Radiation Oncology Journal最新文献

{"title":"Trends in the use of radiation for meningioma across the United States","authors":"H. Matani, S. Abel, A. Yu, S. Karlovits, R. Wegner","doi":"10.3857/roj.2021.00563","DOIUrl":"https://doi.org/10.3857/roj.2021.00563","url":null,"abstract":"Purpose Meningiomas are tumors originating from arachnoid cap cells on the surface of the brain or spinal cord. Treatment differs by grade but can consist of observation, surgery, radiation therapy or both. We utilized the National Cancer Database (NCDB) to compare trends in the use stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) in the management of meningioma. Materials and Methods We queried the NCDB from 2004–2015 for meningioma patients (grade 1–3) treated with radiation therapy, either SRS or EBRT. Multivariable logistic regression was used to identify predictors of each treatment and to generate a propensity score. Propensity adjusted Kaplan-Meier survival curve analysis and multivariable Cox hazards ratios were used to identify predictors of survival. Results We identified 5,406 patients with meningioma meeting above criteria with 45%, 44%, and 11% having World Health Organization (WHO) grade 1, 2, and 3 disease, respectively. Median follow up was 43 months. Predictors for SRS were grade 1 disease, distance from treatment facility, and histology. The only predictor of EBRT was grade 3 disease. Treatment year, histology, race and female sex were associated with improved survival. Five- and 10-year survival rates were 89.2% versus 72.6% (p < 0.0001) and 80.3% versus 61.4% (p = 0.29) for SRS and EBRT respectively. After propensity matching 226 pairs were generated. For SRS, 5-year survival was not significantly improved at 88.2% compared with EBRT (p = 0.056). Conclusion In the present analysis, predictors of SRS utilization in management of meningioma include WHO grade 1 disease, distance from treatment facility and histology whereas conventional EBRT utilization was associated with grade 2 and 3 disease. Future studies need to be performed in order to optimize management of atypical and malignant meningioma.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"8 1","pages":"29 - 36"},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82989887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of low-dose radiotherapy in Kasabach-Merritt syndrome","authors":"Dowook Kim, J. Choi, K. Hong, H. Kang, I. Kim, J. Lee","doi":"10.3857/roj.2021.00983","DOIUrl":"https://doi.org/10.3857/roj.2021.00983","url":null,"abstract":"Purpose Reports on results of radiation therapy (RT) for Kasabach-Merritt syndrome (KMS) are limited. We performed a retrospective study to evaluate the response rates and late complications and to determine the adequate RT dose for patients with KMS patients. Materials and Methods We studied 11 patients who received RT between October 1988 and September 2008 for KMS refractory to pharmacologic therapy. All patients had external hemangiomas and received the diagnosis of KMS within 12 months of birth. All 11 patients received steroids as the first-line therapy; eight patients additionally received interferon-α therapy, and one patient underwent surgery. Nine patients underwent single-course RT with a total dose of 4.5–8 Gy (1.5–2 Gy/fraction). Two patients received multiple courses of RT, with a cumulative total dose of 12 Gy (2 Gy/fraction) and 18 Gy (1.5 Gy/fraction), respectively. Results The median follow-up period was 156 months (interquartile range [IQR], 75 to 226 months). The median total dose of RT was 6 Gy, and all patients maintained complete remission until the last follow-up. An additional course of RT was performed for refractory cases or cases of local relapse after initial RT. Rapid platelet count increase after RT was seen in most patients, which returned to normalcy in a median of 20 days (IQR, 5 to 178 days). However, seven patients experienced radiation-related long-term complications. Conclusion Low-dose RT is effective and yields rapid response in patients with KMS. However, given growth-related late complications, RT should be carefully considered.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"26 1","pages":"45 - 52"},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86104140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation therapy in chronic hidradenitis suppurativa: case report","authors":"P. Sakyanun, Thirada Vongvanichvathana, P. Lertsanguansinchai","doi":"10.3857/roj.2021.00570","DOIUrl":"https://doi.org/10.3857/roj.2021.00570","url":null,"abstract":"A 26-year-old female presented recurrent painful, carbuncles at both axillae for 10 years. It caused offensive odor and scar. Tissue diagnosis was chronic hidradenitis suppurativa. She was treated using antibiotics followed by multiple excisions with drainage but showed no improvement. Isotretinoin provided no benefit. She was socially isolated and experienced lower quality of life. Consequently, she was sent for radiation therapy. Computed tomography simulation was performed revealing an ulcer with deep chronic pus tracts at her axilla. Three-dimensional conformal radiation therapy was provided with 6 MV photon (7.5 Gy in 3 fractions) covering all ulcers and pus tracts. On the last day of radiation therapy, carbuncles and wounds at the left axilla exhibited much improvement without pus. Three months follow-up showed much improvement of the lesions. The skin was smoother without pus or odor. Radiation therapy was confirmed one treatment option for chronic hidradenitis suppurativa.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"19 5 1","pages":"79 - 85"},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85439440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal positive lymph node ratio showing the benefit of postoperative radiotherapy in pathologic N2 non-small cell lung cancer: an exploratory study using the Surveillance, Epidemiology, and End Results data","authors":"Shiho Lee, Kyu Noh","doi":"10.3857/roj.2021.00969","DOIUrl":"https://doi.org/10.3857/roj.2021.00969","url":null,"abstract":"Purpose This study aimed to identify the clinical parameters having the beneficial effect of postoperative radiotherapy (PORT) in pathologic N2 (pN2) non-small cell lung cancer (NSCLC) using the Surveillance, Epidemiology, and End Results (SEER) data. Materials and methods Among non-metastatic NSCLC patients in the SEER data, we included patients who diagnosed after 2002, who confirmed as pN2 after lobectomy or pneumonectomy, and who coded as underwent PORT or observation. Patients who survived less than 4 months of diagnosis were excluded in consideration of the perioperative mortality. After performing propensity score matching (PSM) on the selected patients, we compared PORT group with surgery alone group. We also performed exploratory subgroup analysis to find patients who could benefit from PORT. Results Among the selected 4,456 patients, 1,729 patients received PORT, and 2,727 patients did not. There was no survival benefit of PORT in all patients with pN2 disease (hazard ratio [HR] = 1.03, p = 0.5). In subgroup analyses, the patients with a positive lymph node (LN) ratio of 60%–80% showed the significant benefit of PORT (HR = 0.71, p = 0.002). Conclusion PORT did not show the significant survival benefit in patients with pN2 disease after correcting the confoundedness in the SEER data. However, a specific range of LN ratios can be a potential indicator maximizing the survival benefit of PORT.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"236 1","pages":"37 - 44"},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72419701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Abscopal effect in the radio and immunotherapy”","authors":"François Fabi","doi":"10.3857/roj.2022.00017","DOIUrl":"https://doi.org/10.3857/roj.2022.00017","url":null,"abstract":"general understanding of the abscopal effect. As mentioned by the authors, while this phenomenon has been described for decades, the underlying molecular mechanisms allowing localized radiation to exert a disseminated anti-tumoral effect remains profoundly opaque. Although a multiplicity of pathways, effectors and mediators have been described, little work yielded results which could allow the clinical instrumentalization of this effect. In this review, the authors report the proposed unifying mechanism allowing distant effect of localized radiation therapy, which hinges on the activation of local CD T lymphocytes. These effector cells are exposed and primed to tumoral antigens and then exported to distant lesion sites, where they operate their cytolytic effect. The authors also mention that the generation of a large amount of de novo tumor antigens is responsible for robust immunogenicity, which is required to achieve potent activation of local leukocytes, as confirmed by others [2]. We do agree that tumor mutational burden (TMB) is usually considered as the primary predictor of neoantigen load, which is itself ontologically associated with tumoral immunoreactivity [3]. However, as underlined in pancreatic cancer [4] as well as other organ systems, distinct orthogonal signatures, like chemokine expression, can be used as robust, complementary proxies of the degree of tumoral T-cell infiltration and activation, even in the absence of high TMB or neoantigens. Alternatively, a variety of molecular signatures characteristic of T cell-inflamed phenotypes have been identified, with high T-cell infiltration generally predictive of good immunotherapeutic response. This, in turn, provides a plausibly robust prognosticator of response to immune checkpoint inhibitors [5]. In essence, it is suggested that tumoral immunogenicity, and response to immunotherapy, are not solely contingent on neoantigens and, by extension, TMB. Indeed, recent analysis of the phase 2 pan-cancer study (CA209-538) demonstrated no predictive value of TMB to response to combined PD-1/CTLA-4 (programmed cell death protein-1/cytotoxic T lymphocyte antigen-4) checkpoint inhibition [6]. Rather, tumor infiltration by competent lymphocytes, which appears to be associated with different immunobiologically relevant signatures, could be a complementary, powerful metric of predicted therapeutic sensitivity to both radio and immunotherapies. We agree with the authors that identifying lesions most likely to generate systemic response to loComment on “Abscopal effect in the radio and immunotherapy”","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"10 1","pages":"86 - 87"},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90292899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunomodulatory effect of splenectomy in lung cancer mouse xenograft models receiving radiation therapy","authors":"Yeeun Kim, Changhoon Choi, Jee Hyun Park, Wongyun Ahn, S. Shin, Shin-Yeong Kim, J. Noh","doi":"10.3857/roj.2021.00885","DOIUrl":"https://doi.org/10.3857/roj.2021.00885","url":null,"abstract":"Purpose This study aims to investigate the effect of splenectomy on radiation-mediated growth inhibition and immune modulation in lung cancer xenograft models. Materials and Methods Human non-small cell lung cancer H1299 cells and murine Lewis lung carcinoma LL/2-luc cells were injected into the right hind leg of BALB/c-nude mice and C57BL/6 mice, respectively. Splenectomy or sham operation was performed prior to tumor cell injection or before and after irradiation during tumor growth. Irradiation was delivered with 2–3 fractions of 6 Gy X-ray using a linear accelerator. Flow cytometry analysis was performed for immune cell profiling. Results Splenectomy prior to tumor injection or at early stage inhibited growth of LL/2-luc tumors but not that of H1299 tumors; however, it did not enhance the antitumor effect of radiation regardless of intervention timing. Flow cytometry analysis showed monocytic myeloid-derived suppressor cells (MDSCs) and activated CD8+ T cells increased after irradiation in the tumors of splenectomized mice, compared to those of sham-operated mice. Administration of anti-PD-1 (programmed death-1) antibodies improved the ability of splenectomy to attenuate the growth of irradiated tumors. Conclusion Splenectomy has paradoxical effects on radiation-induced tumor growth inhibition, depending on tumor types and intervention timing, but it has an immune-modulating effect when combined with radiation.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"65 1","pages":"53 - 65"},"PeriodicalIF":2.3,"publicationDate":"2022-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74679562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewing the potential role of radiation therapy in gallbladder cancer: an update","authors":"Divyesh Kumar, N. Kiran, D. Khosla","doi":"10.3857/roj.2021.00717","DOIUrl":"https://doi.org/10.3857/roj.2021.00717","url":null,"abstract":"Gallbladder cancer is a highly malignant disease with a poor prognosis. It is the most common cancer of the biliary tract pathway. Although surgery remains the treatment of choice for early-stage disease, majority of the patients presents in locally advanced, unresectable and metastatic stage of the disease. Radiotherapy and chemotherapy thus form an integral part of management for these locally advanced staged patients. The role of radiation though has been advocated in gallbladder cancer, majorly in the adjuvant setting, its role in neoadjuvant and palliative settings remains in an evolving phase. The article thus aims to review and update the existing literature regarding the role of radiation therapy in gallbladder cancer.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"112 1","pages":"1 - 8"},"PeriodicalIF":2.3,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87657370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of somatic mutations on clinical and pathologic outcomes in borderline resectable and locally advanced pancreatic cancer treated with neoadjuvant chemotherapy and stereotactic body radiotherapy followed by surgical resection.","authors":"Abhinav V Reddy, Colin S Hill, Shuchi Sehgal, Ding Ding, Amy Hacker-Prietz, Jin He, Lei Zheng, Joseph M Herman, Jeffrey Meyer, Amol K Narang","doi":"10.3857/roj.2021.00815","DOIUrl":"10.3857/roj.2021.00815","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine if somatic mutations are associated with clinical and pathologic outcomes in patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who were treated with neoadjuvant chemotherapy and stereotactic body radiotherapy (SBRT).</p><p><strong>Materials and methods: </strong>Patients treated with neoadjuvant chemotherapy and SBRT followed by surgical resection from August 2016 to January 2019 and who underwent next generation sequencing of their primary tumor were included in the study. Next-generation sequencing was performed either in-house with a Solid Tumor Panel or with FoundationOne CDx. Univariate (UVA) and multivariable analyses (MVA) were performed to determine associations between somatic mutations and pathologic and clinical outcomes.</p><p><strong>Results: </strong>Thirty-five patients were included in the study. Chemotherapy consisted of modified FOLFIRINOX, gemcitabine and nab-paclitaxel, or gemcitabine and capecitabine. Patients were treated with SBRT in 33 Gy in 5 fractions. On UVA and MVA, tumors with KRAS G12V mutation demonstrated better pathologic tumor regression grade (TRG) to neoadjuvant therapy when compared to tumors with other KRAS mutations (odds ratio = 0.087; 95% confidence interval [CI], 0.009-0.860; p = 0.036). On UVA and MVA, mutations in NOTCH1/2 were associated with worse overall survival (hazard ratio [HR] = 4.15; 95% CI, 1.57-10.95; p = 0.004) and progression-free survival (HR = 3.61; 95% CI, 1.41-9.28; p = 0.008). On UVA, only mutations in NOTCH1/2 were associated with inferior distant metastasis-free survival (HR = 3.38; 95% CI, 1.25-9.16; p = 0.017).</p><p><strong>Conclusion: </strong>In BRPC and LAPC, the KRAS G12V mutation was associated with better TRG following chemotherapy and SBRT. Additionally, NOTCH1/2 mutations were associated with worse overall survival, distant metastasis-free survival, and progression-free survival.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"39 4","pages":"304-314"},"PeriodicalIF":2.3,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b8/bd/roj-2021-00815.PMC8743453.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39875986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical factors affecting the determination of radiotherapy-induced skin toxicity in breast cancer.","authors":"Elisa Eugenia Córdoba,&nbsp;Ezequiel Lacunza,&nbsp;Alba Mabel Güerci","doi":"10.3857/roj.2020.00395","DOIUrl":"https://doi.org/10.3857/roj.2020.00395","url":null,"abstract":"<p><strong>Purpose: </strong>Radiotherapy is essential for the treatment of breast cancer (BC). However, adverse effects may occur in healthy tissue, during treatment and even after several months. Although it is known that this clinical radiosensitivity is multifactorial, the factors involved are unknown yet. In this study, we evaluated the effect of these factors on the development of radiodermatitis in patients undergoing radiotherapy.</p><p><strong>Materials and methods: </strong>Demographic and lifestyle data collected during face-to-face interviews of 122 BC patients and data from clinical records were investigated. Most patients underwent conventional three-dimensional radiotherapy treatment. A total dose of 50 Gy was administered (2 Gy/day), followed by a boost in a tumor bed with a total dose of 18 Gy (2 Gy/day). Radiotoxicity was evaluated weekly using the Radiation Therapy Oncology Group classification system (range, 0 to 4, according to the severity).</p><p><strong>Results: </strong>In the present study, 75.4% of patients presented acute skin toxic effects with different degrees of severity. In 25% of cases, these effects manifested at the end of the fourth week at a cumulative dose of 40 Gy. The association of grade ≥2 acute skin reactions with body mass index (BMI) and breast size and between grade 3-4 and age was positive compared with controls. However, the role of the other factors could not be confirmed.</p><p><strong>Conclusion: </strong>Analysis of the factors related to individual radiosensitivity suggests that age, BMI and breast size play an important role in the development of acute skin toxicity during treatment. Particular attention to patients who present these characteristics would help to control treatment effectiveness and therefore optimize their quality of life.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"39 4","pages":"315-323"},"PeriodicalIF":2.3,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/85/roj-2020-00395.PMC8743461.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39875987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma-ray irradiation modulates PGRMC1 expression and the number of CD56+ and FoxP3+ cells in the tumor microenvironment of endometrial endometrioid adenocarcinoma.","authors":"Dmitry Aleksandrovich Zinovkin,&nbsp;Yulia Anatolievna Lyzikova,&nbsp;Eldar Arkadievich Nadyrov,&nbsp;Daniil Rudolfovich Petrenyov,&nbsp;Jale Yuzugulen,&nbsp;Md Zahidul Islam Pranjol","doi":"10.3857/roj.2021.00472","DOIUrl":"https://doi.org/10.3857/roj.2021.00472","url":null,"abstract":"<p><strong>Purpose: </strong>Although the conventional gamma ray brachytherapy has been successful in treating endometrioid endometrial adenocarcinoma (EC), the molecular and cellular mechanisms of this anti-tumorigenic response remain unclear. Therefore, we investigated whether gamma ray irradiation induces changes in the number of FoxP3+ T-regulatory lymphocytes (Tregs), CD56+ natural killer cells (NK), and the expression of progesterone receptor membrane component 1 (PGRMC1) in the tumor microenvironment (TME).</p><p><strong>Materials and methods: </strong>According to the inclusion criteria, 127 cases were selected and grouped into irradiation-treated (Rad+) and control (underwent surgery) groups and analyzed using immunohistochemistry. Predictive prognostic values were analyzed using Mann-Whitney U test, ROC analysis, relative risk, log-rank, Spearman rank tests and multivariate Cox's regression.</p><p><strong>Results: </strong>We observed significant differences (p < 0.001) between the radiation-treated patients and the control groups in FoxP3+ Tregs numbers, CD56+ NK cells and PGRMC1 expression. Gamma ray induced a 3.71- and 3.39-fold increase in the infiltration of FoxP3+ cells, CD56+ NK cells, respectively and 0.0034-fold change in PGRMC1 expression. Univariate and multivariate analyses revealed predictive role of the parameters. In the irradiated patients' group, inverted correlations between clinical unfavorable outcome, FoxP3+ Tregs and CD56+ NK cells were observed.</p><p><strong>Conclusion: </strong>Our results suggest an immune-modulating role, specifically by increasing immune cell infiltration, of gamma radiation in the TME which may potentially be utilized as biomarkers in prognostic values.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"39 4","pages":"324-333"},"PeriodicalIF":2.3,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/34/roj-2021-00472.PMC8743460.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39875988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}