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Volumn 187, Issue 8, 2011, Pages 461-466

Patterns of care and course of symptoms in palliative radiotherapy: A multicenter pilot study analysis

Author keywords

Indications; Palliative radiotherapy; Pattern of care; Side effects; Symptom relief

Indexed keywords

ADULT; AGED; ANALGESIA; ARTICLE; BONE METASTASIS; BRAIN METASTASIS; CANCER FATIGUE; CANCER PAIN; CANCER PALLIATIVE THERAPY; CANCER PATIENT; CANCER RADIOTHERAPY; CLINICAL EFFECTIVENESS; CLINICAL TRIAL; COMPUTER ASSISTED RADIOTHERAPY; COUGHING; DIARRHEA; DISEASE SEVERITY; DYSPHAGIA; DYSPNEA; FEMALE; HUMAN; INTRACRANIAL PRESSURE; LIFE EXTENSION; LIVER METASTASIS; LUNG METASTASIS; LYMPH NODE METASTASIS; MAJOR CLINICAL STUDY; MALE; NEUROLOGIC DISEASE; PILOT STUDY; PRIVATE PRACTICE; PROSPECTIVE STUDY; RADIATION DOSE FRACTIONATION; RADIATION INJURY; SPLEEN CANCER; STEREOTACTIC RADIOSURGERY; TOMOTHERAPY; TREATMENT OUTCOME; UNIVERSITY HOSPITAL;

EID: 80052265897     PISSN: 01797158     EISSN: 1439099X     Source Type: Journal    
DOI: 10.1007/s00066-011-2231-9     Document Type: Article
Times cited : (30)

References (40)
  • 1
    • 0038515271 scopus 로고    scopus 로고
    • Palliative radiotherapy for patients with bone metastases: Survey of primary care physicians
    • DOI 10.1016/S0167-8140(02)00366-3
    • E. Barnes M. Parliament J. Hanson, et al. 2003 Palliative radiotherapy for patients with bone metastases: survey of primary care physicians Radiother Oncol 67 221 223 12812854 10.1016/S0167-8140(02)00366-3 (Pubitemid 36695101)
    • (2003) Radiotherapy and Oncology , vol.67 , Issue.2 , pp. 221-223
    • Barnes, E.A.1    Parliament, M.2    Hanson, J.3    Watanabe, S.4    Palmer, J.L.5    Bruera, E.6
  • 2
    • 23944440602 scopus 로고    scopus 로고
    • Symptom distress in patients attending an outpatient palliative radiotherapy clinic
    • DOI 10.1016/j.jpainsymman.2005.02.015, PII S0885392405002551
    • N. Bradley L. Davis E. Chow 2005 Symptom distress in patients attending an outpatient palliative radiotherapy clinic J Pain Symptom Manage 30 123 131 16125027 10.1016/j.jpainsymman.2005.02.015 (Pubitemid 41206575)
    • (2005) Journal of Pain and Symptom Management , vol.30 , Issue.2 , pp. 123-131
    • Bradley, N.1    Davis, L.2    Chow, E.3
  • 3
    • 0035031573 scopus 로고    scopus 로고
    • Multidisciplinary symptom control clinic in a cancer center: A retrospective study
    • DOI 10.1007/s005200000172
    • E. Bruera M. Michaud A. Vigano, et al. 2001 Multidisciplinary symptom control clinic in a cancer center: a retrospective study Support Care Cancer 9 162 168 11401100 10.1007/s005200000172 1:STN:280:DC%2BD3MzjtlCgtA%3D%3D (Pubitemid 32435807)
    • (2001) Supportive Care in Cancer , vol.9 , Issue.3 , pp. 162-168
    • Bruera, E.1    Michaud, M.2    Vigano, A.3    Neumann, C.M.4    Watanabe, S.5    Hanson, J.6
  • 4
    • 0034194414 scopus 로고    scopus 로고
    • Validation of the Edmonton Symptom Assessment Scale
    • DOI 10.1002/(SICI)1097-0142(20000501)88:9<2164::AID-CNCR24>3.0. CO;2-5
    • V.T. Chang S.S. Hwang M. Feuerman 2000 Validation of the Edmonton Symptom Assessment Scale Cancer 88 2164 2171 10813730 10.1002/(SICI)1097-0142(20000501) 88:9<2164::AID-CNCR24>3.0.CO;2-5 1:STN:280:DC%2BD3c3ntlGjsw%3D%3D (Pubitemid 30233220)
    • (2000) Cancer , vol.88 , Issue.9 , pp. 2164-2171
    • Chang, V.T.1    Hwang, S.S.2    Feuerman, M.3
  • 5
    • 57649085848 scopus 로고    scopus 로고
    • Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic
    • 18676092 10.1016/j.ijrobp.2008.05.067
    • E. Chow M. Abdolell T. Panzarella K. Harris, et al. 2009 Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic Int J Radiat Oncol Biol Phys 73 280 287 18676092 10.1016/j.ijrobp.2008.05.067
    • (2009) Int J Radiat Oncol Biol Phys , vol.73 , pp. 280-287
    • Chow, E.1    Abdolell, M.2    Panzarella, T.3    Harris, K.4
  • 6
    • 22544464737 scopus 로고    scopus 로고
    • Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases
    • DOI 10.1016/j.jpainsymman.2005.02.009, PII S0885392405001958
    • E. Chow L. Davis L. Holden, et al. 2005 Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases J Pain Symptom Manage 30 18 23 16043003 10.1016/j.jpainsymman.2005.02.009 (Pubitemid 41021675)
    • (2005) Journal of Pain and Symptom Management , vol.30 , Issue.1 , pp. 18-23
    • Chow, E.1    Davis, L.2    Holden, L.3    Tsao, M.4    Danjoux, C.5
  • 7
    • 34248149008 scopus 로고    scopus 로고
    • Palliative radiotherapy trials for bone metastases: A systematic review
    • DOI 10.1200/JCO.2006.09.5281
    • E. Chow K. Harris G. Fan, et al. 2007 Palliative radiotherapy trials for bone metastases: a systematic review J Clin Oncol 25 1423 1436 17416863 10.1200/JCO.2006.09.5281 (Pubitemid 46706892)
    • (2007) Journal of Clinical Oncology , vol.25 , Issue.11 , pp. 1423-1436
    • Chow, E.1    Harris, K.2    Fan, G.3    Tsao, M.4    Sze, W.M.5
  • 8
    • 19944428113 scopus 로고    scopus 로고
    • Symptom control and quality of life in people with lung cancer: A randomised trial of two palliative radiotherapy fractionation schedules
    • DOI 10.1016/j.clon.2004.09.008, PII S0936655504003723
    • S.C. Erridge M.N. Gaze A. Price, et al. 2005 Symptom control and quality of life in people with lung cancer: a randomized trial of two palliative radiotherapy fractionation schedules Clin Oncol (R Coll Radiol) 17 61 67 1:STN:280:DC%2BD2M%2FosFChsg%3D%3D (Pubitemid 40090198)
    • (2005) Clinical Oncology , vol.17 , Issue.1 , pp. 61-67
    • Erridge, S.C.1    Gaze, M.N.2    Price, A.3    Kelly, C.G.4    Kerr, G.R.5    Cull, A.6    MacDougall, R.H.7    Howard, G.C.W.8    Cowie, V.J.9    Gregor, A.10
  • 9
    • 70349420282 scopus 로고    scopus 로고
    • International patterns of practice in palliative radiotherapy for painful bone metastases: Evidence-based practice?
    • 19464820 10.1016/j.ijrobp.2008.12.084
    • A. Fairchild E. Barnes S. Ghosh, et al. 2009 International patterns of practice in palliative radiotherapy for painful bone metastases: evidence-based practice? Int J Radiat Oncol Biol Phys 75 1501 1510 19464820 10.1016/j.ijrobp.2008.12.084
    • (2009) Int J Radiat Oncol Biol Phys , vol.75 , pp. 1501-1510
    • Fairchild, A.1    Barnes, E.2    Ghosh, S.3
  • 10
    • 50549094169 scopus 로고    scopus 로고
    • Palliative thoracic radiotherapy for lung cancer: A systematic review
    • 18711191 10.1200/JCO.2007.15.3312
    • A. Fairchild K. Harris E. Barnes, et al. 2008 Palliative thoracic radiotherapy for lung cancer: a systematic review J Clin Oncol 26 4001 4011 18711191 10.1200/JCO.2007.15.3312
    • (2008) J Clin Oncol , vol.26 , pp. 4001-4011
    • Fairchild, A.1    Harris, K.2    Barnes, E.3
  • 11
    • 58149095371 scopus 로고    scopus 로고
    • The rapid access palliative radiotherapy program: Blueprint for initiation of a one-stop multidisciplinary bone metastases clinic
    • 10.1007/s00520-008-0468-3 1:STN:280:DC%2BD1M%2FhsVKrug%3D%3D
    • A. Fairchild E. Pituskin B. Rose, et al. 2009 The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic Support Cancer Care 17 163 170 10.1007/s00520-008-0468-3 1:STN:280:DC%2BD1M%2FhsVKrug%3D%3D
    • (2009) Support Cancer Care , vol.17 , pp. 163-170
    • Fairchild, A.1    Pituskin, E.2    Rose, B.3
  • 12
    • 77449083845 scopus 로고    scopus 로고
    • DEGRO Practical Guidelines for palliative radiotherapy of breast cancer patients: Brain metastases and leptomeningeal carcinomatosis
    • 20127222 10.1007/s00066-010-2100-y
    • P. Feyer M.L. Sautter-Bihl W. Budach, et al. 2010 DEGRO Practical Guidelines for palliative radiotherapy of breast cancer patients: brain metastases and leptomeningeal carcinomatosis Strahlenther Onkol 186 63 69 20127222 10.1007/s00066-010-2100-y
    • (2010) Strahlenther Onkol , vol.186 , pp. 63-69
    • Feyer, P.1    Sautter-Bihl, M.L.2    Budach, W.3
  • 13
    • 0036584519 scopus 로고    scopus 로고
    • Palliative radiation therapy in end-of-life care: Evidence-based utilization
    • 12026039 10.1177/104990910201900307
    • P. Fine 2002 Palliative radiation therapy in end-of-life care: evidence-based utilization Am J Hosp Palliat Care 19 166 170 12026039 10.1177/104990910201900307
    • (2002) Am J Hosp Palliat Care , vol.19 , pp. 166-170
    • Fine, P.1
  • 14
    • 38149027835 scopus 로고    scopus 로고
    • Palliative medicine review: Prognostication
    • 18370898 10.1089/jpm.2008.9992
    • P.A. Glare C.T. Sinclair 2008 Palliative medicine review: prognostication J Palliat Med 11 84 103 18370898 10.1089/jpm.2008.9992
    • (2008) J Palliat Med , vol.11 , pp. 84-103
    • Glare, P.A.1    Sinclair, C.T.2
  • 15
    • 77954275609 scopus 로고    scopus 로고
    • Palliative radiotherapy tailored to life expectancy in end-stage cancer patients
    • 20564632 10.1002/cncr.25112
    • S. Gripp S. Mjartan E. Boelke, et al. 2010 Palliative radiotherapy tailored to life expectancy in end-stage cancer patients Cancer 116 3251 3256 20564632 10.1002/cncr.25112
    • (2010) Cancer , vol.116 , pp. 3251-3256
    • Gripp, S.1    Mjartan, S.2    Boelke, E.3
  • 18
    • 66749141846 scopus 로고    scopus 로고
    • Therapeutic guidelines for the treatment of bone metastasis: A report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology
    • 19416037 10.1089/jpm.2009.9633
    • N. Janjan S.T. Lutz J.M. Bedwinek, et al. 2009 Therapeutic guidelines for the treatment of bone metastasis: a report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology J Palliat Med 12 417 426 19416037 10.1089/jpm.2009.9633
    • (2009) J Palliat Med , vol.12 , pp. 417-426
    • Janjan, N.1    Lutz, S.T.2    Bedwinek, J.M.3
  • 20
    • 0036129981 scopus 로고    scopus 로고
    • Health services research: An evolving definition of the field
    • 10.1111/1475-6773.01020
    • K.N. Lohr D.M. Steinwachs 2002 Health services research: an evolving definition of the field Health Services Research 37 15 17 10.1111/1475-6773. 01020
    • (2002) Health Services Research , vol.37 , pp. 15-17
    • Lohr, K.N.1    Steinwachs, D.M.2
  • 21
    • 4444285379 scopus 로고    scopus 로고
    • Survey on use of palliative radiotherapy on hospice care
    • DOI 10.1200/JCO.2004.11.151
    • S. Lutz C. Spence E. Chow, et al. 2004 Survey on use of palliative radiotherapy in hospice care J Clin Oncol 22 3581 3586 15337808 10.1200/JCO.2004.11.151 (Pubitemid 41103665)
    • (2004) Journal of Clinical Oncology , vol.22 , Issue.17 , pp. 3581-3586
    • Lutz, S.1    Spence, C.2    Chow, E.3    Janjan, N.4    Connor, S.5
  • 22
    • 34247178416 scopus 로고    scopus 로고
    • A review of hypofractionated palliative radiotherapy
    • DOI 10.1002/cncr.22555
    • S. Lutz L. Chow W. Hartsell, et al. 2007 A review of hypofractionated palliative radiotherapy Cancer 109 1462 1470 17330854 10.1002/cncr.22555 (Pubitemid 46595679)
    • (2007) Cancer , vol.109 , Issue.8 , pp. 1462-1470
    • Lutz, S.T.1    Chow, E.L.2    Hartsell, W.F.3    Konski, A.A.4
  • 23
    • 34347227456 scopus 로고    scopus 로고
    • National survey of perspectives of palliative radiation therapy: Role, barriers, and needs
    • 17476142 10.1097/PPO.0b013e31804675d4
    • S.A. McCloskey M.L. Tao C.M. Rose, et al. 2007 National survey of perspectives of palliative radiation therapy: role, barriers, and needs Cancer J 13 130 137 17476142 10.1097/PPO.0b013e31804675d4
    • (2007) Cancer J , vol.13 , pp. 130-137
    • McCloskey, S.A.1    Tao, M.L.2    Rose, C.M.3
  • 24
    • 0003575140 scopus 로고
    • National Cancer Institut (NCI) Division of Cancer Treatment, National Cancer Institute, Bethesda, Maryland (USA)
    • National Cancer Institut (NCI). Common toxicity criteria. Division of Cancer Treatment, National Cancer Institute, Bethesda, Maryland (USA) 1988.
    • (1988) Common Toxicity Criteria
  • 26
    • 0033844506 scopus 로고    scopus 로고
    • Midos - Validierung eines minimalen dokumentationssystems fur die Palliativmedizin
    • DOI 10.1007/s004820070028
    • L. Radbruch R. Sabatowski G. Loick, et al. 2000 MIDOS - Validierung eines minimalen Dokumentationssystems für die Palliativmedizin Schmerz 14 231 239 12800029 10.1007/s004820070028 1:STN:280:DC%2BD3s3ntlenug%3D%3D (Pubitemid 30662857)
    • (2000) Schmerz , vol.14 , Issue.4 , pp. 231-239
    • Radbruch, L.1    Sabatowski, R.2    Loick, G.3    Jonen-Thielemann, I.4    Elsner, F.5    Hormann, E.6
  • 27
    • 42449151738 scopus 로고    scopus 로고
    • A new scoring system to predicting the survival of patients treated with whole-brain radiotherapy for brain metastases
    • DOI 10.1007/s00066-008-1831-5
    • D. Rades J. Dunst S.E. Schild 2008 A new scoring system to predict the survival of patients treated with whole-brain radiotherapy for brain metastases Strahlenther Onkol 184 251 255 18427755 10.1007/s00066-008-1831-5 (Pubitemid 351572841)
    • (2008) Strahlentherapie und Onkologie , vol.184 , Issue.5 , pp. 251-255
    • Rades, D.1    Dunst, J.2    Schild, S.E.3
  • 28
    • 77957565853 scopus 로고    scopus 로고
    • The role of radiotherapy for metastatic epidural spinal cord compression
    • 20808299 10.1038/nrclinonc.2010.137
    • D. Rades J.L. Abrahm 2010 The role of radiotherapy for metastatic epidural spinal cord compression Nat Rev Clin Oncol 7 590 598 20808299 10.1038/nrclinonc.2010.137
    • (2010) Nat Rev Clin Oncol , vol.7 , pp. 590-598
    • Rades, D.1    Abrahm, J.L.2
  • 29
    • 79851508872 scopus 로고    scopus 로고
    • Palliative thoracic radiotherapy in non-small cell lung cancer. An analysis of 1250 patients. Palliation of symptoms, tolerance and toxicity
    • 20674068 10.1016/j.lungcan.2010.06.019
    • M. Reinfuss A. Mucha-Malecka T. Walasek, et al. 2011 Palliative thoracic radiotherapy in non-small cell lung cancer. An analysis of 1250 patients. Palliation of symptoms, tolerance and toxicity Lung Cancer 71 344 349 20674068 10.1016/j.lungcan.2010.06.019
    • (2011) Lung Cancer , vol.71 , pp. 344-349
    • Reinfuss, M.1    Mucha-Malecka, A.2    Walasek, T.3
  • 30
    • 34250303823 scopus 로고    scopus 로고
    • Barriers to palliative radiotherapy referral: A Canadian perspective
    • DOI 10.1080/02841860600979005, PII 779467186
    • R.S. Samant E. Fitzgibbon J. Meng, et al. 2007 Barriers to palliative radiotherapy referral: A Canadian perspective Acta Oncologica 46 659 663 17562442 10.1080/02841860600979005 (Pubitemid 46911900)
    • (2007) Acta Oncologica , vol.46 , Issue.5 , pp. 659-663
    • Samant, R.S.1    Fitzgibbon, E.2    Meng, J.3    Graham, I.D.4
  • 31
    • 69549121584 scopus 로고    scopus 로고
    • DEGRO practice guidelines for palliative radiotherapy of metastatic breast cancer: Bone metastases and metastatic spinal cord compression (MSCC)
    • 19714302 10.1007/s00066-009-2044-2
    • R. Souchon F. Wenz F. Sedlmayer W. Budach, et al. 2009 DEGRO practice guidelines for palliative radiotherapy of metastatic breast cancer: bone metastases and metastatic spinal cord compression (MSCC) Strahlenther Onkol 185 417 424 19714302 10.1007/s00066-009-2044-2
    • (2009) Strahlenther Onkol , vol.185 , pp. 417-424
    • Souchon, R.1    Wenz, F.2    Sedlmayer, F.3    Budach, W.4
  • 32
    • 63449084550 scopus 로고    scopus 로고
    • Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party
    • 19330297 10.1007/s00066-009-1904-0
    • D. Steinmann C. Schäfer B. van Oorschot, et al. 2009 Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party Strahlenther Onkol 185 190 197 19330297 10.1007/s00066-009-1904-0
    • (2009) Strahlenther Onkol , vol.185 , pp. 190-197
    • Steinmann, D.1    Schäfer, C.2    Van Oorschot, B.3
  • 33
    • 38149075264 scopus 로고    scopus 로고
    • A new prognostic index and comparison to three other indices for patients with brain metastases: An analysis of 1,960 patients in the RTOG database
    • 17931798 10.1016/j.ijrobp.2007.06.074
    • P.W. Sperduto B. Berkey L.E. Gaspar, et al. 2008 A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database Int J Radiat Oncol Biol Phys 70 510 514 17931798 10.1016/j.ijrobp.2007.06.074
    • (2008) Int J Radiat Oncol Biol Phys , vol.70 , pp. 510-514
    • Sperduto, P.W.1    Berkey, B.2    Gaspar, L.E.3
  • 34
    • 1542713367 scopus 로고    scopus 로고
    • Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: A national phase III trial
    • DOI 10.1200/JCO.2004.06.123
    • S. Sundstrom R. Brennes U. Aasebo, et al. 2004 Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell Lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial J Clin Oncol 22 801 810 14990635 10.1200/JCO.2004.06.123 (Pubitemid 41103591)
    • (2004) Journal of Clinical Oncology , vol.22 , Issue.5 , pp. 801-810
    • Sundstrom, S.1    Bremnes, R.2    Aasebo, U.3    Aamdal, S.4    Hatlevoll, R.5    Brunsvig, P.6    Johannessen, D.C.7    Klepp, O.8    Fayers, P.M.9    Kaasa, S.10
  • 36
    • 12344278795 scopus 로고    scopus 로고
    • Prediction of survival in patients with metastases in the spinal column: Results based on a randomized trial of radiotherapy
    • DOI 10.1002/cncr.20756
    • Y.M. Van der Linden S.P. Dijkstra E.J. Vonk, et al. 2005 Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy Cancer 103 320 328 15593360 10.1002/cncr.20756 (Pubitemid 40129292)
    • (2005) Cancer , vol.103 , Issue.2 , pp. 320-328
    • Van Der Linden, Y.M.1    Dijkstra, S.P.D.S.2    Vonk, E.J.A.3    Marijnen, C.A.M.4    Leer, J.W.H.5
  • 37
    • 77951651777 scopus 로고    scopus 로고
    • Emotional state of patients in radiotherapy and how they deal with their disorder
    • 10.1007/s00066-010-2109-2
    • K. Voigtmann V. Köllner F. Einsle, et al. 2010 Emotional state of patients in radiotherapy and how they deal with their disorder Strahlenther Onkol 4 229 235 10.1007/s00066-010-2109-2
    • (2010) Strahlenther Onkol , vol.4 , pp. 229-235
    • Voigtmann, K.1    Köllner, V.2    Einsle, F.3
  • 38
    • 3843127661 scopus 로고    scopus 로고
    • Palliation of metastatic bone pain: Single fraction versus multifraction radiotherapy - A systematic review of the randomized trials
    • Wai MS, Mike S, Ines H et al. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomized trials. The Cochrane database of systematic reviews (2) 2004; CD004721.
    • (2004) The Cochrane Database of Systematic Reviews , Issue.2
    • Wai, M.S.1    Mike, S.2    Ines, H.3
  • 39
    • 70449723708 scopus 로고    scopus 로고
    • Symptoms and quality of life in cancer patients with brain metastases following palliative radiotherapy
    • 10.1016/j.ijrobp.2008.12.013
    • J. Wong A. Hird L. Zhang, et al. 2009 Symptoms and quality of life in cancer patients with brain metastases following palliative radiotherapy Int J Radiation Oncology Biol Phys 75 1125 1131 10.1016/j.ijrobp.2008.12.013
    • (2009) Int J Radiation Oncology Biol Phys , vol.75 , pp. 1125-1131
    • Wong, J.1    Hird, A.2    Zhang, L.3
  • 40
    • 0347928796 scopus 로고    scopus 로고
    • Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases
    • DOI 10.1016/S0360-3016(02)04147-0, PII S0360301602041470
    • J.S. Wu R. Wong M. Johnston, et al. 2003 Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases Int J Radiat Oncol Biol Phys 55 594 605 12573746 10.1016/S0360- 3016(02)04147-0 (Pubitemid 36170000)
    • (2003) International Journal of Radiation Oncology Biology Physics , vol.55 , Issue.3 , pp. 594-605
    • Wu, J.S.-Y.1    Wong, R.2    Johnston, M.3    Bezjak, A.4    Whelan, T.5


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