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Dementie kenmerkt zich door geleidelijke progressieve cognitieve achteruitgang en bijkomende problemen in het dagelijks functioneren. Voor goede begeleiding, zorg en onderzoek naar nieuwe behandelingen is het essentieel om veranderingen in cognitie en dagelijks functioneren goed te kunnen meten. Dit is echter lastig, omdat het merendeel van het neuropsychologisch instrumentarium gericht is op de diagnostiek van dementie en niet altijd geschikt is om klinisch relevante veranderingen over tijd ná de diagnose te meten. Er is dus behoefte aan een meetinstrument om klinische progressie gericht, betrouwbaar en valide in kaart te brengen. In samenwerking met experts, mensen met dementie en hun naasten werd de Cognitive- Functional Composite (CFC) ontwikkeld: een selectie van zeven bestaande cognitieve tests en de verkorte versie van de Amsterdam IADL- vragenlijst. In dit overzichtsartikel beschrijven we de ontwikkeling en validatie van de CFC. We presenteren de onderzoeken naar de kwaliteit van het meetinstrument en de implementatie in de klinische praktijk.

Mensen met een ernstige psychische aandoening (EPA) die langdurig afhankelijk zijn van intensieve psychiatrische zorg, hebben vaak cognitieve problemen die het dagelijks functioneren be- perken. Cognitieve Adaptatietraining (CAT) beoogt dagelijks functione- ren te verbeteren door cognitieve beperkingen te ondervangen met eenvoudige, praktische hulpmiddelen. In deze studie werd CAT ingezet als verpleegkundige interventie. Twaalf verpleegkundige teams en hun cliënten werden willekeurig toe- gewezen aan CAT (n = 42) of gebruikelijke zorg (n = 47). Gedurende een jaar werden dagelijks functioneren, kwaliteit van leven, empower- ment, negatieve symptomen en cognitief funtioneren (onder andere executief functioneren, visuele perceptie) gemeten. De CAT-groep werd een jaar extra gevolgd. Dagelijks functioneren, executief functioneren en visuele perceptie verbeterden bij de CAT-groep vergeleken met deelnemers die gebruike- lijke zorg ontvingen. De groepen verschilden niet op andere uitkomst- maten. Verbeteringen in het dagelijks functioneren in de CAT-groep bleven behouden bij follow-up. CAT lijkt hiermee een waardevolle aanvulling voor de ondersteuning van mensen met een EPA in langdurige klinische psychiatrische zorg.

Since 2017, repetitive transcranial magnetic stimulation (rTMS) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system.br/AIM: To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rTMS for the treatment of depression.br/METHOD: Based on literature review, existing guidelines and consensus among Dutch rTMS experts, recommendations were developed regarding the implementation of rTMS as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group.br/RESULTS: rTMS targeting the dorsolateral prefrontal cortex (DLPFC) should be seen as a first choice in the treatment of depression using high-frequency rTMS (left) or, as an alternative, low-frequency rTMS (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rTMS include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant.br/CONCLUSION: rTMS, performed by competent professionals is an effective and safe treatment for depression.

Since 2017, repetitive transcranial magnetic stimulation (rTMS) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system. AIM: To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rTMS for the treatment of depression. METHOD: Based on literature review, existing guidelines and consensus among Dutch rTMS experts, recommendations were developed regarding the implementation of rTMS as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group. RESULTS: rTMS targeting the dorsolateral prefrontal cortex (DLPFC) should be seen as a first choice in the treatment of depression using high-frequency rTMS (left) or, as an alternative, low-frequency rTMS (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rTMS include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant. CONCLUSION: rTMS, performed by competent professionals is an effective and safe treatment for depression. ispartof: Tijdschr Psychiatr vol:61 issue:6 pages:411-420 ispartof: location:Netherlands status: published

BACKGROUND: Since 2017, repetitive transcranial magnetic stimulation (rTMS) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system. AIM: To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rTMS for the treatment of depression. METHOD: Based on literature review, existing guidelines and consensus among Dutch rTMS experts, recommendations were developed regarding the implementation of rTMS as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group. RESULTS: rTMS targeting the dorsolateral prefrontal cortex (DLPFC) should be seen as a first choice in the treatment of depression using high-frequency rTMS (left) or, as an alternative, low-frequency rTMS (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rTMS include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant. CONCLUSION: rTMS, performed by competent professionals is an effective and safe treatment for depression.

At present, the use of repetitive transcranial magnetic stimulation (rtms) for treatment-resistant depression is sufficiently substantiated to be applied in clinical practice. In the Netherlands, it will be reimbursed when offered in combination with cognitive behavior therapy.br/AIM: Proposal for a clinical treatment protocol for rtms in The Netherlands.br/METHOD: A study of the literature and a critical appraisal of available international guidelines for rtms.br/RESULTS: rtms is a safe treatment for patients suffering from a moderate to severe depressive disorder that is relatively treatment-resistant. The duration of the effect is still unknown. It is advised to stimulate the left dorsolateral prefrontal cortex using an intensity of 120% of the resting motor threshold, with a frequency of 10 Hz and using 3000 pulses per session during a total of 20-30 sessions.br/CONCLUSION: The proposed treatment protocol is favored based on the available evidence when rtms is used as a treatment aimed to acutely decrease the severity of depressive symptoms. It is further proposed to systematically collect technical and outcome data on treatment with rtms to further improve treatment with rtms in clinical practice.

BACKGROUND: At present, the use of repetitive transcranial magnetic stimulation (rtms) for treatment-resistant depression is sufficiently substantiated to be applied in clinical practice. In the Netherlands, it will be reimbursed when offered in combination with cognitive behavior therapy. AIM: Proposal for a clinical treatment protocol for rtms in The Netherlands. METHOD: A study of the literature and a critical appraisal of available international guidelines for rtms. RESULTS: rtms is a safe treatment for patients suffering from a moderate to severe depressive disorder that is relatively treatment-resistant. The duration of the effect is still unknown. It is advised to stimulate the left dorsolateral prefrontal cortex using an intensity of 120% of the resting motor threshold, with a frequency of 10 Hz and using 3000 pulses per session during a total of 20-30 sessions. CONCLUSION: The proposed treatment protocol is favored based on the available evidence when rtms is used as a treatment aimed to acutely decrease the severity of depressive symptoms. It is further proposed to systematically collect technical and outcome data on treatment with rtms to further improve treatment with rtms in clinical practice.

New approaches are needed in the treatment of characteristic symptoms of schizophrenia such as hallucinations and negative symptoms. Non-invasive brain stimulation can make a useful contribution.br/AIM: To discuss the published evidence regarding efficacy and safety of repetitive transcranial magnetic stimulation (rtms) and transcranial direct current stimulation (tdcs) when used in the treatment of auditory verbal hallucinations and negative symptoms.br/METHOD: We review and discuss recent meta-analyses and we analyse relevant factors.br/RESULTS: On average, when compared to sham-stimulation, rtms was found to have a significant effect on hallucinations and negative symptoms. Nevertheless, the results of some studies were variable and some studies did not report any improvement. There are indications that some factors such as age and distance between scalp and cortex may influence efficiency. There were only a few studies relating to the use of tdcs and none of these reported a clear effect.br/CONCLUSION: There is reasonable evidence that rtms is an efficient treatment for hallucinations and negative symptoms, although some variable results have been reported. There is insufficient evidence for conclusions to be drawn about the efficacy of tdcs for the treatment of hallucinations and negative symptoms. However, both simulation methods are safe and largely without side-effects.

BACKGROUND: Brain stimulation is the most direct form of neuromodulation. Direct brain stimulation is an older procedure that has taken various forms, but 'non-invasive brain stimulation' is a more recent development. AIM: To provide an overview of the current arsenal of non-invasive brain stimulation techniques. METHOD: We discuss the underlying principles, the pros and cons, and the applicability of non-invasive brain stimulation in experimental research and treatment of neuropsychiatric disorders. RESULTS: Non-invasive brain stimulation is a direct form of neuromodulation, which is not invasive, harmful or painful. Its effects are in principle temporary, which makes the technique suitable for experimental research. At the same time, temporary effects can have lasting clinical consequences, if they target neuroplasticity to aid rehabilitation or alleviate symptoms. CONCLUSION: Whereas the value of non-invasive brain stimulation for research purposes is undisputed, its efficacy and value as a treatment for neuropsychiatric disorders are still being debated. Nevertheless, the accumulated evidence about the clinical efficacy of the treatment for certain disorders is sufficiently compelling to start thinking about European regulations and standard medical insurance coverage.

Brain stimulation is the most direct form of neuromodulation. Direct brain stimulation is an older procedure that has taken various forms, but 'non-invasive brain stimulation' is a more recent development.To provide an overview of the current arsenal of non-invasive brain stimulation techniques.We discuss the underlying principles, the pros and cons, and the applicability of non-invasive brain stimulation in experimental research and treatment of neuropsychiatric disorders.Non-invasive brain stimulation is a direct form of neuromodulation, which is not invasive, harmful or painful. Its effects are in principle temporary, which makes the technique suitable for experimental research. At the same time, temporary effects can have lasting clinical consequences, if they target neuroplasticity to aid rehabilitation or alleviate symptoms.Whereas the value of non-invasive brain stimulation for research purposes is undisputed, its efficacy and value as a treatment for neuropsychiatric disorders are still being debated. Nevertheless, the accumulated evidence about the clinical efficacy of the treatment for certain disorders is sufficiently compelling to start thinking about European regulations and standard medical insurance coverage.

In Je brein de baas neemt neuropsycholoog André Aleman het op voor het bewuste denken. Onderzoek heeft eerder aangetoond dat juist onbewuste processen in ons brein een grote invloed kunnen hebben op ons gedrag. Daardoor zijn veel wetenschappers de rol van bewust denken gaan bagatelliseren: het heeft volgens hen slechts een gering effect op ons doen en laten. Dat betekent dat er van een vrije wil ook geen sprake kan zijn. In dit boek horen we een heel ander geluid: Aleman laat aan de hand van de nieuwste inzichten uit de hersenwetenschap zien dat het menselijk bewustzijn wel degelijk ons gedrag stuurt. Wat je doet en wie je bent, heeft veel te maken met wat je denkt en wilt. Sterker nog, we kunnen bewust ons eigen denken en doen beïnvloeden om onze doelen te bereiken. Hoewel onbewuste processen zeker een rol spelen, laat Aleman zien dat bewust denken die onbewuste processen in goede banen kan leiden. Mindfulness en spiritualiteit kunnen daarbij behulpzaam zijn. Het feit dat ons brein ‘bezield’ is, maakt ons uniek. Over Het seniorenbrein: ‘Alemans verdienste is dat hij duidelijk weet waarover hij spreekt en dat hij zin van onzin scheidt.’ – het financieele dagblad ‘Een boek dat je niet weglegt, of je nu 20 jaar bent of 100.’ – psychologie magazine

Persons with a psychotic disorder commonly experience difficulties with what is considered to be metacognitive capacity. In this article we discuss several definitions of this concept, the measurement instruments involved and the clinical interventions that target this concept.To present a review of various frequently used definitions of metacognition and related concepts and to describe the measurement instruments involved and the treatment options available for improving the metacognitive capacity of persons with a psychotic disorder.We present an overview of several definitions of metacognition in psychotic disorders and we discuss frequently used measurement instruments and treatment options. The article focuses on recent developments in a model devised by Semerari et al. The measurement instrument involved (Metacognition Assessment Scale - A) is discussed in terms of it being an addition to existing methods.On the basis of the literature it appears that metacognition and related concepts are measurable constructs, although definitions and instruments vary considerably. The new conceptualisation of social information processing also leads to the development of a new form of psychotherapy that aims to help patients suffering from psychotic disorders to improve metacognitive capacity.There seems to be evidence that metacognitive abilities are a possible target for treatment, but further research is needed.

ACHTERGROND: Mensen met een psychotische stoornis ondervinden veelal problemen in wat kan worden beschreven als de metacognitieve vaardigheden. Er zijn verscheidene definities van dit concept, alsmede meetinstrumenten en klinische interventies die zich op dit concept richten. DOEL: Een overzicht bieden van enkele veelgebruikte definities van metacognitie en gerelateerde concepten, alsmede de bijbehorende meetinstrumenten en behandelopties om metacognitie bij mensen met een psychotische stoornis te verbeteren. METHODE: Aan de hand van de literatuur een overzicht geven van de verschillende definities van metacognitie bij psychotische stoornissen, alsmede veelgebruikte meetinstrumenten en behandelmethoden. De nadruk ligt hierbij op de recente ontwikkelingen in een model van Semerari en collega’s met bijbehorende meetinstrument (de Metacognition Assessment Scale – A). We bekijken hoe dit een toevoeging kan zijn op de bestaande methoden. RESULTATEN: Op basis van de literatuur lijken de concepten metacognitie en gelieerde concepten meetbare constructen, alhoewel de definities en meetinstrumenten heterogeen blijken. De nieuwe conceptualisering van de sociale informatieverwerking leidt tevens tot de ontwikkeling van een nieuwe vorm van psychotherapie, die gericht is op het verbeteren van de metacognitieve vaardigheden bij mensen met een psychotische stoornis. CONCLUSIE: Er lijken aanwijzingen dat metacognitieve vaardigheden een doel van behandeling kunnen zijn, maar meer onderzoek is noodzakelijk. BACKGROUND: Persons with a psychotic disorder commonly experience difficulties with what is considered to be metacognitive capacity. In this article we discuss several definitions of this concept, the measurement instruments involved and the clinical interventions that target this concept. AIM: To present a review of various frequently used definitions of metacognition and related concepts and to describe the measurement instruments involved and the treatment options available for improving the metacognitive capacity of persons with a psychotic disorder. METHOD: We present an overview of several definitions of metacognition in psychotic disorders and we discuss frequently used measurement instruments and treatment options. The article focuses on recent developments in a model devised by Semerari et al. The measurement instrument involved (Metacognition Assessment Scale – A) is discussed in terms of it being an addition to existing methods. RESULTS: On the basis of the literature it appears that metacognition and related concepts are measurable constructs, although definitions and instruments vary considerably. The new conceptualisation of social information processing also leads to the development of a new form of psychotherapy that aims to help patients suffering from psychotic disorders to improve metacognitive capacity. CONCLUSION: There seems to be evidence that metacognitive abilities are a possible target for treatment, but further research is needed.

The Dutch BETER consortium has established a national care infrastructure for Hodgkin lymphoma survivors. 'BETER' [the Dutch word for 'better'] stands for Better care after Hodgkin lymphoma (HL): Evaluation of long-term Treatment Effects and screening Recommendations. The survivorship care focuses on long-term effects of HL treatment. Over 10,000 HL survivors who were treated in the period spanning 1965-2008 have been identified. As part of the survivorship care initiative, specific BETER out-patient clinics have been set up. A dedicated website, www.beternahodgkin.nl, provides HL survivors with relevant information. The stakeholders of the BETER survivorship care programme aim to achieve an improved healthy life expectancy for patients treated for HL.

Adjuvant radiotherapy is frequently used in women with breast cancer to improve both local control of the tumour and overall survival. Hypofractionated regimens are increasingly being used as they involve fewer treatment sessions and, in terms of tumour control, the effects of conventionally fractionated and hypofractionated radiotherapy seem to be comparable. However, there is concern regarding increased cardiotoxicity following hypofractionated radiotherapy treatment to the left side. In order to determine if cardiac mortality increases with hypofractionation relative to conventional fractionation, a Canadian research group performed a retrospective analysis in 5334 women with breast cancer treated between 1990-1998 with postoperative radiotherapy to the breast/chest wall only. At 15-year follow-up the authors concluded that cardiac mortality was not statistically different among patients with left-sided breast cancer whether treated with hypofractionated or conventionally fractionated whole breast/chest wall irradiation. This commentary discusses the data presented in the paper, puts them into perspective and describes the clinical implications.

Toepassingen van beeldvormende tech­nie­ken om de structuur en functies van de hersenen te ontrafelen hebben de af­ge­lo­pen decennia een hoge vlucht genomen. Het beeldvormend onderzoek bij patiënten met psychiatrische stoornissen heeft ook belangrijke nieuwe inzichten gegeven. Zo is met behulp van beeldvormende technieken aangetoond dat de uitkomst van ziekte bij patiënten met schizofrenie samenhangt met volumeverlies van de hersenen en dat patiënten met een angststoornis een excessieve reactie van specifieke hersengebieden laten zien op confronterende stimuli. Neuro-imagingonderzoek heeft tevens verminderde activiteit van de linker dorsolaterale prefrontale cortex aangetoond bij depressieve patiënten. Dit boek geeft een overzicht van beeldvormende technieken van de structuur en functies van de hersenen, met hun toepassingen in gezondheid en bij psychiatrische ziekten. De hoofdstukken zijn geschreven door internationale deskundigen binnen het beeldvormend onderzoek en de toepassing daarvan binnen de psychiatrie. In 25 hoofdstukken wordt inzicht gegeven in de anatomie van de hersenen en in hersenfuncties. Hoe wordt connectiviteit gemeten? Hoe wordt taal in beeld gebracht, hoe reageren de hersenen op emoties? Hoe veranderen de hersenen van baby's, kinderen, pubers of jongvolwassenen tot die van oudere volwassenen? Hoe meet je genetische invloeden en om­ge­vings­in­vloe­den aan de hand van beeldvorming? Een substantieel aantal hoofdstukken is gewijd aan bevindingen bij patiënten met psychiatrische stoornissen, waaronder schizofrenie, bipolaire stoornis, autisme, ADHD, angststoornis en obsessieve-compulsieve stoornis. Dit boek is in de eerste plaats gericht op psychiaters en psychologen (in opleiding) met interesse voor beeldvormende technieken. Het is ook geschikt voor de geïnteresseerde lezer die inzicht wil verkrijgen in beeldvormend onderzoek naar de menselijke hersenen en voor allen die dagelijks werken met beeldvormende technieken en een breder overzicht wensen. 'Wie meer wil dan louter populaire wetenschap kan terecht bij Beeldvorming van het brein, dat zijn titel volledig rechtdoet. Bekende deskundigen geven een state-of-the-artoverzicht van de toepassing van beeldvormende technieken bij psychiatrische ziekten – schizofrenie, depressie, angststoornissen, autisme, bipolaire stoornis – , maar ook bij onderzoek naar (de ontwikkeling van) het gezonde brein. Dus kijken we mee in zowel het babybrein als in het brein van de verouderende mens. Dit boek kan ook dienstdoen als uitstekend geïnformeerd en gedocumenteerd naslagwerk.' - Medisch Contact, juli 2015.

The Dutch BETER consortium has established a national care infrastructure for Hodgkin lymphoma survivors. 'BETER' [the Dutch word for 'better'] stands for Better care after Hodgkin lymphoma (HL): Evaluation of long-term Treatment Effects and screening Recommendations. The survivorship care focuses on long-term effects of HL treatment. Over 10,000 HL survivors who were treated in the period spanning 1965-2008 have been identified. As part of the survivorship care initiative, specific BETER out-patient clinics have been set up. A dedicated website, www.beternahodgkin.nl, provides HL survivors with relevant information. The stakeholders of the BETER survivorship care programme aim to achieve an improved healthy life expectancy for patients treated for HL.

Many factors are involved in the pathogenesis of depression. This article provides an overview of the results given in the thesis entitled 'Linking Depression', in which some putative underlying neurobiological and genetic mechanisms of depression are examined.To gain more insight in brain activity as endophenotype for depression.As part of the Netherlands Study of Depression and Anxiety (nesda), 301 people, including patients with depression and/or anxiety and healthy volunteers, underwent functional magnetic resonance imaging (fmri) and genotyping.During the processing of negative emotions, patients with depression showed a pattern of heightened limbic activation but less prefrontal activation. The same pattern, but in reverse, was seen during the processing of positive emotions. We showed that the disc1, comt and npy genes were associated with brain activation patterns comparable to those seen in patients with depression. In addition, in cases of depression, there was a different kind of relationship between these genes and brain activation.Depression is characterised by the disturbed processing not only of negative emotions but also of positive emotions. In addition, the studies we describe contribute to our insight into the neurobiology of depression and relevant genetic influences because the results demonstrate that depression alters the relationship between genes and brain activation.

BACKGROUND: Many factors are involved in the pathogenesis of depression. This article provides an overview of the results given in the thesis entitled 'Linking Depression', in which some putative underlying neurobiological and genetic mechanisms of depression are examined. AIM: To gain more insight in brain activity as endophenotype for depression. METHOD: As part of the Netherlands Study of Depression and Anxiety (nesda), 301 people, including patients with depression and/or anxiety and healthy volunteers, underwent functional magnetic resonance imaging (fmri) and genotyping. RESULTS: During the processing of negative emotions, patients with depression showed a pattern of heightened limbic activation but less prefrontal activation. The same pattern, but in reverse, was seen during the processing of positive emotions. We showed that the disc1, comt and npy genes were associated with brain activation patterns comparable to those seen in patients with depression. In addition, in cases of depression, there was a different kind of relationship between these genes and brain activation. CONCLUSION: Depression is characterised by the disturbed processing not only of negative emotions but also of positive emotions. In addition, the studies we describe contribute to our insight into the neurobiology of depression and relevant genetic influences because the results demonstrate that depression alters the relationship between genes and brain activation.

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Het humaan papillomavirus (HPV) kan weefselafwijkingen in de baarmoederhals veroorzaken die zich kunnen ontwikkelen tot baarmoederhalskanker. Voor de behandeling van deze meer uitgebreide afwijkingen en invasieve kankers wordt het weefsel via conisatie verwijderd. De meest gebruikte techniek hierbij is het verwijderen van de transformatiezone (large loop excision of the transformation zone LLETZ). Uit andere studies is gebleken dat de conisatie het risico op vroeggeboorte en andere negatieve zwangerschapsuitkomsten, zoals perinatale mortaliteit, kan verhogen. In dit artikel worden verschillende studies die het verband onderzochten tussen conisatie en vroeggeboorte met elkaar vergeleken. Hieruit blijkt dat er door LLETZ een verhoogd risico bestaat op vroeggeboorte en dat er bij de neonatale factoren een hoger risico voorkomt op zowel een laag geboortegewicht als perinatale mortaliteit.

The percentage of persons with schizophrenia who have only a limited insight into their illness is rather large (50–80%); this has a negative impact on specific outcomes. Up till now there has not been a universal model that can explain this limited insight. Furthermore, there is a lack of treatment options and interventions likely to improve patients' insight into their illness.To provide an overview of the literature on insight of patients into their illness and suggest a model for treatment.In this essay we review the literature dealing with the insight of patients with schizophrenia and thereafter we discuss the correlates of insight (illness variables as well as outcomes), theoretical models of insight and current treatment of options.On the basis of the literature we propose a new theoretical model which incorporates factors from earlier models and which aims to improve patients' insight into their illness. Using the preconditions for insight specified in our models (namely, sensitivity to stigma, seeing the illness in perspective, mental flexibility and self-reflection) we have developed a new treatment (reflex) for improving the insight of persons with schizophrenia.The treatment will be evaluated in the course of the next two years at eight centres in the Netherlands providing treatment for persons with schizophrenia; the evaluation should tell us whether the proposed treatment is effective in increasing patient's insight into their illness.

Patients who were treated in the past with radiotherapy or chemotherapy for testicular cancer or Hodgkin lymphoma are at risk of new malignancies and cardiovascular disease on the long run. Two patient groups who were diagnosed in various hospitals in the Netherlands as having testicular cancer and Hodgkin lymphoma in the period 1965-1995 have survived for a mean period of almost 20 years by now. Both patient groups have higher risks of a new malignancy or cardiovascular disease following radiotherapy and/or chemotherapy than the general population or patients treated without or with less intensive radiotherapy or chemotherapy. As recovery of Hodgkin lymphoma is only achieved by a more intensive treatment approach than the treatment approach for testicular cancer, the risks of a new malignancy or cardiovascular disease are considerably higher among survivors of Hodgkin lymphoma than among survivors of testicular cancer. In both patient groups the long-term risks of new malignancies and cardiovascular disease are still raised in both patient groups up to 25 years after treatment. Because of the relatively high risks of late treatment complications, recommendations for follow-up for survivors of testicular cancer and Hodgkin lymphoma are necessary.

To compare the results of single-dose internal irradiation (brachytherapy) and self-expanding metal stent placement in the palliation of oesophageal obstruction due to cancer of the oesophagus.Randomised trial.In the period from December 1999-Jun 2002, 209 patients with dysphagia due to inoperable carcinoma of the oesophagus were randomised to placement of an Ultraflex stent (n = 108) or single-dose (12 Gy) brachytherapy (n = 101). Primary outcome was relief of dysphagia; secondary outcomes were complications, persistent or recurrent dysphagia, health-related quality of life, and costs. Patients were followed up by monthly home visits from a specialised nurse.Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. Stent placement resulted in more complications than did brachytherapy (36/108 (33%) versus 21/101 (21%); p = 0.02), due mainly to an increased incidence of late haemorrhage in the stent group (14 versus 5; p = 0.05). The groups did not differ with regard to the incidence of persistent or recurrent dysphagia or median survival (p0.20). In the long term, quality-of-life scores were higher in the brachytherapy group. Total medical costs were also similar for both treatments: Euro 8,215 for stent placement and Euro 8,135 for brachytherapy.Brachytherapy provided better long-term relief of dysphagia than did stent placement and also produced fewer complications. Brachytherapy is therefore recommended as the preferred treatment for the palliation of dysphagia due to oesophageal cancer.

OBJECTIVE: To compare the results of single-dose internal irradiation (brachytherapy) and self-expanding metal stent placement in the palliation of oesophageal obstruction due to cancer of the oesophagus. DESIGN: Randomised trial. METHOD: In the period from December 1999-Jun 2002, 209 patients with dysphagia due to inoperable carcinoma of the oesophagus were randomised to placement of an Ultraflex stent (n = 108) or single-dose (12 Gy) brachytherapy (n = 101). Primary outcome was relief of dysphagia; secondary outcomes were complications, persistent or recurrent dysphagia, health-related quality of life, and costs. Patients were followed up by monthly home visits from a specialised nurse. RESULTS: Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. Stent placement resulted in more complications than did brachytherapy (36/108 (33%) versus 21/101 (21%); p = 0.02), due mainly to an increased incidence of late haemorrhage in the stent group (14 versus 5; p = 0.05). The groups did not differ with regard to the incidence of persistent or recurrent dysphagia or median survival (p > 0.20). In the long term, quality-of-life scores were higher in the brachytherapy group. Total medical costs were also similar for both treatments: Euro 8,215 for stent placement and Euro 8,135 for brachytherapy. CONCLUSION: Brachytherapy provided better long-term relief of dysphagia than did stent placement and also produced fewer complications. Brachytherapy is therefore recommended as the preferred treatment for the palliation of dysphagia due to oesophageal cancer