H Nellemann

Aarhus University Hospital, Aarhus, Central Jutland, Denmark

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Publications (10)25.17 Total impact

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    ABSTRACT: Surgical resection provides long term survival in approximately 30% of patients with colorectal carcinoma (CRC) liver metastases. However, only a limited number of patients with CRC-metastases are amendable for surgery. We have tested the effect of stereotactic body radiotherapy (SBRT) in the treatment of inoperable patients with CRC-metastases. Sixty-four patients with a total number of 141 CRC-metastases in the liver (n = 44), lung (n = 12), lymph nodes (n = 3), suprarenal gland (n = 1) or two organs (n = 4) were treated with SBRT with a central dose of 15 Gy x 3 within 5-8 days. Median follow-up was 4.3 years. After 2 years, actuarial local control was 86% and 63% in tumor and patient based analysis, respectively. Nineteen percent were without local or distant progression after 2 years and overall survival was 67, 38, 22, 13, and 13% after 1, 2, 3, 4 and 5 years, respectively. One patient died due to hepatic failure, one patient was operated for a colonic perforation and two patients were conservatively treated for duodenal ulcerations. Beside these, only moderate toxicities such as nausea, diarrhoea and skin reactions were observed. SBRT in patients with inoperable CRC-metastases resulted in high probability of local control and promising survival rate. One toxic death and few severe reactions were observed. For the majority of patients, the treatment related toxicity was moderate.
    Acta Oncologica 02/2006; 45(7):823-30. · 2.87 Impact Factor
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    ABSTRACT: Purpose: To test the effect of stereotactic body radiotherapy (SBRT) in the treatment of medically inoperable patients with limited-stage non-small-cell lung cancer (NSCLC) in a Phase II trial. Methods and Materials: Forty patients with Stage I NSCLC were treated with SBRT with a central dose of 15 Gy x 3 within 5-8 days. Results: Eight patients (20%) obtained a complete response, 15 (38%) had a partial response, and 12 (30%) had no change or could not be evaluated. Only 3 patients had a local recurrence, and the local control rate 2 years after SBRT was 85%. At 2 years, 54% were without local or distant progression, and overall survival was 47%. Within 6 months after treatment, one or more Grade {>=}2 reactions were observed in 48% of the patients. Conclusions: Stereotactic body radiotherapy in patients with limited-stage NSCLC resulted in a high probability of local control and a promising survival rate. The toxicity after SBRT of lung tumors was moderate. However, deterioration in performance status, respiratory insufficiency, and other side effects were observed.
    International Journal of Radiation Oncology Biology Physics - INT J RADIAT ONCOL BIOL PHYS. 01/2006; 66(4).
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    ABSTRACT: Histamine inhibits formation and release of phagocyte-derived reactive oxygen species, and thereby protects natural killer and T cells against oxidative damage. Thus, the addition of histamine may potentially improve the efficacy of interleukin-2 (IL-2). Two randomised phase II trials of IL-2 with or without histamine dihydrochloride (HDC) in patients with metastatic renal cell carcinoma (mRCC) were run in parallel. A total of 41 patients were included in Manchester, UK and 63 in Aarhus, Denmark. The self-administered, outpatient regimen included IL-2 as a fixed dose, 18 MIU s.c. once daily, 5 days per week for 3 weeks followed by 2 weeks rest. Histamine dihydrochloride was added twice daily, 1.0 mg s.c., concomitantly with IL-2. A maximum of four cycles were given. The Danish study showed a statistically significant 1-year survival benefit (76 vs 47%, P = 0.03), a trend towards benefit in both median survival (18.3 vs 11.4 months, P = 0.07), time to PD (4.5 vs 2.2 months, P = 0.13) and clinical benefit (CR + PR + SD) (58 vs 37%, P = 0.10) in favour of IL-2/HDC, whereas the UK study was negative for all end points. Only three patients had grade 4 toxicity; however, two were fatal. A randomised phase III trial is warranted to clarify the potential role of adding histamine to IL-2 in mRCC.
    British Journal of Cancer 11/2005; 93(7):757-62. · 5.08 Impact Factor
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    ABSTRACT: The majority of patients with pancreatic cancer have advanced disease at the time of diagnosis and are not amenable for surgery. Stereotactic radiotherapy (SRT) may be an alternative treatment for patients with locally advanced disease. The effect of SRT was investigated in the present phase-II trial. Twenty-two patients with locally advanced and surgically non-resectable, histological proven pancreatic carcinoma were included into the trial. The patients were immobilized by the Elekta stereotactic body frame (SBF) or a custom made body frame. SRT was given on standard LINAC with standard multi-leaf collimator. Central dose was 15 Gyx3 within 5-10 days. Evaluation of response was found to be very difficult due to radiation and tumour related tissue reaction. Only two patients (9%) were found to have a partial response (PR), the remaining had no change (NC) or progression (PD) after treatment. Six patients had local tumour progression, but only one patient had an isolated local failure without simultaneous distant metastasis. Median time to local or distant progression was 4.8 months. Median survival time was 5.7 months and only 5% were alive 1 year after treatment. Acute toxicity reported 14 days after treatment was pronounced. There was a significant deterioration of performance status (P=0.008), more nausea (P=0.001) and more pain (P=0.008) after 14 days compared with base-line. However, 8 of 12 patients (66%) improved in performance status, scored less nausea, pain, or needed less analgesic drugs at 3 months after treatment. Four patients suffered from severe mucositis or ulceration of the stomach or duodenum and one of the patients had a non-fatal ulcer perforation of the stomach. SRT was associated with poor outcome, unacceptable toxicity and questionable palliative effect and cannot be recommended for patients with advanced pancreatic carcinoma.
    Radiotherapy and Oncology 08/2005; 76(1):48-53. · 4.52 Impact Factor
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    ABSTRACT: Purpose: To correlate the functional changes of the esophagus determined by manometry and radiography using bread and barium with the severity of esophageal symptoms.Material and Methods: Fifty-seven patients, mean age 44.4 years, suspected of primary esophageal motility disorders underwent simultaneous video-radiography and manometry. Based on interviews the patients were divided into subgroups according to predominant symptom − gastro-esophageal reflux symptoms, dysphagia, or chest pain – and to severity of symptoms, i.e., symptoms with negative or no influence on daily life. The manometric diagnosis and esophageal emptying were based on both liquid and solid swallows.Results: There was significant difference in the incidence of esophageal dysmotility disorders both globally and in the subgroup of patients with dysphagia between patients with and those without severe symptoms, but only after solid swallows.Conclusion: We suggest employment of bread in esophageal function tests to improve the correlation between symptomatology and positive diagnostics findings.
    Acta Radiologica 04/2003; 44(2):127 - 130. · 1.33 Impact Factor
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    ABSTRACT: To correlate the functional changes of the esophagus determined by manometry and radiography using bread and barium with the severity of esophageal symptoms. Fifty-seven patients, mean age 44.4 years, suspected of primary esophageal motility disorders underwent simultaneous video-radiography and manometry. Based on interviews the patients were divided into subgroups according to predominant symptom - gastro-esophageal reflux symptoms, dysphagia, or chest pain - and to severity of symptoms, i.e., symptoms with negative or no influence on daily life. The manometric diagnosis and esophageal emptying were based on both liquid and solid swallows. There was significant difference in the incidence of esophageal dysmotility disorders both globally and in the subgroup of patients with dysphagia between patients with and those without severe symptoms, but only after solid swallows. We suggest employment of bread in esophageal function tests to improve the correlation between symptomatology and positive diagnostics findings.
    Acta Radiologica 04/2003; 44(2):127-30. · 1.33 Impact Factor
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    ABSTRACT: Histamine inhibits formation and release of monocyte/macrophage-derived reactive oxygen metabolites and thereby protects natural killer (NK) and T cells against oxidative inhibition. Efficacy and safety of histamine, when given in combination with interleukin-2 (IL-2) and interferon-alpha (IFN-alpha), were evaluated in patients with metastatic renal cell carcinoma (mRCC). Forty-eight mRCC patients were included. The self-administered, outpatient regimen included IFN-alpha, 3 MIU s.c., once daily for 1 week, followed by up to nine 4 week cycles of IFN-alpha, 3 MIU s.c., days 1-7, weeks 1-4; interleukin-2, 2.4 MIU/m2 s.c., b.i.d., days 1-5, weeks 1 and 2; and histamine dihydrochloride, 1 mg s.c., b.i.d. days 1-5, weeks 1-4. Forty-six patients were eligible. Forty-two patients were evaluable for response with four partial responses (9% of eligible patients, 10% of evaluable patients). Fifteen patients (36%) had stable disease. After subsequent surgery of residual tumours, three patients (7%) had no evidence of disease at 14+, 21+ and 21+ months. Median survival time for all patients was 16.3 months. One grade 4 toxicity (thrombocytopenia) was observed. Most frequent grade 3 toxicities were fatigue/malaise (26%), dyspnoe (11%), nausea (9%) and stomatitis (9%). Four patients discontinued due to treatment-related toxicity. There were no treatment-related deaths. The present combination of histamine with IL-2 and IFN-alpha. as self-administered outpatient therapy is a safe and well-tolerated regimen. However, histamine does not appear to add efficacy with respect to response in this low-dose schedule of IL-2 and IFN-alpha. Whether histamine might improve efficacy with higher doses of IL-2 and IFN-alpha requires further investigation.
    Annals of Oncology 04/2002; 13(3):441-9. · 7.38 Impact Factor
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    ABSTRACT: To evaluate the significance of bread and barium studies as a diagnostic tool as well as a supplement to manometric investigation of the esophagus in patients with suspected esophageal motility disorders. Eighty-nine patients suspected for primary esophageal motility disorders were examined. All patients were interviewed before the investigation to determine the prevalence of symptoms like heartburn, chest pain, and dysphagia. The patients underwent simultaneous roentgenologic and manometric investigations in the supine position during wet and solid barium swallow, and during continuous drinking, followed by investigation for gastroesophageal reflux (GER). The manometric examination was performed with triple-lumen catheters connected to a hydraulic capillary infusion system and external transducers. All patients with normal esophageal clearing (n=31) had normal manometry. Patients with delayed esophageal clearing (n=58) required manometry for identifying concommittant motility disorders; achalasia and diffuse esophageal spasms were found only in patients with delayed liquid and solid emptying. GER and/or esophageal rings was demonstrated in 31 patients. We suggest bread and barium as the first diagnostic step in patients with clinical suspicion of primary esophageal motility disorders.
    Acta Radiologica 04/2000; 41(2):145-50. · 1.33 Impact Factor
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    ABSTRACT: Purpose: To evaluate the significance of bread and barium studies as a diagnostic tool as well as a supplement to manometric investigation of the esophagus in patients with suspected esophageal motility disorders.Material and Methods: Eighty-nine patients suspected for primary esophageal motility disorders were examined. All patients were interviewed before the investigation to determine the prevalence of symptoms like heartburn, chest pain, and dysphagia. The patients underwent simultaneous roentgenologic and manometric investigations in the supine position during wet and solid barium swallow, and during continuous drinking, followed by investigation for gastroesophageal reflux (GER). The manometric examination was performed with triple-lumen catheters connected to a hydraulic capillary infusion system and external transducers.Results: All patients with normal esophageal clearing (n=31) had normal manometry. Patients with delayed esophageal clearing (n=58) required manometry for identifying concommittant motility disorders; achalasia and diffuse esophageal spasms were found only in patients with delayed liquid and solid emptying. GER and/or esophageal rings was demonstrated in 31 patients.Conclusion: We suggest bread and barium as the first diagnostic step in patients with clinical suspicion of primary esophageal motility disorders.
    Acta Radiologica 03/2000; 41(2). · 1.33 Impact Factor
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