Virtual Library

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    OA06 - Early Stage Lung Cancer: Outcomes and Interventions (ID 902)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 8
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 202 BD
      • Abstract
      • Presentation
      • Slides

      Background
      Sex differences in non-small cell lung cancer (NSCLC) susceptibility, tumor biology and survival have been retrospectively reported. We conducted a prospective, case-series intergroup study (SWOG S0424) in 4 cohorts of females (F) and males (M), ever-smokers (ES) and never-smokers (NS) with newly-diagnosed stages I-III NSCLC. This is the first overall survival (OS) report. a9ded1e5ce5d75814730bb4caaf49419 Method
      Patients were accrued at US sites via SWOG/NCI-CTSU. A questionnaire of demographics and exposures (tobacco, environmental, reproductive, hormonal); stage and histology data; treatment; and OS were obtained. Tumor tissue was submitted for EGFR, RAS and p53 mutations. Nuclear and cytoplasmic estrogen receptor (ER) alpha and beta were measured (Cheng, JNCI 2017). Kaplan-Meier (KM) curves and OS modeled using Cox proportional hazards were examined. The NS cohorts remained open longer to maximize accrual. Patients were followed 5 years for OS or until death. 4c3880bb027f159e801041b1021e88e8 Result
      The accrual goal of 981 was achieved from 10/2005-3/2011. Evaluable cases were FES, n=337; MES, 383; FNS, 188; MNS, 49 (MNS under-accrued despite extension). The 4 cohorts differed significantly in demographics, tumor stage, histology, mutational profile (overall, by histology), ER expression, lifestyle factors and exposures. KM curves showed MNS/MES had overlapping OS and FNS/FES had significantly better OS. Five-year estimates were FNS, 73%; FES, 69%; MNS, 58%; MES, 52%. Markedly improved OS for females persisted after adjusting for other factors. Four multivariate OS models were constructed: all patients (model 1) and women only (model 2), each with mutations and ER expression added (models 3, 4). Model 1: better OS for females (HR 0.56, p <.001); higher BMI (continuous, HR 0.98, p=0.045); and adenocarcinoma, BAC, large cell (all vs squamous, HRs 0.84, 0.48, 0.57); worse OS for stages II and III (HRs 1.87, 3.76: each p<.001) and greater age. Model 2: worse OS if ES (HR 1.48, p=0.05), higher stages; histology and hormonal exposure variables were not significant. Model 3: better OS if EGFR mutation (HR 0.53, p=0.013), female, stage I, higher BMI or greater height; worse OS if p53 mutation, higher ER-alpha cytoplasmic or ER-beta nuclear H-scores. Model 4: worse OS if higher stage, p53 mutation or ER-alpha cytoplasmic H-score; EGFR mutation lost significance. 8eea62084ca7e541d918e823422bd82e Conclusion
      Sex, histology, mutations and exposures impacted OS, with dramatically better OS for females regardless of the analysis/model. Hormonal influences (persistent association of ER-expression with OS) were independently significant. Despite adjustments, favorable female survival could not be explained away. Randomized studies should stratify by sex and validation analyses should be conducted in targeted therapy and immunotherapy trials.

      SUPPORT: NIH/NCI grants R01CA106815, U10CA180888, U10CA180819 and UG1CA189974. 6f8b794f3246b0c1e1780bb4d4d5dc53

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      OA06.02 - Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell Lung Cancer: Oncologic Outcome of a Randomized Trial (ID 12455)

      13:40 - 13:50  |  Presenting Author(s): Dongrong Situ  |  Author(s): Hao Long, Qunyou Tan, Qingquan Luo, Zheng Wang, Gening Jiang, Tie-Hua Rong

      • Abstract
      • Presentation
      • Slides

      Background

      Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of early-stage non–small cell lung cancer (NSCLC). However, there has not been a robust randomized control trial (RCT) to conclude VATS has similar oncologic efficacy to open surgery. Therefore, a large multicenter RCT in China was designed and initialed in order to verify the role of VATS.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A non-inferiority phase 3 RCT was undertaken at five thoracic surgical centers in China. Patients aged 18-75 years who were diagnosed of clinically early-stage NSCLCs were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus hilar and mediastinal lymph node dissection was the standard surgical intervention as per protocol. The long-term oncologic outcomes including 3-year locoregional recurrence rate, overall survival (OS) and disease-free survival (DFS) would be analyzed and reported here. This study is registered with the ClinicalTrials.gov, number NCT01102517.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 508 patients were recruited in the trial between January 2008 and March 2014. And 433 patients were eligible for final analysis (222 cases in VATS group and 211 cases in thoracotomy group). At 3 years, the locoregional recurrence rates were 4.5% in VATS group and 5.7% in thoracotomy group respectively (P=0.664). Patients who received VATS procedures had a similar DFS rate to those who underwent open surgery (66% versus 69%, P=0.925; Fig 1A). Again, the 3-year OS rates were of no significant difference between VATS and thoracotomy groups (74% versus 73%, P=0.382; Fig 1B).

      fig 1.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      VATS in the treatment of clinically early-stage NSCLCs was associated with equivalent oncologic efficacy when compared to open surgery.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      OA06.03 - Sublobar Resection is Equivalent to Lobectomy for Screen Detected Lung Cancer (ID 13968)

      13:50 - 14:00  |  Presenting Author(s): Brendon Stiles  |  Author(s): Mohamed K Hussein, Mohamed Rahouma, Benjamin Lee, Sebron Harrison, Jeffrey L. Port, Nasser Altorki

      • Abstract
      • Presentation

      Background

      Despite the lack of survival data from modern, ongoing randomized clinical trials (CALGB 140503, JCOG 0802), sublobar resection (SLR) is increasingly offered to patients with small, peripheral lung cancers. In particular, SLR may be an attractive surgical strategy for screen detected lung cancers, some of which may be less biologically aggressive than cancers detected by other means. Utilizing prospective data collected from patients undergoing surgery in the National Lung Screening Trial (NLST), we sought to determine whether the extent of resection affected survival for patients with screen detected lung cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The NLST database was queried for patients who underwent surgical resection for confirmed lung cancer. Numerical variables were compared using Mann-Whitney U test. Categorical variables were compared using Chi-squared test. Propensity score matching analysis (lobectomy versus sublobar resection) controlling for age, gender, race, tumor size, and stage was performed (nearest neighbor, 1:1, matching with no replacement, caliper 0.2). Overall survival (OS) and cancer specific survival (CSS) were compared using log rank test in Kaplan Meier curves.

      4c3880bb027f159e801041b1021e88e8 Result

      Among 1,029 patients who underwent resection for lung cancer, we identified 821 patients (80%) who had lobectomy and 166 patients (16%) who had SLR, among whom the majority (n=114, 69%) had wedge resection. Patients who underwent SLR were older (64 vs. 61, p=0.66), more likely to be female (53% vs. 41%, p=0.004), had smaller tumors (2 cm vs. 4.5 cm, p<0.001), and were more likely to be stage I (80% vs. 75%, p=0.001). At five years, for stage I patients undergoing SLR (n=129) there was no difference in OS (77% vs. 77%, p=0.889) or CSS (83% vs. 83%, p=0.959) compared to patients undergoing lobectomy (n=613). In order to more accurately compare surgical outcomes, we propensity matched 134 patients from each group undergoing SLR and lobectomy. Among these matched groups, there were no differences in age, gender, histology, or stage. Postoperatively, patients undergoing SLR had less total complications (22% vs. 32%, p=0.05) than those undergoing lobectomy (HR 0.59, CI 0.38-0.94). In matched patients at five years, there was no difference in OS (67% vs. 70%, p=0.629) or CSS (74% vs. 74%, p=0.980) for patients undergoing SLR compared to those undergoing lobectomy.

      8eea62084ca7e541d918e823422bd82e Conclusion

      For patients with screen detected lung cancer, SLR confers equivalent survival to lobectomy. By decreasing perioperative complications and potentially preserving lung function, SLR may provide distinct advantages in a screen detected lung cancer patient cohort.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Information from this presentation has been removed upon request of the author.

      Information from this presentation has been removed upon request of the author.

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      OA06.04 - Discussant - OA 06.01, OA 06.02, OA 06.03 (ID 14556)

      14:00 - 14:15  |  Presenting Author(s): Valerie W Rusch

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      OA06.05 - Do SBRT Planning and Delivery Factors Influence Local Control for Early Stage Non-Small Cell Lung Cancer (e-NSCLC)?  (ID 12730)

      14:15 - 14:25  |  Presenting Author(s): Gregory M.M. Videtic  |  Author(s): Chandana A. Reddy, Aditya Juloori, Bindu Manyam, Neil M Woody, Kevin L Stephans

      • Abstract
      • Presentation
      • Slides

      Background

      Stereotactic Body Radiation (SBRT) utilizes a variety of techniques to deliver very high-dose radiation to moving targets in the lung. We investigated the impact of dose-delivery factors on local failure (LF) by surveying our 12 year experience with e-NSCLC from our prospective database.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Curative SBRT was administered to 1,085 patients (pts) between 2005 and 2016 and planned with either pencil beam (PB) or collapsed cone convolution (CCC) dose calculation algorithms (DCA), using open (dynamic arcs) or modulated beams (IMRT or VMAT), immobilized by abdominal compression or automatic breathing control (ABC), and treated with/without available CBCT (aligned to external fiducials and KV x-rays to bone if no CBCT, PTV margins were not altered based on availability of CBCT). We limited our analysis to standard fractionation regimens, [60 Gy/3, 48 Gy/4, 50 Gy/5, & 30-34 Gy/1) chosen per the treating physician in a risk-adapted approach relative to tumor size and location. The intreaction of technical variables with known patient and tumor factors on LF was analyzed using Fine and Gray univariate regression, with significant predictors selected for a forward step-wise multivariate regression model.

      4c3880bb027f159e801041b1021e88e8 Result

      At mean follow-up time of 25.6 months the cumulative incidence of LF at 1, 2, & 5 years was 3.0, 8.3, and 9.8% respectively. Overall survival (1, 2, 5 years) was 83, 62, & 28%. Univariate correlates with LF were PB TPS (HR 2.87, p=0.0004), modulated beam (HR 2.3, p=0.005), lack of CBCT (HR 2.69, p=0.0004), SBRT dose relative to 60 Gy/3 (HR 5.2, p=0.0001 for 4-5 fx; HR 2.7, p=0.051 for 1 fx), tumor size (HR 1.2 per cm, p=0.0009), PET SUV (HR 1.04 per SUV, p=0.0039), and squamous histology (HR 1.8, p=0.0051). Immobilization with ABC (n=96) versus abdominal compression (n=989) did not correlate with LF (p=0.99). On multivariate analysis PET SUV, modulated beam, and use of CBCT were no longer significant correlates with LF, while TPS (HR 2.62, p=0.0019), SBRT dose (HR 4.1, p=0.0009 for 4-5 fx relative to 60 Gy/3) & HR 2.9, p=0.039 for 1 fx versus 60 Gy/3), tumor size (HR 1.2 per cm, p=0.042) and squamous histology (HR 1.7, p=0.027) remained statistically significant.

      8eea62084ca7e541d918e823422bd82e Conclusion

      While the use of PB versus CCC DCA was associated with higher rates of LF after SBRT, the use of abdominal compression vs ABC (univariate), open vs modulated beam, and CBCT vs bony alignment (multivariate) were not correlated with higher rates of LF after SBRT in e-NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      OA06.06 - MISSILE-NSCLC: A Phase II Trial Measuring the Integration of Stereotactic Radiotherapy Plus Surgery in Early-Stage Non-Small Cell Lung Cancer (ID 13028)

      14:25 - 14:35  |  Presenting Author(s): David Palma  |  Author(s): Alexander Louie, Richard Malthaner, Dalilah Fortin, George Rodrigues, Brian Yaremko, Joanna M Laba, Keith Kwan, Stewart Gaede, Ting Lee, Aaron Ward, Andrew Warner, Richard Inculet

      • Abstract
      • Presentation
      • Slides

      Background

      Stereotactic Ablative Radiotherapy (SABR) has emerged as a standard treatment option in patients with medically inoperable early-stage non-small cell lung cancer (NSCLC), yet the pathologic complete response (pCR) rate after SABR is unknown. Neoadjuvant SABR in operable patients has been proposed as a mechanism of improving local control and inducing anti-tumor immune activity.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This phase II study (NCT02136355) enrolled patients with biopsy-proven clinical T1-2N0M0 NSCLC who were candidates for surgical resection. Patients underwent neoadjuvant SABR using a risk-adapted fractionation of 54 Gy/3 fractions, 55 Gy/5 or 60 Gy/8. Surgical resection took place 10 weeks after SABR. Patients also underwent dynamic FDG-PET and dynamic contrast-enhanced CT prior to SABR and approximately 2 weeks prior to surgery. The primary endpoint was the pCR rate, and secondary endpoints included local, regional, and distant recurrence, quality of life using the FACT Trial Outcome Index (TOI), and toxicity.

      4c3880bb027f159e801041b1021e88e8 Result

      Accrual began in Sept 2014 and completed in August 2017 with 40 patients enrolled. Median age was 69 years (range 44–83 years), and 58% were female. Thirty-one patients (78%) had T1 tumors and 9 (23%) had T2 tumors; histology was adenocarcinoma (n=26; 65%), squamous cell (n=13; 33%) and NSCLC not otherwise specified (n=1; 3%). Baseline FEV1 was median 73% percent predicted (range 50%–117%). Nine patients (23%) received the 3-fraction regimen, 21 (53%) received 5 fractions and 10 (25%) received 8 fractions. Thirty-five patients underwent surgery and were evaluable for the primary endpoint. The pCR rate was 60% (95% CI 44%–76%). 30-day and 90-day post-surgical mortality rates were both 0%. Eighteen percent of patients had grade 3 or 4 toxicities, most commonly pulmonary in nature (Grade 4: atelectasis and respiratory failure [n=1]; Grade 3: pneumonia/pneumonitis [n=2]; bronchopleural fistula [n=1]). In the patients receiving surgery, 2-year outcomes were: overall survival 77%, local control 100%, regional control 53% and distant control 76%. There were no significant changes in FACT-TOI score within the first year of follow-up.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The pCR rate after SABR for T1 and T2 NSCLC was 60%. Toxicity of the combined approach appears favorable, compared to historical series of surgery alone, and there was no perioperative mortality. Larger studies are needed to determine the clinical role of this combined treatment approach.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      OA06.07 - Predictors and Consequences of Refusing Surgery for Clinical Stage I NSCLC: A National Cancer Database Analysis (ID 13865)

      14:35 - 14:45  |  Presenting Author(s): Brendon Stiles  |  Author(s): Mohamed Rahouma, Mohamed Kamel, Abu Nasar, Sebron Harrison, Benjamin Lee, Jeffrey L. Port, Nasser Altorki

      • Abstract
      • Presentation

      Background

      Given perceived morbidity of lung cancer surgery, patients may instead pursue other treatment options, particularly in the current era of shared decision-making. We sought to determine predictors of refusal of surgery for clinical stage I non-small cell lung cancer (NSCLC) patients and to determine associated outcomes.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The NCDB (2004-2014) was queried for clinical stage I NSCLC patients who underwent or were recommended to undergo surgery. A unique field in the NCDB allows identification of those patients who were recommended to have surgery, but refused. We only included cases in which surgery was refused “by the patient, patient’s family member or guardian”. We excluded patients with multiple primary tumors, unknown treatment modality/sequence, those who did not undergo recommended surgery for unknown reasons, and those initially not recommended to have surgery. Survival was compared using log rank test in Kaplan Meier curves. Logistic regression was performed to identify predictors of refusing surgery.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 118,0217 patients undergoing surgery and 3,210 (2.6%) who were recommended, but refused surgery. By multivariate analysis older age (HR=1.09, CI=1.08-1.09), non-white race (HR=2.18, CI=1.97-2.42), low income (HR=1.28,CI=1.16-1.41), lack of insurance (HR=2.62,CI=1.89-3.62), squamous histology (HR=1.40,CI=1.29-1.53), and larger tumor size (HR=1.57,CI=1.42-1.73) predicted refusal of surgery.Patients refusing surgery were treated with chemoradiation (n=249, 7.8%), radiation or chemotherapy alone (n=1,568, 48.8%), or no treatment (n=1393, 43.4%). Median survival was worse for patients who refused any treatment versus those who received other treatment modalities (19.8 vs 42.2 months, P<0.001). Among those patients refusing surgery who were treated with radiation, we identified 758 patients (23.6%) who received stereotactic body radiation therapy (SBRT). The proportion of patients who refused surgery and received SBRT increased over time, from 3.8% in 2004-2006, to 17% in 2007-2009, to 31.1% in 2010-2012, and to 37.9% in 2013-2014. Patients receiving SBRT had improved survival compared to other patients refusing surgery (47.9 vs. 25.2 months, p<0.001), although survival in the SBRT group was inferior to patients undergoing surgery as recommended (47.9 vs. 82.8 months, p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Although patients may be reluctant to undergo surgery for early stage NSCLC, refusal of surgery when recommended comes at the expense of decreased survival. Socioeconomic factors may be associated with refusal of surgery. The use of SBRT is an effective and increasingly used alternative in these patients, which improves survival compared to no treatment but which is still not equivalent to surgery in this unmatched, retrospective cohort.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Information from this presentation has been removed upon request of the author.

      Information from this presentation has been removed upon request of the author.

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      OA06.08 - Discussant - OA 06.05, OA 06.06, OA 06.07 (ID 14557)

      14:45 - 15:00  |  Presenting Author(s): Steven H Lin

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    PC07 - The Future of Cytotoxic Chemotherapy in Advanced NSCLC (ID 846)

    • Event: WCLC 2018
    • Type: Pro-Con Session
    • Track: Advanced NSCLC
    • Presentations: 4
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 202 BD
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      PC07.03 - Debate 1: For Wild-Type NSCLC, Which Will Be the Preferred Strategy: IO Alone versus Chemo + IO - IO Alone (ID 11631)

      13:30 - 13:50  |  Presenting Author(s): Leora Horn

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      PC07.04 - Debate 1: For Wild-Type NSCLC, Which Will Be the Preferred Strategy: IO Alone versus Chemo + IO - Chemo + IO (ID 11632)

      13:50 - 14:10  |  Presenting Author(s): Federico Cappuzzo

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      PC07.01 - Debate 2: Chemotherapy Will Become a Thing of the Past in the Management of Advanced NSCLC - For (ID 11629)

      14:10 - 14:30  |  Presenting Author(s): Suresh S. Ramalingam

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      PC07.02 - Debate 2: Chemotherapy Will Become a Thing of the Past in the Management of Advanced NSCLC - Against (ID 11630)

      14:30 - 14:50  |  Presenting Author(s): Keunchil Park

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    PR01 - Press Conference (ID 872)

    • Event: WCLC 2018
    • Type: Press Conference
    • Track:
    • Presentations: 5
    • Moderators:
    • Coordinates: 9/23/2018, 16:00 - 17:30, Room 202 BD
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      Welcome (ID 13396)

      16:00 - 16:05  |  Presenting Author(s): Natasha B Leighl, Andrea Bezjak, Gail Elizabeth Darling

      • Abstract

      Abstract not provided

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      Preview of the WCLC/Key Themes/Practice-Changing Abstracts (ID 14871)

      16:05 - 16:13  |  Presenting Author(s): Natasha B Leighl, Andrea Bezjak, Gail Elizabeth Darling

      • Abstract

      Abstract not provided

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      Oncogene-Driven Patient Groups: A New Era For Research Partnerships (ID 14872)

      16:13 - 16:21  |  Presenting Author(s): Janet Freeman-Daily

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      No Longer Outliers: Understanding the Needs of Long-Term Cancer Survivors (ID 14873)

      16:21 - 16:29  |  Presenting Author(s): Maureen Rigney

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      The Role of Comprehensive Genomic Profiling in the Community Setting (ID 14874)

      16:29 - 16:37  |  Presenting Author(s): Kimberly Ann Rohan

      • Abstract
      • Presentation
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    SH02 - Highlight of the Previous Day Sessions (ID 994)

    • Event: WCLC 2018
    • Type: Highlight of the Day Session
    • Track:
    • Presentations: 4
    • Moderators:
    • Coordinates: 9/25/2018, 07:00 - 08:00, Room 202 BD
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      SH02.01 - Targeted tx (ID 14781)

      07:00 - 07:12  |  Presenting Author(s): Robert Pirker

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      SH02.02 - Mesothelioma (ID 14782)

      07:12 - 07:24  |  Presenting Author(s): Anne S. Tsao

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      SH02.03 - IO (ID 14783)

      07:24 - 07:36  |  Presenting Author(s): Gregory J Riely

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      SH02.04 - Pathology/Biology/Diagnostics (ID 14784)

      07:36 - 07:48  |  Presenting Author(s): Rafael Rosell

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      Abstract not provided

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