Practical Radiation Oncology最新文献

{"title":"Intrafraction Patient Positional Uncertainty in Lung Stereotactic Ablative Radiotherapy with Abdominal Compression.","authors":"Yohan A Walter, Chiachien J Wang, Daniel B Speir, William E Burrell, Carlos D Palomeque, James C Henry, Megan M Rodrigues, Troy D Jacobs, Bethany L Broekhoven, Joseph P Dugas, Anne N Hubbard, Philip F Durham, Hsinshun T Wu","doi":"10.1016/j.prro.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.001","url":null,"abstract":"<p><strong>Purpose: </strong>Motion management presents a significant challenge in thoracic stereotactic ablative radiotherapy (SABR). Currently, a 5.0 mm standard planning target volume (PTV) margin is widely used to ensure adequate dose to the tumor. Considering recent advancements in tumor localization and motion management, there is merit to reassessing the necessary PTV margins for modern techniques. This work presents a large-scale analysis of intrafraction repositioning for lung SABR under forced shallow breathing to determine the margin requirements for modern delivery techniques.</p><p><strong>Methods and materials: </strong>Treatment data for 124 lung SABR patients treated in 607 fractions on a linear accelerator were retrospectively collected for analysis. All patients were treated using pneumatic abdominal compression and intrafraction 4D cone beam computed tomography (4D CBCT)-guided repositioning halfway through treatment. Executed repositioning shifts were collected and used to calculate margin requirements using the 2-standard deviation (2SD) method and an analytic model which accounts for systematic and random errors in treatment.</p><p><strong>Results: </strong>85.7% of treated fractions had 3D repositioning shifts under 5.0 mm. 53 fractions (8.7%) had shifts ≥5.0 mm in at least one direction. Margins in the right-left, inferior-superior, and posterior-anterior directions were 3.62 mm, 4.34 mm, and 3.50 mm, respectively, calculated using the 2SD method. The analytic approach estimated 4.01 mm, 4.37 mm, and 3.95 mm margins were appropriate for our workflow. Executing intrafraction repositioning reduced margin requirements by 0.73 ± 0.07 mm.</p><p><strong>Conclusions: </strong>Clinical data suggests that the uniform 5.0 mm margin is conservative for our workflow. Utilizing modern techniques such as 4D CT, 4D CBCT, and effective motion management can significantly reduce required margins, and therefore necessary healthy tissue dose. However, the limitations of margin calculation models must be considered, and margin reduction must be approached with caution. Users should conduct a formal risk assessment prior to adopting new standard PTV margins.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903455","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":"Radiopharmaceutical therapy and radioembolization: Clinical guidance for medical physicists in radiation oncology.","authors":"Jonathan A Polignani, Kenneth J Nichols","doi":"10.1016/j.prro.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.005","url":null,"abstract":"<p><p>Recent advances in radiopharmaceutical therapy (RPT) and radioembolization (RE) will make these forms of therapy more prevalent in radiation oncology and nuclear medicine clinics. This article guides medical physicists in radiation oncology by summarizing current RPT and RE techniques, processes, safety, quality assurance, equipment, etc. The summarized guidance, which addresses technical considerations, may be applied broadly to develop a clinical RPT/RE program that offers multiple types of such therapies.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903660","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":"Patterns of recurrence following radiation and ADT for pathologic lymph node positive prostate cancer: A multi-institutional study.","authors":"Leslie K Ballas, Chandana A Reddy, Hye Ri Han, Jelena B Makar, Omar Mian, James Broughman, Conchita de Bustamante, Scott Eggener, Stanley L Liauw, Matthew Abramowitz, Christopher Montoya, Rahul Tendulkar","doi":"10.1016/j.prro.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.006","url":null,"abstract":"<p><strong>Background and objective: </strong>We evaluate prognostic factors and patterns of recurrence in patients who received RT ± androgen deprivation therapy (ADT) for pathologic node-positive (pN1) prostate cancer (PCa) in a multi-institutional cohort.</p><p><strong>Methods: </strong>Data from patients with pN1 PCa and received RT with short term (ST, ≤6 mo) or long term (LT, >6 mo) ADT were obtained from 4 academic institutions. Biochemical progression free survival (bPFS) and distant metastasis free survival (DMFS) were evaluated.</p><p><strong>Key findings and limitations: </strong>270 patients were included, with a median follow-up of 48 months. 256 (95%) patients had extracapsular extension, 70% had seminal vesicle invasion, 59% had positive surgical margins, 49% had grade group 5, and 64% had a detectable (>0.1 ng/mL) post-operative PSA. ADT was ST (20%) or LT (68%, median 24 months), while 26 (10%) received no ADT. Biochemical failure (bF) was observed in 29%, with 5% having pelvic nodal failure and 11% having distant metastases. The 4-year bPFS was 72% overall, and was 83% for a pre-RT PSA of <0.1 ng/mL, 76% for PSA 0.1-<0.5 ng/mL, 60% for PSA 0.5-2 ng/mL, and 35% for PSA >2 ng/mL (p<0.0001). On multivariable analysis, pre-RT PSA >0.5 (0.5 to 2.0 vs <0.1 HR=2.97; >2.0 vs <0.1 HR=7.63), use of LT ADT vs no ADT (HR=0.43) and use of LT ADT compared to ST ADT (HR= 0.34), Grade group 4 vs 2 (HR=4.11), and positive surgical margins (HR 1.773) were significantly associated with bPFS.</p><p><strong>Conclusions: </strong>Post-prostatectomy RT at PSA <0.5 ng/mL is associated with favorable bPFS in pN1 prostate cancer.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903383","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":"Defining an Undergraduate Radiation Oncology Microclerkship via the Delphi Method.","authors":"Julia Willcox, Austin T Gregg, Steve Braunstein, Malcolm D Mattes, Jillian Gunther, Matthew Abrams","doi":"10.1016/j.prro.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.003","url":null,"abstract":"<p><strong>Purpose: </strong>Many medical students in the U.S. lack formal exposure to radiation oncology (RO). In contrast to multi-week electives, microclerkships, defined here as brief (<1 week) observerships, could provide exposure to RO. The primary objective of this study was to establish expert consensus for the duration, curriculum, target audience, and goals/objectives of a RO microclerkship. With these components, the microclerkship aims to provide medical students with necessary exposure to RO.</p><p><strong>Materials and methods: </strong>A needs assessment evaluating the demand for, and essential elements of, a RO microclerkship was distributed to medical student clerkship directors. Based on responses, authors developed a preliminary set of seven goals, five objectives, and four curricular items. These were refined through an iterative Delphi process. Three surveys were sent to seven medical education experts across several institutions and medical specialties. Surveys asked experts to rank elements for inclusion, comment on clarity, and suggest new elements. Consensus threshold was defined as 83% of respondents selecting \"Definitely Include\" or \"Maybe Include\". The final survey asked experts to explain selection of exclusionary options.</p><p><strong>Results: </strong>Surveys demonstrated that third-year medical students and 3-5 days were the ideal target audience and duration for a RO microclerkship. Final goals emphasized the following: role/value of RO, understanding of RO mechanisms, RO integration in care, interdisciplinary management, longitudinal care, and workflow. Final objectives included seeing a consult, follow-up, and on-treatment visit, participating in a simulation, and observing contouring, treatment planning. and radiation plan review. Curricular items were pre-clinic/post-clinic quizzes, 1-hour introduction to RO lecture, and shadowing experience.</p><p><strong>Conclusions: </strong>Through the Delphi process, we have established a framework for a RO microclerkship with a consensus duration, curriculum, target audience, and goals/objectives. Integration of this 3-5 day microclerkship into third-year medical school curricula would provide an avenue for increased exposure to RO during undergraduate medical education.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902870","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":"On-Table Virtual Reality to Reduce Anxiety/Distress during Radiotherapy Treatments: A Pilot Randomized Trial.","authors":"Petra Woehrle, Bari Hillman, Nicole Herstad, Anna Hjelle, Xuan Li, Mark Ingram, Nils D Arvold","doi":"10.1016/j.prro.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.004","url":null,"abstract":"<p><p>We report the first randomized trial of a virtual reality (VR) headset used on-table during external beam radiotherapy treatments to reduce anxiety/distress during receipt of radiotherapy. A small pilot study was conducted among 10 patients, with VR randomized to start in the first week ('immediate VR') vs. second week ('delayed VR') of treatment. All patients (100%) in the immediate VR group had declines in measured distress scores after their first radiation treatment, compared to only 1 patient (16.7%) in the delayed VR group (P = .048), yet score declines generally did not meet the minimal clinically important difference threshold in the context of overall low distress scores at baseline. By day 5 of treatment, distress score changes were similar between immediate and delayed VR groups. Overall, 80% of patients in the study, including all patients with moderate or high level of baseline anxiety/distress, reported that on-table VR improved their radiotherapy experience and/or they would recommend VR to others. We propose that on-table VR is a readily-available, non-pharmacologic intervention that can be utilized to help reduce anxiety/distress associated with radiotherapy, and may be particularly helpful at the start of treatment among those with moderate/high baseline levels of anxiety/distress.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899252","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":"Highs and Lows of Spatially Fractionated Radiation Therapy: Dosimetry and Clinical Outcomes.","authors":"Dawn Owen, W Scott Harmsen, Safia K Ahmed, Ivy A Petersen, Michael G Haddock, Daniel J Ma, Sidney Pulsipher, Kimberly S Corbin, Scott C Lester, Sean S Park, Christopher L Deufel, James A Kavanaugh, Michael P Grams","doi":"10.1016/j.prro.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.002","url":null,"abstract":"<p><strong>Objectives: </strong>Spatially fractionated radiation therapy (SFRT) intentionally delivers a heterogeneous dose distribution characterized by alternating regions of high and low doses throughout a tumor. This modality may enhance response to subsequent whole tumor radiation in bulky and radioresistant lesions that are historically less responsive to conventional radiation doses alone. The current study presents a single institution experience with modern era SFRT using predominantly a volumetric modulated arc therapy (VMAT) lattice technique.</p><p><strong>Methods: </strong>Patients treated with SFRT between 10/2019 and 6/2022 were included for analysis. Patient characteristics, tumor characteristics, and dosimetric parameters were collected retrospectively as part of an institutional review board approved registry and protocol. Descriptive statistics were used to collate patient data and Kaplan Meier analysis were generated for overall survival and local control. Univariate analyses were used to investigate factors associated with outcomes.</p><p><strong>Results: </strong>A total of 176 patients with 186 sites treated were included. Median age was 64 and the most commonly treated histologies were non-small cell lung cancer and sarcoma. The most common SFRT dose was 20 Gy in 1 fraction with 88% of patients receiving follow-up whole tumor radiotherapy to a median EQD2 dose of 32.5 Gy (α/β=10). Median gross tumor volume (GTV) was 480.5 cc (7.8-10,897.8). Median follow-up was 322 days with 1 year overall survival 37% and 1 year local control 81%. Local control was available in 138 treated sites (131 patients. SFRT factors including dose to 10% (D10%), dose to 90% (D90%), equivalent uniform dose, and mean dose were highly predictive of local control. Grade 3 toxicity occurred in 9 patients. All of these patients received follow-up whole tumor radiation and at least two of these were attributable to unexpected rapid regression of tumor.</p><p><strong>Conclusions: </strong>SFRT is a promising technique that appears to confer good local control across a disparate group of patients with bulky and radioresistant tumors. Dosimetric parameters of SFRT treatment plans may be independent predictors of local control. Further investigation is warranted as are prospective trials to evaluate the role of SFRT in both the palliative and definitive setting.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900445","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":"RadOncCalc: A Mobile-Friendly Tool to Enhance Radiation Oncology Practice.","authors":"Matthew M Culbert, Hope Boucher, Armita Motaparthi, Swati Vanaparthy, Jeffrey M Ryckman","doi":"10.1016/j.prro.2024.11.009","DOIUrl":"https://doi.org/10.1016/j.prro.2024.11.009","url":null,"abstract":"<p><p>This study introduces RadOncCalc, a mobile and web-based platform designed to consolidate oncology research and guidelines into one accessible tool for radiation oncologists. By providing up-to-date dose constraints and contouring guidelines, RadOncCalc enhances clinical decision-making and patient care quality in radiation oncology.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856674","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":"Reirradiation in the Management of Locally Recurrent Rectal Adenocarcinoma.","authors":"Michael S Rutenberg, Michael D Chuong, Jessica M Frakes","doi":"10.1016/j.prro.2024.11.008","DOIUrl":"https://doi.org/10.1016/j.prro.2024.11.008","url":null,"abstract":"<p><p>Rectal cancer recurrence after prior radiotherapy presents a difficult treatment challenge. Salvage treatment can be curative, however, it often requires multimodal therapy which can come with significant treatment related morbidity. Reirradiation is a common part of treatment considerations in this setting and presents challenges in balancing appropriately aggressive therapy to improve disease control and cure rates with the addition of excess toxicity. Surgery remains the mainstay of curative salvage therapy for locally recurrent rectal cancer (LRRC) after prior radiation. Preoperative reirradiation improves R0 resection rates and local control and is associated with improved disease control outcomes. Altered fractionationation and intraoperative radiotherapy are often used to improve the therapeutic ratio in the setting of reirradiation for LRRC. Herein we discuss the evidence supporting multimodal salvage therapy for LRRC, including the importance of surgical salvage, the benefits of reirradiation, various approaches for reirradiation, and treatment associated toxicities. Finally, we provide our recommendations for how to approach reirradiation for locally recurrent rectal cancer.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822839","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":"Impact of the ASTRO 2024 Guideline on Partial Breast Irradiation Eligibility in Breast Cancer Patients (KROG 24-01).","authors":"Seok-Joo Chun, Sangjoon Park, Yong Bae Kim, Sung-Ja Ahn, Kyubo Kim, Kyung Hwan Shin","doi":"10.1016/j.prro.2024.11.007","DOIUrl":"10.1016/j.prro.2024.11.007","url":null,"abstract":"<p><strong>Purpose: </strong>The American Society for Radiation Oncology (ASTRO) has recently published new guidelines for the eligibility for partial breast irradiation (PBI). This study aims to evaluate the eligibility rates of PBI according to the ASTRO 2017 and 2024 guidelines.</p><p><strong>Methods and materials: </strong>Patients diagnosed with pTis-T2N0 breast cancer in 2019 from 3 tertiary medical centers were accrued. All patients received standard treatment consisting of breast-conserving surgery followed by radiation therapy. Subsequently, patients were classified according to the ASTRO 2017 and 2024 guidelines.</p><p><strong>Results: </strong>For invasive breast cancer, 785 patients were included, among whom 192 received PBI. Classification according to the ASTRO guidelines showed a substantial increase in the proportion of patients eligible for PBI: 19.2% were classified as \"suitable\" under the ASTRO 2017 guidelines, while 42.4% were classified as \"strongly recommended\" under the ASTRO 2024 guidelines. Among 286 patients diagnosed with ductal carcinoma in situ (DCIS), 50 (17.5%) received PBI. The proportion of PBI-eligible patients nearly doubled, from 27.3% under the ASTRO 2017 guidelines to 51.7% under the ASTRO 2024 guidelines. The expanded age criterion from 50 to 40 years and the removal of the clear resection margin requirement were key factors contributing to this substantial increase in both invasive breast cancer and DCIS.</p><p><strong>Conclusions: </strong>The eligibility for PBI has dramatically increased for both invasive breast cancer and DCIS under the ASTRO 2024 guidelines. These findings suggest a potential for increased use of PBI, offering individualized and optimized treatment options in early breast cancer.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820011","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":"Dose Planning and Radiation Optimization for Thoracic Conventional, Twice Daily, and Stereotactic Radiation Therapy: A Delphi Consensus From a National Survey of Practitioners.","authors":"Julius Weng, Jeff Ryckman, Matthew S Katz, Hina Saeed, Christopher Estes, Issam El Naqa, Amy Moreno, Sue S Yom","doi":"10.1016/j.prro.2024.11.006","DOIUrl":"10.1016/j.prro.2024.11.006","url":null,"abstract":"<p><strong>Purpose: </strong>We sent surveys to a large number of radiation oncologists with active thoracic cancer practices and applied the Delphi method over 3 rounds to generate consensus dose-volume histogram metrics. We used these results to create consensus-based organs-at-risk dose constraints and target goal templates for practical implementation.</p><p><strong>Methods and materials: </strong>In this institutional review board-approved study, data were collected using REDCap electronic data capture on a secure server. Radiation oncologists identified from the Accreditation Council for Graduate Medical Education-accredited departments' websites were asked to confirm their self-identification as thoracic radiation oncologists and nominate other respondents. All invitees were asked to complete 3 rounds of questions related to normal tissue constraints, target coverage metrics, prescribing practices, and other planning considerations. Preliminary consensus statements were presented in the second round of surveys for voting on a 5-point Likert scale. The third and last round of surveys presented the iterated consensus statements and target coverage metric statements for final voting. The high consensus was predefined as ≥ 75% agreement.</p><p><strong>Results: </strong>Eighty-three (42.8%) of 194 invitees completed at least 1 round of surveys. The group included a diversity of gender, geography, and clinical settings. Response rates were 83%, 57%, and 55%, respectively, for the 3 rounds. By the end of the process, 48 of 96 (50%) originally proposed normal tissue dose constraint statements were iterated to consensus, and 5 of 7 (71%) proposed target coverage metric statements achieved consensus. These were used to create crowdsourced treatment planning templates.</p><p><strong>Conclusion: </strong>This study achieved broad-based consensus-building on ideal and acceptable dose constraints for conventional, twice-daily, and stereotactic thoracic radiation therapy. Future directions could include extending this approach to other disease sites, studying the influence of widespread implementation on treatment planning, or facilitating the development of community consensus around emergent or controversial questions.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774823","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}