{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T16:28:40Z","timestamp":1781886520572,"version":"3.54.5"},"reference-count":29,"publisher":"Akademiai Kiado Zrt.","issue":"4","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["PhysInt"],"published-print":{"date-parts":[[2025,1,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Smoking and alcohol consumption remain the two most important risk factors for the development of oropharyngeal tumours, but there is an increasing number of younger patients (age &lt;50 years) with human papillomavirus (HPV) association origin, also known as positivity. The role of radiotherapy (RT) in the treatment of this disease is paramount.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To describe the radiotherapy results for oropharyngeal tumours and to search for prognostic parameters that influence the response of these malignant lesions to radio-chemotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>95 patients underwent definitive radio- or radio-chemotherapy (RCT) for histologically squamous cell, oropharyngeal carcinoma at our Institute between 1\u00a0January 2019 and 31 December 2020, of which 51 (54%) received the latter. The mean age was 61.9 years (37\u201382 years) and the male-female ratio was 69:26. The average total dose was 69\u2009Gy (range: 54\u201370\u2009Gy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 5-year local control (LC), cancer-specific survival (CCS), and overall survival (OS) calculated by the Kaplan-Meier method were 71, 69, and 58%, respectively. Forty-four cases (46%) were confirmed to\u00a0have HPV involvement. HPV positive (+) tumours showed significantly better behaviour compared to HPV negative (\u2212) cases in LC, CCS and OS. Smoking had a significant negative effect on cure rates: LC, CCS and OS were better in non-smokers. A significant negative effect of smoking on survival was also\u00a0observed in HPV-associated cases. For HPV- lesions, RCT had a stronger effect on LC than RT alone\u00a0(64 vs\u00a043%, <jats:italic>P<\/jats:italic> = 0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HPV-associated malignancies show better survival outcomes to\u00a0radio\u2009\u00b1\u2009chemotherapy than their HPV- counterparts. In all cases, smoking worsens the response to treatment. For HPV- tumours, chemotherapy with radiation, compared to irradiation alone, has a more significant effect on survival outcomes, whereas for HPV+ tumours this effect is less pronounced.<\/jats:p><\/jats:sec>","DOI":"10.1556\/2060.2024.00439","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T17:20:06Z","timestamp":1732728006000},"page":"312-320","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of results of radiotherapy for oropharyngeal cancer"],"prefix":"10.1556","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7158-7919","authenticated-orcid":true,"given":"P\u00e9ter","family":"Trauttwein","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Semmelweis University, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"Major","sequence":"additional","affiliation":[{"name":"Centre of Radiotherapy, National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary"},{"name":"Department of Oncology, Semmelweis University, Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Tak\u00e1csi-Nagy","sequence":"additional","affiliation":[{"name":"Centre of Radiotherapy, National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary"},{"name":"Department of Oncology, Semmelweis University, Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"9","key":"B1","series-title":"Cancer Epidemiol Biomarkers Prev","first-page":"1849","article-title":"Oral cancer prevalence, mortality, and costs in medicaid and commercial insurance claims data","volume":"31","author":"Tranby EP","year":"2022","unstructured":"Tranby EP, Heaton LJ, Tomar SL, Kelly AL, Fager GL, Backley M, et\u00a0al. Oral cancer prevalence, mortality, and costs in medicaid and commercial insurance claims data. Cancer Epidemiol Biomarkers Prev 2022; 31(9): 1849\u201357. https:\/\/doi.org\/10.1158\/1055-9965.EPI-22-0114."},{"issue":"5","key":"B2","series-title":"Nat Rev Clin Oncol","first-page":"306","article-title":"HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management","volume":"19","author":"Lechner M","year":"2022","unstructured":"Lechner M, Liu J, Masterson L, Fenton TR. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol 2022; 19(5): 306\u201327. https:\/\/doi.org\/10.1038\/s41571-022-00603-7."},{"issue":"8","key":"B3","series-title":"Lancet Oncol","first-page":"781","article-title":"HPV-associated head and neck cancer: a virus-related cancer epidemic","volume":"11","author":"Marur S","year":"2010","unstructured":"Marur S, D'Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol 2010; 11(8): 781\u20139. https:\/\/doi.org\/10.1016\/S1470-2045(10)70017-6."},{"issue":"11","key":"B4","series-title":"Anticancer Res","first-page":"6297","article-title":"Effect of radiation on cell proliferation and tumor hypoxia in HPV-positive head and neck cancer in vivo models","volume":"34","author":"S\u00f8rensen BS","year":"2014","unstructured":"S\u00f8rensen BS, Busk M, Horsman MR, Alsner J, Overgaard J, Kyle AH, et\u00a0al. Effect of radiation on cell proliferation and tumor hypoxia in HPV-positive head and neck cancer in vivo models. Anticancer Res 2014; 34(11): 6297\u2013304."},{"key":"B5","series-title":"PeerJ","article-title":"The relation between human papillomavirus (HPV) and oropharyngeal cancer: a review","volume":"11","author":"Ferreira CC","year":"2023","unstructured":"Ferreira CC. The relation between human papillomavirus (HPV) and oropharyngeal cancer: a review. PeerJ 2023; 11: e15568. https:\/\/doi.org\/10.7717\/peerj.15568."},{"issue":"2","key":"B6","series-title":"Cancer Lett","first-page":"71","article-title":"Impact of HPV status on treatment of squamous cell cancer of the oropharynx: what we know and what we need to know","volume":"304","author":"Tribius S","year":"2011","unstructured":"Tribius S, Ihloff AS, Rieckmann T, Petersen C, Hoffmann M. Impact of HPV status on treatment of squamous cell cancer of the oropharynx: what we know and what we need to know. Cancer Lett 2011; 304(2): 71\u20139. https:\/\/doi.org\/10.1016\/j.canlet.2011.02.002."},{"issue":"282","key":"B7","series-title":"J Am Stat Assoc","first-page":"457","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan EL","year":"1958","unstructured":"Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53(282): 457\u201381. https:\/\/doi.org\/10.1080\/01621459.1958.10501452."},{"issue":"2","key":"B8","series-title":"J R Stat Soc Ser B Stat Methodol","first-page":"187","article-title":"Regression models and life-tables","volume":"34","author":"Cox DR","year":"1972","unstructured":"Cox DR. Regression models and life-tables. J R Stat Soc Ser B Stat Methodol 1972; 34(2): 187\u2013202. https:\/\/doi.org\/10.1111\/j.2517-6161.1972.tb00899.x."},{"issue":"3","key":"B9","series-title":"Otolaryngol Head Neck Surg","first-page":"375","article-title":"The \u201cnew\u201d head and neck cancer patient-young, nonsmoker, nondrinker, and HPV positive: evaluation","volume":"151","author":"Deschler DG","year":"2014","unstructured":"Deschler DG, Richmon JD, Khariwala SS, Ferris RL, Wang MB. The \u201cnew\u201d head and neck cancer patient-young, nonsmoker, nondrinker, and HPV positive: evaluation. Otolaryngol Head Neck Surg 2014; 151(3): 375\u201380. https:\/\/doi.org\/10.1177\/0194599814538605."},{"issue":"1","key":"B10","series-title":"N Engl J Med","first-page":"24","article-title":"Human papillomavirus and survival of patients with oropharyngeal cancer","volume":"363","author":"Ang KK","year":"2010","unstructured":"Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, et\u00a0al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010; 363(1): 24\u201335. https:\/\/doi.org\/10.1056\/NEJMoa0912217."},{"issue":"5","key":"B11","series-title":"Ann Oncol","first-page":"1071","article-title":"Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial","volume":"22","author":"Posner MR","year":"2011","unstructured":"Posner MR, Lorch JH, Goloubeva O, Tan M, Schumaker LM, Sarlis NJ, et\u00a0al. Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial. Ann Oncol 2011; 22(5): 1071\u20137. https:\/\/doi.org\/10.1093\/annonc\/mdr006."},{"issue":"34","key":"B12","series-title":"J\u00a0Clin Oncol","first-page":"3858","article-title":"Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity","volume":"32","author":"Nguyen-Tan PF","year":"2014","unstructured":"Nguyen-Tan PF, Zhang Q, Ang KK, Weber RS, Rosenthal DI, Soulieres D, et\u00a0al. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity. J\u00a0Clin Oncol 2014; 32(34): 3858\u201366. https:\/\/doi.org\/10.1200\/JCO.2014.55.3925."},{"issue":"12","key":"B13","series-title":"Head Neck","first-page":"1780","article-title":"Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma","volume":"38","author":"Liskamp CP","year":"2016","unstructured":"Liskamp CP, Janssens GO, Bussink J, Melchers WJ, Kaanders JH, Verhoef CG. Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma. Head Neck 2016; 38(12): 1780\u20137. https:\/\/doi.org\/10.1002\/hed.24516."},{"issue":"5","key":"B14","series-title":"Head Neck","first-page":"1255","article-title":"Treatment de-escalation for HPV+ oropharyngeal cancer: a systematic review and meta-analysis","volume":"44","author":"Petrelli F","year":"2022","unstructured":"Petrelli F, Luciani A, Ghidini A, Cherri S, Gamba P, Maddalo M, et\u00a0al. Treatment de-escalation for HPV+ oropharyngeal cancer: a systematic review and meta-analysis. Head Neck 2022; 44(5): 1255\u201366. https:\/\/doi.org\/10.1002\/hed.27019."},{"issue":"5","key":"B15","series-title":"Head Neck","first-page":"747","article-title":"Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer--systematic review and meta-analysis of trends by time and region","volume":"35","author":"Mehanna H","year":"2013","unstructured":"Mehanna H, Beech T, Nicholson T, El-Hariry I, McConkey C, Paleri V, et\u00a0al. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer--systematic review and meta-analysis of trends by time and region. Head Neck 2013; 35(5): 747\u201355. https:\/\/doi.org\/10.1002\/hed.22015."},{"issue":"22","key":"B16","series-title":"J Clin Oncol","first-page":"1909","article-title":"Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiotherapy in human papillomavirus-associated oropharynx squamous cell carcinoma","volume":"37","author":"Ma DJ","year":"2019","unstructured":"Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, et\u00a0al. Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiotherapy in human papillomavirus-associated oropharynx squamous cell carcinoma. J Clin Oncol 2019; 37(22): 1909\u201318. https:\/\/doi.org\/10.1200\/JCO.19.00463. Erratum in: J Clin Oncol. 2020; 38(10): 1118. https:\/\/doi.org\/10.1200\/JCO.20.00242."},{"issue":"15","key":"B17","series-title":"J Clin Oncol","first-page":"TPS6592","article-title":"CCTG HN.10: a phase II single-arm trial of elective volume adjusted de-escalation radiotherapy (EVADER) in patients with low-risk HPV-related oropharyngeal squamous cell carcinoma (NCT03822897)","volume":"38","author":"Bratman SV","year":"2020","unstructured":"Bratman SV, Berthelet E, Butler JB, de Almeida JR, Karam I, Metser U, et\u00a0al. CCTG HN.10: a phase II single-arm trial of elective volume adjusted de-escalation radiotherapy (EVADER) in patients with low-risk HPV-related oropharyngeal squamous cell carcinoma (NCT03822897). J Clin Oncol 2020; 38(15): TPS6592\u2013TPS. https:\/\/doi.org\/10.1200\/jco.2020.38.15_suppl.tps6592."},{"issue":"6","key":"B18","series-title":"Lancet Oncol","first-page":"803","article-title":"Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study","volume":"18","author":"Chen AM","year":"2017","unstructured":"Chen AM, Felix C, Wang PC, Hsu S, Basehart V, Garst J, et\u00a0al. Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study. Lancet Oncol 2017; 18(6): 803\u201311. https:\/\/doi.org\/10.1016\/S1470-2045(17)30246-2."},{"issue":"5","key":"B19","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1425","article-title":"Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?","volume":"60","author":"Eisbruch A","year":"2004","unstructured":"Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, et\u00a0al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 2004; 60(5): 1425\u201339. https:\/\/doi.org\/10.1016\/j.ijrobp.2004.05.050."},{"issue":"9","key":"B20","series-title":"J Clin Oncol","first-page":"956","article-title":"Reduced-dose radiation therapy for HPV-associated oropharyngeal carcinoma (NRG Oncology HN002)","volume":"39","author":"Yom SS","year":"2021","unstructured":"Yom SS, Torres-Saavedra P, Caudell JJ, Waldron JN, Gillison ML, Xia P, et\u00a0al. Reduced-dose radiation therapy for HPV-associated oropharyngeal carcinoma (NRG Oncology HN002). J Clin Oncol 2021; 39(9): 956\u201365. https:\/\/doi.org\/10.1200\/JCO.20.03128."},{"issue":"4","key":"B21","series-title":"Int J Radiat Oncol Biol Phys","first-page":"876","article-title":"Randomized trial of radiation therapy with weekly cisplatin or cetuximab in low-risk HPV-associated oropharyngeal cancer (TROG 12.01) \u2013 a trans-tasman radiation oncology group study","volume":"111","author":"Rischin D","year":"2021","unstructured":"Rischin D, King M, Kenny L, Porceddu S, Wratten C, Macann A, et\u00a0al. Randomized trial of radiation therapy with weekly cisplatin or cetuximab in low-risk HPV-associated oropharyngeal cancer (TROG 12.01) \u2013 a trans-tasman radiation oncology group study. Int J Radiat Oncol Biol Phys 2021; 111(4): 876\u201386. https:\/\/doi.org\/10.1016\/j.ijrobp.2021.04.015."},{"issue":"10166","key":"B22","series-title":"Lancet","first-page":"51","article-title":"Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial","volume":"393","author":"Mehanna H","year":"2019","unstructured":"Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, et\u00a0al. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet 2019; 393(10166): 51\u201360. https:\/\/doi.org\/10.1016\/S0140-6736(18)32752-1."},{"issue":"10166","key":"B23","series-title":"Lancet","first-page":"40","article-title":"Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial","volume":"393","author":"Gillison ML","year":"2019","unstructured":"Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, et\u00a0al. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet 2019; 393(10166): 40\u201350. https:\/\/doi.org\/10.1016\/S0140-6736(18)32779-X. Erratum in: Lancet. 2020; 395(10226): 784. https:\/\/doi.org\/10.1016\/S0140-6736(20)30454-2."},{"issue":"8","key":"B24","series-title":"Ear Nose Throat J","first-page":"E14","article-title":"Transoral robotic surgery and oropharyngeal cancer: a literature review","volume":"93","author":"O'Leary P","year":"2014","unstructured":"O'Leary P, Kjaergaard T. Transoral robotic surgery and oropharyngeal cancer: a literature review. Ear Nose Throat J 2014; 93(8): E14\u201321. https:\/\/doi.org\/10.1177\/014556131409300821."},{"issue":"4","key":"B25","series-title":"Acta Otorhinolaryngol Ital","first-page":"334","article-title":"Upfront transoral robotic surgery (TORS) versus intensity-modulated radiation therapy (IMRT) in HPV-positive oropharyngeal cancer: real-world data from a tertiary comprehensive cancer centre","volume":"42","author":"Zorzi SF","year":"2022","unstructured":"Zorzi SF, Agostini G, Chu F, Tagliabue M, Pietrobon G, Corrao G, et\u00a0al. Upfront transoral robotic surgery (TORS) versus intensity-modulated radiation therapy (IMRT) in HPV-positive oropharyngeal cancer: real-world data from a tertiary comprehensive cancer centre. Acta Otorhinolaryngol Ital 2022; 42(4): 334\u201347. https:\/\/doi.org\/10.14639\/0392-100X-N2144."},{"issue":"1","key":"B26","series-title":"J Clin Oncol","first-page":"69","article-title":"Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma","volume":"22","author":"Denis F","year":"2004","unstructured":"Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, et\u00a0al. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 2004; 22(1): 69\u201376. https:\/\/doi.org\/10.1200\/JCO.2004.08.021."},{"issue":"3","key":"B27","series-title":"Int J Radiat Oncol Biol Phys","first-page":"860","article-title":"Radiosensitization of oropharyngeal squamous cell carcinoma cells by human papillomavirus 16 oncoprotein E6 *I","volume":"79","author":"Pang E","year":"2011","unstructured":"Pang E, Delic NC, Hong A, Zhang M, Rose BR, Lyons JG. Radiosensitization of oropharyngeal squamous cell carcinoma cells by human papillomavirus 16 oncoprotein E6 *I. Int J Radiat Oncol Biol Phys 2011; 79(3): 860\u20135. https:\/\/doi.org\/10.1016\/j.ijrobp.2010.06.028."},{"issue":"11","key":"B28","series-title":"Head Neck","first-page":"1652","article-title":"Definitive radiation therapy without chemotherapy for human papillomavirus-positive head and neck cancer","volume":"35","author":"Chen AM","year":"2013","unstructured":"Chen AM, Zahra T, Daly ME, Farwell DG, Luu Q, Gandour-Edwards R, et\u00a0al. Definitive radiation therapy without chemotherapy for human papillomavirus-positive head and neck cancer. Head Neck 2013; 35(11): 1652\u20136. https:\/\/doi.org\/10.1002\/hed.23209."},{"issue":"6","key":"B29","series-title":"Int J Clin Oncol","first-page":"640","article-title":"Radiotherapy alone as a possible de-intensified treatment for human papillomavirus-related locally advanced oropharyngeal squamous cell carcinoma","volume":"24","author":"Yamamoto Y","year":"2019","unstructured":"Yamamoto Y, Takemoto N, Michiba T, Seo Y, Isohashi F, Otani K, et\u00a0al. Radiotherapy alone as a possible de-intensified treatment for human papillomavirus-related locally advanced oropharyngeal squamous cell carcinoma. Int J Clin Oncol 2019; 24(6): 640\u20138. https:\/\/doi.org\/10.1007\/s10147-019-01394-1."}],"container-title":["Physiology International"],"original-title":[],"link":[{"URL":"https:\/\/akjournals.com\/view\/journals\/2060\/111\/4\/article-p312.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/2060\/111\/4\/article-p312.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/2060\/111\/4\/article-p312.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T15:13:18Z","timestamp":1738249998000},"score":1,"resource":{"primary":{"URL":"https:\/\/akjournals.com\/view\/journals\/2060\/111\/4\/article-p312.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,30]]},"references-count":29,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.1556\/2060.2024.00439","relation":{},"ISSN":["2498-602X","2677-0164"],"issn-type":[{"value":"2498-602X","type":"print"},{"value":"2677-0164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,30]]}}}