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Background: Although stereotactic body radiotherapy (SBRT) was progressively adopted in clinical practice in Belgium, a reimbursement request in 2011 was not granted because of remaining clinical and economic uncertainty. A coverage with evidence development (CED) program on SBRT started in 2013, with the aim to assess clinical and technical patterns-of-care in Belgium and monitor survival per indication, in view of supporting inclusion in the reimbursement system. Methods: The Belgian National Institute for Health and Disability Insurance (NIHDI) initiated this prospective observational registry. Participating departments, using SBRT in clinical practice, signed the ‘NIHDI convention’. Eligible patients had a primary tumour (PT) or oligometastatic disease (OMD). Patient, tumour, and treatment characteristics were collected through an online module of the Belgian Cancer Registry, prerequisite for financing. Five-year overall survival (5YOS) and 30- and 90-days mortality were primary outcomes, derived from vital status information. Findings: Between 10/2013 and 12/2019, 20 of the 24 accredited radiotherapy departments participated, 6 were academic. Registered cases per department ranged from 21 to 867. Of 5675 registrations analysed, the majority had good performance status and limited number of lesions. Enrolment of PTs remained stable over time, OMDs almost doubled. Peripheral lung lesions dominated in PTs as in OMDs. Other metastases were (para)spinal, ‘non-standard’ and hepatic. Thirty- and 90-days mortalities remained below 0.5% [95% CI 0.3%–0.8%] respectively 2.1% [95% CI 1.6%–2.7%]. 5YOS varied by indication, primary prostate patients performing best (85%, 95% CI [76%, 96%]), those with liver metastases worst (19%, 95% CI [15%, 24%]). Better OS was observed in academic departments, department size did not significantly impact survival. OMD survival was better in 2018–19. Interpretation: CED can be used to define patterns-of-care and real-life outcome of innova, SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

Purpose /objective: To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments’ evaluation of this initiative. Material and methods: The Donabedian approach was used, focussing on structural, process and outcome QIs. The criteria for QI selection were availability, required for low-threshold regular collection, and applicability to guidelines and good practice. The QIs were collected yearly and individualized reports were sent out to all RT departments. In 2021, a national survey was held to evaluate the ease of data collection and submission, and the perceived importance and validity of the collected QIs. Results: 18 structural QI and 37 process and outcome parameters (n = 25 patients/pathology/department) were collected. The participation rate amounted to 95 % overall. The analysis gave a national overview of RT activity, resources, clinical practice and reported acute toxicities. The individualized reports allowed departments to benchmark their performance. The 2021 survey indicated that the QIs were overall easy to collect, relevant and reliable. The collection of acute recorded toxicities was deemed a weak point due to inter-observer variabilities and lack of follow-up time. Conclusion: QI collection on a national level is a valuable process in steering quality improvement initiatives. The feasibility and relevance was demonstrated with a high level of participation. The national initiative will continue to evolve as a quality monitoring and improvement tool., SCOPUS: ar.j, info:eu-repo/semantics/published

The Quality Assurance project for stage III non-small cell lung cancer radiotherapy ProCaLung performed a multicentric two-step exercise evaluating mediastinal nodal Target Volume Definition and Delineation (TVD) variability and the opportunity for standardization. The TVD variability before and after providing detailed guidelines and the value of qualitative contour reviewing before applying quantitative measures were investigated. The case of a patient with stage III NSCLC and involved mediastinal lymph nodes was used as a basis for this study. Twenty-two radiation oncologists from nineteen centers in Belgium and Luxembourg participated in at least one of two phases of the project (before and after introduction of ProCaLung contouring guidelines). The resulting thirty-three mediastinal nodal GTV and CTV contours were then evaluated using a qualitative-before-quantitative (QBQ) approach. First, a qualitative analysis was performed, evaluating adherence to most recent guidelines. From this, a list of observed deviations was created and these were used to evaluate contour conformity. The second analysis was quantitative, using overlap and surface distance measures to compare contours within qualitative groups and between phases. A 'most robust' reference volume for these analyses was created using the STAPLE-algorithm and an averaging method. Five GTV and seven CTV qualitative groups were identified. Second step contours were more often in higher-conformity groups (p = 0.012 for GTV and p = 0.024 for CTV). Median Residual Mean Square Distances improved from 2.34 mm to 1.36 mm for GTV (p = 0.01) and from 4.53 mm to 1.58 mm for CTV (p < 0.0001). Median Dice coefficients increased from 0.81 to 0.84 for GTV (p = 0.07) and from 0.82 to 0.89 for CTV (p ≤ 0.001). Using HC-contours only to generate references translated in more robust quantitative evaluations. Variability of mediastinal nodal TVD was reduced after providing the ProCaLung consensus guidelines. A qualitative r

We report the case of a 50-year old women with an oncological history of metastatic breast carcinoma who underwent lung stereotactic body radiation therapy (SBRT) of 60Gy in 8 fractions for a left upper lobe metastatic lesion. Seven months later, she complains about hoarseness and weakness of voice. Tumoral relapse and other frequent etiologies were excluded. The diagnosis of radiation induced left recurrent laryngeal nerve paralysis causing left vocal cord paralysis (VCP) was made. The symptomatology did not improve till the disease progression and death of the patient 29 months after SBRT. VCP after lung SBRT is a rare adverse event that has not yet been well described in the medical literature.

In our department, during lung stereotactic body radiation therapy (SBRT), all patients receive an intra-fractional midpoint cone beam computed tomography (CBCT). This study aimed to quantify the benefit of adding a second midpoint CBCT over a course of peripheral lung SBRT. Six-hundred-sixty-four CBCTs from 166 patients were retrospectively analyzed. Treatments were based on the internal target volume (ITV) approach. An isotropic 0.5 cm margin was used to create the planning target volume (PTV) around the ITV. The prescribed dose was 48 Gy in 4 fractions to the PTV. Patients were divided into two groups: patients for whom the 3D-intra-fractional-variation (IFV) was < 0.5 cm (105 patients, low risk group) and patients with at least one 3D-IFV ≥ 0.5 cm (61 patients, high-risk group). Plans simulating the dosimetric impact of the IFV were created as follows: the original 2 arcs (ARC ) were copied into a new plan consisting of 4 times ARC 1 and 4 times ARC 2. The delivery of ARC 1 was always assumed to have occurred with the isocenter initially coordinated, whereas the positions of ARC 2 were modified for each arc by the measured the 3D-IFV. For the PTV, we obtained: D99% (Gy) = 45.2 . 48.2 Gy (p < 0.0001); Dmean = 53 . 54 Gy (p < .0001) for the reconstructed . planned dose values, respectively. For the ITV, the changes are less pronounced: D99% (Gy) = 52.2 . 53.6 Gy (p = 0.0007); Dmean = 56 . 56.8 Gy (p = 0.0144). The V48 Gy(%)-ITV coverage did not statistically change between the delivered . planned dose (p = 0.1803). Regarding the organs at risk for both groups, dose-volume-histograms were near-identical. We demonstrated that a single CBCT is sufficient and reliable to manage the IFV during peripheral lung SBRT.

To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments' evaluation of this initiative. The Donabedian approach was used, focussing on structural, process and outcome QIs. The criteria for QI selection were availability, required for low-threshold regular collection, and applicability to guidelines and good practice. The QIs were collected yearly and individualized reports were sent out to all RT departments. In 2021, a national survey was held to evaluate the ease of data collection and submission, and the perceived importance and validity of the collected QIs. 18 structural QI and 37 process and outcome parameters (n = 25 patients/pathology/department) were collected. The participation rate amounted to 95 % overall. The analysis gave a national overview of RT activity, resources, clinical practice and reported acute toxicities. The individualized reports allowed departments to benchmark their performance. The 2021 survey indicated that the QIs were overall easy to collect, relevant and reliable. The collection of acute recorded toxicities was deemed a weak point due to inter-observer variabilities and lack of follow-up time. QI collection on a national level is a valuable process in steering quality improvement initiatives. The feasibility and relevance was demonstrated with a high level of participation. The national initiative will continue to evolve as a quality monitoring and improvement tool.

We report the case of a 50-year old women with an oncological history of metastatic breast carcinoma who underwent lung stereotactic body radiation therapy (SBRT) of 60 Gy in 8 fractions for a left upper lobe metastatic lesion. Seven months later, she complains about hoarseness and weakness of voice. Tumoral relapse and other frequent etiologies were excluded. The diagnosis of radiation induced left recurrent laryngeal nerve paralysis causing left vocal cord paralysis (VCP) was made. The symptomatology did not improve till the disease progression and death of the patient 29 months after SBRT. VCP after lung SBRT is a rare adverse event that has not yet been well described in the medical literature., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Background: In our department, during lung stereotactic body radiation therapy (SBRT), all patients receive an intra-fractional midpoint cone beam computed tomography (CBCT). This study aimed to quantify the benefit of adding a second midpoint CBCT over a course of peripheral lung SBRT. Materials and methods: Six-hundred-sixty-four CBCTs from 166 patients were retrospectively analyzed. Treatments were based on the internal target volume (ITV) approach. An isotropic 0.5 cm margin was used to create the planning target volume (PTV) around the ITV. The prescribed dose was 48 Gy in 4 fractions to the PTV. Patients were divided into two groups: patients for whom the 3D-intra-fractional-variation (IFV) was < 0.5 cm (105 patients, low risk group) and patients with at least one 3D-IFV ≥ 0.5 cm (61 patients, high-risk group). Plans simulating the dosimetric impact of the IFV were created as follows: the original 2 arcs (ARC ) were copied into a new plan consisting of 4 times ARC 1 and 4 times ARC 2. The delivery of ARC 1 was always assumed to have occurred with the isocenter initially coordinated, whereas the positions of ARC 2 were modified for each arc by the measured the 3D-IFV. Results: For the PTV, we obtained: D99%(Gy) = 45.2 vs. 48.2 Gy (p < 0.0001); Dmean = 53 vs. 54 Gy (p <.0001) for the reconstructed vs. planned dose values, respectively. For the ITV, the changes are less pronounced: D99%(Gy) = 52.2 vs. 53.6 Gy (p = 0.0007); Dmean = 56 vs. 56.8 Gy (p = 0.0144). The V48 Gy(%)-ITV coverage did not statistically change between the delivered vs. planned dose (p = 0.1803). Regarding the organs at risk for both groups, dose-volume-histograms were near-identical. Conclusion: We demonstrated that a single CBCT is sufficient and reliable to manage the IFV during peripheral lung SBRT., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Background and purpose: The Quality Assurance project for stage III non-small cell lung cancer radiotherapy ProCaLung performed a multicentric two-step exercise evaluating mediastinal nodal Target Volume Definition and Delineation (TVD) variability and the opportunity for standardization. The TVD variability before and after providing detailed guidelines and the value of qualitative contour reviewing before applying quantitative measures were investigated. Materials and methods: The case of a patient with stage III NSCLC and involved mediastinal lymph nodes was used as a basis for this study. Twenty-two radiation oncologists from nineteen centers in Belgium and Luxembourg participated in at least one of two phases of the project (before and after introduction of ProCaLung contouring guidelines). The resulting thirty-three mediastinal nodal GTV and CTV contours were then evaluated using a qualitative-before-quantitative (QBQ) approach. First, a qualitative analysis was performed, evaluating adherence to most recent guidelines. From this, a list of observed deviations was created and these were used to evaluate contour conformity. The second analysis was quantitative, using overlap and surface distance measures to compare contours within qualitative groups and between phases. A ‘most robust’ reference volume for these analyses was created using the STAPLE-algorithm and an averaging method. Results: Five GTV and seven CTV qualitative groups were identified. Second step contours were more often in higher-conformity groups (p = 0.012 for GTV and p = 0.024 for CTV). Median Residual Mean Square Distances improved from 2.34 mm to 1.36 mm for GTV (p = 0.01) and from 4.53 mm to 1.58 mm for CTV (p < 0.0001). Median Dice coefficients increased from 0.81 to 0.84 for GTV (p = 0.07) and from 0.82 to 0.89 for CTV (p ≤ 0.001). Using HC-contours only to generate references translated in more robust quantitative evaluations. Conclusion: Variability of mediastinal nodal TVD was reduced, SCOPUS: ar.j, info:eu-repo/semantics/published

Our recently developed prone crawl position (PCP) for radiotherapy of breast cancer patients with lymphatic involvement showed promising preliminary data and it is being optimized for clinical use. An important aspect in this process is making new, position specific delineation guidelines to ensure delineation (for treatment planning) is uniform across different centers. The existing ESTRO and PROCAB guidelines for supine position (SP) were adapted for PCP. Nine volunteers were MRI scanned in both SP and PCP. Lymph node regions were delineated in SP using the existing ESTRO and PROCAB guidelines and were then translated to PCP, based on the observed changes in reference structure position. Nine PCP patient CT scans were used to verify if the new reference structures were consistently identified and easily applicable on different patient CT scans. Based on these data, a team of specialists in anatomy, CT- and MRI radiology and radiation oncology postulated the final guidelines. By taking the ESTRO and PROCAB guidelines for SP into account and by using a relatively big number of datasets, these new PCP specific guidelines incorporate anatomical variability between patients. The guidelines are easily and consistently applicable, even for people with limited previous experience with delineations in PCP.

PURPOSE/OBJECTIVE(S): In our department, during lung SBRT, all patients (regardless of tumor location) receive an additional intra-fractional CBCT, allowing us to adjust the beam delivery accordingly to the intra-fractional variation (IFV). It is to be expected that each IFV exceeding the planning target volume (PTV) margins could lead to potential discrepancies between planned and delivered plans. A posteriori robust dosimetric evaluation will help us to quantify the actual impact on the target's volumes coverage. MATERIALS/METHODS: Six hundred sixty-four CBCTs from 166 consecutives free-breathing lung SBRT patients were retrospectively analyzed. Treatments were based on the internal target volume (ITV) approach with a 4D-CT at simulation and performed using volumetric modulated arc therapy. An isotropic 0.5 cm margin was used to create the PTV around the ITV. The prescribed dose was 48 Gy in 4 fractions to the PTV (80% isodose line). Patients were divided into two groups: patients for whom the 3D-IFV was below 0.5 cm (low-risk group: 105 patients, 573/664 fractions) and patients with at least one 3D-IFV ≥ 0.5 cm (high-risk group: 61 patients, 91/664 fractions). Plans simulating the dosimetric impact of the IFV were created as follows: the original two arcs were copied into a new plan consisting of 4 times ARC1 and 4 times ARC2. The delivery of ARC1 was always assumed to have occurred with the isocenter coordinates as those in the original plan, whereas the positions of ARC2 were modified for each arc by the measured the 3D displacement for that fraction according to the intra-fraction CBCT. RESULTS: The IFV reduces both the minimal (D99%) and mean (Dmean) dose to both the PTV and the ITV. For the PTV, we obtained: D99(%) = 45.2 vs 48.2 Gy (P < .0001); Dmean = 53 vs 54 Gy (P < .0001) for the reconstructed vs planned dose values, respectively. For the ITV, the changes are less pronounced: D99(%) = 52.2 vs 53.6 Gy (P = .0007); Dmean = 56 vs 56.8 Gy (P = .0144). Maxim, SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Het oude continent Europa heeft de afgelopen jaren veel stormen het hoofd moeten bieden en sommige van die stormen dreigen het Westen de kop te kosten. Politiek en media zijn druk bezig om propaganda te voeren voor verschillende ontwrichtende ontwikkelingen en bewegingen: de toestroom van personen op zoek naar welvaart en welzijnsverbetering, energietransitie, inclusiviteit en diversiteit en aanpassing van de (inter- )nationale geschiedenis. De 'kleine man' in Moskou bekijkt die passeerbewegingen met glimmende pretogen en constateert tevreden dat politiek-correcte politici en liberale media hartstochtelijk de westerse samenlevingen in de geest van miljardairs als Soros en Gates naar de bestaansafgrond duwen.

De NAVO heeft tijdens de dertigste zitting van staatshoofden en regeringsleiders een aantal belangrijke besluiten genomen over de versterking van de Noordoostflank van het grondgebied van de alliantie. Hoewel details van die besluiten nog niet openbaar zijn gemaakt blijkt het Kremlin het veronderstelde effect van die besluiten zeer serieus te nemen.Of de stevige kritiek van de Russische president voor de bühne is of dat hij de gelegenheid wil benutten om Belarus opnieuw de duimschroeven aan te draaien, zullen de ontwikkelingen binnen en buiten Rusland in de nabije toekomst kunnen bevestigen.

Het oude continent Europa heeft de afgelopen jaren veel stormen het hoofd moeten bieden en sommige van die stormen dreigen het Westen de kop te kosten. Politiek en media zijn druk bezig om propaganda te voeren voor verschillende ontwrichtende ontwikkelingen en bewegingen: de toestroom van personen op zoek naar welvaart en welzijnsverbetering, energietransitie, inclusiviteit en diversiteit en aanpassing van de (inter- )nationale geschiedenis. De 'kleine man' in Moskou bekijkt die passeerbewegingen met glimmende pretogen en constateert tevreden dat politiek-correcte politici en liberale media hartstochtelijk de westerse samenlevingen in de geest van miljardairs als Soros en Gates naar de bestaansafgrond duwen.

De NAVO heeft tijdens de dertigste zitting van staatshoofden en regeringsleiders een aantal belangrijke besluiten genomen over de versterking van de Noordoostflank van het grondgebied van de alliantie. Hoewel details van die besluiten nog niet openbaar zijn gemaakt blijkt het Kremlin het veronderstelde effect van die besluiten zeer serieus te nemen.Of de stevige kritiek van de Russische president voor de bühne is of dat hij de gelegenheid wil benutten om Belarus opnieuw de duimschroeven aan te draaien, zullen de ontwikkelingen binnen en buiten Rusland in de nabije toekomst kunnen bevestigen.

info:eu-repo/semantics/published

Two prior surveys were carried out in 1995 and 1999 to evaluate the use of radiotherapy in the treatment of non-malignant disease. In 2016, the same questionnaire was used and sent to the 24 centers of the country: 22 responded. A major decrease was observed in the number of patients treated: 360 in 2016 in contrast to 954 in 1999 and 1113 in 1995. The most frequent indications remain the prevention of heterotopic bone formation, keloids or gynecomastia. A new indication was observed: trigeminal nevralgia treated with radiosurgery. Two frequent indications in the past disappeared: the prevention of coronary restenosis and the macular degeneration. A great agreement was observed regarding the possible indications for radiotherapy but also to avoid it for inflammatory pathologies., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Lung large-cell neuroendocrine carcinoma (L-LCNEC) is a rare subset of lung carcinoma associated with poor overall survival. Due to its rarity, little has been established about its optimal treatment in the advanced stage. We report the case of a 41-year-old woman diagnosed with an unresectable locally advanced L-LCNEC who presented an impressive tumor response to immunotherapy with nivolumab after non-curative thoracic radiotherapy. Salvage surgery was then performed, and pathologic analysis of the resected piece revealed the absence of residual viable tumor cells. Based on this case report, we discuss the literature regarding the efficacy of inhibitors of programmed death-1 protein (PD-1) in L-LCNEC and their use in association with radiotherapy and in the neoadjuvant setting.

BACKGROUND: To evaluate the outcome of patients treated with stereotactic ablative body radiotherapy (SABR) with curative intent for stage I non-small cell lung cancer (NSCLC) with regard to local, regional and distant tumor control, disease-free survival (DFS), overall survival (OS) and toxicity. METHODS: Data of 300 patients treated with SABR for NSCLC cancer for the period of November 2007 to June 2016 were retrospectively analyzed. Of which, 189 patients had single primary lung lesion and were included in the study. The prescribed dose for the tumor was 48 Gy, given in 12 Gy × 4 fractions for all patients. In 2010, an improved protocol was established in advanced technology for the planning CT, dose calculation and imaging. Cumulative incidence function (CIF) of local, regional, distant or any recurrences were computed using competing risk analysis with death as a competing event. Survivals (DFS and OS) were estimated using the Kaplan-Meier method and Cox proportional regression was used for comparisons. Toxicities were graded according to the common terminology criteria for adverse events version 4.0 (CTCAE v.4). RESULTS: Diagnosis was histologically confirmed in 42% of the patients (N = 80). At 1, 2 and 4 years, the cumulative incidence function (CIF) of local relapses were 8% [4-13%], 15% [10-21%] and 18% [12-25%], the CIF of regional relapses were 4% [2-8%], 10% [6-16%] and 12% [8-19%], the CIF of distant relapses were 9% [5-14%], 15% [11-22%] and 20% [15-28%] and the CIF of any relapses were 14% [10-20%], 28% [22-36%], 34% [27-43%], respectively. After 1, 2 and 4 years, the OS rates were 83% [95% CI: 78-89%] (N = 128), 65% [95% CI: 57-73%] (N = 78) and 37% [95% CI: 29-47%] (N = 53), respectively. The median survival time was 37 months. The DFS after 1, 2 and 4 years reached 75% [95% CI: 68-81%] (N = 114), 49% [95% CI: 42-58%] (N = 60) and 31% [95% CI: 24-41%] (N = 41), respectively. No grade 4 or 5 toxicity was observed. CONCLUSIONS: We observed a long-term

Met literatuuropgave., Als het om Moskou en Poetin gaat, lijkt de politieke antenne van Europese politici gebroken te zijn of in een andere kompasrichting te wijzen. Anders is het onverklaarbaar dat die politici keer op keer zich overvallen voelen door een uitspraak, een handeling of een maatregel van de Russische president.

Met literatuuropgave., Als het om Moskou en Poetin gaat, lijkt de politieke antenne van Europese politici gebroken te zijn of in een andere kompasrichting te wijzen. Anders is het onverklaarbaar dat die politici keer op keer zich overvallen voelen door een uitspraak, een handeling of een maatregel van de Russische president.

info:eu-repo/semantics/published, 1

info:eu-repo/semantics/published, 30e Congrès national de la Société française de radiothérapie oncologique

[Purpose or Objective] Lymph node delineation in stage III non-small cell lung cancer (NSCLC) remains the subject of discussion as the inclusion or omission of a lymph node or station can have an important impact on both oncological outcome and toxicity. The Belgian College for Physicians in Radiation Oncology aims to improve the quality of radiotherapy in Belgium. Within this framework the Project on Cancer of the Lung (ProCaLu) focuses on standardizing delineation for locally advanced NSCLC. A two-phase contouring dummy-run on a single test case was performed to analyze the baseline interobserver variability on target definition and delineation and evaluate the effects of a national consensus before the start of a peer-review program for routine clinical practice. [Material and Methods] All 25 radiotherapy centers in Belgium and Luxembourg were invited to take part in a delineation dummy-run by sending contours from at least one radiation oncologist (RO) dedicated to lung cancer treatments. The case consisted of a squamous cell carcinoma of the right upper lobe with nodal extension to station 4R staged cT1bN2M0 (TNM 7). The results of chest CT, PET/CT and endoscopic samplings were provided to participants and the planning CT was made available through a secure transfer platform. RO's were asked to delineate and upload back the GTV and CTV for the nodal disease. More than a year later and after the formulation of a national consensus based on current ESTRO guidelines (inclusion of only involved nodes with a 5 mm CTV margin) the case was resent to all centers with the same purpose. On all received contours, a description of the TV definition and delineation was obtained through visual inspection. Using an open-source software (3D Slicer with SlicerRT), the DICE Similarity Index and Hausdorff distances were analyzed to compare the delineations. To allow an evaluation of uniformity with these metrics, independent GTV and CTV contours by the first author were used as r, info:eu-repo/semantics/published, ESTRO 38, 26-30 April 2019, Milan, Italy

It is now well demonstrated that (F)-fluorodeoxyglucose PET/CT is the most accurate imaging method for determining disease extent in Hodgkin lymphoma. Thus, up-front PET/CT is mandatory for involved node radiation therapy design. For a proper use of this new imaging modality for radiotherapy, some adaptations should be made to the PET/CT acquisition as well as to the report. Initial PET/CT should be performed in the radiotherapy treatment position. Nuclear medicine physicians should report to the radiation oncologist the precise location of each involved lymph node, for which the use of a common atlas of upper diaphragmatic nodal stations could be useful. All these new procedures have to be implemented in close collaboration among the different medical specialists providing care to Hodgkin lymphoma patients. We report here the usual procedures of PET/CT acquisition in the radiotherapy environment and propose a more sophisticated description of the different lymph nodes for a more efficient nuclear medicine report to the radiation oncologist., [Imagerie multimodale incluant la TEP/TDM au (18F)-fluorodésoxyglucose pour ladélinéation des champs d’irradiation du lymphome de Hodgkin localisé] Il est maintenant clairement établi que la TEP/tomodensitométrie au (18F)-fluorodésoxyglucose est la technique d’imagerie de référence pour le bilan d’extension des lymphomes de Hodgkin. Par conséquent, l’utilisation de la TEP/tomodensitométrie est indispensable pour la réalisation d’une radiothérapie de type involved-node. L’utilisation de cette imagerie fonctionnelle par les radiothérapeutes nécessite une acquisition des images et un compte rendu d’examen particuliers. La TEP préthérapeutique doit être réalisée en position de traitement. Le compte rendu doit décrire précisément l’ensemble des ganglions supposés envahis, raison pour laquelle une classification unique décrivant l’ensemble des aires ganglionnaires sus-diaphragmatiques est proposée. Cette nouvelle technique thérapeutique nécessite une collaboration étroite entre différentes spécialités médicales. Cet article a pour objet la description de la réalisation pratique de la TEP/tomodensitométrie en position de radiothérapie ainsi qu’une trame de compte rendu d’examen prenant en compte la description des différents ganglions sus-diaphragmatiques.

Hoeveel artikelen zijn er in de achterliggende twee jaar geschreven over de effecten die de aanhoudende deplorabele toestand van de Russische economie heeft voor de man en vrouw in de straat en vooral op het platteland? Veel! De geïnteresseerde Ruslandvolger zou inmiddels genoeg informatie hebben om een evenwichtige inschatting te kunnen maken van de waarde van de dreigende barpraatjes van Poetin c.s. Die Ruslandvolger moet inmiddels ook hebben vastgesteld dat Poetin naar alternatieven zoekt om de aandacht van zijn binnenlandse financiële problemen af te leiden en dat die alternatieven altijd buiten Ruslands grenzen liggen: Georgië, de Krim, Donbas, Syrië, Belarus en de Baltische staten.

Met literatuuropgave., Nog steeds is de geïnstitutionaliseerde corruptie de belangrijkste hindernis die het doorstoten van Oekraïne naar het niveau van een transparante democratie blokkeert en de mogelijkheden beperkt om de krijgsmacht tot volle ontplooiing te laten komen.

Met literatuuropgave., Het uitstappen van Amerika uit de wankele Iran-overeenkomst heeft een aantal zaken helder gemaakt: het voortbestaan van nationale concerns is voor de twee Europese grootmachten, Duitsland en Frankrijk, belangrijker dan het straffen van een staat die zich niet aan de internationale gedragsregels wil houden en deze bewust schendt om geostrategische doelen te bereiken. In andere woorden: het nationale belang laten prevaleren boven het alliantiebelang en vervolgens verwijten dat Amerika te veel naar binnen gekeerd is. Secundair: het dreigen met een handelsoorlog, omdat Trump vindt dat er teveel geprofiteerd wordt van de Amerikaanse markt terwijl Europa bepaalde marktsegmenten d.m.v. vette subsidies op de been houdt.

Hoeveel artikelen zijn er in de achterliggende twee jaar geschreven over de effecten die de aanhoudende deplorabele toestand van de Russische economie heeft voor de man en vrouw in de straat en vooral op het platteland? Veel! De geïnteresseerde Ruslandvolger zou inmiddels genoeg informatie hebben om een evenwichtige inschatting te kunnen maken van de waarde van de dreigende barpraatjes van Poetin c.s. Die Ruslandvolger moet inmiddels ook hebben vastgesteld dat Poetin naar alternatieven zoekt om de aandacht van zijn binnenlandse financiële problemen af te leiden en dat die alternatieven altijd buiten Ruslands grenzen liggen: Georgië, de Krim, Donbas, Syrië, Belarus en de Baltische staten.

Met literatuuropgave., Nog steeds is de geïnstitutionaliseerde corruptie de belangrijkste hindernis die het doorstoten van Oekraïne naar het niveau van een transparante democratie blokkeert en de mogelijkheden beperkt om de krijgsmacht tot volle ontplooiing te laten komen.

Met literatuuropgave., Het uitstappen van Amerika uit de wankele Iran-overeenkomst heeft een aantal zaken helder gemaakt: het voortbestaan van nationale concerns is voor de twee Europese grootmachten, Duitsland en Frankrijk, belangrijker dan het straffen van een staat die zich niet aan de internationale gedragsregels wil houden en deze bewust schendt om geostrategische doelen te bereiken. In andere woorden: het nationale belang laten prevaleren boven het alliantiebelang en vervolgens verwijten dat Amerika te veel naar binnen gekeerd is. Secundair: het dreigen met een handelsoorlog, omdat Trump vindt dat er teveel geprofiteerd wordt van de Amerikaanse markt terwijl Europa bepaalde marktsegmenten d.m.v. vette subsidies op de been houdt.

info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/published

Item does not contain fulltext, Importance: Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. Objective: The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Design, Setting, and Participants: Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. Interventions: No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. Main Outcomes and Measures: Time to ipsilateral breast tumor recurrence (IBTR) as first event. Results: The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15% (95% CI, 12%-17%). Young age (P < .001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P = .001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34% (95% CI, 25%-41%), 14% (95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P < .001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P < .001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15% (95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P < .001) in high-risk patients (

Item does not contain fulltext, Importance: Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. Objective: The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Design, Setting, and Participants: Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. Interventions: No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. Main Outcomes and Measures: Time to ipsilateral breast tumor recurrence (IBTR) as first event. Results: The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15% (95% CI, 12%-17%). Young age (P < .001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P = .001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34% (95% CI, 25%-41%), 14% (95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P < .001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P < .001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15% (95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P < .001) in high-risk patients (

AIM: The aim of the study was to assess the feasibility of an individualized 18F fluorodeoxyglucose positron emission tomography (FDG-PET)-guided dose escalation boost in non-small cell lung cancer (NSCLC) patients and to assess its impact on local tumor control and toxicity. PATIENTS AND METHODS: A total of 13 patients with stage II-III NSCLC were enrolled to receive a dose of 62.5 Gy in 25 fractions to the CT-based planning target volume (PTV; primary turmor and affected lymph nodes). The fraction dose was increased within the individual PET-based PTV (PTVPET) using intensity modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) until the predefined organ-at-risk (OAR) threshold was reached. Tumor response was assessed during follow-up by means of repeat FDG-PET/computed tomography. Acute and late toxicity were recorded and classified according to the CTCAE criteria (Version 4.0). Local progression-free survival was determined using the Kaplan-Meier method. RESULTS: The average dose to PTVPET reached 89.17 Gy for peripheral and 75 Gy for central tumors. After a median follow-up period of 29 months, seven patients were still alive, while six had died (four due to distant progression, two due to grade 5 toxicity). Local progression was seen in two patients in association with further recurrences. One and 2-year local progression free survival rates were 76.9% and 52.8%, respectively. Three cases of acute grade 3 esophagitis were seen. Two patients with central tumors developed late toxicity and died due to severe hemoptysis. CONCLUSION: These results suggest that a non-uniform and individualized dose escalation based on FDG-PET in IMRT delivery is feasible. The doses reached were higher in patients with peripheral compared to central tumors. This strategy enables good local control to be achieved at acceptable toxicity rates. However, dose escalation in centrally located tumors with direct invasion of mediastinal organs must be performed with grea

Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. Time to ipsilateral breast tumor recurrence (IBTR) as first event. The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15% (95% CI, 12%-17%). Young age (P < .001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P = .001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34% (95% CI, 25%-41%), 14% (95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P < .001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P < .001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15% (95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P < .001) in high-risk patients (≤50 years with DCIS present). The association of high-grade invasive tumor with IBTR diminished during follow-up, while the eff

Met literatuuropgave., Lena Jonsson, een Zweedse professor die in London de ins and outs van haar specialiteit Post-Soviet Peacekeeping, of beter gezegd Peacekeeping the Moscow Way, aan haar geïnteresseerde publiek doceerde, legde in 1997 in een helder betoog voor een gemêleerd publiek de speerpunten van Peacekeeping the Moscow Way uit. Symbolisch genoeg vond de presentatie plaats in een kuuroord in de bossen oost van Kiev, omringd door een niet te negeren aantal bruine beren. Het kwam erop neer dat volgens haar peacekeeping (pk) door Rusland niet aan VN-normen voldeed en het maar de vraag zou zijn of en in hoeverre Moskou ooit aan die vastgelegde normen voor moderne pk-missies wilde voldoen.

Het gerucht gaat dat Poetin op zoek is naar een eervolle oplossing voor het oosten van Oekraïne. Vermoedelijk hebben de politieke hoofdmannen aan het Rode Plein eindelijk ontdekt dat de ontwikkelingen in de Donbas niet erg gunstig zijn voor een daar gewenste herverkiezing van Poetin. Voorts is de gevechtskracht van de Oekraïense strijdmacht door de steun van het Westen zo sterk geworden, dat van een pijnloze militaire oplossing geen sprake meer kan zijn.

President Loekasjenko van Belarus claimt dat zijn land een eigen nationale identiteit heeft, uitgedrukt in een unieke culturele achtergrond en bevestigd door een eigen geschiedenis. Zoals gebruikelijk bij politici, die graag de historie gebruiken om hun eigen beweringen te accentueren, rust die claim op drijfzand. Zijn uitlatingen zijn een poging om een balanss te vinden tussen de economische wurggreep van het Kremlin en de hang van de doorsnee burger naar een zelfstandig en neutraal Belarus. Kort gezegd: de man wil rust in de tent. Het grote probleem van Loekasjenko ligt verborgen in het gegeven dat beid processen een onderscheidend tempoverschil bezitten en niet door hem gestuurd, laat staan beheerst kunnen worden.

IMPORTANCE Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. OBJECTIVE The EORTC boost no boost trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. DESIGN, SETTING, AND PARTICIPANTS Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III boost no boost trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. INTERVENTIONS No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. MAIN OUTCOMES AND MEASURES Time to ipsilateral breast tumor recurrence (IBTR) as first event. RESULTS The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15%(95% CI, 12%-17%). Young age (P <. 001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P =. 001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34%(95% CI, 25%-41%), 14%(95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P <. 001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P <. 001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15%(95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P <. 001) in high-risk patients (<= 50 years with DCIS present).

Item does not contain fulltext, Importance: Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. Objective: The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Design, Setting, and Participants: Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. Interventions: No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. Main Outcomes and Measures: Time to ipsilateral breast tumor recurrence (IBTR) as first event. Results: The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15% (95% CI, 12%-17%). Young age (P < .001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P = .001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34% (95% CI, 25%-41%), 14% (95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P < .001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P < .001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15% (95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P < .001) in high-risk patients (

Item does not contain fulltext, Importance: Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. Objective: The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Design, Setting, and Participants: Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. Interventions: No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. Main Outcomes and Measures: Time to ipsilateral breast tumor recurrence (IBTR) as first event. Results: The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15% (95% CI, 12%-17%). Young age (P < .001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P = .001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34% (95% CI, 25%-41%), 14% (95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P < .001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P < .001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15% (95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P < .001) in high-risk patients (

President Loekasjenko van Belarus claimt dat zijn land een eigen nationale identiteit heeft, uitgedrukt in een unieke culturele achtergrond en bevestigd door een eigen geschiedenis. Zoals gebruikelijk bij politici, die graag de historie gebruiken om hun eigen beweringen te accentueren, rust die claim op drijfzand. Zijn uitlatingen zijn een poging om een balanss te vinden tussen de economische wurggreep van het Kremlin en de hang van de doorsnee burger naar een zelfstandig en neutraal Belarus. Kort gezegd: de man wil rust in de tent. Het grote probleem van Loekasjenko ligt verborgen in het gegeven dat beid processen een onderscheidend tempoverschil bezitten en niet door hem gestuurd, laat staan beheerst kunnen worden.

Met literatuuropgave., Lena Jonsson, een Zweedse professor die in London de ins and outs van haar specialiteit Post-Soviet Peacekeeping, of beter gezegd Peacekeeping the Moscow Way, aan haar geïnteresseerde publiek doceerde, legde in 1997 in een helder betoog voor een gemêleerd publiek de speerpunten van Peacekeeping the Moscow Way uit. Symbolisch genoeg vond de presentatie plaats in een kuuroord in de bossen oost van Kiev, omringd door een niet te negeren aantal bruine beren. Het kwam erop neer dat volgens haar peacekeeping (pk) door Rusland niet aan VN-normen voldeed en het maar de vraag zou zijn of en in hoeverre Moskou ooit aan die vastgelegde normen voor moderne pk-missies wilde voldoen.

Het gerucht gaat dat Poetin op zoek is naar een eervolle oplossing voor het oosten van Oekraïne. Vermoedelijk hebben de politieke hoofdmannen aan het Rode Plein eindelijk ontdekt dat de ontwikkelingen in de Donbas niet erg gunstig zijn voor een daar gewenste herverkiezing van Poetin. Voorts is de gevechtskracht van de Oekraïense strijdmacht door de steun van het Westen zo sterk geworden, dat van een pijnloze militaire oplossing geen sprake meer kan zijn.

IMPORTANCE Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. OBJECTIVE The EORTC boost no boost trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. DESIGN, SETTING, AND PARTICIPANTS Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III boost no boost trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. INTERVENTIONS No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. MAIN OUTCOMES AND MEASURES Time to ipsilateral breast tumor recurrence (IBTR) as first event. RESULTS The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15%(95% CI, 12%-17%). Young age (P <. 001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P =. 001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34%(95% CI, 25%-41%), 14%(95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P <. 001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P <. 001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15%(95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P <. 001) in high-risk patients (<= 50 years with DCIS present).

Item does not contain fulltext

Item does not contain fulltext