3626
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Sharad S, Srivastava A, Ravulapalli S, Parker P, Chen Y, Li H, Petrovics G, Dobi A. Prostate cancer gene expression signature of patients with high body mass index. Prostate Cancer Prostatic Dis 2010; 14:22-9. [PMID: 21060327 PMCID: PMC3059752 DOI: 10.1038/pcan.2010.44] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The goal of this study was to evaluate prostate cancer gene expression signatures associated with elevated body mass index (BMI). Global gene expression profiles of prostate tumor cells and matching normal epithelial cells were compared between patients with features of normal- and high BMI at the time of radical prostatectomy. Knowledge-based analyses revealed an association of high BMI with altered levels of lipid metabolism and cholesterol homeostasis genes, such as stearoyl-CoA desaturase 1 (SCD1) and insulin-induced gene 1 (INSIG1), respectively, in prostate tumor cells. These genes were connected to known pathways of tumorigenesis revealed by the v-maf (musculoaponeurotic fibrosarcoma) oncogene homolog (MAF), notch receptor ligand, jagged 1 (JAG1), and the alanyl aminopeptidase (ANPEP/CD13) genes. This study highlighted that SCD1, a known target of statins, may play a mechanistic role in the recently noted beneficial effects of statin treatment in reducing biochemical recurrence of prostate cancer. An additional finding of our study is that some of the obesity related genes were upregulated in tumor-matched normal cells within the high BMI group, when compared to normal cells within the normal BMI cohort.
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Xu H, Wang Y, Wang D, Li Y, Chen Y, Liang Z. Laparoscopic Inguinal Lymphadenectomy for the Vulvar Cancer: Description of Technique and Surgical Outcomes. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chew M, Grimm J, Chen Y, LaCouture T, Kramer N, Asbell S, Hughes L, Pahlajani N, Xue J. Regression Analysis of the Dose Tolerance Limits of Some Critical Structures in Hypofractionated SBRT. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3629
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Chen Y, Pan S, Wang J, Chou C, Kuo S, Cheng J, Teng C. Radiation-induced VEGF-C Expression Stimulate Endothelial Cell Proliferation through PI3K/Akt/mTOR Pathway. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3630
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Margalit D, Sreedhara M, Chen Y, Catalano P, Nguyen P, Harris J, Brock J. Microinvasive Breast Cancer: Incidence of Axillary Metastases at Diagnosis and Recurrence Rates after Breast-conserving Therapy (BCT) or Mastectomy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3631
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Zhang H, Chen R, Hyrien O, Travis L, Milano M, Newlands S, Chen Y. Patient Demographics and Socioeconomic Status on Laryngeal Cancer Survival: A Population-based Study of 28,715 Patients. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3632
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Chen Y, Suh S, Nelson R, Liu A, Pezner R, Wong J. Setup Variations in Radiotherapy of Anal Cancer: Advantages of Target Volume Reduction using Image-guided Radiation Treatment (IGRT). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3633
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Chen Q, Chen M, Henderson D, Chen Y, Olivera G, Lu W. Verification and Validation of GPU-based TomoTherapy Dose Calculation Engine. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3634
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Chen Y, Adams J, Abramson J, Hochberg E, Tarbell N, DeLaney T. Preliminary Experience with Proton Radiotherapy in Mediastinal Lymphoma. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3635
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Liu H, Qiu D, Zhou X, Niu W, Qin X, Cai Y, Wang J, Chen Y. Erythromycin inhibited glycinergic inputs to gastric vagal motoneurons in brainstem slices of newborn rats. Neurogastroenterol Motil 2010; 22:1232-9. [PMID: 20731779 DOI: 10.1111/j.1365-2982.2010.01586.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Motilin has been known to stimulate the motility of digestive organs peripherally via activation of motilin receptors located at gastrointestinal (GI) cholinergic nerve endings and/or smooth muscle cells. Recent studies have indicated that motilin may also promote GI motility via actions in the central nervous system; however the sites of action and the mechanisms are not clear yet. The present study aimed to test the hypothesis that motilin receptor agonist erythromycin alters the synaptic inputs of preganglionic gastric vagal motoneurons (GVMs) located in the dorsal motor nucleus of the vagus (DMV). METHODS Gastric vagal motoneurons were retrogradely labeled by fluorescent tracer from the stomach wall of newborn rats. Fluorescently labeled GVMs in DMV were recorded using whole-cell patch-clamp in brainstem slices and the effects of motilin receptor agonist erythromycin on the synaptic inputs were examined. KEY RESULTS Erythromycin (100 nmol L(-1), 1 μmol L(-1), 10 μmol L(-1)) significantly inhibited the frequency of glycinergic spontaneous inhibitory postsynaptic currents (sIPSCs) of GVMs and significantly inhibited the amplitude at the concentration of 10 μmol L(-1). These responses were prevented by GM-109, a selective motilin receptor antagonist. In the pre-existence of tetradotoxin (TTX, 1 μmol L(-1)), erythromycin (10 μmol L(-1)) caused significant decreases of the glycinergic miniature inhibitory postsynaptic currents (mIPSCs), in both the frequency and the amplitude. However, erythromycin (10 μmol L(-1)) didn't cause significant changes of the GABAergic sIPSCs. CONCLUSIONS & INFERENCES Erythromycin selectively inhibits the glycinergic inputs of GVMs.
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3636
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Ren F, Chen Y, Wang Y, Yan Y, Zhao J, Ding M, Zhang J, Jiang Y, Zhai Y, Duan Z. Comparative serum proteomic analysis of patients with acute-on-chronic liver failure: alpha-1-acid glycoprotein maybe a candidate marker for prognosis of hepatitis B virus infection. J Viral Hepat 2010; 17:816-24. [PMID: 20002297 DOI: 10.1111/j.1365-2893.2009.01242.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The acute-on-chronic liver failure (AoCLF) caused by hepatitis B virus (HBV) infection remains to be a challenge in clinics with a high mortality rate in China, and it is important to identify biomarkers to foresee the prognosis of patients with HBV. The current study analysed serum proteome changes of acute-on-chronic liver failure as a result of acute exacerbation of chronic hepatitis B infection. Serum samples were collected from normal subjects (NS, n = 8), patients with chronic hepatitis B (CHB, n = 12) and patients with AoCLF (n = 12). After removal of albumin/IgG and ultramembrane centrifugation, serum proteins were separated by two-dimensional gel electrophoresis. Differentially expressed spots were identified by matrix-associated laser desorption ionization time-of-flight tandem mass spectrometry. Through the removal of albumin/IgG and ultramembrane centrifugation, the well-resolved and reproducible two-dimensional gel electrophoresis (2-DE) profiles were obtained. A total of 23 proteins were identified on 2-DE profiles by their differential expression between the three cohorts. Mass spectrometry analysis resulted in the identification of 12 proteins unambiguously. Western blot analysis confirmed the proteomics results that the α1-acid glycoprotein (α1-AGP) levels decrease significantly in plasma of patients with AoCLF, but somewhat decreased in patients with chronic HBV. Further α1-AGP levels in bulk serum samples were measured by immune turbidimetry including normal subjects group (n = 25), acute hepatitis group (n = 36), chronic hepatitis group (n = 52) and AoCLF group (n = 48), the level of α1-AGP in AoCLF groups sharply decrease than other groups. Our study shows that α1-AGP may be a potential plasma biomarker for AoCLF diagnosis because of acute exacerbation of chronic hepatitis B infection.
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Chen Y, Xu H, Wang D, Lin A, Chen G, Liang Z. Laparoscopic Comprehensive Staging for Apparent Early Invasive Epithelial Ovarian Cancers: Surgical and Outcome. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3638
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Liang Z, Xu H, Chen Y. Laparoscopic Repair of Complex Vesicouterine Fistula. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3639
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Chen Y, Lu W, Sterpin E, Chen M, Ruchala K, Olivera G. Modeling the Fluence Output Factor for TomoTherapy Dynamic Jaw Delivery. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khimani N, Ng A, Chen Y, Catalano P, Silver B, Mauch P. Salvage Radiotherapy in Patients with Recurrent or Refractory CNS Lymphoma. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3641
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Li Y, Chen Y, Ng A, Mauch P, Kozono D. Peri-transplant Radiation Therapy for Non-Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3642
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Buescher M, Chin J, Chen Y, Cohen S. P102. Gene-regulatory networks in trichome morphogenesis. Differentiation 2010. [DOI: 10.1016/j.diff.2010.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3643
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Bylund K, Chen Y, Okunieff P, Philip A, Milano M. Reirradiation with a Second Course of Stereotactic Body Radiotherapy for Locally Recurrent Lung Lesions. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3644
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Pan J, Zong J, Lin S, Zhang Y, Chen Y, Guo Q. Comparison of the Chinese 2008 and the 7th Edition AJCC Staging Systems for Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3645
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Chen Y, Li J, Liu X, Zhao W, Wang Y, Wang X. Transplantation of immortalized human fetal hepatocytes prevents acute liver failure in 90% hepatectomized mice. Transplant Proc 2010; 42:1907-14. [PMID: 20620547 DOI: 10.1016/j.transproceed.2010.01.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 01/25/2010] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to investigate whether human fetal hepatocytes are amenable to simian virus 40 large T-antigen (SV40Tag) mediated immortalization and whether the immortalized cells rescue mice with acute liver failure induced by 90% hepatectomy. METHODS We constructed a retroviral vector expressing a thermolabile mutant SV40Tag for transfer into primary human fetal hepatocytes. We quantitatively detected the synthetic ability for albumin and urea by the immortalized cells, which were subcutaneously inoculated into mice with severe combined immunodeficiency (SCID) to evaluate tumorigenzcity. The immortalized cells were also transplanted into the spleens of mice with acute liver failure. RESULTS One clone resulting after selection, referred to as HepCL, was highly differentiated, growing steadily in a chemically defined serum-free medium. HepCL cells were positive for albumin, cytokeratin 18, and cytokeratin 19 immunocytochemical staining. The average synthetic efficacies of HepCL cells for albumin and urea were comparable to that of unmodified primary human fetal hepatocytes. The population doubling time of HepCL cells in the logarithmic growth phase was approximately 17 hours. HepCL cells showed no oncogenicity in immunodeficient mice at 16 months. Mice receiving HepCL cells (G1) and primary human fetal hepatocytes (G2) showed significantly lower blood ammonia levels after 90% hepatectomy. Pairwise comparisons between the 4 groups showed that xenotransplantation of HepCL (G1) or primary fetal hepatocytes (G2) significantly improved survivals of recipient mice. CONCLUSIONS HepCL may be useful as a source of hepatic function for cell-based therapeutics in acute liver failure.
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3646
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Li W, Kong XH, Ruan M, Ma FM, Jiang YF, Liu MZ, Chen Y, Zuo XH. Green waxes, adhesives and lubricants. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:4869-90. [PMID: 20855324 DOI: 10.1098/rsta.2010.0197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
General characteristics of waxes, adhesives and lubricants as well as the recent fundamental investigations on their physical and mechanical behaviour are introduced. The current R&D status for new type/generation of waxes, adhesives and lubricants from natural products is reviewed, with an emphasis on their tribological applications. In particular, some crucial issues and challenges relating to technological improvement and materials development are discussed. Based on the current predicted shortage of energy resources and environmental concerns, prospective research on the development of green waxes, adhesives and lubricants is suggested.
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Tan Y, Chen Y, Yu L, Zhu H, Meng X, Huang X, Meng L, Ding M, Wang Z, Shan L. Two-fold elevation of expression of FoxM1 transcription factor in mouse embryonic fibroblasts enhances cell cycle checkpoint activity by stimulating p21 and Chk1 transcription. Cell Prolif 2010; 43:494-504. [PMID: 20887555 DOI: 10.1111/j.1365-2184.2010.00699.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Forkhead Box M1 (FoxM1) transcription factor regulates expression of cell cycle effective genes and is stabilized by checkpoint kinase 2 (Chk2) to stimulate expression of DNA repair enzymes in response to DNA damage. This study intended to test whether FoxM1 is involved in cell cycle checkpoint pathways. MATERIALS AND METHODS Analysis of senescence and cell proliferation in FoxM1 transgenic (TG) mouse embryonic fibroblasts (MEFs) with 2-fold elevation of FoxM1, and overexpression or knockdown of FoxM1 in an inducible FoxM1 expression cell line, or FoxM1 siRNA. Chromatin immunoprecipitation (ChIP), electrophoretic mobility shift assays (EMSA), and cotransfection to determine FoxM1 transcription targets, as well as RNase protection assays and western blot analysis, were performed. RESULTS Two-fold elevation of FoxM1 in FoxM1-TG-MEFs resulted in low levels of cell proliferation and increase in permanent cell cycle arrest at early passages (from passage 6 to 9). These phenotypes correlated with increased phosphorylation of p53 on Ser15, elevated expression of cell cycle inhibitor p21 and Chk1 at passage 3. FoxM1 was stabilized in response to DNA damage in MEFs and FoxM1 overexpression induced p21. Knockdown of FoxM1 resulted in decrease in Chk1. ChIP, EMSA and cotransfection assays confirmed that FoxM1 stimulated promoters of p21 and Chk1. CONCLUSIONS Chk1 and p21 are direct transcription targets of FoxM1 and FoxM1 participates in transcriptional responses to stress in normal cells.
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Stridh S, Kerjaschki D, Chen Y, Rügheimer L, Astrand ABM, Johnsson C, Friberg P, Olerud J, Palm F, Takahashi T, Ikegami-Kawai M, Hansell P. Angiotensin converting enzyme inhibition blocks interstitial hyaluronan dissipation in the neonatal rat kidney via hyaluronan synthase 2 and hyaluronidase 1. Matrix Biol 2010; 30:62-9. [PMID: 20933085 DOI: 10.1016/j.matbio.2010.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/01/2010] [Accepted: 09/29/2010] [Indexed: 11/18/2022]
Abstract
A functional renin-angiotensin system (RAS) is required for normal kidney development. Neonatal inhibition of the RAS in rats results in long-term pathological renal phenotype and causes hyaluronan (HA), which is involved in morphogenesis and inflammation, to accumulate. To elucidate the mechanisms, intrarenal HA content was followed during neonatal completion of nephrogenesis with or without angiotensin converting enzyme inhibition (ACEI) together with mRNA expression of hyaluronan synthases (HAS), hyaluronidases (Hyal), urinary hyaluronidase activity and cortical lymphatic vessels, which facilitate the drainage of HA from the tissue. In 6-8days old control rats cortical HA content was high and reduced by 93% on days 10-21, reaching adult low levels. Medullary HA content was high on days 6-8 and then reduced by 85% to 12-fold above cortical levels at day 21. In neonatally ACEI-treated rats the reduction in HA was abolished. Temporal expression of HAS2 corresponded with the reduction in HA content in the normal kidney. In ACEI-treated animals cortical HAS2 remained twice the expression of controls. Medullary Hyal1 increased in controls but decreased in ACEI-treated animals. Urine hyaluronidase activity decreased with time in control animals while in ACEI-treated animals it was initially 50% lower and did not change over time. Cells expressing the lymphatic endothelial mucoprotein podoplanin in ACEI-treated animals were increased 18-fold compared to controls suggesting compensation. In conclusion, the high renal HA content is rapidly reduced due to reduced HAS2 and increased Hyal1 mRNA expressions. Normal angiotensin II function is crucial for inducing these changes. Due to the extreme water-attracting and pro-inflammatory properties of HA, accumulation in the neonatally ACEI-treated kidneys may partly explain the pathological renal phenotype of the adult kidney, which include reduced urinary concentration ability and tubulointerstitial inflammation.
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Chen Y, Hill TW, Rymer AM, Wilson RJ. Rate of radial transport of plasma in Saturn's inner magnetosphere. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2010ja015412] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tanyi JA, Kato CM, Chen Y, Chen Z, Fuss M. Impact of the high-definition multileaf collimator on linear accelerator-based intracranial stereotactic radiosurgery. Br J Radiol 2010; 84:629-38. [PMID: 20923911 DOI: 10.1259/bjr/19726857] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The impact of two multileaf collimator (MLC) systems for linear accelerator-based intracranial stereotactic radiosurgery (SRS) was assessed. METHODS 68 lesions formed the basis of this study. 2.5 mm leaf width plans served as reference. Comparative plans, with identical planning parameters, were based on a 5 mm leaf width MLC system. Two collimation strategies, with collimation fixed at 0° or 90° and optimised per arc or beam, were also assessed. Dose computation was based on the pencil beam algorithm with allowance for tissue heterogeneity. Plan normalisation was such that 100% of the prescription dose covered 95% of the planning target volume. Plan evaluation was based on target coverage and normal tissue avoidance criteria. RESULTS The median conformity index difference between the MLC systems ranged between 0.8% and 14.2%; the 2.5 mm MLC exhibited better dose conformation. The median reduction of normal tissue exposed to ≥100%, ≥50% and ≥25% of the prescription dose ranged from 13.4% to 29.7%, favouring the 2.5 mm MLC system. Dose fall-off was steeper for the 2.5 mm MLC system with an overall median absolute difference ranging from 0.4 to 1.2 mm. The use of collimation optimisation resulted in a decrease in differences between the MLC systems. The results demonstrated the dosimetric merit of the 2.5 mm leaf width MLC system over the 5 mm leaf width system, albeit small, for the investigated range of intracranial SRS targets. CONCLUSION The clinical significance of these results warrants further investigation to determine whether the observed dosimetric advantages translate into outcome improvements.
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