22 results on '"Horeweg, Nanda"'
Search Results
2. Prediction of recurrence risk in endometrial cancer with multimodal deep learning
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Volinsky-Fremond, Sarah, Horeweg, Nanda, Andani, Sonali, Barkey Wolf, Jurriaan, Lafarge, Maxime W., de Kroon, Cor D., Ørtoft, Gitte, Høgdall, Estrid, Dijkstra, Jouke, Jobsen, Jan J., Lutgens, Ludy C. H. W., Powell, Melanie E., Mileshkin, Linda R., Mackay, Helen, Leary, Alexandra, Katsaros, Dionyssios, Nijman, Hans W., de Boer, Stephanie M., Nout, Remi A., de Bruyn, Marco, Church, David, Smit, Vincent T. H. B. M., Creutzberg, Carien L., Koelzer, Viktor H., and Bosse, Tjalling
- Abstract
Predicting distant recurrence of endometrial cancer (EC) is crucial for personalized adjuvant treatment. The current gold standard of combined pathological and molecular profiling is costly, hampering implementation. Here we developed HECTOR (histopathology-based endometrial cancer tailored outcome risk), a multimodal deep learning prognostic model using hematoxylin and eosin-stained, whole-slide images and tumor stage as input, on 2,072 patients from eight EC cohorts including the PORTEC-1/-2/-3 randomized trials. HECTOR demonstrated C-indices in internal (n= 353) and two external (n= 160 and n= 151) test sets of 0.789, 0.828 and 0.815, respectively, outperforming the current gold standard, and identified patients with markedly different outcomes (10-year distant recurrence-free probabilities of 97.0%, 77.7% and 58.1% for HECTOR low-, intermediate- and high-risk groups, respectively, by Kaplan–Meier analysis). HECTOR also predicted adjuvant chemotherapy benefit better than current methods. Morphological and genomic feature extraction identified correlates of HECTOR risk groups, some with therapeutic potential. HECTOR improves on the current gold standard and may help delivery of personalized treatment in EC.
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- 2024
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3. Non-specialist palliative care - question prompt list preparation: patient, family and clinician experiences
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Verhoef, Mary-Joanne, de Nijs, Ellen, Sweep, Boudewijn, Warmerdam-Vergroesen, Desirée, Horeweg, Nanda, Pieterse, Arwen, van der Steen, Jenny, and van der Linden, Yvette
- Abstract
ObjectivesQuestion prompt lists (QPLs) support patients and family to ask questions they consider important during conversations with clinicians. We aimed to evaluate how a QPL developed for specialist palliative care is used during consultations and is perceived by patients and family, and how non-specialist clinicians would use the QPL. We further developed the QPL using these perspectives.MethodsThe QPL is part of a conversation guide on palliative care. Patients and family were asked to select topics and questions before consultation with a palliative care consultant. This qualitative study (2016–2018) included 18 interviews with patients and family who had used the QPL, 17 interviews with non-specialist clinicians and 32 audiotaped consultations with palliative care consultants. The data were analysed thematically and iteratively to adjust the QPL accordingly.ResultsAll participants considered the QPL elaborate, but recommended keeping all content. Patients and family found that it helps to structure thoughts, ask questions and regain a sense of control. They also felt the QPL could support them in gathering information. Although it could evoke strong emotions, their real challenge was being in the palliative phase. Clinicians considered the QPL especially helpful as an overview of possible discussion topics. During audiotaped consultations, topics other than those selected were also addressed.ConclusionBy using the QPL, patients and family felt empowered to express their information needs. Its use may not be as unsettling as clinicians assume. Nevertheless, clinicians who hand out the QPL should introduce the QPL properly to optimise its use.
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- 2024
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4. Molecular Classification Predicts Response to Radiotherapy in the Randomized PORTEC-1 and PORTEC-2 Trials for Early-Stage Endometrioid Endometrial Cancer.
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Horeweg, Nanda, Nout, Remi A., Jürgenliemk-Schulz, Ina M., Lutgens, Ludy C.H.W., Jobsen, Jan J., Haverkort, Marie A.D., Mens, Jan Willem M., Slot, Annerie, Wortman, Bastiaan G., de Boer, Stephanie M., Stelloo, Ellen, Verhoeven-Adema, Karen W., Putter, Hein, Smit, Vincent T.H.B.M., Bosse, Tjalling, Creutzberg, Carien L., Creutzberg, C.L., Koper, P.C.M., van Putten, W.L.J., and Dercksen, R.
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- 2023
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5. Interpretable deep learning model to predict the molecular classification of endometrial cancer from haematoxylin and eosin-stained whole-slide images: a combined analysis of the PORTEC randomised trials and clinical cohorts
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Fremond, Sarah, Andani, Sonali, Barkey Wolf, Jurriaan, Dijkstra, Jouke, Melsbach, Sinéad, Jobsen, Jan J, Brinkhuis, Mariel, Roothaan, Suzan, Jurgenliemk-Schulz, Ina, Lutgens, Ludy C H W, Nout, Remi A, van der Steen-Banasik, Elzbieta M, de Boer, Stephanie M, Powell, Melanie E, Singh, Naveena, Mileshkin, Linda R, Mackay, Helen J, Leary, Alexandra, Nijman, Hans W, Smit, Vincent T H B M, Creutzberg, Carien L, Horeweg, Nanda, Koelzer, Viktor H, and Bosse, Tjalling
- Abstract
Endometrial cancer can be molecularly classified into POLEmut, mismatch repair deficient (MMRd), p53 abnormal (p53abn), and no specific molecular profile (NSMP) subgroups. We aimed to develop an interpretable deep learning pipeline for whole-slide-image-based prediction of the four molecular classes in endometrial cancer (im4MEC), to identify morpho-molecular correlates, and to refine prognostication.
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- 2023
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6. p53 immunohistochemistry in endometrial cancer: clinical and molecular correlates in the PORTEC-3 trial
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Vermij, Lisa, Léon-Castillo, Alicia, Singh, Naveena, Powell, Melanie E., Edmondson, Richard J., Genestie, Catherine, Khaw, Pearly, Pyman, Jan, McLachlin, C. Meg, Ghatage, Prafull, de Boer, Stephanie M., Nijman, Hans W., Smit, Vincent T.H.B.M., Crosbie, Emma J., Leary, Alexandra, Creutzberg, Carien L., Horeweg, Nanda, Bosse, Tjalling, Horeweg, N., de Boer, S.M., Creutzberg, C.L., Bosse, T., Smit, V.T.H.B.M., Kroep, J., Nout, R.A., Nijman, H.W., de Bruyn, M., Powell, M.E., Singh, N., Kitchener, H.C., Crosbie, E., Edmondson, R., Church, D.N., Leary, A., Mileshkin, L., Pollock, P.M., and MacKay, H.
- Abstract
Standard molecular classification of endometrial cancers (EC) is now endorsed by the WHO and identifies p53-abnormal (p53abn) EC as the subgroup with the poorest prognosis and the most likely to benefit from adjuvant chemo(radio)therapy. P53abn EC are POLEwildtype, mismatch repair proficient and show abnormal immunohistochemical (IHC) staining for p53. Correct interpretation of routinely performed p53 IHC has therefore become of paramount importance. We aimed to comprehensively investigate abnormal p53 IHC patterns and their relation to clinicopathological and molecular features. Tumor material of 411 molecularly classified high-risk EC from consenting patients from the PORTEC-3 clinical trial were collected. p53 IHC was successful in 408 EC and was considered abnormal when the tumor showed a mutant expression pattern (including subclonal): overexpression, null or cytoplasmic. The presence of pathogenic mutations was determined by next generation sequencing (NGS). Abnormal p53 expression was observed in 131/408 (32%) tumors. The most common abnormal p53 IHC pattern was overexpression (n= 89, 68%), followed by null (n= 12, 9%) and cytoplasmic (n= 3, 2%). Subclonal abnormal p53 staining was observed in 27 cases (21%), which was frequently but not exclusively, associated with POLEmutations and/or MMRd (n= 22/27; p< 0.001). Agreement between p53 IHC and TP53NGS was observed in 90.7%, resulting in a sensitivity and specificity of 83.6% and 94.3%, respectively. Excluding POLEmut and MMRd EC, as per the WHO-endorsed algorithm, increased the accuracy to 94.5% with sensitivity and specificity of 95.0% and 94.1%, respectively. Our data shows that awareness of the abnormal p53 IHC patterns are prerequisites for correct EC molecular classification. Subclonal abnormal p53 expression is a strong indicator for POLEmut and/or MMRd EC. No significant differences in clinical outcomes were observed among the abnormal p53 IHC patterns. Our data support use of the WHO-endorsed algorithm and combining the different abnormal p53 IHC patterns into one diagnostic entity (p53abn EC).
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- 2022
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7. p53 immunohistochemistry in endometrial cancer: clinical and molecular correlates in the PORTEC-3 trial
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Vermij, Lisa, Léon-Castillo, Alicia, Singh, Naveena, Powell, Melanie E., Edmondson, Richard J., Genestie, Catherine, Khaw, Pearly, Pyman, Jan, McLachlin, C. Meg, Ghatage, Prafull, de Boer, Stephanie M., Nijman, Hans W., Smit, Vincent T. H. B. M., Crosbie, Emma J., Leary, Alexandra, Creutzberg, Carien L., Horeweg, Nanda, and Bosse, Tjalling
- Abstract
Standard molecular classification of endometrial cancers (EC) is now endorsed by the WHO and identifies p53-abnormal (p53abn) EC as the subgroup with the poorest prognosis and the most likely to benefit from adjuvant chemo(radio)therapy. P53abn EC are POLEwildtype, mismatch repair proficient and show abnormal immunohistochemical (IHC) staining for p53. Correct interpretation of routinely performed p53 IHC has therefore become of paramount importance. We aimed to comprehensively investigate abnormal p53 IHC patterns and their relation to clinicopathological and molecular features. Tumor material of 411 molecularly classified high-risk EC from consenting patients from the PORTEC-3 clinical trial were collected. p53 IHC was successful in 408 EC and was considered abnormal when the tumor showed a mutant expression pattern (including subclonal): overexpression, null or cytoplasmic. The presence of pathogenic mutations was determined by next generation sequencing (NGS). Abnormal p53 expression was observed in 131/408 (32%) tumors. The most common abnormal p53 IHC pattern was overexpression (n= 89, 68%), followed by null (n= 12, 9%) and cytoplasmic (n= 3, 2%). Subclonal abnormal p53 staining was observed in 27 cases (21%), which was frequently but not exclusively, associated with POLEmutations and/or MMRd (n= 22/27; p< 0.001). Agreement between p53 IHC and TP53NGS was observed in 90.7%, resulting in a sensitivity and specificity of 83.6% and 94.3%, respectively. Excluding POLEmut and MMRd EC, as per the WHO-endorsed algorithm, increased the accuracy to 94.5% with sensitivity and specificity of 95.0% and 94.1%, respectively. Our data shows that awareness of the abnormal p53 IHC patterns are prerequisites for correct EC molecular classification. Subclonal abnormal p53 expression is a strong indicator for POLEmut and/or MMRd EC. No significant differences in clinical outcomes were observed among the abnormal p53 IHC patterns. Our data support use of the WHO-endorsed algorithm and combining the different abnormal p53 IHC patterns into one diagnostic entity (p53abn EC).
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- 2022
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8. Vaginal brachytherapy management of stage I and II endometrial cancer.
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van den Heerik, Anne Sophie V. M., Horeweg, Nanda, Creutzberg, Carien L., and Nout, Remi A.
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- 2022
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9. Adjuvant therapy for endometrial cancer in the era of molecular classification: radiotherapy, chemoradiation and novel targets for therapy.
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den Heerik, Anne Sophie V. M. van, Horeweg, Nanda, de Boer, Stephanie M., Bosse, Tjalling, and Creutzberg, Carien L.
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ENDOMETRIAL cancer ,CANCER relapse ,ENDOMETRIAL surgery ,CANCER treatment ,CHEMORADIOTHERAPY ,EXTERNAL beam radiotherapy ,RADIOTHERAPY - Abstract
Endometrial cancer is primarily treated with surgery. Adjuvant treatment strategies for endometrial cancer, such as external beam pelvic radiotherapy, vaginal brachytherapy, chemotherapy, and combined chemotherapy and radiotherapy, have been studied in several randomized trials. Adjuvant treatment is currently based on the presence of clinicopathological risk factors. Low- risk disease is adequately managed with surgery alone. In high- intermediate risk endometrial cancer, adjuvant vaginal brachytherapy is recommended to maximize local control, with only mild side effects and without impact on quality of life. For high- risk endometrial cancer, recent large randomized trials support the use of pelvic radiotherapy, especially in stage I-II endometrial cancer with risk factors. For women with serous cancers and those with stage III disease, chemoradiation increased both recurrence- free and overall survival, while GOG-258 showed similar recurrence- free survival compared with six cycles of chemotherapy alone, but with better pelvic and para- aortic nodal control with combined chemotherapy and radiotherapy. Recent molecular studies, most notably the work from The Cancer Genome Atlas (TCGA) project, have shown that four endometrial cancer molecular classes can be distinguished; POLE ultra- mutated, microsatellite instable hypermutated, copy- number- low, and copy- number- high. Subsequent studies, using surrogate markers to identify groups analogous to TCGA sub- classes, showed that all four endometrial cancer sub- types are found across all stages, histological types, and grades. Moreover, the molecular sub- groups have proved to have a stronger prognostic impact than histo- pathological tumor characteristics. This introduces an new era of molecular classification based diagnostics and treatment approaches. Integration of the molecular factors and new therapeutic targets will lead to molecular- integrated adjuvant treatment including targeted treatments, which are the rationale of new and ongoing trials. This review presents an overview of current adjuvant treatment strategies in endometrial cancer, highlights the development and evaluation of a molecular- integrated risk profile, and briefly discusses ongoing developments in targeted treatment [ABSTRACT FROM AUTHOR]
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- 2021
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10. PORTEC-4a: international randomized trial of molecular profile-based adjuvant treatment for women with high-intermediate risk endometrial cancer.
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van den Heerik, Anne Sophie V. M., Horeweg, Nanda, Nout, Remi A., Lutgens, Ludy C. H. W., van der Steen-Banasik, Elzbieta M., Westerveld, G. Henrike, van den Berg, Hetty A., Slot, Annerie, Koppe, Friederike L. A., Kommoss, Stefan, Mens, Jan Willem M., Nowee, Marlies E., Bijmolt, Stefan, Cibula, David, Stam, Tanja C., Jurgenliemk-Schulz, Ina M., Snyers, An, Hamann, Moritz, Zwanenburg, Aleida G., and Coen, Veronique L. M. A.
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RANDOMIZED controlled trials ,ENDOMETRIAL cancer ,RADIOISOTOPE brachytherapy ,QUALITY of life ,ADJUVANT treatment of cancer - Abstract
Background Vaginal brachytherapy is currently recommended as adjuvant treatment in patients with highintermediate risk endometrial cancer to maximize local control and has only mild side effects and no or limited impact on quality of life. However, there is still considerable overtreatment and also some undertreatment, which may be reduced by tailoring adjuvant treatment to the patients' risk of recurrence based on molecular tumor characteristics. Primary objectives To compare the rates of vaginal recurrence in women with high-intermediate risk endometrial cancer, treated after surgery with molecularintegrated risk profile-based recommendations for either observation, vaginal brachytherapy or external pelvic beam radiotherapy or with standard adjuvant vaginal brachytherapy Study hypothesis Adjuvant treatment based on a molecular-integrated risk profile provides similar local control and recurrence-free survival as current standard adjuvant brachytherapy in patients with high-intermediate risk endometrial cancer, while sparing many patients the morbidity of adjuvant treatment and reducing healthcare costs. Trial design A multicenter, international phase III randomized trial (2:1) of molecular-integrated risk profilebased adjuvant treatment (experimental arm) or adjuvant vaginal brachytherapy (standard arm). Major inclusion/exclusion criteria Women aged 18 years and over with a histological diagnosis of highintermediate risk endometrioid endometrial cancer after total abdominal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy. High-intermediate risk factors are defined as: (i) International Federation of Gynecology and Obstetrics stage IA (with invasion) and grade 3; (ii) stage IB grade 1 or 2 with age ≥60 and/or lymph-vascular space invasion; (iii) stage IB, grade 3 without lymph-vascular space invasion; or (iv) stage II (microscopic and grade 1). Endpoints The primary endpoint is vaginal recurrence. Secondary endpoints are recurrence-free and overall survival; pelvic and distant recurrence; 5-year vaginal control (including treatment for relapse); adverse events and patient-reported symptoms and quality of life; and endometrial cancer-related healthcare costs. Sample size 500 eligible and evaluable patients. Estimated dates for completing accrual and presenting results Estimated date for completing accrual will be late 2021. Estimated date for presentation of (first) results is expected in 2023. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Efficacy and toxicity of postoperative external beam radiotherapy or chemoradiation for early-stage cervical cancer.
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van den Akker, Mick J. E., Horeweg, Nanda, Beltman, Jogchum Jan, Creutzberg, Carien L., and Nout, Remi A.
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RADIOTHERAPY ,CERVICAL cancer ,CANCER chemotherapy ,RADIOISOTOPE brachytherapy ,HYSTERECTOMY ,METASTASIS ,LYMPH nodes - Abstract
Objective The aim of this study was to assess the impact of the evolving role of the addition of chemotherapy to postoperative radiotherapy on oncological outcomes and toxicity in patients with early-stage cervical cancer after radical hysterectomy. Methods Retrospective cohort study of patients with stage IB1--IIB FIGO 2009 cervical cancer treated from November 1999 to May 2015 by primary surgery and radiotherapy (46--50.4 Gy in 1.8--2.0 Gy fractions) with or without concurrent cisplatin (40 mg/m2, 5--6 weekly cycles) with or without a brachytherapy boost. Chemotherapy was allocated depending on the risk factors for recurrence. Incidences of all outcomes were calculated using Kaplan--Meier's methodology and compared by log-rank tests. Risk factors for recurrence and survival were identified using Cox's proportional hazards models. results A total of 154 patients were included, median follow-up was 9.6 years (IQR: 6.1--12.8). Five-year pelvic recurrence-free survival was 75.3%; 74.7% in patients with high-risk factors treated with radiotherapy; and 77.3% in those treated with chemoradiation (P=0.43). Distant metastasis-free survival at 5 years was 63.4%; 63.6% in high-risk patients after radiotherapy; and 57.1% after chemoradiation (P=0.36). Five-year overall survival was 63.9%: 66.8% and 51.6% after radiotherapy and after chemoradiation in patients with high-risk factors (P=0.37), respectively. Large tumor size was a risk factor for vaginal and pelvic recurrence, ≥2 involved lymph nodes was a significant risk factor for para-aortic recurrence and death. Mild treatment-related late toxicity was observed in 53.9% of the patients. Five-year severe (grade 3--5) late rectal, bladder, bowel, and vaginal toxicities were, respectively, 1.3%, 0%, 3.4%, and 0.9%. Any late severe toxicity was observed in 5.5% of patients treated with radiotherapy and in 15.3% of those treated with chemoradiation (P=0.07). Conclusion Postoperative (chemo)radiation for earlystage cervical cancer patients with risk factors for recurrence yields adequate pelvic tumor control, but overall survival is limited due to distant metastasis. [ABSTRACT FROM AUTHOR]
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- 2020
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12. Molecular Classification of the PORTEC-3 Trial for High-Risk Endometrial Cancer: Impact on Prognosis and Benefit From Adjuvant Therapy.
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León-Castillo, Alicia, de Boer, Stephanie M., Powell, Melanie E., Mileshkin, Linda R., Mackay, Helen J., Leary, Alexandra, Nijman, Hans W., Singh, Naveena, Pollock, Pamela M., Bessette, Paul, Fyles, Anthony, Haie-Meder, Christine, Smit, Vincent T. H. B. M., Edmondson, Richard J., Putter, Hein, Kitchener, Henry C., Crosbie, Emma J., de Bruyn, Marco, Nout, Remi A., and Horeweg, Nanda
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- 2020
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13. Molecular and Clinicopathologic Characterization of Mismatch Repair-Deficient Endometrial Carcinoma Not Related to MLH1Promoter Hypermethylation
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Kaya, Merve, Post, Cathalijne C.B., Tops, Carli M., Nielsen, Maartje, Crosbie, Emma J., Leary, Alexandra, Mileshkin, Linda R., Han, Kathy, Bessette, Paul, de Boer, Stephanie M., Jürgenliemk-Schulz, Ina M., Lutgens, Ludy, Jobsen, Jan J., Haverkort, Marie A.D., Nout, Remi A., Kroep, Judith, Creutzberg, Carien L., Smit, Vincent T.H.B.M., Horeweg, Nanda, van Wezel, Tom, and Bosse, Tjalling
- Abstract
Universal tumor screening in endometrial carcinoma (EC) is increasingly adopted to identify individuals at risk of Lynch syndrome (LS). These cases involve mismatch repair-deficient (MMRd) EC without MLH1promoter hypermethylation (PHM). LS is confirmed through the identification of germline MMR pathogenic variants (PV). In cases where these are not detected, emerging evidence highlights the significance of double-somatic MMR gene alterations as a sporadic cause of MMRd, alongside POLE/POLD1exonuclease domain (EDM) PV leading to secondary MMR PV. Our understanding of the incidence of different MMRd EC origins not related to MLH1-PHM, their associations with clinicopathologic characteristics, and the prognostic implications remains limited.
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- 2024
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14. Author Correction: Prediction of recurrence risk in endometrial cancer with multimodal deep learning
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Volinsky-Fremond, Sarah, Horeweg, Nanda, Andani, Sonali, Barkey Wolf, Jurriaan, Lafarge, Maxime W., de Kroon, Cor D., Ørtoft, Gitte, Høgdall, Estrid, Dijkstra, Jouke, Jobsen, Jan J., Lutgens, Ludy C. H. W., Powell, Melanie E., Mileshkin, Linda R., Mackay, Helen, Leary, Alexandra, Katsaros, Dionyssios, Nijman, Hans W., de Boer, Stephanie M., Nout, Remi A., de Bruyn, Marco, Church, David, Smit, Vincent T. H. B. M., Creutzberg, Carien L., Koelzer, Viktor H., and Bosse, Tjalling
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- 2024
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15. Management of conjunctival melanoma with local excision and adjuvant brachytherapy
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Brouwer, Niels J., Marinkovic, Marina, Peters, Femke P., Hulshof, Maarten C. C. M., Pieters, Bradley R., de Keizer, Rob J. W., Horeweg, Nanda, Laman, Mirjam S., Bleeker, Jaco C., van Duinen, Sjoerd G., Jager, Martine J., Creutzberg, Carien L., and Luyten, Gregorius P. M.
- Abstract
Background/objectives: To evaluate the management of conjunctival melanoma with local excision and adjuvant brachytherapy. Subjects/methods: Data of all patients who received local excision and adjuvant brachytherapy for conjunctival melanoma between 1999 and 2016 in a Dutch national referral centre were reviewed. A protocol with Sr-90 was used until 2012, a protocol with Ru-106 was used hereafter. Local recurrence, metastasis, survival, visual acuity and treatment complications were assessed. Results: A total of 58 patients was identified: 32 patients were treated with Sr-90 and 26 with Ru-106. Mean follow-up time was 97.3 months (143.1 months after Sr-90, and 40.2 months after Ru-106). All lesions were epibulbar, the median tumour thickness was 0.9?mm. Local recurrence occurred in 13/58 cases (22%), with a 5-year recurrence rate of 21%. Local recurrence occurred equally often in both protocols, with 5-year recurrence rates of 19% (Sr-90) versus 23% (Ru-106) (p?=?0.68). Metastasis developed in 3/58 cases (5%), with 2 cases after Sr-90, and 1 after Ru-106 (p?=?1.00). The most reported complications were pain (29%), dry eyes (21%), symblepharon (9%), ptosis (12%) and cataract (9%). No severe corneal or scleral complications were observed. Median visual acuity was 1.00 pre-surgery, at the end of follow-up this was 1.00 (Sr-90) and 0.95 (Ru-106). Conclusion: Local excision with adjuvant brachytherapy provides good tumour control with excellent visual outcome and mild side effects in patients with limited conjunctival melanoma. Results after Sr-90 or Ru-106 were comparable; a choice for either treatment may be based on experience of the clinician and availability of materials.
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- 2021
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16. Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer.
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Horeweg, Nanda, Carien, L Creutzberg, Eva, C Rijkmans, Mirjam, S Laman, Laura, A Velema, Veronique, L M A Coen, Tanja, C Stam, Ellen, M Kerkhof, Judith, R Kroep, de Kroon Cor, D, and Remi, A Nout
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RADIOISOTOPE brachytherapy ,CERVICAL cancer ,CISPLATIN ,KAPLAN-Meier estimator ,LYMPH nodes - Abstract
Objective: To evaluate the efficacy and toxicity of primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer and to identify predictors of treatment failure and toxicity. Methods: Retrospective analysis of 155 stage IB-IVA cervical cancer patients treated from 2008 to 2016 with chemoradiation and image-guided adaptive brachytherapy. Treatment consisted of external beam radiotherapy (45 – 48.6 Gy in 1.8 – 2 Gy fractions) with concurrent weekly cisplatin (40 mg/m
2 , 5 – 6 cycles) and image-guided adaptive brachytherapy (3−4 × 7 Gy high dose rate) using intracavitary or combined intracavitary-interstitial techniques according to GEC-ESTRO (Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology) recommendations. Incidences of all outcomes were calculated using Kaplan-Meier's methodology. Risk factors for treatment failure and toxicity were identified using Cox's proportional hazards model and the Kruskal-Wallis H-test respectively. Results: Median follow-up was 57 months. Five-year local control was 90.4 %. Five-year para-aortic lymph node metastasis-free and distant metastasis-free survival were 85.3 % and 70.2 % respectively. Tumor size and lymph node metastasis were independent risk factors for treatment failure. Cumulative incidences of severe late bladder, rectal, bowel, and vaginal toxicity were 0.8%, 3.3%, 3.6%, and 1.4% respectively at 5 years of follow-up. Combined intracavitary-interstitial brachytherapy techniques were associated with less vaginal morbidity. Conclusions: Primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer is a highly effective local and loco-regional treatment. However, survival is compromised by the occurrence of distant metastasis. Patients with large tumors and nodal involvement at diagnosis are at increased risk and may benefit from intensified treatment. Severe late gastrointestinal and urogenital toxicity is limited and may be further reduced by increasing conformity, using combined intracavitary-interstitial techniques and lowering doses to organs at risk. [ABSTRACT FROM AUTHOR]- Published
- 2019
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17. CCTG EN10: A phase II study of tailored adjuvant therapy in POLE -mutated and p53-wildtype/NSMP early-stage endometrial cancer (EC)—RAINBO BLUE and TAPER.
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McAlpine, Jessica N., Han, Kathy Chai-Zung, Kinloch, Mary, Barkati, Maroie, Ferguson, Sarah E., Fyles, Anthony W., Huang, Fleur, Kong, Iwa, Kwon, Janice S., Mackay, Helen, Carey, Mark Stafford, Welch, Stephen, Bosse, Tjalling, Creutzberg, Carien L., Horeweg, Nanda, Leary, Alexandra, Liu, WenLing, Tu, Dongsheng, and Parulekar, Wendy R.
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- 2023
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18. The RAINBO MMRd-GREEN trial (GCIG/DGOG/ENGOT-EN14 2): A phase III trial on the addition of adjuvant durvalumab to radiotherapy in patients with high-risk MMRd endometrial cancer.
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Kaya, Merve, Horeweg, Nanda, Leary, Alexandra, Welch, Stephen, Kommoss, Stefan, Weidner, Nicola, Fanfani, Francesco, Lorusso, Domenica, McGrane, John, Van Gorp, Toon, Boere, Ingrid, Westermann, Anneke M., Heijns, Joan B., Putter, Hein, Verhoeven-Adema, Karen, Smit, Vincent T.H.B.M., Creutzberg, Carien L., Bosse, Tjalling, and Kroep, Judith R.
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- 2023
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19. Ruthenium-106 brachytherapy for iris and iridociliary melanomas
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Marinkovic, Marina, Horeweg, Nanda, Laman, Mirjam S, Bleeker, Jaco C, Ketelaars, Martijn, Peters, Femke P, Luyten, Gre P M, and Creutzberg, Carien L
- Abstract
Background and purposeTo evaluate ruthenium-106 (Ru106) brachytherapy as eye-conserving treatment of iris melanomas (IMs) and iridociliary melanomas (ICMs).Materials and methodsEighty-eight patients received Ru106 brachytherapy between 2006 and 2016. Primary outcome was local control, and secondary outcomes were metastasis, survival, eye preservation, complications and visual acuity (VA).ResultsOverall median follow-up was 36 months. Of 88 patients, 58 (65.9%) had IM and 30 (34.1%) had ICM. ICM were on average larger and more advanced than IM. Local failure-free survival at 3years was 98.9% (SE 1.2%). Metastasis-free survival was 98.2% (SE 1.8%) at 3years; no deaths due to melanoma occurred during follow-up. Eye preservation rate was 97.7%. Treatment-related toxicities were mostly mild and observed in 80.7% of the patients. Common toxicities were worsening of pre-existing or new cataract (51.1%), dry eyes (29.5%) and glaucoma (20.5%). VA was not affected by Ru106 brachytherapy, with only 2.3% having VA <0.33 (low vision) at follow-up.ConclusionsRu106 for IM and ICM yielded excellent local control (98.9%) and eye preservation (97.7%). Toxicities were common, but mostly mild and transient. Moreover, Ru106 did not affect visual acuity.
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- 2018
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20. Baseline Characteristics and Mortality Outcomes of Control Group Participants and Eligible Non-Responders in the NELSON Lung Cancer Screening Study
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Yousaf-Khan, Uraujh, Horeweg, Nanda, van der Aalst, Carlijn, ten Haaf, Kevin, Oudkerk, Mathijs, and de Koning, Harry
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Individuals who are younger, have a high socioeconomic background and/or have a healthy lifestyle are more inclined to participate in screening trials. This form of bias may affect the generalizability of study results to the target population. This study aimed to investigate the generalizability of the NELSON lung cancer screening trial to the Dutch population.
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- 2015
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21. Low-dose computed tomography screening for lung cancer: results of the first screening round
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Horeweg, Nanda, Nackaerts, Kristiaan, Oudkerk, Matthijs, and de Koning, Harry J
- Abstract
Evaluation of: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR et al.Results of initial low-dose computed tomographic screening for lung cancer. N. Engl. J. Med.368, 1980–1991 (2013).In 2011, the US NLST trial demonstrated that mortality from lung cancer can be reduced by using low-dose computed tomography (LDCT) screening rather than chest x-ray (CXR) screening. This paper from the US NLST research team focuses on the results of the initial round of LDCT for lung cancer. A total of 53,439 participants were included and randomly assigned to LDCT screening (n = 26,715) or CXR screening (n = 26,724). In total, 27.3% of the participants in the LDCT group and 9.2% in the CXR group had a positive screening result. As a result, 3.8% (LDCT group) and 5.7% (CXR group) of these subjects were diagnosed with lung cancer. The sensitivity (93.8%) and specificity (73.4%) for lung cancer were higher for LDCT compared with CXR screening; 73.5 and 91.3%, respectively.
- Published
- 2013
- Full Text
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22. The Role of Conventional Bronchoscopy in the Workup of Suspicious CT Scan Screen-Detected Pulmonary Nodules
- Author
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van 't Westeinde, Susan C., Horeweg, Nanda, Vernhout, René M., Groen, Harry J.M., Lammers, Jan-Willem J., Weenink, Carla, Nackaerts, Kristiaan, Oudkerk, Matthijs, Mali, Willem, Thunnissen, Frederik B., de Koning, Harry J., and van Klaveren, Rob J.
- Abstract
Up to 50% of the participants in CT scan lung cancer screening trials have at least one pulmonary nodule. To date, the role of conventional bronchoscopy in the workup of suspicious screen-detected pulmonary nodules is unknown. If a bronchoscopic evaluation could be eliminated, the cost-effectiveness of a screening program could be enhanced and the potential harms of bronchoscopy avoided.
- Published
- 2012
- Full Text
- View/download PDF
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