International Journal of Radiation Oncology Biology Physics最新文献

{"title":"In Regard to Torizuka et al","authors":"Pouya Saraei PhD, Sare Hosseini MD","doi":"10.1016/j.ijrobp.2024.12.028","DOIUrl":"10.1016/j.ijrobp.2024.12.028","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"121 5","pages":"Pages 1394-1395"},"PeriodicalIF":6.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase I/II Dose-Escalation Trial of 3-Fraction Stereotactic Radiosurgery for Resection Cavities from Large Brain Metastases.","authors":"Daniella Klebaner, Erqi L Pollom, Elham Rahimy, Iris C Gibbs, John R Adler, Steven D Chang, Gordon Li, Clara Yh Choi, Scott G Soltys","doi":"10.1016/j.ijrobp.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.015","url":null,"abstract":"<p><strong>Purpose: </strong>We performed a dose escalation trial of hypofractionated stereotactic radiosurgery (SRS) to determine the maximum tolerated dose (MTD) of 3-fraction SRS for brain metastases resection cavities.</p><p><strong>Methods and materials: </strong>Following surgical resection of a brain metastasis, patients were enrolled by SRS treatment volume onto 2 arms: Arm 1=4.2-14.1 cm³, approximating a 2-3 cm diameter sphere, and Arm 2=14.2-33.5 cm³ or a 3-4 cm sphere equivalent. Dose escalation levels were 24, 27, 30, and 33 Gy in 3 consecutive-day fractions, with 6 patients at each dose level in a 6 + 6 trial design. Dose-limiting toxicity (DLT) was defined as either acute (within 30 days of SRS) Grade 3-5 CNS toxicity and/or late Grade 3-5 radiation necrosis occurring at any subsequent timepoint. The MTD was defined as the highest dose where 0-1 out of 6 or 0-3 out of 12 had a DLT.</p><p><strong>Results: </strong>From 2009 to 2014, 48 evaluable patients were enrolled. One (2%) patient had acute G3 toxicity; dose escalation proceeded to 33 Gy. No MTD was reached. Overall, 14 (29%) of 48 patients had G1-4 late radiation necrosis; G1 in 4(8%), G2 in 6(13%), G3 in 2(4%), and G4 in 2(4%). At the 33 Gy dose level, any grade necrosis was 58% in all 12 patients, 83% in the 6 patients on the larger volume Arm 2; no G3-4 necrosis occurred in smaller Arm 1 targets. With a median overall survival of 24 months (95% Confidence Interval (CI) 18-35), the 1-year cumulative incidence rates were: 10% (95%CI 3.8-21) for local progression, 48% (95%CI 33-61) for distant intracranial progression, and 13% (95%CI 5-24) for radiation necrosis. Nodular meningeal disease occurred in 15% (7 of 48) of patients.</p><p><strong>Conclusions: </strong>Grade 3-4 toxicity was 8% and no MTD was reached with dose-escalation to 33 Gy in 3 fractions. However, with a 58% incidence of G1-4 radiation necrosis at the 33 Gy level and 33% G3-4 necrosis at 30 Gy on Arm 2, a 3-fraction dose of 27-30 Gy for targets 2 to 3 cm and 27 Gy for targets 3 to 4 cm may provide the optimal balance between toxicity and tumor control. A dose of 33 Gy is reserved for cavities less than 3 cm where tumor control may benefit from higher doses.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a deep learning model that integrates pre- and mid-treatment computed tomography to predict treatment response for non-small cell lung cancer.","authors":"Xuming Chen, Fanrui Meng, Ping Zhang, Lei Wang, Shengyu Yao, Chengyang An, Hui Li, Dongfeng Zhang, Hongxia Li, Jie Li, Lisheng Wang, Yong Liu","doi":"10.1016/j.ijrobp.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Patients with identical stages or similar tumor volumes can vary significantly in their responses to radiotherapy (RT) due to individual characteristics, making personalized RT for non-small cell lung cancer (NSCLC) challenging. This study aimed to develop a deep learning (DL) model by integrating pre- and mid-treatment computed tomography (CT) to predict the treatment response in NSCLC patients.</p><p><strong>Methods and material: </strong>We retrospectively collected data from 168 NSCLC patients across three hospitals. Data from A (35 patients) and B (93 patients) were used for model training and internal validation, while data from C (40 patients) was used for external validation. DL, radiomics, and clinical features were extracted to establish a varying time-interval long short-term memory network (VTI-LSTM) for response prediction. Furthermore, we derived a model-deduced personalize dose escalation (DE) for patients predicted to have suboptimal gross tumor volume (GTV) regression. The area under the receiver operating characteristic curve (AUC) and predicted absolute error (PAE) were used to evaluate the predictive Response Evaluation Criteria in Solid Tumors (RECIST) classification and proportion of GTV residual. DE was calculated as biological equivalent dose (BED) using an α/β ratio of 10 Gy.</p><p><strong>Results: </strong>The model using only pre-treatment CT achieved the highest AUC of 0.762 and 0.687 in internal and external validation respectively, while the model integrating both pre- and mid-treatment CT achieved AUC of 0.869 and 0.798, with PAE of 0.137 and 0.185. We performed personalized DE for 29 patients. Their original BED was approximately 72 Gy, within the range of 71.6 Gy to 75 Gy. DE ranged from 77.7 to 120 Gy for 29 patients, with 17 patients exceeding 100 Gy and eight patients reaching the model's preset upper limit of 120 Gy.</p><p><strong>Conclusions: </strong>Combining pre- and mid-treatment CT enhances prediction performance for RT response and offers a promising approach for personalized DE in NSCLC.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Organized Approach to Ablative Radiation Therapy","authors":"Michael Chisam MD,&nbsp;Manisha Palta MD","doi":"10.1016/j.ijrobp.2024.12.040","DOIUrl":"10.1016/j.ijrobp.2024.12.040","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"121 5","pages":"Pages 1100-1101"},"PeriodicalIF":6.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Regard to Sanford et al","authors":"Marco Lorenzo Bonù,&nbsp;Luca Triggiani,&nbsp;Andrea Guerini,&nbsp;Michela Buglione,&nbsp;Stefano Maria Magrini","doi":"10.1016/j.ijrobp.2024.12.025","DOIUrl":"10.1016/j.ijrobp.2024.12.025","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"121 5","pages":"Pages 1396-1397"},"PeriodicalIF":6.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long Term Results of a Phase II Study of Adjuvant Proton Radiotherapy for Node-Positive Cancer of the Uterus and Cervix: Proton Radiation for Uterine/Cervical Cancer.","authors":"Andrea L Russo, Nicolas Depauw, Nora K Horick, Jennifer Y Wo, Jacqueline A Nyamwanda, Fantine Giap, Leilana Ly, Marcela G Del Carmen, Annekathryn Goodman, Richard T Penson, Thomas F DeLaney, Anthony H Russell","doi":"10.1016/j.ijrobp.2025.03.010","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.010","url":null,"abstract":"<p><strong>Purpose/objective(s): </strong>Patients with node-positive (LN+) uterine or cervical cancer often require post-operative radiation (RT) to the pelvis and para-aortic nodes. A prospective phase II study was conducted to evaluate the efficacy of proton beam RT for LN+ uterine or cervical cancer.</p><p><strong>Materials/methods: </strong>Patients with IIIC uterine and cervical cancer post hysterectomy and lymphadenectomy were eligible. Patients received 45 Gy(RBE) in 25 fractions with proton pencil beam scanning (PBS-PT). Primary endpoints included comparing dose volume histogram (DVH) and toxicity (CTCAE v4.02) between PBS-PT and IMRT or 3DCRT. Secondary endpoints included progression free survival (PFS), overall survival (OS), patterns of recurrence, and quality of life (QOL using FACT-En/Cx V4).</p><p><strong>Results: </strong>21 patients completed RT between 10/2013 and 10/2018. Median follow-up was 60.6 months (range, 11.2 - 68.8). There were 15 uterine and 6 cervical cancer patients. Four received pelvic and 17 received extended-field-RT. DVH comparisons showed significantly less volume treated with PBS-PT compared to 3D-CRT and IMRT for bowel, bone marrow, and kidney (all p<0.05) at all dose levels except V45 bladder and bowel. Acute and late grade 3 GI toxicity were 14 % and 4.7 %, respectively. There were no acute or late grade 3 GU toxicities. Acute and late grade 3 hematologic toxicities were 24 % and 4.7 %, respectively. There was one late grade 3 lymphedema. The 2- and 5- year PFS were 81 % (95 % CI, 56 %-92 %) and 76 % (95 % CI, 51 %-89 %). There were no in-field recurrences. The 2- and 5-year OS were 86 % (95 % CI, 62 %-95 %) and 80 % (95 % CI, 55 %-92 %). QOL increased significantly over time with average increase of 10.7 points from baseline to 5 years (95 % CI: 0.9 to 20.4, p=0.032).</p><p><strong>Conclusion: </strong>Compared to photon radiotherapy, PBS-PT treats significantly less normal tissue volume. PBS-PT appears effective in preventing local-regional recurrence in LN+ patients with minimal acute and late toxicity. QOL significantly improved from baseline to 5 years.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joining Forces to Advance Reirradiation: Establishing the Reirradiation Collaborative Group.","authors":"Charles S Mayo, Ane L Appelt, Kelly C Paradis, Laura A Dawson, Nicolaus Andratschke, Eliana M Vasquez Osorio, Søren M Bentzen, Ellen D Yorke, Andrew Jackson, Lawrence B Marks, Sue S Yom","doi":"10.1016/j.ijrobp.2025.01.038","DOIUrl":"10.1016/j.ijrobp.2025.01.038","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetry and Toxicity Comparison of Three-Dimensional Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy in Locally Advanced Lung Cancer Across a Large Statewide Quality Collaborative.","authors":"Steven G Allen, Caitlin A Schonewolf, Matthew J Schipper, Huiying Maggie Yin, Peter A Paximadis, Larry L Kestin, Michael Dominello, Melissa Wilson, Martha M Matuszak, James A Hayman, Shruti Jolly","doi":"10.1016/j.ijrobp.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.007","url":null,"abstract":"<p><strong>Purpose/objective(s): </strong>Use of intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal external beam radiation therapy (3D-CRT) for definitive chemoradiation therapy (CRT) in locally advanced non-small cell lung cancer (LA-NSCLC) has been associated with decreased late pneumonitis, decreased high dose to the heart (itself associated with improved overall survival), and improved patient quality of life. In a statewide radiation oncology quality consortium, we sought to evaluate the impact of IMRT versus 3D-CRT treatment technique on dosimetry and toxicity.</p><p><strong>Materials/methods: </strong>From 2012 to 2022, 1746 LA-NSCLC patients meeting inclusion criteria underwent definitive RT (90% CRT) with either 3D-CRT (n=313) or IMRT (n=1433) and were enrolled in the [quality consortium] prospective, multicenter statewide initiative. Physician reported toxicity and patient reported outcomes (PROs) were collected during treatment through 6 months after RT and compared by treatment technique. Inverse probability of treatment weighting (IPTW) was used to account for differences in prognostic factors between IMRT and 3D-CRT patients.</p><p><strong>Results: </strong>Compared with 3D-CRT patients, IMRT patients had significantly larger PTVs (median 386 cc vs 292 cc, p<0.0001) and were more likely to have Stage IIIB disease (34.3% vs 23.0%, p<0.0001). After adjustment using IPTW, treatment with IMRT compared to 3D-CRT reduced high dose to the lung (mean V30Gy 17.9% vs 19.2%, p=0.027) and heart (proportion with V40Gy≥20% 6.4% vs 15.3% p<0.0001). In logistic regression models using IPTW, through 6 months of early follow-up there were no significant differences between 3D-CRT and IMRT in rates of grade 2+ acute esophagitis (Odds Ratio = 1.02; 95% CI=0.73,1.42; p=0.91) and grade 2+ early pneumonitis (OR = 1.62; 95% CI:0.89, 2.96; p=0.11) or in likelihood of a clinically significant decline in PROs.</p><p><strong>Conclusion: </strong>With late follow-up ongoing, the current study supports the continued preferential use of IMRT over 3D-CRT for LA-NSCLC treatment due to improvements in heart and lung doses.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrahypofractionation and Simultaneous Integrated Boost in Breast Cancer: Early Side Effects Analysis.","authors":"Maia Dzhugashvili, Ana Serradilla, Jaume Fernández-Ibiza, Graciela García, Kirill Matskov Malinochka, Lisellot Torres, Antonio Seral, José Begara, Daniela Gonsalves, Juan José De la Cruz Troca, Philip Poortmans, Felipe Couñago, Escarlata López","doi":"10.1016/j.ijrobp.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.003","url":null,"abstract":"<p><strong>Purpose: </strong>The FAST-Forward study paved the way for ultrahypofractionation (UHF) in breast cancer. We prospectively registered and analyzed our case series receiving UHF + simultaneous integrated boost (SIB) to further reduce the treatment to a total of 5 days. The study aimed to present the 6-month early side effects results of the first patients treated with this scheme in 16 radiation oncology centers in Spain.</p><p><strong>Methods and materials: </strong>A total of 242 breast cancer patients received adjuvant radiation therapy between April and December 2020. The median age was 61 years (interquartile range, 53-70). All patients underwent breast-conserving surgery. Chemotherapy (QT) was administered to 27.7%, and endocrine therapy to 85.1%. A SIB of 29 Gy was applied to 60.7% of the patients, while 39.3% did not have a boost indication. Breast radiation therapy (RT) with SIB to the tumor bed and regional node irradiation was done in 5.4 % of patients.</p><p><strong>Results: </strong>Most patients were treated with Volumetric modulated arc therapy (66.1%) and intensity modulated RT (30.6%). One patient received treatment by 3-dimensional techniques (0.4%) and 7 patients (2.9%) a combined intensity modulated RT-3-dimensional technique. Deep inspiration breath-hold was used in 16.9% of cases. At the end of treatment, erythema grade (G) 0 was presented in 56.1%, G1 in 43.1%, and G2 in 0.8%. G1 edema was observed in 14.6% and less than 1% had G2. After 6 months, 97% had G0 erythema, 3% G1, and 0% G2, while G1 edema was observed in 11.4% and G2 in 2.5%. No statistically significant impact on side effects was found for planning target volume breast and planning target volume boost volumes.</p><p><strong>Conclusions: </strong>UHF with SIB of 29 Gy to the tumor bed in patients with early-stage breast cancer is clinically feasible, safe, and free of an excess of early side effects. Further analysis of late toxicity is needed.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Neoadjuvant Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Adenocarcinoma-A Systematic Review and Meta-Analysis.","authors":"Hsiao-Yu Wu, Hsiao-Hui Tsou, Long-Sheng Lu, Hsin-Lun Lee, Jeng Fong Chiou, Hui-Ju Ch'ang","doi":"10.1016/j.ijrobp.2025.02.037","DOIUrl":"10.1016/j.ijrobp.2025.02.037","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials and meta-analyses have indicated longer survival with neoadjuvant than with adjuvant therapy in patients with resectable or borderline resectable (R/BR) pancreatic adenocarcinoma. Despite the efficacy of chemotherapy, the role of radiation therapy as an adjuvant or neoadjuvant treatment for patients with R/BR pancreatic adenocarcinoma remains unclear. In this systematic review and meta-analysis, we compared the benefits of additional chemoradiation therapy (CRT) to neoadjuvant chemotherapy (NAC) with NAC alone for R/BR pancreatic adenocarcinoma.</p><p><strong>Methods and materials: </strong>A systematic literature search was conducted on Embase, Web of Science, PubMed, Cochrane, and Google Scholar. Median overall survival (OS) was the primary endpoint. Secondary endpoints included disease-free survival (DFS), resection rate, and R0 resection rate.</p><p><strong>Results: </strong>This review and meta-analysis included 31 prospective studies, of which 9 were randomized trials. In these studies, 658 patients from 14 study arms received NAC alone and 912 patients from 19 study arms received both NAC and CRT (NAC-CRT). The pooled median OS was 25.55 months (95% CI, 21.59-30.24 months) for NAC alone and 17.55 months (95% CI, 16.47-18.70 months; P < .0001) for NAC-CRT. The pooled R0 resection rate was higher with NAC-CRT (83.43%) than with NAC (69.97%; P < .0001). No significant difference was observed in DFS or resection rate between the 2 groups. In patients who received 5 or more cycles of initial chemotherapy, NAC-CRT was associated with longer OS than NAC (23.30 vs 21.85 months; P = .856).</p><p><strong>Conclusions: </strong>NAC provides significantly longer OS than NAC-CRT to R/BR pancreatic adenocarcinoma. NAC-CRT is associated with a significantly improved R0 resection rate. This positive local effect of CRT can be translated to extended survival when 5 cycles or more of NAC are prescribed.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}