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Jereczek-Fossa BA, Palazzi MF, Soatti CP, Cazzaniga LF, Ivaldi GB, Pepa M, Amadori M, Antognoni P, Arcangeli S, Buffoli A, Beltramo G, Berlinghieri S, Bignardi M, Bracelli S, Bruschieri L, Castiglioni S, Catalano G, Di Muzio N, Fallai C, Fariselli L, Filippi AR, Gramaglia A, Italia C, Lombardi F, Magrini SM, Nava S, Orlandi E, Pasinetti N, Sbicego EL, Scandolaro L, Scorsetti M, Stiglich F, Tonoli S, Tortini R, Valdagni R, Vavassori V, Marvaso G. COVID-19 Outbreak and Cancer Radiotherapy Disruption in Lombardy, Northern Italy. Clin Oncol (R Coll Radiol) 2020; 32:e160-e161. [PMID: 32354669 PMCID: PMC7177150 DOI: 10.1016/j.clon.2020.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
Affiliation(s)
- B A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - M F Palazzi
- Radiotherapy Unit, ASST Ospedale Niguarda, Milano, Italy
| | - C P Soatti
- Radiation Oncology Center, Ospedale Manzoni, Lecco, Italy
| | - L F Cazzaniga
- Radiation Oncology Center, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - G B Ivaldi
- Radiation Oncology Center, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - M Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy
| | - M Amadori
- Radiation Oncology Center, Ospedale C. Poma, Mantova, Italy
| | - P Antognoni
- Radiation Oncology Center, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | - S Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca", Milano, Italy
| | - A Buffoli
- Radiation Oncology Center, Istituto Clinico S. Anna, Brescia, Italy
| | - G Beltramo
- Radiation Oncology Center, Centro Diagnostico Italiano (CDI), Milano, Italy
| | - S Berlinghieri
- Unit of Radiotherapy, Ospedale di Esine - ASL Vallecamonica-Sebino, Esine, Italy
| | - M Bignardi
- Radiation Oncology Center, Fondazione Poliambulanza, Brescia, Italy
| | - S Bracelli
- Radiation Oncology Center, Ospedale, Busto Arsizio, Italy
| | - L Bruschieri
- Division of Radiation Oncology, Ospedale di Treviglio, Caravaggio di Treviglio, Italy
| | - S Castiglioni
- Radiation Oncology Center, S. Pio X-Humanitas, Milano, Italy
| | - G Catalano
- Radiation Oncology Center, IRCCS Ospedale Multimedica, Sesto San Giovanni/Castellanza, Italy
| | - N Di Muzio
- Radiation Oncology Center, IRCCS Ospedale S. Raffaele and University Vita Salute, Milano, Italy
| | - C Fallai
- Division of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - L Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - A R Filippi
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - A Gramaglia
- Radiation Oncology Center, Policlinico, Monza, Italy
| | - C Italia
- Radiation Oncology Center, Istituti Ospedalieri Bergamaschi, Ponte S. Pietro-Zingonia, Italy
| | - F Lombardi
- Radiotherapy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - S M Magrini
- Radiation Oncology Center, Brescia University Radiation Oncology Department, O. Alberti Radium Institute, Spedali Civili Hospital, Brescia, Italy
| | - S Nava
- Radiation Oncology Center, Istituti Clinici di Pavia e Vigevano, Vigevano, Italy
| | - E Orlandi
- Radiation Oncology Center, National Center of Oncological Hadrontherapy, CNAO, Pavia, Italy
| | - N Pasinetti
- Radiation Oncology Department, Esine and University of Brescia, Esine, Italy
| | - E L Sbicego
- Radiation Oncology Center, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - L Scandolaro
- Radiation Oncology Center, Ospedale Sant'Anna, ASST Lariana, Como, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - F Stiglich
- Radiation Oncology Center, Ospedale, Sondrio, Italy
| | - S Tonoli
- Radiation Oncology Center, Ospedale, Cremona, Italy
| | - R Tortini
- Ospedale di Casalpusterlengo, Azienda Ospedaliera della Provincia di Lodi, Casalpusterlengo, Italy
| | - R Valdagni
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy; Division of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - V Vavassori
- Unit of Radiotherapy, Cliniche Gavezzeni SPA, Bergamo, Italy
| | - G Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Palazzi M, Valdagni R, Poli M, Buffoli A, Leoni M, Vavassori V, Di Lorenzo I, Corbella F, Nava S, Cazzaniga LF. The Role of Radiotherapy in the Treatment of Stage III Non-Small Cell Lung Cancer: A Survey of Clinical Practices in Lombardy, Italy, by the Airo-Lombardia Cooperative Group. Tumori 2018; 80:286-9. [PMID: 7974800 DOI: 10.1177/030089169408000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background The role of radiotherapy in the treatment of stage III non-small cell lung cancer is controversial. The aim of this survey was to investigate the use of this modality in current clinical practice in Lombardy, a highly industrialized region of northern Italy. Methods A questionnaire was sent to all 13 radiotherapy centers in Lombardy, covering statistical, clinical, technical and strategical aspects, and the responses were analyzed. Results A wide range of attitudes was observed among participating radiation oncologists; the percentage of cases treated with curative intent varied largely between centers (4-100%), as did the proportion of patients given to radiation only rather than combined modality treatment (5-100% vs 0-90%). Conclusions An urgent need exists for better cooperation between all clinicians involved in lung cancer treatment, pursuing the goals of a more uniform clinical practice and a more aggressive clinical research attitude.
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Affiliation(s)
- M Palazzi
- Department of Radiotherapy, Istituto Nazionale Tumori, Milano
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Cazzaniga LF, Marinoni MA, Bossi A, Bianchi E, Cagna E, Cosentino D, Scandolaro L, Valli M, Frigerio M. Interphysician variability in defining the planning target volume in the irradiation of prostate and seminal vesicles. Radiother Oncol 1998; 47:293-6. [PMID: 9681893 DOI: 10.1016/s0167-8140(98)00028-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
With the improvements in treatment accuracy the risk exists of over-reliance on the capability of the physician to estimate the extent of the tumour. We assessed the variability between six radiotherapists in defining the planning target volume (PTV) on CT slices for three prostate tumour cases. Percentage differences between measured volumes and mean values calculated for each case ranged from -53.64 to +60.48% (SD 36.00%). There is a considerable variation in delineating the PTV, both in the cranio-caudal direction and in the in-slice extension of the areas drawn on each slice (standard deviations ranged from 0.35 to 2.64 cm2). We also checked the uncertainty in the shape and position of the contours on each CT image. The analysis was performed on three slices of one test case. As we expected, the uncertainty seems largest for seminal vesicle slices and smallest for prostatic apex slices. These results endorse the need for uncertainty analysis of all departmental processes in order to define a detailed protocol and consequently to minimize the interphysician differences in PTV delineations.
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Affiliation(s)
- L F Cazzaniga
- Department of Radiotherapy, Azienda Ospedaliera Sant'Anna, Como, Italy
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Cazzaniga LF, Bossi A, Cosentino D, Frigerio M, Martinelli A, Monti A, Morresi A, Ostinelli A, Scandolaro L, Valli MC, Besana G. Radiological findings when very small lung volumes are irradiated in breast and chest wall treatment. Radiat Oncol Investig 1998; 6:58-62. [PMID: 9503490 DOI: 10.1002/(sici)1520-6823(1998)6:1<58::aid-roi7>3.0.co;2-h] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute pneumonitis following breast irradiation is a rare and transient phenomenon that can be easily managed by drugs. The aim of this study is to evaluate late sequelae on lung, after postoperative radiotherapy (RT) for breast cancer. We were concerned with investigating late radiological findings when very small lung volumes are involved in the irradiated volume. We studied 28 consecutive patients. They underwent clinical examination and all staging procedures before surgery, evaluation of pulmonary function with spirometry, postoperative chest x-ray and high resolution computed tomography (HRCT) of the lung before RT. Clinical examinations were usually performed every 3 months after RT. A second chest x-ray, HRCT and spirometry were carried out after nearly 7 months from the end of RT. We estimated the irradiated lung volume by measuring the area of the lung surface enclosed by the 50% isodose (LA50) in each profile. We found a significant correlation between LA50 and the score of radiological findings after RT. No correlations were found between other factors (i.e., adjuvant chemotherapy, age, weight, smoking) and lung fibrosis. No woman developed radiation pneumonitis syndrome or respiratory symptoms. Our results indicate that irradiation of the breast and/or chest wall is well tolerated if treatment planning is done accurately. The fibrosis likelihood is strongly correlated to the irradiated lung volume. The use of tangential fields limits radiological changes that can be detected only by HRCT examination and are not associated with clinical symptoms.
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Affiliation(s)
- L F Cazzaniga
- Department of Radiotherapy, Azienda Ospedaliera S. Anna, Como, Italy.
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Cazzaniga LF, Frigerio M. [Errors in positioning the patient during transcutaneous radiotherapy of the pelvis]. Radiol Med 1997; 94:664-70. [PMID: 9524607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Quality controls in radiotherapy allow to check the correct running of treatment units and to test our procedures. Portal films taken during the first treatment session are used in quality assurance programs to compare scheduled to administered doses. MATERIAL AND METHODS To analyze the accuracy of patient positioning in pelvic cancer irradiation, a retrospective study was carried out on 50 treatment schedules carried out at the Radiotherapy Department of S. Anna Hospital (Como, Italy) from June to December, 1996. We checked field mispositioning for correlations with patient or treatment variables, such as patient age, sex, weight, thickness, or unit type. We took one portal film at the first treatment session and checked field positioning by measuring the distance of the isocenter from fixed anatomical structures on the simulation film and on the portal film taken in anteroposterior and lateral projections. RESULTS Four vectors were defined to evaluate field mispositioning along right-left (ADS), craniocaudal (ACC, LCC) and anteroposterior (AP) directions. The average values of these four vectors were respectively 2.94, 5.23, 5.54 and 3.20 mm. We found a major shift in field centering leftward and toward the patient's feet. To obtain more information about the total isocenter displacement, a vector T was calculated by summing the vectors ADS, ACC and LAP; a further evidence of field mispositioning is given by the vector T mean value (8.66 +/- 4.95 mm). No correlation was found between vector T values and any patient or treatment variable. DISCUSSION The acquaintance with uncertainties requires adequate statistical tools. A single check at treatment beginning could show a systematic error, but not the random fluctuations which can be recognized only with periodic portal films. To correct a possible systematic error without likely worsening set-up conditions, an adequate threshold value must be chosen for field mispositioning, according to each center's historical data. CONCLUSION One portal film at the beginning of treatment is the minimum requirement in a quality assurance program. We feel the need to change our protocol and acquire more than one portal film, because the higher the number of portal films the easier the distinction of systematic from random errors. Using serial portal films, all at the first session, we will be able to introduce quantitative criteria for various action levels.
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Affiliation(s)
- L F Cazzaniga
- Divisione di Radioterapia Oncologica, Azienda Ospedaliera S. Anna, Como.
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6
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Antognoni P, Bignardi M, Cazzaniga LF, Poli AM, Richetti A, Bossi A, Rampello G, Barbera F, Soatti C, Bardelli D, Giordano M, Danova M. Accelerated radiation therapy for locally advanced squamous cell carcinomas of the oral cavity and oropharynx selected according to tumor cell kinetics--a phase II multicenter study. Int J Radiat Oncol Biol Phys 1996; 36:1137-45. [PMID: 8985036 DOI: 10.1016/s0360-3016(96)00403-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE A Phase II multicenter trial testing an accelerated regimen of radiotherapy in locally advanced and inoperable cancers of the head and neck, in patients selected on the basis of 5-bromo-2-deoxyuridine/DNA flow cytometry-derived tumor potential doubling time (Tpot). METHODS AND MATERIALS From September 1992 to September 1993, 23 patients consecutively diagnosed to have locally advanced, inoperable carcinomas of the oral cavity and the oropharynx, with Tpot of < or = 5 days, received an accelerated radiotherapy regimen (AF) based on a modification of the concomitant boost technique: 2 Gy/fraction once a day, delivered 5 days a week up to 26 Gy, followed by 2 Gy/fraction twice a day, with a 6-h interval, one of the two fractions being delivered as a concomitant boost to reduced fields, up to 66 Gy total dose (off-cord reduction at 46 Gy), shortening the overall treatment time to 4.5 weeks. A contemporary control group of 46 patients with Tpot of >5 days or unknown was treated with conventional fractionation (CF): 2 Gy/fraction once a day, 5 days a week, up to 66 Gy in 6.5 weeks, with fields shrinkage after 46 Gy. RESULTS All patients completed the accelerated regimen according to protocol and in the prescribed overall treatment time. Immediate tolerance was fairly good: 65% of the patients in the AF group experienced Grade 3 mucositis vs. 45% in the CF group (p = n.s.). Symptoms related to mucosal reactions seemed to persist longer in AF than in CF patients. The crude proportion of mild (Grades 1 and 2) late effects on skin (p < 0.01) and salivary glands (p < 0.05) was higher in AF than in CF patients, although these reactions did not exceed the limits of tolerance. Three patients in the AF and 1 in the CF arm experienced a late Grade 4 bone complication. Actuarial estimates of severe (Grades 3 and 4) late complications showed a 2-year hazard of 33.3% in the AF arm and 49.7% in CF (p = NS). The actuarial 2-year local control rate of the AF patients was 49.4%, while actuarial 2-year overall survival for the same patients was 43.5%. CONCLUSION The results suggested that this accelerated regimen is worth testing in a controlled randomized trial to compare different accelerated schedules. Our findings also confirmed the 5-bromo-2-deoxyuridine/DNA flow cytometry technique as a suitable method of evaluating tumor cell kinetics in multicenter clinical studies, on condition that all measurements are carried out by one most experienced laboratory.
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Affiliation(s)
- P Antognoni
- Divisione di Radioterapia, Ospedale Multizonale, Varese, Italy
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Abstract
We illustrate a radiotherapy treatment chart elaborated to fulfil the necessity for clarity in reporting information about radiotherapeutic treatment. The schematic configuration of the chart results from the experience and the cooperation of physicists, physicians and technicians, and an effort has been made to satisfy Levels 2/3 of the ICRU 50 recommendations. The chart has been divided into four sections corresponding to different kinds of information: a cover sheet, a section containing data about the treatment planning geometry and the console parameters adopted, a section showing dosimetric data, and a section showing treatment data. The chart seems to give a good level of accuracy in reporting treatment plan information.
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Affiliation(s)
- A F Monti
- Department of Medical Physics, Ospedale S. Anna, Como, Italy
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Valli MC, Prina M, Bossi A, Cazzaniga LF, Cosentino D, Scandolaro L, Ostinelli A, Monti A, Cappelletti P. Evaluation of most frequent errors in daily compilation and use of a radiation treatment chart. Radiother Oncol 1994; 32:87-9. [PMID: 7938683 DOI: 10.1016/0167-8140(94)90453-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between 1 March and 30 April (1994) we recorded the errors detected by the physician, the radiographer or the physicist during prescription, preparation and execution phases of 227 treatment plans. The radiation treatment modalities used were the following: (i) single or opposed fields, moulded or not; and (ii) multiple fields or kinetic techniques. The total number of sessions performed is 1613 with the cobalt unit and 2131 with the linear accelerator (total, 3744). The total number of wrong data is 155, consisting of 24/227 (10.5%) in compilation, 22/3744 (0.58%) in execution and 109/3744 (2.9%) in registration phases. The number of missing data is 140, consisting of 10/227 (4.4%) in compilation, 9/3744 (0.2%) in execution and 121/3744 (3.2%) in registration phases. Wrong data of compilation, even if in high rate (10.5%), were all found during the same compilation phase or at the first treatment, so that they did not alter the exactness of the treatment plan. Wrong and missing data, found in the registration phase (2.9% and 3.2%, respectively), depend on the repetition of daily treatment and on the registration of data on the chart after having digitized them on the display.
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Affiliation(s)
- M C Valli
- Department of Radiotherapy, Ospedale S. Anna, Como, Italy
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Cazzaniga LF, Bossi A, Scandolaro L, Cagna E, Bianchi E, Valli MC. [The irradiated volume in stage III non-small-cell carcinoma of the lung. Comparison of outdated and new techniques]. Radiol Med 1993; 86:336-41. [PMID: 8210544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
March 1988 through April 1992, three hundred and ninety-six patients affected with bronchogenic carcinoma were treated at the Department of Radiation Oncology of the S. Anna Hospital, Como, Italy. A hundred and ten patients presenting stage-III non-small-cell lung carcinoma were evaluable. All evaluable patients underwent radiation therapy alone, with either palliative or curative purposes. Two main periods can be distinguished: in period A, before June 30th, 1990, treatment planning included conventional techniques, with no simulators; the patients were treated with opposing anteroposterior fields only. In period B, after July 1st, 1990, either the simulator alone was used or a simulator, a CT unit and a treatment planning computer system were combined; anteroposterior opposing fields or multiportal technique were used. Median overall survival was 10 months. Independent of treatment goals, the irradiated volume was markedly different in the patients treated in period A than in those treated in period B. A marked and statistically significant increase in survival was observed in group B. Survival also increased in patients treated with doses > 40 Gy, but only if treatment planning had used adequate technology and accuracy. To conclude, better survival can be achieved only by improving treatment accuracy and quality.
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Affiliation(s)
- L F Cazzaniga
- Divisione di Radioterapia Oncologica, Ospedale S. Anna, Como
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Bertoni F, Cazzaniga LF, Stucchi F, Terraneo F. [Radiotherapy as a single local regional treatment of non-oat cell carcinoma of the lung]. Radiol Med 1986; 72:311-5. [PMID: 3715080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The records of 168 patients treated by definitive radiation therapy for non-oat-cell-carcinoma of the lung in the Radiotherapy Department of the "Ospedale Regionale Multizonale" of Varese, Italy, from may 1979 to december 1984, were analyzed. Cumulative probability of survival from the beginning of radiotherapy were 48 +/- 4% at 12 months and 8 +/- 3% at 60 months. It appears to be no significant difference in survival according to TNM classes, UICC stages, histology and grading. Significant differences in survival were found grouping patients by performance status (I.K. less than 70 v.s. greater than or equal to 70), total absorbed dose (dose less than 56 Gy v.s. greater than or equal to 56 Gy), total isoeffect levels (CRE less than 17 reu v.s. greater than or equal to 17 reu), and response to treatment. The latter could be the most important prognostic factor. Median survival for CR, PR and NC categories were 48.5, 12 and 10 months respectively. We suggest that RT may be of value in improving quality of life and survival of patients affected by non operable non-oat-cell-carcinoma of the lung.
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