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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EThis article reviews a phase 3 trial of biologically-based therapy reduction for intermediate\nrisk neuroblastoma in young patients. Also discussed is a final analysis of the Head Start I and II\nprotocols, which looked at outcome sof children less than three years old at diagnosis with\nnon-metastatic medulloblastoma treated with chemotherapy.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHead \u0026amp; Neck Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ENeuroblastomas account for 15% of cancer-related deaths occurring in childhood. The\nchildren\u0027s cancer group study (CCG) 3881 showed that the chances of overall survival (OS)\nwere greater than 80% with aggressive chemotherapy and surgery. While these results are\nencouraging, the burden of treatment is quite severe in these young patients. The primary goal of\nthis trial (COG 3961) was to achieve a 3-year OS \u0026gt;90% for intermediate risk (IR)\nneuroblastoma with reduced therapy and hopefully toxicity compared to historical controls.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETreatment was administered on an outpatient basis using the most active agents available for\nneuroblastoma. Standard therapies were modified, however, with the aim of reducing toxicity:\ncisplatin was replaced with carboplatin and the total dose of anthracyclines were limited to a\ncumulative dose of below 100mg\/m\u003Csup\u003E2\u003C\/sup\u003E. Patients were stratified according to favorable or\nunfavorable biology; treatment was administered over 64 days in the favorable group with 4 cycles,\nand over 168 days in the unfavorable group with 8 cycles.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EBetween March of 1997 and May of 2005, 463 eligible patients were enrolled in the study; roughly\n70% had favorable biology and 30% had unfavorable biology. Fifty-six (56) percent of\nthe patients had stage III disease (105 children and 156 infants), 37% were infants with\nstage IV disease and 7% were infants with stage IV-S disease. The study was designed such\nthat patients with favorable biology were to receive 4 cycles of treatment, but if they did not\nachieve a response during this time, they were then eligible to receive all 8 cycles; 40% of\npatients in the favorable biology group did so.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAgain, one of the goals of this study was to reduce overall toxicity. Reversible hematological\ntoxicities were seen in 69% of the patients. Importantly, however, renal, cardiac and hearing\ntoxicities were observed in less than 2% of the patients, if transient grade 3\/4 toxicities\nin blood pressure were excluded. Non-hematological toxicities were significantly less in course two\nthan in course one, which is almost certainly related to the release of disease burden by the end of\ncourse one. Finally, deaths due to infection were low at 0.8%.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EResponse rates (comprised of complete response, very good partial response, and partial response)\nwere achieved in 85% of patients in the favorable biology group and 89% of the\nunfavorable biology group. In both groups, 3-year OS was achieved in over 90% of the patients\n(\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u00223-Year Event Free Survival and Overall Survival in the Favorable Biology Group, the Unfavorable Biology Group and in Both Groups Combined.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1640065822\u0022 data-figure-caption=\u00223-Year Event Free Survival and Overall Survival in the Favorable Biology Group, the Unfavorable Biology Group and in Both Groups Combined.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11117\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003E3-Year Event Free Survival and Overall Survival in the Favorable Biology Group, the Unfavorable\nBiology Group and in Both Groups Combined.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThe primary hypothesis of this study, therefore, was confirmed, with 3-year OS \u0026gt;90%\nfor intermediate risk neuroblastoma. More importantly, compared with the historical control CCG\n3881, this outcome has been achieved with a very significant reduction in therapy (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Future phase 3 trials will\nprescribe duration of therapy, at least in part, in accordance with the results of this trial.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11136\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11136\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11136\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EOverall Survival and Treatment Burden in CCG 3881 and COG A391.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EOutcome of Children Less Than Three Years Old at Diagnosis with Non-Metastatic\nMedulloblastoma Treated with Chemotherapy on the \u201cHead Start\u201d I and II Protocols:\nFinal Report\u003C\/h2\u003E\n\u003Cp id=\u0022p-10\u0022\u003EThe majority of malignant brain tumors in children develop within the first 6 years of life. The\nmost common type is medulloblastoma (MB), an aggressive tumor which grows rapidly, recurs often and\nis susceptible to metastasis. The standard of care for older children with medulloblastoma is\nradiation therapy, followed by chemotherapy. However, this treatment is often associated with\nseveral adverse effects, including learning and attention difficulties, short-term memory deficits,\nsocial adjustment problems, hearing, speech and language problems, and impaired physical growth.\nTherefore, a strategy to treat this type of disease without radiation is evident; the goals of Head\nStart I and II were to address this issue.\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003EThe treatment plan was the same in both protocols. After maximum surgical resection, patients\nunderwent 5 cycles of induction chemotherapy, followed by an extensive disease evaluation. If the\nanalysis showed residual tumor, the investigators encouraged a re-resection; if the patients\nprogressed by this time, they were removed from the study. Patients who were either stable at the\nend of induction, or had responsive disease, underwent consolidation chemotherapy with autologous\nhematopoietic stem cell rescue. Finally, patients with no evidence of disease after these treatments\n(the majority of patients in this trial) did not receive radiation.\u003C\/p\u003E\n\u003Cp id=\u0022p-12\u0022\u003ETwelve (12) patients were treated in Head Start I and 9 patients were treated in Head Start II.\nThe male and female ratios were similar in both studies, though patients tended to be younger in\nHead Start I. Gross total resection was more successful in Head Start II. Three (3) patients in Head\nStart I and 6 patients in Head Start II were desmoplastic. Event-free survival (EFS) for all\npatients in the cohort was 52% at 5 years, while the overall survival (OS) was 70% at\n5 years.\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003EThe investigators dissected the data according to the prognostic factors. The EFS when classified\nby extent of resection is shown in \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure\n1\u003C\/a\u003E and desmoplastic vs classical MB is shown in \u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 2\u003C\/a\u003E. Although these results were not statistically\nsignificant, a gross total resection and desmoplastic MB did trend toward improved EFS; OS did not\nshow this same trend. The total radiotherapy-free survival among the surviving patients in this\nstudy was 73%.\u003C\/p\u003E\n\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022EFS by Extent of Resection in Head Start I and II.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1640065822\u0022 data-figure-caption=\u0022EFS by Extent of Resection in Head Start I and II.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11122\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EEFS by Extent of Resection in Head Start I and II.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022EFS Characterized by Desmoplastic or Classical MB in Head Start I and II.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1640065822\u0022 data-figure-caption=\u0022EFS Characterized by Desmoplastic or Classical MB in Head Start I and II.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11126\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n\u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EEFS Characterized by Desmoplastic or Classical MB in Head Start I and II.\u003C\/p\u003E\n\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-16\u0022\u003EThere were 3 toxic deaths in Head Start I and 1 in Head Start II. Five (5) patients relapsed in\nHead Start I, whereas only 2 patients did so in Head Start II; all relapses developed within 25\nmonths and the majority occurred locally. Overall quality of life (QoL) was within the average range\nat both times of assessment (70 months and 124 months); younger patients displayed fewer behavioral\nproblems and higher adaptive function at both time points.\u003C\/p\u003E\n\u003Cp id=\u0022p-17\u0022\u003EIn conclusion, EFS in this study mirrors those reported in the German HIT study [Rutkowski et al.\n\u003Cem\u003ENew Eng J Med\u003C\/em\u003E 2005]. Incomplete resection and absence of desmoplasia trend toward\ninferior EFS, but not OS. These results show that, despite administering the myeloablative\nchemotherapy, these patients can be retrieved with either more chemotherapy or irradiation. Although\nthe number of patients is limited in these studies, the QoL was within the normal range in the Head\nStart I study and it was improved in 3 out of 4 patients in the Head Start II study.\u003C\/p\u003E\n\u003Cdiv id=\u0022F4\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F4.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1640065822\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure4\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F4.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F4.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure4\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/3\/32\/F4.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11132\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EPhoto Courtesy \u00a9 ASCO\/Todd Buchanan 2007\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/3\/32.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmagq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmagq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmagq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}