Biomedical subjects

Olfred Hansen

Publications and source records attributed to Olfred Hansen.

7 recordsLinked to original sources

PubMed2006

Attempts to predict the long-term decrease in lung function due to radiotherapy of non-small cell lung cancer.

PURPOSE: To obtain a model which can predict long-term decrease in lung function due to radiation damage from dose-volume data for patients with non-small cell lung cancer. PATIENTS AND METHODS: 27 patients were included, all long-term survivors after radical radiation therapy. For each patient a regression analysis was performed on a post-RT succession of measurements of FEV1 in order to estimate the decrease after 2 years and a standard error (SE) on this regression estimate. The modelling was based on dose-volume histograms (DVH) exported from the treatment planning system, and involved fits of threshold models, a mean lung dose model as well as more complex models based on the relative damaged volume (rdV). RESULTS: Decreases after 2 years of up to 28% in FEV1 was measured (median 10%), with significant day-to-day variation in FEV1 for the individual patient. The threshold models predicted the long-term decrease in FEV1 well when the SE was interpreted as the uncertainty of the measured decrease. The best threshold value, marginally, was 30 Gy with an R(2) of 0.46. The mean lung dose model did not perform so well. A complex model based on rdV performed better than any of the other models (R(2)=0.52). CONCLUSION: The long-term decrease in FEV1 could be predicted from a simple dose-volume model when the SE was interpreted as the uncertainty of the measured decrease.

Carcinoma, Non-Small-Cell Lung↗

PubMed2005

[Curative radiotherapy of local advanced non-small-cell lung cancer. Eight years of experience from Odense].

INTRODUCTION: No previous reports on 3-D conformal radiotherapy of Danish patients with inoperable local advanced non-small-cell lung cancer have been published. MATERIALS AND METHODS: From 1995 to 2003, 158 patients with inoperable non-small-cell stage III lung cancer received radical radiotherapy in doses of 60-66 Gy in 30-33 fractions. Neoadjuvant chemotherapy was administered to 77 patients. RESULTS: The median survival time was 15.8 months. The one, two-, three-, four-, and five-year survival rates were 61%, 35%, 23%, 19% and 17%, respectively. Gender and age had no influence on survival, while patients in performance status 2 tended to have poorer survival rate than patients in performance status 0-1. The lung function as evaluated byh FEV1 and FVC declined by 8-9% during the first year and was reduced by 9-13% after three years. The cause of death in 90% of the cases was lung cancer. In 50% of all cases, a loco-regional relapse was found, and in 41% distant metastases existed. DISCUSSION: These results show that a significant number of stage III patients treated with modern radiotherapy with curative intent will be long-term survivors.

Adult↗

PubMed2005

Duration of symptoms: impact on outcome of radiotherapy in glottic cancer patients.

PURPOSE: To study the relationship between the durations of symptoms before the start of radiotherapy and treatment outcome in Stage I-III glottic cancer. METHODS AND MATERIALS: From 1965 to 1997, 611 glottic cancer patients from the Southern Region of Denmark were treated with primary radiotherapy. A total of 544 patients fulfilled the criteria for inclusion to the study (Stage I-III glottic cancer, a duration of symptoms less than or equal to 36 months, primary radiotherapy with at least 50 Gy and sufficient data for analysis). The total radiation dose ranged from 50.0 to 71.6 Gy in 22 to 42 fractions, and the median dose per fraction was 2.00 Gy (range, 1.56-2.29 Gy). All patients had 5 years of follow-up, and the 5-year recurrence-free survival rate was used as the primary endpoint. RESULTS: The 5-year recurrence-free survival rate was 74%. In a multivariate Cox regression analysis, duration of symptoms was a significant factor (p < 0.0001) with a hazard ratio of 1.045 (95% CI 1.023, 1.069). Other significant factors included tumor stage and radiation dose, whereas duration of treatment time was borderline significant (p = 0.06). CONCLUSIONS: The duration of symptoms was statistically significantly related to a decrease in recurrence-free survival. One-month delay from onset of symptoms to start of radiotherapy was equivalent to a 4.5% decrease in recurrence-free survival.

Adolescent↗

PubMed2003

Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial.

BACKGROUND: Although head and neck cancer can be cured by radiotherapy, the optimum treatment time for locoregional control is unclear. We aimed to find out whether shortening of treatment time by use of six instead of five radiotherapy fractions per week improves the tumour response in squamous-cell carcinoma. METHODS: We did a multicentre, controlled, randomised trial. Between January, 1992, and December, 1999, of 1485 patients treated with primary radiotherapy alone, 1476 eligible patients were randomly assigned five (n=726) or six (n=750) fractions per week at the same total dose and fraction number (66-68 Gy in 33-34 fractions to all tumour sites except well-differentiated T1 glottic tumours, which were treated with 62 Gy). All patients, except those with glottic cancers, also received the hypoxic radiosensitiser nimorazole. Analysis was by intention to treat. FINDINGS: More than 97% of the patients received the planned total dose. Median overall treatment times were 39 days (six-fraction group) and 46 days (five-fraction group). Overall 5-year locoregional control rates were 70% and 60% for the six-fraction and five-fraction groups, respectively (p=0.0005). The whole benefit of shortening of treatment time was seen for primary tumour control (76 vs 64% for six and five fractions, p=0.0001), but was non-significant for neck-node control. Six compared with five fractions per week improved preservation of the voice among patients with laryngeal cancer (80 vs 68%, p=0.007). Disease-specific survival improved (73 vs 66% for six and five fractions, p=0.01) but not overall survival. Acute morbidity was significantly more frequent with six than with five fractions, but was transient. INTERPRETATION: The shortening of overall treatment time by increase of the weekly number of fractions is beneficial in patients with head and neck cancer. The six-fractions-weekly regimen has become the standard treatment in Denmark.

Adult↗

PubMed2003

Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: a national survey from DAHANCA.

OBJECTIVE: In 1998, the Danish Society for Head and Neck Oncology decided to conduct a nationwide survey at the five head and neck oncology centers with the aim of evaluating the surgical outcome of salvage laryngectomy after radiotherapy with special emphasis on identifying factors that could contribute to the development of pharyngocutaneous fistulae. PATIENTS: A total of 472 consecutive patients undergoing postirradiation salvage laryngectomy in the period July 1, 1987-June 30, 1997 were recorded at the five head and neck oncology centers in Denmark. Age ranged from 36 to 84 years, median 63 years, 405 men and 67 women. Primary tumor site was glottic larynx (n = 242), supraglottic larynx (n = 149), other larynx (n = 45), pharynx (n = 27), and other (n = 9). All patients had received prior radiotherapy. RESULTS: Median time between radiotherapy and laryngectomy was 10 months (range, 1-348 months). A total of 89 fistulae lasting at least 2 weeks were observed, corresponding to an overall average fistulae risk of 19%. The number of performed laryngectomies per year decreased linearly (from 58 to 37), whereas the annual number of fistulae increased slightly (from 7 to 11), which meant that the corresponding estimated fistulae risk increased significantly from 12% in 1987 to 30% in 1997. Other significant risk factors for fistulae in univariate analysis included younger patient age, primary advanced T and N stage, nonglottic primary site, resection of hyoid bone, high total radiation dose, and large radiation fields. Multiple logistic regression analysis of these parameters suggested that nonglottic tumor site, late laryngectomy period (1987-1992 vs 1993-1997), and advanced initial T stage were independent prognostic factors for fistulae risk. Surgical parameters like resection of thyroid/tongue base/trachea or radiotherapy parameters like overall treatment time or fractions per week did not influence fistulae risk. CONCLUSIONS: The risk of fistulae is especially high in patients initially treated with radiotherapy for nonglottic advanced stage tumors. A significant decrease in the number of performed salvage laryngectomies over the 10 years was seen. Over the same time period, the annual number of fistulae remained almost constant. The resulting more than doubling of fistulae rate could thus in part be explained by less surgical routine.

Adult↗

PubMed2002

Cancer of the larynx--treatment results after primary radiotherapy with salvage surgery in a series of 1005 patients.

The aim of this study is to present and discuss the results of initial radiotherapy with salvage surgery and to compare them with those from centres where primary surgery is the prevailing principle. The series comprised 1005 consecutive patients treated during the period 1965-1998. Salvage surgery was performed if patients had residual tumour or developed recurrence. Disease-specific survival (DSS) and crude survival (CS) after 5 years, among 643 patients with glottic carcinomas treated with curative radiotherapy was 88.6% (SE = 1.3) and 65.3% (SE = 2.0), respectively. Among T1 glottic carcinomas the locoregional control was 88%, i.e. 88% of patients were cured after radiotherapy alone, and the DSS was 99% both evaluated after 5 years, i.e. the salvage surgery added approximately 11% to the survival of T1 glottic patients. Only 4% (12/312) of T1 glottic patients had laryngectomies. Locoregional control among T2 glottic cases was 67% and the DSS 88%, but, 18% (41/233) of patients lost their larynx. The corresponding results among T3 glottic cases were 30% and 59%, i.e. the organ preservation was close to 50%. Among patients with supraglottic carcinomas, the two estimates were 440 and 63%, respectively. Compared with our results, recent results published in the literature after initial laser surgery of T1 glottic carcinomas indicate that there are only minor differences in DSS and organ preservation, but it is generally agreed, but not proven, that voice quality after radiotherapy is better. T2 glottic carcinomas treated by initial supracricoid partial laryngectomy in a selected series have yielded very high DSS rates with better organ preservation than was observed in the present series. As to T3 glottic carcinomas, initial surgery does not produce better survival rates than those produced in the present series but our organ preservation is higher. The treatment of patients with supraglottic carcinoma has benefited from optimization of radiotherapy during recent decades. The role of initial laser surgery is as yet undecided.

Adolescent↗

PubMed2002

Hypopharyngeal cancer: results of treatment based on radiation therapy and salvage surgery.

OBJECTIVES: The purpose of this study is to present the treatment results and to identify possible prognostic indicators in patients with hypopharyngeal squamous cell carcinoma (HPC). STUDY DESIGN: A consecutively admitted series of 110 patients was analyzed retrospectively. The female male ratio was 29: 81. The sites of the tumors were: pyriform fossa (72%), postcricoid area (18%), and posterior pharyngeal wall (10%). T-status was T1: 15%, T2: 26%, T3: 28%, and T4: 37%. N-status was N0: 27%, N1: 33%, N2: 26%, and N3: 14%. METHODS: One hundred three patients (94%) were treated with curative intent. Two of these received primary surgery; the remaining 101 patients had primary radiotherapy. Seven patients (6%) received no or only palliative treatment. RESULTS: The 5- and 10-year estimates for crude survival (CS) were 16% and 7% and disease-specific survival (DSS) 28% and 23%, respectively. In the group of patients treated with curatively intended radiotherapy, 71 recurrences were observed at the time of analysis. The 5- and 10-year RFS estimates were both 17%. The values for CS were 18% and 8% and the values for DSS were 31% and 26%, respectively. Univariate survival analyses of age, sex, T-status, N-status, and TNM staging did not show any significant influence on survival. CONCLUSIONS: We conclude that the survival of patients with HPC treated with primary radiotherapy and salvage surgery is poor and that other treatment modalities have to be considered.

Adult↗