{"id":7530,"date":"2023-08-17T06:52:46","date_gmt":"2023-08-17T06:52:46","guid":{"rendered":"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/"},"modified":"2024-03-28T17:52:49","modified_gmt":"2024-03-28T17:52:49","slug":"3-4-response-evaluation","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/","title":{"rendered":"3.4 Response evaluation"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:-60px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row 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\/>\n\t\t\t\t\t\t\t\t\t\t<div class=\"fusion-slider-loading\"><\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t<input type=\"hidden\" name=\"post_type[]\" value=\"any\" \/><input type=\"hidden\" name=\"search_limit_to_post_titles\" value=\"0\" \/><input type=\"hidden\" name=\"live_min_character\" value=\"4\" \/><input type=\"hidden\" name=\"live_posts_per_page\" value=\"100\" \/><input type=\"hidden\" name=\"live_search_display_featured_image\" value=\"1\" \/><input type=\"hidden\" name=\"live_search_display_post_type\" value=\"1\" \/><input type=\"hidden\" name=\"fs\" value=\"1\" \/>\n\t\t\t<\/div>\n\n\n\t\t\t\t\t\t\t<div class=\"fusion-search-results-wrapper\"><div class=\"fusion-search-results\"><\/div><\/div>\n\t\t\t\n\t\t<\/form>\n\t\t<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-title-center fusion-title-text fusion-title-size-five\" style=\"--awb-text-color:#c1c1c1;--awb-sep-color:#e2e2e2;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h5 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\">3.4 Utv\u00e4rdering av behandlingssvar<\/h5><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>RECIST (Response Evaluation Criteria in Solid Tumours) har tagits fram f\u00f6r att tillhandah\u00e5lla en standardiserad och relativt enkel metod f\u00f6r bed\u00f6mning av behandlingseffekten p\u00e5 tum\u00f6rer i studier med protokoll. RECIST-kriterierna anv\u00e4nds dock ocks\u00e5 som ett verktyg f\u00f6r att utv\u00e4rdera behandlingseffekten hos de flesta cancerpatienter p\u00e5 standardbehandling (kemoterapi, m\u00e5lriktad behandling, immunterapi, endokrin terapi). RECIST-kriterierna antogs 2000 och reviderades 2009. Nuvarande standard \u00e4r RECIST 1.1.<sup>1<\/sup><\/p>\n<\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">F\u00f6ljande termer\/definitioner \u00e4r viktiga i RECIST version 1.1:<\/h5><\/div><div class=\"fusion-text fusion-text-2\"><ul>\n<li>M\u00e4tbar sjukdom<\/li>\n<li>icke m\u00e4tbar sjukdom<\/li>\n<li>M\u00e5llesioner<\/li>\n<li>Icke-m\u00e5llesioner<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Ovanst\u00e5ende kan bed\u00f6mas med hj\u00e4lp av f\u00f6ljande m\u00e4tmetoder:<\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>DT eller MR<\/li>\n<li>Kliniskt<\/li>\n<li>Lungr\u00f6ntgen<\/li>\n<\/ul>\n<p>Det \u00e4r viktigt att samma modalitet anv\u00e4nds vid utv\u00e4rdering av effekten av en behandling.<\/p>\n<\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">M\u00e4tbar sjukdom \u2013 tum\u00f6rer och lymfk\u00f6rtlar<\/h5><\/div><div class=\"fusion-text fusion-text-4\"><p>Tum\u00f6rer \u2013 m\u00e4ts p\u00e5 den l\u00e4ngsta diametern d\u00e4r minsta storlek \u00e4r:<\/p>\n<ul>\n<li>\u226510 mm vid DT eller MR<\/li>\n<li>\u226510 mm vid klinisk unders\u00f6kning \u2013 synliga\/kutana\/subkutana metastaser<\/li>\n<li>\u226520 mm p\u00e5 lungr\u00f6ntgen<\/li>\n<\/ul>\n<p>Lymfk\u00f6rtlar \u2013 m\u00e4ts p\u00e5 den kortaste axeln, d\u00e4r minsta storlek \u00e4r:<\/p>\n<ul>\n<li>\u226515 mm \u2013 patologiskt f\u00f6rstorad lymfk\u00f6rtel<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-5 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Icke m\u00e4tbar sjukdom \u2013 alla andra lesioner och sant icke m\u00e4tbara lesioner<\/h5><\/div><div class=\"fusion-text fusion-text-5\"><p>Andra lesioner:<\/p>\n<ul>\n<li>Sm\u00e5 tum\u00f6rer\/lesioner &lt;10 mm<\/li>\n<li>10 mm <u>&lt;<\/u> lymfk\u00f6rtlar <u>&lt;<\/u>15 mm<\/li>\n<\/ul>\n<p>Icke m\u00e4tbara lesioner:<\/p>\n<ul>\n<li>Ascites, pleural och perikardiell v\u00e4tska, leptomeningeal sjukdom, inflammatorisk br\u00f6stcancer, lymfangitkarcinomatos i lungor och hud, bukresistenser eller organomegali, cystiska lesioner, skleroserande skelettmetastaser<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-6 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">M\u00e5llesioner<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><p>Baserat p\u00e5 unders\u00f6kningen vid behandlingsstart (oftast DT) definieras m\u00e4tbara tum\u00f6rer\/lymfk\u00f6rtlar, och m\u00e5llesioner som ska m\u00e4tas\/j\u00e4mf\u00f6ras fr\u00e5n unders\u00f6kning till unders\u00f6kning v\u00e4ljs f\u00f6r bed\u00f6mning av behandlingens effekt. De ska:<\/p>\n<ul>\n<li>Vara representativa f\u00f6r alla engagerade organ<\/li>\n<li>V\u00e4ljas utifr\u00e5n storlek och l\u00e4mplighet f\u00f6r upprepade m\u00e4tningar<\/li>\n<li>Vid flera m\u00e4tbara lesioner v\u00e4ljs totalt upp till fem representativa lesioner, dock h\u00f6gst tv\u00e5 lesioner per organ.<\/li>\n<\/ul>\n<p>Diametern f\u00f6r varje m\u00e5llesion l\u00e4ggs ihop till ett tal \u2013 summan vid behandlingsstart \u2013 som senare anv\u00e4nds f\u00f6r att m\u00e4ta behandlingssvaret.<\/p>\n<\/div><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Icke-m\u00e5llesioner<\/h5><\/div><div class=\"fusion-text fusion-text-7\"><p>\u00c5terst\u00e5ende lesioner, b\u00e5de icke m\u00e4tbara lesioner och resterande m\u00e4tbara lesioner, ska noteras:<\/p>\n<ul>\n<li>M\u00e4tbara tum\u00f6rer som <strong><em>inte<\/em><\/strong> v\u00e4ljs som m\u00e5llesioner<\/li>\n<li>F\u00f6r sm\u00e5 tum\u00f6rer\/lymfk\u00f6rtlar<\/li>\n<li>Icke m\u00e4tbara lesioner (skelettmetastaser, pleurautgjutning, ascites, peritonealkarcinom osv.)<\/li>\n<li>Tidigare bestr\u00e5lade lesioner<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-8 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Utv\u00e4rdering av behandlingssvaret:<\/h5><\/div><div class=\"fusion-text fusion-text-8\"><p>Vid utv\u00e4rdering av behandlingssvar kan det finnas 4 utfall:<\/p>\n<ul>\n<li>CR \u2013 komplett respons<\/li>\n<li>PR \u2013 partiell respons<\/li>\n<li>PD \u2013 progressiv sjukdom\/progression<\/li>\n<li>SD \u2013 stabil sjukdom<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-9 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">CR \u2013 komplett respons<\/h5><\/div><div class=\"fusion-text fusion-text-9\"><ul>\n<li>Krympning av alla m\u00e5llesioner och alla patologiskt f\u00f6rstorade lymfk\u00f6rtlar har minskat till &lt;10 mm i kortaste axeln<\/li>\n<li>Alla icke-m\u00e5llesioner har f\u00f6rsvunnit<\/li>\n<li>Inga nya lesioner har tillkommit<\/li>\n<\/ul>\n<p><b><i>Samtliga ovanst\u00e5ende punkter ska vara uppfyllda.<\/i><\/b><\/p>\n<\/div><div class=\"fusion-title title fusion-title-10 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">PR \u2013 partiell respons<\/h5><\/div><div class=\"fusion-text fusion-text-10\"><ul>\n<li>Minst 30 % minskning av den sammanlagda summan av m\u00e5llesioner j\u00e4mf\u00f6rt med summan vid behandlingsstart<\/li>\n<li>Ingen samtidig entydig progression av icke-m\u00e5llesioner<\/li>\n<li>Inga nya lesioner har tillkommit<\/li>\n<\/ul>\n<p><b><i>Samtliga ovanst\u00e5ende punkter ska vara uppfyllda.<\/i><\/b><\/p>\n<\/div><div class=\"fusion-title title fusion-title-11 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">PD \u2013 progressiv sjukdom\/progression<\/h5><\/div><div class=\"fusion-text fusion-text-11\"><ul>\n<li>Minst 20 % \u00f6kning av den totala summan av m\u00e5llesioner j\u00e4mf\u00f6rt med den l\u00e4gsta uppm\u00e4tta summan (nadirsummam) och en absolut \u00f6kning p\u00e5 minst 5 mm fr\u00e5n nadirsumman<\/li>\n<li>Tillkomst av ny lesion<\/li>\n<li>Otvetydig progression av icke-m\u00e5llesioner<\/li>\n<li>Klinisk progression<\/li>\n<\/ul>\n<p><i><b>Endast en av ovanst\u00e5ende punkter beh\u00f6ver vara uppfylld f\u00f6r att sjukdomen vara progressiv.<\/b><\/i><\/p>\n<\/div><div class=\"fusion-title title fusion-title-12 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">SD \u2013 stabil sjukdom<\/h5><\/div><div class=\"fusion-text fusion-text-12\"><ul>\n<li>Varken PR eller PD<\/li>\n<li>Inga nya lesioner har tillkommit<\/li>\n<\/ul>\n<\/div><div class=\"fusion-text fusion-text-13\"><p>Ovanst\u00e5ende alternativ visas i en tabell f\u00f6r att ge en b\u00e4ttre \u00f6versikt \u00f6ver det totala behandlingssvaret enligt RECIST 1.1.<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">M\u00c5LLEISONER<\/th>\n<th align=\"left\">ICKE-M\u00c5LLEISONER<\/th>\n<th align=\"left\">TILLKOMST AV NY LESION<\/th>\n<th align=\"left\">TOTAL RESPONS<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">CR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">PR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">CR<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ej utv\u00e4rderingsbar <\/span><\/span>(NE)<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">PR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">PR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">SD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">PD<\/td>\n<td align=\"left\">CR, PR, SD, PD, NE<\/td>\n<td align=\"left\">Ja eller nej<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Inte alla utv\u00e4rderade<\/span><\/span><\/td>\n<td align=\"left\">Ej PD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ej utv\u00e4rderingsbar <\/span><\/span>(NE)<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">N\u00e5gon<\/span><\/span><\/td>\n<td align=\"left\">PD<\/td>\n<td align=\"left\">Ja eller nej<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">N\u00e5gon<\/span><\/span><\/td>\n<td align=\"left\">CR, PR, SD, PD, NE<\/td>\n<td align=\"left\">Ja<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:20px;margin-bottom:20px;width:100%;\"><\/div><div class=\"fusion-text fusion-text-14\"><p>Exempel p\u00e5 bed\u00f6mning:<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\"><\/th>\n<th align=\"left\">BEHANDLINGSSTART<\/th>\n<th align=\"left\"><\/th>\n<th align=\"left\">F\u00d6RSTA UTV\u00c4RDERING AV BEHANDLINGSRESPONS<\/th>\n<th align=\"left\">ANDRA UTV\u00c4RDERING AV BEHANDLINGSRESPONS<\/th>\n<th align=\"left\">TREDJE UTV\u00c4RDERING AV BEHANDLINGSRESPONS<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">M\u00c5LLESIONER<\/span><\/span><\/td>\n<td align=\"left\">ORGAN<\/td>\n<td align=\"left\">mm<\/td>\n<td align=\"left\">mm<\/td>\n<td align=\"left\">mm<\/td>\n<td align=\"left\">mm<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Lever<\/span><\/span><\/td>\n<td align=\"left\">47<\/td>\n<td align=\"left\">28<\/td>\n<td align=\"left\">31<\/td>\n<td align=\"left\">45<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Lungor<\/span><\/span><\/td>\n<td align=\"left\">30<\/td>\n<td align=\"left\">19<\/td>\n<td align=\"left\">19<\/td>\n<td align=\"left\">25<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Lymfk\u00f6rtlar<\/span><\/span><\/td>\n<td align=\"left\">25<\/td>\n<td align=\"left\">16<\/td>\n<td align=\"left\">17<\/td>\n<td align=\"left\">24<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Summa m\u00e5llesioner<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\">102<\/td>\n<td align=\"left\">63<\/td>\n<td align=\"left\">67<\/td>\n<td align=\"left\">94<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">f\u00f6r\u00e4ndring fr\u00e5n baslinjen<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><\/td>\n<td align=\"left\">-38.2%<\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">F\u00f6r\u00e4ndring i % fr\u00e5n nadir<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\">+6.3%<\/td>\n<td align=\"left\">+49.2%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Respons f\u00f6r m\u00e5llesioner<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Icke-m\u00e5llesioner<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Multipla levermetastaser<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Multipla levermetastaser&#8221;<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Multipla levermetastaser&#8221;<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Multipla levermetastaser&#8221;<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Respons f\u00f6r icke-m\u00e5llesioner<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Otvetydig progression<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Nya lesioner<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><\/td>\n<td align=\"left\">nej<\/td>\n<td align=\"left\">nej<\/td>\n<td align=\"left\"><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Total respons<\/span><\/span><\/td>\n<td colspan=\"2\" align=\"left\"><\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:20px;margin-bottom:20px;width:100%;\"><\/div><div class=\"fusion-title title fusion-title-13 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">iRECIST \u2013 RECIST f\u00f6r immunbaserad behandling<\/h4><\/div><div class=\"fusion-text fusion-text-15\"><p>Immunterapi anv\u00e4nder kroppens eget immunsystem f\u00f6r att s\u00f6ka upp cancern <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/4-treatment\/4-3-oncology-treatment-immunotherapy\/\">(se avsnittet om onkologisk immunterapi)<\/a>. I kliniska studier med immunterapi observerades ett annorlunda\/ovanligt svar i f\u00f6rh\u00e5llande till vad som tidigare setts med andra onkologiska behandlingar. Dvs. initial progression i enlighet med RECIST 1.1 med \u00f6kande storlek p\u00e5 m\u00e5llesioner och uppkomst av nya lesioner, men d\u00e4refter positiv och l\u00e5ngvarig respons. Baserat p\u00e5 detta beslutade RECIST-arbetsgruppen att ta fram en riktlinje med modifierade RECIST-kriterier f\u00f6r kliniska studier med immunterapi (iRECIST) f\u00f6r att s\u00e4kerst\u00e4lla enhetlig design och datainsamling<sup>2<\/sup>.<\/p>\n<p>iRECIST bygger p\u00e5 RECIST 1.1, men fler begrepp har lagts till i utv\u00e4rderingen av behandlingssvaret:<\/p>\n<ul>\n<li>iCR \u2013 komplett immunrespons<\/li>\n<li>iPR \u2013 partiell immunrespons<\/li>\n<li>iUPD \u2013 immunobekr\u00e4ftad progressiv sjukdom<\/li>\n<li>iCPD \u2013 immunbekr\u00e4ftad progressiv sjukdom<\/li>\n<li>iSD \u2013 immunstabil sjukdom<\/li>\n<li>Nya lesioner delas in i f\u00f6ljande kategorier:\n<ul>\n<li>M\u00e5llesioner<\/li>\n<li>Icke-m\u00e5llesioner<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>De fr\u00e4msta skillnaderna mellan RECIST 1.1 och iRECIST:<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\"><\/th>\n<th align=\"left\">RESIST 1.1<\/th>\n<th align=\"left\">IRECIST<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Definition av m\u00e4tbar och icke-m\u00e4tbar sjukdom; antal och val av m\u00e5llesioner<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">M\u00e4tbara lesioner \u00e4r \u226510 mm i diameter (\u226515 mm f\u00f6r lymfk\u00f6rtlar); maximalt fem \u00a0lesioner (tv\u00e5 per organ); all annan sjukdom anses vara icke-m\u00e5llesioner (m\u00e5ste vara \u226510 mm p\u00e5 den korta axeln f\u00f6r lymfk\u00f6rtlar)<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen f\u00f6r\u00e4ndring enligt RECIST 1.1. Nya lesioner bed\u00f6ms p\u00e5 basis av RECIST 1.1 men \u00a0registreras separat i l\u00e4mpligt fallrapportformul\u00e4r (men inkluderas inte i summan f\u00f6r m\u00e5llesioner identifierade vid baslinjen)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Komplett respons, partiell respons eller stabil sjukdom<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Har kanske inte uppfyllt kriterierna f\u00f6r progression f\u00f6re komplett respons, partiell \u00a0respons eller stabil sjukdom<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kan ha haft iUPD (en eller flera g\u00e5nger), men inte iCPD f\u00f6re iCR, iPR eller iSD<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Bekr\u00e4ftelse av komplett respons eller partiell respons<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kr\u00e4vs endast f\u00f6r icke-randomiserade studier<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Motsvarar RECIST 1.1<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Bekr\u00e4ftelse av stabil sjukdom<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kr\u00e4vs ej<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Motsvarar RECIST 1.1<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Nya lesioner<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Resultat f\u00f6r progression; registrerade men inte uppm\u00e4tta<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Resultat vid iUPD, men iCPD uppn\u00e5s endast om n\u00e4sta skanning p\u00e5visar nya lesioner eller om de nya lesionerna vid f\u00f6reg\u00e5ende skanning har \u00f6kat i storlek (\u22655 mm f\u00f6r summan av nya m\u00e5llesioner eller nya icke-m\u00e5llesioner har \u00f6kat i storlek, oavsett omfattning<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Oberoende blindad granskning och central \u00a0bed\u00f6mning av skanningar<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Rekommenderas i vissa fall \u2013 t.ex. i vissa studier med progressionsbaserade effektm\u00e5tt f\u00f6r godk\u00e4nnande f\u00f6r f\u00f6rs\u00e4ljning<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Insamling av alla skanningar (men inte \u00a0en oberoende granskning) rekommenderas f\u00f6r alla studier<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Bekr\u00e4ftelse av progression<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kr\u00e4vs ej (om inte tvetydig)<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kr\u00e4vs<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Bed\u00f6mning av allm\u00e4ntillst\u00e5nd<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ing\u00e5r inte i bed\u00f6mningen<\/span><\/span><\/td>\n<td align=\"left\">Of\u00f6r\u00e4ndrat allm\u00e4ntillst\u00e5nd\/PS beaktas vid beslut om fortsatt \u00a0behandling efter iUPD<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:20px;margin-bottom:20px;width:100%;\"><\/div><div class=\"fusion-text fusion-text-16\"><p>Mer information om iRECIST och behandling av nya lesioner och iUPD finns i \u201diRECIST: guidelines for response criteria for use in trials testing immunotherapeutics\u201d, Seymour m.fl. Lancet Oncol 2017<sup>2<\/sup>.<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-14 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Referenser<\/h4><\/div><div class=\"fusion-text fusion-text-17\"><ol>\n<li><em>Eisenhauer EA et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). EJC 2019)<\/em><\/li>\n<li><em>Seymour et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics, Lancet Oncol 2017.<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-overflow:hidden;--awb-bg-size:cover;--awb-border-radius:7px 7px 7px 7px;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-5-malignant-hypercalcaemia\/\"><span class=\"fusion-button-text\">Forts\u00e4tt till n\u00e4sta avsnitt: 3.5 Malign hyperkalcemi<\/span><i class=\"fa-arrow-alt-circle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:7px;--awb-border-radius-top-right:7px;--awb-border-radius-bottom-right:7px;--awb-border-radius-bottom-left:7px;--awb-overflow:hidden;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-15 fusion-title-center fusion-title-text fusion-title-size-five\" style=\"--awb-text-color:#c1c1c1;--awb-margin-top:25px;--awb-sep-color:#e2e2e2;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h5 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\"><p style=\"text-align: center;\">Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:16.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:11.52%;--awb-spacing-left-medium:11.52%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.88%;--awb-width-medium:66.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:2.88%;--awb-spacing-left-medium:2.88%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-2 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_bevel_color:rgba(89,96,104,0.7);--button_bevel_color_hover:rgba(89,96,104,0.9);--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:15px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-1-treatment-algorithm\/\"><span class=\"fusion-button-text\">3.1 Behandlingsalgoritm<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-3 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-2-treatment-criteria-for-initiation-of-tki\/\"><span class=\"fusion-button-text\">3.2 Behandlingskriterier vid ins\u00e4ttning av TKI<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-4 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">3.3 Behandlingskriterier f\u00f6r initiering av checkpointh\u00e4mmare<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-5 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\"><span class=\"fusion-button-text\">3.4 Utv\u00e4rdering av behandlingssvar<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-6 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-5-malignant-hypercalcaemia\/\"><span class=\"fusion-button-text\">3.5 Malign hyperkalcemi<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-7 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\"><span class=\"fusion-button-text\">3.6 Funktionsstatus (PS)<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:16.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:11.52%;--awb-spacing-left-medium:11.52%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7514,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7530","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7530","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7530"}],"version-history":[{"count":20,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7530\/revisions"}],"predecessor-version":[{"id":11175,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7530\/revisions\/11175"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7514"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7530"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}