced stage disease will experience a progression either during or after treatment. METHODS This was a retrospective, observational study of all women referred to adjuvant or neoadjuvant treatment for ovarian cancer between 1 June 2013 and 31 May 2014 at two university hospitals in Denmark. RESULTS We included 142 women diagnosed with ovarian cancer. The median overall survival from diagnosis was 48.5 months (95% confidence interval (CI): 36.6-57.9 months). Median survival after the first, second, third, fourth and fifth progression was 19.3 (95% CI: 13.9-27-3), 11.4 (95% CI: 7.7-18.8), 9.5 (95% CI: 6.3-12.7), 8.3 (95% CI: 7.6-11.5) and 5.6
(95% CI: 2.9-not assessed) months, respectively. Median progression-free survival from diagnosis was 15.6 months (95% CI: 14.3-18.4 months). Median progression-free survival after first, second, third, fourth and fifth progression was 9.2 (95% CI: 7.7-10.6), 6.0 (95% CI: 3.5-7.7), 3.3 (95% CI: 2.6-4.6), 4.9 (95% CI: 3.6-8.3) and 3.0 (95% CI: 2.4-5.7) months, respectively. The most frequently used treatment at first progression was carboplatin and pegylated liposomal doxorubicin (n = 37). The most used non-platinum containing treatment at progression was pegylated liposomal doxorubicin (n = 26) followed by paclitaxel (n = 23). CONCLUSIONS Ovarian cancer remains a highly aggressive disease with most patients diagnosed in advanced stages. Treatment has not changed much in the past 15 years and the same is evident for the overall survival. FUNDING Tobias Berg received an unrestricted research grant from the Danish Cancer Society. TRIAL REGISTRATION not relevant.
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Madsen K, Høgdall C, Berthelsen AK, Loft A, Roed H. Diagnostic PET/CT for detecting malignant lymph nodes in patients with cervical cancer Stage IB1. EUR J GYNAECOL ONCOL 2019. [DOI: 10.12892/ejgo4907.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Berg T, Nøttrup TJ, Roed H. Gemcitabine for recurrent ovarian cancer - a systematic review and meta-analysis. Gynecol Oncol 2019; 155:530-537. [DOI: 10.1016/j.ygyno.2019.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
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Christiansen M, Roed H, Phanareth C, Piil K. Nurse-led consultations for patients with gynaecological cancer receiving concurrent cisplatin: A pilot study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz276.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mirza MR, Åvall Lundqvist E, Birrer MJ, dePont Christensen R, Nyvang GB, Malander S, Anttila M, Werner TL, Lund B, Lindahl G, Hietanen S, Peen U, Dimoula M, Roed H, Ør Knudsen A, Staff S, Krog Vistisen A, Bjørge L, Mäenpää JU. Niraparib plus bevacizumab versus niraparib alone for platinum-sensitive recurrent ovarian cancer (NSGO-AVANOVA2/ENGOT-ov24): a randomised, phase 2, superiority trial. Lancet Oncol 2019; 20:1409-1419. [PMID: 31474354 DOI: 10.1016/s1470-2045(19)30515-7] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Platinum-based chemotherapy is the foundation of treatment for platinum-sensitive recurrent ovarian cancer, but has substantial toxicity. Bevacizumab and maintenance poly(ADP-ribose) polymerase (PARP) inhibitors both significantly improve efficacy versus standard therapy, primarily in terms of progression-free survival, and offer the potential for chemotherapy-free treatment. AVANOVA2 compared niraparib and bevacizumab versus niraparib alone as definitive treatment for platinum-sensitive recurrent ovarian cancer. METHODS This open-label, randomised, phase 2, superiority trial in 15 university hospitals in Denmark, Sweden, Finland, Norway, and the USA enrolled women aged 18 years or older with measurable or evaluable high-grade serous or endometrioid platinum-sensitive recurrent ovarian cancer. Patients had to have an Eastern Cooperative Oncology Group performance status of 0-2, and had to have previously received platinum-containing therapy for primary disease but ≤1 prior non-platinum-containing regimen for recurrent disease. Previous treatment with bevacizumab or first-line maintenance PARP inhibitors was permitted. Eligible patients were randomly assigned 1:1 (by random permuted blocks with block sizes of two and four, no masking), stratified by homologous recombination deficiency status and chemotherapy-free interval, to receive once-daily oral niraparib 300 mg alone or with intravenous bevacizumab 15 mg/kg once every 3 weeks until disease progression. The primary endpoint was progression-free survival, assessed by the investigators in the intention-to-treat population after events in at least 62 patients. Safety was analysed in all patients who received at least one dose of study drug. This ongoing trial is registered with ClinicalTrials.gov, number NCT02354131. FINDINGS Between May 23, 2016, and March 6, 2017, 97 patients were enrolled and randomly assigned: 48 to niraparib plus bevacizumab and 49 to single-agent niraparib. Median follow-up was 16·9 months (IQR 15·4-20·9). Niraparib plus bevacizumab significantly improved progression-free survival compared with niraparib alone (median progression-free survival 11·9 months [95% CI 8·5-16·7] vs 5·5 months [3·8-6·3], respectively; adjusted hazard ratio [HR] 0·35 [95% CI 0·21-0·57], p<0·0001). Grade 3 or worse adverse events occurred in 31 (65%) of 48 patients who received niraparib plus bevacizumab and 22 (45%) of 49 who received single-agent niraparib. The most common grade 3 or worse adverse events in both groups were anaemia (7 [15%] of 48 vs 9 [18%] of 49) and thrombocytopenia (5 [10%] vs 6 [12%]), and hypertension in the combination group (10 [21%] vs 0). Niraparib plus bevacizumab was associated with increased incidences of any-grade proteinuria (10 [21%] of 48 patients vs 0) and hypertension (27 [56%] of 48 vs 11 [22%] of 49) compared with niraparib alone. No treatment-related deaths occurred. INTERPRETATION The efficacy observed with this chemotherapy-free combination of approved agents in women with platinum-sensitive recurrent ovarian cancer warrants further evaluation. A randomised phase 3 trial investigating niraparib plus bevacizumab versus chemotherapy plus bevacizumab in platinum-sensitive recurrent ovarian cancer is planned. FUNDING Nordic Society of Gynaecological Oncology and Tesaro.
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Affiliation(s)
- Mansoor Raza Mirza
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Elisabeth Åvall Lundqvist
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Oncology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Michael J Birrer
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rene dePont Christensen
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Research Unit of General Practice University of Southern Denmark, Odense, Denmark
| | - Gitte-Bettina Nyvang
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Odense University Hospital, Odense, Denmark
| | - Susanne Malander
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Lund University Hospital, Lund, Sweden
| | - Maarit Anttila
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Kuopio University Hospital, Kuopio, Finland
| | | | - Bente Lund
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - Gabriel Lindahl
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Oncology, Linköping University, Linköping, Sweden
| | - Sakari Hietanen
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Turku University Hospital, Turku, Finland
| | - Ulla Peen
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Herlev University Hospital, Herlev, Denmark
| | - Maria Dimoula
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Sahlgrenska University Hospital, Göteborg, Sweden
| | - Henrik Roed
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anja Ør Knudsen
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Odense University Hospital, Odense, Denmark
| | - Synnöve Staff
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Obstetrics and Gynecology and Tays Cancer Centre, Faculty of Medicine and Health Technology, Tampere University and University Hospital, Tampere, Finland
| | | | - Line Bjørge
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Center for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Johanna U Mäenpää
- Nordic Society of Gynaecological Oncology, Copenhagen, Denmark; Department of Obstetrics and Gynecology and Tays Cancer Centre, Faculty of Medicine and Health Technology, Tampere University and University Hospital, Tampere, Finland
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Mirza MR, Bergmann TK, Mau-Sørensen M, Christensen RD, Åvall-Lundqvist E, Birrer MJ, Jørgensen M, Roed H, Malander S, Nielsen F, Lassen U, Brøsen K, Bjørge L, Mäenpää J. A phase I study of the PARP inhibitor niraparib in combination with bevacizumab in platinum-sensitive epithelial ovarian cancer: NSGO AVANOVA1/ENGOT-OV24. Cancer Chemother Pharmacol 2019; 84:791-798. [PMID: 31375879 DOI: 10.1007/s00280-019-03917-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/05/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Combining poly(ADP-ribose) polymerase (PARP) inhibitors with antiangiogenic agents appeared to enhance activity vs PARP inhibitors alone in a randomized phase II trial. MATERIALS AND METHODS In AVANOVA (NCT02354131) part 1, patients with measurable/evaluable high-grade serous/endometrioid platinum-sensitive ovarian cancer received bevacizumab 15 mg/kg every 21 days with escalating doses of niraparib capsules (100, 200, or 300 mg daily) in a 3 + 3 dose-escalation design. Primary objectives were to evaluate safety and tolerability and to determine the recommended phase II dose (RP2D). RESULTS Three of 12 enrolled patients had germline BRCA2 mutations. In cycle 1, nine patients experienced grade 3 toxicities: five with hypertension, three with anemia, and one with thrombocytopenia. There was one dose-limiting toxicity (grade 4 thrombocytopenia with niraparib 300 mg), thus the RP2D was bevacizumab 15 mg/kg with niraparib 300 mg. The response rate was 50%; disease was stabilized in a further 42%. Median progression-free survival was 11.6 (95% confidence interval 8.4-20.1) months. Niraparib pharmacokinetics were consistent with historical single-agent data. Overlapping exposure was observed across the dose ranges tested on days 1 and 21. CONCLUSIONS There was one dose-limiting toxicity; other adverse events were typical PARP inhibitor and antiangiogenic class effects. Niraparib-bevacizumab showed promising activity; Part 2 (vs bevacizumab) was recently reported and phase III comparison with standard-of-care therapy is planned.
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Affiliation(s)
- Mansoor Raza Mirza
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark. .,Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Troels K Bergmann
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - René dePont Christensen
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Åvall-Lundqvist
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Michael J Birrer
- Comprehensive Cancer Center, The University of Alabama, Birmingham, USA
| | - Morten Jørgensen
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henrik Roed
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Susanne Malander
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Lund University Hospital, Lund, Sweden
| | - Flemming Nielsen
- Clinical Pharmacology and Pharmacy, Department of Public Health, Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Ulrik Lassen
- Department of Oncology, Copenhagen University Hospital, 5073, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kim Brøsen
- Clinical Pharmacology and Pharmacy, Department of Public Health, Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Line Bjørge
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Clinical Science, Center for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Johanna Mäenpää
- Nordic Society of Gynecological Oncology (NSGO), Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Tampere University Hospital, University of Tampere, Tampere, Finland
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Mirza MR, Avall-Lundqvist E, Birrer MJ, Christensen RD, Nyvang GB, Malander S, Anttila M, Werner TL, Lund B, Lindahl G, Hietanen S, Peen U, Dimoula M, Roed H, Knudsen AØ, Boufercha L, Staff S, Krog Vistisen A, Bjørge L, Maenpaa JU. Combination of niraparib and bevacizumab versus niraparib alone as treatment of recurrent platinum-sensitive ovarian cancer: A randomized controlled chemotherapy-free study—NSGO-AVANOVA2/ENGOT-OV24. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5505 Background: Standard treatment of platinum-sensitive recurrent ovarian cancer (PSROC) is platinum based combination chemotherapy ± bevacizumab. However, this treatment modality is hardly curative, and is associated with significant toxicity. Both bevacizumab (BEV) and PARP inhibitors (PARPi) have demonstrated efficacy in PSROC. There is preclinical evidence of enhanced activity of the combination. This is the proof-of-concept randomized trial of PARPi-BEV combination against PARPi monotherapy as treatment in PSROC, regardless of number of previous lines of therapies. Methods: In this randomized, open-label, phase 2 study, women with measurable/evaluable, high-grade serous or endometrioid PSROC were randomized to niraparib 300mg once daily or the combination of niraparib 300mg once daily and BEV 15mg/kg IV every 3 weeks until disease progression (1:1 randomization). The primary endpoint was progression-free survival (PFS). Stratification was according to homologous recombination-deficiency(HRD) status (MyChoice HRD) and chemotherapy-free-interval (CFI)(6-12months (mo) vs. >12mo). First-line maintenance bevacizumab was permitted. Results: Of 97 enrolled patients, 48 were randomized to niraparib monotherapy and 49 to the chemotherapy-free combination. The combined treatment significantly improved PFS compared to niraparib alone: median 11.9 vs. 5.5 mo; hazard ratio (HR) adjusted for stratification factors 0.35; 95% confidence interval (CI),[0.21 to 0.57]; P<0.001. Pre-planned exploratory subgroup analyses: patients with HRD-positive tumors (n=54) HR 0.36 (CI, 0.18-0.69); HRD-negative disease (n=43) HR, 0.47 (CI, 0.24-0.95); g BRCAmut patients (n=34) HR 0.53 (CI, 0.23-1.21); non-g BRCAmut patients (n=63) HR 0.33; CI, 0.18-0.61); CFI of 6 to 12 mo (n=38) HR, 0.29 (CI, 0.14 to 0.62); CFI of ≥12 mo (n=59) HR, 0.42; (CI, 0.22 to 0.80). There was no difference in treatment-emergent grade 3-4 adverse events except for the rate of hypertension (26.5% vs. 0%) and neutropenia (12.2% vs. 2.1%). Patient-reported outcomes measured using EORTC QLQ-C30 and OV28 were similar for both treatment arms. Conclusions: Both niraparib alone and the combination had meaningful activity in PSROC. Compared to niraparib alone, the chemotherapy-free regimen of niraparib and BEV significantly improved PFS in women with PSROC,regardless of HRD status and duration of CFI. Clinical trial information: NCT02354131.
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Affiliation(s)
- Mansoor Raza Mirza
- NSGO and Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Rene dePont Christensen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Susanne Malander
- Nordic Society of Gynecologic Oncology (NSGO) and Lund University Hospital, Lund, Sweden
| | | | | | | | | | | | - Ulla Peen
- University Hospital of Herev, Rungsted, Denmark
| | | | - Henrik Roed
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Line Bjørge
- Haukeland University Hospital, Bergen, Norway
| | - Johanna Unelma Maenpaa
- NSGO and Tampere University Hospital, Department of Obstetrics and Gynecology, Tampere, Finland
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Astradsson A, Munck Af Rosenschöld P, Poulsgaard L, Ohlhues L, Engelholm SA, Feldt-Rasmussen U, Marsh R, Roed H, Juhler M. Cerebral infarction after fractionated stereotactic radiation therapy of benign anterior skull base tumors. Clin Transl Radiat Oncol 2019; 15:93-98. [PMID: 30815592 PMCID: PMC6378839 DOI: 10.1016/j.ctro.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 01/15/2023] Open
Abstract
Background The purpose of this study was to examine the occurrence of cerebral infarction (ischemic stroke), in a large combined cohort of patients with anterior skull base meningiomas, pituitary adenomas and craniopharyngiomas, after fractionated stereotactic radiation therapy (FSRT). Material and Methods All patients, 18 years and older, with anterior skull base meningiomas, pituitary adenomas and craniopharyngiomas, treated with fractionated stereotactic radiation, in our center, from January 1999 to December 2015 were identified. In total 169 patients were included. The prescription dose to the tumor was 54 Gy for 164 patients (97%) and 46.0-52.2 Gy for 5 patients (3%). Cases of cerebral infarctions subsequent to FSRT were identified from the Danish National Patient Registry and verified with review of case notes. The rate of cerebral infarction after FSRT was compared to the rate in the general population with a one sample t-test after standardization for age and year. We explored if age, sex, disease type, radiation dose and dose per fraction was associated with increased risk of cerebral infarction using univariate Cox models. Results At a median follow-up of 9.3 years (range 0.1-16.5), 7 of the 169 patients (4.1%) developed a cerebral infarction, at a median 5.7 years (range 1.2-11.5) after FSRT. The mean cerebral infarction rate for the general population was 0.0035 and 0.0048 for the FSRT cohort (p = 0.423). Univariate cox models analysis showed that increasing age correlated significantly with the cerebral infarction risk, with a hazard ratio of 1.090 (p = 0.013). Conclusion Increased risk of cerebral infarction after FSRT of anterior skull base tumors was associated with age, similar to the general population. Our study revealed that FSRT did not introduce an excess risk of cerebral infarction.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Traumatic Brain Injury and Neurorehabilitation, Rigshospitalet, Hvidovre, Denmark
| | - Per Munck Af Rosenschöld
- Radiation Physics, Skåne University Hospital, Lund, Sweden.,Niels Bohr Institute, Copenhagen University, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Lars Ohlhues
- Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Reginald Marsh
- Gillies McIndoe Research Institute, Newtown, Wellington, New Zealand
| | - Henrik Roed
- Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Jeppesen JB, Roed H, Kjær-Kristoffersen F, Lauritsen J, Muhic A. P05.27 Reirradiation of brain metastases with stereotactic radiosurgery. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.353] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- J B Jeppesen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H Roed
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - F Kjær-Kristoffersen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Muhic
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Fuglsang K, Haldorsen IS, Avall-Lundqvist E, Lindahl G, Roed H, Woie K, Pakarinen P, Thoroddsen A, Anttila M, Blaakaer J. Cervical cancer staging, pretreatment planning, and surgical treatment in the Nordic countries-Survey from the Surgical Subcommittee of the Nordic Society of Gynecological Oncology. Acta Obstet Gynecol Scand 2018; 97:1178-1184. [DOI: 10.1111/aogs.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Katrine Fuglsang
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | | | - Elisabeth Avall-Lundqvist
- Department of Oncology; Linköping University; Linköping Sweden
- Department of Clinical and Experimental Medicine; Linköping, University; Linköping Sweden
| | - Gabriel Lindahl
- Department of Oncology; Linköping University; Linköping Sweden
| | - Henrik Roed
- Department of Oncology; Rigshospitalet University Hospital; Copenhagen Denmark
| | - Kathrine Woie
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
| | - Päivi Pakarinen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Asgeir Thoroddsen
- Department of Obstetrics and Gynecology; Reykjavik University Hospital; Reykjavik Iceland
| | - Maarit Anttila
- Department of Gynecology; Kuopio University Hospital; Kuopio Finland
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Odense University Hospital; Odense Denmark
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Mirza M, Wang J, Mau-Sørensen M, Birrer M, Wang X, Jørgensen M, Zhang ZY, Roed H, Malander S, Nielsen F, Bjørge L, Lassen U, Boufercha L, Brøsen K, Kansra V, Mäenpää J. A phase 1 study to evaluate the safety and tolerability of bevacizumab-niraparib combination therapy and determine the recommended phase 2 dose (RP2D) in women with platinum-sensitive epithelial ovarian cancer (ENGOT-OV24/AVANOVA1). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Munck af Rosenschöld P, Law I, Engelholm S, Muhic A, Lundemann M, Roed H, Grunnet K, Poulsen H. PO-0642: Influence of Introduction of VMAT and FET-PET on Treatment Outcomes for Glioblastoma Patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Astradsson A, Munck af Rosenschöld P, Feldt-Rasmussen U, Poulsgaard L, Wiencke AK, Ohlhues L, Engelholm SA, Broholm H, Hansen Møller E, Klose M, Roed H, Juhler M. Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort. Acta Oncol 2017; 56:415-421. [PMID: 28084862 DOI: 10.1080/0284186x.2016.1270466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to examine visual outcome, endocrine function and tumor control in a prospective cohort of craniopharyngioma patients, treated with fractionated stereotactic radiation therapy (FSRT). MATERIAL AND METHODS Sixteen adult patients with craniopharyngiomas were eligible for analysis. They were treated with linear accelerator-based FSRT during 1999-2015. In all cases, diagnosis was confirmed by histological analysis. The prescription dose to the tumor was 54 Gy (median, range 48-54) in 1.8 or 2.0 Gy per fraction, and the maximum radiation dose to the optic nerves and chiasm was 54.2 Gy (median, range 48.6-60.0) for the cohort. Serial ophthalmological and endocrine evaluations and magnetic resonance imaging (MRI) scans were performed at regular intervals. Median follow-up was 3.3 years (range 1.1-14.1), 3.7 years (range 0.8-15.2), and 3.6 years (range 0.7-13.1) for visual outcome, endocrine function, and tumor control, respectively. RESULTS Visual acuity impairment was present in 10 patients (62.5%) and visual field defects were present in 12 patients (75%) before FSRT. One patient developed radiation-induced optic neuropathy at seven years after FSRT. Thirteen of 16 patients (81.3%) had pituitary deficiency before FSRT, and did not develop further pituitary deficiency after FSRT. Mean tumor volume pre-FSRT was 2.72 cm3 (range 0.20-9.90) and post-FSRT 1.2 cm3 (range 0.00-13.10). Tumor control rate was 81.3% at two, five, and 10 years after FSRT. CONCLUSIONS FSRT was relatively safe in this prospective cohort of craniopharyngiomas, with only one case of radiation-induced optic neuropathy and no case of new endocrinopathy. Tumor control rate was acceptable.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Hvidovre, Denmark
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Ohlhues
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Helle Broholm
- Department of Neuropathology, Rigshospitalet, Copenhagen, Denmark
| | - Emil Hansen Møller
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Roed
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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17
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Birk Christensen C, Loft-Jakobsen A, Munck Af Rosenschöld P, Højgaard L, Roed H, Berthelsen AK. 18 F-FDG PET/CT for planning external beam radiotherapy alters therapy in 11% of 581 patients. Clin Physiol Funct Imaging 2017; 38:278-284. [PMID: 28168798 DOI: 10.1111/cpf.12411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/22/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND 18 F-FDG PET/CT (FDG PET/CT) used in radiotherapy planning for extra-cerebral malignancy may reveal metastases to distant sites that may affect the choice of therapy. AIM To investigate the role of FDG PET/CT on treatment strategy changes induced by the use of PET/CT as part of the radiotherapy planning. 'A major change of treatment strategy' was defined as either including more lesions in the gross tumour volume (GTV) distant from the primary tumour or a change in treatment modalities. METHODS The study includes 581 consecutive patients who underwent an FDG PET/CT scan for radiotherapy planning in our institution in the year 2008. All PET/CT scans were performed with the patient in treatment position with the use of immobilization devices according to the intended radiotherapy treatment. All scans were evaluated by a nuclear medicine physician together with a radiologist to delineate PET-positive GTV (GTV-PET). RESULTS For 63 of the patients (11%), the PET/CT simulation scans resulted in a major change in treatment strategy because of the additional diagnostic information. Changes were most frequently observed in patients with lung cancer (20%) or upper gastrointestinal cancer (12%). In 65% of the patients for whom the PET/CT simulation scan revealed unexpected dissemination, radiotherapy was given - changed (n = 38) or unchanged (n = 13) according to the findings on the FDG PET/CT. CONCLUSION Unexpected dissemination on the FDG PET/CT scanning performed for radiotherapy planning caused a change in treatment strategy in 11% of 581 patients.
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Affiliation(s)
- Charlotte Birk Christensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigations, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Loft-Jakobsen
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigations, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigations, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Roed
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Anne K Berthelsen
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigations, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
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Rosenschold PMA, Law I, Engelholm SA, Muhic A, Lundemann M, Roed H, Grunnet K, Poulsen HS. RTHP-20. EVALUATION OF RADIATION THERAPY TECHNOLOGY AND DOSIMETRY IMPACT ON TREATMENT OUTCOME FOR GLIOBLASTOMA PATIENTS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Vergote I, Lund B, Havsteen H, Ujmajuridze Z, Leunen K, Aaquist Haslund C, Juhler-Noettrup T, Roed H, Rashal T, Kranich AL, Landesman Y, Saint-Martin JR, Carlson R, Shacham S, Kauffman M, Mirza MR. Preliminary phase II results of selinexor, an oral selective inhibitor of nuclear export in patients with heavily pretreated gynecological cancers. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Bente Lund
- Department of Oncology, Aalborg Hospital, Aalborg, Denmark
| | - Hanne Havsteen
- Department of Oncology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
| | | | | | | | | | - Henrik Roed
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Modvig S, Degn M, Roed H, Sørensen TL, Larsson HBW, Langkilde AR, Frederiksen JL, Sellebjerg F. Cerebrospinal fluid levels of chitinase 3-like 1 and neurofilament light chain predict multiple sclerosis development and disability after optic neuritis. Mult Scler 2015; 21:1761-70. [PMID: 25698172 DOI: 10.1177/1352458515574148] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [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: 10/10/2014] [Accepted: 01/31/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) biomarkers have been suggested to predict multiple sclerosis (MS) after clinically isolated syndromes, but studies investigating long-term prognosis are needed. OBJECTIVE To assess the predictive ability of CSF biomarkers with regard to MS development and long-term disability after optic neuritis (ON). METHODS Eighty-six patients with ON as a first demyelinating event were included retrospectively. Magnetic resonance imaging (MRI), CSF leukocytes, immunoglobulin G index and oligoclonal bands were registered. CSF levels of chitinase-3-like-1, osteopontin, neurofilament light-chain, myelin basic protein, CCL2, CXCL10, CXCL13 and matrix metalloproteinase-9 were measured by enzyme-linked immunosorbent assay. Patients were followed up after 13.6 (range 9.6-19.4) years and 81.4% were examined, including Expanded Disability Status Scale and MS functional composite evaluation. 18.6% were interviewed by phone. Cox regression, multiple regression and Spearman correlation analyses were used. RESULTS Forty-six (53.5%) developed clinically definite MS (CDMS) during follow-up. In a multivariate model MRI (p=0.0001), chitinase 3-like 1 (p=0.0033) and age (p=0.0194) combined predicted CDMS best. Neurofilament light-chain predicted long-term disability by the multiple sclerosis severity scale (p=0.0111) and nine-hole-peg-test (p=0.0202). Chitinase-3-like-1 predicted long-term cognitive impairment by the paced auditory serial addition test (p=0.0150). CONCLUSION Neurofilament light-chain and chitinase-3-like-1 were significant predictors of long-term physical and cognitive disability. Furthermore, chitinase-3-like-1 predicted CDMS development. Thus, these molecules hold promise as clinically valuable biomarkers after ON as a first demyelinating event.
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Affiliation(s)
- S Modvig
- The MS Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - M Degn
- The MS Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - H Roed
- Holbaek municipal eye clinic, Denmark
| | - T L Sørensen
- Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde and The Faculty of Health Sciences, University of Copenhagen, Denmark
| | - H B W Larsson
- Functional Imaging Unit, Department of Diagnostics, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - A R Langkilde
- Department of Neuroradiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J L Frederiksen
- The MS Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - F Sellebjerg
- Danish MS Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Astradsson A, Wiencke AK, Munck af Rosenschold P, Engelholm SA, Ohlhues L, Roed H, Juhler M. Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors. J Neurooncol 2014; 118:101-8. [PMID: 24532196 PMCID: PMC4023078 DOI: 10.1007/s11060-014-1399-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 01/31/2014] [Indexed: 12/25/2022]
Abstract
To determine visual outcome including the occurrence of radiation induced optic neuropathy (RION) as well as tumor control after fractionated stereotactic radiation therapy (FSRT) of benign anterior skull base meningiomas or pituitary adenomas. Thirty-nine patients treated with FSRT for anterior skull base meningiomas and 55 patients treated with FSRT for pituitary adenomas between January 1999 and December 2009 with at least 2 years follow-up were included. Patients were followed up prospectively with magnetic resonance imaging scans, visual acuity and visual field examinations. RION was found in four (10 %) patients with anterior skull base meningiomas and seven patients (13 %) with pituitary adenomas. The five-year actuarial freedom from 25 % RION visual field loss was 94 % following FSRT. Actuarial 2-, 5- and 10-year tumor control rates were 100, 88.4 and 64.5 % for anterior skull base meningiomas and 100, 98.2 and 94.9 % for pituitary adenomas, respectively. Patients with an impaired visual field function pre-FSRT were more likely to experience worsened function (p = 0.016). We found that RION, was a relatively uncommon event, in a large prospective cohort of patients that were systematically monitored following FSRT of benign anterior skull base tumors. Long term tumor control was favorable, especially for pituitary adenomas.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark,
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22
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Rasmussen R, Claesson M, Stangerup SE, Roed H, Christensen IJ, Cayé-Thomasen P, Juhler M. In reply to Maletz et al. Int J Radiat Oncol Biol Phys 2013; 85:1153-4. [PMID: 23332222 DOI: 10.1016/j.ijrobp.2012.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 11/26/2012] [Indexed: 11/30/2022]
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Yoon WS, Kim JT, Han YM, Chung DS, Park YS, Lizarraga KJ, Allen-Auerbach M, De Salles AA, Yong WH, Chen W, Ruge MI, Kickingereder P, Simon T, Treuer H, Sturm V, D'Alessandro PR, Jarrett J, Walling SA, Fleetwood IG, Kim TG, Lim DH, McGovern SL, Grosshans D, McAleer MF, Chintagumpala M, Khatua S, Vats T, Mahajan A, Beauchesne PD, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Astradsson A, Rosenschold PMA, Lund AKW, Feldt-Rasmussen U, Roed H, Juhler M, Kumar N, Kumar R, Sharma SC, Mukherjee KK, Khandelwal N, Kumar R, Gupta PK, Bansal A, Kapoor R, Ghosal S, Barney CL, Brown AP, Lowe MC, McAleer MF, Grosshans DR, de Groot JF, Puduvalli V, Gilbert MR, Vats TS, Brown PD, Mahajan A, Pollock BE, Stafford SL, Link MJ, Brown PD, Garces YI, Foote RL, Ryu S, Kim EY, Yechieli R, Kim JK, Mikkelsen T, Kalkanis S, Rock J, Prithviraj GK, Oppelt P, Arfons L, Cuneo KC, Vredenburgh J, Desjardins A, Peters K, Sampson J, Chang Z, Kirkpatrick J, Nath SK, Sheridan AD, Rauch PJ, Contessa JN, Yu JB, Knisely JP, Minja FJ, Vortmeyer AO, Chiang VL, Koto M, Hasegawa A, Takagi R, Sasahara G, Ikawa H, Kamada T, Iwadate Y, Matsutani M, Kanner AA, Sela G, Gez E, Matceyevsky D, Strauss N, Corn BW, Brachman DG, Smith KA, Nakaji P, Sorensen S, Redmond KJ, Mahone EM, Kleinberg L, Terezakis S, McNutt T, Agbahiwe H, Cohen K, Lim M, Wharam M, Horska A, Amendola B, Wolf A, Coy S, Blach L, Mesfin F, Suki D, Mahajan A, Rao G, Palkonda VAR, More N, Ganesan P, Kesavan R, Shunmugavel M, Kasirajan T, Maram VR, Kakkar S, Upadhyay P, Das S, Nigudgi S, Katz JS, Knisely JP, Ghaly M, Schulder M, Palkonda VAR, More N, Shunmugavel M, Kasirajan T, Ganesan P, Kakkar S, Maram VR, Nigudgi S, Upadhyay P, Das S, Kesavan R, Taylor RB, Schaner PE, Dragovic AF, Markert JM, Guthrie BL, Dobelbower MC, Spencer SA, Fiveash JB, Katz JS, Knisely JP, Ghaly M, Schulder M, Chen L, Guerrero-Cazares H, Ford E, McNutt T, Kleinberg L, Lim M, Quinones-Hinojosa A, Redmond K, Wernicke AG, Chao KC, Nori D, Parashar B, Yondorf M, Boockvar JA, Pannullo S, Stieg P, Schwartz TH, Leeman JE, Clump DA, Flickinger JC, Burton SA, Mintz AH, Heron DE, O'Neil SH, Wong K, Buranahirun C, Gonzalez-Morkos B, Brown RJ, Hamilton A, Malvar J, Sposto R, Dhall G, Finlay J, Olch A, Reddy K, Damek D, Gaspar L, Ney D, Kavanagh B, Waziri A, Lillehei K, Stuhr K, Chen C, Kalakota K, Offor O, Patel R, Dess R, Schumacher A, Helenowski I, Marymont M, Sperduto P, Chmura SJ, Mehta M, Zadeh G, Shi W, Liu H, Studenski M, Fu L, Peng C, Gunn V, Rudoler S, Farrell C, Andrews D, Chu J, Turian J, Rooney JW, Ramiscal JAB, Laack NN, Shah K, Surucu M, Melian E, Anderson D, Prabhu V, Origitano T, Sethi A, Emami B. CLIN-RADIATION THERAPY. Neuro Oncol 2012; 14:vi133-vi141. [PMCID: PMC3488792 DOI: 10.1093/neuonc/nos238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
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Persson GF, Nygaard DE, Hollensen C, Munck af Rosenschöld P, Mouritsen LS, Due AK, Berthelsen AK, Nyman J, Markova E, Roed AP, Roed H, Korreman S, Specht L. Interobserver delineation variation in lung tumour stereotactic body radiotherapy. Br J Radiol 2012; 85:e654-60. [PMID: 22919015 PMCID: PMC3487081 DOI: 10.1259/bjr/76424694] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/22/2011] [Accepted: 09/12/2011] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES In radiotherapy, delineation uncertainties are important as they contribute to systematic errors and can lead to geographical miss of the target. For margin computation, standard deviations (SDs) of all uncertainties must be included as SDs. The aim of this study was to quantify the interobserver delineation variation for stereotactic body radiotherapy (SBRT) of peripheral lung tumours using a cross-sectional study design. METHODS 22 consecutive patients with 26 tumours were included. Positron emission tomography/CT scans were acquired for planning of SBRT. Three oncologists and three radiologists independently delineated the gross tumour volume. The interobserver variation was calculated as a mean of multiple SDs of distances to a reference contour, and calculated for the transversal plane (SD(trans)) and craniocaudal (CC) direction (SD(cc)) separately. Concordance indexes and volume deviations were also calculated. RESULTS Median tumour volume was 13.0 cm(3), ranging from 0.3 to 60.4 cm(3). The mean SD(trans) was 0.15 cm (SD 0.08 cm) and the overall mean SD(cc) was 0.26 cm (SD 0.15 cm). Tumours with pleural contact had a significantly larger SD(trans) than tumours surrounded by lung tissue. CONCLUSIONS The interobserver delineation variation was very small in this systematic cross-sectional analysis, although significantly larger in the CC direction than in the transversal plane, stressing that anisotropic margins should be applied. This study is the first to make a systematic cross-sectional analysis of delineation variation for peripheral lung tumours referred for SBRT, establishing the evidence that interobserver variation is very small for these tumours.
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Affiliation(s)
- G F Persson
- Department of Radiation Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
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Kiil Berthelsen A, Loft A, Sapru W, Andrup Kristensen C, Birk Christnesen C, Roed H, Hojgaard L, Aage Engelholm S, Bjork-Eriksson T. PET/CT Based Dose Planning in Radiotherapy. Curr Med Imaging 2011. [DOI: 10.2174/157340511796411131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Skjøth-Rasmussen J, Roed H, Ohlhues L, Jespersen B, Juhler M. Complications Following Linear Accelerator Based Stereotactic Radiation for Cerebral Arteriovenous Malformations. Int J Radiat Oncol Biol Phys 2010; 77:542-7. [PMID: 19796884 DOI: 10.1016/j.ijrobp.2009.05.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 03/14/2009] [Accepted: 05/05/2009] [Indexed: 11/19/2022]
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Roug S, Rasmussen AK, Juhler M, Kosteljanetz M, Poulsgaard L, Heebøll H, Roed H, Feldt-Rasmussen U. Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit. Eur J Endocrinol 2010; 162:685-94. [PMID: 20133445 DOI: 10.1530/eje-09-1045] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis. PATIENTS AND METHODS Thirty-four patients (17 females, median 43 years (range 30-74)) with acromegaly were treated with FSRT (conformal dynamic arcing, dose 54 Gy, 27-30 fractions) between January 1998 and April 2007. Of the 34 patients, 32 had undergone transsphenoidal adenotomy, and 28 were on medical therapy before FSRT. Patients on medical therapy continued this during and after the irradiation. The treatment was gradually decreased/withdrawn after careful assessment. RESULTS Magnetic resonance scanning of the pituitary gland 34 months (median, range 11-95) after irradiation showed stable or reduced volume of the remaining tumour tissue in 31 of 34 patients (91%). Seventeen patients (50%) were biochemically controlled (normalised nadir GH during oral glucose tolerance test and IGF1 <+2 S.D.) 30 months after FSRT (median, range 6-60), and ten of them had true biochemical remission (off medical therapy) 30 months after FSRT (median, range 12-69). Of 28 patients with one or more functioning pituitary axes before irradiation, 8 (29%) developed further deficit of one or two pituitary axes 48 months (median, range 6-102) after FSRT. Of 34 patients, 20 still required medical treatment for acromegaly at the end of this study, mainly those with a short follow-up period after irradiation. CONCLUSION The FSRT seems promising in terms of treatment of acromegaly. Longer follow-up is, however, needed to assess the overall efficacy and safety of FSRT for acromegaly.
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Affiliation(s)
- S Roug
- Departments of Medical Endocrinology, Rigshospitalet, National University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Risum S, Høgdall C, Markova E, Berthelsen AK, Loft A, Jensen F, Høgdall E, Roed H, Engelholm SA. Influence of 2-(18F) Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography/Computed Tomography on Recurrent Ovarian Cancer Diagnosis and on Selection of Patients for Secondary Cytoreductive Surgery. Int J Gynecol Cancer 2009; 19:600-4. [DOI: 10.1111/igc.0b013e3181a3cc94] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lundvall L, Jensen F, Roed H, Ottosen C, Ewertsen C, Henriksen BM. Vaginal rupture caused by transvaginal ultrasonography in follow-up for ovarian cancer. BMJ Case Rep 2009; 2009:bcr05.2009.1860. [PMID: 21841949 DOI: 10.1136/bcr.05.2009.1860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaginal rupture is a rare complication of hysterectomy. It is, among others, related to age and the incidence is higher in postmenopausal women. The rupture can occur spontaneously or in relation to clinical follow-up. In ovarian cancer the follow-up after surgery includes clinical examination, cancer antigen (CA)-125, and transabdominal and transvaginal ultrasonography. We experienced vaginal rupture in three patients with ovarian cancer. All patients had undergone surgery for ovarian cancer and were receiving chemotherapy. The rupture occurred shortly after transvaginal ultrasonography, performed by separate radiologists specialised in ultrasonography. All patients had acute surgery without any complications. Caution should be taken when performing transvaginal ultrasonography in hysterectomised patients and the complication of vaginal rupture should always be borne in mind.
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Affiliation(s)
- Lene Lundvall
- Rigshospitalet, Copenhagen University Hospital, Department of Gynaecology, Blegdamsvej 9, Copenhagen OE, DK-2100, Denmark
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Muhic A, Hovgaard D, Mørk Petersen M, Daugaard S, Højlund Bech B, Roed H, Kjær-Kristoffersen F, Aage Engelholm S. Local control and survival in patients with soft tissue sarcomas treated with limb sparing surgery in combination with interstitial brachytherapy and external radiation. Radiother Oncol 2008; 88:382-7. [DOI: 10.1016/j.radonc.2008.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 04/21/2008] [Accepted: 06/04/2008] [Indexed: 11/15/2022]
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Hoyer M, Roed H, Traberg Hansen A, Ohlhuis L, Petersen J, Nellemann H, Kiil Berthelsen A, Grau C, Aage Engelholm S, Von der Maase H. Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 2007; 45:823-30. [PMID: 16982546 DOI: 10.1080/02841860600904854] [Citation(s) in RCA: 290] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgical resection provides long term survival in approximately 30% of patients with colorectal carcinoma (CRC) liver metastases. However, only a limited number of patients with CRC-metastases are amendable for surgery. We have tested the effect of stereotactic body radiotherapy (SBRT) in the treatment of inoperable patients with CRC-metastases. Sixty-four patients with a total number of 141 CRC-metastases in the liver (n = 44), lung (n = 12), lymph nodes (n = 3), suprarenal gland (n = 1) or two organs (n = 4) were treated with SBRT with a central dose of 15 Gy x 3 within 5-8 days. Median follow-up was 4.3 years. After 2 years, actuarial local control was 86% and 63% in tumor and patient based analysis, respectively. Nineteen percent were without local or distant progression after 2 years and overall survival was 67, 38, 22, 13, and 13% after 1, 2, 3, 4 and 5 years, respectively. One patient died due to hepatic failure, one patient was operated for a colonic perforation and two patients were conservatively treated for duodenal ulcerations. Beside these, only moderate toxicities such as nausea, diarrhoea and skin reactions were observed. SBRT in patients with inoperable CRC-metastases resulted in high probability of local control and promising survival rate. One toxic death and few severe reactions were observed. For the majority of patients, the treatment related toxicity was moderate.
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Affiliation(s)
- Morten Hoyer
- Department of Oncology, Aarhus University Hospital
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Abstract
In the evaluation of a film used as a personal dosemeter it may be necessary to mark the dosemeters when possible error-conditions are recognised, such as errors that have an influence on the ability to make a correct evaluation of the dose value. In this project a comparison has been carried out to examine how two individual monitoring services, IMS [National Institute of Radiation Hygiene, Denmark (NIRH) and National Research Centre for Environment and Health, Germany (GSF)], from two different EU countries mark their dosemeters. The IMS are different in size, type of customers and issuing period, but both use films as their primary dosemeters. The error-conditions examined are dosemeters exposed to moisture or light, contaminated dosemeters, films exposed outside the badge, missing filters in the badge, films inserted incorrectly in the badge and dosemeters not returned or returned too late to the IMS. The data are collected for the year 2003 where NIRH evaluated approximately 50,000 and GSF approximately 1.4 million film dosemeters. The percentage of film dosemeters is calculated for each error-condition as well as the distribution among eight different employee categories, i.e. medicine, nuclear medicine, nuclear industry, industry, radiography, laboratories, veterinary and others. It turned out, that incorrect insertion of the film in the badge was the most common error-condition observed at both IMS and that veterinarians, as the employee category, generally have the highest number of errors. NIRH has a significantly higher relative number of dosemeters in most error-conditions than GSF, which perhaps reflects that a comparison is difficult due to different systemic and methodical differences between the IMS and countries, e.g. regulations and monitoring programs etc. Also the non-existence of a common categorisation method for employee categories contributes to make a comparison like this difficult.
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Affiliation(s)
- H Roed
- NIRH-National Board of Health, National Institute of Radiation Hygiene Copenhagen, Denmark.
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Hoyer M, Roed H, Hansen AT, Ohlhuis L, Petersen J, Nellemann H, Berthelsen AK, Grau C, Engelholm SA, von der Maase H. Prospective study on stereotactic radiotherapy of limited-stage non–small-cell lung cancer. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.01.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kamenopoulou V, van Dijk JWE, Ambrosi P, Bolognese-Milsztajn T, Castellani CM, Currivan L, Falk R, Fantuzzi E, Figel M, Alves JG, Ginjaume M, Janzekovic H, Kluszczynski D, Lopez MA, Luszik-Bhadra M, Olko P, Roed H, Stadtmann H, Vanhavere F, Vartiainen E, Wahl W, Weeks A, Wernli C. Aspects of harmonisation of individual monitoring for external radiation in Europe: conclusions of a EURADOS action. Radiat Prot Dosimetry 2006; 118:139-43. [PMID: 16581923 DOI: 10.1093/rpd/ncl006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Following the publication of the EU Council Directive 96/29, EURADOS coordinated two working groups (WGs) for promoting the process of harmonisation on individual monitoring of occupationally exposed persons in Europe. An overview of the major findings of the second WG is presented. Information on the technical and quality standards and on the accreditation and approval procedures has been compiled. The catalogue of dosimetric services has been updated and extended. An overview of national regulations and standards for protection from radon and other natural sources in workplaces has been made, attempting to combine the results from individual monitoring for external, internal and workplace monitoring. A first status description of the active personal dosemeters, including legislative and technical information, and their implementation has been made. The importance of practical factors on the uncertainty in the dose measurement has been estimated. Even if a big progress has been made towards harmonisation, there is still work to be done.
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Affiliation(s)
- V Kamenopoulou
- GAEC, Greek Atomic Energy Commission, Aghia Paraskevi, Greece.
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Hoyer M, Roed H, Sengelov L, Traberg A, Ohlhuis L, Pedersen J, Nellemann H, Kiil Berthelsen A, Eberholst F, Engelholm SA, von der Maase H. Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 2005; 76:48-53. [PMID: 15990186 DOI: 10.1016/j.radonc.2004.12.022] [Citation(s) in RCA: 245] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Revised: 11/27/2004] [Accepted: 12/14/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The majority of patients with pancreatic cancer have advanced disease at the time of diagnosis and are not amenable for surgery. Stereotactic radiotherapy (SRT) may be an alternative treatment for patients with locally advanced disease. The effect of SRT was investigated in the present phase-II trial. PATIENTS AND METHODS Twenty-two patients with locally advanced and surgically non-resectable, histological proven pancreatic carcinoma were included into the trial. The patients were immobilized by the Elekta stereotactic body frame (SBF) or a custom made body frame. SRT was given on standard LINAC with standard multi-leaf collimator. Central dose was 15 Gyx3 within 5-10 days. RESULTS Evaluation of response was found to be very difficult due to radiation and tumour related tissue reaction. Only two patients (9%) were found to have a partial response (PR), the remaining had no change (NC) or progression (PD) after treatment. Six patients had local tumour progression, but only one patient had an isolated local failure without simultaneous distant metastasis. Median time to local or distant progression was 4.8 months. Median survival time was 5.7 months and only 5% were alive 1 year after treatment. Acute toxicity reported 14 days after treatment was pronounced. There was a significant deterioration of performance status (P=0.008), more nausea (P=0.001) and more pain (P=0.008) after 14 days compared with base-line. However, 8 of 12 patients (66%) improved in performance status, scored less nausea, pain, or needed less analgesic drugs at 3 months after treatment. Four patients suffered from severe mucositis or ulceration of the stomach or duodenum and one of the patients had a non-fatal ulcer perforation of the stomach. CONCLUSIONS SRT was associated with poor outcome, unacceptable toxicity and questionable palliative effect and cannot be recommended for patients with advanced pancreatic carcinoma.
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Affiliation(s)
- Morten Hoyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
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Hoyer M, Roed H, Hansen A, Ohlhuis L, Jorgen P, Nellemann H, Berthelsen A, Grau C, Engelholm S, von der Maase H. Prospective Study on Stereotactic Radiotherapy of Limited Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIM To study the involvement of the chemokine receptor CXCR3 and its ligands (CXCL9/Mig, CXCL10/IP-10, CXCL11/ITAC) in optic neuritis (ON). METHODS 30 patients with ON and 10 non-inflammatory neurological disease controls were included. The patients underwent a phlebotomy, lumbar puncture, and MRI scan. CXCR3 expression was studied on blood and cerebrospinal fluid (CSF) T cells by flow cytometry. CXCL9, CXCL10, and CXCL11 were measured in plasma and CSF by ELISA. RESULTS CSF concentrations of CXCL10, but not of CXCL9 and CXCL11, were significantly higher in ON patients than in controls. CSF concentrations of CXCL10 correlated with the CSF leucocyte count in ON patients, and CXCR3 expressing cells were significantly enriched in the CSF. CONCLUSION These data show that the CSF concentration of the CXCR3 ligand CXCL10 is selectively increased in CSF from ON patients, and CXCR3 positive cells are recruited to the subarachnoid space.
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Affiliation(s)
- T L Sørensen
- Department of Ophthalmology, University of Copenhagen, Herlev Hospital, 2720 Herlev, Denmark.
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Christensen AF, Nielsen MB, Engelholm SA, Roed H, Svendsen LB, Christensen H. Three-dimensional anal endosonography may improve staging of anal cancer compared with two-dimensional endosonography. Dis Colon Rectum 2004; 47:341-5. [PMID: 14991496 DOI: 10.1007/s10350-003-0056-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Three-dimensional (3-D) endosonography is a new method of staging anal carcinoma that has not yet been validated in comparison with two-dimensional (2-D) endosonography, the latter using only a single scan plane. The aim of this study was to investigate the differences between the two endosonographic techniques. METHODS Thirty patients with an endosonographically detectable anal tumor were examined with a 10 MHz rotating endoprobe. Cross-sectional images of the anal sphincters were stored on a 3-D system during retraction of the endoprobe through the anal canal. Afterwards, any projection could be reconstructed. Cross-sectional images (2-D) were compared with reconstructed projections (3-D) according to five parameters concerning tumor spread and presence of regional lymph nodes. In this study, a scale of 0 to 5 points on critical issues was used; ideally, the results should be identical in 2-D and 3-D endosonography. RESULTS The 3-D method detected a median of 5 diagnostic findings, compared with a median of 4 findings with the 2-D method ( P = 0.001). In eight patients the lateral tumor margin was visualized only by 3-D endosonography. The median number of lymph nodes visualized in 3-D was 1 (range, 0-13), in 2-D the median number was 0 (range, 0-6), P = 0.002. CONCLUSIONS Use of 3-D endosonography in patients with anal carcinoma improves detection of perirectal lymph nodes and may improve that of tumor invasion, compared with 2-D endosonography. This may affect local tumor staging and thus planning of treatment. A study with histopathologic correlation is needed to verify this endosonographic study.
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Affiliation(s)
- Anders F Christensen
- Department of Radiology, Section of Ultrasound X4123, Rigshospitalet, Copenhagen, Denmark.
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Stadtmann H, Figel M, Kamenopoulou V, Kluszczynski D, Roed H, Van Dijk J. Quality control and reliability of reported doses. Radiat Prot Dosimetry 2004; 112:169-189. [PMID: 15574990 DOI: 10.1093/rpd/nch287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Results of performance tests verifying the dosimetric properties of dosimetric systems are published in various reports (e.g. IAEA and EURADOS). However, there is hardly any information in the open literature relating to the uncertainty in a dose measurement or in the annual dose, which is increased by failure of the evaluation or data management system, damage of the dosemeter itself or by the loss of dosemeter. In this article, an attempt is made to estimate the importance of the above-mentioned conditions. This is achieved by sending questionnaires to about 200 approved dosimetric services in Europe. In total 88 questionnaires were returned and analysed. In the questionnaires, the frequency of occurrence of the various error conditions were investigated. Participants were also asked to evaluate the impact of the error condition from a dosimetric point of view and what countermeasures are taken. The article summarises all responses and compares different sources of errors according to their impact on the uncertainty of the resulting dose and gives a comprehensive overview on quality control actions and reliability on reported doses from European dosimetric services.
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Affiliation(s)
- H Stadtmann
- ARC-Seibersdorf Research GmbH, 2440 Seibersdorf, Austria.
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Eigtved A, Berthelsen AK, Roed H, Engelholm SA. PET/CT BASED THREE-DIMENSIONAL (3-D) DOSE-PLANNING OF INTERSTITIAL BRACHYTHERAPY IN PATIENTS WITH ADVANCED GYNECOLOGICAL CANCER. A NEW METHOD. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Paskeviciute L, Roed H, Engelholm A. No rules without exception: a long-term complete remission observed in a study using a LH-RH agonist in platinum-refractory ovarian cancer. Eur J Cancer 2002; 38 Suppl 6:S73. [PMID: 12409084 DOI: 10.1016/s0959-8049(02)00295-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Paskeviciute
- Department of Oncology, The Finsen Center, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark.
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Paskeviciute L, Roed H, Engelholm S. No rules without exception: long-term complete remission observed in a study using a LH-RH agonist in platinum-refractory ovarian cancer. Gynecol Oncol 2002; 86:297-301. [PMID: 12217751 DOI: 10.1006/gyno.2002.6778] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Second-line chemotherapy in platinum/paclitaxel-resistant ovarian cancer induces an objective response in <15% and third-line chemotherapy results in responses less than 10%. Chemotherapy always results in side effects with the risk of a low quality of life. Endocrine therapy is used world-wide among chemo-resistant ovarian cancer. Tamoxifen is a standard palliative treatment in many centers. LH-RH (luteinizing hormone-releasing hormone) agonists have also demonstrated activity among patients with ovarian cancer in several studies with response rates of 9-12% and disease stabilization in 15-26% of these women. METHODS In this retrospective study 32 patients with ovarian cancer who had relapsed after platinum/paclitaxel-based first-line chemotherapy and had exhausted all standard treatments received LH-RH analogue Leuprorelin depot 3.75 mg sc once a month until tumor progression. RESULTS One patient (3%) had a complete response, with remission time over 3 years. Two patients (6%) reached partial response with remission time of 3 and 4 months. Four patients (12%) remained stable for a mean time of 7 months (range 4-12 months). The remaining 25 patients (78%) had progressive disease. The treatment was well tolerated, and no major toxicity has been reported. CONCLUSION This study showed that LH-RH agonist Leuprorelin has only a limited effect in patients pretreated with platinum-based chemotherapy.
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Affiliation(s)
- Ligita Paskeviciute
- Department of Oncology, Finsen Center, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
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Bennedbaek O, Viktor J, Carlsen KS, Roed H, Vinding H, Lundbye-Christensen S. [Infants with colic. A heterogenous group possible to cure? Treatment by pediatric consultation followed by a study of the effect of zone therapy on incurable colic]. Ugeskr Laeger 2001; 163:3773-8. [PMID: 11466984] [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: 02/20/2023]
Abstract
INTRODUCTION The aim of the study was to investigate and treat infants with colic by conventional medicine followed by an investigation of the effect of reflexological treatment. MATERIAL AND METHODS The investigation was prospective, followed by a randomised, single-blind, double-controlled, prospective study of reflexological treatment with an interview and diary. Sixty-three infants aged 1-3 months referred by general practitioners with crying for > 90 minutes a day were given a paediatric examination and intervention. The cause of crying was discovered in 33 infants: Vitamin D (5), elimination of cow's milk protein (3), and anal stenosis (3); counselling on feeding, sleep, reduction of stimulation, and avoidance of passive smoking (22). Thirty infants without the benefit of paediatric consultation were randomised to three groups for a duration of two weeks: A: Presumed non-effective reflexological treatment vs B: Presumed effective reflexological treatment vs C: No treatment--only observation. The most important parameter was the number of crying hours over 24 hours. Cure was defined as crying for less than or equal to 30 minutes. RESULTS Examination by the paediatrician: Thirty-three of 63 infants benefited with a reduction in crying of less than 90 minutes and 13 of these infants were cured. The randomised study: In group C (control), none of the patients was cured. In groups A and B (presumed non-effective reflexological treatment and presumed effective treatment), half the patients were cured, which was significantly better than in group C. There was no significant difference between groups A and B, but B seemed better than group A. B was significantly better than C. DISCUSSION Infantile colic had a significant cure rate at paediatric consultation and the children who did not benefit from this intervention had a significantly better outcome after reflexological treatment than had the observation group. Further investigations in reflexological treatment in infants are recommended.
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Affiliation(s)
- O Bennedbaek
- Aalborg Universitet, Institut for Matematiske Fag
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Jensen PT, Roed H, Engelholm SA, Rosendal F. Pulsed dose rate (PDR) brachytherapy as salvage treatment of locally advanced or recurrent gynecologic cancer. Int J Radiat Oncol Biol Phys 1998; 42:1041-7. [PMID: 9869227 DOI: 10.1016/s0360-3016(98)00290-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Pulsed dose rate (PDR) brachytherapy is a new treatment option permitting dose distribution optimization in interstitial implants. It possesses the advantage of equipment simplification and radiation protection to the staff, compared to the manually afterloading technique. This study presents the first clinical results from The Finsen Center with PDR-brachytherapy in patients with locally advanced or recurrent gynecologic cancer. METHODS AND MATERIALS Between June 1993 and August 1996, 34 patients with gynecologic malignancies (22 pelvic recurrences, 12 primary locally advanced) have been treated with external irradiation, four-field box technique, to 46 Gy/23 fractions, 5 F/week and 192Ir-interstitial PDR-brachytherapy in pulses of 0.6 Gy, one pulse per hour to a total of 30 Gy. The Martinez Universal Perineal Interstitial Template applicator was used for all implantations. RESULTS The overall complete response rate was 74%. At median 14 months follow-up (range 3-40) 15 patients were alive with no evidence of disease. Seven of 14 patients with a second recurrence or progressive disease were still alive. The overall 1- and 2-year survival was 71% and 63%, respectively. There was no difference in survival probability when stratifying the patients by primary diagnosis (recurrent vs. primary advanced), relapse locations (central vs. central + pelvic wall mass) or treatment volume. Seventeen chronic grade III complications were observed in 10 patients. Large treatment volumes significantly correlated to severe gastrointestinal complications. Fifteen of 17 chronic grade III complications were observed in patients treated for recurrent disease. CONCLUSION PDR-brachytherapy in combination with external irradiation is an effective treatment option for patients with locally advanced or recurrent gynecologic cancer, although substantial toxicity is observed in patients with large treatment volumes and recurrent disease.
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Affiliation(s)
- P T Jensen
- The Finsen Center 5074, Copenhagen University Hospital, Denmark.
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Abstract
BACKGROUND AND PURPOSE With radiotherapy of anal carcinomas, sphincter preservation can be obtained at survival rates similar to those obtained with radical surgery. By combining external beam irradiation with interstitial irradiation, superiority over standard external irradiation has been obtained. With the introduction of pulsed dose rate equipment, where a single high activity source moves through catheters, a more individualized dose distribution and a further elimination of radiation exposure to the staff can be achieved. MATERIALS AND METHODS Between June 1993 and November 1994, 17 patients with anal carcinoma (T1:4, T2:4, T3:6, T4:3) have been treated at the Finsen Center. The treatment consisted of three-field external irradiation 46 Gy/23 fractions with five fractions a week to the anal canal and regional pelvic lymph nodes. Seven to 33 days after completion of external irradiation, the tumorspace was given 25.2 Gy PDR brachytherapy with 42 pulses of 0.6 Gy, one pulse every hour. RESULTS One isolated local recurrence has been noted 13 weeks after implantation. One additional local recurrence was seen in a patient with concomitant hepatic and inguinal recurrence. In three patients inguinal recurrence had occurred, two of these patients were irradiated without any further evidence of disease, and one patient with a primary advanced tumour, had local failure. So far necrosis has been observed in 13 patients within 1-49 weeks (median 16 weeks) after implantation. Eight of these patients required colostomy. No relation was observed between the number of implanted needles and the occurrence of necrosis. CONCLUSIONS The results indicate that the treatment is highly effective, but with substantial toxicity.
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Affiliation(s)
- H Roed
- Finsen Center 5074, Copenhagen University Hospital, Denmark
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46
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Aabo K, Roed H, Vindeløv LL, Spang-Thomsen M. A dominated and resistant subpopulation causes regrowth after response to 1,3-bis(2-chloroethyl)-1-nitrosourea treatment of a heterogeneous small cell lung cancer xenograft in nude mice. Cancer Res 1994; 54:3295-9. [PMID: 8205552] [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: 01/29/2023]
Abstract
In order to address the question of the influence of a primarily chemoresistant tumor cell subpopulation on the progression of a heterogeneous tumor after cytotoxic therapy, in vitro established human small cell lung cancer cell lines of a 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU)-sensitive (592) and a resistant (NYH) tumor were used to produce mixed solid tumors in nude mice. Mixtures of 592/NYH (9:1 and 1:1) were inoculated s.c. After 3-4 weeks of tumor growth, the mice were stratified according to tumor size and randomized to treatment with BCNU 40 mg/kg i.p. (10% of lethal dose) or no treatment. Tumor growth curves were used to calculate the effect of the treatment, and changes in the relative proportions of 592 and NYH in the mixed tumors were monitored by flow cytometric DNA analysis by which the two cell lines were distinguishable due to differences in DNA content. A significant response was demonstrated in the 9:1 mixed tumors in which only 592 cells were detectable at the start of the treatment. The response was short and less pronounced compared with tumors containing only 592. In the regrowing tumors after treatment, only NYH was detected. In untreated 9:1 mixed control tumors, only 592 cells were detectable throughout the entire observation period. It is substantiated that the 592 cells were able to inhibit the growth of the NYH cells completely when grown together in 9:1 mixed tumors. This was not the case in the 1:1 mixed tumors. The 1:1 mixed tumors did not respond to BCNU, although 592 was eradicated. These results indicate that resistant and undetectable (dominated) subpopulations in heterogeneous tumors may be responsible for relapse and that the fractional size and the growth characteristics of the resistant subpopulation may determine the magnitude of the clinical response to cytotoxic treatment.
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Affiliation(s)
- K Aabo
- University Institute of Pathological Anatomy, University of Copenhagen, Denmark
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47
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Roed H, Engelholm S, Rosendal F, Olsen K, Svendsen L, Nielsen O. 58 Combination of external irradiation and pulsed dose rate (PDR) brachytherapy of anal carcinoma. Radiother Oncol 1994. [DOI: 10.1016/0167-8140(94)91156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Jensen PB, Roed H, Sehested M, Demant EJ, Vindeløv L, Christensen IJ, Hansen HH. Doxorubicin sensitivity pattern in a panel of small-cell lung-cancer cell lines: correlation to etoposide and vincristine sensitivity and inverse correlation to carmustine sensitivity. Cancer Chemother Pharmacol 1993; 31:46-52. [PMID: 1360876 DOI: 10.1007/bf00695993] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of our investigations is to evaluate whether the sensitivity patterns of small-cell lung-cancer (SCLC) cell lines in vitro can be used in evaluating new drugs and in selecting drugs for the optimization of combination therapy. In our attempts to obtain a panel of cell lines demonstrating differential patterns in sensitivity, we have developed three SCLC lines exhibiting different types of multidrug resistance (MDR). In the present investigations we compared the sensitivity patterns shown by five wild-type SCLC lines and three MDR lines in response to six different types of drugs: doxorubicin, cytarabine, carmustine, cisplatin, vincristine, and etoposide. In the wild-type SCLC cell lines, the range of variation in sensitivity to all drugs was within a factor of 10. Cell lines showing low sensitivity to doxorubicin also exhibited low sensitivity to etoposide and vincristine, and vice versa. In contrast, the pattern of sensitivity to carmustine was almost the opposite of that to doxorubicin. A tendency to an inverse relationship between doxorubicin and carmustine sensitivity was also observed when doxorubicin sensitivity was reduced in near stationary cells and in cells exposed to the metabolic inhibitor 2-deoxy-D-glucose. In agreement with the pattern observed for the wild-type lines, all of the MDR sublines demonstrated collateral sensitivity to carmustine. As to cytarabine, the wild-type lines expressed a sensitivity pattern similar to that shown in response to doxorubicin. Interestingly, the opposite pattern was found in the MDR lines, as all three demonstrated cytarabine hypersensitivity. The combination of alkylating agents and "MDR" drugs are of proven clinical benefit in the treatment of solid tumors, as is the combination of anthracycline and cytarabine in acute myeloid leukemia. The experimentally derived sensitivity data on cytarabine, alkylating agents, and MDR drugs (i.e., etoposide, doxorubicin, vincristine) thus resemble the clinical experience with these drugs, and we conclude that the use of a clonogenic assay on the described panel of SCLC cell lines can give valuable information for the selection of agents for combination therapy.
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Affiliation(s)
- P B Jensen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
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Friche E, Jensen PB, Roed H, Skovsgaard T, Nissen NI. In vitro circumvention of anthracycline--resistance in Ehrlich ascites tumour by anthracycline analogues. Biochem Pharmacol 1990; 39:1721-6. [PMID: 2344368 DOI: 10.1016/0006-2952(90)90117-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In previously reported studies, acquired experimental resistance and cross resistance to anthracyclines are related to decreased drug accumulation and retention. The decreased accumulation seems to depend on a cellular mechanism for active drug efflux. N-Acetyl-daunorubicin (N-acetyl-DNR) has demonstrated the ability to increase drug accumulation and to overcome experimental resistance to daunorubicin (DNR) in resistant cells. In the present in vitro study 25 different anthracycline analogues were tested for their influence on [3H]DNR accumulation in resistant cells. At equimolar concentrations (5 microM) four of the analogues enhanced [3H]DNR accumulation more than 200%. Increasing the concentration of the analogues 3-20-fold, 12 of the compounds could enhance [3H]DNR accumulation above 200%. No specific structural changes separated those 12 compounds from the 13 analogues with no or minor effect. The lipid solubility of the 25 analogues was examined by measuring the partition coefficient in octanol/phosphate and pentanol/phosphate buffer (pH 7.45). A good correlation was demonstrated between increased lipid solubility of the analogues and their effect on [3H]DNR accumulation in resistant cells. Further studies demonstrated that N,N-dibenzyl-DNR was able to potentiate cytotoxicity of DNR in resistant cells. It is concluded that several anthracycline analogues are able to reverse resistance, but it is not possible from the chemical structure to predict which analogue results in enhanced [3H]DNR accumulation in resistant cells.
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Affiliation(s)
- E Friche
- Department of Medicine, Finsen Institute/Rigshospitalet, Copenhagen, Denmark
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Jensen PB, Roed H, Skovsgaard T, Friche E, Vindeløv L, Hansen HH, Spang-Thomsen M. Antitumor activity of the two epipodophyllotoxin derivatives VP-16 and VM-26 in preclinical systems: a comparison of in vitro and in vivo drug evaluation. Cancer Chemother Pharmacol 1990; 27:194-8. [PMID: 2265455 DOI: 10.1007/bf00685712] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The epipodophyllotoxines VP-16 and VM-26 are chemically closely related. VM-26 has been found to be considerably more potent than VP-16 in vitro in a number of investigations. Although the drugs have been known for greater than 20 years, they have not been compared at clearly defined equitoxic doses on an optimal schedule in vivo and it has not been clarified as to whether a therapeutic difference exists between them. A prolonged schedule is optimal for both drugs; accordingly we determined the toxicity in mice using a 5-day schedule. The dose killing 10% of the mice (LD10) was 9.4 mg/kg daily (95% confidence limits, 7.4-11.8) for VP-16 and 3.4 (2.5-4.5) mg/kg daily for VM-26. In vitro, we found VM-26 to be 6-10 times more potent than VP-16 in a clonogenic assay on murine tumors P388 and L1210 leukemia and Ehrlich ascites. This pattern was also demonstrated in a multidrug-resistant subline of Ehrlich selected for resistance to daunorubicin (Ehrlich/DNR+), as it was 30 times less sensitive than Ehrlich cells to both VP-16 and VM-26. Using 90%, 45%, and 22% of the LD10 on the same murine tumors in vivo, we found that the effect of the two drugs was equal as evaluated by both the increase in life span and the number of cures. The drugs were also compared in nude mice inoculated with human small-cell lung cancer lines OC-TOL and CPH-SCCL-123; however, they were more toxic to the nude mice and only a limited therapeutic effect was observed. In conclusion, the complete cross-resistance between the two drugs suggests that they have an identical antineoplastic spectrum. VM-26 was more potent than VP-16 in vitro; however, this was not correlated to a therapeutic advantage for VM-26 over VP-16 in vivo.
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Affiliation(s)
- P B Jensen
- Department of Oncology, Finsen Institute, Copenhagen, Denmark
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