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Leiden, Netherlands

Wiggenraad R.,Radiotherapy Center West | Verbeek-De Kanter A.,Radiotherapy Center West | Mast M.,Radiotherapy Center West | Molenaar R.,Diaconessenhuis | And 4 more authors.
Strahlentherapie und Onkologie | Year: 2012

Purpose. The 1-year local control rates after single-fraction stereotactic radiotherapy (SRT) for brain metastases >3 cm diameter are less than 70%, but with fractionated SRT (FSRT) higher local control rates have been reported. The purpose of this study was to compare our treatment results with SRT and FSRT for large brain metastases.Materials and methods. In two consecutive periods, 41 patients with 46 brain metastases received SRT with 1 fraction of 15 Gy, while 51 patients with 65 brain metastases received FSRT with 3 fractions of 8 Gy. We included patients with brain metastases with a planning target volume of >13 cm3 or metastases in the brainstem.Results. The minimum follow-up of patients still alive was 22 months. Comparing 1 fraction of 15 Gy with 3 fractions of 8 Gy, the 1-year rates of freedom from any local progression (54% and 61%, p=0.93) and pseudo progression (85% and 75%, p=0.25) were not significantly different. Overall survival rates were also not different.Conclusion. The 1-year local progression and pseudo progression rates after 1 fraction of 15 Gy or 3 fractions of 8 Gy for large brain metastases and metastases in the brainstem are similar. For better local control rates, FSRT schemes with a higher biological equivalent dose may be necessary. © Springer-Verlag 2012.

Wijnen P.A.,Maastricht University | Cremers J.P.,Gelderse Vallei Hospital | Nelemans P.J.,Maastricht University | Erckens R.J.,Maastricht University | And 5 more authors.
European Respiratory Journal | Year: 2014

Responsiveness to tumour necrosis factor (TNF) inhibitors has been associated with the TNF-α G-308A polymorphism in rheumatoid arthritis. The aim of this study was to examine the association between the presence of this polymorphism and the response to TNF inhibitors in patients with refractory sarcoidosis. Patients (n=111) who started TNF-inhibitor treatment (76 infliximab, 35 adalimumab) were followed for at least 1 year. The main symptoms in these patients were fatigue (n=100, 90.1%), small fibre neuropathy (n=91, 82.0%), pulmonary involvement (n=69, 62.2%), and/or uveitis (n=31, 27.9%). Patients were additionally genotyped for the presence of the TNF-α G-308A polymorphism. Treatment response was assessed using clinical outcome measures and questionnaires. Three-quarters (n=83, 74.8%) of the patients responded well. Of the patients without the variant A-allele 93.6% (73 out of 78, p0.001) improved, while 30.3% (10 out of 33) of variant A-allele carriers responded favourably to TNF inhibitors. For patients with the GG-genotype, the probability of improving compared with remaining stable or deteriorating was three times higher (risk ratio 3.09, 95% CI 1.84-5.20). Sarcoidosis patients without the TNF-α-308A variant allele (GG-genotype) had a three-fold higher response to TNF inhibitors (adalimumab or infliximab). Further research is needed to evaluate the value of genotyping for the TNF-α G-308A polymorphism in order to tailor TNF-inhibitor treatment. Copyright ©ERS 2014.

Hoitsma E.,Diaconessenhuis | Hoitsma E.,Maastricht University | De Vries J.,Maastricht University | De Vries J.,University of Tilburg | Drent M.,Maastricht University
Respiratory Medicine | Year: 2011

Background: Small fiber neuropathy (SFN) appears to be relatively common in sarcoidosis patients. However, there is no golden standard to establish SFN and diagnostic tests for SFN are not widely available. There is a need for an easy to administer SFN screening instrument for clinical assessment, research or therapeutic trials. The aim of the present study was to develop a screening list to identify sarcoidosis patients with SFN in general clinical practice. Methods: We studied 139 sarcoidosis patients. The first consecutive 84 patients (Group 1) underwent temperature threshold testing (TTT) and completed an extensive SFN-symptoms-questionnaire. Based on data from Group 1 and using distribution measures and discriminant analyses, a screening list for SFN in sarcoidosis consisting of 21 questions was constructed: the Small Fiber Neuropathy Screening List (SFNSL). Subsequently, this SFNSL was crossvalidated in the next 55 consecutive patients (Group 2). Results: The same cut-off scores as found for Group 1 were appropriate in Group 2. The SFNSL was found to have high levels of internal consistency (Cronbach's alpha 0.90) and exploratory factor analysis showed that it measures only one underlying factor. Convergent validity seems good. Conclusion: To assess the presence of SFN in clinical practice the SFNSL, a brief and easy to administer questionaire, was developed in a sarcoidosis population. The results of the present study support the idea that SFN is a serious problem in chronic sarcoidosis. Future studies are needed to establish the broad usefulness of this SFN screening list and expand knowledge on the psychometric properties. © 2010 Elsevier Ltd. All rights reserved.

Datema M.,Leiden University | Gert van Dijk J.,Leiden University | Hoitsma E.,Diaconessenhuis
Clinical Neurophysiology | Year: 2012

Objective: To investigate the diagnostic yield of two simple tests for small fiber neuropathy (SFN): Neuropads® and water immersion skin wrinkling (WISW). Methods: We studied 35 patients clinically diagnosed with SFN and 61 age- and sex-matched healthy controls. Wrinkling was judged as absent (abnormal), or present (normal) after immersion of the hands for 30. min. Neuropads® are plasters impregnated with cobalt blue that are applied with to the soles of the feet. These remain blue when feet are dry (abnormal) or turn pink when there is some moisture (normal). Results: The sensitivity of the Neuropad® was 29% and its specificity 93%. The sensitivity of WISW was 66% and its specificity 70%. Regarding abnormality of at least one test to define the combination as abnormal yielded a sensitivity of 71% and specificity 67%. When both tests had to be abnormal to judge the combination abnormal, sensitivity was 23% and specificity 97%. Conclusions: The Neuropad® has a high specificity, so an abnormal result can be used to confirm SFN. WISW has a moderate sensitivity and specificity. Combining these two tests can be helpful: when both tests are abnormal the diagnosis SFN is highly likely. Significance: The Neuropad® and WISW can be helpful in daily practice by supporting the diagnosis SFN. © 2012 International Federation of Clinical Neurophysiology.

Fischer M.J.,Leiden University | Wiesenhaan M.E.,Leiden University | Heijer A.D.-D.,Diaconessenhuis | Kleijn W.C.,Leiden University | And 2 more authors.
British Journal of Health Psychology | Year: 2013

Objectives This study examined the cross-sectional and longitudinal relationships of illness perceptions, coping, and distress in women with breast cancer. Illness perceptions and coping at baseline and changes in these variables over time served as possible predictors of distress at two follow-up points. Design and methods Fifty-seven women with breast cancer who participated in a psychosocial aftercare programme completed a questionnaire before the start of the intervention, directly after the end of the intervention, and 1 year after the start of the intervention. Study variables were assessed with the Illness Perception Questionnaire-Revised (illness perceptions), the COPE (coping), and the Hopkins Symptom Check List (distress). Results Results showed that 43% of variance in distress at baseline was explained by participants' illness perceptions. Cyclical timeline perceptions were the strongest predictor of distress at baseline. Longitudinal data revealed that after the end of the intervention, the intensity of general distress and breast cancer-related emotions had decreased significantly. Partial correlations showed that baseline illness perceptions were unrelated to distress at follow-up. However, changes in illness perceptions (perceptions about the cyclical and chronic timeline and symptoms associated with breast cancer) showed significant associations with distress at both follow-up assessments. Associations of follow-up distress with coping styles were less consistent. Conclusions Our results suggest that changes in illness perceptions are related to an improvement or worsening of patients' emotional well-being over time. These findings hold promise for the development of interventions that specifically target patients' representations of their illness. Statement of contribution What is already known on this subject? Research has shown that 15%-30% of breast cancer survivors continue to experience elevated distress following treatment. Illness perceptions and coping have been found to contribute to distress in women with breast cancer. What does this study add? Cyclical timeline beliefs affect distress in breast cancer both in cross-sectional and longitudinal analyses. Baseline illness perceptions are less predictive of distress at follow-up than changes in illness perceptions. © 2012 The British Psychological Society.

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