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1. Mixture of Multicenter Experts in Multimodal Generative AI for Advanced Radiotherapy Target Delineation

Author

Oh, Yujin, Park, Sangjoon, Li, Xiang, Yi, Wang, Paly, Jonathan, Efstathiou, Jason, Chan, Annie, Kim, Jun Won, Byun, Hwa Kyung, Lee, Ik Jae, Cho, Jaeho, Wee, Chan Woo, Shu, Peng, Wang, Peilong, Yu, Nathan, Holmes, Jason, Ye, Jong Chul, Li, Quanzheng, Liu, Wei, Koom, Woong Sub, Kim, Jin Sung, and Kim, Kyungsang

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning
Abstract

Clinical experts employ diverse philosophies and strategies in patient care, influenced by regional patient populations. However, existing medical artificial intelligence (AI) models are often trained on data distributions that disproportionately reflect highly prevalent patterns, reinforcing biases and overlooking the diverse expertise of clinicians. To overcome this limitation, we introduce the Mixture of Multicenter Experts (MoME) approach. This method strategically integrates specialized expertise from diverse clinical strategies, enhancing the AI model's ability to generalize and adapt across multiple medical centers. The MoME-based multimodal target volume delineation model, trained with few-shot samples including images and clinical notes from each medical center, outperformed baseline methods in prostate cancer radiotherapy target delineation. The advantages of MoME were most pronounced when data characteristics varied across centers or when data availability was limited, demonstrating its potential for broader clinical applications. Therefore, the MoME framework enables the deployment of AI-based target volume delineation models in resource-constrained medical facilities by adapting to specific preferences of each medical center only using a few sample data, without the need for data sharing between institutions. Expanding the number of multicenter experts within the MoME framework will significantly enhance the generalizability, while also improving the usability and adaptability of clinical AI applications in the field of precision radiation oncology., Comment: 39 pages

Published
2024

2. Biochemical Recurrence Surrogacy for Clinical Outcomes After Radiotherapy for Adenocarcinoma of the Prostate.

Author

Roy, Soumyajit, Romero, Tahmineh, Michalski, Jeff, Feng, Felix, Efstathiou, Jason, Lawton, Colleen, Bolla, Michel, Maingon, Philippe, de Reijke, Theo, Joseph, David, Ong, Wee, Sydes, Matthew, Dearnaley, David, Tree, Alison, Carrier, Nathalie, Nabid, Abdenour, Souhami, Luis, Incrocci, Luca, Heemsbergen, Wilma, Pos, Floris, Zapatero, Almudena, Guerrero, Araceli, Alvarez, Ana, San-Segundo, Carmen, Maldonado, Xavier, Reiter, Robert, Nickols, Nicholas, Ma, T, Farrell, Matthew, Neilsen, Beth, Juarez, Jesus, Deng, Jie, Vangala, Sitaram, Avril, Norbert, Jia, Angela, Zaorsky, Nicholas, Sun, Yilun, Spratt, Daniel, Kishan, Amar, Rettig, Matthew, Steinberg, Michael, and Valle, Luca

Subjects
Male, Humans, Prostate, Prostatic Neoplasms, Androgen Antagonists, Prostate-Specific Antigen, Adenocarcinoma
Abstract

PURPOSE: The surrogacy of biochemical recurrence (BCR) for overall survival (OS) in localized prostate cancer remains controversial. Herein, we evaluate the surrogacy of BCR using different surrogacy analytic methods. MATERIALS AND METHODS: Individual patient data from 11 trials evaluating radiotherapy dose escalation, androgen deprivation therapy (ADT) use, and ADT prolongation were obtained. Surrogate candidacy was assessed using the Prentice criteria (including landmark analyses) and the two-stage meta-analytic approach (estimating Kendalls tau and the R2). Biochemical recurrence-free survival (BCRFS, time from random assignment to BCR or any death) and time to BCR (TTBCR, time from random assignment to BCR or cancer-specific deaths censoring for noncancer-related deaths) were assessed. RESULTS: Overall, 10,741 patients were included. Dose escalation, addition of short-term ADT, and prolongation of ADT duration significantly improved BCR (hazard ratio [HR], 0.71 [95% CI, 0.63 to 0.79]; HR, 0.53 [95% CI, 0.48 to 0.59]; and HR, 0.54 [95% CI, 0.48 to 0.61], respectively). Adding short-term ADT (HR, 0.91 [95% CI, 0.84 to 0.99]) and prolonging ADT (HR, 0.86 [95% CI, 0.78 to 0.94]) significantly improved OS, whereas dose escalation did not (HR, 0.98 [95% CI, 0.87 to 1.11]). BCR at 48 months was associated with inferior OS in all three groups (HR, 2.46 [95% CI, 2.08 to 2.92]; HR, 1.51 [95% CI, 1.35 to 1.70]; and HR, 2.31 [95% CI, 2.04 to 2.61], respectively). However, after adjusting for BCR at 48 months, there was no significant treatment effect on OS (HR, 1.10 [95% CI, 0.96 to 1.27]; HR, 0.96 [95% CI, 0.87 to 1.06] and 1.00 [95% CI, 0.90 to 1.12], respectively). The patient-level correlation (Kendalls tau) for BCRFS and OS ranged between 0.59 and 0.69, and that for TTBCR and OS ranged between 0.23 and 0.41. The R2 values for trial-level correlation of the treatment effect on BCRFS and TTBCR with that on OS were 0.563 and 0.160, respectively. CONCLUSION: BCRFS and TTBCR are prognostic but failed to satisfy all surrogacy criteria. Strength of correlation was greater when noncancer-related deaths were considered events.

Published
2023

3. Genomic Classifier Performance in Intermediate-Risk Prostate Cancer: Results From NRG Oncology/RTOG 0126 Randomized Phase 3 Trial.

Author

Spratt, Daniel, Liu, Vinnie, Michalski, Jeff, Davicioni, Elai, Berlin, Alejandro, Simko, Jeffry, Efstathiou, Jason, Tran, Phuoc, Sandler, Howard, Hall, William, Thompson, Darby, Parliament, Matthew, Dayes, Ian, Correa, Rohann, Robertson, John, Gore, Elizabeth, Doncals, Desiree, Vigneault, Eric, Souhami, Luis, Karrison, Theodore, and Feng, Felix

Subjects
Male, Humans, Prostatic Neoplasms, Prostate-Specific Antigen, Androgen Antagonists, Retrospective Studies, Neoplasm Grading, Genomics, Disease Progression
Abstract

PURPOSE: Intermediate-risk prostate cancer is a heterogeneous disease state with diverse treatment options. The 22-gene Decipher genomic classifier (GC) retrospectively has shown to improve risk stratification in these patients. We assessed the performance of the GC in men with intermediate-risk disease enrolled in NRG Oncology/RTOG 01-26 with updated follow-up. METHODS AND MATERIALS: After National Cancer Institute approval, biopsy slides were collected from NRG Oncology/RTOG 01-26, a randomized phase 3 trial of men with intermediate-risk prostate cancer randomized to 70.2 Gy versus 79.2 Gy of radiation therapy without androgen deprivation therapy. RNA was extracted from the highest-grade tumor foci to generate the locked 22-gene GC model. The primary endpoint for this ancillary project was disease progression (composite of biochemical failure, local failure, distant metastasis, prostate cancer-specific mortality, and use of salvage therapy). Individual endpoints were also assessed. Fine-Gray or cause-specific Cox multivariable models were constructed adjusting for randomization arm and trial stratification factors. RESULTS: Two-hundred fifteen patient samples passed quality control for analysis. The median follow-up was 12.8 years (range, 2.4-17.7). On multivariable analysis, the 22-gene GC (per 0.1 unit) was independently prognostic for disease progression (subdistribution hazard ratio [sHR], 1.12; 95% confidence interval [CI], 1.00-1.26; P = .04), biochemical failure (sHR, 1.22; 95% CI, 1.10-1.37; P < .001), distant metastasis (sHR, 1.28; 95% CI, 1.06-1.55; P = .01), and prostate cancer-specific mortality (sHR, 1.45; 95% CI, 1.20-1.76; P < .001). Ten-year distant metastasis in GC low-risk patients was 4% compared with 16% for GC high-risk patients. In patients with lower GC scores, the 10-year difference in metastasis-free survival rate between arms was -7%, compared with 21% for higher GC patients (P-interaction = .04). CONCLUSIONS: This study represents the first validation of a biopsy-based gene expression classifier, assessing both its prognostic and predictive value, using data from a randomized phase 3 trial of intermediate-risk prostate cancer. Decipher improves risk stratification and can aid in treatment decision-making in men with intermediate-risk disease.

Published
2023

4. Clinical application of bladder MRI and the Vesical Imaging-Reporting And Data System

Author

Panebianco, Valeria, Briganti, Alberto, Boellaard, Thierry N., Catto, James, Comperat, Eva, Efstathiou, Jason, van der Heijden, Antoine G., Giannarini, Gianluca, Girometti, Rossano, Mertens, Laura, Takeuchi, Mitsuru, Muglia, Valdair F., Narumi, Yoshifumi, Novara, Giacomo, Pecoraro, Martina, Roupret, Morgan, Sanguedolce, Francesco, Santini, Daniele, Shariat, Shahrokh F., Simone, Giuseppe, Vargas, Hebert A., Woo, Sungmin, Barentsz, Jelle, and Witjes, J. Alfred

Published
2024
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5. Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials

Author

Martin, Ting, Sun, Yilun, Malone, Shawn, Roach, Mack, Dearnaley, David, Pisansky, Thomas M, Feng, Felix Y, Sandler, Howard M, Efstathiou, Jason A, Syndikus, Isabel, Hall, Emma C, Tree, Alison C, Sydes, Matthew R, Cruickshank, Claire, Roy, Soumyajit, Bolla, Michel, Maingon, Philippe, De Reijke, Theo, Nabid, Abdenour, Carrier, Nathalie, Souhami, Luis, Zapatero, Almudena, Guerrero, Araceli, Alvarez, Ana, San-Segundo, Carmen Gonzalez, Maldonado, Xavier, Romero, Tahmineh, Steinberg, Michael L, Valle, Luca F, Rettig, Matthew B, Nickols, Nicholas G, Shoag, Jonathan E, Reiter, Robert E, Zaorsky, Nicholas G, Jia, Angela Y, Garcia, Jorge A, Spratt, Daniel E, Kishan, Amar U, and Investigators, on behalf of the Meta-Analysis of Randomized Trials in Cancer of the Prostate Consortium

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Aging, Clinical Research, Patient Safety, Urologic Diseases, Cancer, Prostate Cancer, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, Male, Humans, Prostatic Neoplasms, Androgen Antagonists, Androgens, Randomized Controlled Trials as Topic, Prostate-Specific Antigen, Meta-Analysis of Randomized Trials in Cancer of the Prostate (MARCAP) Consortium Investigators, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

PurposeThe sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT).Materials and methodsIndividual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality.ResultsOverall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; P < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; P = .0046), prostate cancer-specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; P < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT.ConclusionADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT.

Published
2023

7. Bladder cancer

Author

Dyrskjøt, Lars, Hansel, Donna E., Efstathiou, Jason A., Knowles, Margaret A., Galsky, Matthew D., Teoh, Jeremy, and Theodorescu, Dan

Published
2023
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8. Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202

Author

Mak, Kimberley S., Scannell Bryan, Molly, Dignam, James J., Shipley, William U., Lin, Yue, Peters, Christopher A., Gore, Elizabeth M., Rosenthal, Seth A., Zeitzer, Kenneth L., D'Souza, David P., Horwitz, Eric M., Pisansky, Thomas M., Maier, Jordan M., Chafe, Susan M., Robin, Tyler P., Roach, Mack, III, Tran, Phuoc T., Souhami, Luis, Michalski, Jeff M., Hartford, Alan C., Feng, Felix Y., Sandler, Howard M., and Efstathiou, Jason A.

Published
2024
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9. Adding Short-Term Androgen Deprivation Therapy to Radiation Therapy in Men With Localized Prostate Cancer: Long-Term Update of the NRG/RTOG 9408 Randomized Clinical Trial

Author

Jones, Christopher U, Pugh, Stephanie L, Sandler, Howard M, Chetner, Michael P, Amin, Mahul B, Bruner, Deborah W, Zietman, Anthony L, Den, Robert B, Leibenhaut, Mark H, Longo, John M, Bahary, Jean-Paul, Rosenthal, Seth A, Souhami, Luis, Michalski, Jeff M, Hartford, Alan C, Amin, Pradip P, Roach, Mack, Yee, Don, Efstathiou, Jason A, Rodgers, Joseph P, Feng, Felix Y, and Shipley, William U

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Prostate Cancer, Clinical Trials and Supportive Activities, Clinical Research, Cancer, Urologic Diseases, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Androgen Antagonists, Androgens, Follow-Up Studies, Humans, Male, Prostate-Specific Antigen, Prostatic Neoplasms, Other Physical Sciences, Oncology & Carcinogenesis, Oncology and carcinogenesis, Theoretical and computational chemistry, Medical and biological physics
Abstract

PurposeFor men with localized prostate cancer, NRG Oncology/Radiation Therapy Oncology Group (RTOG) 9408 demonstrated that adding short-term androgen deprivation therapy (ADT) to radiation therapy (RT) improved the primary endpoint of overall survival (OS) and improved disease-specific mortality (DSM), biochemical failure (BF), local progression, and freedom from distant metastases (DM). This study was performed to determine whether the short-term ADT continued to improve OS, DSM, BF, and freedom from DM with longer follow-up.Methods and materialsFrom 1994 to 2001, NRG/RTOG 9408 randomized 2028 men from 212 North American institutions with T1b-T2b, N0 prostate adenocarcinoma and prostate-specific antigen (PSA) ≤20ng/mL to RT alone or RT plus short-term ADT. Patients were stratified by PSA, tumor grade, and surgical versus clinical nodal staging. ADT was flutamide with either goserelin or leuprolide for 4 months. Prostate RT (66.6 Gy) was started after 2 months. OS was calculated at the date of death from any cause or at last follow-up. Secondary endpoints were DSM, BF, local progression, and DM. Acute and late toxic effects were assessed using RTOG toxicity scales.ResultsMedian follow-up in surviving patients was 14.8 years (range, 0.16-21.98). The 10-year and 18-year OS was 56% and 23%, respectively, with RT alone versus 63% and 23% with combined therapy (HR 0.94; 95% confidence interval [CI], 0.85-1.05; P = .94). The hazards were not proportional (P = .003). Estimated restricted mean survival time at 18 years was 11.8 years (95% CI, 11.4-12.1) with combined therapy versus 11.3 years with RT alone (95% CI, 10.9-11.6; P = .05). The 10-year and 18-year DSM was 7% and 14%, respectively, with RT alone versus 3% and 8% with combined therapy (HR 0.56; 95% CI, 0.41-0.75; P < .01). DM and BF favored combined therapy at 18 years. Rates of late grade ≥3 hepatic, gastrointestinal, and genitourinary toxicity were ≤1%, 3%, and 8%, respectively, with combined therapy versus ≤1%, 2%, and 5% with RT alone.ConclusionsFurther follow-up demonstrates that OS converges at approximately 15 years, by which point the administration of 4 months of ADT had conferred an estimated additional 6 months of life.

Published
2022

10. Long-term Outcomes of Chemoradiation for Muscle-invasive Bladder Cancer in Noncystectomy Candidates. Final Results of NRG Oncology RTOG 0524—A Phase 1/2 Trial of Paclitaxel + Trastuzumab with Daily Radiation or Paclitaxel Alone with Daily Irradiation

Author

Dahl, Douglas M., Karrison, Theodore G., Michaelson, M. Dror, Pham, Huong T., Wu, Chin-Lee, Swanson, Gregory P., Shipley, William U., Vuky, Jacqueline, Lee, R. Jeffrey, Zietman, Anthony L., Souhami, Luis, Chang, Brian K., Deming, Richard L., Ellerton, John A., Sandler, Howard M., Rodgers, Joseph P., Feng, Felix Y., and Efstathiou, Jason A.

Published
2024
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12. Long-Term Results of Bladder Preservation With Twice-Daily Radiation Plus 5-Fluorouracil/Cisplatin or Daily Radiation Plus Gemcitabine for Muscle-Invasive Bladder Cancer—Updated Report of NRG/RTOG 0712: A Randomized Phase 2 Trial

Author

Coen, John J., Rodgers, Joseph P., Saylor, Philip J., Lee, Cheryl T., Wu, Chin-Lee, Parker, William, Lautenschlaeger, Tim, Zietman, Anthony L., Efstathiou, Jason, Jani, Ashesh B., Kucuk, Omer, Souhami, Luis, Pugh, Stephanie L., Sandler, Howard M., and Shipley, William U.

Published
2024
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14. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines

Author

Alfred Witjes, J., Max Bruins, Harman, Carrión, Albert, Cathomas, Richard, Compérat, Eva, Efstathiou, Jason A., Fietkau, Rainer, Gakis, Georgios, Lorch, Anja, Martini, Alberto, Mertens, Laura S., Meijer, Richard P., Milowsky, Matthew I., Neuzillet, Yann, Panebianco, Valeria, Redlef, John, Rink, Michael, Rouanne, Mathieu, Thalmann, George N., Sæbjørnsen, Sæbjørn, Veskimäe, Erik, and van der Heijden, Antoine G.

Published
2024
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16. NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer

Author

Hall, William A, Paulson, Eric, Davis, Brian J, Spratt, Daniel E, Morgan, Todd M, Dearnaley, David, Tree, Alison C, Efstathiou, Jason A, Harisinghani, Mukesh, Jani, Ashesh B, Buyyounouski, Mark K, Pisansky, Thomas M, Tran, Phuoc T, Karnes, R Jeffrey, Chen, Ronald C, Cury, Fabio L, Michalski, Jeff M, Rosenthal, Seth A, Koontz, Bridget F, Wong, Anthony C, Nguyen, Paul L, Hope, Thomas A, Feng, Felix, Sandler, Howard M, and Lawton, Colleen AF

Subjects
Physical Sciences, Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Urologic Diseases, Cancer, Consensus, Humans, Internationality, Lymph Nodes, Male, Oncologists, Organ Size, Pelvis, Prostatic Neoplasms, Other Physical Sciences, Oncology & Carcinogenesis, Oncology and carcinogenesis, Theoretical and computational chemistry, Medical and biological physics
Abstract

PurposeIn 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas.Methods and materialsA literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity.ResultsEighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm3, intact node positive case was 409 cm3, and intact node negative case was 342 cm3. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached.ConclusionsDiscordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.

Published
2021

17. Five-Year Patient-Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer

Author

Lukka, Himanshu R., Deshmukh, Snehal, Bruner, Deborah W., Bahary, Jean-Paul, Lawton, Colleen A.F., Efstathiou, Jason A., Kudchadker, Rajat J., Ponsky, Lee E., Seaward, Samantha A., Dayes, Ian S., Gopaul, Darindra D., Michalski, Jeff M., Delouya, Guila, Kaplan, Irving D., Horwitz, Eric M., Roach, Mack, III, Feng, Felix Y., Pugh, Stephanie L., Sandler, Howard M., and Kachnic, Lisa A.

Published
2023
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18. Analysis of a Biopsy-Based Genomic Classifier in High-Risk Prostate Cancer: Meta-Analysis of the NRG Oncology/Radiation Therapy Oncology Group 9202, 9413, and 9902 Phase 3 Randomized Trials

Author

Nguyen, Paul L., Huang, Huei-Chung (Rebecca), Spratt, Daniel E., Davicioni, Elai, Sandler, Howard M., Shipley, William U., Efstathiou, Jason A., Simko, Jeffry P., Pollack, Alan, Dicker, Adam P., Roach, Mack, Rosenthal, Seth A., Zeitzer, Kenneth L., Mendez, Lucas C., Hartford, Alan C., Hall, William A., Desai, Anand B., Rabinovitch, Rachel A., Peters, Christopher A., Rodgers, Joseph P., Tran, Phuoc, and Feng, Felix Y.

Published
2023
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19. DNA hypomethylation silences anti-tumor immune genes in early prostate cancer and CTCs

Author

Guo, Hongshan, Vuille, Joanna A., Wittner, Ben S., Lachtara, Emily M., Hou, Yu, Lin, Maoxuan, Zhao, Ting, Raman, Ayush T., Russell, Hunter C., Reeves, Brittany A., Pleskow, Haley M., Wu, Chin-Lee, Gnirke, Andreas, Meissner, Alexander, Efstathiou, Jason A., Lee, Richard J., Toner, Mehmet, Aryee, Martin J., Lawrence, Michael S., Miyamoto, David T., Maheswaran, Shyamala, and Haber, Daniel A.

Published
2023
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20. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis

Author

Zlotta, Alexandre R, Ballas, Leslie K, Niemierko, Andrzej, Lajkosz, Katherine, Kuk, Cynthia, Miranda, Gus, Drumm, Michael, Mari, Andrea, Thio, Ethan, Fleshner, Neil E, Kulkarni, Girish S, Jewett, Michael A S, Bristow, Robert G, Catton, Charles, Berlin, Alejandro, Sridhar, Srikala S, Schuckman, Anne, Feldman, Adam S, Wszolek, Matthew, Dahl, Douglas M, Lee, Richard J, Saylor, Philip J, Michaelson, M Dror, Miyamoto, David T, Zietman, Anthony, Shipley, William, Chung, Peter, Daneshmand, Siamak, and Efstathiou, Jason A

Published
2023
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21. A Phase 1 Trial of Durvalumab in Combination with Bacillus Calmette-Guerin (BCG) or External Beam Radiation Therapy in Patients with BCG-unresponsive Non-muscle-Invasive Bladder Cancer: The Hoosier Cancer Research Network GU16-243 ADAPT-BLADDER Study

Author

Hahn, Noah M., O'Donnell, Michael A., Efstathiou, Jason A., Zahurak, Marianna, Rosner, Gary L., Smith, Jeff, Kates, Max R., Bivalacqua, Trinity J., Tran, Phuoc T., Song, Daniel Y., Baras, Alex S., Matoso, Andres, Choi, Woonyoung, Smith, Kellie N., Pardoll, Drew M., Marchionni, Luigi, McGuire, Bridget, Grace Phelan, Mary, Johnson, Burles A., III, O'Neal, Tanya, McConkey, David J., Rose, Tracy L., Bjurlin, Marc, Lim, Emerson A., Drake, Charles G., McKiernan, James M., Deutsch, Israel, Anderson, Christopher B., Lamm, Donald L., Geynisman, Daniel M., Plimack, Elizabeth R., Hallman, Mark A., Horwitz, Eric M., Al-Saleem, Essel, Chen, David Y.T., Greenberg, Richard E., Kutikov, Alexander, Guo, Gordon, Masterson, Timothy A., Adra, Nabil, and Kaimakliotis, Hristos Z.

Published
2023
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22. Addition of Androgen-Deprivation Therapy or Brachytherapy Boost to External Beam Radiotherapy for Localized Prostate Cancer: A Network Meta-Analysis of Randomized Trials.

Author

Jackson, William C, Hartman, Holly E, Dess, Robert T, Birer, Sam R, Soni, Payal D, Hearn, Jason WD, Reichert, Zachary R, Kishan, Amar U, Mahal, Brandon A, Zumsteg, Zachary S, Efstathiou, Jason A, Kaffenberger, Samuel, Morgan, Todd M, Mehra, Rohit, Showalter, Timothy N, Krauss, Daniel A, Nguyen, Paul L, Schipper, Matthew J, Feng, Felix Y, Sandler, Howard M, Hoskin, Peter J, Roach, Mack, and Spratt, Daniel E

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Aging, Clinical Research, Cancer, Prostate Cancer, Clinical Trials and Supportive Activities, Urologic Diseases, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Aged, Androgen Antagonists, Antineoplastic Agents, Hormonal, Brachytherapy, Chemoradiotherapy, Humans, Male, Network Meta-Analysis, Prostatic Neoplasms, Radiation Dosage, Randomized Controlled Trials as Topic, Time Factors, Treatment Outcome, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

PurposeIn men with localized prostate cancer, the addition of androgen-deprivation therapy (ADT) or a brachytherapy boost (BT) to external beam radiotherapy (EBRT) have been shown to improve various oncologic end points. Practice patterns indicate that those who receive BT are significantly less likely to receive ADT, and thus we sought to perform a network meta-analysis to compare the predicted outcomes of a randomized trial of EBRT plus ADT versus EBRT plus BT.Materials and methodsA systematic review identified published randomized trials comparing EBRT with or without ADT, or EBRT (with or without ADT) with or without BT, that reported on overall survival (OS). Standard fixed-effects meta-analyses were performed for each comparison, and a meta-regression was conducted to adjust for use and duration of ADT. Network meta-analyses were performed to compare EBRT plus ADT versus EBRT plus BT. Bayesian analyses were also performed, and a rank was assigned to each treatment after Markov Chain Monte Carlo analyses to create a surface under the cumulative ranking curve.ResultsSix trials compared EBRT with or without ADT (n = 4,663), and 3 compared EBRT with or without BT (n = 718). The addition of ADT to EBRT improved OS (hazard ratio [HR], 0.71 [95% CI, 0.62 to 0.81]), whereas the addition of BT did not significantly improve OS (HR, 1.03 [95% CI, 0.78 to 1.36]). In a network meta-analysis, EBRT plus ADT had improved OS compared with EBRT plus BT (HR, 0.68 [95% CI, 0.52 to 0.89]). Bayesian modeling demonstrated an 88% probability that EBRT plus ADT resulted in superior OS compared with EBRT plus BT.ConclusionOur findings suggest that current practice patterns of omitting ADT with EBRT plus BT may result in inferior OS compared with EBRT plus ADT in men with intermediate- and high-risk prostate cancer. ADT for these men should remain a critical component of treatment regardless of radiotherapy delivery method until randomized evidence demonstrates otherwise.

Published
2020

23. Management of patients with advanced prostate cancer—metastatic and/or castration-resistant prostate cancer: Report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022

Author

Gillessen, Silke, Bossi, Alberto, Davis, Ian D., de Bono, Johann, Fizazi, Karim, James, Nicholas D., Mottet, Nicolas, Shore, Neal, Small, Eric, Smith, Matthew, Sweeney, Christopher J., Tombal, Bertrand, Antonarakis, Emmanuel S., Aparicio, Ana M., Armstrong, Andrew J., Attard, Gerhardt, Beer, Tomasz M., Beltran, Himisha, Bjartell, Anders, Blanchard, Pierre, Briganti, Alberto, Bristow, Rob G., Bulbul, Muhammad, Caffo, Orazio, Castellano, Daniel, Castro, Elena, Cheng, Heather H., Chi, Kim N., Chowdhury, Simon, Clarke, Caroline S., Clarke, Noel, Daugaard, Gedske, De Santis, Maria, Duran, Ignacio, Eeles, Ross, Efstathiou, Eleni, Efstathiou, Jason, Ekeke, Onyeanunam Ngozi, Evans, Christopher P., Fanti, Stefano, Feng, Felix Y., Fonteyne, Valerie, Fossati, Nicola, Frydenberg, Mark, George, Dan, Gleave, Martin, Gravis, Gwenaelle, Halabi, Susan, Heinrich, Daniel, Herrmann, Ken, Higano, Celestia, Hofman, Michael S., Horvath, Lisa G., Hussain, Maha, Jereczek-Fossa, Barbara A., Jones, Rob, Kanesvaran, Ravindran, Kellokumpu-Lehtinen, Pirkko-Liisa, Khauli, Raja B., Klotz, Laurence, Kramer, Gero, Leibowitz, Raja, Logothetis, Christopher, Mahal, Brandon, Maluf, Fernando, Mateo, Joaquin, Matheson, David, Mehra, Niven, Merseburger, Axel, Morgans, Alicia K., Morris, Michael J., Mrabti, Hind, Mukherji, Deborah, Murphy, Declan G., Murthy, Vedang, Nguyen, Paul L., Oh, William K., Ost, Piet, O’Sullivan, Joe M., Padhani, Anwar R., Pezaro, Carmel J., Poon, Darren M.C., Pritchard, Colin C., Rabah, Danny M., Rathkopf, Dana, Reiter, Robert E., Rubin, Mark A., Ryan, Charles J., Saad, Fred, Sade, Juan Pablo, Sartor, Oliver, Scher, Howard I., Sharifi, Nima, Skoneczna, Iwona, Soule, Howard, Spratt, Daniel E., Srinivas, Sandy, Sternberg, Cora N., Steuber, Thomas, Suzuki, Hiroyoshi, Sydes, Matthew R., Taplin, Mary-Ellen, Tilki, Derya, Türkeri, Levent, Turco, Fabio, Uemura, Hiroji, Uemura, Hirotsugu, Ürün, Yüksel, Vale, Claire L., van Oort, Inge, Vapiwala, Neha, Walz, Jochen, Yamoah, Kosj, Ye, Dingwei, Yu, Evan Y., Zapatero, Almudena, Zilli, Thomas, and Omlin, Aurelius

Published
2023
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24. Neighborhood Deprivation and Rurality Associated With Patient-Reported Outcomes and Survival in Men With Prostate Cancer in NRG Oncology RTOG 0415

Author

Bai, Jinbing, Pugh, Stephanie L., Eldridge, Ronald, Yeager, Katherine A., Zhang, Qi, Lee, W. Robert, Shah, Amit B., Dayes, Ian S., D'Souza, David P., Michalski, Jeff M., Efstathiou, Jason A., Longo, John M., Pisansky, Thomas M., Maier, Jordan M., Faria, Sergio L., Desai, Anand B., Seaward, Samantha A., Sandler, Howard M., Cooley, Mary E., and Bruner, Deborah W.

Published
2023
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25. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

Author

Gillessen, Silke, Bossi, Alberto, Davis, Ian D., de Bono, Johann, Fizazi, Karim, James, Nicholas D., Mottet, Nicolas, Shore, Neal, Small, Eric, Smith, Matthew, Sweeney, Christopher, Tombal, Bertrand, Antonarakis, Emmanuel S., Aparicio, Ana M., Armstrong, Andrew J., Attard, Gerhardt, Beer, Tomasz M., Beltran, Himisha, Bjartell, Anders, Blanchard, Pierre, Briganti, Alberto, Bristow, Rob G., Bulbul, Muhammad, Caffo, Orazio, Castellano, Daniel, Castro, Elena, Cheng, Heather H., Chi, Kim N., Chowdhury, Simon, Clarke, Caroline S., Clarke, Noel, Daugaard, Gedske, De Santis, Maria, Duran, Ignacio, Eeles, Ros, Efstathiou, Eleni, Efstathiou, Jason, Ngozi Ekeke, Onyeanunam, Evans, Christopher P., Fanti, Stefano, Feng, Felix Y., Fonteyne, Valerie, Fossati, Nicola, Frydenberg, Mark, George, Daniel, Gleave, Martin, Gravis, Gwenaelle, Halabi, Susan, Heinrich, Daniel, Herrmann, Ken, Higano, Celestia, Hofman, Michael S., Horvath, Lisa G., Hussain, Maha, Jereczek-Fossa, Barbara Alicja, Jones, Robert, Kanesvaran, Ravindran, Kellokumpu-Lehtinen, Pirkko-Liisa, Khauli, Raja B., Klotz, Laurence, Kramer, Gero, Leibowitz, Raya, Logothetis, Christopher J., Mahal, Brandon A., Maluf, Fernando, Mateo, Joaquin, Matheson, David, Mehra, Niven, Merseburger, Axel, Morgans, Alicia K., Morris, Michael J., Mrabti, Hind, Mukherji, Deborah, Murphy, Declan G., Murthy, Vedang, Nguyen, Paul L., Oh, William K., Ost, Piet, O'Sullivan, Joe M., Padhani, Anwar R., Pezaro, Carmel, Poon, Darren M.C., Pritchard, Colin C., Rabah, Danny M., Rathkopf, Dana, Reiter, Robert E., Rubin, Mark. A., Ryan, Charles J., Saad, Fred, Pablo Sade, Juan, Sartor, Oliver A., Scher, Howard I., Sharifi, Nima, Skoneczna, Iwona, Soule, Howard, Spratt, Daniel E., Srinivas, Sandy, Sternberg, Cora N., Steuber, Thomas, Suzuki, Hiroyoshi, Sydes, Matthew R., Taplin, Mary-Ellen, Tilki, Derya, Türkeri, Levent, Turco, Fabio, Uemura, Hiroji, Uemura, Hirotsugu, Ürün, Yüksel, Vale, Claire L., van Oort, Inge, Vapiwala, Neha, Walz, Jochen, Yamoah, Kosj, Ye, Dingwei, Yu, Evan Y., Zapatero, Almudena, Zilli, Thomas, and Omlin, Aurelius

Published
2023
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26. Local Failure Events in Prostate Cancer Treated with Radiotherapy: A Pooled Analysis of 18 Randomized Trials from the Meta-analysis of Randomized Trials in Cancer of the Prostate Consortium (LEVIATHAN)

Author

Ma, Ting Martin, Chu, Fang-I, Sandler, Howard, Feng, Felix Y., Efstathiou, Jason A., Jones, Christopher U., Roach, Mack, 3rd, Rosenthal, Seth A., Pisansky, Thomas, Michalski, Jeff M., Bolla, Michel, de Reijke, Theo M., Maingon, Philippe, Neven, Anouk, Denham, James, Steigler, Allison, Joseph, David, Nabid, Abdenour, Souhami, Luis, Carrier, Nathalie, Incrocci, Luca, Heemsbergen, Wilma, Pos, Floris J., Sydes, Matthew R., Dearnaley, David P., Tree, Alison C., Syndikus, Isabel, Hall, Emma, Cruickshank, Clare, Malone, Shawn, Roy, Soumyajit, Sun, Yilun, Zaorsky, Nicholas G., Nickols, Nicholas G., Reiter, Robert E., Rettig, Matthew B., Steinberg, Michael L., Reddy, Vishruth K., Xiang, Michael, Romero, Tahmineh, Spratt, Daniel E., and Kishan, Amar U.

Published
2022
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28. Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

Author

Gillessen, Silke, Armstrong, Andrew, Attard, Gert, Beer, Tomasz M., Beltran, Himisha, Bjartell, Anders, Bossi, Alberto, Briganti, Alberto, Bristow, Robert G., Bulbul, Muhammad, Caffo, Orazio, Chi, Kim N., Clarke, Caroline S., Clarke, Noel, Davis, Ian D., de Bono, Johann S., Duran, Ignacio, Eeles, Ros, Efstathiou, Eleni, Efstathiou, Jason, Ekeke, Onyeanunam Ngozi, Evans, Christopher P., Fanti, Stefano, Feng, Felix Y., Fizazi, Karim, Frydenberg, Mark, George, Dan, Gleave, Martin, Halabi, Susan, Heinrich, Daniel, Higano, Celesta, Hofman, Michael S., Hussain, Maha, James, Nick, Jones, Robert, Kanesvaran, Ravindran, Khauli, Raja B., Klotz, Laurence, Leibowitz, Raya, Logothetis, Chris, Maluf, Fernando, Millman, Robin, Morgans, Alicia K., Morris, Michael J., Mottet, Nicolas, Mrabti, Hind, Murphy, Declan G., Murthy, Vedang, Oh, William K., Ost, Piet, O'Sullivan, Joe M., Padhani, Anwar R., Parker, Chris, Poon, Darren M.C., Pritchard, Colin C., Rabah, Danny M., Rathkopf, Dana, Reiter, Rob E., Rubin, Mark, Ryan, Charles J., Saad, Fred, Sade, Juan P., Sartor, Oliver, Scher, Howard I., Shore, Neal, Skoneczna, Iwona, Small, Eric, Smith, Matthew, Soule, Howard, Spratt, Daniel E., Sternberg, Cora N., Suzuki, Hiroyoshi, Sweeney, Christopher, Sydes, Matthew R., Taplin, Mary-Ellen, Tilki, Derya, Tombal, Bertrand, Türkeri, Levent, Uemura, Hiroji, Uemura, Hirotsugu, van Oort, Inge, Yamoah, Kosj, Ye, Dingwei, Zapatero, Almudena, and Omlin, Aurelius

Published
2022
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29. High-dose Radiotherapy or Androgen Deprivation Therapy (HEAT) as Treatment Intensification for Localized Prostate Cancer: An Individual Patient–data Network Meta-analysis from the MARCAP Consortium

Author

Kishan, Amar U., Wang, Xiaoyan, Sun, Yilun, Romero, Tahmineh, Michalski, Jeff M., Ma, Ting Martin, Feng, Felix Y., Sandler, Howard M., Bolla, Michel, Maingon, Philippe, De Reijke, Theo, Neven, Anouk, Steigler, Allison, Denham, James W., Joseph, David, Nabid, Abdenour, Carrier, Nathalie, Souhami, Luis, Sydes, Matt R., Dearnaley, David P., Syndikus, Isabel, Tree, Alison C., Incrocci, Luca, Heemsbergen, Wilma D., Pos, Floris J., Zapatero, Almudena, Efstathiou, Jason A., Guerrero, Araceli, Alvarez, Ana, San-Segundo, Carmen Gonzalez, Maldonado, Xavier, Xiang, Michael, Rettig, Matthew B., Reiter, Robert E., Zaorsky, Nicholas G., Ong, Wee Loon, Dess, Robert T., Steinberg, Michael L., Nickols, Nicholas G., Roy, Soumyajit, Garcia, Jorge A., and Spratt, Daniel E.

Published
2022
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33. Bladder Cancer Radiotherapy

Author

Jhavar, Sameer, Axelrud, Gabriel, Efstathiou, Jason A., Lee, Nancy Y., Series Editor, Lu, Jiade J., Series Editor, Solanki, Abhishek A., editor, and Chen, Ronald C., editor

Published
2021
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34. Trimodal Therapy

Author

Swinton, Martin, Choudhury, Ananya, Kiltie, Anne E., Chung, Peter, Billfalk-Kelly, Astrid, James, Nicholas, Kamran, Sophia C., Efstathiou, Jason A., Kamat, Ashish M., editor, and Black, Peter C., editor

Published
2021
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35. Androgen deprivation therapy use and duration with definitive radiotherapy for localised prostate cancer: an individual patient data meta-analysis

Author

Kishan, Amar U, Sun, Yilun, Hartman, Holly, Pisansky, Thomas M, Bolla, Michel, Neven, Anouk, Steigler, Allison, Denham, James W, Feng, Felix Y, Zapatero, Almudena, Armstrong, John G, Nabid, Abdenour, Carrier, Nathalie, Souhami, Luis, Dunne, Mary T, Efstathiou, Jason A, Sandler, Howard M, Guerrero, Araceli, Joseph, David, Maingon, Philippe, de Reijke, Theo M, Maldonado, Xavier, Ma, Ting Martin, Romero, Tahmineh, Wang, Xiaoyan, Rettig, Matthew B, Reiter, Robert E, Zaorsky, Nicholas G, Steinberg, Michael L, Nickols, Nicholas G, Jia, Angela Y, Garcia, Jorge A, and Spratt, Daniel E

Published
2022
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36. Refining neoadjuvant therapy clinical trial design for muscle-invasive bladder cancer before cystectomy: a joint US Food and Drug Administration and Bladder Cancer Advocacy Network workshop

Author

Chang, Elaine, Apolo, Andrea B., Bangs, Rick, Chisolm, Stephanie, Duddalwar, Vinay, Efstathiou, Jason A., Goldberg, Kirsten B., Hansel, Donna E., Kamat, Ashish M., Kluetz, Paul G., Lerner, Seth P., Plimack, Elizabeth, Prowell, Tatiana, Singh, Harpreet, Suzman, Daniel, Yu, Evan Y., Zhang, Hui, Beaver, Julia A., Pazdur, Richard, Weinstock, Chana, and Galsky, Matthew D.

Published
2022
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38. Patient Reported Outcomes in NRG Oncology RTOG 0938, Evaluating Two Ultrahypofractionated Regimens for Prostate Cancer

Author

Lukka, Himanshu R, Pugh, Stephanie L, Bruner, Deborah W, Bahary, Jean-Paul, Lawton, Colleen AF, Efstathiou, Jason A, Kudchadker, Rajat J, Ponsky, Lee E, Seaward, Samantha A, Dayes, Ian S, Gopaul, Darindra D, Michalski, Jeff M, Delouya, Guila, Kaplan, Irving D, Horwitz, Eric M, Roach, Mack, Pinover, Wayne H, Beyer, David C, Amanie, John O, Sandler, Howard M, and Kachnic, Lisa A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Clinical Research, Digestive Diseases, Urologic Diseases, Prostate Cancer, Cancer, Aging, Clinical Trials and Supportive Activities, 7.1 Individual care needs, Management of diseases and conditions, Aged, Disease-Free Survival, Femur Head, Follow-Up Studies, Humans, Male, Middle Aged, Organs at Risk, Patient Reported Outcome Measures, Penis, Prostatic Neoplasms, Quality of Life, Radiation Dose Hypofractionation, Radiotherapy, Rectum, Urethra, Urinary Bladder, Other Physical Sciences, Oncology & Carcinogenesis, Oncology and carcinogenesis, Theoretical and computational chemistry, Medical and biological physics
Abstract

PurposeThere is considerable interest in very short (ultrahypofractionated) radiation therapy regimens to treat prostate cancer based on potential radiobiological advantages, patient convenience, and resource allocation benefits. Our objective is to demonstrate that detectable changes in health-related quality of life measured by the bowel and urinary domains of the Expanded Prostate Cancer Index Composite (EPIC-50) were not substantially worse than baseline scores.Methods and materialsNRG Oncology's RTOG 0938 is a nonblinded randomized phase 2 study of National Comprehensive Cancer Network low-risk prostate cancer in which each arm is compared with a historical control. Patients were randomized to 5 fractions (7.25 Gy in 2 weeks) or 12 fractions (4.3 Gy in 2.5 weeks). The co-primary endpoints were the proportion of patients with a change in EPIC-50 bowel score at 1 year (baseline to 1 year) >5 points and in EPIC-50 urinary score >2 points tested with a 1-sample binomial test.ResultsThe study enrolled 127 patients to 5 fractions (121 analyzed) and 128 patients to 12 fractions (125 analyzed). Median follow-up for all patients at the time of analysis was 3.8 years. The 1-year frequency for >5 point change in bowel score were 29.8% (P < .001) and 28.4% (P < .001) for 5 and 12 fractions, respectively. The 1-year frequencies for >2 point change in urinary score were 45.7% (P < .001) and 42.2% (P < .001) for 5 and 12 fractions, respectively. For 5 fractions, 32.9% of patients had a drop in 1-year EPIC-50 sexual score of ≥11 points (P = .34); for 12 fractions, 30.9% of patients had a drop in 1-year EPIC-50 sexual score of ≥ 11 points (P = .20). Disease-free survival at 2 years is 99.2% (95% confidence interval: 97.5-100) in the 5-fraction arm and 97.5% (95% confidence interval: 94.6-100) in the 12-fraction arm. There was no late grade 4 or 5 treatment-related urinary or bowel toxicity.ConclusionsThis study confirms that, based on changes in bowel and urinary domains and toxicity (acute and late), the 5- and 12-fraction regimens are well tolerated. These ultrahypofractionated approaches need to be compared with current standard radiation therapy regimens.

Published
2018

39. Definitive Radiation Therapy and Survival in Clinically Node-Positive Prostate Cancer.

Author

Bryant, Alex K, Kader, Andrew K, McKay, Rana R, Einck, John P, Mell, Loren K, Mundt, Arno J, Kane, Christopher J, Efstathiou, Jason A, Murphy, James D, and Rose, Brent S

Subjects
Lymph Nodes, Humans, Prostatic Neoplasms, Neoplasm Metastasis, Lymphatic Metastasis, Androgen Antagonists, Prostate-Specific Antigen, Disease-Free Survival, Treatment Outcome, Incidence, Multivariate Analysis, Proportional Hazards Models, Cohort Studies, Time Factors, Databases, Factual, Aged, Middle Aged, Hospitals, Veterans, Male, Prostate Cancer, Patient Safety, Urologic Diseases, Aging, Cancer, Good Health and Well Being, Other Physical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

PurposeThe survival benefit of combined radiation therapy (RT) and androgen deprivation therapy (ADT) compared with ADT alone for clinically lymph node-positive prostate cancer remains controversial.Methods and materialsWe identified patients with clinically node-positive, nonmetastatic prostate cancer diagnosed between 2000 and 2015 and treated with ADT (n = 450) or ADT-RT (n = 198) from a national Veterans Affairs database. We compared prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) between treatment groups using multivariable competing-risks regression and Cox regression, respectively. An interaction term between ADT-RT and prostate-specific antigen (PSA) level (dichotomized about the median) was included in the multivariable models.ResultsADT-RT was associated with improved PCSM among patients with PSA levels less than the median of 26 ng/mL (sub-distribution hazard ratio, 0.50; 95% confidence interval [CI] 0.28-0.88; P = .02) but not greater than the median (hazard ratio [HR], 1.15; 95% CI 0.67-1.96; P = .62) (P = .038 for interaction). ADT-RT was also associated with improved ACM among patients with PSA levels less than the median (HR, 0.38; 95% CI 0.25-0.57; P

Published
2018

40. PD42-11 DEVELOPMENT AND VALIDATION OF A MULTIMODAL ARTIFICIAL INTELLIGENCE (MMAI)-DERIVED DIGITAL PATHOLOGY-BASED BIOMARKER PREDICTING METASTASIS FOR RADICAL PROSTATECTOMY PATIENTS WITH BIOCHEMICAL RECURRENCE IN NRG/RTOG TRIALS

Author

Morgan, Todd M., primary, Ren, Yi, additional, Tang, Siyi, additional, Zwerink, Wouter, additional, Chen, Emmalyn, additional, Mitani, Akinori, additional, Huang, Huei-Chung, additional, Simko, Jeffry P., additional, DeVries, Sandy, additional, Shipley, William U., additional, Pollack, Alan, additional, Bowes, David, additional, Martin, André-Guy, additional, Balogh, Alexander G., additional, Michalski, Jeff M., additional, Greenberg, Michael J., additional, Efstathiou, Jason A., additional, Bahary, Jean-Paul, additional, Ross, Ashley, additional, Esteva, Andre, additional, Showalter, Timothy N., additional, Nguyen, Paul L., additional, Hoffman, Karen E., additional, Rodgers, Joseph, additional, Feng, Felix, additional, and Spratt, Daniel E., additional

Published
2024
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41. Corrigendum to “European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines” [Eur. Urol. 85 (2024) 17–31]

Author

Alfred Witjes, J., primary, Bruins, Harman Max, additional, Carrión, Albert, additional, Cathomas, Richard, additional, Compérat, Eva, additional, Efstathiou, Jason A., additional, Fietkau, Rainer, additional, Gakis, Georgios, additional, Lorch, Anja, additional, Martini, Alberto, additional, Mertens, Laura S., additional, Meijer, Richard P., additional, Milowsky, Matthew I., additional, Neuzillet, Yann, additional, Panebiaco, Valeria, additional, Redlef, John, additional, Rink, Michael, additional, Rouanne, Mathieu, additional, Thalmann, George N., additional, Sæbjørnsen, Sæbjørn, additional, Veskimäe, Erik, additional, Mariappan, Paramananthan, additional, and van der Heijden, Antoine G., additional

Published
2024
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42. Clinical Outcomes of De Novo Versus Relapsed Early Metastatic Testicular Seminoma Treated With Contemporary Radiation Therapy

Author

Rosen, Daniel B., primary, Ghosh, Anushka, additional, Niemierko, Andrzej, additional, Beard, Clair J., additional, Ravi, Praful, additional, Tewari, Alok, additional, Sweeney, Christopher, additional, Lee, Richard J., additional, Saylor, Philip, additional, Martin, Neil, additional, Efstathiou, Jason A., additional, Mouw, Kent, additional, and Kamran, Sophia C., additional

Published
2024
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46. Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop.

Author

Smith, Grace L, Ganz, Patricia A, Bekelman, Justin E, Chmura, Steven J, Dignam, James J, Efstathiou, Jason A, Jagsi, Reshma, Johnstone, Peter A, Steinberg, Michael L, Williams, Stephen B, Yu, James B, Zietman, Anthony L, Weichselbaum, Ralph R, and Tina Shih, Ya-Chen

Subjects
Humans, Neoplasms, Radiotherapy, Program Evaluation, Technology, Radiologic, Decision Making, Radiation Oncology, Diffusion of Innovation, Research Personnel, Costs and Cost Analysis, United States, Radiotherapy, Intensity-Modulated, Proton Therapy, National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division, Cancer, Comparative Effectiveness Research, Quality Education, Other Physical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

PurposeLeaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology.Methods and materialsThe workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders.ResultsChallenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided.ConclusionsDiscussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment.

Published
2017

47. Eligibility and Endpoints for Clinical Trials in Trimodality Therapy for Bladder Cancer

Author

Singh, Parminder, Ballas, Leslie, Sonpavde, Guru P., Chen, Ronald C., Bangs, Rick, Bauman, Brian C., Nagar, Himanshu, Delacroix, Scott E., Lerner, Seth P., and Efstathiou, Jason A.

Abstract

Trimodality therapy (TMT) is a viable option for muscle-invasive localized bladder cancer, providing an alternative to radical cystectomy in properly selected patients. The approval of novel therapeutics in different stages of bladder cancer treatment has sparked interest in exploring concurrent systemic therapies with radiation in clinical trials to enhance long-term outcomes. Achieving uniformity in trial eligibility criteria and endpoint definitions is imperative in describing clinical significance, comparing trials, and changing standard of care guidelines. To delineate eligibility criteria and appropriate endpoints for TMT clinical trials in an attempt to achieve uniformity in trial eligibility criteria and endpoint definitions which will then help move the field of bladder preservation forward and improve the current standard of care. An expert panel, comprising individuals with extensive experience in bladder cancer clinical trials, clinical practice focused on bladder cancer treatment, and patient advocacy, was assembled. The panel systematically reviewed phase II/III clinical trials previously published and assessing the role of radiation in definitive therapy with the specific goal of preserving native bladder function during bladder cancer treatment. Recommendations were summarized based on review of these trials and past experiences of the investigators. To ensure a holistic perspective, the summary was further subjected to rigorous reevaluation by a patient advocate, who added valuable insights from a patient’s standpoint. The resulting consensus statements were summarized in this publication to contribute to the evolving landscape of bladder cancer research and treatment. The eligibility criteria for TMT should be pragmatic to encompass patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, bladder cancer stage T2-T4a N0±N1M0, unilateral tumor-associated hydronephrosis, attempted maximal transurethral resection of bladder tumor (TURBT), both pure urothelial carcinoma and/or mixed histologic subtypes (excluding rare and aggressive small cell variants) and patients who are non- cystectomy candidates. Bladder intact event-free survival (BIEFS) is proposed as a suitable endpoint for registration trials designed to compare two different treatment interventions, defined as the time from randomization to muscle-invasive or locoregional recurrence, systemic recurrence, radical cystectomy from any cause, or death from any cause. Overall survival is deemed an appropriate secondary endpoint or a co-primary end point as recent improvements in systemic therapy can produce significant improvement in long-term outcomes. Primary and secondary endpoints should be supported with patient-reported quality of life assessments, when available. The standardization of clinical trial design, eligibility criteria, and endpoints is essential for expediting progress in the field. Inclusivity, patient-centricity, and clinically meaningful endpoints will facilitate the analysis, comparison, and meta-analysis of different trials, fostering advancements in bladder cancer treatment.

Published
2024
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48. Prognostic Significance of Immune Cell Infiltration in Muscle-invasive Bladder Cancer Treated with Definitive Chemoradiation: A Secondary Analysis of RTOG 0524 and RTOG 0712

Author

Rana, Zaker, Kamran, Sophia C., Shetty, Amol C., Sutera, Philip, Song, Yang, Bazyar, Soha, Solanki, Abhishek A., Simko, Jeffry P., Pollack, Alan, McConkey, David, Kates, Max, Siddiqui, M. Minhaj, Hiken, Jeffrey, Earls, Jon, Messina, David, Mouw, Kent W., Miyamoto, David, Shipley, William U., Michaelson, M. Dror, Zietman, Anthony, Coen, John J., Dahl, Douglas M., Jani, Ashesh B., Souhami, Luis, Chang, Brian K., Lee, R. Jeffrey, Pham, Huong, Marshall, David T., Shen, Xinglei, Pugh, Stephanie L., Feng, Felix Y., Efstathiou, Jason A., Tran, Phuoc T., and Deek, Matthew P.

Abstract

A novel transcriptional profiling platform revealed that gene expression consistent with high immune-cell infiltration and of specific genes associated with T-cell infiltration or IFNγ signaling was correlated with better survival following chemoradiation for muscle-invasive bladder cancer.

Published
2024
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49. Bladder-Preserving Trimodality Treatment for High-Grade T1 Bladder Cancer: Results From Phase II Protocol NRG Oncology/RTOG 0926.

Author

Dahl, Douglas M., Rodgers, Joseph P., Shipley, William U., Michaelson, M. Dror, Wu, Chin-Lee, Parker, William, Jani, Ashesh B., Cury, Fabio L., Hudes, Richard S., Michalski, Jeff M., Hartford, Alan C., Song, Daniel, Citrin, Deborah E., Karrison, Theodore G., Sandler, Howard M., Feng, Felix Y., and Efstathiou, Jason A.

Published
2024
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50. Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy

Author

Fischer-Valuck, Benjamin W., Michalski, Jeff M., Harton, Joanna G., Birtle, Alison, Christodouleas, John P., Efstathiou, Jason A., Arora, Vivek K., Kim, Eric H., Knoche, Eric M., Pachynski, Russell K., Picus, Joel, Rao, Yuan James, Reimers, Melissa, Roth, Bruce J., Sargos, Paul, Smith, Zachary L., Zaghloul, Mohamed S., Gay, Hiram A., Patel, Sagar A., and Baumann, Brian C.

Published
2021
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