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Koontz, Bridget Fey

Overview:

Clinical: Board-certified in radiation treatment for all cancer locations/types.
Research: The long-term goal of Dr. Koontz’s research is to minimize treatment-related side effects of radiotherapy.  To that end she has a laboratory studying the mechanisms of radiation induced erectile dysfunction and testing interventions to treat and prevent this devastating side effect of radiotherapy.  Her clinical research investigates optimizing prostate cancer treatment and utilizes collaborations with colleagues in surgery and psychiatry to pursue further understanding of how sexual dysfunction develops after radiotherapy and how to improve patient-provider interactions regarding the sexuality and intimacy consequences of cancer therapy.

Positions:

Associate Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 1998

B.S. — Allegheny College

M.D. 2002

M.D. — Harvard University

Internship

University of North Carolina at Chapel Hill School of Medicine

Residency Training, Radiation Oncology

Duke University School of Medicine

Grants:

Developing knowledge models to enable rapid learning in radiation therapy

Administered By
Radiation Oncology
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
June 01, 2016
End Date
May 31, 2020

Therapeutic targeting of B7-H3 to reverse prostate cancer treatment resistance.

Administered By
Surgery, Urology
AwardedBy
Department of Defense
Role
Radiation Oncologist
Start Date
September 15, 2016
End Date
September 14, 2019

New therapeutic strategy in reversing radiation-induced erectile dysfunction with prostate cancer pa-tients

Administered By
Radiation Oncology
AwardedBy
North Carolina Biotechnology Center
Role
Co Investigator
Start Date
January 18, 2016
End Date
January 17, 2017

Janssen Research AGreement

Administered By
Radiation Oncology
AwardedBy
Janssen Research & Development, LLC
Role
Co Investigator
Start Date
November 27, 2014
End Date
December 31, 2016
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Publications:

Creation of a Novel Digital Rectal Examination Evaluation Instrument to Teach and Assess Prostate Examination Proficiency.

To create a validated tool to measure digital rectal examination proficiency and aid with teaching of the examination.The Digital Rectal Examination Clinical Tool was created using a modified Delphi method with 5 urologists and 5 radiation oncologists. The instrument was then validated in a population of preclinical medical students examining male urological teaching associates, and clinical trainees (third- and fourth-year medical students and urology resident physicians) examining prospectively enrolled subjects. Trainees completed paired examinations with an attending urologist, and responses were scored with reference to the attending responses.The instrument was validated at the University of Virginia in the urology clinic, endoscopic operating room, and main operating room settings.We tested the instrument on consenting subjects consisting of male urologic teaching associates (n = 12), clinic patients (n = 4), and operating room patients (n = 64). The participants were undergraduate (n = 302) and graduate (n = 9) medical trainees.In preclerkship trainees, improved scores in subjects without abnormal compared to those with abnormal findings demonstrated validity. In clinical trainees, scores on the Digital Rectal Examination Clinical Tool increased by 2% for each additional year of training, demonstrating construct validity.We used an expert panel to create a novel instrument for measuring digital rectal examination proficiency and validated it with preclinical and clinical trainee cohorts at our institution.

Authors
Clements, MB; Schmidt, KM; Canfield, SE; Gilbert, SM; Khandelwal, SR; Koontz, BF; Lallas, CD; Liauw, S; Nguyen, PL; Showalter, TN; Trabulsi, EJ; Cathro, HP; Schenkman, NS; Krupski, TL
MLA Citation
Clements, MB, Schmidt, KM, Canfield, SE, Gilbert, SM, Khandelwal, SR, Koontz, BF, Lallas, CD, Liauw, S, Nguyen, PL, Showalter, TN, Trabulsi, EJ, Cathro, HP, Schenkman, NS, and Krupski, TL. "Creation of a Novel Digital Rectal Examination Evaluation Instrument to Teach and Assess Prostate Examination Proficiency." Journal of surgical education (September 8, 2017).
PMID
28923535
Source
epmc
Published In
Journal of Surgical Education
Publish Date
2017
DOI
10.1016/j.jsurg.2017.08.012

Balancing Risks in Prostate-specific Antigen Recurrence: The Fox Versus the Hedgehog.

Authors
Koontz, BF
MLA Citation
Koontz, BF. "Balancing Risks in Prostate-specific Antigen Recurrence: The Fox Versus the Hedgehog." European urology (July 29, 2017).
PMID
28765010
Source
epmc
Published In
European Urology
Publish Date
2017
DOI
10.1016/j.eururo.2017.07.021

Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care.

Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.

Authors
Berkowitz, C; Allen, DH; Tenhover, J; Zullig, LL; Ragsdale, J; Fischer, JE; Pollak, KI; Koontz, BF
MLA Citation
Berkowitz, C, Allen, DH, Tenhover, J, Zullig, LL, Ragsdale, J, Fischer, JE, Pollak, KI, and Koontz, BF. "Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care." Journal of cancer education : the official journal of the American Association for Cancer Education (July 14, 2017).
PMID
28707205
Source
epmc
Published In
Journal of Cancer Education
Publish Date
2017
DOI
10.1007/s13187-017-1250-3

How can we effectively address the medical and psychological concerns of survivors of pelvic malignancies?

© 2017, UBM Medica Healthcare Publications. All rights reserved. Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.

Authors
Madden-Fuentes, RJ; Koontz, BF; Harrison, MR; George, DJ; Davidson, B; Gilmore, BF; Moul, JW; Mantyh, C; Peterson, AC
MLA Citation
Madden-Fuentes, RJ, Koontz, BF, Harrison, MR, George, DJ, Davidson, B, Gilmore, BF, Moul, JW, Mantyh, C, and Peterson, AC. "How can we effectively address the medical and psychological concerns of survivors of pelvic malignancies?." ONCOLOGY (United States) 31.4 (April 15, 2017): 268-294. (Review)
Source
scopus
Published In
Oncology
Volume
31
Issue
4
Publish Date
2017
Start Page
268
End Page
294

How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?

Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. These treatment sequelae are significantly bothersome to patients and challenging to address. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management. Addressing these issues often necessitates a coordinated multidisciplinary approach; however, the effort required often translates into improvement in patient quality of life. Herein we review the sexual and urinary side effects that may arise during or after treatment of pelvic malignancies.

Authors
Madden-Fuentes, RJ; Koontz, BF; Harrison, MR; George, DJ; Davidson, B; Gilmore, BF; Moul, JW; Mantyh, C; Peterson, AC
MLA Citation
Madden-Fuentes, RJ, Koontz, BF, Harrison, MR, George, DJ, Davidson, B, Gilmore, BF, Moul, JW, Mantyh, C, and Peterson, AC. "How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?." Oncology (Williston Park, N.Y.) 31.4 (April 2017): 286-294. (Review)
PMID
28412780
Source
epmc
Published In
Oncology
Volume
31
Issue
4
Publish Date
2017
Start Page
286
End Page
294

Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO).

Radiation oncologists are frequently involved in providing palliative and supportive care (PSC) for patients with advanced cancers through delivery of palliative radiation. Whether they are confident in their ability to assess and initiate treatments for pain, nonpain, and psychosocial distress is unknown. The American Society for Radiation Oncology surveyed its practicing members in the United States on self-assessment of their primary PSC skills and access to continuing medical education on PSC.We electronically surveyed 4093 practicing radiation oncologists in the United States. The survey consisted of 16-questions in 5 sections1: demographics,2 PSC training,3 domains of PSC,4 perceived barriers as a radiation oncologist to initiate advanced care planning, and5 discussion of prognosis.The survey was e-mailed to 4093 American Society for Radiation Oncology members, and 649 responses were received (response rate 16%). The majority (91%) of radiation oncologists surveyed believe PSC is an important competency for radiation oncologists. Most radiation oncologists reported that they are moderately confident in their ability to assess and manage pain and gastrointestinal symptoms, but less confident in their ability to manage anorexia, anxiety, and depression. Despite areas of decreased confidence, a large number (42%) of radiation oncologists do not receive any additional PSC education beyond their residency training. Lastly, a perceived fear of upsetting referring medical oncologists and lack of clinic time are concerns for radiation oncologists who may want to initiate goals of care/advance care planning discussions with patients and their families.Radiation oncologists are more confident in their ability to assess and manage pain than in their ability to manage depression, anxiety, anorexia, and fatigue. There is a need for increasing continuing medical educational efforts in PSC for practicing radiation oncologists, and strengthening PSC training in residency programs.

Authors
Wei, RL; Mattes, MD; Yu, J; Thrasher, A; Shu, H-K; Paganetti, H; De Los Santos, J; Koontz, B; Abraham, C; Balboni, T
MLA Citation
Wei, RL, Mattes, MD, Yu, J, Thrasher, A, Shu, H-K, Paganetti, H, De Los Santos, J, Koontz, B, Abraham, C, and Balboni, T. "Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO)." Practical radiation oncology 7.2 (March 2017): 113-119.
PMID
28274395
Source
epmc
Published In
Practical Radiation Oncology
Volume
7
Issue
2
Publish Date
2017
Start Page
113
End Page
119
DOI
10.1016/j.prro.2016.08.017

Tumour and normal tissue radiobiology in mouse models: how close are mice to mini-humans?

Animal modelling is essential to the study of radiobiology and the advancement of clinical radiation oncology by providing preclinical data. Mouse models in particular have been highly utilized in the study of both tumour and normal tissue radiobiology because of their cost effectiveness and versatility. Technology has significantly advanced in preclinical radiation techniques to allow highly conformal image-guided irradiation of small animals in an effort to mimic human treatment capabilities. However, the biological and physical limitations of animal modelling should be recognized and considered when interpreting preclinical radiotherapy (RT) studies. Murine tumour and normal tissue radioresponse has been shown to vary from human cellular and molecular pathways. Small animal irradiation techniques utilize different anatomical boundaries and may have different physical properties than human RT. This review addresses the difference between the human condition and mouse models and discusses possible strategies for future refinement of murine models of cancer and radiation for the benefit of both basic radiobiology and clinical translation.

Authors
Koontz, BF; Verhaegen, F; De Ruysscher, D
MLA Citation
Koontz, BF, Verhaegen, F, and De Ruysscher, D. "Tumour and normal tissue radiobiology in mouse models: how close are mice to mini-humans?." The British journal of radiology 90.1069 (January 2017): 20160441-. (Review)
PMID
27612010
Source
epmc
Published In
British Journal of Radiology
Volume
90
Issue
1069
Publish Date
2017
Start Page
20160441
DOI
10.1259/bjr.20160441

Cancer distress coach: Pilot study of a mobile app for managing posttraumatic stress.

Authors
Smith, SK; Kuhn, E; O'Donnell, J; Koontz, BF; Nelson, N; Molloy, K; Chang, J; Hoffman, J
MLA Citation
Smith, SK, Kuhn, E, O'Donnell, J, Koontz, BF, Nelson, N, Molloy, K, Chang, J, and Hoffman, J. "Cancer distress coach: Pilot study of a mobile app for managing posttraumatic stress." Psycho-oncology (December 29, 2016).
PMID
28032921
Source
epmc
Published In
Psycho-Oncology
Publish Date
2016
DOI
10.1002/pon.4363

Salvage Radiation Therapy Dose Response for Biochemical Failure of Prostate Cancer After Prostatectomy-A Multi-Institutional Observational Study.

To determine whether a dose-response relationship exists for salvage radiation therapy (RT) of biochemical failure after prostatectomy for prostate cancer.Individual data from 1108 patients who underwent salvage RT at 10 academic centers were pooled. The cohort was enriched for selection criteria more likely associated with tumor recurrence in the prostate bed (margin positive and pre-RT prostate-specific antigen [PSA] level of ≤2.0 ng/mL) and without the confounding of planned androgen suppression. The cumulative incidence of biochemical failure and distant metastasis over time was computed, and competing risks hazard regression models were used to investigate the association between potential predictors and these outcomes. The association of radiation dose with outcomes was the primary focus.With a 65.2-month follow-up duration, the 5- and 10-year estimates of freedom from post-RT biochemical failure (PSA level >0.2 ng/mL and rising) was 63.5% and 49.8%, respectively, and the cumulative incidence of distant metastasis was 12.4% by 10 years. A Gleason score of ≥7, higher pre-RT PSA level, extraprostatic tumor extension, and seminal vesicle invasion were associated with worse biochemical failure and distant metastasis outcomes. A salvage radiation dose of ≥66.0 Gy was associated with a reduced cumulative incidence of biochemical failure, but not of distant metastasis.The use of salvage radiation doses of ≥66.0 Gy are supported by evidence presented in the present multicenter pooled analysis of individual patient data. The observational reporting method, limited sample size, few distant metastasis events, modest follow-up duration, and elective use of salvage therapy might have diminished the opportunity to identify an association between the radiation dose and this endpoint.

Authors
Pisansky, TM; Agrawal, S; Hamstra, DA; Koontz, BF; Liauw, SL; Efstathiou, JA; Michalski, JM; Feng, FY; Abramowitz, MC; Pollack, A; Anscher, MS; Moghanaki, D; Den, RB; Stephans, KL; Zietman, AL; Lee, WR; Kattan, MW; Stephenson, AJ; Tendulkar, RD
MLA Citation
Pisansky, TM, Agrawal, S, Hamstra, DA, Koontz, BF, Liauw, SL, Efstathiou, JA, Michalski, JM, Feng, FY, Abramowitz, MC, Pollack, A, Anscher, MS, Moghanaki, D, Den, RB, Stephans, KL, Zietman, AL, Lee, WR, Kattan, MW, Stephenson, AJ, and Tendulkar, RD. "Salvage Radiation Therapy Dose Response for Biochemical Failure of Prostate Cancer After Prostatectomy-A Multi-Institutional Observational Study." International journal of radiation oncology, biology, physics 96.5 (December 2016): 1046-1053.
PMID
27745980
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
5
Publish Date
2016
Start Page
1046
End Page
1053
DOI
10.1016/j.ijrobp.2016.08.043

Contemporary Update of a Multi-Institutional Predictive Nomogram for Salvage Radiotherapy After Radical Prostatectomy

Authors
Tendulkar, RD; Agrawal, S; Gao, T; Efstathiou, JA; Pisansky, TM; Michalski, JM; Koontz, BF; Hamstra, DA; Feng, FY; Liauw, SL; Abramowitz, MC; Pollack, A; Anscher, MS; Moghanaki, D; Den, RB; Stephans, KL; Zietman, AL; Lee, WR; Kattan, MW; Stephenson, AJ
MLA Citation
Tendulkar, RD, Agrawal, S, Gao, T, Efstathiou, JA, Pisansky, TM, Michalski, JM, Koontz, BF, Hamstra, DA, Feng, FY, Liauw, SL, Abramowitz, MC, Pollack, A, Anscher, MS, Moghanaki, D, Den, RB, Stephans, KL, Zietman, AL, Lee, WR, Kattan, MW, and Stephenson, AJ. "Contemporary Update of a Multi-Institutional Predictive Nomogram for Salvage Radiotherapy After Radical Prostatectomy." JOURNAL OF CLINICAL ONCOLOGY 34.30 (October 20, 2016): 3648-+.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
30
Publish Date
2016
Start Page
3648
End Page
+
DOI
10.1200/JCO.2016.67.9647

Contemporary Update of a Multi-Institutional Predictive Nomogram for Salvage Radiotherapy After Radical Prostatectomy.

We aimed to update a previously published, multi-institutional nomogram of outcomes for salvage radiotherapy (SRT) following radical prostatectomy (RP) for prostate cancer, including patients treated in the contemporary era.Individual data from node-negative patients with a detectable post-RP prostate-specific antigen (PSA) treated with SRT with or without concurrent androgen-deprivation therapy (ADT) were obtained from 10 academic institutions. Freedom from biochemical failure (FFBF) and distant metastases (DM) rates were estimated, and predictive nomograms were generated.Overall, 2,460 patients with a median follow-up of 5 years were included; 599 patients (24%) had a Gleason score (GS) ≤ 6, 1,387 (56%) had a GS of 7, 244 (10%) had a GS of 8, and 230 (9%) had a GS of 9 to 10. There were 1,370 patients (56%) with extraprostatic extension (EPE), 452 (18%) with seminal vesicle invasion (SVI), 1,434 (58%) with positive surgical margins, and 390 (16%) who received ADT (median, 6 months). The median pre-SRT PSA was 0.5 ng/mL (interquartile range, 0.3 to 1.1). The 5-yr FFBF rate was 56% overall, 71% for those with a pre-SRT PSA level of 0.01 to 0.2 ng/mL (n = 441), 63% for those with a PSA of 0.21 to 0.50 ng/mL (n = 822), 54% for those with a PSA of 0.51 to 1.0 ng/mL (n = 533), 43% for those with a PSA of 1.01 to 2.0 ng/mL (n = 341), and 37% for those with a PSA > 2.0 ng/mL (n = 323); P < .001. On multivariable analysis, pre-SRT PSA, GS, EPE, SVI, surgical margins, ADT use, and SRT dose were associated with FFBF. Pre-SRT PSA, GS, SVI, surgical margins, and ADT use were associated with DM, whereas EPE and SRT dose were not. The nomogram concordance indices were 0.68 (FFBF) and 0.74 (DM).Early SRT at low PSA levels after RP is associated with improved FFBF and DM rates. Contemporary nomograms can estimate individual patient outcomes after SRT in the modern era.

Authors
Tendulkar, RD; Agrawal, S; Gao, T; Efstathiou, JA; Pisansky, TM; Michalski, JM; Koontz, BF; Hamstra, DA; Feng, FY; Liauw, SL; Abramowitz, MC; Pollack, A; Anscher, MS; Moghanaki, D; Den, RB; Stephans, KL; Zietman, AL; Lee, WR; Kattan, MW; Stephenson, AJ
MLA Citation
Tendulkar, RD, Agrawal, S, Gao, T, Efstathiou, JA, Pisansky, TM, Michalski, JM, Koontz, BF, Hamstra, DA, Feng, FY, Liauw, SL, Abramowitz, MC, Pollack, A, Anscher, MS, Moghanaki, D, Den, RB, Stephans, KL, Zietman, AL, Lee, WR, Kattan, MW, and Stephenson, AJ. "Contemporary Update of a Multi-Institutional Predictive Nomogram for Salvage Radiotherapy After Radical Prostatectomy." August 15, 2016.
PMID
27528718
Source
epmc
Published In
Journal of Clinical Oncology
Publish Date
2016

Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer.

Conventional radiotherapy (C-RT) treatment schedules for patients with prostate cancer typically require 40 to 45 treatments that take place from > 8 to 9 weeks. Preclinical and clinical research suggest that hypofractionation-fewer treatments but at a higher dose per treatment-may produce similar outcomes. This trial was designed to assess whether the efficacy of a hypofractionated radiotherapy (H-RT) treatment schedule is no worse than a C-RT schedule in men with low-risk prostate cancer.A total of 1,115 men with low-risk prostate cancer were randomly assigned 1:1 to C-RT (73.8 Gy in 41 fractions over 8.2 weeks) or to H-RT (70 Gy in 28 fractions over 5.6 weeks). This trial was designed to establish (with 90% power and an α of .05) that treatment with H-RT results in 5-year disease-free survival (DFS) that is not worse than C-RT by more than 7.65% (H-RT/C-RT hazard ratio [HR] < 1.52).A total of 1,092 men were protocol eligible and had follow-up information; 542 patients were assigned to C-RT and 550 to H-RT. Median follow-up was 5.8 years. Baseline characteristics were not different according to treatment assignment. The estimated 5-year DFS was 85.3% (95% CI, 81.9 to 88.1) in the C-RT arm and 86.3% (95% CI, 83.1 to 89.0) in the H-RT arm. The DFS HR was 0.85 (95% CI, 0.64 to 1.14), and the predefined noninferiority criterion that required that DFS outcomes be consistent with HR < 1.52 was met (P < .001). Late grade 2 and 3 GI and genitourinary adverse events were increased (HR, 1.31 to 1.59) in patients who were treated with H-RT.In men with low-risk prostate cancer, the efficacy of 70 Gy in 28 fractions over 5.6 weeks is not inferior to 73.8 Gy in 41 fractions over 8.2 weeks, although an increase in late GI/genitourinary adverse events was observed in patients treated with H-RT.

Authors
Lee, WR; Dignam, JJ; Amin, MB; Bruner, DW; Low, D; Swanson, GP; Shah, AB; D'Souza, DP; Michalski, JM; Dayes, IS; Seaward, SA; Hall, WA; Nguyen, PL; Pisansky, TM; Faria, SL; Chen, Y; Koontz, BF; Paulus, R; Sandler, HM
MLA Citation
Lee, WR, Dignam, JJ, Amin, MB, Bruner, DW, Low, D, Swanson, GP, Shah, AB, D'Souza, DP, Michalski, JM, Dayes, IS, Seaward, SA, Hall, WA, Nguyen, PL, Pisansky, TM, Faria, SL, Chen, Y, Koontz, BF, Paulus, R, and Sandler, HM. "Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.20 (July 2016): 2325-2332.
PMID
27044935
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
20
Publish Date
2016
Start Page
2325
End Page
2332
DOI
10.1200/jco.2016.67.0448

A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy.

In men with high Gleason PC and rapid PSA progression after surgery, failure rates remain unacceptably high despite salvage radiation. We explored a novel multimodality approach of docetaxel with anti-angiogenic therapy before salvage radiotherapy (RT).This was a phase 2 single-arm prospective open-label trial with historic controls. Eligible men had a rising PSA of 0.1-3.0 ng ml(-1) within 4 years of radical prostatectomy, no metastases except resected nodal disease, no prior androgen-deprivation therapy (ADT) and Gleason 7-10. Men received four cycles of docetaxel 70 mg m(-2) every 3 weeks with low dose prednisone and sunitinib 37.5 mg daily for 14/21 days each cycle, with no ADT. Salvage prostate bed RT (66 Gy) started at day 100. The primary end point was progression-free survival (PFS) rate at 24 months. Safety data, quality of life (QOL) and dose-limiting toxicities (DLTs) were measured over time.Thirty-four men accrued in this multi-institutional clinical trial: 24% of men were node positive, 47% were Gleason 8-10, median PSA at entry was 0.54. The trial was terminated prematurely owing to excess DLTs (nine) including grade 3 hand-foot syndrome (n=4), neutropenic fever (n=2), AST increase (n=1), fatigue (n=1) and vomiting with diarrhea (n=1). PFS rate at 24 months was 51% (95% CI: 33, 67%) with a median PFS of 26.2 months (95% CI: 12.5, -). Six men (17.6%) had an undetectable PSA at 2 years.Sunitinib and docetaxel/prednisone followed by salvage RT resulted in excess pre-specified DLTs. Although nearly half of the men experienced durable disease control, efficacy was not greater than expected with radiation alone. The use of the intermediate end point of PFS in this salvage setting permitted an early decision on further development of this combination.

Authors
Armstrong, AJ; Halabi, S; Healy, P; Lee, WR; Koontz, BF; Moul, JW; Mundy, K; Creel, P; Wood, S; Davis, K; Carducci, MA; Stein, M; Hobbs, C; Reimer, B; Nguyen, M; Anand, M; Bratt, L; Kim, S; Tran, PT; George, DJ; Department of Defense Prostate Cancer Clinical Trials Consortium,
MLA Citation
Armstrong, AJ, Halabi, S, Healy, P, Lee, WR, Koontz, BF, Moul, JW, Mundy, K, Creel, P, Wood, S, Davis, K, Carducci, MA, Stein, M, Hobbs, C, Reimer, B, Nguyen, M, Anand, M, Bratt, L, Kim, S, Tran, PT, George, DJ, and Department of Defense Prostate Cancer Clinical Trials Consortium, . "A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy." March 2016.
PMID
26754260
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Volume
19
Issue
1
Publish Date
2016
Start Page
100
End Page
106
DOI
10.1038/pcan.2015.59

A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy

Authors
Armstrong, AJ; Halabi, S; Healy, P; Lee, WR; Koontz, BF; Moul, JW; Mundy, K; Creel, P; Wood, S; Davis, K; Carducci, MA; Stein, M; Hobbs, C; Reimer, B; Nguyen, M; Anand, M; Bratt, L; Kim, S; Tran, PT; George, DJ; Tr, DDPCC
MLA Citation
Armstrong, AJ, Halabi, S, Healy, P, Lee, WR, Koontz, BF, Moul, JW, Mundy, K, Creel, P, Wood, S, Davis, K, Carducci, MA, Stein, M, Hobbs, C, Reimer, B, Nguyen, M, Anand, M, Bratt, L, Kim, S, Tran, PT, George, DJ, and Tr, DDPCC. "A phase 2 multimodality trial of docetaxel/prednisone with sunitinib followed by salvage radiation therapy in men with PSA recurrent prostate cancer after radical prostatectomy." PROSTATE CANCER AND PROSTATIC DISEASES 19.1 (March 2016): 100-106.
Source
wos-lite
Published In
Prostate Cancer and Prostatic Diseases
Volume
19
Issue
1
Publish Date
2016
Start Page
100
End Page
106
DOI
10.1038/pcan.2015.59

Management of Postprostatectomy Biochemical Relapse With Salvage Radiotherapy: Results of an International Survey.

OBJECTIVES: The management of patients with postprostatectomy salvage radiotherapy (SRT) presents radiation oncologists (ROs) with multiple treatment decisions that may impact outcomes. As the evidence addressing these issues is limited to retrospective data, it was hypothesized that widely disparate treatment paradigms exist. METHODS: A 21-question survey was sent through SurveyMonkey to members of the American Society of Radiation Oncology. RESULTS: A total of 999 ROs responded. Threshold rPSA values to initiate SRT ranged from 0.1 to 1 ng/mL. The highest dose prescribed by ROs ranged from <60 to >70.2 Gy. Elective lymph node irradiation was offered by 74%, and the majority (64%) referenced the Roach formula, Kattan nomogram, or D'Amico risk stratification to decide when it was appropriate. There was variability in pelvic field design with a preference to place the superior field border at either the upper, middle, or lower sacroiliac joint by 57.6%, 28.8%, and 13.6% of respondents, respectively. Adjuvant androgen deprivation therapy (ADT) was offered by 74%. CONCLUSIONS: Disparate treatment paradigms exist for SRT that may impact patient outcomes. Variability includes patient selection, treatment design, and recommendations for ADT. Many reference formulas to predict the benefit of pelvic lymph node irradiation that are not yet validated in the postprostatectomy setting. These data make it clear that well-designed, prospective clinical trials are needed to better evaluate the role of larger treatment fields, dose escalation, and ADT for the thousands of patients who are treated with postprostatectomy SRT each year.

Authors
Moghanaki, D; Urdaneta, AI; Karlin, JD; Koontz, BF; Anscher, MS
MLA Citation
Moghanaki, D, Urdaneta, AI, Karlin, JD, Koontz, BF, and Anscher, MS. "Management of Postprostatectomy Biochemical Relapse With Salvage Radiotherapy: Results of an International Survey." Am J Clin Oncol 39.1 (February 2016): 64-68.
PMID
24390275
Source
pubmed
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
39
Issue
1
Publish Date
2016
Start Page
64
End Page
68
DOI
10.1097/COC.0000000000000020

US radiation oncology practice patterns for posttreatment survivor care.

Increasing numbers of cancer survivors have driven a greater focus on care of cancer patients after treatment. Radiation oncologists have long considered follow-up of patients an integral part of practice. We sought to document current survivor-focused care patterns and identify barriers to meeting new regulatory commission guidelines for survivorship care plans (SCPs) and provide guidance for survivorship care.A 23-question electronic survey was e-mailed to all practicing US physician American Society of Radiation Oncology members. Responses were collected for 25 days in March 2014. Survey data were descriptively analyzed.A total of 574 eligible providers responded, for a response percentage of 14.7%. Almost all providers follow their patients after treatment (97%). Length of follow-up was frequently extensive: 17% followed up to 2 years, 40% for 3-5 years, 12% for 6-10 years, and 31% indefinitely. Ancillary services, particularly social work and nutrition services, are commonly available onsite to patients in follow-up. Fewer than half of respondents (40%) indicated that they currently use SCPs for curative intent patients and those who do generally use internally developed templates. SCPs typically go to patients (91%), but infrequently to primary care providers (22%). The top 3 barriers to implementation of SCPs were cost (57%), duplicative survivorship care plans provided by other physicians (43%), and lack of consensus or professional guidelines (40%). Eighty-seven percent indicated that SCPs built into an electronic medical record system would be useful.A significant part of radiation oncology practice includes the care of those in the surveillance of follow-up phase of care. SCPs may be beneficial in improving communication with the patient and other care but are not widely used within our field. This survey identified key barriers to use of SCPs and provides specialty guidance for important information to be included in a radiation oncology oriented SCP.

Authors
Koontz, BF; Benda, R; De Los Santos, J; Hoffman, KE; Huq, MS; Morrell, R; Sims, A; Stevens, S; Yu, JB; Chen, RC
MLA Citation
Koontz, BF, Benda, R, De Los Santos, J, Hoffman, KE, Huq, MS, Morrell, R, Sims, A, Stevens, S, Yu, JB, and Chen, RC. "US radiation oncology practice patterns for posttreatment survivor care." Practical radiation oncology 6.1 (January 2016): 50-56.
PMID
26603597
Source
epmc
Published In
Practical Radiation Oncology
Volume
6
Issue
1
Publish Date
2016
Start Page
50
End Page
56
DOI
10.1016/j.prro.2015.10.002

NRG Oncology RTOG 0415: A Randomized Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer

Authors
Lee, WR; Dignam, JJ; Amin, M; Bruner, D; Low, D; Swanson, GP; Shah, AB; D'Souza, DP; Michalski, JM; Dayes, IS; Seaward, SA; Hall, WA; Nguyen, PL; Pisansky, TM; Faria, S; Chen, Y; Koontz, BF; Paulus, R; Sandler, HM
MLA Citation
Lee, WR, Dignam, JJ, Amin, M, Bruner, D, Low, D, Swanson, GP, Shah, AB, D'Souza, DP, Michalski, JM, Dayes, IS, Seaward, SA, Hall, WA, Nguyen, PL, Pisansky, TM, Faria, S, Chen, Y, Koontz, BF, Paulus, R, and Sandler, HM. "NRG Oncology RTOG 0415: A Randomized Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer." January 2016.
Source
crossref
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
1
Publish Date
2016
Start Page
3
End Page
4
DOI
10.1016/j.ijrobp.2015.10.049

Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review.

Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence.

Authors
Kent, C; Horton, J; Blitzblau, R; Koontz, BF
MLA Citation
Kent, C, Horton, J, Blitzblau, R, and Koontz, BF. "Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review." Clinical breast cancer 15.6 (December 2015): 403-412. (Review)
PMID
26198331
Source
epmc
Published In
Clinical Breast Cancer
Volume
15
Issue
6
Publish Date
2015
Start Page
403
End Page
412
DOI
10.1016/j.clbc.2015.06.008

Dose Response for Salvage Radiation Therapy After Radical Prostatectomy in Margin-Positive Prostate Cancer

Authors
Agrawal, S; Pisansky, TM; Hamstra, DA; Liauw, S; Koontz, BF; Efstathiou, JA; Michalski, JM; Feng, FY; Abramowitz, MC; Pollack, A; Anscher, MS; Moghanaki, D; Den, RB; Stephans, KL; Kattan, M; Stephenson, AJ; Tendulkar, RD
MLA Citation
Agrawal, S, Pisansky, TM, Hamstra, DA, Liauw, S, Koontz, BF, Efstathiou, JA, Michalski, JM, Feng, FY, Abramowitz, MC, Pollack, A, Anscher, MS, Moghanaki, D, Den, RB, Stephans, KL, Kattan, M, Stephenson, AJ, and Tendulkar, RD. "Dose Response for Salvage Radiation Therapy After Radical Prostatectomy in Margin-Positive Prostate Cancer." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
S132
End Page
S133

A systematic review of hypofractionation for primary management of prostate cancer

© 2014 European Association of Urology. Context Technological advances in radiation therapy delivery have permitted the use of high-dose-per-fraction radiation therapy (RT) for early-stage prostate cancer (PCa). Level 1 evidence supporting the safety and efficacy of hypofractionated RT is evolving as this modality becomes more widely utilized and refined. Objective To perform a systematic review of the current evidence on the safety and efficacy of hypofractionated RT for early-stage PCa and to provide in-context recommendations for current application of this technology. Evidence acquisition Embase, PubMed, and Scopus electronic databases were queried for English-language articles from January 1990 through June 2014. Prospective studies with a minimum of 50 patients were included. Separate consideration was made for studies involving moderate hypofractionation (doses of 2.5-4 Gy per fraction) and extreme hypofractionation (5-10 Gy in 4-7 fractions). Evidence synthesis Six relatively small superiority designed randomized trials of standard fractionation versus moderate hypofractionation in predominantly low- and intermediate-risk PCa have been published with follow-up ranging from 4 to 8 yr, noting similar biochemical control (5-yr freedom from biochemical failure in modern studies is > 80% for low-risk and intermediate-risk patients) and late grade ≥2 genitourinary and gastrointestinal toxicities (between 2% and 20%). Noninferiority studies are pending. In prospective phase 2 studies, extreme hypofractionation has promising 2- to 5-yr biochemical control rates of > 90% for low-risk patients. Results from a randomized trial are expected in 2015. Conclusions Moderate hypofractionation has 5-yr data to date establishing safety compared with standard fractionation, but 10-yr outcomes and longer follow-up are needed to establish noninferiority for clinical effectiveness. Extreme hypofractionation is promising but as yet requires reporting of randomized data prior to application outside of a clinical protocol. Patient summary Hypofractionation for prostate cancer delivers relatively high doses of radiation per treatment. Prospective studies support the safety of moderate hypofractionation, while extreme fractionation may have greater toxicity. Both show promising cancer control but long-term results of noninferiority studies of both methods are required before use in routine treatment outside of clinical protocols.

Authors
Koontz, BF; Bossi, A; Cozzarini, C; Wiegel, T; D'Amico, A
MLA Citation
Koontz, BF, Bossi, A, Cozzarini, C, Wiegel, T, and D'Amico, A. "A systematic review of hypofractionation for primary management of prostate cancer." European Urology 68.4 (October 1, 2015): 683-691. (Review)
Source
scopus
Published In
European Urology
Volume
68
Issue
4
Publish Date
2015
Start Page
683
End Page
691
DOI
10.1016/j.eururo.2014.08.009

A systematic review of hypofractionation for primary management of prostate cancer.

Technological advances in radiation therapy delivery have permitted the use of high-dose-per-fraction radiation therapy (RT) for early-stage prostate cancer (PCa). Level 1 evidence supporting the safety and efficacy of hypofractionated RT is evolving as this modality becomes more widely utilized and refined.To perform a systematic review of the current evidence on the safety and efficacy of hypofractionated RT for early-stage PCa and to provide in-context recommendations for current application of this technology.Embase, PubMed, and Scopus electronic databases were queried for English-language articles from January 1990 through June 2014. Prospective studies with a minimum of 50 patients were included. Separate consideration was made for studies involving moderate hypofractionation (doses of 2.5-4Gy per fraction) and extreme hypofractionation (5-10Gy in 4-7 fractions).Six relatively small superiority designed randomized trials of standard fractionation versus moderate hypofractionation in predominantly low- and intermediate-risk PCa have been published with follow-up ranging from 4 to 8 yr, noting similar biochemical control (5-yr freedom from biochemical failure in modern studies is >80% for low-risk and intermediate-risk patients) and late grade ≥2 genitourinary and gastrointestinal toxicities (between 2% and 20%). Noninferiority studies are pending. In prospective phase 2 studies, extreme hypofractionation has promising 2- to 5-yr biochemical control rates of >90% for low-risk patients. Results from a randomized trial are expected in 2015.Moderate hypofractionation has 5-yr data to date establishing safety compared with standard fractionation, but 10-yr outcomes and longer follow-up are needed to establish noninferiority for clinical effectiveness. Extreme hypofractionation is promising but as yet requires reporting of randomized data prior to application outside of a clinical protocol.Hypofractionation for prostate cancer delivers relatively high doses of radiation per treatment. Prospective studies support the safety of moderate hypofractionation, while extreme fractionation may have greater toxicity. Both show promising cancer control but long-term results of noninferiority studies of both methods are required before use in routine treatment outside of clinical protocols.

Authors
Koontz, BF; Bossi, A; Cozzarini, C; Wiegel, T; D'Amico, A
MLA Citation
Koontz, BF, Bossi, A, Cozzarini, C, Wiegel, T, and D'Amico, A. "A systematic review of hypofractionation for primary management of prostate cancer." European urology 68.4 (October 2015): 683-691. (Review)
PMID
25171903
Source
epmc
Published In
European Urology
Volume
68
Issue
4
Publish Date
2015
Start Page
683
End Page
691
DOI
10.1016/j.eururo.2014.08.009

Radiotherapy before and after radical prostatectomy for high-risk and locally advanced prostate cancer.

Men with localized high-risk prostate cancer carry significant risk of prostate cancer-specific mortality. The best treatment approach to minimize this risk is unclear. In this review, we evaluate the role of radiation before and after radical prostatectomy.A critical review of the literature was performed regarding the application of external radiation therapy (RT) in combination with prostatectomy for high-risk localized prostate cancer.Up to 70% of men with high-risk localized disease may require adjuvant therapy because of adverse pathologic features or biochemical recurrence in the absence of systemic disease. The utility of adjuvant RT among men with adverse pathologic features are well established at least regarding minimizing biochemical recurrence risk. The optimal timing of salvage radiation is the subject of ongoing studies. Neoadjuvant RT requires further study but is a potentially attractive method because of decreased radiation field sizes and potential radiobiologic benefits of delivering RT before surgery. Salvage prostatectomy is effective at treating local recurrence after radiation but is associated with significant surgical morbidity.Combining local therapies including radical prostatectomy and RT can be a reasonable approach. Care should be taken at the initial presentation of high-risk localized prostate cancer to consider and plan for the likelihood of multimodality care.

Authors
Perez, BA; Koontz, BF
MLA Citation
Perez, BA, and Koontz, BF. "Radiotherapy before and after radical prostatectomy for high-risk and locally advanced prostate cancer." Urologic oncology 33.5 (May 2015): 226-234. (Review)
PMID
25454485
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
33
Issue
5
Publish Date
2015
Start Page
226
End Page
234
DOI
10.1016/j.urolonc.2014.09.018

RADIOPROTECTION OF ERECTILE FUNCTION USING NOVEL ANTI-OXIDANT IN THE RAT

Authors
Granieri, M; Tovmasyan, A; Yan, H; Lu, X; Mao, L; Macias, E; Spasojevic, I; Batinic-Haberle, I; Peterson, AC; Koontz, BF
MLA Citation
Granieri, M, Tovmasyan, A, Yan, H, Lu, X, Mao, L, Macias, E, Spasojevic, I, Batinic-Haberle, I, Peterson, AC, and Koontz, BF. "RADIOPROTECTION OF ERECTILE FUNCTION USING NOVEL ANTI-OXIDANT IN THE RAT." May 2015.
Source
wos-lite
Published In
The Journal of Sexual Medicine
Volume
12
Publish Date
2015
Start Page
178
End Page
179

Investigating the accuracy of microstereotactic-body-radiotherapy utilizing anatomically accurate 3D printed rodent-morphic dosimeters.

Sophisticated small animal irradiators, incorporating cone-beam-CT image-guidance, have recently been developed which enable exploration of the efficacy of advanced radiation treatments in the preclinical setting. Microstereotactic-body-radiation-therapy (microSBRT) is one technique of interest, utilizing field sizes in the range of 1-15 mm. Verification of the accuracy of microSBRT treatment delivery is challenging due to the lack of available methods to comprehensively measure dose distributions in representative phantoms with sufficiently high spatial resolution and in 3 dimensions (3D). This work introduces a potential solution in the form of anatomically accurate rodent-morphic 3D dosimeters compatible with ultrahigh resolution (0.3 mm(3)) optical computed tomography (optical-CT) dose read-out.Rodent-morphic dosimeters were produced by 3D-printing molds of rodent anatomy directly from contours defined on x-ray CT data sets of rats and mice, and using these molds to create tissue-equivalent radiochromic 3D dosimeters from Presage. Anatomically accurate spines were incorporated into some dosimeters, by first 3D printing the spine mold, then forming a high-Z bone equivalent spine insert. This spine insert was then set inside the tissue equivalent body mold. The high-Z spinal insert enabled representative cone-beam CT IGRT targeting. On irradiation, a linear radiochromic change in optical-density occurs in the dosimeter, which is proportional to absorbed dose, and was read out using optical-CT in high-resolution (0.5 mm isotropic voxels). Optical-CT data were converted to absolute dose in two ways: (i) using a calibration curve derived from other Presage dosimeters from the same batch, and (ii) by independent measurement of calibrated dose at a point using a novel detector comprised of a yttrium oxide based nanocrystalline scintillator, with a submillimeter active length. A microSBRT spinal treatment was delivered consisting of a 180° continuous arc at 225 kVp with a 20 × 10 mm field size. Dose response was evaluated using both the Presage/optical-CT 3D dosimetry system described above, and independent verification in select planes using EBT2 radiochromic film placed inside rodent-morphic dosimeters that had been sectioned in half.Rodent-morphic 3D dosimeters were successfully produced from Presage radiochromic material by utilizing 3D printed molds of rat CT contours. The dosimeters were found to be compatible with optical-CT dose readout in high-resolution 3D (0.5 mm isotropic voxels) with minimal artifacts or noise. Cone-beam CT image guidance was possible with these dosimeters due to sufficient contrast between high-Z spinal inserts and tissue equivalent Presage material (CNR ∼10 on CBCT images). Dose at isocenter measured with optical-CT was found to agree with nanoscintillator measurement to within 2.8%. Maximum dose in line profiles taken through Presage and film dose slices agreed within 3%, with FWHM measurements through each profile found to agree within 2%.This work demonstrates the feasibility of using 3D printing technology to make anatomically accurate Presage rodent-morphic dosimeters incorporating spinal-mimicking inserts. High quality optical-CT 3D dosimetry is feasible on these dosimeters, despite the irregular surfaces and implanted inserts. The ability to measure dose distributions in anatomically accurate phantoms represents a powerful useful additional verification tool for preclinical microSBRT.

Authors
Bache, ST; Juang, T; Belley, MD; Koontz, BF; Adamovics, J; Yoshizumi, TT; Kirsch, DG; Oldham, M
MLA Citation
Bache, ST, Juang, T, Belley, MD, Koontz, BF, Adamovics, J, Yoshizumi, TT, Kirsch, DG, and Oldham, M. "Investigating the accuracy of microstereotactic-body-radiotherapy utilizing anatomically accurate 3D printed rodent-morphic dosimeters." Medical physics 42.2 (February 2015): 846-855.
PMID
25652497
Source
epmc
Published In
Medical physics
Volume
42
Issue
2
Publish Date
2015
Start Page
846
End Page
855
DOI
10.1118/1.4905489

Radiotherapy before and after radical prostatectomy for high-risk and locally advanced prostate cancer

© 2015 Elsevier Inc. Objectives: Men with localized high-risk prostate cancer carry significant risk of prostate cancer-specific mortality. The best treatment approach to minimize this risk is unclear. In this review, we evaluate the role of radiation before and after radical prostatectomy. Methods and materials: A critical review of the literature was performed regarding the application of external radiation therapy (RT) in combination with prostatectomy for high-risk localized prostate cancer. Results: Up to 70% of men with high-risk localized disease may require adjuvant therapy because of adverse pathologic features or biochemical recurrence in the absence of systemic disease. The utility of adjuvant RT among men with adverse pathologic features are well established at least regarding minimizing biochemical recurrence risk. The optimal timing of salvage radiation is the subject of ongoing studies. Neoadjuvant RT requires further study but is a potentially attractive method because of decreased radiation field sizes and potential radiobiologic benefits of delivering RT before surgery. Salvage prostatectomy is effective at treating local recurrence after radiation but is associated with significant surgical morbidity. Conclusions: Combining local therapies including radical prostatectomy and RT can be a reasonable approach. Care should be taken at the initial presentation of high-risk localized prostate cancer to consider and plan for the likelihood of multimodality care.

Authors
Perez, BA; Koontz, BF
MLA Citation
Perez, BA, and Koontz, BF. "Radiotherapy before and after radical prostatectomy for high-risk and locally advanced prostate cancer." Urologic Oncology: Seminars and Original Investigations 33.5 (January 1, 2015): 226-234. (Review)
Source
scopus
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
33
Issue
5
Publish Date
2015
Start Page
226
End Page
234
DOI
10.1016/j.urolonc.2014.09.018

External beam radiation therapy for clinically localized prostate cancer

© Springer-Verlag London 2015. All rights reserved. Radiation therapy is used in approximately one-third of patients newly diagnosed with prostate cancer. External beam radiotherapy alone to doses of 75.6 Gy or higher is appropriate for patients with low risk disease (T1, GS < 7, PSA≤10 ng/ml). For intermediate or high risk disease, numerous randomized trials indicate that outcomes are improved by addition of androgen deprivation. In the postoperative setting, Level I evidence supports the use of adjuvant radiotherapy for certain pathologic feature’s (pathologic T3 or positive surgical margins) but debate continues whether early salvage radiotherapy (post-operative PSA < 0.5 ng/ml) will be just as effective. Radiation technology continues to improve, with both intensity-modulated and image-guided radiotherapy commonly available. These techniques allow significant reduction in dose to normal tissues, lowering the risk of radiation toxicities. Additionally, this technology has allowed for hypofractionation (fewer, larger treatment fractions) which significantly shorten treatment courses.

Authors
Koontz, BF; Lee, WR
MLA Citation
Koontz, BF, and Lee, WR. "External beam radiation therapy for clinically localized prostate cancer." Urological Oncology. January 1, 2015. 731-742.
Source
scopus
Publish Date
2015
Start Page
731
End Page
742
DOI
10.1007/978-0-85729-482-1_42

Statin use is associated with decreased prostate cancer recurrence in men treated with brachytherapy.

Recent in vitro and in vivo evidence has suggested that statin medications may have anticancer activity. We sought to determine whether statin use was associated with improved clinical outcome in men treated with brachytherapy for prostate cancer.A database of men with prostate cancer treated with permanent Iodine-125 brachytherapy between January 1999 and February 2009 was retrospectively analyzed. Standard guidelines (i.e., American Brachytherapy Society selection criteria) were used for selecting patients for brachytherapy. Biochemical failure was defined using the Phoenix definition.From a total of 247 men with prostate adenocarcinoma treated with brachytherapy, 174 patients (70 %) were identified as using statin medications, either during initial visit or during follow-up. Median PSA follow-up was 51 months after date of implant (range 9.4-140.35). Overall biochemical failure rate was 7.3 % (18 patients). On univariate analysis, statin use was associated with significantly improved freedom from biochemical failure [hazard ratio (HR) 0.28; 95 % CI 0.10-0.72; p < 0.01 by log-rank test]. In multivariate Cox analysis performed with the variables statin use, pretreatment PSA, clinical T stage, Gleason score, and D90 or V100, statin use remained significantly associated with improved freedom from biochemical failure (HR 0.288; 95 % CI 0.086-0.886; p = 0.0299).Statin use was associated with a significant improvement in freedom from biochemical failure in this cohort of men treated with brachytherapy for prostate cancer. Further investigation into the favorable effect of statin use on brachytherapy and radiation therapy in general is warranted, including prospective trials.

Authors
Oh, DS; Koontz, B; Freedland, SJ; Gerber, L; Patel, P; Lewis, S; Yoo, DS; Oleson, J; Salama, JK
MLA Citation
Oh, DS, Koontz, B, Freedland, SJ, Gerber, L, Patel, P, Lewis, S, Yoo, DS, Oleson, J, and Salama, JK. "Statin use is associated with decreased prostate cancer recurrence in men treated with brachytherapy." World journal of urology 33.1 (January 2015): 93-97.
PMID
24671610
Source
epmc
Published In
World Journal of Urology
Volume
33
Issue
1
Publish Date
2015
Start Page
93
End Page
97
DOI
10.1007/s00345-014-1281-x

Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?

OBJECTIVES: To determine whether oncological outcomes are improved in prostate cancer patients by using a multidisciplinary strategy as compared with a standard clinic paradigm, and whether time to treatment is delayed when using a multidisciplinary approach. METHODS: We retrospectively analyzed patients who were evaluated and pursued radical prostatectomy as primary treatment, by the same surgeons, in the prostate cancer multidisciplinary clinic (n = 194) and standard urology clinic (n = 741) at Duke University Medical Center from 2005 to 2009. Comparisons of baseline characteristics were examined using rank sum and χ(2) -tests. Differences in time to radical prostatectomy and oncological outcomes were evaluated using multivariate linear and Cox regression, respectively. RESULTS: A greater proportion of high-risk patients (D'Amico criteria) were evaluated at the multidisciplinary clinic compared with the urology clinic (23.2% vs 15.6%, P = 0.014). Mean-adjusted time from biopsy to radical prostatectomy was shorter for multidisciplinary clinic patients (85.6 vs 96.8 days, P = 0.006). After a median follow up of 21 months, no significant difference was found between the multidisciplinary clinic and urology clinic in the risk of biochemical recurrence after radical prostatectomy, whether controlling for clinical (hazard ratio 0.71, P = 0.249) or pathological variables (hazard ratio 0.75, P = 0.349). CONCLUSIONS: Despite higher-risk disease, men evaluated using the multidisciplinary approach have similar oncological outcomes compared with men undergoing standard evaluation. Furthermore, time to radical prostatectomy is not delayed by the multidisciplinary management of these patients.

Authors
Stewart, SB; Moul, JW; Polascik, TJ; Koontz, BF; Robertson, CN; Freedland, SJ; George, DJ; Lee, WR; Armstrong, AJ; Bañez, LL
MLA Citation
Stewart, SB, Moul, JW, Polascik, TJ, Koontz, BF, Robertson, CN, Freedland, SJ, George, DJ, Lee, WR, Armstrong, AJ, and Bañez, LL. "Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?." International journal of urology : official journal of the Japanese Urological Association 21.12 (December 2014): 1215-1219.
PMID
25041422
Source
epmc
Published In
International Journal of Urology
Volume
21
Issue
12
Publish Date
2014
Start Page
1215
End Page
1219
DOI
10.1111/iju.12561

Racial differences in adipose tissue distribution and risk of aggressive prostate cancer among men undergoing radiotherapy.

Although elevated body mass index (BMI) has been associated with increased risk of aggressive prostate cancer, the importance of adipose tissue distribution is not well understood. We examined associations between overall and visceral obesity and aggressive prostate cancer risk. Moreover, given racial differences in adipose tissue distribution, we examined whether race modified these associations.We conducted a cross-sectional analysis of 308 radiotherapy-treated patients with prostate cancer within the Durham VA from 2005 to 2011. Multivariable logistic regression examined the association between BMI categories and tertiles of waist circumference (WC), visceral fat area (VFA), and periprostatic adipose tissue area (PPAT) with high-grade prostate cancer risk (Gleason score ≥7 vs. ≤6). Models stratified by race examined whether these associations differed between black and nonblack men.Both elevated BMI (Ptrend = 0.054) and WC (Ptrend = 0.040) were associated with increased high-grade prostate cancer risk, with similar results between races, although the association with BMI was not statistically significant. In contrast, elevated VFA was associated with increased aggressive prostate cancer risk in black men (Ptrend = 0.002) but not nonblack men (Ptrend = 0.831), with a significant interaction between race and VFA (Pinteraction = 0.035). Though similar patterns were observed for PPAT, none was statistically significant.Among men undergoing radiotherapy for prostate cancer, visceral obesity is associated with increased aggressive prostate cancer risk, particularly among black men. If confirmed in future studies, these results suggest that adipose tissue distribution differences may contribute to prostate cancer racial disparity.These findings highlight the need to elucidate mechanisms contributing to racial differences in the association between visceral obesity and aggressive prostate cancer.

Authors
Allott, EH; Howard, LE; Song, H-J; Sourbeer, KN; Koontz, BF; Salama, JK; Freedland, SJ
MLA Citation
Allott, EH, Howard, LE, Song, H-J, Sourbeer, KN, Koontz, BF, Salama, JK, and Freedland, SJ. "Racial differences in adipose tissue distribution and risk of aggressive prostate cancer among men undergoing radiotherapy." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 23.11 (November 2014): 2404-2412.
PMID
25146088
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
23
Issue
11
Publish Date
2014
Start Page
2404
End Page
2412
DOI
10.1158/1055-9965.epi-14-0236

Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer.

Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n=25 per group) after RP. AT consisted of five walking sessions per week at 55-100% of peak oxygen uptake (VO2peak) for 30-60 min per session following a nonlinear prescription. The primary outcome was change in the prevalence of ED, as measured by the International Index of Erectile Function (IIEF), from baseline to 6 mo. Secondary outcomes were brachial artery flow-mediated dilation (FMD), VO2peak, cardiovascular (CV) risk profile (eg, lipid profile, body composition), and patient-reported outcomes (PROs). The prevalence of ED (IIEF score ≤ 21) decreased by 20% in the AT group and by 24% in the UC group (difference: p=0.406). There were no significant between-group differences in any erectile function subscale (p>0.05). Significant between-group differences were observed for changes in FMD and VO2peak, favoring AT. There were no group differences in other markers of CV risk profile or PROs. In summary, nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP.Clinicaltrials.gov identifier NCT00620932.

Authors
Jones, LW; Hornsby, WE; Freedland, SJ; Lane, A; West, MJ; Moul, JW; Ferrandino, MN; Allen, JD; Kenjale, AA; Thomas, SM; Herndon, JE; Koontz, BF; Chan, JM; Khouri, MG; Douglas, PS; Eves, ND
MLA Citation
Jones, LW, Hornsby, WE, Freedland, SJ, Lane, A, West, MJ, Moul, JW, Ferrandino, MN, Allen, JD, Kenjale, AA, Thomas, SM, Herndon, JE, Koontz, BF, Chan, JM, Khouri, MG, Douglas, PS, and Eves, ND. "Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer." European urology 65.5 (May 2014): 852-855.
PMID
24315706
Source
epmc
Published In
European Urology
Volume
65
Issue
5
Publish Date
2014
Start Page
852
End Page
855
DOI
10.1016/j.eururo.2013.11.009

Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer

Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n = 25 per group) after RP. AT consisted of five walking sessions per week at 55-100% of peak oxygen uptake (VO 2peak ) for 30-60 min per session following a nonlinear prescription. The primary outcome was change in the prevalence of ED, as measured by the International Index of Erectile Function (IIEF), from baseline to 6 mo. Secondary outcomes were brachial artery flow-mediated dilation (FMD), VO 2peak , cardiovascular (CV) risk profile (eg, lipid profile, body composition), and patient-reported outcomes (PROs). The prevalence of ED (IIEF score ≤21) decreased by 20% in the AT group and by 24% in the UC group (difference: p = 0.406). There were no significant between-group differences in any erectile function subscale (p > 0.05). Significant between-group differences were observed for changes in FMD and VO 2peak , favoring AT. There were no group differences in other markers of CV risk profile or PROs. In summary, nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP. Trial registration Clinicaltrials.gov identifier NCT00620932. © 2013 European Association of Urology.

Authors
Jones, LW; Hornsby, WE; Freedland, SJ; Lane, A; West, MJ; Moul, JW; Ferrandino, MN; Allen, JD; Kenjale, AA; Thomas, SM; Herndon, JE; Koontz, BF; Chan, JM; Khouri, MG; Douglas, PS; Eves, ND
MLA Citation
Jones, LW, Hornsby, WE, Freedland, SJ, Lane, A, West, MJ, Moul, JW, Ferrandino, MN, Allen, JD, Kenjale, AA, Thomas, SM, Herndon, JE, Koontz, BF, Chan, JM, Khouri, MG, Douglas, PS, and Eves, ND. "Effects of nonlinear aerobic training on erectile dysfunction and cardiovascular function following radical prostatectomy for clinically localized prostate cancer." European Urology 65.5 (January 1, 2014): 852-855.
Source
scopus
Published In
European Urology
Volume
65
Issue
5
Publish Date
2014
Start Page
852
End Page
855
DOI
10.1016/j.eururo.2013.11.009

Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?

© 2014 The Japanese Urological Association. Objectives: To determine whether oncological outcomes are improved in prostate cancer patients by using a multidisciplinary strategy as compared with a standard clinic paradigm, and whether time to treatment is delayed when using a multidisciplinary approach. Methods: We retrospectively analyzed patients who were evaluated and pursued radical prostatectomy as primary treatment, by the same surgeons, in the prostate cancer mul tidisciplinary clinic (n=194) and standard urology clinic (n=741) at Duke University Medical Center from 2005 to 2009. Comparisons of baseline characteristics were examined using rank sum and χ 2 -tests. Differences in time to radical prostatectomy and oncological outcomes were evaluated using multivariate linear and Cox regression, respectively. Results: A greater proportion of high-risk patients (D'Amico criteria) were evaluated at the multidisciplinary clinic compared with the urology clinic (23.2% vs 15.6%, P=0.014). Mean-adjusted time from biopsy to radical prostatectomy was shorter for multidisciplinary clinic patients (85.6 vs 96.8 days, P=0.006). After a median follow up of 21 months, no significant difference was found between the multidisciplinary clinic and urology clinic in the risk of biochemical recurrence after radical prostatectomy, whether controlling for clinical (hazard ratio 0.71, P=0.249) or pathological variables (hazard ratio 0.75, P=0.349). Conclusions: Despite higher-risk disease, men evaluated using the multidisciplinary approach have similar oncological outcomes compared with men undergoing standard evaluation. Furthermore, time to radical prostatectomy is not delayed by the multidisciplinary management of these patients.

Authors
Stewart, SB; Moul, JW; Polascik, TJ; Koontz, BF; Robertson, CN; Freedland, SJ; George, DJ; Lee, WR; Armstrong, AJ; Bañez, LL
MLA Citation
Stewart, SB, Moul, JW, Polascik, TJ, Koontz, BF, Robertson, CN, Freedland, SJ, George, DJ, Lee, WR, Armstrong, AJ, and Bañez, LL. "Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?." International Journal of Urology 21.12 (January 1, 2014): 1215-1219.
Source
scopus
Published In
International Journal of Urology
Volume
21
Issue
12
Publish Date
2014
Start Page
1215
End Page
1219
DOI
10.1111/iju.12561

Image Guidance Affects Biochemical Outcome for Postprostatectomy Radiation Therapy

Authors
Koontz, BF; Kalman, NS; Banez, LL; Livengood, KP; Anscher, MS; Moul, JW; Lee, WR
MLA Citation
Koontz, BF, Kalman, NS, Banez, LL, Livengood, KP, Anscher, MS, Moul, JW, and Lee, WR. "Image Guidance Affects Biochemical Outcome for Postprostatectomy Radiation Therapy." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S362
End Page
S363

Identifying appropriate patients for early salvage radiotherapy after prostatectomy.

PURPOSE: It remains unclear whether relapsed prostate specific antigen at postprostatectomy salvage radiotherapy impacts outcomes as long it is 1.0 ng/ml or less. MATERIALS AND METHODS: We performed a retrospective cohort study of 197 patients treated with salvage radiotherapy in the setting of detectable relapsed prostate specific antigen 1.0 ng/ml or less. Patients were excluded from analysis if they had lymph node involvement or received androgen deprivation therapy. Freedom from prostate specific antigen progression after salvage radiotherapy was analyzed by a Cox regression model. RESULTS: Median relapsed prostate specific antigen was 0.33 ng/ml (range 0.07 to 1.0). There was 86% freedom from prostate specific antigen progression at a median followup of 52 months. Relapsed prostate specific antigen (HR 1.9, p = 0.004), Gleason score 8-10 (HR 5.2, p <0.001) and negative margin status (HR 2.0, p = 0.02) were independently associated with an increased risk of prostate specific antigen progression after salvage radiotherapy. We identified interaction between relapsed prostate specific antigen and Gleason score (p = 0.04) but not margin status. A significant association was noted between higher relapsed prostate specific antigen and prostate specific antigen progression after salvage radiotherapy in patients with Gleason score 8-10 but not 7 or less. In patients with Gleason score 8-10 the rate of freedom from prostate specific antigen progression at 53 months was 77% vs 26% when salvage radiotherapy was initiated at a relapsed prostate specific antigen of 0.33 or less vs 0.34 to 1.0 ng/ml (log rank p = 0.003). CONCLUSIONS: Different relapsed prostate specific antigen thresholds for unsuccessful salvage radiotherapy may exist based on Gleason score. These data suggest that patients with Gleason score 8-10 should be offered salvage radiotherapy at the earliest detectable relapsed prostate specific antigen, even 0.33 ng/ml or less. Those with Gleason score 7 or less may have the opportunity to be followed with serial prostate specific antigen measurements to improve risk stratification, and delay and/or avoid the potential toxicity of salvage radiotherapy.

Authors
Karlin, JD; Koontz, BF; Freedland, SJ; Moul, JW; Grob, BM; Wan, W; Hagan, MP; Anscher, MS; Moghanaki, D
MLA Citation
Karlin, JD, Koontz, BF, Freedland, SJ, Moul, JW, Grob, BM, Wan, W, Hagan, MP, Anscher, MS, and Moghanaki, D. "Identifying appropriate patients for early salvage radiotherapy after prostatectomy." J Urol 190.4 (October 2013): 1410-1415.
PMID
23648223
Source
pubmed
Published In
The Journal of Urology
Volume
190
Issue
4
Publish Date
2013
Start Page
1410
End Page
1415
DOI
10.1016/j.juro.2013.04.078

Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer.

PURPOSE: To evaluate, in a phase 1 study, the safety of neoadjuvant whole-pelvis radiation therapy (RT) administered immediately before radical prostatectomy in men with high-risk prostate cancer. METHODS AND MATERIALS: Twelve men enrolled and completed a phase 1 single-institution trial between 2006 and 2010. Eligibility required a previously untreated diagnosis of localized but high-risk prostate cancer. Median follow-up was 46 months (range, 14-74 months). Radiation therapy was dose-escalated in a 3 × 3 design with dose levels of 39.6, 45, 50.4, and 54 Gy. The pelvic lymph nodes were treated up to 45 Gy with any additional dose given to the prostate and seminal vesicles. Radical prostatectomy was performed 4-8 weeks after RT completion. Primary outcome measure was intraoperative and postoperative day-30 morbidity. Secondary measures included late morbidity and oncologic outcomes. RESULTS: No intraoperative morbidity was seen. Chronic urinary grade 2+ toxicity occurred in 42%; 2 patients (17%) developed a symptomatic urethral stricture requiring dilation. Two-year actuarial biochemical recurrence-free survival was 67% (95% confidence interval 34%-86%). Patients with pT3 or positive surgical margin treated with neoadjuvant RT had a trend for improved biochemical recurrence-free survival compared with a historical cohort with similar adverse factors. CONCLUSIONS: Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with neoadjuvant androgen deprivation therapy to improve biochemical outcomes.

Authors
Koontz, BF; Quaranta, BP; Pura, JA; Lee, WR; Vujaskovic, Z; Gerber, L; Haake, M; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Pura, JA, Lee, WR, Vujaskovic, Z, Gerber, L, Haake, M, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer." Int J Radiat Oncol Biol Phys 87.1 (September 1, 2013): 88-93.
PMID
23790772
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
87
Issue
1
Publish Date
2013
Start Page
88
End Page
93
DOI
10.1016/j.ijrobp.2013.05.014

Intensity-modulated radiotherapy

© 2013 Springer-Verlag London. All rights are reserved. Intensity-modulated radiotherapy (IMRT) is a radiation delivery technique that allows dose sculpting to improve target coverage while sparing normal tissues. In an IMRT plan, the number of photons delivered (or fluence) varies within a field. Such variability can be used to avoid normal structures with lower radiation tolerance than the cancer and increases the ability to provide focal treatment. It does require significant quality assurance and consideration of patient setup and target motion to ensure treatment accuracy. While the technique itself is not more efficacious in achieving biochemical control, its ability to spare normal tissues allows for dose escalation, which does provide improved prostate cancer control. For prostate cancer, the cancer control benefit of dose escalation has driven a widespread adoption of IMRT for definitive external beam radiotherapy.

Authors
Koontz, BF; Godfrey, D; Lee, WR
MLA Citation
Koontz, BF, Godfrey, D, and Lee, WR. "Intensity-modulated radiotherapy." Prostate Cancer: A Comprehensive Perspective. July 1, 2013. 749-759.
Source
scopus
Publish Date
2013
Start Page
749
End Page
759
DOI
10.1007/978-1-4471-2864-9_63

WE-E-108-09: An Investigation of the Feasibility of Rodentmorphic 3D Dosimeters for Verification of Precision Micro-Irradiator Treatment.

To evaluate the feasibility of novel rodentmorphic 3D dosimeters for comprehensive high-resolution verification of the treatment accuracy of a state-of-the-art micro-irradiator equipped with on-line cone-beam-CT guidance.Anatomically accurate 3D dosimeter molds were created in a two step procedure. First, rodents were CT scanned and the structures of interest contoured (e.g. body and spine). These contours were then exported for input to a 3D printer, to generate positive dosimeter molds. The rat body dosimeter was made of regular water-equivalent PRESAGE, while the spine was made from high-Z PRESAGE with an effective atomic-number close to bone. Evaluation of the dosimeters involved (i) establishing the feasibility of manufacture and accurate positioning of heterogenous inserts, (ii) verification of accurate dose-readout by optical-CT, and (iii) verification of sufficient bony/soft-tissue contrast for representative CBCT IGRT positioning. Simulated rat prostate treatments were delivered with dose of 16Gy given by 4 2.5cm diameter circular fields.High resolution (0.5mm isotropic) 3D dosimetry data was acquired in rodentmorphic dosimeters both with and without the high-Z spinal insert. The spinal insert was visible under kV radiographs and CBCT, demonstrating the feasibility of IGRT positioning. Pronounced edge artifacts were observed near the flat undersurface of the rat, and near regions of sharp curvature. Further artifacts were observed in some regions near the spinal insert caused by bubbles trapped during manufacture. New manufacturing procedures utilizing the flexibility of 3D printing to precisely customize contours in non-critical regions have improved on both of these limitations.This work demonstrates promising feasibility for anatomically accurate 3D rodentmorphic dosimeters compatible with very high resolution 3D dosimetry. The ability to create such dosimeters is an important step forward in enabling accurate verification of complex micro-irradiator treatments in the pre-clinical setting. NIH Grant No. R01 CA 100835.

Authors
Bache, S; Juang, T; Adamovics, J; Benning, R; Koontz, B; Predmore, K; Dewhirst, M; Oldham, M
MLA Citation
Bache, S, Juang, T, Adamovics, J, Benning, R, Koontz, B, Predmore, K, Dewhirst, M, and Oldham, M. "WE-E-108-09: An Investigation of the Feasibility of Rodentmorphic 3D Dosimeters for Verification of Precision Micro-Irradiator Treatment." Medical physics 40.6Part29 (June 2013): 490-.
PMID
28518639
Source
epmc
Published In
Medical physics
Volume
40
Issue
6Part29
Publish Date
2013
Start Page
490
DOI
10.1118/1.4815587

Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?

Authors
Kalman, NS; Banez, LL; Gerber, L; Moul, JW; Anscher, MS; Lee, WR; Koontz, BF
MLA Citation
Kalman, NS, Banez, LL, Gerber, L, Moul, JW, Anscher, MS, Lee, WR, and Koontz, BF. "Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?." February 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
6
Publish Date
2013

Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy.

BACKGROUND: Success rates with salvage radiotherapy (SRT) in men who have a postprostatectomy biochemical relapse are suboptimal. One treatment-intensification strategy includes elective irradiation of the pelvic lymph nodes with whole pelvis radiotherapy (WPRT). METHODS: An inter-institutional retrospective cohort study compared outcomes for patients who received SRT at 2 separate academic institutions with disparate treatment paradigms: almost exclusively favoring WPRT (n = 112) versus limiting treatment to the prostate bed (PBRT) (n = 135). Patients were excluded if they had lymph node involvement or if they received androgen-deprivation therapy. The Cox proportional hazards model was used to adjust for potential confounders. RESULTS: In total, 247 patients were analyzed with a median follow-up of 4 years. The pre-SRT prostate-specific antigen (PSA) level (adjusted hazard ratio [HR], 1.58; P < .0001) and a Gleason score of 8 to 10 (adjusted HR, 3.21; P < .0001) were identified as independent predictors of increased risk of biochemical PSA progression after SRT. However, WPRT was not independently associated with biochemical progression-free survival in the multivariate model (adjusted HR, 0.79; P = .20). Neither low-risk patients nor high-risk patients (defined a priori by a preoperative PSA level ≥20 ng/mL, a pathologic Gleason score between 8 and 10, or pathologic T3 tumor classification) benefited from WPRT. Overall survival was similar between treatment groups. When restricting the analysis to patients with pre-SRT PSA levels ≥0.4 ng/mL (n = 139), WPRT was independently associated with a 53% reduction in the risk of biochemical progression (adjusted HR, 0.47; P = .031). CONCLUSIONS: WPRT did not improve outcomes among the entire group but was independently associated with improved biochemical control among patients with pre-SRT PSA levels ≥0.4 ng/mL.

Authors
Moghanaki, D; Koontz, BF; Karlin, JD; Wan, W; Mukhopadhay, N; Hagan, MP; Anscher, MS
MLA Citation
Moghanaki, D, Koontz, BF, Karlin, JD, Wan, W, Mukhopadhay, N, Hagan, MP, and Anscher, MS. "Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy." Cancer 119.1 (January 1, 2013): 52-60.
PMID
22736478
Source
pubmed
Published In
Cancer
Volume
119
Issue
1
Publish Date
2013
Start Page
52
End Page
60
DOI
10.1002/cncr.27712

Radiation Therapy for Prostate Cancer

Radiation therapy is an effective treatment for newly diagnosed prostate cancer, salvage treatment, or for palliation of advanced disease. Herein we briefly discuss the indications, results, and complications associated with brachytherapy and external beam radiotherapy, when used as monotherapy and in combination with each other or androgen deprivation. © 2013 Elsevier Inc. All rights reserved.

Authors
Koontz, BF; Lee, WR
MLA Citation
Koontz, BF, and Lee, WR. "Radiation Therapy for Prostate Cancer." Surgical Oncology Clinics of North America (2013).
PMID
23622075
Source
scival
Published In
Surgical Oncology Clinics of North America
Publish Date
2013
DOI
10.1016/j.soc.2013.02.006

Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy

Background: Success rates with salvage radiotherapy (SRT) in men who have a postprostatectomy biochemical relapse are suboptimal. One treatment- intensification strategy includes elective irradiation of the pelvic lymph nodes with whole pelvis radiotherapy (WPRT). Methods: An inter-institutional retrospective cohort study compared outcomes for patients who received SRT at 2 separate academic institutions with disparate treatment paradigms: almost exclusively favoring WPRT (n = 112) versus limiting treatment to the prostate bed (PBRT) (n = 135). Patients were excluded if they had lymph node involvement or if they received androgen-deprivation therapy. The Cox proportional hazards model was used to adjust for potential confounders. Results: In total, 247 patients were analyzed with a median follow-up of 4 years. The pre-SRT prostate-specific antigen (PSA) level (adjusted hazard ratio [HR], 1.58; P <.0001) and a Gleason score of 8 to 10 (adjusted HR, 3.21; P <.0001) were identified as independent predictors of increased risk of biochemical PSA progression after SRT. However, WPRT was not independently associated with biochemical progression-free survival in the multivariate model (adjusted HR, 0.79; P =.20). Neither low-risk patients nor high-risk patients (defined a priori by a preoperative PSA level ≥20 ng/mL, a pathologic Gleason score between 8 and 10, or pathologic T3 tumor classification) benefited from WPRT. Overall survival was similar between treatment groups. When restricting the analysis to patients with pre-SRT PSA levels ≥0.4 ng/mL (n = 139), WPRT was independently associated with a 53% reduction in the risk of biochemical progression (adjusted HR, 0.47; P =.031). Conclusions: WPRT did not improve outcomes among the entire group but was independently associated with improved biochemical control among patients with pre-SRT PSA levels ≥0.4 ng/mL. © 2012 American Cancer Society.

Authors
Moghanaki, D; Koontz, BF; Karlin, JD; Wan, W; Mukhopadhay, N; Hagan, MP; Anscher, MS
MLA Citation
Moghanaki, D, Koontz, BF, Karlin, JD, Wan, W, Mukhopadhay, N, Hagan, MP, and Anscher, MS. "Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy." Cancer 119.1 (2013): 52-60.
Source
scival
Published In
Cancer
Volume
119
Issue
1
Publish Date
2013
Start Page
52
End Page
60
DOI
10.1002/cncr.27712

Radiation Therapy for Prostate Cancer

Radiation therapy is an effective treatment for newly diagnosed prostate cancer, salvage treatment, or for palliation of advanced disease. Herein we briefly discuss the indications, results, and complications associated with brachytherapy and external beam radiotherapy, when used as monotherapy and in combination with each other or androgen deprivation. © 2013 Elsevier Inc.

Authors
Koontz, BF; Lee, WR
MLA Citation
Koontz, BF, and Lee, WR. "Radiation Therapy for Prostate Cancer." Surgical Oncology Clinics of North America 22.3 (2013): 483-494.
Source
scival
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
3
Publish Date
2013
Start Page
483
End Page
494
DOI
10.1016/j.soc.2013.02.006

Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer

Purpose: To evaluate, in a phase 1 study, the safety of neoadjuvant whole-pelvis radiation therapy (RT) administered immediately before radical prostatectomy in men with high-risk prostate cancer. Methods and Materials: Twelve men enrolled and completed a phase 1 single-institution trial between 2006 and 2010. Eligibility required a previously untreated diagnosis of localized but high-risk prostate cancer. Median follow-up was 46 months (range, 14-74 months). Radiation therapy was dose-escalated in a 3 × 3 design with dose levels of 39.6, 45, 50.4, and 54 Gy. The pelvic lymph nodes were treated up to 45 Gy with any additional dose given to the prostate and seminal vesicles. Radical prostatectomy was performed 4-8 weeks after RT completion. Primary outcome measure was intraoperative and postoperative day-30 morbidity. Secondary measures included late morbidity and oncologic outcomes. Results: No intraoperative morbidity was seen. Chronic urinary grade 2+ toxicity occurred in 42%; 2 patients (17%) developed a symptomatic urethral stricture requiring dilation. Two-year actuarial biochemical recurrence-free survival was 67% (95% confidence interval 34%-86%). Patients with pT3 or positive surgical margin treated with neoadjuvant RT had a trend for improved biochemical recurrence-free survival compared with a historical cohort with similar adverse factors. Conclusions: Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with neoadjuvant androgen deprivation therapy to improve biochemical outcomes. © 2013 Elsevier Inc.

Authors
Koontz, BF; Quaranta, BP; Pura, JA; Lee, WR; Vujaskovic, Z; Gerber, L; Haake, M; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Pura, JA, Lee, WR, Vujaskovic, Z, Gerber, L, Haake, M, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer." International Journal of Radiation Oncology Biology Physics 87.1 (2013): 88-93.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
1
Publish Date
2013
Start Page
88
End Page
93
DOI
10.1016/j.ijrobp.2013.05.014

Identifying appropriate patients for early salvage radiotherapy after prostatectomy

Purpose It remains unclear whether relapsed prostate specific antigen at postprostatectomy salvage radiotherapy impacts outcomes as long it is 1.0 ng/ml or less. Materials and Methods We performed a retrospective cohort study of 197 patients treated with salvage radiotherapy in the setting of detectable relapsed prostate specific antigen 1.0 ng/ml or less. Patients were excluded from analysis if they had lymph node involvement or received androgen deprivation therapy. Freedom from prostate specific antigen progression after salvage radiotherapy was analyzed by a Cox regression model. Results Median relapsed prostate specific antigen was 0.33 ng/ml (range 0.07 to 1.0). There was 86% freedom from prostate specific antigen progression at a median followup of 52 months. Relapsed prostate specific antigen (HR 1.9, p = 0.004), Gleason score 8-10 (HR 5.2, p <0.001) and negative margin status (HR 2.0, p = 0.02) were independently associated with an increased risk of prostate specific antigen progression after salvage radiotherapy. We identified interaction between relapsed prostate specific antigen and Gleason score (p = 0.04) but not margin status. A significant association was noted between higher relapsed prostate specific antigen and prostate specific antigen progression after salvage radiotherapy in patients with Gleason score 8-10 but not 7 or less. In patients with Gleason score 8-10 the rate of freedom from prostate specific antigen progression at 53 months was 77% vs 26% when salvage radiotherapy was initiated at a relapsed prostate specific antigen of 0.33 or less vs 0.34 to 1.0 ng/ml (log rank p = 0.003). Conclusions Different relapsed prostate specific antigen thresholds for unsuccessful salvage radiotherapy may exist based on Gleason score. These data suggest that patients with Gleason score 8-10 should be offered salvage radiotherapy at the earliest detectable relapsed prostate specific antigen, even 0.33 ng/ml or less. Those with Gleason score 7 or less may have the opportunity to be followed with serial prostate specific antigen measurements to improve risk stratification, and delay and/or avoid the potential toxicity of salvage radiotherapy. © 2013 by American Urological Association Education and Research, Inc.

Authors
Karlin, JD; Koontz, BF; Freedland, SJ; Moul, JW; Grob, BM; Wan, W; Hagan, MP; Anscher, MS; Moghanaki, D
MLA Citation
Karlin, JD, Koontz, BF, Freedland, SJ, Moul, JW, Grob, BM, Wan, W, Hagan, MP, Anscher, MS, and Moghanaki, D. "Identifying appropriate patients for early salvage radiotherapy after prostatectomy." Journal of Urology 190.4 (2013): 1410-1415.
Source
scival
Published In
The Journal of Urology
Volume
190
Issue
4
Publish Date
2013
Start Page
1410
End Page
1415
DOI
10.1016/j.juro.2013.04.078

Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation. OBJECTIVES: • To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). • To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses. PATIENTS AND METHODS: • We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. • The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. • Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of >75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. • Logistic regression analysis was used to identify factors associated with treatment participation and its success. RESULTS: • Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. • In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation. • Higher preoperative PSA concentration (OR 0.50, P = 0.004) and presence of positive surgical margins (OR 0.68, P = 0.042) were found to be independent predictors for non-participation in the rehabilitation. • For rehabilitation outcomes, being older at surgery (OR 0.93, P = 0.001) and adjuvant therapy (OR 0.34, P = 0.047) had a negative association with successful outcome. • There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P = 0.053) CONCLUSIONS: • Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. • Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided.

Authors
Kimura, M; Caso, JR; Bañez, LL; Koontz, BF; Gerber, L; Senocak, C; Donatucci, CF; Vujaskovic, Z; Moul, JW; Polascik, TJ
MLA Citation
Kimura, M, Caso, JR, Bañez, LL, Koontz, BF, Gerber, L, Senocak, C, Donatucci, CF, Vujaskovic, Z, Moul, JW, and Polascik, TJ. "Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy." BJU Int 110.11 Pt C (December 2012): E931-E938.
PMID
22520165
Source
pubmed
Published In
Bju International
Volume
110
Issue
11 Pt C
Publish Date
2012
Start Page
E931
End Page
E938
DOI
10.1111/j.1464-410X.2012.11168.x

Elective Pelvic Lymph Node Irradiation, Without Androgen Deprivation Therapy, During Postprostatectomy Salvage Radiation Therapy

Authors
Moghanaki, D; Koontz, BF; Karlin, JD; Wan, W; Mukhopadhay, ND; Hagan, MP; Anscher, MS
MLA Citation
Moghanaki, D, Koontz, BF, Karlin, JD, Wan, W, Mukhopadhay, ND, Hagan, MP, and Anscher, MS. "Elective Pelvic Lymph Node Irradiation, Without Androgen Deprivation Therapy, During Postprostatectomy Salvage Radiation Therapy." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S184
End Page
S185

Significant Variation in Provider Discussion of Sexual Side Effects With Radiation Therapy Patients

Authors
Koontz, BF; Flynn, K; Reese, JB; Urdeneta, AI; Moghanaki, D; Porter, LS
MLA Citation
Koontz, BF, Flynn, K, Reese, JB, Urdeneta, AI, Moghanaki, D, and Porter, LS. "Significant Variation in Provider Discussion of Sexual Side Effects With Radiation Therapy Patients." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S210
End Page
S210

Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast.

Benign papillary lesions of the breast include papilloma and papillomatosis. A retrospective analysis of patients with a papillary breast lesion diagnosed between October 1992 and December 2009 was performed. Patients were excluded if they had a previous or concurrent diagnosis of invasive or in situ cancer or less than 6 months of follow-up. The Kaplan-Meier method was used to determine the risk of developing subsequent malignancy. The log rank test was used to compare groups of patients. Median follow-up for the 167 patients included in the study was 4.6 years. Fifty-one patients had a papillary lesion with atypia and 116 patients had a papillary lesion without atypia. Patients with a papillary lesion with atypia were more likely to develop invasive or in situ breast cancer with a 5 year risk of 13.0% versus 4.6% in patients with no atypia (p = 0.03).

Authors
Cuneo, KC; Dash, RC; Wilke, LG; Horton, JK; Koontz, BF
MLA Citation
Cuneo, KC, Dash, RC, Wilke, LG, Horton, JK, and Koontz, BF. "Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast." Breast J 18.5 (September 2012): 475-478.
PMID
22776070
Source
pubmed
Published In
The Breast Journal
Volume
18
Issue
5
Publish Date
2012
Start Page
475
End Page
478
DOI
10.1111/j.1524-4741.2012.01276.x

Role of oxidative stress in a rat model of radiation-induced erectile dysfunction.

INTRODUCTION: Chronic oxidative stress is one of the major factors playing an important role in radiation-induced normal tissue injury. However, the role of oxidative stress in radiation-induced erectile dysfunction (ED) has not been fully investigated. Aims.  To investigate role of oxidative stress after prostate-confined irradiation in a rat model of radiation-induced ED. METHODS: Fifty-four young adult male rats (10-12 weeks of age) were divided into age-matched sham radiotherapy (RT) and RT groups. Irradiated animals received prostate-confined radiation in a single 20 Gy fraction. MAIN OUTCOME MEASURES: Intracavernous pressure (ICP) measurements with cavernous nerve electrical stimulation were conducted at 2, 4, and 9 weeks following RT. The protein expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits (Nox4 and gp91(phox)), markers of oxidative DNA damage (8-hydroxy-2'-deoxyguanosine [8-OHdG]), lipid peroxidation (4-hydroxynonenal [4HNE]), and inflammatory response including inducible nitric oxide synthase, macrophage activation (ED-1), and nitrotyrosine, and endogenous antioxidant defense by nuclear factor erythroid 2-related factor (Nrf2) were evaluated in irradiated prostate tissue and corpora cavernosa (CC). In addition, we investigated the relationships between results of ICP/mean arterial pressure (MAP) ratios and expression level of oxidative stress markers. RESULTS: In the RT group, hemodynamic functional studies demonstrated a significant time-dependent decrease in ICP. Increased expression of Nox4, gp91(phox), 8-OHdG, and 4HNE were observed in the prostate and CC after RT. Similarly, expressions of inflammatory markers were significantly increased. There was a trend for increased Nrf2 after 4 weeks. ICP/MAP ratio negatively correlated with higher expression level of oxidative markers. CONCLUSION: NADPH oxidase activation and chronic oxidative stress were observed in irradiated prostate tissue and CC, which correlated with lower ICP/MAP ratio. Persistent inflammatory responses were also found in both tissues after RT. These findings suggest that oxidative stress plays a crucial role in the development of radiation-induced ED.

Authors
Kimura, M; Rabbani, ZN; Zodda, AR; Yan, H; Jackson, IL; Polascik, TJ; Donatucci, CF; Moul, JW; Vujaskovic, Z; Koontz, BF
MLA Citation
Kimura, M, Rabbani, ZN, Zodda, AR, Yan, H, Jackson, IL, Polascik, TJ, Donatucci, CF, Moul, JW, Vujaskovic, Z, and Koontz, BF. "Role of oxidative stress in a rat model of radiation-induced erectile dysfunction." J Sex Med 9.6 (June 2012): 1535-1549.
PMID
22489731
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
9
Issue
6
Publish Date
2012
Start Page
1535
End Page
1549
DOI
10.1111/j.1743-6109.2012.02716.x

Impact of primary Gleason grade on risk stratification for Gleason score 7 prostate cancers.

PURPOSE: To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling. METHODS: One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D'Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome. RESULTS: Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%). CONCLUSIONS: Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.

Authors
Koontz, BF; Tsivian, M; Mouraviev, V; Sun, L; Vujaskovic, Z; Moul, J; Lee, WR
MLA Citation
Koontz, BF, Tsivian, M, Mouraviev, V, Sun, L, Vujaskovic, Z, Moul, J, and Lee, WR. "Impact of primary Gleason grade on risk stratification for Gleason score 7 prostate cancers." Int J Radiat Oncol Biol Phys 82.1 (January 1, 2012): 200-203.
PMID
21237582
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
1
Publish Date
2012
Start Page
200
End Page
203
DOI
10.1016/j.ijrobp.2010.11.023

Utilization trends at a multidisciplinary prostate cancer clinic: initial 5-year experience from the Duke Prostate Center.

PURPOSE: The multidisciplinary approach is becoming increasingly encouraged but little is known about the multidisciplinary experience compared to routine care. For patients with prostate cancer the goal is to provide evaluations by urologists, medical and radiation oncologists at a single visit. Although additional resources are required, this strategy may enhance the overall health care experience. We compared utilization determinants between a multidisciplinary and a urology prostate cancer clinic at Duke University Medical Center and identified factors associated with pursuing treatment at the university medical center for multidisciplinary clinic patients. MATERIALS AND METHODS: We retrospectively analyzed data on patients referred for primary prostate cancer treatment evaluation at Duke University Medical Center from 2005 to 2009. Comparisons between 701 multidisciplinary clinic and 1,318 urology prostate cancer clinic patients were examined with the rank sum and chi-square tests. Predictive factors for pursuing treatment at the university medical center were assessed using multivariate adjusted logistic regression. RESULTS: Compared to patients at the urology prostate cancer clinic those at the multidisciplinary clinic were more likely to be younger and white, have a higher income and travel a longer distance for evaluation. Of multidisciplinary clinic patients 58% pursued primary treatment at the university medical center. They were more likely to be younger, black and physician referred, have a lower income and reside closer to the medical center. Factors predictive of pursuing treatment at the medical center included high risk disease and physician referral. Factors predictive of not receiving care at the university medical center were income greater than $40,000 and a distance traveled of greater than 100 miles. CONCLUSIONS: A different patient demographic is using the multidisciplinary approach. However, when treatment is pursued at the institution providing multidisciplinary services, the patient demographic resembles that of the treating institution.

Authors
Stewart, SB; Bañez, LL; Robertson, CN; Freedland, SJ; Polascik, TJ; Xie, D; Koontz, BF; Vujaskovic, Z; Lee, WR; Armstrong, AJ; Febbo, PG; George, DJ; Moul, JW
MLA Citation
Stewart, SB, Bañez, LL, Robertson, CN, Freedland, SJ, Polascik, TJ, Xie, D, Koontz, BF, Vujaskovic, Z, Lee, WR, Armstrong, AJ, Febbo, PG, George, DJ, and Moul, JW. "Utilization trends at a multidisciplinary prostate cancer clinic: initial 5-year experience from the Duke Prostate Center." J Urol 187.1 (January 2012): 103-108.
PMID
22088334
Source
pubmed
Published In
The Journal of Urology
Volume
187
Issue
1
Publish Date
2012
Start Page
103
End Page
108
DOI
10.1016/j.juro.2011.09.040

Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy

OBJECTIVES • To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). • To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses. PATIENTS AND METHODS • We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. • The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. • Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of > 75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. • Logistic regression analysis was used to identify factors associated with treatment participation and its success. RESULTS • Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. • In multivariable regression analysis, African-Americans (odds ratio [ OR ] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation. • Higher preoperative PSA concentration (OR 0.50, P =0.004) and presence of positive surgical margins (OR 0.68, P =0.042) were found to be independent predictors for non-participation in the rehabilitation. • For rehabilitation outcomes, being older at surgery (OR 0.93, P =0.001) and adjuvant therapy (OR 0.34, P =0.047) had a negative association with successful outcome. • There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P =0.053) CONCLUSIONS • Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. • Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided. © 2012 THE AUTHORS.

Authors
Kimura, M; Caso, JR; Bañez, LL; Koontz, BF; Gerber, L; Senocak, C; Donatucci, CF; Vujaskovic, Z; Moul, JW; Polascik, TJ
MLA Citation
Kimura, M, Caso, JR, Bañez, LL, Koontz, BF, Gerber, L, Senocak, C, Donatucci, CF, Vujaskovic, Z, Moul, JW, and Polascik, TJ. "Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy." BJU International 110.11 C (2012): E931-E938.
Source
scival
Published In
Bju International
Volume
110
Issue
11 C
Publish Date
2012
Start Page
E931
End Page
E938
DOI
10.1111/j.1464-410X.2012.11168.x

External beam radiation therapy for clinically localized prostate cancer: when and how we optimize with concurrent hormonal deprivation.

Androgen deprivation plays a major role in the treatment of prostate cancer.Preclinical studies have shown that androgen deprivation provides both an independent cytotoxic effect and radiosensitization on prostate tumors. For men with non-metastatic prostate cancer, the addition of androgen deprivation to radiotherapy has been shown to improve survival for intermediate and high risk disease compared to radiation alone.This review discusses the clinical trial data regarding combination of androgen deprivation and radiation and provides recommendations for its use in men undergoing radiotherapy for localized prostate cancer.

Authors
Koontz, BF; Lee, WR
MLA Citation
Koontz, BF, and Lee, WR. "External beam radiation therapy for clinically localized prostate cancer: when and how we optimize with concurrent hormonal deprivation." Arch Esp Urol 64.8 (October 2011): 858-864. (Review)
PMID
22052767
Source
pubmed
Published In
Archivos espanoles de urologia
Volume
64
Issue
8
Publish Date
2011
Start Page
858
End Page
864

Salvage radiation in men after prostate-specific antigen failure and the risk of death.

BACKGROUND: A survival benefit has been observed with salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure after radical prostatectomy (RP) in men with rapid rises in PSA doubling time (DT, < 6 months). Whether such a benefit exits in men with a protracted PSA rise in DT (≥ 6 months) is unclear and was examined in the current study. METHODS: Of 4036 men who underwent RP at Duke University between 1988 and 2008, 519 experienced a PSA failure, had complete data, and were the subjects of this study. Univariate and multivariate Cox regression analyses were performed to evaluate whether salvage RT in men with either a rapid (< 6 months) or a protracted (≥ 6 months) PSA DT was associated with the risk of all-cause mortality adjusting for age at the time of PSA failure, known prostate cancer prognostic factors, and cardiac comorbidity. RESULTS: After a median follow-up of 11.3 years after PSA failure, 195 men died. Salvage RT was associated with a significant reduction in all-cause mortality for men with either a PSA DT of < 6 months (adjusted hazard ratio [AHR], 0.53; P = .02) or a PSA DT of ≥ 6 months (AHR, 0.52; P = .003). In a subset of patients with comorbidity data at the time of PSA failure, salvage RT remained associated with a significant reduction in all-cause mortality for both men with a PSA DT of < 6 months (AHR, 0.35; P = .042) or a PSA DT of ≥ 6 months (AHR, 0.60; P = .04). CONCLUSIONS: Salvage RT for PSA DTs less than or in excess of 6 months is associated with a decreased risk in all-cause mortality.

Authors
Cotter, SE; Chen, MH; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; Robertson, CN; Walther, PJ; Polascik, TJ; D'Amico, AV
MLA Citation
Cotter, SE, Chen, MH, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, Robertson, CN, Walther, PJ, Polascik, TJ, and D'Amico, AV. "Salvage radiation in men after prostate-specific antigen failure and the risk of death." Cancer 117.17 (September 1, 2011): 3925-3932.
PMID
21437885
Source
pubmed
Published In
Cancer
Volume
117
Issue
17
Publish Date
2011
Start Page
3925
End Page
3932
DOI
10.1002/cncr.25993

Radiation-induced erectile dysfunction using prostate-confined modern radiotherapy in a rat model.

INTRODUCTION: The mechanisms of radiation-induced erectile dysfunction (ED) are unclear, as clinical studies are limited, and previous animal models were based on wide-field irradiation, which does not model current radiotherapy (RT) techniques. AIMS: To perform functional and morphological analyses of erectile function (EF) utilizing image-guided stereotactic prostate-confined RT in a rat model. METHODS: Sixty young adult male rats aged 10-12 weeks old were divided into age-matched sham and RT groups. A single 20-Gy fraction to the prostate was delivered to RT animals. Penile bulb, shaft, and testes were excluded from treatment fields. MAIN OUTCOME MEASURES: Bioassay and intracavernous pressure (ICP) measurements were conducted at 2, 4, and 9 weeks following RT. Perfusion analysis of the corpora cavernosa (CC) was conducted using Hoechst injected prior to sacrifice. Penile shaft and cavernous nerve (CN) were evaluated by immunohistochemistry. Plasma testosterone level was analyzed using a testosterone enzyme-linked immunosorbent assay (ELISA) assay kit. RESULTS: Irradiated animals demonstrated statistically significant time-dependent functional impairment of EF by bioassay and ICP measurement from 4 weeks. Neuronal nitric oxide synthase (NOS) expression was decreased in CN by 4 weeks. In CC, expression levels of anti-alpha smooth muscle actin and endothelial NOS were significantly decreased at 9 weeks. In penile dorsal vessels, smooth muscle/collagen ratio was significantly decreased at 4 and 9 weeks. Additionally, Hoechst perfusion showed time-dependent decrease in CC of RT animals, whereas CD31 expression was not affected. No toxicities were noted; testosterone levels were similar in both groups. CONCLUSION: We demonstrated time-dependent ED following image-guided stereotactic RT. Our results imply that reduction of neuronal NOS expression in cavernous nerve could trigger consecutive reduction of smooth muscle content as well as blood perfusion in CC that resulted in corporal veno-occlusive dysfunction. Present study could be a cornerstone to future research that may bring comprehensive scientific understanding of radiation-induced ED.

Authors
Kimura, M; Yan, H; Rabbani, Z; Satoh, T; Baba, S; Yin, F-F; Polascik, TJ; Donatucci, CF; Vujaskovic, Z; Koontz, BF
MLA Citation
Kimura, M, Yan, H, Rabbani, Z, Satoh, T, Baba, S, Yin, F-F, Polascik, TJ, Donatucci, CF, Vujaskovic, Z, and Koontz, BF. "Radiation-induced erectile dysfunction using prostate-confined modern radiotherapy in a rat model." J Sex Med 8.8 (August 2011): 2215-2226.
PMID
21679303
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
8
Issue
8
Publish Date
2011
Start Page
2215
End Page
2226
DOI
10.1111/j.1743-6109.2011.02351.x

Feasibility study of an intensity-modulated radiation model for the study of erectile dysfunction.

INTRODUCTION: Preclinical studies of radiotherapy (RT) induced erectile dysfunction (ED) have been limited by radiation toxicity when using large fields. AIM: To develop a protocol of rat prostate irradiation using techniques mimicking the current clinical standard of intensity modulated radiotherapy (IMRT). MAIN OUTCOME MEASURES: Quality assurance (QA) testing of plan accuracy, animal health 9 weeks after RT, and intracavernosal pressure (ICP) measurement on cavernosal nerve stimulation. METHODS: Computed tomography-based planning was used to develop a stereotactic radiosurgery (SRS) treatment plan for five young adult male Sprague-Dawley rats. Two treatment planning strategies were utilized to deliver 20 Gy in a single fraction: three-dimensional dynamic conformal arc and intensity-modulated arc (RapidArc). QA testing was performed for each plan type. Treatment was delivered using a NovalisTX (Varian Medical Systems) with high-definition multi-leaf collimators using on-board imaging prior to treatment. Each animal was evaluated for ED 2 months after treatment by nerve stimulation and ICP measurement. RESULTS: The mean prostate volume and target volume (5 mm expansion of prostate) for the five animals was 0.36 and 0.66 cm3, respectively. Both conformal and RapidArc plans provided at least 95% coverage of the target volume, with rapid dose fall-off. QA plans demonstrated strong agreement between doses of calculated and delivered plans, although the conformal arc plan was more homogenous in treatment delivery. Treatment was well tolerated by the animals with no toxicity out to 9 weeks. Compared with control animals, significant reduction in ICP/mean arterial pressure, maximum ICP, and ICP area under the curve were noted. CONCLUSION: Tightly conformal dynamic arc prostate irradiation is feasible and results in minimal toxicity and measurable changes in erectile function.

Authors
Koontz, BF; Yan, H; Kimura, M; Vujaskovic, Z; Donatucci, C; Yin, F-F
MLA Citation
Koontz, BF, Yan, H, Kimura, M, Vujaskovic, Z, Donatucci, C, and Yin, F-F. "Feasibility study of an intensity-modulated radiation model for the study of erectile dysfunction." J Sex Med 8.2 (February 2011): 411-418.
PMID
21143413
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
8
Issue
2
Publish Date
2011
Start Page
411
End Page
418
DOI
10.1111/j.1743-6109.2010.02125.x

Re: Salvage radiation in men after prostate-specific antigen failure and the risk of death

Authors
Cotter, SE; Chen, MH; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; Robertson, CN; Walther, PJ; Polascik, TJ; D'Amico, AV
MLA Citation
Cotter, SE, Chen, MH, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, Robertson, CN, Walther, PJ, Polascik, TJ, and D'Amico, AV. "Re: Salvage radiation in men after prostate-specific antigen failure and the risk of death." Journal of Urology 186.5 (2011): 1876--.
Source
scival
Published In
The Journal of Urology
Volume
186
Issue
5
Publish Date
2011
Start Page
1876-
DOI
10.1016/j.juro.2011.08.056

3D Conformal and Intensity Modulated Radiotherapy to the Prostate Bed have Similar Biochemical Outcomes

Authors
Koontz, BF; Gerber, L; Banez, LL; Degirmenci, IT; Vujaskovic, Z; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW; Lee, WR
MLA Citation
Koontz, BF, Gerber, L, Banez, LL, Degirmenci, IT, Vujaskovic, Z, Anscher, MS, Robertson, CN, Polascik, TJ, Moul, JW, and Lee, WR. "3D Conformal and Intensity Modulated Radiotherapy to the Prostate Bed have Similar Biochemical Outcomes." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S406
End Page
S407

Exploring the Ideal Therapeutic Window for Successful Post-prostatectomy Salvage Radiotherapy (SRT) Below a Relapsed PSA of 1.0 ng/mL

Authors
Karlin, JD; Koontz, BF; Mukhopadhyay, ND; Hagan, MP; Anscher, MS; Moghanaki, D
MLA Citation
Karlin, JD, Koontz, BF, Mukhopadhyay, ND, Hagan, MP, Anscher, MS, and Moghanaki, D. "Exploring the Ideal Therapeutic Window for Successful Post-prostatectomy Salvage Radiotherapy (SRT) Below a Relapsed PSA of 1.0 ng/mL." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S74-S74.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S74
End Page
S74

Neoadjuvant Radiotherapy plus Prostatectomy for High Risk Prostate Cancer

Authors
Koontz, BF; Lee, WR; Vujaskovic, Z; Carroll, M; Quaranta, BP; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Lee, WR, Vujaskovic, Z, Carroll, M, Quaranta, BP, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Neoadjuvant Radiotherapy plus Prostatectomy for High Risk Prostate Cancer." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S397
End Page
S397

Abstract P6-01-01: Risk of Invasive Breast Cancer and Ductal Carcinoma In-Situ in Women with Atypical Papillary Lesions of the Breast:

Authors
Cuneo, KC; Dash, RC; Wilke, LG; Koontz, BF
MLA Citation
Cuneo, KC, Dash, RC, Wilke, LG, and Koontz, BF. "Abstract P6-01-01: Risk of Invasive Breast Cancer and Ductal Carcinoma In-Situ in Women with Atypical Papillary Lesions of the Breast:." Cancer Research 70.24 Supplement (December 15, 2010): P6-01-01-P6-01-01.
Source
crossref
Published In
Cancer Research
Volume
70
Issue
24 Supplement
Publish Date
2010
Start Page
P6-01-01
End Page
P6-01-01
DOI
10.1158/0008-5472.SABCS10-P6-01-01

Carcinoma of the urethra: radiation oncology.

Urethral cancer is a rare but aggressive neoplasm. Early-stage distal lesions can be successfully treated with a single modality. Results for definitive radiotherapy using either or both external beam radiation therapy and brachytherapy have shown excellent cure rates in men and women. The primary advantage of radiotherapy is organ preservation. Advanced tumors, however, have poor outcomes with single modality treatment. Results have been improved using a combination of radiotherapy and chemotherapy, chiefly 5-fluorouracil and mitomycin C. Although literature is limited to case reports because of the rarity of the disease, the markedly improved results compared with older results of surgery with or without radiation warrant consideration.

Authors
Koontz, BF; Lee, WR
MLA Citation
Koontz, BF, and Lee, WR. "Carcinoma of the urethra: radiation oncology." Urol Clin North Am 37.3 (August 2010): 459-466.
PMID
20674700
Source
pubmed
Published In
Urologic Clinics of North America
Volume
37
Issue
3
Publish Date
2010
Start Page
459
End Page
466
DOI
10.1016/j.ucl.2010.04.007

TH-C-204B-07: Development of Image-Guided Radiosurgery with Novalis TX for Small Animal Study

Authors
Yan, H; Koontz, B; Kimura, M; Vujaskovic, Z; Yin, F
MLA Citation
Yan, H, Koontz, B, Kimura, M, Vujaskovic, Z, and Yin, F. "TH-C-204B-07: Development of Image-Guided Radiosurgery with Novalis TX for Small Animal Study." June 2010.
Source
crossref
Published In
Medical physics
Volume
37
Issue
6Part13
Publish Date
2010
Start Page
3456
End Page
3456
DOI
10.1118/1.3469500

Salvage Radiation in Men with PSA Failure following Radical Prostatectomy and the Risk of Death

Authors
Cotter, SE; Chen, M; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; D'Amico, AV
MLA Citation
Cotter, SE, Chen, M, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, and D'Amico, AV. "Salvage Radiation in Men with PSA Failure following Radical Prostatectomy and the Risk of Death." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S149
End Page
S149

A Modern Animal Model of Radiation-induced Erectile Dysfunction

Authors
Kimura, M; Koontz, BF; Yan, H; Rabbani, Z; Satoh, T; Baba, S; Yin, F; Donatucci, CF; Polascik, TJ; Vujaskovic, Z
MLA Citation
Kimura, M, Koontz, BF, Yan, H, Rabbani, Z, Satoh, T, Baba, S, Yin, F, Donatucci, CF, Polascik, TJ, and Vujaskovic, Z. "A Modern Animal Model of Radiation-induced Erectile Dysfunction." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S40
End Page
S40

Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy.

OBJECTIVE: To compare open radical prostatectomy (RP) and robot-assisted laparoscopic prostatectomy (RALP), and to determine whether RALP is associated with a higher risk of features that determine recommendations for postoperative radiation therapy (RT). PATIENTS AND METHODS: Patients undergoing RP from 2003 to 2007 were stratified into two groups: open RP and RALP. Preoperative (PSA level, T stage and Gleason score), pathological factors (T stage, Gleason score, extracapsular extension [ECE] and the status of surgical margins and seminal vesicle invasion [SVI]) and early treatment with RT or referral for RT within 6 months were compared between the groups. Multivariate analysis was used to control for selection bias in the RALP group. RESULTS: In all, 904 patients were identified; 368 underwent RALP and 536 underwent open RP (retropubic or perineal). Patients undergoing open RP had a higher pathological stage with ECE present in 24.8% vs 19.3% in RALP (P = 0.05) and SVI in 10.3% vs 3.8% (P < 0.001). In the RALP vs open RP group, there were positive surgical margins in 31.5% vs 31.9% (P = 0.9) and there were postoperative PSA levels of (3) 0.2 ng/mL in 5.7% vs 6.3% (P = 0.7), respectively. On multivariate analysis to control for selection bias, RALP was not associated with indication for RT (odds ratio (OR) 1.10, P = 0.55), or referral for RT (OR 1.04, P = 0.86). CONCLUSION: RALP was not associated with an increase in either indication or referral for early postoperative RT.

Authors
Chino, J; Schroeck, FR; Sun, L; Lee, WR; Albala, DM; Moul, JW; Koontz, BF
MLA Citation
Chino, J, Schroeck, FR, Sun, L, Lee, WR, Albala, DM, Moul, JW, and Koontz, BF. "Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy." BJU Int 104.10 (November 2009): 1496-1500.
PMID
19388991
Source
pubmed
Published In
Bju International
Volume
104
Issue
10
Publish Date
2009
Start Page
1496
End Page
1500
DOI
10.1111/j.1464-410X.2009.08588.x

Review: alcohol and other factors related to late prostate radiation injury.

Authors
Koontz, BF; Vujaskovic, Z
MLA Citation
Koontz, BF, and Vujaskovic, Z. "Review: alcohol and other factors related to late prostate radiation injury." Clin Adv Hematol Oncol 7.4 (April 2009): 262-. (Review)
PMID
19521330
Source
pubmed
Published In
Clinical advances in hematology & oncology : H&O
Volume
7
Issue
4
Publish Date
2009
Start Page
262

Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer.

PURPOSE: Dose escalation has been shown beneficial in prostate cancer. Brachytherapy (BT) provides an opportunity for dose escalation beyond what can be safely delivered using only teletherapy methods. The purpose of this study was to determine cancer control and morbidity of external beam radiation therapy (EBRT) plus low-dose-rate (LDR) BT boost in patients with prostate cancer treated at Duke University Health System. METHODS: Between June 1997 and August 2007, 199 patients were consecutively treated at our facility with 46Gy EBRT followed by 100Gy palladium-103 ((103)Pd) or 120Gy iodine-125 ((125)I) LDR prostate implant. Treatment characteristics and followup data were retrospectively analyzed. Intermediate risk was defined as T2b-c, Gleason score 7 (GS 7), or prostate-specific antigen (PSA) of 10.1-19.9ng/mL. High risk was defined as GS 8-10, PSA>20, T3+, or two intermediate risk factors. The Radiation Therapy Oncology Group toxicity scale was used to report morbidity for gastrointestinal (GI) and genitourinary (GU) effects. PSA recurrence was defined as nadir+2ng/mL. RESULTS: Median followup was 4.2 years for all patients, 4.8 years for high-risk patients. Risk categories were as follows: 20% low risk, 47% intermediate risk, and 33% high risk. Forty five percent of patients received adjuvant androgen deprivation therapy (ADT). The median length of time since end of ADT to last followup was 2.7 years in all patients, 2.0 years for high-risk patients. Five-year biochemical relapse-free survival was 87% for all, 81% for high-risk patients. PSA control was similar at 92% for all and 86% for high-risk patients. Five-year actuarial risk of any and Grade 3 late GI morbidity was 38% and 7% respectively, and any and Grade 3 late GU morbidity was 21% and 3%, respectively. There were no significant differences in risk of Grade 2+GI or GU morbidity with choice of isotope. CONCLUSIONS: EBRT plus LDR BT has acceptable morbidity and, with 5-year followup, provides excellent cancer control even in high-risk patients.

Authors
Koontz, BF; Chino, J; Lee, WR; Hahn, CA; Buckley, N; Huang, S; Kim, J; Reagan, R; Joyner, R; Anscher, MS
MLA Citation
Koontz, BF, Chino, J, Lee, WR, Hahn, CA, Buckley, N, Huang, S, Kim, J, Reagan, R, Joyner, R, and Anscher, MS. "Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer." Brachytherapy 8.2 (April 2009): 191-196.
PMID
19433320
Source
pubmed
Published In
Brachytherapy
Volume
8
Issue
2
Publish Date
2009
Start Page
191
End Page
196
DOI
10.1016/j.brachy.2009.01.002

Dosimetric and radiobiologic comparison of 3D conformal versus intensity modulated planning techniques for prostate bed radiotherapy.

Adjuvant radiotherapy for locally advanced prostate cancer improves biochemical and clinical disease-free survival. While comparisons in intact prostate cancer show a benefit for intensity modulated radiation therapy (IMRT) over 3D conformal planning, this has not been studied for post-prostatectomy radiotherapy (RT). This study compares normal tissue and target dosimetry and radiobiological modeling of IMRT vs. 3D conformal planning in the postoperative setting. 3D conformal plans were designed for 15 patients who had been treated with IMRT planning for salvage post-prostatectomy RT. The same computed tomography (CT) and target/normal structure contours, as well as prescription dose, was used for both IMRT and 3D plans. Normal tissue complication probabilities (NTCPs) were calculated based on the dose given to the bladder and rectum by both plans. Dose-volume histogram and NTCP data were compared by paired t-test. Bladder and rectal sparing were improved with IMRT planning compared to 3D conformal planning. The volume of the bladder receiving at least 75% (V75) and 50% (V50) of the dose was significantly reduced by 28% and 17%, respectively (p = 0.002 and 0.037). Rectal dose was similarly reduced, V75 by 33% and V50 by 17% (p = 0.001 and 0.004). While there was no difference in the volume of rectum receiving at least 65 Gy (V65), IMRT planning significant reduced the volume receiving 40 Gy or more (V40, p = 0.009). Bladder V40 and V65 were not significantly different between planning modalities. Despite these dosimetric differences, there was no significant difference in the NTCP for either bladder or rectal injury. IMRT planning reduces the volume of bladder and rectum receiving high doses during post-prostatectomy RT. Because of relatively low doses given to the bladder and rectum, there was no statistically significant improvement in NTCP between the 3D conformal and IMRT plans.

Authors
Koontz, BF; Das, S; Temple, K; Bynum, S; Catalano, S; Koontz, JI; Montana, GS; Oleson, JR
MLA Citation
Koontz, BF, Das, S, Temple, K, Bynum, S, Catalano, S, Koontz, JI, Montana, GS, and Oleson, JR. "Dosimetric and radiobiologic comparison of 3D conformal versus intensity modulated planning techniques for prostate bed radiotherapy." Med Dosim 34.3 (2009): 256-260.
PMID
19647638
Source
pubmed
Published In
Medical Dosimetry
Volume
34
Issue
3
Publish Date
2009
Start Page
256
End Page
260
DOI
10.1016/j.meddos.2008.10.005

Alcohol and other factors related to late prostate radiation injury

Authors
Koontz, BF; Vujaskovic, Z
MLA Citation
Koontz, BF, and Vujaskovic, Z. "Alcohol and other factors related to late prostate radiation injury." Clinical Advances in Hematology and Oncology 7.4 (2009): 262--.
Source
scival
Published In
Clinical advances in hematology & oncology : H&O
Volume
7
Issue
4
Publish Date
2009
Start Page
262-

Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer.

PURPOSE: The (111)In-capromab pendetide scan (ProstaScint; Cytogen Corp., Princeton NJ) is approved by the Food and Drug Administration to evaluate increasing prostate-specific antigen (PSA) levels after radical prostatectomy. This study evaluated the role of prostate bed (111)In-capromab pendetide scan findings to predict response to salvage radiotherapy (RT). METHODS AND MATERIALS: Forty patients who had PSA recurrence after radical prostatectomy and a (111)In-capromab pendetide scan immediately before salvage prostate bed RT (median, 66 Gy) were identified from the Duke Prostate Center database. Patients with distant uptake of capromab pendetide or long-term androgen deprivation therapy were excluded. Median follow-up after salvage RT was 2.7 years. Patient demographic, clinical, and pathologic characteristics; PSA values; and (111)In-capromab pendetide scan results were retrospectively analyzed. A PSA failure after salvage RT was defined as PSA level greater than 0.2 ng/ml. Data were combined with other published results in a secondary pooled analysis of 106 patients. RESULTS: (111)In-Capromab pendetide findings included 20 patients with negative scan results and 20 with locally positive scan results. Two-year progression-free survival rates were 60% for patients with a negative scan result and 74% for those with a locally positive scan result (p = 0.49). Combined analysis did not show a difference in outcome based on local (111)In-capromab pendetide scan result. CONCLUSION: For patients without distant signal detected by using (111)In-capromab pendetide scan, patients with locally positive scan findings did not have statistically different progression-free survival than those with a negative scan result, suggesting that salvage RT may be successful in patients with either a locally positive or negative (111)In-capromab pendetide scan result.

Authors
Koontz, BF; Mouraviev, V; Johnson, JL; Mayes, J; Chen, SH; Wong, TZ; Anscher, MS; Sun, L; Moul, J; Polascik, TJ
MLA Citation
Koontz, BF, Mouraviev, V, Johnson, JL, Mayes, J, Chen, SH, Wong, TZ, Anscher, MS, Sun, L, Moul, J, and Polascik, TJ. "Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer." Int J Radiat Oncol Biol Phys 71.2 (June 1, 2008): 358-361.
PMID
18164863
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
71
Issue
2
Publish Date
2008
Start Page
358
End Page
361
DOI
10.1016/j.ijrobp.2007.10.020

Re: Neoadjuvant therapy followed by prostatectomy for clinically localized prostate cancer.

Authors
Koontz, BF; Moul, J
MLA Citation
Koontz, BF, and Moul, J. "Re: Neoadjuvant therapy followed by prostatectomy for clinically localized prostate cancer." Cancer 112.11 (June 2008): 2518-2519. (Letter)
PMID
18338760
Source
pubmed
Published In
Cancer
Volume
112
Issue
11
Publish Date
2008
Start Page
2518
End Page
2519
DOI
10.1002/cncr.23464

Preoperative radiotherapy and bevacizumab for angiosarcoma of the head and neck: two case studies.

BACKGROUND: Angiosarcoma of the face is a vascular tumor with poor local control and short median survival despite standard treatment. Bevacizumab is a humanized monoclonal antibody to vascular endothelial growth factor (VEGF), which can inhibit tumor growth. It is synergistic with radiotherapy in gastrointestinal malignancies. Given the vascular nature of angiosarcoma and the need for better treatment of this disease, we investigated the concurrent use of bevacizumab with preoperative radiotherapy for head and neck angiosarcoma. METHODS: Two patients diagnosed with angiosarcoma of the nose were treated preoperatively with bevacizumab (5-10 mg/kg) and concurrent radiotherapy (50 Gy), followed by resection of the tumor bed. RESULTS: Both patients had a complete pathologic response with no residual disease. Neither has developed recurrence, with follow-up of 8.5 months and 2.1 years. CONCLUSIONS: The neoadjuvant combination of bevacizumab and radiation therapy is promising and should be further studied in the setting of vascular malignancies.

Authors
Koontz, BF; Miles, EF; Rubio, MAD; Madden, JF; Fisher, SR; Scher, RL; Brizel, DM
MLA Citation
Koontz, BF, Miles, EF, Rubio, MAD, Madden, JF, Fisher, SR, Scher, RL, and Brizel, DM. "Preoperative radiotherapy and bevacizumab for angiosarcoma of the head and neck: two case studies." Head Neck 30.2 (February 2008): 262-266.
PMID
17685450
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
30
Issue
2
Publish Date
2008
Start Page
262
End Page
266
DOI
10.1002/hed.20674

Neoadjuvant therapy followed by prostatectomy for clinically localized prostate cancer

Authors
Koontz, BF; Moul, J
MLA Citation
Koontz, BF, and Moul, J. "Neoadjuvant therapy followed by prostatectomy for clinically localized prostate cancer." Cancer 112.11 (2008): 2518-2519.
Source
scival
Published In
Cancer
Volume
112
Issue
11
Publish Date
2008
Start Page
2518
End Page
2519
DOI
10.1002/cncr.23464

Does robotic prostatectomy increase the need for adjuvant radiation therapy? The impact of choice of surgery and pretreatment disease characteristics on adjuvant indications

Authors
Chino, JP; Schroeck, FR; Sun, L; Lee, W; Albala, DM; Moul, JW; Koontz, BF
MLA Citation
Chino, JP, Schroeck, FR, Sun, L, Lee, W, Albala, DM, Moul, JW, and Koontz, BF. "Does robotic prostatectomy increase the need for adjuvant radiation therapy? The impact of choice of surgery and pretreatment disease characteristics on adjuvant indications." 2008.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
S304
End Page
S304
DOI
10.1016/j.ijrobp.2008.06.1065

What factors influence referral for postoperative radiation therapy for prostate cancer?

Authors
Koontz, BF; Chino, J; Schroeck, FR; Sun, L; Lee, WR; Moul, JW
MLA Citation
Koontz, BF, Chino, J, Schroeck, FR, Sun, L, Lee, WR, and Moul, JW. "What factors influence referral for postoperative radiation therapy for prostate cancer?." 2008.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
S137
End Page
S137
DOI
10.1016/j.ijrobp.2008.06.451

Dosimetric comparison of patient-specific margins Vs. uniform margins for prostate IMRT treatments

Authors
Yoo, S; Das, S; Kim, S; Koontz, B; Lee, W; Light, K; Yin, F
MLA Citation
Yoo, S, Das, S, Kim, S, Koontz, B, Lee, W, Light, K, and Yin, F. "Dosimetric comparison of patient-specific margins Vs. uniform margins for prostate IMRT treatments." June 2007.
Source
wos-lite
Published In
Medical physics
Volume
34
Issue
6
Publish Date
2007
Start Page
2383
End Page
2383
DOI
10.1118/1.2760573

Estimation of dose variations during prostate radiation treatment due to elastic deformations of soft tissues

Authors
Stakhursky, V; Das, S; Yoo, S; Yin, F; Kim, S; Koontz, B
MLA Citation
Stakhursky, V, Das, S, Yoo, S, Yin, F, Kim, S, and Koontz, B. "Estimation of dose variations during prostate radiation treatment due to elastic deformations of soft tissues." June 2007.
Source
wos-lite
Published In
Medical physics
Volume
34
Issue
6
Publish Date
2007
Start Page
2386
End Page
2387
DOI
10.1118/1.2760586

Palliative radiation therapy for metastatic Ewing sarcoma.

BACKGROUND: Although radiotherapy is an accepted component of curative treatment for Ewing sarcoma (EWS), to the authors' knowledge, there are scant data evaluating its use for palliation. The authors reviewed the Duke University Medical Center experience to evaluate treatment response and response durability. METHODS: Between 1980 and 2002, 21 patients with metastatic EWS received palliative radiotherapy. Pain was the primary indication for treatment. The majority of patients were male (n = 16 patients), and the median age at diagnosis was 11.6 years (range, 2.7-28.8 yrs). Fifty-two percent of patients had metastases at initial diagnosis. For the others, the median interval from initial diagnosis to metastases was 1.7 years. RESULTS: Sixty-three metastatic sites were irradiated (median dose, 30 gray [Gy]; range, 4.5-68.5 Gy), and a median of 3 sites were treated per patient (range, 1-16 sites per patient). At the time of last follow-up, 1 patient with a solitary brain metastasis has been disease free for 3.4 years after resection and cranial radiotherapy; all other patients died of their disease. Censoring this survivor, patients lived for a median of 1.0 year after metastatic diagnosis (range, from 17 days to 6.8 years), 41 days of which were spent in treatment (range, 1-93 days). Of all sites, 55% had a complete clinical response of symptoms, and 29% had a partial response. The median response duration was 4.0 months (range, 10 days to 4.8 years). Only the survivor was noted to have a treatment complication (growth hormone insufficiency). CONCLUSIONS: It was possible to treat metastatic EWS effectively with palliative radiotherapy. Because these patients live a median of 1 year after diagnosis of metastases, providing symptom relief without a protracted treatment course is valuable and appropriate therapy.

Authors
Koontz, BF; Clough, RW; Halperin, EC
MLA Citation
Koontz, BF, Clough, RW, and Halperin, EC. "Palliative radiation therapy for metastatic Ewing sarcoma." Cancer 106.8 (April 15, 2006): 1790-1793.
PMID
16534788
Source
pubmed
Published In
Cancer
Volume
106
Issue
8
Publish Date
2006
Start Page
1790
End Page
1793
DOI
10.1002/cncr.21812

Combined-modality therapy versus radiotherapy alone for treatment of early-stage Hodgkin's disease: cure balanced against complications.

PURPOSE: The treatment of early-stage Hodgkin's disease (HD) has evolved from radiotherapy alone (RT) to combined-modality therapy (CMT) because of concerns about late adverse effects from high-dose subtotal nodal irradiation (STNI). However, there is little information regarding the long-term results of CMT programs that substantially reduce the dose and extent of radiation. In addition, lowering the total radiation dose may reduce the complication rate without compromising cure. This retrospective study compares the long-term results of STNI with CMT using modestly reduced RT dose in the treatment of early-stage HD. PATIENTS AND METHODS: Between 1982 and 2002, 111 patients with stage IA and IIA HD were treated definitively with RT (mean dose, 37.9 Gy); 70 patients were treated with CMT with low-dose involved-field radiotherapy (LDIFRT; mean dose, 25.5 Gy). Median follow-up was 11.7 years for RT patients and 8.1 years for the CMT group. RESULTS: There was a trend toward improved 20-year overall survival with CMT (83% v 70%; P = .405). No second cancers were observed in the CMT group; in the RT group the actuarial frequency of a second cancer was 16% at 20 years. There was no difference in the frequency of cardiac complications (9% v 6%, RT v CMT). CONCLUSION: In this retrospective review, CMT with LDIFRT was effective in curing early-stage HD and was not associated with an increase in second malignancies. For RT alone, a moderate dose seemed to reduce cardiac complications but did not lessen second malignancies compared with higher doses used historically.

Authors
Koontz, BF; Kirkpatrick, JP; Clough, RW; Prosnitz, RG; Gockerman, JP; Moore, JO; Prosnitz, LR
MLA Citation
Koontz, BF, Kirkpatrick, JP, Clough, RW, Prosnitz, RG, Gockerman, JP, Moore, JO, and Prosnitz, LR. "Combined-modality therapy versus radiotherapy alone for treatment of early-stage Hodgkin's disease: cure balanced against complications." J Clin Oncol 24.4 (February 1, 2006): 605-611.
PMID
16446333
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
24
Issue
4
Publish Date
2006
Start Page
605
End Page
611
DOI
10.1200/JCO.2005.02.9850

Radiation therapy alone or combined with chemotherapy for early-stage Hodgkin's disease: A case study

Authors
Koontz, BF; Prosnitz, LR
MLA Citation
Koontz, BF, and Prosnitz, LR. "Radiation therapy alone or combined with chemotherapy for early-stage Hodgkin's disease: A case study." American Journal of Oncology Review 5.6 (2006): 360-363.
Source
scival
Published In
American Journal of Oncology Review
Volume
5
Issue
6
Publish Date
2006
Start Page
360
End Page
363

Evaluation of adequate margin size for prostate IMRT by cone-beam CT interfraction imaging

Authors
Koontz, BF; Yoo, S; Kim, S; Das, S; Anscher, M; Yin, F
MLA Citation
Koontz, BF, Yoo, S, Kim, S, Das, S, Anscher, M, and Yin, F. "Evaluation of adequate margin size for prostate IMRT by cone-beam CT interfraction imaging." 2006.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
66
Issue
3
Publish Date
2006
Start Page
S623
End Page
S623
DOI
10.1016/j.ijrobp.2006.07.1158

Effects of magnesium ions on the stabilization of RNA oligomers of defined structures.

Optical melting was used to determine the stabilities of 11 small RNA oligomers of defined secondary structure as a function of magnesium ion concentration. The oligomers included helices composed of Watson-Crick base pairs, GA tandem base pairs, GU tandem base pairs, and loop E motifs (both eubacterial and eukaryotic). The effect of magnesium ion concentration on stability was interpreted in terms of two simple models. The first assumes an uptake of metal ion upon duplex formation. The second assumes nonspecific electrostatic attraction of metal ions to the RNA oligomer. For all oligomers, except the eubacterial loop E, the data could best be interpreted as nonspecific binding of metal ions to the RNAs. The effect of magnesium ions on the stability of the eubacterial loop E was distinct from that seen with the other oligomers in two ways. First, the extent of stabilization by magnesium ions (as measured by either change in melting temperature or free energy) was three times greater than that observed for the other helical oligomers. Second, the presence of magnesium ions produces a doubling of the enthalpy for the melting transition. These results indicate that magnesium ion stabilizes the eubacterial loop E sequence by chelating the RNA specifically. Further, these results on a rather small system shed light on the large enthalpy changes observed upon thermal unfolding of large RNAs like group I introns. It is suggested that parts of those large enthalpy changes observed in the folding of RNAs may be assigned to variations in the hydration states and types of coordinating atoms in some specifically bound magnesium ions and to an increase in the observed cooperativity of the folding transition due to the binding of those magnesium ions coupling the two stems together. Brownian dynamic simulations, carried out to visualize the metal ion binding sites, reveal rather delocalized ionic densities in all oligomers, except for the eubacterial loop E, in which precisely located ion densities were previously calculated.

Authors
Serra, MJ; Baird, JD; Dale, T; Fey, BL; Retatagos, K; Westhof, E
MLA Citation
Serra, MJ, Baird, JD, Dale, T, Fey, BL, Retatagos, K, and Westhof, E. "Effects of magnesium ions on the stabilization of RNA oligomers of defined structures." RNA 8.3 (March 2002): 307-323.
PMID
12003491
Source
pubmed
Published In
RNA (New York, N.Y.)
Volume
8
Issue
3
Publish Date
2002
Start Page
307
End Page
323
Show More

Research Areas:

  • Adult
  • Aged
  • Androgen Antagonists
  • Animals
  • Antibodies, Monoclonal
  • Biological Markers
  • Bone Neoplasms
  • Brachytherapy
  • Breast Neoplasms
  • Chemotherapy, Adjuvant
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Disease Models, Animal
  • Disease-Free Survival
  • Dose-Response Relationship, Radiation
  • Epidemiologic Methods
  • Erectile Dysfunction
  • Follow-Up Studies
  • Head and Neck Neoplasms
  • Health Facilities
  • Heart Diseases
  • Hospitals
  • Humans
  • Indicators and Reagents
  • Indium Radioisotopes
  • Inflammation
  • Lymph Nodes
  • Lymphatic Irradiation
  • Male
  • Mammary Glands, Human
  • Matched-Pair Analysis
  • Middle Aged
  • Models, Molecular
  • Morbidity
  • NADPH Oxidase
  • Neoadjuvant Therapy
  • Neoplasm Grading
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Neoplasms, Hormone-Dependent
  • Neoplasms, Radiation-Induced
  • North Carolina
  • Organ Specificity
  • Oxidative Stress
  • Palliative Care
  • Patient Care Team
  • Patient Selection
  • Pelvis
  • Penile Erection
  • Penile Prosthesis
  • Penis
  • Preoperative Care
  • Prostate
  • Prostate-Specific Antigen
  • Prostatectomy
  • Prostatic Neoplasms
  • Radiation Dosage
  • Radiation Injuries
  • Radiation Injuries, Experimental
  • Radiosurgery
  • Radiotherapy
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy, Adjuvant
  • Radiotherapy, Conformal
  • Radiotherapy, High-Energy
  • Rats
  • Rats, Sprague-Dawley
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Salvage Therapy
  • Soft Tissue Neoplasms
  • Survival Rate
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tumor Markers, Biological
  • Urinary Bladder