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Derks SHAE, van der Meer EL, Joosse A, de Jonge MJA, Slagter C, Schouten JW, Hoop EOD, Smits M, van den Bent MJ, Jongen JLM, van der Veldt AAM. The development of brain metastases in patients with different therapeutic strategies for metastatic renal cell cancer. Int J Cancer 2024. [PMID: 38703351 DOI: 10.1002/ijc.34984] [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: 01/09/2024] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
A diagnosis of brain metastasis (BM) significantly affects quality of life in patients with metastatic renal cell cancer (mRCC). Although systemic treatments have shown efficacy in mRCC, active surveillance (AS) is still commonly used in clinical practice. In this single-center cohort study, we assessed the impact of different initial treatment strategies for metastatic RCC (mRCC) on the development of BM. All consecutive patients diagnosed with mRCC between 2011 and 2022 were included at the Erasmus MC Cancer Institute, the Netherlands, and a subgroup of patients with BM was selected. In total, 381 patients with mRCC (ECM, BM, or both) were identified. Forty-six patients had BM of whom 39 had metachronous BM (diagnosed ≥1 month after ECM). Twenty-five (64.1%) of these 39 patients with metachronous BM had received prior systemic treatment for ECM and 14 (35.9%) patients were treatment naive at BM diagnosis. The median BM-free survival since ECM diagnosis was significantly longer (p = .02) in previously treated patients (29.0 [IQR 12.6-57.0] months) compared to treatment naive patients (6.8 [IQR 1.0-7.0] months). In conclusion, patients with mRCC who received systemic treatment for ECM prior to BM diagnosis had a longer BM-free survival as compared to treatment naïve patients. These results emphasize the need for careful evaluation of treatment strategies, and especially AS, for patients with mRCC.
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Affiliation(s)
- Sophie H A E Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Edgar L van der Meer
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maja J A de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cleo Slagter
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost L M Jongen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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Wu Y, Derks SHAE, Wood TC, de Blois E, van der Veldt AAM, Smits M, Warnert EAH. Improved postprocessing of dynamic glucose-enhanced CEST MRI for imaging brain metastases at 3 T. Eur Radiol Exp 2023; 7:78. [PMID: 38066225 PMCID: PMC10709288 DOI: 10.1186/s41747-023-00390-5] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Dynamic glucose-enhanced (DGE) chemical exchange saturation transfer (CEST) has the potential to characterize glucose metabolism in brain metastases. Since the effect size of DGE CEST is small at 3 T (< 1%), measurements of signal-to-noise ratios are challenging. To improve DGE detection, we developed an acquisition pipeline and extended image analysis for DGE CEST on a hybrid 3-T positron emission tomography/magnetic resonance imaging system. METHODS This cross-sectional study was conducted after local ethical approval. Static Z-spectra (from -100 to 100 ppm) were acquired to compare the use of 1.2 versus 2 ppm to calculate static glucose-enhanced (glucoCEST) maps in 10 healthy volunteers before and after glucose infusion. Dynamic CEST images were acquired during glucose infusion. Image analysis was optimized using motion correction, dynamic B0 correction, and principal component analysis (PCA) to improve the detection of DGE CEST in the sagittal sinus, cerebrospinal fluid, and grey and white matter. The developed DGE CEST pipeline was applied to four patients diagnosed with brain metastases. RESULTS GlucoCEST was strongest in healthy tissues at 2 ppm. Correcting for motion, B0, and use of PCA locally improved DGE maps. A larger contrast between healthy tissues and enhancing regions in brain metastases was found when dynamic B0 correction and PCA denoising were applied. CONCLUSION We demonstrated the feasibility of DGE CEST with our developed acquisition and analysis pipeline at 3 T in patients with brain metastases. This work enables a direct comparison of DGE CEST to 18F-fluoro-deoxy-D-glucose positron emission tomography of glucose metabolism in patients with brain metastases. RELEVANCE STATEMENT Contrast between brain metastasis and healthy brain tissue in DGE CEST MR images is improved by including principle component analysis and dynamic magnetic field correction during postprocessing. This approach enables the detection of increased DGE CEST signal in brain metastasis, if present. KEY POINTS • Despite the low signal-to-noise ratio, dynamic glucose-enhanced CEST MRI is feasible at 3 T. • Principal component analyses and dynamic magnetic field correction improve DGE CEST MRI. • DGE CEST MRI does not consequently show changes in brain metastases compared to healthy brain tissue. • Increased DGE CEST MRI in brain metastases, if present, shows overlap with contrast enhancement on T1-weighted images.
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Affiliation(s)
- Yulun Wu
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Sophie H A E Derks
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
- Departments of Neurology, Erasmus MC, Rotterdam, Netherlands
- Departments of Medical Oncology, Erasmus MC, Rotterdam, Netherlands
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Erik de Blois
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Astrid A M van der Veldt
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
- Departments of Medical Oncology, Erasmus MC, Rotterdam, Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Medical Delta, Delft, Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands.
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
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Wu Y, Wood TC, Derks SHAE, Pruis IJ, van der Voort S, van Zanten SEMV, Smits M, Warnert EAH. Reproducibility of APT-weighted CEST-MRI at 3T in healthy brain and tumor across sessions and scanners. Sci Rep 2023; 13:18115. [PMID: 37872418 PMCID: PMC10593824 DOI: 10.1038/s41598-023-44891-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/17/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Amide proton transfer (APT)-weighted chemical exchange saturation transfer (CEST) imaging is a recent MRI technique making its way into clinical application. In this work, we investigated whether APT-weighted CEST imaging can provide reproducible measurements across scan sessions and scanners. Within-session, between-session and between scanner reproducibility was calculated for 19 healthy volunteers and 7 patients with a brain tumor on two 3T MRI scanners. The APT-weighted CEST effect was evaluated by calculating the Lorentzian Difference (LD), magnetization transfer ratio asymmetry (MTRasym), and relaxation-compensated inverse magnetization transfer ratio (MTRREX) averaged in whole brain white matter (WM), enhancing tumor and necrosis. Within subject coefficient of variation (COV) calculations, Bland-Altman plots and mixed effect modeling were performed to assess the repeatability and reproducibility of averaged values. The group median COVs of LD APT were 0.56% (N = 19), 0.84% (N = 6), 0.80% (N = 9) in WM within-session, between-session and between-scanner respectively. The between-session COV of LD APT in enhancing tumor (N = 6) and necrotic core (N = 3) were 4.57% and 5.67%, respectively. There were no significant differences in within session, between session and between scanner comparisons of the APT effect. The COVs of LD and MTRREX were consistently lower than MTRasym in all experiments, both in healthy tissues and tumor. The repeatability and reproducibility of APT-weighted CEST was clinically acceptable across scan sessions and scanners. Although MTRasym is simple to acquire and compute and sufficient to provide robust measurement, it is beneficial to include LD and MTRREX to obtain higher reproducibility for detecting minor signal difference in different tissue types.
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Affiliation(s)
- Yulun Wu
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sophie H A E Derks
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ilanah J Pruis
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sebastian van der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Sophie E M Veldhuijzen van Zanten
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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Derks SHAE, Jongen JLM, van der Meer EL, Ho LS, Slagter C, Joosse A, de Jonge MJA, Schouten JW, Oomen-de Hoop E, van den Bent MJ, van der Veldt AAM. Impact of Novel Treatments in Patients with Melanoma Brain Metastasis: Real-World Data. Cancers (Basel) 2023; 15:cancers15051461. [PMID: 36900253 PMCID: PMC10000692 DOI: 10.3390/cancers15051461] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Melanoma brain metastasis (MBM) is associated with poor outcome, but targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) have revolutionized treatment over the past decade. We assessed the impact of these treatments in a real-world setting. METHODS A single-center cohort study was performed at a large, tertiary referral center for melanoma (Erasmus MC, Rotterdam, the Netherlands). Overall survival (OS) was assessed before and after 2015, after which TTs and ICIs were increasingly prescribed. RESULTS There were 430 patients with MBM included; 152 pre-2015 and 278 post-2015. Median OS improved from 4.4 to 6.9 months (HR 0.67, p < 0.001) after 2015. TTs and ICIs prior to MBM diagnosis were associated with poorer median OS as compared to no prior systemic treatment (TTs: 2.0 vs. 10.9 and ICIs: 4.2 vs. 7.9 months, p < 0.001). ICIs directly after MBM diagnosis were associated with improved median OS as compared to no direct ICIs (21.5 vs. 4.2 months, p < 0.001). Stereotactic radiotherapy (SRT; HR 0.49, p = 0.013) and ICIs (HR 0.32, p < 0.001) were independently associated with improved OS. CONCLUSION After 2015, OS significantly improved for patients with MBM, especially with SRT and ICIs. Demonstrating a large survival benefit, ICIs should be considered first after MBM diagnosis, if clinically feasible.
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Affiliation(s)
- Sophie H. A. E. Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Joost L. M. Jongen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Edgar L. van der Meer
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Li Shen Ho
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Cleo Slagter
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Maja J. A. de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Joost W. Schouten
- Department of Neurosurgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Martin J. van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Astrid A. M. van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-10-704-02-52
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Abstract
Imaging of brain metastases (BMs) has advanced greatly over the past decade. In this review, we discuss the main challenges that BMs pose in clinical practice and describe the role of imaging.Firstly, we describe the increased incidence of BMs of different primary tumours and the rationale for screening. A challenge lies in selecting the right patients for screening: not all cancer patients develop BMs in their disease course.Secondly, we discuss the imaging techniques to detect BMs. A three-dimensional (3D) T1W MRI sequence is the golden standard for BM detection, but additional anatomical (susceptibility weighted imaging, diffusion weighted imaging), functional (perfusion MRI) and metabolic (MR spectroscopy, positron emission tomography) information can help to differentiate BMs from other intracranial aetiologies.Thirdly, we describe the role of imaging before, during and after treatment of BMs. For surgical resection, imaging is used to select surgical patients, but also to assist intraoperatively (neuronavigation, fluorescence-guided surgery, ultrasound). For treatment planning of stereotactic radiosurgery, MRI is combined with CT. For surveillance after both local and systemic therapies, conventional MRI is used. However, advanced imaging is increasingly performed to distinguish true tumour progression from pseudoprogression.FInally, future perspectives are discussed, including radiomics, new biomarkers, new endogenous contrast agents and theranostics.
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Affiliation(s)
- Sophie H A E Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Derks SHAE, Jongen JLM, van den Bent MJ, van der Veldt AAM. Assessment of imaging biomarkers in the follow-up of brain metastases after SRS. Neuro Oncol 2021; 23:1983-1984. [PMID: 34427666 PMCID: PMC8563304 DOI: 10.1093/neuonc/noab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sophie H A E Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Joost L M Jongen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
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Derks SHAE, Jongen JLM, Slagter C, Joosse A, Schouten JW, van den Bent MJ, van der Veldt AAM. P14.25 Melanoma brain metastases in the era of novel therapies: a single-center, Dutch cohort study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.147] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Until recently, patients with melanoma brain metastases (MBMs) had limited therapeutic options. With the arrival of immune checkpoint inhibitors (ICIs), targeted therapy (TT) and advances in stereotactic radiotherapy (SRT), treatment has improved. We evaluated treatments and patient outcome before and after the introduction of these novel therapies.
MATERIAL AND METHODS
In this retrospective, single-center study, patients presenting with MBMs at the Erasmus MC between November 2005 and January 2021 with sufficient follow-up were included. Overall survival (OS), measured from date of MBM diagnosis, was calculated using the Kaplan-Meier method. Patients were stratified according to MBM diagnosis before and after January 1, 2016, since novel therapies were mostly prescribed in our clinic after this date. Results were significant (p<0.05), unless otherwise stated.
RESULTS
Overall, 413 patients were included. Median [IQR] age was 56.6 years [52–71] with a 60% male predominance. A BRAF mutation was present in 46.7% of patients. A single MBM was found in 29.3% and ≥4 MBMs were found in 49.0% of patients. Before January 1, 2016, 191 patients were treated, and 222 patients after that date. Chemotherapy was more frequently used before 2016, both prior to (3.9% pre-2016 vs. 0.9% post-2016) and after (7.0% vs. 0.0%) the diagnosis of MBMs. In contrast, treatment with TT was more frequent after 2016, both prior to (3.7% vs. 16.2%) and after (7.9% vs. 41.4%) the diagnosis of MBMs. Comparable changes were observed for treatment with ICIs (prior to MBM diagnosis: 0.5% vs. 25.2%; after MBM diagnosis: 18.3% vs 39.2%). The application of SRT did not differ significantly before and after 2016 (12.0% vs. 19.4%, p=0.89), while the application of whole brain radiotherapy (WBRT) decreased (52.4% vs. 13.5%). Surgical resection was not significantly different between those periods (15.7% vs. 16.7%, p=0.90). Before 2016, median OS [IQR] was shorter than after 2016 (4.6 [1.9–10.9] vs. 6.6 [1.8–24.5] months). The effect of novel therapies on OS was further analysed in patients diagnosed after 2016; treatment vs. no treatment was compared. ICI treatment prior to MBM diagnosis was associated with worse OS (median OS 4.0 vs. 7.5 months). ICI treatment after MBM diagnosis was associated with better OS (median OS 24.5 vs. 3.0 months). In patients with a BRAF mutation, TT before MBM diagnosis was associated with worse OS (median OS 1.8 vs. 9.4 months). TT after MBM diagnosis in those patients was not significantly associated with improved OS (median OS 7.6 vs. 5.2 months, p=0.96).
CONCLUSION
Recent therapeutic advances for MBM replaced WBRT and chemotherapy with SRT, TT and ICIs. In that period, prognosis of MBM patients increased significantly. OS in patients treated with ICIs or TT prior to MBM diagnosis is still poor, but OS is improved in patients treated with ICIs after the diagnosis of MBM.
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Affiliation(s)
| | - J L M Jongen
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - C Slagter
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - A Joosse
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
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