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Lafata KJ, Corradetti MN, Gao J, Jacobs CD, Weng J, Chang Y, Wang C, Hatch A, Xanthopoulos E, Jones G, Kelsey CR, Yin FF. Radiogenomic Analysis of Locally Advanced Lung Cancer Based on CT Imaging and Intratreatment Changes in Cell-Free DNA. Radiol Imaging Cancer 2021; 3:e200157. [PMID: 34114913 DOI: 10.1148/rycan.2021200157] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The radiologic appearance of locally advanced lung cancer may be linked to molecular changes of the disease during treatment, but characteristics of this phenomenon are poorly understood. Radiomics, liquid biopsy of cell-free DNA (cfDNA), and next-generation sequencing of circulating tumor DNA (ctDNA) encode tumor-specific radiogenomic expression patterns that can be probed to study this problem. Preliminary findings are reported from a radiogenomic analysis of CT imaging, cfDNA, and ctDNA in 24 patients (median age, 64 years; range, 49-74 years) with stage III lung cancer undergoing chemoradiation on a prospective pilot study (NCT00921739) between September 2009 and September 2014. Unsupervised clustering of radiomic signatures resulted in two clusters that were associated with ctDNA TP53 mutations (P = .03) and changes in cfDNA concentration after 2 weeks of chemoradiation (P = .02). The radiomic features dissimilarity (hazard ratio [HR] = 0.56; P = .05), joint entropy (HR = 0.56; P = .04), sum entropy (HR = 0.53; P = .02), and normalized inverse difference (HR = 1.77; P = .05) were associated with overall survival. These results suggest heterogeneous and low-attenuating disease without a detectable ctDNA TP53 mutation was associated with early surges of cfDNA concentration in response to therapy and a generally better prognosis. Keywords: CT-Quantitative, Radiation Therapy, Lung, Computer Applications-3D, Oncology, Tumor Response, Outcomes Analysis Clinical trial registration no. NCT00921739 Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Kyle J Lafata
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Michael N Corradetti
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Junheng Gao
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Corbin D Jacobs
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Jingxi Weng
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Yushi Chang
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Chunhao Wang
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Ace Hatch
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Eric Xanthopoulos
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Greg Jones
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Chris R Kelsey
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
| | - Fang-Fang Yin
- From the Departments of Radiation Oncology (K.J.L., M.N.C., C.D.J., J.W., Y.C., C.W., C.R.K., F.F.Y.), Radiology (K.J.L.), Biostatistics and Bioinformatics (J.G.), and Medicine (A.H.), Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710; Department of Electrical and Computer Engineering, Duke University Pratt School of Engineering, Durham, NC (K.J.L.); Radiology Medical Group of Napa, Napa, Calif (M.N.C.); Department of Radiation Oncology, Columbia University School of Medicine, New York, NY (E.X.); and Inivata, Cambridge, England (G.J.)
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Burgess JT, Rose M, Boucher D, Plowman J, Molloy C, Fisher M, O'Leary C, Richard DJ, O'Byrne KJ, Bolderson E. The Therapeutic Potential of DNA Damage Repair Pathways and Genomic Stability in Lung Cancer. Front Oncol 2020; 10:1256. [PMID: 32850380 PMCID: PMC7399071 DOI: 10.3389/fonc.2020.01256] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
Despite advances in our understanding of the molecular biology of the disease and improved therapeutics, lung cancer remains the most common cause of cancer-related deaths worldwide. Therefore, an unmet need remains for improved treatments, especially in advanced stage disease. Genomic instability is a universal hallmark of all cancers. Many of the most commonly prescribed chemotherapeutics, including platinum-based compounds such as cisplatin, target the characteristic genomic instability of tumors by directly damaging the DNA. Chemotherapies are designed to selectively target rapidly dividing cells, where they cause critical DNA damage and subsequent cell death (1, 2). Despite the initial efficacy of these drugs, the development of chemotherapy resistant tumors remains the primary concern for treatment of all lung cancer patients. The correct functioning of the DNA damage repair machinery is essential to ensure the maintenance of normal cycling cells. Dysregulation of these pathways promotes the accumulation of mutations which increase the potential of malignancy. Following the development of the initial malignancy, the continued disruption of the DNA repair machinery may result in the further progression of metastatic disease. Lung cancer is recognized as one of the most genomically unstable cancers (3). In this review, we present an overview of the DNA damage repair pathways and their contributions to lung cancer disease occurrence and progression. We conclude with an overview of current targeted lung cancer treatments and their evolution toward combination therapies, including chemotherapy with immunotherapies and antibody-drug conjugates and the mechanisms by which they target DNA damage repair pathways.
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Affiliation(s)
- Joshua T Burgess
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Maddison Rose
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Didier Boucher
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Jennifer Plowman
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Christopher Molloy
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Mark Fisher
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Connor O'Leary
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Derek J Richard
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Kenneth J O'Byrne
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Emma Bolderson
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
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He K, Zhang S, Shao LL, Yin JC, Wu X, Shao YW, Yuan S, Yu J. Developing more sensitive genomic approaches to detect radioresponse in precision radiation oncology: From tissue DNA analysis to circulating tumor DNA. Cancer Lett 2019; 472:108-118. [PMID: 31837443 DOI: 10.1016/j.canlet.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
Despite the common application and considerable efforts to achieve precision radiotherapy (RT) in several types of cancer, RT has not yet entered the era of precision medicine; the ability to predict radiosensitivity and treatment responses in tumors and normal tissues is lacking. Therefore, development of genome-based methods for individual prognosis in radiation oncology is urgently required. Traditional DNA sequencing requires tissue samples collected during invasive operations; therefore, repeated tests are nearly impossible. Intra- and inter-tumoral heterogeneity may undermine the predictive power of a single assay from tumor samples. In contrast, analysis of circulating tumor DNA (ctDNA) allows for non-invasive and near real-time sampling of tumors. By investigating the genetic composition of tumors and monitoring dynamic changes during treatment, ctDNA analysis may potentially be clinically valuable in prediction of treatment responses prior to RT, surveillance of responses during RT, and evaluation of residual disease following RT. As a biomarker for RT response, ctDNA profiling may guide personalized treatments. In this review, we will discuss approaches of tissue DNA sequencing and ctDNA detection and summarize their clinical applications in both traditional RT and in combination with immunotherapy.
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Affiliation(s)
- Kewen He
- Department of Radiology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong, 250117, People's Republic of China; Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Shaotong Zhang
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, 250013, People's Republic of China
| | - Liang L Shao
- Geneseeq Technology Inc., Toronto, Ontario, M5G 1L7, Canada
| | - Jiani C Yin
- Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, People's Republic of China
| | - Xue Wu
- Geneseeq Technology Inc., Toronto, Ontario, M5G 1L7, Canada
| | - Yang W Shao
- Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, People's Republic of China; School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Shuanghu Yuan
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China.
| | - Jinming Yu
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China.
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Corradetti MN, Torok JA, Hatch AJ, Xanthopoulos EP, Lafata K, Jacobs C, Rushing C, Calaway J, Jones G, Kelsey CR, Nixon AB. Dynamic Changes in Circulating Tumor DNA During Chemoradiation for Locally Advanced Lung Cancer. Adv Radiat Oncol 2019; 4:748-752. [PMID: 31673668 PMCID: PMC6817521 DOI: 10.1016/j.adro.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose Concurrent chemoradiation therapy (CRT) is the principal treatment modality for locally advanced lung cancer. Cell death due to CRT leads to the release of cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA) into the bloodstream, but the kinetics and characteristics of this process are poorly understood. We hypothesized that there could be clinically meaningful changes in cfDNA and ctDNA during a course of CRT for lung cancer. Methods and materials Multiple samples of plasma were obtained from 24 patients treated with CRT for locally advanced lung cancer to a mean dose of 66 Gy (range, 58-74 Gy) at the following intervals: before CRT, at weeks 2 and 5 during CRT, and 6 weeks after treatment. cfDNA was quantified, and a novel next generation sequencing (NGS) technique using enhanced tagged/targeted-amplicon sequencing was performed to analyze ctDNA. Results Patients for whom specific mutations in ctDNA were undetectable at the baseline time point had improved survival, and potentially etiologic driver mutations could be tracked throughout the course of CRT via NGS in multiple patients. We quantified the levels of cfDNA from patients before CRT, at week 2, week 5, and at 6 weeks after treatment. No differences were observed at weeks 2 and 5 of therapy, but we noted a significant increase in cfDNA in the posttreatment follow-up samples compared with samples collected before CRT (P = .05). Conclusions Dynamic changes in both cfDNA and ctDNA were observed throughout the course of CRT in patients with locally advanced lung cancer. Specific mutations with therapeutic implications can be identified and tracked using NGS methodologies. Further work is required to characterize the changes in cfDNA and ctDNA over time in patients treated with CRT and to assess the predictive and prognostic potential of this powerful technology.
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Affiliation(s)
- Michael N Corradetti
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Jordan A Torok
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Ace J Hatch
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Eric P Xanthopoulos
- Department of Radiation Oncology, Columbia University School of Medicine, New York, New York
| | - Kyle Lafata
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Corbin Jacobs
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Christel Rushing
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - John Calaway
- Inivata, Inc, Research Triangle Park, North Carolina
| | - Greg Jones
- Inivata, Inc, Research Triangle Park, North Carolina
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Andrew B Nixon
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
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De Ruysscher D, Jin J, Lautenschlaeger T, She JX, Liao Z, Kong FMS. Blood-based biomarkers for precision medicine in lung cancer: precision radiation therapy. Transl Lung Cancer Res 2017; 6:661-669. [PMID: 29218269 DOI: 10.21037/tlcr.2017.09.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Both tumors and patients are complex and models that determine survival and toxicity of radiotherapy or any other treatment ideally must take into account this variability as well as its dynamic state. The genetic features of the tumor and the host, and increasingly also the epi-genetic and proteomic characteristics, are being unraveled. Multiple techniques, including histological examination, blood sampling, measurement of circulating tumor cells (CTCs), and functional and molecular imaging, can be used for this purpose. However, the effects of radiation on the tumor and on organs at risk (OARs) are also influenced by the applied dose and volume of irradiated tissues. Combining all these biological, clinical, imaging, and dosimetric parameters in a validated prognostic or predictive model poses a major challenge. Here we aimed to provide an objective review of the potential of blood markers to guide high precision radiation therapy. A combined biological-mathematical approach opens new doors beyond prognostication of patients, as it allows truly precise oncological treatment. Indeed, the core for individualized and precision medicine is not only selection of patients, but even more the optimization of the therapeutic window on an individual basis. A holistic model will allow for determination of an individual dose-response relationship for each organ at risk for each tumor in each individual patient for the complete oncological treatment package. This includes, but is not limited to, radiotherapy alone. Individualized dose-response curves will allow for consideration of different doses of radiation and combinations with other drugs to plan for both optimal toxicity and complete response. Insights into the interactions between a multitude of parameters will lead to the discovery of new pathways and networks that will fuel new biological research on target discovery.
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Affiliation(s)
- Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.,KU Leuven Radiation Oncology, Leuven, Belgium
| | - Jianyue Jin
- Department of Radiation Oncology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine and Department of OB/GYN, Augusta University, Augusta, GA, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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