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Jünger ST, Schödel P, Ruess D, Ruge M, Brand JS, Wittersheim M, Eich ML, Schmidt NO, Goldbrunner R, Grau S, Proescholdt M. Timing of Development of Symptomatic Brain Metastases from Non-Small Cell Lung Cancer: Impact on Symptoms, Treatment, and Survival in the Era of Molecular Treatments. Cancers (Basel) 2020; 12:cancers12123618. [PMID: 33287226 PMCID: PMC7761690 DOI: 10.3390/cancers12123618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary In order to clarify whether an early development of brain metastases from non-small cell lung cancer represents a poor prognostic factor for further survival we analyzed 377 patients with brain metastases, treated by radiosurgery or surgery at two German institutions. Our results show that an early appearance of brain metastasis does not influence further survival in a comprehensive treatment setting. Abstract Objective: We attempted to analyze whether early presentation with brain metastases (BM) represents a poor prognostic factor in patients with non-small cell lung cancer (NSCLC), which should guide the treatment team towards less intensified therapy. Patients and methods: In a retrospective bi-centric analysis, we identified patients receiving surgical treatment for NSCLC BM. We collected demographic-, tumor-, and treatment-related parameters and analyzed their influence on further survival. Results: We included 377 patients. Development of BM was precocious in 99 (26.3%), synchronous in 152 (40.3%), and metachronous in 126 (33.4%) patients. The groups were comparable in terms of age (p = 0.76) and number of metastases (p = 0.11), and histology (p = 0.1); however, mutational status significantly differed (p = 0.002). The precocious group showed the worst clinical status as assessed by Karnofsky performance score (KPS) upon presentation (p < 0.0001). Resection followed by postoperative radiotherapy was the predominant treatment modality for precocious BM, while in syn- and metachronous BM surgical and radio-surgical treatment was balanced. Overall survival (OS) did not differ between the groups (p = 0.76). A good postoperative clinical status (KPS ≥ 70) and the application of any kind of adjuvant systemic therapy were independent predictive factors for OS. Conclusion: Early BM presentation was not associated with worse OS in NSCLC BM patients.
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Affiliation(s)
- Stephanie T. Jünger
- Centre for Neurosurgery, Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (R.G.); (S.G.)
- Centre for Integrated Oncology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (D.R.); (M.R.)
- Correspondence: ; Tel.: +49-221-478-4550; Fax: +49-221-478-82825
| | - Petra Schödel
- Department of Neurosurgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (P.S.); (N.-O.S.); (M.P.)
- Wilhelm Sander Neuro-Oncology Unit, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Daniel Ruess
- Centre for Integrated Oncology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (D.R.); (M.R.)
- Centre for Neurosurgery, Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany;
| | - Maximilian Ruge
- Centre for Integrated Oncology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (D.R.); (M.R.)
- Centre for Neurosurgery, Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany;
| | - Julia-Sarita Brand
- Centre for Neurosurgery, Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany;
| | - Maike Wittersheim
- Department of Pathology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (M.W.); (M.-L.E.)
| | - Marie-Lisa Eich
- Department of Pathology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (M.W.); (M.-L.E.)
| | - Nils-Ole Schmidt
- Department of Neurosurgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (P.S.); (N.-O.S.); (M.P.)
- Wilhelm Sander Neuro-Oncology Unit, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Roland Goldbrunner
- Centre for Neurosurgery, Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (R.G.); (S.G.)
- Centre for Integrated Oncology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (D.R.); (M.R.)
| | - Stefan Grau
- Centre for Neurosurgery, Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (R.G.); (S.G.)
- Centre for Integrated Oncology, Faculty of Medicine and University Hospital, University of Cologne, 50931 Cologne, Germany; (D.R.); (M.R.)
| | - Martin Proescholdt
- Department of Neurosurgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (P.S.); (N.-O.S.); (M.P.)
- Wilhelm Sander Neuro-Oncology Unit, University Medical Centre Regensburg, 93053 Regensburg, Germany
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Zhang J, Jin J, Ai Y, Zhu K, Xiao C, Xie C, Jin X. Differentiating the pathological subtypes of primary lung cancer for patients with brain metastases based on radiomics features from brain CT images. Eur Radiol 2020; 31:1022-1028. [PMID: 32822055 DOI: 10.1007/s00330-020-07183-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It is of high clinical importance to identify the primary lesion and its pathological types for patients with brain metastases (BM). The purpose of this study is to investigate the feasibility and accuracy of differentiating the primary adenocarcinoma (AD) and squamous cell carcinoma (SCC) of non-small-cell lung cancer (NSCLC) for patients with BM based on radiomics from brain contrast-enhanced computer tomography (CECT) images. METHODS A total of 144 BM patients (94 male, 50 female) were enrolled in this study with 102 with primary lung AD and 42 with SCC, respectively. Radiomics features from manually contoured tumors were extracted using python. Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) logistic regression were applied to select relative radiomics features. Binary logistic regression and support vector machines (SVM) were applied to build models with radiomics features alone and with radiomics features plus age and sex. RESULTS Fourteen features were selected from a total of 105 radiomics features for the final model building. The area under the curves (AUCs) and accuracy of SVM and binary logistic regression models were 0.765 vs. 0.769, 0.795 vs.0.828, and 0.716 vs. 0.726, 0.768 vs. 0.758, respectively, for models with radiomics features alone and models with radiomics features plus sex and age. CONCLUSIONS Brain CECT radiomics are promising in differentiating primary AD and SCC to achieve optimal therapeutic management in patients with BM from NSCLC. KEY POINTS • It is of high clinical importance to identify the primary lesion and its pathological types for patients with brain metastases (BM) to define the prognosis and treatment. • Few studies had investigated the feasibility and accuracy of differentiating the pathological subtypes of primary non-small-cell lung cancer between adenocarcinoma (AD) and squamous cell carcinoma (SCC) for patients with BM based on radiomics from brain contrast-enhanced CT (CECT) images, although CECT images are often the initial imaging modality to screen for metastases and are recommended on equal footing with MRI for the detection of cerebral metastases. • Brain CECT radiomics are promising in differentiating primary AD and SCC to achieve optimal therapeutic management in patients with BM from NSCLC with a highest area under the curve (AUC) of 0.828 and an accuracy of 0.758, respectively.
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Affiliation(s)
- Ji Zhang
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Juebin Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yao Ai
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kecheng Zhu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chengjian Xiao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. .,Department of Radiation and Medical Oncology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou, 325000, China.
| | - Xiance Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Franchino F, Rudà R, Soffietti R. Mechanisms and Therapy for Cancer Metastasis to the Brain. Front Oncol 2018; 8:161. [PMID: 29881714 PMCID: PMC5976742 DOI: 10.3389/fonc.2018.00161] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Advances in chemotherapy and targeted therapies have improved survival in cancer patients with an increase of the incidence of newly diagnosed brain metastases (BMs). Intracranial metastases are symptomatic in 60–70% of patients. Magnetic resonance imaging (MRI) with gadolinium is more sensitive than computed tomography and advanced neuroimaging techniques have been increasingly used in the detection, treatment planning, and follow-up of BM. Apart from the morphological analysis, the most effective tool for characterizing BM is immunohistochemistry. Molecular alterations not always reflect those of the primary tumor. More sophisticated methods of tumor analysis detecting circulating biomarkers in fluids (liquid biopsy), including circulating DNA, circulating tumor cells, and extracellular vesicles, containing tumor DNA and macromolecules (microRNA), have shown promise regarding tumor treatment response and progression. The choice of therapeutic approaches is guided by prognostic scores (Recursive Partitioning Analysis and diagnostic-specific Graded Prognostic Assessment-DS-GPA). The survival benefit of surgical resection seems limited to the subgroup of patients with controlled systemic disease and good performance status. Leptomeningeal disease (LMD) can be a complication, especially in posterior fossa metastases undergoing a “piecemeal” resection. Radiosurgery of the resection cavity may offer comparable survival and local control as postoperative whole-brain radiotherapy (WBRT). WBRT alone is now the treatment of choice only for patients with single or multiple BMs not amenable to surgery or radiosurgery, or with poor prognostic factors. To reduce the neurocognitive sequelae of WBRT intensity modulated radiotherapy with hippocampal sparing, and pharmacological approaches (memantine and donepezil) have been investigated. In the last decade, a multitude of molecular abnormalities have been discovered. Approximately 33% of patients with non-small cell lung cancer (NSCLC) tumors and epidermal growth factor receptor mutations develop BMs, which are targetable with different generations of tyrosine kinase inhibitors (TKIs: gefitinib, erlotinib, afatinib, icotinib, and osimertinib). Other “druggable” alterations seen in up to 5% of NSCLC patients are the rearrangements of the “anaplastic lymphoma kinase” gene TKI (crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib). In human epidermal growth factor receptor 2-positive, breast cancer targeted therapies have been widely used (trastuzumab, trastuzumab-emtansine, lapatinib-capecitabine, and neratinib). Novel targeted and immunotherapeutic agents have also revolutionized the systemic management of melanoma (ipilimumab, nivolumab, pembrolizumab, and BRAF inhibitors dabrafenib and vemurafenib).
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Affiliation(s)
- Federica Franchino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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Shibahara I, Kanamori M, Watanabe T, Utsunomiya A, Suzuki H, Saito R, Sonoda Y, Jokura H, Uenohara H, Tominaga T. Clinical Features of Precocious, Synchronous, and Metachronous Brain Metastases and the Role of Tumor Resection. World Neurosurg 2018; 113:e1-e9. [DOI: 10.1016/j.wneu.2017.10.145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 01/10/2023]
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Ji X, Zhuang Y, Yin X, Zhan Q, Zhou X, Liang X. Survival time following resection of intracranial metastases from NSCLC-development and validation of a novel nomogram. BMC Cancer 2017; 17:774. [PMID: 29157203 PMCID: PMC5697061 DOI: 10.1186/s12885-017-3763-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 11/08/2017] [Indexed: 01/21/2023] Open
Abstract
Background Brain metastases (BM) from non-small cell lung cancer (NSCLC) are the most frequent intracranial tumors. To identify patients who might benefit from intracranial surgery, we compared the six existing prognostic indexes(PIs) and built a nomogram to predict the survival for NSCLC with BM before they intended to receive total intracranial resection in China. Methods First, clinical data of NSCLC presenting with BM were retrospectively reviewed. All of the patients had received total intracranial resection and were randomly distributed to developing cohort and validation cohort by 2:1. Second, we stratified the cohort using a recursive partitioning analysis(RPA), a score index for radiosurgery (SIR), a basic score for BM (BS-BM), a Golden Grading System (GGS), a disease-specific graded prognostic assessment (DS-GPA) and by NSCLC-RADES. The predictive power of the six PIs was assessed using the Kaplan–Meier method and the log-rank test. Third, univariate and multivariate analysis were explored, and the nomogram predicting survival of BMs from NSCLC was constructed using R 3.2.3 software. The concordance index (C-index) was calculated to evaluate the discriminatory power of the nomogram in the developing cohort and validation cohort. Results BS-BM could better predict survival of patients before intracranial surgery compared with other PIs. In the final multivariate analysis, KPS at diagnosis of BM, metachronous or synchronous BM and the histology of lung cancer appeared to be the independent prognostic predictors for survival. The C-index in the developing cohort and validation cohort were 0.75 and 0.71 respectively, which was better than the C-index of the other six PIs. Conclusions The new nomogram is a promising tool in further choosing the candidates for intracranial surgery among NSCLC with BM and in helping physicians tailor suitable treatment options before operation in clinical practice.
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Affiliation(s)
- Xiaoyu Ji
- Department of oncology, Huashan Hospital Fudan University, Shanghai, 200040, China
| | - Yingjie Zhuang
- Company 4, Battalion 1, Cadet Brigade 1, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiangye Yin
- Company 4, Battalion 1, Cadet Brigade 1, Fourth Military Medical University, Xi'an, 710032, China
| | - Qiong Zhan
- Department of oncology, Huashan Hospital Fudan University, Shanghai, 200040, China
| | - Xinli Zhou
- Department of oncology, Huashan Hospital Fudan University, Shanghai, 200040, China
| | - Xiaohua Liang
- Department of oncology, Huashan Hospital Fudan University, Shanghai, 200040, China.
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High probability and frequency of EGFR mutations in non-small cell lung cancer with brain metastases. J Neurooncol 2017; 135:413-418. [DOI: 10.1007/s11060-017-2590-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/23/2017] [Indexed: 01/01/2023]
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Bekaert L, Emery E, Levallet G, Lechapt-Zalcman E. Histopathologic diagnosis of brain metastases: current trends in management and future considerations. Brain Tumor Pathol 2016; 34:8-19. [PMID: 27878432 DOI: 10.1007/s10014-016-0275-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/16/2016] [Indexed: 12/14/2022]
Abstract
Confronted with brain metastases (BM), pathologists aim to rule out a primary central nervous system (CNS) tumor and to identify or verify the primary tumor site to guide the clinician to specific therapies. Apart from morphological features, ancillary immunohistochemical analysis is the most effective tool for characterizing a metastatic neoplasm of unknown origin. A limited array of antibodies is used, taking into account relevant clinical information and the known brain tropism of lung cancer, breast cancer and melanoma. Recently, targeted therapies have enriched the therapeutic arsenal, in particular for patients with non-small cell lung cancer or melanoma and for patients carrying molecular anomalies. These therapies can lead to a substantial tumor response, brain metastases included, which justifies rapid determination of a molecular profile. To combine different tools and provide timely results, good tumor sample management and careful attention at the pre-analytical phase are critical. Appropriate strategies for molecular and immunohistochemical analysis are needed to identify theranostic markers. This article aims to review the anatomopathological diagnostic approach for BM in the age of targeted therapies.
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Affiliation(s)
- Lien Bekaert
- Neurosurgery Department, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Evelyne Emery
- Neurosurgery Department, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Guénaëlle Levallet
- Department of Pathology, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Emmanuèle Lechapt-Zalcman
- Department of Pathology, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France. .,Normandie Univ, UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, 14000, Caen, France.
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Lechapt Zalcman E, Bazille C, Rousseau A, Burel-Vandenbos F, Pierga JY. [Histological and molecular analysis of brain metastases]. Cancer Radiother 2015; 19:10-5. [PMID: 25636728 DOI: 10.1016/j.canrad.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 11/27/2022]
Abstract
The first step in the diagnosis of a metastatic brain lesion is to exclude a primary central nervous sytem tumour, followed by verification or identification of the primary tumor site, in order to guide the clinician to specific therapy. In addition to morphological features, ancillary immunohistochemical study is most effective for the evaluation of a metastatic neoplasm of unknown primary. Although the main principles are same, there are slight variations in the approach to the secondary lesion in the central nervous system versus other regions. Indeed, immunohistochemical approach focuses on the most common tumor types associated with secondary brain colonization: lung cancer, breast cancer and melanoma. Several studies have reported that targeted therapies are capable of reducing brain metastases in melanoma or non-small cell lung cancer, sometimes with a high dramatic response. These results have clearly impacted routine neuropathological practice. It is likely that molecular subtyping of central nervous system metastases will play an increasing role in the future. In accordance with the recommendations of Inca (French national cancer institute), the pathologist develops appropriate strategies for molecular and immunohistochemical analysis, in order to provide results as soon as possible. This article summarizes the diagnosic approach to brain metastases, with a focus on the recent emergence of targeted therapies.
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Affiliation(s)
- E Lechapt Zalcman
- Laboratoire d'anatomie pathologique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; CNRS, UMR 6301 ISTCT, CERVOxy, GIP Cyceron, boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex, France.
| | - C Bazille
- Laboratoire d'anatomie pathologique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - A Rousseau
- Département de pathologie cellulaire et tissulaire, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - F Burel-Vandenbos
- Laboratoire central d'anatomie pathologique, centre hospitalier universitaire de Nice, 06000 Nice, France
| | - J-Y Pierga
- Département d'oncologie médicale, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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Liu Y, Chen J. [Advances in diagnosis and treatment of brain metastases from the primary lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2013; 16:382-6. [PMID: 23866671 PMCID: PMC6000654 DOI: 10.3779/j.issn.1009-3419.2013.07.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
肺癌脑转移的发生率为23%-65%,是脑转移性肿瘤中最常见的类型,且预后较差。目前肺癌脑转移的诊治和分子机理已成为众多研究的热点之一。本文就肺癌脑转移的临床特征、诊断和治疗方面的进展以及最新脑转移的机制学研究做了系统的综述。
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Affiliation(s)
- Yi Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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