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The role of PET-CT in the evaluation of the response of the vertebra metastases in stereotactic radiosurgery

Year 2019, Volume: 44 Issue: 1, 206 - 214, 31.03.2019
https://doi.org/10.17826/cumj.453287

Abstract

Purpose: The aim of this study was to evaluate the role of positron emission tomography in assessing the response of stereotactic radiosurgery (SRS) for vertebral metastases (VM).  

Materials and Methods: Patients who received 16 Gy or 18 Gy SRS with no history of vertebral compression fracture, proven histologies except small-cell lung carcinoma and hematologic malignancies which are known as radiosensitive tumors, available pre- and post SRS PET images were included. All vertebral segments were categorized according to spinal instability neoplastic score in terms of stability and PET Response Criteria in Solid Tumors (PERCIST) criteria was utilized for treatment response.

Results: Seventy-five patients with 119 VS (101 single, 9 double VS) received SRS. Breast cancer (66.7%) was the commonest pathology. Most patients (70.6%) had SINS 0-6. The local control was achieved in 87.4% VS with a 1-year local relapse-free survival rate of 92.5%. The median PET-CT time for the first SRS response assessment was 3 months (range:1-35 months) and there were only 4 (3.3%) local relapses in contrast to the positive responses in the remainders (30.3% complete, 43.7% partial responses and 22.7% stabil disease). While there were 11 local relapses in the last PET-CT response, no patient experienced any relapse complete response was achieved in the first PET-CT. Complete response in the first PET-CT was correlated with positive response in the last PET–CT also.

Conclusion: First PET-CT response after SRS seems to be valuable in anticipation of both the final vertebral response status and planning of alternative interventions for non-responders. 


References

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  • 2. Frange P, Alapetite C, Gaboriaud G, et al: From childhood to adulthood: long-term outcome of medulloblastoma patients. The Institut Curie experience (1980-2000). J Neurooncol 95:271-279, 2009
  • 3. Bohm P, Huber J: The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg Br 84:521-9, 2002
  • 4. Klimo P, Jr., Schmidt MH: Surgical management of spinal metastases. Oncologist 9:188-96, 2004
  • 5. Shah LM, Salzman KL: Imaging of spinal metastatic disease. Int J Surg Oncol 2011:769753, 2011
  • 6. Tseng CL, Eppinga W, Charest-Morin R, et al: Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution. Global Spine J 7:179-197, 2017
  • 7. Keegan TH, Ries LA, Barr RD, et al: Comparison of cancer survival trends in the United States of adolescents and young adults with those in children and older adults. Cancer 122:1009-16, 2016
  • 8. Allemani C, Weir HK, Carreira H, et al: Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977-1010, 2015
  • 9. Rades D, Lange M, Veninga T, et al: Preliminary results of spinal cord compression recurrence evaluation (score-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression. Int J Radiat Oncol Biol Phys 73:228-34, 2009
  • 10. Rades D, Stalpers LJ, Veninga T, et al: Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol 23:3366-75, 2005
  • 11. Mizumoto M, Harada H, Asakura H, et al: Radiotherapy for patients with metastases to the spinal column: a review of 603 patients at Shizuoka Cancer Center Hospital. Int J Radiat Oncol Biol Phys 79:208-13, 2011
  • 12. Chow E, Harris K, Fan G, et al: Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 25:1423-36, 2007
  • 13. Campos S, Presutti R, Zhang L, et al: Elderly patients with painful bone metastases should be offered palliative radiotherapy. Int J Radiat Oncol Biol Phys 76:1500-6, 2010
  • 14. Chow E, Zeng L, Salvo N, et al: Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol) 24:112-24, 2012
  • 15. Gerszten PC, Burton SA, Ozhasoglu C, et al: Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 32:193-9, 2007
  • 16. Anand AK, Venkadamanickam G, Punnakal AU, et al: Hypofractionated stereotactic body radiotherapy in spinal metastasis - with or without epidural extension. Clin Oncol (R Coll Radiol) 27:345-52, 2015
  • 17. Nguyen QN, Shiu AS, Rhines LD, et al: Management of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76:1185-92, 2010
  • 18. Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228-47, 2009
  • 19. Wu HC, Yen RF, Shen YY, et al: Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients with renal cell carcinomas - a preliminary report. J Cancer Res Clin Oncol 128:503-6, 2002
  • 20. Moog F, Bangerter M, Kotzerke J, et al: 18-F-fluorodeoxyglucose-positron emission tomography as a new approach to detect lymphomatous bone marrow. J Clin Oncol 16:603-9, 1998
  • 21. Wahl RL, Jacene H, Kasamon Y, et al: From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 50 Suppl 1:122S-50S, 2009
  • 22. de Langen AJ, van den Boogaart V, Lubberink M, et al: Monitoring response to antiangiogenic therapy in non-small cell lung cancer using imaging markers derived from PET and dynamic contrast-enhanced MRI. J Nucl Med 52:48-55, 2011
  • 23. Kanna RM, Kamal Y, Mahesh A, et al: The impact of routine whole spine MRI screening in the evaluation of spinal degenerative diseases. Eur Spine J 26:1993-1998, 2017
  • 24. Fisher CG, DiPaola CP, Ryken TC, et al: A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35:E1221-9, 2010
  • 25. Cox BW, Spratt DE, Lovelock M, et al: International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 83:e597-605, 2012
  • 26. Genant HK, Wu CY, van Kuijk C, et al: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137-48, 1993
  • 27. Boyce-Fappiano D, Elibe E, Schultz L, et al: Analysis of the Factors Contributing to Vertebral Compression Fractures After Spine Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 97:236-245, 2017
  • 28. Brown JM, Carlson DJ, Brenner DJ: The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys 88:254-62, 2014
  • 29. Dewan MZ, Galloway AE, Kawashima N, et al: Fractionated but not single-dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody. Clin Cancer Res 15:5379-88, 2009
  • 30. Kirkpatrick JP, Meyer JJ, Marks LB: The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Semin Radiat Oncol 18:240-3, 2008
  • 31. Park HJ, Griffin RJ, Hui S, et al: Radiation-induced vascular damage in tumors: implications of vascular damage in ablative hypofractionated radiotherapy (SBRT and SRS). Radiat Res 177:311-27, 2012
  • 32. Postow MA, Callahan MK, Barker CA, et al: Immunologic correlates of the abscopal effect in a patient with melanoma. N Engl J Med 366:925-31, 2012
  • 33. Guckenberger M, Mantel F, Gerszten PC, et al: Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiat Oncol 9:226, 2014
  • 34. Wang XS, Rhines LD, Shiu AS, et al: Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13:395-402, 2012
  • 35. Lovelock DM, Zhang Z, Jackson A, et al: Correlation of local failure with measures of dose insufficiency in the high-dose single-fraction treatment of bony metastases. Int J Radiat Oncol Biol Phys 77:1282-7, 2010
  • 36. Bishop AJ, Tao R, Rebueno NC, et al: Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence. Int J Radiat Oncol Biol Phys 92:1016-1026, 2015
  • 37. Lecouvet FE, Talbot JN, Messiou C, et al: Monitoring the response of bone metastases to treatment with Magnetic Resonance Imaging and nuclear medicine techniques: a review and position statement by the European Organisation for Research and Treatment of Cancer imaging group. Eur J Cancer 50:2519-31, 2014
  • 38. Kumar KA, Peck KK, Karimi S, et al: A Pilot Study Evaluating the Use of Dynamic Contrast-Enhanced Perfusion MRI to Predict Local Recurrence After Radiosurgery on Spinal Metastases. Technol Cancer Res Treat:1533034617705715, 2017
  • 39. Yankelevitz DF, Henschke CI, Knapp PH, et al: Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. AJR Am J Roentgenol 157:87-92, 1991
  • 40. Biffar A, Dietrich O, Sourbron S, et al: Diffusion and perfusion imaging of bone marrow. Eur J Radiol 76:323-8, 2010
  • 41. Brown AL, Middleton G, MacVicar AD, et al: T1-weighted magnetic resonance imaging in breast cancer vertebral metastases: changes on treatment and correlation with response to therapy. Clin Radiol 53:493-501, 1998
  • 42. Lu W, Chen W: Positron emission tomography/computerized tomography for tumor response assessment-a review of clinical practices and radiomics studies. Transl Cancer Res 5:364-370, 2016
  • 43. Verma V, Choi JI, Sawant A, et al: Use of PET and Other Functional Imaging to Guide Target Delineation in Radiation Oncology. Semin Radiat Oncol 28:171-177, 2018
  • 44. Langsteger W, Balogova S, Huchet V, et al: Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading. Q J Nucl Med Mol Imaging 55:448-57, 2011
  • 45. Therasse P, Arbuck SG, Eisenhauer EA, et al: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205-16, 2000
  • 46. Cook G, Jr., Parker C, Chua S, et al: 18F-fluoride PET: changes in uptake as a method to assess response in bone metastases from castrate-resistant prostate cancer patients treated with 223Ra-chloride (Alpharadin). EJNMMI Res 1:4, 2011
  • 47. Ursino S, Montrone S, Cantarella M, et al: Stereotactic body radiotherapy of bone metastases in oligometastatic disease: prognostic factors of oncologic outcomes. Tumori 102:59-64, 2016

Stereotaktik radyocerrahi uygulanan vertebra metastazlarında yanıt değerlendirmesinde PET-BT’nin yeri

Year 2019, Volume: 44 Issue: 1, 206 - 214, 31.03.2019
https://doi.org/10.17826/cumj.453287

Abstract

Amaç: Bu çalışmada vertebra metastazlarında stereotaktik radyocerrahi (SRC) sonrası yanıt değerlendirmesinde pozitron emisyon tomografisinin (PET-BT) rolü araştırılmıştır.

Gereç ve Yöntem: Geriye dönük olarak 16 veya 18 Gy SRC uygulanmış hastalar incelenmiştir. Analizlere SRC öncesinde herhangi bir derecede vertebra kompresyon kırığı gelişmemiş, radyosensitif olarak bilinen küçük hücreli akciğer ve hematolojik kanserlerli olgular dışındaki tedavi öncesi ve sonrası PET-BT verileri olan hastalar dâhil edilmiştir. Tüm vertebra segmentleri  stabilite açısından spinal instability neoplastic score ’e göre sınıflandırılmış ve yanıt değerlendirmesinde PET Response Criteria in Solid Tumors (PERCIST) kriterleri kullanılmıştır.

Bulgular: Toplam 75 hasta 119 VS’e (101 tek, 9 çift) SRC uygulanmış olup büyük kısmını (%66,7) meme kanserli hastalar oluşturmaktadır. VS’lerin %70,6’sı SINS 0-6’ya uymaktadır. Lokal kontrol hastaların %87,4’nde sağlanmış olup 1 yıllık lokal nükssüz sağkalım oranı %92,5 olarak bulunmuştur. İlk yanıt değerlendirme PET-BT’si ortanca 3 ayda (aralık: 1-35 ay) çekilmiş olup sadece 4 (%3.3) VS’de progresyon raporlanırken diğer VS’lerde SRC’ye yanıt mevcuttur (%30.3 tam, %43.7 kısmi, %22.7 stabil). Son PET’de sadece 11 VS’de lokal nüks tespit edilirken ilk PET’de tam yanıt olan hiçbir VS’de nihai olarak lokal nüks gelişmemiştir. İlk PET’de tam yanıt olması son PET’de de yanıt olmasıyla ilişkili bulunmuştur.

Sonuç: SRC sonrası yanıt değerlendirmesinde ilk PET-BT yanıtı gerek son kontrol durumunu göstermesi açısından gerekse alternatif tedavileri planlamak açısından değerli bulunmuştur.


References

  • 1. Elson A, Bovi J, Kaur K, et al: Effect of treatment modality on the hypothalamic-pituitary function of patients treated with radiation therapy for pituitary adenomas: hypothalamic dose and endocrine outcomes. Front Oncol 4:73, 2014
  • 2. Frange P, Alapetite C, Gaboriaud G, et al: From childhood to adulthood: long-term outcome of medulloblastoma patients. The Institut Curie experience (1980-2000). J Neurooncol 95:271-279, 2009
  • 3. Bohm P, Huber J: The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg Br 84:521-9, 2002
  • 4. Klimo P, Jr., Schmidt MH: Surgical management of spinal metastases. Oncologist 9:188-96, 2004
  • 5. Shah LM, Salzman KL: Imaging of spinal metastatic disease. Int J Surg Oncol 2011:769753, 2011
  • 6. Tseng CL, Eppinga W, Charest-Morin R, et al: Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution. Global Spine J 7:179-197, 2017
  • 7. Keegan TH, Ries LA, Barr RD, et al: Comparison of cancer survival trends in the United States of adolescents and young adults with those in children and older adults. Cancer 122:1009-16, 2016
  • 8. Allemani C, Weir HK, Carreira H, et al: Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977-1010, 2015
  • 9. Rades D, Lange M, Veninga T, et al: Preliminary results of spinal cord compression recurrence evaluation (score-1) study comparing short-course versus long-course radiotherapy for local control of malignant epidural spinal cord compression. Int J Radiat Oncol Biol Phys 73:228-34, 2009
  • 10. Rades D, Stalpers LJ, Veninga T, et al: Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol 23:3366-75, 2005
  • 11. Mizumoto M, Harada H, Asakura H, et al: Radiotherapy for patients with metastases to the spinal column: a review of 603 patients at Shizuoka Cancer Center Hospital. Int J Radiat Oncol Biol Phys 79:208-13, 2011
  • 12. Chow E, Harris K, Fan G, et al: Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 25:1423-36, 2007
  • 13. Campos S, Presutti R, Zhang L, et al: Elderly patients with painful bone metastases should be offered palliative radiotherapy. Int J Radiat Oncol Biol Phys 76:1500-6, 2010
  • 14. Chow E, Zeng L, Salvo N, et al: Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol) 24:112-24, 2012
  • 15. Gerszten PC, Burton SA, Ozhasoglu C, et al: Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 32:193-9, 2007
  • 16. Anand AK, Venkadamanickam G, Punnakal AU, et al: Hypofractionated stereotactic body radiotherapy in spinal metastasis - with or without epidural extension. Clin Oncol (R Coll Radiol) 27:345-52, 2015
  • 17. Nguyen QN, Shiu AS, Rhines LD, et al: Management of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76:1185-92, 2010
  • 18. Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228-47, 2009
  • 19. Wu HC, Yen RF, Shen YY, et al: Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients with renal cell carcinomas - a preliminary report. J Cancer Res Clin Oncol 128:503-6, 2002
  • 20. Moog F, Bangerter M, Kotzerke J, et al: 18-F-fluorodeoxyglucose-positron emission tomography as a new approach to detect lymphomatous bone marrow. J Clin Oncol 16:603-9, 1998
  • 21. Wahl RL, Jacene H, Kasamon Y, et al: From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 50 Suppl 1:122S-50S, 2009
  • 22. de Langen AJ, van den Boogaart V, Lubberink M, et al: Monitoring response to antiangiogenic therapy in non-small cell lung cancer using imaging markers derived from PET and dynamic contrast-enhanced MRI. J Nucl Med 52:48-55, 2011
  • 23. Kanna RM, Kamal Y, Mahesh A, et al: The impact of routine whole spine MRI screening in the evaluation of spinal degenerative diseases. Eur Spine J 26:1993-1998, 2017
  • 24. Fisher CG, DiPaola CP, Ryken TC, et al: A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35:E1221-9, 2010
  • 25. Cox BW, Spratt DE, Lovelock M, et al: International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 83:e597-605, 2012
  • 26. Genant HK, Wu CY, van Kuijk C, et al: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137-48, 1993
  • 27. Boyce-Fappiano D, Elibe E, Schultz L, et al: Analysis of the Factors Contributing to Vertebral Compression Fractures After Spine Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 97:236-245, 2017
  • 28. Brown JM, Carlson DJ, Brenner DJ: The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys 88:254-62, 2014
  • 29. Dewan MZ, Galloway AE, Kawashima N, et al: Fractionated but not single-dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody. Clin Cancer Res 15:5379-88, 2009
  • 30. Kirkpatrick JP, Meyer JJ, Marks LB: The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Semin Radiat Oncol 18:240-3, 2008
  • 31. Park HJ, Griffin RJ, Hui S, et al: Radiation-induced vascular damage in tumors: implications of vascular damage in ablative hypofractionated radiotherapy (SBRT and SRS). Radiat Res 177:311-27, 2012
  • 32. Postow MA, Callahan MK, Barker CA, et al: Immunologic correlates of the abscopal effect in a patient with melanoma. N Engl J Med 366:925-31, 2012
  • 33. Guckenberger M, Mantel F, Gerszten PC, et al: Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiat Oncol 9:226, 2014
  • 34. Wang XS, Rhines LD, Shiu AS, et al: Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13:395-402, 2012
  • 35. Lovelock DM, Zhang Z, Jackson A, et al: Correlation of local failure with measures of dose insufficiency in the high-dose single-fraction treatment of bony metastases. Int J Radiat Oncol Biol Phys 77:1282-7, 2010
  • 36. Bishop AJ, Tao R, Rebueno NC, et al: Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence. Int J Radiat Oncol Biol Phys 92:1016-1026, 2015
  • 37. Lecouvet FE, Talbot JN, Messiou C, et al: Monitoring the response of bone metastases to treatment with Magnetic Resonance Imaging and nuclear medicine techniques: a review and position statement by the European Organisation for Research and Treatment of Cancer imaging group. Eur J Cancer 50:2519-31, 2014
  • 38. Kumar KA, Peck KK, Karimi S, et al: A Pilot Study Evaluating the Use of Dynamic Contrast-Enhanced Perfusion MRI to Predict Local Recurrence After Radiosurgery on Spinal Metastases. Technol Cancer Res Treat:1533034617705715, 2017
  • 39. Yankelevitz DF, Henschke CI, Knapp PH, et al: Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. AJR Am J Roentgenol 157:87-92, 1991
  • 40. Biffar A, Dietrich O, Sourbron S, et al: Diffusion and perfusion imaging of bone marrow. Eur J Radiol 76:323-8, 2010
  • 41. Brown AL, Middleton G, MacVicar AD, et al: T1-weighted magnetic resonance imaging in breast cancer vertebral metastases: changes on treatment and correlation with response to therapy. Clin Radiol 53:493-501, 1998
  • 42. Lu W, Chen W: Positron emission tomography/computerized tomography for tumor response assessment-a review of clinical practices and radiomics studies. Transl Cancer Res 5:364-370, 2016
  • 43. Verma V, Choi JI, Sawant A, et al: Use of PET and Other Functional Imaging to Guide Target Delineation in Radiation Oncology. Semin Radiat Oncol 28:171-177, 2018
  • 44. Langsteger W, Balogova S, Huchet V, et al: Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading. Q J Nucl Med Mol Imaging 55:448-57, 2011
  • 45. Therasse P, Arbuck SG, Eisenhauer EA, et al: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205-16, 2000
  • 46. Cook G, Jr., Parker C, Chua S, et al: 18F-fluoride PET: changes in uptake as a method to assess response in bone metastases from castrate-resistant prostate cancer patients treated with 223Ra-chloride (Alpharadin). EJNMMI Res 1:4, 2011
  • 47. Ursino S, Montrone S, Cantarella M, et al: Stereotactic body radiotherapy of bone metastases in oligometastatic disease: prognostic factors of oncologic outcomes. Tumori 102:59-64, 2016
There are 47 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research
Authors

Yurday Özdemir 0000-0002-2218-2074

Neşe Torun 0000-0002-5597-676X

Erkan Topkan 0000-0001-8120-7123

Publication Date March 31, 2019
Acceptance Date October 8, 2018
Published in Issue Year 2019 Volume: 44 Issue: 1

Cite

MLA Özdemir, Yurday et al. “Stereotaktik Radyocerrahi Uygulanan Vertebra metastazlarında yanıt değerlendirmesinde PET-BT’nin Yeri”. Cukurova Medical Journal, vol. 44, no. 1, 2019, pp. 206-14, doi:10.17826/cumj.453287.