Caro C E Koning

University of Amsterdam, Amsterdamo, North Holland, Netherlands

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Publications (102)407.21 Total impact

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    ABSTRACT: Background: The thentest design aims to detect and control for recalibration response shift. This design assumes (1) more consistency in the content of the cognitive processes underlying patients' quality of life (QoL) between posttest and thentest assessments than between posttest and pretest assessments; and (2) consistency in the time frame and description of functioning referenced at pretest and thentest. Our objective is to utilize cognitive interviewing to qualitatively examine both assumptions. Methods: We conducted think-aloud interviews with 24 patients with cancer prior to and after radiotherapy to elicit cognitive processes underlying their assessment of seven EORTC QLQ-C30 items at pretest, posttest and thentest. We used an analytic scheme based on the cognitive process models of Tourangeau et al. and Rapkin and Schwartz that yielded five cognitive processes. We subsequently used this input for quantitative analysis of count data. Results: Contrary to expectation, the number of dissimilar cognitive processes between posttest and thentest was generally larger than between pretest and posttest across patients. Further, patients considered a range of time frames when answering the thentest questions. Moreover, patients' description at the thentest of their pretest functioning was often not similar to that which was noted at pretest. Items referring to trouble taking a short walk, overall health and QoL were most often violating the assumptions. Conclusions: Both assumptions underlying the thentest design appear not to be supported by the patients' cognitive processes. Replacing the conventional pretest-posttest design with the thentest design may simply be replacing one set of biases with another.
    No preview · Article · Nov 2015 · Quality of Life Research
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    ABSTRACT: Despite intravesical therapy with immunotherapy or chemotherapy, intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) is associated with a high risk of recurrence and progression to muscle-invasive bladder carcinoma. Whereas intravesical hyperthermia in combination with mitomycin C (MMC) has proven effective in the treatment of NMIBC, there is less experience with invasive regional 70 MHz hyperthermia (RHT) and MMC. Therefore, this study examines the safety and feasibility of this treatment combination in intermediate and high-risk NMIBC. Between 2009 and 2011, 20 patients with intermediate and high-risk NMIBC were treated with intravesical MMC 40 mg combined with RHT. Treatment consisted of 6 weekly sessions followed by a maintenance period of 1 year with one hyperthermia/MMC session every 3 months. RHT was given with a 70 MHz phased array system with 4 antennas. Toxicity was scored using the Common Toxicity Criteria (CTC) 3.0. Of the 20 patients, 18 could be analysed; their median follow-up period was 46 months. Of the 18 patients, 15 (83%) completed the induction period of 6 treatments. Four patients (22%) discontinued treatment because of physical complaints without exceeding grade 2 toxicity. Toxicity scored according to the CTC 3.0 was limited to grade 1 (43%) and grade 2 (14%). The mean T90 and T50 bladder temperatures were 40.6 and 41.6°C, respectively. The recurrence-free survival rate at 24 months was 78%. Treatment with RHT combined with MMC in patients with intermediate and high-risk NMIBC is feasible with low toxicity and excellent bladder temperatures. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Jul 2015 · The Journal of urology
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    Preview · Article · Apr 2015

  • No preview · Article · Dec 2014 · Radiotherapy and Oncology
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    ABSTRACT: To determine the prevalence of valvular abnormalities after radiation therapy involving the heart region and/or treatment with anthracyclines and to identify associated risk factors in a large cohort of 5-year childhood cancer survivors (CCS). The study cohort consisted of all 626 eligible 5-year CCS diagnosed with childhood cancer in the Emma Children's Hospital/Academic Medical Center between 1966 and 1996 and treated with radiation therapy involving the heart region and/or anthracyclines. We determined the presence of valvular abnormalities according to echocardiograms. Physical radiation dose was converted into the equivalent dose in 2-Gy fractions (EQD2). Using multivariable logistic regression analyses, we examined the associations between cancer treatment and valvular abnormalities. We identified 225 mainly mild echocardiographic valvular abnormalities in 169 of 545 CCS (31%) with a cardiac assessment (median follow-up time, 14.9 years [range, 5.1-36.8 years]; median attained age 22.0 years [range, 7.0-49.7 years]). Twenty-four CCS (4.4%) had 31 moderate or higher-graded abnormalities. Most common abnormalities were tricuspid valve disorders (n=119; 21.8%) and mitral valve disorders (n=73; 13.4%). The risk of valvular abnormalities was associated with increasing radiation dose (using EQD2) involving the heart region (odds ratio 1.33 per 10 Gy) and the presence of congenital heart disease (odds ratio 3.43). We found no statistically significant evidence that anthracyclines increase the risk. Almost one-third of CCS treated with potentially cardiotoxic therapy had 1 or more asymptomatic, mostly mild valvular abnormalities after a median follow-up of nearly 15 years. The most important risk factors are higher EQD2 to the heart region and congenital heart disease. Studies with longer follow-up are necessary to investigate the clinical course of asymptomatic valvular abnormalities in CCS. Copyright © 2014 Elsevier Inc. All rights reserved.
    Full-text · Article · Oct 2014 · International journal of radiation oncology, biology, physics
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    ABSTRACT: Purpose In epidemiologic research radiation-associated late effects after childhood cancer are usually analyzed without considering fraction dose. According to radiobiological principles, fraction dose is an important determinant of late effects. We aim to provide the rationale for using equivalent dose in 2-Gy fractions (EQD2α/β) as the measure of choice rather than total physical dose as prescribed according to the clinical protocol. Methods Between 1966 and 1996, 597 (43.8 %) children in our cohort of 1,362 5-year childhood cancer survivors(CCS) received radiotherapy before the age of 18 years as part of their primary cancer treatment. Detailed information from individual patients’ charts was collected and physical doses were converted into the EQD2α/β, which includes total dose, fraction dose, and the tissue-specific α/β ratio. The use of EQD2α/β is illustrated in examples studies describing different analyses using EQD2α/β and physical dose. Results Radiotherapy information was obtained for 510 (85.4 %) CCS. Multivariable analyses rendered different risk estimates for total body irradiation in EQD2α/β-based vs. physical-dose-based models. For other radiotherapy regimens, risk estimates were similar. Conclusions Using the total physical dose is not adequate for advanced analyses of radiation-associated late effects in CCS. Therefore, it is advised that for future studies the EQD2α/β is used, because the EQD2α/β incorporates the fraction dose, and the tissue-specific α/β ratio. Furthermore, it enables comparisons across fractionation regimens and allows for summing doses delivered by various contemporary and future radiation modalities. Implications for Cancer Survivors Risk estimates of radiation-associated side effects expressed in EQD2α/β provide more precise, clinically relevant information for cancer survivor screening guidelines.
    Full-text · Article · Jun 2014 · Journal of Cancer Survivorship
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    ABSTRACT: Over 20% of all newly diagnosed Dutch patients with small-cell lung cancer (SCLC) are aged ≥75years. Uncertainties still exist about safety and efficacy of chemotherapy and chemoradiation in elderly patients. We evaluated the association between patient characteristics and (completion of) treatment and also evaluated toxicity, response and survival in elderly patients with SCLC. Population-based data from patients aged 75years or older and diagnosed with limited SCLC in 1997-2004 in The Netherlands were used (N=368). Additional data on co-morbidity, motive for deviating from guidelines, grades 3-5 toxicity, response and survival were gathered from medical records. Although only relatively fit elderly were selected for chemotherapy, almost 70% developed toxicity, leading to early termination of chemotherapy in over half of all patients. Median survival time was 6.7months, but differed strongly according to type and completion of treatment (13.5months for chemoradiation, 7.1months for chemotherapy, 2.9months for best supportive care, 11.5months for patients receiving at least 4cycles of chemotherapy and 3.6months for less than 4cycles). Although toxicity rate was high and many patients could not complete the full chemotherapy, those who received chemotherapy or chemoradiation had a significantly better survival. We hypothesize that a better selection by proper geriatric assessments is needed to achieve a more favourable balance between benefit and harm.
    No preview · Article · Jan 2014 · Journal of Geriatric Oncology
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    ABSTRACT: Impaired glomerular function is one of the health problems affecting childhood cancer survivors (CCS). It is unclear whether glomerular function deteriorates or recovers. We investigated time trends and predictors of glomerular function in CCS. We evaluated repeated observations of estimated glomerular filtration rate (GFR) and glomerular dysfunction (GFR <90 mL/min/1.73 m(2)) among adult five-year CCS treated in the EKZ/AMC between 1966 and 2003. Ifosfamide, cisplatin, carboplatin, high-dose (HD) methotrexate, HD-cyclophosphamide, radiotherapy to the kidney region, and nephrectomy (i.e., potentially nephrotoxic therapy) were investigated as predictors of glomerular function patterns over time in multivariable longitudinal analyses. At a median follow-up of 21 years after diagnosis, glomerular function was assessed in 1,122 CCS aged ≥18 years. CCS treated with potentially nephrotoxic therapy had a significantly lower GFR and higher glomerular dysfunction probability up to 35 years after cancer diagnosis compared with CCS treated without nephrotoxic therapy (P < 0.001). Especially ifosfamide, cisplatin, and nephrectomy were associated with worse glomerular function that persisted during the entire follow-up period (P < 0.001). Glomerular function deteriorated over time in all CCS (P < 0.001). CCS treated with higher doses of cisplatin seem to have a higher deterioration rate as compared with other CCS (P < 0.005). The loss in glomerular function starts early, especially for CCS treated with ifosfamide, higher doses of cisplatin, and nephrectomy, and seems to be persistent. We have an indication that CCS treated with higher doses of cisplatin experience faster decline than other CCS. As glomerular function continues to deteriorate, CCS are at risk for premature chronic renal failure. Cancer Epidemiol Biomarkers Prev; 22(10); 1-11. ©2013 AACR.
    Full-text · Article · Sep 2013 · Cancer Epidemiology Biomarkers & Prevention
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    ABSTRACT: To study incidence of local recurrences, postoperative complications and survival, in patients with rectal carcinoma aged 75 years and older, treated with either surgery and pre-operative 5 × 5 Gy radiotherapy or surgery alone. A random sample of patients aged over 75 years with pT2-T3, N0-2, M0 rectal carcinoma diagnosed between 2002 and 2004 in the Netherlands was included, treated with surgery alone (N = 296) or surgery in combination with pre-operative radiotherapy (N = 346). Information on local recurrent disease, postoperative complications, ECOG-performance score and comorbidity was gathered from the medical files. Local recurrences developed less frequently in patients treated with pre-operative radiotherapy compared to surgery alone (2% vs 6%, p = 0.002). Postoperative complications developed more frequently in irradiated patients (58% vs 42%, p < 0.0001). Especially deep infections (anastomotic leakage, pelvic abscess) were significantly increased in this group (16% vs 10%, p = 0.02). 30-day mortality was equal in both groups (8%). A significant increase in postoperative complication rate and 30-day mortality was only seen in those with "severe comorbidity" compared to patients without comorbidity (respectively 58% and 10% vs 43% and 3%), COPD (59% and 12%), diabetes (60% and 11%) and cerebrovascular disease (62% and 14%). In multivariable analysis, postoperative complications predicted 5-year survival. Elderly patients receiving pre-operative radiotherapy show a lower local recurrence rate. However, as incidence rates of local recurrent disease are low and incidence of postoperative complications is increased in irradiated patients, omitting preoperative RT may be suitable in elderly patients with additional risks for complications or early death.
    No preview · Article · Aug 2013 · European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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    ABSTRACT: Concurrent radiochemotherapy (RCT) is the treatment of choice for patients with locally advanced non-small-cell lung cancer (NSCLC). Two meta-analyses were inconclusive in an attempt to define the optimal concurrent RCT scheme. Besides efficacy, treatment toxicity will influence the appointed treatment of choice. A systematic review of the literature was performed to record the early and late toxicities, as well as overall survival, of concurrent RCT regimens in patients with NSCLC. The databases of PubMed, Ovid, Medline, and the Cochrane Library were searched for articles on concurrent RCT published between January 1992 and December 2009. Publications of phase II and phase III trials with ≥ 50 patients per treatment arm were selected. Patient characteristics, chemotherapy regimen (mono- or polychemotherapy, high or low dose) and radiotherapy scheme, acute and late toxicity, and overall survival data were compared. Seventeen articles were selected: 12 studies with cisplatin-containing regimens and 5 studies using carboplatin. A total of 13 series with mono- or polychemotherapy schedules-as single dose or double or triple high-dose or daily cisplatin-containing (≤ 30 mg/m(2)/wk) chemotherapy were found. Acute esophagitis ≥ grade 3 was observed in up to 18% of the patients. High-dose cisplatin regimens resulted in more frequent and severe hematologic toxicity, nausea, and vomiting than did other schemes. The toxicity profile was more favorable in low-dose chemotherapy schedules. From phase II and III trials published between 1992 and 2010, it can be concluded that concurrent RCT with monochemotherapy consisting of daily cisplatin results in favorable acute and late toxicity compared with concurrent RCT with single high-dose chemotherapy, doublets, or triplets.
    Full-text · Article · Jun 2013 · Clinical Lung Cancer
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    ABSTRACT: - The standard treatment for muscle-invasive bladder cancer is surgical removal of the bladder and construction of a neobladder. Recently, important improvements have been made in the potential for bladder-conserving treatment using radiotherapy.- External beam radiotherapy has undergone technological improvements, as a result of which it is possible to radiate the tumour more precisely while decreasing radiation to healthy tissue.- Radiochemotherapy improves local recurrence-free and overall survival compared with radiotherapy alone. The results of this combined treatment are comparable with those of surgery.- Additionally, Dutch radiotherapy departments have collected data in a national database of 1040 selected patients with confined bladder cancer. These patients were treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%.- Bladder conserving treatment options for muscle-invasive bladder cancer should be discussed during the multidisciplinary meeting.
    No preview · Article · May 2013 · Nederlands tijdschrift voor geneeskunde
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    Full-text · Dataset · Mar 2013
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    Full-text · Article · Mar 2013
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    E. Kaljouw · C. Koedooder · C. Lucas · C.C.E. Koning · B.R. Pieters

    Preview · Article · Mar 2013
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    ABSTRACT: Background: Due to improved visibility on MRI, contouring of the prostate is improved compared to CT. The aim of this study was to quantify the benefits of using MRI for treatment planning as compared to CT-based planning for temporary implant prostate brachytherapy. Material and methods: CT and MRI image data of 13 patients were used to delineate the prostate and organs at risk (OARs) and to reconstruct the implanted catheters (typically 12). An experienced treatment planner created plans on the CT-based structure sets (CT-plan) and on the MRI-based structure sets (MRI-plan). Then, active dwell-positions and weights of the CT-plans were transferred to the MRI-based structure sets (CT-plan(MRI-contours)) and resulting dosimetric parameters and tumour control probabilities (TCPs) were studied. Results: For the CT-plan(MRI-contours) a statistically significant lower target coverage was detected: mean V100 was 95.1% as opposed to 98.3% for the original plans (p < 0.01). Planning on CT caused cold-spots that influence the TCP. MRI-based planning improved the TCPs by 6-10%, depending on the parameters of the radiobiological model used for TCP calculation. Basing the treatment plan on either CT- or MRI-delineations does not influence plan quality. Conclusion: Evaluation of CT-based treatment planning by transferring the plan to MRI reveals underdosage of the prostate, especially at the base side. Planning on MRI can prevent cold-spots in the tumour and improves the TCP.
    Full-text · Article · Jan 2013 · Acta oncologica (Stockholm, Sweden)
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    ABSTRACT: With daily portal images and repeated CT scans from 20 patients with gold markers (GM) an adaptive margin radiotherapy strategy (AMRT) was simulated and compared to traditional bony anatomy (BA) and standard GM verification protocols. AMRT is comparable with BA. GM protocols are superior.
    No preview · Article · Nov 2012 · Radiotherapy and Oncology
  • B.R. Pieters · S Horenblas · C.C.E. Koning

    No preview · Article · Nov 2012 · The Journal of urology

  • No preview · Article · Nov 2012 · European Urology Supplements
  • Caro C E Koning · J W R Hans Nortier
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    ABSTRACT: Little is known about what the best treatment is for patients returning with painful bone metastases after their first radiotherapy. Treatment should be individualized and should depend on the histology of the primary tumour, the general condition of the patient, systemic treatment options and prognosis. The precise effect of re-irradiation of painful bone metastases has scarcely been studied. A recent meta-analysis published in the Dutch Journal of Medicine sheds only some light on this subject; the meta-analysis provided only some indications as to the effects of re-irradiation, but did not provide any evidence. The studies included were, methodologically speaking, not very strong, as much data were derived from very small numbers of patients. In addition, re-irradiation was never the primary object of study. An international, prospective, randomized clinical trial into the effects of re-irradiation of bone metastases has recently achieved its patient-inclusion target. The first results will be available by the end of 2012; these results will hopefully fill the current gaps in our knowledge.
    No preview · Article · Oct 2012 · Nederlands tijdschrift voor geneeskunde
  • C.C.E. Koning · J.W.R. Hans Nortier

    No preview · Article · Oct 2012 · Nederlands tijdschrift voor geneeskunde

Publication Stats

2k Citations
407.21 Total Impact Points

Institutions

  • 2007-2015
    • University of Amsterdam
      • Department of Radiation Oncology
      Amsterdamo, North Holland, Netherlands
  • 2005-2014
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Academic Medical Center
      • • Department of Radiotherapy
      Amsterdamo, North Holland, Netherlands
    • Medisch Centrum Haaglanden
      's-Gravenhage, South Holland, Netherlands
  • 2010
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 1996-2005
    • Netherlands Cancer Institute
      • Department of Radiotherapy
      Amsterdamo, North Holland, Netherlands