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S Sörenson

Publications and source records attributed to S Sörenson.

At least 19 recordsLinked to original sources
PubMed2001

The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions.

This report by The Swedish Council on Technology Assessment in Health Care (SBU) reviews, classifies, and grades the scientific literature on cancer chemotherapy in some major tumour types, describes the practice of chemotherapy in Sweden, compares practice with scientific knowledge, and analyses the costs and cost-effectiveness of chemotherapy. The report is intended primarily for decision-makers at various levels, both practitioners and administrators. It is also of interest for the medical profession. The extensive body of scientific literature was reviewed according to strict criteria that reflected the scientific weight of the literature. Sixteen experts representing different disciplines (oncology, surgery, internal medicine, health economy and quality of life research) participated in the literature review. Each section was discussed within the project group and was reviewed by at least one, but usually two international researchers. Additional input was provided by national experts representing different scientific disciplines. For the final evaluation to be as close to the objective truth as possible, a concerted effort was made to guarantee objectivity and thorough assessment of current knowledge about the effects of chemotherapy on the selected cancers. The tumour types selected for this assessment include firstly those types where three investigations had shown an increased use of chemotherapy in Sweden during the latest decade. These were non-small cell lung cancer (NSCLC), gastric cancer, pancreatic cancer, colorectal cancer and urinary bladder cancer. Secondly, the two tumour types comprising the greatest number of patients treated with chemotherapy in Sweden, breast cancer and haematological malignancies, were included. Among the haematological malignancies, the most prevalent ones, acute myeloid leukaemia (AML), chronic lymphocytic leukaemia (CLL), Hodgkin's disease (HD), aggressive non-Hodgkin's lymphoma (NHL) of the large B-cell type and indolent NHL of follicular type were evaluated. These constitute about 75%, of all haematological malignancies. Thirdly, ovarian cancer was included since chemotherapy has been extensively used and since, at the time of the planning of this overview, a group of very expensive drugs, the taxanes, had preliminarily shown promising results. A wealth of scientific literature has been published on cancer therapy. The review presented in this report is limited to scientific studies judged to be important for evaluating chemotherapy efficacy. Assessments of the content and quality of these studies, and a critical summary of the results in all stages of the selected tumours, have never before been attempted in this way. However, similar comprehensive overviews of certain stages of the tumours have previously been made. These overviews were also critically evaluated. Totally 1,496 studies involving 558,743 patients were reviewed. The survey of practice of chemotherapy use involved all departments of surgery, urology, gynaecology, internal medicine including haematologic units, pulmonary medicine and general and gynaecologic oncology at 16 hospitals in two health care regions in Sweden, covering 39% of the Swedish population. During the 4 weeks of the survey, all patients with the diagnoses concerned who received chemotherapy were registered. The study included 1,590 patients. The working group's general conclusions are summarised in the following points: The literature on the effects of chemotherapy is extensive. Chemotherapy has a well-documented role in the curative and palliative treatment of patients with several types of cancer. The use of chemotherapy is of utmost importance for the possibility of cure in certain tumour types. In other tumours, chemotherapy increases the possibility of cure when added to local and regional treatments, particularly surgery. In the instances of no possibility of cure, chemotherapy may to a variable extent improve both patient survival and well-being. In Sweden chemotherapy is largely used in accordance with that documented in the scientific literature. The extent of both over- and under-treatment seems to be limited but cannot be excluded at the individual patient level. The literature-based knowledge is scientifically of lower quality in the most chemotherapy sensitive tumours than in tumours showing more limited sensitivity. In the more sensitive tumours, positive effects on a symptomatic stage and survival were seen several decades ago. In those days, clinical treatment studies did not fulfil the current high quality requirements. Small life-prolonging effects of chemotherapy are sometimes very well documented in large, high quality scientific studies. Some of these s

Antineoplastic Agents↗
PubMed2001

A systematic overview of chemotherapy effects in non-small cell lung cancer.

A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This overview of the literature on chemotherapy for non-small cell lung cancer (NSCLC) is based on 53 scientific publications including six meta-analyses based on 65 prospective randomised trials comprising 15,607 patients and an additional 32 prospective randomised studies including 8,902 patients. The conclusions reached can be summarised into the following points: In stage IIIB-IV disease, published data demonstrate that cisplatin-based chemotherapy confers a modest, median 1.5-3 months, prolongation of survival. The closely related compound carboplatin seems to provide similar effects. Randomised studies indicate symptomatic relief and improvement of indices of quality of life (QoL) for patients who receive platinum-based combination chemotherapy or single drug therapy with more recent compounds. Data supporting the use of chemotherapy are not available for patients in poor general condition (WHO performance status 3 4) and evidence is limited for elderly patients (above 70-75 years). Platinum-based chemotherapy can be recommended for selective use in routine care of advanced NSCLC although patients should be encouraged to participate in controlled clinical trials to further elucidate the role of chemotherapy in advanced disease. In advanced disease, recent data suggest that the newer agents gemcitabine, paclitaxel, irinotecan and vinorelbine, in combination with cisplatin, provide an additional survival benefit compared with earlier cisplatin-based regimens. Furthermore, paclitaxel, docetaxel and vinorelbine as single agents seemingly provide a survival benefit over supportive care alone comparable to that of older cisplatin-based combinations. A standard regimen for advanced disease cannot yet be defined. Until more data are at hand, it is recommended to be platinum-based and preferably combined with one of the newer agents. At progression after platinum-based chemotherapy for advanced disease, limited data indicate a small survival benefit from docetaxel over supportive care alone. Such second-line chemotherapy of advanced disease can be recommended for selected patients but should preferably be confined to controlled clinical trials. In stage III disease, published data show that induction cisplatin-based chemotherapy before radical radiotherapy modestly prolongs long-term survival and lowers the incidence of distant metastases compared with radiotherapy alone. Furthermore, published data show that concurrent chemo- and radiotherapy with cisplatin or carboplatin may enhance local control and long-term survival. Chemotherapy in this setting can be recommended for selected patients but treatment should preferably be given within a controlled clinical trial. In stage IIIAN2 disease, data from pilot studies demonstrate that surgery after induction chemotherapy is feasible. Pathologically complete remissions have been confirmed in 10-20% of treated patients. Two small randomised studies demonstrate a significant survival advantage for induction chemotherapy followed by surgery compared with surgery alone. Induction chemotherapy can be recommended for selected patients but treatment should preferably be given within a controlled clinical trial. The superiority of induction chemotherapy plus surgery compared with combined chemotherapy and radical irradiation has not been proven in a randomised trial but currently such studies are under way. In the adjuvant setting, published data suggest that cisplatin-based chemotherapy after radical surgery may increase five-year survival from around 50% by a further 5% but the confidence interval for this estimate is too wide for firm conclusions. Large-scale prospective randomised trials are under way to resolve this important issue and adjuvant chemotherapy is, thus, not recommended for routine treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Two schedules of teniposide with or without cisplatin in advanced non-small-cell lung cancer: a randomized study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group.

PURPOSE: We conducted a randomized trial to investigate the value of the addition of cisplatin to teniposide (VM26) and to investigate the schedule dependence of the topoisomerase II inhibitor VM26, in advanced non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Two hundred twenty-five NSCLC patients were randomized to receive VM26 120 mg/m2 on days 1, 3, and 5 or 360 mg/m2 on day 1 only, either as a single drug or in combination with cisplatin 80 mg/m2 on day 1. Cycles were repeated every 3 weeks. Response rates, side effects, and survival were compared according to the 2 x 2 factorial design of this study. RESULTS: The response rate of the two cisplatin-containing arms was superior to that of the two arms that contained VM26 only (22% v 6%, P < .001); progression-free survival and survival times were also longer in the cisplatin-containing arms (median, 4.3 v 2.2 months, P = .003; median 7.2 v 5.9 months, P = .008, respectively). Toxicity was significantly higher in the cisplatin-containing arms; the most frequent side effects were leukopenia, nausea and vomiting, and alopecia. The schedule of VM26 did not significantly influence the response rate, progression-free survival interval, or survival duration. However, the response rate of the 1-day administration was significantly lower than that of the 3-day administration when given as single drugs. CONCLUSION: The addition of cisplatin to VM26 improves the response rate, progression-free survival interval, and survival duration over VM26 alone, although at the cost of a significant increase in toxicity. Cisplatin should be considered as the basis for combination chemotherapies in advanced NSCLC.

Adult↗
PubMed1993

The effect of immunotherapy on T-cell subsets in peripheral blood and bronchoalveolar lavage fluid in pollen-allergic patients.

The effect of immunotherapy (IT) on T-cell subsets in peripheral blood and bronchoalveolar lavage fluid (BAL) was examined in 15 patients with rhinoconjunctivitis and asthma caused by sensitivity to birch pollen. They were treated with IT for 3 years. Seven patients were treated with highly standardized birch-pollen extract (Pharmacia, Sweden). Eight untreated patients served as controls. Histamine challenge, blood sampling, and BAL were performed before (January, February), and at the peak of, the birch-pollen season (May). The subpopulations of T cells in peripheral blood and BAL fluid were investigated by immunocytochemistry and flow cytometry. During the birch-pollen season, the percentage of CD3+ and CD4+ cells of blood mononuclear cells in the IT patients increased significantly (P < 0.03 and P < 0.02, respectively). The percentage of CD8+ cells remained unaltered. In control patients, no changes of T-cell subsets in the peripheral blood were observed. T-cell subsets in BAL did not change during the season in relation to preseasonal values for either IT-treated or non-IT-treated patients.

Adolescent↗
PubMed1992

Quality of life during chemotherapy for small cell lung cancer. II. A longitudinal study of the EORTC Core Quality of Life Questionnaire and comparison with the Sickness Impact Profile.

Sixty-two patients with small cell lung cancer, 36-80 years of age, who were receiving chemotherapy during a maximum of one year, were consecutively included in a study of quality of life during treatment. An interim version (C-36) of the EORTC Core Quality of Life Questionnaire (QLQ) was applied for quality of life assessment prior to treatment and every third month during the treatment period. The assessments were related to clinical variables (performance status and tumour response), and compared with results from assessment with the Sickness Impact Profile (SIP). The QLQ was sensitive to differences in clinical status and responded to clinical change over time. In general, the pattern of correlations with SIP lends support to the construct validity of the QLQ. However, some questions arose from the comparison with SIP: QLQ emotional functioning did not change in concordance with SIP, and assessment of social functioning was not optimal prior to treatment. The questionnaire was well accepted by the patients. The EORTC QLQ C-36 constitutes a promising step in the development of a feasible standard instrument for quality of life assessment in cancer clinical trials.

Aged↗
PubMed1991

The effect of immunotherapy on eosinophil accumulation and production of eosinophil chemotactic activity in the lung of subjects with asthma during natural pollen exposure.

Two groups of birch pollen--allergic patients with seasonal rhinoconjunctivitis and asthma were followed during two consecutive birch-pollen seasons, one group, N = 10, during a season with high pollen load, and one group, N = 15, during a season of low pollen load. Half the patients were treated with immunotherapy (IT) for 3 and 4 years, respectively. The other half of the patients served as control group (non-IT). Bronchoalveolar lavage (BAL) was performed once before each season and once during the pollen season. Eosinophil (EOS) numbers in BAL were increased (p less than 0.01) during the season with high pollen load but not in the season with a low pollen load, and this increment was absent in the IT-treated group. Also, the EOS cationic protein levels were raised in the non-IT-treated group during the season with a high pollen load. The levels of EOS and neutrophil chemotactic activity were raised in BAL in both seasons in the non-IT-treated group compared with the IT-treated group (p less than 0.02, p less than 0.003, p less than 0.04, and p less than 0.005 in high- and low-load pollen season, respectively). Serum and BAL eosinophil chemotactic activity (ECA) were positively correlated (p less than 0.001). We conclude that there is an influx of active EOSs into the lung of pollen-allergic patients with asthma during a pollen season, which may be abrogated by IT. Furthermore, the generation of ECA appears to be an extremely sensitive marker of antigenic exposure, and the potent inhibition of the generation of ECA by IT may provide a clue as to the mechanism of this treatment.

Adolescent↗
PubMed1991

Combination chemotherapy of limited-stage small-cell lung cancer. A controlled trial on 221 patients comparing two alternating regimens.

The outcome of two different alternating regimens of chemotherapy was investigated in a prospective controlled trial in limited-stage small-cell lung cancer (SCLC). Both regimens comprised cyclophosphamide, lomustine, vincristine, methotrexate, doxorubicin and etoposide administered in different schedules. The investigative regimen (B) included simultaneous administration of cyclophosphamide + lomustine alternating with cyclophosphamide + doxorubicin, and with doxorubicin + lomustine. The hypothetical superiority of this regimen was based on data from experimental animal tumors suggesting potentiated efficacy of the three specific combinations. A total of 234 patients were included, and 113 vs 108 patients were eligible. Median survival in both groups was 48 weeks (p = 0.89). Complete remissions were observed in 36/101 and in 42/99 patients evaluable for response. There was no significant difference in response duration. At restaging after 18 months of chemotherapy 27 patients (16%) and 22 patients (16%), respectively, were free of disease. Six patients, three in each arm, are still alive, 8+ to 10.5+ years after diagnosis. Scheduled doses of the six agents were the same in the two regimens except for a 30% reduction of every second dose of cyclophosphamide in regimen B. Nevertheless, regimen B resulted in significantly more leukopenic patients, septicemic episodes, and blood transfusions, and the dosage of etoposide was more often reduced in arm B than in arm A. The increased toxicity was not associated with improved treatment results.

Adult↗
PubMed1991

Quality of life during chemotherapy for small cell lung cancer. I. An evaluation with generic health measures.

The Sickness Impact Profile (SIP) and the Hospital Anxiety and Depression scale (HAD) were used for assessment of physical and psychosocial functioning and emotional distress in patients with small cell lung cancer (SCLC) receiving chemotherapy. Treatment schedules extended over 12 months. Before treatment sixty-two patients, 36-80 years of age, completed the questionnaires and a selection of lung cancer symptom items. Approximately 50% of the patients reported clinically significant physical dysfunction, while emotional distress was reported by 25% and social restraints by 40%. Self-reported overall dysfunction, as assessed by SIP total index, was clinically significant in 60% of the patients. SIP physical and total indices were strongly related to WHO performance status (grade 0-4). The assessment was subsequently repeated every third month during the treatment period. Overall tumour response rate was 82%. The changes of physical and psychosocial functioning, as assessed by SIP, were significantly related to tumour response, although a persistent substantial overall dysfunction was shown among 50% of the responders after 3 months and among c. 40% after 6 months. In addition to tumour response, pain and appetite changes correlated with the change of overall SIP in multivariate analysis, implying the importance of pain control and appetite stimulating measures for patients with advanced cancer. Anxiety and depression, as measured by HAD, were reduced in 21 patients who completed 12 months chemotherapy, but only anxiety co-varied with tumour response. The results lend support to the use of the generic SIP and HAD as outcome measures in clinical research with SCLC patients receiving chemotherapy.

Adult↗
PubMed1990

Hospitalization during chemotherapy for small cell lung cancer.

Ninety patients with small cell lung cancer, who received combination chemotherapy, were studied with regard to hospitalization during the treatment period. Chemotherapy was discontinued in case of tumour progression, or, if progression did not occur, after 18 months. The mean hospitalization time was 18 days per patient which constituted 6.7% of the total treatment time in all 90 patients. The hospitalization rate significantly decreased during the first 10 weeks of treatment, and then remained constantly low, with an average hospital time of 3.7 days per patient during maintenance chemotherapy, accounting for 2% of the total maintenance treatment time. Tumour-associated disability was a major purpose for hospital admissions, accounting for 69% of the hospital time during treatment. Except for the first treatment course, which was routinely given in hospital, chemotherapy was administered on an out-patient basis, and only four patients were admitted to hospital to receive maintenance treatment. In these patients, comorbidity and long-distance living may have contributed to the need for hospitalization. Sixteen patients were admitted to hospital at different times of treatment because of treatment complications, mainly severe infections and haemorrhages. It is concluded, that hospitalization rate is a useful and easily understood treatment outcome measure, which, in our study, implied that patients who responded to chemotherapy also gained an improved social mobility in terms of days outside the hospital, although this should not be interpreted as a comprehensive quality of life measure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Immunohistological detection of fucosyl-GM1 ganglioside in human lung cancer and normal tissues with monoclonal antibodies.

With the aid of a highly specific murine monoclonal antibody, F12, an immunofluorescence method was elaborated that allowed sensitive and specific detection of the ganglioside antigen fucosyl-GM1 (IV2FucII3NeuAcGgOse4Cer) in different types of human lung cancer and normal tissues. Nineteen of 21 cases of small cell lung cancer were positive with the F12 immunofluorescence method as compared to 2 of 10 squamous epithelial cell lung cancers and 1 of 5 large cell lung cancer specimens. Specimens of lung adenocarcinoma (8 cases) and bronchial carcinoid (3 cases) were all negative, as were 2 examined cases of neuroblastoma. No fucosyl-GM1 could be detected in normal lung and bronchus. However, in thymus, spleen, and lamina propria of the small intestine sparsely distributed clusters of small round cells were stained as well as intramural ganglionic cells of the small intestine and islet cells of the pancreas. All other normal tissues tested were negative. Results obtained with immunofluorescence closely agreed with immunochemical determination of fucosyl-GM1 in lipid extracts of tissues. Our findings suggest that fucosyl-GM1 is strongly associated with small cell cancer of the lung and demonstrate that this tumor-associated antigen can be detected with high sensitivity and specificity with an immunofluorescence method based on the use of the F12 monoclonal antibody.

Animals↗
PubMed1989

A phase II study of vincristine in malignant mesothelioma--a negative report.

A total of 23 consecutive, previously untreated patients with radiographically evaluable, malignant pleural mesothelioma were treated in a phase II study with vincristine. Vincristine was given i.v. at a dose of 1.3 mg/m2 once weekly for 4 weeks, then every 2 weeks. No response was observed. The result suggests that vincristine has little or no therapeutic value in the treatment of malignant mesothelioma.

Adult↗
PubMed1988

Smoking and effect of chemotherapy in small cell lung cancer.

The relationship between smoking habits and outcome of treatment was studied in 154 patients with small cell lung cancer (SCLC) who received combination chemotherapy. Thirty-two patients had stopped smoking at least 6 months before the initiation of treatment or had never smoked (NS), 51 patients stopped smoking less than 6 months prior to the start of treatment (SS) and 71 patients continued to smoke during the treatment period (CS). Life table analysis of overall survival showed no significant heterogeneity among the groups (p greater than 0.7). Chi-square test for trend in survival yielded 0.23 (p greater than 0.6) with the longest survival in SS and CS patients, and the shortest survival in NS patients. Corresponding analysis of time to progression showed similar results, with a non-significant heterogeneity (p greater than 0.5) and trend (p greater than 0.4) among the three groups, with the CS patients doing best. In the whole series the disease-free two-year survival rate was higher in the CS patients than in the SS and NS patients (p = 0.04). The results do not imply that continued smoking during chemotherapy in SCLC has unfavourable effects on the outcome of treatment.

Actuarial Analysis↗
PubMed1987

Return to work among patients with small cell lung cancer.

Forty-four patients with small cell lung cancer (SCLC), who were working in some kind of profession when they were taken ill, were studied with regard to return to work during or after cancer treatment. All patients received combination chemotherapy without chest radiotherapy or prophylactic brain irradiation. Twelve patients, referred to as W, returned to work during some period (14-83 weeks) after commencement of treatment, and 32 did not (NW). The stage of the disease prior to treatment and the type of profession seemed to be major prognostic factors. Patients with limited disease or "light" occupations more often returned to work than did patients with extensive disease or "heavy" occupations (P = 0.027 and 0.037, respectively). Age, sex and performance status were less important factors. Long-term survival was not a necessary condition for return to work, and overall survival was not prolonged in W patients compared with NW patients. It is concluded that increased occupational activity is an important palliative gain from chemotherapy in SCLC, and that this gain is not confined to a specific subgroup of patients, but is most likely to occur in patients with limited disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Detection of a ganglioside antigen associated with small cell lung carcinomas using monoclonal antibodies directed against fucosyl-GM1.

Monoclonal antibodies with an apparent specificity for fucosyl-GM1 (Fuc-GM1) were produced by the immunization of mice with Fuc-GM1 adsorbed to Salmonella minnesota bacteria and fusion of the spleen cells with the myeloma cell line Sp 2/0. The antibodies detected Fuc-GM1 with a unique ceramide composition containing 2-hydroxy fatty acids in 11 of 12 cases of small cell carcinoma of the lung. Trace amounts of Fuc-GM1 were detected in 1 of 11 squamous epithelial cell lung carcinomas. Fuc-GM1 was also detected in 1 of 7 pancreas carcinomas but was not detected in any of the other cancers analyzed. Small amounts of Fuc-GM1 without 2-hydroxy fatty acids were detected in normal adult pancreas, spleen, and brain but could not be detected in normal lung tissue. Fuc-GM1 with 2-hydroxy fatty acids is suggested to be a specific ganglioside associated with small cell lung carcinomas. The monoclonal antibodies directed against Fuc-GM1 may be useful for specific immunodiagnosis of small cell lung carcinomas and might also be useful for specific immunotherapy of these malignant tumors.

Animals↗
PubMed1984

Regional lung function in patients with a complete radiographic regression of small cell bronchogenic carcinoma.

Regional lung function was studied in 21 patients with small cell bronchogenic carcinoma who demonstrated a complete radiographic regression of intrathoracic tumour after 3 months of combination chemotherapy. Spirometry was performed in 20 patients. VC and FEV1 were, on average, 89 and 88% of predicted normal values. Impairment of ventilation and/or perfusion at the site of previous tumour was documented in 13 patients, while no such abnormalities were observed in 8 cases. Reduction of blood flow was generally more severe than impairment of ventilation. Neither median survival nor disease-free 2-yr survival was improved in patients with normal regional lung function compared to patients with functional impairment. This lack of survival advantage suggests that factors other than persistent tumour, such as scar formation, may contribute to reduction of regional lung function after chemotherapy for small cell bronchogenic carcinoma.

Aged↗
PubMed1983

Bronchoscopic findings in patients with a complete radiographic regression of small cell bronchogenic carcinoma.

Fibre-optic bronchoscopy was performed in 21 patients with small cell bronchogenic carcinoma who demonstrated a complete radiographic regression of their chest lesions after 3-4 months of combination chemotherapy. Fifteen patients showed abnormalities at the site of the original tumour consisting of nodular elevations, narrowing of bronchi and/or fibrous strands or membranes. Microscopic evidence of residual cancer was obtained in 3 cases. In 3 out of 8 patients who underwent a further bronchoscopy after 18 months of treatment, disappearance of nodules was noted at the later examination. Persistent bronchial narrowing was observed in patients who became disease-free 2-yr survivors. It is concluded that tumour regression may be accompanied by scar formation, which complicate the interpretation of post-treatment abnormalities, and that further regression of intrabronchial lesions may occur beyond 3-4 months.

Aged↗