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  • 1.
    Ajithkumar, Thankamma
    et al.
    Cambridge Univ Hosp, Dept Oncol, Cambridge, England.
    Horan, Gail
    Cambridge Univ Hosp, Dept Oncol, Cambridge, England.
    Padovani, Laetitia
    Assistance Publ Hop Marseille, Dept Radiat Oncol, Marseille, France.
    Thorp, Nicky
    Clatterbridge Canc Ctr, Dept Oncol, Liverpool, Merseyside, England.
    Timmermann, Beate
    Univ Essen Gesamthsch, West German Proton Ctr, Essen, Germany.
    Alapetite, Claire
    Inst Curie, Dept Radiat Oncol, Paris, France;Inst Curie, Proton Ctr, Paris, France;Inst Curie, Dept Radiat Oncol, Orsay, France;Inst Curie, Proton Ctr, Orsay, France.
    Gandola, Lorenza
    Fdn IRCCS Ist Nazl Tumori, Dept Radiat Oncol, Milan, Italy.
    Ramos, Monica
    Hosp Univ Vall dHebron, Barcelona, Spain.
    Van Beek, Karen
    UZ Leuven, Radiotherapie Oncol, Leuven, Belgium.
    Christiaens, Melissa
    UZ Leuven, Radiotherapie Oncol, Leuven, Belgium.
    Lassen-Ramshad, Yasmin
    Aarhus Univ Hosp, Danish Ctr Particle Therapy, Aarhus, Denmark.
    Magelssen, Henriette
    Norwegian Radium Hosp, Oslo Univ Hosp, Dept Oncol, Oslo, Norway.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Saran, Frank
    Royal Marsden Hosp, Dept Oncol, Sutton, Surrey, England.
    Rombi, Barbara
    Santa Chiara Hosp, Proton Therapy Ctr, Trento, Italy.
    Kortmann, Rolf
    Univ Leipzig, Dept Radiat Oncol, Leipzig, Germany.
    Janssens, Geert O.
    Univ Med Ctr Utrecht, Dept Radiat Oncol, Utrecht, Netherlands;Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands.
    SIOPE - Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy2018In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 128, no 2, p. 192-197Article in journal (Refereed)
    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.

  • 2. Alcorn, S. R.
    et al.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Dieckmann, K.
    McNutt, T. R.
    Chen, M. J.
    Ermoian, R. P.
    Ford, E. C.
    MacDonald, S.
    Nechesnyuk, A.
    Tryggestad, E. J.
    Smith, K.
    Villar, R. C.
    Winey, B.
    Terezakis, S. A.
    Predictors of Setup Accuracy in Image-Guided CNS Radiation Therapy: Prospective Data From a Multinational Pediatrics Consortium2014In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 90, no S1, p. S723-S723Article in journal (Other academic)
  • 3.
    Alcorn, Sara
    et al.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Rao, Avani D.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA.
    Ladra, Matthew M.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA.
    Ermoian, Ralph P.
    Univ Washington, Dept Radiat Oncol, Seattle, WA 98195 USA.
    Villar, Rosangela C.
    Ctr Infantil Boldrini, Dept Radiat Oncol, Campinas, SP, Brazil.
    Chen, Michael J.
    Grp Apoio Adolescente & Crianca Canc, Dept Radiat, Sao Paulo, Brazil.
    Kobyzeva, Daria
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Dept Radiotherapy, Moscow, Russia.
    Nechesnyuk, Alexey V.
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Dept Radiotherapy, Moscow, Russia.
    Ford, Eric
    Univ Washington, Dept Radiat Oncol, Seattle, WA 98195 USA.
    MacDonald, Shannon
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA.
    Winey, Brian
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA.
    Dieckmann, Karin
    Univ Klin Strahlentherapie & Strahlenbiol, Dept Radiat Oncol, Vienna, Austria.
    Terezakis, Stephanie A.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA.
    Practice Patterns of Stereotactic Radiotherapy in Pediatrics: Results From an International Pediatric Research Consortium2018In: Journal of pediatric hematology/oncology (Print), ISSN 1077-4114, E-ISSN 1536-3678, Vol. 40, no 7, p. 522-526Article in journal (Refereed)
    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.

  • 4. Alcorn, Sara R
    et al.
    Chen, Michael J
    Claude, Line
    Dieckmann, Karin
    Ermoian, Ralph P
    Ford, Eric C
    Malet, Claude
    MacDonald, Shannon M
    Nechesnyuk, Alexey V
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Villar, Rosangela C
    Winey, Brian A
    Tryggestad, Erik J
    Terezakis, Stephanie A
    Practice patterns of photon and proton pediatric image guided radiation treatment: results from an International Pediatric Research consortium2014In: Practical radiation oncology, ISSN 1879-8500, Vol. 4, no 5, p. 336-341Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Image guided radiation therapy (IGRT) has become common practice for both photon and proton radiation therapy, but there is little consensus regarding its application in the pediatric population. We evaluated clinical patterns of pediatric IGRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiation therapy.

    METHODS AND MATERIALS: Seven international institutions with dedicated pediatric expertise completed a 53-item survey evaluating patterns of IGRT use in definitive radiation therapy for patients ≤21 years old. Two institutions use proton therapy for children and all others use IG photon therapy. Descriptive statistics including frequencies of IGRT use and means and standard deviations for planning target volume (PTV) margins by institution and treatment site were calculated.

    RESULTS: Approximately 750 pediatric patients were treated annually across the 7 institutions. IGRT was used in tumors of the central nervous system (98%), abdomen or pelvis (73%), head and neck (100%), lung (83%), and liver (69%). Photon institutions used kV cone beam computed tomography and kV- and MV-based planar imaging for IGRT, and all proton institutions used kV-based planar imaging; 57% of photon institutions used a specialized pediatric protocol for IGRT that delivers lower dose than standard adult protocols. Immobilization techniques varied by treatment site and institution. IGRT was utilized daily in 45% and weekly in 35% of cases. The PTV margin with use of IGRT ranged from 2 cm to 1 cm across treatment sites and institution.

    CONCLUSIONS: Use of IGRT in children was prevalent at all consortium institutions. There was treatment site-specific variability in IGRT use and technique across institutions, although practices varied less at proton facilities. Despite use of IGRT, there was no consensus of optimum PTV margin by treatment site. Given the desire to restrict any additional radiation exposure in children to instances where the exposure is associated with measureable benefit, prospective studies are warranted to optimize IGRT protocols by modality and treatment site.

  • 5. Baumann, Pia
    et al.
    Nyman, Jan
    Hoyer, Morten
    Gagliardi, Giovanna
    Lax, Ingmar
    Wennberg, Berit
    Drugge, Ninni
    Ekberg, Lars
    Friesland, Signe
    Johansson, Karl-Axel
    Lund, Jo-Smund
    Morhed, Elisabeth
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Oncology.
    Levin, Nina
    Paludan, Merete
    Sederholm, Christer
    Traberg, Anders
    Wittgren, Lena
    Lewensohn, Rolf
    Stereotactic body radiotherapy for medically inoperable patients with stage I non-small cell lung cancer: a first report of toxicity related to COPD/CVD in a non-randomized prospective phase II study2008In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 88, no 3, p. 359-67Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: In a retrospective study using stereotactic body radiotherapy (SBRT) in medically inoperable patients with stage I NSCLC we previously reported a local control rate of 88% utilizing a median dose of 15Gyx3. This report records the toxicity encountered in a prospective phase II trial, and its relation to coexisting chronic obstructive pulmonary disease (COPD) and cardio vascular disease (CVD). MATERIAL AND METHODS: Sixty patients were entered in the study between August 2003 and September 2005. Fifty-seven patients (T1 65%, T2 35%) with a median age of 75 years (59-87 years) were evaluable. The baseline mean FEV1% was 64% and median Karnofsky index was 80. A total dose of 45Gy was delivered in three fractions at the 67% isodose of the PTV. Clinical, pulmonary and radiological evaluations were made at 6 weeks, 3, 6, 9, 12, 18, and 36 months post-SBRT. Toxicity was graded according to CTC v2.0 and performance status was graded according to the Karnofsky scale. RESULTS: At a median follow-up of 23 months, 2 patients had relapsed locally. No grade 4 or 5 toxicity was reported. Grade 3 toxicity was seen in 12 patients (21%). There was no significant decline of FEV1% during follow-up. Low grade pneumonitis developed to the same extent in the CVD 3/17 (18%) and COPD 7/40 (18%) groups. The incidence of fibrosis was 9/17 (53%) and pleural effusions was 8/17 (47%) in the CVD group compared with 13/40 (33%) and 5/40 (13%) in the COPD group. CONCLUSION: SBRT for stage I NSCLC patients who are medically inoperable because of COPD and CVD results in a favourable local control rate with a low incidence of grade 3 and no grade 4 or 5 toxicity.

  • 6. Baumann, Pia
    et al.
    Nyman, Jan
    Hoyer, Morten
    Wennberg, Berit
    Gagliardi, Giovanna
    Lax, Ingmar
    Drugge, Ninni
    Ekberg, Lars
    Friesland, Signe
    Johansson, Karl-Axel
    Lund, Jo-Asmund
    Morhed, Elisabeth
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Levin, Nina
    Paludan, Merete
    Sederholm, Christer
    Traberg, Anders
    Wittgren, Lena
    Lewensohn, Rolf
    Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy.2009In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 27, no 20, p. 3290-6Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The impact of stereotactic body radiotherapy (SBRT) on 3-year progression-free survival of medically inoperable patients with stage I non-small-cell lung cancer (NSCLC) was analyzed in a prospective phase II study.

    PATIENTS AND METHODS: Fifty-seven patients with T1NOMO (70%) and T2N0M0 (30%) were included between August 2003 and September 2005 at seven different centers in Sweden, Norway, and Denmark and observed up to 36 months. SBRT was delivered with 15 Gy times three at the 67% isodose of the planning target volume.

    RESULTS: Progression-free survival at 3 years was 52%. Overall- and cancer-specific survival at 1, 2, and 3 years was 86%, 65%, 60%, and 93%, 88%, 88%, respectively. There was no statistically significant difference in survival between patients with T1 or T2 tumors. At a median follow-up of 35 months (range, 4 to 47 months), 27 patients (47%) were deceased, seven as a result of lung cancer and 20 as a result of concurrent disease. Kaplan-Meier estimated local control at 3 years was 92%. Local relapse was observed in four patients (7%). Regional relapse was observed in three patients (5%). Nine patients (16%) developed distant metastases. The estimated risk of all failure (local, regional, or distant metastases) was increased in patients with T2 (41%) compared with those with T1 (18%) tumors (P = .027).

    CONCLUSION: With a 3-year local tumor control rate higher than 90% with limited toxicity, SBRT emerges as state-of-the-art treatment for medically inoperable stage I NSCLC and may even challenge surgery in operable instances.

  • 7.
    Blomquist, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Ronne Engström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Borota, Ljubisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Gál, Gyula
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Lewén, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Montelius, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
    Grusell, Erik
    Isacsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
    Enblad, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Positive correlation between occlusion rate and nidus size of proton beam treated brain arteriovenous malformations (AVMs)2016In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 1, p. 105-112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Proton beam radiotherapy of arteriovenous malformations (AVM) in the brain has been performed in Uppsala since 1991. An earlier study based on the first 26 patients concluded that proton beam can be used for treating large and medium sized AVMs that were considered difficult to treat with photons due to the risk of side effects. In the present study we analyzed the result from treating the subsequent 65 patients.

    MATERIAL AND METHODS: A retrospective review of the patients' medical records, treatment protocols and radiological results was done. Information about gender, age, presenting symptoms, clinical course, the size of AVM nidus and rate of occlusion was collected. Outcome parameters were the occlusion of the AVM, clinical outcome and side effects.

    RESULTS: The rate of total occlusion was overall 68%. For target volume 0-2cm(3) it was 77%, for 3-10 cm(3) 80%, for 11-15 cm(3) 50% and for 16-51 cm(3) 20%. Those with total regress of the AVM had significantly smaller target volumes (p < 0.009) higher fraction dose (p < 0.001) as well as total dose (p < 0.004) compared to the rest. The target volume was an independent predictor of total occlusion (p = 0.03). There was no difference between those with and without total occlusion regarding mean age, gender distribution or symptoms at diagnosis. Forty-one patients developed a mild radiation-induced brain edema and this was more common in those that had total occlusion of the AVM. Two patients had brain hemorrhages after treatment. One of these had no effect and the other only partial occlusion from proton beams. Two thirds of those presenting with seizures reported an improved seizure situation after treatment.

    CONCLUSION: Our observations agree with earlier results and show that proton beam irradiation is a treatment alternative for brain AVMs since it has a high occlusion rate even in larger AVMs.

  • 8.
    Engvall, Gunn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ångstrom-Brännstrom, Charlotte
    Umea Univ, Dept Nursing, Umea, Sweden..
    Mullaney, Tara
    Umea Univ, Umea Inst Design, Umea, Sweden..
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Wickart-Johansson, Gun
    Karolinska Univ Hosp, Radiumhemmet, Dept Oncol, Stockholm, Sweden..
    Svärd, Anna-Maja
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Nyholm, Tufve
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Lindh, Jack
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Lindh, Viveca
    Umea Univ, Dept Nursing, Umea, Sweden..
    It Is Tough and Tiring but It Works - Children's Experiences of Undergoing Radiotherapy2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 4, article id e0153029Article in journal (Refereed)
    Abstract [en]

    Approximately 300 children ages 0 to 18 are diagnosed with cancer in Sweden every year, and 80 to 90 of them undergo radiotherapy treatment. The aim was to describe children's experiences of preparing for and undergoing radiotherapy, and furthermore to describe children's suggestions for improvement. Thirteen children between the ages of 5 and 15 with various cancer diagnoses were interviewed. Data was analyzed using qualitative content analysis. The findings revealed five categories: positive and negative experiences with hospital stays and practical arrangements; age-appropriate information, communication, and guidance to various degrees; struggle with emotions; use of distraction and other suitable coping strategies; and children's suggestions for improvement during radiotherapy. An overarching theme emerged: "It is tough and tiring but it works". Some key areas were: explanatory visits, the need for information and communication, being afraid, discomfort and suffering, the need for media distraction, dealing with emotions, and the need for support. A systematic, family-centered preparation program could possible help families prepare and individualized distraction during radiotherapy could contribute to reducing distress. Further studies with interventions could clarify successful programs.

  • 9. Hallqvist, A.
    et al.
    Wagenius, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Rylander, H.
    Brodin, O.
    Holmberg, E.
    Lödén, B.
    Ewers, S. -B
    Bergström, S.
    Wichardt-Johansson, G.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Ekberg, L.
    Sederholm, C.
    Nyman, J.
    Concurrent cetuximab and radiotherapy after docetaxel-cisplatin induction chemotherapy in stage III NSCLC: Satellite-A phase II study from the Swedish Lung Cancer Study Group2011In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 71, no 2, p. 166-172Article in journal (Refereed)
    Abstract [en]

    Background: Several attempts to increase the locoregional control in locally advanced lung cancer including concurrent chemotherapy, accelerated fractionation and dose escalation have been made during the last years. As the EGFR directed antibody cetuximab has shown activity concurrent with radiotherapy in squamous cell carcinoma of the head and neck, as well as in stage IV NSCLC combined with chemotherapy, we wanted to investigate radiotherapy with concurrent cetuximab in locally advanced NSCLC, a tumour type often over expressing the EGF-receptor. Methods: Between February 2006 and August 2007 75 patients in stage Ill NSCLC with good performance status (PS 0 or 1) and adequate lung function (FEV1 > 1.0) were enrolled in this phase II study at eight institutions. Treatment consisted of 2 cycles of induction chemotherapy, docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) with 3 weeks interval. An initial dose of cetuximab 400 mg/m(2) was given before start of 3D-CRT to 68 Gy with 2 Gy per fraction in 7 weeks concurrent with weekly cetuximab 250 mg/m(2). Toxicity was scored weekly during radiotherapy (CTC 3.0), and after treatment the patients were followed every third month with CT-scans, toxicity scoring and QLQ. Results: Seventy-one patients were eligible for analysis as four were incorrectly enrolled. Histology: adenocarcinoma 49%, squamous cell carcinoma 39% and other NSCLC 12%. The majority had PS 0 (62.5%), median age 62.2 (42-81), 50% were women and 37% had a pre-treatment weight loss > 5%. Toxicity: esophagitis grade 1-2: 72%; grade 3:1.4%. Hypersensitivity reactions grade 3-4: 5.6%. Febrile neutropenia grade 3-4: 15.4%. Skin reactions grade 1-2: 74%; grade 3: 4.2%. Diarrhoea grade 1-2: 38%; grade 3: 11.3%. Pneumonitis grade 1-2: 26.8%; grade 3: 4.2%; grade 5:1.4%. The median follow-up was 39 months for patients alive and the median survival was 17 months with a 1-, 2- and 3-year OS of 66%, 37% and 29% respectively. Until now local or regional failure has occurred in 20 patients and 22 patients have developed distant metastases. Weight loss, PS and stage were predictive for survival in univariate as well as in multivariate analysis. Conclusion: Induction chemotherapy followed by concurrent cetuximab and RT to 68 Gy is clearly feasible with promising survival. Toxicity, e.g. pneumonitis and esophagitis is low compared to most schedules with concurrent chemotherapy. This treatment strategy should be evaluated in a randomised manner vs. concurrent chemoradiotherapy to find out if it is a valid treatment option.

  • 10.
    Isacsson, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Asplund, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Morhed, Elizabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Montelius, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Turesson, Ingela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    A method to separate the rectum from the prostate during proton beam radiotherapy of prostate cancer patients2010In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 49, no 4, p. 500-505Article in journal (Refereed)
    Abstract [en]

    The use of protons for curative treatment of prostate cancer is increasing, either as a single treatment modality or in combination with conventional radiotherapy. The proximity between prostate (target) and rectum (organ at risk) often leads to a compromise between dose to target and organ at risk. Material and methods. The present study describes a method where the distance between prostate and rectum is increased by retraction of the rectum in dorsal direction. Comparative treatment plans with and without retraction of the rectum in the same patients have been studied. Nine patients with biopsy proven, localised adenocarcinoma of the prostate were studied. A cylindrical rod of Perspex was inserted into the rectum. This device allows the rectum to be retracted posteriorly. The patients were given a proton boost of 20 Gy in four fractions of 5 Gy in addition to a conventional photon beam treatment to a dose of 50 Gy in 25 fractions of 2 Gy. Results. Comparative treatment planning shows that the treatment plan with rectal retraction significantly reduces (p < 0.01) the volume of the rectal wall receiving high doses (equal to 70 Gy in 2 Gy fractions) in all patients. Conclusions. The proton boost treatment with retraction of rectum during treatment decreases the rectal dose substantially. This is expected to reduce rectal side effects.

  • 11.
    Kristensen,
    et al.
    Lund Univ, Skane Univ Hosplital Lund, Radiat Phys, Lund, Sweden.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala Univ Hosp, Clin Oncol, Dept Immunol Genet & Pathol Expt & Clin Oncol Cli, Uppsala, Sweden.
    Knöös, T.
    Lund Univ, Skane Univ Hosplital Lund, Radiat Phys, Lund, Sweden.
    Nilsson, P.
    Lund Univ, Skane Univ Hosplital Lund, Radiat Phys, Lund, Sweden.
    Evaluation of inter-observer variations in target delineation - A dose based approach2018In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 127, no Suppl. 1, p. S883-S884, article id EP-1642Article in journal (Other academic)
  • 12. Kristensen, Ingrid
    et al.
    Agrup, Mans
    Bergstrom, Per
    Engellau, Jacob
    Haugen, Hedda
    Martinsson, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Taheri-Kadkhoda, Zahra
    Lindh, Jack
    Nilsson, Per
    Assessment of volume segmentation in radiotherapy of adolescents; a treatment planning study by the Swedish Workgroup for Paediatric Radiotherapy2014In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 1, p. 126-133Article in journal (Refereed)
    Abstract [en]

    Background and purpose. The variability in target delineation for similar cases between centres treating paediatric and adolescent patients, and the apparent differences in interpretation of radiotherapy guidelines in the treatment protocols encouraged us to perform a dummy-run study as a part of our quality assurance work. The aim was to identify and quantify differences in the segmentation of target volumes and organs at risk (OARs) and to analyse the treatment plans and dose distributions. Materials and methods. Four patient cases were selected: Wilm's tumour, Hodgkin's disease, rhabdomyosarcoma of the prostate and chordoma of the skull base. The five participating centres received the same patient-related material. They introduced the cases in their treatment planning system, delineated target volumes and OARs and created treatment plans. Dose-volume histograms were retrieved for relevant structures and volumes and dose metrics were derived and compared, e. g. target volumes and their concordance, dose homogeneity index (HI), treated and irradiated volumes, remaining volume at risk and relevant V x and D x values. Results. We found significant differences in target segmentation in the majority of the cases. The planning target volumes (PTVs) varied two-to four-fold and conformity indices were in the range of 0.3-0.6. This resulted in large variations in dose distributions to OARs as well as in treated and irradiated volumes even though the treatment plans showed good conformity to the PTVs. Potential reasons for the differences in target delineation were analysed. Conclusion. Considerations of the growing child and difficulties in interpretation of the radiotherapy information in the treatment protocols were identified as reasons for the variation. As a result, clarified translated detailed radiotherapy guidelines for paediatric/adolescent patients have been recognised as a way to reduce this variation.

  • 13.
    Lindh, Viveca
    et al.
    Umea Univ, Dept Nursing, Umea, Sweden..
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ångström-Brannström, Charlotte
    Umea Univ, Dept Nursing, Umea, Sweden..
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Wickart-Johansson, Gun
    Karolinska Univ Hosp, Dept Oncol, Stockholm, Sweden..
    Lindh, Jack
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Children's Voices On Experiencing Radiotherapy2016In: Oncology Nursing Forum, ISSN 0190-535X, E-ISSN 1538-0688, Vol. 43, no 2, p. 134-134Article in journal (Other academic)
  • 14.
    Myrdal, Gunnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Lambe, Mats
    Gustafsson, Gunnar
    Nilsson, Kristina
    Ståhle, Elisabeth
    Survival in primary lung cancer potentially cured by operation: Influences of tumor stage and clinical characteristics2003In: Annals of Thoracic Surgery, Vol. 75, p. 356-363Article in journal (Refereed)
  • 15.
    Nilsson, K
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Evander, E
    Wollmer, P
    Wollmer, P
    Pulmonary clearance of (99mTc)DTPA and (99mTc)albumin in smokers.1997In: Cl Physiol, Vol. 17, p. 183-Article in journal (Refereed)
  • 16.
    Nilsson, K
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lachmann, JB
    Robertson, B
    Wollmer, P
    Pulmonary clearance of (99mTc)DTPA in experimental surfactant dysfunction treated with surfactant instillation.1997In: Acta Anaesthesiol. Scand., Vol. 41, p. 297-Article in journal (Refereed)
  • 17.
    Nilsson, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Wollmer, P
    Pulmonary clearance of 99mTc--DTPA and 99mTc-albumin in rabbits with surfactant dysfunction and lung injury.1992In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 12, no 5, p. 587-94Article in journal (Refereed)
    Abstract [en]

    We measured the pulmonary clearance of inhaled 99mTc-DTPA and 99mTc-albumin in rabbits with surfactant dysfunction induced by dioctyl sodium sulphosuccinate and in rabbits with lung injury induced by oleic acid. The animals were tracheotomized and mechanically ventilated. After inhalation of 99mTc-albumin in ten animals, clearance of the tracer from the lungs was monitored for 90 min. The first 30 min was a control period. Dioctyl sodium sulphosuccinate was then administered in aerosol and after another 30 min oleic acid was injected intravenously. Ten other rabbits were given 99mTc-DTPA, and clearance was externally recorded for 60 min. Five animals inhaled detergent aerosol and five animals were given oleic acid intravenously after 30 min. Airway pressures, tidal volume, and arterial blood gases were measured before and after each intervention. The half-life of 99mTc-albumin in the lung was 442 +/- 123 min during the control period, 363 +/- 52 min after detergent administration, and 134 +/- 18 min after oleic acid administration (P less than 0.05 compared to control and P less than 0.01 compared to the period after detergent). The half-life of 99mTc-DTPA was 94 +/- 16 min before and 10 +/- 0.6 min (P less than 0.01) after detergent administration and 75 +/- 12 min before and 18 +/- 1.8 min (P less than 0.01) after oleic acid administration. Gas exchange was not affected by administration of dioctyl sodium sulphosuccinate but markedly impaired after injection of oleic acid. Compliance of the respiratory system remained unaffected by detergent but decreased after injection of oleic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

  • 18.
    Nilsson, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Wollmer, P
    Pulmonary clearance of tracers with different lipid and water solubility in experimental surfactant dysfunction.1993In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 6, no 4, p. 505-8Article in journal (Refereed)
    Abstract [en]

    We measured the pulmonary clearance of inhaled 99mTc-diethylenetriamine penta-acetic acid (DTPA), 99mTc-sestamibi and 99mTc-dimethyliminodiacetic acid (HIDA) in normal rabbits, and rabbits with surfactant dysfunction induced by the detergent dioctyl sodium sulfosuccinate. The tracers differ widely in lipid/water partition coefficients, but have similar molecular radius and weight. Five animals in each group received the detergent in aerosol, and the other five a vehicle aerosol, before the administration of the tracer. Pulmonary clearance of the tracers was measured with a gamma camera. The half-life of 99mTc-DTPA was 94 +/- 16 min in normal lungs, and 10 +/- 1 min after detergent administration (p < 0.001). The half-life for 99mTc-sestamibi was 45 +/- 4 min and 39 +/- 4 min, respectively, (p < 0.05). There was no significant difference between the half-life of 99mTc-HIDA in normal lungs and in lungs with surfactant dysfunction. The half-life was 20 +/- 3 min and 17 +/- 2 min, respectively. The results indicate that the clearance rate limiting factors for the alveolocapillary transfer of water and lipid soluble substances are not the same. Surfactant dysfunction affects the transfer of water soluble substances (99mTc-DTPA) but not of substances with high lipid solubility (99mTc-HIDA).

  • 19.
    Ogasawara, Hiroyuki
    et al.
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Teramura, Yuji
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Univ Tokyo, Dept Bioengn, Tokyo, Japan.
    Imura, Takehiro
    Tohoku Univ, Div Transplantat & Regenerat Med, Sendai, Miyagi, Japan.
    Inagaki, Akiko
    Tohoku Univ, Div Transplantat & Regenerat Med, Sendai, Miyagi, Japan.
    Saito, Yoshikatsu
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Matsumura, Muneyuki
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Fukuoka, Kengo
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Fathi, Ibrahim
    Tohoku Univ, Div Transplantat & Regenerat Med, Sendai, Miyagi, Japan.
    Miyagi, Shigehito
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Ohashi, Kazuo
    Osaka Univ, Grad Sch Pharmaceut Sci, Osaka, Japan.
    Unno, Michiaki
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Kamei, Takashi
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Satomi, Susumu
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan.
    Nilsson, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Gustafson, Elisabet K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Surgery.
    Goto, Masafumi
    Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan;Tohoku Univ, Div Transplantat & Regenerat Med, Sendai, Miyagi, Japan.
    The Optimization of the Hepatocyte Surface Modification Procedures in Terms of Heparin and Apyrase for Improving Hepatocyte Engraftment2018In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 102, p. S727-S727Article in journal (Other academic)
  • 20.
    Rao, A.
    et al.
    Johns Hopkins Univ, Radiat Oncol, Baltimore, MD USA..
    Ermoian, R.
    Univ Washington, Med Ctr, Radiat Oncol, Seattle, WA 98195 USA..
    Alcorn, S.
    Johns Hopkins Univ, Radiat Oncol, Baltimore, MD USA..
    Figueiredo, M. L.
    Grp Apoio Adolescente & Crianca Com Canc, Radiat Oncol, Sao Paulo, Brazil..
    Chen, M.
    Grp Apoio Adolescente & Crianca Com Canc, Radiat Oncol, Sao Paulo, Brazil..
    Dieckmann, K.
    Med Univ Vienna, Radiat Oncol, Vienna, Austria..
    MacDonald, S.
    Harvard Univ, Massachusetts Gen Hosp, Radiat Oncol, Boston, MA 02115 USA..
    Ladra, M.
    Provis Ctr Proton Therapy, Radiat Oncol, Nashville, TN USA..
    Kobyzeva, D.
    Nechesnyuk, A.
    Fed Res & Clin Ctr Paediat Haematol Oncol & Immun, Radiat Oncol, Moscow, Russia..
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Winey, B.
    Harvard Univ, Massachusetts Gen Hosp, Radiat Oncol, Boston, MA 02115 USA..
    Villar, R.
    Ctr Infantil Boldrini, Radiat Oncol, Sao Paulo, Brazil..
    Terezakis, S.
    Johns Hopkins Univ, Radiat Oncol, Baltimore, MD USA..
    Practice Patterns of Palliative Radiation Therapy in Paediatric Oncology Patients Amongst An International Paediatric Research Consortium2016In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 63, p. S63-S64Article in journal (Refereed)
  • 21.
    Rao, Avani D.
    et al.
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Rashid, Arif
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Chen, Qinyu
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Villar, Rosangela C.
    Ctr Infantil Boldrini, Dept Radiat Oncol, Campinas, SP, Brazil..
    Kobyzeva, Daria
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Moscow, Russia..
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Dieckmann, Karin
    Univ Klin Strahlentherapie & Strahlenbiol, Vienna, Austria..
    Nechesnyuk, Alexey
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Moscow, Russia..
    Ermoian, Ralph
    Univ Washington, Seattle, WA 98195 USA..
    Alcorn, Sara
    Johns Hopkins Sch Med, Baltimore, MD USA..
    MacDonald, Shannon M.
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Ladra, Matthew M.
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Ford, Eric C.
    Univ Washington, Seattle, WA 98195 USA..
    Winey, Brian A.
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Figueiredo, Maria Luisa S.
    Grp Apoio Ao Adolescente & Crianca Canc, Sao Paulo, Brazil..
    Terezakis, Stephanie A.
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Chen, Michael J.
    Grp Apoio Ao Adolescente & Crianca Canc, Sao Paulo, Brazil..
    Re-Irradiation for Recurrent Pediatric CNS Malignancies: A Multi-Institutional Retrospective Review2017In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 98, no 2, p. E14-E15Article in journal (Other academic)
  • 22.
    Rao, Avani D.
    et al.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Rashid, Arif S.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Chen, Qinyu
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Villar, Rosangela C.
    Ctr Infantil Boldrini, Dept Radiat Oncol, Sao Paulo, Brazil..
    Kobyzeva, Daria
    Fed Res & Clin Ctr Pediat Hematol Oncol & Immunol, Dept Radiat Oncol, Moscow, Russia..
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Dieckmann, Karin
    Univ Klin Strahlentherapie & Strahlenbiol, Dept Radiat Oncol, Vienna, Austria..
    Nechesnyuk, Alexey
    Fed Res & Clin Ctr Pediat Hematol Oncol & Immunol, Dept Radiat Oncol, Moscow, Russia..
    Ermoian, Ralph
    Univ Washington, Dept Radiat Oncol, Seattle, WA USA..
    Alcorn, Sara
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    MacDonald, Shannon M.
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA..
    Ladra, Matthew M.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Ford, Eric C.
    Univ Washington, Dept Radiat Oncol, Seattle, WA USA..
    Winey, Brian A.
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA..
    Figueiredo, Maria Luisa S.
    Grp Apoio Adolescente & Crianca Com Canc, Dept Radiat Oncol, Sao Paulo, Brazil..
    Chen, Michael J.
    Grp Apoio Adolescente & Crianca Com Canc, Dept Radiat Oncol, Sao Paulo, Brazil..
    Terezakis, Stephanie A.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review2017In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 99, no 3, p. 634-641Article in journal (Refereed)
    Abstract [en]

    Purpose: Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients.

    Methods and Materials: The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed.

    Results: Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n = 20; 30%), ependymoma (n = 19; 28%), germ cell tumor (n = 8; 12%), high-grade glioma (n = 9; 13%), low-grade glioma (n = 5; 7%), and other (n = 6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n = 46), 3-dimensional conformal RT (n = 9), stereotactic radiosurgery (n = 4; 1213 Gy x 1 or 5 Gy x 5), protons (n = 4), combined modality (n = 3), 2-dimensional RT (n = 1), and brachytherapy (n = 1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively.

    Conclusions: CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

  • 23.
    Rao, Avani Dholakia
    et al.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
    Chen, Qinyu
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
    Ermoian, Ralph P.
    Univ Washington, Dept Radiat Oncol, Seattle, WA 98195 USA..
    Alcorn, Sara R.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
    Figueiredo, Maria Luisa S.
    Grp Apoio Adolescente & Crianca Canc, Dept Radiat, Sao Paulo, Brazil..
    Chen, Michael J.
    Grp Apoio Adolescente & Crianca Canc, Dept Radiat, Sao Paulo, Brazil..
    Dieckmann, Karin
    Univ Klin Strahlentherapie & Strahlenbiol, Dept Radiat Oncol, Vienna, Austria..
    MacDonald, Shannon M.
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA..
    Ladra, Matthew M.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
    Kobyzeva, Daria
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Dept Radiotherapy, Moscow, Russia..
    Nechesnyuk, Alexey V.
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Dept Radiotherapy, Moscow, Russia..
    Nilsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Ford, Eric C.
    Univ Washington, Dept Radiat Oncol, Seattle, WA 98195 USA..
    Winey, Brian A.
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA..
    Villar, Rosangela C.
    Ctr Infantil Boldrini, Dept Radiat Oncol, Sao Paulo, Brazil.;Ctr Infantil Boldrini, Dept Radiat Oncol, Regiao, Brazil..
    Terezakis, Stephanie A.
    Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
    Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium2017In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 64, no 11, article id e26589Article in journal (Refereed)
    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.