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Spinal Metastases

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CyberKnife NeuroRadiosurgery

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Abstract

The treatment of metastatic spine disease is an evolving field which has seen advances in both surgical and radiotherapy techniques over the past decade. The goals of local radiotherapy within the context of spinal metastases are the palliation of pain, prevention of local disease progression and fractures, and halting or reversing progressive neurological compromise. Conventional radiotherapy (cEBRT) utilizes one or two radiation beams without high-precision or highly conformational treatment methods. Although it is widely accepted as an appropriate treatment modality for other organ systems, its effectiveness for spinal malignancies is limited by the finite tolerance of the spinal cord for high-dose radiation.

To avoid this limitation, one of the major advances in spinal malignancy treatment has been high-dose conformational photon radiation therapy or radiosurgery (SRS). SRS represents a major advance in terms of both local tumor control and pain control for spinal metastases of several tumor origins. The spine radiosurgery treatment paradigm involves accurately identifying targets along with normal surrounding tissue, radiosurgery treatment planning, reliable patient immobilization, image-guided verification, and targeted delivery with sub-mm accuracy. Due to these steps, the safety of radiosurgery has been well documented, even in the setting of prior spinal cord irradiation. The primary indications for spine SRS include primary treatment for tumors, reirradiation of resistant tumors, a postoperative adjuvant, and neoadjuvant therapy.

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References

  1. Agarwal N. Neurosurgery fundamentals. New York: Thieme; 2019.

    Google Scholar 

  2. Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine. 2009;34:S78–92.

    PubMed  Google Scholar 

  3. McClelland S III, Kim E, Passias PG, Murphy JD, Attia A, Jaboin JJ. Spinal stereotactic body radiotherapy in the United States: a decade-long nationwide analysis of patient demographics, practice patterns, and trends over time. J Clin Neurosci. 2017;46:109–12.

    PubMed  Google Scholar 

  4. Sahgal A, Atenafu EG, Chao S, Al-Omair A, Boehling N, Balagamwala EH, et al. Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31:3426–31.

    Google Scholar 

  5. Klimo P, Schmidt MH. Surgical management of spinal metastases. Oncologist. 2004;9:188–96.

    PubMed  Google Scholar 

  6. Bilsky MH, Angelov L, Rock J, Weaver J, Sheehan J, Rhines L, et al. Spinal radiosurgery: a neurosurgical perspective. J Radiosurg SBRT. 2011;1:47.

    PubMed  PubMed Central  Google Scholar 

  7. Black P. Spinal metastasis: current status and recommended guidelines for management. Neurosurgery. 1979;5:726–46.

    CAS  PubMed  Google Scholar 

  8. Faul CM, Flickinger JC. The use of radiation in the management of spinal metastases. J Neuro-Oncol. 1995;23:149–61.

    CAS  Google Scholar 

  9. Guckenberger M, Mantel F, Gerszten PC, Flickinger JC, Sahgal A, Létourneau D, et al. Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiat Oncol. 2014;9:226.

    PubMed  PubMed Central  Google Scholar 

  10. Husain ZA, Sahgal A, De Salles A, Funaro M, Glover J, Hayashi M, et al. Stereotactic body radiotherapy for de novo spinal metastases: systematic review: International Stereotactic Radiosurgery Society practice guidelines. J Neurosurg Spine. 2017;27:295–302.

    PubMed  Google Scholar 

  11. Gerszten PC, Burton SA. Radiosurgery of spinal metastases. In: Gerszten PC, Ryu S, editors. Spine radiosurgery. New York: Thieme; 2009. p. 82–90.

    Google Scholar 

  12. Moulding HD, Elder JB, Lis E, Lovelock DM, Zhang Z, Yamada Y, et al. Local disease control after decompressive surgery and adjuvant high-dose single-fraction radiosurgery for spine metastases. J Neurosurg Spine. 2010;13:87–93.

    PubMed  Google Scholar 

  13. Ryu SI, Chang SD, Kim DH, Murphy MJ, Le Q-T, Martin DP, et al. Image-guided hypo-fractionated stereotactic radiosurgery to spinal lesions. Neurosurgery. 2001;49:838–46.

    CAS  PubMed  Google Scholar 

  14. Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA. Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery. 2009;64:A67–72.

    PubMed  Google Scholar 

  15. Hamilton AJ, Lulu BA, Fosmire H, Stea B, Cassady JR. Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. Neurosurgery. 1995;36:311–9.

    CAS  PubMed  Google Scholar 

  16. Thibault I, Chang EL, Sheehan J, Ahluwalia MS, Guckenberger M, Sohn M-J, et al. Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in neuro-oncology (SPINO) group. Lancet Oncol. 2015;16:e595–603.

    PubMed  Google Scholar 

  17. Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, et al. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012;83:e597–605.

    PubMed  Google Scholar 

  18. Patel VB, Wegner RE, Heron DE, Flickinger JC, Gerszten P, Burton SA. Comparison of whole versus partial vertebral body stereotactic body radiation therapy for spinal metastases. Technol Cancer Res Treat. 2012;11:105–15.

    PubMed  Google Scholar 

  19. Sahgal A, Weinberg V, Ma L, Chang E, Chao S, Muacevic A, et al. Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys. 2013;85:341–7.

    PubMed  Google Scholar 

  20. Toussaint A, Richter A, Mantel F, Flickinger JC, Grills IS, Tyagi N, et al. Variability in spine radiosurgery treatment planning–results of an international multi-institutional study. Radiat Oncol. 2016;11:57.

    PubMed  PubMed Central  Google Scholar 

  21. Bilsky MH, Yamada Y, Yenice KM, Lovelock M, Hunt M, Gutin PH, et al. Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report. Neurosurgery. 2004;54:823–31.

    PubMed  Google Scholar 

  22. Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK, et al. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine. 2007;7:151–60.

    PubMed  Google Scholar 

  23. Joaquim AF, Ghizoni E, Tedeschi H, Pereira EB, Giacomini LA. Stereotactic radiosurgery for spinal metastases: a literature review. Einstein (São Paulo). 2013;11:247–55.

    Google Scholar 

  24. Klish MD, Watson GA, Shrieve DC. Radiation and intensity-modulated radiotherapy for metastatic spine tumors. Neurosurg Clin. 2004;15:481–90.

    Google Scholar 

  25. Rock JP, Ryu S, Yin F-F. Novalis radiosurgery for metastatic spine tumors. Neurosurg Clin N Am. 2004;15:503–9.

    PubMed  Google Scholar 

  26. Ryu S, Fang Yin F, Rock J, Zhu J, Chu A, Kagan E, et al. Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis. Cancer. 2003;97:2013–8.

    PubMed  Google Scholar 

  27. Yamada Y, Lovelock DM, Yenice KM, Bilsky MH, Hunt MA, Zatcky J, et al. Multifractionated image-guided and stereotactic intensity-modulated radiotherapy of paraspinal tumors: a preliminary report. Int J Radiat Oncol Biol Phys. 2005;62:53–61.

    PubMed  Google Scholar 

  28. Kong F-M, Ritter T, Quint DJ, Senan S, Gaspar LE, Komaki RU, et al. Consideration of dose limits for organs at risk of thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Int J Radiat Oncol Biol Phys. 2011;81:1442–57.

    PubMed  Google Scholar 

  29. Sahgal A, Ma L, Gibbs I, Gerszten PC, Ryu S, Soltys S, et al. Spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2010;77:548–53.

    PubMed  Google Scholar 

  30. Sahgal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang U-K, et al. Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82:107–16.

    PubMed  Google Scholar 

  31. Gerszten PC, Quader M, Novotny J Jr, Flickinger JC. Prospective evaluation of spinal cord and cauda equina dose constraints using cone beam computed tomography (cbct) image guidance for spine radiosurgery. J Radiosurg SBRT. 2011;1:197.

    PubMed  PubMed Central  Google Scholar 

  32. Bruner D, Winter K, Hartsell W, Konski A, Curran W, Roach M, et al. Prospective health-related quality of life valuations (utilities) of 8 Gy in 1 fraction vs 30 Gy in 10 fractions for palliation of painful bone metastases: Preliminary results of RTOG 97–14. Int J Radiat Oncol Biol Phys. 2004;60:S142.

    Google Scholar 

  33. Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach M III, et al. Randomized trial of short-versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97:798–804.

    PubMed  Google Scholar 

  34. Maranzano E, Latini P, Perrucci E, Beneventi S, Lupattelli M, Corgna E. Short-course radiotherapy (8 Gy× 2) in metastatic spinal cord compression: an effective and feasible treatment. Int J Radiat Oncol Biol Phys. 1997;38:1037–44.

    CAS  PubMed  Google Scholar 

  35. Rades D, Fehlauer F, Stalpers LJA, Wildfang I, Zschenker O, Schild SE, et al. A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression. Cancer. 2004;101:2687–92.

    PubMed  Google Scholar 

  36. Rades D, Karstens JH, Alberti W. Role of radiotherapy in the treatment of motor dysfunction due to metastatic spinal cord compression: comparison of three different fractionation schedules. Int J Radiat Oncol Biol Phys. 2002;54:1160–4.

    PubMed  Google Scholar 

  37. Rades D, Stalpers L, Veninga T, Schulte R, Hoskin PJ, Obralic N, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol. 2005;23:3366–75.

    PubMed  Google Scholar 

  38. Redmond KJ, Sahgal A, Foote M, Knisely J, Gerszten PC, Chao ST, et al. Single versus multiple session stereotactic body radiotherapy for spinal metastasis: the risk–benefit ratio. Future Oncol. 2015;11:2405–15.

    CAS  PubMed  Google Scholar 

  39. Wu JS-Y, Wong R, Johnston M, Bezjak A, Whelan T. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003;55:594–605.

    PubMed  Google Scholar 

  40. Chow E, Van Der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JSY, et al. Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. Lancet Oncol. 2014;15:164–71.

    PubMed  Google Scholar 

  41. Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine. 2007;32:193–9.

    PubMed  Google Scholar 

  42. Degen JW, Gagnon GJ, Voyadzis J-M, McRae DA, Lunsden M, Dieterich S, et al. CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. J Neurosurg Spine. 2005;2:540–9.

    PubMed  Google Scholar 

  43. Benzil DL, Saboori M, Mogilner AY, Rocchio R, Moorthy CR. Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg. 2004;101:413–8.

    PubMed  Google Scholar 

  44. Milker-Zabel S, Zabel A, Thilmann C, Schlegel W, Wannenmacher M, Debus J. Clinical results of retreatment of vertebral bone metastases by stereotactic conformal radiotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2003;55:162–7.

    PubMed  Google Scholar 

  45. Ryken TC, Meeks SL, Pennington EC, Hitchon P, Traynelis V, Mayr NA, et al. Initial clinical experience with frameless stereotactic radiosurgery: analysis of accuracy and feasibility. Int J Radiat Oncol Biol Phys. 2001;51:1152–8.

    CAS  PubMed  Google Scholar 

  46. Sung W-S, Sung M-J, Chan JH, Manion B, Song J, Dubey A, et al. Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg. 2013;79:576–84.

    PubMed  Google Scholar 

  47. Adler JR Jr, Colombo F, Heilbrun MP, Winston K. Toward an expanded view of radiosurgery. Neurosurgery. 2004;55:1374–6.

    PubMed  Google Scholar 

  48. Coste-Manière È, Olender D, Kilby W, Schulz R. Robotic whole body stereotactic radiosurgery: clinical advantages of the CyberKnife® integrated system. Int J Med Robot. 2005;1:28–39.

    PubMed  Google Scholar 

  49. Gerszten PC, Burton SA. Clinical assessment of stereotactic IGRT: spinal radiosurgery. Med Dosim. 2008;33:107–16.

    PubMed  Google Scholar 

  50. Jabbari S, Gerszten PC, Ruschin M, Larson DA, Lo SS, Sahgal A. Stereotactic body radiotherapy for spinal metastases: practice guidelines, outcomes, and risks. Cancer J. 2016;22:280–9.

    PubMed  Google Scholar 

  51. Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys. 1995;32:959–67.

    CAS  PubMed  Google Scholar 

  52. Bishop AJ, Tao R, Rebueno NC, Christensen EN, Allen PK, Wang XA, et al. Outcomes for spine stereotactic body radiation therapy and an analysis of predictors of local recurrence. Int J Radiat Oncol Biol Phys. 2015;92:1016–26.

    PubMed  Google Scholar 

  53. Gerszten PC, Burton SA, Ozhasoglu C, Vogel WJ, Welch WC, Baar J, et al. Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine. 2005;3:288–95.

    PubMed  Google Scholar 

  54. Gerszten PC, Burton SA, Quinn AE, Agarwala SS, Kirkwood JM. Radiosurgery for the treatment of spinal melanoma metastases. Stereotact Funct Neurosurg. 2005;83:213–21.

    PubMed  Google Scholar 

  55. Gerszten PC, Burton SA, Welch WC, Brufsky AM, Lembersky BC, Ozhasoglu C, et al. Single-fraction radiosurgery for the treatment of spinal breast metastases. Cancer. 2005;104:2244–54.

    PubMed  Google Scholar 

  56. Chao ST, Koyfman SA, Woody N, Angelov L, Soeder SL, Reddy CA, et al. Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases. Int J Radiat Oncol Biol Phys. 2012;82:1738–43.

    PubMed  Google Scholar 

  57. Tang C, Hess K, Bishop AJ, Pan HY, Christensen EN, Yang JN, et al. Creation of a prognostic index for spine metastasis to stratify survival in patients treated with spinal stereotactic radiosurgery: secondary analysis of mature prospective trials. Int J Radiat Oncol Biol Phys. 2015;93:118–25.

    PubMed  Google Scholar 

  58. Hashmi A, Guckenberger M, Kersh R, Gerszten PC, Mantel F, Grills IS, et al. Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis. J Neurosurg Spine. 2016;25:646–53.

    PubMed  Google Scholar 

  59. Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W, et al. Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys. 2009;74:723–31.

    PubMed  Google Scholar 

  60. Sahgal A, Ma L, Fowler J, Weinberg V, Gibbs I, Gerszten P, et al. Impact of dose hot spots on spinal cord tolerance following stereotactic body radiotherapy: a generalized biological effective dose analysis. Technol Cancer Res Treat. 2012;11:35–40.

    CAS  PubMed  Google Scholar 

  61. Choi CY, Adler JR, Gibbs IC, Chang SD, Jackson PS, Minn AY, et al. Stereotactic radiosurgery for treatment of spinal metastases recurring in close proximity to previously irradiated spinal cord. Int J Radiat Oncol Biol Phys. 2010;78:499–506.

    PubMed  Google Scholar 

  62. Damast S, Wright J, Bilsky M, Hsu M, Zhang Z, Lovelock M, et al. Impact of dose on local failure rates after image-guided reirradiation of recurrent paraspinal metastases. Int J Radiat Oncol Biol Phys. 2011;81:819–26.

    PubMed  Google Scholar 

  63. Bilsky MH, Laufer I, Burch S. Shifting paradigms in the treatment of metastatic spine disease. Spine. 2009;34:S101–7.

    PubMed  Google Scholar 

  64. Sahgal A, Bilsky M, Chang EL, Ma L, Yamada Y, Rhines LD, et al. Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient: a review. J Neurosurg Spine. 2011;14:151–66.

    PubMed  Google Scholar 

  65. Klekamp J, Samii H. Surgical results for spinal metastases. Acta Neurochir. 1998;140:957–67.

    CAS  PubMed  Google Scholar 

  66. Rock JP, Ryu S, Shukairy MS, Yin F-F, Sharif A, Schreiber F, et al. Postoperative radiosurgery for malignant spinal tumors. Neurosurgery. 2006;58:891–8.

    PubMed  Google Scholar 

  67. Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, et al. Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine. 2013;18:207–14.

    PubMed  PubMed Central  Google Scholar 

  68. Gwak H-S, Youn S-M, Chang U, Lee D, Cheon GJ, Rhee C, et al. Usefulness of 18F-fluorodeoxyglucose PET for radiosurgery planning and response monitoring in patients with recurrent spinal metastasis. Minim Invasive Neurosurgery. 2006;49:127–34.

    Google Scholar 

  69. Thariat J, Castelli J, Chanalet S, Marcie S, Mammar H, Bondiau P-Y. CyberKnife stereotactic radiotherapy for spinal tumors: value of computed tomographic myelography in spinal cord delineation. Neurosurgery. 2009;64:A60–6.

    PubMed  Google Scholar 

  70. Fourney DR, Frangou EM, Ryken TC, DiPaola CP, Shaffrey CI, Berven SH, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011;29:3072–7.

    PubMed  Google Scholar 

  71. Ling DC, Flickinger JC, Burton SA, Heron DE, Quinn AE, Bejjani GK, et al. Long-term outcomes after stereotactic radiosurgery for spine metastases: radiation dose–response for late toxicity. Int J Radiat Oncol Biol Phys. 2018;101:602–9.

    PubMed  Google Scholar 

  72. Yamada Y, Bilsky MH, Lovelock DM, Venkatraman ES, Toner S, Johnson J, et al. High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys. 2008;71:484–90.

    PubMed  Google Scholar 

  73. Ryu S, Rock J, Rosenblum M, Kim JH. Patterns of failure after single-dose radiosurgery for spinal metastasis. J Neurosurg. 2004;101:402–5.

    PubMed  Google Scholar 

  74. Jawad MS, Fahim DK, Gerszten PC, Flickinger JC, Sahgal A, Grills IS, et al. Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation. J Neurosurg Spine. 2016;24:928–36.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Souvik Roy, Nitin Agarwal, John C. Flickinger & Peter Gerszten

  2. Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Steven A. Burton, John C. Flickinger & Peter Gerszten

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  1. Souvik Roy
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  2. Nitin Agarwal
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  3. Steven A. Burton
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  4. John C. Flickinger
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  5. Peter Gerszten
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Correspondence to Peter Gerszten .

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Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Roy, S., Agarwal, N., Burton, S.A., Flickinger, J.C., Gerszten, P. (2020). Spinal Metastases. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_38

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