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Lee J, Park CS, Oh JH, Park IC, Seong MK, Noh WC, Kim HA. Can chemotherapy be omitted for patients with N0 or N1 endocrine-sensitive breast cancer treated with gonadotropin-releasing hormone agonist and tamoxifen? Ann Surg Treat Res 2023; 105:31-36. [PMID: 37441320 PMCID: PMC10333805 DOI: 10.4174/astr.2023.105.1.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose Whether administering chemotherapy followed by tamoxifen plus a gonadotropin-releasing hormone (GnRH) agonist to treat patients with lower-risk hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer provides a greater benefit than administering tamoxifen plus GnRH agonist alone remains unclear. This study aimed to compare the outcomes of propensity score-matched (PSM) patients who underwent these 2 types of treatment plans. Methods This retrospective study included patients treated at our institution between 2009 and 2019. Eligible patients had HR-positive, HER2-negative, invasive breast cancer who had undergone surgery. There were 579 patients with HR-positive, HER2-negative breast cancer who were treated with a GnRH agonist and tamoxifen; patients with pathologic N2 and those who received neoadjuvant chemotherapy were excluded. After 1:1 PSM of patients who underwent GnRH agonist treatment and tamoxifen with versus without chemotherapy, 122 patients from these 2 groups were analyzed. Survival rates were calculated using the Kaplan-Meier method and compared via the log-rank test. Results After PSM, there were no significant differences in several baseline characteristics between the 2 groups. After a median follow-up of 62.8 months, the patients in both groups demonstrated similar outcomes with no significant difference in disease-free survival (P = 0.596). Conclusion Patients derived no significant survival benefit from undergoing a chemotherapy regimen before receiving tamoxifen and GnRH agonist therapy compared to forgoing such chemotherapy.
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Affiliation(s)
- Juhyeon Lee
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chan Sub Park
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Jeong Hun Oh
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - In-Chul Park
- Division of Fusion Radiology Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Woo Chul Noh
- Department of Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Vanidassane I, Gogia A, Raina V, Gupta R. Treatment Related Acute Myeloid Leukemia in Breast Cancer Survivors: A Single Institutional Experience. Indian J Hematol Blood Transfus 2019; 35:561-562. [PMID: 31388274 DOI: 10.1007/s12288-019-01078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Ajay Gogia
- 1Department of Medical Oncology, AIIMS, New Delhi, India
| | - Vinod Raina
- 2Department of Medical Oncology, Fortis Memorial Research Institute, Gurugram, India
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Tanizawa RSDS, Zerbini MCN, Rosenfeld R, Kumeda CA, Azevedo RS, Siqueira SAC, Velloso EDRP. Secondary myeloid neoplasms: bone marrow cytogenetic and histological features may be relevant to prognosis. Rev Bras Hematol Hemoter 2016; 39:4-12. [PMID: 28270344 PMCID: PMC5339394 DOI: 10.1016/j.bjhh.2016.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/18/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background Secondary myeloid neoplasms comprise a group of diseases arising after chemotherapy, radiation, immunosuppressive therapy or from aplastic anemia. Few studies have addressed prognostic factors in these neoplasms. Method Forty-two patients diagnosed from 1987 to 2008 with secondary myeloid neoplasms were retrospectively evaluated concerning clinical, biochemical, peripheral blood, bone marrow aspirate, biopsy, and immunohistochemistry and cytogenetic features at diagnosis as prognostic factors. The International Prognostic Scoring System was applied. Statistical analysis employed the Kaplan–Meier method, log-rank and Fisher's exact test. Results Twenty-three patients (54.8%) were male and the median age was 53.5 years (range: 4–88 years) at diagnosis of secondary myeloid neoplasms. Previous diseases included hematologic malignancies, solid tumors, aplastic anemia, autoimmune diseases and conditions requiring solid organ transplantations. One third of patients (33%) were submitted to chemotherapy alone, 2% to radiotherapy, 26% to both modalities and 28% to immunosuppressive agents. Five patients (11.9%) had undergone autologous hematopoietic stem cell transplantation. The median latency between the primary disease and secondary myeloid neoplasms was 85 months (range: 23–221 months). Eight patients were submitted to allogeneic hematopoietic stem cell transplantation to treat secondary myeloid neoplasms. Important changes in bone marrow were detected mainly by biopsy, immunohistochemistry and cytogenetics. The presence of clusters of CD117+ cells and p53+ cells were associated with low survival. p53 was associated to a higher risk according to the International Prognostic Scoring System. High prevalence of clonal abnormalities (84.3%) and thrombocytopenia (78.6%) were independent factors for poor survival. Conclusion This study demonstrated that cytogenetics, bone marrow biopsy and immunohistochemistry are very important prognostic tools in secondary myeloid neoplasms.
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Affiliation(s)
| | | | - Ricardo Rosenfeld
- Universidade Federal de São Paulo (UNIFESP), Hospital São Paulo, São Paulo, SP, Brazil
| | - Cristina Aiko Kumeda
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
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Kyriazanos I, Kalles V, Stefanopoulos A, Spiliotis J, Mohamed F. Operating personnel safety during the administration of Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Surg Oncol 2016; 25:308-14. [PMID: 27566037 DOI: 10.1016/j.suronc.2016.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 06/04/2016] [Accepted: 06/22/2016] [Indexed: 11/24/2022]
Abstract
Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is increasingly used in the treatment of peritoneal malignancies. The administration of HIPEC after complete cytoreduction offers the combination of the pharmacokinetic advantages inherent to the intraperitoneal delivery of cytotoxic chemotherapy, with the direct cytotoxic effects of hyperthermia, and has been reported to offer significantly improved patient outcomes. As a result, this novel method disseminates rapidly, with many surgical teams having developed peritoneal malignancy treatment programs. Protocols are needed for the introduction, handling, and management of chemotherapeutic agents in the operating room to minimize risk to the staff involved in the procedure. The personnel exposure during CRS and HIPEC may arise from different routes, such as air contamination, direct contact, manipulation of perfusates or chemotherapy solutions, and manipulation of objects/tissues exposed to chemotherapeutics. Guidelines for safe administration of HIPEC including environmental contamination risk management, personal protective equipment, and occupational health issues are yet to be established. This review summarizes the existing evidence regarding the safety considerations of HIPEC administration.
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Affiliation(s)
- Ioannis Kyriazanos
- 2nd Department of Surgery, Naval and Veterans Hospital of Athens, Greece
| | - Vasileios Kalles
- 2nd Department of Surgery, Naval and Veterans Hospital of Athens, Greece.
| | | | - John Spiliotis
- 1st Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, United Kingdom
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VILLA AF, EL BALKHI S, ABOURA R, SAGEOT H, HASNI-PICHARD H, POCARD M, ELIAS D, JOLY N, PAYEN D, BLOT F, POUPON J, GARNIER R. Evaluation of oxaliplatin exposure of healthcare workers during heated intraperitoneal perioperative chemotherapy (HIPEC). INDUSTRIAL HEALTH 2014; 53:28-37. [PMID: 25327298 PMCID: PMC4331192 DOI: 10.2486/indhealth.2014-0025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/28/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to evaluate air and surface contaminations, and internal contamination of healthcare workers during open-abdomen HIPEC using oxaliplatin. Platinum (Pt) was measured in urine of exposed workers and in multiple air and surface samples. Three successive HIPEC procedures were investigated in each of the two hospitals participating in the study. Analysis of air samples did not detect any oxaliplatin contamination. Heavy contamination of the operating table, the floor at the surgeon's feet, and the surgeon's overshoes were observed. Hand contamination was observed in surgeons using double gloves for intra-abdominal chemotherapy administration, but not in those using three sets of gloves. Pt was not detected in urine samples obtained after HIPEC (<5 ng/L). The main risk of HIPEC is related to direct or indirect skin exposure and can be prevented by correct use of adapted protective equipment.
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Affiliation(s)
- Antoine F. VILLA
- Poison Centre, Occupational and Environmental Unit, Fernand
Widal Hospital, France
| | | | - Radia ABOURA
- Toxicology Laboratory, Lariboisière Hospital, France
| | | | | | - Marc POCARD
- Department of Digestive Diseases, Lariboisiere Hospital,
France
- University Paris Diderot, France
| | - Dominique ELIAS
- Department of Surgical Oncology, Institut Gustave Roussy
Cancer Center, France
| | - Nathalie JOLY
- Occupational Medicine, Institut Gustave Roussy Cancer Center,
France
| | - Didier PAYEN
- Department of Anesthesiology and Critical Care, Lariboisiere
Hospital, France
- University Paris Diderot, France
| | - François BLOT
- Intensive Care Unit, Institut Gustave Roussy Cancer Center,
France
| | - Joel POUPON
- Toxicology Laboratory, Lariboisière Hospital, France
| | - Robert GARNIER
- Poison Centre, Occupational and Environmental Unit, Fernand
Widal Hospital, France
- University Paris Diderot, France
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Diamond HR, Ornellas MH, Orfao A, Gomes BE, Campos MM, Fernandez TS, da Silva RI, Alves G, Lage C, da Silva DA, Moellmann-Coelho A, da Cruz GS, Bouzas LF, Abdelhay E. Acute myeloid leukemia of donor origin after allogeneic stem cell transplantation from a sibling who harbors germline XPD and XRCC3 homozygous polymorphisms. J Hematol Oncol 2011; 4:39. [PMID: 21951951 PMCID: PMC3197559 DOI: 10.1186/1756-8722-4-39] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 09/27/2011] [Indexed: 11/10/2022] Open
Abstract
A 54-year-old woman was diagnosed with infiltrative ductal breast carcinoma. Two years after treatment, the patient developed an acute myeloid leukemia (AML) which harbored del(11q23) in 8% of the blast cells. The patient was submitted for allogeneic stem cell transplantation (aSCT) from her HLA-compatible sister. Ten months after transplantation, she relapsed with an AML with basophilic maturation characterized by CD45low CD33high, CD117+, CD13-/+, HLA Drhigh, CD123high, and CD203c+ blast cells lacking expression of CD7, CD10, CD34, CD15, CD14, CD56, CD36, CD64, and cytoplasmic tryptase. Karyotype analysis showed the emergence of a new clone with t(2;14) and FISH analysis indicated the presence of MLL gene rearrangement consistent with del(11q23). Interestingly, AML blast cell DNA tested with microsatellite markers showed the same pattern as the donor's, suggesting that this AML emerged from donor cells. Additionally, polymorphisms of the XPA, XPD, XRCC1, XRCC3 and RAD51 DNA repair genes revealed three unfavorable alleles with low DNA repair capacity. In summary, we report the first case of AML involving XPD and XRCC3 polymorphisms from donor origin following allogeneic stem cell transplantation and highlight the potential need for careful analysis of DNA repair gene polymorphisms in selecting candidate donors prior to allogeneic stem cell transplantation.
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Affiliation(s)
- Hilda Rachel Diamond
- Laboratory of Immunology, Bone Marrow Transplantation Unit, National Cancer Institute, Praça Cruz Vermelha n° 23, 6° andar. Centro, Rio de Janeiro, RJ, 20230-130, Brazil.
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Ofori S, Heddon MA, Griffis M. Toward a risk-based assessment of the adult cancer survivor: late effects of chemotherapy. Hosp Pract (1995) 2009; 37:113-120. [PMID: 20877179 DOI: 10.3810/hp.2009.12.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Survivorship care of the cancer patient has become a growing concern among oncologists and primary care physicians in communities across the country. It is now recognized as a distinct phase in the continuum of cancer care. There are an estimated 12 million Americans with a history of cancer looking to their oncologists and primary care physicians for assistance in navigating the difficult waters of survivorship. Although a concerted effort is underway, there are few evidence-based guidelines or recommendations for managing long-term and late effects of adult cancer survivors. The Children 's Oncology Group has developed consensus guidelines to improve and standardize care of the survivors of childhood to young adult cancers. Their successful efforts could serve as a model for a similar undertaking to address the post-treatment care of adult survivors. In the absence of evidence-based or consensus guidelines, knowledge of late effects can inform and direct assessment of survivors presenting with late sequelae of chemotherapy agents.
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Affiliation(s)
- Samuel Ofori
- South Georgia Medical Center, Pearlman Cancer Center, Valdosta, GA 31602, USA
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Ellis MC, Mason T, Barnett J, Kiesow LL, Vetto JT. Gastric malignancies in breast cancer survivors: pathology and outcomes. Am J Surg 2009; 197:633-6. [PMID: 19306975 DOI: 10.1016/j.amjsurg.2008.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 12/12/2008] [Accepted: 12/12/2008] [Indexed: 01/03/2023]
Abstract
BACKGROUND As the number of breast cancer survivors increases, the appearance of second malignancies and unusual metastatic patterns likely also is increasing. In particular, we and others have observed gastric malignancies in breast cancer survivors. METHODS We reviewed 3 regional hospital system tumor databases, comprising 19,049 analytic breast cancer cases, to determine the number, types, and outcomes of subsequent gastric malignancies. RESULTS Twenty-eight patients developed subsequent gastric malignancies, representing .15% of breast cancer survivors; 82% of patients had gastric symptoms. Overall survival for the cohort was 39%. Twenty-four patients (86%) had gastric primaries and 13 died of their second cancers. Four patients had gastric metastases; all had lobular histology in both their primary tumors and metastatic lesions. Five patients had gastrointestinal stromal tumors; all patients underwent resection and currently are alive. CONCLUSION Gastric symptoms in breast cancer survivors may represent malignant lesions, often second primaries. All gastric metastases in our series were of lobular histology.
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Affiliation(s)
- Michelle C Ellis
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR 97239, USA
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Bishara MRY, Ross C, Sur M. Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation. Diagn Pathol 2009; 4:11. [PMID: 19341480 PMCID: PMC2678081 DOI: 10.1186/1746-1596-4-11] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 04/02/2009] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Primary non-Hodgkin lymphoma (NHL) of the breast represents 0.04-0.5% of malignant lesions of the breast and accounts for 1.7-2.2% of extra-nodal NHL. Most primary cases are of B-cell phenotype and only rare cases are of T-cell phenotype. Anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults with the breast being one of the least common locations. There are a total of eleven cases of primary ALCL of the breast described in the literature. Eight of these cases occurred in proximity to breast implants, four in relation to silicone breast implant and three in relation to saline filled breast implant with three out of the eight implant related cases having previous history of breast cancer treated surgically. Adjuvant postoperative chemotherapy is given in only one case. Secondary hematological malignancies after breast cancer chemotherapy have been reported in literature. However in contrast to acute myeloid leukemia (AML), the association between lymphoma and administration of chemotherapy has never been clearly demonstrated. CASE PRESENTATION In this report we present a case of primary ALCL of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for infiltrating ductal carcinoma followed by postoperative chemotherapy twelve years ago. CONCLUSION Primary ALK negative ALCL arising at the site of saline filled breast implant is rare. It is still unclear whether chemotherapy and breast implantation increases risk of secondary hematological malignancies significantly. However, it is important to be aware of these complications and need for careful pathologic examination of tissue removed for implant related complications to make the correct diagnosis for further patient management and treatment. It is important to be aware of this entity at this site as it can be easily misdiagnosed on histologic grounds and to exclude sarcomatoid carcinoma, malignant melanoma and pleomorphic sarcoma by an appropriate panel of immunostains to arrive at the correct diagnosis of ALCL.
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Affiliation(s)
- Mona RY Bishara
- Department of Anatomical Pathology, Henderson Hospital, 711 Concession Street, ON L8V13C, Hamilton, Ontario, Canada
| | - Cathy Ross
- Department of Anatomical Pathology, Henderson Hospital, 711 Concession Street, ON L8V13C, Hamilton, Ontario, Canada
| | - Monalisa Sur
- Department of Anatomical Pathology, Henderson Hospital, 711 Concession Street, ON L8V13C, Hamilton, Ontario, Canada
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Abstract
Leukaemia cutis following chemotherapy for a malignancy is a multifactorial process that is dependent on the chemotherapeutic agent used, the dosing regimen, and the cumulative dose as well as potential contributing therapies such as radiation and possibly even hematopoietic support from granulocyte colony stimulating factor. In the right combination and in a patient with a conducive milieu of epigenetic factors, leukaemia can develop as a treatment complication. Leukaemia cutis is the specific infiltration of the skin by leukaemic cells and occurs most commonly when the underlying leukaemia is an acute myeloid leukaemia. Although it is well reviewed in the literature as a result of primary leukaemia, leukaemia cutis has only very rarely been reported in association with therapy-induced leukaemia. This article reviews the factors that contribute to therapy-related leukaemia and the development of leukaemia cutis.
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Affiliation(s)
- Sarah Weinel
- Division of Dermatology, Department of Medicine, University of Louisville, Kentucky, USA.
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Abstract
In the past 3 decades, the number of cancer survivors in the United States has tripled, reaching approximately 10.7 million in 2004. Although cancer survivors now comprise about 3.5% of the population, subsequent malignancies among this high-risk group account for about 16% (or 1 in 6) of all cancer incidence. Multiple primary cancers can reflect the influence of antecedent cancer therapy, shared etiologic factors, environmental exposures, genetic susceptibility, lifestyle choices, other factors, and the combinations of effects, including gene-environment and gene-gene interactions. Survivors of individual types of primary cancers are at increased risk for distinctive types of subsequent neoplasms. Careful documentation of the magnitude and temporal patterns of these site-specific excess risks, as well as delineation of the contribution of treatment exposures and other factors, will facilitate the development of optimal follow-up plans. Management approaches should include patient education, screening, and prevention strategies. An improved understanding of those malignancies that are largely treatment-related will facilitate the formulation of customized therapeutic approaches for newly diagnosed cancer patients aimed at minimizing the risk of subsequent neoplasms and other late effects, without compromising cure rates.
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Weinel S, Malone J, Jain D, Callen JP. Leukaemia cutis in a patient treated for breast cancer. Australas J Dermatol 2009; 50:52-5. [DOI: 10.1111/j.1440-0960.2008.00504.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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