15 results on '"Johansson, Karl-Axel"'
Search Results
2. A method to estimate composite doses for organs at risk in prostate cancer patients treated with EBRT in combination with HDR BT.
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Pettersson, Niclas, Johansson, Karl-Axel, Alsadius, David, Tucker, Susan L., Steineck, Gunnar, and Olsson, Caroline
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STATISTICAL correlation , *DOSE-response relationship (Radiation) , *PROSTATE tumors , *RADIATION injuries , *RADIOISOTOPE brachytherapy , *STATISTICS , *DATA analysis , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Background. When evaluating late toxicity after combined external beam radiation therapy (EBRT) and high-dose rate brachytherapy (HDR BT) prostate cancer treatments, it is important that the composite dose distribution is taken into account. This can be challenging if organ-at-risk (OAR) dose data are incomplete, i.e. due to a limited ultrasound imaging field-of-view in the HDR BT procedure. This work proposes a method that provides estimates of composite OAR doses for such situations. Material and methods. Original EBRT, simulated HDR BT, and composite dose-volume histograms (DVHs) for 10 pelvic OARs in 30 prostate cancer cases were used for method implementation and evaluation (EBRT: 25 × 2.0 Gy + BT: 2 × 10.0 Gy). The proposed method used information from the EBRT DVH to estimate OAR BT doses (with or without fractionation correction). Coefficients of determination (R2) were calculated for linear relationships between several EBRT DVH parameters and a BT DVH parameter of interest. The largest R2 value decided the relationship that best predicted the BT DVH parameter. The composite dose value was then calculated by adding the EBRT DVH and the estimated BT DVH parameter values and was compared to the reference composite value (in 1200 OAR/patient/parameter cases). Results. The linear relationships had an average R2 of 0.68 (range 0.42-0.88). Only one ninth of the 1200 estimated composite DVH values differed more than 2 Gy from their reference values. Conclusion. Given a successful implementation, the proposed method only requires original or simulated BT plan data for a subset of patients to estimate composite doses for large study populations in a time-efficient manner. This can assist in evaluating radiation-induced late toxicity in multimodality treatments with limited OAR dose data. [ABSTRACT FROM AUTHOR]
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- 2014
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3. Dose-response relationships for an atomized symptom of fecal incontinence after gynecological radiotherapy.
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Alevronta, Eleftheria, Lind, Helena, Al-Abany, Massoud, Waldenström, Ann-Charlotte, Olsson, Caroline, Dunberger, Gail, Mavroidis, Panayotis, Nyberg, Tommy, Johansson, Karl-Axel, Åvall-Lundqvist, Elisabeth, Steineck, Gunnar, and Lind, Bengt K.
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FECAL incontinence -- Risk factors ,COLON (Anatomy) ,CONFIDENCE intervals ,STATISTICAL correlation ,FISHER exact test ,FEMALE reproductive organ tumors ,DOSE-response relationship (Radiation) ,QUESTIONNAIRES ,RADIOTHERAPY ,RECTUM ,STATISTICS ,T-test (Statistics) ,U-statistics ,DATA analysis ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Purpose. The aim of this study was to investigate what bowel organ and delivered dose levels are most relevant for the development of 'emptying of all stools into clothing without forewarning' so that the related dose-responses could be derived as an aid in avoiding this distressing symptom in the future. Material and methods. Of the 77 gynecological cancer survivors treated with radiotherapy (RT) for gynecological cancer, 13 developed the symptom. The survivors were treated between 1991 and 2003. The anal-sphincter region, the rectum, the sigmoid and the small intestines were all delineated and the dose-volume histograms were exported for each patient. The dose-volume parameters were estimated fitting the data to the Relative Seriality (RS), the Lyman and the generalized Equivalent Uniform Dose (gEUD) model. Results. The dose-response parameters for all three models and four organs at risk (OARs) were estimated. The data from the sigmoid fits the studied models best: D50 was 58.8 and 59.5 Gy (RS, Lyman), γ50 was 1.60 and 1.57 (RS, Lyman), s was 0.32, n was 0.13 and a was 7.7 (RS, Lyman, gEUD). The estimated volume parameters indicate that the investigated OARs behave serially for this endpoint. Our results for the three models studied indicate that they have the same predictive power (similar LL values) for the symptom as a function of the dose for all investigated OARs. Conclusions. In our study, the anal-sphincter region and sigmoid fit our data best, but all OARs were found to have steep dose-responses for 'emptying of all stools into clothing without forewarning' and thus, the outcome can be predicted with an NTCP model. In addition, the dose to the four studied OARs may be considered when minimizing the risk of the symptom. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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4. Do we need fractionation-corrected doses in sequential two-phase treatments? A quantification of dose differences between non-corrected and corrected combined non-uniform dose distributions in normal tissue.
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Olsson, Caroline and Johansson, Karl-Axel
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PHARMACEUTICAL arithmetic , *RADIATION protection , *RADIOTHERAPY , *T-test (Statistics) , *TUMORS - Abstract
Background. For many tumour sites, external beam radiation therapy (EBRT) is delivered with a sequential two-phase treatment regime. Yet, there is a lack of consensus of how to add two different non-uniform dose distributions in order to evaluate the late radiation effect for normal tissue. The purpose of this novel investigation is to quantify the dose differences between non-corrected and fractionation-corrected combined non-uniform dose distributions. Material and methods. We used a model of an organ at risk (OAR) located in six different positions relative the treated volume giving 16 clinically representative two-phase treatment situations (46 Gy + 22 Gy). The linear-quadratic model was applied to correct for fractionation effects in each voxel before the doses were added. Dose differences were quantified using mean and maximum doses with corresponding fractionation-corrected doses as reference. Results. Non-corrected doses were higher than fractionation-corrected doses in all treatment situations (mean dose: p<0.001; maximum dose: p=0.003). With the OAR outside the treated volume, non-corrected doses were 3-6 Gy higher representing 10-50% of the reference dose (10-25 Gy); with the OAR included in the treated volume, 1-6 Gy higher representing 1-15% (30-60 Gy). Mean dose differences were generally larger than maximum dose differences. Conclusion. Substantial dose differences were present in all of the simulated treatment situations but more apparent when the OAR was located outside the treated volume in both phases. Our findings require verification in clinical cases but nevertheless indicate a need for fractionation-corrected doses in two-phase treatments both in the daily clinical routine as well as in the modelling of late radiation effects. Our data suggest that adjusting for fractionation effects would lead to lower tolerance doses than currently suggested, in particular for OARs with parallel tissue architecture. [ABSTRACT FROM AUTHOR]
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- 2010
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5. Variation in position and volume of organs at risk in the small pelvis.
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Waldenström, Ann-Charlotte, Alsadius, David, Pettersson, Niclas, Johansson, Karl-Axel, Holmberg, Erik, Steineck, Gunnar, and Müller, Markus
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RADIOTHERAPY ,ORGANS (Anatomy) ,PELVIS ,DRUG dosage ,DRUG side effects - Abstract
In preparation for studies of dose volume of ionizing radiation and long-term side effects, we assessed both variation in position and volume of organs at risk in the small pelvis. Material and methods. On 10 men and seven women we delineated the sigmoid, rectum, anal sphincter, bladder, penile bulb, and cavernous bodies in two CT scans taken between five to 69 days apart. Results. The measured overlap of the two delineated volumes divided by the maximum possible overlap, was below 50% for the sigmoid in six of 17 patients, for the distal 4 cm of the sigmoid in five of 17 patients, for the rectum in none of 17 patients, for the anal sphincter in three of 17 patients and for the urinary bladder in none of 17 patients. The smaller volume divided by the larger volume was below 50% in three of 17 patients for the sigmoid, in six of 17 patients for the 4 distal cm of the sigmoid, in two of 17 patients for the rectum, in two of 17 patients for the anal sphincter and in seven of 17 patients for the urinary bladder. For the urinary bladder the largest deviation was found cranially, 4.0 cm (SD 2.0 cm), the caudal part being relatively fixed. For the rectum the largest deviation was found in the anterior wall, 1.8 cm (SD 0.7 cm), with maximum documented variation in cranial direction of 3.2 cm (SD 1.8 cm). Conclusions. The sigmoid varies considerably in documented position with the largest deviation anteriorly, the urinary bladder change in volume with the extension mainly located cranially and for the rectum the anterior wall is the most mobile with the distension becoming more pronounced cranially. In modeling dose-volume effects one may consider our results. [ABSTRACT FROM AUTHOR]
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- 2010
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6. Long-term treatment results for nasopharyngeal carcinoma: The Sahlgrenska University Hospital experience.
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Taheri-Kadkhoda, Zahra, Björk-Eriksson, Thomas, Johansson, Karl-Axel, and Mercke, Claes
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CANCER treatment ,TUMORS ,DRUG therapy ,SAHLGRENSKA University Hospital (Goteborg, Sweden) - Abstract
Nasopharyngeal carcinoma (NPC) is a rare disease in Sweden. For evaluation of the treatment outcomes in our NPC patients, 52 new cases that were referred to our department between 1991 and 2002 were retrospectively analysed. Tumor stage, according to the 1997 AJCC staging system, was I in five, II in ten, III in 12 and IV in 25 patients. Majority of the patients (87%) had World Health Organization type II-III tumors. Neoadjuvant chemotherapy was delivered in 33 patients. Thirty-two patients received hyperfractionated accelerated radiation therapy with a median dose of 64.6Gy (1.7Gy/fr bid). Conventional external irradiation with a median dose of 66Gy (2Gy/fr) was delivered to 18 patients. An intracavitary brachy-boost of 4.5-12Gy was delivered to 40 patients. Two patients were excluded from the analysis due to treatment refusal. For the patients with tumor stages I-IVB, the 5-year disease-free and overall survival rates were 61% and 55%, respectively. The 5-year local, regional, and distant relapse-free survival rates were 70%, 92% and 77%, respectively. The most frequent late side effects were xerostomia (98%), otitis (70%) and hearing deterioration (64%). Our data suggest that optimization of the treatment outcomes in NPC patients requires implementation of new therapeutic strategies. [ABSTRACT FROM AUTHOR]
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- 2007
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7. A review of the impact of photon and proton external beam radiotherapy treatment modalities on the dose distribution in field and out-of-field; implications for the long-term morbidity of cancer survivors.
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Palm, Åsa and Johansson, Karl-Axel
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RADIOTHERAPY , *CANCER treatment , *CANCER patients , *QUALITY of life , *MONTE Carlo method ,TUMOR prevention - Abstract
The use of untraditional treatment modalities for external beam radiotherapy such as intensity modulated radiation therapy (IMRT) and proton beam therapy is increasing. This review focuses on the changes in the dose distribution and the impact on radiation related risks for long-term cancer survivors. We compare conventional radiotherapy, IMRT, and proton beam therapy based on published treatment planning studies as well as published measurements and Monte Carlo simulations of out-of-field dose distributions. Physical dose parameters describing the dose distribution in the target volume, the conformity index, the dose distribution in organs at risk, and the dose distribution in non-target tissue, respectively, are extracted from the treatment planning studies. Measured out-of-field dose distributions are presented as the dose equivalent as a function of distance from the treatment field. Data in the literature clearly shows that, compared with conventional radiotherapy, IMRT improves the dose distribution in the target volume, which may increase the probability of tumor control. IMRT also seems to increase the out-of-field dose distribution, as well as the irradiated non-target volume, although the data is not consistent, leading to a potentially increased risk of radiation induced secondary malignancies, while decreasing the dose to normal tissues close to the target volume, reducing the normal tissue complication probability. Protons show no or only minor advantage on the dose distribution in the target volume and the conformity index compared to IMRT. However, the data consistently shows that proton beam therapy substantially decreases the OAR average dose compared to the other two techniques. It is also clear that protons provide an improved dose distribution in non-target tissues compared to conventional radiotherapy and IMRT. IMRT and proton beam therapy may significantly improve tumor control for cancer patients and quality of life for long-term cancer survivors. [ABSTRACT FROM AUTHOR]
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- 2007
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8. Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries.
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Baumann, Pia, Nyman, Jan, Lax, Ingmar, Friesland, Signe, Hoyer, Morten, Rehn Ericsson, Suzanne, Johansson, Karl-Axel, Ekberg, Lars, Morhed, Elisabeth, Paludan, Merete, Wittgren, Lena, Blomgren, Henrik, and Lewensohn, Rolf
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RADIOTHERAPY ,LUNG cancer ,ONCOLOGY ,MEDICAL electronics ,PATHOLOGY - Abstract
We reviewed results of SBRT treatment of 138 patients with medically inoperable stage I NSCLC treated during 1996–2003 at five different centres in Sweden and Denmark. Mean age was 74 years (range 56–90) with 69 men and 72 women. SBRT was delivered using a 3D conformal multifield technique and a stereotactic body frame. Doses delivered were 30–48 Gy (65% isodose at the periphery of planning target volume, PTV) in 2–4 fractions. Equivalent dose in 2 Gy fractions (EQD2) was in the range of 50–100 Gy. Mean gross tumour volume (GTV) was 39 cm 3 (2–436), and planning target volume was 101 cm 3 (11–719). Overall response rate (CR, PR) was 61% (84/138). SD was noted in 36% (50/138). During a median follow-up period of 33 months (1–107), 16 (12%) local failures occurred, ten of which also included distant metastases. Local failure was associated with tumour size, target definition and central or pleura proximity. Distant metastases occurred in 25% (35/138) of the patients. Ninety-one (65%) patients died during follow-up of which 55 patients (60%) died of other causes than lung cancer. Three- and 5-year overall survival was 52 and 26% respectively. Lung cancer specific 3- and 5-year overall survival was 66 and 40% respectively. Fifty nine percent (83/138) of the patients had no side effects. Fourteen patients experienced grade 3–4 toxicity according to radiation therapy oncology group (RTOG). EQD2 (> v.s. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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9. Does electron and proton therapy reduce the risk of radiation induced cancer after spinal irradiation for childhood medulloblastoma? A comparative treatment planning study.
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Xiangkui Mu, Björk-Eriksson, Thomas, Nill, Simeon, Oelfke, Uwe, Johansson, Karl-Axel, Gagliardi, Giovanna, Johansson, Lennart, Karlsson, Mikael, and Zackrisson, Björn
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CANCER treatment ,MEDICAL radiology ,THERAPEUTIC complications ,RADIATION carcinogenesis ,MEDULLOBLASTOMA ,TUMORS in children ,MEDICAL research - Abstract
The aim of this treatment planning comparison study was to explore different spinal irradiation techniques with respect to the risk of late side-effects, particularly radiation-induced cancer. The radiotherapy techniques compared were conventional photon therapy, intensity modulated x-ray therapy (IMXT), conventional electron therapy, intensity/energy modulated electron therapy (IMET) and proton therapy (IMPT). CT images for radiotherapy use from five children, median age 8 and diagnosed with medulloblastoma, were selected for this study. Target volumes and organs at risk were defined in 3-D. Treatment plans using conventional photon therapy, IMXT, conventional electron therapy, IMET and IMPT were set up. The probability of normal tissue complication (NTCP) and the risk of cancer induction were calculated using models with parameters-sets taken from published data for the general population; dose data were taken from dose volume histograms (DVH). Similar dose distributions in the targets were achieved with all techniques but the absorbed doses in the organs-at-risk varied significantly between the different techniques. The NTCP models based on available data predicted very low probabilities for side-effects in all cases. However, the effective mean doses outside the target volumes, and thus the predicted risk of cancer induction, varied significantly between the techniques. The highest lifetime risk of secondary cancers was estimated for IMXT (30%). The lowest risk was found with IMPT (4%). The risks associated with conventional photon therapy, electron therapy and IMET were 20%, 21% and 15%, respectively. This model study shows that spinal irradiation of young children with photon and electron techniques results in a substantial risk of radiation-induced secondary cancers. Multiple beam IMXT seems to be associated with a particularly high risk of secondary cancer induction. To minimise this risk, IMPT should be the treatment of choice. If proton therapy is not available, advanced electron therapy may provide a better alternative. [ABSTRACT FROM AUTHOR]
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- 2005
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10. Accelerated radiotherapy for advanced laryngeal cancer.
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Haugen, Hedda, Johansson, Karl-Axel, Ejnell, Hasse, Edström, Staffan, and Mercke, Claes
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LARYNGEAL cancer , *LARYNX , *RADIOTHERAPY , *DRUG therapy , *CANCER chemotherapy , *CANCER radiotherapy ,LARYNGEAL tumors - Abstract
The purpose of this study was to evaluate a single institution's outcome for patients with advanced laryngeal cancer treated with accelerated radiotherapy (RT). Fifty-eight patients with advanced laryngeal cancer (T3/T4N0/N + M0) were treated with curative intent with accelerated RT during the period 1990 - 1998. Patients received radiotherapy alone or with induction chemotherapy. The 5-year local control (LC) and loco-regional control (LRC) probabilities were both 49% for T3 and 75% for T4 tumors. The 5-year disease-free survival probability was 46% and 68% and overall survival probability was 30% and 39% for T3 and T4 tumors respectively. No significant statistical difference in outcome was found, either between T3 and T4 tumors, or between patients who received induction chemotherapy and those who did not. The treatment results for advanced laryngeal cancer at this institution were comparable to those reported in the literature. The results for T3 and T4 were similar. T4 classification alone should not be an exclusion criterion for larynx preservation. Overall survival was poor, partly because of a high incidence of deaths from intercurrent diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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11. Radiation Therapy Dose Delivery.
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Johansson, Karl-axel, Mattsson, Sören, Brahme, Anders, Carlsson, Jörgen, Zackrisson, Björn, and Turesson, Ingela
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RADIOTHERAPY , *DOSE-response relationship (Radiation) - Abstract
In an investigation by the Swedish Cancer Society, the present status, critical issues and future aspects and potentials in each of nine major areas of radiation therapy research were described by an expert group. The report presented here deals with radiation therapy dose delivery, dose distributions, beam shaping and intensity modulation. [ABSTRACT FROM AUTHOR]
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- 2003
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12. The Potential of Proton and Light Ion Beams in Radiotherapy.
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Turesson, Ingela, Johansson, Karl-axel, and Mattsson, Sören
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RADIOTHERAPY , *PROTONS , *ION bombardment - Abstract
In an investigation by the Swedish Cancer Society, the present status, critical issues and future aspects and potentials were described by an expert group for each of nine major areas of radiation therapy research. The present report deals with the potential of proton and light ion beams in radiotherapy. [ABSTRACT FROM AUTHOR]
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- 2003
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13. Swedish Cancer Society Radiation Therapy Research Investigation.
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Mattsson, Sören, Brahme, Anders, Carlsson, Jörgen, Denekamp, Juliana, Forssell-Aronsson, Eva, Hellström, Mikael, Johansson, Karl-Axel, Kjellén, Elisabeth, Littbrand, Bo, Nordenskjöld, Bo, Stenerlöw, Bo, Turesson, Ingela, Zackrisson, Björn, and Glimelius, Bengt
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RADIOTHERAPY ,PALLIATIVE treatment ,TUMOR treatment - Abstract
In an investigation by the Swedish Cancer Society, the present status, critical issues and future aspects and prospects were described by an expert group for each of nine major areas of radiation research. A summary of the investigation is presented in this report. A more extensive summary (in Swedish) can be found at www.Cancerfonden.se. It is concluded that radiation therapy plays an increasingly important role in curative and palliative tumour treatment and presents a considerable challenge to research. Several suggestions are made that could improve the possibilities for high-quality radiation therapy research in Sweden. [ABSTRACT FROM AUTHOR]
- Published
- 2002
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14. Normal Tissue Response to Low Doses of Radiotherapy Assessed by Molecular Markers—A Study of Skin in Patients Treated for Prostate Cancer.
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Turesson, Ingela, Bernefors, Ragnhild, Book, Majlis, Flogegård, Max, Hermansson, Ingegerd, Johansson, Karl-Axel, Lindh, Anna, Sigurdardottir, Sunna, Thunberg, Ulf, and Nyman, Jan
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RADIOTHERAPY ,TISSUES ,ONCOLOGY ,RADIATION ,PHYSIOLOGY - Abstract
The aim of this study was to evaluate normal tissue response by molecular markers to multifraction low doses of ionizing radiation, with the focus on changes in repopulation, estimated using Ki-67 as the proliferation marker, and on expressions of the p53 and p21 proteins, identified as key proteins in the DNA damage checkpoint. Repeated skin biopsies were taken from patients treated for prostate cancer with radiotherapy. The expressions of Ki-67, p53 and p21 of the keratinocytes in the basal cell layer of the epidermis were quantified immunohistochemically. The dose to the basal layer was 1.1 Gy per fraction, given five times per week for seven weeks. The indices of the three markers were determined over the whole period. A significant suppression of the Ki-67 index was observed during the first weeks, followed by a significant gradual increase in the Ki-67 index over the last weeks. The p53 and p21 protein levels were almost zero in the unirradiated skin. Upon irradiation, both the p53 and p21 index increased in a pattern very congruent to the Ki-67 index. In conclusion, daily fractions of about 1 Gy to the skin resulted in, for the keratinocytes in the basal layer, a cell growth arrest for a couple of weeks and a subsequent acceleration in repopulation during the following weeks of irradiation. The present findings also provided novel insights into the role of the p53/p21 pathway in the response of a normal epithelium to ionizing radiation as it is applied in radiotherapy. [ABSTRACT FROM AUTHOR]
- Published
- 2001
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15. Doses to the right coronary artery and the left anterior descending coronary artery and death from ischemic heart disease after breast cancer radiotherapy: a case-control study in a population-based cohort.
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Perman M, Johansson KA, Holmberg E, and Karlsson P
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- Humans, Female, Case-Control Studies, Middle Aged, Aged, Adult, Radiation Injuries etiology, Radiation Injuries epidemiology, Radiation Injuries mortality, Radiotherapy Dosage, Dose-Response Relationship, Radiation, Organs at Risk radiation effects, Follow-Up Studies, Cohort Studies, Breast Neoplasms radiotherapy, Breast Neoplasms mortality, Coronary Vessels radiation effects, Coronary Vessels pathology, Myocardial Ischemia etiology, Myocardial Ischemia mortality
- Abstract
Background and Purpose: Doses to the coronary arteries in breast cancer (BC) radiotherapy (RT) have been suggested to be a risk predictor of long-term cardiac toxicity after BC treatment. We investigated the dose-risk relationships between near maximum doses (Dmax) to the right coronary artery (RCA) and left anterior descending coronary artery (LAD) and ischemic heart disease (IHD) mortality after BC RT., Patients and Methods: In a cohort of 2,813 women diagnosed with BC between 1958 and 1992 with a follow-up of at least 10 years, we identified 134 cases of death due to IHD 10-19 years after BC diagnosis. For each case, one control was selected within the cohort matched for age at diagnosis. 3D-volume and 3D-dose reconstructions were obtained from individual RT charts. We estimated the Dmax to the RCA and the LAD and the mean heart dose (MHD). We performed conditional logistic regression analysis comparing piecewise spline transformation and simple linear modeling for best fit., Results: There was a linear dose-risk relationship for both the Dmax to the RCA (odds ratio [OR]/Gray [Gy] 1.03 [1.01-1.05]) and the LAD (OR/Gy 1.04 [1.02-1.06]) in a multivariable model. For MHD there was a linear dose-risk relationship (1,14 OR/Gy [1.08-1.19]. For all relationships, simple linear modelling was superior to spline transformations., Interpretation: Doses to both the RCA and LAD are independent risk predictors of long-term cardiotoxicity after RT for BC In addition to the LAD, the RCA should be regarded as an organ at risk in RT planning.
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- 2024
- Full Text
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