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  • 1. Carlsson, J
    et al.
    Nordgren, H
    Sjöström, J
    Wester, K
    Villman, K
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Ostenstad, B
    Lundqvist, H
    Blomqvist, C
    HER2 expression in breast cancer primary tumours and corresponding metastases. Original data and literature review2004In: Br J Cancer, ISSN 0007-0920, Vol. 90, no 12, p. 2344-2348Article in journal (Refereed)
  • 2. Chadda, S.
    et al.
    Larkin, M.
    Jones, C.
    Sykes, D.
    Barber, B.
    Zhao, Z.
    Gao, S.
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    The impact of infusion reactions associated with monoclonal antibodies in metastatic colorectal cancer: a european perspective2011In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, no 3, p. A173-A173Article in journal (Refereed)
  • 3. Early Breast Cancer Trialists' Collaborative Group, EBCTCG
    et al.
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Larsson, Lars-Gunnar
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials.2005In: The Lancet, ISSN 0140-6736, Vol. 366, no 9503, p. 2087-2106Article in journal (Refereed)
  • 4. Edlund, Per
    et al.
    Ahlgren, Johan
    Bjerre, Karsten
    Andersson, Michael
    Bergh, Jonas
    Mouridsen, Henning
    Holmberg, Stig B
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jakobsen, Erik
    Møller, Susanne
    Lindman, Henrik
    Blomqvist, Carl
    Dose-tailoring of FEC adjuvant chemotherapy based on leukopenia is feasible and well tolerated. Toxicity and dose intensity in the Scandinavian Breast Group phase 3 adjuvant Trial SBG 2000-12011In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 50, no 3, p. 329-337Article in journal (Refereed)
    Abstract [en]

    The SBG 2000-1 trial is a randomised study that investigates if dose-tailored adjuvant FEC therapy based on the individual's leukocyte nadir value can improve outcome. The study has included 1535 women with medium and high-risk breast cancer. Patients and methods. After a first standard dosed FEC course (5-fluorouracil 600 mg/m2, epirubicin 60 mg/mg2 and cyclophosphamide 600 mg/m2), patients who did not reach leukopenia grade III or IV were randomised to standard doses (group standard) or doses tailored to achieve grade III leukopenia (group tailored) at courses 2–7. Patients who achieved leukopenia grade III or more after the first course were not randomised but continued on standard doses (group registered). Results. Both planned and actually delivered number of courses (seven) were the same in all three arms. The relative dose intensity was increased by a factor of 1.31 (E 1.22, C 1.43) for patients in the tailored arm compared to the expected on standard dose. Ninety percent of the patients in the tailored arm achieved leukopenia grade III–IV compared with 29% among patients randomised to standard dosed therapy. Dose tailoring was associated with acceptable acute non-haematological toxicity with more total alopecia, nausea, vomiting and fatigue. Conclusion. Dose tailoring according to leukopenia was feasible. It led to an increased dose intensity and was associated with acceptable excess of acute non-haematological toxicity.Read More: http://informahealthcare.com/doi/abs/10.3109/0284186X.2011.554435

  • 5. Ejlertsen, Bent
    et al.
    Mouridsen, Henning T
    Jensen, Maj-Britt
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Bergh, Jonas
    Cold, Soren
    Edlund, Per
    Ewertz, Marianne
    de Graaf, Peter W
    Kamby, Claus
    Nielsen, Dorte L
    Similar efficacy for ovarian ablation compared with cyclophosphamide, methotrexate, and fluorouracil: from a randomized comparison of premenopausal patients with node-positive, hormone receptor-positive breast cancer2006In: J Clin Oncol, ISSN 1527-7755, Vol. 24, no 31, p. 4956-4962Article in journal (Refereed)
  • 6.
    Margolin, Sara
    et al.
    Department of Oncology, Karolinska Institute and University Hospital, Stockholm, Sweden.
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Carlsson, Lena
    Department of Oncology, Sundsvall Hospital, Sweden.
    Edlund, Per
    Department of Oncology, Gävle Hopsital, Sweden.
    Hellstrøm, Mats
    Department of Oncology, Karolinska Institute and University Hospital, Stockholm, Sweden.
    Karlsson, Per
    Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lidbrink, Elisabet
    Department of Oncology, Karolinska Institute and University Hospital, Stockholm, Sweden.
    Linderholm, Barbro
    Department of Oncology, Linkøping University Hospital, Sweden.
    Lindman, Henrik
    Department of Oncology, Uppsala University Hospital, Sweden.
    Malmström, Per
    Department of Oncology, Lund University Hospital, Sweden.
    Pettersson Skøld, Dagny
    Department of Oncology, Karolinska Institute and University Hospital, Stockholm, Sweden.
    Søderberg, Martin
    Department of Oncology, Malmø University Hospital, Sweden.
    Villman, Kenneth
    Department of Oncology, Örebro University Hospital, Sweden.
    Bergh, Jonas
    Department of Oncology, Karolinska Institute and University Hospital, Stockholm, Sweden.
    A randomised feasibility/phase II study (SBG 2004-1) with dose-dense/tailored epirubicin, cyclophoshamide (EC) followed by docetaxel (T) or fixed dosed dose-dense EC/T versus T, doxorubicin and C (TAC) in node-positive breast cancer.2011In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 50, no 1, p. 35-41Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to evaluate the feasibility of tailored and dose-dense epirubicin and cyclophosphamide followed by docetaxel as adjuvant breast cancer therapy. Material and methods. Patients with node-positive breast cancer received either four cycles of biweekly and tailored EC (epirubicin 38-60-75-90-105-120 mg/m(2), cyclophosphamide 450-600-900-1200 mg/m(2)) followed by four cycles of docetaxel (60-75-85-100 mg/m(2)) (arm A) or the same regimen with fixed doses (E(90)C(600) + 4 → T(75) + 4) (arm B) or docetaxel, doxorubicin and cyclophosphamide (T(75)A(50)C(500)) every three weeks for six cycles (arm C). All patients received G-CSF support and prophylactic ciprofloxacin. Results. One-hundred and twenty-four patients were randomised in the study. In the A, B and C arm, 17% 19% and 3% of the patients had one or more cycles delayed due to side-effects whereas 24%, 5% and 15% experienced a grade 3 infection or febrile neutropenia. After the introduction of an extra week between the EC and T parts in the A and B arms, grade 3 hand-foot-skin reactions were reduced from 5 to 0.2%. Twenty-nine percent (A and B) and 20% (C) of the patients were hospitalised due to side-effects. Discussion. Dose-dense and tailored EC/T can be given with manageable toxicity and is after adjustment presently studied in the phase III Panther trial.

  • 7. McGale, Paul
    et al.
    Darby, Sarah C.
    Hall, Per
    Adolfsson, Jan
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Bennet, Anna M.
    Fornander, Tommy
    Gigante, Bruna
    Jensen, Maj-Britt
    Peto, Richard
    Rahimi, Kazem
    Taylor, Carolyn W.
    Ewertz, Marianne
    Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden2011In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 100, no 2, p. 167-175Article in journal (Refereed)
    Abstract [en]

    Purpose: To study incidence of radiation-related heart disease in a large population of breast cancer patients followed for up to 30 years.

    Material and methods: 72,134 women diagnosed with breast cancer in Denmark or Sweden during 1976-2006 and followed prospectively. Radiation-related risk was studied by comparing women with left-sided and right-sided tumours.

    Results: 34,825 women (48%) received radiotherapy. Among unirradiated women tumour laterality had little relevance to heart disease. Among irradiated women mean dose to the whole heart was 6.3 Gy for left-sided tumours and 2.7 Gy for right-sided tumours. Mortality was similar in irradiated women with left-sided and right-sided tumours, but incidence ratios, left-sided versus right-sided, were raised: acute myocardial infarction 1.22 (95% CI 1.06-1.42), angina 1.25 (1.05-1.49), pericarditis 1.61 (1.06-2.43), valvular heart disease 1.54 (1.11-2.13). Incidence ratios for all heart disease were as high for women irradiated since 1990 (1.09 [1.00-1.19]) as for women irradiated during 1976-1989 (1.08 [0.99-1.17]), and were higher for women diagnosed with ischaemic heart disease prior to breast cancer than for other women (1.58 [1.19-2.10] versus 1.08 [1.01-1.15], p for difference = 0.01).

    Conclusions: Breast cancer radiotherapy has, at least until recently, increased the risk of developing ischaemic heart disease, pericarditis and valvular disease. Women with ischaemic heart disease before breast cancer diagnosis may have incurred higher risks than others. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 100 (2011) 167-175

  • 8. Nordenskjöld, Bo
    et al.
    Rosell, Johan
    Rutqvist, Lars-Erik
    Malmström, Per-Olof
    Bergh, Jonas
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hatschek, Thomas
    Wallgren, Arne
    Carstensen, John
    Coronary heart disease mortality after 5 years of adjuvant tamoxifen therapy: results from a randomized trial2005In: J Natl Cancer Inst, ISSN 1460-2105, Vol. 97, no 21, p. 1609-1610Article in journal (Refereed)
  • 9. Rosell, Johan
    et al.
    Nordenskjold, Bo
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Fornander, Tommy
    Hatschek, Thomas
    Lindman, Henrik
    Malmstrom, Per-Olof
    Wallgren, Arne
    Stal, Olle
    Carstensen, John
    Effects of adjuvant tamoxifen therapy on cardiac disease: results from a randomized trial with long-term follow-up2013In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 138, no 2, p. 467-473Article in journal (Refereed)
    Abstract [en]

    Tamoxifen is associated with a reduced risk of coronary heart disease (CHD). However, there are few reports on long-term effects. Using data from a large Swedish randomized trial of 5 and 2 years of adjuvant tamoxifen in women with early breast cancer, we here present results on morbidity and mortality from cardiac diseases during treatment and long-term after treatment. A total of 4,150 patients were breast cancer recurrence-free after 2 years. Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry were used to define events of disease. Hazard ratios were estimated using Cox regression. Patients assigned to 5 years in comparison with 2 years of postoperative tamoxifen experienced a reduced incidence of CHD [hazard ratio (HR), 0.83; 95 % CI 0.70-1.00], especially apparent during the active treatment period (HR 0.65; 95 % CI 0.43-1.00). The mortality from CHD was significantly reduced (HR 0.72; 95 % CI 0.53-0.97). During the active treatment, the morbidity of other heart diseases was also significantly reduced (HR 0.40; 95 % CI 0.25-0.64) but not after treatment stopped (HR 1.06; 95 % CI 0.87-1.30). Similar results were seen for both heart failure and atrial fibrillation/flutter. As compared to 2 years of therapy, 5 years of postoperative tamoxifen therapy prevents CHD as well as other heart diseases. The risk reduction is most apparent during the active treatment period, and later tends to diminish.

  • 10. Rosell, Johan
    et al.
    Nordenskjold, Bo
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Fornander, Tommy
    Hatschek, Thomas
    Lindman, Henrik
    Malmstrom, Per-Olof
    Wallgren, Arne
    Stal, Olle
    Carstensen, John
    Long-term effects on the incidence of second primary cancers in a randomized trial of two and five years of adjuvant tamoxifen2017In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 4, p. 614-617Article in journal (Refereed)
    Abstract [en]

    Background: Tamoxifen is a well established treatment for breast cancer, but its long-term effects on the incidence of secondary cancers are not fully evaluated.Material and methods: We have studied 4128 postmenopausal patients with early stage breast cancer who were alive and free of breast cancer recurrence after two years of tamoxifen, and who were randomized to receive totally two or five years of therapy.Results: Compared to patients randomized to two years of tamoxifen the incidence of contralateral breast cancer [hazard ratio (HR) 0.73; 95% CI 0.56-0.96] and of lung cancer (HR 0.45; 95% CI 0.27-0.77), especially squamous cell and small cell lung cancer, were reduced in the five-year group, and similar results were seen when restricting the analysis to the 10-year period after treatment stopped. An increased incidence of endometrial cancer was observed in the five-year group, but the excess risk decreased over time.Conclusion: Further studies of the effects of tamoxifen on the risk of different histological types of lung cancer are needed.

  • 11. Rosell, Johan
    et al.
    Nordenskjöld, B
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Fornander, T
    Hatschek, T
    Lindman, H
    Malmström, P-O
    Wallgren, A
    Stål, O
    Carstensen, J
    Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial2011In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 104, no 6, p. 899-902Article in journal (Refereed)
    Abstract [en]

    Background:  

    Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease.

    Methods:  

    Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression.

    Results:  

    Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of cerebrovascular diseases was increased (HR 1.70, 95% CI 1.05–2.75) during the active treatment phase and reduced after the active treatment period (HR 0.78, 95% CI 0.63–0.96), and the difference in HR between the two time-periods was significant (P=0.0033). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03–9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40–0.90) with a significant difference in HR between the two periods of follow-up (P=0.0066). Similar results were seen for subgroups of cerebrovascular diseases, such as stroke and ischaemic stroke.

    Conclusion:  

    In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period.

  • 12. Sjöström-Mattson, Johanna
    et al.
    Von Boguslawski, Kristina
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Mjaaland, Ingvil
    Salmenkivi, Kaisa
    Blomqvist, Carl
    The expression of p53, bcl-2, bax, fas and fasL in the primary tumour and lymph node metastases of breast cancer.2009In: Acta oncologica (Stockholm, Sweden), ISSN 1651-226X, Vol. 48, no 8, p. 1137-1143Article in journal (Refereed)
    Abstract [en]

    PURPOSE. It is unknown to what extent lymph node metastases differ from primary tumours of breast cancer. Our aim was to investigate the similarity between primary breast tumours and the matching lymph node metastases in 59 breast cancer patients. EXPERIMENTAL DESIGN. Immunohistochemical stainings of p53, bax, bc-l2, fas and fasL were performed in primary tumours and the parallel lymph node metastases. RESULTS. When using a cut point of 10%, the concordance between primary tumours and parallel lymph node metastases in the expression of p53 was 85%, bcl-2 79%, bax 69%, fas 59% and fasL 43%. In most tumours the staining status of p53, bcl-2 and bax in the primary tumour and the corresponding lymph node did not change more than 20%. However, these variables could fluctuate in both directions. In 15-25% of the cases, nodal expression was more than 20% lower than in the primary tumours, while in 10-17% of the cases, nodal expression was more than 20% higher than in the primary tumours. In half of the tumours, fas status did not change. Most fasL positive tumours lost positivity in the lymph node metastases or showed positively staining cancer cells only in the peripheral region of the node. A phenotype analysis of combined information of tumour fas/tumour fasL/nodal fas/nodal fasL expression (+/ - ) was assessed. The most frequently observed phenotype was tumour fas - /tumour fasL + /nodal fas - /nodal fasL- (22% of the tumours), although almost all combinations were seen. CONCLUSIONS. The expression of p53, bax, bcl - 2, fas and fasL is not maintained in the matching lymph node metastases of breast cancer. Large studies comparing the expression of relevant tumour biology factors in primary tumours and parallel lymph node metastases and their impact on therapy outcome, especially in the adjuvant setting, are warranted.

  • 13. Stendahl, M
    et al.
    Kronblad, Å
    Rydén, L
    Emdin, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Landberg, G
    Cyclin D1 overexpression is a negative predictive factor for tamoxifen response in postmenopausal breast cancer patients2004In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 90, no 10, p. 1942-1948Article in journal (Refereed)
    Abstract [en]

    Antioestrogen treatment by tamoxifen is a well-established adjuvant therapy for oestrogen receptor-alpha (ER) positive breast cancer. Despite ER expression some tumours do not respond to tamoxifen and we therefore delineated the potential link between the cell cycle regulator and ERco-factor, cyclin D1, and tamoxifen response in a material of 167 postmenopausal breast cancers arranged in a tissue array. The patients had been randomised to 2 years of tamoxifen treatment or no treatment and the median follow-up time was 18 years. Interestingly in the 55 strongly ERpositive samples with moderate or low cyclin D1 levels, patients responded to tamoxifen treatment whereas the 46 patients with highly ER positive and cyclin D1 overexpressing tumours did not show any difference in survival between tamoxifen and no treatment. Survival in untreated patients with cyclin D1 high tumours was slightly better than for patients with cyclin D1 low/moderate tumours. However, there was a clearly increased risk of death in the cyclin D1 high group compared to an age-matched control population. Our results suggest that cyclin D1 overexpression predicts for tamoxifen treatment resistance in breast cancer, which is line with recent experimental data using breast cancer cell lines and overexpression systems.

  • 14. Villman, Kenneth
    et al.
    Sjöström, Johanna
    Heikkilä, Reino
    Hultborn, Ragnar
    Malmström, Per
    Bengtsson, Nils-Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Söderberg, Martin
    Saksela, Eero
    Blomqvist, Carl
    TOP2A and HER2 gene amplification as predictors of response to anthracycline treatment in breast cancer2006In: Acta Oncol, ISSN 0284-186X, Vol. 45, no 5, p. 590-596Article in journal (Refereed)
1 - 14 of 14
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