Five younger researchers have received support for coverage of travel expenses for international conference participation
Five younger researchers have from March through August received support for coverage of their travel expenses for international conference participation
WP 2.9: ICG-BREAST-LYMPH (IBL) – Breast cancer related lymphedema (BCRL) and breast reconstruction. An Inter-Regional Observational Study – Caroline Lilja, Ph.D. student, Odense University Hospital
Barcelona Breast Meeting, 20th to 22nd og March 2024, Barcelona, Spain (Oral presentation)..
Background: Surgical treatments are increasingly adopted and gaining popularity for lymphedema treatment. However, challenges persist in selecting appropriate treatment modalities targeted for individual patients and achieving consensus on choice of treatment as well as outcomes.(1–3) The systematic review aimed to address these issues by developing a treatment algorithm based on current scientific evidence. We evaluated and synthesized the evidence on the effectiveness of three surgical treatments for breast cancer-related lymphedema (BCRL): lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and liposuction.
Method: We conducted a systematic search of electronic databases on 18 June 2023, including Medline, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.org. Eligible studies were randomized controlled trials, non-randomized comparative studies, and observational studies that assessed the outcomes of LVA, VLNT, or liposuction in managing BCRL. The primary outcome of interest were changes in arm volume, lymphatic flow, and quality of life. Two independent reviewers performed the study selection and data extraction. Following this, we systematically reviewed and conducted a risk of bias assessment. Results were qualitatively presented and a treatment algorithm was developed based on the available data.
Results: We identified 16,593 papers, after removal of duplicates. Following assessment of studies, 73 articles met the inclusion criteria. We were not able to conduct a meta-analysis due to considerable heterogeneity. Liposuction appears effective for patients presenting with non-pitting lymphedema. LVA indicate variable success rate, with some evidence indicating a reduction in limb volume and symptomatic relief amongst early stages of lymphedema. VLNT showed promising results for limb volume reduction and symptom improvement in patients presenting with mild and moderate lymphedema.
Conclusion: Liposuction, LVA and VLNT seems to be effective treatments for BCRL, when targeted for the appropriate patient. Well-conducted high evidence clinical studies in the field are still lacking to uncover the efficacy of surgical treatment for BCRL.
WP 3.5: ‘Melacare: nurse-led follow-up after early-stage melanoma – feasibility study‘ – Sara Mølgaard Hansen, Ph.D. student, Herlev and Gentofte Hospital
SCAPLAS Congress, 12th to14th og June, Helsingfors, Finland (Oral presentation)
Introduction: We developed the Melacare nurse-led intervention combining management of fear of cancer recurrence (FCR) and skin self-examination (SSE) as a resource-conscious method to detect recurrence in patients with melanoma.
Aims: This study aims to evaluate the feasibility of the Melacare intervention before a later RCT.
Methods: In this intervention-only feasibility study, the included patients attended the first 2 nurse sessions of the intervention and were provided an educational booklet. The patients completed patient-reported outcome questionnaires at baseline and before each nurse session. After the intervention had ended, the patients completed a study-specific feedback questionnaire. Feasibility was evaluated in terms of recruitment, adherence, and attendance. The effect of the intervention was also evaluated.
Results: Fourteen patients were included in the feasibility study, 9 stage IA and 5 stage IB. The attendance and recruitment rates were both 100 % and adherence in terms of completed questionnaires (98 % completion rate) and booklet use (100 % read at least half) was very good. The effect of the intervention showed that all patients felt better at coping with FCR and knew how to perform SSE. Conclusion: This feasibility study demonstrated that the Melacare intervention was feasible and accepted by patients with early-stage melanoma, but it also highlighted some minor issues that we needed to adjust before the commencement of the RCT e.g., the method of recruitment and making both face-to-face consultations and telephone/video consultations an option.
WP 2.17: Free vascularized Fibular Grafting for Reconstruction After Sarcoma in Denmark – Christian Lind Nielsen, Ph.D. student, Aarhus Univeristy Hospital
36th Annual Meeting of the European Musculo-Sceletal Oncology Society 24th EMSOS Nurse and Allied Professions Group Meeting, 12th to 14th of June, Stettin, Poland (Poster presentation)
Background and Objective: Vascularized fibula grafting following tumor resection is an important component in limb salvage surgery. The purpose of this study was to determine both surgical and oncological outcomes of patients treated in Denmark between 2009 and 2023.
Materials and methods: We describe a retrospective review of 27 consecutively treated patients who underwent surgery between January 1st, 2009, and November 1st, 2023, at Aarhus or Copenhagen University Hospitals. Patients were identified from the national Danish Sarcoma Database. There were 12 cases of osteosarcoma, 13 cases of Ewing’s sarcoma and 2 cases of giant cell tumor. Mean age at the time of surgery was 15.1 years (range: 2.4-38.9). Mean follow-up was 74.8 months (range: 12-138). Patients were analyzed overall and stratified on basis of tumor location in an upper and a lower extremity group.
Results: During the follow-up period, 18 patients attained graft union (66.7 %) with a mean time to union of 13.9 months (range: 7-28.5). 6 patients developed nonunion (22.2 %) and 20 patients (74.1 %) had to undergo one or more reoperations in relation to the primary surgery. Patients in the upper extremity group were more likely to attain graft union (91.7 % vs. 46.7 %, RR=5.5, 95 % CI=1.3-31.5, p=0.02) and less likely to undergo multiple reoperations (16.7 % vs 60 %, RR=0.3, 95 % CI:0.1-0.9, p=0.047) compared to patients in the lower extremity group. 6 patients died during follow-up. 5- year overall survival was 81.2 % (95 % CI: 60.5-91.7). 8 patients (29.6 %) experienced relapse with distant metastases. Among these patients, 5 also developed local recurrence (18.5 %). Mean time to metastasis was 10.3 months (range: 1-18) while mean time to local recurrence was 13.2 months (range: 7-17).
Conclusion: Biological reconstruction with vascularized fibula graft following tumor resection remains a viable option, despite the low rate of graft union and the need for multiple reoperations, particularly in lower extremity cases.
WP 2.11: In-house 3D printed porous implants: in-vivo study of oaaeointegration – Anna Bertoli Borgognoni, Ph.D. student, Aarhus Univeristy Hospital
36th Annual Meeting of the European Musculo-Sceletal Oncology Society 24th EMSOS Nurse and Allied Professions Group Meeting, 12th to 14th of June, Stettin, Poland (Oral presentation)
Introduction: A collaboration between a 3DP centre in Aarhus University Hospital (AUH)
and the Danish Technological Institute (DTI), allow us to manufacture custom-made 3D metal implant in house. Aim of this study was to assess the osseointegration of 3D-printed titanium implants through a validated randomized animal study.
Methods: 20 stable, non-weight-loaded, 6*10 mm cylindrical implants were 3D printed by
DTI: 10 with a rough and 10 with a smooth surface. Implants were randomized and implanted
into the left humerus of 20 skeletally mature sheep. After 4 weeks of observation all sheep were euthanized. The specimens were collected and cut into blokes, each containing an implant and surrounding tissue. Each block was then cut into a 3 mm block for mechanical test, closest to the surgical entry site, and a 6 mm block for future histomorphometrical evaluation. Biomechanical testing was performed as failure by push-out test on an Instron Universal Test Machine.
Results: Implants with a smooth surface demonstrate complete absence of osseointegration,
as they fall out of the bone during sample preparation. Testing was therefore not possible.
Porous implants showed macroscopic integration and breaking point at implant´s surface. We measured a median Ultimate Shear Strength of 0,06 MPa (IQR:1,14), a median Apparent Shear Stiffness of 0,16 MPa/mm (IQR:0,48) and a median Energy Absorption of 19,98 J/m2 (IQR:25,80).
Conclusion: Our study shows superior osseointegration in 3DP implants with a porous surface.
WP 3.17: RESPONSE: coloRectal cancEr Survivors’ follow-uP care – nOw digital and Need-baSEd. A national interventional trial for stage I and II patients – Mai-Britt Worm Ørntoft, MD, PhD, Gødstrup Hospital
European Survivorship and Rehabilitation Symposium 2024, 9th to 10th of September, Copenhagen, Denmark (Poster presentation).
Introduction: Due to colorectal cancer (CRC) screening, the number of early stage I-II CRC survivors increases. Their risk of recurrence is low (5-10%), whereas their risk of moderate to severe ‘late adverse effects’ (LAEs) after treatment is much higher (30-50%), including poor health-related quality of life (HRQoL). This is not addressed in the current ‘one-size-fits-all’ follow-up program, which solely focus on recurrence detection. Thus for 90-95% of stage I-II CRC survivors, today’s program is irrelevant. To balance their low recurrence risk against their need for support due to LAEs, we aim to develop an improved follow-up program and compare it to standard-of-care.
Methodology: The RESPONSE follow-up program includes 1) circulating tumor DNA guided recurrence detection; 2) identification of LAEs with digital assessment of Patient Reported Outcomes (PROs); 3) standardised treatment of LAEs; and 4) a smartphone app to guide the patient through the program. The new program will be compared to standard-of-care in a national multicentre two-armed intervention effectiveness trial, including 200 survivors in each arm. All stage I-II CRC patients >18 years, who have received curative surgery, are eligible. The primary outcome is difference in EORTC-QLQ-C30 global scores 3-years post-surgery. Secondary outcomes include differences in fear-of-cancer-recurrence, severity of LAEs, overall survival, and health care costs measured in QUALY.
Results: Circulating tumor DNA markers for recurrence detection have been developed and validated. A smartphone app to guide follow-up is currently evaluated in a pilot study. RESPONSE inclusion begins 01-06-24.
Conclusion: The results from RESPONSE will be used to qualify the future follow-up program for patients with stage I-II CRC in Denmark. We expect our study to facilitate a shift in survivorship care from recurrence monitoring only to an increased awareness of LAEs, which we hypothesize will improve HRQoL, without compromising overall survival or increasing health care costs.
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