Upplýsingar frá sænsku krabbameinsskráinni voru notaðar til að reikna út hlutfallslegar lífslíkur (relative survival rate) sjúklinga í Svíþjóð með ristil- og endaþarmskrabbamein og til að finna síðkomin krabbamein (second cancers) tengd geislameðferð hjá sjúklingunum sem gengist hafa undir aðgerð vegna endaþarmskrabbameins. Sjúkraskýrslur auk upplýsinga um innlagnir frá sænsku sjúklingaskránni voru notaðar til að meta seinar aukaverkanir vegna geislameðferðar fyrir aðgerð hjá sjúklingum með endaþarmskrabbamein. Lifunarrannsóknirnar byggðust á upplýsingum frá allri sænsku þjóðinni meðan sjúklingar sem tóku þátt í Uppsala rannsókninni og Sænsku endaþarmskrabbameinsrannsókninni á geislameðferð vegna endaþarmskrabbameins lágu að baki rannsóknunum um seinar aukaverkanir og uppkomu síðkomra krabbameina.
Hlutfallslegar 5 ára lífslíkur sjúklinga með bæði ristil- og endaþarmskrabbamein bötnuðu marktækt á tímabilinu 1960-1999, frá 39,6% til 57,2% og frá 36,1% til 57,6%. Lífslíkur sjúklinga með endaþarmskrabbamein bötnuðu hlutfallslega meir.
Sjúklingar sem voru geislaðir vegna endaþarmskrabbameins voru í meiri áhættu á að fá síðkomin krabbamein samanborið við þá sjúklinga sem höfðu eingöngu gengist undir skurðaðgerð. Þessi aukna áhættu var nær eingöngu tengd uppkomu krabbameina í líffærum sem lágu innan eða við geislunarsvæðið (RR 2,04; 95% CI 1,10-3,79). Auk þess reyndust mikilvægustu seinu aukaverkanirnar eftir geislameðferðina vera tengdar meltingarveginum, þ.e. þarmastífla (RR 1.88; 95% CI 1,10-3,20) og kviðverkir (RR 1,92; 95% CI 1,14-3,23). Ávinningur geislameðferðar fyrir aðgerð reyndist yfirvega neikvæðar hliðar meðferðarinnar en þessir sjúklingar höfðu betri lífslíkur og staðbundin endurkoma krabbameinsins var sjaldgæfari. Þannig voru 20,3% sjúklinga í Sænsku endaþarmskrabbameinsrannsókninnni sem höfðu verið geislaðir greindir með staðbundna endurkomu krabbameinsins eða síðkomið krabbamein samanborið við 30,7% sjúklinga sem voru eingöngu meðhöndlaðir með skurðaðgerð (RR 0,55; 95% CI 0,44-0,70).
Álykta má að lífslíkur sjúklinga með ristil- og endaþarmskrabbamein hafi batnað umtalsvert á undanförnum áratugum. Sérstaklega á þetta við um sjúklinga með endaþarmskrabbamein, sem er líklegast tengt betri skurðtækni
og geislameðferð fyrir aðgerð. Neikvæð áhrif geislameðferðarinnar eru þó til staðar þar sem þessir sjúklingar eru í aukinni áhættu á að fá síðkomin krabbamein og þarmastíflu. Þetta sýnir að bæta þarf geislunartæknina og einnig velja til geisla meðferðar sjúklinga sem hafa meira gagn en ógagn af henni.
Acknowledgements
I would like to express my sincere gratitude to all those who have helped me to accomplish this work. My special thanks are due to:
Lars Påhlman, my main tutor, for his energetic tutorship and stimulation and
for his devoted interest in colorectal surgery and great efforts to fight for better treatment of colon and rectal cancer;
Bengt Glimelius, my co-tutor, for allowing me to benefit from his profound
knowledge and experience in the field of oncology and research;
Ulf Gunnarsson, my co-tutor, for sharing his invaluable ambitions for
re-search and for his good humour when solving different problems;
Mats Talbäck, Hans Garmo and Niclas Eriksson, for valuable statistical and
epidemiological advice;
Ewa Lundgren and Ulf Haglund, present and former chiefs of the surgical
department, and Lars Wiklund, head of the department of surgical sciences, for allowing me to work at the surgical department, and for providing condi-tions that made this work possible;
Wilhelm Graf, Urban Karlbom, Haile Mahteme, Ulla-Maria Gustafsson, Pia Jestin, Erik Lundin, Joakim Folkesson, Helena Laurell, Ulrik Wallin and Lars Österlund, my colleagues at the colorectal department, who themselves
have gone through or are going through the same process, for help and friendship.
Agneta Gustafsson, for helping me with different time consuming tasks; Maud Marsden, for correcting the English of all the published manuscripts
My research group, for helpful and harmonious collaboration (Fig. 15);
Figure 15. My research group, at the annual “Christmas doctoral research meeting”,
12th December 2003. From the left, standing: Ulf (my co-tutor), Staffan, Pålle (my main tutor), Bengt (my co-tutor), Kerry, Gabriel, Joakim, Pia, Eva, Annika; and sitting: Helena and Hans.
And most of all;
My wife Margrét, for her support and stimulation and for her non-stop ten-der care and love throughout this process;
My daughter Fanney, for her patience and for understanding why her father has had to spend so much time on this research;
My family and friends in Iceland and other places in the world for their total back-up and friendship.
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