研究评估调强放疗后的晚期毒性和具有相应治疗余量的两种图像引导策略。 (RCMIGI)
随机 II 期研究评估调强放疗后的晚期毒性和具有相应治疗裕度的两种图像引导策略。 (RCMIGI)
Calypso® 系统(Varian Medical Systems, Inc., Palo Alto, CA)是一项使用植入前列腺内的电磁转发器的最新技术。 它是一个实时目标跟踪系统,同时考虑了分次间和分次内的目标运动。 因此可以在放射治疗期间确定前列腺的确切位置和运动。
本研究的目的是评估调强放疗 (IMRT) 后使用 Calypso® 系统降低治疗边缘时的盆腔晚期毒性率。 在这项随机研究中,患者将接受使用 Calypso 系统的 IGRT 治疗或传统的 IGRT 治疗。
研究概览
详细说明
前列腺癌是男性中最常见的癌症。 放射治疗是局限性前列腺癌的参考治疗方法之一。 前列腺最初被认为是一个不动的目标,但最新的报告提出了相反的证据。 图像引导放射治疗 (IGRT) 是目前局部前列腺癌的标准治疗方法,它能够在治疗前考虑到分次前列腺运动。
Calypso® 系统(Varian Medical Systems, Inc., Palo Alto, CA)是一项使用植入前列腺内的电磁转发器的最新技术。 它是一个实时目标跟踪系统,同时考虑了分次间和分次内的目标运动。 因此可以在放射治疗期间确定前列腺的确切位置和运动。
由于计划目标体积 (PTV) 余量整合了设置余量和器官运动管理,因此在目标运动管理改进的情况下可以合理地考虑减少余量。
迄今为止,尚无前瞻性随机临床数据可用于使用该技术通过现代标准分割放疗和影像引导治疗低危或中危前列腺癌患者。
本研究的目的是评估调强放疗 (IMRT) 后使用 Calypso® 系统降低治疗边缘时的盆腔晚期毒性率。 在这项随机研究中,患者将接受使用 Calypso 系统的 IGRT 治疗或传统的 IGRT 治疗。
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Montpellier、法国、34298
- Institut regional du Cancer - Val d Aurelle
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
描述
纳入标准:
- 局限性前列腺癌,经组织学证实。
- 没有转移的证据 (M0)。 无淋巴结受累证据 (N0)(如果根据 Partin 表淋巴结受累风险较低,则双侧淋巴结清扫不是强制性的)。
- 根据 D'Amico 分类的低风险或中间临床阶段(T1-T2 和 Gleason < 8 和 PSA < 20 ng/ml)(附录 3)。
- 根据 CTCAE V4.03 量表,没有 > 2 级的泌尿或直肠临床体征或症状。
- 体能状态 ECOG ≤ 1。
- 前列腺附近没有髋关节假体或金属血管移植物。
- 没有内切支架。
- 没有心脏起搏器、植入式除颤器或神经刺激器。
- 对局部麻醉药不过敏。
- 植入期间无需进行不可逆的抗凝或抗血小板治疗。
- 骨盆和腹部解剖学与 Calypso® 系统的使用兼容(预测检测器到基准点的距离小于 19 厘米,根据计划 CT 扫描进行评估)(从皮肤表面到前列腺中心的距离小于 17 厘米)。
- 患者年龄≥18岁且未满80岁。
- 提供注明日期并签署的书面知情同意书。
- 患者必须隶属于法国社会保障体系。
排除标准:
- 骨盆淋巴结照射的指示。
- 先前的盆腔照射。
- 活检证实的精囊浸润。
- 既往双侧睾丸切除术。
- 先前的根治性前列腺切除术。
- 其他恶性肿瘤,除了充分治疗的皮肤基底细胞癌或患者已至少 5 年无病的其他恶性肿瘤。
- 可能妨碍遵守研究方案和后续计划的心理、家庭、社会或地理条件;在试验注册之前,应与患者讨论这些情况。
- 其他未控制的全身性疾病(心血管、肾脏、肝脏、肺栓塞等)。
- 已知的 VIH 阳性患者(无需特定测试)。
- 已知纯合子 ATM 突变 (Ataxia telengiectasia)。
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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有源比较器:具有标准边缘的图像引导放射治疗 (IGRT)
4周中度大分割
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适度大分割放疗
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实验性的:减少保证金的 Calypso 跟踪系统
calypso beacon 植入前 10 天后 4 周内进行中度大分割
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适度大分割放疗
放疗前的 Calypso 信标植入物
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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评估> 2级骨盆毒性晚期毒性
大体时间:辐射期后3个月至2年
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辐射期3个月至2年之间的骨盆毒性> 2级的评估
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辐射期后3个月至2年
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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无生物复发生存
大体时间:放疗后的5年
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用PSA剂量评估5年
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放疗后的5年
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简单的生存期(局部复发或转移性复发)
大体时间:放疗后的5年
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评估放射学检查5年后的ET
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放疗后的5年
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总体生存
大体时间:放射治疗后的基线到5年
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从基线到治疗后5年的死亡人数
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放射治疗后的基线到5年
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合作者和调查者
调查人员
- 学习椅:Riou Olivier、Institut Regional du Cancer de Montpellier
出版物和有用的链接
一般刊物
- Ozsahin M, Crompton NE, Gourgou S, Kramar A, Li L, Shi Y, Sozzi WJ, Zouhair A, Mirimanoff RO, Azria D. CD4 and CD8 T-lymphocyte apoptosis can predict radiation-induced late toxicity: a prospective study in 399 patients. Clin Cancer Res. 2005 Oct 15;11(20):7426-33. doi: 10.1158/1078-0432.CCR-04-2634.
- Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun;49(6):822-30. doi: 10.1016/s0090-4295(97)00238-0.
- Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365-76. doi: 10.1093/jnci/85.5.365.
- Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, Bauman GS, Bahary JP, Ahmed S, Cheung P, Tai KH, Wu JS, Parliament MB, Tsakiridis T, Corbett TB, Tang C, Dayes IS, Warde P, Craig TK, Julian JA, Levine MN. Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. J Clin Oncol. 2017 Jun 10;35(17):1884-1890. doi: 10.1200/JCO.2016.71.7397. Epub 2017 Mar 15.
- Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N, Grummet J, Henry AM, van der Kwast TH, Lam TB, Lardas M, Liew M, Mason MD, Moris L, Oprea-Lager DE, van der Poel HG, Rouviere O, Schoots IG, Tilki D, Wiegel T, Willemse PM, Cornford P. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021 Feb;79(2):243-262. doi: 10.1016/j.eururo.2020.09.042. Epub 2020 Nov 7.
- Kupelian P, Willoughby T, Mahadevan A, Djemil T, Weinstein G, Jani S, Enke C, Solberg T, Flores N, Liu D, Beyer D, Levine L. Multi-institutional clinical experience with the Calypso System in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy. Int J Radiat Oncol Biol Phys. 2007 Mar 15;67(4):1088-98. doi: 10.1016/j.ijrobp.2006.10.026. Epub 2006 Dec 21.
- Jereczek-Fossa BA, Orecchia R. Evidence-based radiation oncology: definitive, adjuvant and salvage radiotherapy for non-metastatic prostate cancer. Radiother Oncol. 2007 Aug;84(2):197-215. doi: 10.1016/j.radonc.2007.04.013. Epub 2007 May 29.
- Zaorsky NG, Harrison AS, Trabulsi EJ, Gomella LG, Showalter TN, Hurwitz MD, Dicker AP, Den RB. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol. 2013 Oct;10(10):565-79. doi: 10.1038/nrurol.2013.185. Epub 2013 Sep 10.
- Budaus L, Bolla M, Bossi A, Cozzarini C, Crook J, Widmark A, Wiegel T. Functional outcomes and complications following radiation therapy for prostate cancer: a critical analysis of the literature. Eur Urol. 2012 Jan;61(1):112-27. doi: 10.1016/j.eururo.2011.09.027. Epub 2011 Oct 6.
- Ohri N, Dicker AP, Showalter TN. Late toxicity rates following definitive radiotherapy for prostate cancer. Can J Urol. 2012 Aug;19(4):6373-80.
- de Crevoisier R, Fiorino C, Dubray B. [Dosimetric factors predictive of late toxicity in prostate cancer radiotherapy]. Cancer Radiother. 2010 Oct;14(6-7):460-8. doi: 10.1016/j.canrad.2010.07.225. Epub 2010 Aug 24. French.
- Valdagni R, Rancati T, Fiorino C. Predictive models of toxicity with external radiotherapy for prostate cancer: clinical issues. Cancer. 2009 Jul 1;115(13 Suppl):3141-9. doi: 10.1002/cncr.24356.
- Yu JB. Hypofractionated Radiotherapy for Prostate Cancer: Further Evidence to Tip the Scales. J Clin Oncol. 2017 Jun 10;35(17):1867-1869. doi: 10.1200/JCO.2017.72.7016. Epub 2017 Mar 29. No abstract available.
- Lee WR, Dignam JJ, Amin MB, Bruner DW, Low D, Swanson GP, Shah AB, D'Souza DP, Michalski JM, Dayes IS, Seaward SA, Hall WA, Nguyen PL, Pisansky TM, Faria SL, Chen Y, Koontz BF, Paulus R, Sandler HM. Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. J Clin Oncol. 2016 Jul 10;34(20):2325-32. doi: 10.1200/JCO.2016.67.0448. Epub 2016 Apr 4.
- Incrocci L, Wortel RC, Alemayehu WG, Aluwini S, Schimmel E, Krol S, van der Toorn PP, Jager H, Heemsbergen W, Heijmen B, Pos F. Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2016 Aug;17(8):1061-1069. doi: 10.1016/S1470-2045(16)30070-5. Epub 2016 Jun 20.
- Arcangeli G, Saracino B, Arcangeli S, Gomellini S, Petrongari MG, Sanguineti G, Strigari L. Moderate Hypofractionation in High-Risk, Organ-Confined Prostate Cancer: Final Results of a Phase III Randomized Trial. J Clin Oncol. 2017 Jun 10;35(17):1891-1897. doi: 10.1200/JCO.2016.70.4189. Epub 2017 Mar 29.
- Rodin D, Tawk B, Mohamad O, Grover S, Moraes FY, Yap ML, Zubizarreta E, Lievens Y. Hypofractionated radiotherapy in the real-world setting: An international ESTRO-GIRO survey. Radiother Oncol. 2021 Apr;157:32-39. doi: 10.1016/j.radonc.2021.01.003. Epub 2021 Jan 14.
- Chapet O, Decullier E, Bin S, Faix A, Ruffion A, Jalade P, Fenoglietto P, Udrescu C, Enachescu C, Azria D. Prostate hypofractionated radiation therapy with injection of hyaluronic acid: acute toxicities in a phase 2 study. Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):730-6. doi: 10.1016/j.ijrobp.2014.11.027.
- Palombarini M, Mengoli S, Fantazzini P, Cadioli C, Degli Esposti C, Frezza GP. Analysis of inter-fraction setup errors and organ motion by daily kilovoltage cone beam computed tomography in intensity modulated radiotherapy of prostate cancer. Radiat Oncol. 2012 Apr 2;7:56. doi: 10.1186/1748-717X-7-56.
- Tanyi JA, He T, Summers PA, Mburu RG, Kato CM, Rhodes SM, Hung AY, Fuss M. Assessment of planning target volume margins for intensity-modulated radiotherapy of the prostate gland: role of daily inter- and intrafraction motion. Int J Radiat Oncol Biol Phys. 2010 Dec 1;78(5):1579-85. doi: 10.1016/j.ijrobp.2010.02.001. Epub 2010 May 14.
- Nguyen NP, Davis R, Bose SR, Dutta S, Vinh-Hung V, Chi A, Godinez J, Desai A, Woods W, Altdorfer G, D'Andrea M, Karlsson U, Vo RA, Sroka T; International Geriatric Radiotherapy Group. Potential applications of image-guided radiotherapy for radiation dose escalation in patients with early stage high-risk prostate cancer. Front Oncol. 2015 Feb 2;5:18. doi: 10.3389/fonc.2015.00018. eCollection 2015.
- Crehange G, Martin E, Supiot S, Chapet O, Mazoyer F, Naudy S, Maingon P. [Image-guided radiotherapy in prostate cancer: concepts and implications]. Cancer Radiother. 2012 Sep;16(5-6):430-8. doi: 10.1016/j.canrad.2012.07.183. Epub 2012 Aug 23. French.
- Bernchou U, Agergaard SN, Brink C. Radiopaque marker motion during pre-treatment CBCT as a predictor of intra-fractional prostate movement. Acta Oncol. 2013 Aug;52(6):1168-74. doi: 10.3109/0284186X.2012.747698. Epub 2012 Dec 17.
- Badakhshi H, Wust P, Budach V, Graf R. Image-guided radiotherapy with implanted markers and kilovoltage imaging and 6-dimensional position corrections for intrafractional motion of the prostate. Anticancer Res. 2013 Sep;33(9):4117-21.
- Tong X, Chen X, Li J, Xu Q, Lin MH, Chen L, Price RA, Ma CM. Intrafractional prostate motion during external beam radiotherapy monitored by a real-time target localization system. J Appl Clin Med Phys. 2015 Mar 8;16(2):5013. doi: 10.1120/jacmp.v16i2.5013.
- Das S, Liu T, Jani AB, Rossi P, Shelton J, Shi Z, Khan MK. Comparison of image-guided radiotherapy technologies for prostate cancer. Am J Clin Oncol. 2014 Dec;37(6):616-23. doi: 10.1097/COC.0b013e31827e4eb9.
- Foster RD, Pistenmaa DA, Solberg TD. A comparison of radiographic techniques and electromagnetic transponders for localization of the prostate. Radiat Oncol. 2012 Jun 21;7:101. doi: 10.1186/1748-717X-7-101.
- Korreman S, Rasch C, McNair H, Verellen D, Oelfke U, Maingon P, Mijnheer B, Khoo V. The European Society of Therapeutic Radiology and Oncology-European Institute of Radiotherapy (ESTRO-EIR) report on 3D CT-based in-room image guidance systems: a practical and technical review and guide. Radiother Oncol. 2010 Feb;94(2):129-44. doi: 10.1016/j.radonc.2010.01.004. Epub 2010 Feb 12.
- Santanam L, Malinowski K, Hubenshmidt J, Dimmer S, Mayse ML, Bradley J, Chaudhari A, Lechleiter K, Goddu SK, Esthappan J, Mutic S, Low DA, Parikh P. Fiducial-based translational localization accuracy of electromagnetic tracking system and on-board kilovoltage imaging system. Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):892-9. doi: 10.1016/j.ijrobp.2007.10.005.
- Langen KM, Willoughby TR, Meeks SL, Santhanam A, Cunningham A, Levine L, Kupelian PA. Observations on real-time prostate gland motion using electromagnetic tracking. Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1084-90. doi: 10.1016/j.ijrobp.2007.11.054. Epub 2008 Feb 14.
- Willoughby TR, Kupelian PA, Pouliot J, Shinohara K, Aubin M, Roach M 3rd, Skrumeda LL, Balter JM, Litzenberg DW, Hadley SW, Wei JT, Sandler HM. Target localization and real-time tracking using the Calypso 4D localization system in patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):528-34. doi: 10.1016/j.ijrobp.2006.01.050.
- Mayyas E, Chetty IJ, Chetvertkov M, Wen N, Neicu T, Nurushev T, Ren L, Lu M, Stricker H, Pradhan D, Movsas B, Elshaikh MA. Evaluation of multiple image-based modalities for image-guided radiation therapy (IGRT) of prostate carcinoma: a prospective study. Med Phys. 2013 Apr;40(4):041707. doi: 10.1118/1.4794502.
- Noel C, Parikh PJ, Roy M, Kupelian P, Mahadevan A, Weinstein G, Enke C, Flores N, Beyer D, Levine L. Prediction of intrafraction prostate motion: accuracy of pre- and post-treatment imaging and intermittent imaging. Int J Radiat Oncol Biol Phys. 2009 Mar 1;73(3):692-8. doi: 10.1016/j.ijrobp.2008.04.076. Epub 2008 Aug 7.
- Zhu M, Bharat S, Michalski JM, Gay HA, Hou WH, Parikh PJ. Adaptive radiation therapy for postprostatectomy patients using real-time electromagnetic target motion tracking during external beam radiation therapy. Int J Radiat Oncol Biol Phys. 2013 Mar 15;85(4):1038-44. doi: 10.1016/j.ijrobp.2012.08.001. Epub 2012 Sep 25.
- Su Z, Zhang L, Murphy M, Williamson J. Analysis of prostate patient setup and tracking data: potential intervention strategies. Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):880-7. doi: 10.1016/j.ijrobp.2010.07.1978. Epub 2010 Oct 8.
- Klayton T, Price R, Buyyounouski MK, Sobczak M, Greenberg R, Li J, Keller L, Sopka D, Kutikov A, Horwitz EM. Prostate bed motion during intensity-modulated radiotherapy treatment. Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):130-6. doi: 10.1016/j.ijrobp.2011.11.041. Epub 2012 Feb 11.
- Mantz C. A Phase II Trial of Stereotactic Ablative Body Radiotherapy for Low-Risk Prostate Cancer Using a Non-Robotic Linear Accelerator and Real-Time Target Tracking: Report of Toxicity, Quality of Life, and Disease Control Outcomes with 5-Year Minimum Follow-Up. Front Oncol. 2014 Nov 14;4:279. doi: 10.3389/fonc.2014.00279. eCollection 2014.
- Sandler HM, Liu PY, Dunn RL, Khan DC, Tropper SE, Sanda MG, Mantz CA. Reduction in patient-reported acute morbidity in prostate cancer patients treated with 81-Gy Intensity-modulated radiotherapy using reduced planning target volume margins and electromagnetic tracking: assessing the impact of margin reduction study. Urology. 2010 May;75(5):1004-8. doi: 10.1016/j.urology.2009.10.072. Epub 2010 Feb 13.
- Azria D, Betz M, Bourgier C, Jeanneret Sozzi W, Ozsahin M. Identifying patients at risk for late radiation-induced toxicity. Crit Rev Oncol Hematol. 2012 Dec;84 Suppl 1:e35-41. doi: 10.1016/j.critrevonc.2010.08.003. Epub 2010 Sep 24.
- Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014 Nov 10;72(1):39. doi: 10.1186/2049-3258-72-39. eCollection 2014.
- Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, Graham J, Kirkbride P, Logue J, Malik Z, Money-Kyrle J, O'Sullivan JM, Panades M, Parker C, Patterson H, Scrase C, Staffurth J, Stockdale A, Tremlett J, Bidmead M, Mayles H, Naismith O, South C, Gao A, Cruickshank C, Hassan S, Pugh J, Griffin C, Hall E; CHHiP Investigators. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016 Aug;17(8):1047-1060. doi: 10.1016/S1470-2045(16)30102-4. Epub 2016 Jun 20.
- Pardo Y, Guedea F, Aguilo F, Fernandez P, Macias V, Marino A, Hervas A, Herruzo I, Ortiz MJ, Ponce de Leon J, Craven-Bratle J, Suarez JF, Boladeras A, Pont A, Ayala A, Sancho G, Martinez E, Alonso J, Ferrer M. Quality-of-life impact of primary treatments for localized prostate cancer in patients without hormonal treatment. J Clin Oncol. 2010 Nov 1;28(31):4687-96. doi: 10.1200/JCO.2009.25.3245. Epub 2010 Oct 4.
- Riou O, Fenoglietto P, Jarlier M, Prunaretty J, Ailleres N, Poinas G, Debuire P, Gourgou S, Meignant L, Segui B, Llacer Moscardo C, Charissoux M, Azria D. Image-guided intensity-modulated radiotherapy with reduced margins in patients with prostate cancer: Results of the RCMIGI randomized phase II trial. Radiother Oncol. 2025 Dec 7;215:111322. doi: 10.1016/j.radonc.2025.111322. Online ahead of print.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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适度大分割放疗的临床试验
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University Hospital, GhentJules Bordet Institute; AZ Sint-Lucas Gent; GZA Ziekenhuizen Campus Sint-Augustinus; AZ Sint-Lucas...完全的