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  • 1.
    Johansson, Andreas K
    et al.
    Section of Medical Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Lennernäs, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Isacsson, Ulf
    Section of Medical Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Rudbecklaboratoriet, Uppsala, Sweden.
    Neurovascular Bundle Infiltration Can Explain Local Relapses Using Conformal Radiotherapy of Prostate Cancer2017Inngår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, nr 4, s. 1825-1830Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To quantify the impact of decreased margins for two treatment techniques, three-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT), on local control in curative treatment of prostate cancer.

    MATERIALS AND METHODS: The planning target volume (PTV) margins were decreased in steps of 1 mm from 10 to 1 mm. Treatment plans using 3D-CRT and VMAT technique were produced for all margin sizes and the dose to the neuro vascular bundles (NVB), that was not included in the PTV, was investigated.

    RESULTS: Due to the more conformal dose delivery using VMAT, the dose to the NVB decreased more rapidly by VMAT compared to the 3D-CRT plans. The dose difference was significant for margins from 1-7 mm.

    CONCLUSION: One should be very cautious before clinical routines are changed, bearing in mind whether the change means more conformal treatment technique, smaller margins or target segmentation in different imaging modalities.

  • 2.
    Lundin, Erik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Oncology.
    Bergqvist, Michael
    Department of Oncology, Gävle Hospital, Gävle, Sweden.
    Ahlgren, Johan
    ppsala Örebro Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden.
    Reizenstein, Johan
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Lennernäs, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology.
    Validation of a Clinical Cancer Register at the Head and Neck Oncology Center in Orebro2019Inngår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 39, nr 1, s. 285-289Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: This was a validation study of a regional register of oral cancer in Örebro, Sweden. The purpose was to assess the rate of errors in baseline, and treatment, and the completeness and accuracy of data on recurrences.

    Materials and Methods: A total of 653 cases with squamous cell cancer in the oral cavity were identified from the register. A randomized sample of 73 (11%) was selected, and a set of relevant data was compared to medical records.

    Results: Data on patient and tumour characteristics showed high accuracy, with 98% correct data and more than 99% of treatment data were correct. Follow-up data had a higher rate of errors, with 23% of recurrences not recorded, 13.6% misclassified, and 9.1% of cases showing errors in timing of the recurrence.

    Conclusion: data concerning patients, tumour status, and treatment in the Regional Head and Neck Register in Örebro are highly accurate. However, the follow-up data contain a higher rate of errors, that must be taken into consideration when evaluating outcome after treatment.

  • 3.
    Majumder, Khairul
    et al.
    Department of Oncology‑Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Brandberg, Yvonne
    Department of Oncology‑Pathology, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Hemming
    Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Castellanos, Enrique
    Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Ullén, Anders
    Department of Oncology‑Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Lennernäs, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology.
    Nilsson, Sten
    Department of Oncology‑Pathology, Karolinska Institutet, Stockholm, Sweden.
    Effect on prostate volume following neoadjuvant treatment with an androgen receptor inhibitor monotherapy versus castration plus an androgen receptor inhibitor in prostate cancer patients intended for curative radiation therapy: A randomised study2018Inngår i: Molecular and clinical oncology, ISSN 2049-9450, E-ISSN 2049-9469, Vol. 8, nr 1, s. 141-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To avoid pubic arch interference, prostate cancer patients are treated with neoadjuvant androgen deprivation therapy (ADT) to achieve prostate volume (PV) reduction prior to radiation treatment. The aim of the present randomised study was to compare the effects on PV of two regimens of ADT, an androgen receptor inhibitor monotherapy vs. castration plus an androgen receptor inhibitor. Consecutive patients with non-metastatic prostate cancer were included in a randomised neoadjuvant study, comparing an androgen receptor inhibitor monotherapy vs. castration plus an androgen receptor inhibitor. PV was assessed prior to the start of endocrine neoadjuvant treatment and prior to the start of radiation therapy (RT). PV assessment was performed by transrectal ultrasound. A total of 110 patients were included. Final sample constituted 88 (80%) patients due to lack of PV information. Castration plus an androgen receptor inhibitor was more effective in PV reduction compared with an androgen receptor inhibitor alone (P<0.001). Planning target volume decreased in the combination arm. There was no significant difference in clinical or demographic or length of neoadjuvant hormonal treatment between the groups. Overall, a significantly larger PV reduction was achieved by castration plus androgen receptor inhibitor, as compared with androgen receptor inhibitor monotherapy. The PV reduction, however, appeared not to translate into better health associated quality of life during the subsequently given curative intended combined EBRT and HDR-brachytherapy. Potential differences between these two treatments regarding anti-tumor effects on micro metastatic disease and radiation potentiating effect remains to be addressed in future prospective trials.

  • 4.
    Tammela, Teuvo L.
    et al.
    Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland.
    Häggman, Michael
    Department of Urology, Uppsala University Hospital, Uppsala, Sweden.
    Ladjevardi, Sam
    Department of Urology, Uppsala University Hospital, Uppsala, Sweden.
    Taari, Kimmo
    Department of Urology, Helsinki University Hospital, Helsinki, Finland.
    Isotalo, Taina
    Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland.
    Lennernäs, Hans
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Weis, Jan
    Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    von Below, Catrin
    Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Wassberg, Cecilia
    Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Lennernäs, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Tolf, Anna
    Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Axén, Niklas
    LIDDS AB, Uppsala, Sweden.
    Gölander, Carl-Gustaf
    LIDDS AB, Uppsala, Sweden.
    Ahlström, Håkan
    Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    An Intraprostatic Modified Release Formulation of Antiandrogen 2-Hydroxyflutamide for Localized Prostate Cancer2017Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 198, nr 6, s. 1333-1339Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: We investigated the tolerability, safety and antitumor effects of a novel intraprostatic depot formulation of antiandrogen 2-hydroxyflutamide (in Nano-Zolid (R)) in men with localized prostate cancer.

    Materials and Methods: Two clinical trials, LPC-002 and LPC-003, were performed in a total of 47 men. The formulation was injected transrectally into the prostate under ultrasound guidance. In LPC-002 the effects on prostate specific antigen and prostate volume were measured for 6 months in 24 patients. In LPC-003 antitumor effects were evaluated by histopathology and magnetic resonance imaging including spectroscopy during 6 or 8 weeks in 23 patients. In each study testosterone and 2-hydroxyflutamide in plasma were measured as well as quality of life parameters.

    Results: In LPC-002 (mean dose 690 mg) a reduction was observed in prostate specific antigen and prostate volume. Average nadir prostate specific antigen and prostate volume were 24.9% and 14.0% below baseline, respectively. When increasing the dose in LPC-003 to 920 and 1,740 mg, average prostate specific antigen decreased 16% and 23% after 6 and 8 weeks, respectively. Magnetic resonance imaging and magnetic resonance spectroscopy showed morphological changes and a global reduction in metabolite concentrations following treatment, indicating an antitumor response. Injections did not result in hormone related side effects. Three serious adverse events were reported and all resolved with oral antibiotic treatment.

    Conclusions: Intraprostatic injections of 2-hydroxyflutamide depot formulations showed antitumor effects, and proved to be safe and tolerable. However, for better anticancer effects higher doses and better dose distribution are suggested.

  • 5.
    Wikström, Johan
    et al.
    Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden.
    Isacsson, Ulf
    Department of Immunology, Genetics and Pathology, Section of Medical Radiation Sci-ence, Uppsala University, Uppsala, Sweden.
    Johansson, Bengt
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Lennernäs, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Magnetic Resonance Compatibility of a Transponder Aimed for Radiotherapy Positioning - A Phantom Study2017Inngår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, nr 9, s. 4993-4996Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background/Aim: Electromagnetic Positioning Systems (EMP) is a new position-ing technique in four-dimensional radiotherapy. Patients with implanted transponders may be referred for magnetic resonance imaging (MRI) making it important to establish the MR safety.

    Materials and Methods: Oranges were prepared with transponders and imaged on a 3T MR scanner with different sequences. Computed tomography (CT) was performed as comparison. MR artifacts were assessed. An estimation of the maximum transponder de-flection force and heating was made.

    Results: The mean measured displacement of transponders was 0.1 mm (range=0.03-0.3 mm). Artifacts were observed adjacent to transponders using all sequences. The deflection force on the transponder in the gantry was less than 38 mN. No heating was observed.

    Conclusion: The absence of any substantial movement, the weak measured deflection force and absence of observed heating speaks for the safe use of MR imaging with transponder 3T. Local artefacts makes evaluation impossible adjacent to transponders.

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