Current Opinion in Urology最新文献

{"title":"MR-guided radiotherapy for prostate cancer: an inevitable transition?","authors":"Rafał Stando, Grzegorz Chmielewski","doi":"10.1097/MOU.0000000000001315","DOIUrl":"10.1097/MOU.0000000000001315","url":null,"abstract":"<p><strong>Purpose of review: </strong>The rising global incidence of prostate cancer has intensified both clinical and economic pressures to optimize radiotherapy (RT) delivery. Advances in imaging and fractionation - particularly magnetic resonance imaging (MR)-guided workflows and stereotactic body RT (SBRT) - aim to reduce treatment duration and minimize toxicity. This review explores these innovations and their potential inclusion into routine clinical practice.</p><p><strong>Recent findings: </strong>MR-guided RT (MRgRT) planning and delivery offer superior soft tissue contrast and real-time motion tracking, enabling reduced target margins and improved sparing of adjacent normal tissues. Hypofractionated regimens (e.g., 60 Gy in 20 fractions) have become standard, while ultra-hypofractionated SBRT (up to 12 Gy per fraction over 2-5 sessions) is gaining traction due to MRgRT capabilities. Adaptive RT allows for daily modification of treatment plans, based on real-time imaging. Several trials, including MIRAGE and SCIMITAR, have demonstrated reductions in acute genitourinary and gastrointestinal toxicity with MR-guided SBRT. Ongoing clinical trials and the MOMENTUM registry aim to clarify long-term outcomes and contribute to the standardization of MRgRT workflows.</p><p><strong>Summary: </strong>Based on available, preliminary evidence, MRgRT and adaptive SBRT are associated with a promising toxicity profiles. Nonetheless, further multicenter studies with extended follow-up are needed to validate outcomes and establish practice guidelines.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"562-567"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical recurrence after radical prostatectomy and postoperative radiotherapy: current evidence and controversial issues.","authors":"Mattia Longoni, Fabian Falkenbach, Markus Graefen, Tobias Maurer, Pierre I Karakiewicz, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia","doi":"10.1097/MOU.0000000000001292","DOIUrl":"10.1097/MOU.0000000000001292","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores challenges in managing biochemical recurrence (BCR) after radical prostatectomy and postoperative radiotherapy for prostate cancer (PCa) highlighting gaps in risk stratification, imaging, and emerging therapies, as well as advances in molecular imaging and personalized treatment.</p><p><strong>Recent findings: </strong>Approximately half of PCa patients experience a second BCR after postoperative radiotherapy. Time to recurrence, PSA kinetics, adverse pathological features (ISUP 4-5, pT3-4, and positive surgical margins), alongside genetic profile, are key factors for risk stratification. Combination of androgen deprivation therapy (ADT) and novel androgen receptor pathway inhibitors (ARPIs) represents an established treatment choice. However, recent findings emphasize the growing role of prostate-specific membrane antigen (PSMA) PET in detecting recurrent disease and guide tailored strategies. Based on early phase II trials and retrospective studies, metastasis-directed therapy (MDT) has demonstrated promising efficacy in oligorecurrent PCa, although further validation is warranted.</p><p><strong>Summary: </strong>BCR after radical prostatectomy and postoperative radiotherapy represents a challenge in PCa management. Risk stratification is key for guiding the addition of ARPIs to standard ADT. PSMA PET may further refine tailored strategies such as MDT, whose promising efficacy needs further exploration. Ongoing trials will clarify treatment sequencing and patient selection in the evolving paradigm of BCR management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"510-516"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of biochemical recurrence after primary therapy with curative intent.","authors":"Navid Roessler, Marcin Miszczyk, Nadja Strewinsky, Paweł Rajwa, Shahrokh F Shariat","doi":"10.1097/MOU.0000000000001312","DOIUrl":"10.1097/MOU.0000000000001312","url":null,"abstract":"<p><strong>Purpose of review: </strong>We aimed to summarize the recent advancements in management of biochemical recurrence (BCR) after primary curative therapy for prostate cancer (PCa), and the role of advanced imaging technologies in guiding and improving treatment decisions.</p><p><strong>Recent findings: </strong>Recent studies have reshaped the approach to managing BCR after primary treatment for PCa. A key shift is the preference for early salvage radiotherapy (sRT), which has proven to offer comparable or even superior outcomes to immediate adjuvant therapy when closely monitored for progression. PSA kinetics (PSA doubling time) continue to guide treatment decisions, together with the time to PSA rise, Gleason Grade of the original tumor, and PSMA-PET imaging at the time of recurrence. While PSMA-PET significantly enhances the precision of recurrence detection, its sensitivity for smaller pelvic lymph node metastases remains limited, underscoring the need for careful consideration of all factors together to develop a risk-based consulting for all individualized treatment plan integrating patient wishes and health.</p><p><strong>Summary: </strong>Recent studies underscore the efficacy of early sRT in managing BCR, with PSA kinetics and ISUP score as a crucial factor in guiding treatment decisions. Furthermore, the integration of PSMA-PET imaging has improved the precision of recurrence detection, facilitating more tailored and effective treatment strategies for patients with BCR. We are finally entering the age of personalized, risk-based, patient-centred case delivery, where treatment of the primary tumor with curative intent is offered to patients with BCR.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"517-521"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate-specific membrane antigen positron-emission tomography for novel risk-stratification of biochemical recurrence.","authors":"Madeleine J Karpinski, Claudia Kesch, Boris A Hadaschik, Wolfgang P Fendler","doi":"10.1097/MOU.0000000000001291","DOIUrl":"10.1097/MOU.0000000000001291","url":null,"abstract":"<p><strong>Purpose of review: </strong>The variety of prostate cancer aggressiveness in patients with biochemical recurrence (BCR) leads to the unmet need of accurate risk stratification. This review examined the recently published risk stratification tool using prostate-specific membrane antigen positron-emission tomography (PSMA-PET) compared to the risk categories by European Association of Urology (EAU).</p><p><strong>Recent findings: </strong>The risk stratification by EAU was proposed for patients with BCR, including the doubling time of the prostate-specific-antigen and Gleason score as predictors for survival. Although stratification into low- vs. high-risk groups reached significant differences in the external validation, C-indices determined moderate discriminative ability and the need to improve the EAU risk categories. PSMA-PET was recently validated as prognostic biomarker and PSMA-PET standardized by Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) metrics were combined to create a visual and a quantitative nomogram to predict overall survival.</p><p><strong>Summary: </strong>The unmet need to improve risk stratification for prostate cancer patients experiencing BCR was addressed with PSMA-PET PROMISE (PPP) nomograms. Although PPP nomograms are not applied for individual patient counselling yet, they can be used additionally to EAU risk categories.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"506-509"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-hypofractionation for the treatment of macroscopic prostate bed recurrence: a focus on stereotactic radiotherapy and brachytherapy.","authors":"Magdalena Stankiewicz, Wojciech Majewski","doi":"10.1097/MOU.0000000000001314","DOIUrl":"10.1097/MOU.0000000000001314","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review is to assess contemporary studies on ultra-hypofractionated local salvage therapies - stereotactic body radiation therapy (SBRT) and brachytherapy - for macroscopic prostate bed recurrence after radical prostatectomy, with or without prior external beam radiotherapy (EBRT), and to highlight knowledge gaps guiding current trials.</p><p><strong>Recent findings: </strong>Recent studies, primarily retrospective, report 1-year biochemical control rates of 56-88% for SBRT and up to 87% for high-dose-rate brachytherapy, with low to moderate rates of severe genitourinary toxicity. Higher biologically effective doses and limited tumour volume predict improved outcomes, yet focal-only strategies carry some risk of out-of-field relapse within the prostate bed. The role of concomitant androgen deprivation therapy remains unclear. Several phase II trials (e.g. STARR, PROSTARE, REPAIR, and HypoFocal SRT) are underway.</p><p><strong>Summary: </strong>Ultra-hypofractionated salvage radiotherapy offers effective disease control with manageable toxicity for selected patients and may defer systemic therapy. Further studies are needed to standardize imaging, biopsy confirmation, dose escalation, and systemic treatment integration. Prospective, randomized studies are crucial to define optimal modality, target volume, and patient selection criteria before widespread adoption.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"583-589"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of radiotherapy in pelvic nodal recurrence following definitive treatment for prostate cancer.","authors":"Alessandro Dematteis, Marcin Miszczyk, Angelo Cormio, Akihiro Matsukawa, Paolo Gontero, Shahrokh F Shariat","doi":"10.1097/MOU.0000000000001322","DOIUrl":"10.1097/MOU.0000000000001322","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize recent evidence on the role of radiotherapy in managing pelvic lymph node (PLN) recurrence following curative-intent primary therapy for prostate cancer (PCa), focusing on radiotherapy strategies, novel medical imaging, and oncological outcomes.</p><p><strong>Recent findings: </strong>Prostate-specific membrane antigen PET (PSMA-PET) has improved accuracy of staging in patients with PCa; however, more often than not, it fails to correctly identify PLN metastases, and the impact on clinical outcomes of the patients is uncertain. Metastasis-directed therapies (MDT) combined with short-term androgen-deprivation therapy (ADT) in patients with PLN recurrence are associated with a significantly higher risk of recurrence compared to more comprehensive approaches. Emerging data support the role of elective nodal radiotherapy (ENRT) combined with short-term androgen deprivation therapy (ADT) and radiotherapy boost to the PLN metastases to enhance disease control. Notably, despite treating a more extensive pelvic region than MDT, ENRT does not appear to significantly increase acute toxicity or negatively impact quality of life (QoL). Recent evidence suggests a role for androgen receptor pathway inhibitors (ARPI), such as enzalutamide, in patients with high-risk biochemical recurrence, introducing a new treatment paradigm for patients ineligible for salvage radiotherapy. Ongoing prospective studies are refining the role of radiotherapy in combination with systemic treatments.</p><p><strong>Summary: </strong>Despite PSMA-PET allowing for improved staging and better patient-tailored decisions, patients with PLN recurrence continue to benefit from comprehensive multimodal treatment approach. Elective PLN irradiation combined with radiotherapy boost and ADT lead to improved disease control, without compromising safety and toxicity. ARPI+ADT and ARPI-monotherapy emerge as alternatives for select patients.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"574-582"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we redefine the Phoenix criteria for biochemical recurrence after primary radiotherapy?","authors":"Ugo Giovanni Falagario, Francesco Pellegrino, Peter Wiklund","doi":"10.1097/MOU.0000000000001313","DOIUrl":"10.1097/MOU.0000000000001313","url":null,"abstract":"<p><strong>Purpose of review: </strong>The Phoenix criteria, which define biochemical recurrence (BCR) after radiotherapy as a prostate specific antigen (PSA) rise of at least 2 ng/ml above nadir, were developed to improve consistency in outcome reporting and distinguish genuine cancer recurrence from transient, noncancerous PSA fluctuations, commonly referred to as PSA \"bounces\". However, in the current era of advanced imaging and precision oncology, this definition is increasingly viewed as inadequate. This review critically examines recent evidence challenging the clinical utility of the Phoenix definition and explores potential alternatives that better reflect disease biology and patient outcomes.</p><p><strong>Recent findings: </strong>Modern imaging techniques, particularly prostate-specific membrane antigen (PSMA) PET/computed tomography (CT), have demonstrated the ability to detect recurrent prostate cancer at PSA levels well below the Phoenix threshold, allowing for earlier salvage interventions. Additionally, PSA kinetics such as nadir levels and doubling time provide superior prognostic information compared to static PSA thresholds. Multiparametric risk models that also incorporate PSMA PET/CT findings, PSA kinetics and clinical features may enable more accurate stratification of patients into low-risk and high-risk BCR categories. This evolving approach supports the notion that early, risk-adapted treatment can improve outcomes in high-risk patients, while reducing overtreatment in those at low risk.</p><p><strong>Summary: </strong>The Phoenix criteria no longer align with the capabilities of current diagnostic and prognostic tools. Redefining BCR using dynamic PSA metrics and advanced imaging could facilitate timely salvage treatment in patients at a high risk and allow surveillance strategies in those unlikely to progress. Prospective validation is warranted to inform future clinical guidelines.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"499-505"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's in a name? Why differentiation between biochemical recurrence and metastatic prostate cancer matters.","authors":"Anael S Rizzo, Pratik Kanabur, Adam B Weiner","doi":"10.1097/MOU.0000000000001317","DOIUrl":"10.1097/MOU.0000000000001317","url":null,"abstract":"<p><strong>Purpose of review: </strong>The natural history of biochemical recurrence (BCR) is highly variable, complicating the distinction between BCR and metastasis. A targeted approach to risk stratifying disease progression is needed. This review proposes a 'framework,' that categorizes disease progression into five distinct groups: low-risk BCR, high-risk BCR, oligometastatic disease, low-volume metastatic disease, and high-volume metastatic disease. Each group is defined by clinicopathological and molecular features, along with targeted treatment strategies to tailor therapy and optimize disease management.</p><p><strong>Recent findings: </strong>Recent clinical trials and updates to guidelines have focused on treatment intensification and early identification of patients at risk for recurrence. In addition, the utilization of molecular imaging and implementation of metastasis directed therapy has led to a change in the conventions of recurrence and metastasis. Therefore, the patients with BCR or metastatic disease require a more individualized and multimodal treatment for their prostate cancer.</p><p><strong>Summary: </strong>Distinguishing BCR from metastatic disease has important implications. It offers ways to avoid unnecessary treatment in patients who are less likely to progress and helps identify those who are more likely to benefit from earlier or more aggressive interventions.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"535-540"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant radiotherapy following radical cystectomy in patients with muscle-invasive bladder cancer: a narrative review.","authors":"Agata Suleja, Ekaterina Laukhtina, Angelo Cormio, Marcin Miszczyk, Shahrokh F Shariat","doi":"10.1097/MOU.0000000000001310","DOIUrl":"10.1097/MOU.0000000000001310","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to synthesize emerging evidence on the role of adjuvant radiotherapy (RT) following radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).</p><p><strong>Recent findings: </strong>A randomized trial comparing adjuvant chemoradiotherapy to chemotherapy alone in 125 MIBC patients demonstrated a significant improvement in 2-year local recurrence- free survival (LRFS) (96% vs. 69%; P  < 0.01). Three studies have evaluated adjuvant RT alone. A single-arm study reported a 5-year local control rate of 79% among 72 patients, with 17% experiencing serious gastrointestinal (GI) adverse events (AEs). A randomized controlled trial (RCT) involving 122 patients found improved 3-year LRFS in the RT arm (81% vs. 71% at three years; P  = 0.046), with low rate of severe GI AEs (3%); however, the survival difference was not statistically significant. Another RCT with 153 patients showed similar rates of acute severe AEs between RT and observation groups (1.6% vs. 4.2%; P  = 0.34). Key limitations across studies include heterogeneity in design, lack of statistical power to detect survival differences, limited patient-reported outcome data, and absence of direct comparisons with immune checkpoint inhibitors - the current standard of care in the adjuvant setting.</p><p><strong>Summary: </strong>Modern adjuvant RT appears to be associated with acceptable toxicity, likely due to improved delivery techniques. Although data suggest a benefit in local-regional control, an overall survival advantage has not been demonstrated. Adjuvant RT may be considered in selected high-risk patients, particularly in settings where access to salvage therapies or immunotherapy is limited.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"549-553"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in muscle-invasive bladder cancer: opportunities, challenges, and clinical impact.","authors":"Federico Mastroleo, Giulia Marvaso, Barbara Alicja Jereczek-Fossa","doi":"10.1097/MOU.0000000000001309","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001309","url":null,"abstract":"<p><strong>Purpose of review: </strong>Muscle-invasive bladder cancer (MIBC) represents an aggressive malignancy with significant morbidity and mortality. Recent advances in artificial intelligence (AI) offer promising opportunities to enhance patient care across the entire MIBC management spectrum. This comprehensive review examines the current state and future potential of AI applications in MIBC, from diagnosis through treatment to response assessment.</p><p><strong>Recent findings: </strong>In the diagnostic domain, AI systems demonstrate superior accuracy in cystoscopic cancer detection and staging, with deep learning models achieving high performance in differentiating muscle-invasive from noninvasive disease. For treatment planning, AI facilitates precise tumor delineation for radiotherapy, automates adaptive planning, and supports surgical decision-making through predictive lymph node involvement models. In treatment response evaluation, machine learning algorithms show encouraging results in predicting neoadjuvant chemotherapy outcomes, while radiomics and quantitative imaging biomarkers enable early response assessment. Despite these advances, significant challenges persist, including methodological limitations, dataset heterogeneity, workflow integration barriers, and regulatory uncertainties. Future directions should prioritize prospective clinical validation, federated learning approaches to address data scarcity, development of interpretable AI models, and interdisciplinary collaboration.</p><p><strong>Summary: </strong>The integration of AI in MIBC management represents a paradigm shift toward personalized medicine, with the potential to improve diagnostic accuracy, optimize treatment selection, and enhance response prediction.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"35 5","pages":"543-548"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}