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Belfiore MP, Nardone V, D’Onofrio I, Pirozzi M, Sandomenico F, Farese S, De Chiara M, Balbo C, Cappabianca S, Fasano M. Recurrent Versus Metastatic Head and Neck Cancer: An Evolving Landscape and the Role of Immunotherapy. Biomedicines 2024; 12:2080. [PMID: 39335592 PMCID: PMC11428618 DOI: 10.3390/biomedicines12092080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/01/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is among the ten most common cancers worldwide, with advanced SCCHN presenting with a 5-year survival of 34% in the case of nodal involvement and 8% in the case of metastatic disease. Disease-free survival at 2 years is 67% for stage II and 33% for stage III tumors, whereas 12-30% of patients undergo distant failures after curative treatment. Previous treatments often hinder the success of salvage surgery and/or reirradiation, while the standard of care for the majority of metastatic SCCHN remains palliative chemo- and immuno-therapy, with few patients eligible for locoregional treatments. The aim of this paper is to review the characteristics of recurrent SCCHN, based on different recurrence sites, and metastatic disease; we will also explore the possibilities not only of salvage surgery and reirradiation but also systemic therapy choices and locoregional treatment for metastatic SCCHN.
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Affiliation(s)
- Maria Paola Belfiore
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Valerio Nardone
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Ida D’Onofrio
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Mario Pirozzi
- SCDU Oncologia, “Maggiore della Carità” University Hospital, 28100 Novara, Italy;
| | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy;
| | - Stefano Farese
- Medical Oncology, Department of Precision Medicine, Campania University “L.Vanvitelli”, 80131 Naples, Italy; (S.F.); (C.B.); (M.F.)
| | - Marco De Chiara
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Ciro Balbo
- Medical Oncology, Department of Precision Medicine, Campania University “L.Vanvitelli”, 80131 Naples, Italy; (S.F.); (C.B.); (M.F.)
| | - Salvatore Cappabianca
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Morena Fasano
- Medical Oncology, Department of Precision Medicine, Campania University “L.Vanvitelli”, 80131 Naples, Italy; (S.F.); (C.B.); (M.F.)
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Tran NA, Gorolay VV, Wu X. Differentiating Post-treatment Changes from Tumor Recurrence in the Oral Cavity and Oropharynx. Semin Roentgenol 2023; 58:272-289. [PMID: 37507169 DOI: 10.1053/j.ro.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/17/2023] [Accepted: 04/02/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Vineet V Gorolay
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Xin Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
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Zorzi SF, Agostini G, Chu F, Tagliabue M, Pietrobon G, Corrao G, Volpe S, Marvaso G, Colombo F, Rocca MC, Gandini S, Gaeta A, Ruju F, Alterio D, Ansarin M. Upfront transoral robotic surgery (TORS) versus intensity-modulated radiation therapy (IMRT) in HPV-positive oropharyngeal cancer: real-world data from a tertiary comprehensive cancer center. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:334-347. [PMID: 35938555 PMCID: PMC9577690 DOI: 10.14639/0392-100x-n2144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022]
Abstract
Objective Methods Results Conclusions
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Pilar A, O’Sullivan B, Huang SH. Risk Stratification of HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Are All Tumors Created Equally? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Surgeon practice patterns in transoral robotic surgery for HPV-related oropharyngeal cancer. Oral Oncol 2021; 121:105460. [PMID: 34298289 DOI: 10.1016/j.oraloncology.2021.105460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Analyze how otolaryngologists approach HPV-related oropharyngeal cancer in terms of patient selection for transoral surgery, perceptions of treatment related risks and benefits, and adjuvant treatment decisions. MATERIALS AND METHODS A survey on HPV-related cancer management was distributed to otolaryngologists in the US through RedCap. Differences in responses were analyzed using Pearson's chi-squared and Fisher's exact tests. RESULTS A total of 111 out of 143 (77.6%) otolaryngologists completed the survey. Overall, most prefer treating T1/T2 tumors using transoral robotic surgery (TORS) and T3 tumors through primary radiation therapy (RT), though there were significant differences between cohorts. Non-fellowship-trained surgeons and those in community practices favored RT for T1/T2 more than their fellowship-trained and academic counterparts, respectively. For adjuvant treatment, non-fellowship-trained surgeons favored adjuvant CRT, whereas fellowship-trained surgeons preferred only adjuvant RT, for patients with lymphovascular or perineural invasion, >1 lymph node involvement, or close deep margins. TORS was viewed as having less adverse sequelae (i.e. dysphagia, dysphonia, xerostomia). Though the two modalities had similar oncologic outcomes, TORS was perceived as providing better quality of life (QOL). CONCLUSIONS There are variations in HPV-related OPSCC management based on surgeon background and preferences across the US. TORS and primary RT are believed to offer similar oncologic control, but the former provides lesser adverse sequelae and better QOL. Additionally, surgeon demographics (i.e. fellowship status, practice type, and region) can affect management decisions, including patient selection for TORS and adjuvant therapy decisions. Further study is required to better understand and standardize appropriate HPV-positive OPSCC management.
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Iorio GC, Arcadipane F, Martini S, Ricardi U, Franco P. Decreasing treatment burden in HPV-related OPSCC: A systematic review of clinical trials. Crit Rev Oncol Hematol 2021; 160:103243. [PMID: 33516806 DOI: 10.1016/j.critrevonc.2021.103243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Favorable outcomes are observed after treatment with standard chemoradiotherapy (CRT) for Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) patients. The consistent growing interest on treatment-related toxicity burden, potentially jeopardizing survivors' quality of life, led clinicians to investigate possible de-escalation strategies. MATERIALS AND METHODS A comprehensive systematic literature search of clinical trials was performed through the EMBASE database to provide an overview of the de-escalation strategies spectrum. Additionally, hand searching and clinicaltrials.gov were also used. RESULTS Herein, we report and discuss different approaches to de-escalation of therapy, with respect to both local and systemic strategies. CONCLUSIONS Several promising de-escalation experiences have been published. However, while further evidence is awaited, no changes in the management nor deviation from the standard of care should be made outside of clinical trials.
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Affiliation(s)
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
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Potential therapeutic implications of the new tumor, node, metastasis staging system for human papillomavirus-mediated oropharyngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2020; 28:100-106. [PMID: 32022732 DOI: 10.1097/moo.0000000000000607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The 8th edition tumor, node, metastasis (TNM) classification (TNM-8) introduced a new classification for human papillomavirus (HPV)-mediated oropharyngeal carcinoma (HPV+ OPC). This review summarizes its potential therapeutic implications focusing on literature published since 2018. RECENT FINDINGS The following are active research areas involved in clinical care and therapy relevant to TNM-8: tumor HPV testing and its clinical implications; stage I disease: treatment selection and lessons learned from recent deintensification trials; emerging strategies addressing stage II and III disease. SUMMARY The TNM-8 classification depicts prognosis of HPV+ OPC much more reliably compared with TNM-7. Among the advantages in outcome comparison and stratification for clinical trial entry and conduct, it also enables more satisfactory individual patient consultation to adequately estimate prognosis, and facilitates clinical and translational research. However, clinicians must remain mindful that the TNM classification is not a guideline for treatment but, instead, provides a framework for clinical research and treatment decision-making. The TNM-8 has potential to improve risk-tailored treatment algorithms for HPV+ OPC including selection of treatment modality (primary trans-oral surgery vs. radiotherapy, addition of chemotherapy) and adjusting the intensity of approaches. To realize these goals fully, it is apparent that the TNM-8 needs to evolve further.
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Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:1462-1475. [PMID: 33239190 DOI: 10.1016/j.annonc.2020.07.011] [Citation(s) in RCA: 365] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- J-P Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - W Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences and The Greater Poland Cancer Centre, Poznan, Poland
| | - C Grau
- Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - L Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - V Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V. Reprint of "Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Oral Oncol 2020; 113:105042. [PMID: 33583513 DOI: 10.1016/j.oraloncology.2020.105042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- J-P Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - W Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences and The Greater Poland Cancer Centre, Poznan, Poland
| | - C Grau
- Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - L Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - V Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Hussain T, Mattheis S, Lang S. [The role of surgery and salvage surgery in the era of HPV-associated oropharyngeal carcinomas]. HNO 2020; 68:688-694. [PMID: 32638060 DOI: 10.1007/s00106-020-00900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of human papillomavirus (HPV)-positive oropharyngeal carcinomas is increasing worldwide. Due to a markedly different response to treatment compared to HPV-negative oropharyngeal carcinomas, determining the ideal therapeutic approach can be challenging. Particularly in never-smokers, HPV-positive oropharyngeal carcinomas respond well to primary radiation therapy; at the same time recent studies indicate comparable survival after primary surgery. For stage I tumors according to TNM‑8, retrospective analyses show very good oncologic outcomes after surgery alone, and no added benefit of adjuvant radio- or chemotherapy. Results of prospective treatment deintensification trials are expected in the coming years. Minimally invasive transoral surgical approaches for selected oropharyngeal cancers can improve preservation of postoperative function and quality of life. For both HPV-positive and HPV-negative oropharyngeal carcinomas, salvage surgery is the treatment of choice for resectable recurrent locoregional disease and resectable distant metastases.
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Affiliation(s)
- T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Galmiche A, Saidak Z, Bouaoud J, Mirghani H, Page C, Dakpé S, Clatot F. Genomics and precision surgery for head and neck squamous cell carcinoma. Cancer Lett 2020; 481:45-54. [PMID: 32272147 DOI: 10.1016/j.canlet.2020.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022]
Abstract
The identification of the biological determinants that shape the response of tumors to medical therapies offers perspectives for better patient stratification and therapeutic targeting. Here, we discuss how genomics could help to improve the surgical treatment of head and neck squamous cell carcinoma (HNSCC). We examine the potential use of genomic analyses for: i) refining and standardizing the indications for surgery, ii) the choice of surgical procedure, and iii) the follow-up of patients with resected tumors. We highlight the studies that used genomics to explore the contribution of tumor biology to the outcome of surgery. We discuss the important developments that are challenging current surgical practice in HNSCC, such as neoadjuvant immunotherapy and the analysis of circulating DNA. Genomic analyses provide practical tools that could help improve the pathological diagnosis and staging of HNSCC, and increase the appreciation of the importance of tumor biology in the outcome of surgery. Identification of biomarkers will likely contribute to a move toward precision surgery of HNSCC, i.e. the personalization of surgical practice based on tumor biology.
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Affiliation(s)
- Antoine Galmiche
- EA7516 « CHIMERE », Université de Picardie Jules Verne, Amiens, France; Department of Biochemistry, Centre de Biologie Humaine, CHU, Amiens, France.
| | - Zuzana Saidak
- EA7516 « CHIMERE », Université de Picardie Jules Verne, Amiens, France; Department of Molecular Oncobiology, Centre de Biologie Humaine, CHU, Amiens, France
| | - Jebrane Bouaoud
- Department of Maxillofacial Surgery and Stomatology, Pitié Salpétrière Hospital, Pierre et Marie Curie University Paris 6, Sorbonne Paris Cité, Paris, France
| | - Haitham Mirghani
- Department of Otorhinolaryngology and Head and Neck Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Cyril Page
- Department of Otorhinolaryngology, CHU, Amiens, France
| | - Stéphanie Dakpé
- EA7516 « CHIMERE », Université de Picardie Jules Verne, Amiens, France; Department of Maxillofacial Surgery, CHU, Amiens, France
| | - Florian Clatot
- Centre Henri Becquerel, Rouen, France; INSERM U1245, IRON Team, Rouen, France
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Karsten RT, Brekel MW, Smeele LE, Navran A, Leary S, Ingarfield K, Pawlita M, Waterboer T, Thomas SJ, Ness AR. Patient‐reported swallowing function after treatment for early‐stage oropharyngeal carcinoma: Population‐based study. Head Neck 2020; 42:1981-1993. [DOI: 10.1002/hed.26131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Rebecca T. Karsten
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute Amsterdam The Netherlands
| | - Michiel W.M. Brekel
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute Amsterdam The Netherlands
| | - Ludi E. Smeele
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute Amsterdam The Netherlands
- Department of Oral and Maxillofacial SurgeryAcademic Medical Center Amsterdam The Netherlands
| | - Arash Navran
- Department of Radiation OncologyThe Netherlands Cancer Institute Amsterdam The Netherlands
| | - Sam Leary
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
| | - Kate Ingarfield
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff University Cardiff UK
| | - Michael Pawlita
- Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Tim Waterboer
- Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Steve J. Thomas
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
| | - Andy R. Ness
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
- Bristol Dental SchoolFaculty of Health Sciences, University of Bristol Bristol UK
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Billfalk-Kelly A, Yu E, Su J, O'Sullivan B, Waldron J, Ringash J, Bartlett E, Perez-Ordonez B, Weinreb I, Bayley A, Bratman SV, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Hansen AR, de Almeida J, Tong L, Xu W, Huang SH. Radiologic Extranodal Extension Portends Worse Outcome in cN+ TNM-8 Stage I Human Papillomavirus–Mediated Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2019; 104:1017-1027. [DOI: 10.1016/j.ijrobp.2019.03.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/01/2019] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
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