5a2ad8493632277210e0d77684438280 pmc_10295927.pdf 939d1ff0fd977f8f16581f8d5cf9df350ec7f11c pmc_10295927.pdf f597a66b11f0ab30d576980840b7bb41e2d5ff368e7239b5f9912afc54178409 pmc_10295927.pdf Title: Updated Review and Clinical Recommendations for the Diagnosis and Treatment of Patients with Retroperitoneal Sarcoma by the Spanish Sarcoma Research Group (GEIS) Subject: Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10–15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS. Keywords: retroperitoneal sarcoma; soft tissue sarcoma; retroperitoneum; multidisciplinary board; reference centers Author: Rosa Álvarez Álvarez, Aránzazu Manzano, Carolina Agra Pujol, Vicente Artigas Raventós, Raquel Correa, Josefina Cruz Jurado, Juan Angel Fernandez, Xavier Garcia del Muro, Jose Antonio Gonzalez, Nadia Hindi, Pablo Lozano Lominchar, Javier Martínez-Trufero, Ramiro Méndez, Mercedes Muñoz, Cristobal Muñoz Casares, Francisco Orbis Castellanos, Ruth Orellana Fernandez, Miguel Paniagua González, Andres Redondo, Claudia Valverde Morales and Jose Manuel Asencio Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Jun 15 08:26:41 2023 CEST ModDate: Thu Jun 15 08:29:54 2023 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 23 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1116493 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HKBJPQ+VnURWPalladioL Type 1 Custom yes yes no 10 0 YJLJGN+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 BHDVRA+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 BZTYBK+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 FFAYKL+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 HBLPAQ+CMSY10 Type 1 Builtin yes yes no 72 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 83 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 87 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 91 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 95 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 117 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 121 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 125 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 129 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-03 02:40:44 CEST RepresentationInformation: pmc_10295927.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-04-24 02:40:44 CEST Size: 1116493 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 540 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methodology Destination: section.2 Item: Title: Warning Signs and Indications for Referral to Specialist Sarcoma Centers What Can the Reference Center Offer? Destination: section.3 Item: Title: Diagnostic Approach to RPS: Imaging and Pathology Diagnosis Destination: section.4 Children: Item: Title: Imaging Diagnosis Destination: subsection.4.1 Item: Title: Biopsy Destination: subsection.4.2 Item: Title: Pathological Diagnosis of Soft Tissue Sarcomas Indication of Molecular Studies Destination: subsection.4.3 Item: Title: Preoperative Functional Assessment Destination: section.5 Item: Title: Staging and Risk Assessment Destination: section.6 Item: Title: Treatment of Resectable Localized Disease Destination: section.7 Children: Item: Title: The Primary Surgical Approach in Localized Disease Adapting the Surgical Approach to the Histological Subtype Destination: subsection.7.1 Item: Title: Management after Simple Excision (with Residual Macroscopic Disease) Destination: subsection.7.2 Item: Title: Preoperative or Postoperative Radiotherapy Destination: subsection.7.3 Item: Title: Adjuvant/Neoadjuvant Chemotherapy Destination: subsection.7.4 Item: Title: Treatment of Local Recurrence Destination: section.8 Item: Title: Treatment of Localized Unresectable Disease Destination: section.9 Item: Title: Treatment of Advanced Disease Destination: section.10 Children: Item: Title: Surgical Treatment of Advanced Disease Destination: subsection.10.1 Item: Title: Radiotherapy Treatment in Advanced Disease Destination: subsection.10.2 Item: Title: Systemic Treatment of Advanced Disease Destination: subsection.10.3 Item: Title: New and Upcoming Therapies Destination: section.11 Item: Title: Follow-Up Destination: section.12 Item: Title: Conclusions Destination: section.13 Item: Title: References Destination: section.14 Info: Title: Updated Review and Clinical Recommendations for the Diagnosis and Treatment of Patients with Retroperitoneal Sarcoma by the Spanish Sarcoma Research Group (GEIS) Author: Rosa Álvarez Álvarez, Aránzazu Manzano, Carolina Agra Pujol, Vicente Artigas Raventós, Raquel Correa, Josefina Cruz Jurado, Juan Angel Fernandez, Xavier Garcia del Muro, Jose Antonio Gonzalez, Nadia Hindi, Pablo Lozano Lominchar, Javier Martínez-Trufero, Ramiro Méndez, Mercedes Muñoz, Cristobal Muñoz Casares, Francisco Orbis Castellanos, Ruth Orellana Fernandez, Miguel Paniagua González, Andres Redondo, Claudia Valverde Morales and Jose Manuel Asencio Subject: Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10 15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS. Keywords: retroperitoneal sarcoma; soft tissue sarcoma; retroperitoneum; multidisciplinary board; reference centers Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Jun 15 08:26:41 CEST 2023 ModDate: Thu Jun 15 08:29:54 CEST 2023 ID: 0x298108db3338ed8d3d5229ae01136028, 0x298108db3338ed8d3d5229ae01136028 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: BHDVRA+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: BHDVRA+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: BZTYBK+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 151 FontDescriptor: FontName: BZTYBK+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: HBLPAQ+CMSY10 FontSubset: true FirstChar: 2 LastChar: 20 FontDescriptor: FontName: HBLPAQ+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: HKBJPQ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: HKBJPQ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: FFAYKL+VnURWPalladioL-Bold FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: FFAYKL+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: YJLJGN+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 241 FontDescriptor: FontName: YJLJGN+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 34, 292, 152, 301 Annotation: Subtype: Link Rect: 34, 282, 87, 289 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 152, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 349, 642, 360, 655 Annotation: Subtype: Link Rect: 107, 629, 118, 643 Annotation: Subtype: Link Rect: 364, 617, 375, 630 Annotation: Subtype: Link Rect: 497, 617, 508, 630 Annotation: Subtype: Link Rect: 118, 605, 129, 618 Annotation: Subtype: Link Rect: 160, 591, 171, 605 Annotation: Subtype: Link Rect: 308, 591, 319, 605 Annotation: Subtype: Link Rect: 410, 591, 421, 605 Annotation: Subtype: Link Rect: 160, 579, 171, 592 Annotation: Subtype: Link Rect: 114, 17, 265, 28 Annotation: Subtype: Link Rect: 410, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 437, 87, 456 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 204, 505, 211, 514 ActionDest: 168 Annotation: Subtype: Link Rect: 211, 505, 218, 514 ActionDest: 168 Annotation: Subtype: Link Rect: 355, 430, 362, 439 ActionDest: 168 Annotation: Subtype: Link Rect: 228, 405, 235, 414 ActionDest: 168 Annotation: Subtype: Link Rect: 412, 163, 492, 175 Annotation: Subtype: Link Rect: 283, 78, 290, 87 ActionDest: 168 Annotation: Subtype: Link Rect: 323, 76, 330, 88 ActionDest: 69 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 541, 353, 548, 362 ActionDest: 168 Annotation: Subtype: Link Rect: 549, 353, 556, 362 ActionDest: 168 Annotation: Subtype: Link Rect: 208, 315, 215, 324 ActionDest: 168 Annotation: Subtype: Link Rect: 200, 290, 207, 299 ActionDest: 168 Annotation: Subtype: Link Rect: 507, 103, 519, 112 ActionDest: 168 Annotation: Subtype: Link Rect: 522, 103, 534, 112 ActionDest: 171 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 412, 733, 419, 745 ActionDest: 76 Annotation: Subtype: Link Rect: 426, 736, 438, 744 ActionDest: 168 Annotation: Subtype: Link Rect: 438, 735, 450, 744 ActionDest: 171 Annotation: Subtype: Link Rect: 218, 698, 230, 707 ActionDest: 168 Annotation: Subtype: Link Rect: 348, 331, 360, 340 ActionDest: 168 Annotation: Subtype: Link Rect: 339, 306, 351, 315 ActionDest: 168 Annotation: Subtype: Link Rect: 352, 306, 364, 315 ActionDest: 171 Annotation: Subtype: Link Rect: 490, 281, 502, 290 ActionDest: 168 Annotation: Subtype: Link Rect: 502, 281, 514, 290 ActionDest: 168 Annotation: Subtype: Link Rect: 401, 256, 413, 265 ActionDest: 168 Annotation: Subtype: Link Rect: 414, 256, 425, 265 ActionDest: 171 Annotation: Subtype: Link Rect: 260, 243, 272, 252 ActionDest: 168 Annotation: Subtype: Link Rect: 217, 180, 229, 189 ActionDest: 168 Annotation: Subtype: Link Rect: 532, 180, 544, 189 ActionDest: 168 Annotation: Subtype: Link Rect: 545, 180, 557, 189 ActionDest: 171 Annotation: Subtype: Link Rect: 183, 155, 195, 164 ActionDest: 168 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 527, 695, 539, 704 ActionDest: 171 Annotation: Subtype: Link Rect: 539, 695, 551, 704 ActionDest: 171 Annotation: Subtype: Link Rect: 469, 607, 481, 616 ActionDest: 171 Annotation: Subtype: Link Rect: 433, 506, 445, 516 ActionDest: 171 Annotation: Subtype: Link Rect: 445, 506, 457, 516 ActionDest: 171 Annotation: Subtype: Link Rect: 456, 88, 468, 98 ActionDest: 171 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 459, 607, 466, 619 ActionDest: 106 Annotation: Subtype: Link Rect: 362, 234, 369, 246 ActionDest: 109 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 400, 416, 411, 425 ActionDest: 171 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 419, 723, 431, 732 ActionDest: 171 Annotation: Subtype: Link Rect: 295, 523, 307, 532 ActionDest: 171 Annotation: Subtype: Link Rect: 286, 460, 298, 469 ActionDest: 171 Annotation: Subtype: Link Rect: 414, 435, 426, 444 ActionDest: 171 Annotation: Subtype: Link Rect: 427, 435, 439, 444 ActionDest: 171 Annotation: Subtype: Link Rect: 507, 312, 519, 321 ActionDest: 171 Annotation: Subtype: Link Rect: 365, 286, 377, 296 ActionDest: 171 Annotation: Subtype: Link Rect: 339, 261, 351, 270 ActionDest: 171 Annotation: Subtype: Link Rect: 544, 236, 556, 245 ActionDest: 171 Annotation: Subtype: Link Rect: 208, 211, 220, 220 ActionDest: 171 Annotation: Subtype: Link Rect: 396, 211, 408, 220 ActionDest: 171 Annotation: Subtype: Link Rect: 510, 199, 522, 208 ActionDest: 171 Annotation: Subtype: Link Rect: 524, 199, 536, 208 ActionDest: 171 Annotation: Subtype: Link Rect: 265, 173, 277, 183 ActionDest: 171 Annotation: Subtype: Link Rect: 310, 172, 317, 183 ActionDest: 143 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 70, 645, 79, 652 ActionDest: 171 Annotation: Subtype: Link Rect: 498, 644, 554, 653 Annotation: Subtype: Link Rect: 491, 636, 529, 645 Annotation: Subtype: Link Rect: 70, 524, 79, 531 ActionDest: 171 Annotation: Subtype: Link Rect: 70, 374, 79, 381 ActionDest: 171 Annotation: Subtype: Link Rect: 498, 349, 554, 358 Annotation: Subtype: Link Rect: 491, 341, 529, 350 Annotation: Subtype: Link Rect: 70, 259, 79, 266 ActionDest: 171 Annotation: Subtype: Link Rect: 70, 156, 79, 163 ActionDest: 171 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 70, 645, 79, 652 ActionDest: 171 Annotation: Subtype: Link Rect: 241, 450, 253, 460 ActionDest: 171 Annotation: Subtype: Link Rect: 256, 450, 268, 460 ActionDest: 174 Annotation: Subtype: Link Rect: 481, 425, 493, 434 ActionDest: 171 Annotation: Subtype: Link Rect: 496, 425, 508, 434 ActionDest: 171 Annotation: Subtype: Link Rect: 507, 350, 519, 359 ActionDest: 171 Annotation: Subtype: Link Rect: 522, 350, 534, 359 ActionDest: 171 Annotation: Subtype: Link Rect: 314, 225, 321, 234 ActionDest: 168 Annotation: Subtype: Link Rect: 321, 225, 333, 234 ActionDest: 174 Annotation: Subtype: Link Rect: 247, 200, 254, 209 ActionDest: 168 Annotation: Subtype: Link Rect: 254, 199, 266, 209 ActionDest: 174 Annotation: Subtype: Link Rect: 259, 137, 266, 146 ActionDest: 168 Annotation: Subtype: Link Rect: 267, 137, 278, 146 ActionDest: 171 Annotation: Subtype: Link Rect: 475, 86, 487, 96 ActionDest: 171 Annotation: Subtype: Link Rect: 487, 86, 499, 96 ActionDest: 171 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 229, 710, 241, 719 ActionDest: 171 Annotation: Subtype: Link Rect: 242, 710, 254, 719 ActionDest: 171 Annotation: Subtype: Link Rect: 430, 673, 442, 682 ActionDest: 171 Annotation: Subtype: Link Rect: 445, 673, 457, 682 ActionDest: 171 Annotation: Subtype: Link Rect: 362, 499, 374, 508 ActionDest: 174 Annotation: Subtype: Link Rect: 377, 499, 389, 508 ActionDest: 174 Annotation: Subtype: Link Rect: 410, 474, 417, 483 ActionDest: 168 Annotation: Subtype: Link Rect: 417, 474, 424, 483 ActionDest: 168 Annotation: Subtype: Link Rect: 425, 474, 436, 483 ActionDest: 171 Annotation: Subtype: Link Rect: 437, 474, 449, 483 ActionDest: 174 Annotation: Subtype: Link Rect: 452, 474, 464, 483 ActionDest: 174 Annotation: Subtype: Link Rect: 377, 449, 383, 458 ActionDest: 168 Annotation: Subtype: Link Rect: 384, 449, 396, 458 ActionDest: 174 Annotation: Subtype: Link Rect: 318, 424, 330, 433 ActionDest: 174 Annotation: Subtype: Link Rect: 330, 424, 342, 433 ActionDest: 174 Annotation: Subtype: Link Rect: 528, 386, 540, 395 ActionDest: 171 Annotation: Subtype: Link Rect: 540, 386, 552, 395 ActionDest: 174 Annotation: Subtype: Link Rect: 440, 323, 452, 333 ActionDest: 171 Annotation: Subtype: Link Rect: 421, 298, 433, 307 ActionDest: 171 Annotation: Subtype: Link Rect: 477, 150, 489, 159 ActionDest: 174 Annotation: Subtype: Link Rect: 320, 100, 332, 109 ActionDest: 174 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 299, 647, 311, 657 ActionDest: 174 Annotation: Subtype: Link Rect: 252, 622, 264, 631 ActionDest: 174 Annotation: Subtype: Link Rect: 500, 560, 512, 569 ActionDest: 174 Annotation: Subtype: Link Rect: 544, 484, 556, 493 ActionDest: 174 Annotation: Subtype: Link Rect: 380, 447, 391, 456 ActionDest: 174 Annotation: Subtype: Link Rect: 232, 422, 244, 431 ActionDest: 174 Annotation: Subtype: Link Rect: 368, 236, 379, 245 ActionDest: 171 Annotation: Subtype: Link Rect: 307, 198, 319, 207 ActionDest: 174 Annotation: Subtype: Link Rect: 206, 173, 218, 182 ActionDest: 174 Annotation: Subtype: Link Rect: 252, 160, 264, 169 ActionDest: 174 Annotation: Subtype: Link Rect: 544, 135, 556, 144 ActionDest: 174 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 506, 723, 518, 732 ActionDest: 177 Annotation: Subtype: Link Rect: 437, 660, 449, 669 ActionDest: 177 Annotation: Subtype: Link Rect: 189, 560, 200, 569 ActionDest: 177 Annotation: Subtype: Link Rect: 264, 350, 276, 359 ActionDest: 174 Annotation: Subtype: Link Rect: 531, 325, 543, 334 ActionDest: 174 Annotation: Subtype: Link Rect: 544, 325, 556, 334 ActionDest: 177 Annotation: Subtype: Link Rect: 347, 287, 359, 296 ActionDest: 171 Annotation: Subtype: Link Rect: 508, 275, 520, 284 ActionDest: 174 Annotation: Subtype: Link Rect: 520, 275, 532, 284 ActionDest: 174 Annotation: Subtype: Link Rect: 533, 275, 545, 284 ActionDest: 174 Annotation: Subtype: Link Rect: 390, 159, 402, 168 ActionDest: 177 Annotation: Subtype: Link Rect: 495, 106, 507, 115 ActionDest: 174 Annotation: Subtype: Link Rect: 507, 106, 519, 115 ActionDest: 177 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 302, 710, 314, 719 ActionDest: 177 Annotation: Subtype: Link Rect: 315, 710, 327, 719 ActionDest: 177 Annotation: Subtype: Link Rect: 234, 673, 246, 682 ActionDest: 174 Annotation: Subtype: Link Rect: 246, 673, 258, 682 ActionDest: 177 Annotation: Subtype: Link Rect: 262, 635, 274, 644 ActionDest: 174 Annotation: Subtype: Link Rect: 241, 584, 253, 594 ActionDest: 171 Annotation: Subtype: Link Rect: 470, 559, 482, 568 ActionDest: 177 Annotation: Subtype: Link Rect: 495, 547, 507, 556 ActionDest: 177 Annotation: Subtype: Link Rect: 238, 484, 250, 493 ActionDest: 177 Annotation: Subtype: Link Rect: 233, 358, 245, 368 ActionDest: 177 Annotation: Subtype: Link Rect: 523, 296, 535, 305 ActionDest: 177 Annotation: Subtype: Link Rect: 378, 271, 390, 280 ActionDest: 177 Annotation: Subtype: Link Rect: 390, 271, 402, 280 ActionDest: 177 Annotation: Subtype: Link Rect: 517, 245, 529, 255 ActionDest: 177 Annotation: Subtype: Link Rect: 420, 221, 432, 229 ActionDest: 177 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 219, 631, 226, 640 ActionDest: 168 Annotation: Subtype: Link Rect: 226, 631, 238, 640 ActionDest: 177 Annotation: Subtype: Link Rect: 306, 619, 313, 628 ActionDest: 168 Annotation: Subtype: Link Rect: 314, 619, 320, 628 ActionDest: 168 Annotation: Subtype: Link Rect: 321, 618, 333, 628 ActionDest: 177 Annotation: Subtype: Link Rect: 492, 594, 499, 603 ActionDest: 168 Annotation: Subtype: Link Rect: 412, 518, 424, 527 ActionDest: 177 Annotation: Subtype: Link Rect: 209, 493, 221, 502 ActionDest: 177 Annotation: Subtype: Link Rect: 451, 480, 463, 490 ActionDest: 181 Annotation: Subtype: Link Rect: 241, 455, 253, 464 ActionDest: 181 Annotation: Subtype: Link Rect: 417, 418, 429, 427 ActionDest: 177 Annotation: Subtype: Link Rect: 531, 330, 543, 339 ActionDest: 174 Annotation: Subtype: Link Rect: 280, 169, 292, 178 ActionDest: 181 Annotation: Subtype: Link Rect: 441, 156, 453, 165 ActionDest: 177 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 257, 657, 268, 666 ActionDest: 181 Annotation: Subtype: Link Rect: 269, 657, 281, 666 ActionDest: 181 Annotation: Subtype: Link Rect: 456, 619, 468, 629 ActionDest: 181 Annotation: Subtype: Link Rect: 479, 607, 491, 616 ActionDest: 181 Annotation: Subtype: Link Rect: 202, 594, 214, 603 ActionDest: 181 Annotation: Subtype: Link Rect: 471, 582, 483, 591 ActionDest: 181 Annotation: Subtype: Link Rect: 333, 544, 345, 553 ActionDest: 181 Annotation: Subtype: Link Rect: 353, 519, 365, 528 ActionDest: 181 Annotation: Subtype: Link Rect: 244, 469, 256, 478 ActionDest: 174 Annotation: Subtype: Link Rect: 324, 456, 336, 465 ActionDest: 181 Annotation: Subtype: Link Rect: 395, 431, 407, 440 ActionDest: 181 Annotation: Subtype: Link Rect: 298, 406, 310, 415 ActionDest: 181 Annotation: Subtype: Link Rect: 237, 381, 249, 390 ActionDest: 181 Annotation: Subtype: Link Rect: 249, 381, 261, 390 ActionDest: 181 Page: Sequence: 17 Annotations: Annotation: Subtype: Link Rect: 292, 657, 304, 666 ActionDest: 181 Annotation: Subtype: Link Rect: 531, 644, 543, 654 ActionDest: 181 Annotation: Subtype: Link Rect: 544, 644, 556, 654 ActionDest: 184 Annotation: Subtype: Link Rect: 393, 619, 405, 629 ActionDest: 184 Annotation: Subtype: Link Rect: 439, 607, 451, 616 ActionDest: 184 Annotation: Subtype: Link Rect: 523, 569, 540, 578 ActionDest: 184 Annotation: Subtype: Link Rect: 273, 506, 290, 516 ActionDest: 184 Annotation: Subtype: Link Rect: 458, 431, 475, 440 ActionDest: 184 Annotation: Subtype: Link Rect: 330, 368, 347, 377 ActionDest: 184 Annotation: Subtype: Link Rect: 361, 258, 378, 267 ActionDest: 184 Annotation: Subtype: Link Rect: 378, 258, 395, 267 ActionDest: 184 Annotation: Subtype: Link Rect: 390, 245, 402, 254 ActionDest: 174 Annotation: Subtype: Link Rect: 403, 245, 420, 254 ActionDest: 184 Annotation: Subtype: Link Rect: 261, 233, 268, 242 ActionDest: 168 Annotation: Subtype: Link Rect: 301, 230, 307, 242 ActionDest: 165 Annotation: Subtype: Link Rect: 377, 211, 388, 219 ActionDest: 184 Annotation: Subtype: Link Rect: 391, 211, 406, 219 ActionDest: 184 Page: Sequence: 18 Annotations: Annotation: Subtype: Link Rect: 188, 374, 226, 384 Annotation: Subtype: Link Rect: 232, 374, 268, 384 Annotation: Subtype: Link Rect: 430, 350, 467, 361 Annotation: Subtype: Link Rect: 473, 350, 509, 361 Annotation: Subtype: Link Rect: 397, 304, 435, 315 Annotation: Subtype: Link Rect: 441, 304, 477, 315 Annotation: Subtype: Link Rect: 239, 281, 277, 292 Annotation: Subtype: Link Rect: 416, 246, 453, 257 Annotation: Subtype: Link Rect: 59, 213, 96, 223 Annotation: Subtype: Link Rect: 472, 189, 510, 200 Annotation: Subtype: Link Rect: 194, 155, 231, 165 Annotation: Subtype: Link Rect: 288, 131, 326, 142 Annotation: Subtype: Link Rect: 117, 109, 155, 119 Annotation: Subtype: Link Rect: 117, 75, 155, 85 Annotation: Subtype: Link Rect: 161, 75, 197, 85 Page: Sequence: 19 Annotations: Annotation: Subtype: Link Rect: 108, 722, 146, 733 Annotation: Subtype: Link Rect: 465, 676, 502, 687 Annotation: Subtype: Link Rect: 59, 642, 96, 652 Annotation: Subtype: Link Rect: 448, 618, 486, 629 Annotation: Subtype: Link Rect: 59, 584, 96, 594 Annotation: Subtype: Link Rect: 335, 549, 373, 560 Annotation: Subtype: Link Rect: 379, 549, 415, 560 Annotation: Subtype: Link Rect: 59, 527, 96, 537 Annotation: Subtype: Link Rect: 102, 527, 138, 537 Annotation: Subtype: Link Rect: 519, 514, 557, 525 Annotation: Subtype: Link Rect: 59, 504, 95, 514 Annotation: Subtype: Link Rect: 177, 458, 215, 468 Annotation: Subtype: Link Rect: 221, 458, 257, 468 Annotation: Subtype: Link Rect: 400, 422, 437, 433 Annotation: Subtype: Link Rect: 444, 422, 480, 433 Annotation: Subtype: Link Rect: 287, 376, 325, 387 Annotation: Subtype: Link Rect: 331, 376, 367, 387 Annotation: Subtype: Link Rect: 254, 342, 292, 353 Annotation: Subtype: Link Rect: 127, 320, 164, 330 Annotation: Subtype: Link Rect: 440, 284, 477, 295 Annotation: Subtype: Link Rect: 483, 284, 519, 295 Annotation: Subtype: Link Rect: 298, 250, 336, 261 Annotation: Subtype: Link Rect: 135, 216, 173, 226 Annotation: Subtype: Link Rect: 104, 182, 141, 192 Annotation: Subtype: Link Rect: 236, 146, 274, 157 Annotation: Subtype: Link Rect: 325, 112, 362, 123 Annotation: Subtype: Link Rect: 345, 89, 382, 100 Annotation: Subtype: Link Rect: 427, 66, 465, 77 Annotation: Subtype: Link Rect: 471, 66, 507, 77 Page: Sequence: 20 Annotations: Annotation: Subtype: Link Rect: 59, 699, 96, 710 Annotation: Subtype: Link Rect: 102, 699, 138, 710 Annotation: Subtype: Link Rect: 418, 664, 455, 675 Annotation: Subtype: Link Rect: 394, 641, 431, 652 Annotation: Subtype: Link Rect: 498, 618, 535, 629 Annotation: Subtype: Link Rect: 193, 595, 230, 606 Annotation: Subtype: Link Rect: 59, 550, 96, 560 Annotation: Subtype: Link Rect: 59, 527, 96, 537 Annotation: Subtype: Link Rect: 388, 491, 425, 502 Annotation: Subtype: Link Rect: 432, 491, 468, 502 Annotation: Subtype: Link Rect: 59, 458, 96, 468 Annotation: Subtype: Link Rect: 102, 458, 138, 468 Annotation: Subtype: Link Rect: 358, 422, 395, 433 Annotation: Subtype: Link Rect: 59, 377, 96, 387 Annotation: Subtype: Link Rect: 102, 377, 138, 387 Annotation: Subtype: Link Rect: 381, 342, 419, 353 Annotation: Subtype: Link Rect: 429, 307, 467, 318 Annotation: Subtype: Link Rect: 470, 273, 508, 284 Annotation: Subtype: Link Rect: 425, 250, 463, 261 Annotation: Subtype: Link Rect: 519, 227, 557, 238 Annotation: Subtype: Link Rect: 59, 216, 95, 226 Annotation: Subtype: Link Rect: 513, 204, 550, 215 Annotation: Subtype: Link Rect: 520, 169, 557, 180 Annotation: Subtype: Link Rect: 59, 159, 95, 169 Annotation: Subtype: Link Rect: 108, 124, 146, 134 Annotation: Subtype: Link Rect: 113, 101, 151, 111 Annotation: Subtype: Link Rect: 496, 66, 533, 77 Page: Sequence: 21 Annotations: Annotation: Subtype: Link Rect: 498, 710, 535, 721 Annotation: Subtype: Link Rect: 349, 676, 386, 687 Annotation: Subtype: Link Rect: 59, 630, 96, 640 Annotation: Subtype: Link Rect: 102, 630, 138, 640 Annotation: Subtype: Link Rect: 317, 595, 354, 606 Annotation: Subtype: Link Rect: 190, 560, 227, 571 Annotation: Subtype: Link Rect: 162, 527, 200, 537 Annotation: Subtype: Link Rect: 172, 492, 209, 502 Annotation: Subtype: Link Rect: 444, 468, 482, 479 Annotation: Subtype: Link Rect: 319, 434, 356, 445 Annotation: Subtype: Link Rect: 446, 411, 484, 422 Annotation: Subtype: Link Rect: 152, 376, 190, 387 Annotation: Subtype: Link Rect: 196, 376, 232, 387 Annotation: Subtype: Link Rect: 149, 343, 186, 353 Annotation: Subtype: Link Rect: 192, 343, 228, 353 Annotation: Subtype: Link Rect: 453, 319, 491, 330 Annotation: Subtype: Link Rect: 497, 319, 533, 330 Annotation: Subtype: Link Rect: 144, 285, 182, 295 Annotation: Subtype: Link Rect: 417, 261, 454, 272 Annotation: Subtype: Link Rect: 359, 227, 397, 238 Annotation: Subtype: Link Rect: 200, 204, 238, 215 Annotation: Subtype: Link Rect: 244, 204, 280, 215 Annotation: Subtype: Link Rect: 433, 169, 470, 180 Annotation: Subtype: Link Rect: 476, 169, 512, 180 Annotation: Subtype: Link Rect: 59, 136, 96, 146 Annotation: Subtype: Link Rect: 306, 112, 343, 123 Annotation: Subtype: Link Rect: 59, 90, 96, 100 Page: Sequence: 22 Annotations: Annotation: Subtype: Link Rect: 59, 711, 96, 721 Annotation: Subtype: Link Rect: 102, 711, 138, 721 Annotation: Subtype: Link Rect: 506, 687, 544, 698 Annotation: Subtype: Link Rect: 422, 664, 459, 675 Annotation: Subtype: Link Rect: 474, 629, 511, 640 Annotation: Subtype: Link Rect: 112, 596, 150, 606 Annotation: Subtype: Link Rect: 463, 560, 501, 571 Annotation: Subtype: Link Rect: 320, 388, 358, 399 Annotation: Subtype: Link Rect: 59, 343, 96, 353 Annotation: Subtype: Link Rect: 199, 308, 236, 318 Annotation: Subtype: Link Rect: 81, 274, 119, 284 Annotation: Subtype: Link Rect: 59, 228, 96, 238 Annotation: Subtype: Link Rect: 117, 182, 155, 192 Annotation: Subtype: Link Rect: 418, 100, 455, 111 Annotation: Subtype: Link Rect: 325, 66, 363, 77 Page: Sequence: 23 Annotations: Annotation: Subtype: Link Rect: 59, 653, 96, 664 Annotation: Subtype: Link Rect: 433, 618, 470, 629 Annotation: Subtype: Link Rect: 59, 573, 96, 583 Annotation: Subtype: Link Rect: 181, 537, 218, 548 Annotation: Subtype: Link Rect: 223, 469, 261, 479 Annotation: Subtype: Link Rect: 423, 445, 460, 456 Annotation: Subtype: Link Rect: 109, 412, 146, 422 Annotation: Subtype: Link Rect: 307, 388, 345, 399 Checksum: fe2ad8be Type: CRC32 Checksum: 5a2ad8493632277210e0d77684438280 Type: MD5 Checksum: 939d1ff0fd977f8f16581f8d5cf9df350ec7f11c Type: SHA-1 Checksum: f597a66b11f0ab30d576980840b7bb41e2d5ff368e7239b5f9912afc54178409 Type: SHA-256