Biomedical subjects

Torgil R Möller

Publications and source records attributed to Torgil R Möller.

7 recordsLinked to original sources

PubMed2003

Radiotherapy and cancer care in Sweden.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. It included an overview of the organisation of radiotherapy and cancer care in Sweden and education of staff. It further included an update of cancer statistics for Sweden and an estimate of the need for radiotherapy resources by the year 2010. The following conclusions were drawn: Compared with a similar assessment in 1992, the number of departments of oncology at the county hospital level has increased by one, and one more department was scheduled to start radiotherapy during 2002. The speciality of oncology in Sweden includes all types of non-surgical cancer treatment, in contrast to the situation in most countries, where radiation oncology and medical oncology are independent specialities. Gynaecologic oncology is a unique speciality for Sweden. The number of new cancer cases increased by 13% between 1990 and 2000, and continues to increase by more than 1.0% per year. The projections of cancer incidence stated in the previous report were checked against observed data for the year 2000 and found to be an underestimation. To maintain the current capacity for radiotherapy in relation to number of new cancer cases by the year 2010, a total of 65 accelerators would be needed.

Cancer Care Facilities↗

PubMed2003

The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001--summary and conclusions.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) and published in 1996. The assessment reviewed the scientific literature up to 1993 on the use of radiotherapy in the treatment of solid tumours, and estimated the costs associated with radiotherapy. It also described the current practise of radiotherapy in Sweden 1992 and compared practise with scientific knowledge. The SBU has now conducted a follow-up study on radiotherapy for cancer, including a review of the scientific literature from 1994 and a prospective survey of radiotherapy practise in Sweden 2001. The following conclusions were drawn: The role of radiotherapy as an important form of treatment for cancer with both curative and palliative intent has been further confirmed. The use of radiotherapy in Sweden has increased and is now at the internationally recommended level. Radiotherapy in Sweden is mostly given in accordance with the scientific evidence but may still be underutilized in certain situations. The resources for radiotherapy are being utilized more efficiently. The costs of radiotherapy are still 5% of the total cost of cancer care, while the cost of an individual treatment (fraction) has decreased. The need for radiotherapy capacity will increase. In addition, half of the treatment equipment will have to be replaced in the next few years.

Female↗

PubMed2003

Radiotherapy techniques in current use in Sweden.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included a review of radiotherapy techniques in current use in Sweden. The following conclusions were drawn: Radiotherapy demands adequate knowledge of diagnostic methods, anatomy, cancer biology and of the physical and biological properties of ionizing radiation. Well-functioning teamwork on the part of the oncologist, medical physicist and oncology nurse is important. Radiotherapy has a high degree of technical sophistication, including the use of computers, which necessitates expert technical support. Technical development is rapid, and since the previous report, multileaf collimators and electronic portal imaging have been introduced in the clinical routine. The use of brachytherapy for treatment of non-gynaecological malignancies is rapidly increasing. The need for quality assurance in all steps of the radiotherapy procedure is stressed. A critical review of the literature on intraoperative radiotherapy is also included as an Appendix.

Brachytherapy↗

PubMed2003

A prospective survey of radiotherapy practice 2001 in Sweden.

A prospective survey of radiotherapy practice in Sweden was conducted during 12 weeks in the autumn of 2001. All hospitals that provided radiotherapy participated, and all patients who started radiotherapy during the study period were included. The final patient sample comprised 5,105 treatments given to 4,171 patients. The results were compared with those of a similar survey conducted in 1992, and the following conclusions were drawn: A substantial increase in the use of radiotherapy was noted; The estimated proportion of cancer cases receiving radiotherapy (compared to the incident number of cases) had increased from 32% in 1992 to 47%; The proportion of cancer patients receiving radiotherapy was estimated at between 37 and 46%; 54% of treatments were given with curative intent, a small increase since 1992; The difference between regional and county departments for proportion of treatments with curative intent had diminished; Treatments with curative intent used a higher proportion of resources measured in terms of fractions; The proportion of palliative treatment was slightly lower than in 1992, but the absolute number of treatments had increased by more than 20%; No improvement in participation in clinical trials was noted; Treatments given with curative intent were more complex with more fields; Hyperfractionation was used, mainly in treatments of cancers of the head and neck, lung, and bladder; The use of brachytherapy for non-gynaecological malignancies had increased dramatically; Treatment of bone metastases with a single or few fractions was used much more frequently; Dose planning and patient set-up showed a high standard but quality control of dosimetry of given treatment did not fully comply with Swedish and European recommendations; The treatment devices seem to be used more efficiently.

Brachytherapy↗

PubMed2003

Developments in radiotherapy.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included a review of future developments in radiotherapy and an estimate of the potential benefits of improved radiotherapy in Sweden. The conclusions reached from this review can be summarized as: Successively better knowledge is available on dose-response relationships for tumours and normal tissues at different fractionation schedules and treated volumes. Optimization of dose levels and fractionation schedules should improve the treatment outcome. Improved treatment results may be expected with even more optimized fractionation schedules. The radiosensitivity of the tumour is dependent on the availability of free oxygen in the cells. The oxygen effect has been studied for a long time and new knowledge has emerged, but there is still no consensus on the best way to minimize its negative effect in the treatment of hypoxic tumours. Development in imaging techniques is rapid, improving accuracy in outlining targets and organs at risk. This is a prerequisite for advanced treatment planning. More accurate treatment can be obtained using all the computer techniques that are successively made available for calculating dose distributions, controlling the accelerator and multileaf collimator (MLC) and checking patient set-up. Optimized treatment plans can be achieved using inverse dose planning and intensity modulation radiation therapy (IMRT). Optimization algorithms based on biological data from clinical trials could be a part of future dose planning. New genetic markers might be developed that give a measure of the radiation responsiveness of tumours and normal tissue. This could lead to more individualized treatments. New types of radiation sources may be expected: protons, light ions, and improved beams (and compounds) for boron neutron capture therapy (BNCT). Proton accelerators with scanned-beam systems and energy modulation give good dose distribution. The results reported with carbon ions from Japan and Germany are promising. An interesting development is to verify the dose and position for the irradiated volume with PET on line. Safer margins are obtained and the treatment volume can thus be limited. Very large accelerators are needed to accelerate the carbon ions. Still, it should be possible to keep the costs per patient at the same level as those for other types of advanced radiotherapy, since far fewer treatments per patient are needed. It might also be possible to treat new groups of patients. Increased resources are needed to introduce all the currently available techniques. New types of particle accelerators require large investments and a new structure of radiotherapy in Sweden.

Brachytherapy↗

PubMed2003

Radiotherapy practices in Sweden compared to the scientific evidence.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included a critical review of the literature on radiotherapy for cancer published in 1994-2001 and a prospective survey of radiotherapy practice in Sweden during 12 weeks in the autumn of 2001. The results of the survey were compared with the evidence derived from the scientific literature, and the following conclusions could be drawn: Radiotherapy is currently given to approximately 47% of new cancer cases This figure is on a par with rates reported from other countries. For most tumour types, curative radiotherapy practices in Sweden are generally supported by the literature. Interstitial brachytherapy has been included in the treatment of non-gynaecological malignancies, and prostate cancer is now the most common indication. Palliative radiotherapy has increased and is today given in a more rational way using single or few fractions However, it still seems to be under-utilized in Sweden. The need for radiotherapy can be expected to increase until the year 2010.

Biopsy, Needle↗

PubMed2002

Do changes in surgical procedures for breast cancer have consequences for hospital mean length of stay? A study of women operated on for breast cancer in Sweden, 1980-95.

BACKGROUND: Between 1986 and 1996, the overall mean overnight length of stay for all diagnoses in Sweden decreased from 20.8 to 7.1 days. OBJECTIVES: The study describes changes in surgical technique, from mastectomy to breast-conserving surgery, in treatment of female breast cancer and the parallel change in average length of hospital stay, and discusses the possible link between the trends. RESEARCH DESIGN: The study was performed as a descriptive register study on hospital admission data from the Swedish Hospital Discharge Register over a 16-year period (1980-95). RESULTS: During the study period, the mean length of stay for surgical curative breast cancer treatment in Sweden decreased by 56%. In 1980, the proportion of women receiving conservative surgery was 7%. At the end of the period, this share had increased to 51%. Breast-conserving surgery had an approximately 30% shorter mean length of stay compared with mastectomy. The gap was remarkably stable during the study period. The shift from mastectomy to breast-conserving surgery had a limited effect on the share of patients that went through lymph node dissection. Neither age nor the number of operations per woman could, to any significant extent, explain the decrease in mean length of stay. Approximately 14% of the overall decline can be attributed to the changes in technique. CONCLUSIONS: Clinical practice style, in this case the surgical technique, has had an effect on length of stay, but the surgical technique can only to some extent explain the trend.

Adult↗