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Milgrom SA, van Luijk P, Pino R, Ronckers CM, Kremer LC, Gidley PW, Grosshans DR, Laskar S, Okcu MF, Constine LS, Paulino AC. Salivary and Dental Complications in Childhood Cancer Survivors Treated With Radiation Therapy to the Head and Neck: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:467-481. [PMID: 34074567 DOI: 10.1016/j.ijrobp.2021.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/14/2021] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Radiation therapy (RT) to the head and neck (H&N) region is critical in the management of various pediatric malignancies; however, it may result in late toxicity. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on salivary dysfunction and dental abnormalities in survivors who received RT to the H&N region as children. MATERIALS & METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS Of the 2,164 articles identified through a literature search, 40 were included in a qualitative synthesis and 3 were included in a quantitative synthesis. The dose-toxicity data regarding salivary function demonstrate that a mean parotid dose of 35 to 40 Gy is associated with a risk of acute and chronic grade ≥2 xerostomia of approximately 32% and 13% to 32%, respectively, in patients treated with chemo-radiation therapy. This risk increases with parotid dose; however, rates of xerostomia after lower dose exposure have not been reported. Dental developmental abnormalities are common after RT to the oral cavity. Risk factors include higher radiation dose to the developing teeth and younger age at RT. CONCLUSIONS This PENTEC task force considers adoption of salivary gland dose constraints from the adult experience to be a reasonable strategy until more data specific to children become available; thus, we recommend limiting the parotid mean dose to ≤26 Gy. The minimum toxic dose for dental developmental abnormalities is unknown, suggesting that the dose to the teeth should be kept as low as possible particularly in younger patients, with special effort to keep doses <20 Gy in patients <4 years old.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ramiro Pino
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas
| | - Cecile M Ronckers
- Princess Máxima Centrum for Pediatric Oncology, Utrecht, Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | - Leontien C Kremer
- Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany; UMC Amsterdam, Location AMC, Department of Pediatrics, Amsterdam, Netherlands
| | - Paul W Gidley
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Siddhartha Laskar
- Department of Radiation Oncgqtology, Tata Memorial Hospital, Mumbai, India
| | - M Fatih Okcu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
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Seremidi K, Gizani S, Dahllöf G, Barr-Agholme M, Kloukos D, Tsilingaridis G. Dental management of long-term childhood cancer survivors: a systematic review. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00896-5. [PMID: 38773051 DOI: 10.1007/s40368-024-00896-5] [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: 06/26/2023] [Accepted: 03/19/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Critically review and summarise existing knowledge on prevalence of oral, dental, and craniofacial side-effects of antineoplastic treatment in childhood cancer survivors (CCS). METHODS A literature search was conducted for studies reporting on children aged 4-19 years treated for any type of malignancy up to the age of 15 years and for whom, at the time of the examination, more than 8 months have elapsed since the end of treatment. Data regarding dental late effects on teeth and craniofacial complex were collected and mean prevalence of each defect was reported. RESULTS From the 800 articles identified, 17 studies fulfilled inclusion criteria and were included. A total of 983 CCS were examined, with the total number of healthy controls being 1266 children. Haematological malignancy was the most prevalent diagnosis with the age at diagnosis ranging between 0-15 years. Multiple antineoplastic protocols were implemented with the elapsed time being 8 months up to 17 years. One-third of CCS experienced at least one late effect, with corresponding value for the control group being below 25%. Among the defects identified clinically, microdontia, hypodontia and enamel developmental defects were recorded in 1/4 of CCS. Impaired root growth and agenesis were the two defects mostly recorded radiographically. The effect on dental maturity and on salivary glands was unclear. CONCLUSION CCS are at risk of developing dental late effects because of their disease and its treatment and therefore, routine periodic examinations are essential to record their development and provide comprehensive oral healthcare.
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Affiliation(s)
- K Seremidi
- Department of Pediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - S Gizani
- Department of Pediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - G Dahllöf
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, 14104, Huddinge, Sweden
- Center of Pediatric Oral Health, Stockholm, Sweden
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - M Barr-Agholme
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, 14104, Huddinge, Sweden
- Center of Pediatric Oral Health, Stockholm, Sweden
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
- Department of Orthodontics, 251 Greek Air Force Hospital, Athens, Greece
| | - G Tsilingaridis
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, 14104, Huddinge, Sweden.
- Center of Pediatric Oral Health, Stockholm, Sweden.
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Pombo Lopes J, Rodrigues I, Machado V, Botelho J, Bandeira Lopes L. Chemotherapy and Radiotherapy Long-Term Adverse Effects on Oral Health of Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 16:110. [PMID: 38201538 PMCID: PMC10777916 DOI: 10.3390/cancers16010110] [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: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The survival rate for pediatric cancer has increased over the past few decades, short- and long-term complications have been detected and studied, and oral complications have emerged as an important topic of research. Here, we aimed to highlight the importance of oral manifestations that may only become apparent years or even decades after cancer treatment. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched articles using PubMed via the MEDLINE, Web of Science, and LILACS databases until October 2023. Overall, 35 observational studies were included, and the results estimated a pooled prevalence of the following dental anomalies: discoloration, 53%; crown-root malformations and agenesis, 36%; enamel hypoplasia, 32%; root development alterations, 29%; unerupted teeth, 24%; microdontia, 16%; hypodontia, 13%; and macrodontia, 7%. Most childhood cancer survivors have at least one dental sequela. Childhood cancer survivors presented a higher risk of having dental alterations than control counterparts. Additional analyses reveal possible sex-based differences that should be explored in future studies. These results collectively highlight the importance of oral healthcare and the prevention of disease in childhood cancer survivors.
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Affiliation(s)
- Joana Pombo Lopes
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
| | - Inês Rodrigues
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
| | - Vanessa Machado
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - João Botelho
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Luísa Bandeira Lopes
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
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Abstract
One of many possible complications of cancer therapy in children is enamel demineralization and such changes in the ion content of dental hard tissues may increase susceptibility to caries. The study aims to assess the prevalence of dental caries among childhood cancer survivors.A cross-sectional study was conducted on 225 children aged between 4 and 18 years, including 75 cancer patients and 150 sex- and age-matched controls. The cancer survivors were recruited from single pediatric oncology center. The control group was formed from students of randomly selected kindergartens and schools. Dental investigation was held between July 2013 and January 2016, approximately 5 years after the cessation of anticancer treatment (range: 6-155 months). The occurrence of dental caries was assessed with DMF/dmf index (showing the mean number of decayed, missing and filled permanent/deciduous teeth). Univariate statistical approach was performed and P-values < .05 were considered as statistically significant.The frequency of dental caries was comparable in both groups (85.4% vs 84%). However, the DMF index was higher in cancer patients than in controls: the median and interquartile ranges were 2 (0-4) vs 0 (0-2); P < .01. This correlates with duration of anticancer therapy (r = 0.26; P < .05). Moreover, children who had radiotherapy of the head and neck regions had significantly higher DMF scores than the ones who did not: 4.5 (1-6) vs 2 (0-4); P < .05. Socioeconomic and education status within family also has a significant impact on DMF scores in the cancer group. In conclusion, cancer patients, particularly those with a poor social background, should receive professional dental care as their caries process is more active than that of healthy peers.
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Affiliation(s)
| | | | | | - Małgorzata Zubowska
- Departments of Pediatrics, Oncology and Hematology, Medical University of Lodz, Poland
| | - Wojciech Fendler
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Departments of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Wojciech Młynarski
- Departments of Pediatrics, Oncology and Hematology, Medical University of Lodz, Poland
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Gupta A, Marwaha M, Bansal K, Sachdeva A, Gupta A. Dental Awareness among Parents and Oral Health of Paediatric Cancer Patients Receiving Chemotherapy. J Clin Diagn Res 2016; 10:ZC92-5. [PMID: 27437369 DOI: 10.7860/jcdr/2016/17412.7819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dental care is often overlooked by the parents of children receiving treatment for cancer including chemotherapy who are in a phase of severe immunosuppression. AIM (i) To study dental attitudes of parents of children receiving chemotherapy towards importance of dental care. (ii) To evaluate oral hygiene status and compare it with healthy controls. MATERIALS AND METHODS A questionnaire assessing the awareness towards dental care was given to the parents of 47 paediatric patients suffering from cancer receiving chemotherapy and to parents of 47 paediatric patients reporting to outpatient Department of Pedodontics at SGT Dental College. Oral examination was also carried out for both the groups and DMFT/dmft, plaque and gingival index were noted. RESULTS Parents had a varying opinion regarding dental health of their child. The caries status of children in the control group was greater than children in the study group. The mean plaque index of children in the control group (1.40) was greater than children in the study group (1.34) which was statistically significant according to Mann-Whitney U test. The gingival health of children in the study group was better than children in the control group which was also not statistically significant. CONCLUSION This study highlights need for a periodic referral of the child cancer patients to the paediatric dental clinic in hospitals for the timely dental care.
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Affiliation(s)
- Aarushi Gupta
- Postgraduate Student, Department of Pedodontics & Preventive Dentistry, Faculty of Dental Sciences, SGT University Budhera, Gurgaon, Haryana, India
| | - Mohita Marwaha
- Reader, Department of Pedodontics & Preventive Dentistry, Faculty of Dental Sciences, SGT University , Budhera, Gurgaon, Haryana, India
| | - Kalpana Bansal
- Assistant Professor, Department of Pedodontics & Preventive Dentistry, AIIMS , New Delhi, India
| | - Anupam Sachdeva
- Consultant and Head, Department of Paediatric Haemato- Oncology, Sir Gangaram Hospital , New Delhi, India
| | - Ajay Gupta
- Consultant and Head, Department of Radiotherapy, Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi, India
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Cubukcu CE, Sevinir B, Ercan I. Disturbed dental development of permanent teeth in children with solid tumors and lymphomas. Pediatr Blood Cancer 2012; 58:80-4. [PMID: 21254371 DOI: 10.1002/pbc.22902] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/11/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Deficient dental root development has been reported after conventional pediatric anticancer therapy but less information is available on children with solid tumors and lymphomas. PROCEDURE We examined dental development from panoramic radiographs (PRGs) of 37 childhood cancer survivors (CCS) treated under the age of 10 years with multimodal chemotherapy (CT) and/or head and neck radiotherapy (RT). A novel defect index (DeI) was used to describe the total damage to permanent dentition. The DeI was also tested in matched controls. RESULTS All CCS had dental disturbances including abnormal root development (86.4%), microdontia (13.5%) and tooth agenesis (16.2%). Testing the controls gave the mean DeI value 1.9 ± 2.7 (range, 0-12), while the index scores in the study group varied from 0 to 49 (mean 10.8 ± 11.2) (P < 0.01). The statistical differences in the mean DeI values were insignificant between CT and CT and RT groups (P > 0.05). CONCLUSIONS Children treated for solid tumors and lymphomas are at considerable risk of some disturbances in developing dental structures. RT increased the severity of disturbances induced by CT. Studies should further elucidate dose-, age and time-related effects of anticancer treatment on dental development.
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Casillas J, Castellino SM, Hudson MM, Mertens AC, Lima ISF, Liu Q, Zeltzer LK, Yasui Y, Robison LL, Oeffinger KC. Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS). Cancer 2010; 117:1966-75. [PMID: 21509774 DOI: 10.1002/cncr.25688] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/26/2010] [Accepted: 09/02/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lack of health insurance is a key barrier to accessing care for chronic conditions and cancer screening. The influence of insurance type (private, public, none) on survivor-focused and general preventive health care in adult survivors of childhood cancer was examined. METHODS The Childhood Cancer Survivor Study is a retrospective cohort study of childhood cancer survivors diagnosed between 1970 and 1986. Among 8425 adult survivors, the relative risk (RR) and 95% confidence interval (CI) of receiving survivor-focused and general preventive health care were estimated for uninsured (n = 1390) and publicly insured (n = 640), compared with for the privately insured (n = 6395) RESULTS Uninsured survivors were less likely than those privately insured to report a cancer-related visit (adjusted RR, 0.83; 95% CI, 0.75-0.91) or a cancer center visit (adjusted RR, 0.83; 95% CI, 0.71-0.98). Uninsured survivors had lower levels of utilization in all measures of care in comparison with privately insured. In contrast, publicly insured survivors were more likely to report a cancer-related visit (adjusted RR, 1.22; 95% CI, 1.11-1.35) or a cancer center visit (adjusted RR, 1.41; 95% CI, 1.18-1.70) than were privately insured survivors. Although publicly insured survivors had similar utilization of general health examinations, they were less likely to report a Papanicolaou test or a dental examinations CONCLUSIONS Among this large, socioeconomically diverse cohort, publicly insured survivors utilize survivor-focused health care at rates at least as high as survivors with private insurance. Uninsured survivors have lower utilization of both survivor-focused and general preventive health care.
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Affiliation(s)
- Jacqueline Casillas
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California 90095, USA.
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Hong CHL, Napeñas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 2010; 18:1007-21. [PMID: 20449756 PMCID: PMC2914291 DOI: 10.1007/s00520-010-0873-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/29/2010] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies. REVIEW METHOD A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. RESULTS Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%. CONCLUSIONS Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.
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Affiliation(s)
- Catherine H. L. Hong
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Joel J. Napeñas
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Brian D. Hodgson
- Program in Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, 1801 W. Wisconsin Ave, Milwaukee, WI 53233 USA
| | - Monique A. Stokman
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | - Linda S. Elting
- The University of Texas M.D. Anderson Cancer Centre, P.O. Box 301402, Houston, TX 77230-1402 USA
| | - Fred K. L. Spijkervet
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG Groningen, The Netherlands
| | - Michael T. Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Dental Disease Section, Oral Care Study Group, Multi-national Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
- Program in Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, 1801 W. Wisconsin Ave, Milwaukee, WI 53233 USA
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Penrose Cancer Center, 2222 North Nevada Avenue, Colorado Springs, CO 80907 USA
- The University of Texas M.D. Anderson Cancer Centre, P.O. Box 301402, Houston, TX 77230-1402 USA
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG Groningen, The Netherlands
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