uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Mahteme, Haile
Alternative names
Publications (10 of 59) Show all publications
Cashin, P., Mahteme, H., Syk, I., Frodin, J. E., Glimelius, B. & Graf, W. (2018). Quality of life and cost effectiveness in a randomized trial of patients with colorectal cancer and peritoneal metastases. European Journal of Surgical Oncology, 44(7), 983-990
Open this publication in new window or tab >>Quality of life and cost effectiveness in a randomized trial of patients with colorectal cancer and peritoneal metastases
Show others...
2018 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 44, no 7, p. 983-990Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to compare health-related quality-of-life (HRQOL) and cost-effectiveness between cytoreductive surgery with intraperitoneal chemotherapy (CRS + IPC) and systemic chemotherapy for patients with colorectal peritoneal metastases. Methods: Patients included in the Swedish Peritoneal Trial comparing CRS + IPC and systemic chemotherapy completed the EORTC QLQ-C30 and SF-36 questionnaires at baseline, 2, 4, 6, 12, 18, and 24 months. HRQOL at 24 months was the primary endpoint. EORTC sum score, SF-36 physical and mental component scores at 24 months were calculated and compared for each arm and then referenced against general population values. Two quality-adjusted life-year (QALY) indices were applied (EORTC-8D and SF-6D) and an incremental cost-effectiveness ratio (ICER) per QALY gained was calculated. A projected life-time ICER per QALY gained was calculated using predicted survival according to Swedish population statistics. Results: No statistical differences in HRQOL between the arms were noted at 24 months. Descriptively, survivors in the surgery arm had higher summary scores than the general population at 24 months, whereas survivors in the chemotherapy arm had lower scores. The projected life-time QALY benefit was 3.8 QALYs in favor of the surgery arm (p=0.06) with an ICER per QALY gained at 310,000 SEK (EORTC-8D) or 362,000 SEK (SF-6D) corresponding to 26,700-31,200 GBP. Conclusion: The HRQOL in patients with colorectal peritoneal metastases undergoing CRS + IPC appear similar to those receiving systemic chemotherapy. Two-year survivors in the CRS + IPC arm have comparable HRQOL to a general population reference. The treatment is cost-effective according to NICE guidelines.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
Keywords
Colorectal cancer, Peritoneal metastases, Cytoreductive surgery, Intraperitoneal chemotherapy, Quality of life, Cost-effectiveness
National Category
Nursing Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-361107 (URN)10.1016/j.ejso.2018.02.012 (DOI)000437391100010 ()29530346 (PubMedID)
Funder
Swedish Cancer Society, 150767
Available from: 2018-09-21 Created: 2018-09-21 Last updated: 2018-09-21Bibliographically approved
Hultman, B., Gunnarsson, U., Nygren, P., Sundbom, M., Glimelius, B. & Mahteme, H. (2017). Prognostic factors in patients with loco-regionally advanced gastric cancer. World Journal of Surgical Oncology, 15, Article ID 172.
Open this publication in new window or tab >>Prognostic factors in patients with loco-regionally advanced gastric cancer
Show others...
2017 (English)In: World Journal of Surgical Oncology, ISSN 1477-7819, E-ISSN 1477-7819, Vol. 15, article id 172Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to investigate epidemiologic and prognostic factors relevant to the treatment of loco-regionally advanced gastric cancer (GC).

METHODS: Two hundred and fifty-five patients with GC were identified in Uppsala County between 2000 and 2009. Patient records were analyzed for loco-regionally advanced GC defined as tumor with peritoneal involvement, excluding serosal invasion from the primary tumor only, at primary diagnosis or during follow-up. The presence or not of distant metastasis (DM), including hematogenous metastases (e.g., liver, lung, and bone) and/or distant lymph node metastases, was also analyzed. The Cox proportional hazard model was used for multivariate analysis of factors influencing survival.

RESULTS: One hundred and twenty patients (47% of all patients with GC; median age 70.5 years) had loco-regionally advanced disease, corresponding to an incidence of 3.8 per 100,000 person-years. Forty-one percent of these also had DM. Median overall survival (mOS) from the time of the diagnosis of loco-regionally advanced disease was 4.8 months for the total patient cohort, 5.1 months for the subgroup of patients without DM, and 4.7 months for the subgroup with DM. There was no significant difference in mOS between the subgroups with synchronous versus metachronous loco-regionally advanced GC: 4.8 months (range 0.0-67.4) versus 4.7 months (range 0.0-28.3). Using multivariate Cox analysis, positive prognostic factors for survival were good performance status at diagnosis and treatment with palliative chemotherapy and/or radiotherapy. Synchronous DM was a negative prognostic factor. The mOS did not differ when comparing the time period 2000-2004 (5.1 months, range 0-67.4) with the period 2005-2009 (4.0 months, range 0.0-28.3).

CONCLUSION: Peritoneal involvement occurred in almost half of the patients with GC in this study and was associated with short life expectancy. New treatment strategies are warranted.

Keywords
Gastric cancer, Loco-regionally advanced cancer, Metastases, Peritoneal, Prognostic factor, Surgery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333265 (URN)10.1186/s12957-017-1243-z (DOI)000410928100002 ()28915886 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2017-12-12Bibliographically approved
Cashin, P. H., Mahteme, H., Spang, N., Syk, I., Frodin, J. E., Torkzad, M., . . . Graf, W. (2016). Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial. European Journal of Cancer, 53, 155-162
Open this publication in new window or tab >>Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial
Show others...
2016 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 53, p. 155-162Article in journal (Refereed) Published
Abstract [en]

Background: First-line treatment of isolated resectable colorectal peritoneal metastases remains unclear. This study (the Swedish peritoneal study) compares cytoreductive surgery and intraperitoneal chemotherapy (surgery arm) with systemic chemotherapy (chemotherapy arm). Methods: Patients deemed resectable preoperatively were randomised to surgery and intraperitoneal 5-fluorouracil 550 mg/m(2) /d for 6 d with repeated courses every month or to systemic oxaliplatin and 5-fluorouracil regimen every second week. Both treatments continued for 6 months. Primary end-point was overall survival (OS) and secondary end-points were progression-free survival (PFS), and morbidity. Results: The study terminated prematurely when 48 eligible patients (24/arm) were included due to recruitment difficulties. Two-year OS was 54% in the surgery arm and 38% in the chemotherapy arm (p = 0.04). After 5 years, 8 versus 1 patient were alive, respectively (p = 0.02). Median OS was 25 months versus 18 months, respectively, hazard ratio 0.51 (95% confidence interval: 0.27-0.96, p = 0.04). PFS in the surgery arm was 12 months versus 11 months in the chemotherapy arm (p = 0.16) with 17% versus 0% 5-year PFS. Grade III-IV morbidity was seen in 42% and 50% of the patients, respectively. No mortalities. Conclusions: Cytoreductive surgery with intraperitoneal chemotherapy may be superior to systemic oxaliplatin-based treatment of colorectal cancer with resectable isolated peritoneal metastases.(ClinicalTrials. gov nr: NCT01524094).

Keywords
Cytoreductive surgery, Intraperitoneal chemotherapy, Colorectal cancer, Systemic chemotherapy, Peritoneal metastases, Peritoneal carcinomatosis
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-280096 (URN)10.1016/j.ejca.2015.09.017 (DOI)000368789100017 ()26751236 (PubMedID)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-11-30Bibliographically approved
Torkzad, M., Casta, N., Bergman, A., Ahlström, H., Påhlman, L. & Mahteme, H. (2015). Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist. Journal of Surgical Oncology, 111(6), 746-751
Open this publication in new window or tab >>Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist
Show others...
2015 (English)In: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 111, no 6, p. 746-751Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

To compare CT and MRI for peritoneal carcinomatosis index (PCI) assessment and to compare assessments made by the radiologist based on their experiences.

METHOD AND MATERIALS:

MRI and CT of abdomen and pelvis were performed on 39 prospectively followed by surgery directly. Two blinded radiologists with different experience levels evaluated PCI separately on different occasions on 19 cases initially and later on the remaining 20. The agreement between the radiologists' assessment and surgical findings in total and per site were recorded.

RESULTS:

Total PCI: The experienced radiologist was able to assess total tumor burden correctly on both CT and MRI (kappa = 1.0). For the inexperienced radiologist the assessment was better on CT (kappa = 0.73) compared to MRI (kappa = 0.58). Different sites: The experienced radiologist showed high agreement with kappa = 0.77 for MRI and 0.80 for CT. Corresponding figures were 0.39 and 0.60 for the inexperienced radiologist. For the second phase the agreement levels increased for the inexperienced radiologist increased to 0.80 and 0.70, respectively.

CONCLUSION:

CT and MRI are equal when read by experienced radiologist. CT shows better results when read by an inexperienced radiologist compared to MRI, however the results of the latter can easily be improved.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-244159 (URN)10.1002/jso.23878 (DOI)000353417700014 ()25580825 (PubMedID)
Available from: 2015-02-12 Created: 2015-02-12 Last updated: 2017-12-04Bibliographically approved
Cashin, P., Graf, W., Nygren, P. & Mahteme, H. (2015). Considerations on the Selection Process for Cytoreductive Surgery and Hyperthermic IntraPeritoneal Chemotherapy for Colorectal Carcinomatosis Reply [Letter to the editor]. Annals of Surgery, 262(2), e48-e49
Open this publication in new window or tab >>Considerations on the Selection Process for Cytoreductive Surgery and Hyperthermic IntraPeritoneal Chemotherapy for Colorectal Carcinomatosis Reply
2015 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 262, no 2, p. e48-e49Article in journal, Letter (Refereed) Published
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-261054 (URN)000357949100010 ()25719806 (PubMedID)
Available from: 2015-09-01 Created: 2015-08-28 Last updated: 2017-12-04Bibliographically approved
Bjersand, K., Mahteme, H., Sundström Poromaa, I., Andreasson, H., Graf, W., Larsson, R. & Nygren, P. (2015). Drug Sensitivity Testing in Cytoreductive Surgery and Intraperitoneal Chemotherapy of Pseudomyxoma Peritonei. Annals of Surgical Oncology, 22, S810-S816
Open this publication in new window or tab >>Drug Sensitivity Testing in Cytoreductive Surgery and Intraperitoneal Chemotherapy of Pseudomyxoma Peritonei
Show others...
2015 (English)In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 22, p. S810-S816Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is an established therapy for pseudomyxoma peritonei (PMP). However, the role of IPC is unclear. By ex vivo assessment of PMP tumor cell sensitivity to cytotoxic drugs, we investigated the basis for IPC drug selection and the role of IPC in the management of PMP.

METHODS: Tumor cells were prepared by collagenase digestion of tumor tissue from 133 PMP patients planned for CRS and IPC. Tumor cell sensitivity to oxaliplatin, 5FU, mitomycin C, doxorubicin, irinotecan, and cisplatin was assessed in a 72-h cell-viability assay. Drug sensitivity was correlated to progression-free survival (PFS) and overall survival (OS).

RESULTS: Samples from 92 patients were analyzed successfully. Drug sensitivity varied considerably between samples. Peritoneal mucinous carcinomatosis (PMCA), compared with PMCA intermediate or disseminated peritoneal adenomucinosis, was slightly more resistant to platinum and 5FU and tumor cells from patients previously treated with chemotherapy were generally less sensitive than those from untreated patients. Multivariate analysis showed patient performance status and completeness of CRS to be prognostic for OS. Among patients with complete CRS (n = 61), PFS tended to be associated with sensitivity to mitomycin C and cisplatin (p ≈ 0.06). At the highest drug concentration tested, the hazard ratio for disease relapse increased stepwise with drug resistance for all drugs.

CONCLUSIONS: Ex vivo assessment of drug sensitivity in PMP provides prognostic information. The results suggest a role for IPC as therapeutic adjunct to CRS and for individualization of IPC by pretreatment assessment of drug sensitivity.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-265752 (URN)10.1245/s10434-015-4675-0 (DOI)000367288100072 ()26193962 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2018-04-23Bibliographically approved
Strömberg, H., Mahteme, H., Hellman, P. & Sandblom, G. (2015). Prpophylactic reinforcement of midline incisions using tigr matrix®. Hernia, Suppl 2, S195
Open this publication in new window or tab >>Prpophylactic reinforcement of midline incisions using tigr matrix®
2015 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. Suppl 2, p. S195-Article in journal, Meeting abstract (Refereed) Published
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-277318 (URN)10.1007/BF03355352 (DOI)26518803 (PubMedID)
Note

Topic: Abdominal Wall Hernia - Prophylactic Mesh

Available from: 2016-02-19 Created: 2016-02-19 Last updated: 2017-05-09Bibliographically approved
Hultman, B., Mahteme, H., Sundbom, M., Ljungman, M., Larsson, R. & Nygren, P. (2014). Benchmarking of gastric cancer sensitivity to anti-cancer drugs ex vivo as a basis for drug selection in systemic and intraperitoneal therapy. Journal of Experimental & Clinical Cancer Research, 33, Article ID 110.
Open this publication in new window or tab >>Benchmarking of gastric cancer sensitivity to anti-cancer drugs ex vivo as a basis for drug selection in systemic and intraperitoneal therapy
Show others...
2014 (English)In: Journal of Experimental & Clinical Cancer Research, ISSN 1756-9966, E-ISSN 1756-9966, Vol. 33, article id 110Article in journal (Refereed) Published
Abstract [en]

Background  

The choice of drugs for treatment of advanced gastric cancer (GC) is empirical. The purpose of the current study was to benchmark ex vivo the sensitivity of GC tumor cells from patients to standard cytotoxic and some newly introduced targeted drugs (TDs), as a basis for drug selection in the treatment of GC.

Methods  

Tumor cell samples from patients with GC were analyzed for sensitivity to 5-fluorouracil, cisplatin, oxaliplatin, irinotecan, mito­mycin C, doxorubicin and docetaxel as well as for the targeted drugs bortezomib, sorafenib, sunitinib and rapamycin using a short-term in vitro assay based on retention of viable tumor cells of fluorescent fluorescein. Samples of normal mononuclear cells, chronic lymphocytic leukemia, ovarian cancer and colorectal cancer were included for comparison.

Results    

The GC samples were essentially as sensitive to the standard drugs and the TDs as those from colorectal cancer whereas the ovarian cancer samples were more sensitive. The individual GC samples varied considerably in sensitivity to increasing concentrations of the clinically used standard drugs. In GC, cisplatin was cross-resistant to oxaliplatin and 5-fluorouracil which, on the other hand, was not cross-resistant to the other cytotoxic drugs. The activity of sunitinib did not obviously correlate to that of the standard drugs.

Conclusion    

Ex vivo assessment of drug sensitivity of tumor cells from patients with GC is feasible and may provide information that could be useful for selection of drugs for treatment. Drug sensitivity varies considerably between and within individual samples arguing for individualized selection of drugs for chemotherapy.

Keywords
gastric cancer, cultured tumor cells, fluorometric analysis, cancer drug tests, chemo-sensitivity, anti tumor drugs
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-197739 (URN)10.1186/s13046-014-0110-9 (DOI)000349128000002 ()25528067 (PubMedID)
Note

Submitted article title: Benchmarking of gastric cancer tumor cell sensitivity ex vivo to standard and targeted anti-cancer drugs as a basis for drug selection in systemic and intraperitoneal therapy

Available from: 2013-04-03 Created: 2013-04-03 Last updated: 2017-12-06Bibliographically approved
von Heideman, A., Tholander, B., Grundmark, B., Cajander, S., Gerdin, E., Holm, L., . . . Nygren, P. (2014). Chemotherapeutic drug sensitivity of primary cultures of epithelial ovarian cancer cells from patients in relation to tumour characteristics and therapeutic outcome. Acta Oncologica, 53(2), 242-250
Open this publication in new window or tab >>Chemotherapeutic drug sensitivity of primary cultures of epithelial ovarian cancer cells from patients in relation to tumour characteristics and therapeutic outcome
Show others...
2014 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 2, p. 242-250Article in journal (Refereed) Published
Abstract [en]

Background

A number of chemotherapeutic drugs are active in epithelial ovarian cancer (EOC) but so far choice of drugs for treatment is mostly empirically based. Testing of drug activity in tumour cells from patients might provide a rationale for a more individualised approach for drug selection.

Material and methods

Sensitivity of EOC to chemotherapeutic drugs was analysed in 125 tumour samples from 112 patients using a short-term primary culture assay based on the concept of total cell kill. Sensitivity was related to tumour histology, treatment status and clinical tumour response.

Results

For most EOC standard drugs serous high grade and clear cell EOC were the most sensitive subtypes and the mucinous tumours the most resistant subtype. Docetaxel, however, tended to show the opposite pattern. Samples from previously treated patients tended to be more resistant than those from treatment naive patients. The activity of cisplatin correlated with that of other drugs with the exception of docetaxel. Tumour samples from two sites in the same patient at the same occasion showed similar cisplatin sensitivity in contrast to samples taken at different occasions. Samples from patients responding in the clinic to treatment were more sensitive to most drugs than samples from non-responding patients. At the individual patient level, drug sensitivity in vitro compared with clinical response showed sensitivities and specificities in the 83-100% and 55-83% ranges, respectively.

Conclusions

Assessment of EOC tumour cell drug sensitivity in vitro provides clinically relevant and potentially useful information for the optimisation of drug treatment.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-217645 (URN)10.3109/0284186X.2013.794956 (DOI)000329522000011 ()
Available from: 2014-02-12 Created: 2014-02-04 Last updated: 2017-12-06Bibliographically approved
Cashin, P. H., Dranichnikov, F. & Mahteme, H. (2014). Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy Treatment of Colorectal Peritoneal Metastases: Cohort Analysis of High Volume Disease and Cure Rate. Journal of Surgical Oncology, 110(2), 203-206
Open this publication in new window or tab >>Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy Treatment of Colorectal Peritoneal Metastases: Cohort Analysis of High Volume Disease and Cure Rate
2014 (English)In: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 110, no 2, p. 203-206Article in journal (Refereed) Published
Abstract [en]

Background: Cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) treatment of colorectal peritoneal metastases (PM) is an established treatment alternative. The study aim was, first, to investigate the outcome of high-volume disease defined by the peritoneal cancer index (PCI) 20; second, to report the long-term disease-free survival of patients with >5 years observation. Methods: Consecutive patients with colorectal PM from a prospective HIPEC database between 2004 and 2010 were included, 67 patients. Clinicopathological and outcome parameters were compared between low PCI (n = 40) and high PCI (n = 27). A subgroup analysis on patients with >5 years observation was performed (n = 32). Disease-free survival after 5 years defined cure. Results: Median overall survival (OS) was 28 months, low PCI-group 33 months versus high PCI-group 17 months (P = 0.03). Median OS of patients with complete CRS (n = 56) was 30 months, low PCI-group 37 months versus high PCI-group 27 months (P = 0.2), with 5-year survival of 31% and 21%, respectively. No difference in morbidity/mortality. The cure rate was 22% in the subgroup (7/32) and 28% in those with complete CRS (7/25). Two patients in the cured group had PCI 29 and 34. Discussion: Treatment of high-volume disease may result in long-term survival and even cure. The key is to reach a complete CRS. The overall cure rate is 22%. 

Keywords
cytoreductive surgery, hyperthermic intra-peritoneal chemotherapy (HIPEC), colorectal cancer, peritoneal metastases, cure, high volume disease
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-231115 (URN)10.1002/jso.23610 (DOI)000339434800016 ()24846340 (PubMedID)
Available from: 2014-09-05 Created: 2014-09-04 Last updated: 2017-12-05Bibliographically approved
Organisations

Search in DiVA

Show all publications