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Enrollment of patients with involved lymph nodes was low throughout the trial. Adoption of HF increased over time and when using the guideline publication date as cutoff. Results of the multiple logistic regressions showed an interaction between time and setting. Furthermore, the use of HF was significantly more common in university hospitals. The use of HF in the standard arm increased over the course of the HYPOSIB trial and after publication of the S3 guideline update. This was primarily driven by patients treated in university hospit
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