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Nilsson, Kristina
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Publications (10 of 32) Show all publications
van Griensven, M., Ricklin, D., Denk, S., Halbgebauer, R., Braun, C. K., Schultze, A., . . . Huber-Lang, M. (2019). PROTECTIVE EFFECTS OF THE COMPLEMENT INHIBITOR COMPSTATIN CP40 IN HEMORRHAGIC SHOCK. Shock, 51(1), 78-87
Open this publication in new window or tab >>PROTECTIVE EFFECTS OF THE COMPLEMENT INHIBITOR COMPSTATIN CP40 IN HEMORRHAGIC SHOCK
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2019 (English)In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 51, no 1, p. 78-87Article in journal (Refereed) Published
Abstract [en]

Trauma-induced hemorrhagic shock (HS) plays a decisive role in the development of immune, coagulation, and organ dysfunction often resulting in a poor clinical outcome. Imbalanced complement activation is intricately associated with the molecular danger response and organ damage after HS. Thus, inhibition of the central complement component C3 as turnstile of both inflammation and coagulation is hypothesized as a rational strategy to improve the clinical course afterHS. Applying intensive care conditions, anaesthetized, monitored, and protectively ventilated nonhuman primates (NHP; cynomolgusmonkeys) received a pressure-controlled severe HS (60min at mean arterial pressure 30 mmHg) with subsequent volume resuscitation. Thirty minutes after HS, animals were randomly treated with either an analog of the C3 inhibitor compstatin (i.e., Cp40) in saline (n =4) or with saline alone (n =4). The observation period lasted 300 min after induction of HS. We observed improved kidney function in compstatin Cp40-treated animals after HS as determined by improved urine output, reduced damage markers and a tendency of less histopathological signs of acute kidney injury. Sham-treated animals revealed classical signs ofmucosal edema, especially in the ileum and colon reflected by worsened microscopic intestinal injury scores. In contrast, Cp40-treated HS animals exhibited only minor signs of organ edema and significantly less intestinal damage. Furthermore, early systemic inflammation and coagulation dysfunction were both ameliorated by Cp40. The data suggest that therapeutic inhibition of C3 is capable to significantly improve immune, coagulation, and organ function and to preserve organ-barrier integrity early after traumatic HS. C3-targeted complement inhibition may therefore reflect a promising therapeutic strategy in fighting fatal consequences of HS.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
Keywords
Complement, hemorrhagic shock, inflammation, intestine, kidney, nonhuman primate
National Category
Immunology
Identifiers
urn:nbn:se:uu:diva-381929 (URN)10.1097/SHK.0000000000001127 (DOI)000462687800010 ()29461464 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme
Available from: 2019-04-18 Created: 2019-04-18 Last updated: 2019-04-18Bibliographically approved
Kristensen, ., Nilsson, K., Knöös, T. & Nilsson, P. (2018). Evaluation of inter-observer variations in target delineation - A dose based approach. Paper presented at 37th Meeting of the European-Society-for-Radiotherapy-and-Oncology (ESTRO), APR 20-24, 2018, Barcelona, SPAIN. Radiotherapy and Oncology, 127(Suppl. 1), S883-S884, Article ID EP-1642.
Open this publication in new window or tab >>Evaluation of inter-observer variations in target delineation - A dose based approach
2018 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 127, no Suppl. 1, p. S883-S884, article id EP-1642Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-364844 (URN)10.1016/S0167-8140(18)31951-0 (DOI)000438676101032 ()
Conference
37th Meeting of the European-Society-for-Radiotherapy-and-Oncology (ESTRO), APR 20-24, 2018, Barcelona, SPAIN
Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2018-11-05Bibliographically approved
Ångström-Brännström, C., Lindh, V., Mullaney, T., Nilsson, K., Wickart-Johansson, G., Svärd, A.-M., . . . Engvall, G. (2018). Parents' Experiences and Responses to an Intervention for Psychological Preparation of Children and Families During the Child's Radiotherapy.. Journal of Pediatric Oncology Nursing, 35(2), 132-148
Open this publication in new window or tab >>Parents' Experiences and Responses to an Intervention for Psychological Preparation of Children and Families During the Child's Radiotherapy.
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2018 (English)In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 35, no 2, p. 132-148Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate parents' experiences and responses to a systematic intervention for psychological preparation of children and families during the child's radiotherapy (RT) treatment. In this case-control study at 3 pediatric RT centers, an intervention with a preparatory kit, including age-adjusted information on tablets, gift of a stuffed toy or a pair of headphones, a parent booklet, and toy models of the computed tomography and RT machines was implemented. For evaluation, a mixed methods data collection was conducted. A total of 113 parents of children undergoing RT were included-n = 59 in the baseline group and n = 54 in the intervention group. Health-related quality of life was rated low, but parents in the intervention group expressed less anxiety after the RT compared with the baseline group. They found information suitable for their young children, siblings, and friends were involved and the toy models were used for play. Parents expressed positive feelings due to close interaction with staff and each other within the family. The solutions developed within a human-centered design approach and shaped as a systematic family-centered strategy contributed to parents understanding and coping with the child's RT.

Keywords
child, childhood cancer, intervention, parent, radiotherapy
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-343399 (URN)10.1177/1043454217741876 (DOI)000427356900006 ()29172925 (PubMedID)
Funder
Swedish Childhood Cancer Foundation
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-05-28Bibliographically approved
Alcorn, S., Nilsson, K., Rao, A. D., Ladra, M. M., Ermoian, R. P., Villar, R. C., . . . Terezakis, S. A. (2018). Practice Patterns of Stereotactic Radiotherapy in Pediatrics: Results From an International Pediatric Research Consortium. Journal of pediatric hematology/oncology (Print), 40(7), 522-526
Open this publication in new window or tab >>Practice Patterns of Stereotactic Radiotherapy in Pediatrics: Results From an International Pediatric Research Consortium
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2018 (English)In: Journal of pediatric hematology/oncology (Print), ISSN 1077-4114, E-ISSN 1536-3678, Vol. 40, no 7, p. 522-526Article in journal (Refereed) Published
Abstract [en]

Purpose/Objectives: There is little consensus regarding the application of stereotactic radiotherapy (SRT) in pediatrics. We evaluated patterns of pediatric SRT practice through an international research consortium. Materials and Methods: Eight international institutions with pediatric expertise completed a 124-item survey evaluating patterns of SRT use for patients 21 years old and younger. Frequencies of SRT use and median margins applied with and without SRT were evaluated. Results: Across institutions, 75% reported utilizing SRT in pediatrics. SRT was used in 22% of brain, 18% of spine, 16% of other bone, 16% of head and neck, and <1% of abdomen/pelvis, lung, and liver cases across sites. Of the hypofractionated SRT cases, 42% were delivered with definitive intent. Median gross tumor volume to planning target volume margins for SRT versus non-SRT plans were 0.2 versus 1.4 cm for brain, 0.3 versus 1.5 cm for spine/other bone, 0.3 versus 2.0 cm for abdomen/pelvis, 0.7 versus 1.5 cm for head and neck, 0.5 versus 1.7 cm for lung, and 0.5 versus 2.0 cm for liver sites. Conclusions: SRT is commonly utilized in pediatrics across a range of treatment sites. Margins used for SRT were substantially smaller than for non-SRT planning, highlighting the utility of this approach in reducing treatment volumes.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
pediatric stereotactic radiosurgery, stereotactic radiosurgery, stereotactic body radiation therapy
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-367409 (URN)10.1097/MPH.0000000000001290 (DOI)000446191900024 ()30247288 (PubMedID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved
Wikström, K., Isacsson, U., Nilsson, K. & Ahnesjö, A. (2018). Reproducibility of heart and thoracic wall positionin repeated deep inspiration breath holds forradiotherapy of left-sided breast cancer patients. Acta Oncologica, 57(10), 1318-1324
Open this publication in new window or tab >>Reproducibility of heart and thoracic wall positionin repeated deep inspiration breath holds forradiotherapy of left-sided breast cancer patients
2018 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, no 10, p. 1318-1324Article in journal (Refereed) Published
Abstract [en]

Background: Deep inspiration breath hold (DIBH) for radiotherapy of left-sided breast cancer patientscan effectively move the heart away from the target and reduce the heart dose compared to treatmentsin free breathing. This study aims to investigate the positional reproducibility of heart edge(HE) and thoracic wall (TW) during repeated DIBHs.

Material and methods: At three occasions, 11 left-sided breast cancer patients were CT imaged during6 minutes of repeated DIBHs with 60 cine CT series. The series were evenly distributed over threebed positions and for each bed position, the heart edge associated maximum heart distance (MHD)and thoracic wall-associated maximum lung distance (MLD) from a reference line were retrospectivelyanalyzed. The high temporal resolution of the CT series enabled intrinsic heart movements to beresolved from breath hold variations. A body surface laser scanning system continuously extracted thethorax height and displayed it in a pair of goggles for patient feedback. To check for ‘fake-breathing’movements, e.g. that the patient lifts its back from the couch to reach DIBH, the couch-to-spine distancewas also measured in all CT series.

Results: The analysis was done for 1432 cine CTs captured during 292 breath holds. The DIBH movedthe heart on average 15mm in medial direction compared with free breathing. For the three bed positionsstudied, the mean value of the max range, across all patients, was between 11–13mm for theMHD and 4–8mm for the MLD. The MHD variation due to breath hold variation was twice as large asthe MHD variation due to intrinsic heart movement. The couch-to-spine distance varied less than3mm for all fractions, i.e., no fake-breathing was discovered.

Conclusions: The heart edge and thoracic wall reproducibility was high in relation to the medial heartdisplacement induced by the DIBH.

Keywords
Radiotherapy, Deep Inspiration Breath Hold, Breast Cancer
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-358938 (URN)10.1080/0284186X.2018.1490027 (DOI)000448595500006 ()30074438 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-01-17Bibliographically approved
Ajithkumar, T., Horan, G., Padovani, L., Thorp, N., Timmermann, B., Alapetite, C., . . . Janssens, G. O. (2018). SIOPE - Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy. Radiotherapy and Oncology, 128(2), 192-197
Open this publication in new window or tab >>SIOPE - Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy
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2018 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 128, no 2, p. 192-197Article in journal (Refereed) Published
Abstract [en]

Objective: To develop a consensus guideline for craniospinal target volume (TV) delineation in children and young adults participating in SIOPE studies in the era of high-precision radiotherapy. Methods and materials: During four consensus meetings (Cambridge, Essen, Liverpool, and Marseille), conventional field-based TV has been translated into image-guided high-precision craniospinal TV by a group of expert paediatric radiation oncologists and enhanced by MRI images of liquor distribution. Results: The CTVcranial should include the whole brain, cribriform plate, most inferior part of the temporal lobes, and the pituitary fossa. If the full length of both optic nerves is not included, the dose received by different volumes of optic nerve should be recorded to correlate with future patterns of relapse (no consensus). The CTVcranial should be modified to include the dural cuffs of cranial nerves as they pass through the skull base foramina. Attempts to spare the cochlea by excluding CSF within the internal auditory canal should be avoided. The CTVspinal should include the entire subarachnoid space, including nerve roots laterally. The lower limit of the spinal CTV is at the lower limit of the thecal sac, best visible on MRI scan. There is no need to include sacral root canals in the spinal CTV. Conclusion: This consensus guideline has the potential to improve consistency of craniospinal TV delineation in an era of high-precision radiotherapy. This proposal will be incorporated in the RTQA guidelines of future SIOPE-BTG trials using CSI.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Clinical target volume, Delineation, Craniospinal radiotherapy, Guideline, CSI
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-363061 (URN)10.1016/j.radonc.2018.04.016 (DOI)000440972900002 ()29729847 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2018-10-18Bibliographically approved
Ogasawara, H., Teramura, Y., Imura, T., Inagaki, A., Saito, Y., Matsumura, M., . . . Goto, M. (2018). The Optimization of the Hepatocyte Surface Modification Procedures in Terms of Heparin and Apyrase for Improving Hepatocyte Engraftment. Paper presented at 14th World Congress of the International-Pancreas-and-Islet-Transplant-Association (IPITA), SEP 24-27, 2013, Monterey, CA. Transplantation, 102, S727-S727
Open this publication in new window or tab >>The Optimization of the Hepatocyte Surface Modification Procedures in Terms of Heparin and Apyrase for Improving Hepatocyte Engraftment
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2018 (English)In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 102, p. S727-S727Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-368383 (URN)10.1097/01.tp.0000543706.60801.e9 (DOI)000444541201427 ()
Conference
14th World Congress of the International-Pancreas-and-Islet-Transplant-Association (IPITA), SEP 24-27, 2013, Monterey, CA
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2018-12-06Bibliographically approved
Vlachogiannis, P., Gudjonsson, O., Montelius, A., Grusell, E., Isacsson, U., Nilsson, K. & Blomquist, E. (2017). Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas. Acta Neurochirurgica, 159(12), 2391-2400
Open this publication in new window or tab >>Hypofractionated high-energy proton-beam irradiation is an alternative treatment for WHO grade I meningiomas
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2017 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 159, no 12, p. 2391-2400Article in journal (Refereed) Published
Abstract [en]

Radiation treatment is commonly employed in the treatment of meningiomas. The aim of this study was to evaluate the effectiveness and safety of hypofractionated high-energy proton therapy as adjuvant or primary treatment for WHO grade I meningiomas. A total of 170 patients who received irradiation with protons for grade I meningiomas between 1994 and 2007 were included in the study. The majority of the tumours were located at the skull base (n = 155). Eighty-four patients were treated post subtotal resection, 42 at tumour relapse and 44 with upfront radiotherapy after diagnosis based on the typical radiological image. Irradiation was given in a hypofractionated fashion (3-8 fractions, usually 5 or 6 Gy) with a mean dose of 21.9 Gy (range, 14-46 Gy). All patients were planned for follow-up with clinical controls and magnetic resonance imaging scans at 6 months and 1, 2, 3, 5, 7 and 10 years after treatment. The median follow-up time was 84 months. Age, gender, tumour location, Simpson resection grade and target volume were assessed as possible prognostic factors for post-irradiation tumour progression and radiation related complications. The actuarial 5- and 10-year progression-free survival rates were 93% and 85% respectively. Overall mortality rate was 13.5%, while disease-specific mortality was 1.7% (3/170 patients). Older patients and patients with tumours located in the middle cranial fossa had a lower risk for tumour progression. Radiation-related complications were seen in 16 patients (9.4%), with pituitary insufficiency being the most common. Tumour location in the anterior cranial fossa was the only factor that significantly increased the risk of complications. Hypofractionated proton-beam radiation therapy may be used particularly in the treatment of larger World Health Organisation grade I meningiomas not amenable to total surgical resection. Treatment is associated with high rates of long-term tumour growth control and acceptable risk for complications.

Keywords
Meningioma, Benign meningioma, Proton beam irradiation, Hypofractionation
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-342199 (URN)10.1007/s00701-017-3352-4 (DOI)000415354800024 ()29064038 (PubMedID)
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-02-20Bibliographically approved
Stoppel, G., Eich, H.-T., Matuschek, C., Kortmann, R.-D., Meyer, F., Martinsson, U., . . . Steinmann, D. (2017). Lung toxicity after radiation in childhood: Results of the International Project on Prospective Analysis of Radiotoxicity in Childhood and Adolescence. Radiotherapy and Oncology, 125(2), 286-292
Open this publication in new window or tab >>Lung toxicity after radiation in childhood: Results of the International Project on Prospective Analysis of Radiotoxicity in Childhood and Adolescence
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2017 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 125, no 2, p. 286-292Article in journal (Refereed) Published
Abstract [en]

Background and purpose: This study presents the evaluation of acute and late toxicities of the lung in children and adolescents after irradiation in terms of dose-volume effects. Materials and methods: Irradiated children and adolescents in Germany have prospectively been documented since 2001 in the "Registry for the Evaluation of Side-Effects after Radiotherapy in Childhood and Adolescence (RiSK)"; in Sweden since 2008 in the RADTOX registry. Results: Up to April 2012, 1,392 children were recruited from RiSK, and up to June 2013, 485 from the RADTOX-registry. Of these patients, 295 were irradiated to the lung. Information about acute toxicity was available for 228 patients. 179 patients have been documented concerning late toxicity (>= grade 1: n = 28). The acute toxicity rate was noticeably higher in children irradiated with 5-20 Gy (p < 0.05). In the univariate analysis, a shorter time until late toxicity was noticeably associated with irradiation with 5-15 Gy (p < 0.05). Conclusion: Acute and late toxicities appear to be correlated with higher irradiation volumes and low doses. Our data indicate that similar to the situation in adult patients, V5, V10, V15 and V20 should be kept as low as possible (e.g., at least V5 < 50%, V10 and V15 < 35% and V20 < 30%) in children and adolescents to lower the risk of toxicity. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Radiation, Lung, Long-term effects, Late toxicity, Childhood
National Category
Cancer and Oncology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-339718 (URN)10.1016/j.radonc.2017.09.026 (DOI)000418314100016 ()29050956 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-01-26Bibliographically approved
Rao, A. D., Chen, Q., Ermoian, R. P., Alcorn, S. R., Figueiredo, M. L., Chen, M. J., . . . Terezakis, S. A. (2017). Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium. Pediatric Blood & Cancer, 64(11), Article ID e26589.
Open this publication in new window or tab >>Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium
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2017 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 64, no 11, article id e26589Article in journal (Refereed) Published
Abstract [en]

Background/Objectives:

The practice of palliative radiation therapy (RT) is based on extrapolation from adult literature. We evaluated patterns of pediatric palliative RT to describe regimens used to identify opportunity for future pediatric-specific clinical trials.

Design/Methods:

Six international institutions with pediatric expertise completed a 122-item survey evaluating patterns of palliative RT for patients 21 years old from 2010 to 2015. Two institutions use proton RT. Palliative RT was defined as treatment with the goal of symptom control or prevention of immediate life-threatening progression.

Results:

Of 3,225 pediatric patients, 365 (11%) were treated with palliative intent to a total of 427 disease sites. Anesthesia was required in 10% of patients. Treatment was delivered to metastatic disease in 54% of patients. Histologies included neuroblastoma (30%), osteosarcoma (18%), leukemia/lymphoma (12%), rhabdomyosarcoma (12%), medulloblastoma/ependymoma (12%), Ewing sarcoma (8%), and other (8%). Indications included pain (43%), intracranial symptoms (23%), respiratory compromise (14%), cord compression (8%), and abdominal distention (6%). Sites included nonspine bone (35%), brain (16% primary tumors, 6% metastases), abdomen/pelvis (15%), spine (12%), head/neck (9%), and lung/mediastinum (5%). Re-irradiation comprised 16% of cases. Techniques employed three-dimensional conformal RT (41%), intensity-modulated RT (23%), conventional RT (26%), stereotactic body RT (6%), protons (1%), electrons (1%), and other (2%). The most common physician-reported barrier to consideration of palliative RT was the concern about treatment toxicity (83%).

Conclusion:

There is significant diversity of practice in pediatric palliative RT. Combined with ongoing research characterizing treatment response and toxicity, these data will inform the design of forthcoming clinical trials to establish effective regimens and minimize treatment toxicity for this patient population.

Keywords
palliative radiation therapy, palliative therapy, pediatric radiation therapy
National Category
Pediatrics Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-336285 (URN)10.1002/pbc.26589 (DOI)000411059000022 ()
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-01-25Bibliographically approved
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