Publications by authors named "Kauko Saarilahti"

56 Publications

Retrospective four-dimensional magnetic resonance imaging of liver: Method development.

J Appl Clin Med Phys 2020 Dec 3;21(12):304-313. Epub 2020 Dec 3.

Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Radiotherapy, Finland.

Purpose of our research was to develop a four-dimensional (4D) magnetic resonance imaging (MRI) method of liver. Requirements of the method were to create a clinical procedure with acceptable imaging time and sufficient temporal and spatial accuracy. The method should produce useful planning image sets for stereotactic body radiation therapy delivery both during breath-hold and in free breathing. The purpose of the method was to improve the localization of liver metastasis. The method was validated with phantom tests. Imaging parameters were optimized to create a 4D dataset compressed to one respiratory cycle of the whole liver with clinically reasonable level of image contrast and artifacts. Five healthy volunteers were imaged with T2-weighted SSFSE research sequence. The respiratory surrogate signal was observed by the linear navigator interleaved with the anatomical liver images. The navigator was set on head-feet - direction on the superior surface of the liver to detect the edge of diaphragm. The navigator signal and 2D liver image data were retrospectively processed with a self-developed MATLAB algorithm. A deformable phantom for 4D imaging tests was constructed by combining deformable tissue-equivalent material and a commercial programmable motor unit of the 4D phantom with a clinically relevant range of deformation patterns. 4D Computed Tomography images were used as reference to validate the MRI protocol. The best compromise of reasonable accuracy and imaging time was found with 2D T2-weighted SSFSE imaging sequence using parameters: TR = 500-550 ms, images/slices = 20, slice thickness = 3 mm. Then, image processing with number of respiratory phases = 8 constructed accurate 4D images of liver. We have developed the 4D-MRI method visualizing liver motions three-dimensionally in one representative respiratory cycle. From phantom tests it was found that the spatial agreement to 4D-CT is within 2 mm that is considered sufficient for clinical applications.
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http://dx.doi.org/10.1002/acm2.13108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769409PMC
December 2020

Nutritional Counseling for Head and Neck Cancer Patients Undergoing (Chemo) Radiotherapy-A Prospective Randomized Trial.

Front Nutr 2019 18;6:22. Epub 2019 Mar 18.

Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Locally advanced head and neck cancer is managed either by combined surgery and (chemo) radiotherapy or definitive (chemo) radiotherapy, which may deteriorate nutritional status. Previous data have shown that intensive nutritional intervention by a dietician reduces radiation-induced adverse events including weight loss. To determine if on-demand nutritional counseling (ODC, control group) would be as efficacious as intensive nutritional counseling (INC, experimental group) in patients undergoing (chemo) radiotherapy. Fifty-eight patients were randomly assigned to receive INC ( = 26) or ODC ( = 32). Outcome measures were nutritional status (PG-SGA), weight loss, handgrip strength (HGS), body composition, and survival. Weight loss and impaired nutritional parameters during oncological treatment were seen equally in both groups (NS). Leaner patients at baseline maintained their weight, while overweight patients lost both weight and handgrip strength during treatment. Disease-free survival (DFS) (median = 43 months) was not affected by weight loss during treatment. Lower baseline HGS and malnutrition were associated with worse DFS (low vs. normal HGS: 15 vs. 42 months; = 0.05 and malnutrition vs. good nutrition status: 17 vs. 42 months; = 0.014, respectively). Survival according to low vs. normal HGS in the INC group was 4 vs. 44 months ( = 0.007) and in the ODC group 28 vs. 40 months ( = 0.944). According to malnutrition vs. good nutritional status in the INC group, DFS was 21 vs. 43 months ( = 0.025) and in the ODC group 15 vs. 41 months ( = 0.03). As for our primary endpoint, individualized on-demand nutritional counseling was as efficacious as intensive counseling in preventing deterioration of nutritional status and incidence of malnutrition during (chemo) radiotherapy. This should be verified with larger number of patients. Additional findings were that overweight patients had more severe weight loss, but not poorer survival. Low HGS and malnutrition at baseline were associated with poor survival. www.ClinicalTrials.gov, identifier NCT02159508.
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http://dx.doi.org/10.3389/fnut.2019.00022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432820PMC
March 2019

Tumor volume as a prognostic marker in p16-positive and p16-negative oropharyngeal cancer patients treated with definitive intensity-modulated radiotherapy.

Strahlenther Onkol 2018 08 17;194(8):759-770. Epub 2018 May 17.

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, 00029 HUS, Helsinki, Finland.

Purpose: To investigate the impact of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) in oropharyngeal squamous cell carcinoma (OPSCC) and the difference in their role between human papillomavirus (HPV)-positive and HPV-negative patients.

Methods: The patient cohort consists of 91 OPSCC patients treated with definitive radiochemotherapy or radiotherapy using intensity-modulated radiotherapy (IMRT). All patients had a minimum follow-up of 31 months. Volume measurements were made from computer tomography (CT) scans and HPV status was assessed by p16 immunohistochemistry. The end points were as follows: overall survival (OS), disease-free survival (DFS) and locoregional control (LRC).

Results: pGTV was a significant independent prognostic factor for overall survival (OS; p = 0.020) in p16-negative patients. nGTV of p16-negative tumors had significant prognostic value in all end points in multivariate analyses. High-stage (III-IVc) p16-negative tumors were only associated with significantly poorer OS (p = 0.046) but not with poorer LRC or DFS when compared with the low-stage (I-II) tumors. nGTV of p16-positive tumors was an independent prognostic factor for DFS (p = 0.005) and LRC (p = 0.007) in multivariate analyses.

Conclusion: pGTV may serve as an independent prognostic factor in p16-negative patients and nGTV may serve as an independent prognostic factor both in p16-positive and p16-negative patients treated with radiochemotherapy or radiotherapy using IMRT. Tumor volume may have an impact on selecting patients for de-escalation protocols in the future, both in p16-positive and p16-negative patients.
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http://dx.doi.org/10.1007/s00066-018-1309-zDOI Listing
August 2018

MRI-only based radiation therapy of prostate cancer: workflow and early clinical experience.

Acta Oncol 2018 Jul 28;57(7):902-907. Epub 2018 Feb 28.

a Cancer Centre, Helsinki University Hospital , Helsinki , Finland.

Background: Magnetic resonance imaging (MRI) is the most comprehensive imaging modality for radiation therapy (RT) target delineation of most soft tissue tumors including prostate cancer. We have earlier presented step by step the MRI-only based workflow for RT planning and image guidance for localized prostate cancer. In this study we present early clinical experiences of MRI-only based planning.

Material And Methods: We have analyzed the technical planning workflow of the first 200 patients having received MRI-only planned radiation therapy for localized prostate cancer in Helsinki University Hospital Cancer center. Early prostate specific antigen (PSA) results were analyzed from n = 125 MRI-only patients (n = 25 RT only, n = 100 hormone treatment + RT) and were compared with the corresponding computed tomography (CT) planned patient group.

Results: Technically the MRI-only planning procedure was suitable for 92% of the patients, only 8% of the patients required supplemental CT imaging. Early PSA response in the MRI-only planned group showed similar treatment results compared with the CT planned group and with an equal toxicity level.

Conclusion: Based on this retrospective study, MRI-only planning procedure is an effective and safe way to perform RT for localized prostate cancer. It is suitable for the majority of the patients.
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http://dx.doi.org/10.1080/0284186X.2018.1445284DOI Listing
July 2018

Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study.

Eur Arch Otorhinolaryngol 2018 Apr 27;275(4):959-966. Epub 2018 Jan 27.

Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland.

Background: The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population.

Patients And Methods: This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland. Thirty-nine (89%) of them also received radiotherapy. The senses of smell (odour detection, identification and threshold test) and taste (electrogustometry) and quality of life (UW-QOL) were evaluated preoperatively, and at 6 weeks, 3 months, 6 months and 12 months, postoperatively.

Results: There were higher scores in the odour detection values in the 6-week and 3-month tests compared with preoperative values for the tumour side. Other detection scores did not differ statistically from the preoperative values neither in the tumour nor the contralateral side. However, in the odour identification test, all posttreatment values were statistically significantly higher than pretreatment ones. In the olfactory threshold test, no statistically significant differences were found between pre- and posttreatment values. Electrogustometry values for the taste on the tumour side were statistically significantly impaired at 6 weeks (p < 0.05) and at 3 months (p < 0.01) compared with the pretreatment results. They were also impaired at 6 months and at 12 months, although the differences were not statistically significant. The quality of life was impaired after treatment in this patient series. However, the correlation between quality of life and sense of taste was found only at one time point (3 months) and only with contralateral side measurements.

Conclusions: We conclude that in oral and pharyngeal cancer patients the postoperative taste problems are related to the impairment on the taste sensation in the tongue but not with the sense of smell. Moreover, the impairment in the quality of life is not clearly related to the impaired sense of taste.
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http://dx.doi.org/10.1007/s00405-018-4883-xDOI Listing
April 2018

Epidemiological and treatment-related factors contribute to improved outcome of oropharyngeal squamous cell carcinoma in Finland.

Acta Oncol 2018 Apr 17;57(4):541-551. Epub 2017 Nov 17.

a Department of Otorhinolaryngology-Head and Neck Surgery , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.

Background: Treatment for oropharyngeal squamous cell carcinoma (OPSCC) has changed, as the proportion of human papilloma virus (HPV)-related disease has increased. We evaluated nationwide information on its management and outcome during the treatment paradigm change period.

Methods: We included all patients diagnosed and treated for OPSCC at the five Finnish university hospitals from 2000 to 2009. Patient records and pathology registries provided the clinicopathological data. p16 staining was performed on primary tumor samples of patients who had received treatment with curative intent.

Results: A total of 674 patients were diagnosed and treated for OPSCC and the incidence increased along the study period. Of the evaluable tumors 58.5% were p16-positive and the number of p16-positive tumors increased along the years. The treatment was given with curative intent for 600 patients and it was completed in 564. Of them, 47.9% underwent primary surgery and 52.1% received definitive oncological treatment. Also, the treatment protocol changed towards a more oncological approach. Among patients treated with curative intent the five-year overall, disease-specific and disease-free survival rates were 60.1, 71.5 and 57.0%. In multivariate analysis, p16-positivity seemed to relate to reduced disease mortality in lateral and anterior-wall disease. Depending on primary tumor localization, also sex, classes T3-4, presence of regional metastasis and radiotherapy modality had an association with disease mortality.

Conclusion: The incidence of p16-positive OPSCC and delivery of definitive oncological treatment increased in Finland during the study period. An improved survival outcome compared with the previous nationwide investigation was observed in this subset of patients.
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http://dx.doi.org/10.1080/0284186X.2017.1400688DOI Listing
April 2018

Submandibular gland cancer: Specific features and treatment considerations.

Head Neck 2018 Jan 30;40(1):154-162. Epub 2017 Oct 30.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: In the absence of unified treatment protocol, we evaluated the management and outcomes of submandibular gland cancers in an unselected patient series.

Methods: We included all patients with resected submandibular gland cancer treated at the Helsinki University Hospital from 2000 to 2010 with a 5-year minimum follow-up.

Results: Twenty-five patients with cancer represented 30% of submandibular gland neoplasms, and most were adenoid cystic carcinomas (ACCs; 56%). At presentation, 3 patients showed clinical signs of probable malignancy. Of 22 neck dissection specimens, 5 patients (20%) had metastases with an occult metastasis rate of 4%. Cancer recurred in 11 patients (44%), of which 7 (28%) were only at a distant site. The 5-year disease-specific survival (DSS) and overall survival (OS) rates were 76%, and disease-free survival (DFS) was 68%.

Conclusion: Most tumors were ACCs differing from the histological pattern of parotid gland cancers. Occult metastases were rare. The rarity of submandibular gland cancer, its variable histological pattern, and varying biological behavior warrant centralized management.
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http://dx.doi.org/10.1002/hed.24981DOI Listing
January 2018

Outcome of nasopharyngeal carcinoma in Finland: A nationwide study.

Acta Oncol 2018 Feb 7;57(2):251-256. Epub 2017 Jul 7.

j Department of Oncology , Turku University Hospital and University of Turku , Turku , Finland.

Background: Nasopharyngeal carcinoma (NPC) is uncommon in western countries and data on the outcome and histological presentation are scarce in nonendemic areas. We report here the outcome on all patients with NPC treated in Finland between 1990 and 2009.

Material And Methods: The Finnish Cancer Registry database was used to identify the patients. Histopathological specimens and clinical records were reviewed to confirm the histological subtypes, prognostic factors, treatment techniques and outcome across different stage groups.

Results: Primary NPC was identified in 207 patients and 42 (20%) had keratinizing squamous cell carcinoma (SCC). The stage distribution was: I, 11%; II, 25%; III, 39%; IV, 25%. Of 191 patients treated with curative intent 85 (44%) received radiotherapy and 106 (56%) chemoradiotherapy. The five-year overall survival for all patients was 57% and for stages I-IV 87%, 69%, 55% and 31%, respectively. The five-year disease-specific and overall survival of all patients treated between 1990 and 1999 were 58% and 49%, and those between 2000 and 2009 66% and 63%, respectively.

Conclusions: While survival rates are improving and comparable to other western countries they remain inferior to those of endemic countries. This may reflect the different biology of NPC in nonendemic areas, where keratinizing SCC is common.
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http://dx.doi.org/10.1080/0284186X.2017.1346378DOI Listing
February 2018

Early stage minor salivary gland adenoid cystic carcinoma has favourable prognosis.

Virchows Arch 2017 Dec 10;471(6):785-792. Epub 2017 Jun 10.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

The purpose of the study was to evaluate the long-term outcome of minor salivary and mucous gland (MiSG) adenoid cystic carcinoma (ACC) of the head and neck and to compare the results with earlier reports including our recently published series on major salivary gland (MaSG) ACC. The study comprised 68 MiSG ACCs operated during 1974-2012 at the Helsinki University Hospital, Helsinki, Finland. Medical records and histological samples were reviewed. Our previously published cohort comprising 54 MaSG ACCs during the years from 1974 to 2009 was used for comparison. The most common locations were the oral cavity and sinonasal cavities. Most patients presented stages IV (33.8%) and I (23.5%) disease. Primary treatment with curative intent, mainly surgery, was offered for 64 patients. Thirty-three (51.6%) of these patients developed a disease recurrence and 22 (66.7%) patients in less than 5 years. The difference in the length of recurrence-free time (<5 vs. >5 years) had an impact on OS and DSS (p < 0.001) showing worse prognosis for the earlier recurring group. T classes 2-4 (p = 0.005, p < 0.001, and p = 0.001, respectively) and stages II-IV (p = 0.019, p < 0.001, and p = 0.002, respectively) were associated with worse OS, DSS, and DFS. MiSG ACC had a similar long-term survival compared to MaSG ACC. Patients with stage I MiSG ACC seem to carry a favourable prognosis compared with those with stages II, III, and IV tumours. It is thus noteworthy that stage II tumours represent a truly advanced disease entity warranting a more aggressive treatment approach.
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http://dx.doi.org/10.1007/s00428-017-2163-6DOI Listing
December 2017

Changing trends in the management of the neck in oropharyngeal squamous cell carcinoma.

Head Neck 2017 07 2;39(7):1412-1420. Epub 2017 May 2.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS, Helsinki, Finland.

Background: Treatment for oropharyngeal squamous cell carcinoma (SCC) has changed toward a more oncologic approach. We evaluated treatment of the neck, the incidence of regional recurrences, and factors associated with regional recurrence during the treatment approach transition period in patients with regional lymph node metastasis.

Methods: All patients with oropharyngeal SCC diagnosed at the Helsinki University Hospital during 2000-2009 were analyzed for clinicopathological factors, treatment, p16 expression, and regional recurrence.

Results: Altogether, 169 patients had a complete response, and among them regional recurrence occurred in 5 patients (4.7%) treated with surgery ± radiotherapy (RT) or chemoradiotherapy (CRT) and in 2 patients (3.2%) treated with RT or CRT ± surgery. All these 7 patients had N2b disease or higher, and 5 of them had regional recurrence in the contralateral side of the neck.

Conclusion: The incidence of regional recurrence was low, and remained unchanged despite the increased use of RT or CRT ± surgery. Treatment and follow-up of the contralateral neck warrants special attention in patients with advanced neck disease (≥N2b).
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http://dx.doi.org/10.1002/hed.24781DOI Listing
July 2017

Cachexia at diagnosis is associated with poor survival in head and neck cancer patients.

Acta Otolaryngol 2017 Jul 26;137(7):778-785. Epub 2017 Jan 26.

g Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.

Conclusions: One third of the patients had cachexia with an association of significantly shorter survival. These results suggest that combining HGS and MAMA seems to be a practical method to screen cachexia in patients with head and neck cancer and may also be used when assessing their prognosis.

Objectives: The aim of this study was to analyze the hypothesis that cachexia defined as both low mid-arm muscle area (MAMA) and handgrip strength (HGS) is associated with decreased survival in patients with head and neck squamous cell carcinoma (HNSCC).

Methods: Sixty-five consecutive patients with primary HNSCC were enrolled prior to cancer therapy. Cachexia was defined as low handgrip strength (HGS) and low mid-arm muscle area (MAMA). Nutritional status was assessed by patient-generated subjective global assessment (PG-SGA) and sarcopenia by low MAMA. Biochemical parameters reflecting nutritional status and S-25-OHD were measured.

Results: Cachexia was seen in 31% and sarcopenia in 46% of patients. Altogether, 34% of patients were malnourished. Disease-free survival was 13 months (3-62) in cachectic patients, compared with 66 months (31-78) in non-cachectic patients (p = 0.009). S-25-OHD was 28 nmol/l in cachectic patients, compared with 46 nmol/l in non-cachectic patients (p = 0.009) and prealbumin 187 mg/l and 269 mg/l, respectively (p < 0.001).
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http://dx.doi.org/10.1080/00016489.2016.1277263DOI Listing
July 2017

Radiotherapy in desmoid tumors : Treatment response, local control, and analysis of local failures.

Strahlenther Onkol 2017 Apr 2;193(4):269-275. Epub 2017 Jan 2.

Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, PO Box 180, 00029 HUS, Helsinki, Finland.

Background: Desmoid tumors (aggressive fibromatosis) are rare soft tissue tumors which frequently recur after surgery. Desmoid tumors arise from musculoaponeurotic tissue in the extremities, head and neck, abdominal wall, or intra-abdominally. Our aim was to examine the outcome of radiotherapy of desmoid tumors in a single institution series.

Patients And Methods: We evaluated 41 patients with desmoid tumors treated with 49 radiotherapies between 1987 and 2012. Radiologic images for response evaluation were reassessed and responses to treatment registered according to RECIST criteria 1.1. For patients with local failures radiation dose distribution was determined in each local failure volume using image co-registration. Recurrences were classified as in-target, marginal, or out-of-target. Prognostic factors for radiotherapy treatment failure were evaluated.

Results: Radiotherapy doses varied from 20-63 Gy (median 50 Gy) with a median fraction size of 2 Gy. The objective response rate to definitive radiotherapy was 55% (12/22 patients). Median time to response was 14 months. A statistically significant dose-response relation for definitive and postoperative radiotherapy was observed both in univariate (p-value 0.002) and in multivariate analysis (p-value 0.02) adjusted for potential confounding factors. Surgery before radiotherapy or surgical margin had no significant effect on time to progression. Nine of 11 (82%) local failures were classified as marginal and two of 11 (18%) in-target. None of the recurrences occurred totally out-of-target.

Conclusions: Radiotherapy is a valuable option for treating desmoid tumors. Radiotherapy dose appears to be significantly associated to local control.
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http://dx.doi.org/10.1007/s00066-016-1091-8DOI Listing
April 2017

A Novel Digital Patient-Reported Outcome Platform for Head and Neck Oncology Patients-A Pilot Study.

Clin Med Insights Ear Nose Throat 2016 27;9:1-6. Epub 2016 Sep 27.

Department of Otolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Introduction: The patient's role in toxicity reporting is increasingly acknowledged. There is also a need for developing modern communication methods between the patient and the medical personnel. Furthermore, the increasing number of head and neck cancer (HNC) patients is reflected in the volume of treatment follow-up visits, which remains a challenge for the health care. Electronic patient-reported outcome (ePRO) measures may provide a cost-efficient way to organize follow-up for cancer patients.

Materials And Methods: We tested a novel ePRO application called Kaiku, which enables real-time, online collection of patient-reported outcomes, such as side effects caused by treatment and quality of life. We conducted a pilot study to assess the suitability of Kaiku for HNC patients at the Department of Oncology, Helsinki University Hospital, Helsinki, Finland. Patients used Kaiku during and one month after radiotherapy to report treatment-related side effects and quality of life. Two physicians and a nurse performed the practical electronic communication part of the study.

Results: Five of the nine patients agreed to participate in the study: three of them had local early-stage larynx cancer (T2N0, T1aN0, and T2N0) and the remaining two patients had early-stage base of tongue cancer (T2N0 and T1N2b). The degree of side effects reported by the patients via Kaiku ranged from mild to life threatening. The number of outcome data points on patients' progress was significantly increased, which resulted in a better follow-up and improved communication between the patient and the care team.

Conclusions: Kaiku seems to be a suitable tool to monitor side effects and quality of life during and after radiotherapy among HNC patients. Kaiku and similar tools could be useful in organizing a cost-effective follow-up process for HNC patients. We recommend conducting a larger study to further assess the impact of an ePRO solution in routine clinical practice. ePRO solutions may aid in the follow-up for cancer patients.They seem suitable to monitor, for example, side effects and quality of life.These systems ensure fast patient-driven reporting.
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http://dx.doi.org/10.4137/CMENT.S40219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040424PMC
September 2016

Diffusion-weighted magnetic resonance imaging for evaluation of salivary gland function in head and neck cancer patients treated with intensity-modulated radiotherapy.

Radiother Oncol 2017 02 27;122(2):178-184. Epub 2016 Jul 27.

Helsinki University Central Hospital, Cancer Center, Department of Radiation Oncology, Finland.

Background And Purposes: Permanent xerostomia as a result of radiation-induced salivary gland damage remains a common side effect of radiotherapy (RT) of the head and neck. The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in assessing the post-RT salivary gland function in patients with head and neck cancer (HNC).

Materials And Methods: In this prospective study, 20 HNC patients scheduled for bilateral neck chemoradiotherapy (CRT) with weekly cisplatin went through diffusion-weighted magnetic resonance imaging (DW-MRI) and salivary gland scintigraphy (SGS) prior to and at a mean of six months after completing the treatment. The changes in apparent diffusion coefficient (ADC) before and after treatment were compared with ejection fraction (EF) measured with SGS and the radiation dose absorbed by the salivary glands.

Results: As a result of gustatory stimulation with ascorbic acid, the ADC showed a biphasic response with an initial increase and subsequent decrease. This pattern was seen both before and after RT. Post-RT ADC increased as a function of RT dose absorbed by the salivary glands. A moderate statistical correlation between pre- and post-RT ADCs at rest and EF measured with SGS was found.

Conclusions: DW-MRI seems a promising tool for detection of physiological and functional changes in major salivary glands after RT.
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http://dx.doi.org/10.1016/j.radonc.2016.07.008DOI Listing
February 2017

Boron Neutron Capture Therapy in the Treatment of Recurrent Laryngeal Cancer.

Int J Radiat Oncol Biol Phys 2016 May 10;95(1):404-410. Epub 2015 Nov 10.

Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Purpose: To investigate the safety and efficacy of boron neutron capture therapy (BNCT) as a larynx-preserving treatment option for patients with recurrent laryngeal cancer.

Methods And Materials: Six patients with locally recurrent squamous cell laryngeal carcinoma and 3 patients with persistent laryngeal cancer after prior treatment were treated with BNCT at the FiR1 facility (Espoo, Finland) in 2006 to 2012. The patients had received prior radiation therapy with or without concomitant chemotherapy to a cumulative median dose of 66 Gy. The median tumor diameter was 2.9 cm (range, 1.4-10.9 cm) before BNCT. Boron neutron capture therapy was offered on a compassionate basis to patients who either refused laryngectomy (n=7) or had an inoperable tumor (n=2). Boronophenylalanine-fructose (400 mg/kg) was used as the boron carrier and was infused over 2 hours intravenously before neutron irradiation.

Results: Six patients received BNCT once and 3 twice. The estimated average gross tumor volume dose ranged from 22 to 38 Gy (W) (mean; 29 Gy [W]). Six of the 8 evaluable patients responded to BNCT; 2 achieved complete and 4 partial response. One patient died early and was not evaluable for response. Most common side effects were stomatitis, fatigue, and oral pain. No life-threatening or grade 4 toxicity was observed. The median time to progression within the target volume was 6.6 months, and the median overall survival time 13.3 months after BNCT. One patient with complete response is alive and disease-free with a functioning larynx 60 months after BNCT.

Conclusions: Boron neutron capture therapy given after prior external beam radiation therapy is well tolerated. Most patients responded to BNCT, but long-term survival with larynx preservation was infrequent owing to cancer progression. Selected patients with recurrent laryngeal cancer may benefit from BNCT.
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http://dx.doi.org/10.1016/j.ijrobp.2015.11.010DOI Listing
May 2016

Toward a more patient-specific model of post-radiotherapy saliva secretion for head and neck cancer patients.

Acta Oncol 2015 27;54(9):1310-6. Epub 2015 Aug 27.

a HUCH Comprehensive Cancer Center, Department of Radiation Oncology , Helsinki University Central Hospital , Helsinki , Finland.

Background: Reduction of saliva secretion is a common side effect following radiotherapy (RT) for cancer of the head and neck region. The aim of this study is to predict the post-RT salivary function for individual patients prior to treatment and to recognise possible differences in individual radiosensitivity.

Material And Methods: A predictive model for post-RT salivary function was validated for 64 head and neck cancer patients. The input parameters for the model were salivary excretion fraction (sEF) measured by 99mTc-pertechnetate scintigraphy, total stimulated salivary flow and mean absorbed dose for the major salivary glands. SEF values after RT relative to the baseline before RT (rEF) were compared among the patients using the distance ΔrEF between single gland rEF and the corresponding expected value at the dose response curve.

Results: A significant correlation (R = 0.86, p = 0.018) was found between the modelled and the measured values of stimulated salivary flow six months after RT. The average prediction error for the saliva flow rate was 6 ml/15 min. A linear relationship between ΔrEF for the left and the right parotid glands was observed both six (R = 0.53) and 12 (R = 0.79) months after RT. The average of absolute values of ΔrEF was 0.20 for parotid glands and 0.22 for submandibular glands.

Conclusions: The salivary flow model was validated for 64 patients. The results imply, that one explanation for the discrepancies between the predicted and the measured salivary flow rate values and the common variations found in ΔrEF for the parotid glands may be differences in patients' individual response to radiation. However, quantitative extraction of individual radiosensitivity would require further studies in order to take it into account in predictive models.
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http://dx.doi.org/10.3109/0284186X.2015.1067717DOI Listing
August 2016

Converting from CT- to MRI-only-based target definition in radiotherapy of localized prostate cancer: A comparison between two modalities.

Strahlenther Onkol 2015 Nov 14;191(11):862-8. Epub 2015 Jul 14.

Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, POB 180, 00029, Helsinki, Finland.

Purpose: To investigate the conversion of prostate cancer radiotherapy (RT) target definition from CT-based planning into an MRI-only-based planning procedure.

Materials And Methods: Using the CT- and MRI-only-based RT planning protocols, 30 prostate cancer patients were imaged in the RT fixation position. Two physicians delineated the prostate in both CT and T2-weighted MRI images. The CT and MRI images were coregistered based on gold seeds and anatomic borders of the prostate. The uncertainty of the coregistration, as well as differences in target volumes and uncertainty of contour delineation were investigated. Conversion of margins and dose constraints from CT- to MRI-only-based treatment planning was assessed.

Results: On average, the uncertainty of image coregistration was 0.4 ± 0.5 mm (one standard deviation, SD), 0.9 ± 0.8 mm and 0.9 ± 0.9 mm in the lateral, anterior-posterior and base-apex direction, respectively. The average ratio of the prostate volume between CT and MRI was 1.20 ± 0.15 (one SD). Compared to the CT-based contours, the MRI-based contours were on average 2-7 mm smaller in the apex, 0-1 mm smaller in the rectal direction and 1-4 mm smaller elsewhere.

Conclusion: When converting from a CT-based planning procedure to an MRI-based one, the overall planning target volumes (PTV) are prominently reduced only in the apex. The prostate margins and dose constraints can be retained by this conversion.
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http://dx.doi.org/10.1007/s00066-015-0868-5DOI Listing
November 2015

Pattern of recurrent disease in major salivary gland adenocystic carcinoma.

Virchows Arch 2015 Jul 3;467(1):19-25. Epub 2015 Apr 3.

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, HUCH, P.O.Box 220, FI-00029, Helsinki, Finland,

This study aims to evaluate the long-term outcome of major salivary gland adenocystic carcinoma (ACC). This is a retrospective review of 54 cases of ACC during a 35-year period from 1974 to 2009 at the Helsinki University Central Hospital, Helsinki, Finland. Medical records and histological samples were reviewed. All patients had a minimum follow-up time of 5 years or until death. Most of the tumours occurred in the parotid gland (n = 30, 56%) followed by submandibular gland (n = 22, 41%) and sublingual gland (n = 2, 4%). Fifty-two patients (96%) were treated with curative intent. All of these patients except one were primarily treated with surgery, and 29 patients (54%) also received postoperative radiotherapy for their primary tumour. Two patients (4%) received palliative radiotherapy. For those treated with curative intent, 32 patients (62%) had disease recurrence. Twenty-four patients (75%) had their first disease recurrence within 5 years and eight patients (25%) later than 5 years. The difference in the length of recurrence-free time interval (<5 vs. >5 years) had a significant impact on 5-year overall survival (OS) and disease-specific survival (DSS). The OS, DSS and disease-free survival (DFS) across stages I-IV varied between 46-100, 50-100 and 46-100%, respectively. Age over 45 years, T stage, and presence of neck metastases had a significant negative prognostic effect. More than half of the patients had recurrent disease. An extended follow-up for these patients seems feasible as most of the distant metastases were detected within a 10-year period.
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http://dx.doi.org/10.1007/s00428-015-1760-5DOI Listing
July 2015

NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients.

Support Care Cancer 2015 Jun 5;23(6):1495-502. Epub 2014 Nov 5.

Department of Clinical Nutrition Therapy, Ravioli, Helsinki University Central Hospital, P.O. Box 100, 00029, Helsinki, Finland,

Background: The aim of this study was to assess the value of nutritional risk screening-2002 (NRS-2002) as a nutritional risk screening and status assessment method and to compare it with nutritional status assessed by subjective and objective methods in the screening of head and neck cancer patients.

Methods: Sixty-five consecutive patients (50 male), with a median age of 61 years (range, 33-77), with head and neck squamous cell carcinoma (HNSCC) were enrolled prior to cancer therapy. Nutritional status was assessed by NRS-2002, patient-generated subjective global assessment (PG-SGA), handgrip strength (HGS) and mid-arm muscle area (MAMA).

Results: Twenty-eight percent of patients were at nutritional risk based on NRS-2002, and 34 % were malnourished according to PG-SGA, while 43 % had low HGS. NRS-2002 cut-off score of ≥3 compared with the nutritional status according to PG-SGA showed 77 % specificity and 98 % sensitivity (K = 0.78). NRS-2002 was able to predict malnutrition (PG-SGA BC) both in men (p < 0.001) and in women (p < 0.05). NRS-2002 identified correctly patients with malnutrition with a score of ≥3 (p < 0.001) and risk patients with a score of ≥2 (p < 0.001).

Conclusions: These results suggest that NRS-2002 seems to be a reliable indicator of malnutrition, while NRS-2002 with the cut-off score of ≥2 seems to be more reliable for nutrition screening in head and neck cancer patients prior to oncological treatment.
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http://dx.doi.org/10.1007/s00520-014-2500-0DOI Listing
June 2015

Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy.

Int J Radiat Oncol Biol Phys 2014 Oct;90(2):255-60

Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland.

Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial.

Methods And Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living.

Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization.

Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.
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http://dx.doi.org/10.1016/j.ijrobp.2014.06.032DOI Listing
October 2014

FDG-PET/CT in the Assessment of Treatment Response after Oncologic Treatment of Head and Neck Squamous Cell Carcinoma.

Clin Med Insights Ear Nose Throat 2014 19;7:25-9. Epub 2014 Aug 19.

Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.

Background: In many centers, (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used to monitor treatment response after definitive (chemo)radiotherapy [(C)RT] for head and neck squamous cell carcinoma (HNSCC), but its usefulness remains somewhat controversial. We aimed at assessing the accuracy of FDG-PET/CT in detecting residual disease after (C)RT.

Method: All HNSCC patients with FDG-PET/CT performed to assess treatment response 10-18 weeks after definitive (C)RT at our institution during 2008-2010 were included. The patient charts were reviewed for FDG-PET/CT findings, histopathologic findings, and follow-up data. The median follow-up time for FDG-PET/CT negative patients was 26 months.

Results: Eighty-eight eligible patients were identified. The stage distribution was as follows: I, n = 1; II, n = 15; III, n = 17; IV, n = 55. The negative predictive value, positive predictive value, specificity, sensitivity, and accuracy of FDG-PET/CT in detecting residual disease were 87%, 81%, 94%, 65%, and 85%, respectively. The corresponding specific figures for the primary tumor site were 91%, 71%, 94%, 59%, and 86% and for the neck 93%, 100%, 100%, 75%, and 94%, respectively.

Conclusions: In patients who have received definitive (C)RT for HNSCC, post-treatment FDG-PET/CT has good potential to guide clinical decision-making. Patients with negative scan can safely be followed up clinically only, while positive scan necessitates tissue biopsies or a neck dissection to rule out residual disease.
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http://dx.doi.org/10.4137/CMENT.S16399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149379PMC
September 2014

Intensity-modulated radiotherapy in definitive oncological treatment of hypopharyngeal squamous cell carcinoma.

Eur Arch Otorhinolaryngol 2015 Sep 8;272(9):2489-95. Epub 2014 Aug 8.

Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O.Box 220, 00029, Helsinki, Finland,

Hypopharyngeal squamous cell carcinoma (HSCC) is treated by definitive concomitant chemoradiotherapy at most centres. Intensity-modulated radiotherapy (IMRT) is an advanced computer-controlled high-precision radiotherapy technique that has been used at our institution in the treatment of HSCC since 2002. Our aim was to review the treatment results of IMRT-based chemoradiotherapy (CRT) in patients diagnosed with HSCC. The cohort comprised all patients with previously untreated, biopsy-proven squamous cell carcinoma of the hypopharynx treated by definitive CRT using IMRT between March 2002 and November 2010. All patients were diagnosed M0. Forty-five eligible patients were identified. Six patients were treated by radiotherapy alone and 39 patients received concomitant chemotherapy. All patients had a minimum follow-up of 3 years or until death. Complete response was achieved in 29/45 (64 %) patients. Salvage surgery was performed on 10/16 patients with incomplete response. The 5-year estimates for overall survival, disease-specific survival, and local control in the whole cohort were 31, 45, and 64 %, respectively. Classifications T4 and N2c-N3 were prognostic for worse survival. None of the surviving patients needed permanent tracheotomy or PEG tube. We conclude that survival after IMRT-based CRT remained unsatisfactory with frequent relapses at distant sites. The outcome figures were comparable with those that have been achieved by surgery and postoperative radiotherapy. However, all the surviving patients in the current study cohort could retain their functioning larynx. These results using IMRT-based definitive CRT as the primary option for the treatment of HSCC support its continued usage for the delivery of radiotherapy.
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http://dx.doi.org/10.1007/s00405-014-3221-1DOI Listing
September 2015

Laryngeal cancer in Finland: A 5-year follow-up study of 366 patients.

Head Neck 2016 Jan 27;38(1):36-43. Epub 2015 Jan 27.

Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.

Background: The purpose of this study was to acquire nationwide data on the management and outcome of laryngeal squamous cell carcinoma (SCC) in Finnish university hospitals over a 5-year posttreatment follow-up.

Methods: All records of patients diagnosed and treated for primary laryngeal SCC during 2001 to 2005 were reviewed.

Results: Three hundred sixty-six patients with laryngeal cancer were identified, 360 of whom had laryngeal SCC. Three hundred forty-two patients with laryngeal SCC (95%) were treated with curative intent. Five-year disease-specific survival (DSS) for T1a, T1b, T2, T3, and T4 glottic SCC was 100%, 95%, 78%, 79%, and 53%, respectively. The corresponding figures for T1 to T4 supraglottic SCC were 68%, 54%, 72%, and 59%.

Conclusion: Results of this nationwide study give a general overview of the outcome of unselected patients treated with unified guidelines. Patients with T2 tumors, usually treated with radiotherapy (RT), had a worse prognosis than expected. This patient group warrants further investigation and possibly treatment intensification.
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http://dx.doi.org/10.1002/hed.23834DOI Listing
January 2016

Gold seed fiducials in analysis of linear and rotational displacement of the prostate bed.

Radiother Oncol 2014 Feb 11;110(2):256-60. Epub 2013 Dec 11.

Helsinki University Central Hospital, Department of Oncology, Finland.

Background And Purpose: This study aimed to investigate the magnitude of interfraction prostate bed motion during radiotherapy using both the implanted gold seed fiducials and the soft tissue registration and to define reasonable planning target volume (PTV) margins for different localization methods.

Material And Methods: Thirteen prostatectomized prostate cancer patients, after implanting four gold seed fiducials into their prostate bed, were imaged daily using a pretreatment cone-beam computed tomography (CBCT). Linear and the rotational prostate bed motion (PBM) was measured for 466 CBCTs.

Results: The linear PBM mean and standard deviation values in millimeters are 0.0 ± 0.5, 0.7 ± 2.1 and 0.8 ± 1.6 in the LR, SI and AP axes, respectively. In 20% of the fractions the rotation of the prostate bed in sagittal plane exceeds ±6° and in 5% it exceeds ±10° from the position on the planning CT. In the transversal and coronal planes 1% and 2% of it exceeds ±6°. The PTV margins are 2.4, 6.5 and 6.6mm in the LR, SI and AP axes, respectively, if imaging is performed for the first three treatment fractions.

Conclusion: The linear PBM is largest in the SI and AP axis, whereas the rotation is largest in the sagittal plane. Bone localization during the first three treatment fractions can reduce PTV margins by 52%, 18% and 10% in the LR, SI and AP axes, respectively, whereas in daily CBCT the use of the gold seed fiducials seems profitable.
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http://dx.doi.org/10.1016/j.radonc.2013.10.037DOI Listing
February 2014

Implementation of adaptive radiation therapy for urinary bladder carcinoma: imaging, planning and image guidance.

Acta Oncol 2013 Oct 23;52(7):1451-7. Epub 2013 Aug 23.

Department of Oncology, Helsinki University Central Hospital , Helsinki , Finland.

Background: Adaptive radiation therapy (ART) for urinary bladder cancer has emerged as a promising alternative to conventional RT with potential to minimize radiation-induced toxicity to healthy tissues. In this work we have studied bladder volume variations and their effect on healthy bladder dose sparing and intrafractional margins, in order to refine our ART strategy.

Material And Methods: An online ART treatment strategy was followed for five patients with urinary bladder cancer with the tumors demarcated using Lipiodol(®). A library of 3-4 predefined treatment plans for each patient was created based on four successive computed tomography (CT) scans. Cone beam CT (CBCT) images were acquired before each treatment fraction and after the treatment at least weekly. In partial bladder treatment the sparing of the healthy part of the bladder was investigated. The bladder wall displacements due to bladder filling were determined in three orthogonal directions (CC, AP, DEX-SIN) using the treatment planning CT scans. An ellipsoidal model was applied in order to find the theoretical maximum values for the bladder wall displacements. Moreover, the actual bladder filling rate during treatment was evaluated using the CBCT images. Results. In partial bladder treatment the volume of the bladder receiving high absorbed doses was generally smaller with a full than empty bladder. The estimation of the bladder volume and the upper limit for the intrafractional movement of the bladder wall could be represented with an ellipsoidal model with a reasonable accuracy. Observed maximum growth of bladder dimensions was less than 10 mm in all three orthogonal directions during 15 minute interval.

Conclusion: The use of Lipiodol contrast agent enables partial bladder treatment with reduced irradiation of the healthy bladder volume. The ellipsoidal bladder model can be used for the estimation of the bladder volume changes and the upper limit of the bladder wall movement during the treatment fraction.
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http://dx.doi.org/10.3109/0284186X.2013.813639DOI Listing
October 2013

[Application of image guided radiation therapy].

Duodecim 2013 ;129(7):721-9

HUS, syöpätautien klinikka.

The application of different imaging techniques in the planning of and during radiation therapy enables a precise definition of the target region and healthy tissue. New three-dimensional radiotherapy techniques and advanced radiation equipment enable precise implementation of the desired dose of radiation to the treatment region. By using different imaging techniques, a higher treatment dose to the tumor region is enabled with simultaneous protection of healthy tissue structures. The likelihood of mistakes between the treatment plan and its implementation can also be reduced. Accordingly, the aim of image guided radiation therapy is to improve treatment results and at the same time reduce treatment-related side effects.
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July 2013

Commissioning of MRI-only based treatment planning procedure for external beam radiotherapy of prostate.

Magn Reson Med 2013 Jul 10;70(1):127-35. Epub 2012 Aug 10.

Department of Oncology, Helsinki University Central Hospital, POB-180, 00029 HUS, Finland.

In radiotherapy, target tissues are defined best on MR images due to their superior soft tissue contrast. Computed tomography imaging is geometrically accurate and it is needed for dose calculation and generation of reference images for treatment localization. Co-registration errors between MR and computed tomography images can be eliminated using magnetic resonance imaging-only based treatment planning. Use of ionizing radiation can be avoided which is especially important in adaptive treatments requiring several re-scans. We commissioned magnetic resonance imaging-only based procedure for external radiotherapy, treatment planning of the prostate cancer. Geometrical issues relevant in radiotherapy, were investigated including quality assurance testing of the scanner, evaluation of the displacement of skin contour and radiosensitive rectum wall, and detection of intraprostatic fiducial gold seed markers used for treatment localization. Quantitative analysis was carried out for 30 randomly chosen patients. Systematic geometrical errors were within 2.2 mm. The gold seed markers were correctly identified for 29 out of the 30 patients. Positions of the seed midpoints were consistent within 1.3 mm in magnetic resonance imaging and computed tomography. Positional error of rectal anterior wall due to susceptibility effect was minimal. Geometrical accuracy of the investigated equipment and procedure was sufficient for magnetic resonance imaging-only based radiotherapy, treatment planning of the prostate cancer including treatment virtual simulation.
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http://dx.doi.org/10.1002/mrm.24459DOI Listing
July 2013

Transforming growth factor beta 1 genotype and p16 as prognostic factors in head and neck squamous cell carcinoma.

Acta Otolaryngol 2012 Sep 5;132(9):1006-12. Epub 2012 Jun 5.

Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland.

Conclusion: Transforming growth factor β1 gene (TGFβ1) genotype is a potential p16 independent prognostic factor predicting response to chemoradiotherapy in head and neck squamous cell carcinoma (HNSCC).

Objectives: Expression of p16 and epidermal growth factor receptor (EGFR) has been reported to be associated with survival in HNSCC. We have previously reported that genetic polymorphism of TGFβ1 is linked with survival in HNSCC patients who have undergone chemoradiotherapy. We evaluate here whether TGFB1 genotype can serve as a prognostic factor independent of tumor p16 and EGFR expression.

Methods: Expression of p16 and EGFR was studied by immunohistochemistry in tumors from 130 HNSCC patients. Peripheral blood DNA was used to genotype 95 patients for single nucleotide polymorphism rs1800470 within the TGFβ1 gene. The minimum follow-up time was 31 months.

Results: p16 overexpression was associated with an improved disease-free survival (hazard ratio (HR) = 0.39, 95% CI 0.19-0.78), whereas no evident association was observed between EGFR expression and disease-free survival (HR = 0.90, 95% CI 0.68-1.19). Among the 37 patients who had received chemoradiotherapy, TGFβ1 genotype was associated with disease-free (HR = 0.44, 95% CI 0.19-1.02) and overall survival (HR = 0.31, 95% CI 0.12-0.80) independent of tumor p16 expression.
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http://dx.doi.org/10.3109/00016489.2012.678944DOI Listing
September 2012

Management and outcome of salivary duct carcinoma in major salivary glands.

Eur Arch Otorhinolaryngol 2013 Jan 22;270(1):281-5. Epub 2012 Mar 22.

Department of Otolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, University of Helsinki, P.O. Box 220, 00029 HUCH, Helsinki, Finland.

Salivary duct carcinoma (SDC) is a rare and aggressive malignancy with poor prognosis. Its histomorphology is distinctly reminiscent of the ductal carcinoma of the breast. We reviewed the treatment and outcome of SDCs at a single tertiary care centre. Twenty-five cases of SDC of major salivary gland origin, diagnosed and treated at the Department of Otolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland, during a 14-year period from 1997 to 2011, were reviewed retrospectively. Survival outcome was analyzed for 18 patients with a minimum follow-up of 24 months. There were 16 male (64 %) and 9 female (36 %) patients with a median age of 61 years (range 36-82 years). The majority of the cases occurred in the parotid gland (n = 21, 84 %) followed by the submandibular gland (n = 4, 16 %). The primary treatment consisted of surgical resection in all cases and 17 (68 %) patients also underwent neck dissection. Most of the patients (n = 18, 72 %) were treated with postoperative radiotherapy. Seven patients (28 %) had a disease recurrence within a median follow-up time of 15 months (range 3-27 months). In the group (n = 18) with a minimum follow-up time of 24 months, the 2- and 5-year overall and disease-specific survival rates were 66, 41 % and 75, 55 %, respectively. These results confirm the aggressive nature of SDCs in major salivary glands. Diagnostics and management of these tumours need to be centralized in experienced surgical Head and Neck Oncology Centres, and new treatment strategies should be investigated.
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http://dx.doi.org/10.1007/s00405-012-1997-4DOI Listing
January 2013

High prevalence of vitamin D insufficiency in patients with head and neck cancer at diagnosis.

Head Neck 2012 Oct 27;34(10):1450-5. Epub 2012 Jan 27.

Department of Clinical Nutrition Therapy, Helsinki University Central Hospital, Helsinki, Finland.

Background: Low serum levels of vitamin D, measured as serum 25-hydroxy-vitamin D (S-25-OHD), have been observed in several cancers.

Methods: Sixty-five adult patients with head and neck cancer, 50 men, median age 61 years (range, 33-77 years), were enrolled in this prospective cohort study. Concentrations of S-25-OHD and plasma calcium (Ca) and phosphate (Pi) were measured before cancer treatment.

Results: The mean S-25-OHD was 42.0 (SD 22) nmol/L. Hypovitaminosis D (37.5-50 nmol/L) was found in 20% of the patients and vitamin D deficiency (<37.5 nmol/L) in 45% of the patients. No seasonal variation was seen. Subnormal plasma Ca and Pi levels were found in 11% and 9% of the patients, respectively.

Conclusion: Subnormal vitamin D levels were found in a significant proportion of the patients. Because vitamin D deficiency may pose these patients to increased risk of therapy-related morbidity, special attention should be paid to correction of this nutritional deficiency.
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http://dx.doi.org/10.1002/hed.21954DOI Listing
October 2012