A new “ASAP Scoring System and Risk Table” in patients with Atypical Small Acinar Proliferation (ASAP) to predict the second prostate biopsy outcomes

Background: To discuss the necessity of the second prostate biopsy in the patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table as a new re-biopsy criteria. Methods: 2845 patients who were performed transrectal ultrasonography-guided prostate biopsy between January 2008 and May 2019 were evaluated. 128 patients, whose data were reached, were enrolled into the study. Before the first and the second biopsy, tPSA, fPSA, f/tPSA rate and PSA-Density assessment and changes in these parameters between the two biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy. Results: The mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of the patients with PCa were statistically significantly higher than the patients with non-PCa (p: 0.001). In the ROC curve analysis of ASS-RT, area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT score in diagnosis of malignancy was ≥ 7. The sensitivity of this value was found to be 60.8% and its specificity as 80.5%. Conclusions: The threshold value for the ASS-RT score may be used as 7 and the second biopsy may be performed immediately to patients over this value. We think that there may be no need for a second biopsy if the ASS-RT score under the 7 (especially low-risk group) before the second biopsy.

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A new “ASAP Scoring System and Risk Table” to predict second prostate biopsy outcomes

Archives of Medical Science ◽

10.5114/aoms/131789 ◽

2021 ◽

Author(s):

Caner Ediz ◽

Serkan Akan ◽

Neslihan Kaya Terzi ◽

Aysenur Ihvan

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Roc Curve ◽

Scoring System ◽

Area Under The Curve ◽

Roc Curve Analysis ◽

Atypical Small Acinar Proliferation ◽

Risk Patients ◽

The Mean ◽

New Criteria

IntroductionThis study aimed to discuss the necessity of a second prostate biopsy in patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table to be used as new criteria for a second biopsy.Material and methodsThe study reviewed the data of 2,845 patients; who underwent transrectal ultrasonography-guided prostate biopsy in the period between January 2008 and May 2019. A total of 128 patients with ASAP were included in the study. The tPSA, fPSA, f/tPSA, and PSA-Density levels before the first and second biopsies and changes in the measured levels between the values obtained before the first and the second biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy.ResultsThe mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of prostate cancer patients were significantly higher compared to patients without prostate cancer (p: 0.001). In the ROC curve analysis of ASS-RT, the area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT scores in diagnosing cancer was ≥ 7 with 60.8% sensitivity and 80.5% specificityConclusionsThe cut-off value of 7 determined for the ASS-RT score in this study suggests that patients with ASS-RT scores of ≥7 should undergo a second prostate biopsy. We think that there may be no need for a second biopsy if the ASS-RT score is <7, especially for low-risk patients.

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Evaluation of prediction score of contrast-induced nephropathy in inpatients undergone to digital or CT angiography

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcshci.v10i3.974 ◽

2020 ◽

Vol 10 (3) ◽

pp. 78-84

Author(s):

Seleno Glauber de Jesus-Silva ◽

Ana Elisa Chaves ◽

Caio Augusto Alves Maciel ◽

Edson Eziel Ferreira Scotini ◽

Pablo Girardelli Mendonça Mesquita ◽

...

Keyword(s):

Computed Tomography ◽

Roc Curve ◽

Computed Tomography Angiography ◽

Score Test ◽

Area Under The Curve ◽

Roc Curve Analysis ◽

Contrast Induced Nephropathy ◽

Mean Values ◽

Iodinated Contrast ◽

The Mean

Objectives: To assess the incidence of contrast-induced nephropathy (CIN) and determine the Mehran Score's (MS) ability to predict CIN in patients undergoing digital angiography or computed tomography angiography. Methods: 252 medical records of inpatients who underwent DA or CTA over 28 months in a quaternary hospital were reviewed. CIN was defined as serum creatinine> 0.5 mg / dL or > 25% increase in baseline creatinine, 48 h after administration of iodinated contrast. The ROC curve and the area under the curve (AUC) were used as a score test. Results: The majority (159; 63.1%) were male, and the average age was 60.4 years. Anemia, diabetes mellitus, and age > 75 years were the most prevalent factors. The incidence of CIN was 17.8% (n = 45). There was a decrease in the mean values of creatinine pre and post among patients who did not suffer CIN (1.38 ± 1.22 vs 1.19 ± 0.89; t = 3.433; p = 0.0007), while among patients who suffering CIN, the mean increase was 1.03 mg / dL (1.43 ± 1.48 vs 2.46 ± 2.35 mg / dL; t = 5.44; p = 0.117). The ROC curve analysis identified a low correlation between MS and the occurrence of CIN (AUC = 0.506). Conclusion: The incidence of CIN in hospitalized patients undergoing angiography or computed tomography angiography was high. The EM did not allow the prediction of NIC.

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Gestational Age as a Predictor of Pregnancy Outcome After Repeat Cerclage

10.21203/rs.3.rs-330034/v1 ◽

2021 ◽

Author(s):

Benshuo Cai ◽

Xinni Na

Keyword(s):

Survival Rate ◽

Pregnancy Outcome ◽

Gestational Age ◽

Roc Curve ◽

Univariate Analysis ◽

Area Under The Curve ◽

Roc Curve Analysis ◽

Kaplan Meier ◽

Significant Difference ◽

The Mean

Abstract Background: The role of repeat cerclage (RC) as a remedy for patients with prolapsed membranes after prior cerclage remains controversial. We aimed to investigate whether gestational age (GA) could be used as a valuable factor for predicting pregnancy outcome following RC in women with prolapsed membranes after prior cerclage. Methods: We retrospectively investigated the clinical data of 29 patients who underwent RC resulting from prolapsed membrane after prior cerclage. Receiving operating characteristic (ROC) curve analysis and univariate analysis were performed to determine predictive factors. Patients were divided into two groups according to GA at RC, GA<24.2 weeks and GA≥24.2 weeks. Pregnancy outcomes were compared between groups.Results: The mean GA at prior cerclage was 16.5 weeks; mean GA at RC was 23.6 weeks. The mean GA at delivery was 27.8 weeks with a 69.0% neonatal survival rate. ROC curve and univariate analysis demonstrated that GA at RC was significantly predictive for neonatal survival (area under the curve: 0.928; p=0.000). Using a GA cut-off of ≥24.2 weeks at RC, the sensitivity and specificity of predicting neonatal survival were 93.75% and 61.54%, respectively. There was a significant difference in neonatal survival rate between the GA <24.2 weeks group and GA ≥24.2 weeks group (38.5% vs. 93.8%, p=0.003). Kaplan–Meier survival curves showed a lower incidence of neonatal death in the GA ≥24.2 weeks group (6.3%) compared with GA <24.2 weeks group (61.5%, p=0.023).Conclusions: GA could be a valuable factor for predicting pregnancy outcome post-RC in women with prolapsed membrane after prior cerclage.

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Side Scatter Level of Main Populations in Peripheral Blood using Flow Cytometry as a Tool for the Screening/Detection of Dysplasia and Its Utility in the Diagnosis of Myelodysplastic Syndromes

Blood ◽

10.1182/blood.v112.11.5091.5091 ◽

2008 ◽

Vol 112 (11) ◽

pp. 5091-5091

Author(s):

Ekaterina Rusanova ◽

Ramon Simon-Lopez

Keyword(s):

Flow Cytometry ◽

Myelodysplastic Syndromes ◽

Roc Curve ◽

Statistical Significance ◽

Area Under The Curve ◽

Curve Analysis ◽

Control Group ◽

Roc Curve Analysis ◽

Significance Level ◽

The Mean

Abstract The myelodysplastic syndromes (MDS) are a group of clonal bone marrow disorders characterized by peripheral cytopenias, ineffective hematopoiesis, and unilineage or multilineage dysplasia. The feature used commonly for the diagnostic of MDS includes several morphological cell characteristics such as the presence of hypogranulation in the neutrophils. We have observed in our daily experience at the Mean Scatter of neutrophils was lower in MDS than in normal cases. We have observed that Lymphocyte scatter is quite constant in normal cases and in the majority of MDS. 11 patients diagnosed with MDS and 16 normal blood donors as a control group were enrolled into this study. The protocol of study included evaluation of blood cell populations by hematological analyzer GenS (BC), smears microscopy and flow cytometry for identification a level of granularity of neutrophils (FC500, BC). We created a single tube protocol for immunophenotyping of blood cells by multiparametric flow cytometry using a panel of monoclonal antibodies: CD14-FITC, CD16-PE, CD33-PC5 and CD45-PC7 (BC). We isolated the neutrophil and the lymphocyte populations by subsequent gating steps according to FS/SS, CD45/SS, CD45/CD16 and CD33/CD14. After gating, we measured the Mean Side Scatter in lymphocytes and neutrophils. In order to standardize the NE Mean Scatter we used also a ratio that was calculated by dividing the Neutrophil Mean Scatter by Lymphocyte Mean Scatter. Descriptive Statistics Mean Scatter n Mean SD Median Normals 16 633.6 99.7 612 MDS 11 564.4 83.1 543 Comparative Statistics Normals vs MDS T-test Mean differences ROC AUC ROC cut-off sensitivity specificity sign. ROC Mean NE Scatter 0.071 69.11 0.685 <=543 54.5 87.5 0.0732 Ratio NES/LYS 0.016 2.175 0.824 <=8.34 81.82 81.25 0.0001 The results show the consistent differences between the Neutrophil Mean Scatter in the MDS group compared with the normals with a p =0.07 near the level of statistical significance. The Ratio between Mean Scatter of Neutrophils and the Mean Scatter of Lymphocytes (Ratio NE S/LY S) was significantly lower in MDS than in the group of normals (p=0.016). The ROC Curve analysis using the Neutrophil Mean Scatter to detect/flag MDS showed an acceptable area under the curve AUC=0.685 (significance level 0.073) with a cut-off of <=533 we obtain a sensitivity of 54.5% with a specificity of 87.5%. The ROC Curve analysis using the Ratio NE S/LY S to detect/flag MDS have shown a good area under the curve AUC=0.824 (significance level 0.0001) with a cut-off of <=8.34 we obtain a sensitivity of 81.8% with a specificity of 81.2%. The fact about hypogranularity of the neutrophils is a well known feature of MDS. Using the Neutrophil Mean Scatter and the Ratio between Mean Scatter of Neutrophils and the Mean Scatter of Lymphocytes may be useful tool to detect or flag the neutrophil hypogranularity and will permit to help in the differential diagnosis of MDS. These data are numerical, quantitative and objective. It will be necessary to increase the number of cases (MDS) and to include other hematologic malignancies in order to see the specificity of this findings compared with other diseases.

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Development and validation of a prognostic model to predict clinical deterioration in hospitalized patients with COVID-19

10.21203/rs.3.rs-701172/v2 ◽

2021 ◽

Author(s):

Javid Azadbakht ◽

Sina Rashedi ◽

Soheil Kooraki ◽

Hamed Kowsari ◽

Elnaz Tabibian

Keyword(s):

Roc Curve ◽

Scoring System ◽

Prognostic Model ◽

Operating Characteristic ◽

Clinical Laboratory ◽

External Validation ◽

Clinical Deterioration ◽

Roc Curve Analysis ◽

Prospective Multicenter Study ◽

Development And Validation

Abstract Objectives We aimed to develop and validate a prognostic model to predict clinical deterioration defined as either death or intensive care unit admission of hospitalized COVID-19 patients.Methods This prospective, multicenter study investigated 172 consecutive hospitalized COVID-19 patients who underwent a chest computed tomography (CT) scan between March 20 and April 30, 2020 (development cohort), as well as an independent sample of 40 consecutive patients for external validation (validation cohort). The clinical, laboratory, and radiologic data were gathered, and logistic regression along with receiver operating characteristic (ROC) curve analysis was performed.Results The overall clinical deterioration rates of the development and validation cohorts were 28.4% (49 of 172) and 30% (12 of 40), respectively. Seven predictors were included in the scoring system with a total score of 15: CT severity score\(\ge\)15 (Odds Ratio (OR)=6.34, 4 points), pleural effusion (OR = 6.80, 2 points), symptom onset to admission ≤ 6 days (OR = 2.44, 2 points), age\(\ge\)70 years (OR = 2.44, 2 points), diabetes mellitus (OR = 2.24, 2 points), dyspnea (OR = 2.17, 1.5 points), and abnormal leukocyte count (OR = 1.89, 1.5 points). The area under the ROC curve for the scoring system in the development and validation cohorts was 0.823 (CI [0.751–0.895]) and 0.558 (CI [0.340–0.775]), respectively.Conclusion This study provided a new easy-to-calculate scoring system with external validation for hospitalized COVID-19 patients to predict clinical deterioration based on a combination of seven clinical, laboratory, and radiologic parameters.

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CLINICAL SIGNIFICANCE OF PROCALCITONIN AND C-REACTIVE PROTEIN IN THE PREDICTION OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i9.19524 ◽

2017 ◽

Vol 10 (9) ◽

pp. 297

Author(s):

Hanaa H. Ahmed ◽

Wafaa Gh Shousha ◽

Hatem A El Mezayen ◽

Ibrahim A Emara ◽

Marwa E Hassan

Keyword(s):

Roc Curve ◽

Cardiovascular Complication ◽

Curve Analysis ◽

Diabetic Patients ◽

C Reactive Protein ◽

Roc Curve Analysis ◽

Reactive Protein ◽

The Mean ◽

Type 2 Diabetic

Objective: This work was delineated to assess procalcitonin (PCT) and C-reactive protein (CRP) as prognostic markers for cardiovascular complication in type 2 diabetic patients.Methods: Forty diabetic patients without cardiovascular disease (CVD), 40 diabetic patients with CVD, and 20 healthy control counterparts were participated in this study. Serum PCT and CRP levels were assayed and correlated with metabolic parameters. Receiver operating characteristic (ROC) curve analysis was done for each biochemical marker.Results: The mean level of PCT was 707.17±99.19 ng/l in diabetic patients versus 881.30±123.56 ng/l for the cardio-diabetic patients (p<0.0001). The mean value of CRP was 34.43±17.27 mg/l in diabetic patients versus 50.32±20.19 mg/l for the cardio-diabetic patients (p=0.0003). PCT levels were significantly amplified in the cardio-diabetic patients with increasing CRP, triglycerides (TG), fasting blood glucose (FBG), and cholesterol (p=0.004, 0.0005, 0.002, and 0.01, respectively). CRP levels were significantly enhanced in the cardio-diabetic patients with increasing TG, FBG, cholesterol, and microalbumin (p=0.002, 0.047, 0.003, and 0.001 respectively). ROC curve analysis for PCT and CRP revealed that the area under curve (AUC) was 0.878 and 0.727, respectively. These findings indicate the good validity of the above biomarkers especially PCT as a prognostic marker for cardiovascular complication in type 2 diabetic patients.Conclusion: This study evidences the usefulness of measuring serum levels of PCT and CRP in diagnosis of cardiovascular complication in type 2 diabetic patients.

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Doppler ultrasound for diagnosis of soft tissue sarcoma: efficacy of ultrasound-based screening score

Radiology and Oncology ◽

10.1515/raon-2015-0011 ◽

2015 ◽

Vol 49 (2) ◽

pp. 135-140 ◽

Cited By ~ 9

Author(s):

Satoshi Nagano ◽

Yuhei Yahiro ◽

Masahiro Yokouchi ◽

Takao Setoguchi ◽

Yasuhiro Ishidou ◽

...

Keyword(s):

Doppler Ultrasound ◽

Ultrasound Imaging ◽

Operating Characteristic ◽

Soft Part ◽

Imaging Modality ◽

Screening Method ◽

Area Under The Curve ◽

Roc Curve Analysis ◽

Diagnostic Efficacy ◽

The Mean

Abstract Background. The utility of ultrasound imaging in the screening of soft-part tumours (SPTs) has been reported. We classified SPTs according to their blood flow pattern on Doppler ultrasound and re-evaluated the efficacy of this imaging modality as a screening method. Additionally, we combined Doppler ultrasound with several values to improve the diagnostic efficacy and to establish a new diagnostic tool. Patients and methods. This study included 189 cases of pathologically confirmed SPTs (122 cases of benign disease including SPTs and tumour-like lesions and 67 cases of malignant SPTs). Ultrasound imaging included evaluation of vascularity by colour Doppler. We established a scoring system to more effectively differentiate malignant from benign SPTs (ultrasound-based sarcoma screening [USS] score). Results. The mean scores in the benign and malignant groups were 1.47 ± 0.93 and 3.42 ± 1.30, respectively. Patients with malignant masses showed significantly higher USS scores than did those with benign masses (p < 1 × 10-10). The area under the curve was 0.88 by receiver operating characteristic (ROC) analysis. Based on the cut-off value (3 points) calculated by ROC curve analysis, the sensitivity and specificity for a diagnosis of malignant SPT was 85.1% and 86.9%, respectively. Conclusions. Assessment of vascularity by Doppler ultrasound alone is insufficient for differentiation between benign and malignant SPTs. Preoperative diagnosis of most SPTs is possible by combining our USS score with characteristic clinical and magnetic resonance imaging findings.

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Utility of VSRAD for diagnosing Alzheimer’s disease in patients screened for dementia

Journal of International Medical Research ◽

10.1177/0300060520917270 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091727 ◽

Cited By ~ 1

Author(s):

Gaku Oshikubo ◽

Akihisa Akahane ◽

Aki Unno ◽

Yukako Watanabe ◽

Emi Ikebuchi ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Roc Curve ◽

Early Stage ◽

Regional Analysis ◽

Mean Value ◽

Cognitive Status ◽

Roc Curve Analysis ◽

Z Scores ◽

The Mean

Objective To investigate the utility of the voxel-based specific regional analysis system for Alzheimer’s disease (VSRAD). Methods Clinical data from patients who underwent screening for dementia using VSRAD and the Japanese version of COGNISTAT, the Neurobehavioral Cognitive Status Examination, were retrospectively investigated to specify the domains of cognitive function that correlate with the statistical mean value of positive Z-scores in the target volume-of-interest (VOI). A receiver operating characteristic (ROC) curve was constructed to assess the mean value of positive Z-scores in discriminating patients with AD. Results A total of 72 patients were included (18 male and 54 female; 15 patients with AD). The mean value of positive Z-scores in the target VOI was significantly correlated with standardized COGNISTAT scores for Orientation and Memory in all patients (r = –0.35 and –0.38, respectively). ROC curve analysis revealed that a cut-off of 1.57 for mean value of positive Z-scores in the target VOI provided 69.4% accuracy in discriminating patients with AD, with a sensitivity of 0.80 and specificity of 0.67. Conclusions The results evinced the value of VSRAD in diagnosing AD. The degree of atrophy represented by the target VOI may reflect impairments in Orientation and Memory, which are early stage symptoms observed in AD.

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Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Nutrients ◽

10.3390/nu12020402 ◽

2020 ◽

Vol 12 (2) ◽

pp. 402

Author(s):

Renée Blaauw ◽

Daan G. Nel ◽

Gunter K. Schleicher

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Area Under The Curve ◽

Threshold Value ◽

High Plasma ◽

Apache Ii ◽

Apache Ii Score ◽

Roc Curve Analysis ◽

Reactive Protein ◽

Proxy Indicators

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

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Use of percent positive biopsy cores to predict prostate cancer–specific death in patients treated with dose-escalated radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.35 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 35-35

Author(s):

Y. Qian ◽

F. Y. Feng ◽

S. Halverson ◽

K. Blas ◽

H. M. Sandler ◽

...

Keyword(s):

Prostate Cancer ◽

Roc Curve ◽

Risk Group ◽

Curve Analysis ◽

External Beam Radiation ◽

Rank Test ◽

Roc Curve Analysis ◽

Cut Point ◽

Log Rank Test ◽

Positive Biopsy

35 Background: The percent of positive biopsy cores (PPC)-considered a surrogate of local disease burden-has been shown to predict biochemical failure (BF) after external beam radiation therapy (EBRT), but most series have used conventional dose RT. Dose-escalated RT has been demonstrated to improve prostate cancer outcomes, but the value of PPC is unclear in the setting of RT doses high enough to decrease local failure. Methods: A retrospective evaluation was performed of 651 patients treated to ≥75 Gy with biopsy core information available. Patients were stratified for PPC by quartile, and differences by quartile in BF, freedom from metastasis (FFM), cause specific survival (CSS), and overall survival (OS) were assessed using the log-rank test. Receiver operated characteristic (ROC) curve analysis was utilized to determine an optimal cut-point for PPC. Cox proportional hazards multivariate regression was utilized to assess the impact of PPC on clinical outcome when adjusting for risk group. Results: With median follow-up of 62 months the median number of cores sampled was 7 (IQR: 6–12) with median PPC in 38% (IQR: 17%-67%). On log-rank test, BF, FFM, and CSS were all associated with PPC (p < 0.005 for all), with worse outcomes only for the highest PPC quartile (>67%). There was no observed difference in OS based upon PPC. ROC curve analysis confirmed a cut-point of 67% as most closely associated with CSS (p<0.001, AUC=0.71). On multivariate analysis after adjusting for NCCN risk group and ADT use, PPC>67% increased the risk for BF (p<0.0001, HR:2.1 [1.4–3.0]), FFM (p<0.05, HR:1.7 [1.1 to 2.9]), and CSS (p<0.06 (HR:2.1 [1.0–4.6]). When analyzed as a continuous variable controlling for risk group and ADT use, increasing PPC increased the risk for BF (p < 0.002), metastasis (p < 0.05), and CSS (p < 0.02), with a 1–2% increase in relative risk of recurrence for each 1% increase in the PPC. Conclusions: For patients treated with dose-escalated RT, the PPC adds prognostic value but at a higher cut-point then previously utilized. Patients with PPC >67% remain at increased risk for failure even with dose-escalated EBRT and may receive benefit from further intensification of therapy. No significant financial relationships to disclose.

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