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  • 1.
    Johansson, Bengt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Leif
    Örebro University, School of Health and Medical Sciences.
    Liljegren, Göran
    Örebro University, School of Health and Medical Sciences.
    Hardell, Lennart
    Persliden, Jan
    Örebro University, School of Health and Medical Sciences.
    Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1-T2 breast cancer: first long time results from a clinical study2009In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 90, no 1, p. 30-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: To evaluate the long time outcome with regard to local tumour control, cosmetic outcome and side effects of a short (5 days) accelerated interstitial brachytherapy treatment delivered to the surroundings of the operated sector. PATIENTS AND METHODS: Between 1993 and 2003 we treated 50 women with early T1 and T2 breast cancer. Radical sector resection was performed and followed later with an interstitial pulsed dose rate (PDR) brachytherapy of 50Gy in 5 days. The treatment was centred on the tumour with a margin of 30mm. One patient was treated bilaterally. The patients were followed for a median of 86 (32-126) months. RESULTS: Ipsilateral breast cancer recurrence was seen in 3 patients (6%). Two of them occurred outside the treated volume. The 5- and 7-year rates of actuarial local control were 96% and 96%, respectively, overall survival 88% and 85%, disease free survival 88% and 88%, respectively. A dosimetrical analysis showed that the partial breast irradiation covered a median of 31% of the total breast volume. Fat necrosis was seen in 12% and local (moderate-strong) fibrosis in 26% of the patients. Independent cosmetic scoring showed good or excellent result in 56% of the patients. CONCLUSIONS: Local outcome is favourable and very similar to other published studies of accelerated partial breast irradiation. Our long time cosmetic results are lower than other published results.

  • 2.
    Johansson, Bengt
    et al.
    Örebro University, Department of Clinical Medicine.
    Persson, Essie
    Örebro University, Department of Clinical Medicine.
    Westman, Gunnar
    Örebro University, Department of Clinical Medicine.
    Persliden, Jan
    Örebro University, Department of Clinical Medicine.
    Phantom study of radiation doses outside the target volume brachytherapy versus external radiotherapy of early breast cancer2003In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 69, no 1, p. 107-112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Brachytherapy is sometimes suggested as an adjuvant treatment after surgery of some tumours. When introducing this, it would be useful to have an estimate of the dose distribution to different body sites, both near and distant to target, comparing conventional external irradiation to brachytherapy. The aim of the present study was to determine radiation doses with both methods at different body sites, near and distant to target, in an experimental situation on an operated left sided breast cancer on a female Alderson phantom. METHODS: Five external beam treatments with isocentric tangential fields were given by a linear accelerator. A specified dose of 1.0 Gy was given to the whole left sided breast volume. Five interstitial brachytherapy treatments were given to the upper, lateral quadrant of the left breast by a two plane, 10 needles implant. A dose of 1.0 Gy specified according to the Paris system was administered by a pulsed dose rate afterloading machine. Absorbed dose in different fixed dose points were measured by thermoluminescence dosimeters. RESULTS: Both methods yielded an absorbed dose of the same size to the bone marrow and internal organs distant to target, 1.0-1.4% of the prescribed dose. There was a trend of lower doses to the lower half of the trunk and higher doses to the upper half of the trunk, respectively, by brachytherapy. A 90% reduction of absorbed dose with brachytherapy compared to external irradiation was found in the near-target region within 5 cm from target boundary where parts of the left lung and the heart are situated. If an adjuvant dose of 50 Gy is given with the external radiotherapy and brachytherapy, the absorbed dose in a part of the myocardium could be reduced from 31.8 to 2.1 Gy. CONCLUSIONS: Near target, brachytherapy yielded a considerably lower absorbed dose which is of special importance when considering radiation effects on the myocard and lungs. We could not demonstrate any difference of importance, in absorbed dose to dose points distant to target.

  • 3.
    Kovács, György
    et al.
    Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany; Uniklinik Lübeck (UKSH CL), Lübeck, Germany.
    Martinez-Monge, Rafael
    Department of Radiation Oncology, University of Navarra, Pamplona, Spain.
    Budrukkar, Ashwini
    Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
    Guinot, Jose Luis
    Department of Radiation Oncology, Fundacion Institito Valenciano de Oncologia (IVO), Valencia, Spain.
    Johansson, Bengt
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Strnad, Vratislav
    Department of Radiation Oncology, University Hospital of Erlangen, Erlangen, Germany.
    Skowronek, Janusz
    Department of Brachytherapy, Greater Poland Cancer Centre, Poznan, Poland; Department of Elektroradiology, Poznan University of Medical Sciences, Poznań, Poland.
    Rovirosa, Angeles
    Department of Radiation Oncology, Hospital Clinic i Universitari, Barcelona, Spain.
    Siebert, Frank-André
    Department of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein (UKSH-C), Christian-Albrechts-University, Kiel, Germany.
    GEC-ESTRO ACROP recommendations for head & neck brachytherapy in squamous cell carcinomas: 1st update - Improvement by cross sectional imaging based treatment planning and stepping source technology2017In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 122, no 2, p. 248-254Article in journal (Refereed)
    Abstract [en]

    The Head and Neck Working Group of the GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Therapeutic Radiology and Oncology) published in 2009 the consensus recommendations for low-dose rate, pulsed-dose rate and high-dose rate brachytherapy in head & neck cancers. The use of brachytherapy in combination with external beam radiotherapy and/or surgery was also covered as well as the use of brachytherapy in previously irradiated patients. Given the developments in the field, these recommendations needed to be updated to reflect up-to-date knowledge.

    The present update does not repeat basic knowledge which was published in the first recommendation but covers in a general part developments in (1) dose and fractionation, (2) aspects of treatment selection for brachytherapy alone versus combined BT+EBRT and (3) quality assurance issues.

    Detailed expert committee opinion intends to help the clinical practice in lip-, oral cavity-, oropharynx-, nasopharynx-, and superficial cancers. Different aspects of adjuvant treatment techniques and their results are discussed, as well the possibilities of salvage brachytherapy applications.

  • 4.
    Lööf, Jasmine
    et al.
    University of Linköping.
    Pfeifer, Daniella
    University of Linköping.
    Adell, Gunnar
    Karolinska University Hospital, Stockholm, Sweden.
    Sun, Xiao-Feng
    University of Linköping.
    Significance of an exon 2 G4C14-to-A4T14 polymorphism in the p73 gene on survival in rectal cancer patients with or without preoperative radiotherapy2009In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 92, no 2, p. 215-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: An exon 2 G4C14-->A4T14 polymorphism in the p73 gene was shown to be related to survival in several types of cancers, including colorectal cancer. The purpose was to investigate if this polymorphism was related to survival in rectal cancer patients with or without preoperative radiotherapy.

    MATERIALS AND METHODS: DNA extracted from tissue of 138 rectal cancer patients that received preoperative radiotherapy or had surgery alone was typed for the polymorphism by PCR using confronting two-pair primers.

    RESULTS: Among patients, 69% had GC/GC genotype, 27% had GC/AT and 4% had AT/AT. In the radiotherapy group, patients carrying the AT (GC/AT+AT/AT) allele had stronger expression of p53 (p=0.001) and survivin protein (p=0.03) than those carrying the GC/GC genotype. Further, among patients receiving preoperative radiotherapy the GC/GC genotype tended to be related to better survival (p=0.20). Patients with GC/GC genotype, along with negative p53 and weak survivin expression showed better survival than the other patients (p=0.03), even after adjusting for TNM stage and tumor differentiation (p=0.01, RR, 7.63, 95% CI, 1.50-38.74). In the non-radiotherapy group, the polymorphism was not related to survival (p=0.74).

    CONCLUSIONS: Results suggest that the p73 G4C14-->A4T14 polymorphism could be one factor influencing outcome of preoperative radiotherapy in rectal cancer patients.

  • 5.
    Nyholm, Tufve
    et al.
    Department of Radiation Sciences, Umeå University, Umeå, Sweden; Medical Radiation Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Olsson, Caroline
    Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Regional Cancer Center West, Western Sweden Healthcare Region, Göteborg, Sweden.
    Agrup, Måns
    Department of Oncology, Linköping University Hospital, Linköping, Sweden.
    Björk, Peter
    Department of Physics and Biomedical Engineering, Mälar Hospital, Eskilstuna, Sweden.
    Björk-Eriksson, Thomas
    Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gagliardi, Giovanna
    Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
    Grinåker, Hanne
    Swedish Radiation Safety Authority, Stockholm, Sweden.
    Gunnlaugsson, Adalsteinn
    Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Gustafsson, Anders
    Cureos AB, Uppsala, Sweden.
    Gustafsson, Magnus
    Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Johansson, Bengt
    Örebro University, School of Medical Sciences. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Johnsson, Stefan
    Department of Radiation Physics, Kalmar County Hospital, Kalmar, Sweden.
    Karlsson, Magnus
    Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Kristensen, Ingrid
    Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Nilsson, Per
    Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Nyström, Leif
    Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Onjukka, Eva
    Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
    Reizenstein, Johan
    Department of Oncology, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Skönevik, Johan
    Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Soderström, Karin
    Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Valdman, Alexander
    Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Zackrisson, Bjorn
    Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Montelius, Anders
    Medical Radiation Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    A national approach for automated collection of standardized and population-based radiation therapy data in Sweden2016In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 119, no 2, p. 344-350Article in journal (Refereed)
    Abstract [en]

    Purpose: To develop an infrastructure for structured and automated collection of interoperable radiation therapy (RT) data into a national clinical quality registry.

    Materials and methods: The present study was initiated in 2012 with the participation of seven of the 15 hospital departments delivering RT in Sweden. A national RT nomenclature and a database for structured unified storage of RT data at each site (Medical Information Quality Archive, MIQA) have been developed. Aggregated data from the MIQA databases are sent to a national RT registry located on the same IT platform (INCA) as the national clinical cancer registries.

    Results: The suggested naming convention has to date been integrated into the clinical workflow at 12 of 15 sites, and MIQA is installed at six of these. Involvement of the remaining 3/15 RT departments is ongoing, and they are expected to be part of the infrastructure by 2016. RT data collection from ARIA (R), Mosaiq (R), Eclipse (TM), and Oncentra (R) is supported. Manual curation of RT-structure information is needed for approximately 10% of target volumes, but rarely for normal tissue structures, demonstrating a good compliance to the RT nomenclature. Aggregated dose/volume descriptors are calculated based on the information in MIQA and sent to INCA using a dedicated service (MIQA2INCA). Correct linkage of data for each patient to the clinical cancer registries on the INCA platform is assured by the unique Swedish personal identity number.

    Conclusions: An infrastructure for structured and automated prospective collection of syntactically inter operable RT data into a national clinical quality registry for RT data is under implementation. Future developments include adapting MIQA to other treatment modalities (e.g. proton therapy and brachytherapy) and finding strategies to harmonize structure delineations. How the RT registry should comply with domain-specific ontologies such as the Radiation Oncology Ontology (ROO) is under discussion. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 6.
    Wengström, Yvonne
    et al.
    Division of Nursing Research at Karolinska Hospital, Department of Medicine, Karolinska Institutet, Stockholm,Sweden.
    Forsberg, Christina
    2Karolinska Insitute, Dep of Surgery, Stockholm, Sweden.
    Näslund, I.
    1Karolinska Institutet, Radiotherapy, Stockholm, Sweden.
    Bergh, J.
    3Karolinska Institute, Dep of oncology, Stockholm, Sweden.
    Quantitative assessment of skin erythema following breast cancer RT2003In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 68, p. S20-S20Article in journal (Refereed)
    Abstract [en]

    Visual assessment is the most common clinical investigation of skin reactions in radiotherapy. Due to the unquantitative and subjective nature of this method additional non-invasive methods are needed for more accurate evaluation of the visible acute adverse skin reactions due to radiotherapy• The purpose of this study was to evaluate a new objective measure with regard to reliability and validity and compare it with an established objective measure and a visual assessment.

    Material and Methods: A sample of fifty-three consecutive patients commencing curative tangential radiation therapy to the breast parenchyma was included in the study• The skin area of the treated breast was divided into five sections and assessed individually at 0 Gy, 24 Gy and 50 Gy. The RTOG scoring system was used for the visual assessment of the skin reactions. The first objective measure included reflectance spectrometry (DermaSpectrometer) measures at fixed points within the treatment area. For the second objective measure digital images were taken with a system using a digital camera and software. The images were analyzed using the Adobe Photoshop 5•0 software program•

    Results: The results provided significant evidence of the test-retest reliability of the camera• The correlation between the objective measures proved to be significant as the treatment progressed• The results suggest that the Camera may be used in a reliable and valid way to measure skin erythema due to radiotherapy•

  • 7.
    Wengström, Yvonne
    et al.
    Department of Nursing Research, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology, Radiumhemmet, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Forsberg, Christina
    Department of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; The Swedish Red Cross University College of Nursing, Stockholm, Sweden.
    Näslund, Ingmar
    Department of Oncology, Radiumhemmet, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Bergh, Jonas
    Department of Oncology, Radiumhemmet, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Quantitative assessment of skin erythema due to radiotherapy: evaluation of different measurements2004In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 72, no 2, p. 191-197Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Visual assessment is the most common clinical investigation of skin reactions in radiotherapy. Due to the unquantitative and subjective nature of this method additional non-invasive methods are needed for more accurate evaluation of the visible acute adverse skin reactions due to radiotherapy. The purpose of this study was to evaluate a new objective measure with regard to reliability and validity and compare it with an established objective measure and a visual assessment. Patients and methods: A sample of 53 consecutive patients commencing curative tangential radiation therapy to the breast parenchyma were included in the study. The skin area of the treated breast was divided into five sections and assessed individually at 0, 24 and 50 Gy. The RTOG scoring system was used for the visual assessment of the skin reactions. The first objective measure included reflectance spectrometry (DermaSpectrometer) measures at fixed points within the treatment area. For the second objective measure digital images (Camera) were taken with a system using a digital camera and software. The images were analyzed using the Adobe Photoshop 5.0 software program. Results: The results provided significant evidence of the test-retest reliability of the camera. The correlation between the objective measures proved to be significant as the treatment progressed. Conclusions: The results suggest that the camera may be used in a reliable and valid way to measure skin erythema due to radiotherapy. (C) 2004 Published by Elsevier Ireland Ltd.

  • 8.
    Widmark, A.
    et al.
    Radiation Sciences/Onkology, Umeå University, Umeå, Sweden.
    Gunnlaugsson, A.
    Dept. of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden .
    Beckman, L.
    Dept. Radiation Sciences, Sundsvall Hospital, Sundsvall, Sweden; Umeå University, Umeå, Sweden.
    Thellenberg-Karlsson, C.
    Radiation Sciences/Oncology, Umeå University, Umeå, Sweden.
    Hoyer, M.
    Danish Centre For Particle Therapy, Aarhus University Hospital, Aarhus, Denmark .
    Lagerlund, M.
    Department Of Oncology, Kalmar Hospital, Kalmar, Sweden .
    Fransson, P.
    Umeå University, Radiation Sciences/Onkology, Umeå, Sweden.
    Tavelin, B.
    Radiation Sciences/Onkology, Umeå University, Umeå, Sweden.
    Norman, D. B.
    Regional Cancer Centre North, Umeå University Hospital, Umeå, Sweden .
    Kindblom, J.
    Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ginman, C.
    Department of Oncology, Karlstad Central Hospital, Karlstad, Sweden .
    Johansson, Bengt
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Seke, M.
    Department of Oncology, Centrallasarettet Växjö, Växjö, Sweden.
    Björlinger, K.
    Department of Oncology, Jönköping Hospital, Jönköping, Sweden.
    Ågrup, M.
    Department of Oncology, Linköping University Hospital, Linköping, Sweden.
    Kjellen, E.
    Dept. of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Franzen, L.
    Radiation Sciences/Onkology, Umeå University, Umeå, Sweden.
    Nilsson, P.
    Dept. of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden .
    Ultrahypofractionation for prostate cancer: Outcome from the Scandinavian phase 3 HYPO-RT-PC trial2018In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 127, no Suppl. 1, p. S314-S314Article in journal (Other academic)
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