World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 15, Number 4, August 2024, pages 598-611

Association of Definitive Radiotherapy for Esophageal Cancer and the Incidence of Secondary Head and Neck Cancers: A SEER Population-Based Study

Figure 1. Flow diagram depicting the study population obtained from SEER database. PSM: propensity score matching; RT: radiotherapy; NRT: no radiation therapy.

Figure 2. Comparisons of cumulative incidence related to SHNC between the patients who received RT and patients who did not receive RT. EC: esophageal cancer; SHNC: secondary head and neck cancer; RT: radiotherapy; NRT: no radiation therapy.

Figure 3. Comparisons of cumulative incidence rates of SHNCs of different pathological origins between patients who received RT and those who did not. (a) Cumulative incidences of SHNC originated from ESCC. (b) Cumulative incidences of SHNC originated from EAC. (c) Cumulative incidences of secondary HNSCC originated from ESCC. EAC: esophageal adenocarcinoma; EC: esophageal cancer; ESCC: esophageal squamous cell cancer; HNSCC: head and neck squamous cell cancer; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

Figure 4. Subgroup analyses of competing risk regression for the risk of developing SHNC. CI: confidence interval; EC: esophageal cancer; HR: hazard ratio; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

Figure 5. Dynamic standardized incidence ratio of SHNC. (a) Year of EC diagnosis. (b) Age at EC diagnosis (years). (c) Latency after EC diagnosis (months). EC: esophageal cancer; NRT: no radiation therapy; RT: radiotherapy.

Figure 6. Comparison of overall survival between EC patients who developed SHNC after RT and NRT. EC: esophageal cancer; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

Figure 7. Comparison of overall survival between EC patients who developed SHNC and matched only primary HNC. (a) SHNC after RT and matched only primary HNC. (b) SHNC after NRT and matched only primary HNC. EC: esophageal cancer; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

**Table 1.** Baseline Characteristics of Patients With EC Depending on RT or NRT and Their Comparison
Characteristics	NRT (N = 4,919)	RT (N = 9,239)	P-value
EC: esophageal cancer; IQR: interquartile range; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.
Race			< 0.001
Black	432 (8.8%)	1,184 (12.8%)
White	4,239 (86.2%)	7,513 (81.3%)
Other	248 (5.0%)	542 (5.9%)
Sex			< 0.001
Female	1,040 (21.1%)	2,231 (24.1%)
Male	3,879 (78.9%)	7,008 (75.9%)
Age of EC diagnosis			0.002
20 - 49	462 (9.4%)	756 (8.2%)
50 - 74	3,454 (70.2%)	6,741 (73.0%)
≥ 75	1,003 (20.4%)	1,742 (18.9%)
Year of EC diagnosis			0.004
1975 - 1984	551 (11.2%)	1,037 (11.2%)
1985 - 1994	960 (19.5%)	1,580 (17.1%)
1995 - 2004	1,271 (25.8%)	2,433 (26.3%)
≥ 2005	2,137 (43.4%)	4,189 (45.3%)
Tumor stage of EC			< 0.001
Distant	722 (14.7%)	1,513 (16.4%)
Localized	2,150 (43.7%)	2,416 (26.2%)
Regional	1,053 (21.4%)	3,603 (39.0%)
Unknown	994 (20.2%)	1,707 (18.5%)
Tumor histology of EC			< 0.001
Adenocarcinoma	2,963 (60.2%)	4,227 (45.8%)
Squamous carcinoma	1,347 (27.4%)	4,263 (46.1%)
Others	609 (12.4%)	749 (8.1%)
Tumor grade of EC			< 0.001
Grade I/II	1,956 (39.8%)	3,631 (39.3%)
Grade III/IV	1,545 (31.4%)	3,702 (40.1%)
Unknown	1,418 (28.8%)	1,906 (20.6%)
Tumor primary site of EC			< 0.001
Upper esophagus	188 (3.8%)	981 (10.6%)
Middle esophagus	700 (14.2%)	1,911 (20.7%)
Lower esophagus	3,187 (64.8%)	5,119 (55.4%)
NOS	723 (14.7%)	827 (9.0%)
Overlapping	121 (2.5%)	401 (4.3%)
Tumor size of EC			< 0.001
< 2 cm	360 (7.3%)	214 (2.3%)
≥ 2 cm	771 (15.7%)	2,430 (26.3%)
Unknown	3,788 (77.0%)	6,595 (71.4%)
Chemotherapy of EC			< 0.001
No/unknown	3,763 (76.5%)	1,666 (18.0%)
Yes	1,156 (23.5%)	7,573 (82.0%)
Surgery of EC			< 0.001
No surgery	1,824 (37.1%)	5,542 (60.0%)
Surgery performed	3,095 (62.9%)	3,697 (40.0%)
Patients who developed SHNC	36 (0.7%)	110 (1.2%)	0.011
Median age of EC diagnosis (IQR), years	65 (57.0 - 73.0)	65 (57.0 - 72.0)	0.397
Median year of EC diagnosis (IQR)	2,002 (1,992.0 - 2,010.0)	2,003 (1,993.0 - 2,011.0)	0.006
Median latency between esophagus cancer and SHNC (IQR), months	93.5 (41.5 - 156.0)	45.5 (25.3 - 84.3)	< 0.001
Median follow-up time of patients with EC (IQR), months	36 (19.0 - 91.5)	27 (17.0 - 56.0)	< 0.001

Table 1. Baseline Characteristics of Patients With EC Depending on RT or NRT and Their Comparison

Characteristics

NRT (N = 4,919)

RT (N = 9,239)

P-value

EC: esophageal cancer; IQR: interquartile range; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

Race

< 0.001

Black

432 (8.8%)

1,184 (12.8%)

White

4,239 (86.2%)

7,513 (81.3%)

Other

248 (5.0%)

542 (5.9%)

Sex

< 0.001

Female

1,040 (21.1%)

2,231 (24.1%)

Male

3,879 (78.9%)

7,008 (75.9%)

Age of EC diagnosis

0.002

20 - 49

462 (9.4%)

756 (8.2%)

50 - 74

3,454 (70.2%)

6,741 (73.0%)

≥ 75

1,003 (20.4%)

1,742 (18.9%)

Year of EC diagnosis

0.004

1975 - 1984

551 (11.2%)

1,037 (11.2%)

1985 - 1994

960 (19.5%)

1,580 (17.1%)

1995 - 2004

1,271 (25.8%)

2,433 (26.3%)

≥ 2005

2,137 (43.4%)

4,189 (45.3%)

Tumor stage of EC

< 0.001

Distant

722 (14.7%)

1,513 (16.4%)

Localized

2,150 (43.7%)

2,416 (26.2%)

Regional

1,053 (21.4%)

3,603 (39.0%)

Unknown

994 (20.2%)

1,707 (18.5%)

Tumor histology of EC

< 0.001

Adenocarcinoma

2,963 (60.2%)

4,227 (45.8%)

Squamous carcinoma

1,347 (27.4%)

4,263 (46.1%)

Others

609 (12.4%)

749 (8.1%)

Tumor grade of EC

< 0.001

Grade I/II

1,956 (39.8%)

3,631 (39.3%)

Grade III/IV

1,545 (31.4%)

3,702 (40.1%)

Unknown

1,418 (28.8%)

1,906 (20.6%)

Tumor primary site of EC

< 0.001

Upper esophagus

188 (3.8%)

981 (10.6%)

Middle esophagus

700 (14.2%)

1,911 (20.7%)

Lower esophagus

3,187 (64.8%)

5,119 (55.4%)

NOS

723 (14.7%)

827 (9.0%)

Overlapping

121 (2.5%)

401 (4.3%)

Tumor size of EC

< 0.001

< 2 cm

360 (7.3%)

214 (2.3%)

≥ 2 cm

771 (15.7%)

2,430 (26.3%)

Unknown

3,788 (77.0%)

6,595 (71.4%)

Chemotherapy of EC

< 0.001

No/unknown

3,763 (76.5%)

1,666 (18.0%)

Yes

1,156 (23.5%)

7,573 (82.0%)

Surgery of EC

< 0.001

No surgery

1,824 (37.1%)

5,542 (60.0%)

Surgery performed

3,095 (62.9%)

3,697 (40.0%)

Patients who developed SHNC

36 (0.7%)

110 (1.2%)

0.011

Median age of EC diagnosis (IQR), years

65 (57.0 - 73.0)

65 (57.0 - 72.0)

0.397

Median year of EC diagnosis (IQR)

2,002 (1,992.0 - 2,010.0)

2,003 (1,993.0 - 2,011.0)

0.006

Median latency between esophagus cancer and SHNC (IQR), months

93.5 (41.5 - 156.0)

45.5 (25.3 - 84.3)

< 0.001

Median follow-up time of patients with EC (IQR), months

36 (19.0 - 91.5)

27 (17.0 - 56.0)

< 0.001

**Table 2.** Baseline Characteristics of EC Patients Who Experienced SHNC Categorized by Therapeutic Modalities Including RT and NRT
Characteristics	NRT (N = 36)	RT (N = 110)	P-value
EC: esophageal cancer; IQR: interquartile range; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.
Race			0.576
Black	8 (22.2%)	34 (30.9%)
White	26 (72.2%)	68 (61.8%)
Other	2 (5.6%)	8 (7.3%)
Year of EC diagnosis			0.052
1975 - 1984	12 (33.3%)	16 (14.5%)
1985 - 1994	8 (22.2%)	32 (29.1%)
1995 - 2004	12 (33.3%)	34 (30.9%)
≥ 2005	4 (11.1%)	28 (25.5%)
Age of EC diagnosis			0.929
20 - 49	5 (13.9%)	13 (11.8%)
50 - 74	29 (80.6%)	90 (81.8%)
≥ 75	2 (5.6%)	7 (6.4%)
Sex			0.226
Female	9 (25.0%)	41 (37.3%)
Male	27 (75.0%)	69 (62.7%)
Tumor stage of EC			0.148
Distant	2 (5.6%)	8 (7.3%)
Localized	21 (58.3%)	42 (38.2%)
Regional	7 (19.4%)	41 (37.3%)
Unknown	6 (16.7%)	19 (17.3%)
Tumor histology of EC			0.094
Adenocarcinoma	6 (16.7%)	7 (6.4%)
Squamous carcinoma	27 (75.0%)	98 (89.1%)
Others	3 (8.3%)	5 (4.5%)
Tumor grade of EC			0.630
Grade I/II	21 (58.3%)	53 (48.2%)
Grade III/IV	7 (19.4%)	27 (24.5%)
Unknown	8 (22.2%)	30 (27.3%)
Tumor primary site of EC			0.002
Upper esophagus	1 (2.8%)	34 (30.9%)
Middle esophagus	9 (25.0%)	25 (22.7%)
Lower esophagus	19 (52.8%)	31 (28.2%)
NOS	6 (16.7%)	15 (13.6%)
Overlapping	1 (2.8%)	5 (4.5%)
Tumor size of EC			0.461
< 2 cm	0 (0%)	1 (0.9%)
≥ 2 cm	3 (8.3%)	18 (16.4%)
Unknown	33 (91.7%)	91 (82.7%)
Chemotherapy of EC			< 0.001
No/unknown	31 (86.1%)	18 (16.4%)
Yes	5 (13.9%)	92 (83.6%)
Surgery of EC			< 0.001
No surgery	9 (25.0%)	75 (68.2%)
Surgery performed	27 (75.0%)	35 (31.8%)
Median age of EC diagnosis (IQR), years	59 (56.0 - 65.3)	59 (54.0 - 66.0)	0.969
Median year of EC diagnosis (IQR)	1,991 (1,983.8 - 2,000.5)	1,996 (1,989.0 - 2,004.8)	0.063
Median follow-up time of patients with EC (IQR), months	151 (73.5 - 203.0)	82 (42.5 - 117.8)	< 0.001

Table 2. Baseline Characteristics of EC Patients Who Experienced SHNC Categorized by Therapeutic Modalities Including RT and NRT

Characteristics

NRT (N = 36)

RT (N = 110)

P-value

EC: esophageal cancer; IQR: interquartile range; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

Race

0.576

Black

8 (22.2%)

34 (30.9%)

White

26 (72.2%)

68 (61.8%)

Other

2 (5.6%)

8 (7.3%)

Year of EC diagnosis

0.052

1975 - 1984

12 (33.3%)

16 (14.5%)

1985 - 1994

8 (22.2%)

32 (29.1%)

1995 - 2004

12 (33.3%)

34 (30.9%)

≥ 2005

4 (11.1%)

28 (25.5%)

Age of EC diagnosis

0.929

20 - 49

5 (13.9%)

13 (11.8%)

50 - 74

29 (80.6%)

90 (81.8%)

≥ 75

2 (5.6%)

7 (6.4%)

Sex

0.226

Female

9 (25.0%)

41 (37.3%)

Male

27 (75.0%)

69 (62.7%)

Tumor stage of EC

0.148

Distant

2 (5.6%)

8 (7.3%)

Localized

21 (58.3%)

42 (38.2%)

Regional

7 (19.4%)

41 (37.3%)

Unknown

6 (16.7%)

19 (17.3%)

Tumor histology of EC

0.094

Adenocarcinoma

6 (16.7%)

7 (6.4%)

Squamous carcinoma

27 (75.0%)

98 (89.1%)

Others

3 (8.3%)

5 (4.5%)

Tumor grade of EC

0.630

Grade I/II

21 (58.3%)

53 (48.2%)

Grade III/IV

7 (19.4%)

27 (24.5%)

Unknown

8 (22.2%)

30 (27.3%)

Tumor primary site of EC

0.002

Upper esophagus

1 (2.8%)

34 (30.9%)

Middle esophagus

9 (25.0%)

25 (22.7%)

Lower esophagus

19 (52.8%)

31 (28.2%)

NOS

6 (16.7%)

15 (13.6%)

Overlapping

1 (2.8%)

5 (4.5%)

Tumor size of EC

0.461

< 2 cm

0 (0%)

1 (0.9%)

≥ 2 cm

3 (8.3%)

18 (16.4%)

Unknown

33 (91.7%)

91 (82.7%)

Chemotherapy of EC

< 0.001

No/unknown

31 (86.1%)

18 (16.4%)

Yes

5 (13.9%)

92 (83.6%)

Surgery of EC

< 0.001

No surgery

9 (25.0%)

75 (68.2%)

Surgery performed

27 (75.0%)

35 (31.8%)

Median age of EC diagnosis (IQR), years

59 (56.0 - 65.3)

59 (54.0 - 66.0)

0.969

Median year of EC diagnosis (IQR)

1,991 (1,983.8 - 2,000.5)

1,996 (1,989.0 - 2,004.8)

0.063

Median follow-up time of patients with EC (IQR), months

151 (73.5 - 203.0)

82 (42.5 - 117.8)

< 0.001

**Table 3.** Pathological Origins of Primary Tumors in Patients With SHNC
	ESCC	EAC	Other histological types of EC	Total
EAC: esophageal adenocarcinoma; EC: esophageal cancer; ESCC: esophageal squamous cell cancer; HNAC: head and neck adenocarcinoma; HNSCC: head and neck squamous cell cancer; SHNC: secondary head and neck cancer.
Secondary HNSCC	117	13	8	138
Secondary HNAC	1	0	0	1
Other histological types of SHNC	7	0	0	7
Total	125	13	8	146

Table 3. Pathological Origins of Primary Tumors in Patients With SHNC

ESCC

EAC

Other histological types of EC

Total

EAC: esophageal adenocarcinoma; EC: esophageal cancer; ESCC: esophageal squamous cell cancer; HNAC: head and neck adenocarcinoma; HNSCC: head and neck squamous cell cancer; SHNC: secondary head and neck cancer.

Secondary HNSCC

117

138

Secondary HNAC

Other histological types of SHNC

Total

125

146

**Table 4.** Standardized Incidence Ratio Related to the SHNC
	Total (n = 14,158)	NRT (n = 4,919)	RT
*P < 0.05. EC: esophageal cancer; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.
All	5.95 (5.15 - 6.84)*	3.51 (2.64 - 4.58)*	8.04 (6.78 - 9.47)*
Race
White	4.33 (3.60 - 5.16)*	2.56 (1.78 - 3.56)*	5.95 (4.77 - 7.32)*
Black	16.74 (12.77 - 21.55)*	13.96 (8.13 - 22.36)*	18.17 (13.15 - 24.47)*
Other	13.43 (7.34 - 22.53)*	4.17 (0.51 - 15.07)	21.31 (11.01 - 37.22)*
Sex
Female	18.18 (13.87 - 23.40)*	8.71 (4.50 - 15.22)*	24.95 (18.40 - 33.08)*
Male	4.60 (3.87 - 5.44)*	3.00 (2.16 - 4.06)*	6.01 (4.87 - 7.34)*
Age
20 - 59	9.13 (7.45 - 11.09)*	5.69 (3.84 - 8.13)*	12.20 (9.55 - 15.37)*
60 - 74	4.82 (3.85 - 5.95)*	2.62 (1.62 - 4.01)*	6.64 (5.11 - 8.47)*
≥ 75	2.47 (1.23 - 4.42)*	1.43 (0.30 - 4.19)	3.40 (1.47 - 6.70)*
Year of EC diagnosis
1975 - 1984	9.41 (6.59 - 13.02)*	7.86 (4.58 - 12.58)*	11.42 (6.88 - 17.84)*
1985 - 1994	7.66 (5.78 - 9.94)*	2.81 (1.35 - 5.16)*	12.26 (8.97 - 16.35)*
1995 - 2004	6.11 (4.73 - 7.78)*	4.07 (2.48 - 6.28)*	7.83 (5.73 - 10.44)*
≥ 2005	3.53 (2.52 - 4.81)*	1.48 (0.60 - 3.05)	4.99 (3.44 - 7.01)*
Tumor grade
Grade I/II	7.92 (6.50 - 9.57)*	5.01 (3.42 - 7.07)*	10.50 (8.27 - 13.14)*
Grade III/IV	4.00 (2.89 - 5.38)*	2.55 (1.22 - 4.69)*	4.82 (3.32 - 6.77)*
Unknown	5.23 (3.83 - 6.97)*	2.40 (1.24 - 4.19)*	8.95 (6.20 - 12.51)*
Tumor stage
Distant	3.74 (1.79 - 6.87)*	3.00 (0.36 - 10.83)	3.98 (1.72 - 7.84)*
Localized	5.32 (4.26 - 6.57)*	3.01 (2.03 - 4.30)*	9.03 (6.82 - 11.72)*
Regional	6.09 (4.66 - 7.83)*	4.70 (2.43 - 8.21)*	6.57 (4.86 - 8.68)*
Unknown	9.27 (6.65 - 12.58)*	4.56 (2.18 - 8.38)*	13.91 (9.45 - 19.75)*
Surgery
Yes	3.94 (3.14 - 4.88)*	3.18 (2.25 - 4.36)*	4.92 (3.60 - 6.56)*
No	9.53 (7.86 - 11.45)*	4.69 (2.68 - 7.62)*	11.46 (9.30 - 13.97)*
Chemotherapy
Yes	7.59 (6.33 - 9.02)*	3.84 (1.41 - 8.36)*	7.97 (6.62 - 9.52)*
No	4.27 (3.33 - 5.39)*	3.48 (2.56 - 4.61)*	8.48 (5.31 - 12.84)*
Latency
12 - 59	5.26 (4.25 - 6.44)*	2.23 (1.27 - 3.62)*	7.31 (5.77 - 9.12)*
60 - 119	7.20 (5.53 - 9.21)*	3.47 (1.94 - 5.72)*	10.83 (7.99 - 14.36)*
120 - 239	7.13 (5.12 - 9.67)*	7.22 (4.58 - 10.84)*	7.01 (4.16 - 11.08)*
≥ 240	0.00 (0.00 - 4.10)	0.00 (0.00 - 5.45)	0.00 (0.00 - 16.45)

Table 4. Standardized Incidence Ratio Related to the SHNC

Total (n = 14,158)

NRT (n = 4,919)

*P < 0.05. EC: esophageal cancer; NRT: no radiation therapy; RT: radiotherapy; SHNC: secondary head and neck cancer.

All

5.95 (5.15 - 6.84)*

3.51 (2.64 - 4.58)*

8.04 (6.78 - 9.47)*

Race

White

4.33 (3.60 - 5.16)*

2.56 (1.78 - 3.56)*

5.95 (4.77 - 7.32)*

Black

16.74 (12.77 - 21.55)*

13.96 (8.13 - 22.36)*

18.17 (13.15 - 24.47)*

Other

13.43 (7.34 - 22.53)*

4.17 (0.51 - 15.07)

21.31 (11.01 - 37.22)*

Sex

Female

18.18 (13.87 - 23.40)*

8.71 (4.50 - 15.22)*

24.95 (18.40 - 33.08)*

Male

4.60 (3.87 - 5.44)*

3.00 (2.16 - 4.06)*

6.01 (4.87 - 7.34)*

Age

20 - 59

9.13 (7.45 - 11.09)*

5.69 (3.84 - 8.13)*

12.20 (9.55 - 15.37)*

60 - 74

4.82 (3.85 - 5.95)*

2.62 (1.62 - 4.01)*

6.64 (5.11 - 8.47)*

≥ 75

2.47 (1.23 - 4.42)*

1.43 (0.30 - 4.19)

3.40 (1.47 - 6.70)*

Year of EC diagnosis

1975 - 1984

9.41 (6.59 - 13.02)*

7.86 (4.58 - 12.58)*

11.42 (6.88 - 17.84)*

1985 - 1994

7.66 (5.78 - 9.94)*

2.81 (1.35 - 5.16)*

12.26 (8.97 - 16.35)*

1995 - 2004

6.11 (4.73 - 7.78)*

4.07 (2.48 - 6.28)*

7.83 (5.73 - 10.44)*

≥ 2005

3.53 (2.52 - 4.81)*

1.48 (0.60 - 3.05)

4.99 (3.44 - 7.01)*

Tumor grade

Grade I/II

7.92 (6.50 - 9.57)*

5.01 (3.42 - 7.07)*

10.50 (8.27 - 13.14)*

Grade III/IV

4.00 (2.89 - 5.38)*

2.55 (1.22 - 4.69)*

4.82 (3.32 - 6.77)*

Unknown

5.23 (3.83 - 6.97)*

2.40 (1.24 - 4.19)*

8.95 (6.20 - 12.51)*

Tumor stage

Distant

3.74 (1.79 - 6.87)*

3.00 (0.36 - 10.83)

3.98 (1.72 - 7.84)*

Localized

5.32 (4.26 - 6.57)*

3.01 (2.03 - 4.30)*

9.03 (6.82 - 11.72)*

Regional

6.09 (4.66 - 7.83)*

4.70 (2.43 - 8.21)*

6.57 (4.86 - 8.68)*

Unknown

9.27 (6.65 - 12.58)*

4.56 (2.18 - 8.38)*

13.91 (9.45 - 19.75)*

Surgery

Yes

3.94 (3.14 - 4.88)*

3.18 (2.25 - 4.36)*

4.92 (3.60 - 6.56)*

9.53 (7.86 - 11.45)*

4.69 (2.68 - 7.62)*

11.46 (9.30 - 13.97)*

Chemotherapy

Yes

7.59 (6.33 - 9.02)*

3.84 (1.41 - 8.36)*

7.97 (6.62 - 9.52)*

4.27 (3.33 - 5.39)*

3.48 (2.56 - 4.61)*

8.48 (5.31 - 12.84)*

Latency

12 - 59

5.26 (4.25 - 6.44)*

2.23 (1.27 - 3.62)*

7.31 (5.77 - 9.12)*

60 - 119

7.20 (5.53 - 9.21)*

3.47 (1.94 - 5.72)*

10.83 (7.99 - 14.36)*

120 - 239

7.13 (5.12 - 9.67)*

7.22 (4.58 - 10.84)*

7.01 (4.16 - 11.08)*

≥ 240

0.00 (0.00 - 4.10)

0.00 (0.00 - 5.45)

0.00 (0.00 - 16.45)