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Lal BK, Mayorga-Carlin M, Kashyap V, Jordan W, Mukherjee D, Cambria R, Moore W, Neville RF, Eckstein HH, Sahoo S, Macdonald S, Sorkin JD. Learning curve and proficiency metrics for transcarotid artery revascularization. J Vasc Surg 2022; 75:1966-1976.e1. [PMID: 35063612 PMCID: PMC11057007 DOI: 10.1016/j.jvs.2021.12.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND When introduced to a new procedure, physicians improve their performance and reduce their procedural adverse event rates rapidly during the initial cases and then improvement slows, signaling that proficiency has been achieved. Determining when they have acquired proficiency has important implications for procedural innovation, education, credentialing, and patient safety. We analyzed the worldwide experience with transcarotid artery revascularization (TCAR), a hybrid approach to carotid revascularization, to identify the (1) procedural performance measures associated with clinical and technical adverse events; (2) target levels of performance measures that minimize adverse event rates; and (3) number of TCAR cases needed to achieve the target levels for the performance measures. METHODS The patient, lesion, and physician characteristics were collected for each TCAR procedure performed by each physician worldwide in an international quality assurance database. Four procedural performance measures were recorded for each procedure: flow-reversal time, fluoroscopy time, contrast volume, and total skin-to-skin time. Composite clinical adverse events (ie, transient ischemic attack, stroke, myocardial infarction, death) and composite technical adverse events (ie, aborted procedure, conversion to surgery, bleeding, dissection, cranial nerve injury, device failure), occurring within 24 hours were also recorded. Correlations between each performance measure and the clinical and technical adverse event rates were computed. The inflection points in the performance measures were identified at which no further improvements occurred in the adverse event rates. Finally, the minimum number of TCAR cases required to achieve the target performance measure levels was computed. RESULTS A total of 18,240 procedures performed by 1273 physicians were analyzed. Of the 18,240 patients, 34.9% were women and 62.5% were asymptomatic. The flow-reversal time correlated with clinical adverse events adjusted for age, sex, and symptomatic status (R2 = 0.91; P < .0001) and adjusted technical adverse events (R2 = 0.86; P < .0001). The skin-to-skin time correlated with adjusted technical adverse events (R2 = 0.92; P < .0001). A reduction in flow-reversal times to <13.1 minutes and the skin-to-skin time to <81 minutes did not translate into further improvements in the adverse event rates. A minimum of 26 TCAR cases was required to achieve the target flow-reversal time, and a minimum of 15 cases was required to achieve the target skin-to-skin time. CONCLUSIONS The flow-reversal time and skin-to-skin time are appropriate performance measures for establishing the level of expertise of physicians as they acquire skills to perform TCAR. A target time of ≤13.1 minutes for flow-reversal and 81 minutes for skin-to-skin time minimized the adverse event rates. Familiarity with the steps involved in performing TCAR was achieved after ≥15 cases, and minimizing clinical adverse events occurred after ≥26 cases.
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Affiliation(s)
- Brajesh K Lal
- Department of Vascular Surgery, University of Maryland, Baltimore, Md.
| | | | - Vikram Kashyap
- Division of Vascular Surgery, University Hospitals Case Western Reserve University, Cleveland, Ohio
| | - William Jordan
- Department of Vascular Surgery, The University of Alabama at Birmingham, Birmingham, Ala
| | | | - Richard Cambria
- Division of Vascular Surgery, St Elizabeth's Medical Center, Boston, Mass
| | - Wesley Moore
- Division of Vascular Surgery, University of California, Los Angeles, Los Angeles, Calif
| | | | | | - Shalini Sahoo
- Department of Vascular Surgery, University of Maryland, Baltimore, Md
| | | | - John D Sorkin
- Department of Medicine, University of Maryland, Baltimore, Md
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Corrao G, Marvaso G, Pepa M, Zaffaroni M, Vincini M, Bellerba F, Gandini S, Volpe S, Rojas D, Zerini D, Fodor C, Pricolo P, Alessi S, Petralia G, Mistretta F, Cambria R, Cattani F, De Cobelli O, Orecchia R, Jereczek-Fossa B. MO-0551 Short-term RT for early PCa with concomitant boost to the DIL (phase II trial AIRC-IG-13218)-updates. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02385-4] [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: 10/18/2022]
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Casbarra A, Frassoni S, Fodor C, Ferrari A, Cambria R, Colombo F, Franzetti J, Giandini C, Repetti I, Bagnardi V, Della Pasqua S, Colleoni M, Leonardi M, Jereczek-Fossa B. PO-1181 The impact of RT on oligorecurrent BC: a retrospective analysis of predictors of clinical outcome. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03145-0] [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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Augugliaro M, Pepa M, Zerini D, Marvaso G, Cambria R, Bagnardi V, Frassoni S, Pansini F, Rojas D, Colombo F, Fodor C, Cattani F, Jereczek-Fossa B. PO-1355 Finding safe dose-volume constraints for re-irradiation of intraprostatic prostate cancer relapse. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07806-3] [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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Malas MB, Nejim B, Leal Lorenzo JI, Kwolek CJ, Kashyap V, Cambria R. Mid-term Outcomes of the (Roadster) Multi-center Trial of Transcarotid Stenting With Dynamic Flow Reversal. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.885] [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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Mohebali J, Latz CA, Cambria R, Patel V, Ergul E, Lancaster RT, Conrad MF, Clouse WD. VESS22. The Long-Term Fate of Renal and Visceral Vessel Reconstruction After Open Thoracoabdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.049] [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: 10/26/2022]
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Marvaso G, Ciardo D, Gandini S, Riva G, Frigo E, Zerini D, Comi S, Cambria R, De Cobelli O, Orecchia R, Jereczek-Fossa B. PO-0854 Extreme vs moderate hypofractionation for localized Pca: a Propensity Score Matching Analisys. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31274-5] [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: 11/28/2022]
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Ciardo D, Marvaso G, Gandini S, Mambretti M, Fodor C, Zerini D, Volpe S, Riva G, Rojas D, Petralia G, Cambria R, Orecchia R, Jereczek-Fossa B. EP-1550 Give-me-five trial: toxicity assessment in ultra-hypofractionated prostate cancer radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31970-x] [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: 10/26/2022]
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Malas MB, Leal Lorenzo JI, Nejim B, Hanover TM, Mehta M, Kashyap V, Kwolek CJ, Cambria R. Analysis of the ROADSTER pivotal and extended-access cohorts shows excellent 1-year durability of transcarotid stenting with dynamic flow reversal. J Vasc Surg 2019; 69:1786-1796. [PMID: 30611582 DOI: 10.1016/j.jvs.2018.08.179] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 03/05/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We report the 1-year outcomes of the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) multicenter trial. This trial introduced a novel transcarotid neuroprotection system (NPS), the ENROUTE transcarotid NPS (Silk Road Medical Inc, Sunnyvale, Calif). Postoperative results demonstrated that the use of the ENROUTE transcarotid NPS is safe and effective. The aim of this study was to evaluate the safety of transcarotid artery revascularization (TCAR) and to present the 1-year outcomes. METHODS This study is a prospective, single-arm clinical trial. Current enrollment occurs in 14 centers. Primary end points were incidence rates of ipsilateral stroke at 1 year after TCAR. Occurrence of stroke was ascertained by an independent Clinical Events Committee. Patients with anatomic or medical high-risk factors for carotid endarterectomy (CEA) were eligible to be enrolled in the ROADSTER trial. RESULTS Overall, 165 patients were included in the long-term follow-up (112 of 141 patients from the pivotal phase and 53 of 78 patients from the extended access). Mean age was 73.9 years (range, 42.1-91.3 years). Patients aged 75 years and older were 43.3% of the cohort. The majority of patients were white (92.7%) and male (75.2%). Most patients were asymptomatic (79.9%). Anatomic risk factors were distributed as follows: contralateral carotid artery occlusion (11.0%), tandem stenosis of >70% (1.8%), high cervical carotid artery stenosis (25.0%), restenosis after CEA (25.6%), bilateral stenosis requiring treatment (4.3%), and hostile neck (14.6%). Medical high-risk criteria included two-vessel coronary artery disease (14.0%) and severe left ventricular dysfunction with ejection fraction <30% (1.8%). In general, 43.3% of patients had at least one anatomic high-risk factor, whereas 29.9% of patients had medical high-risk factors. Both subsets of factors were present simultaneously in 26.8% of the cohort. At 1-year follow-up, ipsilateral stroke incidence rate was 0.6%, and seven patients (4.2%) died. None of the deaths were neurologic in origin. CONCLUSIONS TCAR with dynamic flow reversal had previously shown favorable 30-day perioperative outcomes. This excellent performance seems to extend to 1 year after TCAR as illustrated in this analysis. The promising results from the ROADSTER trial likely stem from the novel cerebral protection provided through the ENROUTE transcarotid NPS in comparison to distal embolic protection devices as well as the transcarotid approach's circumventing diseased aortic arch manipulation and minimizing embolization. TCAR offers a safe and durable revascularization option for patients who are deemed to be at high risk for CEA.
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Affiliation(s)
- Mahmoud B Malas
- Vascular and Endovascular Research Center, Johns Hopkins University, Baltimore, Md.
| | | | - Besma Nejim
- Vascular and Endovascular Research Center, Johns Hopkins University, Baltimore, Md
| | - Todd M Hanover
- Academic Department of Surgery, Greenville Hospital System, Greenville, SC
| | - Manish Mehta
- Albany Vascular Group, The Institute for Vascular Health and Disease, Albany, NY
| | - Vikram Kashyap
- Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Christopher J Kwolek
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Richard Cambria
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Hospital, Boston, Mass
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Mambretti M, Romanò C, Marvaso G, Comi S, Cambria R, Emiro F, Jereczek-Fossa B, Cattani F. 29. Ultra-hypofractionated prostate cancer radiotherapy: A global Unified Dosimetry Index (gUDI) for treatment plans evaluation (AIRC, grant: IG-13218). Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Jereczek-Fossa BA, Maucieri A, Marvaso G, Gandini S, Fodor C, Zerini D, Riva G, Alessandro O, Surgo A, Volpe S, Fanetti G, Arculeo S, Zerella MA, Parisi S, Maisonneuve P, Vavassori A, Cattani F, Cambria R, Garibaldi C, Starzyńska A, Musi G, De Cobelli O, Ferro M, Nolè F, Ciardo D, Orecchia R. Impact of image guidance on toxicity and tumour outcome in moderately hypofractionated external-beam radiotherapy for prostate cancer. Med Oncol 2018; 36:9. [PMID: 30483899 DOI: 10.1007/s12032-018-1233-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 10/02/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
Abstract
To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69-77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P < 0.001) were included. Acute gastro-intestinal (GI) toxicity G > 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G > 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G > 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G > 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU > 1 (P = 0.004) and for GI > 1 (P < 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.
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Affiliation(s)
- B A Jereczek-Fossa
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Maucieri
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Marvaso
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - S Gandini
- Department of Experimental Oncology, European Institute of Oncology, Via Adamello 16, 20139, Milan, Italy
| | - C Fodor
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D Zerini
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Riva
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - O Alessandro
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Surgo
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Volpe
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G Fanetti
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Arculeo
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M A Zerella
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - S Parisi
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - P Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Vavassori
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Cambria
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Garibaldi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - G Musi
- Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - O De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Ferro
- Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Nolè
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D Ciardo
- Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Volpe S, Jereczek-Fossa BA, Zerini D, Rojas DP, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Dicuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. Case series on multiple prostate re-irradiation for locally recurrent prostate cancer: something ventured, something gained. Neoplasma 2018; 66:308-314. [PMID: 30509110 DOI: 10.4149/neo_2018_180723n520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/16/2018] [Indexed: 11/08/2022]
Abstract
The aim is to present the technical feasibility and efficacy of multiple re-irradiation (re-EBRT) for local recurrence of prostate cancer (PCa) using retrospective analysis of an updated series of patients who received ablative re-EBRT with stereotactic image-guided technique for isolated local recurrence of PCa. Eight patients received three RT courses (2 re-RTs); of those 2 received 4 RT courses (3 re-RTs). Local relapse in the prostate was assessed by multiparametric magnetic resonance and/ or choline positron emission tomography. Before treatment planning, all patients had been evaluated for late toxicity from previous RT according to RTOG/EORTC. Biochemical control was assessed according to Phoenix definition. Mean age at the third RT course was 68 (standard deviation, SD: 7.2); all patients had a good performance status. At diagnosis, four cases were classified as high risk PCa, three as intermediate and one as low per NCCN 2017. Biochemical progression free interval after first and second RT-course were 74 (IQR: 59.3-133.6) months and 33 (IQR: 20.8-53.1) months, respectively. Biochemical and radiological response was registered in all patients. At present, seven out of eight patients are disease free. Overall toxicity profile was good; no severe acute or late genitourinary or gastrointestinal events were recorded. Multiple RT courses with high precision technology and image guidance can be proposed as a possible salvage therapy for locally recurrent, low-burden PCa recurrence in adequately selected patients. Deeper understanding of radiobiological effects of hypofractionation and larger series of patients are warranted to fully evaluate the applicability of multiple RT courses in the setting of locally recurrent PCa.
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Affiliation(s)
- S Volpe
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - B Alicja Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - D Zerini
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - D Patricia Rojas
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - P Romanelli
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Vigorito
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Comi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - P De Marco
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | | | - G Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - G Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Scientific Directorate, European Institute of Oncology, Milan, Italy
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Volpe S, Jereczek Fossa B, Zerini D, Rojas D, Fodor C, Vavassori A, Romanelli P, Vigorito S, Rondi E, Comi S, Cambria R, Cattani F, Di Cuonzo S, De Marco P, Beltramo G, Musi G, De Cobelli O, Marvaso G, Orecchia R. EP-1555: Multiple re-irradiation for locally recurrent prostate cancer: proof of concept and clinical outcome. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31864-4] [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: 11/27/2022]
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Marvaso G, Fanetti G, Fodor C, Ricotti R, Ciardo D, Riva G, Volpe S, Rojas D, Zerini D, Romanelli P, Cambria R, Pansini F, Jereczek-Fossa B. PO-1084: Short-term RT for early PCa with concomitant boost to the DIL : QoL after the end of the accrual. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31394-x] [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: 11/24/2022]
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Dicuonzo S, Leonardi M, Radice D, Morra A, Dell'Acqua V, Gerardi M, Rojas D, Surgo A, Cattani F, Cambria R, Fodor C, De Lorenzi F, Galimberti V, Orecchia R, Jereczek-Fossa B. EP-1344: Long-term reconstruction failure after postmastectomy RT to temporary expander or permanent implant. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31653-0] [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: 10/14/2022]
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Malas M, Nejim BJ, Kwolek CJ, Leal Lorenzo JI, Hanover T, Mehta M, Kashyap VS, Cambria R. One-Year Results of the ROADSTER Multicenter Trial of Transcarotid Stenting With Dynamic Flow Reversal. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2017.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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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Schram AM, Reales D, Galle J, Cambria R, Durany R, Feldman D, Sherman E, Rosenberg J, D’Andrea G, Baxi S, Janjigian Y, Tap W, Dickler M, Baselga J, Taylor BS, Chakravarty D, Gao J, Schultz N, Solit DB, Berger MF, Hyman DM. Oncologist use and perception of large panel next-generation tumor sequencing. Ann Oncol 2017; 28:2298-2304. [PMID: 28911072 PMCID: PMC5834089 DOI: 10.1093/annonc/mdx294] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Genomic profiling is increasingly incorporated into oncology research and the clinical care of cancer patients. We sought to determine physician perception and use of enterprise-scale clinical sequencing at our center, including whether testing changed management and the reasoning behind this decision-making. PATIENTS AND METHODS All physicians who consented patients to MSK-IMPACT, a next-generation hybridization capture assay, in tumor types where molecular profiling is not routinely performed were asked to complete a questionnaire for each patient. Physician determination of genomic 'actionability' was compared to an expertly curated knowledgebase of somatic variants. Reported management decisions were compared to chart review. RESULTS Responses were received from 146 physicians pertaining to 1932 patients diagnosed with 1 of 49 cancer types. Physicians indicated that sequencing altered management in 21% (331/1593) of patients in need of a treatment change. Among those in whom treatment was not altered, physicians indicated the presence of an actionable alteration in 55% (805/1474), however, only 45% (362/805) of these cases had a genomic variant annotated as actionable by expert curators. Further evaluation of these patients revealed that 66% (291/443) had a variant in a gene associated with biologic but not clinical evidence of actionability or a variant of unknown significance in a gene with at least one known actionable alteration. Of the cases annotated as actionable by experts, physicians identified an actionable alteration in 81% (362/445). In total, 13% (245/1932) of patients were enrolled to a genomically matched trial. CONCLUSION Although physician and expert assessment differed, clinicians demonstrate substantial awareness of the genes associated with potential actionability and report using this knowledge to inform management in one in five patients. CLINICAL TRIAL NUMBER NCT01775072.
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Affiliation(s)
- A. M. Schram
- Department of Medicine, Division of Solid Tumor Oncology
| | | | - J. Galle
- Clinical Research Administration
| | | | - R. Durany
- Josie Robertson Surgical Center, MSKCC, New York
| | - D. Feldman
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - E. Sherman
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - J. Rosenberg
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - G. D’Andrea
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - S. Baxi
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - Y. Janjigian
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - W. Tap
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - M. Dickler
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
| | - J. Baselga
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
- Human Oncology and Pathogenesis Program
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
| | - B. S. Taylor
- Human Oncology and Pathogenesis Program
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
- Department of Epidemiology and Biostatistics
| | - D. Chakravarty
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
| | - J. Gao
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
| | - N. Schultz
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
- Department of Epidemiology and Biostatistics
| | - D. B. Solit
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
- Human Oncology and Pathogenesis Program
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
| | - M. F. Berger
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology
- Department of Pathology, MSKCC, New York, USA
| | - D. M. Hyman
- Department of Medicine, Division of Solid Tumor Oncology
- Weill Cornell Medical College, New York
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Latz C, Patel V, Ergul E, Lancaster RT, LaMuraglia G, Conrad M, Cambria R, Clouse W. The Durability of Open Surgical Repair of Type IV Thoracoabdominal Aneurysm. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.05.021] [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: 11/26/2022]
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19
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Riva G, Timon G, Ciardo D, Bazani A, Maestri D, De Lorenzo D, Pansini F, Cambria R, Cattani F, Marvaso G, Zerini D, Rojas D, Volpe S, Golino F, Scroffi V, Fodor C, Petralia G, De Cobelli O, Orecchia R, Jereczek-Fossa B. EP-1338: High precision radiotherapy for early prostate cancer with concomitant boost to the dominant lesion. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31773-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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20
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Gerardi M, Rojas D, Ricotti R, Leonardi M, Riva G, Ciardo D, Francia C, Cambria R, Luraschi R, Cattani F, Fodor C, De Lorenzi F, Rietjens M, Veronesi P, Morra A, Dell’Acqua V, Orecchia R, Jereczek-Fossa B. EP-1191: Postmastectomy locoregional irradiation to temporary tissue-expander or permanent breast implant. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31627-4] [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: 11/27/2022]
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21
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Alberta H, Takayama T, Phelan P, Panthofer A, Cambria R, Farber M, Jordan W, Matsumura J. Thoracic Endovascular Aortic Repair Migration and Aortic Elongation Differentiated Using Dual Reference Point Analysis. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.07.018] [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: 12/01/2022]
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22
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Mehta M, Kashyap V, Malas M, Paty P, Cambria R, Kwolek C, Shah R, Criado E, Molnar R. The ROADSTER Investigational Device Exemption Trial Leads to Food and Drug Administration Approval of the First Stent Labeled for Trans-Carotid Artery Revascularization. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.06.029] [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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23
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Saraidaridis J, Ergul E, Patel V, Cambria R, Conrad MF. Natural History of Claudicants After Endovascular Therapy. Ann Vasc Surg 2016. [DOI: 10.1016/j.avsg.2016.05.017] [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: 12/01/2022]
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Timon G, Zerini D, Fodor C, Bazzani F, Maucieri A, Ronchi S, Rojas D, Volpe S, Vavassori A, Cattani F, Garibaldi C, Comi S, Cambria R, De Cobelli O, Orecchia R, Jereczek-Fossa B. EP-1372: Salvage image-guided stereotactic re-irradiation of local recurrence in prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32622-6] [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: 11/30/2022]
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25
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Jereczek-Fossa B, Ciardo D, Colangione S, Fodor C, Zerini D, Cecconi A, Surgo A, Gerardi M, Muto M, Timon G, Comi S, Pansini F, Bazani A, Maestri D, Garioni M, Scroffi V, Cattani F, Cambria R, De Cobelli O, Orecchia R. OC-0448: Give me five: extreme hypofractionated IG-IMRT for organ confined prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31697-8] [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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26
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Mehta M, Paty PS, Kwolek C, Cambria R, Keenan M, Feustel P. A Novel Transcarotid Artery Revascularization Procedure With Flow Reversal: 30-Day Pivotal Results of the ROADSTER IDE Trial. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.06.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Zerini D, Jereczek-Fossa BA, Fodor C, Bazzani F, Maucieri A, Ronchi S, Ferrario S, Colangione SP, Gerardi MA, Caputo M, Cecconi A, Gherardi F, Vavassori A, Comi S, Cambria R, Garibaldi C, Cattani F, De Cobelli O, Orecchia R. Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer. Br J Radiol 2015; 88:20150197. [PMID: 26055506 DOI: 10.1259/bjr.20150197] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). METHODS 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). RESULTS Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. CONCLUSION re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. ADVANCES IN KNOWLEDGE Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.
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Affiliation(s)
- D Zerini
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - B A Jereczek-Fossa
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - C Fodor
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Bazzani
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Maucieri
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ronchi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ferrario
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S P Colangione
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M A Gerardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M Caputo
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Cecconi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Gherardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Comi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Garibaldi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- 2 Department of Health Sciences, University of Milan, Milan, Italy.,4 Department of Urology, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy.,5 Clinical Division of the National Center of Oncological Hadrontherapy, Pavia, Italy
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28
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Ciardo D, Bazani A, Pansini F, Russo S, Molinelli S, Comi S, Cambria R, Cattani F, Petralia G, Vischioni B, Zerini D, Baroni G, Valvo F, Orecchia R, Jereczek-Fossa B. PO-0995: Evaluation of VMAT-RapidArc, IMRT-VERO and proton-RT for a hypofractionated scheme of prostate cancer treatment. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40987-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Durham CA, Wang L, Ergul EA, Aranson NJ, Patel VI, Cambria R, Conrad MF. SS6. Natural History of Medically-Managed Acute Type B Aortic Dissections. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.059] [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: 10/25/2022]
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30
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Saraidaridis J, Patel VI, Lancaster RT, Mukhopadhyay S, Cambria R, Conrad MF. PS160. Applicability of the Society for Vascular Surgery's Objective Performance Goals for Critical Limb Ischemia to Current Practice of Lower Extremity Bypass. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.161] [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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31
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Cambria R, Cattani F, Jereczek-Fossa BA, Pansini F, Ciardo D, Vigorito S, Russo S, Zerini D, Cozzi L, Orecchia R. Planning study to compare dynamic and rapid arc techniques for postprostatectomy radiotherapy of prostate cancer. Strahlenther Onkol 2014; 190:569-74. [PMID: 24557057 DOI: 10.1007/s00066-014-0601-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare our standard technique for postprostatectomy radiotherapy of prostate cancer, i.e. using two lateral conformal dynamic arcs with volumetric-modulated arc therapy (VMAT) performed with the RapidArc(®) (Varian Medical Systems, Palo Alto, CA, USA). The plans were referred to as DA and RA, respectively. MATERIALS AND METHODS The treatment plans of 44 patients receiving adjuvant/salvage radiotherapy in the first months of 2010 were compared. In all cases, the prescribed total dose was 66-68.2 Gy (2.2 Gy per fraction). Both DA and RA plans were optimized in terms of dose coverage and constraints. RESULTS Small differences between the techniques were observed for planning target volume (PTV) dose distribution, whereas significant differences in sparing of organs at risk (OARs) were recorded (p < 0.0001). The OAR values (median; 95 % confidence interval, CI) were: rectum: D30 % = 60.7 Gy (59.40-62.04 Gy) and 48.2 Gy (46.40-52.72 Gy), D60 % = 34.1 Gy (28.50-38.92 Gy) and 27.7 Gy (21.80-31.51 Gy); bladder: D30 % = 57.3 Gy (45.83-64.53 Gy) and 46.4 Gy (33.23-61.48 Gy), D50 % = 16.4 Gy (11.89-42.38 Gy) and 17.2 Gy (10.97-27.90 Gy), for DA and RA, respectively. Treatment times were very similar, whereas the monitor units (MU) were 550 ± 29 versus 277 ± 3 for RA and DA, respectively. CONCLUSION Dose-volume histograms (DVHs) show improvements in OAR sparing with RA. However, the RA technique is associated with almost double the number of MUs compared to DA. Regarding the PTV, DA is slightly superior in terms of D2 % and dose homogeneity. On the whole, the results suggest that RA be the favorable technique.
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Affiliation(s)
- R Cambria
- Department of Medical Physics, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy,
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Dell'Acqua V, Leonardi M, Morra A, Fodor C, Dicuonzo S, Cambria R, Luraschi R, Pansini F, Jereczek B, Orecchia R. EP-1190: Anticipated boost with IORT followed by hypofractionated wholebreast radiotherapy (AFTEREIGHT phase II study). Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31308-6] [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: 11/26/2022]
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33
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Ciardo D, Jereczek-Fossa B, Zerini D, Petralia G, Cambria R, Rondi E, Cattani F, Fodor C, Baroni G, Orecchia R. EP-1695: Multimodal image registration to identify the dominant intraprostatic lesion in radiotherapy - AIRC grant IG 13218. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31813-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Cambria R, Cattani F, Luraschi R, Russo S, Morra A, Leonardi M, Pedroli G, Orecchia R. PO-0811: From 3D conformal to TomoDirect™ modality treatment for the postoperative breast radiotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33117-0] [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: 10/23/2022]
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35
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Leonardi M, Dell'Acqua V, Cattani F, Morra A, Fodor C, Cambria R, Luraschi R, Gerardi M, Jereczek-Fossa B, Orecchia R. PO-0687: Technical feasibility of whole breast radiotherapy for local relapse after a previous partial breast irradiation. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32993-5] [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: 11/25/2022]
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Affiliation(s)
- Benjamin Patterson
- From St. George’s Vascular Institute, London, UK (B.P., P.H., M.T.); University of Rostock, Rostock, Germany (C.N.); Massachusetts General Hospital, Boston, MA (R.C.); and Hospital of the University of Pennsylvania, Philadelphia (R.F.)
| | - Peter Holt
- From St. George’s Vascular Institute, London, UK (B.P., P.H., M.T.); University of Rostock, Rostock, Germany (C.N.); Massachusetts General Hospital, Boston, MA (R.C.); and Hospital of the University of Pennsylvania, Philadelphia (R.F.)
| | - Chrisoph Nienaber
- From St. George’s Vascular Institute, London, UK (B.P., P.H., M.T.); University of Rostock, Rostock, Germany (C.N.); Massachusetts General Hospital, Boston, MA (R.C.); and Hospital of the University of Pennsylvania, Philadelphia (R.F.)
| | - Richard Cambria
- From St. George’s Vascular Institute, London, UK (B.P., P.H., M.T.); University of Rostock, Rostock, Germany (C.N.); Massachusetts General Hospital, Boston, MA (R.C.); and Hospital of the University of Pennsylvania, Philadelphia (R.F.)
| | - Ronald Fairman
- From St. George’s Vascular Institute, London, UK (B.P., P.H., M.T.); University of Rostock, Rostock, Germany (C.N.); Massachusetts General Hospital, Boston, MA (R.C.); and Hospital of the University of Pennsylvania, Philadelphia (R.F.)
| | - Matt Thompson
- From St. George’s Vascular Institute, London, UK (B.P., P.H., M.T.); University of Rostock, Rostock, Germany (C.N.); Massachusetts General Hospital, Boston, MA (R.C.); and Hospital of the University of Pennsylvania, Philadelphia (R.F.)
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Boulom V, Conrad M, Mukhopadhyay S, Patel V, Garg A, Furie K, Cambria R. Progression of Asymptomatic Carotid Stenosis Despite Optimal Medical Therapy. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.08.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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38
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Jereczek-Fossa B, Piperno G, Ronchi S, Catalano G, Fodor C, Cambria R, Fossati P, Zerini D, Garibaldi C, Orecchia R. OC-0042 STEREOTACTIC BODY RADIOTHERAPY FOR OLIGOMETASTATIC PATIENTS WITH SINGLE ABDOMINAL LYMPH NODE RECURRENT CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70381-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Cecconi A, Lazzari R, Jereczek-Fossa B, Cattani F, Piperno G, Cambria R, Garibaldi C, Acqua VD, Fodor C, Orecchia R. EP-1292 STEREOTACTIC BODY VS RAPIDARCTM RADIOTHERAPY IN LYMPH-NODES RECURRENCE OF GYNAECOLOGICAL MALIGNANCIES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71625-0] [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: 10/28/2022]
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40
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Lombardi JV, Nienaber CA, Cambria R, Chiesa R, Teebken O, Lee A, Mossop P, Bharadwaj P. SS18. Endovascular Treatment of Complicated Type B Aortic Dissection Using a Composite Device Design: Initial Results of a Prospective Multicenter Clinical Trial (STABLE). J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.055] [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: 11/17/2022]
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41
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Di Rosa A, Cambria R, Crescenti M, Pata M. P02-244 - Evaluation of cognitive-executive functions in subjects with borderline personality disorder and childhood ADHD. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70870-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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43
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Vavassori A, Jereczek-Fossa BA, Zerini D, De Cicco L, Cambria R, Cattani F, Garibaldi C, Ciocca M, Orecchia R. Intraprostatic fiducial markers: a potential application for ultrasound-guided radiotherapy in prostate cancer. Ecancermedicalscience 2009; 3:143. [PMID: 22276008 PMCID: PMC3224014 DOI: 10.3332/ecancer.2009.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Indexed: 12/02/2022] Open
Abstract
We report on a two-phase test performed to assess the ability of the ultrasound-based B-mode acquisition and targeting (BAT) trans-abdominal system to identify non-dedicated fiducial markers implanted into the prostate gland for subsequent image-guided radiotherapy. Although further investigation is warranted in order to identify the optimal echogenic marker and to define its potential use for image-guided radiotherapy in prostate cancer patients, we demonstrate the feasibility of the BAT system for the visualization of non-ultrasound-dedicated markers.
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Affiliation(s)
- A Vavassori
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
- Correspondence to A Vavassori.
| | - BA Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
- University of Milan, European Institute of Oncology, 20141 Milan, Italy
| | - D Zerini
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
| | - L De Cicco
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
| | - R Cambria
- Department of Medical Physics, European Institute of Oncology, 20141 Milan, Italy
| | - F Cattani
- Department of Medical Physics, European Institute of Oncology, 20141 Milan, Italy
| | - C Garibaldi
- Department of Medical Physics, European Institute of Oncology, 20141 Milan, Italy
| | - M Ciocca
- Department of Medical Physics, European Institute of Oncology, 20141 Milan, Italy
| | - R Orecchia
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
- University of Milan, European Institute of Oncology, 20141 Milan, Italy
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Zoccali R, Muscatello MRA, Bruno A, Cambria R, Cavallaro L, D'Amico G, Isgrò S, Romeo V, Meduri M. Mental disorders and request for psychiatric intervention in an Italian local jail. Int J Law Psychiatry 2008; 31:447-450. [PMID: 18799217 DOI: 10.1016/j.ijlp.2008.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The issue of the prevalence of psychiatric illnesses in Italian prison samples has not received the same attention paid at an international level. The aims of the present study were to evaluate the prevalence of psychiatric disorders diagnosed according to DSM-III-R criteria among an Italian prisoner population, and to examine prisoners' requests for psychiatric intervention in relationship to the presence or absence of different psychiatric disorders. One hundred forty-two Italian male subjects from the Casa Circondariale of Messina, Italy, were evaluated using the Structured Clinical Interview for DSM-III-R Non-Patient Version - SCID I and SCID II. A very high rate of disorders was found among inmates: 85.2% (n=121) of the sample were affected by a psychiatric disorder. Of the total sample, 51.4% (n=73) had requested psychiatric treatment during detention. The detection, diagnosis and treatment of the mentally ill prisoners is a primary goal for a better organization of services and prison settings; screening procedures for evaluating the presence of psychiatric disorders, with the aim to promote differential strategies for the care and rehabilitation of inmates, are needed.
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Affiliation(s)
- R Zoccali
- University Hospital, Messina, Italy.
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Cambria R. Christian Etz, James Halstead, David Spielvogel, et al. Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time? Ann Thorac Surg. 2006;82:1670-1677. ACTA ACUST UNITED AC 2008; 20:221-3. [DOI: 10.1177/1531003508317595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kang J, Albadawi H, Abbruzzese T, Patel V, Patel R, Quatromoni J, Yoo HJ, Cambria R, Watkins M. 199. Delayed Paralysis in a Murine Model of Thoracic Aortic Ischemia. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.226] [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: 10/22/2022]
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Riboldi M, Baroni G, Spadea MF, Tagaste B, Garibaldi C, Cambria R, Orecchia R, Pedotti A. Genetic evolutionary taboo search for optimal marker placement in infrared patient setup. Phys Med Biol 2007; 52:5815-30. [PMID: 17881802 DOI: 10.1088/0031-9155/52/19/006] [Citation(s) in RCA: 9] [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: 11/12/2022]
Abstract
In infrared patient setup adequate selection of the external fiducial configuration is required for compensating inner target displacements (target registration error, TRE). Genetic algorithms (GA) and taboo search (TS) were applied in a newly designed approach to optimal marker placement: the genetic evolutionary taboo search (GETS) algorithm. In the GETS paradigm, multiple solutions are simultaneously tested in a stochastic evolutionary scheme, where taboo-based decision making and adaptive memory guide the optimization process. The GETS algorithm was tested on a group of ten prostate patients, to be compared to standard optimization and to randomly selected configurations. The changes in the optimal marker configuration, when TRE is minimized for OARs, were specifically examined. Optimal GETS configurations ensured a 26.5% mean decrease in the TRE value, versus 19.4% for conventional quasi-Newton optimization. Common features in GETS marker configurations were highlighted in the dataset of ten patients, even when multiple runs of the stochastic algorithm were performed. Including OARs in TRE minimization did not considerably affect the spatial distribution of GETS marker configurations. In conclusion, the GETS algorithm proved to be highly effective in solving the optimal marker placement problem. Further work is needed to embed site-specific deformation models in the optimization process.
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Affiliation(s)
- M Riboldi
- TBMLab, Department of Bioengineering, Politecnico di Milano University, Plaza Leonardo da Vinci 32, 20133 Milano, Italy.
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Zoccali R, Muscatello MR, Bruno A, Cambria R, Micò U, Spina E, Meduri M. The effect of lamotrigine augmentation of clozapine in a sample of treatment-resistant schizophrenic patients: a double-blind, placebo-controlled study. Schizophr Res 2007; 93:109-16. [PMID: 17383857 DOI: 10.1016/j.schres.2007.02.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 02/12/2007] [Accepted: 02/16/2007] [Indexed: 01/15/2023]
Abstract
Based on the evidence that lamotrigine added to clozapine in refractory schizophrenic patients has reported promising results, the present 24-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and neurocognitive assessments patients were randomly allocated to receive, in a double-blind design, either up to 200 mg/day of lamotrigine or a placebo. A final sample of fifty-one patients completed the study. The results obtained indicate that lamotrigine added to stable clozapine treatment showed a beneficial effect on the negative, positive and general psychopathological symptomatology in a sample of treatment-resistant schizophrenic patients. Regarding cognitive functions, improvement was observed in some explored areas, such as attentional resistance to interference, verbal fluency and executive functioning. The findings provide evidence that lamotrigine augmentation of clozapine treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant schizophrenia.
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Affiliation(s)
- R Zoccali
- Section of Psychiatry, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Italy.
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Bagnato G, De Filippis LG, Caliri A, De Filippis G, Bagnato G, Bruno A, Gambardella N, Muscatello MR, Cambria R, Zoccali R. [Comparation of levels of anxiety and depression in patients with autoimmune and chronic-degenerative rheumatic: preliminary data]. Reumatismo 2006; 58:206-11. [PMID: 17013437 DOI: 10.4081/reumatismo.2006.206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/23/2022] Open
Abstract
UNLABELLED Scientific research on rheumatic diseases was often focused on the link between psychological features and disease. Depression and anxiety are frequently observed with an higher incidence among rheumatic patients in comparison to general population. In autoimmune diseases, such as rheumatoid arthritis, an important role for psychiatric symptoms could be played by the alteration of cytokines levels. In the chronic-degenerative diseases, psychological factors such as stress and depression, can be involved in perception of pain. OBJECTIVE We aimed at evaluating in a sample of 50 patients (25 with rheumatoid arthritis and 25 with osteoarthritis) levels of pain, anxiety and depression. METHODS We evaluated two group of patients with rheumatic disease, group A (25 with Rheumatoid Arthritis, mean age = 45.1; DS =15.24) and group B (25 with osteoarthritis, mean age = 54.3; DS =14.74) by clinic examination and with the following tests, SF-MPQ, HAQ, HAM-A, HAM-D. RESULTS We found in group A higher levels of depression and anxiety but lower levels of pain, which was more expressed in group B. CONCLUSION Depression and anxiety were observed with an higher prevalence in patients with autoimmune disease, whereas pain was stronger in patients with osteoarthritis, a degenerative disease. We could explain this phenomenon considering the aetiopathology of the two conditions. As regard to autoimmune disorders, these symptoms may reflect the direct effect of cytokines on the central nervous system. As far as it concerns chronic-degenerative diseases, anxiety and depression are usually considered "reactive" to pain, not "constitutive".
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Affiliation(s)
- G Bagnato
- U.O. di Reumatologia, Dip. Medicina Interna, Policlinico Universitario G. Martino, Messina, Italia
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Stone D, Conrad M, AlBadawi H, Entabi F, Cambria R, Watkins M. COX-2 inhibition enhances spinal cord mitochondrial activity in a murine model of thoracic aortic ischemia reperfusion. J Am Coll Surg 2005. [DOI: 10.1016/j.jamcollsurg.2005.06.252] [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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