Ulla Martinsson

Maternal and perinatal risk factors for childhood brain tumors (Sweden)

Childhood brain tumors (CBT) include a diversity of rare neoplasms of largely unknown etiology. To assess possible maternal and perinatal risk factors for CBT according to subtype, we carried out a nested (within Swedish birth-cohorts, 1973–89) case-control study, utilizing data from the nationwide Birth Registry. We ascertained incident brain tumor cases through linkage of the nationwide Birth and Cancer Registries and randomly selected five living controls from the former, matching each case on gender and birthdate. There were 570CBT cases, including 205 low grade astrocytomas, 58 high grade astrocytomas, 93 medulloblastomas, 54 ependymomas, and 160 ‘others.’ Risks for all brain tumors combined were elevated in relation to: (i) three maternal exposures-oral contraceptives prior to conception (odds ratios [OR]=1.6, 95 percent confidence interval [CI]=1.0–2.8), use of narcotics (OR=1.3, CI=1.0–1.6), or penthrane (OR=1.5, CI=1.1–2.0) during delivery); (ii) characteristics of neonatal distress (a combined variable including low one-minute Apgar score, asphyxia [OR=1.5, CI=1.1–2.0]) or treatments for neonatal distress (use of supplemental oxygen, ventilated on mask, use of incubator, scalp vein infusion, feeding with a jejunal tube [OR=1.6, CI=0.9–2.6]); and (iii) neonatal infections (OR=2.4, CI=1.5–4.0). Higher subtype-specific risks, observed for a few risk factors, did not differ significantly from the risk estimates for all subtypes combined for the corresponding risk factors. Childhood brain tumors were not associated significantly with other maternal reproductive, lifestyle, or disease factors; perinatal pain, anesthetic medications, birth-related complications; or with birthweight, birth defects, or early neonatal diseases. These findings suggest several new leads, but only weak evidence of brain tumor subtype-specific differences.

Prognostic relevance of serum-markers in relation to histopathology, stage and initial symptoms in advanced low-grade non-Hodgkin lymphomas

The prognostic relevance of 4 different serum markers (deoxythymidine kinase = S‐TK, lactic dehydrogenase = S‐LDH, S‐Haptoglobin and S‐Orosomucoid) in relation to histopathology according to the Kiel classification, stage and presence or absence of initial symptoms were investigated in 168 consecutive cases of low‐grade non‐Hodgkin lymphomas (NHL). All serum markers, as well as the other three parameters, gave prognostic information. Univariate analysis yielded a high predictive value (p<0.0002) for both S‐TK and S‐LDH. The best information regarding the probability of survival was, however, obtained from the presence or absence of symptoms from lymphoma manifestations other than those caused by a strictly local tumor mass. Since S‐TK and S‐LDH correlated well with each other, only the better of them, S‐TK, gave information additional to initial symptoms in a multivariate test.

Primarily asymptomatic low‐grade non‐Hodgkin lymphomas: Prediction of symptom‐free survival and total survival

Low‐grade non‐Hodgkin lymphomas (NHL) constitute a group of tumours with an often long survival time but, at present, with little — or no — chance of cure if the disease is not strictly local. In primarily asymptomatic patients, treatment may either be started immediately after diagnosis or deferred until symptoms occur. The possibility of predicting the symptom‐free time was investigated in 64 non‐selected initially asymptomatic patients with advanced low grade NHL, all of whom had treatment deferred until symptoms occurred. The most powerful predictor was the histopathological subgroup. Lymphocytic (LC) and follicular centroblastic‐centrocytic (fCBCC) lymphomas had a median symptom‐free period of 2 years, which was four times longer than that for immunocytoma (IC) and follicular and diffuse CBCC (fdCBCC). In addition, the serum levels of deoxythymidine kinase (S‐TK) and lactic dehydrogenase (S‐LDH) could predict the symptom‐free period. This did not apply to S‐Haptoglobin, S‐Orosomucoid or stage. In a multivariate analysis, only S‐TK gave additional information to histopathology. The only variable that predicted the overall survival time was the length of the symptom‐free period.

Telemedicine as a tool for sharing competence in paediatric radiotherapy – Implementation and initial experiences from a Swedish project

Telemedicine as a tool for sharing competence in paediatric radiotherapy : implementation and initial experiences from a Swedish project.

Immunophenotype analysis of B-CLL lymphoma and immunocytoma

The differential diagnosis between lymphocytic lymphoma of the B‐CLL type and immunocytoma (IC) can be difficult when it is based only upon morphological criteria. With the aim of improving the distinction between these subgroups, frozen sections of lymph nodes or other biopsied tissues from 14 cases of B‐CLL and 16 cases of IC were investigated according to immunophenotype. A panel of 13 B cell‐associated and 2 T cell‐associated monoclonal antibodies was used. All but one of the B‐CLL cases were FMC7, while 14/16 IC cases were FMC7+ (p < 0.001). The two negative IC cases were both of the lymphoplasmacytic type, claimed to be “more differentiated” than the lymphoplasmacytoid type. We suggest that the cells in these cases are mature enough to have lost their FMC7 positivity, similar to plasma cells. There was also a statistically significant (p < 0.01) difference, although not as pronounced, for the anti‐CD38 antibody (Leu‐17, B‐CLL: 3/14, IC: 10/16 positive). No significant difference in expression of determinants was found for any of the other antibodies.

Assessment of volume segmentation in radiotherapy of adolescents :: a treatment planning study by the Swedish Workgroup for Paediatric Radiotherapy.

Abstract Background and purpose. The variability in target delineation for similar cases between centres treating paediatric and adolescent patients, and the apparent differences in interpretation of radiotherapy guidelines in the treatment protocols encouraged us to perform a dummy-run study as a part of our quality assurance work. The aim was to identify and quantify differences in the segmentation of target volumes and organs at risk (OARs) and to analyse the treatment plans and dose distributions. Materials and methods. Four patient cases were selected: Wilms tumour, Hodgkins disease, rhabdomyosarcoma of the prostate and chordoma of the skull base. The five participating centres received the same patient-related material. They introduced the cases in their treatment planning system, delineated target volumes and OARs and created treatment plans. Dose-volume histograms were retrieved for relevant structures and volumes and dose metrics were derived and compared, e.g. target volumes and their concordance, dose homogeneity index (HI), treated and irradiated volumes, remaining volume at risk and relevant Vx and Dx values. Results. We found significant differences in target segmentation in the majority of the cases. The planning target volumes (PTVs) varied two- to four-fold and conformity indices were in the range of 0.3–0.6. This resulted in large variations in dose distributions to OARs as well as in treated and irradiated volumes even though the treatment plans showed good conformity to the PTVs. Potential reasons for the differences in target delineation were analysed. Conclusion. Considerations of the growing child and difficulties in interpretation of the radiotherapy information in the treatment protocols were identified as reasons for the variation. As a result, clarified translated detailed radiotherapy guidelines for paediatric/adolescent patients have been recognised as a way to reduce this variation.