Hopp om förbättring av överlevnad i ovarialcancer

Ovarian cancer is the most common cause of death from a gynecologic cancer. Every year around 700 women contracts ovarian cancer in Sweden. The overall survival is among the highest in Europe, but still long term relative survival is only 46%. It is a long-held myth that ovarian cancer is a disease without symptoms. Almost 90% of women have symptoms, even in the early stages. Symptoms that should arise suspicion of ovarian cancer and initiate diagnostic work-up are continuous abdominal extension, early feeling of satiety, pelvic or abdominal pain, urinary urge and postmenopausal bleeding. Women's awareness of symptoms and willingness to seek medical advice and the organization of the health care system are important factors determining cancer survival. Ovarian cancer is a heterogeneous group of diseases with different tumor traits and prognosis. Personalized medicine and preventive measures recognizing recent knowledge about tumor biology will positively affect survival

Current practice in proton therapy delivery in adult cancer patients across Europe

BACKGROUND AND PURPOSE Major differences exist among proton therapy (PT) centres regarding PT delivery in adult cancer patient. To obtain insight into current practice in Europe, we performed a survey among European PT centres. MATERIALS AND METHODS We designed electronic questionnaires for eight tumour sites, focusing on four main topics: 1) indications and patient selection methods; 2) reimbursement; 3) on-going or planned studies, 4) annual number of patients treated with PT. RESULTS Of 22 centres, 19 (86%) responded. In total, 4233 adult patients are currently treated across Europe annually, of which 46% consists of patients with central nervous system tumours (CNS), 15% head and neck cancer (HNC), 15% prostate, 9% breast, 5% lung, 5% gastrointestinal, 4% lymphoma, 0.3% gynaecological cancers. CNS are treated in all participating centres (n = 19) using PT, HNC in 16 centres, lymphoma in 10 centres, gastrointestinal in 10 centres, breast in 7 centres, prostate in 6 centres, lung in 6 centres, and gynaecological cancers in 3 centres. Reimbursement is provided by national health care systems for the majority of commonly treated tumour sites. Approximately 74% of centres enrol patients for prospective data registration programs. Phase II-III trials are less frequent, due to reimbursement and funding problems. Reasons for not treating certain tumour types with PT are lack of evidence (30%), reimbursement issues (29%) and/or technical limitations (20%). CONCLUSION Across European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Lack of evidence for PT and reimbursement issues are the most reported reasons for not treating specific tumour types with PT

Malignancies associated with gynecological cancer : epidemiological and etiological aspects

The aims of this thesis were to analyze the incidence and risk of second primary malignancies (SPM) in a Swedish cohort of gynecological cancer patients, to explore suggested risk factors associated with second primary malignancies in ovarian cancer patients, and to evaluate the risk of ovarian cancer in a cohort of breast cancer patients in relation to family history of breast or ovarian cancer. Incidence of second primary malignancies in 15,200 gynecologicaI cancer patients were investigated in a register-based study and compared to age- and calendar-specific incidence for women in the general population. Increased risk of leukemia was found after ovarian and endometrial cancer. Additional sites of excess risk in ovarian cancer patients were breast, endometrial, colon, rectum, and bladder, while women with endometrial cancer were documented having an increased risk of cancer of the colon, ovaries, vulva, and bladder. Cervical cancer patients were found with increased risk of cancer of colon, rectum, lung, vulva, kidney, and bladder (Paper I). Validity of register data was investigated by comparisons with hospital records for 347 women registered with ovarian cancer and one or more second primary malignancy. Errors in cancer registrations were revealed concerning the first as well as the second primary cancer, although previously risk estimates remained increased when corrected for registration errors (H). In a multi-center case-control study, platinum-based chemotherapy was shown to be highly associated with an increased risk of leukemia (HI). The risk of second primary breast cancer in women with ovarian cancer was associated with heredity, nulliparity, and late menopause. Furthermore, 43 % of the breast cancer cases were diagnosed without symptoms of the disease in line of routine follow-up, indicating clinical surveillance to be important when reflecting the incidence of SPM (IV). In order to further investigate family history as a risk factor, the risk of ovarian cancer in breast cancer patients was analyzed using data from the Swedish Generation Register. Breast cancer patients with a family history of breast or notably ovarian cancer were found to be at high risk of subsequent ovarian cancer (V). The results confirm that women with gynecological cancer have an increased risk of second primary malignancies at certain sites, knowledge that should be considered in clinical follow-up. In ovarian cancer patients, a part of the excess risk of subsequent malignancies could be referred to register errors and intense clinical surveillance. Regarding the appearance of ovarian cancer as a second primary malignancy in breast cancer patients, the risk was found to be high in young women with a family history of breast or ovarian cancer, implementing the need of intense clinical surveillance in high-risk groups, even considering prophylactic oophorectomy in selected cases

Long term survival in women with borderline ovarian tumors: a population-based survey of borderline ovarian tumors in Sweden 1960-2007.

Evaluation of incidence and survival of patients with borderline ovarian tumors in Sweden MATERIAL AND METHODS: All women diagnosed with borderline ovarian tumor in the Swedish Cancer Register 1960-2007 (n=6,252) combined with follow-up in the Swedish Death Registry to 1 July 2009 were included. Estimation of age-standardized relative survival rate according to time periods for diagnosis RESULTS: The incidence of borderline ovarian tumors increased during the study period, with a steep increase during the 1980-ies. The age standardized 5 year relative survival including all borderline tumors diagnosed 2000-2007 was 97% (95% confidence interval: 92-99%). In women age 64 or younger 10 year relative survival related to age at diagnosis of borderline tumors ranged from 95 to 98% and were 89% in women 65-74. In a multivariable analysis including age and decade of diagnosis relative survival for every decade increased. The 10-year relative survival in patients with mucinous and serous borderline tumors did not differ significantly (p=0.121)

Predictors of ovarian cancer survival: A population-based prospective study in Sweden

Ovarian cancer is the leading cause of death from gynecologic malignancies among women worldwide. Little is known about reproductive factors or lifestyle determinants and ovarian cancer prognosis. The objective of this study was to examine whether ovarian cancer survival is influenced by reproductive history, anthropometric characteristics, prediagnostic life-style factors and family history or breast or ovarian cancer. The study population consisted of 635 epithelial Ovarian, cancer (EOC) cases derived from a nationwide population-based case-control study conducted in Sweden between 1993 and 1995. Exposure data on prediagnostic factors of interest were collected through questionnaires at the beginning of the parent study. Clinical data were abstracted from medical records. Cases were followed-up by means of record linkage to nationwide registers until December 31, 2002. Cox proportional hazard regression model was used to estimate the prognostic effect of each factor in terms of hazard ratios (HR) and 95% confidence intervals (CI), following adjustment for age at diagnosis, FIGO tumor stage and WHO grade of tumor differentiation. Tumor characteristics significantly influenced the risk of death from EOC. After adjustment for these, no clear associations were detected between reproductive history (parity, age at first or last birth, oral contraceptive use, age at menarche or menopause), anthropometric characteristics (body size and shape in different periods of life), lifestyle factors before diagnosis (alcohol consumption, smoking and physical activity over lifetime), nor family history of breast cancer or ovarian cancer and EOC survival. Our findings indicate that these prediagnostic factors do not influence the EOC survival. Nevertheless, among women with early stage disease (FIGO stage I and II), there was some indication that overweight in young adulthood or recent years increased the risk of death, while physical activity in young adult life appeared to reduce the risk of death due to EOC

Panitumumab and Pegylated Liposomal Doxorubicin in Platinum-Resistant Epithelial Ovarian Cancer With KRAS Wild-Type:The PaLiDo Study, a Phase II Nonrandomized Multicenter Study

OBJECTIVE: The increasing number of negative trials for ovarian cancer treatment has prompted an evaluation of new biologic agents, which in combination with chemotherapy may improve survival. The aim of this study was to investigate the response rate in platinum-resistant, KRAS wild-type ovarian cancer patients treated with pegylated liposomal doxorubicin (PLD) supplemented with panitumumab. PATIENTS AND METHODS: Major eligibility criteria were relapsed ovarian/fallopian/peritoneal cancer patients with platinum-resistant disease, measurable disease by GCIG CA125 criteria and KRAS wild-type. Patients were treated with panitumumab 6 mg/kg day 1 and day 15 and with PLD 40 mg/m day 1, every 4 weeks. RESULTS: Forty-six patients were enrolled by 6 study sites in this multi-institutional phase II trial. The response rate in the intention-to-treat population (n = 43) was 18.6%. Progression-free and overall survival in the intention-to-treat population was 2.7 months (2.5-3.2 months, 95% confidence interval) and 8.1 months (5.6-11.7 months, 95% confidence interval), respectively. The most common treatment-related grade 3 toxicities included skin toxicity (42%), fatigue (19%), and vomiting (12%). CONCLUSIONS: The combination of PLD and panitumumab demonstrates efficacy in platinum refractory/resistant patients but the skin toxicity was considerable

Ovarian epithelial neoplasia after hormonal infertility treatment: long-term follow-up of a historical cohort in Sweden

OBJECTIVE: To study the association between hormonal infertility treatment and ovarian neoplasia. DESIGN: Historical cohort study. SETTING: Three university hospitals in Sweden. PATIENT(S): A total of 2,768 women assessed and treated for infertility and infertility-associated disorders between 1961 and 1975. INTERVENTION(S): Exposed women received clomiphene citrate and/or gonadotropins. MAIN OUTCOME MEASURE(S): Incidence of ovarian neoplasia. RESULT(S): No overall excess risk of invasive ovarian cancer emerged compared with the general population. In women with gonadotropin treatment for non-ovulatory disorders, the risk was elevated (standardized incidence ratio [SIR] = 5.89; 95% confidence interval [CI] 1.91-13.75); four of the five cases reported hCG treatment only, rendering the biological plausibility uncertain. Multivariate analysis within the cohort indicated that treatment with gonadotropins only was associated with an increased risk of invasive cancer (relative risk = 5.28; 95% CI 1.70-16.47). For borderline tumors, a more than threefold overall increase of tumors (SIR = 3.61; 95% CI 1.45-7.44) was noted; women exposed to clomiphene because of ovulatory disorders showed the highest risk (SIR = 7.47; 95% CI 1.54-21.83). CONCLUSION(S): Our findings of increased risk of ovarian cancer after gonadotropins and of borderline tumors after clomiphene treatment need to be interpreted with caution. However, concern is raised, and further research on the long-term safety particularly of modern hormonal infertility treatment in IVF programs is warranted

Initial experience with introducing national guidelines for CT- and MRI-based delineation of organs at risk in radiotherapy

A fundamental problem in radiotherapy is the variation of organ at risk (OAR) volumes. Here we present our initial experience in engaging a large Radiation Oncology (RO) community to agree on national guidelines for OAR delineations. Our project builds on associated standardization initiatives and invites professionals from all radiotherapy departments nationwide. Presently, one guideline (rectum) has successfully been agreed on by a majority vote. Reaching out to all relevant parties in a timely manner and motivating funding agencies to support the work represented early challenges. Population-based data and a scalable methodological approach are major strengths of the proposed strategy