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Saripalli AL, Venkatesulu BP, Nickols NG, Valle LF, Harkenrider MM, Kishan AU, Solanki AA. Systematic review and recommendations for re-irradiation for intraprostatic radiorecurrent prostate cancer after definitive radiation therapy. World J Urol 2024; 42:520. [PMID: 39264453 DOI: 10.1007/s00345-024-05205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/17/2024] [Indexed: 09/13/2024] Open
Abstract
PURPOSE Intraprostatic recurrence (IRR) of prostate cancer after radiation therapy is increasingly identified. Our objective was to review the literature to determine the optimal workup for identifying IRR, the management options, and practical considerations for the delivery of re-irradiation as salvage local therapy. METHODS We performed a systematic review of available publications and ongoing studies on the topics of IRR, with a focus on salvage re-irradiation. RESULTS Work up of biochemically recurrent prostate cancer includes PSMA PET/CT and multiparametric MRI, followed by biopsy to confirm IRR. Management options include continued surveillance, palliative hormonal therapy, and salvage local therapy. Salvage local therapy can be delivered using re-irradiation with low dose rate brachytherapy, high dose rate (HDR) brachytherapy, and stereotactic body radiotherapy (SBRT), as well as non-radiation modalities, such as cryotherapy, high-intensity focused ultrasound, irreversible electroporation and radical prostatectomy. Data demonstrate that HDR brachytherapy and SBRT have similar efficacy compared to the other salvage local therapy modalities, while having more favorable side effect profiles. Recommendations for radiation therapy planning and delivery using HDR and SBRT based on the available literature are discussed. CONCLUSION Salvage re-irradiation is safe and effective and should be considered in patients with IRR.
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Affiliation(s)
- Anjali L Saripalli
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - Bhanu Prasad Venkatesulu
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - Luca F Valle
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiation Oncology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA.
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Meraouna Y, Blanchard P, Losa S, Labib A, Krhili S, Pommier P, Crehange G, Flam T, Cosset JM, Kissel M. Salvage low-dose-rate brachytherapy for locally recurrent prostate cancer after definitive irradiation. Clin Transl Radiat Oncol 2024; 48:100809. [PMID: 39027689 PMCID: PMC11254530 DOI: 10.1016/j.ctro.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The optimal management of locally recurrent prostate cancer after definitive irradiation is still unclear but local salvage treatments are gaining interest. A retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity after salvage I-125 low-dose-rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer was conducted in a Comprehensive Cancer Center. Patients and methods A total of 94 patients treated with salvage LDR-BT between 2006 and 2021 were included. The target volume was either the whole-gland +/- a boost on the GTV, the hemigland, or only the GTV. The prescribed dose ranged from 90 to 145 Gy. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results Median follow-up was 34 months. Initial radiotherapy was external beam radiotherapy in 73 patients (78 %) with a median dose of 76 Gy and I-125 BT in 21 patients (22 %) with a prescribed dose of 145 Gy. Median PSA at salvage was 3.75 ng/ml with a median interval between first and salvage irradiation of 9.4 years. Salvage brachytherapy was associated with androgen deprivation therapy for 32 % of the patients. Only 4 % of the patients were castrate-resistant. Failure free survival was 82 % at 2 years and 66 % at 3 years. The only factors associated with failure-free survival on multivariate analysis were hormonosensitivity at relapse and European Association of Urology (EAU) prognostic group. Late grade 3 urinary and rectal toxicities occurred in 12 % and 1 % of the patients respectively.No significant difference in toxicity or efficacy was observed between the three implant volume groups. Conclusion The efficacy and toxicity results are consistent with those in the LDR group of the MASTER meta-analysis. Salvage BT confirms to be an effective and safe option for locally recurrent prostate cancer. A focal approach could be interesting to reduce late severe toxicities, especially urinary.
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Affiliation(s)
- Y. Meraouna
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Faculté de médecine Sorbonne Université, 91-105 Boulevard de l’Hôpital, 75013 Paris, France
| | - P. Blanchard
- Radiotherapy Department, Gustave Roussy, 114 Boulevard Edouard Vaillant, 94220 Villejuif, France
| | - S. Losa
- Physics Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - A. Labib
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - S. Krhili
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - P. Pommier
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - G. Crehange
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - T. Flam
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Urology Department, Clinique Saint Jean de Dieu, 2 rue Rousselet, 75007 Paris, France
| | - J-M. Cosset
- Radiotherapy Department, Centre Charlebourg – La Défense – Amethyst Radiothérapie, 65 Avenue Foch, 92250 La Garenne-Colombes, France
| | - M. Kissel
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
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Lee PL, Ruth K, Lee DY, Hallman MA, Chen DYT, Wong JK, Correa AF, Veltchev I, Lin T, Chen X, Panetta J, Kutikov A, Horwitz EM. Comparison of perioperative and subacute postoperative complications between LDR and HDR monotherapy brachytherapy for prostate cancer. Brachytherapy 2024; 23:559-568. [PMID: 39060143 DOI: 10.1016/j.brachy.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE We aim to investigate perioperative and subacute postoperative complications in patients undergoing LDR or HDR monotherapy for prostate cancer. We hypothesize a low rate of complications, and a favorable toxicity profile in patients treated with HDR compared to LDR. MATERIALS AND METHODS A prospectively collected institutional database was queried for patients treated with HDR or LDR prostate monotherapy between 1998 and 2021. Toxicities were determined per CTCAE. Claims based billing codes were obtained to identify additional events. Events occurring within 4 months of treatment were defined as perioperative or subacute postoperative complications. RESULTS 759 patients were identified, 446 received LDR with 125I, and 313 received HDR with 192Ir. HDR patients had higher risk features: 75.7% with Gleason score 7+ versus 2.4% of LDR, and 16% with initial PSA 10+ ng/mL versus 2.7% of LDR. Toxicities were mild with the most common being grade 1 GU frequency and nocturia at ∼50%. HDR patients had significantly less grade 2 dysuria (2.6% vs. 9.0%), frequency (4.8% vs. 9.4%), hematuria (1.0% vs. 5.2%), nocturia (3.8% vs. 9.4%), and urinary obstructive symptoms (7.3% vs. 11.2%), all statistically significant. 11 (1.4%) patients had infection requiring antibiotics: 8 (1.8%) from the LDR group and 3 (1%) from the HDR group. Cardiopulmonary events were low at <2% overall, without difference between HDR and LDR. CONCLUSIONS Overall toxicity rates support the safety of prostate brachytherapy. HDR monotherapy is associated with significantly less perioperative and subacute postoperative GU events when compared to LDR monotherapy. Cardiopulmonary events were equally rare in both groups.
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Affiliation(s)
- Peter L Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
| | - Karen Ruth
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA
| | - Douglas Y Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - David Y T Chen
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jessica Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Andres F Correa
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Iavor Veltchev
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Teh Lin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Xiaoming Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Joseph Panetta
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Wang H, Gong L, Huang X, White SD, Chung HT, Vesprini D, Petchiny TN, Fokas E, He H, Kerbel RS, Liu SK. Potentiating Salvage Radiotherapy in Radiorecurrent Prostate Cancer Through Anti-CTLA4 Therapy: Implications from a Syngeneic Model. Cancers (Basel) 2024; 16:2839. [PMID: 39199612 PMCID: PMC11352774 DOI: 10.3390/cancers16162839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
High-risk prostate cancer (PCa) is a leading cause in cancer death and can elicit significant morbidity and mortality. Currently, the salvage of local disease recurrence after radiation therapy (RT) is a major clinical problem. Immune checkpoint inhibitors (ICIs), which enhance immune activation, have demonstrated clinical therapeutic promise in combination with ionizing radiation (IR) in certain advanced cancers. We generated the TRAMP-C2 HF radiorecurrent syngeneic mouse model to evaluate the therapeutic efficacy of ICIs in combination with RT. The administration of anti-PDL1 and/or anti-CTLA4 did not achieve a significant tumor growth delay compared to the control. The combination of IR and anti-PDL1 did not yield additional a growth delay compared to IR and the isotype control. Strikingly, a significant tumor growth delay and complete cure in one-third of the mice were seen with the combination of IR and anti-CTLA4. Immune cells in tumor-draining lymph nodes and tumor-infiltrating lymphocytes from mice treated with IR and anti-CTLA4 demonstrated an upregulation of genes in T-cell functions and enrichment in both CD4+ and CD8+ T-cell populations compared to mice given IR and the isotype control. Taken together, these results indicate enhancement of T-cell response in radiorecurrent PCa by IR and anti-CTLA4.
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Affiliation(s)
- Hanzhi Wang
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1L7, Canada; (L.G.); (S.D.W.); (H.H.); (R.S.K.); (S.K.L.)
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
| | - Linsey Gong
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1L7, Canada; (L.G.); (S.D.W.); (H.H.); (R.S.K.); (S.K.L.)
| | - Xiaoyong Huang
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
| | - Stephanie D. White
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1L7, Canada; (L.G.); (S.D.W.); (H.H.); (R.S.K.); (S.K.L.)
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
| | - Hans T. Chung
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1P5, Canada
| | - Danny Vesprini
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1P5, Canada
| | - Tera N. Petchiny
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emmanouil Fokas
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Hansen He
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1L7, Canada; (L.G.); (S.D.W.); (H.H.); (R.S.K.); (S.K.L.)
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert S. Kerbel
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1L7, Canada; (L.G.); (S.D.W.); (H.H.); (R.S.K.); (S.K.L.)
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
| | - Stanley K. Liu
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1L7, Canada; (L.G.); (S.D.W.); (H.H.); (R.S.K.); (S.K.L.)
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (X.H.); (D.V.); (T.N.P.)
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1P5, Canada
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Karius A, Kreppner S, Strnad V, Schweizer C, Lotter M, Fietkau R, Bert C. Inter-observer effects in needle reconstruction for temporary prostate brachytherapy: Dosimetric implications and adaptive CBCT-TRUS registration solutions. Brachytherapy 2024; 23:421-432. [PMID: 38845268 DOI: 10.1016/j.brachy.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To investigate geometric and dosimetric inter-observer variability in needle reconstruction for temporary prostate brachytherapy. To assess the potential of registrations between transrectal ultrasound (TRUS) and cone-beam computed tomography (CBCT) to support implant reconstructions. METHODS AND MATERIALS The needles implanted in 28 patients were reconstructed on TRUS by three physicists. Corresponding geometric deviations and associated dosimetric variations to prostate and organs at risk (urethra, bladder, rectum) were analyzed. To account for the found inter-observer variability, various approaches (template-based, probe-based, marker-based) for registrations of CBCT to TRUS were investigated regarding the respective needle transfer accuracy in a phantom study. Three patient cases were examined to assess registration accuracy in-vivo. RESULTS Geometric inter-observer deviations >1 mm and >3 mm were found for 34.9% and 3.5% of all needles, respectively. Prostate dose coverage (changes up to 7.2%) and urethra dose (partly exceeding given dose constraints) were most affected by associated dosimetric changes. Marker-based and probe-based registrations resulted in the phantom study in high mean needle transfer accuracies of 0.73 mm and 0.12 mm, respectively. In the patient cases, the marker-based approach was the superior technique for CBCT-TRUS fusions. CONCLUSION Inter-observer variability in needle reconstruction can substantially affect dosimetry for individual patients. Especially marker-based CBCT-TRUS registrations can help to ensure accurate reconstructions for improved treatment planning.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Claudia Schweizer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Majewski W, Miszczyk M, Graupner D, Goc B, Goldner G, Napieralska A. Stereotactic body radiotherapy (SBRT) re-irradiation for local failures following radical prostatectomy and post-operative radiotherapy. Strahlenther Onkol 2024; 200:230-238. [PMID: 38157016 PMCID: PMC10876733 DOI: 10.1007/s00066-023-02187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Local recurrences after radical prostatectomy (RP) and postoperative radiotherapy (RT) are challenging for salvage treatment. Retrospective analysis of own experiences with salvage re-irradiation was performed. METHODS The study included all consecutive patients treated with salvage stereotactic body radiotherapy (sSBRT) for prostate bed recurrence following RP and postoperative RT at a single tertiary center between 2014 and 2021. Treatment toxicity defined as the occurrence of CTCAE grade ≥ 2 genito-urinary (GU) or gastro-intestinal (GI) adverse events (AEs) was assessed. A PSA response, biochemical control (BC) and overall survival (OS) were also evaluated. RESULTS The study group included 32 patients with a median age of 68 years and a median follow-up of 41 months, treated with CyberKnife (53%) or Linac (47%) sSBRT. Total dose of 33.75-36.25 Gy in five fractions (72%) was applied in the majority of them. Approximately 19% patients reported grade ≥ 2 GU AEs both at baseline and at three months, and grade ≥ 2 GI toxicity increased from 0% at baseline to 6% at three months after sSBRT. There was some clinically relevant increase in late toxicity with 31% patients reporting late ≥ 2 GU, and 12.5% late ≥ 2 GI AEs. Two grade 3 AEs were recorded: recto-urinary fistulas. The majority of patients showed a PSA response (91% at one year post-sSBRT). The 3‑year BC was 40% and 3‑year OS was 87%. CONCLUSIONS Manageable toxicity profile and satisfactory biochemical response suggest that SBRT in patients with local recurrence following RP and postoperative RT might be a salvage option for selected patients.
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Affiliation(s)
- Wojciech Majewski
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland.
| | - Marcin Miszczyk
- III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Donata Graupner
- III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Bartłomiej Goc
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Gregor Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Aleksandra Napieralska
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland
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