Sociodemographic Features, Health Care Costs, and Treatment Implications of Genomic Classifier Testing for Localized Prostate Cancer in the United States.

Purpose: Biopsy tissue-based genomic classifiers (GCs) for prostate cancer are commercially available tools to enhance prognostication. They may corroborate candidacy for active surveillance/watchful waiting (AS/WW) or identify men who are more likely to benefit from radiotherapy (RT) with androgen deprivation therapy (ADT). We analyze real-world use of GC and associations with clinical decision making.

Volumetric Changes and Acute Toxicity with Ga Prostate-Specific Membrane Antigen vs F-Fluciclovine PET/CT Guided Post-Prostatectomy Radiation: Final Analysis of a Randomized Trial.

Purpose: We evaluated changes in radiation (XRT) target volume & acute toxicity using Ga-prostate specific membrane antigen (PSMA) vs F-Fluciclovine fluciclovine PET/CT in post-prostatectomy patients with biochemical recurrence. We hypothesized that both fluciclovine and PSMA guided XRT would a) significantly change pre-PET XRT volumes and b) show similar toxicity.

Methods And Materials: We performed an IRB-approved, randomized trial comparing fluciclovine (Arm 1) and PSMA (Arm 2)-guided post-prostatectomy XRT in patients with detectable PSA after prostatectomy.

Utilization, health care expenditures, and patient costs of definitive treatment modalities for localized prostate cancer in the United States.

Background: Radical prostatectomy (RP) and radiotherapy (RT) are standard-of-care treatments for localized prostate cancer. The authors studied the utilization and total health care and patient-incurred costs of RP and RT in the United States using the Merative MarketScan Medicare (Medicare Supplemental and Coordination of Benefits [MDCR]) and Commercial (Commercial Claims and Encounters [CCAE]) databases.

Methods: Men were identified who had nonmetastatic prostate cancer treated with RP, external-beam RT (EBRT), brachytherapy (BT), EBRT combined with BT (EBRT + BT), stereotactic body RT (SBRT), or proton-beam therapy (PBT) between 2009 and 2022.

Evaluation and failure analysis of four commercial deep learning-based autosegmentation software for abdominal organs at risk.

Purpose: Deep learning-based segmentation of organs-at-risk (OAR) is emerging to become mainstream in clinical practice because of the superior performance over atlas and model-based autocontouring methods. While several commercial deep learning-based autosegmentation solutions are now available, the implementation of these tools is still at such a primitive stage that acceptance criteria are underdeveloped due to a lack of knowledge about the systems' segmentation tendencies and failure modes. As the starting point of the iterative process of clinical implementation, this study focuses on the outlier analysis of four commercial autocontouring tools for the abdominal OARs.

Diuresis During F-Flotufolastat (rhPSMA-7.3) PET/CT Improves Recurrence Detection After Prostatectomy: A Prospective Phase II Trial.

Radiopharmaceuticals targeting prostate-specific membrane antigen (PSMA) have emerged as a sensitive tool for PET imaging of prostate cancer (PCa) recurrence. Yet urinary bladder activity may obscure the visualization of prostate bed recurrence. Among the Food and Drug Administration-approved PSMA radiopharmaceuticals, F-flotufolastat (rhPSMA-7.

Automatic medical imaging segmentation via self-supervising large-scale convolutional neural networks.

Purpose: This study aims to develop a robust, large-scale deep learning model for medical image segmentation, leveraging self-supervised learning to overcome the limitations of supervised learning and data variability in clinical settings.

Methods And Materials: We curated a substantial multi-center CT dataset for self-supervised pre-training using masked image modeling with sparse submanifold convolution. We designed a series of Sparse Submanifold U-Nets (SS-UNets) of varying sizes and performed self-supervised pre-training.

Impact of androgen deprivation therapy in patients with unfavorable intermediate-risk prostate cancer receiving brachytherapy-based dose-escalated radiation therapy.

Purpose: While the benefit of short-term androgen deprivation therapy (ADT) has been established for patients with intermediate-risk (IR) prostate cancer (PCa) receiving dose-escalated external beam radiation therapy (EBRT), the role of ADT for patients treated with brachytherapy (BT) with or without supplemental EBRT (sEBRT) is less clear.

Material And Methods: We conducted a single-institution retrospective analysis of men with National Comprehensive Cancer Network (NCCN) unfavorable IR (UIR) PCa. All patients received BT with or without sEBRT, and were stratified by the receipt of 4-6 months of ADT.

Cross-shaped windows transformer with self-supervised pretraining for clinically significant prostate cancer detection in bi-parametric MRI.

Background: Bi-parametric magnetic resonance imaging (bpMRI) has demonstrated promising results in prostate cancer (PCa) detection. Vision transformers have achieved competitive performance compared to convolutional neural network (CNN) in deep learning, but they need abundant annotated data for training. Self-supervised learning can effectively leverage unlabeled data to extract useful semantic representations without annotation and its associated costs.

Initial experience and patient tolerance of proton stereotactic body radiotherapy.

Purpose: To review our initial experience with proton-based SBRT to evaluate the planning outcomes and initial patient tolerance of treatment.

Patients And Methods: From Sep. 2019 to Dec.

Impact of Rectal Spacer on Toxicity Reduction in Men Treated With Proton Versus Photon Therapy.

Purpose: Rectal toxicity after prostate cancer (PCa) radiation therapy (RT) may be greater with protons compared with photon intensity-modulated RT, perhaps due to lateral penumbra and end-of-range uncertainty. Rectal spacers (RSs) have been shown to mitigate RT-associated acute/late rectal toxicity in men treated with photons. The relative benefit of RS in men treated with protons versus photons is unknown.

Biochemical Relapse-Free Survival in Postprostatectomy Patients Receiving 18F-Fluciclovine-Guided Prostate Bed-Only Radiation: Post Hoc Analysis of a Prospective Randomized Trial.

Purpose: Whole-pelvis (WP) radiation therapy (radiation) improved biochemical relapse-free survival (bRFS) compared with prostate bed (PB)-only radiation in the Radiation Therapy Oncology Group 0534, but was performed in an era prior to positron emission tomography (PET) staging. Separately, 18F-fluciclovine PET/CT-guided postprostatectomy radiation improved 3-year bRFS versus radiation guided by conventional imaging alone. We hypothesized that patients who were changed from WP to PB-only radiation after PET would have bRFS that was: (a) no higher than patients initially planned for PB-only radiation; and (b) lower than patients planned for WP radiation without PET guidance.

Streamlined pin-ridge-filter design for single-energy proton FLASH planning.

Background: FLASH radiotherapy (FLASH-RT) with ultra-high dose rate has yielded promising results in reducing normal tissue toxicity while maintaining tumor control. Planning with single-energy proton beams modulated by ridge filters (RFs) has been demonstrated feasible for FLASH-RT.

Purpose: This study explored the feasibility of a streamlined pin-shaped RF (pin-RF) design, characterized by coarse resolution and sparsely distributed ridge pins, for single-energy proton FLASH planning.

Long-term risk of carotid stenosis and cerebrovascular disease after radiation therapy for head and neck cancer.

Background: Recipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among HNC survivors after RT and (2) whether CAS is associated with a RT dose response effect.

Methods: This single-institution retrospective cohort study examined patients with nonmetastatic HNC who completed (chemo)RT from January 2000 through October 2020 and subsequently received carotid imaging surveillance ≤2 years following RT completion and, in the absence of CAS, every 3 years thereafter.

Streamlined Pin-Ridge-Filter Design for Single-energy Proton FLASH Planning.

Purpose: This study explored the feasibility of a streamlined pin-shaped ridge filter (pin-RF) design for single-energy proton FLASH planning.

Methods: An inverse planning framework integrated within a TPS was established for FLASH planning. The framework involves generating a IMPT plan based on downstream energy modulation strategy (IMPT-DS), followed by a nested spot reduction process to iteratively reduce the total number of pencil beam directions (PBDs) and energy layers along each PBD for the IMPT-DS plan.

Integration of Radiation Oncology Into the Preclinical Curriculum Through Problem-Based Learning.

Purpose: Early exposure to oncology care during the preclinical years of medical school may translate to increased student interest in oncology-related fields and improved understanding of oncologic treatment modalities, including radiation oncology. Many schools incorporate problem-based learning (PBL) into the medical school curriculum; this is an opportunity to immerse students in oncologic case management. We describe the effective incorporation of one course into the medical school curriculum that may be replicated at other institutions.

Radiation Facility Volume and Survival for Men With Very High-Risk Prostate Cancer Treated with Radiation and Androgen Deprivation Therapy.

Importance: Very high-risk (VHR) prostate cancer is an aggressive substratum of high-risk prostate cancer, characterized by high prostate-specific antigen levels, high Gleason score, and/or advanced T category. Contemporary management paradigms involve advanced molecular imaging and multimodal treatment with intensified prostate-directed or systemic treatment-resources more readily available at high-volume centers.

Objective: To examine radiation facility case volume and overall survival (OS) in men with VHR prostate cancer.

An optimized framework for cone-beam computed tomography-based online evaluation for proton therapy.

Background: Clinical evidence has demonstrated that proton therapy can achieve comparable tumor control probabilities compared to conventional photon therapy but with the added benefit of sparing healthy tissues. However, proton therapy is sensitive to inter-fractional anatomy changes. Online pre-fraction evaluation can effectively verify proton dose before delivery to patients, but there is a lack of guidelines for implementing this workflow.

Factors Affecting Clinical Outcomes Among Patients Infected With HIV and Anal Cancer Treated With Modern Definitive Chemotherapy and Radiation Therapy.

Purpose: Anal cancer affects a disproportionate percentage of persons infected with human immunodeficiency virus (HIV). We analyzed a cohort of patients with HIV and anal cancer who received modern radiation therapy (RT) and concurrent chemotherapy to assess whether certain factors are associated with poor oncologic outcomes.

Patients And Methods: We performed a retrospective chart review of 75 consecutive patients with HIV infection and anal cancer who received definitive chemotherapy and RT from 2008 to 2018 at a single academic institution.

Impact of 18 F-Fluciclovine PET/CT Findings on Failure-Free Survival in Biochemical Recurrence of Prostate Cancer Following Salvage Radiation Therapy.

Purpose: We aimed to evaluate the impact of 18 F-fluciclovine PET/CT imaging on failure-free survival (FFS) post-salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence.

Methods: Seventy-nine patients were recruited in a phase 2/3 clinical trial to undergo 18 F-fluciclovine PET/CT before SRT for PCa. Four patients with extrapelvic disease were excluded.

Differences in Failure-Free Survival After Salvage Radiotherapy Guided by Conventional Imaging Versus F-Fluciclovine PET/CT in Postprostatectomy Patients: A Post Hoc Substratification Analysis of the EMPIRE-1 Trial.

The EMPIRE-1 (Emory Molecular Prostate Imaging for Radiotherapy Enhancement 1) trial reported a survival advantage in recurrent prostate cancer salvage radiotherapy (SRT) guided by F-fluciclovine PET/CT versus conventional imaging. We performed a post hoc analysis of the EMPIRE-1 cohort stratified by protocol-specified criteria, comparing failure-free survival (FFS) between study arms. EMPIRE-1 randomized patients to SRT planning via either conventional imaging only (bone scanning plus abdominopelvic CT or MRI) (arm A) or conventional imaging plus F-fluciclovine PET/CT (arm B).

Incidence and predictors of toxicity in the management of vulvar squamous cell carcinoma treated with radiation therapy.

Purpose/objective: Given the rarity of vulvar cancer, data on the incidence of acute and late severe toxicity and patients' symptom burden from radiotherapy (RT) are lacking.

Materials/methods: This multi-center, single-institution study included patients with vulvar squamous cell carcinoma treated with curative intent RT between 2009 and 2020. Treatment-related acute and late grade ≥ 3 toxicities and late patient subjective symptoms (PSS) were recorded.

Randomized Trial of Conventional Versus Conventional Plus Fluciclovine (F) Positron Emission Tomography/Computed Tomography-Guided Postprostatectomy Radiation Therapy for Prostate Cancer: Volumetric and Patient-Reported Analyses of Toxic Effects.

Purpose: Postprostatectomy radiation therapy planning with fluciclovine (F) positron emission tomography (PET)/computed tomography has demonstrated improved disease-free survival over conventional only (computed tomography- or magnetic resonance imaging-based) treatment planning. We hypothesized that incorporating PET would result in larger clinical target volumes (CTVs) without increasing patient-reported toxic effects.

Methods And Materials: From 2012 to 2019, 165 postprostatectomy patients with detectable prostate-specific antigen were randomized (arm 1 [no PET]: 82; arm 2 [PET]: 83).