41 results on '"Veronique E.M. Mul"'
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2. Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer
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Maaike J. Berveling, Boudewijn van Etten, Veronique E.M. Mul, Esmée A Dijkstra, Geke A. P. Hospers, Christina T. Muijs, Patrick H. J. Hemmer, Mostafa El Moumni, Jannet C. Beukema, Klaas Havenga, Gursah Kats-Ugurlu, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Targeted Gynaecologic Oncology (TARGON), Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Robotics and image-guided minimally-invasive surgery (ROBOTICS) more...
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medicine.medical_specialty ,Colorectal cancer ,SURGERY ,medicine.medical_treatment ,IORT ,Brachytherapy ,Rectal neoplasms ,Radiation oncology ,CLASSIFICATION ,030218 nuclear medicine & medical imaging ,CHEMORADIOTHERAPY ,POOLED ANALYSIS ,03 medical and health sciences ,0302 clinical medicine ,Patient selection ,RADIATION-THERAPY ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,Neoadjuvant therapy ,CONTAINING MULTIMODALITY TREATMENT ,PREOPERATIVE RADIOTHERAPY ,Salvage Therapy ,COMPLICATIONS ,RESECTION MARGIN ,business.industry ,Adverse effects ,Medical record ,Rectum ,Hematology ,medicine.disease ,Surgery ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Resection margin ,Neoplasm Recurrence, Local ,business ,Chemoradiotherapy - Abstract
Background and purpose: A radical resection of locally advanced rectal cancer (LARC) or recurrent rectal cancer (RRC) can be challenging. In case of increased risk of an R1 resection, intra-operative brachytherapy (IOBT) can be applied. We evaluated the clinical selection strategy for IOBT.Materials and methods: Between February 2007 and May 2018, 132 LARC/RRC patients who were scheduled for surgery with IOBT standby, were evaluated. By intra-operative inspection of the resection margin and MR imaging, it was determined whether a resection was presumed to be radical. Frozen sections were taken on indication. In case of a suspected R1 resection, IOBT (1 x 10 Gy) was applied. Histopathologic evaluation, treatment and toxicity data were collected from medical records.Results: Tumour was resected in 122 patients. IOBT was given in 42 patients of whom 54.8% (n = 23) had a histopathologically proven R1 resection. Of the 76 IOBT-omitted R0 resected patients, 17.1% (n = 13) had a histopathologically proven R1 resection. In 4 IOBT-omitted patients, a clinical R1/2 resection was seen. In total, correct clinical judgement occurred in 72.6% (n = 88) of patients. In LARC, 58.3% (n = 14) of patients were overtreated (R0, with IOBT) and 10.9% (n = 5) were undertreated (R1, without IOBT). In RRC, 26.5% (n = 9) of patients were undertreated.Conclusion: In total, correct clinical judgement occurred in 72.6% (n = 88). However, in 26.5% (n = 9) RRC patients, IOBT was unjustifiedly omitted. IOBT is accompanied by comparable and acceptable toxicity. Therefore, we recommend IOBT to all RRC patients at risk of an R1 resection as their salvage treatment.(c) 2021 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology 159 (2021) 91 & ndash;97This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). more...
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- 2021
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3. Re-Irradiation in Patients with Recurrent Rectal Cancer is Safe and Feasible
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Boudewijn van Etten, Esmée A Dijkstra, Geke A. P. Hospers, Klaas Havenga, Christina T. Muijs, Veronique E.M. Mul, Patrick H. J. Hemmer, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Robotics and image-guided minimally-invasive surgery (ROBOTICS) more...
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Re-Irradiation ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Gastroenterology ,Capecitabine ,Surgical oncology ,Internal medicine ,medicine ,Humans ,Pathological ,Neoplasm Staging ,Retrospective Studies ,Colorectal Cancer ,Salvage Therapy ,business.industry ,Rectal Neoplasms ,Rectum ,Chemoradiotherapy ,medicine.disease ,Neoadjuvant Therapy ,Radiation therapy ,Treatment Outcome ,Oncology ,Toxicity ,Surgery ,Neoplasm Recurrence, Local ,business ,medicine.drug - Abstract
Background There is no consensus yet for the best treatment regimen in patients with recurrent rectal cancer (RRC). This study aims to evaluate toxicity and oncological outcomes after re-irradiation in patients with RRC in our center. Clinical (cCR) and pathological complete response (pCR) rates and radicality were also studied. Methods Between January 2010 and December 2018, 61 locally advanced RRC patients were treated and analyzed retrospectively. Patients received radiotherapy at a dose of 30.0–30.6 Gy (reCRT) or 50.0–50.4 Gy chemoradiotherapy (CRT) in cases of no prior irradiation because of low-risk primary rectal cancer. In both groups, patients received capecitabine concomitantly. Results In total, 60 patients received the prescribed neoadjuvant (chemo)radiotherapy followed by surgery, 35 patients (58.3%) in the reRCT group and 25 patients (41.7%) in the long-course CRT group. There were no significant differences in overall survival (p = 0.82), disease-free survival (p = 0.63), and local recurrence-free survival (p = 0.17) between the groups. Patients in the long-course CRT group reported more skin toxicity after radiotherapy (p = 0.040). No differences were observed in late toxicity. In the long-course CRT group, a significantly higher cCR rate was observed (p = 0.029); however, there was no difference in the pCR rate (p = 0.66). Conclusions The treatment of RRC patients with re-irradiation is comparable to treatment with long-course CRT regarding toxicity and oncological outcomes. In the reCRT group, less cCR was observed, although there was no difference in pCR. The findings in this study suggest that it is safe and feasible to re-irradiate RRC patients. more...
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- 2021
4. Reasons for low uptake of a psychological intervention offered to cancer survivors with elevated depressive symptoms
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Robert J. van Ginkel, Robbert Sanderman, Thera P. Links, Loek J. van der Donk, Joke Fleer, Veronique E.M. Mul, Jan L. N. Roodenburg, Peter C. Baas, Maya J. Schroevers, Henriette J. G. Arts, Christiaan Hoff, K. Annika Tovote, Johanna Kluin-Nelemans, Psychology, Health & Technology, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Targeted Gynaecologic Oncology (TARGON), Clinical Psychology and Experimental Psychopathology, and Lifelong Learning, Education & Assessment Research Network (LEARN) more...
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Paper ,medicine.medical_specialty ,CONSORT ,Psychological intervention ,UT-Hybrid-D ,screening guidelines ,Experimental and Cognitive Psychology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Standard care ,Randomized controlled trial ,law ,Medicine ,cancer ,cancer survivors ,030212 general & internal medicine ,Depressive symptoms ,Depression (differential diagnoses) ,business.industry ,screening ,Cancer ,medicine.disease ,humanities ,Psychiatry and Mental health ,recruitment ,030220 oncology & carcinogenesis ,Family medicine ,Papers ,depression ,oncology ,randomized controlled trial ,Observational study ,business ,Limited resources ,consecutive screening - Abstract
Objective In line with screening guidelines, cancer survivors were consecutively screened on depressive symptoms (as part of standard care), with those reporting elevated levels of symptoms offered psychological care as part of a trial. Because of the low uptake, no conclusions could be drawn about the interventions' efficacy. Given the trial set‐up (following screening guidelines and strict methodological quality criteria), we believe that this observational study reporting the flow of participation, reasons for and characteristics associated with nonparticipation, adds to the debate about the feasibility and efficiency of screening guidelines. Methods Two thousand six hundred eight medium‐ to long‐term cancer survivors were consecutively screened on depressive symptoms using the Patient Health Questionnaire‐9 (PHQ‐9). Those with moderate depressive symptoms (PHQ‐9 ≥ 10) were contacted and informed about the trial. Patient flow and reasons for nonparticipation were carefully monitored. Results One thousand thirty seven survivors (74.3%) returned the questionnaire, with 147 (7.6%) reporting moderate depressive symptoms. Of this group, 49 survivors (33.3%) were ineligible, including 26 survivors (17.7%) already receiving treatment and another 44 survivors (30.0%) reporting no need for treatment. Only 25 survivors (1.0%) participated in the trial. Conclusion Of the approached survivors for screening, only 1% was eligible and interested in receiving psychological care as part of our trial. Four reasons for nonparticipation were: nonresponse to screening, low levels of depressive symptoms, no need, or already receiving care. Our findings question whether to spend the limited resources in psycho‐oncological care on following screening guidelines and the efficiency of using consecutive screening for trial recruitment in cancer survivors. more...
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- 2019
5. A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy
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Bas P. L. Wijnhoven, Christina T. Muijs, Willemieke P M Dijksterhuis, Zohra Faiz, Justin K. Smit, Veronique E.M. Mul, Johannes G. M. Burgerhof, John T. M. Plukker, and Surgery
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medicine.medical_specialty ,Neoplasm, Residual ,Esophageal Neoplasms ,DOSE RADIATION ,medicine.medical_treatment ,Esophageal cancer ,Definitive chemoradiotherapy ,Adenocarcinoma ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,SDG 3 - Good Health and Well-being ,law ,RADIATION-THERAPY ,medicine ,Humans ,DECLINED SURGERY ,Clinical significance ,CLINICAL-SIGNIFICANCE ,Survival analysis ,Salvage Therapy ,business.industry ,PHASE-III TRIAL ,General Medicine ,Chemoradiotherapy ,NEOADJUVANT CHEMORADIOTHERAPY ,medicine.disease ,RANDOMIZED-TRIAL ,Confidence interval ,Surgery ,Radiation therapy ,Esophagectomy ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Salvage esophagectomy ,030211 gastroenterology & hepatology ,SQUAMOUS-CELL CARCINOMA ,Esophageal Squamous Cell Carcinoma ,Neoplasm Recurrence, Local ,business ,DEFINITIVE CHEMORADIATION ,RADIOTHERAPY - Abstract
Background: Isolated local recurrent or persistent esophageal cancer (EC) after curative intended definitive (dCRT) or neoadjuvant chemoradiotherapy (nCRT) with initially omitted surgery, is a potential indication for salvage surgery. We aimed to evaluate safety and efficacy of salvage surgery in these patients. Material and methods: A systematic literature search following PRISMA guidelines was performed using databases of PubMed/Medline. All included studies were performed in patients with persistent or recurrent EC after initial treatment with dCRT or nCRT, between 2007 and 2017. Survival analysis was performed with an inverse-variance weighting method. Results: Of the 278 identified studies, 28 were eligible, including a total of 1076 patients. Postoperative complications after salvage esophagectomy were significantly more common among patients with isolated persistent than in those with locoregional recurrent EC, including respiratory (36.6% versus 22.7%; difference in proportion 10.9 with 95% confidence interval (CI) [3.1; 18.7]) and cardiovascular complications (10.4% versus 4.5%; difference in proportion 5.9 with 95% CI [1.5; 10.2]). The pooled estimated 30-and 90-day mortality was 2.6% [1.6; 3.6] and 8.0% [6.3; 9.8], respectively. The pooled estimated 3-year and 5-year overall survival (OS) were 39.0% (95% CI: [35.8; 42.2]) and 19.4% [95% CI:16.5; 22.4], respectively. Patients with isolated persistent or recurrent EC after initial CRT had similar 5-year OS (14.0% versus 19.7%, difference in proportion -5.7, 95% CI [-13.7; 2.3]). Conclusions: Salvage surgery is a potentially curative procedure in patients with locally recurrent or persistent esophageal cancer and can be performed safely after definitive or neoadjuvant chemoradiotherapy when surgery was initially omitted. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved. more...
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- 2019
6. Addition of HER2 and CD44 to F-18-FDG PET-based clinico-radiomic models enhances prediction of neoadjuvant chemoradiotherapy response in esophageal cancer
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Da Wang, Veronique E.M. Mul, Johannes G. M. Burgerhof, Robert P. Coppes, Arend Karrenbeld, Willemieke P M Dijksterhuis, John T. M. Plukker, Roelof J Beukinga, Hette Faber, Riemer H. J. A. Slart, Graduate School, APH - Methodology, APH - Quality of Care, CCA - Imaging and biomarkers, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Biomedical Photonic Imaging, Life Course Epidemiology (LCE), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Translational Immunology Groningen (TRIGR), Cardiovascular Centre (CVC), Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Guided Treatment in Optimal Selected Cancer Patients (GUTS) more...
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medicine.medical_specialty ,Gastrointestinal ,Positron emission tomography ,Esophageal Neoplasms ,Receptor, ErbB-2 ,medicine.medical_treatment ,FEATURES ,Esophageal cancer ,THERAPY ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,CHEMORADIATION ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,RECONSTRUCTION ,HETEROGENEITY ,PATHOLOGICAL COMPLETE RESPONSE ,Tumor Regression Grade ,Chemotherapy ,Radiomics ,medicine.diagnostic_test ,business.industry ,ADENOCARCINOMA ,General Medicine ,Chemoradiotherapy ,medicine.disease ,Neoadjuvant Therapy ,Radiation therapy ,Regimen ,Hyaluronan Receptors ,Treatment Outcome ,Esophagectomy ,Oncogene protein HER-2 ,CD44 antigen ,030220 oncology & carcinogenesis ,Positron-Emission Tomography ,TUMOR RESPONSE ,Adenocarcinoma ,Radiology ,Radiopharmaceuticals ,business ,PREOPERATIVE CHEMORADIOTHERAPY ,GASTRIC-CANCER - Abstract
Objectives To assess the complementary value of human epidermal growth factor receptor 2 (HER2)-related biological tumor markers to clinico-radiomic models in predicting complete response to neoadjuvant chemoradiotherapy (NCRT) in esophageal cancer patients. Methods Expression of HER2 was assessed by immunohistochemistry in pre-treatment tumor biopsies of 96 patients with locally advanced esophageal cancer. Five other potentially active HER2-related biological tumor markers in esophageal cancer were examined in a sub-analysis on 43 patients. Patients received at least four of the five cycles of chemotherapy and full radiotherapy regimen followed by esophagectomy. Three reference clinico-radiomic models based on 18F-FDG PET were constructed to predict pathologic response, which was categorized into complete versus incomplete (Mandard tumor regression grade 1 vs. 2–5). The complementary value of the biological tumor markers was evaluated by internal validation through bootstrapping. Results Pathologic examination revealed 21 (22%) complete and 75 (78%) incomplete responders. HER2 and cluster of differentiation 44 (CD44), analyzed in the sub-analysis, were univariably associated with pathologic response. Incorporation of HER2 and CD44 into the reference models improved the overall performance (R2s of 0.221, 0.270, and 0.225) and discrimination AUCs of 0.759, 0.857, and 0.816. All models exhibited moderate to good calibration. The remaining studied biological tumor markers did not yield model improvement. Conclusions Incorporation of HER2 and CD44 into clinico-radiomic prediction models improved NCRT response prediction in esophageal cancer. These biological tumor markers are promising in initial response evaluation. Key Points • A multimodality approach, integrating independent genomic and radiomic information, is promising to improve prediction of γpCR in patients with esophageal cancer. • HER2 and CD44 are potential biological tumor markers in the initial work-up of patients with esophageal cancer. • Prediction models combining 18F-FDG PET radiomic features with HER2 and CD44 may be useful in the decision to omit surgery after neoadjuvant chemoradiotherapy in patients with esophageal cancer. more...
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- 2021
7. PH-0495 A multivariable prediction model for severe toxicity after chemoradiation for esophageal cancer
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Johannes A. Langendijk, van B. Etten, A. Niezink, Veronique E.M. Mul, A. Pattipeiluhu, E. Oldehinkel, Christina T. Muijs, M. Dieters, and van de A. Schaaf
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medicine.medical_specialty ,Oncology ,business.industry ,Multivariable calculus ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Hematology ,Esophageal cancer ,medicine.disease ,business ,Gastroenterology ,Severe toxicity - Published
- 2021
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8. PD-0878 Reduction of post-operative toxicity in esophageal cancer patients after model based proton therapy
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Erik W Korevaar, B. E. van, Nanna M. Sijtsema, Johannes A. Langendijk, M. Dieters, A. Niezink, Christina T. Muijs, S. Visser, Veronique E.M. Mul, A. S. Van de, and P. Klinker
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business.industry ,medicine.medical_treatment ,Hematology ,Esophageal cancer ,medicine.disease ,Intensive care unit ,law.invention ,Radiation therapy ,Regimen ,Oncology ,Esophagectomy ,law ,Cohort ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Nuclear medicine ,Complication ,Chemoradiotherapy - Abstract
Purpose or Objective During the COVID-19 pandemic, health insurance providers permitted to treat esophageal cancer (EC) patients with proton therapy (PT) when treated in the neo-adjuvant setting. This decision was based on the results of the MD Anderson randomized study showing significantly lower rates of the Total Toxicity Burden (TTB), especially of postoperative toxicity and consequently decreased hospital and intensive care unit (ICU) stay. The TTB combines a large range of toxicities with different incidence rates and severities into a single sum score. For patient selection, we used a model-based approach (MBA) using a model for TTB (>60). The aim of this study was to investigate if the post-operative TTB decreased with PT. Materials and Methods In accordance with the MBA, a plan comparison (photon vs proton radiotherapy (RT)) was performed in all EC patients that were to be treated with neo-adjuvant chemoradiotherapy (nCRT) according to the CROSS regimen. For patient selection, we developed a normal tissue complication probability (NTCP)-model for a TTB > 60, which corresponds to at least one grade > III or 2 grade > II complications. Patients, who were eligible for PT in terms of target motion ( 5%, were selected and treated with PT. Postoperative TTB and hospital and ICU stay were compared with a prospective dataset of patients that were treated with photon RT between 2014 and 2018 (n=224). Results Since March 2020, 26 out of 32 patients were selected for PT. The average reduction in mean lung dose was 5.2 Gy with PT compared to VMAT, with a corresponding average NTCP-reduction for TTB of 9.7%. Mean heart, spleen and liver dose were reduced by 7.9, 7.4 and 7.1 Gy, respectively. At the time of analyses, 14 out of 19 patients underwent esophagectomy. Three patients developed intercurrent metastases, in one a wait and see policy was applied and one switched to definitive CRT. In the resected PT patients, the expected proportion of patients with a TTB>60 was 29.7% for photon and 20.8% for proton RT. After resection, only one out of 14 patients (7.1%) had an TTB>60 ((p=0.051), compared to the expected proportion based on the photon plans). On average, the observed post-operative TTB was 15 (SEM: 6) after PT, compared to the historical photon cohort in which the observed post-operative TTB was 45 (SEM: 5). Hospital and ICU stay were also reduced by PT compared to the photon cohort;12.7 (SEM 1.4) vs. 20.0 (SEM 1.2) and 1.9 days (SEM 0.4) vs. 4.9 (SEM 0.6), resulting in an average cost reduction of about 10,000 euro per patient. Follow up will continuously be updated in our dynamic database. Conclusion In the neo-adjuvant setting, the first results indicate that proton-based nCRT reduces the post-operative TTB compared to historic photon-based nCRT. Moreover, there seems to be a trend towards reduced hospital and ICU stay. more...
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- 2021
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9. Spleen Dose Influences Overall Survival In The Neo-Adjuvant Treatment Of Esophageal Cancer
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E. Oldehinkel, Johannes A. Langendijk, Veronique E.M. Mul, A.C.M. van den Bergh, A. Nieznik, J. J. de Haan, Christina T. Muijs, B. Van Etten, M. Dieters, A. Van der Schaaf, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) more...
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Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Spleen ,Neo adjuvant ,Esophageal cancer ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,medicine ,Overall survival ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2020
10. Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields: A Histopathologic Evaluation Study
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Zohra Faiz, Gursah Kats-Ugurlu, Arend Karrenbeld, Hans G. M. Burgerhof, Christel T Muijs, John T. M. Plukker, and Veronique E.M. Mul
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medicine.medical_specialty ,Neoplasm, Residual ,Esophageal Neoplasms ,Anatomic Site ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Submucosa ,medicine ,Humans ,Neoplasm Staging ,Tumor Regression Grade ,business.industry ,Chemoradiotherapy ,Chemoradiotherapy, Adjuvant ,Esophageal cancer ,medicine.disease ,Carboplatin ,Neoadjuvant Therapy ,Surgery ,medicine.anatomical_structure ,Paclitaxel ,chemistry ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Lymph ,business - Abstract
Objective Neoadjuvant chemoradiotherapy followed by surgery establishes a considerable pathologic complete response (pCR) in EC. The aim was to determine site of residual tumor and its prognostic impact. Summary background data High rates of residual tumor in the adventitial region even inside the radiation fields will influence current decision-making. Methods We evaluated resection specimens with marked target fields from 151 consecutive EC patients treated with carboplatin/paclitaxel and 41.4Gy between 2009 and 2018. Results In radically resected (R0) specimens 19.8% (27/136) had a pCR (ypT0N0) and 14% nearly no response (tumor regression grade: tumor regression grade 4-5). Residual tumor commonly extended in or restricted to the adventitia (43.1%; 47/109), whereas 7.3% was in the mucosa (ypT1a), 16.5% in the submucosa (ypT1b) and 6.4% only in lymph nodes (ypT0N+). Macroscopic residues in R0-specimens of partial responders (tumor regression grade 2-3: N = 90) were found in- and outside the gross tumor volume (GTV) in 33.3% and 8.9%, and only microscopic in- and outside the clinical target volume in 58.9% and 1.1%, respectively. Residual nodal disease was observed proximally and distally to the clinical target volume in 2 and 5 patients, respectively. Disease Free Survival decreased significantly if macroscopic tumor was outside the GTV and in ypT2-4aN+. Conclusions After neoadjuvant chemoradiotherapy, pCR and ypT1aN0 were seen in a limited number of R0 resected specimens (19.8% and 7.3%, respectively), whereas 6.4% had only nodal disease (yT0N+). Disease Free Survival decreased significantly if macroscopic residue was outside the GTV and in responders with only nodal disease. Therefore, we should be cautious in applying wait and see strategies. more...
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- 2020
11. The role of mindfulness and self-compassion in depressive symptoms and affect: A Comparison between Cancer Patients and Healthy Controls
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Robbert Sanderman, Loek J. van der Donk, Maya J. Schroevers, Joke Fleer, Veronique E.M. Mul, Adelita V. Ranchor, Ans Smink, Annika Tovote, Health Psychology Research (HPR), Lifelong Learning, Education & Assessment Research Network (LEARN), Clinical Psychology and Experimental Psychopathology, Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Psychology, Health & Technology more...
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050103 clinical psychology ,Health (social science) ,Mindfulness ,animal structures ,Social Psychology ,UT-Hybrid-D ,Five Facet Mindfulness Questionnaire ,QUESTIONNAIRE ,050109 social psychology ,Experimental and Cognitive Psychology ,Affect (psychology) ,Stress ,VALIDATION ,Social support ,Quality of life ,QUALITY-OF-LIFE ,Developmental and Educational Psychology ,medicine ,0501 psychology and cognitive sciences ,Applied Psychology ,SCALE ,DISPOSITIONAL MINDFULNESS ,05 social sciences ,Depressive symptoms ,STRESS REDUCTION INTERVENTION ,Cancer ,ASSOCIATION ,Center for Epidemiologic Studies Depression Scale ,Case-control ,medicine.disease ,Affect ,INDIVIDUALS ,PSYCHOMETRIC PROPERTIES ,Psychology ,SOCIAL SUPPORT ,Self-compassion ,Buffer ,Clinical psychology - Abstract
Objectives Mindfulness and self-compassion are related to psychological well-being and can be regarded as personal resources. It is, however, unclear whether these resources are always beneficial (direct effect) or only in stressful circumstances (buffer effect). We therefore examined whether mindfulness and self-compassion are equally or more strongly related to depressive symptoms and affect in cancer patients, compared to healthy controls. Methods Using a case-control design, 245 cancer patients were matched to 245 healthy controls (without chronic somatic comorbidities). Both groups filled out questionnaires concerning mindfulness (Five Facet Mindfulness Questionnaire), self-compassion (Self-Compassion Scale), depressive symptoms (Center for Epidemiologic Studies Depression Scale), and affect (Positive and Negative Affect Scale). Using correlation and regression analyses, we examined within both groups the associations for mindfulness (i.e., total score and five facets) and self-compassion (i.e., total score, two factors and six facets) with depressive symptoms and affect. Results Mindfulness and self-compassion were equally strongly related to depressive symptoms and affect in cancer patients versus healthy controls. Mindfulness facets Act with awareness and Non-judgment were strongly related to depressive symptoms, negative affect, and the negative self-compassion factor. In contrast, mindfulness facets Describe and Observe were strongly related to positive affect and the positive self-compassion factor. When distinguishing the six self-compassion facets, Isolation and Mindfulness were strongly related to depressive symptoms, Over-identification to negative affect, and Mindfulness to positive affect. Conclusions Results suggest that mindfulness and self-compassion are basic human personal resources associated with psychological functioning, regardless of the presence or absence of stressful life experiences. more...
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- 2020
12. Prediction of Response to Neoadjuvant Chemotherapy and Radiation Therapy with Baseline and Restaging F-18-FDG PET Imaging Biomarkers in Patients with Esophageal Cancer
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Roelof J. Beukinga, Walter Noordzij, Jan Binne Hulshoff, Gursah Kats-Ugurlu, John T. M. Plukker, Riemer H. J. A. Slart, Veronique E.M. Mul, Biomedical Photonic Imaging, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Cardiovascular Centre (CVC), Translational Immunology Groningen (TRIGR), and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) more...
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medicine.medical_specialty ,medicine.medical_treatment ,RECURRENCE PATTERN ,TEXTURAL FEATURES ,030218 nuclear medicine & medical imaging ,18f fdg pet ,03 medical and health sciences ,0302 clinical medicine ,Radiomics ,Quantitative assessment ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,HETEROGENEITY ,JUNCTIONAL CANCER ,Chemotherapy ,business.industry ,Retrospective cohort study ,PATHOLOGICAL RESPONSE ,Esophageal cancer ,medicine.disease ,Radiation therapy ,CHEMORADIATION THERAPY ,GUIDE TREATMENT ,030220 oncology & carcinogenesis ,TUMOR RESPONSE ,FDG PET ,Radiology ,business ,PREOPERATIVE CHEMORADIOTHERAPY - Abstract
Purpose: To assess the value of baseline and restaging fluorine 18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography (PET) radiomics in predicting pathologic complete response to neoadjuvant chemotherapy and radiation therapy (NCRT) in patients with locally advanced esophageal cancer.Materials and Methods: In this retrospective study, 73 patients with histologic analysisconfirmed T1/N1-3/M0 or T2-4a/N0-3/M0 esophageal cancer were treated with NCRT followed by surgery (Chemoradiotherapy for Esophageal Cancer followed by Surgery Study regimen) between October 2014 and August 2017. Clinical variables and radiomic features from baseline and restaging F-18-FDG PET were selected by univariable logistic regression and least absolute shrinkage and selection operator. The selected variables were used to fit a multivariable logistic regression model, which was internally validated by using bootstrap resampling with 20 000 replicates. The performance of this model was compared with reference prediction models composed of maximum standardized uptake value metrics, clinical variables, and maximum standardized uptake value at baseline NCRT radiomic features. Outcome was defined as complete versus incomplete pathologic response (tumor regression grade 1 vs 2-5 according to the Mandard classification).Results: Pathologic response was complete in 16 patients (21.9%) and incomplete in 57 patients (78.1%). A prediction model combining clinical T-stage and restaging NCRT (post-NCRT) joint maximum (quantifying image orderliness) yielded an optimism-corrected area under the receiver operating characteristics curve of 0.81. Post-NCRT joint maximum was replaceable with five other redundant post-NCRT radiomic features that provided equal model performance. All reference prediction models exhibited substantially lower discriminatory accuracy.Conclusion: The combination of clinical T-staging and quantitative assessment of post-NCRT F-18-FDG PET orderliness (joint maximum) provided high discriminatory accuracy in predicting pathologic complete response in patients with esophageal cancer. more...
- Published
- 2018
13. Impact of Endoscopic Ultrasonography on 18F-FDG-PET/CT Upfront Towards Patient Specific Esophageal Cancer Treatment
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Jean-Pierre E. N. Pierie, Veronique E.M. Mul, V. Oppedijk, H. M. van Dullemen, Walter Noordzij, John T. M. Plukker, Wouter B. Nagengast, Tijmen Korteweg, H. E. M. de Boer, J. Hulshoff, Vascular Ageing Programme (VAP), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Lifelong Learning, Education & Assessment Research Network (LEARN), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), and Center for Liver, Digestive and Metabolic Diseases (CLDM) more...
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Male ,Esophageal Neoplasms ,ACCURACY ,medicine.medical_treatment ,Endosonography ,0302 clinical medicine ,Surgical oncology ,Positron Emission Tomography Computed Tomography ,Antineoplastic Combined Chemotherapy Protocols ,Lymph node ,ULTRASOUND ,EUS ,medicine.diagnostic_test ,Esophageal cancer ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Survival Rate ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,030211 gastroenterology & hepatology ,Female ,Radiology ,medicine.medical_specialty ,CARCINOMA ,Biopsy, Fine-Needle ,Adenocarcinoma ,03 medical and health sciences ,Fluorodeoxyglucose F18 ,Biopsy ,MANAGEMENT ,medicine ,Carcinoma ,Humans ,Thoracic Oncology ,Survival rate ,Aged ,Retrospective Studies ,business.industry ,PERFORMANCE ,medicine.disease ,digestive system diseases ,Radiation therapy ,Lymph Node Excision ,Surgery ,Lymphadenectomy ,business ,Follow-Up Studies - Abstract
INTRODUCTION: In patients with potentially resectable esophageal cancer (EC), the value of endoscopic ultrasonography (EUS) after fluorine-18 labeled fluorodeoxyglucose positron emission tomography with computed tomography ((18)F-FDG-PET/CT) is questionable. Retrospectively, we assessed the impact of EUS after PET/CT on the given treatment in EC patients.METHODS: During the period 2009-2015, 318 EC patients were staged as T1-4aN0-3M0 with hybrid (18)F-FDG-PET/CT or (18)F-FDG-PET with CT and EUS if applicable in a nonspecific order. We determined the impact of EUS on the given treatment in 279 patients who also were staged with EUS. EUS had clinical consequences if it changed curability, extent of radiation fields or lymph node resection (AJCC stations 2-5), and when the performed fine-needle aspiration (FNA) provided conclusive information of suspicious lymph node.RESULTS: EUS had an impact in 80 (28.7%) patients; it changed the radiation field in 63 (22.6%), curability in 5 (1.8%), lymphadenectomy in 48 (17.2%), and FNA was additional in 21 (7.5%). In patients treated with nCRT (n = 194), EUS influenced treatment in 53 (27.3%) patients; in 38 (19.6%) the radiation field changed, in 3 (1.5%) the curability, in 35 (18.0%) the lymphadenectomy, and in 17 (8.8%) FNA was additional. EUS influenced both the extent of radiation field and nodal resection in 31 (16.0%) nCRT patients.CONCLUSIONS: EUS had an impact on the given treatment in approximately 29%. In most patients, the magnitude of EUS found expression in the extent of radiotherapy target volume delineation to upper/high mediastinal lymph nodes. more...
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- 2017
14. Society of Surgical Oncology 70th Annual Cancer Symposium
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J. Hulshoff, H. M. van Dullemen, Veronique E.M. Mul, Tijmen Korteweg, John T. M. Plukker, Geke A. P. Hospers, Willemieke P M Dijksterhuis, and Gursah Kats-Ugurlu
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medicine.medical_specialty ,Univariate analysis ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,Esophageal cancer ,medicine.disease ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Esophagectomy ,Medicine ,Adenocarcinoma ,Surgery ,Radiology ,business ,Chemoradiotherapy ,030215 immunology ,Cancer staging - Abstract
Background: Although essential in treatment decision making, clinical nodal (cN) staging in esophageal cancer (EC) remains difficult. We assessed the rate of nodal up- and downstaging and its prognostic value on 5-year disease-free survival (DFS) in EC patients treated with surgery-alone or with neoadjuvant chemoradiotherapy (nCRT). Methods: For this retrospective study, we included 395 EC patients who underwent a curative esophagectomy with or without nCRT between 2000 and 2015. The surgery-alone and nCRT group were matched on clinical T-stage (cT), cN-stage, and histopathological type using propensity score matching (n=270). Staging consisted of PET with CT, or PET/CT, and endoscopic ultrasonography (n = 235). We compared cN and pathological N-stage (pN) and scored correct, down- and upstaging. The prognostic value of nodal up- and downstaging and localization of node metastases on 5-year DFS were assessed with multivariate Cox regression analysis (factors with a P-value 25% nodal downstaging. This inaccuracy might impede assessment of true nodal response to nCRT, affording dubious decisions for a 'wait-and-see' strategy. more...
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- 2017
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15. Reliability of clinical nodal status regarding response to neoadjuvant chemoradiotherapy compared with surgery alone and prognosis in esophageal cancer patients
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Veronique E.M. Mul, Tijmen Korteweg, Willemieke P M Dijksterhuis, Gursah Kats-Ugurlu, John T. M. Plukker, Johannes G. M. Burgerhof, Jan Binne Hulshoff, Geke A. P. Hospers, Hendrik M. van Dullemen, Life Course Epidemiology (LCE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Center for Liver, Digestive and Metabolic Diseases (CLDM) more...
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Male ,Endoscopic ultrasound ,medicine.medical_specialty ,Esophageal Neoplasms ,IMPACT ,medicine.medical_treatment ,STAGING ACCURACY ,THERAPY ,Disease-Free Survival ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,CHEMORADIATION ,0302 clinical medicine ,medicine ,Carcinoma ,Humans ,ENDOSCOPIC ULTRASOUND ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Neoadjuvant therapy ,Aged ,Neoplasm Staging ,LYMPH-NODES ,medicine.diagnostic_test ,business.industry ,ADENOCARCINOMA ,Chemoradiotherapy ,Hematology ,General Medicine ,ASSOCIATION ,Middle Aged ,Esophageal cancer ,Prognosis ,medicine.disease ,Neoadjuvant Therapy ,Surgery ,Esophagectomy ,Oncology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,SURVIVAL ,Adenocarcinoma ,Female ,business ,PREOPERATIVE CHEMORADIOTHERAPY - Abstract
Background: Clinical nodal (cN) staging is a key element in treatment decisions in patients with esophageal cancer (EC). The reliability of cN status regarding the effect on response and survival after neoadjuvant chemoradiotherapy (nCRT) with esophagectomy was evaluated in determining the up- and downstaged pathological nodal (pN) status after surgery alone. Material and methods: From a prospective database, we included all 395 EC patients who had surgery with curative intent with or without nCRT between 2000 and 2015. All patients were staged by a standard pretreatment protocol: 16-64 mdCT, 18 F-FDG-PET or 18 F-FDG-PET/CT and EUS ± FNA. After propensity score matching on baseline clinical tumor and nodal (cT/N) stage and histopathology, a surgery-alone and nCRT group (each N = 135) were formed. Clinical and pathological N stage was scored as equal (cN = pN), downstaged (cN > pN) or upstaged (cN p value Results: The surgery-alone and nCRT group did not differ in cT/N status. Pathologic examination revealed equal staging (32 vs. 27%), nodal up (43 vs. 16%) and downstaging (25 vs. 56%), respectively (p p = .002) and lymph-angioinvasion (p = .016) in surgery-alone, and upper abdominal cN metastases (p = .012) and lymph node ratio (p = .034) in the nCRT group. Conclusions: Despite modern staging methods, correct cN staging remains difficult in EC. Nodal overstaging (cN > pN) occurred more often than understaging impeding an adequate assessment of pathologic complete response and prognosis after nCRT. Preoperative assessment of true nodal response after nCRT in EC remains difficult with clinical nodal upstaging (16% vs. 43%) and downstaging (56% vs. 25%) after nCRT and surgery alone, respectively. more...
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- 2019
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16. Longitudinal analysis of cytokine expression during neoadjuvant chemoradiotherapy and subsequent surgery in esophageal cancer patients
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Veronique E.M. Mul, Michel Struys, Geke A. P. Hospers, Johannes G. M. Burgerhof, Maarten W. N. Nijsten, Da Wang, John T. M. Plukker, Dirk J. Bosch, Microbes in Health and Disease (MHD), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Life Course Epidemiology (LCE), and Damage and Repair in Cancer Development and Cancer Treatment (DARE) more...
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Male ,Esophageal Neoplasms ,PREDICTION ,Colorectal cancer ,medicine.medical_treatment ,Cohort Studies ,0302 clinical medicine ,Longitudinal Studies ,Prospective Studies ,IMMUNE-RESPONSES ,Chemoradiotherapy ,General Medicine ,Middle Aged ,CHEMOTHERAPY ,Esophageal cancer ,Prognosis ,Combined Modality Therapy ,Neoadjuvant Therapy ,Neoadjuvant chemoradiotherapy ,Treatment Outcome ,Cytokine ,Esophagectomy ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,SURVIVAL ,Cytokines ,Female ,SQUAMOUS-CELL CARCINOMA ,ACTIVATING-FACTOR RECEPTOR ,medicine.medical_specialty ,Adenocarcinoma ,Disease-Free Survival ,Statistics, Nonparametric ,03 medical and health sciences ,Biomarkers, Tumor ,medicine ,Humans ,In patient ,RECTAL-CANCER ,Aged ,Chemotherapy ,business.industry ,Cytokine expression ,030208 emergency & critical care medicine ,medicine.disease ,Survival Analysis ,Surgery ,business ,PREOPERATIVE CHEMORADIOTHERAPY - Abstract
BACKGROUND: The purpose of this study was to provide more insight in the course of cytokine concentrations related to pathologic response (pR) and complications after neoadjuvant chemoradiotherapy (NCRT) and esophagectomy in esophageal cancer patients.METHODS: Patients treated with NCRT followed by transthoracic esophagectomy (n = 35) or transthoracic esophagectomy alone (n = 8) were included. Eight different cytokine concentrations were determined during NCRT, esophagectomy, and the first postoperative week.RESULTS: Platelet-activating factor before NCRT was associated with pR (P = .011) and remained elevated in patients with a better response. Concentrations of intestinal fatty acid-binding protein and angiopoietin 1 (Ang-1) were different between patients with and without NCRT. Decreased concentrations of Ang-1 on the third postoperative day were associated with postoperative complications (P = .046).CONCLUSIONS: In this observational study, elevated platelet-activating factor concentrations before NCRT were associated with pR. NCRT is associated with decreased Ang-1 concentrations, whereas reduced Ang-1 concentrations were associated with postoperative complications. (C) 2016 Elsevier Inc. All rights reserved. more...
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- 2016
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17. EP-1392 Preoperative image-guided identification of response to nCRT in esophageal cancer (PRIDE study)
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Francine E.M. Voncken, Veronique E.M. Mul, H.W.M. van Laarhoven, Gert J. Meijer, H. Langendijk, Ingmar L. Defize, Marcel Verheij, and Alicia S Borggreve
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medicine.medical_specialty ,Pride ,business.industry ,media_common.quotation_subject ,Hematology ,Esophageal cancer ,medicine.disease ,Oncology ,medicine ,Radiology, Nuclear Medicine and imaging ,Identification (biology) ,Radiology ,business ,media_common - Published
- 2019
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18. CD44, SHH and SOX2 as novel biomarkers in esophageal cancer patients treated with neoadjuvant chemoradiotherapy
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Arend Karrenbeld, Justin K. Smit, Veronique E.M. Mul, John T. M. Plukker, Kirill Pavlov, Johannes G. M. Burgerhof, Frank A.E. Kruyt, Coby Meijer, Jan H. Kleibeuker, Zohra Faiz, Geke A. P. Hospers, Judith Honing, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Life Course Epidemiology (LCE), and Damage and Repair in Cancer Development and Cancer Treatment (DARE) more...
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Male ,Oncology ,EXPRESSION ,medicine.medical_specialty ,PROGNOSIS ,Esophageal Neoplasms ,PREDICTION ,medicine.medical_treatment ,Disease-Free Survival ,STEM-CELL MARKERS ,Internal medicine ,Biomarkers, Tumor ,medicine ,Humans ,Hedgehog Proteins ,Radiology, Nuclear Medicine and imaging ,Esophageal ,Neoadjuvant therapy ,Aged ,Retrospective Studies ,Cancer ,HEDGEHOG ,Proportional hazards model ,business.industry ,SOXB1 Transcription Factors ,Stem cell biomarkers ,Retrospective cohort study ,ADENOCARCINOMA ,Chemoradiotherapy, Adjuvant ,Hematology ,Chemoradiotherapy ,Middle Aged ,Esophageal cancer ,medicine.disease ,Neoadjuvant Therapy ,Neoplasm Proteins ,Radiation therapy ,Hyaluronan Receptors ,Treatment Outcome ,BARRETTS-ESOPHAGUS ,Adenocarcinoma ,Female ,Neoadjuvant ,business ,PREOPERATIVE CHEMORADIOTHERAPY ,RADIOTHERAPY - Abstract
Background and purpose: Neoadjuvant chemoradiotherapy (nCRT) improves survival in esophageal cancer (EC) patients, but the response to treatment is heterogeneous and little is known regarding prognostic and predictive markers in these patients. CD44, SOX2 and SHH have been implicated in resistance to CRT, possibly through an association with a cancer stem cell phenotype.Material and methods: 101 EC patients treated with nCRT and surgery were included. Sufficient pretreatment biopsy material was present in 71 patients, of which 53 patients were non-complete responders on nCRT (nCR). Protein expression was examined using immunohistochemistry (IHC). Prognostic factors were determined using Cox regression analysis for disease free survival (DFS) and cause specific survival (CSS) in the complete cohort, the pre-treatment biopsies group and post-treatment nCR group.Results: Low CD44 expression in the nCR group was an independent prognostic factor for both DFS and CSS (DFS HR 2.81, p = 0.002 and CSS HR 3.48, p = 0.002). Absent SOX2 expression in pretreatment biopsies was related to systemic recurrence (p = 0.029) while low,SHH in pretreatment biopsies was an independent prognostic factor for a poor DES (HR 2.27, p = 0.036). No relation between marker expression and response to nCRT was observed.Conclusions: Low expression of CD44 and SHH are associated with a poor survival outcome in EC patients treated with nCRT. (C) 2015 Elsevier Ireland Ltd. All rights reserved. more...
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- 2015
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19. Predicting response to neoadjuvant chemoradiotherapy in esophageal cancer with textural features derived from pre-treatment 18F-FDG PET/CT imaging
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John T. M. Plukker, Johannes G. M. Burgerhof, Cornelis H. Slump, Veronique E.M. Mul, Roelof J. Beukinga, Gursah Kats-Ugurlu, Christina T. Muijs, Lisanne V. van Dijk, J. Hulshoff, Riemer H. J. A. Slart, Biomedical Photonic Imaging, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Life Course Epidemiology (LCE), Vascular Ageing Programme (VAP), Cardiovascular Centre (CVC), Translational Immunology Groningen (TRIGR), and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) more...
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medicine.medical_specialty ,medicine.medical_treatment ,TUMOR HETEROGENEITY ,HYPOXIA ,Logistic regression ,CLASSIFICATION ,030218 nuclear medicine & medical imaging ,METIS-320193 ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,textural analysis ,POSITRON-EMISSION-TOMOGRAPHY ,medicine ,Radiology, Nuclear Medicine and imaging ,esophageal cancer ,FDG-PET ,Tumor Regression Grade ,medicine.diagnostic_test ,business.industry ,PATHOLOGICAL RESPONSE ,Esophageal cancer ,medicine.disease ,F-18-FDG PET/CT ,Carboplatin ,CHEMORADIATION THERAPY ,chemistry ,Positron emission tomography ,Esophagectomy ,030220 oncology & carcinogenesis ,SURVIVAL ,T-stage ,response prediction ,Radiology ,SQUAMOUS-CELL CARCINOMA ,Nuclear medicine ,business ,PREOPERATIVE CHEMORADIOTHERAPY ,Predictive modelling - Abstract
Adequate prediction of tumor response to neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer (EC) patients is important in a more personalized treatment. The current best clinical method to predict pathologic complete response is SUVmax in F-18-FDG PET/ CT imaging. To improve the prediction of response, we constructed a model to predict complete response to nCRT in EC based on pretreatment clinical parameters and F-18-FDG PET/CT-derived textural features. Methods: From a prospectively maintained single institution database, we reviewed 97 consecutive patients with locally advanced EC and a pretreatment F-18-FDG PET/CT scan between 2009 and 2015. All patients were treated with nCRT (carboplatin/paclitaxe1/41.4 Gy) followed by esophagectomy. We analyzed clinical, geometric, and pretreatment textural features extracted from both F-18-FDG PET and CT. The current most accurate prediction model with SUVmax as a predictor variable was compared with 6 different response prediction models constructed using least absolute shrinkage and selection operator regularized logistic regression. Internal validation was performed to estimate the model's performances. Pathologic response was defined as complete versus incomplete response (Mandard tumor regression grade system 1 vs. 2-5). Results: Pathologic examination revealed 19 (19.6%) complete and 78 (80.4%) incomplete responders. Least absolute shrinkage and selection operator regularization selected the clinical parameters: histologic type and clinical T stage, the 18F-FDG PET-derived textural feature long run low gray level emphasis, and the CT-derived textural feature run percentage. Introducing these variables to a logistic regression analysis showed areas under the receiver-operating-characteristic curve (AUCs) of 0.78 compared with 0.58 in the SUVmax model. The discrimination slopes were 0.17 compared with 0.01, respectively. After internal validation, the AUCs decreased to 0.74 and 0.54, respectively. Conclusion: The predictive values of the constructed models were superior to the standard method (SUVmax). These results can be considered as an initial step in predicting tumor re sponse to nCRT in locally advanced EC. Further research in refining the predictive value of these models is needed to justify omission of surgery. more...
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- 2017
20. Increased risk of thromboembolism in esophageal cancer patients treated with neoadjuvant chemoradiotherapy
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Quirine A. Van Dalfsen, Veronique E.M. Mul, John T. M. Plukker, Geke A. P. Hospers, Dirk J. Bosch, Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Damage and Repair in Cancer Development and Cancer Treatment (DARE) more...
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Male ,medicine.medical_specialty ,Esophageal Neoplasms ,Paclitaxel ,PULMONARY-EMBOLISM ,medicine.medical_treatment ,Deep vein ,Esophageal cancer ,Antineoplastic Agents ,Adenocarcinoma ,MULTIDETECTOR CT ,Carboplatin ,Endosonography ,EVENTS ,chemistry.chemical_compound ,Thromboembolism ,Humans ,Medicine ,Risk factor ,Aged ,Thromboembolic events ,VENOUS THROMBOEMBOLISM ,business.industry ,Radiotherapy Dosage ,Chemoradiotherapy ,General Medicine ,Perioperative ,Middle Aged ,CHEMOTHERAPY ,medicine.disease ,Thrombosis ,Neoadjuvant Therapy ,Pulmonary embolism ,Surgery ,Esophagectomy ,Neoadjuvant chemoradiotherapy ,medicine.anatomical_structure ,chemistry ,Multivariate Analysis ,business ,human activities - Abstract
BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) patients may increase the formation of thromboembolic events (TEEs). We analyzed the incidence and impact of TEEs in EC patients treated with platinum-based CRT.METHODS: A total of 336 patients with EC underwent an esophagectomy, of which 110 patients received neoadjuvant CRT (41.4 Gy with concurrent Carboplatin/Paclitaxel). Patients were matched based on pre- and perioperative characteristics.RESULTS: Preoperatively, 9 (8.2%) patients with neoadjuvant CRT (P = .004) were diagnosed with TEEs. Despite delay until surgery (P = .021), the postoperative course did not differ. In multivariate analysis, a history of deep vein thrombosis (P = .005) and neoadjuvant CRT (P = .004) were identified as risk factors. Postoperatively, there were no differences in TEEs (P = .560) observed. In multivariate analysis, a history of pulmonary embolism (P = .012) was identified as a risk factor for postoperative TEEs.CONCLUSIONS: Preoperatively, EC patients treated with neoadjuvant CRT have an increased risk to develop a TEE, especially those with a previous history of TEE. After surgery no increased incidence was observed. We recommend secondary prophylaxis during neoadjuvant treatment in this high-risk group. (C) 2014 Elsevier Inc. All rights reserved. more...
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- 2014
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21. Residual Tumor After Neoadjuvant Chemoradiation Outside the Radiation Therapy Target Volume
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Geke A. P. Hospers, Phillip Kluin, Justin K. Smit, Johannes A. Langendijk, Veronique E.M. Mul, Go M. van Dam, John T. M. Plukker, Jannet C. Beukema, Arend Karrenbeld, Christina T. Muijs, Microbes in Health and Disease (MHD), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Stem Cell Aging Leukemia and Lymphoma (SALL), and Targeted Gynaecologic Oncology (TARGON) more...
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Oncology ,Male ,Cancer Research ,Neoplasm, Residual ,Esophageal Neoplasms ,medicine.medical_treatment ,Radiotherapy Planning ,Carboplatin ,Computer-Assisted ,Antineoplastic Combined Chemotherapy Protocols ,80 and over ,Prospective Studies ,Prospective cohort study ,Adjuvant ,Aged, 80 and over ,Radiation ,Hazard ratio ,Esophageal cancer ,Middle Aged ,Prognosis ,Tumor Burden ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,Residual ,Carcinoma, Squamous Cell ,Adenocarcinoma ,Regression Analysis ,Female ,Radiology ,Anatomic Landmarks ,Adult ,medicine.medical_specialty ,Paclitaxel ,Disease-Free Survival ,Internal medicine ,medicine ,Carcinoma ,Chemotherapy ,Humans ,Radiology, Nuclear Medicine and imaging ,Esophagus ,Aged ,Neoplasm Staging ,business.industry ,Proportional hazards model ,Radiotherapy Planning, Computer-Assisted ,medicine.disease ,Radiation therapy ,Squamous Cell ,Neoplasm ,business - Abstract
Purpose/Objective(s): The aim of this study was to analyze the accuracy of gross tumor volume (GTV) delineation and clinical target volume (CTV) margins for neoadjuvant chemoradiation therapy (neo-CRT) in esophageal carcinoma at pathologic examination and to determine the impact on survival.Methods and Materials: The study population consisted of 63 esophageal cancer patients treated with neo-CRT. GTV and CTV borders were demarcated in situ during surgery on the esophagus, using anatomical reference points to provide accurate information regarding tumor location at pathologic evaluation. To identify prognostic factors for disease-free survival (DFS) and overall survival (OS), a Cox regression analysis was performed.Results: After resection, macroscopic residual tumor was found outside the GTV in 7 patients (11%). Microscopic residual tumor was located outside the CTV in 9 patients (14%). The median follow-up was 15.6 months. With multivariate analysis, only microscopic tumor outside the CTV (hazard ratio [HR], 4.96; 95% confidence interval [CI], 1.03-15.36), and perineural growth (HR, 5.77; 95% CI, 1.27-26.13) were identified as independent prognostic factors for OS. The 1-year OS was 20% for patients with tumor outside the CTV and 86% for those without (PConclusions: Microscopic tumor outside the CTV is associated with markedly worse OS after neo-CRT. This may either stress the importance of accurate tumor delineation or reflect aggressive tumor behavior requiring new adjuvant treatment modalities. (C) 2014 Elsevier Inc. more...
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- 2014
22. Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial?
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Robbert Sanderman, Veronique E.M. Mul, Ans Smink, Maya J. Schroevers, Grieteke Pool, Corinne van Scheppingen, and James C. Coyne
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medicine.medical_specialty ,business.industry ,Psychological intervention ,Experimental and Cognitive Psychology ,medicine.disease ,law.invention ,Clinical trial ,Psychiatry and Mental health ,Distress ,Breast cancer ,Oncology ,Randomized controlled trial ,law ,Physical therapy ,medicine ,Generalizability theory ,Intervention trial ,business ,Depression (differential diagnoses) - Abstract
ObjectivesPsychological interventions show greater efficacy when evaluated with distressed patients. We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem-solving therapy (PST), characteristics associated with enrolment, and time investment and challenges of implementing screening. MethodsThree medical settings implemented screening of patients, directly after cancer treatment (T1) and 2months later (T2), using Hopkins Symptom Checklist-25 and one question about need for services. Distressed patients indicating need for services were interviewed. Eligible patients were offered the possibility to participate in the trial. Consenting patients were randomized to PST or waitlist. ResultsAt T1, 366 of 970 screened patients (37%) scored above the cutoff and at T2, 208 of 689 screened patients (30%). At either or both T1 and T2, 423 patients reported distress, of whom 215 indicated need for services. Only 36 (4% of 970) patients consented to trial participation. Twenty-seven patients needed to be screened to recruit a single patient, with 17h required for each patient recruited. Barriers to screening were time constraints and negative attitudes of oncology staff towards screening. ConclusionsImplementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST, with need for services being much less than anticipated. Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients, which may lower generalizability. An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated, funded staff assistance. Copyright (c) 2013 John Wiley & Sons, Ltd. more...
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- 2013
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23. Knowledge of pain management in patients with painful bone metastases; A multicentre randomized trial on pain education
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Y. van der Linden, Anna K.L. Reyners, P. Westhoff, C. Rodenhuis, Jenske I. Geerling, A. de Graeff, E. de Nijs, T. Muilenburg, Veronique E.M. Mul, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Targeted Gynaecologic Oncology (TARGON), and Damage and Repair in Cancer Development and Cancer Treatment (DARE) more...
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medicine.medical_specialty ,Randomization ,business.industry ,Psychological intervention ,Hematology ,Pain management ,law.invention ,Oncology ,Randomized controlled trial ,law ,Structured interview ,Physical therapy ,Clinical endpoint ,Medicine ,Pain catastrophizing ,business ,Cancer pain - Abstract
Background: Education of patients regarding pain management may improve patient empowerment and, consequently, reduce pain intensity. To investigate the effect of education on pain intensity, a multicentre phase 3 study was conducted between 1-3-2011 and 1-4-2016. A total of 354 patients who received radiotherapy for painful bone metastases were randomized between nurse-led tailored education regarding pain management or care as usual. A worst pain score of ≥5 on a 0-10 numeric rating scale (NRS) was one of the inclusion criteria. The primary endpoint was pain intensity. Here we report on pain knowledge in patients randomized in the education arm.Methods: Patient characteristics, pain intensity (NRS) and patients' thoughts regarding pain management were assessed using a structured interview. This interview took place between randomization and start of radiotherapy. Patients were asked whether they completely agreed-completely disagreed on a 5 point Likert scale with the following statements 1) cancer pain can be relieved effectively 2) pain medication should be given only when pain is severe 3) most cancer patients will become addicted to pain medication 4) it is better to give the lowest amount of pain medication, so that larger doses can be used later if pain increases 5) it is better to give pain medication around the clock than only when needed 6) non-pharmacological interventions can relieve pain 7) patients are often overmedicated 8) use of pain medication can be changed without consulting a physician. Lack of knowledge was identified if they completely or fairly disagreed on statement 1, 5, 6 or, completely or fairly agreed on statement 2-4, 7 or 8.Results: 167 patients were interviewed, mean age 65 ±10 years. Mean worst pain at inclusion was 7.9 ±1.4. 52% of patients used strong opioids (WHO step 3). Most patients (91%) lacked knowledge of at least one statement (median 2, range 1-6). Lacks were found most frequently for statements 4 (69%), 2 (41%), 3 and 7 (both 28%). Patients' knowledge was best about statements 8 (77% disagreed), 5 (74% agreed) and 1 (73% agreed).Conclusions: Most patients lack sufficient knowledge on different topics of pain management, advocating tailored pain education. more...
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- 2016
24. Predicting response to neoadjuvant chemoradiotherapy in esophageal cancer by textural features derived from pretreatment FDG-PET scans
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Sanne van Dijk, Marianna Sijtsema, Johannes G. M. Burgerhof, Jan Binne Hulshoff, Veronique E.M. Mul, Kees Slump, Jorn Beukinga, Gursah Kats-Ugurlu, Riemer H. J. A. Slart, Christina T. Muijs, John T. M. Plukker, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Life Course Epidemiology (LCE), Cardiovascular Centre (CVC), Translational Immunology Groningen (TRIGR), and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) more...
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Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cancer ,Esophageal cancer ,medicine.disease ,Carboplatin ,Radiation therapy ,chemistry.chemical_compound ,Regimen ,Oncology ,chemistry ,Esophagectomy ,Positron emission tomography ,medicine ,Radiology ,Nuclear medicine ,business ,Neoadjuvant chemoradiotherapy - Abstract
93 Background: 18-F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is currently the imaging method of choice in assessing response of neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer (EC) patients. PET/CT derived texture analysis is potentially more useful than common PET/CT measurements in response assessment and might also be of predictive value in different cancer types. The aim of this study was to develop a model to predict response to nCRT in EC based on pretreatment FDG-PET derived textural features in combination with clinical parameters. Methods: We reviewed 80 locally advanced EC patients who underwent pretreatment FDG-PET/CT and radiation planning CT scans between 2009 and 2015. Patients received nCRT according to the CROSS regimen (carboplatin/paclitaxel/41.4Gy) followed by esophagectomy. We analyzed 7 clinical, 16 geometry-based, and 87 different texture features derived from pretreatment FDG-PET images of the radiotherapy gross tumor volume. Ordinal logistic regression analysis was performed to construct a prediction model for treatment response, which was pathologically classified in complete, partial and no response on the Mandard tumor regression grade (1 vs. 2-3 vs. 4-5). The performance of this model was estimated by comparison with clinical outcome. Results: Pathologic examination revealed 16 (20.0%) complete, 46 (57.5%) partial, and 18 (22.5%) non- responders. Response analysis yielded the following independent predictive textural features: SUVmin, small zone low gray level emphasis, and contrast; and the independent predictive clinical parameters: nodal stage, endoscopic tumor length, and gender. The model has a sensitivity/specificity, positive/negative predictive value, and accuracy of 69%/97%, 85%/93%, and 91% for the prediction of complete response and 61%/79%, 46%/88%, and 75% for non-response, respectively. Conclusions: The prediction model constructed in this study, shows a good overall performance level in predicting response to nCRT in EC patients, but requires further external validation and refinement before it can be used for clinical decision making. more...
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- 2016
25. Survival after Definitive (Chemo)Radiotherapy in Esophageal Cancer Patients: A Population-Based Study in the North-East Netherlands
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Geke A. P. Hospers, G. Paardekooper, Veronique E.M. Mul, Boukje A. C. van Dijk, Paul R. Timmer, Christina T. Muijs, Johannes A. Langendijk, Justin K. Smit, Johannes G. M. Burgerhof, Dankert Woutersen, Karin Muller, John T. M. Plukker, Jannet C. Beukema, Faculteit Medische Wetenschappen/UMCG, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Life Course Epidemiology (LCE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Targeted Gynaecologic Oncology (TARGON) more...
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Male ,Oncology ,Esophageal Neoplasms ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Carboplatin ,Antineoplastic Combined Chemotherapy Protocols ,ONCOLOGY-GROUP ,Netherlands ,Aged, 80 and over ,education.field_of_study ,Hazard ratio ,RESECTABLE CANCER ,Radiotherapy Dosage ,PHASE-III TRIAL ,Chemoradiotherapy ,Middle Aged ,Esophageal cancer ,Tumor Burden ,Survival Rate ,Carcinoma, Squamous Cell ,Adenocarcinoma ,Female ,Fluorouracil ,SQUAMOUS-CELL CARCINOMA ,Adult ,medicine.medical_specialty ,Paclitaxel ,Population ,Disease-Free Survival ,RADIATION-THERAPY ,Internal medicine ,Confidence Intervals ,medicine ,Humans ,education ,neoplasms ,Survival rate ,METAANALYSIS ,Aged ,Proportional Hazards Models ,Proportional hazards model ,business.industry ,PERIOPERATIVE CHEMOTHERAPY ,ADENOCARCINOMA ,NEOADJUVANT CHEMORADIOTHERAPY ,medicine.disease ,Radiation therapy ,stomatognathic diseases ,Surgery ,Cisplatin ,Neoplasm Recurrence, Local ,business - Abstract
Definitive (chemo)radiotherapy is employed in esophageal cancer patients as an alternative for patients considered medically unfit for surgery or having unresectable tumors. We evaluated a population-based cohort to improve the selection for intensified nonsurgical strategies and to identify prognostic factors.Patients who had squamous cell carcinoma (SCC) or adenocarcinoma (AC) were treated in four referral centers in the north-east Netherlands with definitive chemoradiotherapy (dCRT) or radiotherapy (dRT) between 1996 and 2008.Of the 287 included patients, 110 were treated with dCRT and 177 with dRT. Median overall survival (OS) was 11 months (95 % confidence interval: 10-12 months), with OS of 22 and 8 % and disease-free survival (DFS) of 16 and 5 % at 2 and 5 years, respectively. DFS at 2 and 5 years was 24 and 9 % for SCC versus 10 and 2 % for AC patients (P = 0.006). OS after 2 and 5 years was 29 and 14 % for SCC patients versus 17 and 3 % for AC patients (P = 0.044). On multivariate Cox regression, SCC was an independent prognostic factor for DFS [P = 0.020, hazard ratio (HR) = 0.71] and OS (P = 0.047, HR = 0.76). On matched cohort analysis, DFS was higher in the dCRT group compared with dRT patients (P = 0.016). The locoregional failure rate was lower in the dCRT group and in SCC patients (P = 0.001 and 0.046).Long-term results and the local control rate in SCC patients were better after definitive (chemo)radiotherapy compared with in AC patients. SCC was an independent prognostic factor for survival. Definitive chemoradiotherapy leads to improved local control rate and DFS. more...
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- 2012
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26. External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma
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Veronique E.M. Mul, J. T. Plukker, Johannes A. Langendijk, Christina T. Muijs, Nanna M. Sijtsema, Jannet C. Beukema, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Targeted Gynaecologic Oncology (TARGON) more...
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Male ,Esophageal Neoplasms ,medicine.medical_treatment ,Esophageal cancer ,Brachytherapy ,PROGNOSTIC-FACTORS ,THORACIC ESOPHAGUS ,Treatment Failure ,COMBINED CHEMORADIOTHERAPY ,Aged, 80 and over ,Radiotherapy Dosage ,Hematology ,CHEMOTHERAPY ,Middle Aged ,CANCER ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,Intraluminal brachytherapy ,Female ,SQUAMOUS-CELL CARCINOMA ,medicine.medical_specialty ,Perforation (oil well) ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,External beam radiotherapy ,Esophagus ,DOSE-RATE BRACHYTHERAPY ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Pneumonitis ,Radiotherapy ,business.industry ,medicine.disease ,RANDOMIZED-TRIAL ,Surgery ,Radiation therapy ,Logistic Models ,Dose Fractionation, Radiation ,Neoplasm Recurrence, Local ,FOLLOW-UP ,Tomography, X-Ray Computed ,business ,Esophagitis ,DEFINITIVE RADIATION-THERAPY - Abstract
Purpose: To assess the effectiveness of definitive radiation therapy in patients with potentially curable esophageal cancer and to evaluate the side-effects of this treatment.Methods and materials: Sixty-two patients with esophageal cancer, who were treated with definitive, curatively intended radiotherapy consisting of external radiotherapy (60 Gy in 30 fractions), preceded and followed by LDR or HDR intraluminal brachy (12 Gy in 2 fractions) were retrospectively analyzed.Results: Recurrences were reported in 38 patients (61%), of which 25(64%) failed locally first.Results: The overall survival rates at 1,2 and 5 years were 57%, 34% and 11%, respectively. The median overall survival was 15 months. No prognostic factors could be identified. Most frequently reported treatment related toxicities were esophagitis, ulcerations, (11%) and strictures (16%). In 10 patients (16%) severe toxicities, were reported including grade III ulceration (2 cases), stricture (1 case), radiation pneumonitis (1 case), perforation (1 case), esophageal-pleural-tracheal fistula (1 case), and acute esophageal bleeding (4 cases). A history of gastrectomy was significantly associated with the development of severe toxicity.Conclusion: Curatively intended radiotherapy alone can be offered to esophageal cancer patients, even when surgery and/or chemotherapy are not feasible. However, we observed severe toxicity in a substantial part of the patients. Given the relatively high rate of severe complications and the uncertainties regarding dose escalation, the addition of brachytherapy, with consequently high surface doses, should be limited to well-selected patients. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 102 (2012) 303-308 more...
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- 2012
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27. OC-0389: Pain education of patients with painful bone metastases reduces pain; a multicentre randomized trial
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Y.M. van der Linden, Veronique E.M. Mul, G. H. de Bock, Jenske I. Geerling, E. de Nijs, Natasja J H Raijmakers, A. de Graeff, M. Oudhof, and An K.L. Reyners
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Oncology ,Radiology, Nuclear Medicine and imaging ,Hematology - Published
- 2018
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28. The effect of nurse-led pain education of patients with painful bone metastases on pain and quality of life: A multicenter randomized trial
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Veronique E.M. Mul, Marianne A Oudhof, Gertruida Hendrika de Bock, Natasja J H Raijmakers, Anna K.L. Reyners, Jenske I. Geerling, Yvette M. van der Linden, Ellen de Nijs, and Alexander de Graeff
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Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Pain management ,humanities ,law.invention ,Radiation therapy ,Nurse led ,Oncology ,Randomized controlled trial ,Quality of life ,law ,medicine ,Physical therapy ,Effective treatment ,business - Abstract
203 Background: Radiotherapy (RT) is an effective treatment for painful bone metastases, although pain is not always sufficiently controlled. Pain management education may improve patient empowerment and, consequently, reduce pain intensity. The effect of nurse-led education (NLE) in patients undergoing RT for painful bone metastases was investigated as compared to care as usual (CAU). Primary endpoint was pain intensity at 12 weeks, secondary outcome was quality of life (QoL). Methods: In this multicentre, randomised phase 3 study, patients referred for short schedule RT, with uncontrolled pain (a score of ≥5 on a 0-10 numeric rating scale (NRS)), were randomised between NLE or CAU before start of RT. The NLE consisted of a structured interview including assessment of pain knowledge, verbal and written education on all aspects of pain and follow-up phone calls at 1, 4, 8 & 12 weeks to address pain-related questions. Patients in CAU received leaflets on RT, cancer pain and opioid use. Patient characteristics were assessed at baseline. Pain intensity and QoL were evaluated with the Brief Pain Inventory, EORTC QLQ-C15-PAL and EORTC QLQ-BM22 at baseline, and week 1, 4, 8 & 12. Power calculation showed that there were 89 patients per arm needed to detect a 10% difference in number of patients with a NRS < 5 at 12 weeks(1-sided α = 0.05; β 0.8). Results: Between May 2011-April 2016, 354 patients were randomised (176 NLE, 178 CAU), 38 were excluded (30 NRS < 5 at baseline, 7 no short schedule RT, 1 missing informed consent). At twelve weeks, 185 (NLE 95) had completed follow-up (72 stopped filling out questionnaires, 59 died prematurely). Baseline characteristics were similar in both groups; mean age 65 years, 56% men. At week 12, more patients in NLE than in CAU had controlled pain (NRS < 5; respectively 66% and 52%, p = 0.036). Moreover, patients in NLE reached faster a pain score < 5 than patients in CAU (31 versus 54 days respectively, p = 0.026). On all time points, no significant differences in QoL were found between both groups. Conclusions: Controlled pain, i.e. a pain intensity < 5, was reached faster and by more patients with painful bone metastases undergoing RT by the addition of nurse-led pain education. Clinical trial information: NCT01358539. more...
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- 2017
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29. Impact of current 'insufficient' clinical nodal staging on treatment decisions and response to neoadjuvant chemoradiotherapy in esophageal cancer patients
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Veronique E.M. Mul, Johannes G. M. Burgerhof, Tijmen Korteweg, Willemieke P M Dijksterhuis, Gursah Kats-Ugurlu, John T. M. Plukker, Jan Binne Hulshoff, Geke A. P. Hospers, and Hendrik M. van Dullemen
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Cancer Research ,medicine.medical_specialty ,Univariate analysis ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Retrospective cohort study ,Esophageal cancer ,medicine.disease ,Surgery ,Oncology ,Esophagectomy ,Propensity score matching ,medicine ,Radiology ,business ,Pathological ,Neoadjuvant chemoradiotherapy - Abstract
111 Background: Although essential in treatment decision making, clinical nodal (cN) staging in esophageal cancer (EC) remains difficult. We assessed the rate of nodal up- and downstaging and its prognostic value on 5-year disease-free survival (DFS) in EC patients treated with surgery-alone or with neoadjuvant chemoradiotherapy (nCRT). Methods: For this retrospective study, we included 395 EC patients who underwent a curative esophagectomy with or without nCRT between 2000 and 2015. The surgery-alone and nCRT group were matched on clinical T-stage (cT), cN-stage, and histopathological type using propensity score matching ( n=270). Staging consisted of PET with CT, or PET/CT, and endoscopic ultrasonography (n = 235). We compared cN and pathological N-stage (pN) and scored correct, down- and upstaging. The prognostic value of nodal up- and downstaging and localization of node metastases on 5-year DFS were assessed with multivariate Cox regression analysis (factors with a P-value 25% nodal downstaging. This inaccuracy might impede assessment of true nodal response to nCRT, affording dubious decisions for a ‘wait-and-see’ strategy. more...
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- 2017
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30. Clinical validation of FDG-PET/CT in the radiation treatment planning for patients with oesophageal cancer
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Dankert Woutersen, Veronique E.M. Mul, Jan Pruim, Maaike J. Berveling, J. T. Plukker, Henk Groen, Johannes A. Langendijk, Geke A. P. Hospers, Eric J. van der Jagt, Christina T. Muijs, Jannet C. Beukema, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Targeted Gynaecologic Oncology (TARGON), Methods in Medicines evaluation & Outcomes research (M2O), Reproductive Origins of Adult Health and Disease (ROAHD), and Damage and Repair in Cancer Development and Cancer Treatment (DARE) more...
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Male ,THERAPY TARGET VOLUME ,Esophageal Neoplasms ,SURGERY ,medicine.medical_treatment ,Multimodal Imaging ,Medicine ,Prospective Studies ,Radiation treatment planning ,Prospective cohort study ,RESIDUAL TUMOR ,Aged, 80 and over ,Oesophageal cancer ,Radiotherapy Dosage ,Hematology ,Middle Aged ,TRIALS ,Oncology ,Female ,Radiology ,Tomography ,RADIOTHERAPY ,Adult ,medicine.medical_specialty ,Radiotherapy planning ,CARCINOMA ,Anastomosis ,Median follow-up ,NEOADJUVANT CHEMORADIATION ,Fluorodeoxyglucose F18 ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,RECURRENCE ,Aged ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Cancer ,medicine.disease ,FDG-PET/CT ,Radiation therapy ,Positron-Emission Tomography ,PROGNOSTIC-FACTOR ,Neoplasm Recurrence, Local ,Radiopharmaceuticals ,Radiotherapy, Conformal ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,PREOPERATIVE CHEMORADIOTHERAPY - Abstract
Background: The aim of this prospective study was to determine the proportion of locoregional recurrences (LRRs) that could have been prevented if radiotherapy treatment planning for oesophageal cancer was based on PET/CT instead of CT.Materials and methods: Ninety oesophageal cancer patients, eligible for high dose (neo-adjuvant) (chemo)radiotherapy, were included. All patients underwent a planning FDG-PET/CT-scan. Radiotherapy target volumes (TVs) were delineated on CT and patients were treated according to the CT-based treatment plans. The PET images remained blinded. After treatment, TVs were adjusted based on PET/CT, when appropriate. Follow up included CT-thorax/abdomen every 6 months. If LRR was suspected, a PET/CT was conducted and the site of recurrence was compared to the original TVs. If the LRR was located outside the CT-based clinical TV (CTV) and inside the PET/CT-based CTV, we considered this LRR possibly preventable.Results: Based on PET/CT, the gross tumour volume (GTV) was larger in 23% and smaller in 27% of the cases. In 32 patients (36%), >5% of the PET/CT-based GTV would be missed if the treatment planning was based on CT. The median follow up was 29 months. LRRs were seen in 10 patients (11%). There were 3 in-field recurrences, 4 regional recurrences outside both CT-based and PET/CT-based CTV and 3 recurrences at the anastomosis without changes in TV by PET/CT; none of these recurrences were considered preventable by PET/CT.Conclusion: No LRR was found after CT-based radiotherapy that could have been prevented by PET/Cf. The value of PET/CT for radiotherapy seems limited. (C) 2014 Elsevier Ireland Ltd. All rights reserved. more...
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- 2014
31. Different recurrence pattern after neoadjuvant chemoradiotherapy compared to surgery alone in esophageal cancer patients
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Jannet C. Beukema, Geke A. P. Hospers, Veronique E.M. Mul, John T. M. Plukker, Sahin Güler, Johannes G. M. Burgerhof, Justin K. Smit, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Life Course Epidemiology (LCE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Targeted Gynaecologic Oncology (TARGON) more...
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Male ,genetic structures ,Esophageal Neoplasms ,IMPACT ,medicine.medical_treatment ,Carboplatin ,chemistry.chemical_compound ,QUALITY-OF-LIFE ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Neoadjuvant therapy ,Aged, 80 and over ,COMPLETE RESPONSE ,Chemoradiotherapy ,Esophageal cancer ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Neoadjuvant Therapy ,Survival Rate ,Oncology ,Esophagectomy ,SURVIVAL ,Carcinoma, Squamous Cell ,Female ,Adult ,medicine.medical_specialty ,CARCINOMA ,Paclitaxel ,Adenocarcinoma ,Breast cancer ,BREAST-CANCER ,Humans ,Survival rate ,RECTAL-CANCER ,METAANALYSIS ,Aged ,Neoplasm Staging ,business.industry ,medicine.disease ,Surgery ,Regimen ,chemistry ,Neoplasm Recurrence, Local ,business ,PREOPERATIVE CHEMORADIOTHERAPY ,Follow-Up Studies - Abstract
To evaluate the rate and pattern of recurrences after neoadjuvant chemoradiotherapy (CRT) in esophageal cancer patients.We described survival and differences in recurrences from a single center between neoadjuvant CRT (carboplatin/paclitaxel and 41.4 Gy) and surgery alone for the period 2000-2011. To reduce bias, we performed a propensity score matched analysis.A total of 204 patients were analyzed, 75 treated with neoadjuvant CRT and 129 with surgery alone. The pathologic response to neoadjuvant CRT was 69 % with a complete response rate of 25 %. After matching, baseline characteristics between the groups (both n = 75) were equally distributed. The 3- and 5-year disease-free survival was 53 and 42 % in the neoadjuvant CRT group compared with 24 and 18 % in the surgery-alone group (P = 0.011). After 3 and 5 years' CRT, patients had an estimated locoregional recurrence-free survival of 83 and 73 % compared with 52 and 49 % in the surgery-alone group (P = 0.015). The distant recurrence-free survival was comparable in both groups. Locoregional recurrences were located less in the paraesophageal lymph nodes in the CRT group than in the surgery-alone group, 9 versus 21 %, respectively (P = 0.041). With respect to differences in distant recurrences, we observed more skeletal recurrences in the surgery-alone group compared to CRT, 12 versus 1 % (P = 0.009).The neoadjuvant CRT regimen we used offers a significant improvement in outcome, with a different recurrence pattern compared with surgery alone. This effect is probably due to both the pathologic complete response and eradication of micrometastases in CRT group. more...
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- 2013
32. The value of endoscopic ultrasonography in a PET/CT upfront model in staging esophageal cancer with respect to treatment decision
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Jan Binne Hulshoff, Hendrik M. van Dullemen, Hiske E.M. de Boer, Wouter B. Nagengast, Veronique E.M. Mul, John T. M. Plukker, and Walter Noordzij
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Cancer Research ,PET-CT ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Definitive chemoradiotherapy ,Endoscopic ultrasonography ,Esophageal cancer ,medicine.disease ,digestive system diseases ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Fine-needle aspiration ,Oncology ,Positron emission tomography ,030220 oncology & carcinogenesis ,medicine ,Radiology ,Treatment decision making ,business ,Nuclear medicine ,Lymph node - Abstract
25 Background: The optimal sequence of endoscopic ultrasonography (EUS) and positron emission tomography with computed tomography (PET/CT) in esophageal cancer (EC) is a matter of debate. The use of EUS with fine needle aspiration (FNA) after PET/CT seems to increase the efficacy of curative intended neoadjuvant or definitive chemoradiotherapy. Retrospectively, we assessed the impact of EUS in the PET/CT upfront model on the treatment decision making in EC patients. Methods: In the period 2009 to 2015, 298 EC patients were staged with hybrid PET/CT or PET with CT, and EUS if applicable, in a non-specific order to assess curability (T1-4a,N0-3M0). We determined the feasibility of EUS and whether the initial or additional EUS changed the primary decision suspicious incurable (T4b and M+) into curable disease or added extra nodal information leading to up/downstaging or exhibit suspected nodes at different lymph node stations. In addition, we assessed if EUS changed the radiation area (i.e. lymph nodes > 3.5 cm from the defined radiation target volumes) in the PET/CT “upfront model”. Results: EUS was complete in 185 (62.1%) and incomplete due to stricture from a relative obstructing tumor in 59 (19.8%) patients. Fifty-four patients (18.1%) did not receive EUS because of stenosis (n = 46; 15.4%), patient dependent reasons (n = 4; 1.3%) or other reasons (n = 4; 1.3%). EUS after hybrid PET/CT or PET with CT (n = 244) gave additional information in 166 patients (68.0%); it changed the curability in 4 (1.6%), lead to nodal up and downstaging in respectively, 81 (33.2%) and 27 (11.1%) patients, changed the number of or lymph node station of suspected lymph nodes in an additional 58 patients (n = 23.8%), and FNA gave additional information in 34 (13.9%) patients. EUS after PET/CT ”upfront” changed the treatment plan in 90 patients (36.9%), including alteration in the radiation field (86; 35.2%) and curability (4; 1.6%). Conclusions: EUS gave additional information after PET/CT “up front” and altered the radiation field in about one third of the EC patients, suggesting a better yield of “EUS on indication” after PET/CT upfront. more...
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- 2016
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33. Impact of neoadjuvant chemoradiotherapy on postoperative course after curative-intent transthoracic esophagectomy in esophageal cancer patients
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Johannes G. M. Burgerhof, Christina T. Muijs, John T. M. Plukker, Jannet C. Beukema, Dirk J. Bosch, Veronique E.M. Mul, Geke A. P. Hospers, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Life Course Epidemiology (LCE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Targeted Gynaecologic Oncology (TARGON) more...
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Male ,Esophageal Neoplasms ,Pleural effusion ,THERAPY ,law.invention ,Carboplatin ,CHEMORADIATION ,Postoperative Complications ,law ,Antineoplastic Combined Chemotherapy Protocols ,Prospective Studies ,Prospective cohort study ,RISK ,COMPLICATIONS ,Chemoradiotherapy ,CHEMOTHERAPY ,Esophageal cancer ,Middle Aged ,Prognosis ,Intensive care unit ,Combined Modality Therapy ,Survival Rate ,GASTROESOPHAGEAL JUNCTION ,Oncology ,Thoracotomy ,Carcinoma, Squamous Cell ,Female ,medicine.medical_specialty ,Paclitaxel ,HEART-DISEASE ,medicine ,Humans ,Adverse effect ,Survival rate ,METAANALYSIS ,Aged ,Neoplasm Staging ,business.industry ,Arrhythmias, Cardiac ,Odds ratio ,Pneumonia ,medicine.disease ,Surgery ,Esophagectomy ,Regimen ,Case-Control Studies ,business ,PREOPERATIVE CHEMORADIOTHERAPY ,Follow-Up Studies - Abstract
Background. Neoadjuvant chemoradiotherapy (CRT) improves locoregional control and overall survival in esophageal cancer patients. Although adverse events are relatively low during neoadjuvant CRT, severe postoperative adverse effects may occur, leading to morbidity and even mortality. We investigated the impact of a more frequently used neoadjuvant CRT regimen of 41.4 Gy/5 weeks radiotherapy with concurrent carboplatin and paclitaxel (CROSS schedule) on the postoperative course.Methods. Between 2006 and 2012, a total of 96 esophageal cancer patients (staged cT1N+/T2-4a/N0-3 and M0) were treated according to the above neoadjuvant scheme. To reduce bias in this single-center study, we performed a propensity score-matched analysis with patients who underwent surgery alone (n = 230) from a prospectively maintained database (n = 326).Results. Baseline characteristics between both groups were equally distributed in the matched cohort. In the neoadjuvant treated group, significantly more patients were diagnosed with pneumonia (27.1 vs. 51.0 %; p = 0.001), pleural effusion (12.5 vs. 24.0 %; p = 0.040), and arrhythmia (20.4 vs. 34.4 %; p = 0.008). In addition, in the multivariate analysis, neoadjuvant CRT was significantly associated with an increased risk of pneumonia (p = 0.001, odds ratio 2.896), pleural effusion (p = 0.041, odds ratio 2.268), and arrhythmia (p = 0.023, odds ratio 2.215). Despite these outcomes, no differences were detected in duration of intensive care unit or hospital stay. Short-term mortality did not differ between both groups.Conclusions. We observed an increase of cardiopulmonary complications in the neoadjuvant CRT group, without any effect on hospital or intensive care unit stay and mortality. Further research is warranted on the limitation of chemoradiation-induced cardiopulmonary toxicity. more...
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- 2012
34. Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer
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Ruud Houben, Martin Lacko, Veronique E.M. Mul, J. M. A. de Jong, P. van den Ende, Lars H.P. Murrer, Philippe Lambin, Brigitta G. Baumert, Radiotherapie, Ondersteunend personeel ODB, MUMC+: MA Keel Neus Oorheelkunde (9), RS: GROW - School for Oncology and Reproduction, and Damage and Repair in Cancer Development and Cancer Treatment (DARE) more...
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Central nervous system ,Myelitis ,TOXICITY ,Spinal Cord Diseases ,Lhermitte sign ,Myelopathy ,Disability Evaluation ,Cause of Death ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,TOLERANCE ,Head and neck cancer ,Radiation Injuries ,Survival rate ,Laryngeal Neoplasms ,Aged ,RISK ,Aged, 80 and over ,Radiotherapy ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Chronic progressive radiation myelopathy ,Radiotherapy Dosage ,Chemoradiotherapy, Adjuvant ,Middle Aged ,medicine.disease ,Spinal cord ,Spinal cord tolerance ,Combined Modality Therapy ,Surgery ,Radiation therapy ,Survival Rate ,Oropharyngeal Neoplasms ,medicine.anatomical_structure ,Oncology ,RADIATION MYELOPATHY ,Spinal Cord ,MYELITIS ,Female ,Radiotherapy, Adjuvant ,business ,Chemoradiotherapy ,Follow-Up Studies - Abstract
The goal of this work was to examine toxicity and risk factors after irradiation of the cervical spinal cord.A total of 437 patients irradiated for a laryngeal and oropharyngeal carcinoma were eligible (median follow-up 27 months). Spinal cord contouring was defined differently over time as anatomically defined spinal cord area (SCA) and the spinal cord on CT (SC) with a margin of 3 or 5 mm (SCP3/SCP5).None developed chronic progressive radiation myelopathy (CPRM) (maximum spinal dose 21.8-69 Gy); 3.9% (17/437) developed a Lhermitte sign (LS) with a median duration of 6 months (range 1-30 months) and was reversible in all patients. Risk factors for developing LS were younger age (52 vs. 61 years, p LS is more frequently observed in younger patients and in patients treated with accelerated radiotherapy. A dose-volume relationship was seen for V45 in the case of SCA. For higher doses, no clear dose-volume relationships were observed. more...
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- 2011
35. A systematic review on the role of FDG-PET/CT in tumour delineation and radiotherapy planning in patients with esophageal cancer
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Christina T. Muijs, J. T. Plukker, Henk Groen, Jannet C. Beukema, Jan Pruim, Veronique E.M. Mul, and Johannes A. Langendijk
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medicine.medical_specialty ,Radiotherapy planning ,CARCINOMA ,Esophageal Neoplasms ,IMPACT ,medicine.medical_treatment ,CELL LUNG-CANCER ,ACCURACY ,Esophageal cancer ,ADDITIONAL VALUE ,POSITRON-EMISSION-TOMOGRAPHY ,Fluorodeoxyglucose F18 ,Carcinoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,COMPUTED-TOMOGRAPHY ,Esophagus ,Radiation treatment planning ,METAANALYSIS ,Neoplasm Staging ,Fluorodeoxyglucose ,LYMPH-NODES ,medicine.diagnostic_test ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Retrospective cohort study ,Hematology ,medicine.disease ,FDG-PET/CT ,Radiation therapy ,medicine.anatomical_structure ,Treatment Outcome ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,Radiology ,business ,Tomography, X-Ray Computed ,medicine.drug ,CT - Abstract
Purpose: FDG-PET/CT has proven to be useful in the staging process of esophageal tumours. This review analysed the role of FDG-PET/CT in tumour delineation and radiotherapy planning in comparision with CT alone among patients with esophageal cancer. Thereby we focused on the detection of the primary tumour and lymph nodes by FDG-PET/CT, changes in target volume (TV) delineation base on FDG-PET/CT and its validity, changes in inter- and intra-observer variability in TV delineation, consequences for radiotherapy treatment planning with regard to either target volumes or organs at risk and finally on the validation of FDG-PET/CT-based TVs in terms of treatment outcome. Methods: A literature search was performed in MEDLINE and Cochrance library database for studies concerning the current value of FDG-PET/CT in tumour detection and delineation and radiotherapy-planning procedures among patients with esophageal cancer. Both prospective and retrospective studies were included. Results: fifty publications met the eligibility criteria, of which 19 were review papers and one was a case report. The remaining 30 publications reported on the results of original studies. FDG-PET was able to identify most primary tumours, with a sensitivity and specificity for the detection of metastatic lymph nodes of 30-93% and 79-100%. The use of FDG-PET/CT resulted in changes of target volumes, and consequently in changes in treatment planning. However, evidence supporting the validity the validity of the use of FDG-PET/CT in the tumour delineation process is very limited. Only three studies reported a significant positive correlation between FDG-PET-based tumour lengths and pathological findings. There were two studies that tested the influence of FDG-PET/CT to the inter- and intra-observer variability. One of them found a significant decrease in inter- and intra-observer variability, while the others did not. Furthermore, there are no studies demonstrating the use of PET/CT in terms of improved locoregional control or survival. Conclusion: Science the literature is very limited standard implementation of FDG-PET/CT into the tumour delineation process for radiation treatment seems unjustified and needs further clinical validation first. (C) Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 97 (2010) 165-171 more...
- Published
- 2009
36. In Response to: Study to determine adequate margins in radiotherapy planning for esophageal carcinoma by detailing patterns of recurrence after definitive chemoradiotherapy
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Johannes A. Langendijk, Veronique E.M. Mul, Jannet C. Beukema, Christina T. Muijs, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Targeted Gynaecologic Oncology (TARGON) more...
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Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Radiography ,Movement ,Tumor burden ,MEDLINE ,UNCERTAINTIES ,Neoplasm Recurrence ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiation ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Cancer ,Definitive chemoradiotherapy ,medicine.disease ,CANCER ,Surgery ,Tumor Burden ,Radiation therapy ,Oncology ,Radiology ,Neoplasm Recurrence, Local ,business - Published
- 2009
37. Radiation-induced bullous pemphigoid: a systematic review of an unusual radiation side effect
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Veronique E.M. Mul, Adrienne J. van Geest, Madelon Pijls-Johannesma, Jos J. Jager, Tom Verschueren, Brigitta G. Baumert, Philippe Lambin, and Jan Theys
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Oncology ,medicine.medical_specialty ,Pathology ,Pemphigoid ,Side effect ,Radiotherapy ,business.industry ,medicine.medical_treatment ,Radiation induced ,Breast Neoplasms ,Hematology ,medicine.disease ,Radiation therapy ,Breast cancer ,Anticancer treatment ,Internal medicine ,Pemphigoid, Bullous ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Female ,Bullous pemphigoid ,business - Abstract
Background Percutaneous radiotherapy (RT) may cause a range of acute and late side effects of the skin within the irradiated area. In rare cases radiotherapy can cause bullous pemphigoid (BP). BP is reported to occur mainly within irradiated fields following radiation treatment. Exceptionally, BP may arise during RT. It is unclear which mechanism exactly triggers BP following megavoltage irradiation and whether there is a potential association with hormonal anticancer treatment. Methods A systematic literature based review was performed. Publications reporting histologically confirmed BP and a treatment with RT were retrieved based on a standardized query using electronic databases. A standardized quality assessment was applied. Results Out of 306 potentially relevant publications 21 were identified to be relevant and included in this review. An association between RT and BP was reported in 27 patients. The majority developed BP after RT and a median dose of 50 Gy. Four patients developed BP during RT after a minimal dose of 20 Gy. Conclusions BP induced by RT was observed predominantly in patients with breast cancer. In all reported cases, there is a clear relationship with RT. Therefore, BP may be considered as RT-induced side effect. RT can induce a BP following a minimal dose of 20 Gy. New biological agents may play a role in the future treatment of BP. more...
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- 2006
38. PD-0456: Tumour outside the CTV decreases overall survival after neoadjuvant radiotherapy for oesophageal cancer
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Johannes A. Langendijk, G.M. van Dam, Veronique E.M. Mul, Christina T. Muijs, J. C. Beukema, J.T.H. Plukker, P.M. Kluin, Arend Karrenbeld, Geke A. P. Hospers, and Justin K. Smit
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Oncology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cancer ,Hematology ,medicine.disease ,Radiation therapy ,Radiology Nuclear Medicine and imaging ,Internal medicine ,Overall survival ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2013
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39. Definitive (chemo)radiotherapy in patients with esophageal cancer: A population-based study in northeast Netherlands
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Johannes A. Langendijk, Justin K. Smit, John T. M. Plukker, Jannet C. Beukema, Dankert Woutersen, Karin Muller, Veronique E.M. Mul, G. Paardekooper, Paul R. Timmer, Christina T. Muijs, Geesiena Hospers, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Targeted Gynaecologic Oncology (TARGON) more...
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Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Esophageal cancer ,medicine.disease ,Gastroenterology ,Surgery ,Population based study ,Radiation therapy ,stomatognathic diseases ,Oncology ,Internal medicine ,Cohort ,Medicine ,Adenocarcinoma ,In patient ,Stage (cooking) ,business ,Chemoradiotherapy - Abstract
83 Background: Definitive (chemo)radiation as primary treatment modality is offered to esophageal cancer (EC) patients, as an alternative for patients considered medically unfit for surgery or having irresectable tumors. We evaluated the results in our cohort to improve selection of patients for intensified non-surgical strategies and to identify which clinical factors have a prognostic impact on the overall (OS) and disease free survival (DFS). Methods: EC patients treated with definitive radiotherapy (RT) or chemoradiotherapy (CRT) from 4 radiotherapy referral centers between 1996 and 2008 were used. Only patients with squamouscellcarcinoma (SCC) or adenocarcinoma (AC) were included in the analyses. Results: In total 278 patients were identified of whom 106 (38.1%) were treated with CRT (platinum based, median 50.4 (46.8 – 70)Gy) and 172 (61.9%) with RT alone (median 60 (40-70)Gy). T- stage was cT1=5.6%;cT2=15.3%;cT3=60.9% and cT4=18.2%. Nodal stage consisted of cN0=35%;cN1=65%, including cM1a=5.8%. The male/female ratio was 78.3% to 21.7%. AC occurred in 57.6% and 42.4% had a SCC. The median age was 69 years. Median OS time was 11 (1-166) months with an OS of 45%, 22% and 6% and a DFS of 32%, 18% and 6% at 1, 2 and 5 years, respectively. There was no significant difference between the CRT and RT group in OS (p=0.09) and DFS (p=0.17). The DFS after 2 and 5 year was 25% and 12% for SCC patients versus 11% and 0% for AC patients (p=0.007). The OS at 2 and 5 year was 28% and 11% for SCC versus 14% and 0% for AC patients (p=0.020). Initial recurrence was seen locoregionally in 66.7% and distant metastases occurred in 33.3%. Common sites for distant recurrence were the liver with 52.4%, 17.5% bones and 15.5% lungs. Patients with SCC had a better response to (chemo)radiotherapy considering the OS (p=0.02, HR=0.7) and DFS (p=0.01, HR=0.69) in a multivariate analysis. Conclusions: Patients with a SCC esophageal tumor have better long-term results then AC patients after definitive (chemo)radiation. In this patient group SCC seems to be a strong prognostic factor for both OS and DFS. Furthermore the difference between RT and CRT is still small. more...
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- 2012
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40. Bullous pemphigoid (BP) induced by radiotherapy
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Veronique E.M. Mul, Tom Verschueren, Adrienne J. van Geest, and Brigitta G. Baumert
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Radiation therapy ,medicine.medical_specialty ,Oncology ,business.industry ,medicine.medical_treatment ,medicine ,Radiology, Nuclear Medicine and imaging ,Hematology ,Bullous pemphigoid ,medicine.disease ,business ,Dermatology - Published
- 2007
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41. PO-0699: Pleural and pericardial effusion after neo-adjuvant chemoradiotherapy followed by surgery for esophageal cancer
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Christina T. Muijs, Johannes A. Langendijk, J.T.H. Plukker, Veronique E.M. Mul, EJ van der Jagt, and J. C. Beukema
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medicine.medical_specialty ,business.industry ,Hematology ,Neo adjuvant ,Esophageal cancer ,medicine.disease ,Pericardial effusion ,Surgery ,Oncology ,Radiology Nuclear Medicine and imaging ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Chemoradiotherapy - Full Text
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