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Roy S, Malone S, Sun Y, Zaorsky NG, Spratt DE, Morgan SC, Dess RT, Wallis CJD, Kishan AU, Citrin DE, Saad F. Effect of Pelvic External Beam Radiation Therapy on Bone Mineral Density: A Secondary Analysis of a Phase 3 Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2024; 119:119-126. [PMID: 37924987 PMCID: PMC11023796 DOI: 10.1016/j.ijrobp.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Pelvic radiation therapy may lead to decreased bone mineral density (BMD) and increased risk of fracture that could be of particular concern in patients with prostate cancer who also receive androgen deprivation therapy (ADT). We performed an exploratory analysis of a randomized, double-masked, placebo-controlled trial to determine whether exposure to prior pelvic external beam radiation therapy (XRT) affects BMD and risk of fracture in patients with prostate cancer treated with ADT. METHODS AND MATERIALS Patients with nonmetastatic prostate cancer aged ≥70 years or <70 years with low BMD (T-score < -1) or osteoporotic fracture who had been receiving ADT for ≥12 months were randomly assigned to receive densoumab or placebo every 6 months for 3 years. BMD was measured at baseline and at months 1, 3, 6, 12, 24, and 36. We applied multivariable linear mixed-effects models with an interaction term between the treatment arm and exposure to prior pelvic XRT to evaluate differential XRT effect on percent BMD change between the 2 treatment arms. RESULTS Among 1407 eligible patients, 31% (n = 447) received prior pelvic XRT. There was no significant difference in any clinical fractures among patients with (5.8%, 26 of 447) or without (5.2%, 50 of 960) prior pelvic XRT (P = .42). Prior pelvic XRT was associated with a significant (0.54%) improvement in BMD (95% CI, 0.05-1.02) in the placebo group and a nonsignificant (0.04%) decline in BMD (95% CI, -0.47 to -0.35) in the denosumab group (interaction P = .007). There was no significant difference in pelvic XRT effect on percent BMD change in the lumbar spine (P = .65) or total hip (P = .39) between the 2 treatment groups. CONCLUSIONS We did not find sufficient evidence to suggest any detrimental effect of pelvic XRT on the treatment effect from denosumab on percent BMD change, with only an approximately 5% incidence of clinical fractures.
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Affiliation(s)
- Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Shawn Malone
- Division of Radiation Oncology, Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Scott C Morgan
- Division of Radiation Oncology, Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Christopher J D Wallis
- Department of Urology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Fred Saad
- Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
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Fijardo M, Kwan JYY, Bissey PA, Citrin DE, Yip KW, Liu FF. The clinical manifestations and molecular pathogenesis of radiation fibrosis. EBioMedicine 2024; 103:105089. [PMID: 38579363 PMCID: PMC11002813 DOI: 10.1016/j.ebiom.2024.105089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/25/2024] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
Advances in radiation techniques have enabled the precise delivery of higher doses of radiotherapy to tumours, while sparing surrounding healthy tissues. Consequently, the incidence of radiation toxicities has declined, and will likely continue to improve as radiotherapy further evolves. Nonetheless, ionizing radiation elicits tissue-specific toxicities that gradually develop into radiation-induced fibrosis, a common long-term side-effect of radiotherapy. Radiation fibrosis is characterized by an aberrant wound repair process, which promotes the deposition of extensive scar tissue, clinically manifesting as a loss of elasticity, tissue thickening, and organ-specific functional consequences. In addition to improving the existing technologies and guidelines directing the administration of radiotherapy, understanding the pathogenesis underlying radiation fibrosis is essential for the success of cancer treatments. This review integrates the principles for radiotherapy dosimetry to minimize off-target effects, the tissue-specific clinical manifestations, the key cellular and molecular drivers of radiation fibrosis, and emerging therapeutic opportunities for both prevention and treatment.
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Affiliation(s)
- Mackenzie Fijardo
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Yin Yee Kwan
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, United States of America
| | - Kenneth W Yip
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Research Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
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Lee KH, Mena E, Shih J, Lindenberg L, Wood BJ, Pinto PA, Patel KR, Citrin DE, Choyke PL, Turkbey B. Predicting 18F-DCFPyL-PET/CT Scan Positivity in Prostate Cancer Patients with Biochemical Recurrence. Acad Radiol 2024; 31:1419-1428. [PMID: 37775447 PMCID: PMC10965502 DOI: 10.1016/j.acra.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
RATIONALE AND OBJECTIVES To analyze variables that can predict the positivity of 18F-DCFPyL- positron emission tomography/computed tomography (PET/CT) and extent of disease in patients with biochemically recurrent (BCR) prostate cancer after primary local therapy with either radical prostatectomy or radiation therapy. MATERIALS AND METHODS This is a retrospective analysis of a prospective single institutional review board-approved study. We included 199 patients with biochemical recurrence and negative conventional imaging after primary local therapies (radical prostatectomy n = 127, radiation therapy n = 72). All patients underwent 18F-DCFPyL-PET/CT. Univariate and multivariate logistic regression analyses were used to determine predictors of a positive scan for both cohort of patients. Regression-based coefficients were used to develop nomograms predicting scan positivity and extra-pelvic disease. Decision curve analysis (DCA) was implemented to quantify nomogram's clinical benefit. RESULTS Of the 127 (63%) post-radical prostatectomy patients, 91 patients had positive scans - 61 of those with intrapelvic lesions and 30 with extra-pelvic lesions (i.e., retroperitoneal or distant nodes and/or bone/organ lesions). Of the 72 post-radiation therapy patients, 65 patients had positive scans - 39 of them had intrapelvic lesions and 26 extra-pelvic lesions. In the radical prostatectomy cohort, multivariate regression analysis revealed original International Society of Urological Pathology category, prostate-specific antigen (PSA), prostate-specific antigen doubling time (PSAdt), and time from BCR (mo) to scan were predictors for scan positivity and presence of extra-pelvic disease, with an area under the curve of 80% and 78%, respectively. Positive versus negative tumor margin after radical prostatectomy was not related to scan positivity or to the presence of positive extra-pelvic foci. In the radiation therapy cohort, multivariate regression analysis revealed that PSA, PSAdt, and time to BCR (mo) were predictors of extra-pelvic disease, with area under the curve of 82%. Because only seven patients in the radiation therapy cohort had negative scans, a prediction model for scan positivity could not be analyzed and only the presence of extra-pelvic disease was evaluated. CONCLUSION PSA and PSAdt are consistently significant predictors of 18F-DCFPyL PET/CT positivity and extra-pelvic disease in BCR prostate cancer patients. Stratifying the patient population into primary local treatment group enables the use of other variables as predictors, such as time since BCR. This nomogram may guide selection of the most suitable candidates for 18F-DCFPyL-PET/CT imaging.
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Affiliation(s)
- Katerina H Lee
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., B.J.W.)
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.).
| | - Joanna Shih
- Division Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.S.)
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.)
| | - Bradford J Wood
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., B.J.W.)
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (P.A.P.)
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.R.P., D.E.C.)
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.R.P., D.E.C.)
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.)
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.)
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Johnson LA, Harmon SA, Yilmaz EC, Lin Y, Belue MJ, Merriman KM, Lay NS, Sanford TH, Sarma KV, Arnold CW, Xu Z, Roth HR, Yang D, Tetreault J, Xu D, Patel KR, Gurram S, Wood BJ, Citrin DE, Pinto PA, Choyke PL, Turkbey B. Automated prostate gland segmentation in challenging clinical cases: comparison of three artificial intelligence methods. Abdom Radiol (NY) 2024:10.1007/s00261-024-04242-7. [PMID: 38512516 DOI: 10.1007/s00261-024-04242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Automated methods for prostate segmentation on MRI are typically developed under ideal scanning and anatomical conditions. This study evaluates three different prostate segmentation AI algorithms in a challenging population of patients with prior treatments, variable anatomic characteristics, complex clinical history, or atypical MRI acquisition parameters. MATERIALS AND METHODS A single institution retrospective database was queried for the following conditions at prostate MRI: prior prostate-specific oncologic treatment, transurethral resection of the prostate (TURP), abdominal perineal resection (APR), hip prosthesis (HP), diversity of prostate volumes (large ≥ 150 cc, small ≤ 25 cc), whole gland tumor burden, magnet strength, noted poor quality, and various scanners (outside/vendors). Final inclusion criteria required availability of axial T2-weighted (T2W) sequence and corresponding prostate organ segmentation from an expert radiologist. Three previously developed algorithms were evaluated: (1) deep learning (DL)-based model, (2) commercially available shape-based model, and (3) federated DL-based model. Dice Similarity Coefficient (DSC) was calculated compared to expert. DSC by model and scan factors were evaluated with Wilcox signed-rank test and linear mixed effects (LMER) model. RESULTS 683 scans (651 patients) met inclusion criteria (mean prostate volume 60.1 cc [9.05-329 cc]). Overall DSC scores for models 1, 2, and 3 were 0.916 (0.707-0.971), 0.873 (0-0.997), and 0.894 (0.025-0.961), respectively, with DL-based models demonstrating significantly higher performance (p < 0.01). In sub-group analysis by factors, Model 1 outperformed Model 2 (all p < 0.05) and Model 3 (all p < 0.001). Performance of all models was negatively impacted by prostate volume and poor signal quality (p < 0.01). Shape-based factors influenced DL models (p < 0.001) while signal factors influenced all (p < 0.001). CONCLUSION Factors affecting anatomical and signal conditions of the prostate gland can adversely impact both DL and non-deep learning-based segmentation models.
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Affiliation(s)
- Latrice A Johnson
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Karthik V Sarma
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Corey W Arnold
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ziyue Xu
- NVIDIA Corporation, Santa Clara, CA, USA
| | | | - Dong Yang
- NVIDIA Corporation, Santa Clara, CA, USA
| | | | - Daguang Xu
- NVIDIA Corporation, Santa Clara, CA, USA
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
- Molecular Imaging Branch (B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892, USA.
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Lu X, Chandravanshi M, Sabbasani VR, Gaikwad S, Hughitt VK, Gyabaah-Kessie N, Scroggins BT, Das S, Myint W, Clapp ME, Schwieters CD, Dyba MA, Bolhuis DL, Koscielniak JW, Andresson T, Emanuele MJ, Brown NG, Matsuo H, Chari R, Citrin DE, Mock BA, Swenson RE, Walters KJ. A structure-based designed small molecule depletes hRpn13 Pru and a select group of KEN box proteins. Nat Commun 2024; 15:2485. [PMID: 38509117 PMCID: PMC10954691 DOI: 10.1038/s41467-024-46644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Proteasome subunit hRpn13 is partially proteolyzed in certain cancer cell types to generate hRpn13Pru by degradation of its UCHL5/Uch37-binding DEUBAD domain and retention of an intact proteasome- and ubiquitin-binding Pru domain. By using structure-guided virtual screening, we identify an hRpn13 binder (XL44) and solve its structure ligated to hRpn13 Pru by integrated X-ray crystallography and NMR to reveal its targeting mechanism. Surprisingly, hRpn13Pru is depleted in myeloma cells following treatment with XL44. TMT-MS experiments reveal a select group of off-targets, including PCNA clamp-associated factor PCLAF and ribonucleoside-diphosphate reductase subunit M2 (RRM2), that are similarly depleted by XL44 treatment. XL44 induces hRpn13-dependent apoptosis and also restricts cell viability by a PCLAF-dependent mechanism. A KEN box, but not ubiquitination, is required for XL44-induced depletion of PCLAF. Here, we show that XL44 induces ubiquitin-dependent loss of hRpn13Pru and ubiquitin-independent loss of select KEN box containing proteins.
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Affiliation(s)
- Xiuxiu Lu
- Protein Processing Section, Center for Structural Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Monika Chandravanshi
- Protein Processing Section, Center for Structural Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Venkata R Sabbasani
- Chemistry and Synthesis Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Snehal Gaikwad
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - V Keith Hughitt
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nana Gyabaah-Kessie
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Bradley T Scroggins
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sudipto Das
- Protein Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Wazo Myint
- Cancer Innovation Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Michelle E Clapp
- Genome Modification Core, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Charles D Schwieters
- Computational Biomolecular Magnetic Resonance Core, Laboratory of Chemical Physics, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Marzena A Dyba
- Biophysics Resource, Center for Structural Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Derek L Bolhuis
- Department of Biochemistry and Biophysics and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janusz W Koscielniak
- Basic Science Program, Leidos Biomedical Research Inc., NMR Facility for Biological Research, Center for Structural Biology, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Thorkell Andresson
- Protein Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Michael J Emanuele
- Department of Pharmacology and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicholas G Brown
- Department of Pharmacology and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hiroshi Matsuo
- Cancer Innovation Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Raj Chari
- Genome Modification Core, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Beverly A Mock
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Rolf E Swenson
- Chemistry and Synthesis Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kylie J Walters
- Protein Processing Section, Center for Structural Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA.
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Rydzewski NR, Shi Y, Li C, Chrostek MR, Bakhtiar H, Helzer KT, Bootsma ML, Berg TJ, Harari PM, Floberg JM, Blitzer GC, Kosoff D, Taylor AK, Sharifi MN, Yu M, Lang JM, Patel KR, Citrin DE, Sundling KE, Zhao SG. A platform-independent AI tumor lineage and site (ATLAS) classifier. Commun Biol 2024; 7:314. [PMID: 38480799 PMCID: PMC10937974 DOI: 10.1038/s42003-024-05981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
Histopathologic diagnosis and classification of cancer plays a critical role in guiding treatment. Advances in next-generation sequencing have ushered in new complementary molecular frameworks. However, existing approaches do not independently assess both site-of-origin (e.g. prostate) and lineage (e.g. adenocarcinoma) and have minimal validation in metastatic disease, where classification is more difficult. Utilizing gradient-boosted machine learning, we developed ATLAS, a pair of separate AI Tumor Lineage and Site-of-origin models from RNA expression data on 8249 tumor samples. We assessed performance independently in 10,376 total tumor samples, including 1490 metastatic samples, achieving an accuracy of 91.4% for cancer site-of-origin and 97.1% for cancer lineage. High confidence predictions (encompassing the majority of cases) were accurate 98-99% of the time in both localized and remarkably even in metastatic samples. We also identified emergent properties of our lineage scores for tumor types on which the model was never trained (zero-shot learning). Adenocarcinoma/sarcoma lineage scores differentiated epithelioid from biphasic/sarcomatoid mesothelioma. Also, predicted lineage de-differentiation identified neuroendocrine/small cell tumors and was associated with poor outcomes across tumor types. Our platform-independent single-sample approach can be easily translated to existing RNA-seq platforms. ATLAS can complement and guide traditional histopathologic assessment in challenging situations and tumors of unknown primary.
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Affiliation(s)
- Nicholas R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Yue Shi
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Chenxuan Li
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | | | - Hamza Bakhtiar
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Kyle T Helzer
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Matthew L Bootsma
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Tracy J Berg
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - John M Floberg
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Grace C Blitzer
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - David Kosoff
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Amy K Taylor
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Marina N Sharifi
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Joshua M Lang
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlin E Sundling
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA
- Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, WI, USA
| | - Shuang G Zhao
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA.
- Carbone Cancer Center, University of Wisconsin, Madison, WI, USA.
- William S. Middleton Veterans Hospital, Madison, WI, USA.
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Patel KR, Rydzewski NR, Schott E, Cooley-Zgela T, Ning H, Cheng J, Salerno K, Huang EP, Lindenberg L, Mena E, Choyke P, Turkbey B, Citrin DE. A Phase 1 Trial of Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer After Brachytherapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00323-7. [PMID: 38428681 DOI: 10.1016/j.ijrobp.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE NCT03253744 is a phase 1 trial with the primary objective to identify the maximum tolerated dose (MTD) of salvage stereotactic body radiation therapy (SBRT) in patients with local prostate cancer recurrence after brachytherapy. Additional objectives included biochemical control and imaging response. METHODS AND MATERIALS This trial was initially designed to test 3 therapeutic dose levels (DLs): 40 Gy (DL1), 42.5 Gy (DL2), and 45 Gy (DL3) in 5 fractions. Intensity modulation was used to deliver the prescription dose to the magnetic resonance imaging and prostate-specific membrane antigen-based positron emission tomography imaging-defined gross tumor volume while simultaneously delivering 30 Gy to an elective volume defined by the prostate gland. This phase 1 trial followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities were scored until trial completion at 2 years post-SBRT using Common Terminology Criteria for Adverse Events version 5.0. Escalation was halted if 2 dose limiting toxicities occurred, defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT or any grade ≥3 genitourinary (GU) or grade 4 gastrointestinal toxicity thereafter. RESULTS Between August 2018 and January 2023, 9 patients underwent salvage SBRT and were observed for a median of 22 months (Q1-Q3, 20-43 months). No grade 3 to 5 adverse events related to study treatment were observed; thus, no dose limiting toxicities occurred during the observation period. Escalation was halted by amendment given excellent biochemical control in DL1 and DL2 in the setting of a high incidence of clinically significant late grade 2 GU toxicity. Therefore, the MTD was considered 42.5 Gy in 5 fractions (DL2). One- and 2-year biochemical progression-free survival were 100% and 86%, representing a single patient in the trial cohort with biochemical failure (prostate-specific antigen [PSA] nadir + 2.0) at 20 months posttreatment. CONCLUSIONS The MTD of salvage SBRT for the treatment of intraprostatic radiorecurrence after brachytherapy was 42.5 Gy in 5 fractions producing an 86% 2-year biochemical progression-free survival rate, with 1 poststudy failure at 20 months. The most frequent clinically significant toxicity was late grade 2 GU toxicity.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Nicholas R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Erica Schott
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Holly Ning
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason Cheng
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Erich P Huang
- Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Belue MJ, Harmon SA, Yang D, An JY, Gaur S, Law YM, Turkbey E, Xu Z, Tetreault J, Lay NS, Yilmaz EC, Phelps TE, Simon B, Lindenberg L, Mena E, Pinto PA, Bagci U, Wood BJ, Citrin DE, Dahut WL, Madan RA, Gulley JL, Xu D, Choyke PL, Turkbey B. Deep Learning-Based Detection and Classification of Bone Lesions on Staging Computed Tomography in Prostate Cancer: A Development Study. Acad Radiol 2024:S1076-6332(24)00008-4. [PMID: 38262813 DOI: 10.1016/j.acra.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
RATIONALE AND OBJECTIVES Efficiently detecting and characterizing metastatic bone lesions on staging CT is crucial for prostate cancer (PCa) care. However, it demands significant expert time and additional imaging such as PET/CT. We aimed to develop an ensemble of two automated deep learning AI models for 1) bone lesion detection and segmentation and 2) benign vs. metastatic lesion classification on staging CTs and to compare its performance with radiologists. MATERIALS AND METHODS This retrospective study developed two AI models using 297 staging CT scans (81 metastatic) with 4601 benign and 1911 metastatic lesions in PCa patients. Metastases were validated by follow-up scans, bone biopsy, or PET/CT. Segmentation AI (3DAISeg) was developed using the lesion contours delineated by a radiologist. 3DAISeg performance was evaluated with the Dice similarity coefficient, and classification AI (3DAIClass) performance on AI and radiologist contours was assessed with F1-score and accuracy. Training/validation/testing data partitions of 70:15:15 were used. A multi-reader study was performed with two junior and two senior radiologists within a subset of the testing dataset (n = 36). RESULTS In 45 unseen staging CT scans (12 metastatic PCa) with 669 benign and 364 metastatic lesions, 3DAISeg detected 73.1% of metastatic (266/364) and 72.4% of benign lesions (484/669). Each scan averaged 12 extra segmentations (range: 1-31). All metastatic scans had at least one detected metastatic lesion, achieving a 100% patient-level detection. The mean Dice score for 3DAISeg was 0.53 (median: 0.59, range: 0-0.87). The F1 for 3DAIClass was 94.8% (radiologist contours) and 92.4% (3DAISeg contours), with a median false positive of 0 (range: 0-3). Using radiologist contours, 3DAIClass had PPV and NPV rates comparable to junior and senior radiologists: PPV (semi-automated approach AI 40.0% vs. Juniors 32.0% vs. Seniors 50.0%) and NPV (AI 96.2% vs. Juniors 95.7% vs. Seniors 91.9%). When using 3DAISeg, 3DAIClass mimicked junior radiologists in PPV (pure-AI 20.0% vs. Juniors 32.0% vs. Seniors 50.0%) but surpassed seniors in NPV (pure-AI 93.8% vs. Juniors 95.7% vs. Seniors 91.9%). CONCLUSION Our lesion detection and classification AI model performs on par with junior and senior radiologists in discerning benign and metastatic lesions on staging CTs obtained for PCa.
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Affiliation(s)
- Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Dong Yang
- NVIDIA Corporation, Santa Clara, California, USA (D.Y., Z.X., J.T., D.X.)
| | - Julie Y An
- Department of Radiology, University of California, San Diego, California, USA (J.Y.A.)
| | - Sonia Gaur
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA (S.G.)
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore (Y.M.L.)
| | - Evrim Turkbey
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA (E.T., B.J.W.)
| | - Ziyue Xu
- NVIDIA Corporation, Santa Clara, California, USA (D.Y., Z.X., J.T., D.X.)
| | - Jesse Tetreault
- NVIDIA Corporation, Santa Clara, California, USA (D.Y., Z.X., J.T., D.X.)
| | - Nathan S Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Benjamin Simon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (P.A.P.)
| | - Ulas Bagci
- Radiology and Biomedical Engineering Department, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (U.B.)
| | - Bradford J Wood
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA (E.T., B.J.W.); Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (B.J.W.)
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (D.E.C.)
| | - William L Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (W.L.D., R.A.M.)
| | - Ravi A Madan
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (W.L.D., R.A.M.)
| | - James L Gulley
- Center for Immuno-Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA (J.L.G.)
| | - Daguang Xu
- NVIDIA Corporation, Santa Clara, California, USA (D.Y., Z.X., J.T., D.X.)
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.)
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland, USA (M.J.B., S.A.H., N.S.L., E.C.Y., T.E.P., B.S., L.L., E.M., P.L.C., B.T.).
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Stracker TH, Osagie OI, Escorcia FE, Citrin DE. Exploiting the DNA Damage Response for Prostate Cancer Therapy. Cancers (Basel) 2023; 16:83. [PMID: 38201511 PMCID: PMC10777950 DOI: 10.3390/cancers16010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Prostate cancers that progress despite androgen deprivation develop into castration-resistant prostate cancer, a fatal disease with few treatment options. In this review, we discuss the current understanding of prostate cancer subtypes and alterations in the DNA damage response (DDR) that can predispose to the development of prostate cancer and affect its progression. We identify barriers to conventional treatments, such as radiotherapy, and discuss the development of new therapies, many of which target the DDR or take advantage of recurring genetic alterations in the DDR. We place this in the context of advances in understanding the genetic variation and immune landscape of CRPC that could help guide their use in future treatment strategies. Finally, we discuss several new and emerging agents that may advance the treatment of lethal disease, highlighting selected clinical trials.
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Affiliation(s)
- Travis H. Stracker
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (O.I.O.); (F.E.E.); (D.E.C.)
| | - Oloruntoba I. Osagie
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (O.I.O.); (F.E.E.); (D.E.C.)
| | - Freddy E. Escorcia
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (O.I.O.); (F.E.E.); (D.E.C.)
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (O.I.O.); (F.E.E.); (D.E.C.)
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10
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Roy S, Kishan AU, Morgan SC, Martinka L, Spratt DE, Sun Y, Malone J, Grimes S, Citrin DE, Malone S. Association of PSA kinetics after testosterone recovery with subsequent recurrence: secondary analysis of a phase III randomized controlled trial. World J Urol 2023; 41:3905-3911. [PMID: 37792009 DOI: 10.1007/s00345-023-04635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE After cessation of androgen deprivation therapy (ADT), testosterone gradually recovers to supracastrate levels (> 50 ng/dL). After this, rises in prostate-specific antigen (PSA) are often seen. However, it remains unknown whether early PSA kinetics after testosterone recovery are associated with subsequent biochemical recurrence (BCR). METHODS We performed a secondary analysis of a phase III randomized controlled trial in which newly diagnosed localized prostate cancer patients were randomly allocated to ADT for 6 months starting 4 months prior to or simultaneously with prostate RT. We calculated the PSA doubling time (PSADT) based on PSA values up to 18 months after supracastrate testosterone recovery. Competing risk regression was used to evaluate the association of PSADT with relative incidence of BCR, considering deaths as competing events. RESULTS Overall, 313 patients were eligible. Median PSADT was 8 months. Cumulative incidence of BCR at 10 years from supracastrate testosterone recovery was 19% and 11% in patients with PSADT < 8 months and ≥ 8 months (p = 0.03). Compared to patients with PSADT of < 4 months, patients with higher PSADT (sHR for PSADT 4 to < 8 months: 0.36 [95% CI 0.16-0.82]; 8 to < 12 months: 0.26 [0.08-0.91]; ≥ 12 months: 0.20 [0.07-0.56]) had lower risk of relative incidence of BCR. CONCLUSIONS Early PSA kinetics, within 18 months of recovery of testosterone to a supracastrate level, can predict for subsequent BCR. Taking account of early changes in PSA after testosterone recovery may allow for recognition of potential failures earlier in the disease course and thereby permit superior personalization of treatment.
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Affiliation(s)
- Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, 500 S Paulina St, Atrium Bldg, A-013, Chicago, IL, 60605, USA.
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA, Los Angeles, CA, USA
| | - Scott C Morgan
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Levi Martinka
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, UH-Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Yilun Sun
- Department of Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Julia Malone
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Scott Grimes
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Shawn Malone
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
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11
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Patel KR, Rydzewski NR, Schott E, Cooley-Zgela T, Ning H, Cheng J, Salerno K, Huang EP, Pinto PA, Lindenberg L, Mena E, Choyke P, Turkbey B, Citrin DE. A Phase 1 Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer. Pract Radiat Oncol 2023; 13:540-550. [PMID: 37442430 PMCID: PMC10782822 DOI: 10.1016/j.prro.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE NCT03253744 was a phase 1 trial to identify the maximum tolerated dose (MTD) of image-guided, focal, salvage stereotactic body radiation therapy (SBRT) for patients with locally radiorecurrent prostate cancer. Additional objectives included biochemical control and imaging response. METHODS AND MATERIALS The trial design included 3 dose levels (DLs): 40 Gy (DL1), 42.5 Gy (DL2), and 45 Gy (DL3) in 5 fractions delivered ≥48 hours apart. The prescription dose was delivered to the magnetic resonance- and prostate-specific membrane antigen imaging-defined tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities were scored until 2 years after completion of SBRT using Common Terminology Criteria for Adverse Events, version 5.0, criteria. Escalation was halted if 2 dose-limiting toxicities occurred, defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT and any grade 3 genitourinary (GU) or grade 4 gastrointestinal (GI) toxicity thereafter. RESULTS Between August 2018 and May 2022, 8 patients underwent salvage focal SBRT, with a median follow-up of 35 months. No dose-limiting toxic effects were observed on DL1. Two patients were enrolled in DL2 and experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) at the MTD (DL1). The most common toxicities observed were grade ≥2 GU toxicities, with only a single grade 2 GI toxicity and no grade ≥3 GI toxicities. One patient experienced biochemical failure (prostate-specific antigen nadir + 2.0) at 33 months. CONCLUSIONS The MTD for focal salvage SBRT for isolated intraprostatic radiorecurrence was 40 Gy in 5 fractions, producing a 100% 24-month biochemical progression free survival, with 1 poststudy failure at 33 months. The most frequent clinically significant toxicity was late grade ≥2 GU toxicity.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland.
| | - Nicholas R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Erica Schott
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Holly Ning
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Jason Cheng
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Erich P Huang
- Biometric Research Branch, National Cancer Institute, NIH, Rockville, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland
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12
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Yilmaz EC, Harmon SA, Belue MJ, Merriman KM, Phelps TE, Lin Y, Garcia C, Hazen L, Patel KR, Merino MJ, Wood BJ, Choyke PL, Pinto PA, Citrin DE, Turkbey B. Evaluation of a Deep Learning-based Algorithm for Post-Radiotherapy Prostate Cancer Local Recurrence Detection Using Biparametric MRI. Eur J Radiol 2023; 168:111095. [PMID: 37717420 PMCID: PMC10615746 DOI: 10.1016/j.ejrad.2023.111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To evaluate a biparametric MRI (bpMRI)-based artificial intelligence (AI) model for the detection of local prostate cancer (PCa) recurrence in patients with radiotherapy history. MATERIALS AND METHODS This study included post-radiotherapy patients undergoing multiparametric MRI and subsequent MRI/US fusion-guided and/or systematic biopsy. Histopathology results were used as ground truth. The recurrent cancer detection sensitivity of a bpMRI-based AI model, which was developed on a large dataset to primarily identify lesions in treatment-naïve patients, was compared to a prospective radiologist assessment using the Wald test. Subanalysis was conducted on patients stratified by the treatment modality (external beam radiation treatment [EBRT] and brachytherapy) and the prostate volume quartiles. RESULTS Of the 62 patients included (median age = 70 years; median PSA = 3.51 ng/ml; median prostate volume = 27.55 ml), 56 recurrent PCa foci were identified within 46 patients. The AI model detected 40 lesions in 35 patients. The AI model performance was lower than the prospective radiology interpretation (Rad) on a patient-(AI: 76.1% vs. Rad: 91.3%, p = 0.02) and lesion-level (AI: 71.4% vs. Rad: 87.5%, p = 0.01). The mean number of false positives per patient was 0.35 (range: 0-2). The AI model performance was higher in EBRT group both on patient-level (EBRT: 81.5% [22/27] vs. brachytherapy: 68.4% [13/19]) and lesion-level (EBRT: 79.4% [27/34] vs. brachytherapy: 59.1% [13/22]). In patients with gland volumes >34 ml (n = 25), detection sensitivities were 100% (11/11) and 94.1% (16/17) on patient- and lesion-level, respectively. CONCLUSION The reported bpMRI-based AI model detected the majority of locally recurrent prostate cancer after radiotherapy. Further testing including external validation of this model is warranted prior to clinical implementation.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Katie M Merriman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Charisse Garcia
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Lindsey Hazen
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States; Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, United States.
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13
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Patel K, Rydzewski NR, Schott EE, Cooley-Zgela TC, Ning H, Cheng JY, Pinto PA, Salerno KE, Lindenberg L, Mena E, Turkbey B, Choyke P, Citrin DE. A Phase I Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e426-e427. [PMID: 37785396 DOI: 10.1016/j.ijrobp.2023.06.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Locally recurrent prostate cancer after radiotherapy (RT) is an increasingly recognized entity with no standard management. NCT03253744 was a phase I trial with a primary objective of identifying the maximally tolerated dose (MTD) of a course of image-guided, focal, salvage stereotactic body radiotherapy (SBRT) for patients with local recurrence after prior definitive RT. Additional objectives included biochemical control and imaging response on mpMRI and 18F-DCFPyL (PSMA) PET/CT. MATERIALS/METHODS SBRT was prescribed to three dose levels (DLs): 40Gy (DL1), 42.5Gy (DL2), and 45Gy (DL3) in 5 fractions. The prescription dose was delivered to a PTV defined by mpMRI and PSMA imaging and biopsy confirmed tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities above baseline were scored using CTCAE v5.0 criteria for two years after completion of SBRT. Escalation was halted if 2 dose limiting toxicities (DLTs) were observed. DLTs were defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT, and any grade 3 GU or grade 4 GI toxicity thereafter. Imaging response was compared between baseline and 6-months by the Wilcoxon signed rank test. RESULTS Between 08/2018 and 05/2022, 8 patients underwent salvage SBRT to 11 intraprostatic lesions with a median follow-up of 27 months. No DLTs were observed on DL1. Two patients were enrolled on DL2 and both experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) on DL1, the MTD. The most common toxicities were grade 2 GU toxicities: acute urinary urgency/frequency, acute weak urinary stream, and noninfective cystitis. One patient at DL1 had a self-limited episode of grade 2 GI toxicity (proctitis). No grade 3 GI toxicities were observed. All but two patients achieved an undetectable PSA nadir. Only one of these experienced biochemical failure (nadir + 2.0) at 33 months with suspicion of distant metastatic failure on restaging PET/CT. Imaging response was demonstrated by MRI in all lesions with heterogeneity in volumetric response (6% to 100%). A significant (p<0.01) response on PSMA PET/CT was observed for all measured parameters (SUVMax, SUVMean, GTVPSMA, Total Lesion PSMA [SUVMean × GTVPSMA]). Of the 11 lesions, 1 (9%) demonstrated a complete response (CR) by MRI and 9 (82%) by PSMA PET/CT. A single lesion increased in volume by 0.06 cc (16%) at 6-month PSMA PET/CT compared to baseline in the only patient who did not achieve an undetectable PSA nadir and did not have imaging suggestive of distant failure. CONCLUSION On this phase I dose escalation study of salvage SBRT for isolated intraprostatic local failure after definitive RT, the MTD was 40Gy in 5 fractions. producing a 100% 24-month bPFS, with one late failure at 33 months occurring after the 24-month study period. The most frequent clinically significant toxicity was late grade 2 GU toxicity. Imaging response was demonstrated in all lesions on MRI and PSMA PET/CT with exception of a single lesion.
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Affiliation(s)
- K Patel
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - N R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - E E Schott
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - T C Cooley-Zgela
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - H Ning
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - J Y Cheng
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - P A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - K E Salerno
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - L Lindenberg
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - E Mena
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - B Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - P Choyke
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - D E Citrin
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
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Chung EJ, White A, Kwon S, Citrin DE. Differential Oxidative Stress Responses in Type II Airway Epithelial Cells Impact Premature Senescence and Lung Fibrosis Susceptibility. Int J Radiat Oncol Biol Phys 2023; 117:e223. [PMID: 37784907 DOI: 10.1016/j.ijrobp.2023.06.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation-Induced Pulmonary Fibrosis (RIPF) is a late toxicity characterized by premature senescence in Type II airway epithelial cells (AECII) and accumulation of alternatively activated (M2) macrophages. Differential susceptibility to RIPF is observed across mouse strains. Based on our prior study of the effects of macrophage variation on RIPF, we hypothesized that intrinsic differences in AECII oxidative stress response across mouse strains also impact susceptibility to RIPF. MATERIALS/METHODS Ten-week-old female mice from C57L, C57BL6 and C3H/HeN strains were exposed to thoracic irradiation (5x6 Gy, n>5 per group). Fifteen weeks after radiation, lung tissue was collected and examined with Masson-Trichrome staining (histologic changes) and β-galactosidase activity assay (senescence). AECII prepared from mice of each strain were exposed to irradiation. To assess differential gene expression, total RNA was extracted and assessed with a multiplex analysis platform and quantitative PCR. Senescence was assessed by β-galactosidase activity assay in primary AECII after irradiation or after co-culture with M2 macrophages polarized with IL13. RESULTS Susceptibility to radiation-induced lung injury, survival, and premature AECII senescence vary by mouse strain: C57L (fibrosis-prone), C57BL6J (-intermediate) and C3H/HeN (-resistant). Enriched AECII from each strain exhibited differential expression of genes related to inflammatory responses including SASP production after irradiation. Minimal increased expression of Il1r1 was observed in irradiated and unirradiated AECII from C3H/HeN, however Il1rn levels were markedly elevated in response to irradiation. The expression of Thioredoxin (Txn) and Thioredoxin reductase 1 (Txnrd1) in AECII from C3H/HeN was significantly higher than those observed in other strains. In Vivo, C3H/HeN mouse lungs exhibited the least premature senescence in AECII after irradiation. Premature senescence in AECII irradiated In Vitro or co-cultured with superoxide anion-producing M2 macrophages was substantially less in AECII from C3H/HeN compared to other strains. CONCLUSION A comparison of primary AECII from three different mouse strains identified intrinsic differences in expression of major inflammatory signaling (IL1R and IL1RN) and redox homeostasis status (TXN and TXNDR1) molecules. This study is the first to demonstrate that intrinsic differences in AECII impacts susceptibility to premature senescence and lung fibrosis after irradiation.
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Affiliation(s)
- E J Chung
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - A White
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - S Kwon
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - D E Citrin
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
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15
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Malone S, Morgan SC, Spratt DE, Sun Y, Le ATTH, Malone J, Grimes S, Kishan AU, Citrin DE, Roy S. Association of Prostate Specific Antigen Kinetics after Testosterone Recovery with Subsequent Recurrence: Secondary Analysis of a Phase III Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2023; 117:e414. [PMID: 37785369 DOI: 10.1016/j.ijrobp.2023.06.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The combination of short-term androgen deprivation therapy (ST-ADT) with prostate radiotherapy (RT) is a standard of care for patients with localized prostate cancer (LPCa). After cessation of ST-ADT, it takes about 8 to 10 months for the testosterone (T) to recover to supracastrate levels, which could drive changes in PSA kinetics. It largely remains unknown whether early changes in PSA kinetics after T recovery could predict for subsequent biochemical relapse. MATERIALS/METHODS We performed a secondary analysis of a phase III randomized controlled trial in which patients with newly diagnosed LPCa with Gleason score £7, clinical stage T1b to T3a, and PSA <30 ng/mL were randomly allocated to neoadjuvant and concurrent ADT for 6 months starting 4 months before prostate RT (76 Gy in 38 fractions over 7.5 weeks) or concurrent and adjuvant ADT for 6 months starting simultaneously with prostate RT. Clinical assessment and laboratory investigations were repeated 1 month after completion of ADT, every 4 months for the first 2 years, every 6 months for the next 3 years, and annually thereafter. We calculated the PSA doubling time (PSADT) based on PSA values up to 18 months after recovery of T to a supracastrate level (>50 ng/dL). Patients with ³3 PSA measurements after T recovery to supracastrate level were included in this analysis. Fine and Gray cumulative incidence of biochemical recurrence (BCR) was calculated in patients with PSADT at or above median versus below median. Deaths were considered as competing events. All endpoints were calculated from the time of T recovery to supracastrate level. Subdistribution hazard ratios (sHR) with 95% confidence intervals (CI) were estimated for association of PSADT with relative incidence of recurrence using competing risk regression after adjusting for tumor stage, pre-treatment PSA, Gleason score, treatment regimen, and age at randomization. RESULTS Overall, 311 patients were eligible for this analysis. Median PSADT was 8 months. Cumulative incidence of BCR at 10 years was 31.0% and 20.7% in patients with PSADT <8 months and ³8 months, respectively. Longer PSADT was associated with a significantly lower risk of cumulative incidence of BCR (sHR for PSADT as a continuous variable 0.43, 95% CI: 0.28-0.66; sHR for PSADT ³8 months 0.54, 95% CI: 0.30-0.99). After adjustment for time to recovery of T to supracastrate level in addition to the aforementioned variables, longer PSADT (³8 months) was associated with lower risk of cumulative incidence of BCR (sHR: 0.53, 95% CI: 0.27-1.01). CONCLUSION These findings suggest that early PSA kinetics within 18 months of recovery of T to a supracastrate level predict for subsequent biochemical failure. Taking account of early changes in PSA after testosterone recovery may allow for recognition of potential failures earlier in the disease course and thereby permit greater personalization of management decisions.
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Affiliation(s)
- S Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - S C Morgan
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - Y Sun
- University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH
| | - A T T H Le
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - J Malone
- Department of Radiation Oncology, Ottawa, ON, Canada
| | - S Grimes
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - A U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - D E Citrin
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD
| | - S Roy
- Rush University Medical Centre, Chicago, IL
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Pithadia KJ, Advani PG, Citrin DE, Bekelman JE, Withrow DR, Berrington de Gonzalez A, Morton LM, Schonfeld SJ. Comparing Risk for Second Primary Cancers After Intensity-Modulated vs 3-Dimensional Conformal Radiation Therapy for Prostate Cancer, 2002-2015. JAMA Oncol 2023; 9:1119-1123. [PMID: 37289449 PMCID: PMC10251240 DOI: 10.1001/jamaoncol.2023.1638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/28/2023] [Indexed: 06/09/2023]
Abstract
Importance Compared with 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT) can spare nearby tissue but may result in increased scatter radiation to distant normal tissue, including red bone marrow. It is unclear whether second primary cancer risk varies by radiotherapy type. Objective To evaluate whether radiotherapy type (IMRT vs 3DCRT) is associated with second primary cancer risk among older men treated for prostate cancer. Design, Setting, and Participants In this retrospective cohort study of a linked database of Medicare claims and Surveillance, Epidemiology, and End Results (SEER) Program population-based cancer registries (2002-2015), male patients aged 66 to 84 diagnosed with a first primary nonmetastatic prostate cancer from 2002 to 2013, as reported to SEER, and who received radiotherapy (IMRT and/or 3DCRT without proton therapy) within the first year following prostate cancer were identified. The data were analyzed from January 2022 through June 2022. Exposure Receipt of IMRT and 3DCRT, based on Medicare claims. Main Outcomes and Measures The association between radiotherapy type and development of a subsequent hematologic cancer at least 2 years after prostate cancer diagnosis or a subsequent solid cancer at least 5 years after prostate cancer diagnosis. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional regression. Results The study included 65 235 2-year first primary prostate cancer survivors (median [range] age, 72 [66-82] years; 82.2% White patients) and 45 811 5-year survivors with similar demographic characteristics (median [range] age, 72 [66-79] years; 82.4% White patients). Among 2-year prostate cancer survivors (median [range] follow-up, 4.6 [0.003-12.0] years), 1107 second hematologic cancers were diagnosed (IMRT, 603; 3DCRT, 504). Radiotherapy type was not associated with second hematologic cancers overall or any specific types evaluated. Among 5-year survivors (median [range] follow-up, 3.1 [0.003-9.0] years), 2688 men were diagnosed with a second primary solid cancer (IMRT, 1306; 3DCRT, 1382). The overall HR for IMRT vs 3DCRT was 0.91 (95% CI, 0.83-0.99). This inverse association was restricted to the earlier calendar year period of prostate cancer diagnosis (HR2002-2005 = 0.85; 95% CI, 0.76-0.94; HR2006-2010 = 1.14; 95% CI, 0.96-1.36), with a similar pattern observed for colon cancer (HR2002-2005 = 0.66; 95% CI, 0.46-0.94; HR2006-2010 = 1.06; 95% CI, 0.59-1.88). Conclusions and Relevance The results of this large, population-based cohort study suggest that IMRT for prostate cancer is not associated with an increased risk of second primary cancers, either solid or hematologic, and any inverse associations may be associated with calendar year of treatment.
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Affiliation(s)
- Kishan J. Pithadia
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pragati G. Advani
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin E. Bekelman
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Diana R. Withrow
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sara J. Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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17
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Ku AT, Shankavaram U, Trostel SY, Zhang H, Sater HA, Harmon SA, Carrabba NV, Liu Y, Wood BJ, Pinto PA, Choyke PL, Stoyanova R, Davicioni E, Pollack A, Turkbey B, Sowalsky AG, Citrin DE. Radiogenomic profiling of prostate tumors prior to external beam radiotherapy converges on a transcriptomic signature of TGF-β activity driving tumor recurrence. medRxiv 2023:2023.05.01.23288883. [PMID: 37205576 PMCID: PMC10187349 DOI: 10.1101/2023.05.01.23288883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Patients with localized prostate cancer have historically been assigned to clinical risk groups based on local disease extent, serum prostate specific antigen (PSA), and tumor grade. Clinical risk grouping is used to determine the intensity of treatment with external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT), yet a substantial proportion of patients with intermediate and high risk localized prostate cancer will develop biochemical recurrence (BCR) and require salvage therapy. Prospective identification of patients destined to experience BCR would allow treatment intensification or selection of alternative therapeutic strategies. Methods Twenty-nine individuals with intermediate or high risk prostate cancer were prospectively recruited to a clinical trial designed to profile the molecular and imaging features of prostate cancer in patients undergoing EBRT and ADT. Whole transcriptome cDNA microarray and whole exome sequencing were performed on pretreatment targeted biopsy of prostate tumors (n=60). All patients underwent pretreatment and 6-month post EBRT multiparametric MRI (mpMRI), and were followed with serial PSA to assess presence or absence of BCR. Genes differentially expressed in the tumor of patients with and without BCR were investigated using pathways analysis tools and were similarly explored in alternative datasets. Differential gene expression and predicted pathway activation were evaluated in relation to tumor response on mpMRI and tumor genomic profile. A novel TGF-β gene signature was developed in the discovery dataset and applied to a validation dataset. Findings Baseline MRI lesion volume and PTEN/TP53 status in prostate tumor biopsies correlated with the activation state of TGF-β signaling measured using pathway analysis. All three measures correlated with the risk of BCR after definitive RT. A prostate cancer-specific TGF-β signature discriminated between patients that experienced BCR vs. those that did not. The signature retained prognostic utility in an independent cohort. Interpretation TGF-β activity is a dominant feature of intermediate-to-unfavorable risk prostate tumors prone to biochemical failure after EBRT with ADT. TGF-β activity may serve as a prognostic biomarker independent of existing risk factors and clinical decision-making criteria. Funding This research was supported by the Prostate Cancer Foundation, the Department of Defense Congressionally Directed Medical Research Program, National Cancer Institute, and the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research.
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Affiliation(s)
- Anson T. Ku
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Uma Shankavaram
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Shana Y. Trostel
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Hong Zhang
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Houssein A. Sater
- Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | | | - Nicole V. Carrabba
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Yang Liu
- Veracyte, Inc., South San Francisco, CA, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, NIH Clinical Center, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
| | | | - Alan Pollack
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD, USA
| | - Adam G. Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, Bethesda, MD, USA
| | - Deborah E. Citrin
- Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, USA
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18
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Movsas B, Rodgers JP, Elshaikh MA, Martinez AA, Morton GC, Krauss DJ, Yan D, Citrin DE, Hershatter BW, Michalski JM, Ellis RJ, Kavadi VS, Gore EM, Gustafson GS, Schulz CA, Velker VM, Olson AC, Cury FL, Papagikos MA, Karrison TG, Sandler HM, Bruner DW. Dose-Escalated Radiation Alone or in Combination With Short-Term Total Androgen Suppression for Intermediate-Risk Prostate Cancer: Patient-Reported Outcomes From NRG/Radiation Therapy Oncology Group 0815 Randomized Trial. J Clin Oncol 2023:JCO2202389. [PMID: 37104723 DOI: 10.1200/jco.22.02389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To report patient-reported outcomes (PROs) of a phase III trial evaluating total androgen suppression (TAS) combined with dose-escalated radiation therapy (RT) for patients with intermediate-risk prostate cancer. METHODS Patients with intermediate-risk prostate cancer were randomly assigned to dose-escalated RT alone (arm 1) or RT plus TAS (arm 2) consisting of luteinizing hormone-releasing hormone agonist/antagonist with oral antiandrogen for 6 months. The primary PRO was the validated Expanded Prostate Cancer Index Composite (EPIC-50). Secondary PROs included Patient-Reported Outcome Measurement Information System (PROMIS)-fatigue and EuroQOL five-dimensions scale questionnaire (EQ-5D). PRO change scores, calculated for each patient as the follow-up score minus baseline score (at the end of RT and at 6, 12, and 60 months), were compared between treatment arms using a two-sample t test. An effect size of 0.50 standard deviation was considered clinically meaningful. RESULTS For the primary PRO instrument (EPIC), the completion rates were ≥86% through the first year of follow-up and 70%-75% at 5 years. For the EPIC hormonal and sexual domains, there were clinically meaningful (P < .0001) deficits in the RT + TAS arm. However, there were no clinically meaningful differences by 1 year between arms. There were also no clinically meaningful differences at any time points between arms for PROMIS-fatigue, EQ-5D, and EPIC bowel/urinary scores. CONCLUSION Compared with dose-escalated RT alone, adding TAS demonstrated clinically meaningful declines only in EPIC hormonal and sexual domains. However, even these PRO differences were transient, and there were no clinically meaningful differences between arms by 1 year.
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Affiliation(s)
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | | | - Gerard C Morton
- Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Di Yan
- William Beaumont Hospital, Royal Oak, MI
| | - Deborah E Citrin
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | | | - Rodney J Ellis
- Penn State Milton Hershey Medical Center, Hershey, PA
- Case Western Reserve University, Cleveland, OH
| | | | - Elizabeth M Gore
- Froedtert and the Medical College of Wisconsin and Zablocki VAMC, Milwaukee, WI
| | | | - Craig A Schulz
- Columbia Saint Mary's Water Tower Medical Commons, Milwaukee, WI
| | | | - Adam C Olson
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Fabio L Cury
- The Research Institute of the McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Michael A Papagikos
- Novant Health New Hanover Regional Medical Center-Zimmer Cancer Institute, Wilmington, NC
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Osagie OI, Smakk J, Citrin DE, Stracker TH. Abstract 4802: Identification of critical hypoxia induced factors in castrate resistant prostate cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Prostate cancer (PCa) is the second most diagnosed cancer in men and the second cause of cancer-related death amongst men worldwide. PCa is a heterogeneous disease, and the outcome is worse for patients when the disease progresses from localized PCa to a castrate-resistant disease. Androgen receptor (AR) signaling is crucial for PCa development and has been a major therapeutic target for decades. Despite the success made with hormone therapy to block AR signaling, castration resistant disease can arise through mutations and amplifications of the androgen receptor (AR) and AR splice variants (AR-Vs). Amongst them, AR-V7 and AR-V12 can promote AR signaling independent of androgen. Furthermore, prostate tumors are highly hypoxic due to abnormal tumor vasculature. Hypoxia influences the efficacy of local and systemic treatment strategies, such as radiotherapy, hormone therapy, and chemotherapy, resulting in poorer clinical outcomes for PCa patients. Therefore, a complete understanding of AR and AR variant function, as well as how they are modulated by hypoxia and therapy is warranted for developing new strategies to treat PCa.
Methods: To identify the transcriptional apparatus associated with the AR and its variants under normal and hypoxic conditions, we carried out Bio-ID proximity labeling mass spectrometry (BioID-MS). We generated stable androgen-independent human prostate cancer cell lines, PC-3 and DU145, expressing AR and the AR-V7 and AR-V12 variants fused to a MiniTurboID (MTID) enzyme. To delineate the AR proximal interaction network, we treated cells with androgen or vehicle for 3 hours and affinity-purified biotinylated proteins after the addition of biotin for the final 2 hours. Cells were grown in normoxia (20% O2) or treated with hypoxia (95% N2,5% CO2 and 0.5% O2) for 24 h. Nonspecific interactions were filtered using controls and statistical methods to identify high-confidence interactomes.
Results: BioID proximity labeling in PC3 cells identified several AR-associated proteins, including many knowninteractors, validating the approach. Hypoxic conditions led to a striking alteration in proximal interactions and many metabolic proteins were highly enriched with AR upon exposure of cells to hypoxia for 24h. Among these, phosphoglycerate kinase 1 (PGK1) was a top hit. PGK1 has been reported to interact with AR to mediate the expression of genes that regulates cell proliferation and apoptosis. Additionally, PGK1 has an essential role in metabolic reprogramming induced by c-MYC and HIF-1α, leading to enhanced tumorigenesis.
Conclusion: Bio-ID mass spectrometry was used to map the proximal interactome of AR and its variants, identifying novel interactions partners for further analysis. We found that hypoxia strongly alters interactors with the AR, and we identified PGK1 as a hypoxia induced AR interaction in PCA. Current work to functionally validate this interaction will be presented.
Citation Format: Oloruntoba I. Osagie, Jordann Smakk, Deborah E. Citrin, Travis H. Stracker. Identification of critical hypoxia induced factors in castrate resistant prostate cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4802.
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Chung EJ, White AO, Citrin DE. Methods to assess radiation-induced fibrosis in mice. Methods Cell Biol 2023; 180:113-126. [PMID: 37890925 DOI: 10.1016/bs.mcb.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Therapeutic radiation is used to treat a variety of cancers in organs and tissues throughout the body. Exposure of benign normal tissue to radiation can result in late injury in a subset of patients. Radiation induced fibrosis is one chronic, progressive late toxicity of radiation exposure that can occur in many organs and tissues, including skin and lung. Radiation fibrosis has few effective treatments. The process of radiation fibrosis is known to involve many mitogenic and immunomodulatory cytokines, inflammatory programs, and processes such as stem cell senescence. Murine models of radiation fibrosis can be used to evaluate agents that may prevent, mitigate, or treat this injury. Here, we provide a detailed protocol for the development of radiation induced dermal and pulmonary fibrosis in mice and describe protocols for the measurement of this injury in treated tissue.
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Affiliation(s)
- Eun Joo Chung
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Ayla O White
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.
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21
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Phelps TE, Harmon SA, Mena E, Lindenberg L, Shih JH, Citrin DE, Pinto PA, Wood BJ, Dahut WL, Gulley JL, Madan RA, Choyke PL, Turkbey B. Predicting Outcomes of Indeterminate Bone Lesions on 18F-DCFPyL PSMA PET/CT Scans in the Setting of High-Risk Primary or Recurrent Prostate Cancer. J Nucl Med 2023; 64:395-401. [PMID: 36265908 DOI: 10.2967/jnumed.122.264334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Indeterminate bone lesions (IBLs) on prostate-specific membrane antigen (PSMA) PET/CT are common. This study aimed to define variables that predict whether such lesions are likely malignant or benign using features on PSMA PET/CT. Methods: 18F-DCFPyL PET/CT imaging was performed on 243 consecutive patients with high-risk primary or biochemically recurrent prostate cancer. IBLs identified on PSMA PET/CT could not definitively be interpreted as benign or malignant. Medical records of patients with IBLs were reviewed to determine the ultimate status of each lesion. IBLs were deemed malignant or benign on the basis of evidence of progression or stability at follow-up, respectively, or by biopsy results; IBLs were deemed equivocal when insufficient or unclear evidence existed. Post hoc patient, lesion, and scan variables accounting for clustered data were evaluated using Wilcoxon rank-sum and χ2 tests to determine features that favored benign or malignant interpretation. Results: Overall, 98 IBLs within 267 bone lesions (36.7%) were identified in 48 of 243 patients (19.8%). Thirty-seven of 98 IBLs were deemed benign, and 42 were deemed malignant, of which 8 had histologic verification; 19 remained equivocal. Location and SUVmax categorical variables were predictive of IBL interpretation (P = 0.0201 and P = 0.0230, respectively). For IBLs with new interpretations, 34 of 37 (91.9%) considered benign showed an SUVmax of less than 5 or exhibited focal uptake without coexisting bone metastases; 37 of 42 (88.1%) deemed malignant demonstrated an SUVmax of at least 5 or were present with coexisting bone metastases. Logistic regression predicted IBLs with a high SUVmax (univariable: odds ratio [OR], 9.29 [P = 0.0016]; multivariable: OR, 13.87 [P = 0.0089]) or present with other bone metastases (univariable: OR, 9.87 [P = 0.0112]; multivariable: OR, 11.35 [P = 0.003]) to be malignant. Conclusion: IBLs on PSMA PET/CT are concerning; however, characterizing their location, SUV, and additional scan findings can aid interpretation. IBLs displaying an SUVmax of at least 5 or present with other bone metastases favor malignancy. IBLs without accompanying bone metastases that exhibit an SUVmax of less than 5 and are observed only in atypical locations favor benign processes. These guidelines may assist in the interpretation of IBLs on PSMA PET/CT.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland;
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joanna H Shih
- Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland.,Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - William L Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ravi A Madan
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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22
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Prasanna PGS, Aryankalayil M, Citrin DE, Coleman CN. Radiation-induced pulmonary fibrosis: roles of therapy-induced senescence and microRNAs. Int J Radiat Biol 2023:1-10. [PMID: 36763093 DOI: 10.1080/09553002.2023.2177768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE Progressive, irreversible radiation-induced pulmonary fibrosis (RIPF) is a clinically significant intermediate- to a late-occurring side effect of radiotherapy. Known mechanisms of RIPF include oxidative stress-induced activation of TGF-β with activation of SMAD signaling, TNF-α elaboration, and activation of the Angiotensin Converting Enzyme (ACE) mediated production of angiotensin II with resulting activation of profibrotic cytokine signaling and vasoconstriction. The pioneering work of John Moulder, to whom this paper is dedicated, and several of his colleagues demonstrated that inhibiting the conversion of ACE with drugs such as Captopril, Enalapril, and Losartan can ameliorate radiation fibrosis in various tissues. While this work led several groups to probe mechanism-based pharmacological mitigation of RIPF, in this article, we explore and discuss the roles of microRNAs (miRNA) and therapy-induced senescence (TIS) in the pathogenesis of and potential biomarkers for RIPF. CONCLUSION Our analysis of the published literature in the last decade on RIPF, miRNA, and TIS identifies TIS as a mechanism in the onset and progression of RIPF, which is regulated through several miRNAs. This work may lead to the discovery and development of the next generation of miRNA therapeutics and/or the repurposing of approved pharmaceutical agents and the development of early biomarker panels to predict RIPF.
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Affiliation(s)
- Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, Bethesda, MD, USA
| | | | - Deborah E Citrin
- Radiation Oncology Branch, The National Cancer Institute, Bethesda, MD, USA
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, Bethesda, MD, USA.,Radiation Oncology Branch, The National Cancer Institute, Bethesda, MD, USA.,Department of Health and Human Services, Administration for Strategic Preparedness and Response, Washington, DC, USA
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23
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Chung EJ, Kwon S, Shankavaram U, White AO, Das S, Citrin DE. Natural variation in macrophage polarization and function impact pneumocyte senescence and susceptibility to fibrosis. Aging (Albany NY) 2022; 14:7692-7717. [PMID: 36173617 PMCID: PMC9596223 DOI: 10.18632/aging.204309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
Abstract
Radiation-induced pulmonary fibrosis (RIPF), a late adverse event of radiation therapy, is characterized by infiltration of inflammatory cells, progressive loss of alveolar structure, secondary to the loss of pneumocytes and accumulation of collagenous extracellular matrix, and senescence of alveolar stem cells. Differential susceptibility to lung injury from radiation and other toxic insults across mouse strains is well described but poorly understood. The accumulation of alternatively activated macrophages (M2) has previously been implicated in the progression of lung fibrosis. Using fibrosis prone strain (C57L), a fibrosis-resistant strain (C3H/HeN), and a strain with intermediate susceptibility (C57BL6/J), we demonstrate that the accumulation of M2 macrophages correlates with the manifestation of fibrosis. A comparison of primary macrophages derived from each strain identified phenotypic and functional differences, including differential expression of NADPH Oxidase 2 and production of superoxide in response to M2 polarization and activation. Further, the sensitivity of primary AECII to senescence after coculture with M2 macrophages was strain dependent and correlated to observations of sensitivity to fibrosis and senescence in vivo. Taken together, these data support that the relative susceptibility of different strains to RIPF is closely related to distinct senescence responses induced through pulmonary M2 macrophages after thoracic irradiation.
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Affiliation(s)
- Eun Joo Chung
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Seokjoo Kwon
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Uma Shankavaram
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ayla O White
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shaoli Das
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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24
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Belue MJ, Harmon SA, Patel K, Daryanani A, Yilmaz EC, Pinto PA, Wood BJ, Citrin DE, Choyke PL, Turkbey B. Development of a 3D CNN-based AI Model for Automated Segmentation of the Prostatic Urethra. Acad Radiol 2022; 29:1404-1412. [PMID: 35183438 PMCID: PMC9339453 DOI: 10.1016/j.acra.2022.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVE The combined use of prostate cancer radiotherapy and MRI planning is increasingly being used in the treatment of clinically significant prostate cancers. The radiotherapy dosage quantity is limited by toxicity in organs with de-novo genitourinary toxicity occurrence remaining unperturbed. Estimation of the urethral radiation dose via anatomical contouring may improve our understanding of genitourinary toxicity and its related symptoms. Yet, urethral delineation remains an expert-dependent and time-consuming procedure. In this study, we aim to develop a fully automated segmentation tool for the prostatic urethra. MATERIALS AND METHODS This study incorporated 939 patients' T2-weighted MRI scans (train/validation/test/excluded: 657/141/140/1 patients), including in-house and public PROSTATE-x datasets, and their corresponding ground truth urethral contours from an expert genitourinary radiologist. The AI model was developed using MONAI framework and was based on a 3D-UNet. AI model performance was determined by Dice score (volume-based) and the Centerline Distance (CLD) between the prediction and ground truth centers (slice-based). All predictions were compared to ground truth in a systematic failure analysis to elucidate the model's strengths and weaknesses. The Wilcoxon-rank sum test was used for pair-wise comparison of group differences. RESULTS The overall organ-adjusted Dice score for this model was 0.61 and overall CLD was 2.56 mm. When comparing prostates with symmetrical (n = 117) and asymmetrical (n = 23) benign prostate hyperplasia (BPH), the AI model performed better on symmetrical prostates compared to asymmetrical in both Dice score (0.64 vs. 0.51 respectively, p < 0.05) and mean CLD (2.3 mm vs. 3.8 mm respectively, p < 0.05). When calculating location-specific performance, the performance was highest at the apex and lowest at the base location of the prostate for Dice and CLD. Dice location dependence: symmetrical (Apex, Mid, Base: 0.69 vs. 0.67 vs. 0.54 respectively, p < 0.05) and asymmetrical (Apex, Mid, Base: 0.68 vs. 0.52 vs. 0.39 respectively, p < 0.05). CLD location dependence: symmetrical (Apex, Mid, Base: 1.43 mm vs. 2.15 mm vs. 3.28 mm, p < 0.05) and asymmetrical (Apex, Mid, Base: 1.83 mm vs. 3.1 mm vs. 6.24 mm, p < 0.05). CONCLUSION We developed a fully automated prostatic urethra segmentation AI tool yielding its best performance in prostate glands with symmetric BPH features. This system can potentially be used to assist treatment planning in patients who can undergo whole gland radiation therapy or ablative focal therapy.
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Affiliation(s)
- Mason J Belue
- Molecular Imaging Branch (M.J.B., S.A.H., A.D., E.C.Y., P.L.C., B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Stephanie A Harmon
- Molecular Imaging Branch (M.J.B., S.A.H., A.D., E.C.Y., P.L.C., B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Krishnan Patel
- Radiation Oncology Branch (K.P., D.E.C.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Asha Daryanani
- Molecular Imaging Branch (M.J.B., S.A.H., A.D., E.C.Y., P.L.C., B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Enis Cagatay Yilmaz
- Molecular Imaging Branch (M.J.B., S.A.H., A.D., E.C.Y., P.L.C., B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch (P.A.P.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Radiology (B.J.W.), Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch (K.P., D.E.C.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Branch (M.J.B., S.A.H., A.D., E.C.Y., P.L.C., B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch (M.J.B., S.A.H., A.D., E.C.Y., P.L.C., B.T.), National Cancer Institute, National Institutes of Health, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, Maryland.
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25
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Mena E, Rowe SP, Shih JH, Lindenberg L, Turkbey B, Fourquet A, Lin FI, Adler S, Eclarinal P, McKinney YL, Citrin DE, Dahut W, Wood BJ, Chang R, Levy E, Merino M, Gorin MA, Pomper MG, Pinto PA, Eary JF, Choyke PL, Pienta KJ. Predictors of 18F-DCFPyL PET/CT Positivity in Patients with Biochemical Recurrence of Prostate Cancer After Local Therapy. J Nucl Med 2022; 63:1184-1190. [PMID: 34916246 PMCID: PMC9364352 DOI: 10.2967/jnumed.121.262347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023] Open
Abstract
Our objective was to investigate the factors predicting scan positivity and disease location in patients with biochemical recurrence (BCR) of prostate cancer (PCa) after primary local therapy using prostate-specific membrane antigen-targeted 18F-DCFPyL PET/CT. Methods: This was a 2-institution study including 245 BCR PCa patients after primary local therapy and negative results on conventional imaging. The patients underwent 18F-DCFPyL PET/CT. We tested for correlations of lesion detection rate and disease location with tumor characteristics, time from initial therapy, prostate-specific antigen (PSA) level, and PSA doubling time (PSAdt). Multivariate logistic regression analyses were used to determine predictors of a positive scan. Regression-based coefficients were used to develop nomograms predicting scan positivity and extrapelvic disease. Results: Overall, 79.2% (194/245) of patients had a positive 18F-DCFPyL PET/CT result, with detection rates of 48.2% (27/56), 74.3% (26/35), 84% (37/44), 96.7% (59/61), and 91.8% (45/49) for PSAs of <0.5, 0.5 to <1.0, 1.0 to <2.0, 2.0 to <5.0, and ≥5.0 ng/mL, respectively. Patients with lesions confined to the pelvis had lower PSAs than those with distant sites (1.6 ± 3.5 vs. 3.0 ± 6.3 ng/mL, P < 0.001). In patients treated with prostatectomy (n = 195), 24.1% (47/195) had a negative scan result, 46.1% (90/195) showed intrapelvic disease, and 29.7% (58/195) showed extrapelvic disease. In the postradiation subgroup (n = 50), 18F-DCFPyL PET/CT was always negative at a PSA lower than 1.0 ng/mL and extrapelvic disease was seen only when PSA was greater than 2.0 ng/mL. At multivariate analysis, PSA and PSAdt were independent predictive factors of scan positivity and the presence of extrapelvic disease in postsurgical patients, with area under the curve of 78% and 76%, respectively. PSA and PSAdt were independent predictors of the presence of extrapelvic disease in the postradiation cohort, with area under the curve of 85%. Time from treatment to scan was significantly longer for prostatectomy-bed-only recurrences than for those with bone or visceral disease (6.2 ± 6.4 vs. 2.4 ± 1.3 y, P < 0.001). Conclusion:18F-DCFPyL PET/CT offers high detection rates in BCR PCa patients. PSA and PSAdt are able to predict scan positivity and disease location. Furthermore, the presence of bone or visceral lesions is associated with shorter intervals from treatment than are prostate-bed-only recurrences. These tools might guide clinicians to select the most suitable candidates for 18F-DCFPyL PET/CT imaging.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven P. Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna H. Shih
- Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aloyse Fourquet
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Frank I. Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephen Adler
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Philip Eclarinal
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Yolanda L. McKinney
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E. Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J. Wood
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard Chang
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Elliot Levy
- Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael A. Gorin
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin G. Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Janet F. Eary
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kenneth J. Pienta
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Patel KR, Saad W, Heller T, Turkbey B, Citrin DE. Post-prostatectomy Radiotherapy in the Setting of a Rectal Vascular Malformation. Adv Radiat Oncol 2022; 7:101043. [PMID: 36060633 PMCID: PMC9436711 DOI: 10.1016/j.adro.2022.101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
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Pithadia K, Advani PG, Schonfeld SJ, Withrow D, Bekelman JE, Citrin DE, Berrington de González A, Morton LM. Evaluating risk for second primary cancers by radiotherapy technique in prostate cancer survivors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12005 Background: Radiotherapy-related adverse effects such as the development of subsequent neoplasms cause significant morbidity among prostate cancer survivors. Advances in radiotherapy techniques, including intensity-modulated radiation therapy (IMRT) and proton beam radiotherapy (PBRT), have aimed to reduce exposure to adjacent healthy tissues to reduce adverse effects. Initial reports based on small sample sizes and limited follow up (through 2011) have suggested reduced risks for subsequent colon and rectal cancers following IMRT compared to 3D conformal radiotherapy (CRT) for prostate cancer patients, but not for subsequent bladder cancer. We sought to extend previous reports with larger sample size and longer follow up. Methods: We conducted a retrospective cohort study within the linked database of Surveillance, Epidemiology and End Results (SEER) cancer registries and Medicare claims. The cohort included men diagnosed with first primary non-metastatic prostate cancer at ages 66-84 during 2002-2011; received initial IMRT, PBRT, or CRT; and survived without developing a second primary cancer ≥5 years after diagnosis (follow up through 2016). Cox regression models estimated risks of second primary solid tumors after IMRT and PBRT vs CRT, adjusting for age at prostate cancer diagnosis, tumor grade, race, Charlson comorbidity score, and receipt of initial prostate cancer therapy. Results: The cohort (median follow-up = 8.4 years) included 51,020 patients, of whom 19,536 received CRT alone, 29,868 received IMRT without PBRT, and 1,616 received PBRT. Compared to patients who received CRT (n = 1,348, 7.0%), both IMRT (n = 1,289, 4.3%; hazard ratio [HR] = 0.87; 95% confidence interval [CI], 0.80-0.95) and PBRT (n = 83, 5.1%; HR = 0.77; 95% CI 0.62-0.97) showed a decrease in risk of developing any second solid malignancy. In analyses by second cancer type, risks of colon cancer (HR = 0.70; 95%CI, 0.52-0.94) and bladder cancer (HR = 0.79; 95%CI, 0.65-0.97) were significantly lower after IMRT than CRT, whereas no association was observed for anorectal cancers (HR = 1.00; 95%CI, 0.65-1.53). Further investigation by time since prostate cancer diagnosis revealed a time-dependent decrease after IMRT compared to CRT in risk for bladder cancer (HRs = 0.94, 0.87, 0.61 for 5-7.4, 7.5-9.9, and 10+ years respectively) and anorectal cancer (HRs = 1.22, 0.97, 0.78), whereas the opposite trend was observed for colon cancer (HRs = 0.70, 0.68, 1.05). Conclusions: In this large cohort with increased follow-up time compared with previous reports, we observed reduced risk of colon and bladder cancer with IMRT overall, as well as time-dependent patterns for bladder and anorectal cancer that were consistent with improved tumor targeting. Further research is needed with larger sample sizes to evaluate long-term effects after PBRT. Our study supports the value of quantifying adverse effects as radiotherapy techniques evolve.
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Affiliation(s)
| | | | - Sara J Schonfeld
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Diana Withrow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Justin E. Bekelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Deborah E. Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Salerno KE, Turkbey B, Lindenberg L, Mena E, Schott EE, Brennan AK, Roy S, Shankavaram U, Patel K, Cooley-Zgela T, McKinney Y, Wood BJ, Pinto PA, Choyke P, Citrin DE. Detection of failure patterns using advanced imaging in patients with biochemical recurrence following low-dose-rate brachytherapy for prostate cancer. Brachytherapy 2022; 21:442-450. [PMID: 35523680 DOI: 10.1016/j.brachy.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE/OBJECTIVE(S) This study describes the pattern of failure in patients with biochemical (BCR) recurrence after low-dose-rate (LDR) brachytherapy as a component of definitive treatment for prostate cancer. METHODS Patients with BCR after LDR brachytherapy ± external beam radiation therapy (EBRT) were enrolled on prospective IRB approved advanced imaging protocols. Patients underwent 3T multiparametric MRI (mpMRI); a subset underwent prostate specific membrane antigen (PSMA)-based PET/CT. Pathologic confirmation was obtained unless contraindicated. RESULTS Between January 2011 and April 2021, 51 patients with BCR after brachytherapy (n = 36) or brachytherapy + EBRT (n = 15) underwent mpMRI and were included in this analysis. Of 38 patients with available dosimetry, only two had D90<90%. The prostate and seminal vesicles were a site of failure in 66.7% (n = 34) and 39.2% (n = 20), respectively. PET/CT (n = 32 patients) more often identified lesions pelvic lymph nodes (50%; n = 16) and distant metastases (18.8%; n = 6), than mpMRI. Isolated nodal disease (9.8%; n = 5) and distant metastases (n = 1) without local recurrence were uncommon. Recurrence within the prostate was located in the transition zone in 48.5%, central or midline in 45.5%, and anterior in 36.4% of patients. CONCLUSION In this cohort of patients with BCR after LDR brachytherapy ± EBRT, the predominant recurrence pattern was local (prostate ± seminal vesicles) with frequent occurrence in the anterior prostate and transition zone. mpMRI and PSMA PET/CT provided complementary information to localize sites of recurrence, with PSMA PET/CT often confirming mpMRI findings and identifying occult nodal or distant metastases.
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Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Esther Mena
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Erica E Schott
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alexandra K Brennan
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Soumyajit Roy
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Uma Shankavaram
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Krishnan Patel
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Theresa Cooley-Zgela
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Yolanda McKinney
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter Choyke
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Citrin DE, Schott E, Salerno K, Ning H, Pinto PA, Wood BJ, Lindenberg L, Mena E, Turkbey B. Successful Stereotactic Body Radiation Therapy for Postbrachytherapy Prostate Recurrence and Penile Bulb Metastasis. Adv Radiat Oncol 2022; 7:100860. [PMID: 35647400 PMCID: PMC9133405 DOI: 10.1016/j.adro.2021.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Erica Schott
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Holly Ning
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Peter A. Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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Patil S, Reedy JL, Scroggins BT, White AO, Kwon S, Shankavaram U, López-Coral A, Chung EJ, Citrin DE. Senescence-associated tumor growth is promoted by 12-Lipoxygenase. Aging (Albany NY) 2022; 14:1068-1086. [PMID: 35158337 PMCID: PMC8876904 DOI: 10.18632/aging.203890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
Radiation therapy is a commonly used treatment modality for cancer. Although effective in providing local tumor control, radiation causes oxidative stress, inflammation, immunomodulatory and mitogenic cytokine production, extracellular matrix production, and premature senescence in lung parenchyma. The senescence associated secretory phenotype (SASP) can promote inflammation and stimulate alterations in the surrounding tissue. Therefore, we hypothesized that radiation-induced senescent parenchymal cells in irradiated lung would enhance tumor growth. Using a murine syngeneic tumor model of melanoma and non-small cell lung cancer lung metastasis, we demonstrate that radiation causes a significant increase in markers of premature senescence in lung parenchyma within 4 to 8 weeks. Further, injection of B16F0 (melanoma) or Lewis Lung carcinoma (epidermoid lung cancer) cells at these time points after radiation results in an increase in the number and size of pulmonary tumor nodules relative to unirradiated mice. Treatment of irradiated mice with a senolytic agent (ABT-737) or agents that prevent senescence (rapamycin, INK-128) was sufficient to reduce radiation-induced lung parenchymal senescence and to mitigate radiation-enhanced tumor growth. These agents abrogated radiation-induced expression of 12-Lipoxygenase (12-LOX), a molecule implicated in several deleterious effects of senescence. Deficiency of 12-LOX prevented radiation-enhanced tumor growth. Together, these data demonstrate the pro-tumorigenic role of radiation-induced senescence, introduces the dual TORC inhibitor INK-128 as an effective agent for prevention of radiation-induced normal tissue senescence, and identifies senescence-associated 12-LOX activity as an important component of the pro-tumorigenic irradiated tissue microenvironment. These studies suggest that combining senotherapeutic agents with radiotherapy may decrease post-therapy tumor growth.
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Affiliation(s)
- Shilpa Patil
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jessica L Reedy
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bradley T Scroggins
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ayla O White
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Seokjoo Kwon
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Uma Shankavaram
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alfonso López-Coral
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eun Joo Chung
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Rowe LS, Mandia JJ, Salerno KE, Shankavaram UT, Das S, Escorcia FE, Ning H, Citrin DE. Bowel and bladder reproducibility in image guided radiation therapy for prostate cancer: Results of a patterns of practice survey. Adv Radiat Oncol 2022; 7:100902. [PMID: 35847548 PMCID: PMC9280021 DOI: 10.1016/j.adro.2022.100902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Optimal management of patients with prostate cancer (PCa) to achieve bowel and bladder reproducibility for radiation therapy (RT) and the appropriate planning target volume (PTV) expansions for use with modern image guidance is uncertain. We surveyed American Society of Radiation Oncology radiation oncologists to ascertain practice patterns for definitive PCa RT with respect to patient instructions and set up, daily image guidance, and subsequent PTV expansions. Methods and Materials A pattern of practice survey was sent to American Society of Radiation Oncology radiation oncologists who self-identified as specializing in PCa. Respondents identified the fractionation regimens routinely used, and their practices regarding diet, bowel, and bladder instructions for patients with PCa before RT simulation and throughout treatment. Questions regarding PTV margins, daily set up practices, and use of image guidance were included. Results Of 190 respondents, 158 reported using conventional fractionation (CFx), 49 moderate hypofractionation (MHFx), and 61 stereotactic body radiation therapy (SBRT). Diet modifications during RT were advised by 84% of respondents, treatment with full bladder by 96%, and bowel instructions by 78%. Prescription of bowel medication was higher for respondents using SBRT (95.1%) versus those using CFx/MHFx (55.1%; 34.7%). The most common implantable device reported was fiducial markers, with increased use in SBRT (86.0%; 68.9%) versus CFx/MHFx. Cone beam computed tomography was the most common daily imaging technique across fractionation regimens. SBRT showed correlation between PTV margin expansions, fiducial marker use, and image guidance. Conclusions Survey results indicate heterogeneity in treatment modality, dose, patient instructions, and PTV expansions used by radiation oncologists in the treatment of patients with PCa. Further investigation to define appropriate patient instructions on bowel preparation to maximize target reproducibility in PCa is needed, as is continued guidance on evidence-based approaches for image guidance and PTV margin selection.
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Owens JL, Beketova E, Liu S, Shen Q, Pawar JS, Asberry AM, Yang J, Deng X, Elzey BD, Ratliff TL, Cheng L, Choo CR, Citrin DE, Polascik TJ, Wang B, Huang J, Li C, Wan J, Hu CD. Targeting protein arginine methyltransferase 5 (PRMT5) suppresses radiation-induced neuroendocrine differentiation and sensitizes prostate cancer cells to radiation. Mol Cancer Ther 2022; 21:448-459. [PMID: 35027481 DOI: 10.1158/1535-7163.mct-21-0103] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/17/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
Prostate cancer remains the second leading cause of cancer death among American men. Radiation therapy (RT) is a potentially curative treatment for localized prostate cancer, and failure to control localized disease contributes to the majority of prostate cancer deaths. Neuroendocrine differentiation (NED) in prostate cancer, a process by which prostate adenocarcinoma cells transdifferentiate into neuroendocrine-like (NE-like) cells, is an emerging mechanism of resistance to cancer therapies and contributes to disease progression. NED also occurs in response to treatment to promote the development of treatment-induced neuroendocrine prostate cancer (NEPC), a highly-aggressive and terminal stage disease. We previously demonstrated that by mimicking clinical RT protocol, fractionated ionizing radiation (FIR) induces prostate cancer cells to undergo NED in vitro and in vivo. Here, we performed transcriptomic analysis and confirmed that FIR-induced NE-like cells share some features of clinical NEPC, suggesting that FIR-induced NED represents a clinically-relevant model. Further, we demonstrated that protein arginine methyltransferase 5 (PRMT5), a master epigenetic regulator of the DNA damage response and a putative oncogene in prostate cancer, along with its cofactors pICln and MEP50, mediate FIR-induced NED. Knockdown of PRMT5, pICln, or MEP50 during FIR-inhibited NED sensitized prostate cancer cells to radiation. Significantly, PRMT5 knockdown in prostate cancer xenograft tumors in mice during FIR prevented NED, enhanced tumor killing, significantly reduced and delayed tumor recurrence, and prolonged overall survival. Collectively, our results demonstrate that PRMT5 promotes FIR-induced NED and suggests that targeting PRMT5 may be a novel and effective radiosensitization approach for prostate cancer RT.
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Affiliation(s)
- Jake L Owens
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
| | - Elena Beketova
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
| | - Sheng Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine
| | - Qi Shen
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
| | - Jogendra Singh Pawar
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
| | - Andrew M Asberry
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
| | - Jie Yang
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
| | - Xuehong Deng
- Medicinal Chemistry and Molecular Pharmacolog, Purdue University West Lafayette
| | - Bennett D Elzey
- Department of Comparative Pathobiology, Purdue University West Lafayette
| | - Timothy L Ratliff
- Comparative Pathobiology and the Center for Cancer Research, Purdue University West Lafayette
| | - Liang Cheng
- Pathology and Laboratory Medicine, Indiana University School of Medicine
| | | | | | | | - Bangchen Wang
- Department of Pathology, Duke University School of Medicine
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine
| | | | - Jun Wan
- Medical and Molecular Genetics, Indiana University School of Medicine
| | - Chang-Deng Hu
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University West Lafayette
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Prasanna PG, Citrin DE, Hildesheim J, Ahmed MM, Venkatachalam S, Riscuta G, Xi D, Zheng G, van Deursen J, Goronzy J, Kron SJ, Anscher MS, Sharpless NE, Campisi J, Brown SL, Niedernhofer LJ, O’Loghlen A, Georgakilas AG, Paris F, Gius D, Gewirtz DA, Schmitt CA, Abazeed ME, Kirkland JL, Richmond A, Romesser PB, Lowe SW, Gil J, Mendonca MS, Burma S, Zhou D, Coleman CN. Therapy-Induced Senescence: Opportunities to Improve Anticancer Therapy. J Natl Cancer Inst 2021; 113:1285-1298. [PMID: 33792717 PMCID: PMC8486333 DOI: 10.1093/jnci/djab064] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Cellular senescence is an essential tumor suppressive mechanism that prevents the propagation of oncogenically activated, genetically unstable, and/or damaged cells. Induction of tumor cell senescence is also one of the underlying mechanisms by which cancer therapies exert antitumor activity. However, an increasing body of evidence from preclinical studies demonstrates that radiation and chemotherapy cause accumulation of senescent cells (SnCs) both in tumor and normal tissue. SnCs in tumors can, paradoxically, promote tumor relapse, metastasis, and resistance to therapy, in part, through expression of the senescence-associated secretory phenotype. In addition, SnCs in normal tissue can contribute to certain radiation- and chemotherapy-induced side effects. Because of its multiple roles, cellular senescence could serve as an important target in the fight against cancer. This commentary provides a summary of the discussion at the National Cancer Institute Workshop on Radiation, Senescence, and Cancer (August 10-11, 2020, National Cancer Institute, Bethesda, MD) regarding the current status of senescence research, heterogeneity of therapy-induced senescence, current status of senotherapeutics and molecular biomarkers, a concept of "one-two punch" cancer therapy (consisting of therapeutics to induce tumor cell senescence followed by selective clearance of SnCs), and its integration with personalized adaptive tumor therapy. It also identifies key knowledge gaps and outlines future directions in this emerging field to improve treatment outcomes for cancer patients.
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Affiliation(s)
| | | | | | | | | | | | - Dan Xi
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Guangrong Zheng
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Jorg Goronzy
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | | | | | | | | | - Laura J Niedernhofer
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Ana O’Loghlen
- Epigenetics & Cellular Senescence Group; Blizard Institute; Barts and The London School of Medicine and Dentistry; Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece
| | - Francois Paris
- Universite de Nantes, INSERM, CNRS, CRCINA, Nantes, France
| | - David Gius
- University of Texas Health Sciences Center, San Antonio, San Antonio, TX, USA
| | | | | | - Mohamed E Abazeed
- Johannes Kepler University, 4020, Linz, Austria
- Department of Radiation Oncology, Northwestern, Chicago, IL, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Ann Richmond
- Department of Pharmacology and Department of Veterans Affairs, Vanderbilt University, Nashville, TN, USA
| | - Paul B Romesser
- Translational Research Division, Department of Radiation Oncology and Early Drug Development Service, Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott W Lowe
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, and Howard Hughes Medical Institute, New York, NY, USA
| | - Jesus Gil
- MRC London Institute of Medical Sciences (LMS), and Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Du Cane Road, London, W12 ONN, UK
| | - Marc S Mendonca
- Departments of Radiation Oncology & Medical and Molecular Genetics, Indiana University School of Medicine, IUPUI, Indianapolis, IN 46202, USA
| | - Sandeep Burma
- Departments of Neurosurgery and Biochemistry & Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Daohong Zhou
- College of Pharmacy, University of Florida, Gainesville, FL, USA
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Masoudi S, Mehralivand S, Harmon SA, Lay N, Lindenberg L, Mena E, Pinto PA, Citrin DE, Gulley JL, Wood BJ, Dahut WL, Madan RA, Bagci U, Choyke PL, Turkbey B. Deep Learning Based Staging of Bone Lesions From Computed Tomography Scans. IEEE Access 2021; 9:87531-87542. [PMID: 34733603 PMCID: PMC8562651 DOI: 10.1109/access.2021.3074051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In this study, we formulated an efficient deep learning-based classification strategy for characterizing metastatic bone lesions using computed tomography scans (CTs) of prostate cancer patients. For this purpose, 2,880 annotated bone lesions from CT scans of 114 patients diagnosed with prostate cancer were used for training, validation, and final evaluation. These annotations were in the form of lesion full segmentation, lesion type and labels of either benign or malignant. In this work, we present our approach in developing the state-of-the-art model to classify bone lesions as benign or malignant, where (1) we introduce a valuable dataset to address a clinically important problem, (2) we increase the reliability of our model by patient-level stratification of our dataset following lesion-aware distribution at each of the training, validation, and test splits, (3) we explore the impact of lesion texture, morphology, size, location, and volumetric information on the classification performance, (4) we investigate the functionality of lesion classification using different algorithms including lesion-based average 2D ResNet-50, lesion-based average 2D ResNeXt-50, 3D ResNet-18, 3D ResNet-50, as well as the ensemble of 2D ResNet-50 and 3D ResNet-18. For this purpose, we employed a train/validation/test split equal to 75%/12%/13% with several data augmentation methods applied to the training dataset to avoid overfitting and to increase reliability. We achieved an accuracy of 92.2% for correct classification of benign vs. malignant bone lesions in the test set using an ensemble of lesion-based average 2D ResNet-50 and 3D ResNet-18 with texture, volumetric information, and morphology having the greatest discriminative power respectively. To the best of our knowledge, this is the highest ever achieved lesion-level accuracy having a very comprehensive data set for such a clinically important problem. This level of classification performance in the early stages of metastasis development bodes well for clinical translation of this strategy.
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Affiliation(s)
- Samira Masoudi
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sherif Mehralivand
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nathan Lay
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter A Pinto
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Deborah E Citrin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - James L Gulley
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bradford J Wood
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - William L Dahut
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ravi A Madan
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ulas Bagci
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
Radiation-induced lung injury encompasses radiation-induced pneumonitis, inflammation of the lung which may manifest as a dose-limiting acute or subacute toxicity, and radiation-induced lung fibrosis, a late effect of lung exposure to radiation. This review aims to highlight developments in molecular radiation biology of radiation-induced lung injury and their implications in clinical practice.
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Affiliation(s)
- Soumyajit Roy
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Kilian E Salerno
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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Rowe LS, Harmon S, Horn A, Shankavaram U, Roy S, Ning H, Lindenberg L, Mena E, Citrin DE, Choyke P, Turkbey B. Pattern of failure in prostate cancer previously treated with radical prostatectomy and post-operative radiotherapy: a secondary analysis of two prospective studies using novel molecular imaging techniques. Radiat Oncol 2021; 16:32. [PMID: 33568190 PMCID: PMC7874470 DOI: 10.1186/s13014-020-01733-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prostate Membrane Specific Antigen (PSMA) positron emission tomography (PET) and multiparametric MRI (mpMRI) have shown high accuracy in identifying recurrent lesions after definitive treatment in prostate cancer (PCa). In this study, we aimed to outline patterns of failure in a group of post-prostatectomy patients who received adjuvant or salvage radiation therapy (PORT) and subsequently experienced biochemical recurrence, using 18F-PSMA PET/CT and mpMRI. Methods PCa patients with biochemical failure post-prostatectomy, and no evident site of recurrence on conventional imaging, were enrolled on two prospective trials of first and second generation 18F-PSMA PET agents (18F-DCFBC and 18F-DCFPyL) in combination with MRI between October 2014 and December 2018. The primary aim of our study is to characterize these lesions with respect to their location relative to previous PORT field and received dose. Results A total of 34 participants underwent 18F-PSMA PET imaging for biochemical recurrence after radical prostatectomy and PORT, with 32/34 found to have 18F-PSMA avid lesions. On 18F-PSMA, 17/32 patients (53.1%) had metastatic disease, 8/32 (25.0%) patients had locoregional recurrences, and 7/32 (21.9%) had local failure in the prostate fossa. On further exploration, we noted 6/7 (86%) of prostate fossa recurrences were in-field and were encompassed by 100% isodose lines, receiving 64.8–72 Gy. One patient had marginal failure encompassed by the 49 Gy isodose. Conclusions 18F-PSMA PET imaging demonstrates promise in identifying occult PCa recurrence after PORT. Although distant recurrence was the predominant pattern of failure, in-field recurrence was noted in approximately 1/5th of patients. This should be considered in tailoring radiotherapy practice after prostatectomy. Trial registrationwww.clinicaltrials.gov, NCT02190279 and NCT03181867. Registered July 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02190279 and June 8 2017, https://clinicaltrials.gov/ct2/show/NCT03181867.
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Affiliation(s)
- Lindsay S Rowe
- Radiation Oncology Branch, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B2-3500, Bethesda, MD, 20892, USA. .,Department of Radiation Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada.
| | - Stephanie Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, 10 Center Drive Magnuson Clinical Center, Room B3B69F, Bethesda, MD, 20892, USA
| | - Adam Horn
- Walter Reed National Military Medical Center, Bethesda, MD, 8901 Rockville Pike, USA
| | - Uma Shankavaram
- Radiation Oncology Branch, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room 1002, Bethesda, MD, 20892, USA
| | - Soumyajit Roy
- Radiation Oncology Branch, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B2-3500, Bethesda, MD, 20892, USA
| | - Holly Ning
- Radiation Oncology Branch, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B2-3500, Bethesda, MD, 20892, USA
| | - Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B3B69F, Bethesda, MD, 20892, USA
| | - Esther Mena
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B3B69F, Bethesda, MD, 20892, USA
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B2-3500, Bethesda, MD, 20892, USA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B3B69F, Bethesda, MD, 20892, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, 10 Center Drive Magnuson Clinical Center, Room B3B69F, Bethesda, MD, 20892, USA
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Xie C, Duffy AG, Brar G, Fioravanti S, Mabry-Hrones D, Walker M, Bonilla CM, Wood BJ, Citrin DE, Gil Ramirez EM, Escorcia FE, Redd B, Hernandez JM, Davis JL, Gasmi B, Kleiner D, Steinberg SM, Jones JC, Greten TF. Correction: Immune Checkpoint Blockade in Combination with Stereotactic Body Radiotherapy in Patients with Metastatic Pancreatic Ductal Adenocarcinoma. Clin Cancer Res 2021; 27:358. [PMID: 33397682 DOI: 10.1158/1078-0432.ccr-20-4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lindenberg L, Mena E, Turkbey B, Shih JH, Reese SE, Harmon SA, Lim I, Lin F, Ton A, McKinney YL, Eclarinal P, Citrin DE, Dahut W, Madan R, Wood BJ, Krishnasamy V, Chang R, Levy E, Pinto P, Eary JF, Choyke PL. Evaluating Biochemically Recurrent Prostate Cancer: Histologic Validation of 18F-DCFPyL PET/CT with Comparison to Multiparametric MRI. Radiology 2020; 296:564-572. [PMID: 32633674 DOI: 10.1148/radiol.2020192018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Prostate cancer recurrence is found in up to 40% of men with prior definitive (total prostatectomy or whole-prostate radiation) treatment. Prostate-specific membrane antigen PET agents such as 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) may improve detection of recurrence compared with multiparametric MRI; however, histopathologic validation is lacking. Purpose To determine the sensitivity, specificity, and positive predictive value (PPV) of 18F-DCFPyL PET/CT based on histologic analysis and to compare with pelvic multiparametric MRI in men with biochemically recurrent prostate cancer. Materials and Methods Men were prospectively recruited after prostatectomy and/or radiation therapy with rising prostate-specific antigen level (median, 2.27 ng/mL; range, 0.2-27.45 ng/mL) and a negative result at conventional imaging (bone scan and/or CT). Participants underwent 18F-DCFPyL PET/CT imaging and 3.0-T pelvic multiparametric MRI. Statistical analysis included Wald and modified χ2 tests. Results A total of 323 lesions were visualized in 77 men by using 18F-DCFPyL or multiparametric MRI, with imaging detection concordance of 25% (82 of 323) when including all lesions in the MRI field of view and 53% (52 of 99) when only assessing prostate bed lesions. 18F-DCFPyL depicted more pelvic lymph nodes than did MRI (128 vs 23 nodes). Histologic validation was obtained in 80 locations with sensitivity, specificity, and PPV of 69% (25 of 36; 95% confidence interval [CI]: 51%, 88%), 91% (40 of 44; 95% CI: 74%, 98%), and 86% (25 of 29; 95% CI: 73%, 97%) for 18F-DCFPyL and 69% (24 of 35; 95% CI: 50%, 86%), 74% (31 of 42; 95% CI: 42%, 89%), and 69% (24 of 35; 95% CI: 50%, 88%) for multiparametric MRI (P = .95, P = .14, and P = .07, respectively). In the prostate bed, sensitivity, specificity, and PPV were 57% (13 of 23; 95% CI: 32%, 81%), 86% (18 of 21; 95% CI: 73%, 100%), and 81% (13 of 16; 95% CI: 59%, 100%) for 18F-DCFPyL and 83% (19 of 23; 95% CI: 59%, 100%), 52% (11 of 21; 95% CI: 29%, 74%), and 66% (19 of 29; 95% CI: 44%, 86%) for multiparametric MRI (P = .19, P = .02, and P = .17, respectively). The addition of 18F-DCFPyL to multiparametric MRI improved PPV by 38% overall (P = .02) and by 30% (P = .09) in the prostate bed. Conclusion Findings with 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) were histologically validated and demonstrated high specificity and positive predictive value. In the pelvis, 18F-DCFPyL depicted more lymph nodes and improved positive predictive value and specificity when added to multiparametric MRI. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zukotynski and Rowe in this issue.
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Affiliation(s)
- Liza Lindenberg
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Esther Mena
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Baris Turkbey
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Joanna H Shih
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Sarah E Reese
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Stephanie A Harmon
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Ilhan Lim
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Frank Lin
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Anita Ton
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Yolanda L McKinney
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Philip Eclarinal
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Deborah E Citrin
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - William Dahut
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Ravi Madan
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Bradford J Wood
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Venkatesh Krishnasamy
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Richard Chang
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Elliot Levy
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Peter Pinto
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Janet F Eary
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
| | - Peter L Choyke
- From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.)
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Masoudi S, Mehralivand S, Harmon S, Walker S, Pinto PA, Wood BJ, Citrin DE, Karzai F, Gulley JL, Madan RA, Dahut WL, Choyke PL, Turkbey B. Artificial intelligence assisted bone lesion detection and classification in computed tomography scans of prostate cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17567 Background: Patients diagnosed with prostate cancer undergo computed tomography (CT) for pretreatment staging to rule out bone metastases. However, detection and classification of bone lesions on CT is challenging and subject to inter-reader variability. We present a cascaded deep learning algorithm for automatic detection and classification of bone lesions on staging CT in patients diagnosed with prostate cancer. Methods: CT scans from 56 patients with histopathologically proven prostate cancer were included. An expert radiologist annotated the extent of individual bone lesions (N = 4217) and labelled all regions as either benign or malignant. All scans were anonymized and normalized at the patient-level prior to training. Our method can be described as a two-stage framework, 1) A detection algorithm: Inspired by Yolo-v3 detection method, we designed a network with a backbone of darknet-53 pretrained on Coco dataset and four final scaling blocks to compensate for wide range of lesion diameters, 2) A classification algorithm: we formed a binary classifier based on ResNet-50 pretrained using the ImageNet dataset. We used a train/validation split equal to 90%/10% for this study. To facilitate the learning process, horizontal flipping, relative zooming and mean weighted averaging were used for data augmentation in stage 1. Instead, the classification algorithm took advantage of synthesized patches generated by Deep Convolutional Generative Adversarial Network (DC-GAN) for augmentation. Results: We could achieve a real-time (~120ms per slice) performance on our validation set with a median penalty of 0.3(0.02-0.78) false positives per true positive within each patient. Overall performance of our detection algorithm was 81% sensitivity and 86% positive predictive value. In stage 2, we obtained an accuracy of 89% for correct classification of benign from malignant bone lesions with no augmentation which was improved to 91% when we incorporated the augmented data for training. Conclusions: Our 2-stage algorithm sequentially detects and classifies bone lesions on CT of prostate cancer patients with a significant performance. To further improve our results and for generalizability we are accruing more data from different centers. Eventually, with greater dataset, both algorithms will be cascaded and trained as a whole unit to become one single tool for fully automatic detection and classification which serves as an aid for radiologists who read the staging CTs.
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Affiliation(s)
- Samira Masoudi
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sherif Mehralivand
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute Frederick, Frederick, MD
| | - Stephanie Walker
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Deborah E. Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Fatima Karzai
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - James L. Gulley
- The National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Ravi Amrit Madan
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | - Peter L. Choyke
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Xie C, Duffy AG, Brar G, Fioravanti S, Mabry-Hrones D, Walker M, Bonilla CM, Wood BJ, Citrin DE, Gil Ramirez EM, Escorcia FE, Redd B, Hernandez JM, Davis JL, Gasmi B, Kleiner D, Steinberg SM, Jones JC, Greten TF. Immune Checkpoint Blockade in Combination with Stereotactic Body Radiotherapy in Patients with Metastatic Pancreatic Ductal Adenocarcinoma. Clin Cancer Res 2020; 26:2318-2326. [PMID: 31996388 DOI: 10.1158/1078-0432.ccr-19-3624] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/26/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The effectiveness of immune checkpoint inhibitors (ICI) is limited in pancreatic ductal adenocarcinoma (PDAC). We conducted a phase I study to evaluate the safety of ICI with stereotactic body radiation therapy (SBRT) in patients with metastatic PDAC. PATIENTS AND METHODS Patients enrolled must have received at least one line of prior systemic chemotherapy for metastatic disease. Cohorts A1 and A2 received durvalumab every 2 weeks plus either 8 Gy in one fraction of SBRT on day 1 or 25 Gy in five fractions on day -3 to +1. Cohorts B1 and B2 received durvalumab plus tremelimumab every 4 weeks and either 8 Gy in one fraction of SBRT on day 1 or 25 Gy in five fractions on day -3 to +1. ICIs were continued until unacceptable toxicity or disease progression. The primary objective was the safety and feasibility of treatment. Objective response was assessed in lesions not subjected to SBRT. RESULTS Fifty-nine patients were enrolled and 39 were evaluable for efficacy. No dose-limiting toxicities were seen. The most common adverse event was lymphopenia. Two patients achieved a partial response (one confirmed and the other unconfirmed). The overall response rate was 5.1%. Median PFS and OS was 1.7 months [95% confidence intervals (CI), 0.8-2.0 months] and 3.3 months (95% CI, 1.2-6.6 months) in cohort A1; 2.5 months (95% CI, 0.1-3.7 months) and 9.0 months (95% CI, 0.5-18.4 months) in A2; 0.9 months (95% CI, 0.7-2.1 months) and 2.1 months (95% CI, 1.1-4.3 months) in B1; and 2.3 months (95% CI, 1.9-3.4 months) and 4.2 months (95% CI, 2.9-9.3 months) in B2. CONCLUSIONS The combination of ICI and SBRT has an acceptable safety profile and demonstrates a modest treatment benefit in patients with metastatic PDAC.
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Affiliation(s)
- Changqing Xie
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Austin G Duffy
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Gagandeep Brar
- Hematology/Oncology Fellowship Program, National Heart, Lung, and Blood Institute, NCI, NIH, Bethesda, Maryland
| | - Suzanne Fioravanti
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Donna Mabry-Hrones
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Melissa Walker
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Cecilia Monge Bonilla
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Bradford J Wood
- Radiology and Imaging Sciences, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | | | - Freddy E Escorcia
- Radiation Oncology Branch, Laboratory of Molecular Radiotherapy, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Bernadette Redd
- Radiology and Imaging Sciences, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Billel Gasmi
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - David Kleiner
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Jennifer C Jones
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Tim F Greten
- Gastrointestinal Malignancy Section, Center for Cancer Research, NCI, NIH, Bethesda, Maryland. .,NCI CCR Liver Cancer Program, NIH, Bethesda, Maryland
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Abstract
Radiation therapy is one of the most commonly used treatments for cancer. Radiation modifiers are agents that alter tumor or normal tissue response to radiation, such as radiation sensitizers and radiation protectors. Radiation sensitizers target aspects of tumor molecular biology or physiology to enhance tumor cell killing after irradiation. Radioprotectors prevent damage of normal tissues selectively. Radiation modifiers remain largely investigational at present, with the promise that molecular characterization of tumors may enhance the capacity for successful clinical development moving forward. A variety of radiation modifiers are described.
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Affiliation(s)
- Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10 CRC, Room B2-3500, 10 Center Drive, Bethesda, MD 20892, USA.
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42
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Chung EJ, Reedy JL, Kwon S, Patil S, Valle L, White AO, Citrin DE. 12-Lipoxygenase is a Critical Mediator of Type II Pneumocyte Senescence, Macrophage Polarization and Pulmonary Fibrosis after Irradiation. Radiat Res 2019; 192:367-379. [PMID: 31373871 DOI: 10.1667/rr15356.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radiation-induced pulmonary fibrosis (RIPF) is a chronic, progressive complication of therapeutic irradiation of the thorax. It has been suggested that senescence of type II pneumocytes (AECIIs), an alveolar stem cell, plays a role in the development of RIPF through loss of replicative reserve and via senescent AECII-driven release of proinflammatory and profibrotic cytokines. Within this context, we hypothesized that arachidonate 12-lipoxygenase (12-LOX) is a critical mediator of AECII senescence and RIPF. Treatment of wild-type AECIIs with 12S-hydroxyeicosateraenoic acid (12S-HETE), a downstream product of 12-LOX, was sufficient to induce senescence in a NADPH oxidase 4 (NOX4)-dependent manner. Mice deficient in 12-LOX exhibited reduced AECII senescence, pulmonary collagen accumulation and accumulation of alternatively activated (M2) macrophages after thoracic irradiation (5 × 6 Gy) compared to wild-type mice. Conditioned media from irradiated or 12S-HETE-treated primary pneumocytes contained elevated levels of IL-4 and IL-13 compared to untreated pneumocytes. Primary macrophages treated with conditioned media from irradiated AECII demonstrated preferential M2 type polarization when AECIIs were derived from wild-type mice compared to 12-LOX-deficient mice. Together, these data identified 12-LOX as a critical component of RIPF and a therapeutic target for radiation-induced lung injury.
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Affiliation(s)
- Eun Joo Chung
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Jessica L Reedy
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Seokjoo Kwon
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Shilpa Patil
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Luca Valle
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Ayla O White
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
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He Y, Thummuri D, Zheng G, Okunieff P, Citrin DE, Vujaskovic Z, Zhou D. Cellular senescence and radiation-induced pulmonary fibrosis. Transl Res 2019; 209:14-21. [PMID: 30981698 PMCID: PMC6857805 DOI: 10.1016/j.trsl.2019.03.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/14/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Abstract
Radiation-induced pulmonary fibrosis (RIPF) is a serious treatment complication that affects about 9%-30% cancer patients receiving radiotherapy for thoracic tumors. RIPF is characterized by progressive and irreversible destruction of lung tissues and deterioration of lung function, which can compromise quality of life and eventually lead to respiratory failure and death. Unfortunately, the mechanisms by which radiation causes RIPF have not been well established nor has an effective treatment for RIPF been developed. Recently, an increasing body of evidence suggests that induction of senescence by radiation may play an important role in RIPF and clearance of senescent cells (SnCs) with a senolytic agent, small molecule that can selectively kill SnCs, has the potential to be developed as a novel therapeutic strategy for RIPF. This review discusses some of these new findings to promote further study on the role of cellular senescence in RIPF and the development of senolytic therapeutics for RIPF.
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Affiliation(s)
- Yonghan He
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Dinesh Thummuri
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Guangrong Zheng
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Paul Okunieff
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida
| | - Deborah E Citrin
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Zeljko Vujaskovic
- Department of Radiation Oncology, College of Medicine, University of Maryland, Baltimore, Maryland
| | - Daohong Zhou
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida.
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Mandia J, Escorcia F, Ning H, Salerno KE, Citrin DE, Rowe LS. Bowel and bladder reproducibility in image-guided SBRT prostate: Results of a patterns of practice survey. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
76 Background: Use of prostate stereotactic body radiotherapy (SBRT) as treatment for localized prostate cancer (PCa) is increasing. Given the high dose (>5Gy) per fraction (Fx) being delivered, SBRT requires careful preparation and delivery to ensure accuracy and precision. Guidelines and data on best practice for bowel and bladder preparation are lacking. Therefore, we surveyed practicing radiation oncologists (RO) to document practice patterns for prostate SBRT. Methods: From June to October 2018 we completed a nationwide survey of 1395 American Society for Therapeutic Radiology and Oncology (ASTRO) members who self-identified as managing PCa. A SurveyMonkey link was sent via email, and analysis included practicing RO who treat PCa with SBRT. Results: 204 responses were received with 32% (64/204) using SBRT. 80% (51/64) provided the fractionation used: 33% (17/51) use 35Gy to 36.25Gy, and 17.6% (9/51) use >40Gy in 5 Fx, and 1 used >9Gy Fx. 94% use implantable devices for localization (83% fiducial markers, 17% radiofrequency transponders). 65% (42/64) use a hydrogel spacer. 75% (48/64) use daily cone beam CT (CBCT) for image guidance. The majority use a 5 mm PTV, with 3 mm posteriorly. For bladder and bowel preparation 97% (62/64) provided preferences. For bladder, 90.3% (56/62) required a comfortably full bladder for both simulation and treatment. For simulation, 92% (57/62) have a bowel protocol (BP) to optimize rectal reproducibility. 51.6% (31/62) have patients empty their bowels prior, and 51.6% (31/62) prescribe a BP. Diet alteration was recommended by 77% (48/62). 86% (53/62) used a BP during SBRT treatment. Of those using a BP, 67% (43/64) continued it throughout SBRT with 30% (19/64) continuing BP unless symptoms change management. Only 3% (2/64) stop BP after simulation. Conclusions: The variability of data in the literature on effective BP for treatment reproducibility for PCa is reflected in the varied patterns of practice seen in our survey. Consensus on bladder preparation is seen for a majority of practitioners. A variety of BP regimens are employed.
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Affiliation(s)
- Jeremy Mandia
- Walter Reed National Military Medical Center, Bethesda, MD
| | - Freddy Escorcia
- National Cancer Institute/ National Institutes of Health, Bethesda, MD
| | - Holly Ning
- National Cancer Institute/ National Institutes of Health, Bethesda, MD
| | | | - Deborah E. Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lindsay S. Rowe
- National Cancer Institute/ National Institutes of Health, Bethesda, MD
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45
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Eke I, Makinde AY, Aryankalayil MJ, Reedy JL, Citrin DE, Chopra S, Ahmed MM, Coleman CN. Long-term Tumor Adaptation after Radiotherapy: Therapeutic Implications for Targeting Integrins in Prostate Cancer. Mol Cancer Res 2018; 16:1855-1864. [PMID: 30042176 PMCID: PMC6279542 DOI: 10.1158/1541-7786.mcr-18-0232] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/24/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
Adaptation of tumor cells to radiotherapy induces changes that are actionable by molecular targeted agents and immunotherapy. This report demonstrates that radiation-induced changes in integrin expression can be targeted 2 months later. Integrins are transmembrane cell adhesion molecules that are essential for cancer cell survival and proliferation. To analyze the short- and long-term effects of radiation on the integrin expression, prostate cancer cells (DU145, PC3, and LNCaP) were cultured in a 3D extracellular matrix and irradiated with either a single dose of radiation (2-10 Gy) or a multifractionated regimen (2-10 fractions of 1 Gy). Whole human genome microarrays, immunoblotting, immunoprecipitation assays, and immunofluorescence staining of integrins were performed. The results were confirmed in a prostate cancer xenograft model system. Interestingly, β1 and β4 integrins (ITGB1 and ITGB4) were upregulated after radiation in vitro and in vivo. This overexpression lasted for more than 2 months and was dose dependent. Moreover, radiation-induced upregulation of β1 and β4 integrin resulted in significantly increased tumor cell death after treatment with inhibitory antibodies. Combined, these findings indicate that long-term tumor adaptation to radiation can result in an increased susceptibility of surviving cancer cells to molecular targeted therapy due to a radiation-induced overexpression of the target. IMPLICATIONS: Radiation induces dose- and schedule-dependent adaptive changes that are targetable for an extended time; thus suggesting radiotherapy as a unique strategy to orchestrate molecular processes, thereby providing new radiation-drug treatment options within precision cancer medicine.
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Affiliation(s)
- Iris Eke
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Adeola Y Makinde
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Molykutty J Aryankalayil
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jessica L Reedy
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sunita Chopra
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mansoor M Ahmed
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - C Norman Coleman
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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46
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Scroggins BT, Matsuo M, White AO, Saito K, Munasinghe JP, Sourbier C, Yamamoto K, Diaz V, Mitchell JB, Krishna MC, Citrin DE. Abstract 4106: Hyperpolarized [1-13C]-pyruvate/lactate magnetic resonance spectroscopic imaging of prostate cancer in vivo predicts response to lactate dehydrogenase inhibition. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Non-invasive magnetic resonance spectroscopic imaging (MRSI) of hyperpolarized (HP) 13C-labeled pyruvate and its metabolite lactate is being used to monitor the metabolic flux in solid tumors. In this study, we evaluate the potential of MRSI of HP [1-13C]-pyruvate and [1-13C]-lactate, in prostate cancer as a predictive biomarker for targeting lactate dehydrogenase.
Experimental Design: Two human prostate cancer cell lines (DU145 and PC3) were grown as xenografts. The conversion of pyruvate to lactate in xenografts was measured, after intravenous delivery of hyperpolarized [1-13C] pyruvic acid, by MRSI. Steady state metabolomic analysis of xenograft tumors was performed by mass spectrometry and steady state lactate levels were measured with proton (1H) MRS. Perfusion and oxygenation of xenografts were measured with electron paramagnetic resonance (EPR) imaging. Tumor growth was assessed after lactate dehydrogenase (LDH) inhibition with FX-11 (42 µg/mouse/day for 5 days x 2 weekly cycles). Lactate production, pyruvate uptake, extracellular acidification rates and oxygen consumption of the prostate cancer cell lines was analyzed in vitro. Protein levels of glycolysis regulators were assessed with immunoblotting.
Results: DU145 tumors demonstrated an enhanced conversion of pyruvate to lactate with HP [1-13C] MRSI relative to PC3 tumors (21% higher 13C-lactate/pyruvate p<0.05). In addition, DU145 xenografts have a 42% (p<0.05) reduction in 13C-lactate/pyruvate after FX-11 treatment while PC3 xenografts demonstrate no sensitivity to FX-11 treatment. In correlation FX-11 significantly delayed DU145 tumor volume doubling time by 3.4 days (p<0.05). By comparison no difference was observed between DU145 and PC3 xenografts in steady state measures of lactate, oxygenation, or perfusion. The two cell lines also exhibited similar pyruvate uptake, lactate production, extracellular acidification and oxygen consumption rates and sensitivity to FX-11 in vitro. Difference in the expression of glycolysis regulators such as Hif-1α, LDHA, MCT1, MCT4, HK2 and PFKP were observed in vitro but did not correlate with HP [13C]-lactate/pyruvate MRSI results or FX-11 sensitivity.
Conclusions: Hyperpolarized [1-13C]-pyruvate MRSI of prostate cancer xenografts predicted the efficacy of targeting LDH when steady state markers of glycolysis, in vivo and in vitro, did not.
Citation Format: Bradley T. Scroggins, Masayuki Matsuo, Ayla O. White, Keita Saito, Jeeva P. Munasinghe, Carole Sourbier, Kazutoshi Yamamoto, Vivian Diaz, James B. Mitchell, Murali C. Krishna, Deborah E. Citrin. Hyperpolarized [1-13C]-pyruvate/lactate magnetic resonance spectroscopic imaging of prostate cancer in vivo predicts response to lactate dehydrogenase inhibition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4106.
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Affiliation(s)
| | | | | | | | | | | | | | - Vivian Diaz
- 2National Institute of Neurological Disorders and Stroke, Bethesda, MD
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47
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Abstract
Normal tissue injury from irradiation is an unfortunate consequence of radiotherapy. Technologic improvements have reduced the risk of normal tissue injury; however, toxicity causing treatment breaks or long-term side effects continues to occur in a subset of patients. The molecular events that lead to normal tissue injury are complex and span a variety of biologic processes, including oxidative stress, inflammation, depletion of injured cells, senescence, and elaboration of proinflammatory and profibrogenic cytokines. This article describes selected recent advances in normal tissue radiobiology.
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Affiliation(s)
- Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - James B Mitchell
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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48
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Harmon SA, Bergvall E, Mena E, Shih JH, Adler S, McKinney Y, Mehralivand S, Citrin DE, Couvillon A, Madan RA, Gulley JL, Mease RC, Jacobs PM, Pomper MG, Turkbey B, Choyke PL, Lindenberg ML. A Prospective Comparison of 18F-Sodium Fluoride PET/CT and PSMA-Targeted 18F-DCFBC PET/CT in Metastatic Prostate Cancer. J Nucl Med 2018; 59:1665-1671. [PMID: 29602821 DOI: 10.2967/jnumed.117.207373] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/21/2018] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to compare the diagnostic performance of 18F-DCFBC PET/CT, a first-generation 18F-labeled prostate-specific membrane antigen (PSMA)-targeted agent, and 18F-NaF PET/CT, a sensitive marker of osteoblastic activity, in a prospective cohort of patients with metastatic prostate cancer. Methods: Twenty-eight prostate cancer patients with metastatic disease on conventional imaging prospectively received up to 4 PET/CT scans. All patients completed baseline 18F-DCFBC PET/CT and 18F-NaF PET/CT scans, and 23 patients completed follow-up imaging, with a median follow-up interval of 5.7 mo (range, 4.2-12.6 mo). Lesion detection was compared across the 2 PET/CT agents at each time point. Detection and SUV characteristics of each PET/CT agent were compared with serum prostate-specific antigen (PSA) levels and treatment status at the time of baseline imaging using nonparametric statistical testing (Spearman correlation, Wilcoxon rank). Results: Twenty-six patients had metastatic disease detected on 18F-NaF or 18F-DCFBC at baseline, and 2 patients were negative on both scans. Three patients demonstrated soft tissue-only disease. Of 241 lesions detected at baseline, 56 were soft-tissue lesions identified by 18F-DCFBC only and 185 bone lesions detected on 18F-NaF or 18F-DCFBC. 18F-NaF detected significantly more bone lesions than 18F-DCFBC (P < 0.001). Correlation of PSA with patient-level SUV metrics was strong in 18F-DCFBC (ρ > 0.5, P < 0.01) and poor in 18F-NaF (ρ < 0.3, P > 0.1). When PSA levels were combined with treatment status, patients with below-median levels of PSA (<2 ng/mL) on androgen deprivation therapy (n = 11) demonstrated more lesions on 18F-NaF than 18F-DCFBC (P = 0.02). In PSA greater than 2 ng/mL, patients on androgen deprivation therapy (n = 8) showed equal to or more lesions on 18F-DCFBC than on 18F-NaF. Conclusion: The utility of PSMA-targeting imaging in metastatic prostate cancer appears to depend on patient disease course and treatment status. Compared with 18F-NaF PET/CT, 18F-DCFBC PET/CT detected significantly fewer bone lesions in the setting of early or metastatic castrate-sensitive disease on treatment. However, in advanced metastatic castrate-resistant prostate cancer, 18F-DCFBC PET/CT shows good concordance with NaF PET/CT.
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Affiliation(s)
- Stephanie A Harmon
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, Frederick, Maryland
| | - Ethan Bergvall
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joanna H Shih
- Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephen Adler
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Campus at Frederick, Frederick, Maryland
| | - Yolanda McKinney
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Anna Couvillon
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ravi A Madan
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ronnie C Mease
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Paula M Jacobs
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - M Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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49
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Scroggins BT, Matsuo M, White AO, Saito K, Munasinghe JP, Sourbier C, Yamamoto K, Diaz V, Takakusagi Y, Ichikawa K, Mitchell JB, Krishna MC, Citrin DE. Hyperpolarized [1- 13C]-Pyruvate Magnetic Resonance Spectroscopic Imaging of Prostate Cancer In Vivo Predicts Efficacy of Targeting the Warburg Effect. Clin Cancer Res 2018; 24:3137-3148. [PMID: 29599412 DOI: 10.1158/1078-0432.ccr-17-1957] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 03/20/2018] [Indexed: 12/26/2022]
Abstract
Purpose: To evaluate the potential of hyperpolarized [1-13C]-pyruvate magnetic resonance spectroscopic imaging (MRSI) of prostate cancer as a predictive biomarker for targeting the Warburg effect.Experimental Design: Two human prostate cancer cell lines (DU145 and PC3) were grown as xenografts. The conversion of pyruvate to lactate in xenografts was measured with hyperpolarized [1-13C]-pyruvate MRSI after systemic delivery of [1-13C] pyruvic acid. Steady-state metabolomic analysis of xenograft tumors was performed with mass spectrometry and steady-state lactate concentrations were measured with proton (1H) MRS. Perfusion and oxygenation of xenografts were measured with electron paramagnetic resonance (EPR) imaging with OX063. Tumor growth was assessed after lactate dehydrogenase (LDH) inhibition with FX-11 (42 μg/mouse/day for 5 days × 2 weekly cycles). Lactate production, pyruvate uptake, extracellular acidification rates, and oxygen consumption of the prostate cancer cell lines were analyzed in vitro LDH activity was assessed in tumor homogenates.Results: DU145 tumors demonstrated an enhanced conversion of pyruvate to lactate with hyperpolarized [1-13C]-pyruvate MRSI compared with PC3 and a corresponding greater sensitivity to LDH inhibition. No difference was observed between PC3 and DU145 xenografts in steady-state measures of pyruvate fermentation, oxygenation, or perfusion. The two cell lines exhibited similar sensitivity to FX-11 in vitro LDH activity correlated to FX-11 sensitivity.Conclusions: Hyperpolarized [1-13C]-pyruvate MRSI of prostate cancer predicts efficacy of targeting the Warburg effect. Clin Cancer Res; 24(13); 3137-48. ©2018 AACR.
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Affiliation(s)
- Bradley T Scroggins
- Radiation Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Masayuki Matsuo
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Ayla O White
- Radiation Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Keita Saito
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Jeeva P Munasinghe
- National Institute of Neurological Disorder and Stroke, NIH, Bethesda, Maryland
| | - Carole Sourbier
- Urologic Oncology Branch, Center for Cancer Research, NIH, Bethesda, Maryland
| | - Kazutoshi Yamamoto
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Vivian Diaz
- National Institute of Neurological Disorder and Stroke, NIH, Bethesda, Maryland
| | - Yoichi Takakusagi
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kazuhiro Ichikawa
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Nagasaki International University, Nagasaki, Japan
| | - James B Mitchell
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Murali C Krishna
- Radiation Biology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland.
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Valle LF, Greer MD, Shih JH, Barrett T, Law YM, Rosenkrantz AB, Shebel H, Muthigi A, Su D, Merino MJ, Wood BJ, Pinto PA, Krauze AV, Kaushal A, Choyke PL, Türkbey B, Citrin DE. Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy. Diagn Interv Radiol 2018; 24:46-53. [PMID: 29317377 PMCID: PMC5765929 DOI: 10.5152/dir.2018.17285] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy. METHODS A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling. RESULTS Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI. CONCLUSION This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.
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Affiliation(s)
- Luca F. Valle
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Matthew D. Greer
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Joanna H. Shih
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Tristan Barrett
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Yan Mee Law
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Andrew B. Rosenkrantz
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Haytham Shebel
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Akhil Muthigi
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Daniel Su
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Maria J. Merino
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Bradford J. Wood
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Peter A. Pinto
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Andra V. Krauze
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Aradhana Kaushal
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Peter L. Choyke
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Barış Türkbey
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Deborah E. Citrin
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
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