Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
As the number of breast cancer (BrCA) survivors has markedly increased, clinicians are now seeking to reduce treatment-related toxicities and inconveniences of treatment, namely the traditional 6 weeks of daily radiation treatment (XRT). Skin thickening, fibrosis, and edema are some of the most common acute and potentially long-term debilitating toxicities of BrCA XRT.
The purpose of this study is to learn if three weeks of daily radiation treatment (RT) to the breast is safe in breast cancer patients who are usually prescribed 6 weeks of daily radiation after breast surgery (e.g. lumpectomy or mastectomy) as standard of care.
As the number of breast cancer (BrCA) survivors has markedly increased, clinicians are now seeking to reduce treatment-related toxicities and inconveniences of treatment, namely the traditional 6 weeks of daily radiation treatment (XRT). Skin thickening, fibrosis, and edema are some of the most common acute and potentially long-term debilitating toxicities of BrCA XRT.
The purpose of this study is to learn if three weeks of daily radiation treatment (RT) to the breast is safe in breast cancer patients who are usually prescribed 6 weeks of daily radiation after breast surgery (e.g. lumpectomy or mastectomy) as standard of care.
Investigators seek to assess the rate of cutaneous toxicity, the rates of lymphedema determined by arm measurements and Grade 3 brachial plexopathy in patients receiving regional nodal irradiation, as well as local control, quality of life, and fatigue levels.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Participants with Stage 0-III breast cancer | Experimental | Women with Stage 0-III breast cancer, treated with breast conserving surgery or mastectomy and clear margins, will receive 15 doses of radiation over three weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hypofractionated Simultaneous Integrated Boost Radiotherapy | Radiation | Participants will receive radiotherapy treatments to the whole breast or chest wall to a dose of 2.66 Gy per day x 15 fractions simultaneously with a boost treatment. The boost treatment will be given on the same days as the whole breast treatment. The lumpectomy cavity + scar (in lumpectomy patients) or chest wall scar (mastectomy patients) will receive 0.54 Gy per day x 15 fractions. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants Per Cutaneous Toxicity Grade (0, 1, 2, 3, 4) | Cutaneous toxicity rate will be assessed by the National Cancer Institute - Common Toxicity Criteria (NCI-CTC) v.3 grading scale. THe NCI CTCAE grades go from 0 to 4. Grade 0: none. Grade 1: Mild or localized; topical intervention indicated. Grade 2: Intense or widespread; intermittent; skin changes from scratching (e.g., edema, papulation, excoriations, lichenification, oozing/crusts); limiting instrumental ADLs. Grade 3-4: Severe or life-threatening. The higher the grade, the worse the outcome. | Duration of Study (Up to 18 months) |
| Number of Participants With 20% or Greater Increase in Arm Lymphedema Compared to Baseline | Number of Participants with 20% or greater increase in arm lymphedema (compared to baseline arm measurements) will be assessed among breast cancer patients receiving regional nodal irradiation. | Duration of Study (Up to 18 months) |
| Number of Participants With Grade 3 Brachial Plexopathy | Number of Participants with Grade 3 Brachial Plexopathy will be assessed among breast cancer patients receiving regional nodal irradiation by RTOG and LENT/SOMA scales Brachial plexopathy range minimum 0 and maximum 4. The higher the score, the worse the outcome | Duration of Study (Up to 18 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Cutaneous Toxicity Rate Assessed by Ultrasound Tissue Characterizations (UTC) | Ultrasound tissue characterization (UTC) is driven by knowledge of the physics of ultrasound and its interactions with biological tissue, and has traditionally used signal modelling and analysis to characterize and differentiate between healthy and diseased tissue. Change in mean UTC at last assessment (up to 18 months post XRT) was compared to baseline (pre-XRT) measures. |
Not provided
Inclusion Criteria:
Participants must have one or more of the following characteristics and be eligible for breast or chest wall with or without regional nodal radiotherapy:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Mylin Torres, MD | Emory University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emory University | Atlanta | Georgia | 30322 | United States |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| FG000 | Participants With Stage 0-III Breast Cancer | Women with Stage 0-III breast cancer, treated with breast conserving surgery or mastectomy and clear margins, will receive 15 doses of radiation over three weeks. Hypofractionated Simultaneous Integrated Boost Radiotherapy: Participants will receive radiotherapy treatments to the whole breast or chest wall to a dose of 2.66 Gy per day x 15 fractions simultaneously with a boost treatment. The boost treatment will be given on the same days as the whole breast treatment. The lumpectomy cavity + scar (in lumpectomy patients) or chest wall scar (mastectomy patients) will receive 0.54 Gy per day x 15 fractions. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| BG000 | Participants With Stage 0-III Breast Cancer | Women with Stage 0-III breast cancer, treated with breast conserving surgery or mastectomy and clear margins, will receive 15 doses of radiation over three weeks. Hypofractionated Simultaneous Integrated Boost Radiotherapy: Participants will receive radiotherapy treatments to the whole breast or chest wall to a dose of 2.66 Gy per day x 15 fractions simultaneously with a boost treatment. The boost treatment will be given on the same days as the whole breast treatment. The lumpectomy cavity + scar (in lumpectomy patients) or chest wall scar (mastectomy patients) will receive 0.54 Gy per day x 15 fractions. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants Per Cutaneous Toxicity Grade (0, 1, 2, 3, 4) | Cutaneous toxicity rate will be assessed by the National Cancer Institute - Common Toxicity Criteria (NCI-CTC) v.3 grading scale. THe NCI CTCAE grades go from 0 to 4. Grade 0: none. Grade 1: Mild or localized; topical intervention indicated. Grade 2: Intense or widespread; intermittent; skin changes from scratching (e.g., edema, papulation, excoriations, lichenification, oozing/crusts); limiting instrumental ADLs. Grade 3-4: Severe or life-threatening. The higher the grade, the worse the outcome. | Data is missing on one participant who completed the study. Another patient developed a contralateral breast cancer during the study and another patient was lost to follow up. These latter two patients did not complete the 1 year post radiation assessment. | Posted | Count of Participants | Participants | Duration of Study (Up to 18 months) |
|
60 months
Not provided
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Participants With Stage 0-III Breast Cancer | Women with Stage 0-III breast cancer, treated with breast conserving surgery or mastectomy and clear margins, will receive 15 doses of radiation over three weeks. Hypofractionated Simultaneous Integrated Boost Radiotherapy: Participants will receive radiotherapy treatments to the whole breast or chest wall to a dose of 2.66 Gy per day x 15 fractions simultaneously with a boost treatment. The boost treatment will be given on the same days as the whole breast treatment. The lumpectomy cavity + scar (in lumpectomy patients) or chest wall scar (mastectomy patients) will receive 0.54 Gy per day x 15 fractions. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Recurrance | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Non-systematic Assessment |
Not provided
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Mylin Torres | Emory University | 404-778-3473 | matorre@emory.edu |
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Dec 13, 2016 | Apr 2, 2021 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Apr 1, 2021 | Apr 2, 2021 | SAP_001.pdf |
Not provided
| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
| Baseline, end of Follow Up (Up to 18 months) (up to 18 months) |
| Change in Tumor Necrosis Factor (TNF) - Alpha Levels | Blood will be analyzed for TNF-alpha (TNF)-alpha levels and correlated to the development of cutaneous toxicity. | Baseline, Post Intervention (Up to 18 Months) |
| Change in Soluble TNF Receptor 2 (sTNFR2) Levels | Blood will be analyzed for soluble TNF receptor 2 (sTNFR2) levels and correlated to the development of cutaneous toxicity. | Baseline, Post Intervention (Up to 18 Months) |
| Change in Interleukin (IL)-6 Levels | Blood will be analyzed for interleukin (IL)-6 levels and correlated to the development of cutaneous toxicity. | Baseline, Post Intervention (Up to 18 Months) |
| Change in Interleukin 1 Receptor Agonist (IL-1ra) Levels | Blood will be analyzed for IL-1ra levels and correlated to the development of cutaneous toxicity. | Baseline, Post Intervention (Up to 18 Months) |
| Change in C - Reactive Protein (CRP) Levels | Blood will be analyzed for CRP levels and correlated to the development of cutaneous toxicity. | Baseline, Post Intervention (Up to 18 Months) |
| Change in Multidimensional Fatigue Inventory (MFI) Score | The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue. Scores range from 20 to 100.The higher the score, the more fatigued. The higher the maximum change, the greater increase in fatigue a patient feels. | Baseline, end of Follow Up (Up to 18 months) |
| Change in Pittsburgh Sleep Quality Index (PSQI) Score | The PSQI is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Scores range from 0 to 21. A score of less than or equal to 5 is associated with good sleep quality. A score greater than 5 is associated with poor sleep quality. The higher the maximum change, the greater increase in sleep disturbances a patient has. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Perceived Stress Scale (PSS) Score | The PSS is a self-reported instrument used to measure the perception of stress. Scores range from 0 to 40. Score of 20 or higher are considered high stress. The higher the maximum change, the greater increase in stress the patient feels. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form Score | The PROMIS Fatigue questionnaire is a self-report tool used to evaluate frequency, duration, and intensity of fatigue over the past seven days. Scores range from 7 to 35. The higher the score, the more fatigue. | Baseline, End of Follow Up (Up to 18 months) |
| Change in an Inventory of Depressive Symptomatology-Self Reported (IDS-SR) Score | The IDS-SR is a self-reported measure in which participants rate the frequency of depression symptoms within the past seven days. Scores range from 0 to 84, with higher score reflecting greater severity of depressive symptoms. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Short Form-36 (SF-36) Health Survey Score | The SF-36 is a self-reported survey of health status. Scores range from 0 to 100. Lower scores indicate disability. The higher the score, the less disability. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Godin Leisure-Time Exercise Questionnaire (GLTEQ) Score | The GLTEQ is a self-reported questionnaire used to measure usual leisure-time exercise habits during a typical seven day period. The GLTEQ specifically inquires about frequency of mild, moderate, and strenuous physical activity done during a typical 7-day period with exercise of more than 15 min or more per day during the previous week. Total score for the Godin leisure-time exercise questionnaire is calculated using this formula.Weekly leisure activity score = (9 × Strenuous) + (5 × Moderate) + (3 × Light). The GLTEQ total score can be broken into three categories: less than 14 points = sedentary 14 - 23 points is = moderately active 24 points or more = active The score ranges from 0 to 119. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Lent Soma Scale Patient Questionnaire Score | The Lent Soma questionnaire is a self-reported measure of pain. Scores range from 0 to 9. The higher the score, the more pain reported.The higher the maximum change, the more increase in breast pain, the patient is perceiving. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Breast Pain Level | Participants will be asked to rate their breast pain level on a study specific scale from 0 to 10 where 0 represents no pain, and 10 represents the most extreme pain. The higher the maximum change, the more increase in breast pain, the patient is perceiving. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Breast Appearance Satisfaction Score | Participants will be asked to rate the look of their breast on a study specific scale from 0 to 10 where 0 represents not happy, and 10 represents very happy. The higher the maximum change, the more increase in happiness with breast appearance the patient is reporting. | Baseline, End of Follow Up (Up to 18 months) |
| Change in Radiated Breast Appearance Score | Participants will be asked to rate how different the look of their radiated breast is compared to their non-radiated breast on a study specific scale from 0 to 10 where 0 represents no difference, and 10 represents completely different. | Baseline, End of Follow Up (Up to 18 months) |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Women with Stage 0-III breast cancer, treated with breast conserving surgery or mastectomy and clear margins, will receive 15 doses of radiation over three weeks. Hypofractionated Simultaneous Integrated Boost Radiotherapy: Participants will receive radiotherapy treatments to the whole breast or chest wall to a dose of 2.66 Gy per day x 15 fractions simultaneously with a boost treatment. The boost treatment will be given on the same days as the whole breast treatment. The lumpectomy cavity + scar (in lumpectomy patients) or chest wall scar (mastectomy patients) will receive 0.54 Gy per day x 15 fractions. |
|
|
| Primary | Number of Participants With 20% or Greater Increase in Arm Lymphedema Compared to Baseline | Number of Participants with 20% or greater increase in arm lymphedema (compared to baseline arm measurements) will be assessed among breast cancer patients receiving regional nodal irradiation. | 30 patients received regional nodal irradiation, and per protocol, this subcohort of patients were assessed for lymphedema and brachial plexopathy. Patients who did not receive regional nodal irradiation did not undergo assessments for brachial plexopathy or lymphedema. | Posted | Count of Participants | Participants | Duration of Study (Up to 18 months) |
|
|
|
| Primary | Number of Participants With Grade 3 Brachial Plexopathy | Number of Participants with Grade 3 Brachial Plexopathy will be assessed among breast cancer patients receiving regional nodal irradiation by RTOG and LENT/SOMA scales Brachial plexopathy range minimum 0 and maximum 4. The higher the score, the worse the outcome | Per protocol, only patients who received regional nodal irradiation were assessed for brachial plexopathy. 30 enrolled patients received regional nodal irradiation and then were assessed for brachial plexopath. | Posted | Count of Participants | Participants | Duration of Study (Up to 18 months) |
|
|
|
| Secondary | Change in Cutaneous Toxicity Rate Assessed by Ultrasound Tissue Characterizations (UTC) | Ultrasound tissue characterization (UTC) is driven by knowledge of the physics of ultrasound and its interactions with biological tissue, and has traditionally used signal modelling and analysis to characterize and differentiate between healthy and diseased tissue. Change in mean UTC at last assessment (up to 18 months post XRT) was compared to baseline (pre-XRT) measures. | One patient did not complete her ultrasound measurements of skin toxicity. | Posted | Mean | Standard Deviation | percentage change in skin thickness | Baseline, end of Follow Up (Up to 18 months) (up to 18 months) |
|
|
|
| Secondary | Change in Tumor Necrosis Factor (TNF) - Alpha Levels | Blood will be analyzed for TNF-alpha (TNF)-alpha levels and correlated to the development of cutaneous toxicity. | Specimens were not processed due to limited funds | Posted | Baseline, Post Intervention (Up to 18 Months) |
|
|
| Secondary | Change in Soluble TNF Receptor 2 (sTNFR2) Levels | Blood will be analyzed for soluble TNF receptor 2 (sTNFR2) levels and correlated to the development of cutaneous toxicity. | Specimens were not processed due to limited funds. | Posted | Baseline, Post Intervention (Up to 18 Months) |
|
|
| Secondary | Change in Interleukin (IL)-6 Levels | Blood will be analyzed for interleukin (IL)-6 levels and correlated to the development of cutaneous toxicity. | Specimens were not processed due to limited funds | Posted | Baseline, Post Intervention (Up to 18 Months) |
|
|
| Secondary | Change in Interleukin 1 Receptor Agonist (IL-1ra) Levels | Blood will be analyzed for IL-1ra levels and correlated to the development of cutaneous toxicity. | Specimens were not processed due to limited funds | Posted | Baseline, Post Intervention (Up to 18 Months) |
|
|
| Secondary | Change in C - Reactive Protein (CRP) Levels | Blood will be analyzed for CRP levels and correlated to the development of cutaneous toxicity. | Specimens were not processed due to limited funds | Posted | Baseline, Post Intervention (Up to 18 Months) |
|
|
| Secondary | Change in Multidimensional Fatigue Inventory (MFI) Score | The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue. Scores range from 20 to 100.The higher the score, the more fatigued. The higher the maximum change, the greater increase in fatigue a patient feels. | Posted | Mean | Standard Deviation | score on a scale | Baseline, end of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Pittsburgh Sleep Quality Index (PSQI) Score | The PSQI is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Scores range from 0 to 21. A score of less than or equal to 5 is associated with good sleep quality. A score greater than 5 is associated with poor sleep quality. The higher the maximum change, the greater increase in sleep disturbances a patient has. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Perceived Stress Scale (PSS) Score | The PSS is a self-reported instrument used to measure the perception of stress. Scores range from 0 to 40. Score of 20 or higher are considered high stress. The higher the maximum change, the greater increase in stress the patient feels. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form Score | The PROMIS Fatigue questionnaire is a self-report tool used to evaluate frequency, duration, and intensity of fatigue over the past seven days. Scores range from 7 to 35. The higher the score, the more fatigue. | Patient were asked to complete this instrument only after an amendment was made to the protocol. Therefore, the last 23 patients enrolled completed this survey due to the fact that it was added to the protocol in after the majority of patients had been enrolled on the study. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in an Inventory of Depressive Symptomatology-Self Reported (IDS-SR) Score | The IDS-SR is a self-reported measure in which participants rate the frequency of depression symptoms within the past seven days. Scores range from 0 to 84, with higher score reflecting greater severity of depressive symptoms. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Short Form-36 (SF-36) Health Survey Score | The SF-36 is a self-reported survey of health status. Scores range from 0 to 100. Lower scores indicate disability. The higher the score, the less disability. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Godin Leisure-Time Exercise Questionnaire (GLTEQ) Score | The GLTEQ is a self-reported questionnaire used to measure usual leisure-time exercise habits during a typical seven day period. The GLTEQ specifically inquires about frequency of mild, moderate, and strenuous physical activity done during a typical 7-day period with exercise of more than 15 min or more per day during the previous week. Total score for the Godin leisure-time exercise questionnaire is calculated using this formula.Weekly leisure activity score = (9 × Strenuous) + (5 × Moderate) + (3 × Light). The GLTEQ total score can be broken into three categories: less than 14 points = sedentary 14 - 23 points is = moderately active 24 points or more = active The score ranges from 0 to 119. | This instrument was added to the protocol in an amendment and therefore the first two patients who were enrolled did not complete this instrument because they participated prior to approval of that amendment. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Lent Soma Scale Patient Questionnaire Score | The Lent Soma questionnaire is a self-reported measure of pain. Scores range from 0 to 9. The higher the score, the more pain reported.The higher the maximum change, the more increase in breast pain, the patient is perceiving. | Per protocol, this questionnaire was administered only to patients who received regional nodal irradiation. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Breast Pain Level | Participants will be asked to rate their breast pain level on a study specific scale from 0 to 10 where 0 represents no pain, and 10 represents the most extreme pain. The higher the maximum change, the more increase in breast pain, the patient is perceiving. | This instrument was added in an amendment to the protocol after a number of patients had already been enrolled. Once approved, patients who were enrolled then completed the instrument at the corresponding timepoints after the amendment was approved. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Breast Appearance Satisfaction Score | Participants will be asked to rate the look of their breast on a study specific scale from 0 to 10 where 0 represents not happy, and 10 represents very happy. The higher the maximum change, the more increase in happiness with breast appearance the patient is reporting. | This questionnaire was added in an amendment after the majority of patients were enrolled on study. Once the amendment was approved by Emory IRB, the questionnaire was administered to the remaining 33 patients. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| Secondary | Change in Radiated Breast Appearance Score | Participants will be asked to rate how different the look of their radiated breast is compared to their non-radiated breast on a study specific scale from 0 to 10 where 0 represents no difference, and 10 represents completely different. | This questionnaire was added as an amendment after the majority of patients had been enrolled and assessed. Once the amendment was Emory IRB approved, the questionnaire was administered to the remaining 31 patients. | Posted | Mean | Standard Deviation | score on a scale | Baseline, End of Follow Up (Up to 18 months) |
|
|
|
| 2 |
| 74 |
| 3 |
| 74 |
| 0 |
| 74 |
Not provided
Not provided
Not provided
| D017437 |
| Skin and Connective Tissue Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |