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Mmonu N, Kamdar N, Roach M, Sarma A, Makarov D, Zabar S, Breyer B. Disparities in the Delivery of Prostate Cancer Survivorship Care in the USA: A Claims-based Analysis of Urinary Adverse Events and Erectile Dysfunction Among Prostate Cancer Survivors. EUR UROL SUPPL 2024; 62:26-35. [PMID: 38585209 PMCID: PMC10998258 DOI: 10.1016/j.euros.2024.01.003] [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] [Accepted: 01/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Incidence rates for prostate cancer (PCa) diagnosis and mortality are higher for Black men. It is unknown whether similar disparities exist in survivorship care. We assessed the delivery and quality of survivorship care for Black men undergoing PCa therapy in terms of the burden of and treatment for urinary adverse events (UAEs) and erectile dysfunction (ED). Methods We queried Optum Clinformatics data for all patients diagnosed with PCa from January 1, 2002 to December 31, 2017 and identified those who underwent primary PCa treatment. Index cohorts were identified in each year and followed longitudinally until 2017. Data for UAE diagnoses, UAE treatments, and ED treatments were analyzed in index cohorts. Cox proportional-hazards regression models were used to examine associations of race with UAE diagnosis, UAE treatment, and ED treatment. Key findings and limitations We identified 146, 216 patients with a PCa diagnosis during the study period, of whom 55, 149 underwent primary PCa treatment. In the primary treatment group, 32.7% developed a UAE and 28.2% underwent UAE treatment. The most common UAEs were urinary incontinence (11%), ureteral obstruction/stricture (4.5%), bladder neck contracture (4.5%), and urethral stricture (3.7%). The most common UAE treatments were cystoscopy (13%), suprapubic tube placement (6%), and urethral dilation (5%). Overall, UAE diagnosis rates were higher for Black patients, who had significantly higher risk of urethral obstruction, rectourethral fistula, urinary incontinence, cystitis, urinary obstruction, and ureteral fistula. Overall, UAE treatment rates were lower for Black patients, who had significantly higher risk of fecal diversion and/or rectourethral fistula repair (adjusted hazard ratio [aHR] 1.71, 95% confidence interval [CI] 1.04-2.79). Regarding ED treatments, Black patients had higher risk of penile prosthesis placement (aHR 1.591, 95% CI 1.26-2.00) and intracavernosal injection (aHR 1.215, 95% CI 1.08-1.37). Conclusions and clinical implications Despite a high UAE burden, treatment rates were low in a cohort with health insurance. Black patients had a higher UAE burden and lower UAE treatment rates. Multilevel interventions are needed to address this stark disparity. ED treatment rates were higher for Black patients. Patient summary We reviewed data for patients treated for prostate cancer (PCa) and found that 32.7% were diagnosed with a urinary adverse event (UAE) following their PCa treatment. The overall treatment rate for these UAEs was 28.2%. Analysis by race showed that the UAE diagnosis rate was higher for Black patients, who were also more likely to receive treatment for erectile dysfunction.
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Affiliation(s)
- Nnenaya Mmonu
- Department of Urology, New York University School of Medicine, New York, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mack Roach
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Aruna Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Danil Makarov
- Department of Urology, New York University School of Medicine, New York, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Benjamin Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
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Mell LK, Pugh SL, Jones CU, Nelson TJ, Zakeri K, Rose BS, Zeitzer KL, Gore EM, Bahary JP, Souhami L, Michalski JM, Hartford AC, Mishra MV, Roach M, Parliament MB, Choi KN, Pisansky TM, Husain SM, Malone SC, Horwitz EM, Feng F. Effects of Androgen Deprivation Therapy on Prostate Cancer Outcomes According to Competing Event Risk: Secondary Analysis of a Phase 3 Randomised Trial. Eur Urol 2024; 85:373-381. [PMID: 36710205 PMCID: PMC10372191 DOI: 10.1016/j.eururo.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/19/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Previous studies indicate that the benefit of short-term androgen deprivation therapy (ADT) with radiotherapy (RT) for prostate cancer depends on competing risks. OBJECTIVE To determine whether a quantitative method to stratify patients by risk for competing events (omega score) could identify subgroups that selectively benefit from ADT. DESIGN, SETTING, AND PARTICIPANTS An ancillary analysis of NRG/RTOG 9408 phase 3 trial (NCT00002597) involving 1945 prostate cancer patients was conducted. INTERVENTION Short-term ADT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We applied generalised competing event regression models incorporating age, performance status, comorbidity, T category, Gleason score (GS), and prostate-specific antigen (PSA), to stratify patients according to relative hazards for primary cancer-related events (distant metastasis or prostate cancer death) versus competing noncancer mortality. We tested interactions between ADT and subgroups defined by standard risk criteria versus relative risk (RR) using the omega score. RESULTS AND LIMITATIONS T2b, higher GS, and higher PSA were associated with an increased RR for cancer-related versus competing mortality events (a higher omega score); increased age and comorbidity were associated with a decreased omega score. Of 996 patients with low-risk/favourable intermediate-risk (FIR) disease, 286 (28.7%) had a high omega score (≥0.314). Of 768 patients with unfavourable intermediate-risk disease, 175 (22.8%) had a low omega score. The overall discordance in risk classification was 26.1%. Both standard criteria and omega score identified significant interactions for the effect of ADT on cancer-related events and late mortality in low- versus high-risk subgroups. Within the low-risk/FIR subgroup, a higher omega score identified patients in whom ADT significantly reduced cancer events and improved event-free survival. Limitations are the need for external/prospective validation and lower RT doses than contemporary standards. CONCLUSIONS Stratification based on competing event risk is useful for identifying prostate cancer patients who selectively benefit from ADT. PATIENT SUMMARY We analysed the effectiveness of androgen deprivation therapy (ADT) for localised prostate cancer among patients, defined by the relative risk (RR) for cancer versus noncancer events. Among patients with traditional low-risk/favourable intermediate-risk disease, those with a higher RR benefitted from short-term ADT.
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Affiliation(s)
- Loren K Mell
- University of California San Diego, Moores Cancer Center, San Diego, CA, USA.
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | - Tyler J Nelson
- University of California San Diego, Moores Cancer Center, San Diego, CA, USA
| | - Kaveh Zakeri
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brent S Rose
- University of California San Diego, Moores Cancer Center, San Diego, CA, USA
| | | | - Elizabeth M Gore
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jean-Paul Bahary
- CHUM - Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Luis Souhami
- The Research Institute of the McGill University Health Centre (MUHC), Montreal, QC, Canada
| | | | - Alan C Hartford
- Dartmouth-Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Mark V Mishra
- University of Maryland/Greenebaum Cancer Center, Baltimore, MD, USA
| | - Mack Roach
- UCSF Medical Center-Mount Zion, San Francisco, CA, USA
| | | | - Kwang N Choi
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | | | | | | | | | - Felix Feng
- UCSF Medical Center-Mount Zion, San Francisco, CA, USA
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3
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Schaeffer EM, Srinivas S, Adra N, An Y, Bitting R, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Karnes RJ, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Szmulewitz R, Teply BA, Tward J, Valicenti R, Wong JK, Snedeker J, Freedman-Cass DA. Prostate Cancer, Version 3.2024. J Natl Compr Canc Netw 2024; 22:140-150. [PMID: 38626801 DOI: 10.6004/jnccn.2024.0019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions for the 2024 update to the guidelines with regard to initial risk stratification, initial management of very-low-risk disease, and the treatment of nonmetastatic recurrence.
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Affiliation(s)
| | | | - Nabil Adra
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- Yale Cancer Center/Smilow Cancer Hospital
| | | | - Brian Chapin
- The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | - Shilpa Gupta
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Tamara Lotan
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- University of California San Francisco Patient Services Committee
| | - Ahmad Shabsigh
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Black S, Roach M, Rappuoli R. Primary cancer prevention for cancers with no known infectious etiology: Time for a new paradigm. Vaccine 2024; 42:1906-1909. [PMID: 38365488 DOI: 10.1016/j.vaccine.2024.02.018] [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: 11/02/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
Vaccines developed for hepatitis B and human papilloma virus infections have been very successful in reducing the burden of cancer due to these infections. In the past decade, our understanding of the immunology of cancer has greatly improved and important progress has been made in the use of immunotherapy for several cancers. However, for the majority of cancers, an infectious etiology is either unknown or does not exist. Prostate cancer, for which no infectious etiology is known, is the most common cancer in men in the United States. Here we discuss the rationale for developing a preventive vaccine for prostate cancer, discuss a possible approach for further work in this area and a means of testing the effectiveness of a prostate cancer prevention vaccine in a clinical trial.
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Affiliation(s)
| | - Mack Roach
- Department of Radiation Oncology, University of California San Francisco, USA
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5
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Shaheen H, Salans MA, Mohamad O, Coleman PW, Ahmed S, Roach M. Age 70 +/- 5 Years and Cancer-Specific Outcomes After Treatment of Localized Prostate Cancer: A Systematic Review. Int J Radiat Oncol Biol Phys 2024; 118:672-681. [PMID: 37788716 DOI: 10.1016/j.ijrobp.2023.09.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
A secondary analysis of 2 randomized Radiation Therapy Oncology Group trials demonstrated that age ≥70 years was a favorable prognostic factor among men treated with external beam radiation therapy (EBRT). In contrast, several series based on men undergoing radical prostatectomy (RP) suggested that older age was an unfavorable prognostic factor. Our study was initiated to determine whether these observations reflect a true but paradoxical underlying age-related treatment-dependent biological phenomenon. We conducted a systematic review (PubMed, January 1, 1999-January 30, 2023) evaluating the effect of age on cancer-specific outcomes after definitive local treatment with either RP or EBRT. Our main objective was to assess possible interactions between age (using a cutoff of 70 +/- 5 years) and treatment type, with regard to adverse cancer-specific outcomes (eg, pathology, biochemical failure, distant metastasis, or prostate cancer-specific survival). Forty-five studies were selected for inclusion in this systematic review, including 30 and 15 studies with patients treated with RP and EBRT, respectively. Among patients treated with RP, 10 (50%) of these studies suggested that older age was associated with worse outcome(s) after RP. None suggested that age was a favorable prognostic factor after RP. Among the EBRT-based studies, 8 (53%) suggested that older age was associated with better outcomes, with an additional 3 studies (21%) trending to support a better outcome. None of these studies involving EBRT suggested that older age was an adverse prognostic factor. This systematic review suggests that age using a categorical cutoff of 70 +/- 5 years may be an adverse prognostic factor for men undergoing RP but a favorable prognostic factor for men treated with EBRT. Further research is needed to validate these findings.
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Affiliation(s)
- Haitham Shaheen
- Clinical Oncology, Suez Canal University Hospital, Ismailia, Egypt
| | - Mia A Salans
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Osama Mohamad
- Department of Genitourinary Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela W Coleman
- Division of Urology, Department of Surgery, Howard University Hospital, Washington, DC
| | - Soha Ahmed
- Clinical Oncology Department, Suez University, Suez, Egypt
| | - Mack Roach
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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6
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Wallner PE, Knisely JPS, Phillips TL, Roach M, Sahgal A, Steinberg ML. In Memoriam: David A. Larson, MD, PhD, FASTRO (December 17, 1940 - November 4, 2022). Int J Radiat Oncol Biol Phys 2024; 118:322-324. [PMID: 38220254 DOI: 10.1016/j.ijrobp.2023.10.034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 01/16/2024]
Affiliation(s)
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine Radiation Oncology, New York, New York
| | - Theodore L Phillips
- Department of Radiation Oncology, University of Arizona College of Medicine, Tucson, Arizona
| | - Mack Roach
- Department of Radiation Oncology, UCSF Health, San Francisco, California
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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7
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Mak KS, Scannell Bryan M, Dignam JJ, Shipley WU, Lin Y, Peters CA, Gore EM, Rosenthal SA, Zeitzer KL, D'Souza DP, Horwitz EM, Pisansky TM, Maier JM, Chafe SM, Robin TP, Roach M, Tran PT, Souhami L, Michalski JM, Hartford AC, Feng FY, Sandler HM, Efstathiou JA. Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202. Eur Urol Focus 2024:S2405-4569(24)00011-7. [PMID: 38307806 DOI: 10.1016/j.euf.2024.01.008] [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: 09/12/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) has been associated with coronary heart disease and myocardial infarction (MI) in prostate cancer patients, but controversy persists regarding its effects on cardiovascular mortality (CVM). OBJECTIVE We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202). DESIGN, SETTING, AND PARTICIPANTS From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c-T4, prostate-specific antigen <150 ng/ml) received radiotherapy with 4 mo (short-term [STADT]) versus 28 mo (longer-term [LTADT]) of ADT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Using the Fine-Gray and Cox regression models, the relationship between ADT and mortality was evaluated. RESULTS AND LIMITATIONS With a median follow-up of 19.6 yr, LTADT was associated with improved overall survival (OS) versus STADT (adjusted hazard ratio [HR] 0.88; p = 0.03) and prostate cancer survival (subdistribution HR [sHR] 0.70, p = 0.003). Comparing LTADT with STADT, prostate cancer mortality improved by 6.0% (15.6% [95% confidence interval 13.0-18.3%] vs 21.6% [18.6-24.7%]) at 15 yr, while CVM increased by 2.2% (14.9% [12.4-17.6%] vs 12.7% [10.4-15.3%]). In multivariable analyses, LTADT was not associated with increased CVM versus STADT (sHR 1.22 [0.93-1.59]; p = 0.15). An association between LTADT and MI death was detected (sHR 1.58 [1.00-2.50]; p = 0.05), particularly in patients with prevalent cardiovascular disease (CVD; sHR 2.54 [1.16-5.58]; p = 0.02). CONCLUSIONS With 19.6 yr of follow-up, LTADT was not significantly associated with increased CVM in men with locally advanced prostate cancer. Patients may have increased MI mortality with LTADT, particularly those with baseline CVD. Overall, there remained a prostate cancer mortality benefit and no OS detriment with LTADT. PATIENT SUMMARY In a long-term analysis of a large randomized prostate cancer trial, radiation with 28 mo of hormone therapy did not increase the risk of cardiovascular death significantly versus 4 mo of hormone therapy. Future studies are needed for patients with pre-existing heart disease, who may have an increased risk of myocardial infarction death with longer hormone use.
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Affiliation(s)
- Kimberley S Mak
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | | | - James J Dignam
- University of Chicago, Chicago, IL, USA; NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | - William U Shipley
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yue Lin
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Elizabeth M Gore
- Medical College of Wisconsin and the Zablocki Veteran Affairs Medical Center, Milwaukee, WI, USA
| | | | | | | | | | | | - Jordan M Maier
- Wayne State University-Karmanos Cancer Institute, Detroit, MI, USA
| | | | | | - Mack Roach
- University of California San Francisco, San Francisco, CA, USA
| | | | - Luis Souhami
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Alan C Hartford
- Dartmouth-Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Felix Y Feng
- University of California San Francisco, San Francisco, CA, USA
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Coleman CN, Wong R, Petereit DG, Maguire PD, Heron DE, Steinberg M, Bains Y, Vikram B, Angelis P, Livinski AA, Roach M, Govern FS. The National Cancer Institute's Cancer Disparities Research Partnership Program: a unique funding model 20 years later. J Natl Cancer Inst 2023; 115:1465-1474. [PMID: 37707545 PMCID: PMC10699796 DOI: 10.1093/jnci/djad173] [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: 03/01/2023] [Revised: 06/29/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
The burden of cancer and access to effective treatment are not experienced equally by all in the United States. For underserved populations that often access the health-care system when their cancers are in advanced disease stages, radiation oncology services are essential. In 2001, the National Cancer Institute's (NCI's) Radiation Research Program created and implemented the Cancer Disparities Research Partnership Program (CDRP). CDRP was a pioneering funding model whose goal was to increase participation of medically underserved populations in NCI clinical trials. CDRP's Cooperative Agreement funding supported for awardees the planning, development, and conduct of radiation oncology clinical research in institutions not traditionally involved in NCI-sponsored research and cared for a disproportionate number of medically underserved, health-disparities populations. The awardee secured and provided support for mentorship from 1 of 2 NCI comprehensive cancer centers named in its application. Six CDRP awards were made over two 5-year funding periods ending in 2013, with the end-of-program accomplishments previously reported. With the current focus on addressing equity, diversity, and inclusion, the 6 principal investigators were surveyed, 5 of whom responded about the impact of CDRP on their institutions, communities, and personal career paths. The survey that was emailed included 10 questions on a 5-point Likert scale. It was not possible to collect patient data this long after completion of the program. This article provides a 20-year retrospective of the experiences and observations from those principal investigators that can inform those now planning, building, and implementing equity, diversity, and inclusion programs.
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Affiliation(s)
- C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Rosemary Wong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Patrick D Maguire
- Coastal Carolina Radiation Oncology (Novant-New Hanover Regional Medical Center Radiation Oncology), Wilmington, NC, USA
| | | | - Michael Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | | | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Patricia Angelis
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Mack Roach
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco, CA, USA
| | - Frank S Govern
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Roach M, Coleman PW, Kittles R. Prostate Cancer, Race, and Health Disparity: What We Know. Cancer J 2023; 29:328-337. [PMID: 37963367 DOI: 10.1097/ppo.0000000000000688] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Prostate cancer (PCa) in African American men is one of the most common cancers with a great disparity in outcomes. The higher incidence and tendency to present with more advanced disease have prompted investigators to postulate that this is a problem of innate biology. However, unequal access to health care and poorer quality of care raise questions about the relative importance of genetics versus social/health injustice. Although race is inconsistent with global human genetic diversity, we need to understand the sociocultural reality that race and racism impact biology. Genetic studies reveal enrichment of PCa risk alleles in populations of West African descent and population-level differences in tumor immunology. Structural racism may explain some of the differences previously reported in PCa clinical outcomes; fortunately, there is high-level evidence that when care is comparable, outcomes are comparable.
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Affiliation(s)
- Mack Roach
- From the Particle Therapy Research Program & Outreach, Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Pamela W Coleman
- Department of Surgery/Obstetrics-Gynecology, Howard University College of Medicine, Washington, DC
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10
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Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, Bryce A, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Netto G, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Teply BA, Tward J, Valicenti R, Wong JK, Shead DA, Snedeker J, Freedman-Cass DA. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:1067-1096. [PMID: 37856213 DOI: 10.6004/jnccn.2023.0050] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
The NCCN Guidelines for Prostate Cancer provide a framework on which to base decisions regarding the workup of patients with prostate cancer, risk stratification and management of localized disease, post-treatment monitoring, and treatment of recurrence and advanced disease. The Guidelines sections included in this article focus on the management of metastatic castration-sensitive disease, nonmetastatic castration-resistant prostate cancer (CRPC), and metastatic CRPC (mCRPC). Androgen deprivation therapy (ADT) with treatment intensification is strongly recommended for patients with metastatic castration-sensitive prostate cancer. For patients with nonmetastatic CRPC, ADT is continued with or without the addition of certain secondary hormone therapies depending on prostate-specific antigen doubling time. In the mCRPC setting, ADT is continued with the sequential addition of certain secondary hormone therapies, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies. The NCCN Prostate Cancer Panel emphasizes a shared decision-making approach in all disease settings based on patient preferences, prior treatment exposures, the presence or absence of visceral disease, symptoms, and potential side effects.
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Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - Alan Bryce
- 7Mayo Clinic Comprehensive Cancer Center
| | - Brian Chapin
- 8The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 11UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 10Dana-Farber/Brigham and Women's Cancer Center | Mass General Cancer Center
| | - Shilpa Gupta
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 16Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Tamara Lotan
- 20The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 22University of Michigan Rogel Cancer Center
| | | | | | | | - Mack Roach
- 26UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 28University of California San Francisco, Patient Services Committee Chair
| | - Ahmad Shabsigh
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Roach M, Chapman C, Coleman PW. Racism Might Cause Prostate Cancer and Definitely Causes Excess Unemployment, Lost Wages, and Excess Cancer Deaths. J Clin Oncol 2023; 41:4595-4597. [PMID: 37428995 DOI: 10.1200/jco.23.00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/11/2023] [Accepted: 03/31/2023] [Indexed: 07/12/2023] Open
Affiliation(s)
- Mack Roach
- Mack Roach III, MD, FACR, FASTRO, FASCO, Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Christina Chapman, MD, MS, Department of Radiation Oncology, Section of Health Services Research, Baylor College of Medicine, Houston, TX Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; and Pamela W. Coleman, MD, FACS, FPMRS, Department of Surgery/OB GYN, Howard University College of Medicine, Washington, DC
| | - Christina Chapman
- Mack Roach III, MD, FACR, FASTRO, FASCO, Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Christina Chapman, MD, MS, Department of Radiation Oncology, Section of Health Services Research, Baylor College of Medicine, Houston, TX Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; and Pamela W. Coleman, MD, FACS, FPMRS, Department of Surgery/OB GYN, Howard University College of Medicine, Washington, DC
| | - Pamela W Coleman
- Mack Roach III, MD, FACR, FASTRO, FASCO, Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Christina Chapman, MD, MS, Department of Radiation Oncology, Section of Health Services Research, Baylor College of Medicine, Houston, TX Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; and Pamela W. Coleman, MD, FACS, FPMRS, Department of Surgery/OB GYN, Howard University College of Medicine, Washington, DC
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12
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Sabbagh A, Washington SL, Tilki D, Hong JC, Feng J, Valdes G, Chen MH, Wu J, Huland H, Graefen M, Wiegel T, Böhmer D, Cowan JE, Cooperberg M, Feng FY, Roach M, Trock BJ, Partin AW, D'Amico AV, Carroll PR, Mohamad O. Development and External Validation of a Machine Learning Model for Prediction of Lymph Node Metastasis in Patients with Prostate Cancer. Eur Urol Oncol 2023; 6:501-507. [PMID: 36868922 DOI: 10.1016/j.euo.2023.02.006] [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: 09/13/2022] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Pelvic lymph node dissection (PLND) is the gold standard for diagnosis of lymph node involvement (LNI) in patients with prostate cancer. The Roach formula, Memorial Sloan Kettering Cancer Center (MSKCC) calculator, and Briganti 2012 nomogram are elegant and simple traditional tools used to estimate the risk of LNI and select patients for PLND. OBJECTIVE To determine whether machine learning (ML) can improve patient selection and outperform currently available tools for predicting LNI using similar readily available clinicopathologic variables. DESIGN, SETTING, AND PARTICIPANTS Retrospective data for patients treated with surgery and PLND between 1990 and 2020 in two academic institutions were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We trained three models (two logistic regression models and one gradient-boosted trees-based model [XGBoost]) on data provided from one institution (n = 20267) with age, prostate-specific antigen (PSA) levels, clinical T stage, percentage positive cores, and Gleason scores as inputs. We externally validated these models using data from another institution (n = 1322) and compared their performance to that of the traditional models using the area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis (DCA). RESULTS AND LIMITATIONS LNI was present in 2563 patients (11.9%) overall, and in 119 patients (9%) in the validation data set. XGBoost had the best performance among all the models. On external validation, its AUC outperformed that of the Roach formula by 0.08 (95% confidence interval [CI] 0.042-0.12), the MSKCC nomogram by 0.05 (95% CI 0.016-0.070), and the Briganti nomogram by 0.03 (95% CI 0.0092-0.051; all p < 0.05). It also had better calibration and clinical utility in terms of net benefit on DCA across relevant clinical thresholds. The main limitation of the study is its retrospective design. CONCLUSIONS Taking all measures of performance together, ML using standard clinicopathologic variables outperforms traditional tools in predicting LNI. PATIENT SUMMARY Determining the risk of cancer spread to the lymph nodes in patients with prostate cancer allows surgeons to perform lymph node dissection only in patients who need it and avoid the side effects of the procedure in those who do not. In this study, we used machine learning to develop a new calculator to predict the risk of lymph node involvement that outperformed traditional tools currently used by oncologists.
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Affiliation(s)
- Ali Sabbagh
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Samuel L Washington
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julian C Hong
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Jean Feng
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Jing Wu
- Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, USA
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Wiegel
- Department of Radio Oncology, University Hospital Ulm, Ulm, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Janet E Cowan
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Matthew Cooperberg
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA; Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Mack Roach
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Bruce J Trock
- Division of Epidemiology, Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Alan W Partin
- Department of Urology, Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Peter R Carroll
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Osama Mohamad
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA; Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
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13
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Michalski JM, Winter KA, Prestidge BR, Sanda MG, Amin M, Bice WS, Gay HA, Ibbott GS, Crook JM, Catton CN, Raben A, Bosch W, Beyer DC, Frank SJ, Papagikos MA, Rosenthal SA, Barthold HJ, Roach M, Moughan J, Sandler HM. Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial. J Clin Oncol 2023; 41:4035-4044. [PMID: 37315297 PMCID: PMC10461953 DOI: 10.1200/jco.22.01856] [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: 08/12/2022] [Revised: 03/15/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE To determine whether addition of external beam radiation therapy (EBRT) to brachytherapy (BT) (COMBO) compared with BT alone would improve 5-year freedom from progression (FFP) in intermediate-risk prostate cancer. METHODS Men with prostate cancer stage cT1c-T2bN0M0, Gleason Score (GS) 2-6 and prostate-specific antigen (PSA) 10-20 or GS 7, and PSA < 10 were eligible. The COMBO arm was EBRT (45 Gy in 25 fractions) to prostate and seminal vesicles followed by BT prostate boost (110 Gy if 125-Iodine, 100 Gy if 103-Pd). BT arm was delivered to prostate only (145 Gy if 125-Iodine, 125 Gy if 103-Pd). The primary end point was FFP: PSA failure (American Society for Therapeutic Radiology and Oncology [ASTRO] or Phoenix definitions), local failure, distant failure, or death. RESULTS Five hundred eighty-eight men were randomly assigned; 579 were eligible: 287 and 292 in COMBO and BT arms, respectively. The median age was 67 years; 89.1% had PSA < 10 ng/mL, 89.1% had GS 7, and 66.7% had T1 disease. There were no differences in FFP. The 5-year FFP-ASTRO was 85.6% (95% CI, 81.4 to 89.7) with COMBO compared with 82.7% (95% CI, 78.3 to 87.1) with BT (odds ratio [OR], 0.80; 95% CI, 0.51 to 1.26; Greenwood T P = .18). The 5-year FFP-Phoenix was 88.0% (95% CI, 84.2 to 91.9) with COMBO compared with 85.5% (95% CI, 81.3 to 89.6) with BT (OR, 0.80; 95% CI, 0.49 to 1.30; Greenwood T P = .19). There were no differences in the rates of genitourinary (GU) or GI acute toxicities. The 5-year cumulative incidence for late GU/GI grade 2+ toxicity is 42.8% (95% CI, 37.0 to 48.6) for COMBO compared with 25.8% (95% CI, 20.9 to 31.0) for BT (P < .0001). The 5-year cumulative incidence for late GU/GI grade 3+ toxicity is 8.2% (95% CI, 5.4 to 11.8) compared with 3.8% (95% CI, 2.0 to 6.5; P = .006). CONCLUSION Compared with BT, COMBO did not improve FFP for prostate cancer but caused greater toxicity. BT alone can be considered as a standard treatment for men with intermediate-risk prostate cancer.
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Affiliation(s)
| | - Kathryn A. Winter
- NRG Oncology Statistics and Data Management Center/ACR, Philadelphia, PA
| | | | - Martin G. Sanda
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA
| | - Mahul Amin
- University of Tennessee Health Science Center, Memphis, TN
| | | | - Hiram A. Gay
- Washington University—Siteman Cancer Center, St. Louis, MO
| | | | - Juanita M. Crook
- BCCA-Cancer Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Charles N. Catton
- University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Adam Raben
- Delaware/Christiana Care NCI Community Oncology Research Program, Newark, DE
| | - Walter Bosch
- Washington University—Siteman Cancer Center, St. Louis, MO
| | | | | | - Michael A. Papagikos
- Novant Health New Hanover Regional Medical Center—Zimmer Cancer Institute, Wilmington, NC
| | | | | | - Mack Roach
- UCSF Medical Center-Mount Zion, San Francisco, CA
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center/ACR, Philadelphia, PA
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14
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Lukka HR, Deshmukh S, Bruner DW, Bahary JP, Lawton CAF, Efstathiou JA, Kudchadker RJ, Ponsky LE, Seaward SA, Dayes IS, Gopaul DD, Michalski JM, Delouya G, Kaplan ID, Horwitz EM, Roach M, Feng FY, Pugh SL, Sandler HM, Kachnic LA. Five-Year Patient-Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 116:770-778. [PMID: 36592721 PMCID: PMC10619484 DOI: 10.1016/j.ijrobp.2022.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/06/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE There is considerable interest in very short (ultrahypofractionated) radiation therapy regimens to treat prostate cancer based on potential radiobiological advantages, patient convenience, and resource allocation benefits. Our objective is to demonstrate that detectable changes in health-related quality of life measured by the bowel and urinary domains of the Expanded Prostate Cancer Index Composite (EPIC-50) were not substantially worse than baseline scores. METHODS AND MATERIALS NRG Oncology's RTOG 0938 is a nonblinded randomized phase 2 study of National Comprehensive Cancer Network low-risk prostate cancer in which each arm is compared with a historical control. Patients were randomized to 5 fractions (7.25 Gy in 2 week and a day [twice a week]) or 12 fractions (4.3Gy in 2.5 weeks [5 times a week]). Secondary objectives assessed patient-reported toxicity at 5 years using the EPIC. Chi-square tests were used to assess the proportion of patients with a deterioration from baseline of >5 points for bowel, >2 points for urinary, and >11 points for sexual score. RESULTS The study enrolled 127 patients to 5 fractions (121 eligible) and 128 patients to 12 fractions (125 eligible). The median follow-up for all patients at the time of analysis was 5.38 years. The 5-year frequency for >5 point change in bowel score were 38.4% (P = .27) and 23.4% (P = 0.98) for 5 and 12 fractions, respectively. The 5-year frequencies for >2 point change in urinary score were 46.6% (P = .15) and 36.4% (P = .70) for 5 and 12 fractions, respectively. For 5 fractions, 49.3% (P = .007) of patients had a drop in 5-year EPIC-50 sexual score of ≥11 points; for 12 fractions, 54% (P < .001) of patients had a drop in 5-year EPIC-50 sexual score of ≥11 points. Disease-free survival at 5 years is 89.6% (95% CI: 84.0-95.2) in the 5-fraction arm and 92.3% (95% CI: 87.4-97.1) in the 12-fraction arm. There was no late grade 4 or 5 treatment-related urinary or bowel toxicity. CONCLUSIONS This study confirms that, based on long-term changes in bowel and urinary domains and toxicity, the 5- and 12-fraction regimens are well tolerated. These ultrahypofractionated approaches need to be compared with current standard radiation therapy regimens.
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Affiliation(s)
- Himanshu R Lukka
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Canada.
| | - Snehal Deshmukh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Universite´ de Montreal (CHUM), Montreal, Canada
| | | | | | | | - Lee E Ponsky
- Case Western Reserve University, Cleveland, Ohio
| | | | - Ian S Dayes
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Canada
| | | | | | - Guila Delouya
- Centre Hospitalier de l'Universite´ de Montreal (CHUM), Montreal, Canada
| | | | | | - Mack Roach
- University of California-San Francisco Medical Center, San Francisco, California
| | - Felix Y Feng
- University of California-San Francisco Medical Center, San Francisco, California
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Lisa A Kachnic
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Canada
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15
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Nguyen PL, Huang HCR, Spratt DE, Davicioni E, Sandler HM, Shipley WU, Efstathiou JA, Simko JP, Pollack A, Dicker AP, Roach M, Rosenthal SA, Zeitzer KL, Mendez LC, Hartford AC, Hall WA, Desai AB, Rabinovitch RA, Peters CA, Rodgers JP, Tran P, Feng FY. Analysis of a Biopsy-Based Genomic Classifier in High-Risk Prostate Cancer: Meta-Analysis of the NRG Oncology/Radiation Therapy Oncology Group 9202, 9413, and 9902 Phase 3 Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 116:521-529. [PMID: 36596347 PMCID: PMC10281690 DOI: 10.1016/j.ijrobp.2022.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/07/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE Decipher is a genomic classifier (GC) prospectively validated postprostatectomy. We validated the performance of the GC in pretreatment biopsy samples within the context of 3 randomized phase 3 high-risk definitive radiation therapy trials. METHODS AND MATERIALS A prespecified analysis plan (NRG-GU-TS006) was approved to obtain formalin-fixed paraffin-embedded tissue from biopsy specimens from the NRG biobank from patients enrolled in the NRG/Radiation Therapy Oncology Group (RTOG) 9202, 9413, and 9902 phase 3 randomized trials. After central review, the highest-grade tumors were profiled on clinical-grade whole-transcriptome arrays and GC scores were obtained. The primary objective was to validate the independent prognostic ability for the GC for distant metastases (DM), and secondary for prostate cancer-specific mortality (PCSM) and overall survival (OS) with Cox univariable and multivariable analyses. RESULTS GC scores were obtained on 385 samples, of which 265 passed microarray quality control (69%) and had a median follow-up of 11 years (interquartile range, 9-13). In the pooled cohort, on univariable analysis, the GC was shown to be a prognostic factor for DM (per 0.1 unit; subdistribution hazard ratio [sHR], 1.29; 95% confidence interval [CI], 1.18-1.41; P < .001), PCSM (sHR, 1.28; 95% CI, 1.16-1.41; P < .001), and OS (hazard ratio [HR], 1.16; 95% CI, 1.08-1.22; P < .001). On multivariable analyses, the GC (per 0.1 unit) was independently associated with DM (sHR, 1.22; 95% CI, 1.09-1.36), PCSM (sHR, 1.23; 95% CI, 1.09-1.39), and OS (HR, 1.12; 95% CI, 1.05-1.20) after adjusting for age, Prostate Specific Antigen, Gleason score, cT stage, trial, and randomized treatment arm. GC had similar prognostic ability in patients receiving short-term or long-term androgen-deprivation therapy, but the absolute improvement in outcome varied by GC risk. CONCLUSIONS This is the first validation of a gene expression biomarker on pretreatment prostate cancer biopsy samples from prospective randomized trials and demonstrates an independent association of GC score with DM, PCSM, and OS. High-risk prostate cancer is a heterogeneous disease state, and GC can improve risk stratification to help personalize shared decision making.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Huei-Chung Rebecca Huang
- GenomeDx Inc, Vancouver, British Columbia, Canada; Decipher Biosciences, San Diego, California; Veracyte, South San Francisco CA
| | - Daniel E Spratt
- Department of Radiation Oncology, UH Cleveland Medical Center, Cleveland, Ohio
| | - Elai Davicioni
- Decipher Biosciences, San Diego, California; Veracyte, South San Francisco CA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - William U Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffry P Simko
- Department of Pathology, UCSF Medical Center-Mount Zion, San Francisco, California
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mack Roach
- Department of Pathology, UCSF Medical Center-Mount Zion, San Francisco, California
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Cancer Centers Radiation Oncology Services, Roseville, California
| | - Kenneth L Zeitzer
- Department of Radiation Oncology, Einstein Medical Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Lucas C Mendez
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Alan C Hartford
- Department of Radiation Oncology, Dartmouth-Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - William A Hall
- Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anand B Desai
- Department of Radiation Oncology, Summa Health System, Akron, Ohio
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado
| | - Christopher A Peters
- Department of Radiation Oncology, Northeast Radiation Oncology Center, Dunmore, Pennsylvania
| | | | - Phuoc Tran
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Felix Y Feng
- Department of Radiation Oncology, UCSF Medical Center-Mission Bay, San Francisco, California
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16
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McDonald AM, DeMora L, Yang ES, Hoyle JM, Lenzie A, Williams GR, Michalski JM, Yee D, Bahary JP, Den RB, Roach M, Dess R, Mishra MV, Valicenti RK, Lau HY, Marcrom SR, Souhami L, Mendez LC, Chen Y, Doncals DE, Pugh SL, Feng FY, Sandler HM. Body composition and mortality in men receiving prostate radiotherapy: A pooled analysis of NRG/RTOG 9406 and NRG/RTOG 0126. Cancer 2023; 129:685-696. [PMID: 36579470 PMCID: PMC10231027 DOI: 10.1002/cncr.34596] [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: 03/23/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To validate the association between body composition and mortality in men treated with radiation for localized prostate cancer (PCa). Secondarily, to integrate body composition as a factor to classify patients by risk of all-cause mortality. MATERIALS AND METHODS Participants of NRG/Radiation Therapy Oncology Group (RTOG) 9406 and NRG/RTOG 0126 with archived computed tomography were included. Muscle mass and muscle density were estimated by measuring the area and attenuation of the psoas muscles on a single slice at L4-L5. Bone density was estimated by measuring the attenuation of the vertebral body at mid-L5. Survival analyses, including Cox proportional hazards models, assessed the relationship between body composition and mortality. Recursive partitioning analysis (RPA) was used to create a classification tree to classify participants by risk of death. RESULTS Data from 2066 men were included in this study. In the final multivariable model, psoas area, comorbidity score, baseline prostate serum antigen, and age were significantly associated with survival. The RPA yielded a classification tree with four prognostic groups determined by age, comorbidity, and psoas area. Notably, the classification among older (≥70 years) men into prognostic groups was determined by psoas area. CONCLUSIONS This study strongly supports that body composition is related to mortality in men with localized PCa. The inclusion of psoas area in the RPA classification tree suggests that body composition provides additive information to age and comorbidity status for mortality prediction, particularly among older men. More research is needed to determine the clinical impact of body composition on prognostic models in men with PCa.
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Affiliation(s)
- Andrew M. McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham O’Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lyudmila DeMora
- Statistics and Data Management Department, NRG Oncology, Philadelphia, Pennsylvania, USA
- Statistical and Data Management Department, American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Eddy S. Yang
- Department of Radiation Oncology, University of Alabama at Birmingham O’Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - John M. Hoyle
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew Lenzie
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R. Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Don Yee
- Radiation Oncology Department of Radiation Oncology, Edmonton Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jean-Paul Bahary
- Department of Radio Oncology, CHUM - Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Robert B. Den
- Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mack Roach
- Department of Radiation Oncology, UCSF Medical Center-Mount Zion, San Francisco, California, USA
| | - Robert Dess
- Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Mark V. Mishra
- Department of Radiation Oncology, University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, USA
| | - Richard K. Valicenti
- Department of Radiation Oncology, University of California Davis, Sacramento, California, USA
| | - Harold Y. Lau
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Samuel R. Marcrom
- Department of Radiation Oncology, University of Alabama at Birmingham O’Neal Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - Luis Souhami
- The Research Institute, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Lucas C. Mendez
- Department of Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester, Rochester, New York, USA
| | - Desiree E. Doncals
- Department of Radiation Oncology, Summa Health System - Akron Campus, Akron, Ohio, USA
| | - Stephanie L. Pugh
- Statistics and Data Management Department, NRG Oncology, Philadelphia, Pennsylvania, USA
- Statistical and Data Management Department, American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Felix Y. Feng
- Department of Radiation Oncology, UCSF Medical Center-Mission Bay, San Francisco, California, USA
| | - Howard M. Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ma TM, Sun Y, Malone S, Roach M, Dearnaley D, Pisansky TM, Feng FY, Sandler HM, Efstathiou JA, Syndikus I, Hall EC, Tree AC, Sydes MR, Cruickshank C, Roy S, Bolla M, Maingon P, De Reijke T, Nabid A, Carrier N, Souhami L, Zapatero A, Guerrero A, Alvarez A, Gonzalez San-Segundo C, Maldonado X, Romero T, Steinberg ML, Valle LF, Rettig MB, Nickols NG, Shoag JE, Reiter RE, Zaorsky NG, Jia AY, Garcia JA, Spratt DE, Kishan AU. Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials. J Clin Oncol 2023; 41:881-892. [PMID: 36269935 PMCID: PMC9902004 DOI: 10.1200/jco.22.00970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/22/2022] [Revised: 06/24/2022] [Accepted: 08/17/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). MATERIALS AND METHODS Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality. RESULTS Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; P < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; P = .0046), prostate cancer-specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; P < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT. CONCLUSION ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Shawn Malone
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mack Roach
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - David Dearnaley
- Academic Urology Unit, Royal Marsden Hospital, London, United Kingdom
- Institute of Cancer Research, London, United Kingdom
| | | | - Felix Y. Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | | | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Isabel Syndikus
- Clatterbridge Cancer Centre, Bebington, Wirral, United Kingdom
| | - Emma C. Hall
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, United Kingdom
| | - Alison C. Tree
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Claire Cruickshank
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, United Kingdom
| | - Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Michel Bolla
- Radiotherapy Department Grenoble, Grenoble Alpes University, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Philippe Maingon
- Sorbonne University, APHP Sorbonne University, La Pitié Salpêtrière, Paris, France
| | - Theo De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Abdenour Nabid
- Department of Radiation Oncology, Centre Hospitaler Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Carrier
- Department of Radiation Oncology, Centre Hospitaler Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Center, Montreal, Canada
| | - Almudena Zapatero
- Department of Radiation Oncology, University Hospital La Princesa, Health Research Institute, Madrid, Spain
| | | | - Ana Alvarez
- Department of Radiation Oncology, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain
| | - Carmen Gonzalez San-Segundo
- Department of Radiation Oncology, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain
| | | | - Tahmineh Romero
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA
| | | | - Luca F. Valle
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Matthew B. Rettig
- Department of Urology, University of California, Los Angeles, CA
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | - Jonathan E. Shoag
- Department of Urology, University Hospitals Seidman Cancer Center, Cleveland Medical Center, Cleveland, OH
| | - Robert E. Reiter
- Department of Urology, University of California, Los Angeles, CA
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland Medical Center, Cleveland, OH
| | - Angela Y. Jia
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland Medical Center, Cleveland, OH
| | - Jorge A. Garcia
- Department of Hematology Oncology, University Hospital Cleveland Medical Center, Cleveland, OH
| | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland Medical Center, Cleveland, OH
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, CA
- Department of Urology, University of California, Los Angeles, CA
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Roach M, Coleman PW. Re: Understanding the Role of Urology Practice Organization and Racial Composition in Prostate Cancer Treatment Disparities. JCO Oncol Pract 2023; 19:219-220. [PMID: 36657093 DOI: 10.1200/op.22.00768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Mack Roach
- Particle Therapy Research Program & Outreach Department of Radiation Oncology UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Pamela W Coleman
- Department of Surgery/OB GYN, Howard University College of Medicine, Washington, DC
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Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, Bryce A, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Netto G, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Teply BA, Tward J, Valicenti R, Wong JK, Berardi RA, Shead DA, Freedman-Cass DA. NCCN Guidelines® Insights: Prostate Cancer, Version 1.2023. J Natl Compr Canc Netw 2022; 20:1288-1298. [PMID: 36509074 DOI: 10.6004/jnccn.2022.0063] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, recurrent, and metastatic disease. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. These NCCN Guidelines Insights summarizes much of the panel's discussions for the 4.2022 and 1.2023 updates to the guidelines regarding systemic therapy for metastatic prostate cancer.
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Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Brian Chapin
- 8The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 11UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 15Massachusetts General Hospital Cancer Center
| | - Shilpa Gupta
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 17Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 18Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Tamara Lotan
- 21The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 23University of Michigan Rogel Cancer Center
| | | | | | | | - Mack Roach
- 27UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 29University of California San Francisco Patient Services
| | - Ahmad Shabsigh
- 30The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Ma T, Sun Y, Romero T, Dearnaley D, Tree A, Bolla M, de Reijke T, Maingon P, Neven A, Zapatero A, Malone S, Roy S, Sydes M, Nabid A, Sandler H, Roach M, Pisansky T, Spratt D, Kishan A. Sequencing of Androgen Deprivation Therapy of Short Duration with Radiotherapy for Non-Metastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.459] [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: 11/27/2022]
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21
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Ma TM, Chu FI, Sandler H, Feng FY, Efstathiou JA, Jones CU, Roach M, Rosenthal SA, Pisansky T, Michalski JM, Bolla M, de Reijke TM, Maingon P, Neven A, Denham J, Steigler A, Joseph D, Nabid A, Souhami L, Carrier N, Incrocci L, Heemsbergen W, Pos FJ, Sydes MR, Dearnaley DP, Tree AC, Syndikus I, Hall E, Cruickshank C, Malone S, Roy S, Sun Y, Zaorsky NG, Nickols NG, Reiter RE, Rettig MB, Steinberg ML, Reddy VK, Xiang M, Romero T, Spratt DE, Kishan AU. Local Failure Events in Prostate Cancer Treated with Radiotherapy: A Pooled Analysis of 18 Randomized Trials from the Meta-analysis of Randomized Trials in Cancer of the Prostate Consortium (LEVIATHAN). Eur Urol 2022; 82:487-498. [PMID: 35934601 DOI: 10.1016/j.eururo.2022.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 03/29/2022] [Revised: 07/03/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT The prognostic importance of local failure after definitive radiotherapy (RT) in National Comprehensive Cancer Network intermediate- and high-risk prostate cancer (PCa) patients remains unclear. OBJECTIVE To evaluate the prognostic impact of local failure and the kinetics of distant metastasis following RT. EVIDENCE ACQUISITION A pooled analysis was performed on individual patient data of 12 533 PCa (6288 high-risk and 6245 intermediate-risk) patients enrolled in 18 randomized trials (conducted between 1985 and 2015) within the Meta-analysis of Randomized Trials in Cancer of the Prostate Consortium. Multivariable Cox proportional hazard (PH) models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), distant metastasis-free survival (DMFS), and local failure as a time-dependent covariate. Markov PH models were developed to evaluate the impact of specific transition states. EVIDENCE SYNTHESIS The median follow-up was 11 yr. There were 795 (13%) local failure events and 1288 (21%) distant metastases for high-risk patients and 449 (7.2%) and 451 (7.2%) for intermediate-risk patients, respectively. For both groups, 81% of distant metastases developed from a clinically relapse-free state (cRF state). Local failure was significantly associated with OS (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.06-1.30), PCSS (HR 2.02, 95% CI 1.75-2.33), and DMFS (HR 1.94, 95% CI 1.75-2.15, p < 0.01 for all) in high-risk patients. Local failure was also significantly associated with DMFS (HR 1.57, 95% CI 1.36-1.81) but not with OS in intermediate-risk patients. Patients without local failure had a significantly lower HR of transitioning to a PCa-specific death state than those who had local failure (HR 0.32, 95% CI 0.21-0.50, p < 0.001). At later time points, more distant metastases emerged after a local failure event for both groups. CONCLUSIONS Local failure is an independent prognosticator of OS, PCSS, and DMFS in high-risk and of DMFS in intermediate-risk PCa. Distant metastasis predominantly developed from the cRF state, underscoring the importance of addressing occult microscopic disease. However a "second wave" of distant metastases occurs subsequent to local failure events, and optimization of local control may reduce the risk of distant metastasis. PATIENT SUMMARY Among men receiving definitive radiation therapy for high- and intermediate-risk prostate cancer, about 10% experience local recurrence, and they are at significantly increased risks of further disease progression. About 80% of patients who develop distant metastasis do not have a detectable local recurrence preceding it.
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Affiliation(s)
- Ting Martin Ma
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Fang-I Chu
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Howard Sandler
- Department of Radiation Oncology, Cedars Sinai, Los Angeles, CA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mack Roach
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Medical Group, Roseville, CA, USA
| | - Thomas Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michel Bolla
- Department of Radiation Therapy, CHU Grenoble, Grenoble, France
| | - Theo M de Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Philippe Maingon
- Department of Radiation Oncology, Centre Georges François Leclerc, University of Burgundy, Dijon, Burgundy, France
| | - Anouk Neven
- Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | - James Denham
- School of Medicine and Public Health, Faculty of Health and Medicine University of Newcastle, Newcastle, NSW, Australia
| | - Allison Steigler
- School of Medicine and Public Health, Faculty of Health and Medicine University of Newcastle, Newcastle, NSW, Australia
| | - David Joseph
- Department of Surgery, University of Western Australia
| | - Abdenour Nabid
- Department of Radiation Oncology, Centre Hospitaler Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Nathalie Carrier
- Centre de recherche clinique, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wilma Heemsbergen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - David P Dearnaley
- Academic Urology Unit, Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - Alison C Tree
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Emma Hall
- The Institute of Cancer Research, London, UK
| | | | - Shawn Malone
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Nickols
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew B Rettig
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA; Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael L Steinberg
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Vishruth K Reddy
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Xiang
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Tahmineh Romero
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Amar U Kishan
- Depart of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
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Michaelson D, Dignam J, Hamstra D, Bachand F, Master V, Bruner D, Torres M, Saylor P, Wallace R, Vapiwala N, Efstathiou J, Roach M, Rosenthal S, Raben A, Morgan S, Kavadi V, Spratt D, Michalski J, Rodgers J, Sandler H. Phase III Trial of Dose Escalated Radiation Therapy and Standard Androgen Deprivation Therapy (ADT) vs. Dose Escalated Radiation Therapy and Enhanced ADT with TAK-700 for Men with High-Risk Prostate Cancer (NRG Oncology/RTOG 1115). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.458] [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: 11/30/2022]
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Chen W, Baal J, Lin H, Upadhaya T, Barrios J, Roach M, Hong J, Morin O. Abdominal Aorto-Iliac Calcification Burden Assessment Using Deep Convolutional Neural Networks for Prediction of Cardiovascular Risk Among Prostate Cancer Patients Undergoing Stereotactic Body Radiotherapy (SBRT). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.669] [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: 10/31/2022]
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Bruner D, Pugh S, Michaelson D, Hamstra D, Bachand F, Master V, Torres M, Kaplan I, Rosenthal S, Roach M, Raben A, Michalski J, Kavadi V, Ferguson M, Morgan S, D'Souza D, DeMora L, Sandler H, Movsas B. RTOG/NRG 1115 Quality of Life of Phase III Dose Escalated Radiation Therapy (RT) and Standard Androgen Deprivation Therapy (ADT) with GnRH Agonist vs. Dose Escalated RT and ADT with GnRH Agonist and Orteronel (TAK-700) for Men with High-Risk Prostate. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1151] [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: 10/31/2022]
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Esteva A, Feng J, van der Wal D, Huang SC, Simko JP, DeVries S, Chen E, Schaeffer EM, Morgan TM, Sun Y, Ghorbani A, Naik N, Nathawani D, Socher R, Michalski JM, Roach M, Pisansky TM, Monson JM, Naz F, Wallace J, Ferguson MJ, Bahary JP, Zou J, Lungren M, Yeung S, Ross AE, Sandler HM, Tran PT, Spratt DE, Pugh S, Feng FY, Mohamad O. Prostate cancer therapy personalization via multi-modal deep learning on randomized phase III clinical trials. NPJ Digit Med 2022; 5:71. [PMID: 35676445 PMCID: PMC9177850 DOI: 10.1038/s41746-022-00613-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
Prostate cancer is the most frequent cancer in men and a leading cause of cancer death. Determining a patient's optimal therapy is a challenge, where oncologists must select a therapy with the highest likelihood of success and the lowest likelihood of toxicity. International standards for prognostication rely on non-specific and semi-quantitative tools, commonly leading to over- and under-treatment. Tissue-based molecular biomarkers have attempted to address this, but most have limited validation in prospective randomized trials and expensive processing costs, posing substantial barriers to widespread adoption. There remains a significant need for accurate and scalable tools to support therapy personalization. Here we demonstrate prostate cancer therapy personalization by predicting long-term, clinically relevant outcomes using a multimodal deep learning architecture and train models using clinical data and digital histopathology from prostate biopsies. We train and validate models using five phase III randomized trials conducted across hundreds of clinical centers. Histopathological data was available for 5654 of 7764 randomized patients (71%) with a median follow-up of 11.4 years. Compared to the most common risk-stratification tool-risk groups developed by the National Cancer Center Network (NCCN)-our models have superior discriminatory performance across all endpoints, ranging from 9.2% to 14.6% relative improvement in a held-out validation set. This artificial intelligence-based tool improves prognostication over standard tools and allows oncologists to computationally predict the likeliest outcomes of specific patients to determine optimal treatment. Outfitted with digital scanners and internet access, any clinic could offer such capabilities, enabling global access to therapy personalization.
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Affiliation(s)
| | - Jean Feng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Shih-Cheng Huang
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Jeffry P Simko
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Sandy DeVries
- NRG Oncology Biospecimen Bank, San Francisco, CA, USA
| | | | | | - Todd M Morgan
- Division of Urologic Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | | | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Mack Roach
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Farah Naz
- Department of Radiation Oncology, Horizon Health Network-Saint John Regional Hospital, Saint John, JB E2L 4L2, CA, Canada
| | - James Wallace
- Department of Hematology and Oncology, Ingalls Memorial Hospital, Harvey, IL, USA
| | - Michelle J Ferguson
- Department of Radiation Oncology, Allan Blair Cancer Centre, Regina, SK S4T 7T1, CA, Canada
| | - Jean-Paul Bahary
- Department of Radiation Oncology, CHUM - Centre Hospitalier de l'Universite de Montreal, Montreal, QC H2X 3E4, CA, Canada
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Matthew Lungren
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Serena Yeung
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Ashley E Ross
- Department of Urology, Northwestern University, Evanston, IL, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Phuoc T Tran
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
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Roach M, Zhang J, Esteva A, Mohamad O, Van der Wal D, Simko J, DeVries S, Huang HC, Schaeffer EM, Morgan TM, Monson JM, Naz F, Wallace J, Ferguson MJ, Bahary JP, Sandler HM, Spratt DE, Pugh SL, Tran PT, Feng FY. Prostate cancer risk in African American men evaluated via digital histopathology multi-modal deep learning models developed on NRG Oncology phase III clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.108] [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
108 Background: Artificial intelligence (AI) tools can display racial bias as a result of existing systemic health inequities and biased datasets. We have previously developed multi-modal AI (MMAI) prognostic models based on digital pathology images from five phase III randomized radiotherapy prostate cancer trials that outperform NCCN risk groups for prediction of distant metastasis (DM), biochemical failure (BF), prostate cancer-specific mortality (PCSM) and all-cause mortality (OS). In this study, we assessed the algorithmic fairness of the locked MMAI models between African American (AA) and non-AA populations in the five randomized trials. Methods: Patients enrolled in NRG/RTOG 9202, 9408, 9413, 9910, and 0126 with digitized biopsy histopathology slides were included in this study. The locked MMAI models were applied, and subgroup analyses were conducted by comparing distributions of clinical variables and MMAI scores (medians for continuous variables and proportions for categorical variables reported), and evaluating MMAI models’ prognostic ability among AA and non-AA men. The performance of the models were compared using DM as the primary endpoint and secondary endpoints of BF, PCSM, OS (death without an event as a competing risk) with Fine-Gray or Cox Proportional Hazards models. Either Kaplan Meier or cumulative incidence estimates were computed and compared using log-rank or Gray’s test. Results: This study included 5,624 men: 932 (17%) AA, 4503 (80%) white, and 189 (3%) other races. AA had younger median age (69 vs 71 year [yr]), higher median baseline PSA (12 vs 10 ng/mL), more T1-T2a (62% vs 57%), more Gleason < 7 (42% vs 36%) and 8-10 (15% vs 12%), and more NCCN low and high risk (12% vs 10% and 41% vs 33%). AA and non-AA had estimated 5-yr BF rates 27% and 27%, 5-yr DM rates 5% and 5%, 10-yr PCSM 5% and 7%, and 10-yr OS 58% and 60%, respectively. The median (interquartile range) score of the model optimizing for 5-yr DM (5-yr DM MMAI) was 0.044 (0.037–0.059) in AA and 0.043 (0.036–0.057) in non-AA. Similarly, all other MMAI models had differences in the medians between AA and non-AA ranging from 0.001 to 0.02. For all endpoints, the 5-yr DM MMAI model showed strong prognostic signal (hazard ratio [HR] per one standard deviation increase: 1.6 for DM, 1.4 for BF, 1.6 for PCSM and 1.3 for OS, all p-values < 0.001) and had comparable trends within AA vs. non-AA in the entire cohort (e.g., HR for DM 1.4 vs 1.6). Similar results were observed for the MMAI model optimizing for 10-yr PCSM. Conclusions: To our knowledge, this represents the first comparative analyses of a digital pathology AI prognostic model in AA vs. non-AA prostate cancer patients. The prognostic performance of the AI models was found to be comparable between subgroups. Our data supports the use of these models across racial groups, though further validation in AA cohorts is ongoing.
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Affiliation(s)
- Mack Roach
- University of California San Francisco, San Francisco, CA
| | | | | | - Osama Mohamad
- University of California-San Francisco, San Francisco, CA
| | | | - Jeffry Simko
- Department of Pathology, University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | - Farah Naz
- Horizon Health Network–Saint John Regional Hospital, Saint John, NB, Canada
| | | | | | - Jean-Paul Bahary
- University of Montreal CHUM Research Center, Montreal, QC, Canada
| | | | | | - Stephanie L. Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Phuoc T. Tran
- University of Maryland School of Medicine, Baltimore, MD
| | - Felix Y Feng
- Department of Urology, University of California, San Francisco, CA
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Vickers AJ, Elfiky A, Freeman VL, Roach M. Race, Biology, Disparities, and Prostate Cancer. Eur Urol 2022; 81:463-465. [PMID: 35216858 DOI: 10.1016/j.eururo.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Vincent L Freeman
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Mack Roach
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
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28
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Roach M. Moving Beyond Race-Based Medicine. Ann Intern Med 2022; 175:W20. [PMID: 35286821 DOI: 10.7326/l21-0778] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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29
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Ma TM, Chu FI, Romero T, Michalski JM, Pisansky TM, Roach M, Feng FY, Sandler HM, Bolla M, Neven A, Incrocci L, Sydes MR, Nabid A, Denham JW, Steigler A, Souhami L, Armstrong J, Malone S, Spratt DE, Kishan AU. Local failure, distant metastasis, and survival after definitive radiotherapy for intermediate- and high-risk prostate cancer: An individual patient-level meta-analysis of 18 randomized trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.277] [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
277 Background: The prognostic importance of local failure (LF) after definitive radiotherapy (RT) in patients with NCCN intermediate- (IRPCa) and high-risk prostate cancer (HRPCa) remains unclear, particularly given the likelihood that occult distant metastases (DMs) at presentation may be the true driver of natural history. Here, we leverage individual patient data (IPD) from 18 randomized control trials (RCTs) to evaluate the prognostic impact of LF and the kinetics of DM after RT. Methods: IPD for 18 RCTs were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate (MARCAP) Consortium, comprising a total of 12533 patients (6288 HRPCa & 6245 IRPCa). Multivariable Cox proportional hazards (PH) models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), DM-free survival (DMFS) & LF as a time-dependent covariate, adjusted for clinicodemographic parameters. Markov PH models, defined via transitions between 4 states, were developed to evaluate the aforementioned relationship. Proportional hazards assumption was imposed and examined for both models. Time is from randomization. Results: Median follow-up was 9.1 years. There were 795 (13%) LF & 1288 (21%) DM events for patients with HRPCa; these numbers were 449 (7%) & 451 (7%) for IRPCa. For HRPCa & IRPCa, 81% and 81% of DMs developed from a clinically relapse-free state (cRFS), with a median time of 46 and 60 months, respectively (p < 0.0001). 39% & 13% of DM events occurred within 2 years after RT for HRPCa & IRPCa, respectively. At later time points, DM events were more likely to emerge after an LF event for both HRPCa (9% vs. 34% between 0-2 vs. 8-10 years post-RT, p = 0.001) and IRPCa (10% vs. 34% between 0-2 vs. 8-10 years post-RT, p = 0.008). LF was significantly associated with OS (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.06–1.30), PCSS (HR 2.02, 95% CI 1.75-2.33) & DMFS (HR 1.94, 95% CI 1.75–2.15) (p < 0.01 for all) in patients with HRPCa. LF was also significantly associated with DMFS (HR 1.57, 95% CI 1.36–1.81) but not OS in patients with IRPCa. Patients who had not transitioned to the LF state had a significantly lower HR of transitioning to a PCa-specific death state than those who transitioned to the LF state (HR 0.32, 95% CI 0.21–0.50, p < 0.001). Conclusions: LF is an independent prognosticator of OS, PCSS & DMFS in HRPCa and of DMFS in IRPCa. The predominant mode of DM development is from the cRFS state, underscoring the importance of accurate upfront staging & systemic therapy. However, particularly at late time points, an increasing proportion of DM events originated after diagnosis of a LF, constituting a “second wave” of DM events. This suggests that optimizing local control is also important, though the majority of DM events appear prior to a clinically-detected LF.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Fang-I Chu
- University of California Los Angeles, Los Angeles, CA
| | - Tahmineh Romero
- Department of Medicine Statistics Core, University of California, Los Angeles, CA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University, St. Louis, MO
| | | | - Mack Roach
- University of California San Francisco, San Francisco, CA
| | - Felix Y Feng
- Department of Urology, University of California, San Francisco, CA
| | | | - Michel Bolla
- Grenoble Alpes University, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Anouk Neven
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Luca Incrocci
- Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | | | - Abdenour Nabid
- Centre Hospitalier de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Allison Steigler
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - Luis Souhami
- McGill University Health Centre, Montréal, QC, Canada
| | - John Armstrong
- ICORG (All Ireland Cooperative Oncology Research Group), St Luke's Hospital, Radiation Oncology Department, Dublin, Ireland
| | - Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | | | - Amar Upadhyaya Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
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30
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Jones CU, Pugh SL, Sandler HM, Chetner MP, Amin MB, Bruner DW, Zietman AL, Den RB, Leibenhaut MH, Longo JM, Bahary JP, Rosenthal SA, Souhami L, Michalski JM, Hartford AC, Amin PP, Roach M, Yee D, Efstathiou JA, Rodgers JP, Feng FY, Shipley WU. Adding Short-Term Androgen Deprivation Therapy to Radiation Therapy in Men With Localized Prostate Cancer: Long-Term Update of the NRG/RTOG 9408 Randomized Clinical Trial. Int J Radiat Oncol Biol Phys 2022; 112:294-303. [PMID: 34481017 PMCID: PMC8748315 DOI: 10.1016/j.ijrobp.2021.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 02/15/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE For men with localized prostate cancer, NRG Oncology/Radiation Therapy Oncology Group (RTOG) 9408 demonstrated that adding short-term androgen deprivation therapy (ADT) to radiation therapy (RT) improved the primary endpoint of overall survival (OS) and improved disease-specific mortality (DSM), biochemical failure (BF), local progression, and freedom from distant metastases (DM). This study was performed to determine whether the short-term ADT continued to improve OS, DSM, BF, and freedom from DM with longer follow-up. METHODS AND MATERIALS From 1994 to 2001, NRG/RTOG 9408 randomized 2028 men from 212 North American institutions with T1b-T2b, N0 prostate adenocarcinoma and prostate-specific antigen (PSA) ≤20ng/mL to RT alone or RT plus short-term ADT. Patients were stratified by PSA, tumor grade, and surgical versus clinical nodal staging. ADT was flutamide with either goserelin or leuprolide for 4 months. Prostate RT (66.6 Gy) was started after 2 months. OS was calculated at the date of death from any cause or at last follow-up. Secondary endpoints were DSM, BF, local progression, and DM. Acute and late toxic effects were assessed using RTOG toxicity scales. RESULTS Median follow-up in surviving patients was 14.8 years (range, 0.16-21.98). The 10-year and 18-year OS was 56% and 23%, respectively, with RT alone versus 63% and 23% with combined therapy (HR 0.94; 95% confidence interval [CI], 0.85-1.05; P = .94). The hazards were not proportional (P = .003). Estimated restricted mean survival time at 18 years was 11.8 years (95% CI, 11.4-12.1) with combined therapy versus 11.3 years with RT alone (95% CI, 10.9-11.6; P = .05). The 10-year and 18-year DSM was 7% and 14%, respectively, with RT alone versus 3% and 8% with combined therapy (HR 0.56; 95% CI, 0.41-0.75; P < .01). DM and BF favored combined therapy at 18 years. Rates of late grade ≥3 hepatic, gastrointestinal, and genitourinary toxicity were ≤1%, 3%, and 8%, respectively, with combined therapy versus ≤1%, 2%, and 5% with RT alone. CONCLUSIONS Further follow-up demonstrates that OS converges at approximately 15 years, by which point the administration of 4 months of ADT had conferred an estimated additional 6 months of life.
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Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Mahul B Amin
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | - Robert B Den
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - John M Longo
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jean-Paul Bahary
- Centre Hospitalier De L`Université De Montréal-Notre Dame, Montréal, Quebec, Canada
| | | | - Luis Souhami
- The Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | | | | | - Pradip P Amin
- University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland
| | - Mack Roach
- UCSF Medical Center-Mount Zion, San Francisco, California
| | - Don Yee
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Felix Y Feng
- UCSF Medical Center-Mount Zion, San Francisco, California
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31
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Ali A, Janorkar A, Marquart M, Griggs J, Bumgardner J, Roach M. Photocatalytic Activity and Antibacterial Behavior of Polyaniline-Doped Titanium Oxide Layers. Dent Mater 2022. [DOI: 10.1016/j.dental.2021.12.118] [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: 11/29/2022]
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32
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Vogl UM, Beer TM, Davis ID, Shore ND, Sweeney CJ, Ost P, Attard G, Bossi A, de Bono J, Drake CG, Efstathiou E, Fanti S, Fizazi K, Halabi S, James N, Mottet N, Padhani AR, Roach M, Rubin M, Sartor O, Small E, Smith MR, Soule H, Sydes MR, Tombal B, Omlin A, Gillessen S. Lack of consensus identifies important areas for future clinical research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 findings. Eur J Cancer 2022; 160:24-60. [PMID: 34844839 DOI: 10.1016/j.ejca.2021.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Innovations in treatments, imaging and molecular characterisation have improved outcomes for people with advanced prostate cancer; however, many aspects of clinical management are devoid of high-level evidence. At the Advanced Prostate Cancer Consensus Conference (APCCC) 2019, many of these topics were addressed, and consensus was not always reached. The results from clinical trials will most reliably plus the gaps. METHODS An invited panel of 57 experts voted on 123 multiple-choice questions on clinical management at APCCC 2019. No consensus was reached on 88 (71.5%) questions defined as <75% of panellists voting for the same answer option. We reviewed clinicaltrials.gov to identify relevant ongoing phase III trials in these areas of non-consensus. RESULTS A number of ongoing phase III trials were identified that are relevant to these non-consensus issues. However, many non-consensus issues appear not to be addressed by current clinical trials. Of note, no phase III but only phase II trials were identified, investigating side effects of hormonal treatments and their management. CONCLUSIONS Lack of consensus almost invariably indicates gaps in existing evidence. The high percentage of questions lacking consensus at APCCC 2019 highlights the complexity of advanced prostate cancer care and the need for robust, clinically relevant trials that can fill current gaps with high-level evidence. Our review of these areas of non-consensus and ongoing trials provides a useful summary, indicating areas in which future consensus may soon be reached. This review may facilitate academic investigators to identify and prioritise topics for future research.
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Affiliation(s)
- Ursula M Vogl
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Christopher J Sweeney
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Piet Ost
- Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Alberto Bossi
- Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Johann de Bono
- The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Charles G Drake
- Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | | | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mark Rubin
- Bern Center for Precision Medicine, Bern, Switzerland; Department for Biomedical Research, University of Bern, Bern, Switzerland
| | | | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Aurelius Omlin
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; University of Bern, Bern, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; Division of Cancer Science, University of Manchester, Manchester, UK.
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Ma TM, Romero T, Nickols NG, Rettig MB, Garraway IP, Roach M, Michalski JM, Pisansky TM, Lee WR, Jones CU, Rosenthal SA, Wang C, Hartman H, Nguyen PL, Feng FY, Boutros PC, Saigal C, Chamie K, Jackson WC, Morgan TM, Mehra R, Salami SS, Vince R, Schaeffer EM, Mahal BA, Dess RT, Steinberg ML, Elashoff D, Sandler HM, Spratt DE, Kishan AU. Comparison of Response to Definitive Radiotherapy for Localized Prostate Cancer in Black and White Men: A Meta-analysis. JAMA Netw Open 2021; 4:e2139769. [PMID: 34964855 PMCID: PMC8717118 DOI: 10.1001/jamanetworkopen.2021.39769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Black men have a 2-fold increased risk of dying from prostate cancer compared with White men. However, race-specific differences in response to initial treatment remain unknown. OBJECTIVE To compare overall and treatment-specific outcomes of Black and White men with localized prostate cancer receiving definitive radiotherapy (RT). DATA SOURCES A systematic search was performed of relevant published randomized clinical trials conducted by the NRG Oncology/Radiation Therapy Oncology Group between January 1, 1990, and December 31, 2010. This meta-analysis was performed from July 1, 2019, to July 1, 2021. STUDY SELECTION Randomized clinical trials of definitive RT for patients with localized prostate cancer comprising a substantial number of Black men (self-identified race) enrolled that reported on treatment-specific and overall outcomes. DATA EXTRACTION AND SYNTHESIS Individual patient data were obtained from 7 NRG Oncology/Radiation Therapy Oncology Group randomized clinical trials evaluating definitive RT with or without short- or long-term androgen deprivation therapy. Unadjusted Fine-Gray competing risk models, with death as a competing risk, were developed to evaluate the cumulative incidences of end points. Cox proportional hazards models were used to evaluate differences in all-cause mortality and the composite outcome of distant metastasis (DM) or death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. MAIN OUTCOMES AND MEASURES Subdistribution hazard ratios (sHRs) of biochemical recurrence (BCR), DM, and prostate cancer-specific mortality (PCSM). RESULTS A total of 8814 patients (1630 [18.5%] Black and 7184 [81.5%] White) were included; mean (SD) age was 69.1 (6.8) years. Median follow-up was 10.6 (IQR, 8.0-17.8) years for surviving patients. At enrollment, Black men were more likely to have high-risk disease features. However, even without adjustment, Black men were less likely to experience BCR (sHR, 0.88; 95% CI, 0.58-0.91), DM (sHR, 0.72; 95% CI, 0.58-0.91), or PCSM (sHR, 0.72; 95% CI, 0.54-0.97). No significant differences in all-cause mortality were identified (HR, 0.99; 95% CI, 0.92-1.07). Upon adjustment, Black race remained significantly associated with improved BCR (adjusted sHR, 0.79; 95% CI, 0.72-0.88; P < .001), DM (adjusted sHR, 0.69; 95% CI, 0.55-0.87; P = .002), and PCSM (adjusted sHR, 0.68; 95% CI, 0.50-0.93; P = .01). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis suggest that Black men enrolled in randomized clinical trials present with more aggressive disease but have better BCR, DM, and PCSM with definitive RT compared with White men, suggesting that other determinants of outcome, such as access to care, are important factors of achieving racial equity.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles (UCLA)
| | | | - Nicholas G. Nickols
- Department of Radiation Oncology, University of California, Los Angeles (UCLA)
- Department of Radiation Oncology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew B. Rettig
- Division of Hematology and Oncology, David Geffen School of Medicine, UCLA
- Division of Hematology and Oncology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Isla P. Garraway
- Department of Urology, UCLA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, UCLA
- Division of Urology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | - Mack Roach
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco
| | - Jeff M. Michalski
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - W. Robert Lee
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | | | - Seth A. Rosenthal
- Sutter Medical Group and Sutter Cancer Centers, Roseville, California
| | - Chenyang Wang
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Holly Hartman
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Paul L. Nguyen
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Felix Y. Feng
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco
| | - Paul C. Boutros
- Department of Urology, UCLA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, UCLA
- Department of Human Genetics, UCLA
| | | | | | | | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor
| | | | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor
| | - Edward M. Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brandon A. Mahal
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Robert T. Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | | | | | - Howard M. Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland Medical Center, Cleveland, Ohio
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles (UCLA)
- Department of Urology, UCLA
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Crook J, Rodgers JP, Pisansky TM, Trabulsi EJ, Amin MB, Bice W, Morton G, Murtha AD, Vigneault E, Helou J, Michalski JM, Roach M, Beyer D, Jani AB, Horwitz EM, Raben A, Pugh S, Sandler H. Salvage Low Dose Rate Prostate Brachytherapy: Clinical Outcomes of a Phase II Trial for Local Recurrence after External Beam Radiotherapy (NRG Oncology/xxxx). Int J Radiat Oncol Biol Phys 2021; 112:1115-1122. [PMID: 34740768 DOI: 10.1016/j.ijrobp.2021.10.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 07/14/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We report efficacy of a prospective Phase II trial (YYYY) of salvage low dose rate (LDR) prostate brachytherapy (BT) for local failure (LF) after prior external beam radiotherapy (EBRT) with minimum 5- years' follow up. MATERIALS/METHODS Eligible patients had low/intermediate risk prostate cancer (PCa) prior to EBRT and biopsy-proven LF > 30 months after EBRT, with PSA < 10 ng/mL and no regional/distant disease. The primary endpoint, late GI/GU Adverse Events (AEs) (CTCAE V3.0 ≥ Grade 3) was 14%. With minimum 5-year follow up after salvage BT, secondary clinical outcomes including disease-free (DFS; includes death from any cause), disease-specific (DSS), and overall survival (OS) were estimated using the Kaplan-Meier method and modelled using Cox proportional hazards regression. Local tumor progression (LF), distant and biochemical failure (DF/BF) were estimated using cumulative incidence. Time to LF, DF and BF were modeled by cause-specific Cox proportional hazards regression. RESULTS From 05/2007 -01/2014, 20 centers registered 100 patients (92 analyzable). Median follow up is 6.7 years (range: 0.3-11.2); median age 70 years (range: 55-82); median prior EBRT dose 74 Gy (IQR: 70-76) at a median of 85 months prior(IQR: 60-119). Androgen deprivation was combined with salvage BT in 16%. 10-year OS is 70% (95% confidence interval [CI]: 58 -83). 19 patients died (5 PCa, 10 other, 4 unknown). 10-year failure rates are local 5% (95% CI:1-11), distant 19% (95% CI:10-29) and biochemical 46% (95% CI:34-57). DFS is 61% at 5 years; 33% at 10 years. No baseline characteristic was significantly associated with any clinical outcome. CONCLUSION This is the first prospective multicenter trial reporting outcomes of salvage LDR BT for LF after EBRT. Five-year freedom from BF is 68%, comparable to other salvage modalities. Although further LF is rare (5%), BF climbs to 46% by10-years.
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Affiliation(s)
- Juanita Crook
- BC Cancer Agency Centre for the Southern Interior, Kelowna, University of British Columbia, British Columbia, Canada.
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Edouard J Trabulsi
- Sydney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahul B Amin
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - William Bice
- John Muir Health Systems California, Walnut Creek, California
| | - Gerard Morton
- Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Albert D Murtha
- Cross Cancer Institute, Alberta Health Services, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Vigneault
- L Hotel-Dieu de Quebec, Laval University, Quebec, Quebec, Canada
| | - Joelle Helou
- Princess Margaret Cancer Centre, University of Toronto Faculty of Medicine, University Health Network, Toronto, Ontario, Canada
| | | | - Mack Roach
- University of California San Francisco, San Francisco, California
| | - David Beyer
- Cancer Centers of Northern Arizona Healthcare, Flagstaff, Arizona
| | | | | | | | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Dess R, Sun Y, Bolla M, Zapatero A, Malone S, Kishan A, Roy S, Jackson W, Lawton C, Sartor O, Nguyen P, Michalski J, Pisansky T, Roach M, Sandler H, Schipper M, Feng F, Spratt D. Prognostic and Predictive Performance of Routine Clinicopathologic Variables in 10,535 Men Enrolled on Randomized Phase III Trials in Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.189] [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: 11/25/2022]
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Kishan A, Romero T, Wang X, Pisansky T, Roach M, Bolla M, Steigler A, Denham J, Shipley W, Sandler H, Feng F, Joseph D, Armstrong J, Dunne M, Malone S, Roy S, Zapatero A, Sun Y, Michalski J, Spratt D. Impact of High DosE rAdioTherapy (HEAT) in Localized Prostate Cancer: An Individual Patient Data (IPD) Meta-Analysis of 15 Randomized Trials. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.190] [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: 10/20/2022]
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Shurlock J, Gratton B, Wilson L, Heatley R, Roach M, Dayer M, Furniss G. Rapid rollout of a pacemaker home monitoring service during the 2020 COVID-19 pandemic. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In an effort to reduce non-essential face to face contact during the COVD pandemic our pacemaker service was restructured in March 2020 to home monitoring only. Home monitors were issued at implant and wound reviews were done remotely via photo messages at one month or if prompted by the patient. Existing patients were given monitors on an ad hoc basis. A dedicated physiologist worked off site on home monitoring clinics. We assessed the impact on our service and on patient experience of these changes one year after implementation.
Methods
Baseline characteristics of age at implant and distance of home address from hospital were collected from all patients undergoing pacemaker home monitoring. Patients were surveyed using an adapted version of the Generic Short Patient Experiences Questionnaire (GS-PEQ). Comparison was made with our standard face-to-face follow-up model (1, 3, and 12 months).
Results
Data was collected for 326 patients. 233 received a new permanent pacemaker from March 2020 onwards and 93 existing patients were issued with a home monitor. Average age at pacemaker implant was 80.6 years (±9.9 years). The average one-way distance from home to outpatient clinic saved was 15.1 miles (±10.4 miles). 567 face-to-face appointments were saved. On an average day the off-site physiologist reviewed over 100 patient records a day, contacted 10 patients by phone and dictated reports on 20 patients (14 clinic patients and 6 alerts).
Of patients surveyed 88% agreed with the statement “I feel safe being cared for solely with a remote monitoring service” and 84% agreed with the statement “I receive the same standard of care via remote monitoring and face-to-face appointments”. Time saved by avoiding a face to face appointment was more than 1 hour for 90% of respondents. Respondents requested communication of reassuring monitoring, the ability to contact the pacing team in the event of concerns and clearer instructions for the home monitoring device.
Only 34% of newly implanted patients were able to send a photo message of their wound without prompting. We did not get a post procedure photo in 38% and the rest either spoke to us about the wound or had a face-to face visit. There was a significant difference in mean age between those who sent a photo (73.7 years) and those who didn't (81.4 years) (P=0.0006).
Conclusion
Rapid role out of a remote monitoring service for permanent pacemakers across a large county was feasible, produced significant savings in clinic time and was well received by patients. There were significant time savings for physiologists and patients. However remote wound monitoring in elderly patients was problematic due to the difficulty of sending photo messages.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Shurlock
- Musgrove Park Hospital, Taunton, United Kingdom
| | - B Gratton
- Musgrove Park Hospital, Taunton, United Kingdom
| | - L Wilson
- Musgrove Park Hospital, Taunton, United Kingdom
| | - R Heatley
- Musgrove Park Hospital, Taunton, United Kingdom
| | - M Roach
- Musgrove Park Hospital, Taunton, United Kingdom
| | - M Dayer
- Musgrove Park Hospital, Taunton, United Kingdom
| | - G Furniss
- Musgrove Park Hospital, Taunton, United Kingdom
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Roach M, Hiatt RA, Black S. COMMENTARY: Quality of Health Care in Nursing Homes. J Infect Dis 2021; 225:555-556. [PMID: 34618903 PMCID: PMC8754694 DOI: 10.1093/infdis/jiab516] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mack Roach
- Department of Radiation Oncology, University of California San Francisco
| | - Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco
| | - Steven Black
- Emeritus, University of Cincinnati Children's Hospital
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Henríquez I, Roach M, Morgan TM, Bossi A, Gómez JA, Abuchaibe O, Couñago F. Current and Emerging Therapies for Metastatic Castration-Resistant Prostate Cancer (mCRPC). Biomedicines 2021; 9:biomedicines9091247. [PMID: 34572433 PMCID: PMC8468423 DOI: 10.3390/biomedicines9091247] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 01/05/2023] Open
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) encompasses a heterogeneous wide range of molecular tumor behavior and a high risk of progression. Early detection and treatment are therefore crucial in these patients. Treatment has improved drastically in recent years and many novel therapeutic agents are currently under investigation. However, due to the rapidly changing therapeutic landscape in mCRPC, it is difficult for clinicians to keep up to date with the latest innovations in this area. In the present narrative review, we discuss the current and emerging therapies for mCRPC as well as the clinical and molecular factors that can help predict which patients are most likely to benefit from these novel agents.
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Affiliation(s)
- Iván Henríquez
- Department of Radiation Oncology, Hospital Universitario Sant Joan, 43204 Reus, Spain;
- Correspondence: ; Tel.: +34-655857839
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, San Francisco, CA 94143, USA;
| | - Todd M. Morgan
- Rogel Cancer Center, Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Alberto Bossi
- Prostate Brachytherapy Unit, Department of Radiation Oncology, Genito Urinary Oncology, Goustave Roussy, 94805 Paris, France;
| | - Junior A. Gómez
- Department of Radiation Oncology, Hospital Universitario Sant Joan, 43204 Reus, Spain;
| | - Oscar Abuchaibe
- Virgilio Galvis Ramirez Cancer Centre, Department of Radiation Oncology, Bucaramanga 681004, Colombia;
| | - Felipe Couñago
- Department of Radiation Oncology, Clinical Department, Faculty of Biomedicine, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea, 28223 Madrid, Spain;
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Wu SY, Wong AC, Shinohara K, Roach M, Cunha JAM, Valdes G, Hsu IC. Salvage High-Dose-Rate Brachytherapy for Recurrent Prostate Cancer After Definitive Radiation. Pract Radiat Oncol 2021; 11:515-526. [PMID: 34077809 DOI: 10.1016/j.prro.2021.04.007] [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: 12/08/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Salvage high-dose-rate brachytherapy (sHDRBT) for locally recurrent prostate cancer after definitive radiation is associated with biochemical control in approximately half of patients at 3 to 5 years. Given potential toxicity, patient selection is critical. We present our institutional experience with sHDRBT and validate a recursive partitioning machines model for biochemical control. MATERIALS AND METHODS We performed a retrospective analysis of 129 patients who underwent whole-gland sHDRBT between 1998 and 2016. We evaluated clinical factors associated with biochemical control as well as toxicity. RESULTS At diagnosis the median prostate-specific antigen (PSA) was 7.77 ng/mL. A majority of patients had T1-2 (73%) and Gleason 6-7 (82%) disease; 71% received external beam radiation therapy (RT) alone, and 22% received permanent prostate implants. The median disease-free interval (DFI) was 56 months, and median presalvage PSA was 4.95 ng/mL. At sHDRBT, 46% had T3 disease and 51% had Gleason 8 to 10 disease. At a median of 68 months after sHDRBT, 3- and 5-year disease-free survival were 85% (95% CI, 79-91) and 71% (95% CI, 62-79), respectively. Median PSA nadir was 0.18 ng/mL, achieved a median of 10 months after sHDRBT. Patients with ≥35%+ cores and a DFI <4.1 years had worse biochemical control (19% vs 50%, P = .02). Local failure (with or without regional/distant failure) was seen in 11% of patients (14/129), and 14 patients (11%) developed acute urinary obstruction requiring Foley placement and 19 patients (15%) developed strictures requiring dilation. CONCLUSIONS sHDRBT is a reasonable option for patients with locally recurrent prostate cancer after definitive RT. Those with <35%+ cores or an initial DFI of ≥4.1 years may be more likely to achieve long-term disease control after sHDRBT.
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Affiliation(s)
- Susan Y Wu
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Anthony C Wong
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Katsuto Shinohara
- Department of Urology, University of California, San Francisco, California
| | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, California
| | - J Adam M Cunha
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California, San Francisco, California
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California, San Francisco, California.
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Elghazaly H, Mottet N, Garcia J, Oudard S, Roach M, Abbou C, Merseburger A, Emara A, Shehata S, Tawfik H, Khorshid O, Selim A, Assem A, Abdelkarim K, Ezz El-Arab L, Bazarbashi S, Omar A, Elwakil H, Elashry M, Abou ElFotouh M, Osman T, Ezz El Din M. Clinical recommendations in the management of advanced prostate cancer: International Gastrointestinal, Liver and Uro-oncology (IGILUC 2019) experts. World J Urol 2021; 39:1421-1429. [PMID: 32643031 DOI: 10.1007/s00345-020-03328-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/30/2019] [Accepted: 06/23/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Advancements in the diagnosis and treatment of prostate cancer (PC) have rapidly progressed through the past years. Various factors should be taken into account while treating individual patients to ensure optimal and careful decision making. The purpose of this consensus review is to summarize the current practice patterns when managing patients with advanced prostate cancer (APC) as there is still a lack of or very limited evidence on its clinical management in some areas. METHODS Pre-defined questions were shared with experts prior to the consensus session that took place in Cairo, Egypt in April 2019 during the 8th International gastrointestinal, liver and uro-oncology conference (IGILUC). Voting was based mainly on the expert opinions of the panel after a thorough discussion and review of available evidence from guidelines or best evidence available concerning the topic at hand. RESULTS A strong consensus or unanimity was reached on 47% of the proposed questions. Notably, the panelists reached consensus on several topics based on high-level expert opinion. These findings contribute in several ways to our understanding of the management of PC and provide a basis for future recommendations. There was also a lack of consensus on other several topics, which suggests the need for further supporting data addressing these knowledge gaps. CONCLUSION This review offers a thorough understanding of APC practice and offers insight on the various opinions shared amongst experts in the field that can serve as guidance regionally and deepens our understanding of disease management globally.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Jorge Garcia
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephane Oudard
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France
| | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Claude Abbou
- Department of Urology, Hôpital Henri Mondor, Creteil, France
| | - Axel Merseburger
- Department of Urology and Urologic Oncology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Amr Emara
- Department of Urology, Hampshire Hospitals, NHS Foundation Trust, Basingstoke, UK
| | - Samir Shehata
- Clinical Oncology Department, Assiut University Cancer Centre, Assiut, Egypt
| | - Hesham Tawfik
- Clinical Oncology Department, Tanta University, Tanta, Egypt
| | - Ola Khorshid
- Medical Oncology Department National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Selim
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akram Assem
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Khalid Abdelkarim
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Lobna Ezz El-Arab
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shouki Bazarbashi
- Medical Oncology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abbass Omar
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hesham Elwakil
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Elashry
- Department of Clinical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abou ElFotouh
- Department of Clinical Oncology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Tarek Osman
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Mai Ezz El Din
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Rogowski P, Roach M, Schmidt-Hegemann NS, Trapp C, von Bestenbostel R, Shi R, Buchner A, Stief C, Belka C, Li M. Radiotherapy of oligometastatic prostate cancer: a systematic review. Radiat Oncol 2021; 16:50. [PMID: 33750437 PMCID: PMC7941976 DOI: 10.1186/s13014-021-01776-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Due to improved imaging sensitivity, the term "oligometastatic" prostate cancer disease is diagnosed more often, leading to an increasing interest in metastasis-directed therapy (MDT). There are two types of radiation based MDT applied when treating oligometastatic disease: (1) stereotactic body radiation therapy (SBRT) generally used for bone metastases; or (2) SBRT for isolated nodal oligometastases combined with prophylactic elective nodal radiotherapy. This review aims to summarize current evidence data, which may shed light on the optimal management of this heterogeneous group of patients. METHODS A systematic review of the Medline database through PubMed was performed according to PRISMA guidelines. All relevant studies published up to November 2020 were identified and screened. Fifty-six titles were included. Besides outcome parameters, different prognostic and predictive factors were assessed, including site of metastases, time between primary treatment and MDT, use of systemic therapies, hormone sensitivity, as well as pattern of recurrence. FINDINGS Evidence consists largely of retrospective case series and no consistent precise definition of oligometastasis exists, however, most investigators seem to acknowledge the need to distinguish between patients presenting with what is frequently called "synchronous" versus "metachronous" oligometastatic disease. Available data on radiotherapy as MDT demonstrate high local control rates and a small but relevant proportion of patients without progressive disease after 2 years. This holds true for both hormone sensitive and castration resistant prostate cancer diseases. The use of 68Ga-PSMA PET/CT for staging increased dramatically. Radiation doses and field sizes varied considerably among the studies. The search for relevant prognostic and predictive factors is ongoing. CONCLUSIONS To our best knowledge this review on oligometastatic prostate cancer included the largest number of original articles. It demonstrates the therapeutic potential and challenges of MDT for oligometastatic prostate cancer. Prospective studies are under way and will provide further high-level evidence.
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Affiliation(s)
- Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Mack Roach
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, Suite H 1031, San Francisco, CA 94143-1708 USA
| | | | - Christian Trapp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Rieke von Bestenbostel
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Run Shi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Mohamad O, Roach M. Radiation Delay Is Okay, but Where Is the Evidence? JAMA Oncol 2021; 7:463-464. [PMID: 33443566 DOI: 10.1001/jamaoncol.2020.7612] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Osama Mohamad
- Helen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, University of California, San Francisco
| | - Mack Roach
- Helen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, University of California, San Francisco
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Hall WA, Tree AC, Dearnaley D, Parker CC, Prasad V, Roach M, Lawton CAF. Considering benefit and risk before routinely recommending SpaceOAR. Lancet Oncol 2021; 22:11-13. [PMID: 33387489 PMCID: PMC8882263 DOI: 10.1016/s1470-2045(20)30639-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, USA.
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - David Dearnaley
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Christopher C Parker
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Mack Roach
- Department of Radiation Oncology and Urology, University of California San Francisco, San Francisco, CA, USA
| | - Colleen A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, USA
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Chen WC, Li Y, Lazar A, Altun A, Descovich M, Nano T, Ziemer B, Sudhyadhom A, Cunha A, Thomas H, Gottschalk A, Hsu IC, Roach M. Stereotactic Body Radiation Therapy and High-Dose-Rate Brachytherapy Boost in Combination With Intensity Modulated Radiation Therapy for Localized Prostate Cancer: A Single-Institution Propensity Score Matched Analysis. Int J Radiat Oncol Biol Phys 2020; 110:429-437. [PMID: 33385496 DOI: 10.1016/j.ijrobp.2020.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/01/2020] [Accepted: 12/22/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To perform a propensity-score matched analysis comparing stereotactic body radiation therapy (SBRT) boost and high-dose-rate (HDR) boost for localized prostate cancer. METHODS AND MATERIALS A single-institution retrospective chart review was conducted of men treated with pelvic external beam radiation therapy (EBRT) and SBRT boost (21 Gy and 19 Gy in 2 fractions) to the prostate for prostate cancer. A cohort treated at the same institution with HDR brachytherapy boost (19 Gy in 2 fractions) was compared. Propensity-score (PS) matching and multivariable Cox regression were used for analysis. Outcomes were biochemical recurrence freedom (BCRF) and metastasis freedom (MF). RESULTS One hundred thirty-one men were treated with SBRT boost and 101 with HDR boost with median follow-up of 73.4 and 186.0 months, respectively. In addition, 68.8% of men had high-risk and 26.0% had unfavorable-intermediate disease, and 94.3% received androgen deprivation therapy. Five- and 10-year unadjusted BCRF was 88.8% and 85.3% for SBRT and 91.8% and 74.6% for HDR boost (log-rank P = .3), and 5- and 10-year unadjusted MF was 91.7% and 84.3% for SBRT and 95.8% and 82.0% for HDR (log-rank P = .8). After adjusting for covariates, there was no statistically significant difference in BCRF (hazard ratio [HR] 0.81; 95% confidence interval [CI], 0.37-1.79; P = .6) or MF (HR 1.07; 95% CI, 0.44-2.57; P = .9) between SBRT and HDR boost. Similarly, after PS matching, there was no statistically significant difference between SBRT and HDR (BCRF: HR 0.66, 0.27-1.62, P = .4; MF: HR 0.84, 0.31-2.26, P = .7). Grade 3+ genitourinary and gastrointestinal toxicity in the SBRT cohort were 4.6% and 1.5%, and 3.0% and 0.0% in the HDR cohorts (P = .4, Fisher exact test). CONCLUSIONS SBRT boost plus pelvic EBRT for prostate cancer resulted in similar BCRF and MF to HDR boost in this single institution, PS matched retrospective analysis. Toxicity was modest. Prospective evaluation of SBRT boost for the treatment of unfavorable-intermediate and high-risk prostate cancer is warranted.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Yun Li
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Ann Lazar
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, California; Division of Biostatistics, University of California San Francisco, San Francisco, California
| | - Aysu Altun
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Martina Descovich
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Tomi Nano
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Benjamin Ziemer
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Atchar Sudhyadhom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Adam Cunha
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Horatio Thomas
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Alexander Gottschalk
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Mack Roach
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
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Spratt DE, Malone S, Roy S, Grimes S, Eapen L, Morgan SC, Malone J, Craig J, Dess RT, Jackson WC, Hartman HE, Kishan AU, Mehra R, Kaffenberger S, Morgan TM, Reichert ZR, Alumkal JJ, Michalski J, Lee WR, Pisansky TM, Feng FY, Shipley W, Sandler HM, Schipper MJ, Roach M, Sun Y, Lawton CAF. Prostate Radiotherapy With Adjuvant Androgen Deprivation Therapy (ADT) Improves Metastasis-Free Survival Compared to Neoadjuvant ADT: An Individual Patient Meta-Analysis. J Clin Oncol 2020; 39:136-144. [PMID: 33275486 DOI: 10.1200/jco.20.02438] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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
PURPOSE There remains a lack of clarity regarding the influence of sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) on outcomes in prostate cancer (PCa). Herein, we evaluate the optimal sequencing of ADT with prostate-directed RT in localized PCa. METHODS MEDLINE (1966-2018), Embase (1982-2018), ClinicalTrials.gov, and conference proceedings (1990-2018) were searched to identify randomized trials evaluating the sequencing, but not duration, of ADT with RT. Two randomized phase III trials were identified, and individual patient data were obtained: Ottawa 0101 and NRG Oncology's Radiation Therapy Oncology Group 9413. Ottawa 0101 randomly assigned patients to neoadjuvant or concurrent versus concurrent or adjuvant short-term ADT. Radiation Therapy Oncology Group 9413, a 2 × 2 factorial trial, included a random assignment of neoadjuvant or concurrent versus adjuvant short-term ADT. The neoadjuvant or concurrent ADT arms of both trials were combined into the neoadjuvant group, and the arms receiving adjuvant ADT were combined into the adjuvant group. The primary end point of this meta-analysis was progression-free survival (PFS). RESULTS The median follow-up was 14.9 years. Overall, 1,065 patients were included (531 neoadjuvant and 534 adjuvant). PFS was significantly improved in the adjuvant group (15-year PFS, 29% v 36%, hazard ratio [HR], 1.25 [95% CI, 1.07 to 1.47], P = .01). Biochemical failure (subdistribution HR [sHR], 1.37 [95% CI, 1.12 to 1.68], P = .002), distant metastasis (sHR, 1.40 [95% CI, 1.00 to 1.95], P = .04), and metastasis-free survival (HR, 1.17 [95% CI, 1.00 to 1.37], P = .050) were all significantly improved in the adjuvant group. There were no differences in late grade ≥ 3 gastrointestinal (2% v 3%, P = .33) or genitourinary toxicity (5% v 5%, P = .76) between groups. CONCLUSION The sequencing of ADT with prostate-directed RT has significant association with long-term PFS and MFS in localized PCa. Our findings favor use of an adjuvant over a neoadjuvant approach, without any increase in long-term toxicity.
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Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Shawn Malone
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Soumyajit Roy
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,New York Medical College, New York, NY
| | - Scott Grimes
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Libni Eapen
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Mayo Clinic, Rochester, MN
| | - Scott C Morgan
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Malone
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Craig
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Holly E Hartman
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI.,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Amar U Kishan
- University of California Los Angeles, Los Angeles, CA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Joshi J Alumkal
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | - Mathew J Schipper
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Yilun Sun
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
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47
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Hsu IC, Rodgers JP, Shinohara K, Purdy J, Michalski J, Roach M, Vigneault E, Ivker RA, Pryzant RM, Kuettel M, Taussky D, Gustafson GS, Raben A, Sandler HM. Long-Term Results of NRG Oncology/RTOG 0321: A Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiation Therapy for Adenocarcinoma of the Prostate. Int J Radiat Oncol Biol Phys 2020; 110:700-707. [PMID: 33186617 DOI: 10.1016/j.ijrobp.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/16/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the long-term outcome of patients with prostate cancer treated with external beam radiation therapy and high dose rate (HDR) brachytherapy from a prospective multi-institutional trial conducted by NRG Oncology/RTOG. METHODS AND MATERIALS Patients with clinically localized (T1c-T3b) prostate cancer without prior history of transurethral resection of prostate or hip prosthesis were eligible for this study. All patients were treated with a combination of 45 Gy in 25 fractions from external beam radiation therapy and one HDR implant delivering 19 Gy in 2 fractions. Adverse events (AE) were collected using Common Toxicity Criteria for Adverse Events, version 3. Cumulative incidence was used to estimate time to severe late gastrointestinal (GI)/genitourinary (GU) toxicity, biochemical failure, disease-specific mortality, local failure, and distant failure. Overall survival was estimated using the Kaplan-Meier method. RESULTS One hundred and twenty-nine patients were enrolled from July 2004 to May 2006. AE data was available for 115 patients. Patients were National Comprehensive Cancer Network (NCCN) intermediate to very high risk. The median age was 68, T1c-T2c 91%, T3a-T3b 9%, PSA ≤10 70%, PSA >10 to ≤20 30%, GS 6 10%, GS 7 72%, and GS 8 to 10 18%. Forty-three percent of patients received hormonal therapy. At a median follow-up time of 10 years, there were 6 (5%) patients with grade 3 GI and GU treatment-related AEs, and no late grade 4 to 5 GI and GU AEs. At 5 and 10 years, the rate of late grade 3 gastrointestinal and genitourinary AEs was 4% and 5%, respectively. Five- and 10-year overall survival rates were 95% and 76%. Biochemical failure rates per Phoenix definition at 5 and 10 years were 14% and 23%. The 10-year rate of disease-specific mortality was 6%. At 5 and 10 years, the rates of distant failure were 4% and 8%, respectively. The rates of local failure at 5 and 10 years were 2% at both time points. CONCLUSIONS Combined modality treatment using HDR prostate brachytherapy leads to excellent long-term clinical outcomes in this prospective multi-institutional trial.
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Affiliation(s)
- I-Chow Hsu
- University of California, San Francisco, California.
| | | | | | - James Purdy
- University of California Davis, Davis, California
| | | | - Mack Roach
- University of California, San Francisco, California
| | | | | | | | | | - Daniel Taussky
- Center Hospitalier de l'Université de Montréal-Notre Dame
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48
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Kishan A, Romero T, Rettig M, Garraway I, Roach M, Pisansky T, Michalski J, Lee W, Jones C, Rosenthal S, Feng F, Mahal B, Dess R, Nickols N, Tran P, Boutros P, Steinberg M, Elashoff D, Sandler H, Spratt D. Association of Black Race With Improved Outcomes Following Definitive Radiotherapy With Androgen Deprivation Therapy for High-Risk Prostate Cancer: A Meta-Analysis of Eight Randomized Trials. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2408] [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: 11/25/2022]
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49
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Sachdev S, Carroll P, Sandler H, Nguyen PL, Wafford E, Auffenberg G, Schaeffer E, Roach M, Evans CP, Hussain M. Assessment of Postprostatectomy Radiotherapy as Adjuvant or Salvage Therapy in Patients With Prostate Cancer: A Systematic Review. JAMA Oncol 2020; 6:1793-1800. [PMID: 32852528 DOI: 10.1001/jamaoncol.2020.2832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance After radical prostatectomy, adverse pathologic features and postoperative prostate-specific antigen (PSA) levels can herald disease recurrence or progression. Postoperative radiotherapy (RT) remains beneficial in this setting. Objective To examine the evidence supporting the use of postoperative RT as well as recent advances that help determine timing, scope, and use in combination with androgen deprivation therapy (ADT) with or without lymphatic irradiation. Evidence Review A search was conducted of MEDLINE (Ovid), Embase (Elsevier), and the Cochrane Library (Wiley) databases, in addition to clinical trial registries. The reference list of included studies was reviewed for relevant articles. The search was limited to studies published between January 1, 2014, and December 31, 2019. Findings After 548 citations were screened, 27 articles were selected for inclusion. In addition to conventional imaging, positron-emission tomographic (PET)-based radiotracers can aid in disease localization. While PET imaging may influence management with RT, studies are underway examining this issue, and several limitations must be considered, such as limited detectability at lower PSA levels and regional sensitivity. Available genomic classifiers can risk stratify patients or assess potential added benefit of RT. Prospective validation is underway with cooperative group trials. Adjuvant RT, on the basis of adverse pathologic features (such as extraprostatic extension or positive margins) is beneficial in terms of disease control, but it is unclear whether this therapy translates into more meaningful clinical benefit (eg, improved overall survival and a reduction in metastasis), which has been demonstrated by only 1 older, prospective randomized study. Preliminary data suggest that for a relatively favorable-risk population (low Gleason score but with positive margins), PSA monitoring may be a reasonable alternative in some men. Use of androgen deprivation therapy and lymphatic irradiation should be considered in higher-risk cohorts (those with high PSA, high Gleason score, seminal vesicle invasion or node positivity) in conjunction with postoperative RT. Conclusions and Relevance The findings of this review suggest that postprostatectomy RT should be considered for men with prostate cancer in the setting of adverse pathologic features; in carefully selected patients with favorable characteristics, close PSA monitoring is an option. Androgen deprivation therapy and pelvic lymphatic irradiation should be considered for higher risk cohorts (eg, higher PSA values, higher Gleason score). PET imaging and molecular studies remain unproven as decision tools.
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Affiliation(s)
- Sean Sachdev
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Peter Carroll
- UCSF Hellen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco
| | - Howard Sandler
- Samuel Oschin Cancer Institute, Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul L Nguyen
- Dana Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Cambridge, Illinois
| | - Eileen Wafford
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gregory Auffenberg
- Robert H. Lurie Comprehensive Cancer Center, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Edward Schaeffer
- Robert H. Lurie Comprehensive Cancer Center, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mack Roach
- UCSF Hellen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, University of California, San Francisco
| | - Christopher P Evans
- UC Davis Comprehensive Cancer Center, Department of Urologic Surgery, University of California, Davis, Sacramento
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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50
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Lukka H, Deshmukh S, Bruner D, Bahary J, Lawton C, Efstathiou J, Kudchadker R, Ponsky L, Seaward S, Dayes I, Gopaul D, Michalski J, Delouya G, Kaplan I, Horwitz E, Roach M, Beyer D, Sandler H, Kachnic L. Patient Reported Outcomes in NRG Oncology/RTOG 0938, a Randomized Phase II Study Evaluating 2 Ultrahypofractionated Regimens (UHR) for Prostate Cancer (CaP). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.836] [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: 10/23/2022]
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