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Rana Z, Kamran SC, Shetty AC, Sutera P, Song Y, Bazyar S, Solanki AA, Simko JP, Pollack A, McConkey D, Kates M, Siddiqui MM, Hiken J, Earls J, Messina D, Mouw KW, Miyamoto D, Shipley WU, Michaelson MD, Zietman A, Coen JJ, Dahl DM, Jani AB, Souhami L, Chang BK, Lee RJ, Pham H, Marshall DT, Shen X, Pugh SL, Feng FY, Efstathiou JA, Tran PT, Deek MP. Prognostic Significance of Immune Cell Infiltration in Muscle-invasive Bladder Cancer Treated with Definitive Chemoradiation: A Secondary Analysis of RTOG 0524 and RTOG 0712. Eur Urol Oncol 2024:S2588-9311(24)00095-6. [PMID: 38641541 DOI: 10.1016/j.euo.2024.03.015] [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: 01/09/2024] [Revised: 02/14/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024]
Abstract
Chemoradiation therapy (CRT) is a treatment for muscle-invasive bladder cancer (MIBC). Using a novel transcriptomic profiling panel, we validated prognostic immune biomarkers to CRT using 70 pretreatment tumor samples from prospective trials of MIBC (NRG/RTOG 0524 and 0712). Disease-free survival (DFS) and overall survival (OS) were estimated via the Kaplan-Meier method and stratified by genes correlated with immune cell activation. Cox proportional-hazards models were used to assess group differences. Clustering of gene expression profiles revealed that the cluster with high immune cell content was associated with longer DFS (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.26-1.10; p = 0.071) and OS (HR 0.48, 95% CI 0.24-0.97; p = 0.040) than the cluster with low immune cell content. Higher expression of T-cell infiltration genes (CD8A and ICOS) was associated with longer DFS (HR 0.40, 95% CI 0.21-0.75; p = 0.005) and OS (HR 0.49, 95% CI 0.25-0.94; p = 0.033). Higher IDO1 expression (IFNγ signature) was also associated with longer DFS (HR 0.44, 95% CI 0.24-0.88; p = 0.021) and OS (HR 0.49, 95% CI 0.24-0.99; p = 0.048). These findings should be validated in prospective CRT trials that include biomarkers, particularly for trials incorporating immunotherapy for MIBC. PATIENT SUMMARY: We analyzed patient samples from two clinical trials (NRG/RTOG 0524 and 0712) of chemoradiation for muscle-invasive bladder cancer using a novel method to assess immune cells in the tumor microenvironment. Higher expression of genes associated with immune activation and high overall immune-cell content were associated with better disease-free survival and overall survival for patients treated with chemoradiation.
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Affiliation(s)
- Zaker Rana
- University of Maryland/Greenebaum Cancer Center, Baltimore, MD, USA
| | - Sophia C Kamran
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Amol C Shetty
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Yang Song
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Alan Pollack
- University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, FL, USA
| | - David McConkey
- Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Max Kates
- Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | | | | | - Jon Earls
- CoFactor Genomics, San Francisco, CA, USA
| | | | - Kent W Mouw
- Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - David Miyamoto
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | - Anthony Zietman
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - John J Coen
- Department of Radiation Oncology, GenesisCare USA-Warwick, Warwick, RI, USA
| | - Douglas M Dahl
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Ashesh B Jani
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA, USA
| | - Luis Souhami
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Brian K Chang
- Parkview Regional Medical Center, Fort Wayne, IN, USA
| | | | - Huong Pham
- Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Xinglei Shen
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | - Felix Y Feng
- UCSF Medical Center-Mission Bay, San Francisco, CA, USA
| | | | - Phuoc T Tran
- University of Maryland/Greenebaum Cancer Center, Baltimore, MD, USA.
| | - Matthew P Deek
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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Otani K, Konieczkowski DJ, Rodden DJ, Wu S, Davicioni E, Saylor PJ, Dahl DM, Wu CL, Kamran SC, Efstathiou JA, Miyamoto DT. CGE24-096: Impact of Somatic Mutations on Outcomes of Salvage Radiation and Hormonal Therapy for Prostate Cancer Recurrence After Prostatectomy. J Natl Compr Canc Netw 2024; 22:CGE24-096. [PMID: 38579754 DOI: 10.6004/jnccn.2023.7238] [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] [Indexed: 04/07/2024]
Affiliation(s)
| | | | | | - Shulin Wu
- 1Massachusetts General Hospital, Boston, MA
| | | | - Philip J Saylor
- 1Massachusetts General Hospital, Boston, MA
- 4Harvard Medical School, Boston, MA
| | - Douglas M Dahl
- 1Massachusetts General Hospital, Boston, MA
- 4Harvard Medical School, Boston, MA
| | - Chin-Lee Wu
- 1Massachusetts General Hospital, Boston, MA
- 4Harvard Medical School, Boston, MA
| | - Sophia C Kamran
- 1Massachusetts General Hospital, Boston, MA
- 4Harvard Medical School, Boston, MA
- 5Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jason A Efstathiou
- 1Massachusetts General Hospital, Boston, MA
- 4Harvard Medical School, Boston, MA
| | - David T Miyamoto
- 1Massachusetts General Hospital, Boston, MA
- 4Harvard Medical School, Boston, MA
- 5Broad Institute of Harvard and MIT, Cambridge, MA
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Kamran SC, Otani Y, Qi D, Pompa IR, Dzeng RK, Pittie R, Chung E, Otani K, Wo JY, Zietman AL, Reeves PM, Van Allen EM, Efstathiou JA, Miyamoto DT. PCO24-175: Immune Cell Dynamics After Radiotherapy for Oligometastatic Prostate Cancer. J Natl Compr Canc Netw 2024; 22:PCO24-175. [PMID: 38579846 DOI: 10.6004/jnccn.2023.7170] [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] [Indexed: 04/07/2024]
Affiliation(s)
- Sophia C Kamran
- 1Massachusetts General Hospital, Boston, MA
- 2Harvard Medical School, Boston, MA
- 3Broad Institute of Harvard and MIT, Cambridge, MA
| | | | - David Qi
- 1Massachusetts General Hospital, Boston, MA
| | | | | | - Rea Pittie
- 1Massachusetts General Hospital, Boston, MA
| | - Ella Chung
- 1Massachusetts General Hospital, Boston, MA
| | | | - Jennifer Y Wo
- 1Massachusetts General Hospital, Boston, MA
- 2Harvard Medical School, Boston, MA
| | | | | | - Eliezer M Van Allen
- 2Harvard Medical School, Boston, MA
- 3Broad Institute of Harvard and MIT, Cambridge, MA
- 4Dana-Farber Cancer Institute, Boston, MA
| | - Jason A Efstathiou
- 1Massachusetts General Hospital, Boston, MA
- 2Harvard Medical School, Boston, MA
| | - David T Miyamoto
- 1Massachusetts General Hospital, Boston, MA
- 2Harvard Medical School, Boston, MA
- 3Broad Institute of Harvard and MIT, Cambridge, MA
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Morgan TM, Boorjian SA, Buyyounouski MK, Chapin BF, Chen DYT, Cheng HH, Chou R, Jacene HA, Kamran SC, Kim SK, Kirkby E, Luckenbaugh AN, Nathanson BJ, Nyame YA, Posadas EM, Tran PT, Chen RC. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy. J Urol 2024; 211:518-525. [PMID: 38421243 DOI: 10.1097/ju.0000000000003891] [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: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part II of a three-part series focusing on treatment delivery for non-metastatic biochemical recurrence (BCR) after primary radical prostatectomy (RP). Please refer to Part I for discussion of treatment decision-making and Part III for discussion of evaluation and management of recurrence after radiotherapy (RT) and focal therapy, regional recurrence, and oligometastasis. MATERIALS AND METHODS The systematic review that informs this Guideline was based on searches in Ovid MEDLINE (1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022). Update searches were conducted on July 26, 2023. Searches were supplemented by reviewing electronic database reference lists of relevant articles. RESULTS In a collaborative effort between AUA, ASTRO, and SUO, the Salvage Therapy for Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance for the care of patients who experience BCR after initial definitive local therapy for clinically localized disease. CONCLUSIONS Optimizing and personalizing the approach to salvage therapy remains an ongoing area of work in the field of genitourinary oncology and represents an area of research and clinical care that requires well-coordinated, multi-disciplinary efforts.
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Affiliation(s)
- Todd M Morgan
- Urology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Brian F Chapin
- Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Y T Chen
- Urology, Fox Chase Cancer Center-Temple Health, Rockledge, Pennsylvania
| | - Heather H Cheng
- Division of Hematology and Oncology Medicine, University of Washington, Seattle, Washington
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Portland, Oregon
| | | | - Sophia C Kamran
- Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | - Yaw A Nyame
- Urology, University of Washington, Seattle, Washington
| | | | - Phuoc T Tran
- Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Ronald C Chen
- Radiation Oncology, University of Kansas, Kansas City, Kansas
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Huynh MJ, Eng L, Ngo LH, Power NE, Kamran SC, Pierce TT, Lo AC. Incidence and survival of secondary malignancies after external beam radiotherapy for prostate cancer in the SEER database. Can Urol Assoc J 2024; 18:121-128. [PMID: 38381941 PMCID: PMC11034958 DOI: 10.5489/cuaj.8508] [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: 02/23/2024]
Abstract
INTRODUCTION We investigated the incidence of secondary bladder (BCa) and rectal cancers (RCa) after external beam radiotherapy (EBRT) for prostate cancer (PCa) compared to radical prostatectomy (RP) alone, and compared cancer-specific survival (CSS) of these secondary neoplasms to their primary counterparts. METHODS This retrospective cohort study included men in the SEER cancer registry with a diagnosis of non-metastatic, clinically node-negative PCa treated with either RP or EBRT from 1995-2011 and allowed a minimum five-year lag period for the development of secondary BCa or RCa. Patients were divided into two eras, 1995-2002 and 2003-2011, to examine differences in incidence of secondary malignancies over time. Univariable and multivariable competing risk analyses with Fine-Gray subdistribution hazard and cause-specific hazard models were used to examine the risk of developing a secondary BCa or RCa. Competing risks analyses were used to compare CSS of primary vs. secondary BCa and RCa. RESULTS A total of 198 184 men underwent RP and 190 536 underwent EBRT for PCa. The cumulative incidence of secondary BCa at 10 years was 1.71% for RP, and 3.7% for EBRT (p<0.001), while that of RCa was 0.52% for RP and 0.99% for EBRT (p<0.001). EBRT was associated with almost twice the risk of developing a secondary BCa and RCa compared to RP. The hazard of secondary BCa following EBRT delivered during 2003-2011 was 20% less than from 1995-2002 (p<0.09, Fine-Gray model), while that of secondary RCa was 31% less (p<0.001) (hazard ratio 0.78, p<0.001) for Fine-Gray and cause-specific hazard models. In the Fine-Gray model, the risk of death from BCa was 27% lower for secondary BCa after RP compared to primary BCa, while the risk of death was 9% lower for secondary BCa after EBRT compared to primary BCa. There was no difference in RCa-specific survival between primary or secondary RCa after RP or EBRT. CONCLUSIONS The risk of BCa and RCa is almost twice as high for men undergoing EBRT for localized PCa vs. RP, but that risk is declining, likely reflecting advances in radiation delivery. The development of secondary RCa or BCa does not confer elevated risk of death compared to their primary counterparts.
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Affiliation(s)
- Melissa J Huynh
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
- Division of Surgical Oncology, Department of Oncology, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nicholas E Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
- Division of Surgical Oncology, Department of Oncology, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Sophia C Kamran
- Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Theodore T Pierce
- Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Andrea C Lo
- Division of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC Canada
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Iwai Y, Li J, Isaacs TJ, Ma SJ, Elmore SNC, Kamran SC, Oladeru OT. National Survey of Oncologists' Knowledge, Attitudes, and Practice Behaviors: Caring for Cancer Patients Experiencing Incarceration. J Correct Health Care 2024; 30:97-106. [PMID: 38466954 DOI: 10.1089/jchc.23.08.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Cancer is the leading cause of illness-related death in state prisons in the United States. The experiences of physicians providing oncological care to individuals experiencing incarceration are underexplored. The study aims were to evaluate knowledge, attitudes, and practices of oncologists caring for cancer patients who are incarcerated. An online survey was distributed to a random sample of 150 oncologists from the American Society of Clinical Oncology and the American Society for Radiation Oncology from July 2020 to December 2021. Statistical analyses included two proportion Z-test, Fisher's exact test, Kruskal-Wallis test, and Cramer's V to estimate factors associated with attitudes and barriers to care. Of the 55 respondents (36.7% response rate), 21 were medical oncologists and 34 were radiation oncologists. Academic center oncologists were more likely to report caring for incarcerated patients than community or private practice oncologists (p = .04). Most (53%) incorrectly reported "heart disease" as the leading cause of death, as opposed to "cancer" (15% identified correctly). Oncologists practicing at both academic and community centers were more likely to report care coordination barriers than oncologists at academic or community centers (p < .01). We identified potential barriers in caring for incarcerated cancer patients. Future studies should explore ways to improve care coordination between oncology teams and prisons.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jian Li
- State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Tamia J Isaacs
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Shekinah N C Elmore
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Morgan TM, Boorjian SA, Buyyounouski MK, Chapin BF, Chen DYT, Cheng HH, Chou R, Jacene HA, Kamran SC, Kim SK, Kirkby E, Luckenbaugh AN, Nathanson BJ, Nyame YA, Posadas EM, Tran PT, Chen RC. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part III: Salvage Therapy After Radiotherapy or Focal Therapy, Pelvic Nodal Recurrence and Oligometastasis, and Future Directions. J Urol 2024; 211:526-532. [PMID: 38421252 DOI: 10.1097/ju.0000000000003890] [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: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part III of a three-part series focusing on evaluation and management of suspected non-metastatic recurrence after radiotherapy (RT) and focal therapy, evaluation and management of regional recurrence, management for molecular imaging metastatic recurrence, and future directions. Please refer to Part I for discussion of treatment decision-making and Part II for discussion of treatment delivery for non-metastatic biochemical recurrence (BCR) after radical prostatectomy (RP). MATERIALS AND METHODS The systematic review that informs this Guideline was based on searches in Ovid MEDLINE (1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022). Update searches were conducted on July 26, 2023. Searches were supplemented by reviewing electronic database reference lists of relevant articles. RESULTS In a collaborative effort between AUA, ASTRO, and SUO, the Salvage Therapy for Prostate Cancer Guideline Panel developed evidence- and consensus-based guideline statements to provide guidance for the care of patients who experience BCR after initial definitive local therapy for clinically localized disease. CONCLUSIONS Continuous and deliberate efforts for multidisciplinary care in prostate cancer will be required to optimize and improve the oncologic and functional outcomes of patients treated with salvage therapies in the future.
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Affiliation(s)
- Todd M Morgan
- Urology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Brian F Chapin
- Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Y T Chen
- Urology, Fox Chase Cancer Center-Temple Health, Rockledge, Pennsylvania
| | - Heather H Cheng
- Division of Hematology and Oncology Medicine, University of Washington, Seattle, Washington
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Portland, Oregon
| | | | - Sophia C Kamran
- Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | - Yaw A Nyame
- Urology, University of Washington, Seattle, Washington
| | | | - Phuoc T Tran
- Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Ronald C Chen
- Radiation Oncology, University of Kansas, Kansas City, Kansas
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Morgan TM, Boorjian SA, Buyyounouski MK, Chapin BF, Chen DYT, Cheng HH, Chou R, Jacene HA, Kamran SC, Kim SK, Kirkby E, Luckenbaugh AN, Nathanson BJ, Nyame YA, Posadas EM, Tran PT, Chen RC. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part I: Introduction and Treatment Decision-Making at the Time of Suspected Biochemical Recurrence after Radical Prostatectomy. J Urol 2024; 211:509-517. [PMID: 38421253 DOI: 10.1097/ju.0000000000003892] [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: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part I of a three-part series focusing on treatment decision-making at the time of suspected biochemical recurrence (BCR) after radical prostatectomy (RP). Please refer to Part II for discussion of treatment delivery for non-metastatic BCR after RP and Part III for discussion of evaluation and management of recurrence after radiotherapy (RT) and focal therapy, regional recurrence, and oligometastasis. MATERIALS AND METHODS The systematic review that informs this Guideline was based on searches in Ovid MEDLINE (1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022). Update searches were conducted on July 26, 2023. Searches were supplemented by reviewing electronic database reference lists of relevant articles. RESULTS In a collaborative effort between AUA, ASTRO, and SUO, the Salvage Therapy for Prostate Cancer Panel developed evidence- and consensus-based statements to provide guidance for the care of patients who experience BCR after initial definitive local therapy for clinically localized disease. CONCLUSIONS Advancing work in the area of diagnostic tools (particularly imaging), biomarkers, radiation delivery, and biological manipulation with the evolving armamentarium of therapeutic agents will undoubtedly present new opportunities for patients to experience long-term control of their cancer while minimizing toxicity.
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Affiliation(s)
- Todd M Morgan
- Urology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Brian F Chapin
- Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Y T Chen
- Urology, Fox Chase Cancer Center-Temple Health, Rockledge, Pennsylvania
| | - Heather H Cheng
- Division of Hematology and Oncology Medicine, University of Washington, Seattle, Washington
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Portland, Oregon
| | | | - Sophia C Kamran
- Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | - Yaw A Nyame
- Urology, University of Washington, Seattle, Washington
| | | | - Phuoc T Tran
- Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Ronald C Chen
- Radiation Oncology, University of Kansas, Kansas City, Kansas
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9
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Burgess L, Ghosh A, Yeap BY, Rasheed N, Ragala S, Nwiloh A, Willers H, Zietman A, Vapiwala N, Kamran SC. Recent Trends in "Manels" and Gender Representation Among Panelists at North American Annual Radiation Oncology Meetings. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00434-6. [PMID: 38508466 DOI: 10.1016/j.ijrobp.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Achieving gender equity in radiation oncology is an important goal, as a smaller proportion of women enter radiation oncology residency compared with those graduating from medical school. As invited speaking opportunities at academic medical conferences are vital for promotion/tenure, we investigated the prevalence of all-men panels ("manels") at American Society for Radiation Oncology (ASTRO) and Canadian Society of Radiation Oncology (CARO) annual meetings. METHODS AND MATERIALS Using ASTRO and CARO online meeting programs, 2018 to 2021 faculty information was obtained, including gender, panel role (chair vs nonchair), type of session, and topic. Primary outcomes included percentage of manels and proportion of female panelists over time. Representation of women among chairs was also evaluated. RESULTS Over the 4-year study period across both conferences, a total of 765 panel sessions were held with 2973 faculty members, of whom 1287 (43.3%) were women. Of these sessions, 127 of 765 (16.6%) were manels. ASTRO meetings had 1169 of 2742 (42.6%) female faculty members and held 107 of 680 (15.7%) manels, whereas CARO meetings had 118 of 231 (51.1%) female faculty and held 20 of 85 manels (23.5%). From 2018 to 2021, the proportion of manels decreased at ASTRO and CARO meetings from 25.6% to 8.2% (P < .001) and from 29.6% to 15.0% (P = .130), respectively. The role of chair was majority male in every year from 2018 to 2021 at ASTRO meetings (58.6% overall), but more balanced at CARO meetings (48.0% overall). Among session types, the highest proportion of manels was observed for scientific sessions (19.1%, P = .011) at ASTRO meetings and leadership sessions (29.4%, P = .533) at CARO meetings. The lowest proportion of female panelists was on genitourinary cancer topics at ASTRO meetings (31.9%, P = .018) and physics topics at CARO meetings (40.4%, P = .085). CONCLUSIONS During the study period, the proportion of female panelists increased with a corresponding decrease in manels. ASTRO and CARO should strive for further involvement of women and the elimination of manels whenever possible.
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Affiliation(s)
- Laura Burgess
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nabeel Rasheed
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Siri Ragala
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anthony Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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10
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Rosen DB, Ghosh A, Niemierko A, Beard CJ, Ravi P, Tewari A, Sweeney C, Lee RJ, Saylor P, Martin N, Efstathiou JA, Mouw K, Kamran SC. Clinical Outcomes of De Novo Versus Relapsed Early Metastatic Testicular Seminoma Treated With Contemporary Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:706-711. [PMID: 37717783 DOI: 10.1016/j.ijrobp.2023.09.010] [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: 03/19/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Chemotherapy (CHT) or radiation therapy (RT) are first-line treatments for clinical stage II (CS-II) testicular seminoma. Historically, clinical stage I (CS-I) seminoma was also treated with CHT or RT, but in the past 2 decades practice has shifted toward active surveillance for CS-I with RT or CHT reserved for patients with progression to CS-II. Limited data exist on contemporary RT techniques and patient stratification (ie, de novo [CS-II at orchiectomy] vs relapsed [CS-II diagnosed during surveillance after orchiectomy for CS-I]). We investigated outcomes in CS-II patients treated with RT in the modern era across 2 institutions. METHODS AND MATERIALS A retrospective review identified 73 patients treated with RT for CS-II A or B seminoma between 2001 and 2022. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and univariate analyses were performed with log-rank or Cox proportional hazard regression. Recurrence was defined as biopsy-proven metastatic seminoma after RT completion. Second malignancies were defined as a biopsy-proven malignancy originating in the prior RT field. RESULTS Thirty-eight (52%) patients presented with de novo CS-II and 35 (48%) patients had relapsed CS-II. Median follow-up was 4.8 years (IQR: 2.3-8.1). Five-year RFS was 82% overall (92% in relapsed patients and 73% in de novo patients). Relapsed CS-II disease had lower recurrence rates after RT compared with de novo CS-II disease. All recurrences occurred outside the prior RT field and were salvaged. Disease-specific survival was 100%. Two second malignancies occurred (prostate, colorectal cancer at 67 months and 119 months post-RT, respectively). CONCLUSIONS In patients with CS-II seminoma treated with modern RT, there were no in-field recurrences. Presentation with de novo CS-II is associated with out-of-field recurrence. Subject to further larger-scale validation, our results suggest that compared with CS-II at time of relapse, de novo CS-II may portend more aggressive or micrometastatic disease beyond the retroperitoneum, raising the possibility of benefit from CHT after radiation.
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Affiliation(s)
- Daniel B Rosen
- Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Clair J Beard
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Praful Ravi
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alok Tewari
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Christopher Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Richard J Lee
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Philip Saylor
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Neil Martin
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kent Mouw
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.
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11
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Pursley J, Remillard K, Depauw N, Lee G, Grassberger C, Paganetti H, Efstathiou JA, Kamran SC. Radiation Therapy for Stage IIA/B Seminoma: Modeling Secondary Cancer Risk for Protons and VMAT versus 3D Photons. Cancers (Basel) 2024; 16:784. [PMID: 38398175 PMCID: PMC10886533 DOI: 10.3390/cancers16040784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Radiation therapy (RT) is an effective treatment for stage IIA and select stage IIB seminomas. However, given the long life expectancy of seminoma patients, there are concerns about the risk of secondary cancers from RT. This study assessed differences in secondary cancer risk for stage II seminoma patients following proton pencil-beam scanning (PBS) and photon VMAT, compared to 3D conformal photon RT. Ten seminoma patients, five with a IIA staging who received 30 GyRBE and five with a IIB staging who received 36 GyRBE, had three RT plans generated. Doses to organs at risk (OAR) were evaluated, and secondary cancer risks were calculated as the Excess Absolute Risk (EAR) and Lifetime Attributable Risk (LAR). PBS reduced the mean OAR dose by 60% on average compared to 3D, and reduced the EAR and LAR for all OAR, with the greatest reductions seen for the bowel, liver, and stomach. VMAT reduced high doses but increased the low-dose bath, leading to an increased EAR and LAR for some OAR. PBS provided superior dosimetric sparing of OAR compared to 3D and VMAT in stage II seminoma cases, with models demonstrating that this may reduce secondary cancer risk. Therefore, proton therapy shows the potential to reduce acute and late side effects of RT for this population.
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Affiliation(s)
- Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Kyla Remillard
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Nicolas Depauw
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Grace Lee
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Clemens Grassberger
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
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12
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Kamran SC, Vapiwala N. Approach to Patients with High-Risk Localized Prostate Cancer: Radiation Oncology Perspective. Curr Treat Options Oncol 2024; 25:84-96. [PMID: 38167980 DOI: 10.1007/s11864-023-01163-3] [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] [Accepted: 12/10/2023] [Indexed: 01/05/2024]
Abstract
OPINION STATEMENT High-risk localized prostate cancer is a challenging clinical entity to treat, with heterogeneous responses to an evolving array of multidisciplinary treatment approaches. In addition, this disease state is growing in incidence due to a variety of factors, including shifting recommendations that discouraged routine prostate cancer screening. Current guidelines now incorporate an informed decision-making process for prostate cancer screening and evaluation. More work is underway to improve targeted screening for certain at-risk populations and to implement greater personalization in the use of diagnostic tools. Once diagnosed with high-risk localized disease, a multimodality treatment paradigm is warranted. Radiation-in its various forms and combinations-plays a large and continually evolving role in the management of high-risk prostate cancer, yet treatment outcomes are still suboptimal. There is a growing need to improve upon current treatment approaches, and better personalize a particular treatment recommendation based on both tumor and patient characteristics, as well as patient preference and goals of therapy. Given that treatment generally requires more than one therapy, there are notable implications on long-term quality of life, especially with respect to overlapping and cumulative side effects of local and systemic therapies, respectively. The desire for aggressive therapy to optimize cancer control outcomes must be weighed against the risk of morbidities and overtreatment and discussed with each patient so that an informed decision about treatment and care can be determined. High-level evidence to support treatment recommendations, where available, is critical for a data-driven and tailored approach to address all goals of care.
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Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Cancer Center, Harvard Medical School, 55 Fruit Street, Cox 3, Boston, MA, 02114, USA.
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, TRC 4 West, Philadelphia, PA, 19104, USA
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13
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Deville C, Kamran SC, Morgan SC, Yamoah K, Vapiwala N. Radiation Therapy Summary of the AUA/ASTRO Guideline on Clinically Localized Prostate Cancer. Pract Radiat Oncol 2024; 14:47-56. [PMID: 38182303 DOI: 10.1016/j.prro.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Our purpose was to develop a summary of recommendations regarding the management of patients with clinically localized prostate cancer based on the American Urologic Association/ ASTRO Guideline on Clinically Localized Prostate Cancer. METHODS The American Urologic Association and ASTRO convened a multidisciplinary, expert panel to develop recommendations based on a systematic literature review using an a priori defined consensus-building methodology. The topics covered were risk assessment, staging, risk-based management, principles of management including active surveillance, surgery, radiation, and follow-up after treatment. Presented are recommendations from the guideline most pertinent to radiation oncologists with an additional statement on health equity, diversity, and inclusion related to guideline panel composition and the topic of clinically localized prostate cancer. SUMMARY Staging, risk assessment, and management options in prostate cancer have advanced over the last decade and significantly affect shared decision-making for treatment management. Current advancements and controversies discussed to guide staging, risk assessment, and treatment recommendations include the use of advanced imaging and tumor genomic profiling. An essential active surveillance strategy includes prostate-specific antigen monitoring and periodic digital rectal examination with changes triggering magnetic resonance imaging and possible biopsy thereafter and histologic progression or greater tumor volume prompting consideration of definitive local treatment. The panel recommends against routine use of adjuvant radiation therapy (RT) for patients with prostate cancer after prostatectomy with negative nodes and an undetectable prostate-specific antigen, while acknowledging that patients at highest risk of recurrence were relatively poorly represented in the 3 largest randomized trials comparing adjuvant RT to early salvage and that a role may exist for adjuvant RT in selected patients at highest risk. RT for clinically localized prostate cancer has evolved rapidly, with new trial results, therapeutic combinations, and technological advances. The recommendation of moderately hypofractionated RT has not changed, and the updated guideline incorporates a conditional recommendation for the use of ultrahypofractionated treatment. Health disparities and inequities exist in the management of clinically localized prostate cancer across the continuum of care that can influence guideline concordance.
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Affiliation(s)
- Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott C Morgan
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Kamran SC, Zhou Y, Otani K, Drumm M, Otani Y, Wu S, Wu CL, Feldman AS, Wszolek M, Lee RJ, Saylor PJ, Lennerz J, Van Allen E, Willers H, Hong TS, Liu Y, Davicioni E, Gibb EA, Shipley WU, Mouw KW, Efstathiou JA, Miyamoto DT. Genomic Tumor Correlates of Clinical Outcomes Following Organ-Sparing Chemoradiation Therapy for Bladder Cancer. Clin Cancer Res 2023; 29:5116-5127. [PMID: 37870965 PMCID: PMC10722135 DOI: 10.1158/1078-0432.ccr-23-0792] [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: 03/15/2023] [Revised: 05/20/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE There is an urgent need for biomarkers of radiation response in organ-sparing therapies. Bladder preservation with trimodality therapy (TMT), consisting of transurethral tumor resection followed by chemoradiation, is an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC), but molecular determinants of response are poorly understood. EXPERIMENTAL DESIGN We characterized genomic and transcriptomic features correlated with long-term response in a single institution cohort of patients with MIBC homogeneously treated with TMT. Pretreatment tumors from 76 patients with MIBC underwent whole-exome sequencing; 67 underwent matched transcriptomic profiling. Molecular features were correlated with clinical outcomes including modified bladder-intact event-free survival (mBI-EFS), a composite endpoint that reflects long-term cancer control with bladder preservation. RESULTS With a median follow-up of 74.6 months in alive patients, 37 patients had favorable long-term response to TMT while 39 had unfavorable long-term response. Tumor mutational burden was not associated with outcomes after TMT. DNA damage response gene alterations were associated with improved locoregional control and mBI-EFS. Of these alterations, somatic ERCC2 mutations stood out as significantly associated with favorable long-term outcomes; patients with ERCC2 mutations had significantly improved mBI-EFS [HR, 0.15; 95% confidence interval (CI), 0.06-0.37; P = 0.030] and improved BI-EFS, an endpoint that includes all-cause mortality (HR, 0.33; 95% CI, 0.15-0.68; P = 0.044). ERCC2 mutant bladder cancer cell lines were significantly more sensitive to concurrent cisplatin and radiation treatment in vitro than isogenic ERCC2 wild-type cells. CONCLUSIONS Our data identify ERCC2 mutation as a candidate biomarker associated with sensitivity and long-term response to chemoradiation in MIBC. These findings warrant validation in independent cohorts.
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Affiliation(s)
- Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Yuzhen Zhou
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Keisuke Otani
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Drumm
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yukako Otani
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shulin Wu
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin-Lee Wu
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam S. Feldman
- Harvard Medical School, Boston, Massachusetts
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Wszolek
- Harvard Medical School, Boston, Massachusetts
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard J. Lee
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Philip J. Saylor
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jochen Lennerz
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eliezer Van Allen
- Harvard Medical School, Boston, Massachusetts
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Theodore S. Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yang Liu
- Veracyte, San Francisco, California
| | | | | | - William U. Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kent W. Mouw
- Harvard Medical School, Boston, Massachusetts
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David T. Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Krantz Family Center for Cancer Research, Massachusetts General Hospital, Charlestown, Massachusetts
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15
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Pompa IR, Qi D, Ghosh A, Goldberg SI, Chino F, Efstathiou JA, Kamran SC. Longitudinal Analysis of Bladder Cancer-Specific Mortality Trends in the United States. Bladder Cancer 2023; 9:345-353. [PMID: 38174126 PMCID: PMC10759801 DOI: 10.3233/blc-230062] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Bladder cancer is the tenth leading cause of cancer death in the United States (US). Advances in diagnosis, imaging, and treatments have led to improvements in bladder cancer management. OBJECTIVE To evaluate longitudinal bladder cancer mortality trends from 1999-2020 in the US by gender, race, ethnicity, age, geographic region, and urbanization category. METHODS Age-adjusted bladder cancer death and incidence rates of individuals in the US of all ages between 1999-2020 were obtained using the CDC WONDER and NAACCR databases. Trends and average annual percent changes (AAPC) in age-adjusted Bladder Cancer-Specific Mortality (BCSM) and incidence rates were estimated. Data were analyzed from May 2023 to October 2023. RESULTS From 1999-2020, overall BCSM decreased by 0.4% annually, with a dramatic decrease in deaths between 2015-2020 (AAPC: -2.0% [95% CI: -2.6,-1.3]). However, BCSM rates and metastatic malignant bladder cancer incidence rates from 1999-2020 increased for individuals≥85 years old (AAPC for BCSM: 0.8% [95% CI:0.5,1.1]; AAPC for metastatic malignant incidence: 2.5% [95% CI: 2.0,2.9]). Increases in BCSM were found for certain years in the South, in rural areas, and for Non-Hispanic White and Asian or Pacific Islander individuals. CONCLUSIONS Overall mortality from bladder cancer has been decreasing in the US over two decades. Upon disaggregation, increasing trends were found for BCSM and for metastatic malignant bladder cancer incidence for individuals≥85 years old from 1999-2020. Further evaluation of these trends is essential to understand how to target specific populations to improve patient outcomes.
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Affiliation(s)
- Isabella R. Pompa
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - David Qi
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Saveli I. Goldberg
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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16
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Cha J, Nguyen HB, Salinas KE, Kamran SC. See, seek, support: a policy framework to uplift first-generation low-income medical professionals. J Public Health Policy 2023; 44:685-694. [PMID: 37884675 DOI: 10.1057/s41271-023-00445-2] [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] [Accepted: 09/19/2023] [Indexed: 10/28/2023]
Abstract
The First-Generation and/or Low-Income (FGLI) identity is not readily visible, encapsulating those who are the first in their families to complete a 4-year college degree and/or those living near or below the poverty line. In the backdrop of unprecedented levels of socioeconomic inequality in a country where household income predicts educational attainment, we explore the current state of U.S. society regarding socioeconomic status and health care. We describe challenges in diversifying the health care workforce and present a multi-pronged policy approach for visibilizing, recruiting, supporting, and retaining FGLI trainees in medicine, with the promise of improving the quality of health care delivery altogether. Through this work, we aim to render the field of medicine more equitable for trainees, physicians, and patients alike.
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Affiliation(s)
| | | | | | - Sophia C Kamran
- Harvard Medical School, Boston, MA, USA.
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
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17
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Rosen DB, Tan AJN, Pursley J, Kamran SC. Advances in radiation therapy for testicular seminoma. World J Urol 2023; 41:3895-3903. [PMID: 37979002 DOI: 10.1007/s00345-023-04674-8] [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: 08/03/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Novel techniques and advances in radiation therapy (RT) have been explored to treat testicular seminoma, a highly radiosensitive and curable histology. We evaluated the historical and current indications for radiation therapy (RT) in testicular seminoma. METHODS A narrative literature review was performed. Studies of RT for testicular seminoma were included. Additionally, recent trials testing the use of combination or surgical therapies for clinical stage (CS) II were included. Search parameters included radiation therapy, testicular seminoma, surgery, and chemoradiation. Parameters and outcomes assessed were progression-free survival (PFS), overall survival (OS), acute toxicities, long-term sequelae, and rates of secondary malignancies. RESULTS Practice defining and changing studies in the use or omission of radiation therapy for testicular seminoma were identified along with resultant changes in National Comprehensive Cancer Network (NCCN) and European guidelines. Recent trials in combined chemoradiation and upfront surgical approaches to CS II disease were reviewed. CONCLUSION RT has historically been used as adjuvant treatment for CS I disease and is highly effective at treating CS II (A/B) testicular seminoma. The drive to maintain therapeutic efficacy and reduce acute and long-term side effects, namely secondary malignancies, is being tested using new radiation technologies, combined modality therapy in the form of chemoradiation and with upfront surgical approaches. Also, as guidelines now "strongly prefer" surveillance instead of adjuvant RT for CS I disease, the current CS II population comprises patients presenting with CS II disease ("de novo") and those who present with CSII after relapsing post orchiectomy for CS I ("relapsed"). Emerging evidence suggests that these two groups have different outcomes with respect to RT and chemoradiation. Consequently, future trials may need to sub-stratify according to these groups.
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Affiliation(s)
| | - Arvin Jeremy N Tan
- Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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18
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Zhou Y, Börcsök J, Adib E, Kamran SC, Neil AJ, Stawiski K, Freeman D, Stormoen DR, Sztupinszki Z, Samant A, Nassar A, Bekele RT, Hanlon T, Valentine H, Epstein I, Sharma B, Felt K, Abbosh P, Wu CL, Efstathiou JA, Miyamoto DT, Anderson W, Szallasi Z, Mouw KW. ATM deficiency confers specific therapeutic vulnerabilities in bladder cancer. Sci Adv 2023; 9:eadg2263. [PMID: 37992168 PMCID: PMC10664985 DOI: 10.1126/sciadv.adg2263] [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] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023]
Abstract
Ataxia-telangiectasia mutated (ATM) plays a central role in the cellular response to DNA damage and ATM alterations are common in several tumor types including bladder cancer. However, the specific impact of ATM alterations on therapy response in bladder cancer is uncertain. Here, we combine preclinical modeling and clinical analyses to comprehensively define the impact of ATM alterations on bladder cancer. We show that ATM loss is sufficient to increase sensitivity to DNA-damaging agents including cisplatin and radiation. Furthermore, ATM loss drives sensitivity to DNA repair-targeted agents including poly(ADP-ribose) polymerase (PARP) and Ataxia telangiectasia and Rad3 related (ATR) inhibitors. ATM loss alters the immune microenvironment and improves anti-PD1 response in preclinical bladder models but is not associated with improved anti-PD1/PD-L1 response in clinical cohorts. Last, we show that ATM expression by immunohistochemistry is strongly correlated with response to chemoradiotherapy. Together, these data define a potential role for ATM as a predictive biomarker in bladder cancer.
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Affiliation(s)
- Yuzhen Zhou
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judit Börcsök
- Danish Cancer Institute, Copenhagen, Denmark
- Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Elio Adib
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sophia C. Kamran
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alexander J. Neil
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Konrad Stawiski
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Dory Freeman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dag Rune Stormoen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Zsofia Sztupinszki
- Danish Cancer Institute, Copenhagen, Denmark
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Amruta Samant
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Amin Nassar
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT, USA
| | - Raie T. Bekele
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Timothy Hanlon
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Henkel Valentine
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ilana Epstein
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Bijaya Sharma
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristen Felt
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Philip Abbosh
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
- Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Chin-Lee Wu
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jason A. Efstathiou
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - David T. Miyamoto
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - William Anderson
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Zoltan Szallasi
- Danish Cancer Institute, Copenhagen, Denmark
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
- 2nd Department of Pathology, SE NAP, Brain Metastasis Research Group and Department of Bioinformatics, Semmelweis University, Budapest, Hungary
| | - Kent W. Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA
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19
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Zhong AY, Lui AJ, Katz MS, Berlin A, Kamran SC, Kishan AU, Murthy V, Nagar H, Seible D, Stish BJ, Tree AC, Seibert TM. Use of focal radiotherapy boost for prostate cancer: radiation oncologists' perspectives and perceived barriers to implementation. Radiat Oncol 2023; 18:188. [PMID: 37950310 PMCID: PMC10638743 DOI: 10.1186/s13014-023-02375-5] [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: 09/09/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND In a recent phase III randomized control trial, delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve disease-free survival and regional/distant metastasis-free survival for patients with prostate cancer-without increasing toxicity. The aim of this study was to assess how widely this technique is being applied in current practice, as well as physicians' perceived barriers toward its implementation. METHODS We invited radiation oncologists to complete an online questionnaire assessing their use of intraprostatic focal boost in December 2022 and February 2023. To include perspectives from a broad range of practice settings, the invitation was distributed to radiation oncologists worldwide via email list, group text platform, and social media. RESULTS 263 radiation oncologist participants responded. The highest-represented countries were the United States (42%), Mexico (13%), and the United Kingdom (8%). The majority of participants worked at an academic medical center (52%) and considered their practice to be at least partially genitourinary (GU)-subspecialized (74%). Overall, 43% of participants reported routinely using intraprostatic focal boost. Complete GU-subspecialists were more likely to implement focal boost, with 61% reporting routine use. In both high-income and low-to-middle-income countries, less than half of participants routinely use focal boost. The most cited barriers were concerns about registration accuracy between MRI and CT (37%), concerns about risk of additional toxicity (35%), and challenges to accessing high-quality MRI (29%). CONCLUSIONS Two years following publication of a randomized trial of patient benefit without increased toxicity, almost half of the radiation oncologists surveyed are now routinely offering focal RT boost. Further adoption of this technique might be aided by increased access to high-quality MRI, better registration algorithms of MRI to CT simulation images, physician education on benefit-to-harm ratio, and training on contouring prostate lesions on MRI.
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Affiliation(s)
- Allison Y Zhong
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Asona J Lui
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, USA
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amar U Kishan
- Departments of Radiation Oncology and Urology, UCLA, Los Angeles, CA, USA
| | - Vedang Murthy
- ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Daniel Seible
- Anchorage and Valley Radiation Therapy Centers, Anchorage, AK, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust/The Institute of Cancer Research, London, UK
| | - Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA.
- Departments of Radiology and Bioengineering, University of California San Diego, La Jolla, CA, USA.
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20
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Mayo CS, Feng MU, Brock KK, Kudner R, Balter P, Buchsbaum JC, Caissie A, Covington E, Daugherty EC, Dekker AL, Fuller CD, Hallstrom AL, Hong DS, Hong JC, Kamran SC, Katsoulakis E, Kildea J, Krauze AV, Kruse JJ, McNutt T, Mierzwa M, Moreno A, Palta JR, Popple R, Purdie TG, Richardson S, Sharp GC, Satomi S, Tarbox LR, Venkatesan AM, Witztum A, Woods KE, Yao Y, Farahani K, Aneja S, Gabriel PE, Hadjiiski L, Ruan D, Siewerdsen JH, Bratt S, Casagni M, Chen S, Christodouleas JC, DiDonato A, Hayman J, Kapoor R, Kravitz S, Sebastian S, Von Siebenthal M, Bosch W, Hurkmans C, Yom SS, Xiao Y. Operational Ontology for Oncology (O3): A Professional Society-Based, Multistakeholder, Consensus-Driven Informatics Standard Supporting Clinical and Research Use of Real-World Data From Patients Treated for Cancer. Int J Radiat Oncol Biol Phys 2023; 117:533-550. [PMID: 37244628 PMCID: PMC10741247 DOI: 10.1016/j.ijrobp.2023.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The ongoing lack of data standardization severely undermines the potential for automated learning from the vast amount of information routinely archived in electronic health records (EHRs), radiation oncology information systems, treatment planning systems, and other cancer care and outcomes databases. We sought to create a standardized ontology for clinical data, social determinants of health, and other radiation oncology concepts and interrelationships. METHODS AND MATERIALS The American Association of Physicists in Medicine's Big Data Science Committee was initiated in July 2019 to explore common ground from the stakeholders' collective experience of issues that typically compromise the formation of large inter- and intra-institutional databases from EHRs. The Big Data Science Committee adopted an iterative, cyclical approach to engaging stakeholders beyond its membership to optimize the integration of diverse perspectives from the community. RESULTS We developed the Operational Ontology for Oncology (O3), which identified 42 key elements, 359 attributes, 144 value sets, and 155 relationships ranked in relative importance of clinical significance, likelihood of availability in EHRs, and the ability to modify routine clinical processes to permit aggregation. Recommendations are provided for best use and development of the O3 to 4 constituencies: device manufacturers, centers of clinical care, researchers, and professional societies. CONCLUSIONS O3 is designed to extend and interoperate with existing global infrastructure and data science standards. The implementation of these recommendations will lower the barriers for aggregation of information that could be used to create large, representative, findable, accessible, interoperable, and reusable data sets to support the scientific objectives of grant programs. The construction of comprehensive "real-world" data sets and application of advanced analytical techniques, including artificial intelligence, holds the potential to revolutionize patient management and improve outcomes by leveraging increased access to information derived from larger, more representative data sets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dan Ruan
- University of California, Los Angeles
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sue S Yom
- University of California, San Francisco
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21
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Holzschuh JC, Mix M, Ruf J, Hölscher T, Kotzerke J, Vrachimis A, Doolan P, Ilhan H, Marinescu IM, Spohn SKB, Fechter T, Kuhn D, Bronsert P, Gratzke C, Grosu R, Kamran SC, Heidari P, Ng TSC, Könik A, Grosu AL, Zamboglou C. Deep learning based automated delineation of the intraprostatic gross tumour volume in PSMA-PET for patients with primary prostate cancer. Radiother Oncol 2023; 188:109774. [PMID: 37394103 PMCID: PMC10862258 DOI: 10.1016/j.radonc.2023.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE With the increased use of focal radiation dose escalation for primary prostate cancer (PCa), accurate delineation of gross tumor volume (GTV) in prostate-specific membrane antigen PET (PSMA-PET) becomes crucial. Manual approaches are time-consuming and observer dependent. The purpose of this study was to create a deep learning model for the accurate delineation of the intraprostatic GTV in PSMA-PET. METHODS A 3D U-Net was trained on 128 different 18F-PSMA-1007 PET images from three different institutions. Testing was done on 52 patients including one independent internal cohort (Freiburg: n = 19) and three independent external cohorts (Dresden: n = 14 18F-PSMA-1007, Boston: Massachusetts General Hospital (MGH): n = 9 18F-DCFPyL-PSMA and Dana-Farber Cancer Institute (DFCI): n = 10 68Ga-PSMA-11). Expert contours were generated in consensus using a validated technique. CNN predictions were compared to expert contours using Dice similarity coefficient (DSC). Co-registered whole-mount histology was used for the internal testing cohort to assess sensitivity/specificity. RESULTS Median DSCs were Freiburg: 0.82 (IQR: 0.73-0.88), Dresden: 0.71 (IQR: 0.53-0.75), MGH: 0.80 (IQR: 0.64-0.83) and DFCI: 0.80 (IQR: 0.67-0.84), respectively. Median sensitivity for CNN and expert contours were 0.88 (IQR: 0.68-0.97) and 0.85 (IQR: 0.75-0.88) (p = 0.40), respectively. GTV volumes did not differ significantly (p > 0.1 for all comparisons). Median specificity of 0.83 (IQR: 0.57-0.97) and 0.88 (IQR: 0.69-0.98) were observed for CNN and expert contours (p = 0.014), respectively. CNN prediction took 3.81 seconds on average per patient. CONCLUSION The CNN was trained and tested on internal and external datasets as well as histopathology reference, achieving a fast GTV segmentation for three PSMA-PET tracers with high diagnostic accuracy comparable to manual experts.
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Affiliation(s)
- Julius C Holzschuh
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Faculty of Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
| | - Michael Mix
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center - University Hospital of the European University, Limassol, Cyprus
| | - Paul Doolan
- Department of Radiation Oncology, German Oncology Center - University Hospital of the European University, Limassol, Cyprus
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital - Ludwig-Maximilians-Universität, Munich, Germany
| | - Ioana M Marinescu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Simon K B Spohn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Faculty of Medicine - University of Freiburg, Berta-Ottenstein-Programme, Freiburg, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dejan Kuhn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Peter Bronsert
- Department of Pathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Radu Grosu
- Cyber-Physical Systems Division, Institute of Computer Engineering and Faculty of Informatics, Technical University of Vienna, Vienna, Austria; Department of Computer Science, State University of New York at Stony Brook, NY, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital - Harvard Medical School, Boston, USA
| | - Pedram Heidari
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, USA
| | - Thomas S C Ng
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, USA; Joint Program in Nuclear Medicine, Brigham and Women's Hospital - Harvard Medical School, Boston, USA; Department of Imaging, Dana-Farber Cancer Institute - Harvard Medical School, Boston, USA
| | - Arda Könik
- Joint Program in Nuclear Medicine, Brigham and Women's Hospital - Harvard Medical School, Boston, USA; Department of Imaging, Dana-Farber Cancer Institute - Harvard Medical School, Boston, USA
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Oncology Center, European University of Cyprus, Limassol, Cyprus
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22
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Wisdom AJ, Yeap BY, Michalski JM, Zietman AL, Baumann BC, Christodouleas JP, Kamran SC, Parikh RR, Vapiwala N, Ellis RJ, Hartsell WF, Miyamoto DT, Zeng J, Pisansky TM, Mishra MV, Spratt DE, Mendenhall NP, Soffen EM, Bekelman JE, Efstathiou JA. Prostate Advanced Radiation Technologies Investigating Quality of Life (PARTIQoL): A Phase III Randomized Clinical Trial of Proton Therapy vs. IMRT for Low or Intermediate Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e450. [PMID: 37785451 DOI: 10.1016/j.ijrobp.2023.06.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Prostate cancer is the most common non-cutaneous cancer diagnosed among men in the United States, and the majority of patients are diagnosed with localized disease. Men with localized prostate cancer have several treatment options including external beam radiotherapy with either photons or protons. Proton beam therapy (PBT) has certain dosimetric advantages and the potential to reduce treatment-associated morbidity and improve oncologic outcomes, but current PBT is significantly more costly than intensity-modulated radiotherapy (IMRT). The PARTIQoL trial (NCT01617161) is the first multicenter phase 3 randomized trial comparing protons to photons in the treatment of localized prostate cancer. MATERIALS/METHODS Patients with low or intermediate risk prostate cancer (Stage T1c-T2c, PSA < 20, Gleason score ≤ 7) are randomized to receive either PBT or IMRT, with targeted recruitment efforts for minority populations. A companion registry study has concurrently enrolled patients who declined randomization or whose insurance denied coverage for PBT. Patients are stratified by clinical site, age, use of rectal spacer, and fractionation schedule (conventional fractionation: 79.2 Gy in 44 fractions vs moderate hypofractionation: 70.0 Gy in 28 fractions). Participants are followed longitudinally to assess patient-reported outcomes (PROs) of bowel, urinary, and erectile function for 60 months after completion of radiotherapy (with an option for additional follow up through 10 years). Participants may also participate in correlative studies, including serial CT imaging during treatment and analyses of biopsy tissue, blood and urine specimens. The primary objective is to compare PROs of bowel function using the EPIC score at 24 months following completion of radiation. Secondary objectives are to assess treatment-related differences in urinary and erectile functions, adverse events, efficacy endpoints (biochemical control, metastasis-free survival, disease-specific survival, and overall survival), health state utilities, perceptions of care, late effects, cost-effectiveness, association between radiotherapy dose distribution and PROs, and to identify biomarkers of radiation response and toxicity. RESULTS The randomized trial has completed accrual, with 450 patients enrolled at 27 sites between June 2012 and November 2021. 20.3% of patients enrolled are non-white. Accrual on the companion registry is active, with 354 patients enrolled as of February 2023. CONCLUSION Follow-up for the primary endpoint on the randomized trial will be reached in 2024. The PARTIQoL randomized clinical trial will rigorously assess the clinical benefits of PBT relative to IMRT and results will inform decision making by patients, providers, policymakers, and payers.
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Affiliation(s)
- A J Wisdom
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - B Y Yeap
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - A L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - B C Baumann
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J P Christodouleas
- Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - S C Kamran
- Massachusetts General Hospital, Boston, MA
| | - R R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - W F Hartsell
- Department of Radiation Oncology, Northwestern Medicine Proton Center, Warrenville, IL
| | - D T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - T M Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M V Mishra
- University of Maryland School of Medicine, Baltimore, MD
| | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - N P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - E M Soffen
- Princeton Radiation Oncology, Jamesburg, NJ
| | - J E Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - J A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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23
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Mora J, Pompa I, Qi D, Gold B, Barbesino N, Benson O, Badusi PO, Bhagwat MS, Wo JY, Zietman AL, Efstathiou JA, Miyamoto DT, Kamran SC. Radiation-Associated Lymphopenia in Advanced Prostate Cancer Treated with Contemporary Radiation Techniques. Int J Radiat Oncol Biol Phys 2023; 117:e419. [PMID: 37785380 DOI: 10.1016/j.ijrobp.2023.06.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Lymphocytes play a critical role in the immune system as primary effector cells for cancer control, often depleted by external beam radiation therapy (EBRT). Radiation-associated lymphopenia (RAL) has been shown to be a poor prognostic factor in the management of multiple solid tumors. We hypothesize RAL is similarly observed in advanced prostate cancer (PC) RT with contemporary techniques. MATERIALS/METHODS We identified patients with advanced PC (high-risk or clinical/pathologic node-positive) receiving EBRT including lymph node/prostatic lesion boost on a prospective collection protocol for whom 1 baseline and ≥2 subsequent complete blood count (CBC) with differential samples were available, collected at RT end, 3-, 6-, and 12-months post-RT. Clinicopathological characteristics were retrieved from chart review. Common Terminology Criteria for Adverse Events (CTCAE)v5 was used to grade absolute lymphocyte count (ALC); RAL was defined as CTCAEv5 grade ≥2. As these patients received pelvic nodal irradiation, they were pooled with low/intermediate-risk PC cohort treated with high dose-rate (HDR) brachytherapy or prostate alone EBRT with similar CBC timepoints for univariable analysis to understand RT field size effect on RAL. RESULTS Between 2019 and 2022, among 17 patients in the low/intermediate-risk PC cohort, 6 patients had grade ≥2 lymphopenia. Among 25 patients in the advanced PC cohort, all received androgen deprivation therapy (ADT), 6 received lymph node boost, and 5 received prostatic lesion boost. At RT end, leukopenia was prominently observed (median nadir count 75.1% of baseline), with ALC as major driver (median nadir count 27.3% of baseline). Grade ≥2 lymphopenia was observed in 76% of patients (n = 19) Of 19 advanced PC patients who reached 6 months post-RT follow-up, median ALC was 53.0% of baseline, and Grade ≥2 lymphopenia remained in 37% (n = 7) of patients. Of 8 advanced PC patients who reached 12 months post-RT follow-up, median ALC was 55.6% of baseline. When evaluating whether RT dose or field size contributed to lower nadir ALC counts, combining the low/intermediate-risk and advanced PC cohorts (n = 42), univariable analysis demonstrated Gleason grade group (p = 0.009), RT field size (p = 0.020), ADT use (p = 0.020), baseline ALC (p = 0.037), and baseline hemoglobin (p = 0.009) were independent predictors of Grade ≥2 lymphopenia. Age, prostatic lesion/lymph node boost, and equivalent dose in 2 Gy/fraction (EQD2) were nonsignificant. CONCLUSION Grade ≥2 RAL was observed in patients with advanced PC at end of RT, irrespective of age, RT boost, or EQD2. Lymphocyte recovery from baseline can be prolonged even at 12 months post-RT. Ongoing analyses include expanding data with additional serial CBC, increasing cohort size, and integrating effect of additional systemic therapies. RAL has downstream implications for future chemotherapy/radiopharmaceuticals.
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Affiliation(s)
- J Mora
- Harvard Radiation Oncology Program, Boston, MA
| | - I Pompa
- Massachusetts General Hospital, Boston, MA
| | - D Qi
- Massachusetts General Hospital, Boston, MA
| | - B Gold
- Massachusetts General Hospital, Boston, MA
| | | | - O Benson
- Massachusetts General Hospital, Boston, MA
| | - P O Badusi
- Massachusetts General Hospital, Boston, MA
| | | | - J Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - A L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - D T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - S C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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24
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Zhong AY, Lui AJ, Katz MS, Berlin A, Kamran SC, Kishan AU, Murthy V, Nagar H, Seible DM, Stish BJ, Tree A, Seibert TM. Use of Focal Radiotherapy Boost for Prostate Cancer and Perceived Barriers toward its Implementation: A Survey. Int J Radiat Oncol Biol Phys 2023; 117:e454-e455. [PMID: 37785459 DOI: 10.1016/j.ijrobp.2023.06.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In a recent phase III randomized control trial (FLAME), delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve outcomes for prostate cancer patients without increasing toxicity. The aim of this study was to assess how widely this technique is being applied in current practices worldwide as well as physicians' perceived barriers toward its implementation. MATERIALS/METHODS An online survey assessing the use of intraprostatic focal boost was conducted in December 2022 and February 2023. The survey link was distributed to radiation oncologists worldwide via email list, group text platform, and social media. Survey questions included how many prostate cancer cases participants treat in a typical month; how often they use focal boost, if at all; the degree to which their practice is genitourinary (GU)-subspecialized; main barriers to implementing focal boost more often in their practice; and demographic information. Subgroup analyses were also conducted for participants from high-income or low-to-middle-income countries, as defined by the World Bank. RESULTS The survey initially collected 205 responses from various countries over a two-week period in December 2022. The survey was then reopened for one week in February 2023 to allow for more participation, leading to a total of 263 responses. The highest-represented countries were the United States (42%), Mexico (13%), and the United Kingdom (8%). The majority of respondents worked at an academic medical center (52%) and considered their practice to be at least partially GU-subspecialized (74%). 57% of participants overall reported not routinely using intraprostatic focal boost. Even among complete subspecialists, a substantial proportion (39%) do not routinely use focal boost. Less than half of participants in both high-income and low-to-middle-income countries were shown to routinely use focal boost. Perceived barriers to implementation are shown in Table 1. CONCLUSION Despite the promising level 1 results of the FLAME trial, many radiation oncologists worldwide are not routinely offering focal RT boost. Adoption of this technique might be accelerated by increased access to high-quality MRI, better registration algorithms of MRI to CT simulation images, physician education on benefit-to-harm ratio, automated planning algorithms, and physician training on contouring prostate lesions on MRI.
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Affiliation(s)
- A Y Zhong
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - A J Lui
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - M S Katz
- Radiation Oncology Associates, Lowell, MA
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S C Kamran
- Massachusetts General Hospital, Boston, MA
| | - A U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - H Nagar
- Department of Radiation Oncology, New York-Presbyterian/Weill Cornell Hospital, New York, NY
| | - D M Seible
- Anchorage & Valley Radiation Therapy Centers, Anchorage, AK
| | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Tree
- Radiotherapy and Imaging Division, Institute of Cancer Research, London, United Kingdom
| | - T M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA; Department of Radiology, University of California San Diego, La Jolla, CA
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25
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Gold BO, Ghosh A, Goldberg SI, Chino F, Efstathiou JA, Kamran SC. Disparities in testicular cancer incidence, mortality, and place of death trends from 1999 to 2020: A comprehensive cohort study. Cancer Rep (Hoboken) 2023; 6:e1880. [PMID: 37584159 PMCID: PMC10598251 DOI: 10.1002/cnr2.1880] [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: 05/03/2023] [Revised: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Testicular cancer (TC) mortality rates have decreased over time, however it is unclear whether these improvements are consistent across all communities. AIMS The aim of this study was to analyze trends in TC incidence, mortality, and place of death (PoD) in the United States between 1999-2020 and identify disparities across race, ethnicity, and geographic location. METHODS AND RESULTS This cross-sectional study used CDC WONDER and NAACCR, to calculate age-adjusted rates of TC incidence and mortality, respectively. PoD data for individuals who died of TC were collected from CDC WONDER. Using Joinpoint analysis, longitudinal mortality trends were evaluated by age, race, ethnicity, US census region, and urbanization category. TC stage (localized vs metastatic) trends were also evaluated. Univariate and multivariate regression analysis identified demographic disparities for PoD. A total of 8,456 patients died of TC from 1999-2020. Average annual percent change (AAPC) of testicular cancer-specific mortality (TCSM) remained largely stable (AAPC, 0.4; 95% CI -0.2 to 0.9; p = 0.215). Men ages 25-29 experienced a significant increase in TCSM (AAPC, 1.3, p = 0.003), consistent with increased metastatic testicular cancer-specific incidence (TCSI) trend for this age group (AAPC, 1.6; p < 0.01). Mortality increased for Hispanic men (AAPC, 1.7, p < 0.001), with increased metastatic TCSI (AAPC, 2.5; p < 0.001). Finally, younger (<45), single, and Hispanic or Black men were more likely to die in medical facilities (all p < 0.001). The retrospective study design is a limitation. CONCLUSION Significant increases in metastatic TC were found for Hispanic men and men aged 25-29 potentially driving increasing testicular cancer specific mortality in these groups. Evidence of racial and ethnic differences in place of death may also highlight treatment disparities.
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Affiliation(s)
- Beck O. Gold
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Anushka Ghosh
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Saveli I. Goldberg
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fumiko Chino
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jason A. Efstathiou
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Sophia C. Kamran
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Allen AJ, Savla B, Datnow-Martinez C, Mendes W, Kamran SC, Ambs S, Eggleston C, Baker K, Molitoris JK, Ferris MJ, Patel AN, Rana ZH, Kunaprayoon D, Hong JJ, Davicioni E, Mishra MV, Bentzen SM, Jr WFR, Kwok Y, Vyfhuis MAL. A Precision Medicine Navigator Can Mitigate Inequities Associated with Utilization of Genomic Tests in Black Men with Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S15-S16. [PMID: 37784380 DOI: 10.1016/j.ijrobp.2023.06.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Black men with prostate cancer in the United States experience disproportionately worse clinical outcomes compared to other racial groups. Identifying more reliable prognosticators to address these inequities has thus been the subject of considerable research scrutiny. However, prognostic genomic tools and genomic biorepositories suffer from an even greater lack of racial diversity. Strategies to mitigate these amplifying developments in inequities are desperately needed. We hypothesized that the presence of a precision medicine navigator (PMN) may mitigate inequities with standard of care (SOC) genomic test utilization among Black men with prostate cancer. MATERIALS/METHODS We retrospectively reviewed prostate cancer consults within one healthcare system from 11/2/2021 to 1/2/2022. We compared the frequency of patients who received SOC Decipher or Tempus genomic testing in the 7 months prior to the PMN start (pre-PMN) to the 7 months afterward (post-PMN). Chi square analysis was used to compare subgroups. Binary logistic regression was used to calculate the odds of receiving genomic testing. RESULTS The sample included 693 patients, 44.9% (311/693) pre-PMN and 55.1% (382/693) post-PMN, with a median age of 68 in both groups. Pre- and post-PMN racial distributions were similar with 60.1% and 60.2% White, 35.1% and 34% Black, 3.2% and 3.7% Asian/Pacific Islander, and 1.3% and 2.1% Latino, respectively. Pre- and post-PMN NCCN risk category distribution was 15.2% and 10.4% low risk, 46.8% and 49.9% intermediate risk, and 38.1% and 39.7% high risk, respectively. Pre- and post-PMN groups had 14.5% and 17% distant metastases, 77.2% and 76.9% localized disease, 10.3% and 10% prior prostatectomy, 47% and 51% income below sample median, 51% and 52% with Medicare/Medicaid, and 47% and 48% seen at community hospitals, respectively. There were no statistically significant differences for these variables pre- and post-PMN. However, from pre- to post-PMN, the proportion of Black patients receiving genomic testing increased from 19% to 58%. Black patients seen post-PMN were six times more likely to receive testing (p<0.001). Significant increases in SOC genomic testing post-PMN also occurred among lower median income patients, patients with Medicare/Medicaid, and community hospital patients. CONCLUSION The presence of a PMN may improve disparate rates of Black patients receiving SOC genomic tests for prostate cancer compared to other racial groups and may alleviate genomic testing inequities among other demographics.
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Affiliation(s)
- A J Allen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - B Savla
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - C Datnow-Martinez
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - W Mendes
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - S C Kamran
- Massachusetts General Hospital, Boston, MA
| | - S Ambs
- Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD
| | - C Eggleston
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - K Baker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - J K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - M J Ferris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - A N Patel
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Z H Rana
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - D Kunaprayoon
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - J J Hong
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - M V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - S M Bentzen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD; Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - W F Regine Jr
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Y Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - M A L Vyfhuis
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
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Kamran SC, Yeap BY, Soetan Z, Pompa I, Muise S, Cowan J, Moteabbed M, Silvia BL, Olsen CC, Zietman AL, Efstathiou JA, Miyamoto DT. Prospective Validation of Single Nucleotide Polymorphisms as Predictors of Gastrointestinal, Genitourinary, and Sexual Patient-Reported Outcomes Following Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e398-e399. [PMID: 37785329 DOI: 10.1016/j.ijrobp.2023.06.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiotherapy (RT) for localized prostate cancer (PC) can adversely impact gastrointestinal (GI), genitourinary (GU), and sexual quality of life (QoL). Biomarkers are needed to accurately predict individualized risk of toxicity and enable tailoring of therapy. Single nucleotide polymorphisms (SNPs) have been reported as potential predictors of RT-related toxicities, but have not been associated with patient-report outcomes (PRO) in prospective cohorts. In this study, we sought to validate these SNPs in a prospective registry study of RT for PC, with high-quality prospectively collected PRO data. MATERIALS/METHODS Men with low/intermediate risk PC were consented to a multicenter companion registry study associated with the PARTIQoL Phase III Randomized Trial of proton vs. photon RT. Patients received RT to prostate/seminal vesicles per protocol. Androgen deprivation therapy and pelvic lymph node RT were not allowed. 95 patients enrolled between 2014-2020 at a single institution had blood specimens available for germline DNA analysis. 172 SNPs previously reported to correlate with GI, GU, and/or sexual RT toxicities were genotyped. PRO data through the Expanded Prostate Cancer Index Composite (EPIC) were collected prior to RT and at prespecified follow-up (FU) time points. Change of the EPIC score from baseline was compared between genotypes of previously identified SNPs using a two-sample t-test. Significant clinically meaningful QoL differences were identified by an effect size of at least 0.4σ with two-sided p<0.05, where σ represents the standard deviation of the score change. RESULTS Median FU was 39 months (r, 6-89). Median age was 68 years (r, 52-83). Features at diagnosis include: 77% T1c, median PSA 5.8 (r, 1.43-15.1), 53% Gleason 7, median prostate volume 45.5cc (r, 16-142). 43% received proton RT; 53% had a rectal spacer. 40% received 79.2 Gy/44 fractions; 60% received 70 Gy/28 fractions. Between 6 to 24 months post-RT, there were 19 SNPs that were significantly associated with clinically meaningful decreases in GI QoL scores, 19 that were significantly associated with clinically meaningful decreases in GU QoL scores, and 10 SNPs that were significantly associated with clinically meaningful decreases in sexual QoL scores. Three BRCA2 SNPs (rs1801439, rs1801499, rs1799944) were significantly associated with clinically meaningful decreases in both GI and GU QoL scores. CONCLUSION Of the 172 SNPs previously reported to be associated with GI, GU, and/or sexual toxicity after prostate RT, 23% were validated for domain-specific QoL detriment. Ongoing analyses include integrated modeling of dosimetry and SNP data for prediction of toxicities and PRO, and evaluation of potential interactions between RT modality (proton/photon) and QoL-associated SNPs.
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Affiliation(s)
- S C Kamran
- Massachusetts General Hospital, Boston, MA
| | - B Y Yeap
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Z Soetan
- Massachusetts General Hospital, Boston, MA
| | - I Pompa
- Massachusetts General Hospital, Boston, MA
| | - S Muise
- Massachusetts General Hospital, Boston, MA
| | - J Cowan
- Massachusetts General Hospital, Boston, MA
| | - M Moteabbed
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - B L Silvia
- Massachusetts General Hospital, Boston, MA
| | - C C Olsen
- Massachusetts General Hospital, Boston, MA
| | - A L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J A Efstathiou
- Department of Radiation Oncology, Harvard School of Medicine, Boston, MA
| | - D T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Cheung ATM, Niemierko A, Van Allen E, Vapiwala N, Kamran SC. Reply to: Addressing racial and ethnic disparities in AACR project GENIE. NPJ Precis Oncol 2023; 7:82. [PMID: 37653109 PMCID: PMC10471616 DOI: 10.1038/s41698-023-00426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Alexander T M Cheung
- NYU Grossman School of Medicine, New York, NY, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eliezer Van Allen
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sophia C Kamran
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Pompa IR, Ghosh A, Bhat S, Ragala S, Nwiloh A, Rasheed N, Chino F, Willers H, Goldberg S, Kamran SC. US Cancer Mortality Trends Among Hispanic Populations From 1999 to 2020. JAMA Oncol 2023; 9:1090-1098. [PMID: 37382965 PMCID: PMC10311425 DOI: 10.1001/jamaoncol.2023.1993] [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: 12/12/2022] [Accepted: 04/23/2023] [Indexed: 06/30/2023]
Abstract
Importance Advances in cancer research and treatment access have led to decreasing cancer mortality in the US; however, cancer remains the leading cause of death among Hispanic individuals. Objective To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Hispanic individuals by demographic characteristics and to compare age-adjusted cancer death rates between the Hispanic population and other racial and ethnic populations during 2000, 2010, and 2020. Design, Setting, and Participants This cross-sectional study obtained age-adjusted cancer death rates among Hispanic individuals of all ages between January 1999 and December 2020, using the Centers for Disease Control and Prevention WONDER database. Cancer death rates in other racial and ethnic populations were extracted for 2000, 2010, and 2020. Data were analyzed from October 2021 to December 2022. Exposures Age, gender, race, ethnicity, cancer type, and US census region. Main Outcomes and Measures Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates among Hispanic individuals were estimated by cancer type, age, gender, and region. Results From 1999 to 2020, 12 644 869 patients died of cancer in the US, of whom 690 677 (5.5%) were Hispanic; 58 783 (0.5%) were non-Hispanic American Indian or Alaska Native; 305 386 (2.4%), non-Hispanic Asian or Pacific Islander; 1 439 259 (11.4%), non-Hispanic Black or African American; and 10 124 361 (80.1%), non-Hispanic White. For 26 403 patients (0.2%), no ethnicity was stated. The overall CSM rate among Hispanic individuals decreased by 1.3% (95% CI, 1.2%-1.3%) annually. Overall CSM rate decreased more for Hispanic men (AAPC, -1.6%; 95% CI, -1.7% to -1.5%) compared with women (AAPC, -1.0%; 95% CI, -1.0% to -0.9%). While death rates among Hispanic individuals decreased for most cancer types, mortality rates for liver cancer (AAPC, 1.0%; 95% CI, 0.6%-1.4%) increased among Hispanic men, and rates of liver (AAPC, 1.0%; 95% CI, 0.8%-1.3%), pancreas (AAPC, 0.2%; 95% CI, 0.1%-0.4%), and uterine (AAPC, 1.6%; 95% CI, 1.0%-2.3%) cancers increased among Hispanic women. Overall CSM rates increased for Hispanic men aged 25 to 34 years (AAPC, 0.7%; 95% CI, 0.3%-1.1%). By US region, liver cancer mortality rates increased significantly in the West for both Hispanic men (AAPC, 1.6%; 95% CI, 0.9%-2.2%) and Hispanic women (AAPC, 1.5%; 95% CI, 1.1%-1.9%). There were differential findings in mortality rates when comparing Hispanic individuals with individuals belonging to other racial and ethnic populations. Conclusions and Relevance In this cross-sectional study, despite overall CSM decreasing over 2 decades among Hispanic individuals, disaggregation of data demonstrated that rates of liver cancer deaths among Hispanic men and women and pancreas and uterine cancer deaths among Hispanic women increased from 1999 to 2020. There were also disparities in CSM rates among age groups and US regions. The findings suggest that sustainable solutions need to be implemented to reverse these trends among Hispanic populations.
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Affiliation(s)
- Isabella R. Pompa
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shamik Bhat
- Yale School of Medicine, New Haven, Connecticut
| | - Siri Ragala
- University of Missouri–Kansas City School of Medicine, Kansas City
| | | | - Nabeel Rasheed
- University of Missouri–Kansas City School of Medicine, Kansas City
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Saveli Goldberg
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Zhong AY, Lui AJ, Katz MS, Berlin A, Kamran SC, Kishan AU, Murthy V, Nagar H, Seible D, Stish BJ, Tree AC, Seibert TM. Use of focal radiotherapy boost for prostate cancer and perceived barriers toward its implementation: a survey. medRxiv 2023:2023.02.01.23285345. [PMID: 37333345 PMCID: PMC10274968 DOI: 10.1101/2023.02.01.23285345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background In a recent phase III randomized control trial (FLAME), delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve outcomes for prostate cancer patients without increasing toxicity. The aim of this study was to assess how widely this technique is being applied in current practice as well as physicians' perceived barriers toward its implementation. Methods An online survey assessing the use of intraprostatic focal boost was conducted in December 2022 and February 2023. The survey link was distributed to radiation oncologists worldwide via email list, group text platform, and social media. Results The survey initially collected 205 responses from various countries over a two-week period in December 2022. The survey was then reopened for one week in February 2023 to allow for more participation, leading to a total of 263 responses. The highest-represented countries were the United States (42%), Mexico (13%), and the United Kingdom (8%). The majority of participants worked at an academic medical center (52%) and considered their practice to be at least partially genitourinary (GU)-subspecialized (74%). 57% of participants reported not routinely using intraprostatic focal boost. Even among complete subspecialists, a substantial proportion (39%) do not routinely use focal boost. Less than half of participants in both high-income and low-to-middle-income countries were shown to routinely use focal boost. The most commonly cited barriers were concerns about registration accuracy between MRI and CT (37%), concerns about risk of additional toxicity (35%), and challenges to accessing high-quality MRI (29%). Conclusion Despite level 1 evidence from the FLAME trial, most radiation oncologists surveyed are not routinely offering focal RT boost. Adoption of this technique might be accelerated by increased access to high-quality MRI, better registration algorithms of MRI to CT simulation images, physician education on benefit-to-harm ratio, and training on contouring prostate lesions on MRI.
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Moreno A, Solanki AA, Xu T, Lin R, Palta J, Daugherty E, Hong D, Hong J, Kamran SC, Katsoulakis E, Brock K, Feng M, Fuller C, Mayo C. Identification of Key Elements in Prostate Cancer for Ontology Building via a Multidisciplinary Consensus Agreement. Cancers (Basel) 2023; 15:3121. [PMID: 37370731 DOI: 10.3390/cancers15123121] [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: 04/01/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Clinical data collection related to prostate cancer (PCa) care is often unstructured or heterogeneous among providers, resulting in a high risk for ambiguity in its meaning when sharing or analyzing data. Ontologies, which are shareable formal (i.e., computable) representations of knowledge, can address these challenges by enabling machine-readable semantic interoperability. The purpose of this study was to identify PCa-specific key data elements (KDEs) for standardization in clinic and research. METHODS A modified Delphi method using iterative online surveys was performed to report a consensus agreement on KDEs by a multidisciplinary panel of 39 PCa specialists. Data elements were divided into three themes in PCa and included (1) treatment-related toxicities (TRT), (2) patient-reported outcome measures (PROM), and (3) disease control metrics (DCM). RESULTS The panel reached consensus on a thirty-item, two-tiered list of KDEs focusing mainly on urinary and rectal symptoms. The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire was considered most robust for PROM multi-domain monitoring, and granular KDEs were defined for DCM. CONCLUSIONS This expert consensus on PCa-specific KDEs has served as a foundation for a professional society-endorsed, publicly available operational ontology developed by the American Association of Physicists in Medicine (AAPM) Big Data Sub Committee (BDSC).
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Affiliation(s)
- Amy Moreno
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University Medical Center, Berwyn, IL 60402, USA
| | - Tianlin Xu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ruitao Lin
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jatinder Palta
- Department of Medical Physics, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Emily Daugherty
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - David Hong
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90089, USA
| | - Julian Hong
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 93701, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, James A Haley VA Medical Center, Tampa, FL 33612, USA
| | - Kristy Brock
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 93701, USA
| | - Clifton Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles Mayo
- Department of Radiation Physics, University of Michigan, Ann Arbor, MI 48109, USA
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Anderson MA, Knipp DE, Noda Y, Kamran SC, Baliyan V, Kordbacheh H, Hong TS, Kambadakone A. MRI-Based Tumor Necrosis Depiction in Pancreatic Ductal Adenocarcinoma: Can It Predict Tumor Aggressiveness? Cancers (Basel) 2023; 15:cancers15082313. [PMID: 37190241 DOI: 10.3390/cancers15082313] [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: 03/30/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
The purpose of this study was to investigate whether tumor necrosis depicted on contrast-enhanced abdominal MRI can predict tumor aggressiveness in pancreatic ductal adenocarcinoma (PDAC). In this retrospective analysis, we included 71 patients with pathology-proven PDAC who underwent contrast-enhanced MRI from 2006 to 2020. Assessment for the presence/absence of imaging detected necrosis was performed on T2-weighted and contrast-enhanced T1-weighted images. Primary tumor characteristics, regional lymphadenopathy, metastases, stage, and overall survival were analyzed. Fisher's exact and Mann-Whitney U tests were used for statistical analysis. Of the 72 primary tumors, necrosis was identified on MRI in 58.3% (42/72). Necrotic PDACs were larger (44.6 vs. 34.5 mm, p = 0.0016), had higher rates of regional lymphadenopathy (69.0% vs. 26.7%, p = 0.0007), and more frequent metastases (78.6% vs. 40.0%, p = 0.0010) than those without MRI-evident necrosis. A non-statistically significant reduction in median overall survival was observed in patients with versus without MRI-evident necrosis (15.8 vs. 38.0 months, p = 0.23). PDAC tumor necrosis depicted on MRI was associated with larger tumors and higher frequency of regional lymphadenopathy and metastases.
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Affiliation(s)
- Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - David E Knipp
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1-1 Yanagido Street, Gifu City 501-1194, Japan
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Vinit Baliyan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Hamed Kordbacheh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Wang Y, Boyd G, Zieminski S, Kamran SC, Zietman AL, Miyamoto DT, Kirk MC, Efstathiou JA. A pair of deep learning auto-contouring models for prostate cancer patients injected with a radio-transparent versus radiopaque hydrogel spacer. Med Phys 2023. [PMID: 36940384 DOI: 10.1002/mp.16375] [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: 07/29/2022] [Revised: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Absorbable hydrogel spacer injected between prostate and rectum is gaining popularity for rectal sparing. The spacer alters patient anatomy and thus requires new auto-contouring models. PURPOSE To report the development and comprehensive evaluation of two deep-learning models for patients injected with a radio-transparent (model I) versus radiopaque (model II) spacer. METHODS AND MATERIALS Model I was trained and cross-validated by 135 cases with transparent spacer and tested on 24 cases. Using refined training methods, model II was trained and cross-validated by the same dataset, but with the Hounsfield Unit distribution in the spacer overridden by that obtained from ten cases with opaque spacer. Model II was tested on 64 cases. The models auto-contour eight regions of interest (ROIs): spacer, prostate, proximal seminal vesicles (SVs), left and right femurs, bladder, rectum and penile bulb. Qualitatively, each auto contour (AC), as well as the composite set, was assessed against manual contour (MC), by a radiation oncologist using a 1 (accepted directly or after minor editing), 2 (accepted after moderate editing), 3 (accepted after major editing) and 4 (rejected) scoring scale. The efficiency gain was characterized by the mean score as nearly complete [1 to 1.75], substantial (1.75 to 2.5], meaningful (2.5 to 3.25] and no (3.25 to 4.00]. Quantitatively, the geometric similarity between AC and MC was evaluated by Dice similarity coefficient (DSC) and mean distance to agreement (MDA), using tolerance recommended by AAPM TG-132 Report. The results by the two models were compared to examine the outcome of the refined training methods. The large number of testing cases for model II allowed further investigation of inter-observer variability in clinical dataset. The correlation between score and DSC/MDA was studied on the ROIs with ten or more counts of each acceptable score (1, 2, 3). RESULTS For model I/model II: the mean score was 3.63/1.30 for transparent/opaque spacer, 2.71/2.16 for prostate, 3.25/2.44 for proximal SVs, 1.13/1.02 for both femurs, 2.25/1.25 for bladder, 3.00/2.06 for rectum, 3.38/2.42 for penile bulb and 2.79/2.20 for the composite set; the mean DSC was 0.52/0.84 for spacer, 0.84/0.85 for prostate, 0.60/0.62 for proximal SVs, 0.94/0.96 for left femur, 0.95/0.96 for right femur, 0.91/0.95 for bladder, 0.81/0.84 for rectum and 0.65/0.65 for penile bulb; and the mean MDA was 2.9/0.9 mm for spacer, 1.9/1.7 mm for prostate, 2.4/2.3 mm for proximal SVs, 0.8/0.5 mm for left femur, 0.7/0.5 mm for right femur, 1.5/0.9 mm for bladder, 2.3/1.9 mm for rectum and 2.2/2.2 mm for penile bulb. Model II showed significantly improved scores for all ROIs, and metrics for spacer, femurs, bladder and rectum. Significant inter-observer variability was only found for prostate. Highly linear correlation between the score and DSC was found for the two qualified ROIs (prostate and rectum). CONCLUSIONS The overall efficiency gain was meaningful for model I and substantial for model II. The ROIs meeting the clinical deployment criteria (mean score below 3.25, DSC above 0.8 and MDA below 2.5 mm) included prostate, both femurs, bladder and rectum for both models, and spacer for model II. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yi Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Graham Boyd
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen Zieminski
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxwell C Kirk
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kamran SC, Yeap BY, Ghosh A, Aldrighetti CM, Willers H, Vapiwala N. Recent trends of "manels": gender representation among invited panelists at an international oncology conference. JNCI Cancer Spectr 2023; 7:7034102. [PMID: 36762819 PMCID: PMC9991598 DOI: 10.1093/jncics/pkad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Gender disparities in academic medicine are a long-acknowledged concern, particularly at medical conferences. We investigated gender representation and prevalence of "manels" (all-men panels) among invited speakers at the 2018-2021 American Society of Clinical Oncology Annual Meetings. METHODS Using American Society of Clinical Oncology online programs, 2018-2021 faculty information was obtained, including perceived or self-reported gender, medical specialty, session type, and topic. Primary outcomes were percentage of manels and proportion of women panelists over time; women representation among specialties and topics were evaluated. Cochran-Armitage and Fisher's exact tests were used to analyze trends in proportion of manels and women representation over time and to compare each session type, topic, or specialty with other categories combined, respectively. RESULTS During 2018-2021, there were 670 sessions, 81 of which (12.1%) were manels. Among 2475 panelists, 1181 (47.7%) were women. Over time, the percentage of manels significantly decreased from 17.4% in 2018 to 9.9% in 2021 (P = .030). The highest proportion of manels was observed for leadership or special sessions (17.1%, P = .419). Women panelists were underrepresented for the topics of genitourinary cancers (38.6%, P = .029) and translational or preclinical sciences (36.7%, P < .001). There was a positive trend toward improved women representation among translational or preclinical sciences (27.4% in 2018 vs 41.8% in 2021, P = .031) but not among genitourinary cancers (41.1% in 2018 vs 40.7% in 2021, P = .969). CONCLUSIONS The number of women panelists increased during the study period, with a corresponding decrease in the proportion of manels, specifically in education and leadership or special sessions. Ongoing underrepresentation of women in genitourinary cancers and translational or preclinical topics underscores the importance of annual meeting organizers continuing to strive for diverse gender representation.
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Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher M Aldrighetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Kamran SC, Yeap BY, Soetan Z, Pompa IR, Muise ST, Cowan J, Moteabbed M, Silvia BL, Olsen CC, Zietman AL, Efstathiou JA, Miyamoto DT. Prospective validation of single nucleotide polymorphisms as predictors of gastrointestinal, genitourinary, and sexual toxicities following radiation therapy for prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.385] [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: 03/17/2023] Open
Abstract
385 Background: Radiation therapy (RT) for localized prostate cancer (PC) may result in long-term gastrointestinal (GI), genitourinary (GU), and sexual toxicities that adversely impact quality of life. Biomarkers are needed to accurately predict individualized RT toxicity risk and enable tailoring of treatment. Single nucleotide polymorphisms (SNPs) have been reported as predictors of RT-related toxicities, but have not been independently validated in prospective, prostate-specific cohorts. In this study, we sought to validate these SNPs in a prospective registry study of RT for PC, with high-quality prospectively collected toxicity data. Methods: Men with low/intermediate risk PC were consented to a multicenter companion registry study associated with the PARTIQoL Phase III Randomized Trial of proton vs. photon RT. Patients received RT to prostate/seminal vesicles per protocol. Androgen deprivation therapy/pelvic lymph node RT were not allowed. 95 patients enrolled between 2014-2020 at a single institution had whole blood specimens available for analysis. 172 SNPs previously reported to correlate with GI, GU, and/or sexual RT toxicities were genotyped. CTCAEv4 physician-reported toxicity was collected at prespecified follow-up (FU) time points. Association of previously identified SNP genotypes with the worst toxicity grade was analyzed using two-sided Fisher’s exact test. Results: Median FU was 39 months (r, 6-89). Median age was 68 years (r, 52-83). Features at diagnosis include: 77% T1c, median PSA 5.8 (r, 1.43-15.1), 53% Gleason 7, median prostate volume 45.5cc (r, 16-142). 43% received proton RT; 53% had a rectal spacer. 40% received 79.2 Gy/44 fractions; 60% received 70 Gy/28 fractions. By 24 months post-RT, 21 (22%) patients experienced grade 1-2 Gl toxicity, 33 (35%) experienced grade 1-2 GU toxicity, and 68 (72%) experienced grade 1-3 sexual toxicity. Of the 172 SNPs examined, significant associations were detected for rs1805794 with a higher incidence of grade 1-2 late GI toxicity (P=0.006), rs1800872 with a higher incidence of grade 1-2 late GU effects (P=0.005) and rs25489 with a higher incidence of grade 1-3 sexual dysfunction (P=0.003). rs3749191, rs4073, rs2243250, and rs7356945 were significantly associated with grade 2 late GU toxicity (all P≤0.008). Significant associations were also observed between other SNPs and late toxicity: 4 SNPs GI, 9 SNPs GU, 7 SNPs sexual (all 0.01≤P≤0.05). Conclusions: Of the 172 SNPs previously reported to be associated with GI, GU, and/or sexual toxicity after prostate RT, 16% were validated by conventional statistical criteria. Ongoing analyses include integrated modeling of dosimetry and SNP data for prediction of toxicities and PROs, and evaluation of potential interactions between RT modality (proton/photon) and toxicity-associated SNPs.
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Affiliation(s)
- Sophia C. Kamran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Riaz IB, Islam M, Ikram W, Naqvi SAA, Maqsood H, Saleem Y, Riaz A, Ravi P, Wang Z, Hussain SA, Warner JL, Odedina FT, Duma N, Singh P, Kehl KL, Kamran SC, Murad MH, Landman A, Van Allen E, Bryce AH. Disparities in the Inclusion of Racial and Ethnic Minority Groups and Older Adults in Prostate Cancer Clinical Trials: A Meta-analysis. JAMA Oncol 2023; 9:180-187. [PMID: 36416812 PMCID: PMC9685549 DOI: 10.1001/jamaoncol.2022.5511] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022]
Abstract
Importance Prostate cancer (PCa) is marked by disparities in clinical outcomes by race, ethnicity, and age. Equitable enrollment in clinical trials is fundamental to promoting health equity. Objective To evaluate disparities in the inclusion of racial and ethnic minority groups and older adults across PCa clinical trials. Data Sources MEDLINE, Embase, and ClinicalTrials.gov were searched to identify primary trial reports from each database's inception through February 2021. Global incidence in age subgroups and US population-based incidence in racial and ethnic subgroups were acquired from the Global Burden of Disease and Surveillance, Epidemiology, and End Results 21 incidence databases respectively. Study Selection All phase 2/3 randomized PCa clinical trials were eligible for age disparity analyses. Trials recruiting exclusively from the US were eligible for primary racial and ethnic disparity analyses. Data Extraction and Synthesis This study was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data were pooled using a random-effects model. Main Outcomes and Measures Enrollment incidence ratios (EIRs), trial proportions (TPs) of participants 65 years or older or members of a racial and ethnic subgroup divided by global incidence in the corresponding age group, or US population-based incidence in the corresponding racial and ethnic subgroup, were calculated. Meta-regression was used to explore associations between trial characteristics and EIRs and trends in EIRs during the past 3 decades. Results Of 9552 participants among trials reporting race, 954 (10.8%) were African American/Black, 80 (1.5%) were Asian/Pacific Islander, and 8518 (78.5) were White. Of 65 US trials, 45 (69.2%) reported race and only 9 (13.8%) reported data on all 5 US racial categories. Of 286 global trials, 75 (26.2%) reported the enrollment proportion of older adults. Outcomes by race and age were reported in 2 (3.1%) and 41 (15.0%) trials, respectively. Black (EIR, 0.70; 95% CI, 0.59-0.83) and Hispanic (EIR, 0.70; 95% CI, 0.59-0.83) patients were significantly underrepresented in US trials. There was no disparity in older adult representation (TP, 21 143 [71.1%]; EIR, 1.00; 95% CI, 0.95-1.05). The representation of Black patients was lower in larger trials (meta-regression coefficient, -0.06; 95% CI, -0.10 to -0.02; P = .002). Conclusions and Relevance The results of this meta-analysis suggest that Black and Hispanic men are underrepresented in trials compared with their share of PCa incidence. The representation of Black patients has consistently remained low during the past 2 decades.
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Affiliation(s)
- Irbaz Bin Riaz
- Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Mayo Clinic, Phoenix, Arizona
| | - Mahnoor Islam
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Yusra Saleem
- Dow University of Health Sciences, Karachi, Pakistan
| | - Anum Riaz
- Canyon Vista Hospital, Midwestern University, Glendale, Arizona
| | - Praful Ravi
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Syed A. Hussain
- University of Sheffield and Sheffield Teaching Hospitals, Sheffield, England
| | | | | | - Narjust Duma
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Sophia C. Kamran
- Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | | | - Adam Landman
- Mass General Brigham, Harvard Medical School, Boston, Massachusetts
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Cheung ATM, Palapattu EL, Pompa IR, Aldrighetti CM, Niemierko A, Willers H, Huang F, Vapiwala N, Van Allen E, Kamran SC. Racial and ethnic disparities in a real-world precision oncology data registry. NPJ Precis Oncol 2023; 7:7. [PMID: 36658153 PMCID: PMC9852424 DOI: 10.1038/s41698-023-00351-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Biorepositories enable precision oncology research by sharing clinically annotated genomic data, but it remains unknown whether these data registries reflect the true distribution of cancers in racial and ethnic minorities. Our analysis of Project Genomics Evidence Neoplasia Information Exchange (GENIE), a real-world cancer data registry designed to accelerate precision oncology discovery, indicates that minorities do not have sufficient representation, which may impact the validity of studies directly comparing mutational profiles between racial/ethnic groups and limit generalizability of biomarker discoveries to all populations.
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Affiliation(s)
- Alexander T M Cheung
- NYU Grossman School of Medicine, New York, NY, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Elina L Palapattu
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Isabella R Pompa
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher M Aldrighetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Franklin Huang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Eliezer Van Allen
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sophia C Kamran
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
For muscle-invasive bladder cancer, the historical, gold standard treatment was radical cystectomy. However, the notion of organ preservation using trimodality therapy (TMT, consisting of maximal transurethral resection of bladder tumor followed by chemoradiation) has been established as a viable treatment alternative to complete removal of the bladder. Despite the lack of direct head-to-head randomized comparisons of TMT to radical cystectomy, the Radiation Therapy Oncology Group (RTOG)/NRG has spearheaded the use of radiation therapy as part of bladder preservation for years, with prospective data demonstrating similar long-term clinical outcomes to cystectomy series, particularly with contemporary treatment. We summarize these trials and discuss the evolution of bladder preservation throughout the decades, culminating in our current TMT protocols. We further discuss the future of organ-preservation therapy in MIBC, with continued improvement in radiation techniques, incorporation of novel therapies, and personalization of treatment to optimize benefit for bladder cancer patients.
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Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Spohn SKB, Draulans C, Kishan AU, Spratt D, Ross A, Maurer T, Tilki D, Berlin A, Blanchard P, Collins S, Bronsert P, Chen R, Pra AD, de Meerleer G, Eade T, Haustermans K, Hölscher T, Höcht S, Ghadjar P, Davicioni E, Heck M, Kerkmeijer LGW, Kirste S, Tselis N, Tran PT, Pinkawa M, Pommier P, Deltas C, Schmidt-Hegemann NS, Wiegel T, Zilli T, Tree AC, Qiu X, Murthy V, Epstein JI, Graztke C, Gao X, Grosu AL, Kamran SC, Zamboglou C. Genomic Classifiers in Personalized Prostate Cancer Radiation Therapy Approaches: A Systematic Review and Future Perspectives Based on International Consensus. Int J Radiat Oncol Biol Phys 2022:S0360-3016(22)03691-4. [PMID: 36596346 DOI: 10.1016/j.ijrobp.2022.12.038] [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: 06/02/2022] [Revised: 12/09/2022] [Accepted: 12/24/2022] [Indexed: 01/01/2023]
Abstract
Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk stratification after surgery, but less data exist for patients treated with definitive radiation therapy (RT) or RT in oligo-/metastatic disease stages. To guide future perspectives of GCs for RT, we conducted (1) a systematic review on the evidence of GCs for patients treated with RT and (2) a survey of experts using the Delphi method, addressing the role of GCs in personalized treatments to identify relevant fields of future clinical and translational research. We performed a systematic review and screened ongoing clinical trials on ClinicalTrials.gov. Based on these results, a multidisciplinary international team of experts received an adapted Delphi method survey. Thirty-one and 30 experts answered round 1 and round 2, respectively. Questions with ≥75% agreement were considered relevant and included in the qualitative synthesis. Evidence for GCs as predictive biomarkers is mainly available to the postoperative RT setting. Validation of GCs as prognostic markers in the definitive RT setting is emerging. Experts used GCs in patients with PCa with extensive metastases (30%), in postoperative settings (27%), and in newly diagnosed PCa (23%). Forty-seven percent of experts do not currently use GCs in clinical practice. Expert consensus demonstrates that GCs are promising tools to improve risk-stratification in primary and oligo-/metastatic patients in addition to existing classifications. Experts were convinced that GCs might guide treatment decisions in terms of RT-field definition and intensification/deintensification in various disease stages. This work confirms the value of GCs and the promising evidence of GC utility in the setting of RT. Additional studies of GCs as prognostic biomarkers are anticipated and form the basis for future studies addressing predictive capabilities of GCs to optimize RT and systemic therapy. The expert consensus points out future directions for GC research in the management of PCa.
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Affiliation(s)
- Simon K B Spohn
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium
| | - Amar U Kishan
- Departments of Radiation Oncology and Urology, University of California, Los Angeles, California
| | - Daniel Spratt
- Department of Radiation Oncology, UH Seidman Cancer Center, Case Western Reserve University
| | - Ashley Ross
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Alejandro Berlin
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network. Toronto, Canada
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Oncostat U1018, Inserm, Paris-Saclay University, Villejuif, France
| | - Sean Collins
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC
| | - Peter Bronsert
- Institute for Surgical Pathology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ronald Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, Kansas
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami, Miller School of Medicine
| | - Gert de Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium
| | - Thomas Eade
- Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Höcht
- Xcare Practices Dept. Radiotherapy, Saarlouis, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | - Matthias Heck
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Germany
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Center, The Netherlands
| | - Simon Kirste
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Phuoc T Tran
- Department of Radiation Oncology, University of Maryland
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik Bonn, Germany
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Constantinos Deltas
- Molecular Medicine Research Center and Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | | | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Alison C Tree
- Department of Radiotherapy, Royal Marsden Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Xuefeng Qiu
- Department of Urology, Medical School of Nanjing University, Affiliated Drum Tower Hospital, Nanjing, China
| | - Vedang Murthy
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National University, India
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian Graztke
- Department of Urology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Xin Gao
- Department of Internal Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anca L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Oncology Center, European University of Cyprus, Limassol, Cyprus
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Kamran SC, Kerkmeijer LG, Zamboglou C. Editorial: Advances in radiotherapy for prostate cancer. Front Oncol 2022; 12:1122652. [PMID: 36620549 PMCID: PMC9821149 DOI: 10.3389/fonc.2022.1122652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, MA, Boston, United States,Broad Institute of MIT and Harvard, Cambridge, MA, Boston, United States
| | - Linda G.W. Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany,German Oncology Center, European University Cyprus, Limassol, Cyprus,*Correspondence: Constantinos Zamboglou,
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Kimball A, Sertic M, Saylor PJ, Kamran SC, Boyraz B. Case 38-2022: A 21-Year-Old Woman with Fatigue and Weight Gain. N Engl J Med 2022; 387:2269-2277. [PMID: 36516093 DOI: 10.1056/nejmcpc2201250] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Allison Kimball
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Madeleine Sertic
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Philip J Saylor
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Sophia C Kamran
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Baris Boyraz
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
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Bukavina L, Luckenbaugh AN, Hofman MS, Hope T, Kamran SC, Murphy DG, Yamoah K, Ost P. Incorporating Prostate-specific Membrane Antigen Positron Emission Tomography in Management Decisions for Men with Newly Diagnosed or Biochemically Recurrent Prostate Cancer. Eur Urol 2022; 83:521-533. [PMID: 36404204 DOI: 10.1016/j.eururo.2022.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Prostate-specific membrane antigen (PSMA) is a promising molecular target for prostate cancer (PCa) that has allowed the development of a novel diagnostic approach to PCA in the primary and recurrent settings. OBJECTIVE To summarize available data and recommendations regarding the use of PSMA in newly diagnosed and recurrent PCa via a narrative review. EVIDENCE ACQUISITION A literature review was conducted using MEDLINE (via PubMed) and Scopus. The search strategy included meta-analyses, reviews, and original studies on staging and restaging with 68Ga-PSMA positron emission tomography (PET)/computed tomography (CT). EVIDENCE SYNTHESIS Studies comparing PSMA-targeted imaging and conventional imaging suggest superior performance of PSMA-targeted imaging in primary and recurrent PCa, albeit with several clinically relevant limitations. Pretreatment 68Ga-PSMA PET/CT allowed more accurate PCa staging in compared to routine practice for high-risk cases, and identified a number of otherwise unknown metastatic lesions. In biochemically recurrent PCa, PSMA PET can reveal sites of recurrence with greater sensitivity and specificity than conventional imaging, potentially detecting a major proportion of occult disease. This review will help providers in applying the most up-to-date and relevant literature to (1) determine which patients truly have oligometastatic disease and (2) ascertain who is most likely to experience a meaningful response to local consolidation in the biochemical recurrence setting. CONCLUSIONS Data on PSMA diagnostic studies in primary and recurrent PCa highlight the accuracy and clinical application of PSMA PET. While this review and the evidence to date might lead to a perception of superiority in metastasis directed therapy, fundamental lack of phase III clinical trials with clinically meaningful outcomes are yet to be determined. PATIENT SUMMARY PSMA (prostate-specific membrane antigen) scans have shown great promise for initial evaluation of prostate cancer (PCa) and in detection of PCa recurrence. The benefits are more apparent for initial staging of PCa. There are more limited clinical trial results for PCa recurrence on how best to use this new technique to guide cancer treatment.
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Kamran SC, Pompa IR, Niemierko A, Dawes SL, Zaky SS, Deville C. Demographic trends among ASTRO clinical practice guideline task force participants from 2010-2022. Int J Radiat Oncol Biol Phys 2022; 116:257-269. [PMID: 36368435 DOI: 10.1016/j.ijrobp.2022.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The American Society for Radiation Oncology (ASTRO) has produced evidence-based clinical practice guidelines since 2009. It is unknown whether task force members for these guidelines are representative of the diversity of the radiation oncology field, particularly in comparison to the ASTRO membership demographics. We sought to characterize the demographic composition of all task force members to date. METHODS The author list for ASTRO-led published guidelines from 2010 to 2022 was assessed. Main practice location/institution was extracted from the guideline publication. Self-identified gender and race/ethnicity were obtained from the ASTRO membership database. Years of experience were measured as the number of years post-board certification at time of guideline development. For United States (US)-based physicians, gender was confirmed with the National Provider Identifier database. Proportions of task force members overall and by individual guideline were described by gender, underrepresented in medicine (URM) status, geography (US vs international), US region (if US based), years of experience (separated into ≤5 years including residents, 6-12 years, and >12 years), and type of practice. Proportions for gender, URM, and geography were compared with ASTRO membership demographics. RESULTS Between 2010 and 2022, there were 25 guideline task forces, with a total of 366 participants: 233 men, 126 women, and 7 unknown gender. There were more men than women serving on most individual task force topics, with 28% of all task forces having >80% composition of men. Of those with self-identified race/ethnicity, 9/204 (4.4%) were URM, which was lower in proportion to URM self-identified ASTRO members (336/3277, 10.3%; P = .007). Most participants were based in the US (n = 323, 88.3%), had >12 years of experience (n = 141, 38.5%), and were from academic institutions (n = 302, 82.5%). Community practitioners were less likely to be women or URM. CONCLUSIONS Improved data collection and more intentional efforts are needed to ensure that the diversity of guidelines task forces is representative of ASTRO membership and the specialty.
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Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Isabella R Pompa
- Department of Radiation Oncology, Massachusetts General Cancer Center, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Sandra S Zaky
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland
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Kunzman J, Henry E, Housri N, Kamran SC, Kunz PL, Lee LE, LoConte NK, Burt L. Gender analysis of oncology expert participation on online professional platforms. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.350] [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
350 Background: Social media platforms have been highlighted as a tool to help promote gender equity by amplifying women in medicine and providing means for collaboration and networking. However, limitations of social networks include sexual harassment and persistent gender biases. While the number of female trainees entering oncology specialties has mostly equalized, gender disparities persist among faculty in promotion, publishing, and leadership positions. We sought to characterize the engagement of female and male oncologists via a private, moderated knowledge-sharing platform, theMednet.org, which disseminates expert knowledge via question-and-answer format. Methods: Questions were posted by registered oncologists on theMednet.org and reviewed by a team of physician editors who then invited selected experts to respond. Experts were selected by the editorial team based on research prominence, academic rank, leadership, and other expert recommendations. Physician information, such as role (academic, community, or trainee), specialty (radiation oncology (RO), medical oncology (MO)), questions asked, and questions answered were analyzed from June 2014 through June 2022. The gender of each physician was determined from their associated National Provider Identifier (NPI), which is recorded as female or male; users without an associated NPI were excluded from the data set. Statistical significance was determined through unpaired two-tailed T-tests and chi-squared testing. Results: Among RO and MO physicians, 3376 were identified as female and 6011 were identified as male. Female faculty make up 42% of experts, which was proportionate to the percent of female users. Female and male experts were invited to answer questions at similar rates for all specialties; however, male experts answered questions at a statistically significantly higher rate in RO (51% vs 18%) and MO (27.5% vs 14%) (Table). Conclusions: While female and male experts were equally invited to answer questions, male experts were significantly more likely to answer questions. As online platforms are increasingly raising the prominence of academics on a national level, lower engagement by female experts may further compound gender disparities in academia. Further studies should identify actual and perceived barriers to female experts answering questions and interacting on professional platforms.[Table: see text]
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Affiliation(s)
| | | | | | - Sophia C. Kamran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Pamela L. Kunz
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | | | | | - Lindsay Burt
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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Salinas KE, Nguyen HB, Kamran SC. The invisible minority: A call to address the persistent socioeconomic diversity gap in U.S. medical schools and the physician workforce. Front Public Health 2022; 10:924746. [PMID: 35968485 PMCID: PMC9372571 DOI: 10.3389/fpubh.2022.924746] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Sophia C. Kamran
- Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Sophia C. Kamran
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Kamran SC, Yeap BY, Ghosh A, Aldrighetti C, Willers H, Vapiwala N. Recent trends of “manels” and gender representation among panelists at the ASCO annual meeting. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11053] [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
11053 Background: Gender disparities in academic medicine are a long-acknowledged concern. Efforts to recognize this imbalance and increase inclusivity continue, particularly in academic medical conferences. In June 2019, NIH Director Francis S. Collins MD, PhD publicly called for an end to all-male speaking panels (“manels”). It is unclear whether academic oncology conferences followed suit. We investigated the prevalence and longitudinal trends of manels and gender representation at the ASCO Annual Meeting during 2018-2021. Methods: Using ASCO online programs, 2018-2021 faculty information was obtained. Data collected included perceived or self-reported gender, medical specialty, panel role (chair vs. non-chair), type of session, and topic. Primary outcomes included percentage of manels and proportion of female panelists over time. Female representation among chairs, specialties, and topics were evaluated. Cochran-Armitage test was used to analyze time trends in the proportion of manels and female representation. Fisher’s exact test was used to compare each session type, topic, or specialty to other categories combined. P-values are based on a two-sided hypothesis. Results: During 2018-2021, there were 670 sessions total, 81 of which (12.1%) were manels. Among 2,475 faculty members, 1,181 (47.7%) were females. Over time, there was a significant decrease in the number of manels, from 17.4% in 2018 to 9.9% in 2021 (p = 0.030) and a corresponding increase in proportion of female panelists from 41.6% to 54.0% (p < 0.001). The largest decrease in manels occurred between 2018 (17.4%) and 2019 (10.5%). Among session type and topic, the highest proportion of manels was observed for leadership/special sessions (17.1%, p = 0.419) and translational/pre-clinical topics (19.6%, p = 0.024), respectively. The chair role was majority male (53.2%) in 2018 but increased to > 50% female representation in 2019-2021 (p = 0.157). The lowest proportion of female panelists were in pathology/radiology/dermatology specialties (combined 26.2%, p = 0.001). Female panelists were underrepresented for the topics of genitourinary cancers (38.6%, p = 0.029) and translational/pre-clinical sciences (36.7%, p < 0.001). Females were overrepresented in the topic of supportive oncology (70.3%, p < 0.001). There was a positive trend toward improved female representation among translational/pre-clinical sciences (27.4% in 2018 to 41.8% in 2021, p = 0.031), but with little improvement among genitourinary cancers (41.1% in 2018 to 40.7% in 2021, p = 0.969). Conclusions: The number of female ASCO panelists increased during the study period and surpassed 50% in 2021, with a corresponding decrease in the proportion of manels. Still, there are certain topics/specialties where female representation has remained stagnant. ASCO Annual Meeting organizers should continue to strive for diverse gender representation and the elimination of manels.
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Affiliation(s)
- Sophia C. Kamran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Beow Y. Yeap
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, Boston, MA
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Burgess L, Aldrighetti CM, Ghosh A, Niemierko A, Chino F, Huynh MJ, Efstathiou JA, Kamran SC. Association of the USPSTF Grade D Recommendation Against Prostate-Specific Antigen Screening With Prostate Cancer-Specific Mortality. JAMA Netw Open 2022; 5:e2211869. [PMID: 35576008 PMCID: PMC9112070 DOI: 10.1001/jamanetworkopen.2022.11869] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/20/2022] Open
Abstract
IMPORTANCE The 2012 US Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening for all men has been controversial, with data documenting a shift to a higher stage of disease at diagnosis. The association between the Grade D recommendation and prostate cancer-specific mortality (PCSM) among contemporary cohorts, however, is unclear. OBJECTIVE To evaluate PCSM rates between 1999 and 2019, comparing trends in rates before and after the change in the 2012 USPSTF screening guideline to assess its association with PCSM. EXPOSURE The 2012 USPSTF Grade D recommendation against PSA screening for all men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research maintained by the National Center for Health Statistics to collect data on cause of death for all individuals who died of prostate cancer in the US from 1999 to 2019. Analysis was performed from January to August 2021. MAIN OUTCOMES AND MEASURES Trends in PCSM rates were calculated from 1999 to 2012 and from 2014 to 2019, with a washout year of 2013, using linear regression, with year and binary indicator of pre-2013 and post-2013 status as interaction terms. Trends were further analyzed by age, race and ethnicity, urbanization category, and US Census region. Other measures included diagnosis of localized or metastatic prostate cancer and overall cancer mortality. RESULTS A total of 618 095 patients died of prostate cancer in the US from 1999 to 2019. Age-adjusted PCSM decreased linearly at a rate of -0.273 per 100 000 population per year from 1999 to 2012 and stalled at a rate of -0.009 per 100 000 per year from 2014 to 2019 (P < .001). This finding was significant among men aged 60 years or older, especially among men aged 60 to 69 years, men aged 80 years or older, and among Black men. Men aged 60 to 64 years had a decreasing, age-adjusted PCSM rate of -0.0088 per 100 000 population per year prior to 2013 followed by an increasing rate of 0.0014 per 100 000 per year. Men aged 65 to 69 years had a decreasing, age-adjusted PCSM rate of -0.024 per 100 000 population per year prior to 2013 followed by an increasing rate of 0.0011 per 100 000 population per year. Men aged 80 years or older had the largest absolute difference between rates before and after 2013 compared with all other age groups, with a difference of 0.06 for men aged 80 to 84 years and 0.07 for men 85 aged years or older. Black men had a decreasing, age-adjusted PCSM rate of -0.700 per 100 000 population per year prior to 2013 followed by a flattened rate of -0.091 per 100 000 population per year. Changes were observed across races and ethnicities, urbanization categories, and US Census regions and were accompanied by increased diagnoses of metastatic disease, which are inconsistent with mortality trends across all malignant neoplasms. CONCLUSIONS AND RELEVANCE This cross-sectional study using comprehensive PCSM data through 2019 demonstrated decreasing PCSM rates that flattened or increased after the 2012 USPSTF Grade D recommendation, suggesting that decreased PSA screening may be a factor associated with this change. This change was seen across ages, races and ethnicities, urbanization categories, and US Census regions. The updated 2018 USPSTF guideline supporting shared decision-making may reverse these trends in the coming years.
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Affiliation(s)
- Laura Burgess
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa J. Huynh
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
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Abstract
The 2020 U.S. Census data show a rapidly diversifying U.S. population. We sought to evaluate whether clinical faculty and leadership representation at academic medical schools reflects the diversifying population over time. Using data from the Association of American Medical Colleges for the period of 1977 through 2019, we found notable progress in female representation among clinical faculty, with smaller gains among department chairs and medical school deans. Racial and ethnic groups that are underrepresented in medicine are designated as such because their presence within the medical profession is disproportionate to the U.S. Census data. Even with accounting for this underrepresentation, clinical faculty and leadership positions show even starker disparities. Thoughtful policy implementation could help address this persistent underrepresentation among medical school faculty and leadership positions.
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Affiliation(s)
- Sophia C Kamran
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
| | - Karen M Winkfield
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
| | - Joan Y Reede
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
| | - Neha Vapiwala
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
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Kishan AU, Kamran SC, Soerensen SJC, Leppert JT. Dual X-ray Absorptiometry Screening for Men Receiving Androgen Deprivation Therapy-Hiding in Plain (Film) Sight. JAMA Netw Open 2022; 5:e225439. [PMID: 35363273 DOI: 10.1001/jamanetworkopen.2022.5439] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles
- Department of Urology, University of California, Los Angeles, Los Angeles
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon J C Soerensen
- Department of Urology, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Ghosh A, Goldberg S, Chino F, Efstathiou JA, Kamran SC. Racial, ethnic, and geographical differences in testicular cancer mortality trends in the United States. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.409] [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
409 Background: Incidence rates of Testicular cancer (TC) have been slowly increasing in the United States in recent decades. Prior research has identified racial disparities in mortality; however, these trends have not been extensively evaluated. Given that TC has a diverse presentation, this study was undertaken to establish racial, ethnic, geographical differences in longitudinal mortality trends. Methods: Age-adjusted cancer mortality rates for TC were obtained for men in the United States from the CDC Wide-ranging Online Data for Epidemiologic Research database. Testicular cancer-specific mortality (TCSM) rates from 1999-2019 were calculated using linear regression. Trends in mortality by race (White versus Black), ethnicity (Hispanic versus non-Hispanic), urbanization, and census region were analyzed using SAS 9.4. TCSM rates were compared by F-test. A two-sided hypothesis test was performed for p-values, where values < 0.05 were considered statistically significant. Results: From 1999-2019, overall age-adjusted TCSM has been slowly, but not significantly, increasing per year (Table). There was worsening TCSM rates for Hispanics (+)0.0019 per 100,000 compared to non-Hispanics (-)0.003; p=0.010. Black men had slightly improved TCSM rates/year (-0.0007) compared to white men (+0.0006); p=0.049. Significant geographical differences in mortality rates were observed, with a decreasing TCSM rate of (-)0.00092 the Northeast and an increasing rate of (+)0.00086 in the West (p = 0.032 for difference between slopes). Among urbanization categories, TCSM rates in Large Central Metros regions (central counties in metro areas with population > 1 million) and Small Metro regions (counties with population 50,000-249,999) were significantly different [(-)0.0004 and (+)0.0022 respectively; p =0.048]. All other comparisons were not significant. Conclusions: Using comprehensive, contemporary data on TCSM over 2 decades, we found significant differences in TCSM rates. Mortality rates from TC have been increasing, particularly among Hispanics. Understanding racial, ethnic, and geographical trends in TCSM rates is important in treating men with the disease and, ultimately, reducing deaths caused by TC.[Table: see text]
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Affiliation(s)
- Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, Boston, MA
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