scholarly journals PHYLLOIDES TUMOUR: REVIEW OF AN UNCOMMON BREAST PATHOLOGY AT A SPECIALIZED CANCER CENTRE

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Samiullah K Niazi ◽  
Raza Sayyed ◽  
Zulkernain Chaudary ◽  
Amina I Khan ◽  
Huma M Khan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Breast Tumours ◽  
Cancer Centre ◽  
Increased Risk ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Purpose: Phyllodes tumours are rare breast tumours that comprise almost 1% of breast tumours. The outcome for these tumours is generally considered better than breast cancers. We review the cases of phyllodes tumour presenting to a specialised cancer centre over a 14 year period. Materials and Methods: All case records with the diagnosis of phyllodes tumour between 1999 and 2012 were retrieved from the cancer registry. Patient demographics, tumour site, size, axillary lymph node status, whether primary or recurrent, metastatic status, histological type, type of surgery, any complication, margin positivity, post-operative radiation therapy, local or distant recurrence, morality and follow-up duration were recorded. Data were analysed using SPSS. Results: A total of 77 cases of phyllodes tumour were seen between 1999 and 2012. All patients were female with a mean age of 39.9 years. All patients presented with a breast lump with median duration of 8 months. Almost two-thirds (65%) of the patients presented with primary tumour compared to 10% recurrent tumours and the rest were referred after surgery outside. Median size on histopathology was 5 cm (IQR 3.5–8.5 cm). Over a median follow-up duration of 31 months (IQR 9–48 months), 69 patients (89.6%) were alive, while 3 patients (3.9%) did not survive and 5 patients (6.4%) were lost to follow-up. Recurrence was seen in 10 (13%) patients with median time to recurrence of 12 months (IQR 7–24). Involved axillary lymph nodes and borderline or malignant histopathology were found to be signi cantly associated with recurrence (P = 0.04), while margin positivity, post operative radiation therapy and histopathology were not signi cantly associated with recurrence. Conclusion: Phyllodes tumour is an uncommon breast tumour that is predominantly treated with surgical excision. Although survival with these tumours is better compared to breast cancers, involvement of axillary nodes and borderline or malignant histopathology confer an increased risk of recurrence in these patients. Key words: Breast cancer, phyllodes tumours, survival 

scholarly journals ESTROGEN AFTER ISCHEMIC STROKE: Effect of estrogen replacement on risk of recurrent stroke and death in the Women’s Estrogen for Stroke Trial (WEST)

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 329-329
Author(s):  
Catherine M Viscoli ◽  
Lawrence M Brass ◽  
Walter N Kernan ◽  
Philip M Sarrel ◽  
Ralph Horwitz
Keyword(s):  
Adverse Events ◽  
Cerebrovascular Disease ◽  
Observational Research ◽  
Baseline Risk ◽  
Breast Cancers ◽  
Estrogen Replacement ◽  
Vascular Events ◽  
Fatal Stroke ◽  
Increased Risk

71 Introduction: Observational research has produced conflicting findings concerning the effect of estrogen replacement therapy (ERT) on reducing risk for vascular events or death in women. To test the effect of ERT in women with established cerebrovascular disease, we designed a randomized trial of estradiol-17β(1 mg/day) vs. placebo. Methods: Participants were identified from 20 hospitals in New England. Eligibility criteria included age over 44, at least 1 year since last menstrual period, and TIA or non-disabling stroke within 90 days of entry. Randomization was stratified by baseline risk group and hospital. Primary trial outcomes were non-fatal stroke and all-cause death. Results: From December 1993-May 1998, 652 women were randomized (332 estradiol, 320 placebo). Index event was TIA in 164 subjects and stroke in 488. Mean age of subjects was 71 years (range 46–91); 84% were white, 13% black, and 4% other. Mean follow-up was 2.7 years (range: 18 days-5.8 years). At 1 year, 76% of subjects assigned to estradiol were on study drug. In the estradiol group, adverse events were diagnosed during follow-up in 8 subjects (1 pulmonary embolus (PE), 1 deep venous thrombosis (DVT), 5 breast cancers, 1 endometrial cancer) compared with 7 events in placebo subjects (2 PE, 1 DVT, and 4 breast cancers). Non-fatal strokes were confirmed in 51 subjects in the estradiol group vs. 52 in placebo subjects (rates at 3 years[R]: 16.8% estradiol vs. 17.4% placebo; logrank p-value[p]=.83). Death occurred in 46 estradiol subjects vs. 38 placebo subjects (R=13.0% vs. 12.6%, p=.89). At 3 years, combined rate of non-fatal stroke or death was 27.6% in the estradiol group vs. 27.7% in placebo [p=.80]. Conclusion: During an average follow-up of 2.7 years, estradiol treatment did not protect against recurrent cerebral ischemia or reduce all-cause mortality in postmenopausal women with pre-existing cerebrovascular disease. No increased risk for adverse events associated with estrogen was observed. This trial adds to the growing body of evidence that fails to confirm a protective role for ERT in populations with known vascular disease.

Abstract Submission

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 526-526 ◽  
Author(s):  
L. J. Goldstein ◽  
R. Gray ◽  
B. H. Childs ◽  
D. Watson ◽  
S. G. Rowley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Disease Free Survival ◽  
Recurrence Score ◽  
Recurrence Risk ◽  
Oncotype Dx ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Free Survival ◽  
Increased Risk

526 Background: Evidence suggests modern chemotherapy (CT) regimens are only marginally more effective in HR-pos breast cancer (Berry et al. JAMA 2006: 295: 1658). Genomic classifiers may be useful for selection of high-risk subjects for more aggressive CHT. Methods: A case-cohort sample of 776 patients enrolled on E2197 who did (N=179) or did not have a recurrence after CT (if HR-neg) or CHT (if HR-pos) and had available tissue were evaluated for Oncotype DX™ Recurrence Score (RS). E2197 included 2885 evaluable patients with 0–3 positive nodes treated with four 3-week cycles of doxorubicin (60 mg/m2) plus cyclophosphamide 600 mg/m2 (AC) or docetaxel 60 mg/m2 (AT) and hormonal therapy (if HR-pos). Median follow-up was 76 months. Results: There was no difference in DFS between treatment arms. In multivariate analysis, RS was a significant predictor of recurrence in HR-pos disease (p=0.0007, recurrence risk 21% lower for each 10 point drop in RS, 95% confidence intervals 9% to 31%). Recurrence risk was significantly elevated for an intermediate RS 18–30 (n=138, hazard ratio [HR] 2.96 [p=0.0002]) or a high RS ≥ 31 (n=108, HR 4.00, p=0.0001) compared with low RS < 18(n=196), but not for high compared with intermediate RS (HR 1.34, [p=0.32]); results were similar if only HER2-neg disease was included. The 5-year relapse free interval(RFI), breast cancer free survival (BCFS), disease-free survival (DFS), and overall survival (OS) for patients with HR-pos, HER2-neg disease are shown below (%); patients with both node-neg or node-pos breast cancers whose RS was < 18 had excellent outcomes. Conclusions: Oncotype DX™ RS identifies individuals with HR-pos, HER2-neg breast cancer with 0–3 positive axillary lymph nodes at 3–4-fold increased risk of relapse despite standard CHT, and may serve as a means to distinguish between those who do well with standard CHT (RS <18) from those who may be suitable candidates for clinical trials evaluating alternative CT regimens or other strategies (RS ≥ 18). [Table: see text] [Table: see text]

Value of adjuvant radiation therapy in breast cancer patients with one to three positive lymph nodes undergoing a modified radical mastectomy and systemic therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 507-507 ◽  
Author(s):  
S. Dawood ◽  
A. M. Gonzalez-Angulo ◽  
W. Woodward ◽  
F. Meric-Bernstam ◽  
K. Hunt ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Lymph Nodes ◽  
Systemic Therapy ◽  
Distant Recurrence ◽  
Axillary Lymph Nodes ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Adjuvant Radiation Therapy ◽  
Increased Risk ◽  
Segmental Mastectomy

507 Background: Whether adjuvant radiation therapy should be utilized for patients (pts) with early stage breast cancer with up to 3 positive axillary lymph nodes treated with mastectomy and systemic therapy is controversial. This retrospective study was performed to determine if adjuvant radiation therapy had an impact on survival for this cohort of pts. Methods: 4240 pts with T1–2N0–1 breast cancers, diagnosed between 1980–2007, who underwent either mastectomy without adjuvant radiation therapy or segmental mastectomy with adjuvant radiation therapy were identified. All pts received systemic treatment. Women with >3 positive axillary lymph nodes were excluded. Overall (OS) and distant disease free survival (DDFS) were estimated using the Kaplan-Meir product method. Cox proportional hazards were used to determine associations between OS/DDFS and type of surgery after controlling for pt and disease characteristics. Results: 1336 (18.8%) had T1N0 disease, 1114 (26.27%) had T2N0 disease, 989 (23.33%) had T1N1 disease and 801 (18.89%) had T2N1 disease. Median follow-up was 54 months.5- year DDFS among women who underwent mastectomy and segmental mastectomy was 81% (95% 78%-83%) and 86% (95% CI 84%-87%), respectively (p < 0.0001). In the Cox analysis, pts who had mastectomy without radiation had a significantly increased risk of distant recurrence (HR= 1.39, 95% CI 1.14–1.70, p= 0.0013) than pts treated with segmental mastectomy and radiation. When looking at subgroups, no significant difference in DDFS was observed between the two groups in pts with lymph node negative disease. However, for pts with 1–3 positive lymph nodes, pts treated with mastectomy without radiation had significantly increased risk of distant recurrence compared to pts treated with segmental mastectomy with radiation (HR=1.614, 95% CI 1.198–2.177, p= 0.002). This difference was most pronounce in the subset of patients with T2N1 disease (HR= 1.794, 95% CI 1.220–2.637, p=0.003). Similar trends were observed for OS. Conclusions: This study provides provocative evidence for benefit of radiation therapy among pts with 1–3 positive axillary lymph nodes who are treated with surgery and systemic therapy. No significant financial relationships to disclose.

scholarly journals Giant Metastatic Breast Phyllodes Tumour with an Elusive Diagnosis: A Case Report and Literature Review

2021 ◽  
Author(s):  
Raquel Basto ◽  
Tatiana Cunha Pereira ◽  
Luís Rei ◽  
Fábio Rêgo Salgueiro ◽  
Joana Correia Magalhães ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Metastatic Disease ◽  
Palliative Chemotherapy ◽  
Treatment Options ◽  
Metastatic Breast ◽  
Standard Of Care ◽  
Residual Tumour ◽  
Recurrence Rates ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Background: The term phyllodes tumours, which account for less than 1% of breast neoplasms, describes a spectrum of heterogenous tumours with different clinical behaviours. Less than 30% present as metastatic disease. Complete surgical resection is the standard of care so that recurrence rates are reduced. The role of adjuvant chemotherapy or radiation therapy is controversial. Patients with metastatic disease have a median overall survival of around 30 months. Case description: The authors present the case of a 57-year-old woman with an exuberant left malignant phyllodes tumour with bilateral involvement, as well as lung and axillar metastasis. The patient underwent haemostatic radiation therapy and started palliative chemotherapy with doxorubicin, achieving partial response with significant improvement in quality of life. A posterior simple mastectomy revealed a small residual tumour. Discussion: Metastatic malignant phyllodes tumours are rare, so therapeutic strategies rely on small retrospective studies and guidelines for soft tissue sarcoma. Palliative chemotherapy protocols include anthracycline-based regimens, either as monotherapy with doxorubicin or doxorubicin together with ifosfamide. With few treatment options, management of these patients must rely on a continuum of care

Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients.

1998 ◽  
Vol 16 (11) ◽  
pp. 3493-3501 ◽  
Author(s):  
C L Shapiro ◽  
P H Hardenbergh ◽  
R Gelman ◽  
D Blanks ◽  
P Hauptman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Cardiac Events ◽  
Female Population ◽  
Cardiac Effects ◽  
Dose Volume ◽  
Increased Risk

PURPOSE To assess the cardiac effects of two different cumulative doses of adjuvant doxorubicin and radiation therapy (RT) in breast cancer patients. PATIENTS AND METHODS Two hundred ninety-nine breast cancer patients were prospectively randomized to receive either five cycles (CA5) or 10 cycles (CA10) of adjuvant treatment with cyclophosphamide (500 mg/ m2) and doxorubicin (45 mg/m2) administered by intravenous bolus every 21 days. One hundred twenty-two of these patients also received RT. Estimates of the cardiac RT dose-volume were retrospectively categorized as low, moderate, or high. The risk of major cardiac events (congestive heart failure, acute myocardial infarction) was assessable in 276 patients (92%), with a median follow-up time of 6.0 years (range, 0.5 to 19.4). RESULTS The estimated risk (95% confidence interval) of cardiac events per 100 patient-years was significantly higher for CA10 than for CA5 [1.7 (1.0 to 2.8) v 0.5 (0.1 to 1.2); P=.02]. The risk of cardiac events in CA5 patients, irrespective of the cardiac RT dose-volume, did not differ significantly from rates of cardiac events predicted for the general female population by the Framingham Heart Study. In CA10 patients, the incidence of cardiac events was significantly increased (relative risk ratio, 3.6; P < .00003) compared with the Framingham population, particularly in groups that also received moderate and high dose-volume cardiac RT. CONCLUSION Conventional-dose adjuvant doxorubicin as delivered in the CA5 regimen by itself, or in combination with locoregional RT, was not associated with a significant increase in the risk of cardiac events. Higher doses of adjuvant doxorubicin (CA10) were associated with a threefold to fourfold increased risk of cardiac events. This appears to be especially true in patients treated with higher dose-volumes of cardiac RT. Larger studies with longer follow-up periods are needed to confirm these results.

Treatment of Breast Cancer in Elderly Women: Retrospective Analysis of 111 Wide Lumpectomies Performed in a Day Hospital Regimen between 1982 and 1988

1992 ◽  
Vol 78 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Emanuele Galante ◽  
Annamaria Cerrotta ◽  
Gabriele Martelli ◽  
Ivan Del Prato ◽  
Daniele Moglia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Elderly Women ◽  
Distant Metastases ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Outpatient Basis ◽  
Breast Cancers ◽  
Day Hospital ◽  
Lost To Follow Up

Between 1982 and 1988, 111 elderly women with breast cancer but without clinical involvement of the axillary lymph nodes underwent wide lumpectomy in a Day Hospital regimen at the National Cancer Institute of Milan. The patients ranged in age from 70 to 92 years (median, 79). An adjuvant treatment was carried out in all but 9 cases: tamoxifen only in 84 cases, tamoxifen plus radiotherapy in 6 cases, radiotherapy alone in 12 cases. The median duration of follow-up was 44 months (range, 30–109 months). Four patients (3.6%) were lost to follow-up. In the remaining 107 patients, 10 local-regional relapses (9.1 %) and 7 distant metastases (6.5 %) occurred. Six patients died from the disease, 14 from unrelated conditions. This retrospective study showed that selected elderly patients with breast cancers can be treated successfully under local anesthesia on an outpatient basis. The treatment guarantees local control of the disease, meets the favor of elderly women and consequently improves their quality of life.

p53 expression and clinical outcomes in untreated and treated breast cancer patients after long-term follow-up.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14745-e14745
Author(s):  
Sherry X. Yang ◽  
Erich Huang ◽  
Dat Nguyen
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Endocrine Therapy ◽  
Clinical Outcomes ◽  
Cox Model ◽  
Univariate Analysis ◽  
Specific Treatment ◽  
P53 Expression ◽  
Increased Risk

e14745 Background: p53 alteration represents one of the hallmarks of malignant transformation. However, its role on treatment outcome remains controversial and is unknown in untreated patients in breast cancer. This study aims to evaluate p53 expression in association with clinical outcomes in untreated patients relative to those undergoing homogeneous therapy. Methods: p53 protein was examined by immunohistochemistry in 956 patients with stage I, II and III breast cancer. Overall survival (OS) and relapse-free survival (RFS) between p53-positive and -negative tumors in chemotherapy, radiation or endocrine therapy alone and no treatment groups were estimated by Kaplan-Meier method. OS and RFS were further assessed by multivariable Cox model that incorporates p53, age, tumor size and grade, estrogen receptor, and HER2 in specific treatment group(s). Results: p53 expression was detected in 22.7% of breast cancer. Median follow-up time was 115.5 months, with a range of 5 to 282 months. Expression of p53 was associated with younger age at diagnosis, higher tumor grade, ER/PR negativity, and HER2 positivity ( P< 0.001). Without any treatment including systemic and radiation therapy (n = 227), OS and RFS curves were overlapped from the beginning until the end of follow-up between p53-positive and -negative patients, respectively. In contrast, p53 was significantly associated with worse OS and RFS with univariate analysis and multivariate statistics of OS (HR 4.07, 95% CI 1.95-8.50; P< 0.001) and risk of relapse (HR 2.23, 95% CI 1.11-4.48; P= 0.025) by endocrine therapy alone (n = 130). Moreover, apparent trends for p53 toward unfavorable OS and RFS were observed in those undergoing homogeneous radiation therapy and chemotherapy, only within 150 months of follow-up. Conclusions: p53 is not associated with clinical outcomes in the absence of conventional therapy, and independently predicts worse survival and increased risk of recurrence after endocrine therapy.

The impact of poly ADP ribose polymerase (PARP) inhibitors on clonal hematopoiesis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1513-1513
Author(s):  
Kelly L Bolton ◽  
Lea Anne Moukarzel ◽  
Ryan Ptashkin ◽  
Teng Gao ◽  
Minal Patel ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Parp Inhibitors ◽  
Chemotherapeutic Agents ◽  
Cumulative Exposure ◽  
Blood Draw ◽  
Clonal Hematopoiesis ◽  
Increased Risk ◽  
Cytotoxic Therapies ◽  
The Impact

1513 Background: Poly (ADP-ribose) polymerase (PARP) inhibitors are an important new class of anti-cancer therapies. Therapy-related myeloid neoplasia (tMN) has been reported following PARPi therapy, and is associated with adverse outcomes. Further insight is required into the risk of tMN conferred by PARPi therapy, independent of germline genetic background and prior therapy. We have shown that oncologic therapy selects for acquired mutations in the blood (clonal hematopoiesis; CH) particularly those in the DNA damage response pathway (DDR) including PPM1D, TP53 and CHEK2 and that CH confers an increased risk of tMN. We hypothesized that characterization of the relationship between CH and PARPi therapy provides insight into its potential for leukemogenesis and may offer opportunities for tMN prevention. Methods: We assessed for CH in the blood of 10,156 cancer patients, including 54 who received PARPi therapy, 5942 who received another systematic therapy or radiation therapy and 4160 untreated prior to blood draw. Results: Patients exposed to PARPi therapy were more likely to have CH (33%) compared to those exposed to other systemic therapies or radiation (18%) or untreated patients (16%). This was particularly pronounced for DDR CH; 25% of PARPi treated patients had DDR CH compared to 2% of untreated patients. In a multivariable model accounting for demographics, exposure to chemotherapeutic agents, radiation therapy and germline BRCA mutation status, exposure to PARPi conferred an increased risk of DDR CH (OR = 3.6, 95% CI 1.5-8.5, p = 0.004). This effect was attenuated after accounting for cumulative exposure to therapy (OR = 2.8, 95% CI 0.97-8.2, p = 0.06) suggesting a multifactorial contribution to the enrichment of CH following PARPi therapy. To characterize this further we performed a prospective collection of patients with CH over a median follow-up time of 58 months. During the follow-up period, 17 patients received PARPi, 360 received cytotoxic therapies or radiation and 232 were untreated or received targeted therapies. The growth rate of DDR CH was significantly higher among those who were exposed to PARPi (median, +2.8% increase in VAF per year) compared to untreated patients (+0.08% per year, p = 0.02) and those exposed to other cytotoxic therapies (+1% per year, p = 0.04). Conclusions: Taken together our data suggests that PARPi therapy promotes the expansion of DDR CH. Future studies should examine the potential of CH to identify individuals at high risk of tMN following PARPi therapy and to develop therapies aimed to prevent tMN in patients with CH.

Health care costs among adolescent young adults with cancer at a community-based hospital.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18857-e18857
Author(s):  
Kekoa Taparra ◽  
Alec Fitzsimmons ◽  
Susan M. Frankki ◽  
Andrea DeWall ◽  
Fumiko Chino ◽  
...  
Keyword(s):  
Young Adults ◽  
Radiation Therapy ◽  
Cancer Diagnosis ◽  
Healthcare Costs ◽  
Community Hospital ◽  
Hospital Admissions ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Increased Risk

e18857 Background: Adolescent Young Adults (AYAs) are likely to live for decades after a cancer diagnosis and thus have the potential to accumulate high healthcare costs. Prior research has shown high costs can be associated with increased risk of morbidity and mortality. However, there is limited understanding of how costs impact AYAs, especially in a community hospital. The purpose of this study is to 1) understand total community hospital healthcare costs for AYA patients with cancer, 2) identify risk factors for high costs, and 3) assess the impact of costs on survival. Methods: AYA patients (ages 15-29) treated at a community hospital were identified. Data collected included patient demographics, cancer characteristics, treatments (chemotherapy, radiation, surgery, immunotherapy, hormone therapy), support services (financial counseling, social work, survivorship), hospital admissions, miles from the hospital (great-circle distance), and all healthcare charges from one year prior to cancer diagnosis until last follow-up between 2000-2020. Multivariate logistic regression analyses were used to identify patients with costs greater than the median ($125K). Cox Proportional Hazard (CPH) regression models were used to identify factors associated with the risk of all-cause mortality. Results: A total of 388 AYA patients were identified with a median follow-up of 9 years and 97% survival. Most patients were age 30-39 years (62%), female (61%), white (95%), married (63%), non-smoker (59%), had insurance (78%), had early-stage cancer (85%), and were treated with surgery (83%). The most common cancers were melanoma (17%), breast cancer (14%), and thyroid cancer (14%). Median distance from treatment site was 23 miles. Median number of admissions was one. About a third of patients received chemotherapy (37%), radiation (28%), or hormone therapy (30%). Two-hundred thirty-three patients (60%) had complete healthcare cost data with a median total costs per patient of $123K (range, $73K-$215K). In adjusted analysis, patients with higher than median healthcare cost ( > $125K) had greater odds of hospital admission (odds ratio [OR] = 1.5, p < .001) and chemotherapy treatment (OR = 3.4, p = .005) as well as lower odds of living further from the hospital per one mile (OR = 0.3, p = .049) and being uninsured/unknown insurance (OR = 0.1, p = .047). In adjusted analysis, increased risk of death was associated with receiving radiation therapy (HR = 7.8, p = .02) and higher healthcare costs per $125K (HR = 3.8, p = .001). Conclusions: High costs of healthcare among AYA patients with cancer are related to chemotherapy, hospital admissions, and hospital proximity. High healthcare costs and radiation therapy may be associated with increased risk of death in the AYA population. This data may guide physician decision making for AYA patients ensuring mindfulness of high costs of care and how it relates to poor survival outcomes in community hospitals.

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