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  • 1. Baumgart, Juliane
    et al.
    Nilsson, Kerstin
    Örebro universitet, Hälsoakademin.
    Stavreus-Evers, Anneli
    Kask, Kristiina
    Villman, Kenneth
    Lindman, Henrik
    Kallak, Theodora
    Sundström-Poromaa, Inger
    Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer2011Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 204, nr 1, s. 26.e1-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence of urogenital symptoms and vaginal atrophy in postmenopausal breast cancer patients on adjuvant endocrine therapy. STUDY DESIGN: A population-based, cross-sectional study on postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched control subjects. Vaginal atrophy was assessed by gynecologic examination and atrophy-related symptoms by validated questionnaires. RESULTS: In all, 57.6% of aromatase inhibitor-treated and 32.4% of tamoxifen-treated breast cancer patients rated at least 1 vaginal atrophy symptom as moderate/severe, which was significantly more common than in control subjects ( P < .01). Aromatase inhibitor-treated patients more often had moderate or severe vaginal atrophy ( P < .05), a more atrophic cytohormonal evaluation, and significantly higher vaginal pH ( P < .05) than all control subjects, irrespective of hormonal use. CONCLUSION: Our findings indicate that the frequency of vaginal atrophy symptoms, particularly in aromatase inhibitor-treated women, might have been underestimated in previous clinical trials.

  • 2.
    Joensuu, Heikki
    et al.
    Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
    Kellokumpu-Lehtinen, Pirkko-Liisa
    Tampere University Hospital, Tampere, Finland.
    Huovinen, Riikka
    Turku University Central Hospital, Turku, Finland.
    Jukkola-Vuorinen, Arja
    Oulu University Hospital, Oulu, Finland.
    Tanner, Minna
    Tampere University Hospital, Tampere, Finland.
    Kokko, Riitta
    Kanta-Häme Central Hospital, Hämeenlinna, Finland.
    Ahlgren, Johan
    Gävle Hospital, Gävle, Sweden.
    Auvinen, Paivi
    Cancer Center, Kuopio University Hospital, Kuopio, Finland.
    Paija, Outi
    Turku University Central Hospital, Turku, Finland.
    Helle, Leena
    Kotka Central Hospital, Kotka, Finland.
    Villman, Kenneth
    Region Örebro län.
    Nyandoto, Paul
    Päijät-Häme Central Hospital, Lahti, Finland.
    Nilsson, Greger
    Uppsala University Hospital, Uppsala, Sweden.
    Pajunen, Marjo
    Jyväskylä Central Hospital, Jyväskylä, Finland.
    Asola, Raija
    Satakunta Central Hospital, Pori, Finland.
    Poikonen, Paula
    Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
    Leinonen, Mika
    4Pharma, Turku, Finland.
    Kataja, Vesa
    Cancer Center, Kuopio University Hospital, Kuopio, Finland; Vaasa Central Hospital, Vaasa, Finland.
    Bono, Petri
    Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
    Lindman, Henrik
    Uppsala University Hospital, Uppsala, Sweden.
    Adjuvant Capecitabine, Docetaxel, Cyclophosphamide, and Epirubicin for Early Breast Cancer: Final Analysis of the Randomized FinXX Trial2012Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 30, nr 1, s. 11-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Capecitabine is an active agent in the treatment of breast cancer. It is not known whether integration of capecitabine into an adjuvant regimen that contains a taxane, an anthracycline, and cyclophosphamide improves outcome in early breast cancer.

    Patients and Methods: Women with axillary node-positive or high-risk node-negative breast cancer were randomly assigned to receive either three cycles of docetaxel and capecitabine (TX) followed by three cycles of cyclophosphamide, epirubicin, and capecitabine (CEX; n = 753) or three cycles of docetaxel (T) followed by three cycles of cyclophosphamide, epirubicin, and fluorouracil (CEF; n = 747). The primary end point was recurrence-free survival (RFS).

    Results: During a median follow-up time of 59 months, 214 RFS events occurred (local or distant recurrences or deaths; TX/CEX, n = 96; T/CEF, n = 118). RFS was not significantly different between the groups (hazard ratio [HR], 0.79; 95% CI, 0.60 to 1.04; P = .087; 5-year RFS, 86.6% for TX/CEX v 84.1% for T/CEF). Fifty-six patients assigned to TX/CEX died during the follow-up compared with 75 of patients assigned to T/CEF (HR, 0.73; 95% CI, 0.52 to 1.04; P = .080). In exploratory analyses, TX/CEX improved breast cancer-specific survival (HR, 0.64; 95% CI, 0.44 to 0.95; P = .027) and RFS in women with triple-negative disease and in women who had more than three metastatic axillary lymph nodes at the time of diagnosis. We detected little severe late toxicity.

    Conclusion: Integration of capecitabine into a regimen that contains docetaxel, epirubicin, and cyclophosphamide did not improve RFS significantly compared with a similar regimen without capecitabine. J Clin Oncol 30:11-18. (c) 2011 by American Society of Clinical Oncology

  • 3.
    Joensuu, Heikki
    et al.
    Dept Oncol, Cent Hosp, Univ Helsinki, Helsinki, Finland.
    Kellokumpu-Lehtinen, Pirkko-Liisa
    Dept Oncol, Tampere Univ Hosp, Tampere, Finland.
    Huovinen, Riikka
    Dept Oncol, Cent Hosp, Turku Univ, Turku, Finland.
    Jukkola-Vuorinen, Arja
    Dept Radiotherapy & Oncol, Oulu Univ Hosp, Oulu, Finland.
    Tanner, Minna
    Dept Oncol, Tampere Univ Hosp, Tampere, Finland.
    Kokko, Riitta
    Kanta Hame Cent Hosp, Hameenlinna, Finland.
    Ahlgren, Johan
    Gävle Cent Hosp, Gävle, Sweden.
    Auvinen, Paivi
    Ctr Canc, Kuopio Univ Hosp, Kuopio, Finland.
    Saarni, Outi
    Dept Oncol, Cent Hosp, Turku Univ, Turku, Finland; Satakunta Cent Hosp, Pori, Finland.
    Helle, Leena
    Kotka Cent Hosp, Kotka, Finland.
    Villman, Kenneth
    Region Örebro län.
    Nyandoto, Paul
    Paijat Hame Cent Hosp, Lahti, Finland.
    Nilsson, Greger
    Univ Uppsala Hosp, Uppsala, Sweden.
    Leinonen, Mika
    Pharma, Turku, Finland.
    Kataja, Vesa
    Ctr Canc, Kuopio Univ Hosp, Kuopio, Finland; Vaasa Cent Hosp, Vaasa, Finland.
    Bono, Petri
    Dept Oncol, Cent Hosp, Univ Helsinki, Helsinki, Finland.
    Lindman, Henrik
    Univ Uppsala Hosp, Uppsala, Sweden.
    Outcome of patients with HER2-positive breast cancer treated with or without adjuvant trastuzumab in the Finland Capecitabine Trial (FinXX)2014Inngår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, nr 2, s. 186-194Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Little information is available about survival outcomes of patients with HER2-positive early breast cancer treated with adjuvant capecitabine-containing chemotherapy with or without trastuzumab.

    Patients and methods: One thousand and five hundred patients with early breast cancer were entered to the Finland Capecitabine trial (FinXX) between January 2004 and May 2007, and were randomly assigned to receive either three cycles of adjuvant TX (docetaxel, capecitabine) followed by three cycles of CEX (cyclophosphamide, epirubicin, capecitabine; TX-CEX) or three cycles of docetaxel followed by three cycles of CEF (cyclophosphamide, epirubicin, fluorouracil; T-CEF). The primary endpoint was recurrence-free survival (RFS). The study protocol was amended in May 2005 while study accrual was ongoing to allow adjuvant trastuzumab for patients with HER2-positive cancer. Of the 284 patients with HER2-positive cancer accrued to FinXX, 176 (62.0%) received trastuzumab after amending the study protocol, 131 for 12 months and 45 for nine weeks. The median follow-up time was 6.7 years.

    Results: Patients with HER2-positive cancer who received trastuzumab had better RFS than those who did not (five-year RFS 89.2% vs. 75.9%; HR 0.41, 95% CI 0.23 -0.72; p = 0.001). Patients treated with trastuzumab for 12 months or nine weeks had similar RFS. There was no significant interaction between trastuzumab administration and the type of chemotherapy. Four (2.3%) patients treated with trastuzumab had heart failure or left ventricular dysfunction, three of these received capecitabine.

    Conclusion: Adjuvant trastuzumab improves RFS of patients treated with TX-CEX or T-CEF. Few patients had cardiac failure.

  • 4.
    Wickberg, Åsa
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Holmberg, Lars
    Medical School, King's College, London, United Kingdom; Uppsala University, Uppsala, Sweden.
    Adami, Hans-Olov
    Harvard School of Public Health, Boston MA, United States.
    Magnuson, Anders
    Örebro University Hospital, Örebro, Sweden.
    Villman, Kenneth
    Region Örebro län.
    Liljegren, Göran
    Örebro University Hospital, Örebro, Sweden.
    Reply to a. Levy et Al.2014Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 32, nr 29, s. 3340-3341Artikkel i tidsskrift (Fagfellevurdert)
  • 5.
    Wickberg, Åsa
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Örebro University Hospital, Örebro, Sweden; Uppsala University, Uppsala, Sweden.
    Holmberg, Lars
    Uppsala University, Uppsala, Sweden; Kings Coll, London, England.
    Adami, Hans-Olov
    Karolinska Institutet, Stockholm, Sweden; Harvard School of Public Health, Boston MA, USA.
    Magnuson, Anders
    Örebro University Hospital, Örebro, Sweden.
    Villman, Kenneth
    Region Örebro län.
    Liljegren, Göran
    Region Örebro län.
    Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: 20-Year Results of a Randomized Trial2014Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 32, nr 8, s. 791-797Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To investigate how radiotherapy (XRT) adds to tumor control using a standardized surgical technique with meticulous control of surgical margins in a randomized trial with 20 years of follow-up.

    Patients and Methods: Three hundred eighty-one women with pT1N0 breast cancer were randomly assigned to sector resection with (XRT group) or without (non-XRT group) postoperative radiotherapy to the breast. With follow-up through 2010, we estimated cumulative proportion of recurrence, breast cancer death, and all-cause mortality.

    Results: The cumulative probability of a first breast cancer event of any type after 20 years was 30.9% in the XRT group and 45.1% in the non-XRT group (hazard ratio [HR], 0.58; 95% CI, 0.41 to 0.82). The benefit of radiotherapy was achieved within the first 5 years. After 20 years, 50.4% of the women in the XRT group died compared with 54.0% in the non-XRT group (HR, 0.92; 95% CI, 0.71 to 1.19). The cumulative probability of contralateral cancer or death as a result of cancer other than breast cancer was 27.1% in the XRT group and 24.9% in the non-XRT group (HR, 1.17; 95% CI, 0.77 to 1.77). In an anticipated low-risk group, the cumulative incidence of first breast cancer of any type was 24.8% in the XRT group and 36.1% in the non-XRT group (HR, 0.61; 95% CI, 0.35 to 1.07).

    Conclusion: Radiotherapy protects against recurrences during the first 5 years of follow-up, indicating that XRT mainly eradicates undetected cancer foci present at primary treatment. The similar rate of recurrences beyond 5 years in the two groups indicates that late recurrences are new tumors. There are subgroups with clinically relevant differences in risk.

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