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Rivera CA, Bhatia S, Morell AA, Daggubati LC, Merenzon MA, Sheriff SA, Luther E, Chandar J, S Levy A, Metzler AR, Berke CN, Goryawala M, Mellon EA, Bhatia RG, Nagornaya N, Saigal G, I de la Fuente M, Komotar RJ, Ivan ME, Shah AH. Metabolic signatures derived from whole-brain MR-spectroscopy identify early tumor progression in high-grade gliomas using machine learning. J Neurooncol 2024:10.1007/s11060-024-04812-1. [PMID: 39180640 DOI: 10.1007/s11060-024-04812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Recurrence for high-grade gliomas is inevitable despite maximal safe resection and adjuvant chemoradiation, and current imaging techniques fall short in predicting future progression. However, we introduce a novel whole-brain magnetic resonance spectroscopy (WB-MRS) protocol that delves into the intricacies of tumor microenvironments, offering a comprehensive understanding of glioma progression to inform expectant surgical and adjuvant intervention. METHODS We investigated five locoregional tumor metabolites in a post-treatment population and applied machine learning (ML) techniques to analyze key relationships within seven regions of interest: contralateral normal-appearing white matter (NAWM), fluid-attenuated inversion recovery (FLAIR), contrast-enhancing tumor at time of WB-MRS (Tumor), areas of future recurrence (AFR), whole-brain healthy (WBH), non-progressive FLAIR (NPF), and progressive FLAIR (PF). Five supervised ML classification models and a neural network were developed, optimized, trained, tested, and validated. Lastly, a web application was developed to host our novel calculator, the Miami Glioma Prediction Map (MGPM), for open-source interaction. RESULTS Sixteen patients with histopathological confirmation of high-grade glioma prior to WB-MRS were included in this study, totaling 118,922 whole-brain voxels. ML models successfully differentiated normal-appearing white matter from tumor and future progression. Notably, the highest performing ML model predicted glioma progression within fluid-attenuated inversion recovery (FLAIR) signal in the post-treatment setting (mean AUC = 0.86), with Cho/Cr as the most important feature. CONCLUSIONS This study marks a significant milestone as the first of its kind to unveil radiographic occult glioma progression in post-treatment gliomas within 8 months of discovery. These findings underscore the utility of ML-based WB-MRS growth predictions, presenting a promising avenue for the guidance of early treatment decision-making. This research represents a crucial advancement in predicting the timing and location of glioblastoma recurrence, which can inform treatment decisions to improve patient outcomes.
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Grants
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
- R01CA172210, R01EB016064 NIH HHS
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Affiliation(s)
- Cameron A Rivera
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Shovan Bhatia
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexis A Morell
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lekhaj C Daggubati
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Surgical Neuro-Oncology, District of Columbia, George Washington Medical Faculty Associates, Washington, USA
| | - Martin A Merenzon
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sulaiman A Sheriff
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Jay Chandar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Adam S Levy
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashley R Metzler
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chandler N Berke
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mohammed Goryawala
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, USA
| | - Rita G Bhatia
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalya Nagornaya
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Macarena I de la Fuente
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, USA
| | - Ashish H Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, USA
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Rejimon AC, Ramesh KK, Trivedi AG, Huang V, Schreibmann E, Weinberg BD, Kleinberg LR, Shu HKG, Shim H, Olson JJ. The Utility of Spectroscopic MRI in Stereotactic Biopsy and Radiotherapy Guidance in Newly Diagnosed Glioblastoma. Tomography 2024; 10:428-443. [PMID: 38535775 PMCID: PMC10975697 DOI: 10.3390/tomography10030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
Current diagnostic and therapeutic approaches for gliomas have limitations hindering survival outcomes. We propose spectroscopic magnetic resonance imaging as an adjunct to standard MRI to bridge these gaps. Spectroscopic MRI is a volumetric MRI technique capable of identifying tumor infiltration based on its elevated choline (Cho) and decreased N-acetylaspartate (NAA). We present the clinical translatability of spectroscopic imaging with a Cho/NAA ≥ 5x threshold for delineating a biopsy target in a patient diagnosed with non-enhancing glioma. Then, we describe the relationship between the undertreated tumor detected with metabolite imaging and overall survival (OS) from a pilot study of newly diagnosed GBM patients treated with belinostat and chemoradiation. Each cohort (control and belinostat) were split into subgroups using the median difference between pre-radiotherapy Cho/NAA ≥ 2x and the treated T1-weighted contrast-enhanced (T1w-CE) volume. We used the Kaplan-Meier estimator to calculate median OS for each subgroup. The median OS was 14.4 months when the difference between Cho/NAA ≥ 2x and T1w-CE volumes was higher than the median compared with 34.3 months when this difference was lower than the median. The T1w-CE volumes were similar in both subgroups. We find that patients who had lower volumes of undertreated tumors detected via spectroscopy had better survival outcomes.
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Affiliation(s)
- Abinand C. Rejimon
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Karthik K. Ramesh
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Anuradha G. Trivedi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Vicki Huang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Eduard Schreibmann
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
| | - Brent D. Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Lawrence R. Kleinberg
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Hui-Kuo G. Shu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Hyunsuk Shim
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jeffrey J. Olson
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA
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Mauler J, Lohmann P, Maudsley AA, Sheriff S, Hoevels M, Meissner AK, Hamisch C, Brunn A, Deckert M, Filss CP, Stoffels G, Dammers J, Ruge MI, Galldiks N, Mottaghy FM, Langen KJ, Shah NJ. Diagnostic Accuracy of MR Spectroscopic Imaging and 18F-FET PET for Identifying Glioma: A Biopsy-Controlled Hybrid PET/MRI Study. J Nucl Med 2024; 65:16-21. [PMID: 37884332 DOI: 10.2967/jnumed.123.265868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/22/2023] [Indexed: 10/28/2023] Open
Abstract
Contrast-enhanced MRI is the method of choice for brain tumor diagnostics, despite its low specificity for tumor tissue. This study compared the contribution of MR spectroscopic imaging (MRSI) and amino acid PET to improve the detection of tumor tissue. Methods: In 30 untreated patients with suspected glioma, O-(2-[18F]fluoroethyl)-l-tyrosine (18F-FET) PET; 3-T MRSI with a short echo time; and fluid-attenuated inversion recovery, T2-weighted, and contrast-enhanced T1-weighted MRI were performed for stereotactic biopsy planning. Serial samples were taken along the needle trajectory, and their masks were projected to the preoperative imaging data. Each sample was individually evaluated neuropathologically. 18F-FET uptake and the MRSI signals choline (Cho), N-acetyl-aspartate (NAA), creatine, myoinositol, and derived ratios were evaluated for each sample and classified using logistic regression. The diagnostic accuracy was evaluated by receiver operating characteristic analysis. Results: On the basis of the neuropathologic evaluation of tissue from 88 stereotactic biopsies, supplemented with 18F-FET PET and MRSI metrics from 20 areas on the healthy-appearing contralateral hemisphere to balance the glioma/nonglioma groups, 18F-FET PET identified glioma with the highest accuracy (area under the receiver operating characteristic curve, 0.89; 95% CI, 0.81-0.93; threshold, 1.4 × background uptake). Among the MR spectroscopic metabolites, Cho/NAA normalized to normal brain tissue showed the highest diagnostic accuracy (area under the receiver operating characteristic curve, 0.81; 95% CI, 0.71-0.88; threshold, 2.2). The combination of 18F-FET PET and normalized Cho/NAA did not improve the diagnostic performance. Conclusion: MRI-based delineation of gliomas should preferably be supplemented by 18F-FET PET.
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Affiliation(s)
- Jörg Mauler
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany;
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sulaiman Sheriff
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Moritz Hoevels
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna-Katharina Meissner
- Department of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Hamisch
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuropathology, University Hospital Düsseldorf and Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuropathology, University Hospital Düsseldorf and Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Jürgen Dammers
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Maximillian I Ruge
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany; and
- JARA-BRAIN-Translational Medicine, Aachen, Germany
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Bell JB, Jin W, Goryawala MZ, Azzam GA, Abramowitz MC, Diwanji T, Ivan ME, del Pilar Guillermo Prieto Eibl M, de la Fuente MI, Mellon EA. Delineation of recurrent glioblastoma by whole brain spectroscopic magnetic resonance imaging. Radiat Oncol 2023; 18:37. [PMID: 36814267 PMCID: PMC9948314 DOI: 10.1186/s13014-023-02219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) cellularity correlates with whole brain spectroscopic MRI (sMRI) generated relative choline to N-Acetyl-Aspartate ratio (rChoNAA) mapping. In recurrent GBM (rGBM), tumor volume (TV) delineation is challenging and rChoNAA maps may assist with re-RT targeting. METHODS Fourteen rGBM patients underwent sMRI in a prospective study. Whole brain sMRI was performed to generate rChoNAA maps. TVs were delineated by the union of rChoNAA ratio over 2 (rChoNAA > 2) on sMRI and T1PC. rChoNAA > 2 volumes were compared with multiparametric MRI sequences including T1PC, T2/FLAIR, diffusion-restriction on apparent diffusion coefficient (ADC) maps, and perfusion relative cerebral blood volume (rCBV). RESULTS rChoNAA > 2 (mean 27.6 cc, range 6.6-79.1 cc) was different from other imaging modalities (P ≤ 0.05). Mean T1PC volumes were 10.7 cc (range 1.2-31.4 cc). The mean non-overlapping volume of rChoNAA > 2 and T1PC was 29.2 cm3. rChoNAA > 2 was 287% larger (range 23% smaller-873% larger) than T1PC. T2/FLAIR volumes (mean 111.7 cc, range 19.0-232.7 cc) were much larger than other modalities. rCBV volumes (mean 6.2 cc, range 0.2-19.1 cc) and ADC volumes were tiny (mean 0.8 cc, range 0-3.7 cc). Eight in-field failures were observed. Three patients failed outside T1PC but within rChoNAA > 2. No grade 3 toxicities attributable to re-RT were observed. Median progression-free and overall survival for re-RT patients were 6.5 and 7.1 months, respectively. CONCLUSIONS Treatment of rGBM may be optimized by sMRI, and failure patterns suggest benefit for dose-escalation within sMRI-delineated volumes. Dose-escalation and radiologic-pathologic studies are underway to confirm the utility of sMRI in rGBM.
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Affiliation(s)
- Jonathan B. Bell
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - William Jin
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Mohammed Z. Goryawala
- grid.26790.3a0000 0004 1936 8606Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Gregory A. Azzam
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Matthew C. Abramowitz
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Tejan Diwanji
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Michael E. Ivan
- grid.26790.3a0000 0004 1936 8606Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Maria del Pilar Guillermo Prieto Eibl
- grid.26790.3a0000 0004 1936 8606Department of Neurology and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Macarena I. de la Fuente
- grid.26790.3a0000 0004 1936 8606Department of Neurology and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Eric A. Mellon
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
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