Carien Creutzberg - Academia.edu (original) (raw)

Papers by Carien Creutzberg

Research paper thumbnail of 9325 Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: analysis of 434 cases

Ejc Suppl, 2009

Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4... more Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4 and Cdk4/Cdk6, have been selected for further analysis to evaluate these cyclin dependent kinases as novel therapeutic targets for the treatment of metastatic melanoma. Table1: Effective Cdk inhibitors in two melanoma cell lines Inhibitor Sk-Mel-28% Inhibition (± std dev) Sk-Mel-2% Inhibition (± std dev) Alsterpaullone, 2-Cyanoethyl (Cdk1/5; GSK-3b) 65.6± 13.0 64.5± 4.1 Cdk1/2 Inhibitor III 99.9± 0.0 98.0± 1.0 Cdk4 Inhibitor III (Cdk2/4) 72.6± 22.8 53.9± 8.5 Cdk/Crk Inhibitor 99.8± 0.0 99.6± 0.2 Fascaplysin (Cdk4/6) 99.2± 0.6 98.0± 1.0

Research paper thumbnail of The morbidity of treatment for patients with stage I endometrial cancer: results from a randomized trial

Cancer/Radiothérapie, 2002

La durée moyenne de surveillance était de 8,8 ans. La chirurgie

Research paper thumbnail of 9325 Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: analysis of 434 cases

European Journal of Cancer Supplements, 2009

Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4... more Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4 and Cdk4/Cdk6, have been selected for further analysis to evaluate these cyclin dependent kinases as novel therapeutic targets for the treatment of metastatic melanoma. Table1: Effective Cdk inhibitors in two melanoma cell lines Inhibitor Sk-Mel-28% Inhibition (± std dev) Sk-Mel-2% Inhibition (± std dev) Alsterpaullone, 2-Cyanoethyl (Cdk1/5; GSK-3b) 65.6± 13.0 64.5± 4.1 Cdk1/2 Inhibitor III 99.9± 0.0 98.0± 1.0 Cdk4 Inhibitor III (Cdk2/4) 72.6± 22.8 53.9± 8.5 Cdk/Crk Inhibitor 99.8± 0.0 99.6± 0.2 Fascaplysin (Cdk4/6) 99.2± 0.6 98.0± 1.0

Research paper thumbnail of Impact of cardiovascular counseling and screening in Hodgkin lymphoma survivors

International journal of radiation oncology, biology, physics, 2014

Cardiovascular disease (CVD) is the most common nonmalignant cause of death in Hodgkin lymphoma (... more Cardiovascular disease (CVD) is the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. The role of screening for CVD in HL survivors is unclear, but confrontation with risks of CVD may have a negative influence on health-related quality of life (HRQL). As part of a phase 2 screening study using computed tomography angiography (CTA) among HL survivors, an HRQL analysis was done to evaluate the emotional and practical burden and perceived benefits of screening and the effect of CVD-specific counseling on patient satisfaction. Patients who participated in the screening study also took part in the HRQL study. The impact of undergoing screening was evaluated with a 9-item questionnaire, and impact on HRQL with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire C30, version 3.0. The effect of counseling of CVD on perceived provision of information was evaluated with EO...

Research paper thumbnail of Psychosexual support for gynecological cancer survivors: professionals' current practices and need for assistance

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2015

About half of the gynecological cancer (GC) survivors suffer from sexual dysfunctions and report ... more About half of the gynecological cancer (GC) survivors suffer from sexual dysfunctions and report a need for professional psychosexual support. The current study assessed (1) health care professionals' (HCP) current psychosexual support practices, (2) barriers to providing psychosexual support, and (3) HCP needs for training and assistance. Semistructured interviews were conducted with gynecological oncologists (n = 10), radiation oncologists (n = 10), and oncology nurses involved in the treatment of GC (n = 10). The majority of the professionals reported discussing sexuality at least once with each patient. An important reason for addressing sexual functioning was to reassure patients that it is normal to experience sexual concerns and give them an opportunity to discuss sexual issues. About half of the professionals provided specific suggestions. Patients were rarely referred to a sexologist. Barriers encountered by professionals in the provision of psychosexual support were em...

Research paper thumbnail of North of England Obstetrical and Gynecological Society

Research paper thumbnail of 299 oral VAGINAL BRACHYTHERAPY WITH MRI GUIDANCE: TARGET VOLUME DEFINITION AND EFFECT OF BLADDER FILLING ON DOSE TO ORGANS AT RISK

Radiotherapy and Oncology, 2011

Research paper thumbnail of Multivariate analysis of survival in differentiated thyroid cancer: the prognostic significance of the age factor

European Journal of Cancer and Clinical Oncology, 1988

A retrospective analysis of tumour and patient characteristics was perfowned in 202 patients with... more A retrospective analysis of tumour and patient characteristics was perfowned in 202 patients with papillary (n = 132) orfollicular (n = 70) thyroid carcinoma, in order to identif prognostic factors related to survival. The following facts were found to be unfavourably related to survival: follicular histology, extrathyroidal growth of the primary tumour (stage pT4), regional bmph node involvement (stages pN1-3), presence of distant me&stases at diagnosis (stage pMI), male sex (in papillary cancer) and old age (onb death due to thyroid tumour was evaluated). For 190 patients suffiGient material was available to permit extensive histopathological investigation. In patients with papillary cancer the presence of small anaplastic foci and/or > 25% solidstructures (n = 18) was correlated with a reducedsurvival rate. Our study underlines the importance of distinguishing, histologically, between papillary and follicular cancer and in aa%& akmanrtrates the prognosti value of hi.st&gicGal grade in pap&y (but not j&z@) carkwma. We applied Cox's proportional hazard model to the survival data of these 190 patients and, after stage grouping, found that tumour stage (locoregional vs. advanced disease) was the most important prognostic factor. The second most important factor was the histological (sub)&pe (well dyerentiatcd papillary carcinoma vs. moderately differentiated papillary carcinoma and follicular carn'noma). Age at diagnosis and sex appeared to be of lesser importarue. Therefore our study does not recommend the use of age as a guide for therapeutical decisions in differentiated thyroid cancer.

Research paper thumbnail of Second primary cancers in survivors of cervical cancer in the Netherlands: Implications for prevention and surveillance

Radiotherapy and Oncology, 2014

Background and purpose: We investigated the effects of socio-demographic, treatment-and tumorspec... more Background and purpose: We investigated the effects of socio-demographic, treatment-and tumorspecific determinants on the risk of developing a second malignancy among patients treated for cervical cancer. Material and methods: We included patients with a first cervical cancer (N = 12,048) from the Netherlands Cancer Registry (NCR), 1989-2008. Standardized incidence ratios (SIR) and absolute excess risks (AER) per 10,000 person-years were calculated to estimate the burden of second cancers in cervical cancer survivors. Incidence rate ratios (IRR) were computed to identify predictors for second cancers among cervical cancer survivors. Results: During the study period, 676 (5.6%) patients were diagnosed with a second cancer. Smokingrelated cancers contributed the most to the overall burden of second cancers (AER = 21) and risks remained elevated after 10 years of follow-up (SIR = 1.8, 95% CI: 1.4-2.2), yet it decreased markedly in the younger birth cohorts. Cervical cancer survivors who underwent radiotherapy were at higher risk for a second tumor when compared to those without radiotherapy, especially at smoking-related sites (IRR = 1.6 (1.2-2.3)). Conclusion: Patients with cervical cancer had a significantly increased risk for a second cancer compared to the general population, especially for smoking-and irradiation-related tumors. Long-term follow-up suggested the importance of smoking cessation and the benefits of counseling cervical cancer patients accordingly, particularly those who received radiotherapy.

Research paper thumbnail of 964 poster PATTERNS OF RECURRENCE AND SURVIVAL IN 168 GLIOBLASTOMA PATIENTS AFTER TEMOZOLOMIDE BASED CHEMORADIATION

Radiotherapy and Oncology, 2011

Research paper thumbnail of Long-term outcomes of eye-conserving treatment with Ruthenium106 brachytherapy for choroidal melanoma

Radiotherapy and Oncology, 2010

Eye-conserving treatment Brachytherapy Ruthenium-106 plaque brachytherapy Prognostic factors a b ... more Eye-conserving treatment Brachytherapy Ruthenium-106 plaque brachytherapy Prognostic factors a b s t r a c t Purpose: To evaluate long-term outcomes of eye-conserving treatment using Ruthenium-106 plaque brachytherapy with or without transpupillary thermotherapy (TTT) for small to intermediate size choroidal melanomas. Methods: Outcomes of 425 consecutive patients were analysed. The median basal tumour diameter was 10.9 mm (range 4.8-15.9 mm), and the median apical height 4.2 mm (range 1.2-9.3 mm). Brachytherapy doses ranged from 400 to 600 Gy with TTT (86%), or from 600 to 800 Gy without TTT (14%), specified at the scleral surface. Kaplan-Meier survival curves, log-rank tests and Cox regression analysis were used for analysis. Results: Median follow-up was 50 months. Five-year actuarial local control was 96%. Five-year overall and metastases-free survival rates were 79.6% and 76.5%. Prognostic factors for metastasis-free survival were peripheral location (p = 0.02) and smaller basal diameter (p < 0.001). No dose effect relationships were found. Radiation side effects were frequent, with 2-and 5-year rates free of radiation complications of 60% and 35%. Five-year enucleation rate was 4.4% (10 for local recurrence, 7 for complications). Cosmetic and functional (visual acuity >0.10) eye preservation rates were 96% and 52% at 5 years. Conclusions: Ruthenium-106 brachytherapy for choroidal melanoma provides excellent rates of local control and eye preservation.

Research paper thumbnail of Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: Analysis of 434 cases

Radiotherapy and Oncology, 2010

Background and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and tre... more Background and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and treatment outcomes of two electron beam fractionation schedules were compared. Materials and methods: Outcome data of 434 epithelial skin cancers in 333 patients were analysed; 332 were basal cell carcinomas (BCCs) and 102 squamous cell carcinomas (SCCs). Patients were treated with electron beam, and received either 54 Gy in 18 fractions (n = 159) or 44 Gy in 10 fractions (n = 275). Local recurrence free (LRF) rates were analysed as well as metastases free rates, cancer specific survival (CSS) and cosmetic result. Results: Median follow-up was 42.8 months. For BCC, actuarial 3-year LRF rates were 97.6% for tumours treated with 54 Gy and 96.9% for 44 Gy. In SCC 3-year LRF rates were 97.0% for 54 Gy and 93.6% for 44 Gy (n.s.).

Research paper thumbnail of Conceptual equivalence and health-related quality of life: an exploratory study in Japanese and Dutch cancer patients

Quality of Life Research, 2006

Research into the equivalence of Western and Japanese conceptualizations of health-related qualit... more Research into the equivalence of Western and Japanese conceptualizations of health-related quality of life (HR-QOL) is scarce. We used the Western (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and the Japanese (HRQoL-20) questionnaire in order to analyze the conceptual similarity of HR-QOL factors, and the associations between specific symptom items with overall HR-QOL in Japanese (n=265) and Dutch (n=174) patients with various types of cancer. Both populations completed both instruments. In both patient groups, the overall health scale of the EORTC-QLQ-C30 correlated highly (r=0.59; p<0.001) with the HRQOL-20 composite average score, indicating substantial conceptual comparability. Relationships between all EORTC-QLQ-C30 symptom items with HR-QOL were examined by ranking their correlations with the two overall measures of HR-QOL. Comparable patterns in the Japanese and Dutch samples were observed. The results suggest a considerable conceptual equivalence of HR-QOL in Japanese and Dutch cancer patients, and indicate a satisfactory structural and cross-cultural equivalence for the EORTC-QLQ-C30 with regard to items measuring functioning and specific symptoms. Longitudinal studies are needed to examine the impact of specific symptoms on general quality of life.

Research paper thumbnail of Chest wall irradiation with MLC-shaped photon and electron fields

International Journal of Radiation Oncology*Biology*Physics, 2000

To improve the treatment technique for chest wall irradiation, using the multileaf collimator (ML... more To improve the treatment technique for chest wall irradiation, using the multileaf collimator (MLC) of the MM50 Racetrack Microtron to shape both photon and electron beams, and to check the dose delivery in the match-line region of these fields for the routine and improved technique. Using diode and film phantom measurements, the optimal number of photon beam segments and their positions relative to the electron beam were determined. On phantoms, and during actual patient treatment using in vivo dosimetry, the dose homogeneity in the match-line region was determined for both the routine and improved techniques. Three photon beam segments (9-mm gap, perfect match, and 9-mm overlap) were used to match the electron beam, resulting in minimum-maximum dose values in the match-line region of 88-109%, compared to 80-115% for the routine technique (2 photon beam segments). During patient treatment, the average minimum and maximum dose values were 95% and 115%, respectively, compared to 78% and 127%, respectively, for the routine technique. The interfraction variation in dose delivery was reduced from 11.0% (1 SD) to 4.6% (1 SD). The actual treatment time was reduced from 10 to 4.5 min. Using the MLC of the MM50 to shape both photon and electron beams, an improved treatment technique for chest wall irradiation was developed, which is less labor intensive, faster, and yields a more homogeneous, and better reproducible dose delivery.

Research paper thumbnail of Treatment morbidity in patients with endometrial cancer: results from a multicenter randomized trial

International Journal of Radiation Oncology*Biology*Physics, 2000

Research paper thumbnail of Radiotherapy and Hyperthermia for Treatment of Primary Locally Advanced Cervix Cancer: Results in 378 Patients

International Journal of Radiation Oncology*Biology*Physics, 2009

Purpose: To report response rate, pelvic tumor control, survival, and late toxicity after treatme... more Purpose: To report response rate, pelvic tumor control, survival, and late toxicity after treatment with combined radiotherapy and hyperthermia (RHT) for patients with locally advanced cervical carcinoma (LACC) and compare the results with other published series. Methods and Materials: From 1996 to 2005, a total of 378 patients with LACC (International Federation of Gynecology and Obstetrics Stage IB2-IVA) were treated with RHT. External beam radiotherapy (RT) was applied to 46-50.4 Gy and combined with brachytherapy. The hyperthermia (HT) was prescribed once weekly. Primary end points were complete response (CR) and local control. Secondary end points were overall survival, disease-specific survival, and late toxicity. Patient, tumor, and treatment characteristics predictive for the end points were identified in univariate and multivariate analyses. Results: Overall, a CR was achieved in 77% of patients. At 5 years, local control, disease-specific survival, and incidence of late toxicity Common Terminology Criteria for Adverse Events Grade 3 or higher were 53%, 47%, and 12%, respectively. In multivariate analysis, number of HT treatments emerged as a predictor of outcome in addition to commonly identified prognostic factors. Conclusions: The CR, local control, and survival rates are similar to previously observed results of RHT in the randomized Dutch Deep Hyperthermia Trial. Reported treatment results for currently applied combined treatment modalities (i.e., RT with chemotherapy and/or HT) do not permit definite conclusions about which combination is superior. The present results confirm previously shown beneficial effects from adding HT to RT and justify the application of RHT as first-line treatment in patients with LACC as an alternative to chemoradiation. Ó 2009 Elsevier Inc.

Research paper thumbnail of Adjuvant Chemotherapy for Endometrial Cancer

International Journal of Gynecological Cancer, 2010

Research paper thumbnail of Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting

International Journal of Gynecological Cancer, 2013

The second Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeti... more The second Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting was held on December 1, 2012, and included international multidisciplinary representatives of the 24 member groups. The aims were to review recent advances in molecular pathology of endometrial cancer, focusing on molecular-based therapy, and to identify key hypotheses and issues to be addressed through international collaborative clinical trials. Reviews and summaries of current knowledge were presented followed by parallel working group sessions for surgery, adjuvant and systemic therapy, and translational research. Plenary discussions were held to integrate translational and clinical issues, and a final discussion session to agree on key trial concepts. Proposals to take forward on the following trials were agreed: (1) lymphadenectomy to direct adjuvant treatment in women with high-risk endometrial cancer, including a sentinel node substudy; (2) conservative therapy for low-risk endometrial cancers in morbidly obese women with high surgical risks and for fertility-sparing treatment in premenopausal patients; (3) adjuvant therapy for women with early-stage carcinosarcoma. A proposal was made that a GCIG Early Phase Consortium be developed to serve as an international platform for rapid assessment of biomarkers.

Research paper thumbnail of Survival after relapse in patients with endometrial cancer: results from a randomized trial

European Journal of Cancer, 2001

Objective. The aim of this study was to determine the rates of local control and survival after r... more Objective. The aim of this study was to determine the rates of local control and survival after relapse in patients with stage I endometrial cancer treated in the multicenter randomized PORTEC trial.

Research paper thumbnail of Psychometric validation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24)

European Journal of Cancer, 2011

A validation study was conducted to evaluate the psychometric properties of the European Organisa... more A validation study was conducted to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24). This module was designed to assess disease and treatment specific aspects of the quality of life (QoL) of patients with endometrial cancer. Two hundred and sixty-eight women with endometrial cancer were recruited in different phases of treatment: after pelvic surgery (Group 1); during adjuvant chemotherapy and/or radiotherapy (Group 2); after completion of treatment (Group 3). Patients completed the EORTC QLQ-C30, the endometrial cancer module and a short debriefing questionnaire. Multi-trait scaling analyses confirmed the hypothesised scale structure of the QLQ-EN24. Internal consistency reliability was good with Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha coefficients ranging from 0.74 to 0.86 (lymphoedema 0.80, urological symptoms 0.75, gastrointestinal symptoms 0.74, body image problems 0.86 and sexual/vaginal problems 0.86). Convergent and discriminant validity did not show any scaling errors for the subscales. The QLQ-EN24 module discriminated well between clinically different groups of patients. All items exhibited a high completion rate with less than 2% missing values except for the sexuality items (19%). The validation study supports the reliability, the convergent and divergent validity of the EORTC QLQ-EN24. This newly developed QLQ-EN24 module is a useful instrument for the assessment of the QoL in patients treated for endometrial cancer in clinical trials.

Research paper thumbnail of 9325 Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: analysis of 434 cases

Ejc Suppl, 2009

Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4... more Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4 and Cdk4/Cdk6, have been selected for further analysis to evaluate these cyclin dependent kinases as novel therapeutic targets for the treatment of metastatic melanoma. Table1: Effective Cdk inhibitors in two melanoma cell lines Inhibitor Sk-Mel-28% Inhibition (± std dev) Sk-Mel-2% Inhibition (± std dev) Alsterpaullone, 2-Cyanoethyl (Cdk1/5; GSK-3b) 65.6± 13.0 64.5± 4.1 Cdk1/2 Inhibitor III 99.9± 0.0 98.0± 1.0 Cdk4 Inhibitor III (Cdk2/4) 72.6± 22.8 53.9± 8.5 Cdk/Crk Inhibitor 99.8± 0.0 99.6± 0.2 Fascaplysin (Cdk4/6) 99.2± 0.6 98.0± 1.0

Research paper thumbnail of The morbidity of treatment for patients with stage I endometrial cancer: results from a randomized trial

Cancer/Radiothérapie, 2002

La durée moyenne de surveillance était de 8,8 ans. La chirurgie

Research paper thumbnail of 9325 Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: analysis of 434 cases

European Journal of Cancer Supplements, 2009

Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4... more Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4 and Cdk4/Cdk6, have been selected for further analysis to evaluate these cyclin dependent kinases as novel therapeutic targets for the treatment of metastatic melanoma. Table1: Effective Cdk inhibitors in two melanoma cell lines Inhibitor Sk-Mel-28% Inhibition (± std dev) Sk-Mel-2% Inhibition (± std dev) Alsterpaullone, 2-Cyanoethyl (Cdk1/5; GSK-3b) 65.6± 13.0 64.5± 4.1 Cdk1/2 Inhibitor III 99.9± 0.0 98.0± 1.0 Cdk4 Inhibitor III (Cdk2/4) 72.6± 22.8 53.9± 8.5 Cdk/Crk Inhibitor 99.8± 0.0 99.6± 0.2 Fascaplysin (Cdk4/6) 99.2± 0.6 98.0± 1.0

Research paper thumbnail of Impact of cardiovascular counseling and screening in Hodgkin lymphoma survivors

International journal of radiation oncology, biology, physics, 2014

Cardiovascular disease (CVD) is the most common nonmalignant cause of death in Hodgkin lymphoma (... more Cardiovascular disease (CVD) is the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. The role of screening for CVD in HL survivors is unclear, but confrontation with risks of CVD may have a negative influence on health-related quality of life (HRQL). As part of a phase 2 screening study using computed tomography angiography (CTA) among HL survivors, an HRQL analysis was done to evaluate the emotional and practical burden and perceived benefits of screening and the effect of CVD-specific counseling on patient satisfaction. Patients who participated in the screening study also took part in the HRQL study. The impact of undergoing screening was evaluated with a 9-item questionnaire, and impact on HRQL with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire C30, version 3.0. The effect of counseling of CVD on perceived provision of information was evaluated with EO...

Research paper thumbnail of Psychosexual support for gynecological cancer survivors: professionals' current practices and need for assistance

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2015

About half of the gynecological cancer (GC) survivors suffer from sexual dysfunctions and report ... more About half of the gynecological cancer (GC) survivors suffer from sexual dysfunctions and report a need for professional psychosexual support. The current study assessed (1) health care professionals' (HCP) current psychosexual support practices, (2) barriers to providing psychosexual support, and (3) HCP needs for training and assistance. Semistructured interviews were conducted with gynecological oncologists (n = 10), radiation oncologists (n = 10), and oncology nurses involved in the treatment of GC (n = 10). The majority of the professionals reported discussing sexuality at least once with each patient. An important reason for addressing sexual functioning was to reassure patients that it is normal to experience sexual concerns and give them an opportunity to discuss sexual issues. About half of the professionals provided specific suggestions. Patients were rarely referred to a sexologist. Barriers encountered by professionals in the provision of psychosexual support were em...

Research paper thumbnail of North of England Obstetrical and Gynecological Society

Research paper thumbnail of 299 oral VAGINAL BRACHYTHERAPY WITH MRI GUIDANCE: TARGET VOLUME DEFINITION AND EFFECT OF BLADDER FILLING ON DOSE TO ORGANS AT RISK

Radiotherapy and Oncology, 2011

Research paper thumbnail of Multivariate analysis of survival in differentiated thyroid cancer: the prognostic significance of the age factor

European Journal of Cancer and Clinical Oncology, 1988

A retrospective analysis of tumour and patient characteristics was perfowned in 202 patients with... more A retrospective analysis of tumour and patient characteristics was perfowned in 202 patients with papillary (n = 132) orfollicular (n = 70) thyroid carcinoma, in order to identif prognostic factors related to survival. The following facts were found to be unfavourably related to survival: follicular histology, extrathyroidal growth of the primary tumour (stage pT4), regional bmph node involvement (stages pN1-3), presence of distant me&stases at diagnosis (stage pMI), male sex (in papillary cancer) and old age (onb death due to thyroid tumour was evaluated). For 190 patients suffiGient material was available to permit extensive histopathological investigation. In patients with papillary cancer the presence of small anaplastic foci and/or > 25% solidstructures (n = 18) was correlated with a reducedsurvival rate. Our study underlines the importance of distinguishing, histologically, between papillary and follicular cancer and in aa%& akmanrtrates the prognosti value of hi.st&gicGal grade in pap&y (but not j&z@) carkwma. We applied Cox's proportional hazard model to the survival data of these 190 patients and, after stage grouping, found that tumour stage (locoregional vs. advanced disease) was the most important prognostic factor. The second most important factor was the histological (sub)&pe (well dyerentiatcd papillary carcinoma vs. moderately differentiated papillary carcinoma and follicular carn'noma). Age at diagnosis and sex appeared to be of lesser importarue. Therefore our study does not recommend the use of age as a guide for therapeutical decisions in differentiated thyroid cancer.

Research paper thumbnail of Second primary cancers in survivors of cervical cancer in the Netherlands: Implications for prevention and surveillance

Radiotherapy and Oncology, 2014

Background and purpose: We investigated the effects of socio-demographic, treatment-and tumorspec... more Background and purpose: We investigated the effects of socio-demographic, treatment-and tumorspecific determinants on the risk of developing a second malignancy among patients treated for cervical cancer. Material and methods: We included patients with a first cervical cancer (N = 12,048) from the Netherlands Cancer Registry (NCR), 1989-2008. Standardized incidence ratios (SIR) and absolute excess risks (AER) per 10,000 person-years were calculated to estimate the burden of second cancers in cervical cancer survivors. Incidence rate ratios (IRR) were computed to identify predictors for second cancers among cervical cancer survivors. Results: During the study period, 676 (5.6%) patients were diagnosed with a second cancer. Smokingrelated cancers contributed the most to the overall burden of second cancers (AER = 21) and risks remained elevated after 10 years of follow-up (SIR = 1.8, 95% CI: 1.4-2.2), yet it decreased markedly in the younger birth cohorts. Cervical cancer survivors who underwent radiotherapy were at higher risk for a second tumor when compared to those without radiotherapy, especially at smoking-related sites (IRR = 1.6 (1.2-2.3)). Conclusion: Patients with cervical cancer had a significantly increased risk for a second cancer compared to the general population, especially for smoking-and irradiation-related tumors. Long-term follow-up suggested the importance of smoking cessation and the benefits of counseling cervical cancer patients accordingly, particularly those who received radiotherapy.

Research paper thumbnail of 964 poster PATTERNS OF RECURRENCE AND SURVIVAL IN 168 GLIOBLASTOMA PATIENTS AFTER TEMOZOLOMIDE BASED CHEMORADIATION

Radiotherapy and Oncology, 2011

Research paper thumbnail of Long-term outcomes of eye-conserving treatment with Ruthenium106 brachytherapy for choroidal melanoma

Radiotherapy and Oncology, 2010

Eye-conserving treatment Brachytherapy Ruthenium-106 plaque brachytherapy Prognostic factors a b ... more Eye-conserving treatment Brachytherapy Ruthenium-106 plaque brachytherapy Prognostic factors a b s t r a c t Purpose: To evaluate long-term outcomes of eye-conserving treatment using Ruthenium-106 plaque brachytherapy with or without transpupillary thermotherapy (TTT) for small to intermediate size choroidal melanomas. Methods: Outcomes of 425 consecutive patients were analysed. The median basal tumour diameter was 10.9 mm (range 4.8-15.9 mm), and the median apical height 4.2 mm (range 1.2-9.3 mm). Brachytherapy doses ranged from 400 to 600 Gy with TTT (86%), or from 600 to 800 Gy without TTT (14%), specified at the scleral surface. Kaplan-Meier survival curves, log-rank tests and Cox regression analysis were used for analysis. Results: Median follow-up was 50 months. Five-year actuarial local control was 96%. Five-year overall and metastases-free survival rates were 79.6% and 76.5%. Prognostic factors for metastasis-free survival were peripheral location (p = 0.02) and smaller basal diameter (p < 0.001). No dose effect relationships were found. Radiation side effects were frequent, with 2-and 5-year rates free of radiation complications of 60% and 35%. Five-year enucleation rate was 4.4% (10 for local recurrence, 7 for complications). Cosmetic and functional (visual acuity >0.10) eye preservation rates were 96% and 52% at 5 years. Conclusions: Ruthenium-106 brachytherapy for choroidal melanoma provides excellent rates of local control and eye preservation.

Research paper thumbnail of Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: Analysis of 434 cases

Radiotherapy and Oncology, 2010

Background and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and tre... more Background and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and treatment outcomes of two electron beam fractionation schedules were compared. Materials and methods: Outcome data of 434 epithelial skin cancers in 333 patients were analysed; 332 were basal cell carcinomas (BCCs) and 102 squamous cell carcinomas (SCCs). Patients were treated with electron beam, and received either 54 Gy in 18 fractions (n = 159) or 44 Gy in 10 fractions (n = 275). Local recurrence free (LRF) rates were analysed as well as metastases free rates, cancer specific survival (CSS) and cosmetic result. Results: Median follow-up was 42.8 months. For BCC, actuarial 3-year LRF rates were 97.6% for tumours treated with 54 Gy and 96.9% for 44 Gy. In SCC 3-year LRF rates were 97.0% for 54 Gy and 93.6% for 44 Gy (n.s.).

Research paper thumbnail of Conceptual equivalence and health-related quality of life: an exploratory study in Japanese and Dutch cancer patients

Quality of Life Research, 2006

Research into the equivalence of Western and Japanese conceptualizations of health-related qualit... more Research into the equivalence of Western and Japanese conceptualizations of health-related quality of life (HR-QOL) is scarce. We used the Western (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30) and the Japanese (HRQoL-20) questionnaire in order to analyze the conceptual similarity of HR-QOL factors, and the associations between specific symptom items with overall HR-QOL in Japanese (n=265) and Dutch (n=174) patients with various types of cancer. Both populations completed both instruments. In both patient groups, the overall health scale of the EORTC-QLQ-C30 correlated highly (r=0.59; p<0.001) with the HRQOL-20 composite average score, indicating substantial conceptual comparability. Relationships between all EORTC-QLQ-C30 symptom items with HR-QOL were examined by ranking their correlations with the two overall measures of HR-QOL. Comparable patterns in the Japanese and Dutch samples were observed. The results suggest a considerable conceptual equivalence of HR-QOL in Japanese and Dutch cancer patients, and indicate a satisfactory structural and cross-cultural equivalence for the EORTC-QLQ-C30 with regard to items measuring functioning and specific symptoms. Longitudinal studies are needed to examine the impact of specific symptoms on general quality of life.

Research paper thumbnail of Chest wall irradiation with MLC-shaped photon and electron fields

International Journal of Radiation Oncology*Biology*Physics, 2000

To improve the treatment technique for chest wall irradiation, using the multileaf collimator (ML... more To improve the treatment technique for chest wall irradiation, using the multileaf collimator (MLC) of the MM50 Racetrack Microtron to shape both photon and electron beams, and to check the dose delivery in the match-line region of these fields for the routine and improved technique. Using diode and film phantom measurements, the optimal number of photon beam segments and their positions relative to the electron beam were determined. On phantoms, and during actual patient treatment using in vivo dosimetry, the dose homogeneity in the match-line region was determined for both the routine and improved techniques. Three photon beam segments (9-mm gap, perfect match, and 9-mm overlap) were used to match the electron beam, resulting in minimum-maximum dose values in the match-line region of 88-109%, compared to 80-115% for the routine technique (2 photon beam segments). During patient treatment, the average minimum and maximum dose values were 95% and 115%, respectively, compared to 78% and 127%, respectively, for the routine technique. The interfraction variation in dose delivery was reduced from 11.0% (1 SD) to 4.6% (1 SD). The actual treatment time was reduced from 10 to 4.5 min. Using the MLC of the MM50 to shape both photon and electron beams, an improved treatment technique for chest wall irradiation was developed, which is less labor intensive, faster, and yields a more homogeneous, and better reproducible dose delivery.

Research paper thumbnail of Treatment morbidity in patients with endometrial cancer: results from a multicenter randomized trial

International Journal of Radiation Oncology*Biology*Physics, 2000

Research paper thumbnail of Radiotherapy and Hyperthermia for Treatment of Primary Locally Advanced Cervix Cancer: Results in 378 Patients

International Journal of Radiation Oncology*Biology*Physics, 2009

Purpose: To report response rate, pelvic tumor control, survival, and late toxicity after treatme... more Purpose: To report response rate, pelvic tumor control, survival, and late toxicity after treatment with combined radiotherapy and hyperthermia (RHT) for patients with locally advanced cervical carcinoma (LACC) and compare the results with other published series. Methods and Materials: From 1996 to 2005, a total of 378 patients with LACC (International Federation of Gynecology and Obstetrics Stage IB2-IVA) were treated with RHT. External beam radiotherapy (RT) was applied to 46-50.4 Gy and combined with brachytherapy. The hyperthermia (HT) was prescribed once weekly. Primary end points were complete response (CR) and local control. Secondary end points were overall survival, disease-specific survival, and late toxicity. Patient, tumor, and treatment characteristics predictive for the end points were identified in univariate and multivariate analyses. Results: Overall, a CR was achieved in 77% of patients. At 5 years, local control, disease-specific survival, and incidence of late toxicity Common Terminology Criteria for Adverse Events Grade 3 or higher were 53%, 47%, and 12%, respectively. In multivariate analysis, number of HT treatments emerged as a predictor of outcome in addition to commonly identified prognostic factors. Conclusions: The CR, local control, and survival rates are similar to previously observed results of RHT in the randomized Dutch Deep Hyperthermia Trial. Reported treatment results for currently applied combined treatment modalities (i.e., RT with chemotherapy and/or HT) do not permit definite conclusions about which combination is superior. The present results confirm previously shown beneficial effects from adding HT to RT and justify the application of RHT as first-line treatment in patients with LACC as an alternative to chemoradiation. Ó 2009 Elsevier Inc.

Research paper thumbnail of Adjuvant Chemotherapy for Endometrial Cancer

International Journal of Gynecological Cancer, 2010

Research paper thumbnail of Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting

International Journal of Gynecological Cancer, 2013

The second Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeti... more The second Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting was held on December 1, 2012, and included international multidisciplinary representatives of the 24 member groups. The aims were to review recent advances in molecular pathology of endometrial cancer, focusing on molecular-based therapy, and to identify key hypotheses and issues to be addressed through international collaborative clinical trials. Reviews and summaries of current knowledge were presented followed by parallel working group sessions for surgery, adjuvant and systemic therapy, and translational research. Plenary discussions were held to integrate translational and clinical issues, and a final discussion session to agree on key trial concepts. Proposals to take forward on the following trials were agreed: (1) lymphadenectomy to direct adjuvant treatment in women with high-risk endometrial cancer, including a sentinel node substudy; (2) conservative therapy for low-risk endometrial cancers in morbidly obese women with high surgical risks and for fertility-sparing treatment in premenopausal patients; (3) adjuvant therapy for women with early-stage carcinosarcoma. A proposal was made that a GCIG Early Phase Consortium be developed to serve as an international platform for rapid assessment of biomarkers.

Research paper thumbnail of Survival after relapse in patients with endometrial cancer: results from a randomized trial

European Journal of Cancer, 2001

Objective. The aim of this study was to determine the rates of local control and survival after r... more Objective. The aim of this study was to determine the rates of local control and survival after relapse in patients with stage I endometrial cancer treated in the multicenter randomized PORTEC trial.

Research paper thumbnail of Psychometric validation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24)

European Journal of Cancer, 2011

A validation study was conducted to evaluate the psychometric properties of the European Organisa... more A validation study was conducted to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24). This module was designed to assess disease and treatment specific aspects of the quality of life (QoL) of patients with endometrial cancer. Two hundred and sixty-eight women with endometrial cancer were recruited in different phases of treatment: after pelvic surgery (Group 1); during adjuvant chemotherapy and/or radiotherapy (Group 2); after completion of treatment (Group 3). Patients completed the EORTC QLQ-C30, the endometrial cancer module and a short debriefing questionnaire. Multi-trait scaling analyses confirmed the hypothesised scale structure of the QLQ-EN24. Internal consistency reliability was good with Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha coefficients ranging from 0.74 to 0.86 (lymphoedema 0.80, urological symptoms 0.75, gastrointestinal symptoms 0.74, body image problems 0.86 and sexual/vaginal problems 0.86). Convergent and discriminant validity did not show any scaling errors for the subscales. The QLQ-EN24 module discriminated well between clinically different groups of patients. All items exhibited a high completion rate with less than 2% missing values except for the sexuality items (19%). The validation study supports the reliability, the convergent and divergent validity of the EORTC QLQ-EN24. This newly developed QLQ-EN24 module is a useful instrument for the assessment of the QoL in patients treated for endometrial cancer in clinical trials.