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Chelliah A, Wood DA, Canas LS, Shuaib H, Currie S, Fatania K, Frood R, Rowland-Hill C, Thust S, Wastling SJ, Tenant S, Foweraker K, Williams M, Wang Q, Roman A, Dragos C, MacDonald M, Lau YH, Linares CA, Bassiouny A, Luis A, Young T, Brock J, Chandy E, Beaumont E, Lam TC, Welsh L, Lewis J, Mathew R, Kerfoot E, Brown R, Beasley D, Glendenning J, Brazil L, Swampillai A, Ashkan K, Ourselin S, Modat M, Booth TC. Glioblastoma and Radiotherapy: a multi-center AI study for Survival Predictions from MRI (GRASP study). Neuro Oncol 2024:noae017. [PMID: 38285679 DOI: 10.1093/neuonc/noae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The aim was to predict survival of glioblastoma at eight months after radiotherapy (a period allowing for completing a typical course of adjuvant temozolomide), by applying deep learning to the first brain MRI after radiotherapy completion. METHODS Retrospective and prospective data were collected from 206 consecutive glioblastoma, IDH-wildtype patients diagnosed between March 2014-February 2022 across 11 UK centers. Models were trained on 158 retrospective patients from three centers. Holdout test sets were retrospective (n=19; internal validation), and prospective (n=29; external validation from eight distinct centers).Neural network branches for T2-weighted and contrast-enhanced T1-weighted inputs were concatenated to predict survival. A non-imaging branch (demographics/MGMT/treatment data) was also combined with the imaging model. We investigated the influence of individual MR sequences; non-imaging features; and weighted dense blocks pretrained for abnormality detection. RESULTS The imaging model outperformed the non-imaging model in all test sets (area under the receiver-operating characteristic curve, AUC p=0.038) and performed similarly to a combined imaging/non-imaging model (p>0.05). Imaging, non-imaging, and combined models applied to amalgamated test sets gave AUCs of 0.93, 0.79, and 0.91. Initializing the imaging model with pretrained weights from 10,000s of brain MRIs improved performance considerably (amalgamated test sets without pretraining 0.64; p=0.003). CONCLUSIONS A deep learning model using MRI images after radiotherapy, reliably and accurately determined survival of glioblastoma. The model serves as a prognostic biomarker identifying patients who will not survive beyond a typical course of adjuvant temozolomide, thereby stratifying patients into those who might require early second-line or clinical trial treatment.
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Affiliation(s)
| | | | | | - Haris Shuaib
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stuart Currie
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kavi Fatania
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Russell Frood
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Stefanie Thust
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Stephen J Wastling
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - Sean Tenant
- The Christie NHS Foundation Trust, Withington, Manchester, United Kingdom
| | | | - Matthew Williams
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Qiquan Wang
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Andrei Roman
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Oncology Institute Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania
| | - Carmen Dragos
- Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
| | | | - Yue Hui Lau
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Ahmed Bassiouny
- King's College London, London, United Kingdom
- Mansoura University, Mansoura, Egypt
| | - Aysha Luis
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Young
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Juliet Brock
- Brighton and Sussex University Hospitals NHS Trust, England, United Kingdom
| | - Edward Chandy
- Brighton and Sussex University Hospitals NHS Trust, England, United Kingdom
| | - Erica Beaumont
- Lancashire Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - Tai-Chung Lam
- Lancashire Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joanne Lewis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, England, United Kingdom
| | - Ryan Mathew
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, UK
| | | | | | - Daniel Beasley
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Lucy Brazil
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Keyoumars Ashkan
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Marc Modat
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thomas C Booth
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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Kathirgamakarthigeyan S, Foweraker K, Johnson K, Sivanandan MA, Pascoe A. How has the coronavirus pandemic impacted chemoradiotherapy for stage 3 non-small cell lung cancer (NSCLC) in our centre? Lung Cancer 2022. [PMCID: PMC8829818 DOI: 10.1016/s0169-5002(22)00075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Jones GS, Khakwani A, Pascoe A, Foweraker K, McKeever TM, Hubbard RB, Baldwin DR. Factors associated with survival in small cell lung cancer: an analysis of real-world national audit, chemotherapy and radiotherapy data. Ann Palliat Med 2021; 10:4055-4068. [PMID: 33894719 DOI: 10.21037/apm-20-1824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The mainstay of treatment for small cell lung cancer (SCLC) involves platinum doublet chemotherapy but the optimal duration, 4 vs. 6 cycles, is not known. Concurrent thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is recommended for fit individuals with limited stage. However, outside of clinical trials, the efficacy of sequential thoracic radiotherapy and PCI for extensive stage is uncertain. METHODS This retrospective, observational, cohort study used English national lung cancer data to determine the factors associated with survival for all people diagnosed with SCLC. More precisely, for individuals who received chemotherapy, we examined survival by the chemotherapy duration, thoracic radiotherapy dose and the use of PCI. RESULTS In total 6,438 people were diagnosed with SCLC. We identified that male sex (OR 0.7; 95% CI: 0.62-0.80), increasing age (P=0.01) greater comorbidity (P≤0.01), extensive stage (OR 0.21; 95% CI: 0.19-0.25) and worse performance status (PS2 vs. PS0 adjusted OR 0.38 95% CI: 0.31-0.48) were associated with reduced 1-year survival. Receipt of chemotherapy augmented survival. We analysed data for 1,761 people who had received chemotherapy. Thoracic radiotherapy (≥30 Gy for extensive stage and ≥40 Gy for limited stage) and PCI were independently associated with better survival (P≤0.01 for each), but 6 cycles of chemotherapy instead of 4 was not (limited stage adjusted OR 0.97; 95% CI: 0.48-1.97) extensive stage adjusted OR 1.34; 95% CI: 0.81-2.21). CONCLUSIONS Extending chemotherapy beyond 4 cycles to 6 does not augment survival. Appropriately prescribed thoracic radiotherapy and PCI can prolong survival in both limited and extensive stage SCLC.
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Affiliation(s)
- Gavin S Jones
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Abigail Pascoe
- Department of Clinical Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Karen Foweraker
- Department of Clinical Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Richard B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - David R Baldwin
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
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Kamlow C, Foweraker K, Pascoe A. The effect of volumetric modulated arc therapy (VMAT) on radiotherapy plan quality in radical non-small cell lung cancer radiotherapy. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mccabe A, Foweraker K, Pascoe A. An audit on the outcomes of patients with primary lung cancer treated with stereotactic ablative radiotherapy (SABR) at a single institute between 2013 and 2018. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brookes L, Esler C, Foweraker K, Harron E, Pascoe A. Evolving and Improving Lung SABR Planning Technique. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ho J, O'Cathail M, Clements R, Foweraker K, Griffin M, Aznar-Garcia L. Stereotactic Radiosurgery for Brain Oligometastases: a One-year Single Centre Experience. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sanganalmath P, Lester JE, Bradshaw AG, Das T, Esler C, Roy AEF, Toy E, Lester JF, Button M, Wilson P, Comins C, Atherton P, Pickles R, Foweraker K, Walker GA, Keni M, Hatton MQ. Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres. Clin Oncol (R Coll Radiol) 2018; 30:144-150. [PMID: 29336865 DOI: 10.1016/j.clon.2017.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/27/2017] [Accepted: 11/06/2017] [Indexed: 01/15/2023]
Abstract
AIM Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. MATERIALS AND METHODS UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance. RESULTS In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. CONCLUSION In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.
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Affiliation(s)
| | | | - A G Bradshaw
- Weston Park Hospital, Sheffield, UK; Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - T Das
- Weston Park Hospital, Sheffield, UK
| | - C Esler
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A E F Roy
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - M Button
- Velindre Cancer Centre, Cardiff, UK
| | - P Wilson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - C Comins
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - P Atherton
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - R Pickles
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - K Foweraker
- Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - G A Walker
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
| | - M Keni
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
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Khakwani A, Harden S, Baldwin D, Foweraker K, Navani N, Dickinson R, West D, Beckett P, Hubbard R. P1.05-010 Curative Treatment Rates for Patients Diagnosed with Early Stage Non-Small Cell Lung Cancer (NSCLC) in England. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brookes L, Silverman R, Foweraker K. Improving inpatient flow within the oncology department at Nottingham University Hospitals NHS Trust. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Price J, Pascoe A, Esler C, Foweraker K, Tripathy A. 137: Is there still a role for continuous hyperfractionated accelerated radiotherapy (CHART) in the management of NSCLC? Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pascoe A, Price J, Foweraker K, Esler C, Tripathy A. 138: Management of stage 3 non-small cell lung cancer with radical radiotherapy in a CHART centre. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pascoe A, Foweraker K, Esler C, Morgan S, Wallace A, Launders D, Harron E. Audit of radiotherapy plan quality for stereotactic ablative radiotherapy (SABR) for stage 1 non-small cell lung cancer. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Foweraker K. 172 Issues encountered in implementing stereotactic ablative body radiotherapy (SABR) for NSCLC at Nottingham University Hospitals (NUH). Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Foweraker K, Morgan S, Cardale K. 173 Preliminary results of patients (pts) treated with SABR for early stage non-small cell lung cancer in Nottingham Radiotherapy Centre. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Giotopoulos G, Symonds RP, Foweraker K, Griffin M, Peat I, Osman A, Plumb M. The late radiotherapy normal tissue injury phenotypes of telangiectasia, fibrosis and atrophy in breast cancer patients have distinct genotype-dependent causes. Br J Cancer 2007; 96:1001-7. [PMID: 17325707 PMCID: PMC2360097 DOI: 10.1038/sj.bjc.6603637] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The relationship between late normal tissue radiation injury phenotypes in 167 breast cancer patients treated with radiotherapy and: (i) radiotherapy dose (boost); (ii) an early acute radiation reaction and (iii) genetic background was examined. Patients were genotyped at single nucleotide polymorphisms (SNPs) in eight candidate genes. An early acute reaction to radiation and/or the inheritance of the transforming growth factor-β1 (TGFβ1 −509T) SNP contributed to the risk of fibrosis. In contrast, an additional 15 Gy electron boost and/or the inheritance of X-ray repair cross-complementing 1 (XRCC1) (R399Q) SNP contributed to the risk of telangiectasia. Although fibrosis, telangiectasia and atrophy, all contribute to late radiation injury, the data suggest that they have distinct underlying genetic and radiobiological causes. Fibrosis risk is associated with an inflammatory response (an acute reaction and/or TGFβ1), whereas telangiectasia is associated with vascular endothelial cell damage (boost and/or XRCC1). Atrophy is associated with an acute response, but the genetic predisposing factors that determine the risk of an acute response or atrophy have yet to be identified. A combined analysis of two UK breast cancer patient studies shows that 8% of patients are homozygous (TT) for the TGFβ1 (C-509T) variant allele and have a 15-fold increased risk of fibrosis following radiotherapy (95% confidence interval: 3.76–60.3; P=0.000003) compared with (CC) homozygotes.
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Affiliation(s)
- G Giotopoulos
- Department of Genetics, University of Leicester, Leicester LE1 7RH, UK
| | - R P Symonds
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Level 2, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK
- E-mail:
| | - K Foweraker
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Level 2, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK
| | - M Griffin
- Department of Oncology, Nottingham University Hospitals NHS Trust, CITY Hospital Campus, ICT Services, Hucknall Road, Nottingham, UK
| | - I Peat
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Level 2, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK
| | - A Osman
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Level 2, Osborne Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK
| | - M Plumb
- Department of Genetics, University of Leicester, Leicester LE1 7RH, UK
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