Radiomic profiles improve prognostication and reveal targets for therapy in cervical cancer.

Cervical cancer (CC) is a major global health problem with 570,000 new cases and 266,000 deaths annually. Prognosis is poor for advanced stage disease, and few effective treatments exist. Preoperative diagnostic imaging is common in high-income countries and MRI measured tumor size routinely guides treatment allocation of cervical cancer patients. Recently, the role of MRI radiomics has been recognized. However, its potential to independently predict survival and treatment response requires further clarification. This retrospective cohort study demonstrates how non-invasive, preoperative, MRI radiomic profiling may improve prognostication and tailoring of treatments and follow-ups for cervical cancer patients. By unsupervised clustering based on 293 radiomic features from 132 patients, we identify three distinct clusters comprising patients with significantly different risk profiles, also when adjusting for FIGO stage and age. By linking their radiomic profiles to genomic alterations, we identify putative treatment targets for the different patient clusters (e.g., immunotherapy, CDK4/6 and YAP-TEAD inhibitors and p53 pathway targeting treatments).

Clinicopathological and radiological stratification within FIGO 2018 stages improves risk-prediction in cervical cancer.

OBJECTIVE: Assess the added prognostic value of the updated International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system, and to identify clinicopathological and radiological biomarkers for improved FIGO 2018 prognostication. METHODS: Patient data were retrieved from a prospectively collected patient cohort including all consenting patients with cervical cancer diagnosed and treated at Haukeland University Hospital during 2001-2022 (n = 948). All patients were staged according to the FIGO 2009 and FIGO 2018 guidelines based on available data for individual patients. MRI-assessed maximum tumor diameter and stromal tumor invasion, as well as histopathologically assessed lymphovascular space invasion were applied to categorize patients according to the Sedlis criteria. RESULTS: FIGO 2018 stage yielded the highest area under the receiver operating characteristic (ROC) curve (AUC) (0.86 versus 0.81 for FIGO 2009) for predicting disease-specific survival. The most common stage migration in FIGO 2018 versus FIGO 2009 was upstaging from stages IB/II to stage IIIC due to suspicious lymph nodes identified by PET/CT and/or MRI. In FIGO 2018 stage III patients, extent and size of primary tumor (p = 0.04), as well as its histological type (p = 0.003) were highly prognostic. Sedlis criteria were prognostic within FIGO 2018 IB patients (p = 0.04). CONCLUSIONS: Incorporation of cross-sectional imaging increases prognostic precision, as suggested by the FIGO 2018 guidelines. The 2018 FIGO IIIC stage could be refined by including the size and extent of primary tumor and histological type. The FIGO IB risk prediction could be improved by applying MRI-assessed tumor size and stromal invasion.

MRI-based radiomic signatures for pretreatment prognostication in cervical cancer.

BACKGROUND: Accurate pretherapeutic prognostication is important for tailoring treatment in cervical cancer (CC). PURPOSE: To investigate whether pretreatment MRI-based radiomic signatures predict disease-specific survival (DSS) in CC. STUDY TYPE: Retrospective. POPULATION: CC patients (n = 133) allocated into training(T) (nT = 89)/validation(V) (nV = 44) cohorts. FIELD STRENGTH/SEQUENCE: T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) at 1.5T or 3.0T. ASSESSMENT: Radiomic features from segmented tumors were extracted from T2WI and DWI (high b-value DWI and apparent diffusion coefficient (ADC) maps). STATISTICAL TESTS: Radiomic signatures for prediction of DSS from T2WI (T2rad ) and T2WI with DWI (T2 + DWIrad ) were constructed by least absolute shrinkage and selection operator (LASSO) Cox regression. Area under time-dependent receiver operating characteristics curves (AUC) were used to evaluate and compare the prognostic performance of the radiomic signatures, MRI-derived maximum tumor size ≤/> 4 cm (MAXsize ), and 2018 International Federation of Gynecology and Obstetrics (FIGO) stage (I-II/III-IV). Survival was analyzed using Cox model estimating hazard ratios (HR) and Kaplan-Meier method with log-rank tests. RESULTS: The radiomic signatures T2rad and T2 + DWIrad yielded AUCT /AUCV of 0.80/0.62 and 0.81/0.75, respectively, for predicting 5-year DSS. Both signatures yielded better or equal prognostic performance to that of MAXsize (AUCT /AUCV : 0.69/0.65) and FIGO (AUCT /AUCV : 0.77/0.64) and were significant predictors of DSS after adjusting for FIGO (HRT /HRV for T2rad : 4.0/2.5 and T2 + DWIrad : 4.8/2.1). Adding T2rad and T2 + DWIrad to FIGO significantly improved DSS prediction compared to FIGO alone in cohort(T) (AUCT 0.86 and 0.88 vs. 0.77), and FIGO with T2 + DWIrad tended to the same in cohort(V) (AUCV 0.75 vs. 0.64, p = 0.07). High radiomic score for T2 + DWIrad was significantly associated with reduced DSS in both cohorts. DATA CONCLUSION: Radiomic signatures from T2WI and T2WI with DWI may provide added value for pretreatment risk assessment and for guiding tailored treatment strategies in CC.

Visceral fat percentage for prediction of outcome in uterine cervical cancer.

OBJECTIVE: The prognostic role of adiposity in uterine cervical cancer (CC) is largely unknown. Abdominal fat distribution may better reflect obesity than body mass index. This study aims to describe computed tomography (CT)-assessed abdominal fat distribution in relation to clinicopathologic characteristics, survival, and tumor gene expression in CC. METHODS: The study included 316 CC patients diagnosed during 2004-2017 who had pre-treatment abdominal CT. CT-based 3D segmentation of total-, subcutaneous- and visceral abdominal fat volumes (TAV, SAV and VAV) allowed for calculation of visceral fat percentage (VAV% = VAV/TAV). Liver density (LD) and waist circumference (at L3/L4-level) were also measured. Associations between CT-derived adiposity markers, clinicopathologic characteristics and disease-specific survival (DSS) were explored. Gene set enrichment of primary tumors were examined in relation to fat distribution in a subset of 108 CC patients. RESULTS: High TAV, VAV and VAV% and low LD were associated with higher age (≥44 yrs.; p ≤ 0.017) and high International Federation of Gynecology and Obstetrics (FIGO) (2018) stage (p ≤ 0.01). High VAV% was the only CT-marker predicting high-grade histology (p = 0.028), large tumor size (p = 0.016) and poor DSS (HR 1.07, p < 0.001). Patients with high VAV% had CC tumors that exhibited increased inflammatory signaling (false discovery rate [FDR] < 5%). CONCLUSIONS: High VAV% is associated with high-risk clinical features and predicts reduced DSS in CC patients. Furthermore, patients with high VAV% had upregulated inflammatory tumor signaling, suggesting that the metabolic environment induced by visceral adiposity contributes to tumor progression in CC.

Preoperative pelvic MRI and 2-[18F]FDG PET/CT for lymph node staging and prognostication in endometrial cancer-time to revisit current imaging guidelines?

OBJECTIVE: This study presents the diagnostic performance of four different preoperative imaging workups (IWs) for prediction of lymph node metastases (LNMs) in endometrial cancer (EC): pelvic MRI alone (IW1), MRI and [18F]FDG-PET/CT in all patients (IW2), MRI with selective [18F]FDG-PET/CT if high-risk preoperative histology (IW3), and MRI with selective [18F]FDG-PET/CT if MRI indicates FIGO stage ≥ 1B (IW4). METHODS: In 361 EC patients, preoperative staging parameters from both pelvic MRI and [18F]FDG-PET/CT were recorded. Area under receiver operating characteristic curves (ROC AUC) compared the diagnostic performance for the different imaging parameters and workups for predicting surgicopathological FIGO stage. Survival data were assessed using Kaplan-Meier estimator with log-rank test. RESULTS: MRI and [18F]FDG-PET/CT staging parameters yielded similar AUCs for predicting corresponding FIGO staging parameters in low-risk versus high-risk histology groups (p ≥ 0.16). The sensitivities, specificities, and AUCs for LNM prediction were as follows: IW1-33% [9/27], 95% [185/193], and 0.64; IW2-56% [15/27], 90% [174/193], and 0.73 (p = 0.04 vs. IW1); IW3-44% [12/27], 94% [181/193], and 0.69 (p = 0.13 vs. IW1); and IW4-52% [14/27], 91% [176/193], and 0.72 (p = 0.06 vs. IW1). IW3 and IW4 selected 34% [121/361] and 54% [194/361] to [18F]FDG-PET/CT, respectively. Employing IW4 identified three distinct patient risk groups that exhibited increasing FIGO stage (p < 0.001) and stepwise reductions in survival (p ≤ 0.002). CONCLUSION: Selective [18F]FDG-PET/CT in patients with high-risk MRI findings yields better detection of LNM than MRI alone, and similar diagnostic performance to that of MRI and [18F]FDG-PET/CT in all. KEY POINTS: • Imaging by MRI and [18F]FDG PET/CT yields similar diagnostic performance in low- and high-risk histology groups for predicting central FIGO staging parameters. • Utilizing a stepwise imaging workup with MRI in all patients and [18F]FDG-PET/CT in selected patients based on MRI findings identifies preoperative risk groups exhibiting significantly different survival. • The proposed imaging workup selecting ~54% of the patients to [18F]FDG-PET/CT yield better detection of LNMs than MRI alone, and similar LNM detection to that of MRI and [18F]FDG-PET/CT in all.

What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer?

BACKGROUND: Tumor size assessment by MRI is central for staging uterine cervical cancer. However, the optimal role of MRI-derived tumor measurements for prognostication is still unclear. MATERIAL AND METHODS: This retrospective cohort study included 416 women (median age: 43 years) diagnosed with cervical cancer during 2002-2017 who underwent pretreatment pelvic MRI. The MRIs were independently read by three radiologists, measuring maximum tumor diameters in three orthogonal planes and maximum diameter irrespective of plane (MAXimaging). Inter-reader agreement for tumor size measurements was assessed by intraclass correlation coefficients (ICCs). Size was analyzed in relation to age, International Federation of Gynecology and Obstetrics (FIGO) (2018) stage, histopathological markers, and disease-specific survival using Kaplan-Meier-, Cox regression-, and time-dependent receiver operating characteristics (tdROC) analyses. RESULTS: All MRI tumor size variables (cm) yielded high areas under the tdROC curves (AUCs) for predicting survival (AUC 0.81-0.84) at 5 years after diagnosis and predicted outcome (hazard ratios [HRs] of 1.42-1.76, p < 0.001 for all). Only MAXimaging independently predicted survival (HR = 1.51, p = 0.03) in the model including all size variables. The optimal cutoff for maximum tumor diameter (≥ 4.0 cm) yielded sensitivity (specificity) of 83% (73%) for predicting disease-specific death after 5 years. Inter-reader agreement for MRI-based primary tumor size measurements was excellent, with ICCs of 0.83-0.85. CONCLUSION: Among all MRI-derived tumor size measurements, MAXimaging was the only independent predictor of survival. MAXimaging ≥ 4.0 cm represents the optimal cutoff for predicting long-term disease-specific survival in cervical cancer. Inter-reader agreement for MRI-based tumor size measurements was excellent.

Fully Automatic Whole-Volume Tumor Segmentation in Cervical Cancer.

Uterine cervical cancer (CC) is the most common gynecologic malignancy worldwide. Whole-volume radiomic profiling from pelvic MRI may yield prognostic markers for tailoring treatment in CC. However, radiomic profiling relies on manual tumor segmentation which is unfeasible in the clinic. We present a fully automatic method for the 3D segmentation of primary CC lesions using state-of-the-art deep learning (DL) techniques. In 131 CC patients, the primary tumor was manually segmented on T2-weighted MRI by two radiologists (R1, R2). Patients were separated into a train/validation (n = 105) and a test- (n = 26) cohort. The segmentation performance of the DL algorithm compared with R1/R2 was assessed with Dice coefficients (DSCs) and Hausdorff distances (HDs) in the test cohort. The trained DL network retrieved whole-volume tumor segmentations yielding median DSCs of 0.60 and 0.58 for DL compared with R1 (DL-R1) and R2 (DL-R2), respectively, whereas DSC for R1-R2 was 0.78. Agreement for primary tumor volumes was excellent between raters (R1-R2: intraclass correlation coefficient (ICC) = 0.93), but lower for the DL algorithm and the raters (DL-R1: ICC = 0.43; DL-R2: ICC = 0.44). The developed DL algorithm enables the automated estimation of tumor size and primary CC tumor segmentation. However, segmentation agreement between raters is better than that between DL algorithm and raters.

Interobserver agreement and prognostic impact for MRI-based 2018 FIGO staging parameters in uterine cervical cancer.

OBJECTIVES: To evaluate the interobserver agreement for MRI-based 2018 International Federation of Gynecology and Obstetrics (FIGO) staging parameters in patients with cervical cancer and assess the prognostic value of these MRI parameters in relation to other clinicopathological markers. METHODS: This retrospective study included 416 women with histologically confirmed cervical cancer who underwent pretreatment pelvic MRI from May 2002 to December 2017. Three radiologists independently recorded MRI-derived staging parameters incorporated in the 2018 FIGO staging system. Kappa coefficients (κ) for interobserver agreement were calculated. The predictive and prognostic values of the MRI parameters were explored using ROC analyses and Kaplan-Meier with log-rank tests, and analyzed in relation to clinicopathological patient characteristics. RESULTS: Overall agreement was substantial for the staging parameters: tumor size > 2 cm (κ = 0.80), tumor size > 4 cm (κ = 0.76), tumor size categories (≤ 2 cm; > 2 and ≤ 4 cm; > 4 cm) (κ = 0.78), parametrial invasion (κ = 0.63), vaginal invasion (κ = 0.61), and enlarged lymph nodes (κ = 0.63). Higher MRI-derived tumor size category (≤ 2 cm; > 2 and ≤ 4 cm; > 4 cm) was associated with a stepwise reduction in survival (p ≤ 0.001 for all). Tumor size > 4 cm and parametrial invasion at MRI were associated with aggressive clinicopathological features, and the incorporation of these MRI-based staging parameters improved risk stratification when compared to corresponding clinical assessments alone. CONCLUSION: The interobserver agreement for central MRI-derived 2018 FIGO staging parameters was substantial. MRI improved the identification of patients with aggressive clinicopathological features and poor survival, demonstrating the potential impact of MRI enabling better prognostication and treatment tailoring in cervical cancer. KEY POINTS: • The overall interobserver agreement was substantial (κ values 0.61-0.80) for central MRI staging parameters in the 2018 FIGO system. • Higher MRI-derived tumor size category was linked to a stepwise reduction in survival (p ≤ 0.001 for all). • MRI-derived tumor size > 4 cm and parametrial invasion were associated with aggressive clinicopathological features, and the incorporation of these MRI-derived staging parameters improved risk stratification when compared to clinical assessments alone.

A radiogenomics application for prognostic profiling of endometrial cancer.

Prognostication is critical for accurate diagnosis and tailored treatment in endometrial cancer (EC). We employed radiogenomics to integrate preoperative magnetic resonance imaging (MRI, n = 487 patients) with histologic-, transcriptomic- and molecular biomarkers (n = 550 patients) aiming to identify aggressive tumor features in a study including 866 EC patients. Whole-volume tumor radiomic profiling from manually (radiologists) segmented tumors (n = 138 patients) yielded clusters identifying patients with high-risk histological features and poor survival. Radiomic profiling by a fully automated machine learning (ML)-based tumor segmentation algorithm (n = 336 patients) reproduced the same radiomic prognostic groups. From these radiomic risk-groups, an 11-gene high-risk signature was defined, and its prognostic role was reproduced in orthologous validation cohorts (n = 554 patients) and aligned with The Cancer Genome Atlas (TCGA) molecular class with poor survival (copy-number-high/p53-altered). We conclude that MRI-based integrated radiogenomics profiling provides refined tumor characterization that may aid in prognostication and guide future treatment strategies in EC.

A 10-gene prognostic signature points to LIMCH1 and HLA-DQB1 as important players in aggressive cervical cancer disease.

BACKGROUND: Advanced cervical cancer carries a particularly poor prognosis, and few treatment options exist. Identification of effective molecular markers is vital to improve the individualisation of treatment. We investigated transcriptional data from cervical carcinomas related to patient survival and recurrence to identify potential molecular drivers for aggressive disease. METHODS: Primary tumour RNA-sequencing profiles from 20 patients with recurrence and 53 patients with cured disease were compared. Protein levels and prognostic impact for selected markers were identified by immunohistochemistry in a population-based patient cohort. RESULTS: Comparison of tumours relative to recurrence status revealed 121 differentially expressed genes. From this gene set, a 10-gene signature with high prognostic significance (p = 0.001) was identified and validated in an independent patient cohort (p = 0.004). Protein levels of two signature genes, HLA-DQB1 (n = 389) and LIMCH1 (LIM and calponin homology domain 1) (n = 410), were independent predictors of survival (hazard ratio 2.50, p = 0.007 for HLA-DQB1 and 3.19, p = 0.007 for LIMCH1) when adjusting for established prognostic markers. HLA-DQB1 protein expression associated with programmed death ligand 1 positivity (p < 0.001). In gene set enrichment analyses, HLA-DQB1high tumours associated with immune activation and response to interferon-γ (IFN-γ). CONCLUSIONS: This study revealed a 10-gene signature with high prognostic power in cervical cancer. HLA-DQB1 and LIMCH1 are potential biomarkers guiding cervical cancer treatment.

Automated segmentation of endometrial cancer on MR images using deep learning.

Preoperative MR imaging in endometrial cancer patients provides valuable information on local tumor extent, which routinely guides choice of surgical procedure and adjuvant therapy. Furthermore, whole-volume tumor analyses of MR images may provide radiomic tumor signatures potentially relevant for better individualization and optimization of treatment. We apply a convolutional neural network for automatic tumor segmentation in endometrial cancer patients, enabling automated extraction of tumor texture parameters and tumor volume. The network was trained, validated and tested on a cohort of 139 endometrial cancer patients based on preoperative pelvic imaging. The algorithm was able to retrieve tumor volumes comparable to human expert level (likelihood-ratio test, [Formula: see text]). The network was also able to provide a set of segmentation masks with human agreement not different from inter-rater agreement of human experts (Wilcoxon signed rank test, [Formula: see text], [Formula: see text], and [Formula: see text]). An automatic tool for tumor segmentation in endometrial cancer patients enables automated extraction of tumor volume and whole-volume tumor texture features. This approach represents a promising method for automatic radiomic tumor profiling with potential relevance for better prognostication and individualization of therapeutic strategy in endometrial cancer.

Whole-Volume Tumor MRI Radiomics for Prognostic Modeling in Endometrial Cancer.

BACKGROUND: In endometrial cancer (EC), preoperative pelvic MRI is recommended for local staging, while final tumor stage and grade are established by surgery and pathology. MRI-based radiomic tumor profiling may aid in preoperative risk-stratification and support clinical treatment decisions in EC. PURPOSE: To develop MRI-based whole-volume tumor radiomic signatures for prediction of aggressive EC disease. STUDY TYPE: Retrospective. POPULATION: A total of 138 women with histologically confirmed EC, divided into training (nT = 108) and validation cohorts (nV = 30). FIELD STRENGTH/SEQUENCE: Axial oblique T1 -weighted gradient echo volumetric interpolated breath-hold examination (VIBE) at 1.5T (71/138 patients) and DIXON VIBE at 3T (67/138 patients) at 2 minutes postcontrast injection. ASSESSMENT: Primary tumors were manually segmented by two radiologists with 4 and 8 years' of experience. Radiomic tumor features were computed and used for prediction of surgicopathologically-verified deep (≥50%) myometrial invasion (DMI), lymph node metastases (LNM), advanced stage (FIGO III + IV), nonendometrioid (NE) histology, and high-grade endometrioid tumors (E3). Corresponding analyses were also conducted using radiomics extracted from the axial oblique image slice depicting the largest tumor area. STATISTICAL TESTS: Logistic least absolute shrinkage and selection operator (LASSO) was applied for radiomic modeling in the training cohort. The diagnostic performances of the radiomic signatures were evaluated by area under the receiver operating characteristic curve in the training (AUCT ) and validation (AUCV ) cohorts. Progression-free survival was assessed using the Kaplan-Meier and Cox proportional hazard model. RESULTS: The whole-tumor radiomic signatures yielded AUCT /AUCV of 0.84/0.76 for predicting DMI, 0.73/0.72 for LNM, 0.71/0.68 for FIGO III + IV, 0.68/0.74 for NE histology, and 0.79/0.63 for high-grade (E3) tumor. Single-slice radiomics yielded comparable AUCT but significantly lower AUCV for LNM and FIGO III + IV (both P < 0.05). Tumor volume yielded comparable AUCT to the whole-tumor radiomic signatures for prediction of DMI, LNM, FIGO III + IV, and NE, but significantly lower AUCT for E3 tumors (P < 0.05). All of the whole-tumor radiomic signatures significantly predicted poor progression-free survival with hazard ratios of 4.6-9.8 (P < 0.05 for all). DATA CONCLUSION: MRI-based whole-tumor radiomic signatures yield medium-to-high diagnostic performance for predicting aggressive EC disease. The signatures may aid in preoperative risk assessment and hence guide personalized treatment strategies in EC. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.

The Evans' Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly.

BACKGROUND AND PURPOSE: Assessment of ventricular enlargement is subjective and based on the radiologist's experience. Linear indices, such as the Evans Index (EI), have been proposed as markers of ventricular volume with an EI≥0.3 indicating pathologic ventricular enlargement in any subject. However, normal range for EI measured on magnetic resonance imaging (MRI) scans are lacking in healthy elderly according to age and sex. We propose new age and sex specific cut-off values for ventricular enlargement in the elderly population. MATERIALS AND METHODS: 534 participants (53% women) aged 65-84 years; 226 patients with Alzheimer's disease (AD), and 308 healthy elderly controls (CTR) from the AddNeuroMed and ADNI studies were included. The cut-off for pathological ventricular enlargement was estimated from healthy elderly categorized into age groups of 5 years range and defined as EI 97,5 percentile (mean+2SD). Cut-off values were tested on patients with Alzheimer's disease and a small sample of patients with probable idiopathic normal pressure hydrocephalus (iNPH) to assess the sensitivity. RESULTS: The range of the EI in healthy elderly is wide and 29% of the CTR had an EI of 0.3 or greater. The EI increases with age in both CTR and AD, and the overall EI for women were lower than for men (p<0.001). New EI cut off values for male/female: 65-69 years 0.34/0.32, 70-74 years 0.36/0.33, 75-79 years 0.37/0.34 and 80-84 years 0.37/0.36. When applying the proposed cut-offs for EI in men and women aged 65-84, they differentiated between iNPH and CTR with a sensitivity of 80% and for different age and sex categories of AD and CTR with a sensitivity and specificity of 0-27% and 91-98%, respectively. CONCLUSION: The range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.

Eating disorders: challenges in the later phases of the recovery process: a qualitative study of patients' experiences.

Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.

Recovery from eating disorders: psychometric properties of a patient-related measure.

ALTHOUGH THERE ARE NUMEROUS LISTS OF ITEMS COVERING CLINICALLY VALID ASPECTS OF RECOVERY FROM EATING DISORDERS, THESE LISTS ARE ON THE NOMINAL LEVEL: the potential for multidimensional development has not been explored. Such exploration is the purpose of the present study. The subjects included in the study were 152 female clinicians, 1052 females randomly selected from the general population, and 184 eating-disorder patients. All subjects rated 17 recovery items on a 10-point scale in terms of their relevance and importance. They also completed measures of knowledge about eating disorders and their own eating problems, in addition to providing information about their age and personal acquaintance with eating disorders. Fourteen recovery-item scores were sample unspecific, and hence all samples tended to judge the majority of items in a similar manner. The 17 items successfully formed three separate factors covering specific eating-disorder symptoms, as well as social and psychological issues. The clinician and general population sample analyzed together provided a more condensed scale comprising two factors (specific eating-disorder symptoms and psychosocial factors), with each factor having three items. This factor structure was successfully replicated using the patient-validation sample. The findings indicate an empirical basis for a valid recovery measure that may be suitable in future outcome research.

Clinical confidence following an interprofessional educational program on eating disorders for health care professionals: a qualitative analysis.

There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants' preferences: (1) interprofessional interventions and treatment; (2) the further development of competence; and (3) organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of "clinical confidence." This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders.

Assessment of late urinary, bowel and sexual function after dose escalation from 70 to 76 Gy using image-guided radiotherapy in curative treatment of prostate cancer.

OBJECTIVE: The aim of this study was to evaluate the late urinary, bowel and sexual function among men with localized or locally advanced prostate cancer treated with curative radiotherapy after the introduction of image-guided radiotherapy to 76 Gy using the Swedish BeamCath® technique. MATERIAL AND METHODS: All patients treated with curative radiotherapy during 2003-2006 were invited to participate in this retrospective study. In total, 87% (158/181) participated in the study. The median observation time was 35 months. Comparisons were made between the standard 70 Gy (n = 73) and the 76 Gy (n = 85) treatment groups. Assessments of late urinary, bowel and sexual function were questionnaire based, and included function items in the Expanded Prostate Cancer Index Composite. RESULTS: Most late urinary and bowel symptoms were reported to occur seldom or never in the majority of men, while late sexual toxicity was reported in a large proportion (66%) of men. Seven men (4%) used diapers. Only 25% (n = 40) reported having an erection firm enough for intercourse. None of the reported urinary or sexual function symptoms differed between the treatment groups. Rectal urgency at least once daily was a more frequent symptom in the 70 Gy group than the 76 Gy group (28% vs 9%, p = 0.006). Painful bowel movements were a more common symptom in the 70 Gy group (11% vs 1%, p = 0.01). CONCLUSION: Dose escalation up to 76 Gy using the BeamCath technique was not associated with more late toxicities than the standard 70 Gy dose.

[Eating disorders--how to work with the family?]. / Spiseforstyrrelser--hvordan arbeide med familien?

Working with families with a child or an adult with an eating disorder is to work with the resources and limitations in the families, how they could cope with this challenge. Family interventions in eating disorders are counselling, working with the family and family-oriented therapy. Studies show documented effects, especially for patients below 18 with anorexia nervosa who have had this disorder for less than three years. Indications for going from working with the family to family therapy are conflicts between parents or between the child and parents, delayed or disturbed psychological development of the child, or when siblings or other family members are believed to have an effect on the healing. Family therapy is to work with the family as a system. The professional responsibilities, the practical tasks and the goals are about interaction in the family, about relations and communication patterns. Interventions in the family are mainly rooted in systemic family therapy. Motivational methods are important, as are cognitive methods and psychoeducational methods, information and learning how to cope with eating disorders.