Skip to main content

Imaging Tumor Angiogenesis

  • Living reference work entry
  • First Online:
Tumor Angiogenesis

Abstract

Angiogenesis, the formation of new blood vessels, is critical for the growth and metastasis of most solid tumors. Several cytokines, cytokine receptors, and cell adhesion molecules have been identified as potential targets for cancer treatment and in general most have been inhibited through the use of monoclonal antibodies or small molecule tyrosine kinase inhibitors.

Drug development relies on the earliest possible discrimination of active and inactive new agents, and imaging has been used to assess the anti-vascular effects of new agents for over 15 years. This has been critical for the development of new agents to the extent that any vascular endothelial growth factor (VEGF) inhibitor that does not impact dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in early drug development can be discarded as not hitting its target.

Much further work has looked at the value of imaging in predicting benefit from anti-angiogenic agents. However, in general, conclusions have not been uniform and it is not clear at present whether imaging can be used to select patients who are most likely to benefit from VEGF pathway inhibitors. However, new imaging biomarkers are in development and are already proving novel data on the architecture and function of tumor neovasculature.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Anderson HL, Yap JT, Miller MP, Robbins A, Jones T, Price PM (2003) Assessment of pharmacodynamic vascular response in a phase I trial of combretastatin A4 phosphate. J Clin Oncol 21:2823–2830

    Article  CAS  PubMed  Google Scholar 

  • Barrett T, Kobayashi H, Brechbiel M, Choyke PL (2006) Macromolecular MRI contrast agents for imaging tumor angiogenesis. Eur J Radiol 60:353–366

    Article  PubMed  Google Scholar 

  • Barrett T, Brechbiel M, Bernardo M, Choyke PL (2007) MRI of tumor angiogenesis. J Magn Reson Imaging 26:235–249

    Article  PubMed  Google Scholar 

  • Batchelor TT, Sorensen AG, di Tomaso E, Zhang WT, Duda DG, Cohen KS et al (2007) AZD2171, a pan-VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients. Cancer Cell 11:83–95

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Batchelor TT, Duda DG, di Tomaso E, Ancukiewicz M, Plotkin SR, Gerstner E et al (2010) Phase II study of cediranib, an oral pan-vascular endothelial growth factor receptor tyrosine kinase inhibitor, in patients with recurrent glioblastoma. J Clin Oncol Off J Am Soc Clin Oncol 28:2817–2823

    Article  CAS  Google Scholar 

  • Benjamin RS, Schöffski P, Hartmann JT, Van Oosterom A, Bui BN, Duyster J et al (2011) Efficacy and safety of motesanib, an oral inhibitor of VEGF, PDGF, and kit receptors, in patients with imatinib-resistant gastrointestinal stromal tumors. Cancer Chemother Pharmacol 68:69–77

    Article  CAS  PubMed  Google Scholar 

  • Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR et al (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25:1753–1759

    Article  PubMed  Google Scholar 

  • Donaldson SB, Buckley DL, O’Connor JP, Davidson SE, Carrington BM, Jones AP et al (2009) Enhancing fraction measured using dynamic contrast-enhanced MRI predicts disease-free survival in patients with carcinoma of the cervix. Br J Cancer 102:23–36

    Article  PubMed  PubMed Central  Google Scholar 

  • Dowlati A, Robertson K, Cooney M, Petros WP, Stratford M, Jesberger J et al (2002) A phase I pharmacokinetic and translational study of the novel vascular targeting agent combretastatin A-4 phosphate on a single-dose intravenous schedule in patients with advanced cancer. Cancer Res 62:3408

    CAS  PubMed  Google Scholar 

  • Drevs J, Siegert P, Medinger M, Mross K, Strecker R, Zirrgiebel U et al (2007) Phase I clinical study of AZD2171, an oral vascular endothelial growth factor signaling inhibitor, in patients with advanced solid tumors. J Clin Oncol Off J Am Soc Clin Oncol 25:3045–3054

    Article  CAS  Google Scholar 

  • Flaherty KT, Rosen MA, Heitjan DF, Gallagher ML, Schwartz B, Schnall MD et al (2008) Pilot study of DCE-MRI to predict progression-free survival with sorafenib therapy in renal cell carcinoma. Cancer Biol Ther 7:496–501

    Article  CAS  PubMed  Google Scholar 

  • Gaykema SBM, Brouwers AH, Lub-de Hooge MN, Pleijhuis RG, Timmer-Bosscha H, Pot L et al (2013) 89Zr-bevacizumab PET imaging in primary breast cancer. J Nucl Med 54:1014–1018

    Article  CAS  PubMed  Google Scholar 

  • Haldorsen IS, Stefansson I, Gruner R, Husby JA, Magnussen IJ, Werner HMJ et al (2014) Increased microvascular proliferation is negatively correlated to tumour blood flow and is associated with unfavourable outcome in endometrial carcinomas. Br J Cancer 110:107–114

    Article  CAS  PubMed  Google Scholar 

  • Hasan J, Byers R, Jayson GC (2002) Intra-tumoural microvessel density in human solid tumours. Br J Cancer 86:1566–1577

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hecht JR, Trarbach T, Hainsworth JD, Major P, Jager E, Wolff RA et al (2011) Randomized, placebo-controlled, phase III study of first-line oxaliplatin-based chemotherapy plus PTK787/ZK 222584, an oral vascular endothelial growth factor receptor inhibitor, in patients with metastatic colorectal adenocarcinoma. J Clin Oncol Off J Am Soc Clin Oncol 29:1997–2003

    Article  CAS  Google Scholar 

  • Herbst RS, Hong D, Chap L, Kurzrock R, Jackson E, Silverman JM et al (2009) Safety, pharmacokinetics, and antitumor activity of AMG 386, a selective angiopoietin inhibitor, in adult patients with advanced solid tumors. J Clin Oncol Off J Am Soc Clin Oncol 27:3557–3565

    Article  CAS  Google Scholar 

  • Hoff PM, Hochhaus A, Pestalozzi BC, Tebbutt NC, Li J, Kim TW et al (2012) Cediranib plus FOLFOX/CAPOX versus placebo plus FOLFOX/CAPOX in patients with previously untreated metastatic colorectal cancer: a randomized, double-blind, phase III study (HORIZON II). J Clin Oncol Off J Am Soc Clin Oncol 30:3596–3603

    Article  CAS  Google Scholar 

  • Horn KP, Yap JT, Agarwal N, Morton KA, Kadrmas DJ, Beardmore B et al (2015) FDG and FLT-PET for early measurement of response to 37.5 mg daily sunitinib therapy in metastatic renal cell carcinoma. Cancer Imaging 15:15

    Article  PubMed  PubMed Central  Google Scholar 

  • Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342

    Article  CAS  PubMed  Google Scholar 

  • Jackson A, O’Connor JP, Parker GJ, Jayson GC (2007) Imaging tumor vascular heterogeneity and angiogenesis using dynamic contrast-enhanced magnetic resonance imaging. Clin Cancer Res Off J Am Assoc Cancer Res 13:3449–3459

    Article  Google Scholar 

  • Jayson GC, Parker GJ, Mullamitha S, Valle JW, Saunders M, Broughton L et al (2005) Blockade of platelet-derived growth factor receptor-beta by CDP860, a humanized, PEGylated di-Fab’, leads to fluid accumulation and is associated with increased tumor vascularized volume. J Clin Oncol Off J Am Soc Clin Oncol 23:973–981

    Article  CAS  Google Scholar 

  • Jayson GC, Kerbel R, Ellis LM, Harris AL (2016) Antiangiogenic therapy in oncology: current status and future directions. Lancet 388:518–529

    Article  CAS  PubMed  Google Scholar 

  • Judson I, Scurr M, Gardner K, Barquin E, Marotti M, Collins B et al (2014) Phase II study of Cediranib in patients with advanced gastrointestinal stromal tumors or soft-tissue sarcoma. Clin Cancer Res 20:3603

    Article  CAS  PubMed  Google Scholar 

  • Leach MO, Brindle KM, Evelhoch JL, Griffiths JR, Horsman MR, Jackson A et al (2005) The assessment of antiangiogenic and antivascular therapies in early-stage clinical trials using magnetic resonance imaging: issues and recommendations. Br J Cancer 92:1599–1610

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Leung DW, Cachianes G, Kuang WJ, Goeddel DV, Ferrara N (1989) Vascular endothelial growth factor is a secreted angiogenic mitogen. Science 246:1306–1309

    Article  CAS  PubMed  Google Scholar 

  • Liu G, Jeraj R, Vanderhoek M, Perlman S, Kolesar J, Harrison M et al (2011) Pharmacodynamic study using FLT PET/CT in patients with renal cell cancer and other solid malignancies treated with Sunitinib malate. Clin Cancer Res 17:7634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Liu JF, Barry WT, Birrer M, Lee J-M, Buckanovich RJ, Fleming GF et al (2014) Combination cediranib and olaparib versus olaparib alone for women with recurrent platinum-sensitive ovarian cancer: a randomised phase 2 study. Lancet Oncol 15:1207–1214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lockhart AC, Rothenberg ML, Dupont J, Cooper W, Chevalier P, Sternas L et al (2010) Phase I study of intravenous vascular endothelial growth factor trap, Aflibercept, in patients with advanced solid tumors. J Clin Oncol 28:207–214

    Article  CAS  PubMed  Google Scholar 

  • Lu J-F, Bruno R, Eppler S, Novotny W, Lum B, Gaudreault J (2008) Clinical pharmacokinetics of bevacizumab in patients with solid tumors. Cancer Chemother Pharmacol 62:779–786

    Article  CAS  PubMed  Google Scholar 

  • Mancuso MR, Davis R, Norberg SM, O’Brien S, Sennino B, Nakahara T et al (2006) Rapid vascular regrowth in tumors after reversal of VEGF inhibition. J Clin Invest 116:2610–2621

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Monk BJ, Poveda A, Vergote I, Raspagliesi F, Fujiwara K, Bae D-S et al (2014) Anti-angiopoietin therapy with trebananib for recurrent ovarian cancer (TRINOVA-1): a randomised, multicentre, double-blind, placebo-controlled phase 3 trial. Lancet Oncol 15:799–808

    Article  CAS  PubMed  Google Scholar 

  • Morgan B, Thomas AL, Drevs J, Hennig J, Buchert M, Jivan A et al (2003) Dynamic contrast-enhanced magnetic resonance imaging as a biomarker for the pharmacological response of PTK787/ZK 222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases, in patients with advanced colorectal cancer and liver metastases: results from two phase I studies. J Clin Oncol Off J Am Soc Clin Oncol 21:3955–3964

    Article  CAS  Google Scholar 

  • Motz GT, Coukos G (2011) The parallel lives of angiogenesis and immunosuppression: cancer and other tales. Nat Rev Immunol 11:702–711

    Article  CAS  PubMed  Google Scholar 

  • Mross K, Frost A, Steinbild S, Hedbom S, BĂĽchert M, Fasol U et al (2012) A phase I dose–escalation study of Regorafenib (BAY 73–4506), an inhibitor of oncogenic, angiogenic, and stromal kinases, in patients with advanced solid tumors. Clin Cancer Res 18:2658

    Article  CAS  PubMed  Google Scholar 

  • Mullamitha SA, Ton NC, Parker GJ, Jackson A, Julyan PJ, Roberts C et al (2007) Phase I evaluation of a fully human anti-alpha v integrin monoclonal antibody (CNTO 95) in patients with advanced solid tumors. Clin Cancer Res Off J Am Assoc Cancer Res 13:2128–2135

    Article  CAS  Google Scholar 

  • Nabors LB, Mikkelsen T, Rosenfeld SS, Hochberg F, Akella NS, Fisher JD et al (2007) Phase I and correlative biology study of cilengitide in patients with recurrent malignant glioma. J Clin Oncol 25:1651–1657

    Article  CAS  PubMed  Google Scholar 

  • Nagengast WB, de Vries EG, Hospers GA, Mulder NH, de Jong JR, Hollema H et al (2007) In vivo VEGF imaging with radiolabeled bevacizumab in a human ovarian tumor xenograft. J Nucl Med 48:1313–1319

    Article  CAS  PubMed  Google Scholar 

  • O’Connor JPB, Aboagye EO, Adams JE, Aerts HJWL, Barrington SF, Beer AJ et al (2016) Imaging biomarker roadmap for cancer studies. Nat Rev Clin Oncol. doi:10.1038/nrclinonc.2016.162

    PubMed Central  Google Scholar 

  • O’Connor JP, Jayson GC (2012) Do imaging biomarkers relate to outcome in patients treated with VEGF inhibitors? Clin Cancer Res Off J Am Assoc Cancer Res 18:6588–6598

    Article  Google Scholar 

  • O’Connor JP, Jayson GC, Jackson A, Ghiorghiu D, Carrington BM, Rose CJ et al (2007) Enhancing fraction predicts clinical outcome following first-line chemotherapy in patients with epithelial ovarian carcinoma. Clin Cancer Res Off J Am Assoc Cancer Res 13:6130–6135

    Article  Google Scholar 

  • O’Connor JP, Carano RA, Clamp AR, Ross J, Ho CC, Jackson A et al (2009) Quantifying antivascular effects of monoclonal antibodies to vascular endothelial growth factor: insights from imaging. Clin Cancer Res Off J Am Assoc Cancer Res 15:6674–6682

    Article  Google Scholar 

  • O’Connor JP, Rose CJ, Jackson A, Watson Y, Cheung S, Maders F et al (2011) DCE-MRI biomarkers of tumour heterogeneity predict CRC liver metastasis shrinkage following bevacizumab and FOLFOX-6. Br J Cancer 105:139–145

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Connor JP, Jackson A, Parker GJ, Roberts C, Jayson GC (2012) Dynamic contrast-enhanced MRI in clinical trials of antivascular therapies. Nat Rev Clin Oncol 9:167–177

    Article  PubMed  Google Scholar 

  • Oosting SF, Brouwers AH, van Es SC, Nagengast WB, Oude Munnink TH, Lub-de Hooge MN et al (2015) 89Zr-bevacizumab PET visualizes heterogeneous tracer accumulation in tumor lesions of renal cell carcinoma patients and differential effects of antiangiogenic treatment. J Nucl Med 56:63–69

    Article  CAS  PubMed  Google Scholar 

  • Padhani AR, Krohn KA, Lewis JS, Alber M (2007) Imaging oxygenation of human tumours. Eur Radiol 17:861–872

    Article  PubMed  Google Scholar 

  • Rose CJ, Mills S, O’Connor JP, Buonaccorsi GA, Roberts C, Watson Y et al (2007) Quantifying heterogeneity in dynamic contrast-enhanced MRI parameter maps. Med Image Comput Comput-Assist Interv MICCAI Int Conf Med Image Comput Comput-Assist Int 10:376–384

    CAS  Google Scholar 

  • Schlemmer H-P, Merkle J, Grobholz R, Jaeger T, Michel MS, Werner A et al (2004) Can pre-operative contrast-enhanced dynamic MR imaging for prostate cancer predict microvessel density in prostatectomy specimens? Eur Radiol 14:309–317

    Article  PubMed  Google Scholar 

  • Schmoll H-J, Cunningham D, Sobrero A, Karapetis CS, Rougier P, Koski SL et al (2012) Cediranib with mFOLFOX6 versus bevacizumab with mFOLFOX6 as first-line treatment for patients with advanced colorectal cancer: a double-blind, randomized phase III study (HORIZON III). J Clin Oncol 30:3588–3595

    Article  CAS  PubMed  Google Scholar 

  • Sharabi AB, Lim M, DeWeese TL, Drake CG (2015) Radiation and checkpoint blockade immunotherapy: radiosensitisation and potential mechanisms of synergy. Lancet Oncol 16:e498–e509

    Article  PubMed  Google Scholar 

  • Sitohy B, Nagy JA, Jaminet SC, Dvorak HF (2011) Tumor-surrogate blood vessel subtypes exhibit differential susceptibility to anti-VEGF therapy. Cancer Res 71:7021–7028

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Spratlin JL, Cohen RB, Eadens M, Gore L, Camidge DR, Diab S et al (2010) Phase I pharmacologic and biologic study of ramucirumab (IMC-1121B), a fully human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor-2. J Clin Oncol 28:780–787

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Strauss LG, Koczan D, Klippel S, Pan L, Cheng C, Willis S et al (2008) Impact of angiogenesis-related Gene expression on the tracer kinetics of 18F-FDG in colorectal tumors. J Nucl Med 49:1238–1244

    Article  CAS  PubMed  Google Scholar 

  • Stupp R, Hegi ME, Gorlia T, Erridge SC, Perry J, Hong Y-K et al (2014) Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma with methylated <em>MGMT</em> promoter (CENTRIC EORTC 26071-22072 study): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 15:1100–1108

    Article  CAS  PubMed  Google Scholar 

  • Su M-Y, Cheung Y-C, Fruehauf JP, Yu H, Nalcioglu O, Mechetner E et al (2003) Correlation of dynamic contrast enhancement MRI parameters with microvessel density and VEGF for assessment of angiogenesis in breast cancer. J Magn Reson Imaging 18:467–477

    Article  PubMed  Google Scholar 

  • Taylor NJ, Baddeley H, Goodchild KA, Powell MEB, Thoumine M, Culver LA et al (2001) BOLD MRI of human tumor oxygenation during carbogen breathing. J Magn Reson Imaging 14:156–163

    Article  CAS  PubMed  Google Scholar 

  • Tofts PS (1997) Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging JMRI 7:91–101

    Article  CAS  PubMed  Google Scholar 

  • Tofts PS, Brix G, Buckley DL, Evelhoch JL, Henderson E, Knopp MV et al (1999) Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging JMRI 10:223–232

    Article  CAS  PubMed  Google Scholar 

  • Ton NC, Parker GJ, Jackson A, Mullamitha S, Buonaccorsi GA, Roberts C et al (2007) Phase I evaluation of CDP791, a PEGylated di-Fab’ conjugate that binds vascular endothelial growth factor receptor 2. Clin Cancer Res: Off J Am Assoc Cancer Res 13:7113–7118

    Article  CAS  Google Scholar 

  • Van Cutsem E, Bajetta E, Valle J, Kohne CH, Hecht JR, Moore M et al (2011) Randomized, placebo-controlled, phase III study of oxaliplatin, fluorouracil, and leucovorin with or without PTK787/ZK 222584 in patients with previously treated metastatic colorectal adenocarcinoma. J Clin Oncol Off J Am Soc Clin Oncol 29:2004–2010

    Article  Google Scholar 

  • Wallin JJ, Bendell JC, Funke R, Sznol M, Korski K, Jones S et al (2016) Atezolizumab in combination with bevacizumab enhances antigen-specific T-cell migration in metastatic renal cell carcinoma. Nat Commun 7:12624

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wedam SB, Low JA, Yang SX, Chow CK, Choyke P, Danforth D et al (2006) Antiangiogenic and antitumor effects of bevacizumab in patients with inflammatory and locally advanced breast cancer. J Clin Oncol Off J Am Soc Clin Oncol 24:769–777

    Article  CAS  Google Scholar 

  • Wiestler B, Kluge A, Lukas M, Gempt J, Ringel F, Schlegel J et al (2016) Multiparametric MRI-based differentiation of WHO grade II/III glioma and WHO grade IV glioblastoma. Sci Rep 6:35142

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Willett CG, Boucher Y, di Tomaso E, Duda DG, Munn LL, Tong RT et al (2004) Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nat Med 10:145–147

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Winkler F, Kozin SV, Tong RT, Chae S-S, Booth MF, Garkavtsev I et al (2004) Kinetics of vascular normalization by VEGFR2 blockade governs brain tumor response to radiation: role of oxygenation, angiopoietin-1, and matrix metalloproteinases. Cancer Cell 6:553–563

    CAS  PubMed  Google Scholar 

  • Workman P, Aboagye EO, Chung YL, Griffiths JR, Hart R, Leach MO et al (2006) Minimally invasive pharmacokinetic and pharmacodynamic technologies in hypothesis-testing clinical trials of innovative therapies. J Natl Cancer Inst 98:580–598

    Article  CAS  PubMed  Google Scholar 

  • Yang W, Zhang Y, Fu Z, Sun X, Mu D, Yu J (2012) Imaging proliferation of 18F-FLT PET/CT correlated with the expression of microvessel density of tumour tissue in non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 39:1289–1296

    Article  CAS  PubMed  Google Scholar 

  • Yap TA, Arkenau H-T, Camidge DR, George S, Serkova NJ, Gwyther SJ et al (2013) First-in-human phase I trial of two schedules of OSI-930, a novel multikinase inhibitor. Incorporating translational proof-of-mechanism studies. Clin Cancer Res 19:909

    Article  CAS  PubMed  Google Scholar 

  • Yau T, Chen P-J, Chan P, Curtis CM, Murphy PS, Suttle AB et al (2011) Phase I dose-finding study of Pazopanib in Hepatocellular carcinoma: evaluation of early efficacy, pharmacokinetics, and pharmacodynamics. Clin Cancer Res 17:6914–6923

    Article  CAS  PubMed  Google Scholar 

  • Zhang Y, Hong H, Cai W (2011) PET tracers based on zirconium-89. Curr Radiopharm 4:131–139

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhang Y, Kapur P, Yuan Q, Xi Y, Carvo I, Signoretti S et al (2016) Tumor vascularity in renal masses: correlation of arterial spin-labeled and dynamic contrast-enhanced magnetic resonance imaging assessments. Clin Genitourin Cancer 14:e25–e36

    Article  PubMed  Google Scholar 

  • Zhu AX, Sahani DV, Duda DG, di Tomaso E, Ancukiewicz M, Catalano OA et al (2009) Efficacy, safety, and potential biomarkers of Sunitinib monotherapy in advanced Hepatocellular carcinoma: a phase II study. J Clin Oncol 27:3027–3035

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gordon Jayson .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Jayson, G., O’Connor, J. (2017). Imaging Tumor Angiogenesis. In: Marmé, D. (eds) Tumor Angiogenesis. Springer, Cham. https://doi.org/10.1007/978-3-319-31215-6_7-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31215-6_7-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31215-6

  • Online ISBN: 978-3-319-31215-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics