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Retroperitoneal sarcoma

MedGen UID:
107937
•Concept ID:
C0585129
•
Neoplastic Process
Synonyms: Retroperitoneal Sarcoma; retroperitoneal sarcoma; retroperitoneal space sarcoma; sarcoma of retroperitoneal space
SNOMED CT: Retroperitoneal sarcoma (307219002)
 
Monarch Initiative: MONDO:0001501

Definition

A sarcoma that occurs in the retroperitoneal region. [from NCI]

Professional guidelines

PubMed

Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up(☆).
Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S; ESMO Guidelines Committee, EURACAN and GENTURIS. Electronic address: clinicalguidelines@esmo.org
Ann Oncol 2021 Nov;32(11):1348-1365. Epub 2021 Jul 22 doi: 10.1016/j.annonc.2021.07.006. PMID: 34303806
Overview of primary adult retroperitoneal tumours.
Improta L, Tzanis D, Bouhadiba T, Abdelhafidh K, Bonvalot S
Eur J Surg Oncol 2020 Sep;46(9):1573-1579. Epub 2020 May 21 doi: 10.1016/j.ejso.2020.04.054. PMID: 32600897
Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine.
Gamboa AC, Gronchi A, Cardona K
CA Cancer J Clin 2020 May;70(3):200-229. Epub 2020 Apr 10 doi: 10.3322/caac.21605. PMID: 32275330

Recent clinical studies

Etiology

Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group.
Tseng WW, Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Ford SJ, Gonzalez RJ, Gladdy RA, Gyorki DE, Fairweather M, Lee KW, Albertsmeier M, van Houdt WJ, Fau M, Nessim C, Grignani G, Cardona K, Quagliuolo V, Grignol V, Farma JM, Pennacchioli E, Fiore M, Hayes A, Tzanis D, Skoczylas J, Almond ML, Mullinax JE, Johnston W, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Desai A, Voss R, Sanfilippo R, Jones RL, Baldini EH, Wagner AJ, Catton CN, Stacchiotti S, Thway K, Roland CL, Raut CP, Gronchi A; Transatlantic Australasian Retroperitoneal Sarcoma Working Group
Ann Surg Oncol 2022 Nov;29(12):7335-7348. Epub 2022 Jun 29 doi: 10.1245/s10434-022-11864-y. PMID: 35767103
Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up(☆).
Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S; ESMO Guidelines Committee, EURACAN and GENTURIS. Electronic address: clinicalguidelines@esmo.org
Ann Oncol 2021 Nov;32(11):1348-1365. Epub 2021 Jul 22 doi: 10.1016/j.annonc.2021.07.006. PMID: 34303806
Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial.
Bonvalot S, Gronchi A, Le Péchoux C, Swallow CJ, Strauss D, Meeus P, van Coevorden F, Stoldt S, Stoeckle E, Rutkowski P, Rastrelli M, Raut CP, Hompes D, De Paoli A, Sangalli C, Honoré C, Chung P, Miah A, Blay JY, Fiore M, Stelmes JJ, Dei Tos AP, Baldini EH, Litière S, Marreaud S, Gelderblom H, Haas RL
Lancet Oncol 2020 Oct;21(10):1366-1377. Epub 2020 Sep 14 doi: 10.1016/S1470-2045(20)30446-0. PMID: 32941794
The sacral chordoma margin.
Radaelli S, Fossati P, Stacchiotti S, Akiyama T, Asencio JM, Bandiera S, Boglione A, Boland P, Bolle S, Bruland Ø, Brunello A, Bruzzi P, Campanacci D, Cananzi F, Capanna R, Casadei R, Cordoba A, Court C, Dei Tos AP, DeLaney TF, De Paoli A, De Pas TM, Desai A, Di Brina L, Donati DM, Fabbri N, Fiore MR, Frezza A, Gambarotti M, Gasbarrini A, Georg P, Grignani G, Hindi N, Hug EB, Jones R, Kawai A, Krol AD, Le Grange F, Luzzati A, Marquina G, Martin-Benlloch JA, Mazzocco K, Navarria F, Navarria P, Parchi PD, Patel S, Pennacchioli E, Petrongari MG, Picci P, Pollock R, Porcu L, Quagliuolo V, Sangalli C, Scheipl S, Scotto GM, Spalek M, Steinmeier T, Timmermann B, Trama A, Uhl M, Valverde C, Varga PP, Verges R, Weber DC, Zoccali C, Casali PG, Sommer J, Gronchi A
Eur J Surg Oncol 2020 Aug;46(8):1415-1422. Epub 2020 Apr 27 doi: 10.1016/j.ejso.2020.04.028. PMID: 32402509
Myeloid Sarcoma: Presentation, Diagnosis, and Treatment.
Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A
Clin Lymphoma Myeloma Leuk 2017 May;17(5):263-267. Epub 2017 Mar 7 doi: 10.1016/j.clml.2017.02.027. PMID: 28342811

Diagnosis

Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group.
Tseng WW, Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Ford SJ, Gonzalez RJ, Gladdy RA, Gyorki DE, Fairweather M, Lee KW, Albertsmeier M, van Houdt WJ, Fau M, Nessim C, Grignani G, Cardona K, Quagliuolo V, Grignol V, Farma JM, Pennacchioli E, Fiore M, Hayes A, Tzanis D, Skoczylas J, Almond ML, Mullinax JE, Johnston W, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Desai A, Voss R, Sanfilippo R, Jones RL, Baldini EH, Wagner AJ, Catton CN, Stacchiotti S, Thway K, Roland CL, Raut CP, Gronchi A; Transatlantic Australasian Retroperitoneal Sarcoma Working Group
Ann Surg Oncol 2022 Nov;29(12):7335-7348. Epub 2022 Jun 29 doi: 10.1245/s10434-022-11864-y. PMID: 35767103
Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up(☆).
Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S; ESMO Guidelines Committee, EURACAN and GENTURIS. Electronic address: clinicalguidelines@esmo.org
Ann Oncol 2021 Nov;32(11):1348-1365. Epub 2021 Jul 22 doi: 10.1016/j.annonc.2021.07.006. PMID: 34303806
Overview of primary adult retroperitoneal tumours.
Improta L, Tzanis D, Bouhadiba T, Abdelhafidh K, Bonvalot S
Eur J Surg Oncol 2020 Sep;46(9):1573-1579. Epub 2020 May 21 doi: 10.1016/j.ejso.2020.04.054. PMID: 32600897
Myeloid Sarcoma: Presentation, Diagnosis, and Treatment.
Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A
Clin Lymphoma Myeloma Leuk 2017 May;17(5):263-267. Epub 2017 Mar 7 doi: 10.1016/j.clml.2017.02.027. PMID: 28342811
Primary retroperitoneal soft tissue sarcoma: Imaging appearances, pitfalls and diagnostic algorithm.
Messiou C, Moskovic E, Vanel D, Morosi C, Benchimol R, Strauss D, Miah A, Douis H, van Houdt W, Bonvalot S
Eur J Surg Oncol 2017 Jul;43(7):1191-1198. Epub 2016 Dec 9 doi: 10.1016/j.ejso.2016.10.032. PMID: 28057392

Therapy

Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results.
Callegaro D, Raut CP, Ajayi T, Strauss D, Bonvalot S, Ng D, Stoeckle E, Fairweather M, Rutkowski P, van Houdt WJ, Gelderblom H, Sangalli C, Hayes A, Honoré C, Gladdy RA, Fau M, Haas R, Tzanis D, Miah AB, Chung P, Baldini EH, Marreaud S, Litiere S, Swallow CJ, Gronchi A
Ann Surg 2023 Jul 1;278(1):127-134. Epub 2022 Jul 14 doi: 10.1097/SLA.0000000000005492. PMID: 35833413
Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial.
Bonvalot S, Gronchi A, Le Péchoux C, Swallow CJ, Strauss D, Meeus P, van Coevorden F, Stoldt S, Stoeckle E, Rutkowski P, Rastrelli M, Raut CP, Hompes D, De Paoli A, Sangalli C, Honoré C, Chung P, Miah A, Blay JY, Fiore M, Stelmes JJ, Dei Tos AP, Baldini EH, Litière S, Marreaud S, Gelderblom H, Haas RL
Lancet Oncol 2020 Oct;21(10):1366-1377. Epub 2020 Sep 14 doi: 10.1016/S1470-2045(20)30446-0. PMID: 32941794
The sacral chordoma margin.
Radaelli S, Fossati P, Stacchiotti S, Akiyama T, Asencio JM, Bandiera S, Boglione A, Boland P, Bolle S, Bruland Ø, Brunello A, Bruzzi P, Campanacci D, Cananzi F, Capanna R, Casadei R, Cordoba A, Court C, Dei Tos AP, DeLaney TF, De Paoli A, De Pas TM, Desai A, Di Brina L, Donati DM, Fabbri N, Fiore MR, Frezza A, Gambarotti M, Gasbarrini A, Georg P, Grignani G, Hindi N, Hug EB, Jones R, Kawai A, Krol AD, Le Grange F, Luzzati A, Marquina G, Martin-Benlloch JA, Mazzocco K, Navarria F, Navarria P, Parchi PD, Patel S, Pennacchioli E, Petrongari MG, Picci P, Pollock R, Porcu L, Quagliuolo V, Sangalli C, Scheipl S, Scotto GM, Spalek M, Steinmeier T, Timmermann B, Trama A, Uhl M, Valverde C, Varga PP, Verges R, Weber DC, Zoccali C, Casali PG, Sommer J, Gronchi A
Eur J Surg Oncol 2020 Aug;46(8):1415-1422. Epub 2020 Apr 27 doi: 10.1016/j.ejso.2020.04.028. PMID: 32402509
Systemic therapy in retroperitoneal sarcoma management.
Constantinidou A, Jones RL
J Surg Oncol 2018 Jan;117(1):87-92. Epub 2017 Nov 30 doi: 10.1002/jso.24933. PMID: 29194633
Myeloid Sarcoma: Presentation, Diagnosis, and Treatment.
Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A
Clin Lymphoma Myeloma Leuk 2017 May;17(5):263-267. Epub 2017 Mar 7 doi: 10.1016/j.clml.2017.02.027. PMID: 28342811

Prognosis

Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group.
Tseng WW, Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Ford SJ, Gonzalez RJ, Gladdy RA, Gyorki DE, Fairweather M, Lee KW, Albertsmeier M, van Houdt WJ, Fau M, Nessim C, Grignani G, Cardona K, Quagliuolo V, Grignol V, Farma JM, Pennacchioli E, Fiore M, Hayes A, Tzanis D, Skoczylas J, Almond ML, Mullinax JE, Johnston W, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Desai A, Voss R, Sanfilippo R, Jones RL, Baldini EH, Wagner AJ, Catton CN, Stacchiotti S, Thway K, Roland CL, Raut CP, Gronchi A; Transatlantic Australasian Retroperitoneal Sarcoma Working Group
Ann Surg Oncol 2022 Nov;29(12):7335-7348. Epub 2022 Jun 29 doi: 10.1245/s10434-022-11864-y. PMID: 35767103
Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up(☆).
Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S; ESMO Guidelines Committee, EURACAN and GENTURIS. Electronic address: clinicalguidelines@esmo.org
Ann Oncol 2021 Nov;32(11):1348-1365. Epub 2021 Jul 22 doi: 10.1016/j.annonc.2021.07.006. PMID: 34303806
Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine.
Gamboa AC, Gronchi A, Cardona K
CA Cancer J Clin 2020 May;70(3):200-229. Epub 2020 Apr 10 doi: 10.3322/caac.21605. PMID: 32275330
Giant Retroperitoneal Sarcoma.
Hazen B, Cocieru A
J Gastrointest Surg 2017 Mar;21(3):602-603. Epub 2016 Sep 9 doi: 10.1007/s11605-016-3258-0. PMID: 27613734
Retroperitoneal sarcoma.
Leffall LD Jr
Ann Surg 1991 Jul;214(1):1. PMID: 2064464Free PMC Article

Clinical prediction guides

Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results.
Callegaro D, Raut CP, Ajayi T, Strauss D, Bonvalot S, Ng D, Stoeckle E, Fairweather M, Rutkowski P, van Houdt WJ, Gelderblom H, Sangalli C, Hayes A, Honoré C, Gladdy RA, Fau M, Haas R, Tzanis D, Miah AB, Chung P, Baldini EH, Marreaud S, Litiere S, Swallow CJ, Gronchi A
Ann Surg 2023 Jul 1;278(1):127-134. Epub 2022 Jul 14 doi: 10.1097/SLA.0000000000005492. PMID: 35833413
Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group.
Tseng WW, Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Ford SJ, Gonzalez RJ, Gladdy RA, Gyorki DE, Fairweather M, Lee KW, Albertsmeier M, van Houdt WJ, Fau M, Nessim C, Grignani G, Cardona K, Quagliuolo V, Grignol V, Farma JM, Pennacchioli E, Fiore M, Hayes A, Tzanis D, Skoczylas J, Almond ML, Mullinax JE, Johnston W, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Desai A, Voss R, Sanfilippo R, Jones RL, Baldini EH, Wagner AJ, Catton CN, Stacchiotti S, Thway K, Roland CL, Raut CP, Gronchi A; Transatlantic Australasian Retroperitoneal Sarcoma Working Group
Ann Surg Oncol 2022 Nov;29(12):7335-7348. Epub 2022 Jun 29 doi: 10.1245/s10434-022-11864-y. PMID: 35767103
Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial.
Bonvalot S, Gronchi A, Le Péchoux C, Swallow CJ, Strauss D, Meeus P, van Coevorden F, Stoldt S, Stoeckle E, Rutkowski P, Rastrelli M, Raut CP, Hompes D, De Paoli A, Sangalli C, Honoré C, Chung P, Miah A, Blay JY, Fiore M, Stelmes JJ, Dei Tos AP, Baldini EH, Litière S, Marreaud S, Gelderblom H, Haas RL
Lancet Oncol 2020 Oct;21(10):1366-1377. Epub 2020 Sep 14 doi: 10.1016/S1470-2045(20)30446-0. PMID: 32941794
Surgical morbidity in retroperitoneal sarcoma resection.
MacNeill AJ, Fiore M
J Surg Oncol 2018 Jan;117(1):56-61. Epub 2018 Jan 3 doi: 10.1002/jso.24902. PMID: 29314041
Multiply recurrent retroperitoneal liposarcoma.
Bagaria SP, Gabriel E, Mann GN
J Surg Oncol 2018 Jan;117(1):62-68. Epub 2017 Dec 19 doi: 10.1002/jso.24929. PMID: 29266232

Recent systematic reviews

Neoadjuvant radiotherapy for retroperitoneal sarcoma: A systematic review.
Cheng H, Miura JT, Lalehzari M, Rajeev R, Donahue AE, Bedi M, Gamblin TC, Turaga KK, Johnston FM
J Surg Oncol 2016 May;113(6):628-34. Epub 2016 Mar 16 doi: 10.1002/jso.24221. PMID: 26990903
Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy.
Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS; CholeS Study Group; West Midlands Research Collaborative
Br J Surg 2016 Jan;103(1):27-34; discussion 34. Epub 2015 Sep 2 doi: 10.1002/bjs.9904. PMID: 26331356
Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel.
Baldini EH, Wang D, Haas RL, Catton CN, Indelicato DJ, Kirsch DG, Roberge D, Salerno K, Deville C, Guadagnolo BA, O'Sullivan B, Petersen IA, Le Pechoux C, Abrams RA, DeLaney TF
Int J Radiat Oncol Biol Phys 2015 Jul 1;92(3):602-12. doi: 10.1016/j.ijrobp.2015.02.013. PMID: 26068493
Radiotherapy and surgery-an indispensable duo in the treatment of retroperitoneal sarcoma.
Van De Voorde L, Delrue L, van Eijkeren M, De Meerleer G
Cancer 2011 Oct 1;117(19):4355-64. Epub 2011 Mar 28 doi: 10.1002/cncr.26071. PMID: 21446048
Pregnancy and genital sarcoma: a systematic review of the literature.
Matsuo K, Eno ML, Im DD, Rosenshein NB
Am J Perinatol 2009 Aug;26(7):507-18. Epub 2009 Mar 13 doi: 10.1055/s-0029-1215428. PMID: 19288396

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