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Mizonobe K, Akasaka H, Uehara K, Oki Y, Nakayama M, Tamura S, Munetomo Y, Kubo K, Kawaguchi H, Harada A, Mayahara H. Respiratory motion tracking of spine stereotactic radiotherapy in prone position. J Appl Clin Med Phys 2023; 24:e13910. [PMID: 36650923 PMCID: PMC10161010 DOI: 10.1002/acm2.13910] [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: 07/11/2022] [Revised: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The CyberKnife system is a specialized device for non-coplanar irradiation; however, it possesses the geometric restriction that the beam cannot be irradiated from under the treatment couch. Prone positioning is expected to reduce the dose to normal lung tissue in spinal stereotactic body radiotherapy (SBRT) owing to the efficiency of beam arrangement; however, respiratory motion occurs. Therefore, the Xsight spine prone tracking (XSPT) system is used to reduce the effects of respiratory motion. The purpose of this study was to evaluate the motion-tracking error of the spine in the prone position. MATERIALS AND METHODS Data from all 25 patients who underwent spinal SBRT at our institution between April 2020 and February 2022 using CyberKnife (VSI, version 11.1.0) with the XSPT tracking system were retrospectively analyzed using log files. The tumor motion, correlation, and prediction errors for each patient were examined. Furthermore, to assess the potential relationships between the parameters, the relationships between the tumor-motion amplitudes and correlation or prediction errors were investigated using linear regression. RESULTS The tumor-motion amplitudes in each direction were as follows: superior-inferior (SI), 0.51 ± 0.39 mm; left-right (LR), 0.37 ± 0.29 mm; and anterior-posterior (AP), 3.43 ± 1.63 mm. The overall mean correlation and prediction errors were 0.66 ± 0.48 mm and 0.06 ± 0.07 mm, respectively. The prediction errors were strongly correlated with the tumor-motion amplitudes, whereas the correlation errors were not. CONCLUSIONS This study demonstrated that the correlation error of spinal SBRT in the prone position is sufficiently small to be independent of the tumor-motion amplitude. Furthermore, the prediction error is small, contributing only slightly to the tracking error. These findings will improve the understanding of how to compensate for respiratory-motion uncertainty in the prone position.
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Affiliation(s)
- Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, The University of Melbourne Grattan Street, Parkville, Victoria, Australia.,Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan.,Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Shuhei Tamura
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yoshiki Munetomo
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Katsumaro Kubo
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
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Soltys SG, Grimm J, Milano MT, Xue J, Sahgal A, Yorke E, Yamada Y, Ding GX, Li XA, Lovelock DM, Jackson A, Ma L, El Naqa I, Gibbs IC, Marks LB, Benedict S. Stereotactic Body Radiation Therapy for Spinal Metastases: Tumor Control Probability Analyses and Recommended Reporting Standards. Int J Radiat Oncol Biol Phys 2021; 110:112-123. [PMID: 33516580 DOI: 10.1016/j.ijrobp.2020.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE We sought to investigate the tumor control probability (TCP) of spinal metastases treated with stereotactic body radiation therapy (SBRT) in 1 to 5 fractions. METHODS AND MATERIALS PubMed-indexed articles from 1995 to 2018 were eligible for data extraction if they contained SBRT dosimetric details correlated with actuarial 2-year local tumor control rates. Logistic dose-response models of collected data were compared in terms of physical dose and 3-fraction equivalent dose. RESULTS Data were extracted from 24 articles with 2619 spinal metastases. Physical dose TCP modeling of 2-year local tumor control from the single-fraction data were compared with data from 2 to 5 fractions, resulting in an estimated α/β = 6 Gy, and this was used to pool data. Acknowledging the uncertainty intrinsic to the data extraction and modeling process, the 90% TCP corresponded to 20 Gy in 1 fraction, 28 Gy in 2 fractions, 33 Gy in 3 fractions, and (with extrapolation) 40 Gy in 5 fractions. The estimated TCP for common fractionation schemes was 82% at 18 Gy, 90% for 20 Gy, and 96% for 24 Gy in a single fraction, 82% for 24 Gy in 2 fractions, and 78% for 27 Gy in 3 fractions. CONCLUSIONS Spinal SBRT with the most common fractionation schemes yields 2-year estimates of local control of 82% to 96%. Given the heterogeneity in the tumor control estimates extracted from the literature, with variability in reporting of dosimetry data and the definition of and statistical methods of reporting tumor control, care should be taken interpreting the resultant model-based estimates. Depending on the clinical intent, the improved TCP with higher dose regimens should be weighed against the potential risks for greater toxicity. We encourage future reports to provide full dosimetric data correlated with tumor local control to allow future efforts of modeling pooled data.
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Affiliation(s)
- Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California.
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jinyu Xue
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - D Michael Lovelock
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Issam El Naqa
- Machine Learning Department, Moffitt Cancer Center, Tampa, Florida
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, Lineberger Cancer Center, Chapel Hill, North Carolina
| | - Stanley Benedict
- Department of Radiation Oncology, University of California at Davis, Sacramento, California
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Zhuang H, Zhuang H, Lang N, Liu J. Precision Stereotactic Radiotherapy for Spinal Tumors: Mechanism, Efficacy, and Issues. Front Oncol 2020; 10:826. [PMID: 32528894 PMCID: PMC7256655 DOI: 10.3389/fonc.2020.00826] [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: 02/09/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
Stereotactic ablative radiotherapy (SABR/SBRT) is a revolutionary technique for tumor therapy. Its advantages are especially beneficial for the treatment spinal tumors. It has a wide range of indications in radiotherapy alone and in preoperative and postoperative treatments for spinal tumor. The mechanism of stereotactic radiotherapy for spinal tumors is special, and completely different from traditional radiotherapy. Compared with traditional radiotherapy, SBRT creates more DNA double-strand breaks, leads to less DNA damage repair, and also has anti-vascular effects, in situ vaccine effects and abscopal effect. In the present study, the literature regarding SABR for the treatment of spinal tumors is summarized, and we reviewed characteristics of SABR and spinal tumors, as well as the clinical efficacy and toxicity of SABR in treating spinal tumors. In addition, we proposed several issues around the SABR treatment of spinal tumor, the standard of treatment dose, and the post-treatment follow-up. We also made predictions with respect to future management of spinal tumors, SABR development, multi-modality integration between SABR and other treatments, and other future development trends, thereby providing future research directions as a contribution to the field.
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Affiliation(s)
- Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Hongxia Zhuang
- Department of Hematology, Weifang People's Hospital, Weifang, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Jiandong Liu
- Orthopedic Department, No. 971 Hospital of Navy, Qingdao, China
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Ito K, Furuya T, Shikama N, Nihei K, Tanaka H, Kumazaki Y, Nishimura H, Karasawa K. A prospective multicentre feasibility study of stereotactic body radiotherapy in Japanese patients with spinal metastases. Jpn J Clin Oncol 2020; 49:999-1003. [PMID: 31665478 DOI: 10.1093/jjco/hyz130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Stereotactic body radiotherapy has emerged as an attractive alternative to conventional radiotherapy for spinal metastases. However, it has limitations, including the need for advanced techniques and specific adverse effects. The present trial aimed to validate the feasibility and safety of stereotactic body radiotherapy in Japanese patients with spinal metastases. METHODS Patients with one or two spinal metastases received stereotactic body radiotherapy of 24 Gy in two fractions. The primary endpoint was the proportion of severe adverse effects (≥ grade 3) in patients within 6 months after spine stereotactic body radiotherapy. Adverse effects were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4. The treatment protocol was considered feasible and tolerable if the proportion of severe adverse effects was 10% or less. RESULTS Overall, 20 spinal segments in 20 patients who registered between March 2014 and October 2015 were included. Minor and major deviations were observed in the planning of 2 and 0 cases, respectively. The treatment completion rate was 100%. The median follow-up after registration was 24.5 (range: 1-61) months. Although four patients experienced acute grade 2 adverse effects, no grade 3 or higher adverse effects were observed within 6 months after spine stereotactic body radiotherapy. Vertebral compression fractures were observed in two patients (14 and 16 months after stereotactic body radiotherapy). The local control and pain response rates at 6 months were 100 and 83%, respectively. CONCLUSION This study demonstrated the feasibility and safety of spine stereotactic body radiotherapy in Japanese patients with spinal metastases.
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomohisa Furuya
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiology, Juntendo University, Tokyo, Japan
| | - Keiji Nihei
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Lee YK, Munawar I, Mashouf S, Sahgal A, Ruschin M. Dosimetric comparison of two treatment planning systems for spine SBRT. Med Dosim 2019; 45:77-84. [PMID: 31376988 DOI: 10.1016/j.meddos.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/13/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
Two commonly used treatment planning systems (TPS) are compared for the planning of spine stereotactic body radiotherapy (SBRT). The main purpose is to highlight relative advantages and disadvantages of each system and propose a methodologic approach for comparisons. Twenty clinical plans were inversely planned with step-and-shoot intensity-modulated radiotherapy (IMRT) each using 9 to 11 beams, referred to as IMRT_P. The prescription dose was 24 Gy in 2 fractions, and the plans were generated following our institutional protocol using the Pinnacle3 v9.2. Each case was replanned using a 2-arc volumetric modulated arc therapy (VMAT) approach, referred as VMAT_P. CT and structure sets were DICOM exported to Monaco v5.10 and planned in 2 different ways: IMRT (IMRT_M) and VMAT (VMAT_M) using the same prescription dose. Dose volume histograms (DVH) and other dose statistics of planning target volumes (PTV) and organ-at-risk (OAR) were analyzed and compared between plans. The gradient index (GI = ratio of 50% isodose volume to prescribed isodose volume) was used to measure dose fall-off outside of the PTV. Another metric - Gradient Index Inner (GIinner = the rate (in Gy/mm) - at which the dose changes from the level of the spinal cord/thecal sac toward the prescription dose) was developed and compared. All plans were considered clinically acceptable by institutional guidelines and achieved all of the OAR dose constraints. VMAT_M and IMRT_M showed comparable dose statistics for the PTV when compared to VMAT_P and IMRT_P, respectively. For IMRT plans, the median GIinner was 1.88 Gy/mm vs 1.52 Gy/mm for IMRT_M and IMRT_P respectively (p< 0.001). All other IMRT metrics were statistically similar except for the PTV maximum dose (Dmax), which was higher for IMRT_M than IMRT_P (median 30.7 Gy vs 29.0 Gy, p< 0.001). For VMAT plans, only PTV Dmin showed a statistical different between VMAT_M and VMAT_P of median 12.7 Gy vs 9.7 Gy (p< 0.001). In terms of beam sequencing parameters, the number of monitor units was statistically higher for VMAT_P compared to VMAT_M (median = 6764 vs 5376) whereas the number of segments for IMRT_M was statistically greater than IMRT_P (median = 155 vs 73). We were able to generate clinically acceptable plans for different types of spine SBRT using 2 different TPS. We used an evaluation strategy involving coverage, conformity, and dose gradient that can compared between TPS.
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Affiliation(s)
- Young Kyung Lee
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Iram Munawar
- Department of Medical Physics, Trillium Health Partners, the Credit Valley Hospital, Mississauga, Canada
| | - Shahram Mashouf
- Department of Medical Physics, Marshfield Clinic Health System, Marshfield, WI 54449, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, ON M4N 3M5, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Ruschin
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON M4N 3M5, Canada
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Rilling M, Archambault L, Thibault S. Simulating imaging-based tomographic systems using optical design software for resolving 3D structures of translucent media. APPLIED OPTICS 2019; 58:5942-5951. [PMID: 31503910 DOI: 10.1364/ao.58.005942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
Imaging-based tomography is emerging as the technique of choice for resolving 3D structures of translucent media, in particular for applications in external beam radiation therapy and combustion diagnostics. However, designing experimental prototypes is time-consuming and costly, and is carried out without the certainty of the imaging optics being optimal. In this paper, we present an optical-design-software-based method that enables end-to-end simulation imaging-based tomography systems. The method, developed using the real ray tracing features of Zemax OpticStudio, was validated in the context of 3D scintillation dosimetry, where multiple imaging systems are used to image the 3D light pattern emitted within an irradiated cubic plastic scintillator volume. The flexibility of the workflow enabled the assessment and comparison of the tomographic performance of standard and focused plenoptic cameras for the reconstruction of a clinical radiation dose distribution. The versatility of the proposed method offers the potential to ease the developmental and optimization process of imaging systems used in volumetric emission computed tomography applications.
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Furuya T, Phua JH, Ito K, Karasawa K. Feasibility of spine stereotactic body radiotherapy for patients with large tumors in multiple vertebrae undergoing re-irradiation: Dosimetric challenge using 3 different beam delivery techniques. Med Dosim 2019; 44:415-420. [PMID: 30929978 DOI: 10.1016/j.meddos.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
The objective of the present study was to report whether the adequate spine stereotactic body radiotherapy (SBRT) plans were generated with feasible treatment duration for patients with large vertebral metastases undergoing re-irradiation. For 5 cases, the re-irradiation plans using static-field intensity-modulated radiation therapy (SIMRT), volumetric-modulated arc therapy (VMAT), and CyberKnife with a total prescribed dose (PD) of 24 Gy applied in 2 fractions were generated. A minimum dose to 95% of the evaluated planning target volume (PTVevl) that was >70% of PD (D95 > 70% PD) was defined as minimum criterion. For the dose tolerance of the spinal cord or thecal sac, which could affect the risk of radiation myelopathy, a volume-dose constraint of 12.2 Gy was set for the planning organ-at-risk volume of the spinal cord (PRVcord) or thecal sac and limited to 0.035 cc (D0.035 cc< 12.2 Gy) on the re-irradiation plans. For assessing the impact of the stricter dose constraint of PRVcord on the plan quality, we generated plans with a PRVcord dose constraint of D0.035 cc < 17.0 Gy, which was employed for patients with no previous history of radiation therapy (RT). Dose-volume histogram (DVH) analysis was performed for the PTVevl and spinal cord. Median PTVevl of all cases was 242.3 cc (range; 159.2 to 722.4 cc). Two out of 5 cases had a PTVevl >500 cc. The constraint of the PRVcord D0.035cc was met in all re-irradiation plans; however, a comparison between the re-irradiation plan for patients with large vertebral metastases and the plan for cases with no RT history showed that the decrease of the target dose coverage was correlated with the stricter dose constraint of the PRVcord. For SIMRT and VMAT, the re-irradiation plans met the goal of the PTVevl D95. On the other hand, CyberKnife plans could not achieve the constraints of the PTVevl D95. This discrepancy is due to the constraint of treatment duration, which is defined as the comfortable duration for patients with large spinal metastases. Regardless of the delivery method used, treatment plan quality is impacted to a greater extent by the dose tolerance of the spinal cord than by the size of the tumor.
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Affiliation(s)
- Tomohisa Furuya
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan.
| | - Jun H Phua
- Department of Radiation Oncology, National Cancer Center Singapore, Singapore 169610, Singapore
| | - Kei Ito
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Katsuyuki Karasawa
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
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Knisely JPS. Spine Radiosurgery Dosimetry-A Simple Way Forward. Pract Radiat Oncol 2019; 9:e127-e128. [PMID: 30665863 DOI: 10.1016/j.prro.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan P S Knisely
- Weill Cornell Medicine & New York-Presbyterian, Department of Radiation Oncology, New York, New York.
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