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Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial.

https://arctichealth.org/en/permalink/ahliterature16621
Source
J Clin Oncol. 2005 Dec 1;23(34):8697-705
Publication Type
Article
Date
Dec-1-2005
Author
Helgi Birgisson
Lars Påhlman
Ulf Gunnarsson
Bengt Glimelius
Author Affiliation
Department of Surgery, Akademiska Sjukhuset, S-751 85 Uppsala, Sweden. helgi.birgisson@akademiska.se
Source
J Clin Oncol. 2005 Dec 1;23(34):8697-705
Date
Dec-1-2005
Language
English
Publication Type
Article
Keywords
Abdominal Pain - etiology
Aged
Combined Modality Therapy
Comparative Study
Digestive System Surgical Procedures
Female
Follow-Up Studies
Fractures, Bone - etiology
Humans
Intestinal Obstruction - etiology
Male
Middle Aged
Nausea - etiology
Neoplasm Recurrence, Local
Preoperative Care
Radiotherapy, Adjuvant - adverse effects
Rectal Neoplasms - therapy
Research Support, Non-U.S. Gov't
Risk factors
Sweden
Time Factors
Treatment Outcome
Abstract
PURPOSE: To analyze the occurrence of subacute and late adverse effects in patients treated with preoperative irradiation for rectal cancer. PATIENTS AND METHODS: The study population included 1,147 patients randomly assigned to preoperative radiation therapy or surgery alone in the Swedish Rectal Cancer Trial conducted 1987 through 1990. Patient data were matched against the Swedish Hospital Discharge Register to identify patients admitted to hospital after the primary treatment of the rectal cancer. Patients with known residual disease were excluded, and patients with a recurrence were censored 3 months before the date of recurrence. Relative risks (RR) with 95% CIs were calculated. RESULTS: Irradiated patients were at increased risk of admissions during the first 6 months from the primary treatment (RR = 1.64; 95% CI, 1.21 to 2.22); these were mainly for gastrointestinal diagnoses. Overall, the two groups showed no difference in the risk of admissions more than 6 months from the primary treatment (RR = 0.95; 95% CI, 0.80 to 1.12). Regarding specific diagnoses, however, RRs were increased for admissions later than 6 months from the primary treatment in irradiated patients for unspecified infections, bowel obstruction, abdominal pain, and nausea. CONCLUSION: Gastrointestinal disorders, resulting in hospital admissions, seem to be the most common adverse effect of short-course preoperative radiation therapy in patients with rectal cancer. Bowel obstruction was the diagnosis of potentially greatest importance, which was more frequent in irradiated than in nonirradiated patients.
PubMed ID
16314629 View in PubMed
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Common variants in human CRC genes as low-risk alleles.

https://arctichealth.org/en/permalink/ahliterature98081
Source
Eur J Cancer. 2010 Apr;46(6):1041-8
Publication Type
Article
Date
Apr-2010
Author
Simone Picelli
Pawel Zajac
Xiao-Lei Zhou
David Edler
Claes Lenander
Johan Dalén
Fredrik Hjern
Nils Lundqvist
Ulrik Lindforss
Lars Påhlman
Kennet Smedh
Anders Törnqvist
Jörn Holm
Martin Janson
Magnus Andersson
Susanne Ekelund
Louise Olsson
Joakim Lundeberg
Annika Lindblom
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Source
Eur J Cancer. 2010 Apr;46(6):1041-8
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alleles
Case-Control Studies
Colorectal Neoplasms - epidemiology - genetics
Female
Genetic Predisposition to Disease - epidemiology - genetics
Genome-Wide Association Study
Genotype
Germ-Line Mutation - genetics
Humans
Male
Middle Aged
Penetrance
Polymorphism, Genetic
Risk factors
Sweden - epidemiology
Young Adult
Abstract
The genetic susceptibility to colorectal cancer (CRC) has been estimated to be around 35% and yet high-penetrance germline mutations found so far explain less than 5% of all cases. Much of the remaining variations could be due to the co-inheritance of multiple low penetrant variants. The identification of all the susceptibility alleles could have public health relevance in the near future. To test the hypothesis that what are considered polymorphisms in human CRC genes could constitute low-risk alleles, we selected eight common SNPs for a pilot association study in 1785 cases and 1722 controls. One SNP, rs3219489:G>C (MUTYH Q324H) seemed to confer an increased risk of rectal cancer in homozygous status (OR=1.52; CI=1.06-2.17). When the analysis was restricted to our 'super-controls', healthy individuals with no family history for cancer, also rs1799977:A>G (MLH1 I219V) was associated with an increased risk in both colon and rectum patients with an odds ratio of 1.28 (CI=1.02-1.60) and 1.34 (CI=1.05-1.72), respectively (under the dominant model); while 2 SNPs, rs1800932:A>G (MSH6 P92P) and rs459552:T>A (APC D1822V) seemed to confer a protective effect. The latter, in particular showed an odds ratio of 0.76 (CI=0.60-0.97) among colon patients and 0.73 (CI=0.56-0.95) among rectal patients. In conclusion, our study suggests that common variants in human CRC genes could constitute low-risk alleles.
PubMed ID
20149637 View in PubMed
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Cost-effectiveness of preoperative radiotherapy in rectal cancer: results from the Swedish Rectal Cancer Trial.

https://arctichealth.org/en/permalink/ahliterature18841
Source
Int J Radiat Oncol Biol Phys. 2002 Nov 1;54(3):654-60
Publication Type
Article
Date
Nov-1-2002
Author
Michael Dahlberg
Anna Stenborg
Lars Påhlman
Bengt Glimelius
Author Affiliation
Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden. michael.dahlberg@nll.se
Source
Int J Radiat Oncol Biol Phys. 2002 Nov 1;54(3):654-60
Date
Nov-1-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cost-Benefit Analysis
Direct Service Costs
Female
Hospital Costs
Humans
Male
Middle Aged
Preoperative Care - economics
Radiotherapy - economics
Rectal Neoplasms - economics - radiotherapy - surgery
Recurrence
Research Support, Non-U.S. Gov't
Retrospective Studies
Survival Analysis
Sweden
Value of Life - economics
Abstract
PURPOSE: The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short-term regimen of high-dose fractionated preoperative radiotherapy (5 x 5 Gy) reduced the local recurrence rates and improved overall survival. This has had an impact on the primary treatment of rectal cancer. The current study investigated the cost-effectiveness of the new combined approach. METHODS AND MATERIALS: After an 8-year follow-up, in-hospital and outpatient costs related to the treatment of rectal cancer and its complications were analyzed for 98 randomly allocated patients who participated in the SRCT from a single Swedish health care region. The costs were then related to the clinical data from the SRCT regarding complications, local and distant recurrences, and survival. RESULTS: The total cost for a nonirradiated patient was US$30,080 compared with US$35,268 for an irradiated patient. The surgery-alone group had increased costs related to local recurrences, and the radiotherapy group had increased costs for irradiation and complications. With a survival benefit of 21 months (retrieved from the SRCT), the cost for a saved year was US$3654. Sensitivity analyses for different rates of local recurrences, the costs related to complications and less marked survival benefit showed that this figure could vary up to US$15,228. CONCLUSION: The cost for a life-year saved in these data was US$3654. This figure could reach US$15,228 in the most pessimistic setting of the sensitivity tests, a cost still comparable with other well-accepted medical interventions.
PubMed ID
12377315 View in PubMed
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The effects of short-course preoperative irradiation on local recurrence rate and survival in rectal cancer: a population-based nationwide study.

https://arctichealth.org/en/permalink/ahliterature134697
Source
Dis Colon Rectum. 2011 Jun;54(6):672-80
Publication Type
Article
Date
Jun-2011
Author
Marit Tiefenthal
Per J Nilsson
Robert Johansson
Bengt Glimelius
Lars Påhlman
Author Affiliation
Department of Surgery, Ersta Hospital, Stockholm, Sweden. marit.tiefenthal@erstadiakoni.se
Source
Dis Colon Rectum. 2011 Jun;54(6):672-80
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local - prevention & control
Neoplasm Staging
Preoperative Care
Proportional Hazards Models
Rectal Neoplasms - mortality - pathology - radiotherapy - surgery
Registries
Retrospective Studies
Risk factors
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Abstract
Preoperative irradiation with 5 × 5 Gy in randomized trials reduces local recurrence rate and may improve survival in patients with resectable rectal cancer.
The aim of this study was to determine whether the same favorable effects could be observed in a population-based study.
This study was conducted via a retrospective analysis of prospectively collected data from the Swedish Rectal Cancer Registry.
This study examined population-based data from Sweden.
All newly diagnosed rectal cancers in Sweden are reported to the Swedish Rectal Cancer Registry.
Between 1995 and 2001, 6878 patients (stages I-III) were operated on with an anterior resection, an abdominoperineal resection, or a Hartmann's procedure. Short-course irradiation was given to 41% of patients preoperatively. To reduce bias, patients operated on with a Hartmann procedure or older than 75 years were excluded when 5-year survival was analyzed (n = 3466). Tumors were analyzed according to height (0-5 cm, 6-10 cm, 11-15 cm).
Five-year cumulative local recurrence and survival rates.
The 5-year cumulative local recurrence rate was 6.3% (95% CI 5.4-7.4) for patients receiving preoperative irradiation and 12.1% (95% CI 10.8-13.5) for patients not receiving preoperative irradiation. Multivariate analyses indicated the risk of local recurrence was 50% lower for patients receiving preoperative irradiation compared with patients not receiving irradiation (hazard ratio = 0.50; 95% CI 0.40-0.62). Among patients younger than 76 years and operated on with an anterior resection or abdominoperineal resection, the 5-year cumulative survival rate was 0.70 (95% CI 0.69-0.72). Disease-free and overall survivals were higher in irradiated patients, and the difference was statistically significant in low tumors.
In this population-based analysis, the favorable effect of preoperative short-course irradiation on local recurrence rates, seen in randomized trials, was confirmed for the entire Swedish population irrespective of tumor height and stage. Data also suggested an effect on 5-year survival, especially in patients with low tumors (0-5 cm).
PubMed ID
21552050 View in PubMed
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A population-based comparison of the survival of patients with colorectal cancer in England, Norway and Sweden between 1996 and 2004.

https://arctichealth.org/en/permalink/ahliterature137234
Source
Gut. 2011 Aug;60(8):1087-93
Publication Type
Article
Date
Aug-2011
Author
Eva J A Morris
Fredrik Sandin
Paul C Lambert
Freddie Bray
Asa Klint
Karen Linklater
David Robinson
Lars Påhlman
Lars Holmberg
Henrik Møller
Author Affiliation
Cancer Epidemiology Group, Centre for Epidemiology & Biostatistics, University of Leeds, NYCRIS, St James's University Hospital, Leeds, UK. eva.morris@nycris.leedsth.nhs.uk
Source
Gut. 2011 Aug;60(8):1087-93
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Child
Child, Preschool
Colorectal Neoplasms - diagnosis - mortality
England - epidemiology
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Middle Aged
Norway - epidemiology
Population Surveillance - methods
Retrospective Studies
Survival Analysis
Survival Rate - trends
Sweden - epidemiology
Time Factors
Young Adult
Abstract
To examine differences in the relative survival and excess death rates of patients with colorectal cancer in Norway, Sweden and England.
All individuals diagnosed with colorectal cancer (ICD10 (International Classification of Diseases, 10th revision) C18-C20) between 1996 and 2004 in England, Norway and Sweden were included in this population-based study of patients with colorectal cancer. The main outcome measures were 5-year cumulative relative period of survival and excess death rates stratified by age and period of follow-up.
The survival of English patients with colorectal cancer was significantly lower than was observed in both Norway and Sweden. Five-year age-standardised colon cancer relative survival was 51.1% (95% CI 50.1% to 52.0%) in England compared with 57.9% (95% CI 55.2% to 60.5%) in Norway and 59.9% (95% CI 57.7% to 62.0%) in Sweden. Five-year rectal cancer survival was 52.3% (95% CI 51.1% to 53.5%) in England compared with 60.7% (95% CI 57.0% to 64.2%) and 59.8% (95% CI 56.9% to 62.6%) in Norway and Sweden, respectively. The lower survival for colon cancer in England was primarily due to a high number of excess deaths among older patients in the first 3 months after diagnosis. In patients with rectal cancer, excess deaths remained elevated until 2 years of follow-up. If the lower excess death rate in Norway applied in the English population, then 890 (13.6%) and 654 (16.8%) of the excess deaths in the colon and rectal cancer populations, respectively, could have been prevented at 5 years follow-up. Most of these avoidable deaths occurred shortly after diagnosis.
There was significant variation in survival between the countries, with the English population experiencing a poorer outcome, primarily due to a relatively higher number of excess deaths in older patients in the short term after diagnosis. It seems likely, therefore, that in England a greater proportion of the population present with more rapidly fatal disease (especially in the older age groups) than in Norway or Sweden.
PubMed ID
21303917 View in PubMed
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Prevalence of fecal carriage of antibiotic-resistant bacteria in patients with acute surgical abdominal infections.

https://arctichealth.org/en/permalink/ahliterature143131
Source
Scand J Gastroenterol. 2010 Oct;45(10):1203-10
Publication Type
Article
Date
Oct-2010
Author
Abbas Chabok
Maria Tärnberg
Kenneth Smedh
Lars Påhlman
Lennart E Nilsson
Christian Lindberg
Håkan Hanberger
Author Affiliation
Department of Surgery, Uppsala University, Central Hospital, Västerås, Sweden. abbas.chabok@ltv.se
Source
Scand J Gastroenterol. 2010 Oct;45(10):1203-10
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Abdomen, Acute - surgery
Abdominal Abscess - microbiology - surgery
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Bacteria, Aerobic - drug effects - isolation & purification
Bacteria, Anaerobic - drug effects - isolation & purification
Bacterial Infections - epidemiology - microbiology
Drug Resistance, Multiple, Bacterial
Feces - microbiology
Female
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Prevalence
Prospective Studies
Sampling Studies
Surgicenters
Sweden - epidemiology
Abstract
Antibiotic resistance is increasing worldwide. The aims of the current study were to determine the fecal carriage of antibiotic-resistant bacteria and antibiotic treatment in surgical patients admitted to hospital due to acute intra-abdominal infections.
Eight Swedish surgical units participated in this prospective multicenter investigation. Rectal swabs were obtained on admission to hospital. Cultures were performed on chromogenic agar and antibiotic susceptibility testing was performed using the disk diffusion method. Extended-spectrum beta-lactamase (ESBL)-phenotype was confirmed by Etest.
Rectal samples were obtained and analyzed from 208 patients with intra-abdominal surgical infections. Surgery was performed in 134 patients (65%). Cephalosporins were the most frequently used empirical antibiotic therapy. The highest rates of resistance among Enterobacteriaceae were detected for ampicillin (54%), tetracycline (26%), cefuroxime (26%) and trimethoprim-sulfamethoxazole (20%). The prevalence of decreased susceptibility (I + R) for the other antibiotics tested was for ciprofloxacin 20%, piperacillin-tazobactam 17%, cefotaxime 14%, ertapenem 12%, gentamicin 3% and imipenem 0%. ESBL-producing Enterobacteriaceae were found in samples from 10 patients (5%). Three patients had five E. coli isolates producing AmpC enzymes.
This study shows a high rate of resistance among Enterobacteriaceae against antibiotics which are commonly used in Sweden and should have implications for the future choice of antibiotics for surgical patients.
PubMed ID
20521871 View in PubMed
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Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate.

https://arctichealth.org/en/permalink/ahliterature16830
Source
J Clin Oncol. 2005 Aug 20;23(24):5644-50
Publication Type
Article
Date
Aug-20-2005
Author
Joakim Folkesson
Helgi Birgisson
Lars Pahlman
Bjorn Cedermark
Bengt Glimelius
Ulf Gunnarsson
Author Affiliation
Department of Surgical Sciences and Oncology, Uppsala University Hospital, 751 85 Uppsala, Sweden. joakim.folkesson@surgsci.uu.se
Source
J Clin Oncol. 2005 Aug 20;23(24):5644-50
Date
Aug-20-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Chi-Square Distribution
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Preoperative Care
Rectal Neoplasms - radiotherapy - surgery
Registries
Research Support, Non-U.S. Gov't
Statistics, nonparametric
Survival Rate
Sweden
Treatment Outcome
Abstract
PURPOSE: To evaluate the long-term effects on survival and recurrence rates of preoperative radiotherapy in the treatment of curatively operated rectal cancer patients. PATIENTS AND METHODS: Of 1,168 randomly assigned patients in the Swedish Rectal Cancer Trial between 1987 and 1990, 908 had curative surgery; 454 of these patients had surgery alone, and 454 were administered preoperative radiotherapy (25 Gy in 5 days) followed by surgery within 1 week. Follow-up was performed by matching against three Swedish nationwide registries (the Swedish Cancer Register, the Hospital Discharge Register, and the Cause of Death Register). RESULTS: Median follow-up time was 13 years (range, 3 to 15 years). The overall survival rate in the irradiated group was 38% v 30% in the nonirradiated group (P = .008). The cancer-specific survival rate in the irradiated group was 72% v 62% in the nonirradiated group (P = .03), and the local recurrence rate was 9% v 26% (P
PubMed ID
16110023 View in PubMed
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7 records – page 1 of 1.