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  • 1
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    Table_9.docx
    Frontiers Media SA ; 2023
    In:  Frontiers in Oncology Vol. 13 ( 2023-6-29)
    Details
    In: Frontiers in Oncology, Frontiers Media SA, Vol. 13 ( 2023-6-29)
    Abstract: Radiation-induced lung injury (RILI) is strongly associated with various clinical conditions and dosimetric parameters. Former studies have led to reducing radiotherapy (RT) doses to the lung and have favored the discontinuation of tamoxifen during RT. However, the monocentric design and variability of dosimetric parameters chosen have limited further improvement. The aim of our study was to assess the incidence of RILI in current practice and to determine clinical and dosimetric risk factors associated with RILI occurrence. Material and methods Data from 3 out of the 10 top recruiting centers in CANTO-RT, a subset of the CANTO prospective longitudinal cohort (NCT01993498), were retrospectively analyzed for RILI occurrence. This cohort, which recruited invasive cT0-3 cN0-3 M0 breast cancer patients from 2012 to 2018, prospectively recorded the occurrence of adverse events by questionnaires and medical visits at the end of, and up to 60 months after treatment. RILI adverse events were defined in all patients by the association of clinical symptoms and compatible medical imaging. Results RILI was found in 38/1565 (2.4%) patients. Grade II RILI represented 15/38 events (39%) and grade III or IV 2/38 events (6%). There were no grade V events. The most frequently used technique for treatment was 3D conformational RT (96%). In univariable analyses, we confirmed the association of RILI occurrence with pulmonary medical history, absence of cardiovascular disease medical history, high pT and pN, chemotherapy use, nodal RT. All dosimetric parameters were highly correlated and had close predictive value. In the multivariable analysis adjusted for chemotherapy use and nodal involvement, pulmonary medical history (OR=3.05, p & lt;0.01) and high V30 Gy (OR=1.06, p=0.04) remained statistically significant risk factors for RILI occurrence. V30 Gy & gt;15% was significantly associated with RILI occurrence in a multivariable analysis (OR=3.07, p=0.03). Conclusion Our study confirms the pulmonary safety of breast 3D RT in CANTO-RT. Further analyses with modern radiation therapy techniques such as IMRT are needed. Our results argue in favor of a dose constraint to the ipsilateral lung using V30 Gy not exceeding 15%, especially in patients presenting pulmonary medical history. Pulmonary disease records should be taken into account for RT planning.
    Type of Medium: Online Resource
    ISSN: 2234-943X
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    DOI: 10.3389/fonc.2023.1199043
    DOI: 10.3389/fonc.2023.1199043.s001
    DOI: 10.3389/fonc.2023.1199043.s002
    DOI: 10.3389/fonc.2023.1199043.s003
    DOI: 10.3389/fonc.2023.1199043.s004
    DOI: 10.3389/fonc.2023.1199043.s005
    DOI: 10.3389/fonc.2023.1199043.s006
    DOI: 10.3389/fonc.2023.1199043.s007
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    DOI: 10.3389/fonc.2023.1199043.s009
    DOI: 10.3389/fonc.2023.1199043.s010
    DOI: 10.3389/fonc.2023.1199043.s011
    DOI: 10.3389/fonc.2023.1199043.s012
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
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  • 2
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    CANTO‐RT : Skin toxicities evaluation of a multicentre large prospective cohort of irradiated patients for early‐stage breast cancer
    Wiley ; 2022
    In:  International Journal of Cancer Vol. 151, No. 7 ( 2022-10), p. 1098-1108
    Details
    In: International Journal of Cancer, Wiley, Vol. 151, No. 7 ( 2022-10), p. 1098-1108
    Abstract: Skin damage is the most common and most important toxicity during and after radiation therapy (RT). Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer. CANTO is a prospective clinical cohort study of 10 150 patients with stage I‐III BC treated from 2012 to 2017 in 26 cancer centres. In our study, we used CANTO‐RT, a subcohort of CANTO, including 3480 patients who received RT. We are focus on specific skin toxicities: erythema, fibrosis, telangiectasia and cutaneous pigmentation. The prevalence of toxicities of interest varied over time, so at baseline for early toxicity Month (M) 0‐3‐6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased, respectively, while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M0‐3‐6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane‐based CT and the 3D vs IMRT irradiation technique. Regarding fibrosis, an association is found, at M0‐3‐6, with age at diagnosis, obesity, tobacco and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In our study we identified several risk factors for acute and late skin reactions. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT‐type technique decreased the occurrence of skin erythema.
    Type of Medium: Online Resource
    ISSN: 0020-7136 , 1097-0215
    URL: Issue
    URL: Article
    DOI: 10.1002/ijc.v151.7
    DOI: 10.1002/ijc.34057
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    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 3
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    CANTO-RT: One of the Largest Prospective Multicenter Cohort of Early Breast Cancer Patients Treated with Radiotherapy including Full DICOM RT Data
    MDPI AG ; 2023
    In:  Cancers Vol. 15, No. 3 ( 2023-01-25), p. 751-
    Details
    In: Cancers, MDPI AG, Vol. 15, No. 3 ( 2023-01-25), p. 751-
    Abstract: This article describes the methodology used and provides a characterization of the study population in CANTO-RT (CANcer TOxicities RadioTherapy). CANTO (NCT01993498) is a prospective clinical cohort study including patients with stage I-III BC from 26 French cancer centers. Patients matching all CANTO inclusion and exclusion criteria who received RT in one of the 10 top recruiting CANTO centers were selected. Individual full DICOM RT files were collected, pseudo-anonymized, structured and analyzed on the CANTO-RT/UNITRAD web platform. CANTO-RT included 3875 BC patients with a median follow-up of 64 months. Among the 3797 patients with unilateral RT, 3065 (80.4%) had breast-conserving surgery, and 2712 (71.5%) had sentinel node surgery. Tumor bed boost was delivered in 2658 patients (68.5%) and lymph node RT in 1356 patients (35%), including internal mammary chain in 844 patients (21.8%). Most patients (3691 (95.3%)) were treated with 3D conformal RT. Target volumes, organs at risk contours and dose/volume histograms were extracted after quality-control procedures. CANTO-RT is one of the largest early BC prospective cohorts with full individual clinical, biological, imaging and DICOM RT data available. It is a valuable resource for the identification and validation of clinical and dosimetric predictive factors of RT and multimodal treatment-related toxicities.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers15030751
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
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  • 4
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    Abstract P3-19-01: CANTO RT: The largest prospective multicenter cohort of early breast cancer patients treated with radiotherapy including full DICOM RT data
    American Association for Cancer Research (AACR) ; 2022
    In:  Cancer Research Vol. 82, No. 4_Supplement ( 2022-02-15), p. P3-19-01-P3-19-01
    Details
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 4_Supplement ( 2022-02-15), p. P3-19-01-P3-19-01
    Abstract: Purpose: In this paper, we describe the methodology used, and provide a first characterization of the study population and radiotherapy (RT) data in CANTO-RT (CANcer TOxicities Radiotherapy), the largest available multicenter prospective cohort of early breast cancer (BC) patients treated with RT that aims to identify predictors of development, and persistence of long-term toxicities. Methods: CANTO (NCT01993498) is a French prospective clinical cohort study of 10 150 patients with stage I-III BC from 26 cancer centers. Patients matching all CANTO inclusion and exclusion criteria, who received RT and were still in follow up, in the 10 top recruiting CANTO centers, with a minimum follow up of 3 years, were selected for CANTO-RT. Eligible patients had breast/chest wall +/- lymph node RT with curative intent. Individual full DICOM RT files (CT, RT Structure, RT Dose, RT Plan) were collected, anonymized, structured and analyzed on the CANTO-RT/UNITRAD web platform using AQUILAB Share Place™ and Analytics Dose module. Characteristics of the patients and tumors (including TNM, histology, HER2, estrogen and progesterone receptor) were recorded at baseline. Characteristics of the treatments, skin, lung, cardiovascular, neurological, musculoskeletal toxicities (CTCAE v4.0), QOL (BR23, QLQC30), cosmetic, and oncological outcomes were assessed at diagnosis (baseline), 3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months after completion of primary surgery, chemotherapy or radiotherapy whichever came last together, with blood, plasma and serum tests. Results: CANTO-RT enrolled 3875 BC patients between June 2012 and February 2017 with a median follow-up of 64 months :1947 (50.2%) left side, 1850 (47.8%) right side and 78 (2%) bilateral BC. The vast majority of patients had hormone receptor-positive tumors 3321 (85.7%) and 553 (14.3%) had human epidermal growth factor 2 (HER2) positive tumors; 2586 (66.7%) had stage pT1 and 2525 (65.2%) pN0 disease; 2087 (53.8%) neoadjuvant or adjuvant chemotherapy, 477 (12.3%) adjuvant trastuzumab and 3138 (81%) adjuvant endocrine therapy. Among 3797 patients with unilateral RT, 3065 (80.4%) had breast conserving surgery, 747 (19.6%) total mastectomy; 2712 (71.5%) sentinel node and 1080 (28.5%) axillary dissection. Tumor bed boost was delivered in 2658 patients (68.5%) and lymph node RT in 1356 patients (35%) including internal mammary chain in 844 patients (21.8%). Most patients 3691 (95.3%) were treated with 3D conformal RT and 184 (4.7%) with intensity-modulated RT. Normofractionated RT (2Gy/fraction) was mostly used (69.9%). Clinical target (breast, chest wall, lymph nodes) and contoured organs at risk (heart, left anterior descending coronary, lung, spinal cord, esophagus, thyroid, brachial plexus, contralateral breast, humeral head) contours and dose/volume histograms were automatically extracted after quality control procedure excluding corrupted files and inconsistencies 36 (1%) (Table 1). Conclusion: CANTO-RT is the largest early breast cancer prospective cohort with full individual clinical and DICOM RT data available. CANTO-RT is a valuable resource, open for collaborative projects, for identification and validation of clinical and dosimetric predictive factors of RT related toxicities. Further long term follow up is ongoing. Table 1.Baseline characteristics of the CANTO RT breast cancer patients.CharacteristicsBreast Cancer Patients [N(%) or Mean (range)]Age at enrolmentMean (range), years56.5 (23.3-85.8)Tumour size (pT)T037 (1)T12586 (66.7)T21058 (27.3)T3177 (4.6)Missing17 (0.4)Nodal status (pN)02525 (65.2)11035 (26.7)2223 (5.8)379 (2)Missing13 (0.3)Tumour histologyInfiltrating Ductal3011 (77.7)Lobular473 (12.2)Others (including mixed)381 (9.8)Missing10 (0.3)Hormone Receptors positiveNegative541 (14)Positive3321 (85.7)Missing13 (0.3)HER2Negative3305 (85.3)Positive553 (14.3)Missing17 (0.4)Type of chemotherapyNo chemotherapy1788 (46.1)Neoadjuvant chemotherapy450 (11.6)Adjuvant chemotherapy1629 (42)Peri-adjuvant chemotherapy (neo + adjuvant)8 (0.2)Hormonal therapyNo730 (18.8)Yes3138 (81)Missing7 (0.2)Herceptin treatmentNo or Not applicable3378 (87.2)Yes477 (12.3)Missing20 (0.5)Type of breast surgerylumpectomy3113 (80.3)Mastectomy734 (18.9)Right lumpectomy and Left mastectomy13 (0.3)Right mastectomy and Left lumpectomy9 (0.2)None6 (0.2)Type of lymph node surgerySentinel node2746 (70.9)Axillary dissection1086 (28)Right sentinel node, Left axillary dissection20 (0.5)Right axillary dissection, left sentinel node12 (0.3)None11 (0.3)Radiation therapyRight Side1850 (47.8)Left Side1947 (50.2)Bilateral78 (2.0)Patients with boostNo or Not applicable1217 (31.4)Yes2658 (68.6)Lymph node levels treatedNone2519 (65)Yes1356 (35)Level 1284 (20.9)Level 2340 (25.1)Level 31072 (79.1)Level 41348 (99.4)Internal mammary chain844 (62.2)Irradiation techniques3D3691 (95.3)IMRT184 (4.7)Fractionation regimensNormofractionation 25-fractions2707 (69.9)Hypofractionation 15-16 fractions166 (4.3)Hypofractionation and Partial breast irradiation51 (1.3)Unspecified fractionation - CTV breast or chest wall not delineated951 (24.5) Citation Format: Thomas Sarrade, Rodrigue Allodji, Youssef Ghannam, Guillaume Auzac, Sibille Everhard, Ophélie Querel, Youlia Kirova, Karine Peignaux, Philippe Guilbert, Claire Charra-Brunaud, Julien Blanchecotte, Rezart Belshi, David Pasquier, Séverine Racadot, Céline Bourgier, Sandrine Ducornet, David Gibon, Fabrice André, Florent De Vathaire, Sofia Rivera. CANTO RT: The largest prospective multicenter cohort of early breast cancer patients treated with radiotherapy including full DICOM RT data [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-01.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    URL: Article
    DOI: 10.1158/1538-7445.SABCS21-P3-19-01
    RVK:
    XA 36000
    RVK:
    XA 10000
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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  • 5
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    Abstract P4-11-07: Improfib: Impact of radiotherapy on fatigue in breast cancer survivors
    American Association for Cancer Research (AACR) ; 2022
    In:  Cancer Research Vol. 82, No. 4_Supplement ( 2022-02-15), p. P4-11-07-P4-11-07
    Details
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 4_Supplement ( 2022-02-15), p. P4-11-07-P4-11-07
    Abstract: Background Fatigue is a common and disabling symptom experienced by patients (pts) after breast cancer (BC) treatment, significantly impacting their quality of life. However, this complex and multidimensional symptom often remains poorly managed. Previous studies identified some treatment-related factors associated with increased risk of developing severe and persistent fatigue. A better understanding of the relationship between treatment modalities and fatigue may help prevention and management strategies.Multimodal BC treatment often includes radiotherapy (RT) to the breast and/or nodal areas. RT modalities are now increasingly personalized. While an association between receipt of RT and fatigue after BC was previously suggested, large-scale data analyzing the impact of distinct RT modalities on fatigue are lacking.Our aim was to assess the impact of RT modalities on fatigue one year after treatment among patients with early-stage BC. Methods CANcer TOxicity (CANTO; NCT01993498) is a large multicentric nationwide prospective cohort of patients with stage I-III BC diagnosed from June 2012 to February 2017. The present analysis was performed in CANTO-RT, a sub-cohort of CANTO including 3875 patients who received RT in one of the 10 top recruiting CANTO centers. Among those patients, we selected 3797 patients who received unilateral RT.Our primary outcome was severe global fatigue 1 year after RT completion, defined by EORTC QLQ-C30 score ≥ 40/100. Secondary outcomes included severe physical, emotional and cognitive dimensions of fatigue (EORTC QLQ-FA12). The following RT-related variables were used as independent variables: Technique (3D vs IMRT), type of fractionation: Normofractionation (NF) vs Hypofractionation (HF), Boost to tumor bed (Yes vs No), Nodal RT (Yes vs No) and internal mammary chain (IMC) RT (Yes vs No). Multivariable logistic regression models assessed associations between RT-related variables and fatigue, adjusting for clinical, tumor, and BC treatment-related covariates collected at BC diagnosis. Results Our analytic cohort included 3797 patients. Among them, 2348 patients were postmenopausal (63%), 2030 received chemotherapy (52%), and 3068 endocrine therapy (81%). The prevalence of severe global fatigue 1 year after treatment was 33.3%. In addition, 33.1%, 20.4%, and 12.9% of patients reported severe physical, emotional and cognitive fatigue, respectively. Conformal 3D RT was delivered in 3635 patients (96%) mostly NF (2Gy/fraction) (n=2707; 93%). The majority of patients (n=2600; 68%) received a boost. Nodal RT was delivered in 1317 patients (35%) including 819 patients (22%) with IMC RT. After correction for age, BMI, comorbidities, income, smoke behavior, anxiety, depression, receipt of chemo and endocrine therapy, there was a significant relationship between specific RT modalities and severe global fatigue. Specifically, receipt of IMC RT (adjusted OR vs. no 1.57 [95% CI 1.10-2.25; p=0.0134] ) and NF RT (adjusted OR vs. HF 1.77 [95% CI 1.01-3.11; p=0.048]) were associated with increased odds of severe global fatigue.In addition, there was a significant association between NF RT (adjusted OR vs. HF 1.75 [95% CI 1.01-3.07; p=0.049] ) and an increased likelihood of severe physical fatigue, whereas none of the investigated RT modalities seemed to be associated with emotional and cognitive fatigue dimensions. Conclusions More than one third of patients in this RT-treated cohort reported severe fatigue 1 year after treatment. We found a significant association between RT modalities, such as IMC RT and NF, and increased likelihood of severe global fatigue. NF was also associated with physical fatigue. Our data add to the current understanding of treatment-related factors that can impact fatigue after BC, and inform personalized interventions to improve prevention and management of this disabling symptom. Citation Format: Youssef Ghannam, Antonio Di Meglio, Thomas Sarrade, Alexandra Jacquet, Sibille Everhard, Youlia Kirova, Karine Peigneaux, Philippe Guilbert, Claire Chara-Brunaud, Julien Blanchecotte, Gilles Crehange, David Pasquier, Séverine Racadot, Céline Bourgier, Julien Geffrelot, Ahmed Benyoucef, Francois Paris, Guillaume Auzac, Inès Vaz-Luis, Sofia Rivera. Improfib: Impact of radiotherapy on fatigue in breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-07.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    URL: Article
    DOI: 10.1158/1538-7445.SABCS21-P4-11-07
    RVK:
    XA 36000
    RVK:
    XA 10000
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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  • 6
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    Abstract P3-05-34: CANTO-RT: Skin toxicities evaluation of a multicenter prospective cohort of irradiated patients for early-stage breast cancer
    American Association for Cancer Research (AACR) ; 2023
    In:  Cancer Research Vol. 83, No. 5_Supplement ( 2023-03-01), p. P3-05-34-P3-05-34
    Details
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 5_Supplement ( 2023-03-01), p. P3-05-34-P3-05-34
    Abstract: Purpose: Skin damage is the most common and most important toxicity during and after radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer (BC). Method: CANTO (NCT01993498) is a prospective clinical cohort study of 10 150 patients with stage I-III BC treated from 2012-2017 in 26 cancer centers. In this study, we used CANTO-RT, a sub-cohort of CANTO, including 3480 patients who received RT. We are focus on specifical skin toxicities: Erythema, fibrosis, telangectasia and skin color change (CTCAE v4.0). These toxicities were assessed at baseline 0-3-6 (M0), 12 (M12), 36 (M36) months. The RT-related variables were independent variables. Multivariable logistic regression models assessed associations between RT-related variables and skin toxicities of interest. Results: We studied 3480 patients from 2012 to 2017. Patients had a median age of 56.8 years and a mean BMI of 26. The majority of patients had SBR grade 1-2, TNM 1-2, RH+/HER2- breast cancer. Most patients had conservative surgery and 52.7% received chemotherapy. All the patients received radiotherapy mainly normofractionated 50Gy in 25 fractions, in 3D, with a boost of 16Gy in 8fractions. The prevalence of toxicities of interest varied over time, so at M0, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased from 8.8% to 2.9% respectively while fibrosis remains stable from 25.1% to 22.5%. The prevalence of telangiectasia increases from 1% to 7.1% from M0 to M36. The prevalence of the skin color change decreased from 31.7% to 17.5% from M12 to M36. After adjustments, at M0 and M12, we showed a statistically significant association between the occurrence of skin erythema and obesity (OR: 1.3 p & lt; 0.003); the presence of axillary dissection (OR: 1.33 p & lt; 0.003); the type of surgery (OR: 0.71 p & lt; 0.001); the use of taxane- based chemotherapy (OR: 1.46 p & lt; 0.005) and the 3DvsIMRT irradiation technique (OR: 0.42 p & lt; 0.001). However, no radiotherapy factors were statistically related to erythema from M12. Regarding fibrosis, a statistically significant association is found, at M0, with age at diagnosis (OR: 1.43 p & lt; 0.018), obesity (OR: 1.44 p & lt; 0.001), tobacco (OR: 1.4 p & lt; 0.008), and the use of boost (OR: 1.61 p & lt; 0.001). Only obesity and the type of surgery received by the patient remained statistically significant factors at M12 and M36. Obesity and age at diagnosis represented at M12 and M36 a risk associated with the onset of telangiectasias. The skin color change is consistently correlated at M12-M36 with obesity and smoking. The use of a boost increases the skin color change at M36. Conclusion: In this study we identified several risk factors for acute and late skin toxicity such as obesity in the occurrence of skin erythema, fibrosis or telangiectasia. The use of a boost was mainly related to the occurrence of skin color change while the use of IMRT-type technique decreased the occurrence of skin erythema. The knowledge of its predictive factors allows a personalized management of the patient by adapting our treatments and our monitoring according to these different factors. Table 2a. Skin toxicity if interest: Erythema at M0 and M12 (multivariate analysis) Relationship between radiation therapy parameters and the occurrence of skin toxicity Table 2b. Skin toxicity if interest: Fibrosis at M0, M12, and M36 (multivariate analysis) Evolution of skin toxicities of interest over time for a given patient (Sankey plot) Table 3. Grade CTCAEv4 of toxicities of interest * A= erythema. B= fibrosis, C= telangiectasia, D=skin color Citation Format: Sofiane Allali, Matthieu Carton, Thomas Sarrade, Sibille Everhard, Karine Peigneux, Phillipe Guibert, Claire Chara-brunaud, Julien Blanchecotte, David Pasquier, Severine Racadot, Celine Bourgier, Youlia M. Kirova. CANTO-RT: Skin toxicities evaluation of a multicenter prospective cohort of irradiated patients for early-stage breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-34.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    URL: Article
    DOI: 10.1158/1538-7445.SABCS22-P3-05-34
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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  • 7
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    Impact of radiation therapy on fatigue at 1 year in breast cancer survivors in the prospective multicentre CANcer TOxicity cohort
    Elsevier BV ; 2022
    In:  European Journal of Cancer Vol. 177 ( 2022-12), p. 143-153
    Details
    In: European Journal of Cancer, Elsevier BV, Vol. 177 ( 2022-12), p. 143-153
    Type of Medium: Online Resource
    ISSN: 0959-8049
    URL: Article
    DOI: 10.1016/j.ejca.2022.09.026
    RVK:
    XA 42017.A
    RVK:
    XA 42017
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1120460-6
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    Educative Impact of Automatic Delineation Applied to Head and Neck Cancer Patients on Radiation Oncology Residents
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Cancer Education Vol. 38, No. 2 ( 2023-04), p. 578-589
    Details
    In: Journal of Cancer Education, Springer Science and Business Media LLC, Vol. 38, No. 2 ( 2023-04), p. 578-589
    Type of Medium: Online Resource
    ISSN: 0885-8195 , 1543-0154
    URL: Article
    DOI: 10.1007/s13187-022-02157-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 632898-2
    detail.hit.zdb_id: 2049313-7
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