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  • 1.
    Adjeiwaah, Mary
    et al.
    Umea Univ, Dept Radiat Sci, SE-90187 Umea, Sweden..
    Bylund, Mikael
    Umea Univ, Dept Radiat Sci, SE-90187 Umea, Sweden..
    Lundman, Josef A.
    Umea Univ, Dept Radiat Sci, SE-90187 Umea, Sweden..
    Karlsson, Camilla Thellenberg
    Umea Univ, Dept Radiat Sci, SE-90187 Umea, Sweden..
    Jonsson, Joakim H.
    Umea Univ, Dept Radiat Sci, SE-90187 Umea, Sweden..
    Nyholm, Tufve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Medicinsk strålningsvetenskap. Umea Univ, Dept Radiat Sci, SE-90187 Umea, Sweden.
    Quantifying the Effect of 3T Magnetic Resonance Imaging Residual System Distortions and Patient-Induced Susceptibility Distortions on Radiation Therapy Treatment Planning for Prostate Cancer2018Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 100, nr 2, s. 317-324Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To investigate the effect of magnetic resonance system-and patient-induced susceptibility distortions from a 3T scanner on dose distributions for prostate cancers.

    Methods and Materials: Combined displacement fields from the residual system and patient-induced susceptibility distortions were used to distort 17 prostate patient CT images. VMAT dose plans were initially optimized on distorted CT images and the plan parameters transferred to the original patient CT images to calculate a new dose distribution.

    Results: Maximum residual mean distortions of 3.19 mm at a radial distance of 25 cm and maximum mean patient-induced susceptibility shifts of 5.8 mm were found using the lowest bandwidth of 122 Hz per pixel. There was a dose difference of <0.5% between distorted and undistorted treatment plans. The 90% confidence intervals of the mean difference between the dCT and CT treatment plans were all within an equivalence interval of (-0.5, 0.5) for all investigated plan quality measures.

    Conclusions: Patient-induced susceptibility distortions at high field strengths in closed bore magnetic resonance scanners are larger than residual system distortions after using vendor-supplied 3-dimensional correction for the delineated regions studied. However, errors in dose due to disturbed patient outline and shifts caused by patient-induced susceptibility effects are below 0.5%.

  • 2. Alcorn, S. R.
    et al.
    Nilsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Dieckmann, K.
    McNutt, T. R.
    Chen, M. J.
    Ermoian, R. P.
    Ford, E. C.
    MacDonald, S.
    Nechesnyuk, A.
    Tryggestad, E. J.
    Smith, K.
    Villar, R. C.
    Winey, B.
    Terezakis, S. A.
    Predictors of Setup Accuracy in Image-Guided CNS Radiation Therapy: Prospective Data From a Multinational Pediatrics Consortium2014Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 90, nr S1, s. S723-S723Artikkel i tidsskrift (Annet vitenskapelig)
  • 3.
    Bosco, Cecilia
    et al.
    Kings Coll London, Div Canc Studies, TOUR, London, England..
    Garmo, Hans
    Kings Coll London, Div Canc Studies, TOUR, London, England.;Akad Sjukhuset, Reg Canc Ctr, Uppsala, Sweden..
    Adolfsson, Jan
    Karolinska Inst, CLINTEC Dept, Stockholm, Sweden..
    Stattin, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi. Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Kings Coll London, Div Canc Studies, TOUR, London, England.;Akad Sjukhuset, Reg Canc Ctr, Uppsala, Sweden..
    Nilsson, Per
    Lund Univ, Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Lund, Sweden..
    Gunnlaugsson, Adalsteinn
    Lund Univ, Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Lund, Sweden..
    Widmark, Anders
    Umea Univ, Dept Radiat Sci, Oncol, Umea, Sweden..
    Van Hemelrijck, Mieke
    Kings Coll London, Div Canc Studies, TOUR, London, England.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Prostate Cancer Radiation Therapy and Risk of Thromboembolic Events2017Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 97, nr 5, s. 1026-1031Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To investigate the risk of thromboembolic disease (TED) after radiation therapy (RT) with curative intent for prostate cancer (PCa).

    Patients and Methods: We identified all men who received RT as curative treatment (n=9410) and grouped according to external beam RT (EBRT) or brachytherapy (BT). By comparing with an age-and county-matched comparison cohort of PCa-free men (n = 46,826), we investigated risk of TED after RT using Cox proportional hazard regression models. The model was adjusted for tumor characteristics, demographics, comorbidities, PCa treatments, and known risk factors of TED, such as recent surgery and disease progression.

    Results: Between 2006 and 2013, 6232 men with PCa received EBRT, and 3178 underwent BT. A statistically significant association was found between EBRT and BT and risk of pulmonary embolism in the crude analysis. However, upon adjusting for known TED risk factors these associations disappeared. No significant associations were found between BT or EBRT and deep venous thrombosis.

    Conclusion: Curative RT for prostate cancer using contemporary methodologies was not associated with an increased risk of TED.

  • 4. Braendengen, Morten
    et al.
    Tveit, Kjell Magne
    Bruheim, Kjersti
    Cvancarova, Milada
    Berglund, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Late patient-reported toxicity after preoperative radiotherapy or chemoradiotherapy in nonresectable rectal cancer: Results from a randomized phase III study2011Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 81, nr 4, s. 1017-1024Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Preoperative chemoradiotherapy (CRT) is superior to radiotherapy (RT) in locally advanced rectal cancer, but the survival gain is limited. Late toxicity is, therefore, important. The aim was to compare late bowel, urinary, and sexual functions after CRT or RT.

    Methods and Materials: Patients (N = 207) with nonresectable rectal cancer were randomized to preoperative CRT or RT (2 Gy x 25 +/- 5-fluorouracil/leucovorin). Extended surgery was often required. Self-reported late toxicity was scored according to the LENT SOMA criteria in a structured telephone interview and with questionnaires European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), International Index of Erectile Function (IIEF), and sexual function -vaginal changes questionnaire (SVQ).

    Results: Of the 105 patients alive in Norway and Sweden after 4 to 12 years of follow-up, 78 (74%) responded. More patients in the CRT group had received a stoma (73% vs. 52%, p = 0.09). Most patients without a stoma (7 of 12 in CRT group and 9 of 16 in RT group) had incontinence for liquid stools or gas. No stoma and good anal function were seen in 5 patients (11%) in the CRT group and in 11 (30%) in the RT group (p = 0.046). Of 44 patients in the CRT group, 12 (28%) had had bowel obstruction compared with 5 of 33 (15%) in the RT group (p = 0.27). One-quarter of the patients reported urinary incontinence. The majority of men had severe erectile dysfunction. Few women reported sexual activity during the previous month. However, the majority did not have concerns about their sex life.

    Conclusions: Fecal incontinence and erectile dysfunction are frequent after combined treatment for locally advanced rectal cancer. There was a clear tendency for the problems to be more common after CRT than after RT.

  • 5. Brændengen, Morten
    et al.
    Hansson, Karl
    Radu, Calin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Siegbahn, Albert
    Jacobsson, Hans
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Delineation of gross tumor volume (GTV) for radiation treatment planning of locally advanced rectal cancer using information from MRI or FDG-PET/CT: a prospective study2011Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 81, nr 4, s. e439-e445Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE:

    Accurate delineation of target volumes is important to maximize radiation dose to the tumor and minimize it to nontumor tissue. Computed tomography (CT) and magnetic resonance imaging (MRI) are standard imaging modalities in rectal cancer. The aim was to explore whether functional imaging with F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET), combined with CT (FDG-PET/CT) gives additional information to standard pretreatment evaluation and changes the shape and size of the gross tumor volume (GTV).

    METHODS AND MATERIALS:

    From 2007 to 2009, 77 consecutive patients with locally advanced rectal cancer were prospectively screened for inclusion in the study at two university hospitals in Sweden, and 68 patients were eligible. Standard GTV was delineated using information from clinical examination, CT, and MRI (GTV-MRI). Thereafter, a GTV-PET was defined in the fused PET-CT, and the target volume delineations were compared for total volume, overlap, and mismatch. Pathologic uptake suspect of metastases was also registered.

    RESULTS:

    The median volume of GTV-MRI was larger than that of GTV-PET: 111 cm3 vs. 87 cm3 (p < 0.001). In many cases, the GTV-MRI contained the GTV defined on the PET/CT images as subvolumes, but when a GTV total was calculated after the addition of GTV-PET to GTV-MRI, the volume increased, with median 11% (range, 0.5–72%). New lesions were seen in 15% of the patients for whom PET/CT was used.

    CONCLUSIONS:

    FDG-PET/CT facilitates and adds important information to the standard delineation procedure of locally advanced rectal cancer, mostly resulting in a smaller GTV, but a larger total GTV using the union of GTV-MRI and GTV-PET. New lesions were sometimes seen, potentially changing the treatment strategy.

  • 6. Carlsson, J
    et al.
    Gedda, L
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Grönvik, C
    Hartman, T
    Lindström, A
    Lindström, P
    Lundqvist, H
    Lövqvist, A
    Malmqvist, J
    Olsson, P
    Strategy for boron neutron capture therapy against tumor cells with over-expression of the epidermal growth factor-receptor.1994Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 30, nr 1, s. 105-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Gliomas, squamous carcinomas and different adenocarcinomas from breast, colon and prostate might have an increased number of epidermal growth factor (EGF) receptors. The receptors are, in these cases, candidates for binding of receptor specific toxic conjugates that might inactivate cellular proliferation. The purpose of this study was to evaluate whether it is reasonable to try ligand-dextran based conjugates for therapy.

    METHODS AND MATERIALS: EGF or TGF alpha were conjugated to dextran and binding, internalization, retention and degradation of eight types of such conjugates were analyzed in EGF-receptor amplified glioma cells. The conjugates were labelled with radioactive nuclides to allow detection and two of the conjugates were carrying boron in the form of carboranyl amino acids or aminoalkyl-carboranes. Comparative binding tests, applying 125I-EGF, were made with cultured breast, colon and prostate adenocarcinoma, glioma and squamous carcinoma cells. Some introductory tests to label with 76Br for positron emission tomography and with 131I for radionuclide therapy were also made.

    RESULTS: The dextran part of the conjugates did not prevent receptor specific binding. The amount of receptor specific binding varied between the different types of conjugates and between the tested cell types. The dextran part improved intracellular retention and radioactive nuclides were retained for at least 20-24 h. The therapeutical effect improved when 131I was attached to EGF-dextran instead of native EGF.

    CONCLUSION: The improved cellular retention of the ligand-dextran conjugates is an important property since it gives extended exposure time when radionuclides are applied and flexibility in the choice of time for application of neutrons in boron neutron capture therapy (BNCT). It is possible that ligand-dextran mediated BNCT might allow, if the applied neutron fields covers rather wide areas around the primary tumor, locally spread cells that otherwise would escape treatment to be inactivated.

  • 7. Huguet, F.
    et al.
    Racadot, S.
    Goldstein, D.
    Spry, N.
    Van Laethem, J.
    Van Houtte, P.
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Gubanski, M.
    Bonnetain, F.
    Hammel, P.
    Investigation of Relation of Radiation Therapy Quality Assurance Scores (RTQASc) With Toxicity and Survival in LAP07 Phase 3 Trial for Locally Advanced Pancreatic Carcinoma (LAPC)2013Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 87, nr 2, s. S29-S30Artikkel i tidsskrift (Annet vitenskapelig)
  • 8. Indelicato, Daniel J
    et al.
    Merchant, Thomas
    Laperriere, Normand
    Lassen, Yasmin
    Vennarini, Sabina
    Wolden, Suzanne
    Hartsell, William
    Pankuch, Mark
    Brandal, Petter
    Law, Chi-Ching K
    Taylor, Roger
    Laskar, Siddhartha
    Okcu, Mehmet Fatih
    Bouffet, Eric
    Mandeville, Henry
    Björk-Eriksson, Thomas
    Nilsson, Kristina
    Nyström, Hakan
    Constine, Louis Sandy
    Story, Michael
    Timmermann, Beate
    Roberts, Kenneth
    Kortmann, Rolf-Dieter
    Consensus Report From the Stockholm Pediatric Proton Therapy Conference.2016Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 96, nr 2, s. 387-92, artikkel-id S0360-3016(16)32781-XArtikkel i tidsskrift (Fagfellevurdert)
  • 9. Jebsen, Nina L.
    et al.
    Bruland, Oyvind S.
    Eriksson, Mikael
    Engellau, Jacob
    Turesson, Ingela
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Folin, Annika
    Trovik, Clement S.
    Hall, Kirsten Sundby
    Five-year results from a Scandinavian sarcoma group study (SSG XIII) of adjuvant chemotherapy combined with accelerated radiotherapy in high-risk soft tissue sarcome of extremities and trunk wall2011Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 81, nr 5, s. 1359-1366Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To evaluate adjuvant chemotherapy and interpolated accelerated radiotherapy (RT) for adult patients with high-risk soft tissue sarcoma in the extremities or trunk wall. Methods and Materials: High-risk soft tissue sarcoma was defined as high-grade malignancy and at least two of the following criteria: size >= 8 cm, vascular invasion, or necrosis. Six cycles of doxorubicin and ifosfamide were prescribed for all patients. RT to a total dose of 36 Gy (1.8 Gy twice daily) was inserted between two chemotherapy cycles after marginal margin resection regardless of tumor depth or after wide-margin resection for deep-seated tumors. RT was boosted to 45 Gy in a split-course design in the case of intralesional margin resection. Results: A total of 119 patients were eligible, with a median follow-up of 5 years. The 5-year estimate of the local recurrence, metastasis-free survival, and overall survival rate was 12%, 59%, and 68%, respectively. The group receiving RT to 36 Gy had a local recurrence rate of 10%. In contrast, the local recurrence rate was 29% in the group treated with RT to 45 Gy. The presence of vascular invasion and low chemotherapy dose intensity had a negative effect on metastasis-free and overall survival. Toxicity was moderate after both the chemotherapy and the RT. Conclusions: Accelerated RT interposed between chemotherapy cycles in a selected population of patients with high-risk soft tissue sarcoma resulted in good local and distant disease control, with acceptable treatment-related morbidity. The greater radiation dose administered after intralesional surgery was not sufficient to compensate for the poorer surgical margin. Vascular invasion was the most important prognostic factor for metastasis-free and overall survival.

  • 10.
    Persson, Emilia
    et al.
    Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Klinikgatan 5, S-22185 Lund, Sweden.;Lund Univ, Dept Med Phys, Malmo, Sweden..
    Gustafsson, Christian
    Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Klinikgatan 5, S-22185 Lund, Sweden.;Lund Univ, Dept Med Phys, Malmo, Sweden..
    Nordström, Fredrik
    Sahlgrens Univ Hosp, Dept Med Phys & Biomed Engn, Gothenburg, Sweden..
    Sohlin, Maja
    Sahlgrens Univ Hosp, Dept Med Phys & Biomed Engn, Gothenburg, Sweden..
    Gunnlaugsson, Adalsteinn
    Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Klinikgatan 5, S-22185 Lund, Sweden..
    Petruson, Karin
    Sahlgrens Univ Hosp, Dept Oncol, Gothenburg, Sweden..
    Rintelä, Niina
    Karolinska Univ Hosp, Med Radiat Phys & Nucl Med, Stockholm, Sweden..
    Hed, Kristoffer
    Karolinska Univ Hosp, Med Radiat Phys & Nucl Med, Stockholm, Sweden..
    Blomqvist, Lennart
    Karolinska Univ Hosp, Dept Diagnost Radiol, Stockholm, Sweden.;Umea Univ, Dept Radiat Sci, Umea, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Zackrisson, Björn
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Nyholm, Tufve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Medicinsk strålningsvetenskap. Umea Univ, Dept Radiat Sci, Umea, Sweden.
    Olsson, Lars E.
    Lund Univ, Dept Med Phys, Malmo, Sweden..
    Siversson, Carl
    Spectron Med AB, Helsingborg, Sweden..
    Jonsson, Joakim
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    MR-OPERA: A Multicenter/Multivendor Validation of Magnetic Resonance Imaging-Only Prostate Treatment Planning Using Synthetic Computed Tomography Images2017Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 99, nr 3, s. 692-700Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To validate the dosimetric accuracy and clinical robustness of a commercially available software for magnetic resonance (MR) to synthetic computed tomography (sCT) conversion, in an MR imaginge-only workflow for 170 prostate cancer patients.

    Methods and Materials: The 4 participating centers had MriPlanner (Spectronic Medical), an atlas-based sCT generation software, installed as a cloud-based service. A T2-weighted MR sequence, covering the body contour, was added to the clinical protocol. The MR images were sent from the MR scanner workstation to theMriPlanner platform. The sCT was automatically returned to the treatment planning system. Four MR scanners and 2 magnetic field strengths were included in the study. For each patient, a CT-treatment plan was created and approved according to clinical practice. The sCT was rigidly registered to the CT, and the clinical treatment plan was recalculated on the sCT. The dose distributions from the CT plan and the sCT plan were compared according to a set of dose-volume histogram parameters and gamma evaluation. Treatment techniques included volumetric modulated arc therapy, intensity modulated radiation therapy, and conventional treatment using 2 treatment planning systems and different dose calculation algorithms.

    Results: The overall (multicenter/multivendor) mean dose differences between sCT and CT dose distributions were below 0.3% for all evaluated organs and targets. Gamma evaluation showed a mean pass rate of 99.12% (0.63%, 1 SD) in the complete body volume and 99.97% (0.13%, 1 SD) in the planning target volume using a 2%/ 2-mm global gamma criteria.

    Conclusions: Results of the study show that the sCT conversion method can be used clinically, with minimal differences between sCT and CT dose distributions for target and relevant organs at risk. The small differences seen are consistent between centers, indicating that an MR imagingeonly workflow using MriPlanner is robust for a variety of field strengths, vendors, and treatment techniques.

  • 11.
    Pixberg, Caroline
    et al.
    Univ Hosp Muenster, Dept Radiat Oncol, Bldg A1,1 Albert Schweitzer Campus, D-48149 Munster, Germany..
    Koch, Raphael
    Univ Munster, Inst Biostat & Clin Res, D-48149 Munster, Germany..
    Eich, Hans Theodor
    Univ Hosp Muenster, Dept Radiat Oncol, Bldg A1,1 Albert Schweitzer Campus, D-48149 Munster, Germany.;Univ Cologne, Dept Radiat Oncol, D-50931 Cologne, Germany..
    Martinsson, Ulla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Kristensen, Ingrid
    Skane Univ Hosp, Dept Radiat Phys, Lund, Sweden..
    Matuschek, Christiane
    Univ Hosp Duesseldorf, Dept Radiat Oncol, Dusseldorf, Germany..
    Kortmann, Rolf-Dieter
    Univ Hosp Leipzig, Dept Radiat Oncol, Leipzig, Germany..
    Pohl, Fabian
    Univ Regensburg, Dept Radiat Oncol, D-93053 Regensburg, Germany..
    Elsayad, Khaled
    Univ Hosp Muenster, Dept Radiat Oncol, Bldg A1,1 Albert Schweitzer Campus, D-48149 Munster, Germany..
    Christiansen, Hans
    Hannover Med Sch, Dept Radiat Oncol, Hannover, Germany..
    Willich, Normann
    Univ Hosp Muenster, Dept Radiat Oncol, Bldg A1,1 Albert Schweitzer Campus, D-48149 Munster, Germany..
    Lindh, Jack
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Steinmann, Diana
    Hannover Med Sch, Dept Radiat Oncol, Hannover, Germany..
    Acute Toxicity Grade 3 and 4 After Irradiation in Children and Adolescents: Results From the IPPARCA Collaboration2016Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 94, nr 4, s. 792-799Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: In the context of oncologic therapy for children, radiation therapy is frequently indicated. This study identified the frequency of and reasons for the development of high-grade acute toxicity and possible sequelae. Materials and Methods: Irradiated children have been prospectively documented since 2001 in the Registry for the Evaluation of Side Effects After Radiation in Childhood and Adolescence (RiSK) database in Germany and since 2008 in the registry for radiation therapy toxicity (RADTOX) in Sweden. Data were collected using standardized, published forms. Toxicity classification was based on Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Results: As of June 2013, 1500 children have been recruited into the RiSK database and 485 into the RADTOX registry leading to an analysis population of 1359 patients (age range 0-18). A total of 18.9% (n=257) of all investigated patients developed high-grade acute toxicity (grades 3/4). High-grade toxicity of the bone marrow was documented for 63.8% (n=201) of those patients, oral mucositis for 7.6% (n=24), and dermatitis for 7.6% (n=24). Patients with high-grade acute toxicity received concomitant chemotherapy more frequently (56%) than patients with no or lower acute toxicity (31.5%). In multivariate analyses, concomitant chemotherapy, diagnosis of Ewing sarcoma, and total radiation dose showed a statistically noticeable effect (P <=.05) on acute toxicity, whereas age, concomitant chemotherapy, Hodgkin lymphoma, Ewing sarcoma, total radiation dose, and acute toxicity influenced the time until maximal late toxicity. Conclusions: Generally, high-grade acute toxicity after irradiation in children and adolescence occurs in a moderate proportion of patients (18.9%). As anticipated, the probability of acute toxicity appeared to depend on the prescribed dose as well as concomitant chemotherapy. The occurrence of chronic toxicity correlates with the prior acute toxicity grade. Age seems to influence the time until maximal late toxicity but not the development of acute toxicity.

  • 12. Racadot, S.
    et al.
    Hammel, P.
    Chibaudel, B.
    Goldstein, D.
    Spry, N.
    Van Laethem, J.
    Van Houtte, P.
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Gubanski, M.
    Huguet, F.
    Dummy Run in the Phase III LAP07 Pancreatic Cancer Trial: First Evaluation of Quality of Radiation Therapy Planning2012Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 84, nr 3, s. S322-S322Artikkel i tidsskrift (Annet vitenskapelig)
  • 13.
    Rao, Avani D.
    et al.
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Rashid, Arif
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Chen, Qinyu
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Villar, Rosangela C.
    Ctr Infantil Boldrini, Dept Radiat Oncol, Campinas, SP, Brazil..
    Kobyzeva, Daria
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Moscow, Russia..
    Nilsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Dieckmann, Karin
    Univ Klin Strahlentherapie & Strahlenbiol, Vienna, Austria..
    Nechesnyuk, Alexey
    Fed Sci Clin Ctr Childrens Hematol Oncol & Immuno, Moscow, Russia..
    Ermoian, Ralph
    Univ Washington, Seattle, WA 98195 USA..
    Alcorn, Sara
    Johns Hopkins Sch Med, Baltimore, MD USA..
    MacDonald, Shannon M.
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Ladra, Matthew M.
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Ford, Eric C.
    Univ Washington, Seattle, WA 98195 USA..
    Winey, Brian A.
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Figueiredo, Maria Luisa S.
    Grp Apoio Ao Adolescente & Crianca Canc, Sao Paulo, Brazil..
    Terezakis, Stephanie A.
    Johns Hopkins Sch Med, Baltimore, MD USA..
    Chen, Michael J.
    Grp Apoio Ao Adolescente & Crianca Canc, Sao Paulo, Brazil..
    Re-Irradiation for Recurrent Pediatric CNS Malignancies: A Multi-Institutional Retrospective Review2017Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 98, nr 2, s. E14-E15Artikkel i tidsskrift (Annet vitenskapelig)
  • 14.
    Rao, Avani D.
    et al.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Rashid, Arif S.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Chen, Qinyu
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Villar, Rosangela C.
    Ctr Infantil Boldrini, Dept Radiat Oncol, Sao Paulo, Brazil..
    Kobyzeva, Daria
    Fed Res & Clin Ctr Pediat Hematol Oncol & Immunol, Dept Radiat Oncol, Moscow, Russia..
    Nilsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Dieckmann, Karin
    Univ Klin Strahlentherapie & Strahlenbiol, Dept Radiat Oncol, Vienna, Austria..
    Nechesnyuk, Alexey
    Fed Res & Clin Ctr Pediat Hematol Oncol & Immunol, Dept Radiat Oncol, Moscow, Russia..
    Ermoian, Ralph
    Univ Washington, Dept Radiat Oncol, Seattle, WA USA..
    Alcorn, Sara
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    MacDonald, Shannon M.
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA..
    Ladra, Matthew M.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Ford, Eric C.
    Univ Washington, Dept Radiat Oncol, Seattle, WA USA..
    Winey, Brian A.
    Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA..
    Figueiredo, Maria Luisa S.
    Grp Apoio Adolescente & Crianca Com Canc, Dept Radiat Oncol, Sao Paulo, Brazil..
    Chen, Michael J.
    Grp Apoio Adolescente & Crianca Com Canc, Dept Radiat Oncol, Sao Paulo, Brazil..
    Terezakis, Stephanie A.
    Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
    Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review2017Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 99, nr 3, s. 634-641Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients.

    Methods and Materials: The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed.

    Results: Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n = 20; 30%), ependymoma (n = 19; 28%), germ cell tumor (n = 8; 12%), high-grade glioma (n = 9; 13%), low-grade glioma (n = 5; 7%), and other (n = 6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n = 46), 3-dimensional conformal RT (n = 9), stereotactic radiosurgery (n = 4; 1213 Gy x 1 or 5 Gy x 5), protons (n = 4), combined modality (n = 3), 2-dimensional RT (n = 1), and brachytherapy (n = 1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively.

    Conclusions: CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

  • 15.
    Schernberg, A.
    et al.
    Hosp Tenon, Serv Oncol Radiotherapie, Paris, France..
    Vernerey, D.
    Univ Hosp Besancon, INSERM, UMR 1098, Methodol & Qual Life Oncol Unit, Besancon, France..
    Goldstein, D.
    Kinghorn Canc Ctr, Sydney, NSW, Australia.;Garvan Inst Med Res, Sydney, NSW, Australia..
    Van Laethem, J. L.
    Hop Erasme, Brussels, Belgium..
    Van Houtte, P. J.
    Inst Bordet, Brussels, Belgium..
    Bonnetain, F.
    Univ Hosp Besancon, INSERM, UMR 1098, Methodol & Qual Life Oncol Unit, Besancon, France..
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Louvet, C.
    Inst Mutualiste Montsouris, Dept Med Oncol, Paris, France..
    Hammel, P.
    Hop Beaujon, Serv Gastroenterol, Clichy, France..
    Huguet, F.
    Hosp Tenon, Serv Oncol Radiotherapie, Paris, France..
    Neutrophils Predicting Tumor Local Control After Chemoradiation Therapy in Locally Advanced Pancreatic Carcinoma in the LAP 07 Trial2017Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 99, nr 2, s. S88-S89Artikkel i tidsskrift (Annet vitenskapelig)
  • 16.
    Sclafani, Francesco
    et al.
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Peckitt, Clare
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Cunningham, David
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Tait, Diana
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Giralt, Jordi
    Vall dHebron Univ Hosp, Univ Autonoma Barcelona, Dept Med Oncol, Barcelona, Spain..
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Keranen, Susana Rosello
    Univ Valencia, Biomed Res Inst INCLIVA, Dept Hematol & Med Oncol, E-46003 Valencia, Spain..
    Bateman, Andrew
    Univ Southampton, Southampton Gen Hosp, Canc Sci Unit, Southampton SO9 5NH, Hants, England..
    Hickish, Tamas
    Bournemouth Univ, Poole Hosp NHS Fdn Trust, Dept Med Oncol, Poole BH12 5BB, Dorset, England..
    Tabernero, Josep
    Vall dHebron Univ Hosp, Univ Autonoma Barcelona, Dept Med Oncol, Barcelona, Spain..
    Thomas, Janet
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Brown, Gina
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Oates, Jacqueline
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Chau, Ian
    Royal Marsden NHS Fdn Trust, Sutton SM2 5PT, Surrey, England..
    Short-and Long-Term Quality of Life and Bowel Function in Patients With MRI-Defined, High-Risk, Locally Advanced Rectal Cancer Treated With an Intensified Neoadjuvant Strategy in the Randomized Phase 2 EXPERT-C Trial2015Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 93, nr 2, s. 303-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life (QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC. Methods and Materials: QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. Bowel incontinence was assessed using the modified Fecal Incontinence Severity Index questionnaire. Results: Compared to baseline, QoL scores during preoperative treatment were better for symptoms associated with the primary tumor in the rectum (blood and mucus in stool, constipation, diarrhea, stool frequency, buttock pain) but worse for global health status, role functioning, and symptoms related to the specific safety profile of each treatment modality. During follow-up, improved emotional functioning and lessened anxiety and insomnia were observed, but deterioration of body image, increased urinary incontinence, less sexual interest (men), and increased impotence and dyspareunia were observed. Cetuximab was associated with a deterioration of global health status during neoadjuvant chemotherapy but did not have any long-term detrimental effect. An improvement in bowel continence was observed after preoperative treatment and 3 years after sphincter-sparing surgery. Conclusions: Intensifying neoadjuvant treatment by administering induction systemic chemotherapy before chemoradiation therapy improves tumor-related symptoms and does not appear to have a significantly detrimental effect on QoL and BF, in both the short and the long term.

  • 17.
    Sun, Aijun
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för nuklearmedicin och PET.
    Johansson, Silvia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för nuklearmedicin och PET.
    Turesson, Ingela
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Daşu, Alexandru
    Sörensen, Jens
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för nuklearmedicin och PET.
    Imaging Tumor Perfusion and Oxidative Metabolism in Patients With Head-and-Neck Cancer Using 1- [11C]-Acetate PET During Radiotherapy: Preliminary Results2012Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 82, nr 2, s. 554-560Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    A growing body of in vitro evidence links alterations of the intermediary metabolism in cancer to treatment outcome. This study aimed to characterize tumor oxidative metabolism and perfusion in vivo using dynamic positron emission tomography (PET) with 1- [11C]-acetate (ACE) during radiotherapy.

    Methods and Materials

    Nine patients with head-and-neck cancer were studied. Oxidative metabolic rate (kmono) and perfusion (rF) of the primary tumors were assessed by dynamic ACE-PET at baseline and after 15, 30, and 55 Gy was delivered. Tumor glucose uptake (Tglu) was evaluated with [18F]-fluorodeoxyglucose PET at baseline. Patients were grouped into complete (CR, n = 6) and partial responders (PR, n = 3) to radiotherapy.

    Results

    The 3 PR patients died within a median follow-up period of 33 months. Baseline kmono was almost twice as high in CR as in PR (p = 0.02) and Tglu was lower in CR than in PR (p = 0.04). kmono increased during radiotherapy in PR (p = 0.004) but remained unchanged in CR. There were no differences in rF between CR and PR at any dosage. kmono and rF were coupled in CR (p = 0.001), but not in PR.

    Conclusions

    This study shows that radiosensitive tumors might rely predominantly on oxidative metabolism for their bioenergetic needs. The impairment of oxidative metabolism in radioresistant tumors is potentially reversible, suggesting that therapies targeting the intermediary metabolism might improve treatment outcome.

  • 18.
    Sundberg, Åsa Liljegren
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Steffen, Ann-Charlott
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Enhancing the effect of radionuclide tumor targeting, using lysosomotropic weak bases2007Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 67, nr 1, s. 279-287Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim of the present study was to investigate if treatment with lysosomotropic weak bases could increase the intracellular retention of radiohalogens and thereby increase the therapeutic effect of radionuclide tumor targeting. METHODS AND MATERIALS: Four different lysosomotropic bases, chloroquine, ammonium chloride, amantadine, and thioridazine, were investigated for their ability to increase radiohalogen retention in vitro. The two most promising substances, chloroquine and ammonium chloride, were studied in several cell lines (A431, U343MGaCl2:6, SKOV-3, and SKBR-3) in combination with radiolabeled epidermal growth factor (EGF) or the HER2 binding affibody (Z(HER2:4))(2). RESULTS: The uptake and retention of radionuclides was found to be substantially increased by simultaneous treatment with the lysosomotropic bases. The effect was, however, more pronounced in the epidermal growth factor:epidermal growth factor receptor (EGF:EGFR) system than in the (Z(HER2:4))(2):HER2 system. The therapeutic effect of ammonium chloride treatment combined with (211)At-EGF was also studied. The effect obtained after combined treatment was found to be much better than after (211)At-EGF treatment alone. CONCLUSIONS: The encouraging results from the present study indicate that the use of lysosomotropic weak bases is a promising approach for increasing the therapeutic effect of radionuclide targeting with radiohalogens.

  • 19. Syk, Erik
    et al.
    Torkzad, Michael R.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
    Blomqvist, Lennart
    Nilsson, Per J.
    Glimelius, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för onkologi.
    Local recurrence in rectal cancer: anatomic localization and effect on radiation target2008Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 72, nr 3, s. 658-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To determine the sites of local recurrence after total mesorectal excision for rectal cancer in an effort to optimize the radiation target. METHODS AND MATERIALS: A total of 155 patients with recurrence after abdominal resection for rectal cancer were identified from a population-based consecutive cohort of 2,315 patients who had undergone surgery by surgeons trained in the total mesorectal excision procedure. A total of 99 cross-sectional imaging studies were retrieved and re-examined by one radiologist. The clinical records were examined for the remaining patients. RESULTS: Evidence of residual mesorectal fat was identified in 50 of the 99 patients. In 83 patients, local recurrence was identified on the imaging studies. All recurrences were within the irradiated volume if the patients had undergone preoperative radiotherapy or within the same volume if they had not. The site of recurrence was in the lower 75% of the pelvis, anatomically below the S1-S2 interspace for all patients. Only 5 of the 44 recurrences in patients with primary tumors >5 cm from the anal verge were in the lowest 20% of the pelvis. Six recurrences involved the lateral lymph nodes. CONCLUSION: These data suggest that a lowering of the upper limit of the clinical target volume could be introduced. The anal sphincter complex with surrounding tissue could also be excluded in patients with primary tumors >5 cm from the anal verge.

  • 20. Terezakis, S. A.
    et al.
    MacDonald, S.
    Dieckmann, K.
    Nilsson, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Villar, R.
    Nechesnyuk, A.
    Winey, B.
    Ford, E.
    Malet, C.
    Tryggestad, E.
    Clinical Practice Patterns of Pediatric Image Guided Radiation Treatment: Results From an International Pediatric Research Consortium2013Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 87, nr 2, s. S602-S603Artikkel i tidsskrift (Annet vitenskapelig)
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