Comments on "Chemoradiation for carcinoma of the cervix: advances and opportunities" by Patricia Eifel (Radiat. Res. 154, 229-236, 2000).
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Antineoplastic Agents↗
Biomedical subjects
J van der Zee
Publications and source records attributed to J van der Zee.
Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group.
BACKGROUND: Local-control rates after radiotherapy for locally advanced tumours of the bladder, cervix, and rectum are disappointing. We investigated the effect of adding hyperthermia to standard radiotherapy. METHODS: The study was a prospective, randomised, multicentre trial. 358 patients were enrolled from 1990 to 1996, in cancer centres in the Netherlands, who had bladder cancer stages T2, T3, or T4, NO, MO, cervical cancer stages IIB, IIIB, or IV, or rectal cancer stage M0-1 were assessed. Patients were randomly assigned radiotherapy (median total dose 65 Gy) alone (n=176) or radiotherapy plus hyperthermia (n=182). Our primary endpoints were complete response and duration of local control. We did the analysis by intention to treat. FINDINGS: Complete-response rates were 39% after radiotherapy and 55% after radiotherapy plus hyperthermia (p<0.001). The duration of local control was significantly longer with radiotherapy plus hyperthermia than with radiotherapy alone (p=0.04). Treatment effect did not differ significantly by tumour site, but the addition of hyperthermia seemed to be most important for cervical cancer, for which the complete-response rate with radiotherapy plus hyperthermia was 83% compared with 57% after radiotherapy alone (p=0.003). 3-year overall survival was 27% in the radiotherapy group and 51% in the radiotherapy plus hyperthermia group. For bladder cancer, an initial difference in local control disappeared during follow-up. INTERPRETATION: Hyperthermia in addition to standard radiotherapy may be especially useful in locally advanced cervical tumours. Studies of larger numbers of patients are needed for other pelvic tumour sites before practical recommendations can be made.
Aged↗
Variation in home-birth rates between midwifery practices in The Netherlands.
OBJECTIVE: To examine the reasons for the variation in home-birth rates between midwifery practices. METHOD: Multi-level analysis of client and midwife associated, case-specific and structural factors in relation to 4420 planned and actual home or hospital births in 42 midwifery practices. FINDINGS: Women's choice of birth location and the occurrence of complications that lead to referral to specialist care before or during labour, were found to be the main determinants of the home-birth rate. Yet, about 64% of the variation between midwifery practices is explained by midwife and practice characteristics. Higher home-birth rates were associated with a positive attitude to home-birth, a critical attitude to hospital birth for non-medical reasons, and good co-operation between midwifery practices and hospital obstetricians. CONCLUSIONS: The proportions of planned hospital birth and of referral to specialist care are the most important predictors of the actual hospital-birth rate of women receiving midwifery care. Both can be influenced by the midwife through a positive attitude to home-birth, a critical approach to non-medical reasons for hospital birth, and good co-operation with specialist obstetricians. It is, therefore, important for midwives to be aware of the influence that their own attitudes may have on the choices their clients make about home or hospital birth.
Adult↗
Quality and continuity of care in Dutch nurse clinics for people with rheumatic diseases.
OBJECTIVE: Recently a new form of nurse clinic for people with rheumatic diseases has been introduced into Dutch health care. This study gives insight into: (i) patients' perceptions about the quality and continuity of care given at these (transmural) nurse clinics; and (ii) specialized rheumatology nurses' and rheumatologists' perceptions about the quality and continuity of care in the clinics. DESIGN: Validated measurement tools (QUOTE and QCC) were used, before and after patients visited a clinic, to determine patient perceptions about the quality and continuity of care. Semi-structured interviews with professionals were used to gather information about their perceptions. SETTING: The study was carried out at five locations in The Netherlands where a home care organization and a general hospital collaborated closely and had joint responsibility for a transmural rheumatology nurse clinic. STUDY PARTICIPANTS: A total of 128 patients, six specialist rheumatology nurses and four rheumatologists. INTERVENTION: Transmural nurse clinics for people with rheumatic diseases. RESULTS: In general, patients were positive about the quality and continuity of care given at the clinics. Some continuity aspects, like the presence of a locum nurse and providing the locum with sufficient information could be improved. Professionals were positive about the information given at the clinics, which is additional to the information given by a rheumatologist. Professionals were less positive about some of the clinics' preconditions. CONCLUSION: In this study, a control group (e.g. patients who received standard rheumatologist care) was not available. However, in comparison with patients' experiences of standard medical care in other (comparable) research, patients' experiences in this study were very positive. It was concluded that Dutch transmural nurse clinics, to a large extent, meet patients' and professionals' expectations and were a positive development in the care of rheumatic patients.
Adult↗
Factors influencing the outcome of radiotherapy in malignant mesothelioma of the pleura--a single-institution experience with 189 patients.
PURPOSE: To determine the factors influencing the response to palliative radiotherapy (RT) in malignant mesothelioma of the pleura (MM). METHODS AND MATERIALS: A retrospective review was conducted of the records of all patients with mesothelioma who were referred to our institution between 1979 and 1996. A total of 227 RT series were administered to 189 patients with MM. Of these, 21 patients with chest wall nodules also received concomitant local hyperthermia. RESULTS: The median survival was 5 months from the start of RT and only 17% of patients were alive at 1 year after treatment. Chest pain and painful chest wall metastases were the main indications for RT. A higher local response rate was seen for patients treated with a 4-Gy per fraction scheme, vs. those receiving fractions of less than 4 Gy (50% vs. 39%). Pain recurrence occurred predominantly within the previous RT field, and pain recurred after a median of 69 days (range 32-363) in the group treated using 4-Gy fractions. When compared with a matched group, patients treated with combined RT and hyperthermia had higher response rates and fewer in-field recurrences. CONCLUSIONS: RT provides local palliation in at least 50% of patients with MM who were treated using a 4-Gy/fraction scheme to a median dose of 36 Gy. The low response rates with RT alone suggest that combined RT and local hyperthermia should be further evaluated in MM.
Adult↗
Comparison of the clinical effectiveness of the 433 MHz Lucite cone applicator with that of a conventional waveguide applicator in applications of superficial hyperthermia.
PURPOSE: This report presents the final stage of our program to improve the quality of our superficial hyperthermia treatments. We have already demonstrated that the Lucite cone applicator (LCA), our technically improved water-filled, wave-guide applicator (WGA), is superior to the conventional WGA. The main objective of the present study was to investigate whether the technical improvements of a WGA were reflected in an improved clinical performance, e.g., a better temperature distribution. METHODS AND MATERIALS: Power and temperature analyses were performed retrospectively on 128 treatments of superficially located tumors (less than 4 cm depth). Twenty-three patients were treated alternately with a WGA setup and a LCA setup. RESULTS: The average power level per antenna in an array was 48 W and 62 W for the WGA and LCA respectively. The average invasively measured temperatures increased by 0.27 degrees C when the LCAs were used. The temperature difference between the center and the periphery of an antenna, averaged over the complete array of antennae, was 0.43 degrees C using WGAs and -0.05 degrees C using LCAs indicating a more uniform heating. The T90 of the invasively measured temperatures remained unchanged (WGA: 39.4 degrees C versus LCA: 39.5 degrees C). CONCLUSION: The LCA is now our standard applicator for superficial hyperthermia treatments as it is technically and clinically proven to be superior to the WGA.
Analysis of Variance↗
[Hyperthermia in combination with radiotherapy].
The clinical application of hyperthermia in the treatment of oncological patients is based on a strong biological rationale: hyperthermia is an effective cell-killing agent, the effects of which can be induced selectively in tumour tissue. The mechanism of action of hyperthermia is complementary to that of radiotherapy (and chemotherapy). Furthermore, hyperthermia enhances the effects of radiotherapy (and of chemotherapy). In the approximately 20 years that hyperthermia was clinically investigated, much progress was made in the techniques of application. The clinical results achieved so far show that the therapeutic gain by adding hyperthermia can indeed be substantial.
Combined Modality Therapy↗
[Re-irradiation with hyperthermia in patients with recurrent breast cancer].
In the Daniel den Hoed Cancer Centre in Rotterdam, the Netherlands, patients with recurrent breast cancer within a previously irradiated area, are treated by application of hyperthermia in addition to reirradiation. In this development, the following issues are important: (a) the choice of an effective and tolerable reirradiation schedule; (b) the establishment of the limitations of the hyperthermia techniques available; (c) the finding that additional hyperthermia has to be applied to the total tissue volume at risk for tumour recurrence; (d) the assessment of the value of additional hyperthermia by a randomised study. With the reirradiation schedule of 8 x 4 Gy and the hyperthermia application technique at present available, local control is achieved in 76% of the patients for a median duration of 32 months. The probability of local control is related to tumour size. The treatment is tolerated well, with acceptable toxicity. In patients with recurrent breast cancer in a previously irradiated area, combined reirradiation and hyperthermia is very effective, well tolerated and little toxic.
Aged↗
[Hyperthermia in combination with chemotherapy in gynecological cancers].
Hyperthermia in combination with chemotherapy has a strong biological rationale based on thermal enhancement of cytotoxicity and partial circumvention of resistance. Weekly locoregional hyperthermia in combination with cisplatin is an effective treatment (response rate: 52%) for patients with a recurrence of a previously irradiated carcinoma of the uterine cervix. A comparative trial versus cisplatin alone was recently started. Hyperthermic intraperitoneal chemotherapy is aimed at situations after optimal cytoreductive surgery in patients with carcinomatous peritonitis. The warmth enhances the penetration of the oncolytic agent. Whole-body hyperthermia using the Aquatherm apparatus in combination with chemotherapy is feasible: results in patients with metastatic sarcomas are promising. Trials with whole-body hyperthermia are in progress in patients with platinum refractory ovarian cancer and in patients with a metastatic carcinoma of the uterine cervix.
Antineoplastic Combined Chemotherapy Protocols↗
A three wavelength study on arterial occlusion in skin tissue.
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Arterial Occlusive Diseases↗
National health interview surveys in Europe: an overview.
In order to study the value of national health interview surveys for national and international research and policy activities, this paper examines the existence and content of recent and future health interview surveys in the 15 member states of the European Union (EU), Norway, Iceland and Switzerland. National health interview surveys are performed in most countries, but not in Greece (only regional surveys), Luxembourg, Ireland and Iceland (only multi-purpose surveys). The health interview surveys in the other 14 countries provide regular data on the main health topics. Of the 14 health topics that are examined in this inventory seven are measured in all countries. Questions on health status (e.g. self-assessed health, long-term physical disability, and height and weight) and medical consumption (e.g. consultations with the general practitioner, GP) are often included. Lifestyle topics are less often included, except smoking habits, information about which is sought in all countries. Topics like diet and drugs/narcotics are more often included in special surveys than in general health interview surveys. Despite differences in the content, frequency and methodology of national health interview surveys in different countries, these surveys are a valuable source of information on the health of Europeans.
European Union↗
Reirradiation combined with hyperthermia in recurrent breast cancer results in a worthwhile local palliation.
Both experimental and clinical research have shown that hyperthermia (HT) gives valuable additional effects when applied in combination with radiotherapy (RT). The purpose of this study was evaluation of results in patients with recurrent breast cancer, treated at the Daniel den Hoed Cancer Center (DHCC) with reirradiation (re-RT; eight fractions of 4 Gy twice weekly) combined with HT. All 134 patients for whom such treatment was planned were included in the analysis. The complete response rate in 119 patients with macroscopic tumour was 71%. Including the 15 patients with microscopic disease, the local control rate was 73%. The median duration of local control was 32 months, and toxicity was acceptable. The complete response (CR) rate was higher, and the toxicity was less with the later developed 433-MHz HT technique compared with the 2450-MHz technique used initially. With this relatively well-tolerated treatment, palliation by local tumour control of a worthwhile duration is achieved in the majority of patients. The technique used for hyperthermia appeared to influence the achieved results. The value of HT in addition to this re-RT schedule has been confirmed by a prospective randomized trial in a similar patient group. In The Netherlands, this combined treatment is offered as standard to patients with breast cancer recurring in previously irradiated areas.
Adenocarcinoma↗
A phase I/II study of combined weekly systemic cisplatin and locoregional hyperthermia in patients with previously irradiated recurrent carcinoma of the uterine cervix.
We investigated the feasibility and the anti-tumour activity of weekly cisplatin and the simultaneous application of local hyperthermia in patients with a pelvic recurrence of cervical cancer in previously irradiated area. Dose levels of cisplatin 60 mg m(-2), 70 mg m(-2) and 80 mg m(-2) were studied. Treatment objective of hyperthermia was the achievement of a tumour temperature of > or = 42 degrees for 60 min, during cisplatin administration. The protocol advised six weekly cycles of combined treatment. Nineteen patients, median age 47 years (range 26-71), were treated. A total of 89 cycles of combined treatment were administered. Even at the highest dose level of cisplatin, 80 mg m(-2) weekly, no dose-limiting toxicity was observed. Leucocytopenia at scheduled retreatment resulted in 1 or 2 weeks postponement in five cases. Neurotoxicity and renal toxicity were mild or absent. Maximum tumour temperatures achieved ranged 39.7-43.6 degrees C, mean 41.6+/-0.7 degrees C. All 19 patients were evaluable for response. One patient achieved a complete response that lasted 20 months, and nine patients achieved a partial response for a median duration of 6 months (range 4-50+ months), for an overall response rate of 53%. One patient subsequently underwent salvage surgery and currently remains free of disease at 4 years. We found that this combined hyperthermia-dose-intensive cisplatin regimen was well-tolerated. The true impact of the combination of cisplatin and locoregional hyperthermia can only be answered in a randomized study. Nonetheless, based on existing data on the poor efficacy of cisplatin in pelvic recurrent cervical cancer, we believe that the combined modality approach of weekly hyperthermia plus dose-intensive cisplatin is an attractive regimen, particularly if subsequent salvage surgery is available.
Adult↗
Dutch nurse clinics for children with asthma: views of professionals and parents.
In the Netherlands, there are two kinds of nurse clinics for asthmatics. Extramural nurse clinics are run under the sole responsibility of a home care organization while transmural nurse clinics are run under the joint responsibility of a home care organization and a hospital. This article gives insight into the opinions of professionals and parents of asthmatic children about the care given at these clinics. The conclusion is that organizational differences between the clinics do not influence parents' (positive) perceptions about the quality and continuity of care provided at the clinics.
Asthma↗
Practical limitations of interstitial thermometry during deep hyperthermia.
PURPOSE: Intratumor thermometry during hyperthermia treatment is considered important for several reasons. The morbidity that we experienced from interstitially placed catheters in deep-seated tumors gave reason to weigh the advantages and disadvantages against each other. METHODS AND MATERIALS: The available thermometry in 215 patients treated with hyperthermia for deep-seated tumors was analyzed with the aim to evaluate practically feasible intratumor measurements. The influence of intratumor measurements on the treatment procedure was assessed. RESULTS: Total 120 catheters were placed interstitially in 78 patients. Over the years, the percentage of patients with interstitial thermometry decreased considerably. Forty-nine catheters could remain in place during the whole hyperthermia treatment series. The remaining catheters had to be removed for more or less severe complications, including one fatal event. In fact, the interstitial catheters caused the most severe treatment-related morbidity. During 188 of the total 859 treatments, at least one interstitial catheter was available for thermometry. Per treatment with catheter(s) in situ, the average number of intratumor measurement sites was 6.9. The value of interstitial thermometry for power steering during treatment, to both optimize intratumor temperature distribution and prevent toxicity, appeared limited. The mean volume of the tumors with interstitial thermometry was 314 cm3, SD 325. In relation to the large tumor volumes, the thermal dose parameters calculated from the available data is considered to be of limited value. CONCLUSION: In view of the possible severe complications and the limited clinical value of the information achieved by interstitially placed thermometry catheters, interstitial thermometry was not found to routinely benefit the individual patient.
Catheters, Indwelling↗
Transfer from home to hospital: what is its effect on the experience of childbirth?
BACKGROUND: In the Netherlands women with low-risk pregnancies are free to choose where to give birth, at home or in hospital, attended by an independent midwife or general practitioner. On average one of five women who remains in the care of a midwife at the onset of labor will be referred to an obstetrician during or shortly after childbirth. If women had planned to give birth at home, they would then have to be transferred to the hospital. METHODS: Postal questionnaires were sent to 2301 pregnant women before and after birth to measure the experience of childbirth, appropriateness of the chosen place of birth, satisfaction with the birth, midwife's care, and first days postpartum of women planning to give birth at home or in hospital. The response rate for both questionnaires was 89.3 percent. RESULTS: Of 745 nulliparous women and 895 multiparous women, 39.3 and 10.3 percent, respectively, experienced referral to an obstetrician during labor. Of these women, the ones who wanted to give birth at home but were transferred to hospital because of the referral were as positive about the birth, early puerperium, and attendance of the midwife as the women who wanted to give birth in hospital. CONCLUSION: Our research showed, contrary to expectations, that an unplanned transfer from a planned home birth to hospital has little influence on the experience of childbirth.
Adult↗
Maternity care in The Netherlands: the changing home birth rate.
In 1965 two-thirds of all births in The Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and fewer than one-third at home. Several factors have influenced that change, including the introduction of short-stay hospital birth, hospital facilities for independent midwives, increased referral rates from primary to secondary care, changes in the share of the different professionals involved in maternity care, medical technology, and demographic changes. After a decline up to 1978 and a period of relative stability between 1978 and 1988, the home birth rate started to decline further, to the extent that it might destabilize the Dutch maternity care system and the role of midwives in it. The Dutch maternity care system depends heavily on primary caregivers, midwives and general practitioners who are responsible for the care of women with low-risk pregnancies, and on obstetricians who provide care for high-risk pregnancies. Its preservation requires a high level of cooperation among the different caregivers, and a functional selection system to ensure that all women receive the type of care that is best suited to their needs. Preserving the home birth option in the Dutch maternity care system necessitates the maintenance of high training and postgraduate standards for midwives, the continued provision of maternity home care assistants, and giving women with uncomplicated pregnancies enough confidence in themselves and the system to feel safe in choosing a home birth.
Female↗
Quantitative evaluation of 2 x 2 arrays of Lucite cone applicators in flat layered phantoms using Gaussian-beam-predicted and thermographically measured SAR distributions.
SAR distributions from four different E-field-orientated 2 x 2 arrays of incoherently driven Lucite cone applicators (LCAs) were investigated. The LCAs operated at 433 MHz with an aperture of 10.5 cm x 10.5 cm each. Two techniques were used to obtain SAR distributions in flat layered phantoms: Gaussian beam (GB) predictions and thermographical (TG) imaging. The GB predictions showed that the effective field size of the different array configurations varied by up to 3%. The TG-measured SAR distribution showed significant deviations from the GB-predicted SAR distributions (maximum 34.6%). The difference between GB-predicted and TG-measured SAR levels (averaged per 10% GB-predicted SAR intervals) equalled less than 11.3% for the parallel E-field orientated array and respectively 15.1% for the clockwise-orientated array. When antennae in the clockwise-orientated array were more widely spread (array aperture 23 cm x 23 cm) in order to diminish their mutual interactions, these differences decreased to 12.4%. However, the overall difference within the 50% SAR or higher range decreased from 14% to 9%. The results lead us to conclude that LCAs can be used clinically and their antenna interactions are not considered to be a problem under clinical conditions.
Humans↗