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Lönnemark, M
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Publications (10 of 11) Show all publications
Acosta Ruiz, V., Ladjevardi, S., Brekkan, E., Häggman, M., Lönnemark, M., Wernroth, L. & Magnusson, A. (2018). Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors:: A modified R.E.N.A.L nephrometry score adjusted comparison.. Acta Radiologica, 60(2), 260-268
Open this publication in new window or tab >>Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors:: A modified R.E.N.A.L nephrometry score adjusted comparison.
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2018 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 60, no 2, p. 260-268Article in journal (Refereed) Published
Abstract [en]

Background: Comparable oncological outcomes have been seen after surgical nephrectomy and thermal ablation of renal tumors recently. However, periprocedural outcome needs to be assessed for aiding treatment decision.

Purpose: To compare efficacy rates and periprocedural outcome (technical success, session time, hospitalization time, and complications) after renal tumor treatment with laparoscopic partial nephrectomy (LPN) or radiofrequency ablation (RFA).

Material and Methods: The initial experience with 49 (treated with LPN) and 84 (treated with RFA) consecutive patients for a single renal tumor (diameter ≤ 5 cm, limited to the kidney) during 2007-2014 was evaluated. Patient and tumor characteristics, efficacy rates, and periprocedural outcome were collected retrospectively. The stratified Mantel Haenzel and Van Elteren tests, adjusted for tumor complexity (with the modified R.E.N.A.L nephrometry score [m-RNS]), were used to assess differences in treatment outcomes.

Results: Primary efficacy rate was 98% for LPN and 85.7% for RFA; secondary efficacy rate was 93.9% for LPN and 95.2% for RFA; and technical success rate was 87.8% for LPN and 100% for RFA. Median session (m-RNS adjusted P < 0.001; LPN 215 min, RFA 137 min) and median hospitalization time were longer after LPN (m-RNS adjusted P < 0.001; LPN 5 days, RFA 2 days). Side effects were uncommon (LPN 2%, RFA 4.8%). Complications were more frequent after LPN (m-RNS adjusted P < 0.001; LPN 42.9%, RFA 10.7%).

Conclusion: Both methods achieved equivalent secondary efficacy rates. RFA included several treatment sessions, but session and hospitalization times were shorter, and complications were less frequent than for LPN. The differences remained after adjustment for renal tumor complexity.

Keywords
Ablation procedures, interventional, kidney, percutaneous, primary neoplasms
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-354169 (URN)10.1177/0284185118780891 (DOI)000459621200017 ()29911400 (PubMedID)
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2019-12-09Bibliographically approved
Sahlén, K., Dahlman, P., Brekkan, E., Lönnemark, M., Sahlén, G., Segelsjö, M. & Magnusson, A. (2018). Predictive value of secondary signs of obstruction in follow-up computed tomography of ureteral stones: a study with dynamic computed tomography. Scandinavian journal of urology, 52(1), 59-64
Open this publication in new window or tab >>Predictive value of secondary signs of obstruction in follow-up computed tomography of ureteral stones: a study with dynamic computed tomography
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2018 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 1, p. 59-64Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: This study aimed to determine the ratio of obstruction and predictive values of secondary signs in follow-up computed tomography (CT) of ureterolithiasis patients; to correlate stone characteristics with obstruction; to compare enhancement of obstructed and non-obstructed kidneys; and to compare radiation dose of the dynamic CT protocol to an excretory-phase protocol.

MATERIALS AND METHODS: This retrospective study assessed 49 follow-up CT scans of patients with remaining ureterolithiasis after a renal colic episode. Obstruction was measured as time taken to excretion of contrast medium in dynamic CT. Degree of secondary signs of obstruction was evaluated from the unenhanced CT. Data were collected on patients' gender and age, stone size and location, time from renal colic to follow-up, attenuation of the renal cortex and radiation dose.

RESULTS: Obstruction was present in 28% (n = 14) at follow-up. Predictive values (sensitivity, specificity, positive predictive value, negative predictive value) were calculated for hydronephrosis (1.0, 0.63, 0.52, 1.0), hydroureter (1.0, 0.4, 0.4, 1.0), perirenal stranding (0.21, 0.94, 0.6, 0.75), Gerota's fascia (0.21, 0.97, 0.75, 0.76) and renal swelling (0.21, 0.97, 0.75, 0.76). Obstruction was not correlated with stone characteristics. Enhancement was lower in obstructed kidneys (p < 0.01). Radiation dose was reduced by 43% (1.8 mSv).

CONCLUSIONS: Obstruction was found in 28% of patients. Secondary signs were scarce and of indeterminate value to the diagnosis of obstruction. The absence of hydronephrosis and hydroureter contradicted obstruction. Stone characteristics were not correlated with obstruction. Enhancement of the renal cortex was lower in obstructed kidneys. The dynamic protocol reduced the radiation dose.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
Dynamic CT, follow-up, hydronephrosis, secondary signs of obstruction, unenhanced CT, ureteral stones
National Category
Urology and Nephrology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-333776 (URN)10.1080/21681805.2017.1386232 (DOI)000425799400011 ()29037128 (PubMedID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2019-06-27Bibliographically approved
Laurell, A., Lönnemark, M., Brekkan, E., Magnusson, A., Tolf, A., Wallgren, A. C., . . . Karlsson-Parra, A. (2017). Intratumorally injected pro-inflammatory allogeneic dendritic cells as immune enhancers: a first-in-human study in unfavourable risk patients with metastatic renal cell carcinoma.. Journal for immunotherapy of cancer, 5, Article ID 52.
Open this publication in new window or tab >>Intratumorally injected pro-inflammatory allogeneic dendritic cells as immune enhancers: a first-in-human study in unfavourable risk patients with metastatic renal cell carcinoma.
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2017 (English)In: Journal for immunotherapy of cancer, ISSN 2051-1426, Vol. 5, article id 52Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Accumulating pre-clinical data indicate that the efficient induction of antigen-specific cytotoxic CD8+ T cells characterizing viral infections is caused by cross-priming where initially infected DCs produce an unique set of inflammatory factors that recruit and activate non-infected bystander DCs. Our DC-based immunotherapy concept is guided by such bystander view and accordingly, we have developed a cellular adjuvant consisting of pre-activated allogeneic DCs producing high levels of DC-recruiting and DC-activating factors. This concept doesn't require MHC-compatibility between injected cells and the patient and therefore introduces the possibility of using pre-produced and freeze-stored DCs from healthy blood donors as an off- the-shelf immune enhancer. The use of MHC-incompatible allogeneic DCs will further induce a local rejection process at the injection site that is expected to further enhance recruitment and maturation of endogenous bystander DCs.

METHODS: Twelve intermediate and poor risk patients with newly diagnosed metastatic renal cell carcinoma (mRCC) where included in a phase I/II study. Pro-inflammatory allogeneic DCs were produced from a leukapheresis product collected from one healthy blood donor and subsequently deep-frozen. A dose of 5-20 × 10(6) DCs (INTUVAX) was injected into the renal tumor twice with 2 weeks interval before planned nephrectomy and subsequent standard of care.

RESULTS: No INTUVAX-related severe adverse events were observed. A massive infiltration of CD8+ T cells was found in 5 out of 12 removed kidney tumors. No objective tumor response was observed and 6 out of 11 evaluable patients have subsequently received additional treatment with standard tyrosine kinase inhibitors (TKI). Three of these 6 patients experienced an objective tumor response including one sunitinib-treated patient who responded with a complete and durable regression of 4 brain metastases. Median overall survival (mOS) is still not reached (currently 42.5 months) but has already passed historical mOS in patients with unfavourable risk mRCC on standard TKI therapy.

CONCLUSIONS: Our findings indicate that intratumoral administration of proinflammatory allogeneic DCs induces an anti-tumor immune response that may prolong survival in unfavourable risk mRCC-patients given subsequent standard of care. A randomized, multi-center, phase II mRCC trial (MERECA) with INTUVAX in conjuction with sunitinib has been initiated.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01525017.

Keywords
Allogeneic dendritic cells, Anti-tumor response, INTUVAX, Intratumoral administration, Metastatic renal cell carcinoma, Phase I/II study, Sunitinib, Vaccine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-325567 (URN)10.1186/s40425-017-0255-0 (DOI)000405222000004 ()28642820 (PubMedID)
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2017-10-11Bibliographically approved
Helenius, M., Dahlman, P., Lönnemark, M., Brekkan, E., Wernroth, L. & Magnusson, A. (2016). Comparison of post contrast CT urography phases in bladder cancer detection. European Radiology, 26(2), 585-591
Open this publication in new window or tab >>Comparison of post contrast CT urography phases in bladder cancer detection
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2016 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 26, no 2, p. 585-591Article in journal (Refereed) Published
Abstract [en]

Objectives The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection. Methods The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists. Results Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002). Conclusion In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment.

Keywords
Multidetector computed tomography; Urography; Urinary bladder neoplasms; Haematuria; Early detection of cancer
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
urn:nbn:se:uu:diva-221282 (URN)10.1007/s00330-015-3844-7 (DOI)000368639200034 ()26002135 (PubMedID)
Available from: 2014-03-27 Created: 2014-03-27 Last updated: 2017-12-05Bibliographically approved
Acosta Ruiz, V., Lönnemark, M., Brekkan, E., Dahlman, P., Wernroth, L. & Magnusson, A. (2016). Predictive factors for complete renal tumor ablation using RFA. Acta Radiologica, 57(7), 886-893
Open this publication in new window or tab >>Predictive factors for complete renal tumor ablation using RFA
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2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 7, p. 886-893Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Radiofrequency ablation (RFA) can be used to treat renal masses in patients where surgery is preferably avoided. As tumor size and location can affect ablation results, procedural planning needs to identify these factors to limit treatment to a single session and increase ablation success.

PURPOSE: To identify factors that may affect the primary efficacy of complete renal tumor ablation with radiofrequency after a single session.

MATERIAL AND METHODS: Percutaneous RFA (using an impedance based system) was performed using computed tomography (CT) guidance. Fifty-two renal tumors (in 44 patients) were retrospectively studied (median follow-up, 7 months). Data collection included patient demographics, tumor data (modified Renal Nephrometry Score, histopathological diagnosis), RFA treatment data (electrode placement), and follow-up results (tumor relapse). Data were analyzed through generalized estimating equations.

RESULTS: Primary efficacy rate was 83%. Predictors for complete ablation were optimal electrode placement (P = 0.002, OR = 16.67) and increasing distance to the collecting system (P = 0.02, OR = 1.18). Tumor size was not a predictor for complete ablation (median size, 24 mm; P = 0.069, OR = 0.47), but all tumors ≤2 cm were completely ablated. All papillary tumors and oncocytomas were completely ablated in a single session; the most common incompletely ablated tumor type was clear cell carcinoma (6 of 9).

CONCLUSION: Optimal electrode placement and a long distance from the collecting system are associated with an increased primary efficacy of renal tumor RFA. These variables need to be considered to increase primary ablation success. Further studies are needed to evaluate the effect of RFA on histopathologically different renal tumors.

Keywords
Radiofrequency ablation (RFA); renal tumor; predict; ablation; radiofrequency; ablation success; complete ablation
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-264586 (URN)10.1177/0284185115605681 (DOI)000378051200020 ()26452975 (PubMedID)
Available from: 2015-10-15 Created: 2015-10-15 Last updated: 2019-09-04Bibliographically approved
Helenius, M., Brekkan, E., Dahlman, P., Lönnemark, M. & Magnusson, A. (2015). Bladder cancer detection in patients with gross haematuria: Computed tomography urography with enhancement triggered scan versus flexible cystoscopy. Scandinavian journal of urology, 49(5), 377-381
Open this publication in new window or tab >>Bladder cancer detection in patients with gross haematuria: Computed tomography urography with enhancement triggered scan versus flexible cystoscopy
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2015 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, no 5, p. 377-381Article in journal (Refereed) Published
Abstract [en]

Objective

Computed tomography urography (CTU) can be used to direct further investigation of patients if the bladder tumour detection rate is high. The aim of this study was to compare a CTU protocol including an enhancement-triggered scan and flexible cystoscopy for detecting bladder tumours.

Materials and methods

Patients with gross haematuria undergoing CTU during 2005–2008 were included. For patients younger than 50 years the CTU protocol included unenhanced, enhancement-triggered corticomedullary, and excretory phases. Patients older than 50 years followed the same protocol plus a nephrographic phase. The entire urinary tract was examined in all phases.

Results

Of 435 patients, 55 patients were diagnosed with bladder tumour. CTU detected bladder tumour in 48 patients (87%). Five CTU examination reports were false positive. With CTU, sensitivity for finding bladder tumour was 0.87, specificity 0.99, positive predictive value (PPV) 0.91 and negative predictive value (NPV) 0.98. Cystoscopy detected bladder tumour in 48 patients (87%) and had one false-positive finding, resulting in sensitivity of 0.87, specificity 1.0, PPV 0.98 and NPV 0.98.

Conclusions

The detection rate of bladder tumours for the CTU protocol including an enhancement-triggered scan was high and comparable to flexible cystoscopy. Hence, this protocol could be used to assess the bladder as the primary investigation and direct further investigation of the patient.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
urn:nbn:se:uu:diva-221283 (URN)10.3109/21681805.2015.1026937 (DOI)000364428800006 ()
Available from: 2014-03-27 Created: 2014-03-27 Last updated: 2017-12-05Bibliographically approved
Gunnarsson, J., Dahlman, P., Helenius, M., Liss, P., Lönnemark, M., Magnusson, A. & Malmström, P.-U. (2015). Hematurispåret – en väg att snabbare diagnostisera blåscancer. Paper presented at Urologidagarna - 2015. Karlstad. Svensk Urologi (3), 38
Open this publication in new window or tab >>Hematurispåret – en väg att snabbare diagnostisera blåscancer
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2015 (Swedish)In: Svensk Urologi, no 3, p. 38-Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-264719 (URN)
Conference
Urologidagarna - 2015. Karlstad
Available from: 2015-10-15 Created: 2015-10-15 Last updated: 2015-10-15
Magnusson, A., Wallgren, A., Brekkan, E., Lönnemark, M., Karlsson-Parra, A. & Laurell, A. (2015). Long-term survival in unfavorable-risk mRCC patients after intratumoral administration of a cell-based allogeneic vaccine adjuvant.. Paper presented at Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), MAY 29-JUN 02, 2015, Chicago, IL. Journal of Clinical Oncology, 33(15)
Open this publication in new window or tab >>Long-term survival in unfavorable-risk mRCC patients after intratumoral administration of a cell-based allogeneic vaccine adjuvant.
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2015 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 33, no 15Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-261482 (URN)000358036902598 ()
Conference
Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), MAY 29-JUN 02, 2015, Chicago, IL
Note

Meeting Abstract: e14006

Available from: 2015-09-03 Created: 2015-09-01 Last updated: 2017-12-04Bibliographically approved
Helenius, M., Dahlman, P., Magnusson, M., Lönnemark, M. & Magnusson, A. (2014). Contrast enhancement in bladder tumors examined with CT urography using traditional scan phases. Acta Radiologica, 55(9), 1129-1136
Open this publication in new window or tab >>Contrast enhancement in bladder tumors examined with CT urography using traditional scan phases
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2014 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 55, no 9, p. 1129-1136Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Bladder assessment in an early contrast-enhancing computed tomography urography (CTU) phase requires that bladder tumors be enhanced using contrast material.

PURPOSE:

To investigate the enhancement pattern in bladder tumors using a CTU protocol where the scan is enhancement triggered.

MATERIAL AND METHODS:

Fifty patients diagnosed with bladder cancer were examined during the unenhanced (UP), corticomedullary (CMP), and excretory phases (EP). Twenty-one patients, all aged 50 years or older, were also examined during the nephrographic phase (NP). A ROI placed in the aorta was used to start the scan during the CMP when the attenuation reached 200 Hounsfield units (HU). The NP and EP were started with a 40 s and 300 s delay, respectively, after the CMP was finished. Attenuation and size measurements were made in the axial plane.

RESULTS:

Mean contrast enhancement of bladder tumors was 37, 25, and 17 HU in the CMP, NP, and EP, respectively. The differences in contrast enhancement were significant across all three phases. Eighty-eight percent of patients showed the highest contrast enhancement in the CMP. In 96% of the cases, contrast enhancement >20 HU was seen. The mean value of the shortest dimension of the bladder tumors was 22 ± 12 mm.

CONCLUSION:

The contrast enhancement is significantly higher in the CMP than in the NP and EP, suggesting that the CMP is preferable when assessing the bladder in the early contrast enhancing phase.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-212552 (URN)10.1177/0284185113513762 (DOI)000343887800015 ()24277884 (PubMedID)
Available from: 2013-12-11 Created: 2013-12-11 Last updated: 2017-12-06Bibliographically approved
Magnusson, A., Geterud, K., Brekkan, E., Lindqvist, K., Dahlman, P., Lönnemark, M., . . . Hellström, M. (2014). Ultraljud vs DT vid uretärsten: svenska rutiner gäller. Läkartidningen, 111(49-50), 2236-2237
Open this publication in new window or tab >>Ultraljud vs DT vid uretärsten: svenska rutiner gäller
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2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 49-50, p. 2236-2237Article in journal (Other academic) Published
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-244935 (URN)25584570 (PubMedID)
Available from: 2015-02-23 Created: 2015-02-23 Last updated: 2017-12-04Bibliographically approved
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