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Chen R, An Y, Xu M. Prognostic difference between surgery and external radiation in patients with stage I liver cancer based on competitive risk model and conditional survival rate. PLoS One 2024; 19:e0298014. [PMID: 38547200 PMCID: PMC10977706 DOI: 10.1371/journal.pone.0298014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/17/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE This study aimed to assess the difference in prognosis of patients with early-stage liver cancer after surgery or external radiation. METHODS Between 2010 and 2015, 2155 patients with AJCC 7th stage I liver cancer were enrolled in the SEER database. Among these, 1972 patients had undergone surgery and 183 had undergone external beam radiation. The main research endpoints were overall survival (OS) and disease-specific survival (DSS). The competitive risk model was used to calculate the risk ratio of liver cancer-specific deaths when there was a competitive risk. Propensity Score Matching (PSM) method using a 1:1 ratio was used to match confounders such as sex, age, and treatment method. Conditional survival was dynamically assessed for patient survival after surgery or external radiation. RESULTS Multivariate analysis of the competitive risk model showed that age, disease diagnosis time, grade, and treatment [surgery and external beam radiation therapy (EBRT)] were independent prognostic factors for patients with hepatocellular carcinoma. Surgery had a higher survival improvement rate than that of EBRT. As the survival of patients with liver cancer increased, the survival curve of surgery declined more slowly than that of radiotherapy patients and stabilized around 3 years after surgery. The survival curve of radiotherapy patients significantly dropped within 4 years and then stabilized. CONCLUSION Surgery was better than EBRT for patients with stage I liver cancer. Close follow-up was required for 3 years after surgery or 4 years after external radiation. This study can help clinicians make better informed clinical decisions.
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Affiliation(s)
- Rong Chen
- Department of Oncology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
| | - Yanli An
- Medical School of Southeast University, Nanjing, Jiangsu Province, China
| | - Muhao Xu
- Medical School of Southeast University, Nanjing, Jiangsu Province, China
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Moon AM, Kim HP, Singal AG, Owen D, Mendiratta-Lala M, Parikh ND, Rose SC, McGinty KA, Agala CB, Burke LM, Abate A, Altun E, Beyer C, Do J, Folkert MR, Forbes C, Hattangadi-Gluth JA, Hayashi PH, Jones K, Khatri G, Kono Y, Lawrence TS, Maurino C, Mauro DM, Mayo CS, Pak T, Patil P, Sanders EC, Simpson DR, Tepper JE, Thapa D, Yanagihara TK, Wang K, Gerber DA. Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study. Hepatol Commun 2023; 7:e00184. [PMID: 37314737 PMCID: PMC10270501 DOI: 10.1097/hc9.0000000000000184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND AIMS Early-stage HCC can be treated with thermal ablation or stereotactic body radiation therapy (SBRT). We retrospectively compared local progression, mortality, and toxicity among patients with HCC treated with ablation or SBRT in a multicenter, US cohort. APPROACH RESULTS We included adult patients with treatment-naïve HCC lesions without vascular invasion treated with thermal ablation or SBRT per individual physician or institutional preference from January 2012 to December 2018. Outcomes included local progression after a 3-month landmark period assessed at the lesion level and overall survival at the patient level. Inverse probability of treatment weighting was used to account for imbalances in treatment groups. The Cox proportional hazard modeling was used to compare progression and overall survival, and logistic regression was used for toxicity. There were 642 patients with 786 lesions (median size: 2.1 cm) treated with ablation or SBRT. In adjusted analyses, SBRT was associated with a reduced risk of local progression compared to ablation (aHR 0.30, 95% CI: 0.15-0.60). However, SBRT-treated patients had an increased risk of liver dysfunction at 3 months (absolute difference 5.5%, aOR 2.31, 95% CI: 1.13-4.73) and death (aHR 2.04, 95% CI: 1.44-2.88, p < 0.0001). CONCLUSIONS In this multicenter study of patients with HCC, SBRT was associated with a lower risk of local progression compared to thermal ablation but higher all-cause mortality. Survival differences may be attributable to residual confounding, patient selection, or downstream treatments. These retrospective real-world data help guide treatment decisions while demonstrating the need for a prospective clinical trial.
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Affiliation(s)
- Andrew M. Moon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hannah P. Kim
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven C. Rose
- Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Katrina A. McGinty
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chris B. Agala
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren M. Burke
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anjelica Abate
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christian Beyer
- Division of Hospital Medicine, Baylor Scott and White Hospital System, Waxahachie, Texas, USA
| | - John Do
- Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Michael R. Folkert
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Chalon Forbes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jona A. Hattangadi-Gluth
- Department of Radiation Oncology, University of California-San Diego, San Diego, California, USA
| | - Paul H. Hayashi
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Keri Jones
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yuko Kono
- Department of Radiology, University of California-San Diego, San Diego, California, USA
- Department of Medicine, University of California-San Diego, San Diego, California, USA
| | - Theodore S. Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher Maurino
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - David M. Mauro
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles S. Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Taemee Pak
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Preethi Patil
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C. Sanders
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Daniel R. Simpson
- Department of Radiation Oncology, University of California-San Diego, San Diego, California, USA
| | - Joel E. Tepper
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diwash Thapa
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ted K. Yanagihara
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - David A. Gerber
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Wang F, Numata K, Takeda A, Ogushi K, Fukuda H, Hara K, Chuma M, Eriguchi T, Tsurugai Y, Maeda S. Safety and efficacy study: Short-term application of radiofrequency ablation and stereotactic body radiotherapy for Barcelona Clinical Liver Cancer stage 0-B1 hepatocellular carcinoma. PLoS One 2021; 16:e0245076. [PMID: 33400718 PMCID: PMC7785216 DOI: 10.1371/journal.pone.0245076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022] Open
Abstract
Aim To evaluate the safety and efficacy of the administration of radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) in the short term to the same patients in Barcelona Clinical Liver Cancer (BCLC) stages 0–B1. Methods From April 2014 to June 2019, we retrospectively reviewed BCLC stage 0–B1 patients with fresh hepatocellular carcinoma (HCC) lesions that were repeatedly treated by RFA (control group, n = 72), and by RFA and subsequent SBRT (case group, n = 26). Propensity score matching (PSM) was performed to reduce the selection bias between two groups. Recurrence, survival, Child–Pugh scores and short-term side effects (fever, bleeding, skin change, abdominal pain and fatigue) were recorded and analyzed. Results After PSM, 21 patients remained in each group. Seventeen and 20 patients in the case and control groups experienced recurrence. For these patients, the median times to progression and follow-up were 10.7 and 35.8 months, respectively. After PSM, the 1-year progression-free survival rate in case and control groups were 66.7% and 52.4%, respectively (P = 0.313). The inter-group overall survival (OS) was comparable (3 and 5-year OS rates in case groups were 87.3% and 74.8%, while rates in control groups were 73.7% and 46.3%, respectively; P = 0.090). The short-term side effects were mild, and the incidence showed no inter-group difference. The 1-year rates of the Child–Pugh score deterioration of ≥2 in case and control groups were 23.8% and 33.3% (P > 0.05), respectively. Conclusion The short-term administration of RFA and SBRT to the same BCLC stage 0–B1 patients may be feasible and effective because of their good prognosis and safety.
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Affiliation(s)
- Feiqian Wang
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Ultrasound Department, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- * E-mail:
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa, Japan
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Koji Hara
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | | | | | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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Kim N, Cheng J, Huang WY, Kimura T, Zeng ZC, Lee VHF, Kay CS, Seong J. Dose-Response Relationship in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: A Pooled Analysis of an Asian Liver Radiation Therapy Group Study. Int J Radiat Oncol Biol Phys 2020; 109:464-473. [PMID: 33229165 DOI: 10.1016/j.ijrobp.2020.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Despite the worldwide implementation of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC), there is a lack of consensus guideline on prescription dose. Herein, this multinational study aimed to investigate the effects of the prescribed radiation dose on oncologic outcomes of SBRT for HCC. METHODS AND MATERIALS The multi-institutional retrospective cohort included 510 patients treated with SBRT between 2010 and 2016. All relevant clinical factors and factors related to SBRT were analyzed to evaluate freedom from local progression (FFLP) and overall survival (OS). Based on a biologically effective dose (BED) cutoff value of 100 Gy, 198 tumors were selected from each group in propensity score matching (PSM). RESULTS Baseline characteristics in the BED <100 Gy group were unfavorable (Child-Pugh class B, 19%; advanced stage, 72%; median tumor size was 4 cm) compared with the BED ≥100 Gy group. With a median follow-up of 22 (interquartile range, 9.8-37.6) months, the 2-year FFLP and OS rates were 77% and 73%, respectively. Patients treated with a BED ≥100 Gy showed better rates of 2-year FFLP and OS than patients treated with a BED <100 Gy (FFLP, 89% vs 69%; OS, 80% vs 67%; P < .001). In the multivariable analysis before and after PSM, BED ≥100 Gy was identified as the main prognostic factor for both FFLP and OS (P < .01). Additionally, a dose-response relationship was observed between FFLP and BED (odds ratio, 0.92 per 5 Gy, P = .048). CONCLUSIONS A BED ≥100 Gy was significantly associated with outcomes, and a dose-response relationship was observed between local tumor progression and BED. Given that SBRT is being increasingly used in HCC, detailed consensus guidelines regarding SBRT dose prescription should be established.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jason Cheng
- Department of Radiation Oncology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Zhao Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Victor H F Lee
- Department of Radiation Oncology, University of Hong Kong, Hong Kong, People's Republic of China
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary Hospital, Incheon, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kim N, Cheng J, Jung I, Liang JD, Shih YL, Huang WY, Kimura T, Lee VHF, Zeng ZC, Zhenggan R, Kay CS, Heo SJ, Won JY, Seong J. Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma. J Hepatol 2020; 73:121-129. [PMID: 32165253 DOI: 10.1016/j.jhep.2020.03.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few studies have been conducted to compare the efficacies of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA). Thus, in this multinational study, we compared the effectiveness of SBRT and RFA in patients with unresectable HCC. METHODS The retrospective study cohort included 2,064 patients treated in 7 hospitals: 1,568 and 496 in the RFA and SBRT groups, respectively. More than half of the patients (56.5%) developed recurrent tumors, mainly after transarterial chemoembolization (44.8%). Propensity score matching was performed to adjust for clinical factors (n = 313 in each group). RESULTS At baseline, the SBRT group had unfavorable clinical features compared to the RFA group, including BCLC stage (B-C 65% vs. 16%), tumor size (median 3.0 cm vs. 1.9 cm), and frequent history of liver-directed treatment (81% vs. 49%, all p <0.001). With a median follow-up of 27.7 months, the 3-year cumulative local recurrence rates in the SBRT and RFA groups were 21.2% and 27.9%, respectively (p <0.001). After adjusting for clinical factors, SBRT was related to a significantly lower risk of local recurrence than RFA in both the entire (hazard ratio [HR] 0.45, p <0.001) and matched (HR 0.36, p <0.001) cohorts. In subgroup analysis, SBRT was associated with superior local control in small tumors (≤3 cm) irrespective of location, large tumors located in the subphrenic region, and those that progressed after transarterial chemoembolization. Acute grade ≥3 toxicities occurred in 1.6% and 2.6% of the SBRT and RFA patients, respectively (p = 0.268). CONCLUSIONS SBRT could be an effective alternative to RFA for unresectable HCC, particularly for larger tumors (>3 cm) in a subphrenic location and tumors that have progressed after transarterial chemoembolization. LAY SUMMARY It is currently not known what the best treatment option is for patients with unresectable hepatocellular carcinoma. Here, we show that stereotactic body radiation therapy provides better local control than radiofrequency ablation, with comparable toxicities. Stereotactic body radiation therapy appears to be an effective alternative to radiofrequency ablation that should be considered when there is a higher risk of local recurrence or toxicity after radiofrequency ablation.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Jason Cheng
- Department of Radiation Oncology, National Taiwan University Hospital, Taiwan
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ja Der Liang
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Yu Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Victor H F Lee
- Department of Radiation Oncology, The University of Hong Kong, Hong Kong
| | - Zhao Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, China
| | - Ren Zhenggan
- Department of Medical Hepatology, Zhongshan Hospital, Fudan University, China
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary Hospital, Republic of Korea
| | - Seok Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yoon Won
- Department of Interventional Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea.
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Rajyaguru DJ, Borgert AJ, Halfdanarson TR, Truty MJ, Kurup AN, Go RS. Reply to E.L. Pollom et al, N. Ohri et al, A. Fiorentino et al, D.R. Wahl et al, N. Kim et al, J. Boda-Heggemann et al, S. Rana et al, N. Sanuki et al, J.R. Olsen et al, G.L. Smith et al, and A. Shinde et al. J Clin Oncol 2018; 36:2567-2569. [PMID: 29945519 DOI: 10.1200/jco.2018.78.6418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Devalkumar J Rajyaguru
- Devalkumar J. Rajyaguru, Gundersen Health System, La Crosse, WI; Andrew J. Borgert, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Andrew J Borgert
- Devalkumar J. Rajyaguru, Gundersen Health System, La Crosse, WI; Andrew J. Borgert, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Thorvardur R Halfdanarson
- Devalkumar J. Rajyaguru, Gundersen Health System, La Crosse, WI; Andrew J. Borgert, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Mark J Truty
- Devalkumar J. Rajyaguru, Gundersen Health System, La Crosse, WI; Andrew J. Borgert, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - A Nicholas Kurup
- Devalkumar J. Rajyaguru, Gundersen Health System, La Crosse, WI; Andrew J. Borgert, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Devalkumar J. Rajyaguru, Gundersen Health System, La Crosse, WI; Andrew J. Borgert, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
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