bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health-related quality of life changes due to high-dose rate brachytherapy, low-dose rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer.
Authors: Strom Tobin Joel Crill , Cruz Alex , Figura Nicholas , Shrinath Kushagra , Nethers Kevin , Mellon Eric Albert , Fernandez Daniel Celestino , Saini Amarjit , Hunt Dylan , Heysek Randy , Wilder Richard 
Published: February 2017

72 Background: To compare urinary, bowel, and sexual health-related quality of life (HRQOL) changes due to high-dose rate (HDR) brachytherapy, low-dose rate (LDR) brachytherapy, or intensity modulated radiation therapy (IMRT) monotherapy for prostate cancer. Methods: Between January 2002 and September 2013, 413 low-risk or favorable intermediate-risk prostate cancer patients were treated with HDR brachytherapy monotherapy to 2,700-2,800 cGy in two fractions (n=85), iodine-125 LDR brachytherapy monotherapy to 14,500 cGy in one fraction (n=249), or IMRT monotherapy to 7,400-8,100 cGy in 37-45 fractions (n=79) without pelvic lymph node irradiation. No androgen deprivation therapy was given. Patients used an International Prostate Symptoms Score questionnaire, an Expanded Prostate cancer Index Composite-26 bowel questionnaire, and a Sexual Health Inventory for Men questionnaire to assess their urinary, bowel, and sexual HRQOL, respectively, pre-treatment and at 1, 3, 6, 9, 12, and 18 months post-treatment. Results: Median follow-up was 32 months. HDR brachytherapy and IMRT patients had significantly less deterioration in their urinary HRQOL than LDR brachytherapy patients at 1 and 3 months post-irradiation. The only significant decrease in bowel HRQOL between the groups was seen 18 months following treatment, at which point IMRT patients had a slight, but significant, deterioration in their bowel HRQOL compared with HDR and LDR brachytherapy patients. HDR brachytherapy patients had worse sexual HRQOL than both LDR brachytherapy and IMRT patients following treatment. Conclusions: IMRT and HDR brachytherapy cause less severe acute worsening of urinary HRQOL than LDR brachytherapy. However, IMRT causes a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy.
The impact of subsequent metastasis on medical costs in Medicare patients with prostate cancer.
Authors: Li Tracy , Shore Neal D. , Mehra Maneesha , Todd Mary Beth , Saadi Ryan , Leblay Gaetan , Griffiths Robert 
Published: February 2017

81 Background: The objective of this study was to estimate the direct medical costs of secondary metastases in prostate cancer (PC) patients initially diagnosed with locoregional disease. Methods: We used data from the United States Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims to identify a cohort of PC patients initially diagnosed with locoregional disease between 2000 and 2011, who were age ≥ 66 at diagnosis, and who first had a diagnosis of metastasis (index date) ≥ 4 months after PC diagnosis (cases). We matched each case to up to four controls (patients without metastasis) on baseline patient characteristics to assess the incremental impact of developing metastasis. A “match date” corresponding to the index date of the case was constructed for each control. Cases and controls were followed from up to 12 months before and up to 12 months after metastasis. Medicare claims were used to calculate the average total cost per month in the cases and controls. Monthly costs also were stratified according to place and type of service, e.g. inpatient, outpatient, and by whether costs pertained to cancer services, i.e. chemotherapy or androgen deprivation therapy (ADT), other services with an ICD-9 code for cancer, or other care. Results: The cohort consisted of 10,370 cases and 39,200 controls, with a mean age at baseline of 79 years in both groups. The median time to subsequent metastasis (cases) was 37 months and 85% had bone metastasis. In the control group, total costs remained stable throughout the observation period, averaging $1,354/month before and $1,173 12/month after matched index date. In the cases, costs were similar to the controls from -12 to -6 months before the index date. Thereafter, medical costs rose sharply to $11,982 in the month of diagnosis of metastasis (index date), and then declined but stayed > $2,000/month higher than the control for the remainder of the observation period. Expenses from inpatient, physician services, outpatient, and skilled nursing facility accounted for the largest proportions of total costs. Conclusions: Developing metastasis in Medicare PC patients results in substantial additional costs to the healthcare system.
E2809: Androgen receptor (AR) modulation by bicalutamide (Bic) and MK-2206 (MK) in men with rising PSA at high-risk of progression after local prostate cancer (PC) treatment.
Authors: Ferrari Anna C. , Chen Yu-Hui , Hudes Gary R. , Carducci Michael Anthony , Antonarakis Emmanuel S. , Hahn Noah M. , Wong Yu-Ning , DiPaola Robert S. 
Published: February 2017

9 Background: Men with PSA recurrence and fast PSA doubling time (PSADT) are at high risk of progression. While castration effectively decreases PSA and delays metastases, it compromises heath and quality of life without clear survival benefit. E2809 tested whether blocking Akt with MK alone or together with the AR using Bic, would be more effective than Bic alone to suppress AR activity without castration. Methods: 108 PSA-recurrent N0 M0, non-castrate PC patients (pts) with PSADT<12 months (mo) and PSA>2ng/mL; were randomized 1:1 to 11, 4-week (wk) treatment (tx) cycles (cy), up to18cy: arms (A) cy1-3, observation, cy 4-11, Bic 50 mg daily; (B) cy1-3 MK 200 mg once wk orally, cy 4-11 MK+Bic. Endpoints: Primary: proportion of pts with PSA <0.2 by cy11 (90% power to detect 45% vs. 20% using 0.1 level one-sided Fisher’s exact test); Secondary, PSA decline: ≥85%; nadir levels before and after Bic. Toxicity (Tox). Results: 54 pts/arm. Baseline characteristics (median (m) or %, A/B): age, 66/67 years; Gl>7 81/81%; >T2b 98/86%; prostatectomy, 81/75%; radiation, 30/31%; previous castration, 43/46%; testosterone, 302/333 ng/dL; PS 0, 94/93%; mPSA 5.1/6.1ng/dL; PSADT<9 mo, 87/81%, <3 mo 24/37%; Tox. Grade(G)/n: G4: A, 0; B, 2 (embolism, hyperglycemia). G3: A, 1(LFTs); B, 32, 60% (rash 20, hyperglycemia 5, low lymphs, 5; hypertension, 4). At 23.9 mo follow-up, 1 death B. Tx . A: 4 no tx; 14 (26%) started Bic early; 9 (16.7%) stopped <11cy without SAE’s; 41 (76%) completed 11cy, 23 (43%) 18cy. B: 7 (13%) started Bic early; 21 (39%) stopped <11cy due to AE’s in 14 (66%) cases; 32 (59%) completed 11cy, 14 (26%) 18cy. PSA<0.2 at 44wks (cy11): A, 6 (11.1%); B, 8 (14.8%), p=0.39. Among evaluable pts, PSA ≤0.2 occurred only after Bic: A: 10/49 pts (20.4%); B: 16/45 pts (35.6%), p=0.08. Conclusions: Overall, by intent to treat analysis at 44 wks, MK alone had no effect on PSA, nor did it increase response to Bic by any set criteria. High MK discontinuation due to rash before cy11 may have blunted the significance of a higher proportion of evaluable pts on MK+Bic achieving PSA ≤0.2ng/ml compared to Bic alone. Clinical trial information: 01251861.
Prostate cancer detection rates of negative MP-MRIs.
Authors: Lu Amanda , Nawaf Cayce , Weinreb Jeffrey , Rosoff James , Schulam Peter , Humphrey Peter , Levi Angelique , Sprenkle Preston 
Published: February 2017

91 Background: Increased lesion suspicion score on MRI is known to be associated with increased grade of prostate cancer. However, the negative predictive value (NPV) of MRI is still being investigated. To determine the NPV of mpMRI, we evaluated the frequency of prostate cancer (CaP) detection by 12-core template mapping biopsy (Mbx) in men whose mpMRI showed no suspicious regions. Methods: 374 men undergoing MRI-US fusion biopsy from 12/2012 to 06/2015 were enrolled in an IRB-approved database and met inclusion criteria for this study. The mpMRI sequences T2-weighted, diffusion-weighted imaging, and dynamic contrast enhancement were used to identify and classify targets as low, medium, and high suspicion. Men with negative mpMRI received a template 12-core template mapping biopsy. Only patients with complete mpMRI sequences were included. Results: 53 men with a negative MRI were identified (mean age=63.5 years, PSA=7.53 ng/mL, mean prostate volume=67.2 mL). The NPV of negative MRI was 64.2% for any cancer and 96.2% for clinically significant cancer (Gleason≥7). Men on active surveillance had the highest CDR 56.3%, compared to 38.9% for biopsy-naive men, and 15.8% for men with prior negative biopsy (Figure 1). Clinically significant CaP was found in two patients: Gleason 4+3 in a patient on Active Surveillance, and 4+4 in a biopsy naïve patient. Conclusions: Negative MRI has a high NPV (96%) for clinically significant CaP found in 12-core template mapping biopsy. If we did not biopsy mpMRI negative men, we would have missed 16 patients with Gleason 6 and 2 patients with ≥ Gleason 7. Clinicians can use this information in patient counseling to discuss the likelihood of detecting significant cancer – though these findings should be reproduced widely before a negative MRI is used to recommend against biopsy. Sources of funding: NIH-National Institute of Diabetes and Digestive and Kidney Diseases [Table: see text]
5α-reductase inhibitors and the risk of grade reclassification for men with long-term follow-up on active surveillance for prostate cancer.
Authors: Finelli Antonio , Timilshina Narhari , Komisarenko Maria , Sowerby Robert , Hamilton Robert James , Zlotta Alexandre , Fleshner Neil Eric 
Published: February 2017

92 Background: The role of 5α-reductase inhibitors (5-ARIs) in prostatic diseases remains controversial because of an FDA black box label. We have previously published on the impact of 5-ARIs in men managed with active surveillance (AS), demonstrating their protective effect against progression. However, the long-term safety of 5-ARIs in the setting of AS has never been described, thus we sought to assess this. Methods: This is a single-institution, prospectively maintained, retrospective cohort study comparing men taking a 5-ARI versus no 5-ARI while on AS for PCa. Pathologic progression was evaluated and defined as Gleason score > 6, maximum core involvement > 50%, or more than 3 cores positive on a follow-up prostate biopsy. Time dependent covariate analysis to account for time on AS but not on 5-ARI was conducted to diminish the likelihood of overestimating the benefit. To account for differences in prostate volume at baseline between 5-ARI and non-5-ARI groups sensitivity analyses were performed, restricting men in the non-5-ARI group to those with larger glands (volume > 40 ml). Kaplan-Meier analyses were conducted along with multivariable Cox proportional hazard regression modeling for predictors of pathologic progression. Results: The original cohort of 288 men on AS were analyzed. The median follow-up was 61.2 months (IQR: 29.8-95.24) with 124 men (43%) experiencing pathologic progression and 119 men (41.3%) abandoning AS. Men taking a 5-ARI experienced a lower rate of pathologic progression (24.3% vs 49.1%; p < 0.001) and were less likely to abandon AS (25.7% vs 46.3%; p = 0.002). On multivariable Cox proportional hazards analysis, lack of 5-ARI use was most strongly associated with pathologic progression (HR: 2.56; 95% confidence interval, 1.32-5.02). Sensitivity analyses done to account for gland size demonstrated that lack of 5-ARI use was still predictive of progression (HR: 2.76; CI, 1.45–5.25; p = 0.002). Importantly, 5-ARI use was not associated with increased risk of high-grade prostate cancer. Conclusions: 5-ARIs were associated with a significantly lower rate of pathologic progression and abandonment of AS in men with median follow-up of 5 years.
Salvage radiation therapy after radical prostatectomy: Contribution of a dose escalation to macroscopic local relapses.
Authors: Selmaji Imad Eddine , Udrescu Corina , Brahmi Tristan , Samlali Hamza , Lapierre Ariane , Enachescu Ciprian , Ruffion Alain , Chapet Olivier 
Published: February 2017

e634 Background: Salvage radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer using 66 Gy may not be enough to treat macroscopic disease. The presence of a macroscopic nodule on the MRI could justify a focal dose escalation. This study evaluates the tolerance and efficacy of a new technique of irradiation including a focal boost to the nodule. Methods: Between 2011 and 2015, 14 patients, with a macroscopic relapse diagnosed on the MRI, underwent targeted MRI-guided biopsies. Three gold markers were implanted into the prostatic bed for a more accurate MRI/CT fusion and image guided IMRT. A dose of 60 Gy was delivered to the prostatic bed followed by a dose escalation to 72Gy on the macroscopic nodule. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated using the CTCAE v4. PSA level and late toxicities were assessed at 1 month and then every 6 months for 3 years. Results: The mean follow-up was 26.2 [18 – 36] months. Two patients had a biochemical failure after salvage RT (one bone metastasis and one lymph node recurrence). The local control rate was 100% and the biochemical control rate was 85.7%. Results for acute and late toxicities are summarized in the table. One patient presented with grade 2 urinary toxicity during the prostatic bed irradiation which lowered to grade 1 when the dose was focalized to the nodule. No grade 2 acute GI toxicity was seen. All late GI and GU toxicities were grade 1. Conclusions: Dose escalation to the macroscopic nodule visible on MRI is feasible using an IMRT-IGRT approach with gold makers. This technique allows a perfect initial local control at 3 years with a good tolerance. [Table: see text]
Focal or whole gland salvage prostate brachytherapy with iodine seeds with or without a rectal spacer for a post EBRT local failure: How best to spare the rectum?
Authors: Guimas Valentine , Quivrin Magali , Bertaut Aurelie , Martin Etienne , Mazoyer Frederic , Maingon Philippe , Cormier Luc , Crehange Gilles 
Published: February 2017

e636 Background: Salvage prostate permanent implant (sPPI) for post radiation local failures provides high rates of biochemical control. The cumulative dose delivered to the prostate and the rectum when taking into account the dose from the primary irradiation is still unknown. Besides cancer control, the primary goal of sPPI should be to protect the rectum in order to avoid any rectal fistula in the long term. Methods: We reviewed the post implant CT-based dosimetry of 18 selected patients who underwent sPPI with 125I seeds for an isolated biopsy-proven local failure several years after external beam radiation therapy (EBRT). Ten patients had a whole prostate sPPI and 8 patients had a multi-parametric MRI-based focal sPPI. Eight patients had an injection of hyaluronic acid (HA) gel in the prostate-rectum space. The BED of the primary EBRT and the BED of the sPPI were calculated using several a/b ratios (1.5, 2, 3, 5 and 10) and t1/2 (1h for the prostate and 0.3h for the rectum). Comparisons of BED parameters and doses delivered to the rectum according to the use of HA gel, prostate irradiation (whole gland versus focal) were performed using Wilcoxon exact test. Results: The median dose received by 90% of the prostate (D90) was 65.0 Gy [12.0 - 107.2] and the median prostate volume receiving 100% of the prescribed dose (V100) was 45.3% [14.4 - 98.3]. The median D90 and the median V100 for the index lesion were 162.0 Gy [139.4 - 199.1] and 96.1% [88.4 – 100.0], respectively. The median cumulative Biological Equivalent Dose (BED) after EBRT+sPPI for the prostate and the rectum were higher for patients treated on whole gland versus patients treated with focal sPPI (313.5 Gy2 vs 174.4 Gy2, p = 0.06 and 258.1 Gy3 vs 172.6 Gy3, p < 0.01, respectively). The median D0.1 cc for the rectum was significantly lower for patients who had HA gel: 63.3 Gy [29.0 - 78.3] compared to patients with no gel: 83.9 Gy [34.9 – 180.0] (p = 0.04). Conclusions: Focal sPPI provided lower cumulative prostate and rectum BED when compared to whole gland plans. D0.1cc delivered to the rectum was significantly lower after sPPI with HA gel while it was not different between focal or whole gland plans.
A retrospective feasibility analysis of biweekly reduced dose docetaxel in Korean patients with castration-resistant, metastatic prostate cancer.
Authors: Cho Jinhyun , Yoo Kwai Han , Jung Ki Sun , Song Haa-na , Kim Hae Su , Lee Su Jin , Lim Ho Yeong , Park Se Hoon 
Published: February 2017

e638 Background: The aim of this retrospective study was to evaluate clinical outcomes of biweekly 40 mg/m2 docetaxel plus prednisolone, as compared with standard 3-weekly regimen in Korean patients with castration-resistant prostate cancer (CRPC). Methods: We retrospectively reviewed the medical records of 48 patients with metastatic CRPC who were consecutively treated with docetaxel plus prednisolone as first-line chemotherapy between Jan 2012 and Dec 2014 at Samsung Medical Center (Seoul, Korea). Prior to the adoption of a biweekly regimen in Oct 2013, our institutional standard chemotherapy was docetaxel 75 mg/m2 every 3 weeks for patients with CRPC (n = 24). After Oct 2013, all chemotherapy-naïve CRPC patients received 40 mg/m2 biweekly regimen (n = 24). The primary end point was the PSA response, defined as a greater than 50% decline in PSA levels from baseline. Results: The baseline characteristics of the patients were similar in the two treatment groups. The most common cause of treatment discontinuation was disease progression: 17 (71%) in 3-weekly group and 20 (82%) in biweekly group. PSA responses were observed in 12 (50%) and 11 (46%) patients in the 3-weekly and biweekly groups, respectively. Time-to-failure (TTF, 4.5 versus 3.9 months) and time-to-progression (TTP, 5.0 versus 4.2 months) were statistically similar between the 3-weekly and biweekly groups, respectively. In 3-weekly group, the most commonly observed toxic effects were anemia and neutropenia. Whereas, in biweekly group, fatigue and nail changes were the most commonly observed toxic effects. Conclusions: Within the limitation of a retrospective study, biweekly reduced dose docetaxel regimen is active and well-tolerated in Korean patients with metastatic CRPC.
Perspective of young breast cancer survivors (BCS) on fertility preservation (FP) referral.
Authors: Seminsky Maureen , Yee Samantha , Glass Karen , Foong Shu , Kennedy Erin Diane , Warner Ellen 
Published: February 2017

113 Background: Despite ASCO recommendations (2006, 2013), young cancer patients are frequently not spoken to about the potential effects of treatment on future fertility and are denied the option of FP. Last year we began a 5 year study (SPOKE: Surgeon and Patient Oncofertility Knowledge Enhancement) to increase FP discussion and referral rates of Canadian breast surgeons. To design effective interventions, in addition to interviewing and surveying surgeons we conducted in-depth interviews with young BCS. Methods: Thirty minute semi-structured telephone interviews were conducted with BCS diagnosed < age 40 to explore their oncofertility experiences and their recommendations for future patients. Eligible BCS were recruited by oncologists and fertility specialists. A patient sample was deliberately chosen to reflect diversity of tumor stage, patient demographics and fertility experiences. A $20 incentive was given to each interviewee. Interviews were audio-recorded, transcribed verbatim and the data analyzed using qualitative methods. Subject recruitment was terminated when saturation of themes was obtained. Results: Fifteen BCS from 5 provinces, mean age 32 were interviewed. At diagnosis mean age was 29 with 8 (53%) single, 13 (87%) nulliparous, and 87% receiving adjuvant chemotherapy. At diagnosis all but 1 BCS had either definitely (60%) or possibly (33%) wanted (additional) children but only 8 of the 14 (57%) had been referred for a FP consult. Common recommendations were: discussing fertility as soon as possible after diagnosis to optimize time for decision-making; providing up-to-date information about the various FP options prior to the consult; and encouraging patients ambivalent about future childbearing to pursue FP. Conclusions: Despite the perception by many surgeons that patients are not psychologically able to handle information about fertility and FP at the time of their diagnosis, the majority of BCS interviewed thought that early fertility discussion by the surgical team was essential. SPOKE will include knowledge translations interventions for surgeons, and the creation of a FP information ‘toolbox’ with separate versions for surgeons and patients. Funded by the CBCF and CIHR.
Introducing medical students to survivorship care through an elective oncology summer program.
Authors: McKillip Ryan Patrick , Hahn Olwen Mary , Sulai Nanna Helen , Rosenberg Carol A. , Olopade Olufunmilayo I. , Arora Vineet M , Golden Daniel William 
Published: February 2017

12 Background: Advancing the quality of cancer care requires that physicians be trained in survivorship care. An oncology seminar series was designed and implemented for first year medical students to improve their knowledge of oncologic disciplines, including survivorship care, by educating them about these disciplines from both a research and clinical perspective. Methods: First year medical students (MS1s) at a single United States medical school were invited to participate in the Scholars in Oncology-Associated Research (SOAR) summer program, which included a series of 10 lectures to provide a general survey of how clinical care, basic sciences, and social sciences apply to oncology as a multidisciplinary specialty. Lectures included topics specific to cancer genetics, medical, surgical, and radiation oncology, hospice/palliative medicine, and survivorship care. The students also attended a multidisciplinary tumor board and had the opportunity to shadow a pharmacist, radiation therapist, or palliative care advanced practice nurse. Students completed self-assessments of their understanding of oncology and its related disciplines before and after SOAR. Likert-type scores were 1 = not at all, 2 = somewhat, 3 = moderately, 4 = quite, and 5 = extremely and are reported as median [interquartile range]. Results: Eighteen students successfully completed the SOAR program out of 21 that initially enrolled. 20 pre- and 14 post-assessments were completed. Student self-reported understanding of oncology as a clinical discipline (2[2-3] vs. 4[4-4] p < .01) and as a research discipline (3[2-3] vs. 4[4-4] p < .01) improved after SOAR. Student understanding of survivorship care as a clinical discipline (1[1-2] vs. 2.5 [1-4] p = .02) and as a research discipline (1[1-1] vs. 2[1-3] p < .01) also improved. All students indicated they would be “quite” or “extremely” likely to recommend SOAR to future students. Conclusions: A structured didactic introduction to oncology, SOAR, was successfully piloted. MS1s report improved understanding of oncology and survivorship care as clinical and research disciplines. Future work will focus on expanding SOAR to a larger audience.