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Ruhle A, Roesch J, Oertel M, Fabian A, Wegen S, Trommer M, Hering D, Maeurer M, Dobiasch S, von der Grün J, Medenwald D, Süß C, Hoeck M, Fleischmann DF, Löser A, Heß S, Tamaskovic B, Vinsensia M, Hecht M, Nicolay NH. MRI, FDG-PET/CT and Image-Guidance for Re-Irradiation of Locoregionally Recurrent or Second Primary Head-and-Neck Squamous Cell Carcinoma Patients - Results of a Multicenter Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e619-e620. [PMID: 37785856 DOI: 10.1016/j.ijrobp.2023.06.2002] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To investigate patterns of care and prognostic benefits of MRI, FDG-PET/CT and image-guidance in re-irradiation of locoregionally recurrent or second primary head-and-neck squamous cell carcinomas (r/s HNSCCs) within a multicenter cohort study. MATERIALS/METHODS Patients receiving re-irradiation for r/s HNSCC between 2009 and 2020 at 16 tertiary cancer centers in Germany were retrospectively analyzed in terms of MRI and FDG-PET/CT usage for treatment planning and regarding image-guidance frequency during re-irradiation. Patterns of use of these modalities over time were analyzed by binary logistic regression analysis, and the association between the usage of these modalities and best locoregional treatment response was analyzed with chi-square tests. Cumulative incidence analyses of locoregional failures with death as competing event were performed. RESULTS In the total cohort of 297 patients, 226 (76%) were male, median age was 62 years (IQR, 56-70), and median ECOG was 1 (IQR, 1-2). There were 260 locoregionally recurrent HNSCCs, and 37 second primary HNSCCs; 44 patients (15%) had distant metastases at the time of re-irradiation. MRI and FDG-PET/CT was used for re-irradiation planning in 117 (39%) and 71 patients (24%), respectively. In median, image guidance (IGRT) was performed twice weekly (IQR, 1-5), usually with cone beam CTs or megavolt-CTs, and 85 patients (29%) received daily IGRT during re-irradiation. Usage of MRI (OR = 0.967; 95% CI, 0.892-1.048; p = .416), FDG-PET/CT (OR = 1.053; 95% CI, 0.960-1.156; p = .274), or daily IGRT (OR = 1.057; 95% CI, 0.968-1.115; p = .218) did not increase in frequency over time within the analyzed time span but was significantly dependent on the treatment center (χ2(15), P<.001 for all modalities). Daily IGRT was associated with a higher rate of at least stable disease after re-irradiation as assessed by RECIST criteria (χ2(1) = 4.011, p<.05). There was a trend towards better RECIST-assessed treatment response for MRI (χ2(1) = 3.223, p = .073) and FDG-PET/CT (χ2(1) = 2.792, p = .095) as part of the re-irradiation planning process. Incidence of locoregional failures was not dependent on MRI (SHR = 0.94; 95% CI, 0.67-1.33; p = 0.741, Fine-Gray), FDG-PET/CT (SHR = 0.88; 95% CI, 0.59-1.33; p = 0.552) or daily IGRT (SHR = 0.76; 95% CI, 0.51-1.14, p = 0.182), There was a trend towards lower acute grade 3/4-toxicities in patients receiving daily IGRT (χ2(1) = 3.354, p = 0.067). CONCLUSION Our data suggest that daily IGRT may increase disease control and should be regularly applied for re-irradiation of r/s HNSCCs. MRI and FDG-PET/CT usage were not associated with the incidence of locoregional failures after re-irradiation. However, prospective trials with multiparametric MRI and/or FDG-PET/CT for optimal re-irradiation planning are warranted.
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Affiliation(s)
- A Ruhle
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - J Roesch
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - A Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - S Wegen
- Department of Radiation Oncology, CyberKnife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology, CyberKnife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - D Hering
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - M Maeurer
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - J von der Grün
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - D Medenwald
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - C Süß
- Department of Radiation Oncology, University Hospital Regensburg, Regensburg, Germany
| | - M Hoeck
- Department of Radiation Oncology, University Hospital Augsburg, Augsburg, Germany
| | - D F Fleischmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - A Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany; Department of Radiation Oncology, University Medical Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - S Heß
- Department of Radiation Oncology, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - B Tamaskovic
- Department of Radiation Oncology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - M Vinsensia
- Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany
| | - M Hecht
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - N H Nicolay
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Roesch J, Oertel M, Fabian A, Höck M, von der Grün J, Löser A, Süss C, Vinsensia M, Tamaskovics B, Heß S, Waltenberger M, Wegen S, Trommer M, Mäurer M, Medenwald D, Rühle A, Käsmann L, Fleischmann D, Dobiasch S, Hecht M. PH-0054 Re-Irradiation in head & neck cancer - a pooled analysis of 253 individual cases. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Correction to: Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:560-561. [PMID: 33674905 PMCID: PMC8154766 DOI: 10.1007/s00066-021-01750-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:385-395. [PMID: 33410959 PMCID: PMC8062351 DOI: 10.1007/s00066-020-01727-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In radical radiochemotherapy (RCT) of inoperable non-small-cell lung cancer (NSCLC) typical prognostic factors include T- and N-stage, while there are still conflicting data on the prognostic relevance of gross tumor volume (GTV) and particularly its changes during RCT. The NCT03055715 study of the Young DEGRO working group of the German Society of Radiation Oncology (DEGRO) evaluated the prognostic impact of GTV and its changes during RCT. METHODS A total of 21 university centers for radiation oncology from five different European countries (Germany, Switzerland, Spain, Belgium, and Austria) participated in the study which evaluated n = 347 patients with confirmed (biopsy) inoperable NSCLC in UICC stage III A/B who received radical curative-intent RCT between 2010 and 2013. Patient and disease data were collected anonymously via electronic case report forms and entered into the multi-institutional RadPlanBio platform for central data analysis. GTV before RCT (initial planning CT, GTV1) and at 40-50 Gy (re-planning CT for radiation boost, GTV2) was delineated. Absolute GTV before/during RCT and relative GTV changes were correlated with overall survival as the primary endpoint. Hazard ratios (HR) of survival analysis were estimated by means of adjusted Cox regression models. RESULTS GTV1 was found to have a mean of 154.4 ml (95%CI: 1.5-877) and GTV2 of 106.2 ml (95% CI: 0.5-589.5), resulting in an estimated reduction of 48.2 ml (p < 0.001). Median overall survival (OS) was 18.8 months with a median of 22.1, 20.9, and 12.6 months for patients with high, intermediate, and low GTV before RT. Considering all patients, in one survival model of overall mortality, GTV2 (2.75 (1.12-6.75, p = 0.03) was found to be a stronger survival predictor than GTV1 (1.34 (0.9-2, p > 0.05). In patients with available data on both GTV1 and GTV2, absolute GTV1 before RT was not significantly associated with survival (HR 0-69, 0.32-1.49, p > 0.05) but GTV2 significantly predicted OS in a model adjusted for age, T stage, and chemotherapy, with an HR of 3.7 (1.01-13.53, p = 0.04) per 300 ml. The absolute decrease from GTV1 to GTV2 was correlated to survival, where every decrease by 50 ml reduced the HR by 0.8 (CI 0.64-0.99, p = 0.04). There was no evidence for a survival effect of the relative change between GTV1 and GTV2. CONCLUSION Our results indicate that independently of T stage, the re-planning GTV during RCT is a significant and superior survival predictor compared to baseline GTV before RT. Patients with a high absolute (rather than relative) change in GTV during RT show a superior survival outcome after RCT.
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Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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Trommer M, Marnitz S, Kinsky J, Adams A, Hellmich M, Celik E, Herter J, Morgenthaler J, Von Bergwelt-Baildon M, Schlaak M, Theurich S, Baues C. PH-0525: Radio-immunotherapy versus immunotherapy alone – tolerance and adverse events. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Trommer M, Yeo S, Persigehl T, Bunck A, Schlaak M, Grüll H, Theurich S, Von Bergwelt M, Herter J, Celik E, Marnitz S, Baues C. PO-0890 Abscopal effects in metastasized cancer patients treated with PD-1 inhibition and radiation therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Walther C, Wenzel A, Schneider M, Trommer M, Sturm KP, Jaeger U. Automated classification of stages of anaesthesia by populations of evolutionary optimized fuzzy rules. Current Directions in Biomedical Engineering 2015. [DOI: 10.1515/cdbme-2015-0020] [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: 11/15/2022] Open
Abstract
Abstract
The detection of stages of anaesthesia is mainly performed on evaluating the vital signs of the patient. In addition the frontal one-channel electroencephalogram can be evaluated to increase the correct detection of stages of anaesthesia. As a classification model fuzzy rules are used. These rules are able to classify the stages of anaesthesia automatically and were optimized by multiobjective evolutionary algorithms. As a result the performance of the generated population of fuzzy rule sets is presented. A concept of the construction of an autonomic embedded system is introduced. This system should use the generated rules to classify the stages of anaesthesia using the frontal one-channel electroencephalogram only.
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Affiliation(s)
- C. Walther
- University of Applied Sciences Schmalkalden, Faculty of Electrical Engineering, Embedded Diagnostic Systems, Schmalkalden, Germany and Fraunhofer IOSB, Advanced System Technology, Ilmenau, Germany
| | - A. Wenzel
- University of Applied Sciences Schmalkalden, Faculty of Electrical Engineering, Embedded Diagnostic Systems, Schmalkalden, Germany and Fraunhofer IOSB, Advanced System Technology, Ilmenau, Germany
| | - M. Schneider
- University of Applied Sciences Schmalkalden, Faculty of Electrical Engineering, Embedded Diagnostic Systems, Schmalkalden, Germany
| | - M. Trommer
- University of Applied Sciences Schmalkalden, Faculty of Electrical Engineering, Embedded Diagnostic Systems, Schmalkalden, Germany
| | - K.-P. Sturm
- Hospital of Schmalkalden, Department of Anaesthesia, Schmalkalden, Germany
| | - U. Jaeger
- Medical Practice of Steinbach-Hallenberg, SteinbachHallenberg, Germany
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Collares F, Leitune V, Rostirolla F, Trommer M, Bergmann C, Samuel S. Influence of hydroxyapatite addition on experimental methacrylate-based root canal sealers. Dent Mater 2011. [DOI: 10.1016/j.dental.2011.08.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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