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Song M, Wang Q, Feng H, Wang L, Zhang Y, Liu H. Preoperative Grading of Rectal Cancer with Multiple DWI Models, DWI-Derived Biological Markers, and Machine Learning Classifiers. Bioengineering (Basel) 2023; 10:1298. [PMID: 38002422 PMCID: PMC10669695 DOI: 10.3390/bioengineering10111298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/05/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Background: this study aimed to utilize various diffusion-weighted imaging (DWI) techniques, including mono-exponential DWI, intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for the preoperative grading of rectal cancer. Methods: 85 patients with rectal cancer were enrolled in this study. Mann-Whitney U tests or independent Student's t-tests were conducted to identify DWI-derived parameters that exhibited significant differences. Spearman or Pearson correlation tests were performed to assess the relationships among different DWI-derived biological markers. Subsequently, four machine learning classifier-based models were trained using various DWI-derived parameters as input features. Finally, diagnostic performance was evaluated using ROC analysis with 5-fold cross-validation. Results: With the exception of the pseudo-diffusion coefficient (Dp), IVIM-derived and DKI-derived parameters all demonstrated significant differences between low-grade and high-grade rectal cancer. The logistic regression-based machine learning classifier yielded the most favorable diagnostic efficacy (AUC: 0.902, 95% Confidence Interval: 0.754-1.000; Specificity: 0.856; Sensitivity: 0.925; Youden Index: 0.781). Conclusions: utilizing multiple DWI-derived biological markers in conjunction with a strategy employing multiple machine learning classifiers proves valuable for the noninvasive grading of rectal cancer.
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Affiliation(s)
- Mengyu Song
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Qi Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Hui Feng
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Lijia Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare, Shanghai 201800, China
| | - Hui Liu
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
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2
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Ohue M, Fujita S, Mizusawa J, Kanemitsu Y, Hamaguchi T, Tsukamoto S, Noura S, Yasui M, Itoh M, Shiomi A, Komori K, Watanabe J, Akazai Y, Shiozawa M, Yamaguchi T, Bandou H, Katsumata K, Moriya Y. Preoperative and postoperative prognostic factors of patients with stage II/III lower rectal cancer without neoadjuvant therapy in the clinical trial (JCOG0212). Jpn J Clin Oncol 2021; 52:114-121. [PMID: 34865105 PMCID: PMC9055856 DOI: 10.1093/jjco/hyab183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The JCOG0212 trial was a randomized controlled trial comparing mesorectal excision alone to mesorectal excision with lateral lymph node dissection for stage II/III lower rectal cancer patients without clinical lateral lymph node enlargement. This study aimed to identify clinicopathological prognostic factors for relapse-free survival and overall survival of lower rectal cancer in the trial. METHODS Prospective data were selected from 663 patients with complete data. Uni and multivariable Cox regression model was applied to evaluate the preoperative and the combined preoperative and postoperative factors, respectively. Preoperative factors included age, sex, performance status, clinical T, clinical N and operative procedures. Postoperative factors included histological grade, pathological T, number of metastatic lymph nodes and number of dissected lymph nodes. No patient received neoadjuvant treatment. RESULTS Regarding preoperative factors, multivariable analysis revealed that performance status 1 (vs. 0: HR 2.079, P = 0.0041) and cT4a (vs. cT2-3: HR 2.721, P = 0.0002) were independent risk factors for relapse-free survival, and those for overall survival were male (vs. female: HR 1.660, P = 0.0228) and cT4a (vs. cT2-3: HR 2.486, P = 0.0473). The only independent preoperative risk factor common for relapse-free survival and overall survival was cT4a. Taking preoperative and postoperative factors together, the number of metastatic lymph nodes was the only independent risk factor common for relapse-free survival and overall survival. CONCLUSIONS Clinical stage II/III lower rectal cancer patients with cT4a should be a target of therapeutic development of neoadjuvant therapy. Postoperatively, intensive chemotherapy should be investigated for patients with more metastatic lymph nodes.
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Affiliation(s)
- Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masaaki Itoh
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yoshihiro Akazai
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Manabu Shiozawa
- Department of Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Hiroyuki Bandou
- Department of Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University Hospital, Tokyo, Japan
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Tibermacine H, Rouanet P, Sbarra M, Forghani R, Reinhold C, Nougaret S. Radiomics modelling in rectal cancer to predict disease-free survival: evaluation of different approaches. Br J Surg 2021; 108:1243-1250. [PMID: 34423347 DOI: 10.1093/bjs/znab191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/11/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Radiomics may be useful in rectal cancer management. The aim of this study was to assess and compare different radiomics approaches over qualitative evaluation to predict disease-free survival (DFS) in patients with locally advanced rectal cancer treated with neoadjuvant therapy. METHODS Patients from a phase II, multicentre, randomized study (GRECCAR4; NCT01333709) were included retrospectively as a training set. An independent cohort of patients comprised the independent test set. For both time points and both sets, radiomic features were extracted from two-dimensional manual segmentation (MS), three-dimensional (3D) MS, and from bounding boxes. Radiomics predictive models of DFS were built using a hyperparameters-tuned random forests classifier. Additionally, radiomics models were compared with qualitative parameters, including sphincter invasion, extramural vascular invasion as determined by MRI (mrEMVI) at baseline, and tumour regression grade evaluated by MRI (mrTRG) after chemoradiotherapy (CRT). RESULTS In the training cohort of 98 patients, all three models showed good performance with mean(s.d.) area under the curve (AUC) values ranging from 0.77(0.09) to 0.89(0.09) for prediction of DFS. The 3D radiomics model outperformed qualitative analysis based on mrEMVI and sphincter invasion at baseline (P = 0.038 and P = 0.027 respectively), and mrTRG after CRT (P = 0.017). In the independent test cohort of 48 patients, at baseline and after CRT the AUC ranged from 0.67(0.09) to 0.76(0.06). All three models showed no difference compared with qualitative analysis in the independent set. CONCLUSION Radiomics models can predict DFS in patients with locally advanced rectal cancer.
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Affiliation(s)
- H Tibermacine
- Radiology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - P Rouanet
- Surgical Oncology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - M Sbarra
- Departmental Faculty of Medicine and Surgery, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - R Forghani
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - C Reinhold
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - S Nougaret
- Radiology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
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4
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Ferrando L, Cirmena G, Garuti A, Scabini S, Grillo F, Mastracci L, Isnaldi E, Marrone C, Gonella R, Murialdo R, Fiocca R, Romairone E, Ballestrero A, Zoppoli G. Development of a long non-coding RNA signature for prediction of response to neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma. PLoS One 2020; 15:e0226595. [PMID: 32023246 PMCID: PMC7001901 DOI: 10.1371/journal.pone.0226595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
Standard treatment for locally advanced rectal adenocarcinoma (LARC) includes a combination of chemotherapy with pyrimidine analogues, such as capecitabine, and radiation therapy, followed by surgery. Currently no clinically useful genomic predictors of benefit from neoadjuvant chemoradiotherapy (nCRT) exist for LARC. In this study we assessed the expression of 8,127 long noncoding RNAs (lncRNAs), poorly studied in LARC, to infer their ability in classifying patients’ pathological complete response (pCR). We collected and analyzed, using lncRNA-specific Agilent microarrays a consecutive series of 61 LARC cases undergoing nCRT. Potential lncRNA predictors in responders and non-responders to nCRT were identified with LASSO regression, and a model was optimized using k-fold cross-validation after selection of the three most informative lncRNA. 11 lncRNAs were differentially expressed with false discovery rate < 0.01 between responders and non-responders to NACT. We identified lnc-KLF7-1, lnc-MAB21L2-1, and LINC00324 as the most promising variable subset for classification building. Overall sensitivity and specificity were 0.91 and 0.94 respectively, with an AUC of our ROC curve = 0.93. Our study shows for the first time that lncRNAs can accurately predict response in LARC undergoing nCRT. Our three-lncRNA based signature must be independently validated and further analyses must be conducted to fully understand the biological role of the identified signature, but our results suggest lncRNAs may be an ideal biomarker for response prediction in the studied setting.
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Affiliation(s)
- Lorenzo Ferrando
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | - Gabriella Cirmena
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | - Anna Garuti
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | | | - Federica Grillo
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, Università degli Studi di Genova, Genova, Italy
| | - Luca Mastracci
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, Università degli Studi di Genova, Genova, Italy
| | - Edoardo Isnaldi
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | - Ciro Marrone
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Roberta Gonella
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Roberto Fiocca
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, Università degli Studi di Genova, Genova, Italy
| | | | - Alberto Ballestrero
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- * E-mail: (AB); (GZ)
| | - Gabriele Zoppoli
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- * E-mail: (AB); (GZ)
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5
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Nougaret S, Castan F, de Forges H, Vargas HA, Gallix B, Gourgou S, Rouanet P. Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial. Br J Surg 2019; 106:1530-1541. [PMID: 31436325 DOI: 10.1002/bjs.11233] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC. METHODS All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated. RESULTS A total of 133 randomized patients were analysed. Median follow-up was 41·4 (95 per cent c.i. 36·6 to 45·2) months. Thirty-one patients (23·3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0·015). After induction chemotherapy, a larger tumour volume on MRI (P = 0·019), tumour volume regression of 60 per cent or less (P = 0·002), involvement of the CRM (P = 0·037), mrEMVI (P = 0·026) and a poor mrTRG (P = 0·023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0·004), mrEMVI (P = 0·038) and a poor mrTRG (P = 0·005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0·011), sphincter involvement (P = 0·009), mrEMVI at baseline (P = 0·002) and early tumour volume regression of 60 per cent or less after induction (P = 0·007) were associated with relapse. CONCLUSION Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.
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Affiliation(s)
- S Nougaret
- Department of Radiology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, Institut National de la Santé et de la Recherche Médicale, U1194, Montpellier, France
| | - F Castan
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H de Forges
- Clinical Research Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B Gallix
- Department of Radiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Gourgou
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - P Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
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6
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Bogner A, Kirchberg J, Weitz J, Fritzmann J. State of the Art - Rectal Cancer Surgery. Visc Med 2019; 35:252-258. [PMID: 31602388 DOI: 10.1159/000501133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background In an aging society, the incidence and relevance of rectal cancer as one of the most frequent gastrointestinal cancers gains in importance. Excellent surgery and up-to-date multimodal treatments are essential for adequate oncological results and good quality of life. Summary In this review, we describe modern developments in rectal cancer surgery and its embedment in modern multimodal therapy concepts. Key Message Distinguished interdisciplinary cooperation combined with an outstanding surgical expertise is the basic requirement for an optimal treatment of rectal cancer. Thus, high standards of oncological outcome and patient's quality of life can be achieved.
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Affiliation(s)
- Andreas Bogner
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Johanna Kirchberg
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Johannes Fritzmann
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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7
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Affiliation(s)
- P Mroczkowski
- Department for General and Visceral Surgery, Elisabeth-Hospital-Kassel, Weinbergstr. 7, 34117, Kassel, Germany.,An Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University of Magdeburg, Leipziger Str.44, 39120, Magdeburg, Germany
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8
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Intravoxel Incoherent Motion MRI of Rectal Cancer: Correlation of Diffusion and Perfusion Characteristics With Prognostic Tumor Markers. AJR Am J Roentgenol 2018; 210:W139-W147. [PMID: 29446674 DOI: 10.2214/ajr.17.18342] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the intravoxel incoherent motion (IVIM)-DWI derived parameters and their relationships with tumor prognostic markers using 3-T MRI in patients with rectal cancer. SUBJECTS AND METHODS Fifty-two patients with histopathologically proven rectal cancer who underwent preoperative pelvic MRI were prospectively enrolled in this study. Diffusion and perfusion parameters including the apparent diffusion coefficient (ADC), pure diffusion coefficient, perfusion fraction, and pseudodiffusion coefficient derived from IVIMDWI were independently measured by two radiologists. Comparisons of IVIM-DWI-derived parameters in patients with different tumor prognostic markers were made using the independent-samples t test, ANOVA, and Mann-Whitney U test. The correlations between IVIM-DWI-derived parameters and tumor grade and tumor stage were further evaluated using Spearman correlation analysis. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). RESULTS Excellent interobserver reproducibility was obtained for the IVIM-DWI-derived parameters (range of ICCs with 95% limits of agreement = 0.9309-0.9948, which is narrow). ADC, pseudodiffusion coefficient, and perfusion fraction tended to rise with greater tumor differentiation (r = 0.520, p < 0.001; r = 0.447, p = 0.001; r = 0.354, p = 0.010, respectively). The pure diffusion coefficient and pseudodiffusion coefficient showed a trend of decreasing with increasing tumor stages (r = 0.479, p < 0.001; r = 0.517, p < 0.001). The group of patients with extramural vascular invasion (EMVI) showed lower pseudodiffusion coefficient values than the group of patients with no EMVI (p < 0.05). CONCLUSION IVIM-DWI-derived parameters in patients with rectal cancer, especially the pseudodiffusion coefficient, are associated with tumor grade and tumor stage and show statistically significant differences between subjects with EMVI and those without EMVI. IVIM-DWI-derived parameters would be helpful in predicting tumor aggressiveness and prognosis.
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9
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Liu H, Cui Y, Shen W, Fan X, Cui L, Zhang C, Ren G, Fu J, Wang D. Pretreatment magnetic resonance imaging of regional lymph nodes with carcinoembryonic antigen in prediction of synchronous distant metastasis in patients with rectal cancer. Oncotarget 2017; 7:27199-207. [PMID: 27070083 PMCID: PMC5053642 DOI: 10.18632/oncotarget.7979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/23/2016] [Indexed: 01/14/2023] Open
Abstract
Distant metastasis in patients with rectal cancer remains a problem influencing prognosis. Prediction of synchronous distant metastasis is important for the choice of personalized treatment strategies and postoperative follow-up protocol. So far, there are few studies about the predictive value of MRI features combined with clinical characteristics for synchronous distant metastasis in rectal cancer, especially for the lesions developed within 6 months after surgery. We retrospectively reviewed the pretreatment clinical characteristics and magnetic resonance imaging (MRI) features of 271 patients from January 2010 to December 2011with pathologically confirmed rectal adenocarcinoma and tried to identify independent risk factors for synchronous distant metastasis. Forty-nine patients (18.1%) were confirmed to have synchronous distant metastasis. Multivariate logistic regression model demonstrated that the elevated carcinoembryonic antigen (CEA), positive MRI-predicted lymph nodes staging (mrN), and MRI-predicted mesorectal fascia (mrMRF) involvement were independent risk factors. The odd ratios were 12.2 for elevated CEA, 5.4 for mrN1 and 7.6 for mrN2, and 3.8 for mrMRF involvement, respectively. The accuracy and specificity for predicting synchronous distant metastasis by evaluating the positive mrN combined with elevated CEA were improved to 87.8% and 94.6%, respectively. The accuracy, sensitivity and specificity of positive mrN assessment were 86.1%, 71.4% and 91.7%, respectively using the histopathologic results as the reference standard. Altogether, our findings suggest that pretreatment positive mrN and elevated CEA are independent risk factors for synchronous distant metastasis in rectal cancer and combination of both could help to recognize the patients with high risk for structuring personalized treatment protocol.
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Affiliation(s)
- Huanhuan Liu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yanfen Cui
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Wei Shen
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Xingwen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Long Cui
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Caiyuan Zhang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Gang Ren
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Jihong Fu
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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10
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Harris DA, Thorne K, Hutchings H, Islam S, Holland G, Hatcher O, Gwynne S, Jenkins I, Coyne P, Duff M, Feldman M, Winter DC, Gollins S, Quirke P, West N, Brown G, Fitzsimmons D, Brown A, Beynon J. Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR). BMJ Open 2016; 6:e012496. [PMID: 27872117 PMCID: PMC5129046 DOI: 10.1136/bmjopen-2016-012496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT. A more selective approach to RT may be appropriate given the associated toxicity. METHODS AND ANALYSIS This trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8-12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up. OBJECTIVES Objectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored. ETHICS AND DISSEMINATION The trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review publication and to trial participants. TRIAL REGISTRATION NUMBER ISRCTN02406823.
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Affiliation(s)
- Dean A Harris
- Department of Colorectal Surgery, Singleton Hospital, Swansea, UK
| | | | | | - Saiful Islam
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Gail Holland
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Olivia Hatcher
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - Sarah Gwynne
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - Ian Jenkins
- Department of Colorectal Surgery, St Marks Hospital, London, UK
| | - Peter Coyne
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - Michael Duff
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Melanie Feldman
- Department of Colorectal Surgery, Royal Cornwall Hospital, Truro, UK
| | - Des C Winter
- Department of Colorectal Surgery, St Vincent's Hospital, Dublin, Ireland
| | - Simon Gollins
- Department of Oncology, North Wales Cancer Treatment Centre, Rhyl, UK
| | - Phil Quirke
- Pathology and Tumour Biology, Leeds Institute of Oncology and Pathology, Wellcome Trust Brenner Building, St James Hospital, Leeds, UK
| | - Nick West
- Pathology and Tumour Biology, Leeds Institute of Oncology and Pathology, Wellcome Trust Brenner Building, St James Hospital, Leeds, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, London, UK
| | | | - Alan Brown
- Involving People Network, Health and Care Research Wales
| | - John Beynon
- Department of Colorectal Surgery, Singleton Hospital, Swansea, UK
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11
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Abstract
BACKGROUND Treatment of early stage rectal cancer has excellent oncological results. To reduce treatment-related mortality and morbidity and improve functional results, a focus on local resections is increasingly important. OBJECTIVE The purpose of this study was to compare outcomes after transanal endoscopic microsurgery and total mesorectal excision for early stage rectal cancer (T1 + T2) in Norway. DESIGN This was an observational study based on prospective data from the Norwegian Colorectal Cancer Registry. SETTINGS The study was conducted as a national, population-based study. PATIENTS All 543 patients with T1 and 1593 patients with T2 rectal cancer without distant metastases that was treated by transanal endoscopic microsurgery or total mesorectal excision without radiochemotherapy during 2000-2009 were included. MAIN OUTCOME MEASURES The primary outcomes were 5-year relative survival and 5-year local recurrence rate. RESULTS Among 543 patients with T1 cancer, the 5-year overall survival rate was 65.3% after transanal endoscopic microsurgery versus 81.5% after total mesorectal excision (p = 0.012). Adjusted for age and sex there was no excess mortality for transanal endoscopic microsurgery (HR = 1.28 (95% CI, 0.8-1.9); p = 0.22). The 5-year relative survival rate was 96.8% after transanal endoscopic microsurgery versus 98.2% after total mesorectal excision (p = 0.603), and the 5-year local recurrence rate was 14.5% versus 1.4% (p < 0.001). Among 1593 patients with T2 cancer, 5-year overall survival was 42.1% versus 76.1% (p < 0.001), 5-year relative survival was 65.4% versus 93.9% (p < 0.001), and 5 year local recurrence rate was 11.4% versus 4.4% in the 2 groups. LIMITATIONS The study is limited by its observational design and that the 2 groups were different according to patient and tumor characteristics. Another limitation was the low number of transanal endoscopic microsurgery procedures. CONCLUSIONS Transanal endoscopic microsurgery had comparable 5-year relative survival to total mesorectal excision in T1 rectal cancer but inferior 5-year relative survival in T2 rectal cancer. Transanal endoscopic microsurgery was associated with higher local recurrence rates for both T1 and T2 tumors.
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12
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Czeiger D, Shaked G, Sebbag G, Vakhrushev A, Flomboym A, Lior Y, Belochitski O, Ariad S, Douvdevani A. Elevated Cell-Free DNA Measured by a Simple Assay Is Associated With Increased Rate of Colorectal Cancer Relapse. Am J Clin Pathol 2016; 145:852-7. [PMID: 27267374 DOI: 10.1093/ajcp/aqw068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES For patients with early stage colorectal cancer (CRC), markers of high-risk relapse are needed. In a previous study on 38 randomly selected patients with CRC, we found good correlation between presurgery cell-free DNA (CFD) concentrations and standard prognostic factors. In the current study, we revisited the same patients at 5-year survival, aiming to evaluate the predictive power of presurgery CFD levels. METHODS We revisited 38 patients with CRC previously analyzed for 5-year outcome. CFD was measured using a simple fluorescent assay that we developed. RESULTS All recurrent patients and patients who had died of cancer within 5 years were shown to have presurgery CFD values above 800 ng/mL. The negative predictive value for cancer-related disease was 100%. Cox regression analysis for disease-free survival showed a hazard ratio of 6.03 (P = .003) for CFD, which was higher than the ratio of the disease stage, 1.9 (P = .006). The survival-free curve of stage I and II patients with elevated CFD was significantly different from patients with normal levels (P = .0136); 5 (41.7%) of 12 patients had died of cancer or had experienced a recurrence. CONCLUSIONS CFD may possibly be a decisive criterion to identify patients with local disease who might benefit from adjuvant chemotherapy.
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Affiliation(s)
| | | | | | | | | | - Yotam Lior
- Clinical Research Center Department of Clinical Biochemistry and Pharmacology
| | - Olga Belochitski
- Department of Oncology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Samuel Ariad
- Department of Oncology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel
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13
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Stornes T, Wibe A, Endreseth BH. Complications and risk prediction in treatment of elderly patients with rectal cancer. Int J Colorectal Dis 2016; 31:87-93. [PMID: 26298183 DOI: 10.1007/s00384-015-2372-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The primary aim of this study was to characterise complications, identify predictors of postoperative morbidity and mortality and to evaluate existing risk prediction models in elderly rectal cancer patients. METHODS An observational single-centre study of 330 consecutive patients >75 years treated in 1994-2006. Analyses were performed by age group: 75-79 years, 80-85 years and >85 years. RESULTS Total observed in-hospital morbidity was 48.7 %. In multivariate analysis, age (OR 1.04, 95 % CI 1.01-1.08, p = 0.04), ASA grade ≥ 3 (p = 0.01), acute presentation (OR 1.67, 95 % CI 1.2-13.2, p = 0.02) and major surgery (APR OR 3.72, 95 % CI 1.37-10.15, p = 0.01, LAR OR 2.98, 95 % CI 1.14-7.79, p = 0.03, Hartmann OR 5.46, 95 % CI 1.60-19.28, p = 0.02) were independent risk factors for postoperative morbidity. The 30-day mortality was 6.3, 6.4 and 14.3 % (p = 0.146) in the three age groups, and the 100-day mortality was 8.7, 10.1 and 22.2 % (p = 0.03), respectively. ASA group 3 (OR 6.21, 95 % CI 4.39-27.69, p = 0.017), ASA group 4 (OR 32.6, 95 % CI 5.12-207.75, p < 0.001) and acute presentation (OR 6.48, 95 % CI 1.62-25.99, p = 0.008) increased the risk of 100-day mortality. The Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) observed/estimated (O/E) ratio for morbidity was 1.05. For 30-day mortality, the colorectal POSSUM (Cr-POSSUM) O/E ratio was 0.74, Surgical Risk Scale 0.61 and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) mortality model 0.63, and for 100-day mortality, ratios were 1.12, 0.91 and 0.95, respectively. CONCLUSION In this series, age increased the risk of in-hospital morbidity and 100-day mortality. Cr-POSSUM, SRS and ACPGBI overestimated 30-day mortality but predicted 100-day mortality with a high degree of accuracy. POSSUM correctly predicted in-hospital morbidity.
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Affiliation(s)
- T Stornes
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, N-7006, Norway.
| | - A Wibe
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, N-7006, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - B H Endreseth
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, N-7006, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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14
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Wasmuth HH, Rekstad LC, Tranø G. The outcome and the frequency of pathological complete response after neoadjuvant radiotherapy in curative resections for advanced rectal cancer: a population-based study. Colorectal Dis 2016. [PMID: 26201935 DOI: 10.1111/codi.13072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM Pathological complete response (ypCR) after neoadjuvant treatment for rectal cancer is associated with favourable survival and a low rate of local recurrence. The aim of the study was to assess the incidence of ypCR among patients with advanced rectal cancer treated with neoadjuvant chemoradiotherapy and curative resection and to explore factors associated with survival. METHOD From 2000 to 2009, 1384 patients enrolled in the national population- based colorectal cancer registry of Norway with advanced T3 and T4 rectal cancer with N0-2, M0 received neoadjuvant long-course (chemo)radiation. The duration of follow-up was a median of 5 years. RESULTS ypCR was achieved in 147 (10.6%) patients. The estimated 5-year overall survival rate was 87% (confidence interval ± 5.4) among ypCR and 67% among non-ypCR (confidence interval ± 2.7) (P < 0.0001). Distant metastasis developed in 12 (8%) of 147 and 328 (26.5%) of 1237 patients respectively (P < 0.001). In a Cox proportional hazards ratio model the effect of ypCR on survival was adjusted for age [hazard ratio (HR) 1.056, P = 0.0001], metachronous metastasis (HR 4.7, P = 0.0001), local recurrence (HR 4.3, P = 0.0001) and surgical procedure (HR 1.48, P = 0.0001). The independent effect of ypCR (HR 0.65, P = 0.041) on survival almost disappeared compared with the univariate analysis. CONCLUSION The rate of ypCR in advanced rectal cancer was about 10%. This phenomenon seems to occur in tumours with a low risk of metastasizing. The contribution of neoadjuvant therapy to ypCR on survival was small or absent.
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Affiliation(s)
- H H Wasmuth
- Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - L C Rekstad
- Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - G Tranø
- Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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15
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Dziki Ł, Mroczkowski P. Do we still need proxies for quality control in rectal cancer surgery? J Clin Oncol 2015; 33:1411-2. [PMID: 25800771 DOI: 10.1200/jco.2014.58.9622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Williamson JS, Jones HG, Davies M, Evans MD, Hatcher O, Beynon J, Harris DA. Outcomes in locally advanced rectal cancer with highly selective preoperative chemoradiotherapy. Br J Surg 2014; 101:1290-8. [PMID: 24924947 DOI: 10.1002/bjs.9570] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/20/2014] [Accepted: 04/17/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study compared outcomes after surgery alone for stage II/ III rectal cancer in a tertiary cancer unit versus highly selective use of preoperative chemoradiotherapy (CRT). METHODS This was a single-centre retrospective cohort study of consecutive patients receiving potentially curative surgery for stage II and III primary rectal cancer. CRT was given only for magnetic resonance imaging-predicted circumferential resection margin (CRM) involvement and nodal disease (at least N2). Primary endpoints were CRM involvement and local recurrence rates. Secondary endpoints were systemic recurrence and overall survival. Data were analysed by log rank test, and univariable and multivariable analysis. RESULTS Between 2002 and 2012, 363 patients were treated for rectal cancer. After applying exclusion criteria, 266 patients with stage II/III mid or low rectal cancer were analysed. Of these, 103 received neoadjuvant CRT and 163 proceeded directly to surgery, seven of whom required postoperative radiotherapy; the latter patients were included in the neoadjuvant CRT group for analysis. There was a significant difference in local recurrence between the CRT and surgery-alone groups (6·5 versus 0 per cent at 5 years; P = 0·040), but not in CRM involvement (7·2 versus 5·1 per cent; P = 0·470), 5-year systemic recurrence (37·2 versus 43·0 per cent; P = 0·560) and overall survival (64·2 versus 64·6 per cent; P = 0·628) rates. Metastatic disease developed more frequently in low rectal cancers (odds ratio 0·14; P < 0·001), regardless of whether neoadjuvant treatment was delivered. CONCLUSION Locally advanced rectal cancer does not necessarily require neoadjuvant CRT.
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Affiliation(s)
- J S Williamson
- Department of Colorectal Surgery, Singleton Hospital, Swansea, UK
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Meldolesi E, van Soest J, Dinapoli N, Dekker A, Damiani A, Gambacorta MA, Valentini V. An umbrella protocol for standardized data collection (SDC) in rectal cancer: a prospective uniform naming and procedure convention to support personalized medicine. Radiother Oncol 2014; 112:59-62. [PMID: 24853366 DOI: 10.1016/j.radonc.2014.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 01/01/2023]
Abstract
Predictive models allow treating physicians to deliver tailored treatment moving from prescription by consensus to prescription by numbers. The main features of an umbrella protocol for standardizing data and procedures to create a consistent dataset useful to obtain a trustful analysis for a Decision Support System for rectal cancer are reported.
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Affiliation(s)
- Elisa Meldolesi
- Sacred Heart University, Radiotherapy Department, Rome, Italy.
| | - Johan van Soest
- Maastricht University Medical Centre+, Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, The Netherlands
| | - Nicola Dinapoli
- Sacred Heart University, Radiotherapy Department, Rome, Italy
| | - Andre Dekker
- Maastricht University Medical Centre+, Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, The Netherlands
| | - Andrea Damiani
- Sacred Heart University, Radiotherapy Department, Rome, Italy
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