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Lee, William Robert

Overview:

Prostate cancer, Intensity-modulated radiation therapy (IMRT), Image-guided radiation therapy (IGRT), Stereotactic Body Radiation Therapy (SBRT), Prostate HDR and LDR Brachytherapy, Quality of Life, Educational Technology

Positions:

Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Associate Professor of Surgery

Surgery, Urology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1989

M.D. — University of Virginia

M.S. 2000

M.S. — Wake Forest University

News:

Grants:

Image-Guide Radiation Therapy of Prostate Cancer

Administered By
Radiation Oncology
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 01, 2006
End Date
July 31, 2011

Digital tomosynthesis: a new paradigm for radiation treatment verification

Administered By
Radiation Oncology
AwardedBy
National Institutes of Health
Role
Collaborator
Start Date
August 11, 2007
End Date
July 31, 2009

Publications:

Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer.

Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT).To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM).A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo.WPRT and/or ADT in addition to PBRT.FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression.Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p<0.001) and no ADT versus ADT (HR 1.70, p<0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p<0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p=0.012). No significant differences in DM cumulative incidence were found.For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival.We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning).

Authors
Ramey, SJ; Agrawal, S; Abramowitz, MC; Moghanaki, D; Pisansky, TM; Efstathiou, JA; Michalski, JM; Spratt, DE; Hearn, JWD; Koontz, BF; Liauw, SL; Pollack, A; Anscher, MS; Den, RB; Stephans, KL; Zietman, AL; Lee, WR; Stephenson, AJ; Tendulkar, RD
MLA Citation
Ramey, SJ, Agrawal, S, Abramowitz, MC, Moghanaki, D, Pisansky, TM, Efstathiou, JA, Michalski, JM, Spratt, DE, Hearn, JWD, Koontz, BF, Liauw, SL, Pollack, A, Anscher, MS, Den, RB, Stephans, KL, Zietman, AL, Lee, WR, Stephenson, AJ, and Tendulkar, RD. "Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer." European urology (November 8, 2017).
PMID
29128208
Source
epmc
Published In
European Urology
Publish Date
2017

Multi-institutional Outcomes of Postprostatectomy Adjuvant Versus Early Salvage Radiation Therapy in Prostate Cancer Patients With Adverse Pathologic Features

Authors
Hwang, W; Tendulkar, RD; Niemierko, A; Agrawal, S; Stephans, KL; Spratt, DE; Hearn, JWD; Koontz, BF; Lee, WR; Michalski, JM; Pisansky, TM; Liauw, S; Abramowitz, MC; Pollack, A; Moghanaki, D; Anscher, MS; Den, RB; Zietman, AL; Stephenson, AJ; Efstathiou, JA
MLA Citation
Hwang, W, Tendulkar, RD, Niemierko, A, Agrawal, S, Stephans, KL, Spratt, DE, Hearn, JWD, Koontz, BF, Lee, WR, Michalski, JM, Pisansky, TM, Liauw, S, Abramowitz, MC, Pollack, A, Moghanaki, D, Anscher, MS, Den, RB, Zietman, AL, Stephenson, AJ, and Efstathiou, JA. "Multi-institutional Outcomes of Postprostatectomy Adjuvant Versus Early Salvage Radiation Therapy in Prostate Cancer Patients With Adverse Pathologic Features." October 1, 2017.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
99
Issue
2
Publish Date
2017
Start Page
S96
End Page
S97

Toxicity and Biochemical Outcomes of Hypofractionated Intensity Modulated Post-Operative Radiation Therapy for Prostate Cancer

Authors
Tandberg, DJ; Lee, WR; Salama, JK; Koontz, BF
MLA Citation
Tandberg, DJ, Lee, WR, Salama, JK, and Koontz, BF. "Toxicity and Biochemical Outcomes of Hypofractionated Intensity Modulated Post-Operative Radiation Therapy for Prostate Cancer." October 1, 2017.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
99
Issue
2
Publish Date
2017
Start Page
E267
End Page
E267

Exploring the Margin Recipe for Online Adaptive Radiation Therapy for Intermediate-Risk Prostate Cancer: An Intrafractional Seminal Vesicles Motion Analysis.

To provide a benchmark for seminal vesicle (SV) margin selection to account for intrafractional motion and to investigate the effectiveness of 2 motion surrogates in predicting intrafractional SV coverage.Fifteen prostate patients were studied. Each patient had 5 pairs (1 patient had 4 pairs) of pretreatment and posttreatment cone beam CTs (CBCTs). Each pair of CBCTs was registered on the basis of prostate fiducial markers. All pretreatment SVs were expanded with 1-, 2-, 3-, 4-, 5-, and 8-mm isotropic margins to form a series of planning target volumes, and their intrafractional coverage to the posttreatment SV determined the "ground truth" for exact coverage. Two motion surrogates, the center of mass (COM) and the border of contour, were evaluated by the use of Pearson product-moment correlation coefficient and exponential fitting for predicting SV underdosage. Action threshold of each surrogate was calculated. The margin for each surrogate was calculated according to a traditional margin recipe.Ninety-five percent posttreatment SV coverage was achieved in 9%, 53%, 73%, 86%, 95%, and 97% of fractions with 1-, 2-, 3-, 4-, 5-, and 8-mm margins, respectively. The 5-mm margins provided 95% intrafractional SV coverage in over 90% of fractions. The correlation between the COM and border was weak, moderate, and strong in the left-right (L-R), anterior-posterior (A-P), and superior-inferior (S-I) directions, respectively. Exponential fitting gave the underdosage threshold of 4.5 and 7.0 mm for the COM and border. The Van Herk margin recipe recommended 0-, 0.5-, and 0.8-mm margins in the L-R, A-P, and S-I directions based on the COM, and 1.2-, 3.9-, and 2.5-mm margins based on the border.Five-millimeter isotropic margins for the SV constitute the minimum required to mitigate the intrafractional motion. Both the COM and the border are acceptable predictors for SV underdosage with 4.5- and 7.0-mm action threshold. Traditional margin based on the COM or border underestimates the margin.

Authors
Sheng, Y; Li, T; Lee, WR; Yin, F-F; Wu, QJ
MLA Citation
Sheng, Y, Li, T, Lee, WR, Yin, F-F, and Wu, QJ. "Exploring the Margin Recipe for Online Adaptive Radiation Therapy for Intermediate-Risk Prostate Cancer: An Intrafractional Seminal Vesicles Motion Analysis." International journal of radiation oncology, biology, physics 98.2 (June 2017): 473-480.
PMID
28463167
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
98
Issue
2
Publish Date
2017
Start Page
473
End Page
480
DOI
10.1016/j.ijrobp.2017.02.089

Why the Aversion?

Authors
Lee, WR
MLA Citation
Lee, WR. "Why the Aversion?." Journal of Graduate Medical Education 9.2 (April 2017): 255-.
PMID
28439366
Source
epmc
Published In
Journal of graduate medical education
Volume
9
Issue
2
Publish Date
2017
Start Page
255
DOI
10.4300/jgme-d-16-00850.1

Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer.

Authors
Bekelman, JE; Lee, WR
MLA Citation
Bekelman, JE, and Lee, WR. "Six Questions to Ask Before We Shorten Radiation Treatments for Intact Prostate Cancer." International journal of radiation oncology, biology, physics 97.4 (March 2017): 718-721.
PMID
28244406
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
97
Issue
4
Publish Date
2017
Start Page
718
End Page
721
DOI
10.1016/j.ijrobp.2016.11.038

Toxicity and quality of life report of a phase II study of stereotactic body radiotherapy (SBRT) for low and intermediate risk prostate cancer.

Clinical data indicates that delivery of larger daily doses of radiation may improve the therapeutic ratio for prostate cancer compared to conventional fractionation. A phase II study of stereotactic body radiotherapy with real-time motion management and daily plan re-optimization for low to intermediate risk prostate cancer was undertaken to evaluate this hypothesis. This report details the toxicity and quality of life following treatment.From 2009 to 2013, 60 patients with T1-T2c prostate cancer with a Gleason score of 6 and PSA ≤ 15 or Gleason score of 7 and PSA ≤ 10 were enrolled. Patients with nodal metastases, an American Urological Association symptom score > 18, or gland size > 100 g were not eligible. Patients were treated to 37 Gy in 5 fractions. Early and late genitourinary and gastrointestinal toxicity were graded based on NCI CTCAE v4.0 and quality of life was assessed by the American Urological Association symptom score, International Index of Erectile Function, and Expanded Prostate cancer Index Composite Short Form up to 36 months after treatment.After a median follow-up of 27.6 months, no grade 3 or greater genitourinary toxicity was observed. Four patients (6.7%) reported a late grade 2 genitourinary toxicity. One patient (1.7%) reported a late grade 3 gastrointestinal toxicity. Five patients (8.3%) developed a late grade 2 gastrointestinal toxicity. The median American Urological Association symptom score increased from 4.5 prior to treatment to 11 while on treatment (p < 0.01), but was 5 at 36 months post-treatment (p = 0.65). Median International Index of Erectile Function scores decreased from 19 to 17 over the course of follow-up (p < 0.01). Only median scores within the Expanded Prostate Cancer Index Composite Short Form sexual domain were significantly decreased at 36 months post-treatment (67.9 vs 45.2, p = 0.02). There was no significant difference in median score within the urinary, bowel, or hormonal domains at 36 months of follow-up.Stereotactic body radiotherapy for low to intermediate risk prostate cancer is well tolerated with limited toxicity or decrease in quality of life. Longer follow-up is necessary to assess the efficacy of treatment.Clinicaltrials.gov NCT00941915 Registered 17 June 2009.

Authors
Boyer, MJ; Papagikos, MA; Kiteley, R; Vujaskovic, Z; Wu, J; Lee, WR
MLA Citation
Boyer, MJ, Papagikos, MA, Kiteley, R, Vujaskovic, Z, Wu, J, and Lee, WR. "Toxicity and quality of life report of a phase II study of stereotactic body radiotherapy (SBRT) for low and intermediate risk prostate cancer." Radiation oncology (London, England) 12.1 (January 13, 2017): 14-.
PMID
28086825
Source
epmc
Published In
Radiation Oncology
Volume
12
Issue
1
Publish Date
2017
Start Page
14
DOI
10.1186/s13014-016-0758-8

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

Invited commentary on GETUG-AFU 16.

Authors
Lee, WR
MLA Citation
Lee, WR. "Invited commentary on GETUG-AFU 16." Translational andrology and urology 5.6 (December 2016): 958-960.
PMID
28078230
Source
epmc
Published In
Translational Andrology and Urology
Volume
5
Issue
6
Publish Date
2016
Start Page
958
End Page
960
DOI
10.21037/tau.2016.11.10

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

NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results

Authors
Bruner, DW; Pugh, SL; Lee, WR; Dignam, JJ; Low, D; Swanson, GP; Shah, AB; D'Souza, DP; Michalski, JM; Dayes, IS; Seaward, SA; Nguyen, PL; Hall, WA; Pisansky, TM; Chen, Y; Sandler, HM; Movsas, B
MLA Citation
Bruner, DW, Pugh, SL, Lee, WR, Dignam, JJ, Low, D, Swanson, GP, Shah, AB, D'Souza, DP, Michalski, JM, Dayes, IS, Seaward, SA, Nguyen, PL, Hall, WA, Pisansky, TM, Chen, Y, Sandler, HM, and Movsas, B. "NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S2
End Page
S3

Toxicity and Quality of Life Report of a Phase 2 Study of Stereotactic Body Radiation Therapy (SBRT) for Low- and Intermediate-Risk Prostate Cancer

Authors
Boyer, MJ; Rushing, C; Peterson, B; Papagikos, MA; Kiteley, RA; Lee, WR
MLA Citation
Boyer, MJ, Rushing, C, Peterson, B, Papagikos, MA, Kiteley, RA, and Lee, WR. "Toxicity and Quality of Life Report of a Phase 2 Study of Stereotactic Body Radiation Therapy (SBRT) for Low- and Intermediate-Risk Prostate Cancer." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E256
End Page
E257

NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results

Authors
Bruner, DW; Pugh, SL; Lee, WR; Dignam, JJ; Low, D; Swanson, GP; Shah, AB; D'Souza, DP; Michalski, JM; Dayes, IS; Seaward, SA; Nguyen, PL; Hall, WA; Pisansky, TM; Chen, Y; Sandler, HM; Movsas, B
MLA Citation
Bruner, DW, Pugh, SL, Lee, WR, Dignam, JJ, Low, D, Swanson, GP, Shah, AB, D'Souza, DP, Michalski, JM, Dayes, IS, Seaward, SA, Nguyen, PL, Hall, WA, Pisansky, TM, Chen, Y, Sandler, HM, and Movsas, B. "NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S2
End Page
S3

NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results.

Authors
Watkins Bruner, D; Pugh, SL; Lee, WR; Dignam, JJ; Low, D; Swanson, GP; Shah, AB; D'Souza, DP; Michalski, JM; Dayes, IS; Seaward, SA; Nguyen, PL; Hall, WA; Pisansky, TM; Chen, Y; Sandler, HM; Movsas, B
MLA Citation
Watkins Bruner, D, Pugh, SL, Lee, WR, Dignam, JJ, Low, D, Swanson, GP, Shah, AB, D'Souza, DP, Michalski, JM, Dayes, IS, Seaward, SA, Nguyen, PL, Hall, WA, Pisansky, TM, Chen, Y, Sandler, HM, and Movsas, B. "NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results." International journal of radiation oncology, biology, physics 96.2S (October 2016): S2-S3.
PMID
27675773
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S2
End Page
S3
DOI
10.1016/j.ijrobp.2016.06.023

Toxicity and Quality of Life Report of a Phase 2 Study of Stereotactic Body Radiation Therapy (SBRT) for Low- and Intermediate-Risk Prostate Cancer.

Authors
Boyer, MJ; Rushing, C; Peterson, B; Papagikos, MA; Kiteley, RA; Lee, WR
MLA Citation
Boyer, MJ, Rushing, C, Peterson, B, Papagikos, MA, Kiteley, RA, and Lee, WR. "Toxicity and Quality of Life Report of a Phase 2 Study of Stereotactic Body Radiation Therapy (SBRT) for Low- and Intermediate-Risk Prostate Cancer." International journal of radiation oncology, biology, physics 96.2S (October 2016): E256-E257.
PMID
27674191
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E256
End Page
E257
DOI
10.1016/j.ijrobp.2016.06.1266

Developing Teaching Strategies in the EHR Era: A Survey of GME Experts.

There is limited information on the impact of widespread adoption of the electronic health record (EHR) on graduate medical education (GME).To identify areas of consensus by education experts, where the use of EHR impacts GME, with the goal of developing strategies and tools to enhance GME teaching and learning in the EHR environment.Information was solicited from experienced US physician educators who use EPIC EHR following 3 steps: 2 rounds of online surveys using the Delphi technique, followed by telephone interviews. The survey contained 3 stem questions and 52 items with Likert-scale responses. Consensus was defined by predetermined cutoffs. A second survey reassessed items for which consensus was not initially achieved. Common themes to improve GME in settings with an EHR were compiled from the telephone interviews.The panel included 19 physicians in 15 states in Round 1, 12 in Round 2, and 10 for the interviews. Ten items were found important for teaching and learning: balancing focus on EHR documentation with patient engagement achieved 100% consensus. Other items achieving consensus included adequate learning time, balancing EHR data with verbal history and physical examination, communicating clinical thought processes, hands-on EHR practice, minimizing data repetition, and development of shortcuts and templates. Teaching strategies incorporating both online software and face-to-face solutions were identified during the interviews.New strategies are needed for effective teaching and learning of residents and fellows, capitalizing on the potential of the EHR, while minimizing any unintended negative impact on medical education.

Authors
Atwater, AR; Rudd, M; Brown, A; Wiener, JS; Benjamin, R; Lee, WR; Rosdahl, JA
MLA Citation
Atwater, AR, Rudd, M, Brown, A, Wiener, JS, Benjamin, R, Lee, WR, and Rosdahl, JA. "Developing Teaching Strategies in the EHR Era: A Survey of GME Experts." Journal of graduate medical education 8.4 (October 2016): 581-586.
PMID
27777671
Source
epmc
Published In
Journal of graduate medical education
Volume
8
Issue
4
Publish Date
2016
Start Page
581
End Page
586
DOI
10.4300/jgme-d-15-00788.1

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

Hypofractionation for prostate cancer: tested and proven.

Authors
Lee, WR
MLA Citation
Lee, WR. "Hypofractionation for prostate cancer: tested and proven." The Lancet. Oncology 17.8 (August 2016): 1020-1022.
PMID
27339117
Source
epmc
Published In
The Lancet Oncology
Volume
17
Issue
8
Publish Date
2016
Start Page
1020
End Page
1022
DOI
10.1016/s1470-2045(16)30150-4

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

In regard to Wu and Vapiwala et al.

Authors
Meyer, JE; Dilling, TJ; Amdur, RJ; Strasser, JF; Tendulkar, R; Lee, WR; Jani, AB; Elshaikh, M; Poppe, MM; Takita, C; Currey, A; Cheng, SK; Jagsi, R; Kuo, JV; Chen, AM; Dragun, AE; Bradley, K; Beriwal, S; Smith, RP; Chen, RC; Rosenzweig, K; Kim, S; Mehta, K
MLA Citation
Meyer, JE, Dilling, TJ, Amdur, RJ, Strasser, JF, Tendulkar, R, Lee, WR, Jani, AB, Elshaikh, M, Poppe, MM, Takita, C, Currey, A, Cheng, SK, Jagsi, R, Kuo, JV, Chen, AM, Dragun, AE, Bradley, K, Beriwal, S, Smith, RP, Chen, RC, Rosenzweig, K, Kim, S, and Mehta, K. "In regard to Wu and Vapiwala et al." International journal of radiation oncology, biology, physics 94.4 (March 2016): 858-859. (Letter)
PMID
26972659
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
4
Publish Date
2016
Start Page
858
End Page
859
DOI
10.1016/j.ijrobp.2015.12.001

NRG Oncology RTOG 0415: A randomized phase III non-inferiority study comparing two fractionation schedules in patients with low-risk prostate cancer

Authors
Lee, WR; Dignam, JJ; Amin, M; Bruner, D; Low, D; Swanson, GP; Shah, A; D'Souza, D; Michalski, JM; Dayes, I; 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, A, D'Souza, D, Michalski, JM, Dayes, I, 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 III non-inferiority study comparing two fractionation schedules in patients with low-risk prostate cancer." January 10, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
2
Publish Date
2016

Six-Year Checkup: Narrowing the Scope of Practical Radiation Oncology.

Authors
Lee, WR
MLA Citation
Lee, WR. "Six-Year Checkup: Narrowing the Scope of Practical Radiation Oncology." Practical radiation oncology 6.1 (January 2016): 1-2.
PMID
26679423
Source
epmc
Published In
Practical Radiation Oncology
Volume
6
Issue
1
Publish Date
2016
Start Page
1
End Page
2
DOI
10.1016/j.prro.2015.11.009

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

Longitudinal Trends in Costs of Palliative Radiation for Metastatic Prostate Cancer

Authors
Robinson, TJ; Dinan, MA; Li, Y; Lee, WR; Reed, SD
MLA Citation
Robinson, TJ, Dinan, MA, Li, Y, Lee, WR, and Reed, SD. "Longitudinal Trends in Costs of Palliative Radiation for Metastatic Prostate Cancer." JOURNAL OF PALLIATIVE MEDICINE 18.11 (November 1, 2015): 933-939.
Source
wos-lite
Published In
Journal of Palliative Medicine
Volume
18
Issue
11
Publish Date
2015
Start Page
933
End Page
939
DOI
10.1089/jpm.2015.0171

Longitudinal Trends in Costs of Palliative Radiation for Metastatic Prostate Cancer.

In recent years, palliative treatment of prostate cancer metastases has been characterized by the use of more complex radiation treatment, despite a lack of evidence demonstrating a clinical benefit of these technologies in the palliative setting. The impact of adoption of these technologies on the costs of palliative radiation treatment in patients with metastatic prostate cancer remains poorly understood in the general patient population.The study was a retrospective analysis of Surveillance, Epidemiology and End Results (SEER) Medicare data of men aged 66 and older who died from metastatic prostate cancer between 2000 and 2007 and received radiation therapy for bony metastases in the last year of life. Direct costs were obtained from Medicare carrier and outpatient facility payments for all radiation treatment claims and adjusted to 2008 dollars.A total of 1705 men met study inclusion criteria. Total Medicare payments for radiation therapy for bony metastases in the last year of life increased by 44.4% from an average of $2,763 in 2000 to $3,989 in 2007, with the proportion of all payments accrued within hospital-based settings increasing from 48% to 57%. Complexity of radiation therapy techniques over the same period was characterized by use of less simple (30.1% to 23.3%) and more complex (59.9% versus 66.7%) radiation therapy. From 2000-2003 to 2004-2007, the use of shorter treatment courses (≤5 fractions) decreased from 22% to 14%, and the use of single fraction treatment courses decreased by half (6.3% to 2.9%; P≤.001).Between 2000 and 2007, palliative radiation therapy for bony prostate cancer metastases was characterized by the use of more advanced treatment technologies and prolonged radiation treatment courses. Further research investigating barriers to cost-effective palliation is warranted.

Authors
Robinson, TJ; Dinan, MA; Li, Y; Lee, WR; Reed, SD
MLA Citation
Robinson, TJ, Dinan, MA, Li, Y, Lee, WR, and Reed, SD. "Longitudinal Trends in Costs of Palliative Radiation for Metastatic Prostate Cancer." November 2015.
PMID
26241733
Source
epmc
Published In
Journal of Palliative Medicine
Volume
18
Issue
11
Publish Date
2015
Start Page
933
End Page
939
DOI
10.1089/jpm.2015.0171

Atlas-guided prostate intensity modulated radiation therapy (IMRT) planning.

An atlas-based IMRT planning technique for prostate cancer was developed and evaluated. A multi-dose atlas was built based on the anatomy patterns of the patients, more specifically, the percent distance to the prostate and the concaveness angle formed by the seminal vesicles relative to the anterior-posterior axis. A 70-case dataset was classified using a k-medoids clustering analysis to recognize anatomy pattern variations in the dataset. The best classification, defined by the number of classes or medoids, was determined by the largest value of the average silhouette width. Reference plans from each class formed a multi-dose atlas. The atlas-guided planning (AGP) technique started with matching the new case anatomy pattern to one of the reference cases in the atlas; then a deformable registration between the atlas and new case anatomies transferred the dose from the atlas to the new case to guide inverse planning with full automation. 20 additional clinical cases were re-planned to evaluate the AGP technique. Dosimetric properties between AGP and clinical plans were evaluated. The classification analysis determined that the 5-case atlas would best represent anatomy patterns for the patient cohort. AGP took approximately 1 min on average (corresponding to 70 iterations of optimization) for all cases. When dosimetric parameters were compared, the differences between AGP and clinical plans were less than 3.5%, albeit some statistical significances observed: homogeneity index (p  >  0.05), conformity index (p  <  0.01), bladder gEUD (p  <  0.01), and rectum gEUD (p  =  0.02). Atlas-guided treatment planning is feasible and efficient. Atlas predicted dose can effectively guide the optimizer to achieve plan quality comparable to that of clinical plans.

Authors
Sheng, Y; Li, T; Zhang, Y; Lee, WR; Yin, F-F; Ge, Y; Wu, QJ
MLA Citation
Sheng, Y, Li, T, Zhang, Y, Lee, WR, Yin, F-F, Ge, Y, and Wu, QJ. "Atlas-guided prostate intensity modulated radiation therapy (IMRT) planning." Physics in medicine and biology 60.18 (September 8, 2015): 7277-7291.
PMID
26348663
Source
epmc
Published In
Physics in Medicine and Biology
Volume
60
Issue
18
Publish Date
2015
Start Page
7277
End Page
7291
DOI
10.1088/0031-9155/60/18/7277

Seduced by technology?

Authors
Lee, WR
MLA Citation
Lee, WR. "Seduced by technology?." Cancer 121.14 (July 2015): 2300-2302.
PMID
25847582
Source
epmc
Published In
Cancer
Volume
121
Issue
14
Publish Date
2015
Start Page
2300
End Page
2302
DOI
10.1002/cncr.29358

Is radical prostatectomy appropriate for very-high-risk prostate cancer patients? No.

Authors
Boyle, JM; Lee, WR
MLA Citation
Boyle, JM, and Lee, WR. "Is radical prostatectomy appropriate for very-high-risk prostate cancer patients? No." Oncology (Williston Park, N.Y.) 29.5 (May 2015): 349-389.
PMID
25979544
Source
epmc
Published In
Oncology
Volume
29
Issue
5
Publish Date
2015
Start Page
349
End Page
389

Quantitative comparison of automatic and manual IMRT optimization for prostate cancer: the benefits of DVH prediction.

A recent publication indicated that the patient anatomical feature (PAF) model was capable of predicting optimal objectives based on past experience. In this study, the benefits of IMRT optimization using PAF-predicted objectives as guidance for prostate were evaluated. Three different optimization methods were compared.1) Expert Plan: Ten prostate cases (16 plans) were planned by an expert planner using conventional trial-and-error approach started with institutional modified OAR and PTV constraints. Optimization was stopped at 150 iterations and that plan was saved as Expert Plan. 2) Clinical Plan: The planner would keep working on the Expert Plan till he was satisfied with the dosimetric quality and the final plan was referred to as Clinical Plan. 3) PAF Plan: A third sets of plans for the same ten patients were generated fully automatically using predicted DVHs as guidance. The optimization was based on PAF-based predicted objectives, and was continued to 150 iterations without human interaction. DMAX and D98% for PTV, DMAX for femoral heads, DMAX, D10cc, D25%/D17%, and D40% for bladder/rectum were compared. Clinical Plans are further optimized with more iterations and adjustments, but in general provided limited dosimetric benefits over Expert Plans. PTV D98% agreed within 2.31% among Expert, Clinical, and PAF plans. Between Clinical and PAF Plans, differences for DMAX of PTV, bladder, and rectum were within 2.65%, 2.46%, and 2.20%, respectively. Bladder D10cc was higher for PAF but < 1.54% in general. Bladder D25% and D40% were lower for PAF, by up to 7.71% and 6.81%, respectively. Rectum D10cc, D17%, and D40% were 2.11%, 2.72%, and 0.27% lower for PAF, respectively. DMAX for femoral heads were comparable (< 35 Gy on average). Compared to Clinical Plan (Primary + Boost), the average optimization time for PAF plan was reduced by 5.2 min on average, with a maximum reduction of 7.1min. Total numbers of MUs per plan for PAF Plans were lower than Clinical Plans, indicating better delivery efficiency. The PAF-guided planning process is capable of generating clinical-quality prostate IMRT plans with no human intervention. Compared to manual optimization, this automatic optimization increases planning and delivery efficiency, while maintainingplan quality.

Authors
Yang, Y; Li, T; Yuan, L; Ge, Y; Yin, F-F; Lee, WR; Wu, QJ
MLA Citation
Yang, Y, Li, T, Yuan, L, Ge, Y, Yin, F-F, Lee, WR, and Wu, QJ. "Quantitative comparison of automatic and manual IMRT optimization for prostate cancer: the benefits of DVH prediction." Journal of applied clinical medical physics 16.2 (March 8, 2015): 5204-.
PMID
26103191
Source
epmc
Published In
Journal of applied clinical medical physics / American College of Medical Physics
Volume
16
Issue
2
Publish Date
2015
Start Page
5204
DOI
10.1120/jacmp.v16i2.5204

Practice patterns for peer review in radiation oncology

© 2015. Physician peer review seeks to improve the quality of care through the evaluation of physician performance, specifically medical decision making and technical expertise. To establish current peer review practice patterns, evaluate interest in recommendations for peer review, and establish a framework for future recommendations, the American Society for Radiation Oncology (ASTRO) surveyed its physician members. Methods and materials: A radiation oncology-specific peer review survey instrument was developed, formally tested, and found to meet established levels of reliability and validity. The final instrument was delivered using a web-based survey platform including reminders. All ASTRO physician-members and members-in-training worldwide were invited by email to participate. Results: A total of 5674 physicians were contacted starting in January 2013. A total of 572 physicians participated (10%) yielding a ±. 4% margin of error. Those responding were split evenly between academic providers and private practice and others. The median time since training. = 16. years, median number of new patients per year. = 215, and median practice size. = 6 physicians; 83% of respondents were involved in peer review and 75% were comfortable with their program. Of those involved, 65% report doing some review before radiation begins. Of patients treated by these physicians, 56% are reviewed before treatment. Peer review elements reviewed include overall treatment strategy (86%), dose and fractionation (89%), contouring (59%), and isodose or dose-volume histogram (75%). Ninety percent of physicians have changed radiation plans because of peer review. These providers make changes in 7%-10% of cases. Seventy-four percent of physici ans agree that ASTRO should make formal peer review recommendations, with 7% in opposition. Conclusions: This survey suggests that peer review in radiation oncology is common and leads to changes in management in a meaningful fraction of cases. There is much variation in the manner of conducting, and reported utility of, peer review. The majority of ASTRO physician members support formal recommendations and guidance on peer review.

Authors
Hoopes, DJ; Johnstone, PA; Chapin, PS; Schubert Kabban, CM; Lee, WR; Chen, AB; Fraass, BA; Skinner, WJK; Marks, LB
MLA Citation
Hoopes, DJ, Johnstone, PA, Chapin, PS, Schubert Kabban, CM, Lee, WR, Chen, AB, Fraass, BA, Skinner, WJK, and Marks, LB. "Practice patterns for peer review in radiation oncology." Practical Radiation Oncology 5.1 (January 1, 2015): 32-38.
Source
scopus
Published In
Practical Radiation Oncology
Volume
5
Issue
1
Publish Date
2015
Start Page
32
End Page
38
DOI
10.1016/j.prro.2014.04.004

Quantitative comparison of automatic and manual IMRT optimization for prostate cancer: The benefits of DVH predictionQuantitative comparison of automatic and manual IMRT optimization for prostate cancer: The benefits of DVH prediction

A recent publication indicated that the patient anatomical feature (PAF) model was capable of predicting optimal objectives based on past experience. In this study, the benefits of IMRT optimization using PAF-predicted objectives as guidance for prostate were evaluated. Three different optimization methods were compared. 1) Expert Plan: Ten prostate cases (16 plans) were planned by an expert planner using conventional trial-and-error approach started with institutional modified OAR and PTV constraints. Optimization was stopped at 150 iterations and that plan was saved as Expert Plan. 2) Clinical Plan: The planner would keep working on the Expert Plan till he was satisfied with the dosimetric quality and the final plan was referred to as Clinical Plan. 3) PAF Plan: A third sets of plans for the same ten patients were generated fully automatically using predicted DVHs as guidance. The optimization was based on PAF-based predicted objectives, and was continued to 150 iterations without human interaction. D MAX and D 98% for PTV, D MAX for femoral heads, D MAX , D 10cc , D 25% /D 17% , and D 40% for bladder/rectum were compared. Clinical Plans are further optimized with more iterations and adjustments, but in general provided limited dosimetric benefits over Expert Plans. PTV D 98% agreed within 2.31% among Expert, Clinical, and PAF plans. Between Clinical and PAF Plans, differences for D MAX of PTV, bladder, and rectum were within 2.65%, 2.46%, and 2.20%, respectively. Bladder D 10cc was higher for PAF but < 1.54% in general. Bladder D 25% and D 40% were lower for PAF, by up to 7.71% and 6.81%, respectively. Rectum D 10cc , D 17% , and D 40% were 2.11%, 2.72%, and 0.27% lower for PAF, respectively. D MAX for femoral heads were comparable ( < 35 Gy on average). Compared to Clinical Plan (Primary + Boost), the average optimization time for PAF plan was reduced by 5.2 min on average, with a maximum reduction of 7.1min. Total numbers of MUs per plan for PAF Plans were lower than Clinical Plans, indicating better delivery efficiency. The PAF-guided planning process is capable of generating clinical-quality prostate IMRT plans with no human intervention. Compared to manual optimization, this automatic optimization increases planning and delivery efficiency, while maintaining plan quality.

Authors
Yang, Y; Li, T; Yuan, L; Ge, Y; Yin, FF; Lee, WR; Wu, QJ; Yang, Y; Li, T; Yuan, L; Ge, Y; Yin, FF; Lee, WR; Wu, QJ
MLA Citation
Yang, Y, Li, T, Yuan, L, Ge, Y, Yin, FF, Lee, WR, Wu, QJ, Yang, Y, Li, T, Yuan, L, Ge, Y, Yin, FF, Lee, WR, and Wu, QJ. "Quantitative comparison of automatic and manual IMRT optimization for prostate cancer: The benefits of DVH predictionQuantitative comparison of automatic and manual IMRT optimization for prostate cancer: The benefits of DVH prediction (PublishedPublished)." Journal of Applied Clinical Medical Physics 16.2 (January 1, 2015): 241-250.
Source
scopus
Published In
Journal of applied clinical medical physics / American College of Medical Physics
Volume
16
Issue
2
Publish Date
2015
Start Page
241
End Page
250
DOI
10.1120/jacmp.v16i2.5204

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

Practice patterns for peer review in radiation oncology.

Physician peer review seeks to improve the quality of care through the evaluation of physician performance, specifically medical decision making and technical expertise. To establish current peer review practice patterns, evaluate interest in recommendations for peer review, and establish a framework for future recommendations, the American Society for Radiation Oncology (ASTRO) surveyed its physician members.A radiation oncology-specific peer review survey instrument was developed, formally tested, and found to meet established levels of reliability and validity. The final instrument was delivered using a web-based survey platform including reminders. All ASTRO physician-members and members-in-training worldwide were invited by email to participate.A total of 5674 physicians were contacted starting in January 2013. A total of 572 physicians participated (10%) yielding a ±4% margin of error. Those responding were split evenly between academic providers and private practice and others. The median time since training=16 years, median number of new patients per year=215, and median practice size=6 physicians; 83% of respondents were involved in peer review and 75% were comfortable with their program. Of those involved, 65% report doing some review before radiation begins. Of patients treated by these physicians, 56% are reviewed before treatment. Peer review elements reviewed include overall treatment strategy (86%), dose and fractionation (89%), contouring (59%), and isodose or dose-volume histogram (75%). Ninety percent of physicians have changed radiation plans because of peer review. These providers make changes in 7%-10% of cases. Seventy-four percent of physicians agree that ASTRO should make formal peer review recommendations, with 7% in opposition.This survey suggests that peer review in radiation oncology is common and leads to changes in management in a meaningful fraction of cases. There is much variation in the manner of conducting, and reported utility of, peer review. The majority of ASTRO physician members support formal recommendations and guidance on peer review.

Authors
Hoopes, DJ; Johnstone, PA; Chapin, PS; Kabban, CMS; Lee, WR; Chen, AB; Fraass, BA; Skinner, WJK; Marks, LB
MLA Citation
Hoopes, DJ, Johnstone, PA, Chapin, PS, Kabban, CMS, Lee, WR, Chen, AB, Fraass, BA, Skinner, WJK, and Marks, LB. "Practice patterns for peer review in radiation oncology." Practical radiation oncology 5.1 (January 2015): 32-38.
PMID
25413419
Source
epmc
Published In
Practical Radiation Oncology
Volume
5
Issue
1
Publish Date
2015
Start Page
32
End Page
38
DOI
10.1016/j.prro.2014.04.004

Editor's note: Say "Yes!" to NO.

Authors
Corn, BW; Lee, WR
MLA Citation
Corn, BW, and Lee, WR. "Editor's note: Say "Yes!" to NO." Practical radiation oncology 5.1 (January 2015): 1-.
PMID
25567157
Source
epmc
Published In
Practical Radiation Oncology
Volume
5
Issue
1
Publish Date
2015
Start Page
1
DOI
10.1016/j.prro.2014.08.011

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

Practical Radiation Oncology (PRO).

Authors
Robert Lee, W
MLA Citation
Robert Lee, W. "Practical Radiation Oncology (PRO)." Practical radiation oncology 4.4 (July 2014): 207-.
PMID
25012826
Source
epmc
Published In
Practical Radiation Oncology
Volume
4
Issue
4
Publish Date
2014
Start Page
207
DOI
10.1016/j.prro.2014.05.001

Why three is better than two: An overview of three-vs. two-view thoracic radiographic studies

Authors
Strelec, CD; Lee, WR
MLA Citation
Strelec, CD, and Lee, WR. "Why three is better than two: An overview of three-vs. two-view thoracic radiographic studies." Veterinary Medicine 109.5 (May 1, 2014).
Source
scopus
Published In
Veterinary Medicine
Volume
109
Issue
5
Publish Date
2014

Reporting of uncertainty at the 2013 annual meeting of the American Society for Radiation Oncology.

PURPOSE: The annual meeting of the American Society for Radiation Oncology (ASTRO) is designed to disseminate new scientific findings and technical advances to professionals. Best practices of scientific dissemination require that some level of uncertainty (or imprecision) is provided. METHODS AND MATERIALS: A total of 279 scientific abstracts were selected for oral presentation in a clinical session at the 2013 ASTRO Annual Meeting. A random sample of these abstracts was reviewed to determine whether a 95% confidence interval (95% CI) or analogous measure of precision was provided for time-to-event analyses. RESULTS: A sample of 140 abstracts was reviewed. Of the 65 abstracts with Kaplan-Meier or cumulative incidence analyses, 6 included some measure of precision (6 of 65 = 9%; 95% CI, 2-16). Of the 43 abstracts reporting ratios for time-to-event analyses (eg, hazard ratio, risk ratio), 22 included some measure of precision (22 of 43 = 51%; 95% CI, 36-66). CONCLUSIONS: Measures of precision are not provided in a significant percentage of abstracts selected for oral presentation at the Annual Meeting of ASTRO.

Authors
Lee, WR
MLA Citation
Lee, WR. "Reporting of uncertainty at the 2013 annual meeting of the American Society for Radiation Oncology." International journal of radiation oncology, biology, physics 89.1 (May 2014): 222-223.
PMID
24725704
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
89
Issue
1
Publish Date
2014
Start Page
222
End Page
223
DOI
10.1016/j.ijrobp.2013.12.031

Palliative radiotherapy for prostate cancer.

Radiotherapy is an effective tool for the palliation of symptoms commonly caused by prostate cancer. The majority of painful bone metastases respond equally well to single or multiple fractions of external radiotherapy. Retreatment with a second course of radiation induces pain responses in approximately 50% of patients. For more diffuse metastases, either hemibody radiation or systemic radiopharmaceuticals can reduce pain, and radium-223 is associated with improved survival in men with castration-resistant prostate cancer. Hematuria, bladder outlet obstruction, and rectal compression are all improved with palliative radiotherapy. The ability of stereotactic body radiation therapy to reduce pain compared with standard external radiation is being investigated, as is its role in treating those with limited metastatic disease.

Authors
Boyer, MJ; Salama, JK; Lee, WR
MLA Citation
Boyer, MJ, Salama, JK, and Lee, WR. "Palliative radiotherapy for prostate cancer." Oncology (Williston Park, N.Y.) 28.4 (April 2014): 306-312. (Review)
PMID
24839802
Source
epmc
Published In
Oncology
Volume
28
Issue
4
Publish Date
2014
Start Page
306
End Page
312

We need better figures!

Authors
Lee, WR
MLA Citation
Lee, WR. "We need better figures!." Int J Radiat Oncol Biol Phys 88.1 (January 1, 2014): 236-. (Letter)
PMID
24331670
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
88
Issue
1
Publish Date
2014
Start Page
236
DOI
10.1016/j.ijrobp.2013.10.027

Can electronic web-based technology improve quality of life data collection? Analysis of radiation therapy oncology group 0828

Purpose: Missing data are a significant problem in clinical trials, particularly for quality of life (QOL), which cannot be obtained retrospectively. The purpose of this study was to evaluate the feasibility of an electronic web-based strategy for QOL data collection in a cooperative group radiation oncology trial setting. Methods and materials: Radiation Therapy Oncology Group (RTOG) 0828 was a prospective National Cancer Institute cooperative group companion study of RTOG-0415, a randomized study of conventional versus hypofractionated radiation. Forty-nine English-speaking patients with favorable risk prostate cancer who enrolled on RTOG-0415 consented to using web-based technology for completing QOL. In RTOG-0415, using paper forms, the 6-month QOL compliance rate was 52%. The purpose of RTOG-0828 was to test the feasibility of a web-based strategy with the goal of increasing the 6-month QOL completion rate by 25% (from 52% to 77%) for a relative improvement of ~. 50%. The web-based tool used in this study was VisionTree Optimal Care (VTOC; VisionTree Software, Inc, San Diego, CA), a Health-Insurance-Portability-Accountability-Act secure, online technology that allows real-time tracking and e-mail reminders. The primary endpoint was the 6-month complianc e rate for the validated QOL instrument, Expanded Prostate Index Composite. Results: The QOL completion rate at baseline was 98%. Compared with the prior 52% QOL completion rate at 6 months using paper forms, the QOL web-based completion rate at 6 months was 90% (2-sided P value < .001). At 12 months, the EPIC completion rate was 82% (compared with 36% using paper forms). Conclusions: This RTOG study suggests that a web-based strategy to collect QOL appears to be feasible in the cooperative group radiation oncology trial setting and is associated with an increase in the 6-month QOL compliance rate compared with the prior method of using paper forms. The RTOG plans to further test this strategy in a head-and-neck cancer trial across all participating RTOG sites. © 2014 American Society for Radiation Oncology.

Authors
Movsas, B; Hunt, D; Watkins-Bruner, D; Lee, WR; Tharpe, H; Goldstein, D; Moore, J; Dayes, IS; Parise, S; Sandler, H
MLA Citation
Movsas, B, Hunt, D, Watkins-Bruner, D, Lee, WR, Tharpe, H, Goldstein, D, Moore, J, Dayes, IS, Parise, S, and Sandler, H. "Can electronic web-based technology improve quality of life data collection? Analysis of radiation therapy oncology group 0828." Practical Radiation Oncology 4.3 (January 1, 2014): 187-191.
Source
scopus
Published In
Practical Radiation Oncology
Volume
4
Issue
3
Publish Date
2014
Start Page
187
End Page
191
DOI
10.1016/j.prro.2013.07.014

Palliative radiotherapy for prostate cancer.

Radiotherapy is an effective tool for the palliation of symptoms commonly caused by prostate cancer. The majority of painful bone metastases respond equally well to single or multiple fractions of external radiotherapy. Retreatment with a second course of radiation induces pain responses in approximately 50% of patients. For more diffuse metastases, either hemibody radiation or systemic radiopharmaceuticals can reduce pain, and radium-223 is associated with improved survival in men with castration-resistant prostate cancer. Hematuria, bladder outlet obstruction, and rectal compression are all improved with palliative radiotherapy. The ability of stereotactic body radiation therapy to reduce pain compared with standard external radiation is being investigated, as is its role in treating those with limited metastatic disease.

Authors
Boyer, MJ; Salama, JK; Lee, WR
MLA Citation
Boyer, MJ, Salama, JK, and Lee, WR. "Palliative radiotherapy for prostate cancer." Oncology (Williston Park, N.Y.) 28.4 (January 1, 2014): 306-312. (Review)
Source
scopus
Published In
Oncology
Volume
28
Issue
4
Publish Date
2014
Start Page
306
End Page
312

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

Editor's Note: PubMed inclusion and recognizing top reviewers.

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note: PubMed inclusion and recognizing top reviewers." Practical radiation oncology 4.1 (January 2014): 1-2.
PMID
24621415
Source
epmc
Published In
Practical Radiation Oncology
Volume
4
Issue
1
Publish Date
2014
Start Page
1
End Page
2
DOI
10.1016/j.prro.2013.11.001

Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs

Purpose: To describe resident-reported experience in brachytherapy in Accreditation Council of Graduate Medical Education-accredited radiation oncology training programs over the last 5 years. Methods and Materials: Archived reports of Accreditation Council of Graduate Medical Education final resident case logs from the last 5 years were reviewed and summarized. Brachytherapy was categorized according to the dose rate (low dose rate vs. high dose rate), technique (interstitial vs. intracavitary), and primary tumor site. Linear regression was used to test for trends. Results: The mean number of total brachytherapy procedures performed per resident in the last 5 years has decreased from 80.8 in 2006-2007 to 71.0 in 2010-2011, but the trend is not statistically significant. The average number of intracavitary procedures has remained steady. The average resident experience with interstitial brachytherapy has decreased in a statistically significant manner. The average number of interstitial procedures has decreased by 25%. Conclusions: The average number of interstitial procedures reported by residents has decreased by 25%. The community charged with training residents in interstitial brachytherapy should consider methods to ensure that residents obtain sufficient experience in the future. © 2013 American Brachytherapy Society.

Authors
Compton, JJ; Gaspar, LE; Shrieve, DC; Wilson, LD; Griem, KL; Amdur, RJ; Lee, WR
MLA Citation
Compton, JJ, Gaspar, LE, Shrieve, DC, Wilson, LD, Griem, KL, Amdur, RJ, and Lee, WR. "Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs." Brachytherapy 12.6 (November 1, 2013): 622-627.
Source
scopus
Published In
Brachytherapy
Volume
12
Issue
6
Publish Date
2013
Start Page
622
End Page
627
DOI
10.1016/j.brachy.2013.06.004

Prostate cancer and the hypofractionation hypothesis.

Authors
Lee, WR
MLA Citation
Lee, WR. "Prostate cancer and the hypofractionation hypothesis." J Clin Oncol 31.31 (November 1, 2013): 3849-3851.
PMID
24101055
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
31
Issue
31
Publish Date
2013
Start Page
3849
End Page
3851
DOI
10.1200/JCO.2013.52.4942

Strategies for automatic online treatment plan reoptimization using clinical treatment planning system: a planning parameters study.

PURPOSE: Adaptive radiation therapy for prostate cancer using online reoptimization provides an improved control of interfractional anatomy variations. However, the clinical implementation of online reoptimization is currently limited by the low efficiency of current strategies and the difficulties associated with integration into the current treatment planning system. This study investigates the strategies for performing fast (~2 min) automatic online reoptimization with a clinical fluence-map-based treatment planning system; and explores the performance with different input parameters settings: dose-volume histogram (DVH) objective settings, starting stage, and iteration number (in the context of real time planning). METHODS: Simulated treatments of 10 patients were reoptimized daily for the first week of treatment (5 fractions) using 12 different combinations of optimization strategies. Options for objective settings included guideline-based RTOG objectives, patient-specific objectives based on anatomy on the planning CT, and daily-CBCT anatomy-based objectives adapted from planning CT objectives. Options for starting stages involved starting reoptimization with and without the original plan's fluence map. Options for iteration numbers were 50 and 100. The adapted plans were then analyzed by statistical modeling, and compared both in terms of dosimetry and delivery efficiency. RESULTS: All online reoptimized plans were finished within ~2 min with excellent coverage and conformity to the daily target. The three input parameters, i.e., DVH objectives, starting stage, and iteration number, contributed to the outcome of optimization nearly independently. Patient-specific objectives generally provided better OAR sparing compared to guideline-based objectives. The benefit in high-dose sparing from incorporating daily anatomy into objective settings was positively correlated with the relative change in OAR volumes from planning CT to daily CBCT. The use of the original plan fluence map as the starting stage reduced OAR dose at the mid-dose region, but increased the monitor units by 17%. Differences of only 2cc or less in OAR V50%/V70Gy/V76Gy were observed between 100 and 50 iterations. CONCLUSIONS: It is feasible to perform automatic online reoptimization in ~2 min using a clinical treatment planning system. Selecting optimal sets of input parameters is the key to achieving high quality reoptimized plans, and should be based on the individual patient's daily anatomy, delivery efficiency, and time allowed for plan adaptation.

Authors
Li, T; Wu, Q; Zhang, Y; Vergalasova, I; Lee, WR; Yin, F-F; Wu, QJ
MLA Citation
Li, T, Wu, Q, Zhang, Y, Vergalasova, I, Lee, WR, Yin, F-F, and Wu, QJ. "Strategies for automatic online treatment plan reoptimization using clinical treatment planning system: a planning parameters study." Med Phys 40.11 (November 2013): 111711-.
PMID
24320419
Source
pubmed
Volume
40
Issue
11
Publish Date
2013
Start Page
111711
DOI
10.1118/1.4823473

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

Early Results From the ASTRO Practice Patterns in Peer Review Survey Project

Authors
Hoopes, DJ; Johnstone, PA; Chapin, PS; Kabban, CMS; Lee, WR; Chen, AB; Fraass, BA; Skinner, WJK; Marks, LB
MLA Citation
Hoopes, DJ, Johnstone, PA, Chapin, PS, Kabban, CMS, Lee, WR, Chen, AB, Fraass, BA, Skinner, WJK, and Marks, LB. "Early Results From the ASTRO Practice Patterns in Peer Review Survey Project." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S119
End Page
S119

A Decision Analysis of Primary Radiation Therapy and Androgen Deprivation Therapy Versus Radical Prostatectomy for High-Risk Prostate Cancer

Authors
Dorth, JA; Lee, WR; Myers, ER
MLA Citation
Dorth, JA, Lee, WR, and Myers, ER. "A Decision Analysis of Primary Radiation Therapy and Androgen Deprivation Therapy Versus Radical Prostatectomy for High-Risk Prostate Cancer." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S500
End Page
S500

Single Institution's Dosimetry and IGRT Analysis of Prostate SBRT

Background and purpose: To report single institution's IGRT and dosimetry analysis on the 37 Gy/5 fraction prostate SBRT clinical trial.Materials/methods: The IRB (Duke University Medical Center) approved clinical trial has treated 28 patients with stage T1-T2c prostate cancer with a regimen of 37 Gy in 5 fractions using IMRT and IGRT protocols since 2009. The clinical trial protocol requires CT/MRI imaging for the prostate delineation; a margin of 3 mm in posterior direction and 5 mm elsewhere for planning target volume (PTV); and strict dose constraints for primary organs-at-risks (OARs) including the bladder, the rectum, and the femoral heads. Rigid IGRT process is also an essential part of the protocol. Precise patient and prostate positioning and dynamic tracking of prostate motion are performed with electromagnetic localization device (Calypso) and on-board imaging (OBI) system. Initial patient and target alignment is performed based on fiducials with OBI imaging system and Calypso system. Prior to treatment, cone-beam CT (CBCT) is performed for soft tissue alignment verification. During treatment, per-beam corrections for target motion using translational couch movements is performed before irradiating each field, based on electromagnetic localization or on-board imaging localization. Dosimetric analysis on target coverage and OAR sparing is performed based on key DVH parameters corresponding to protocol guidance. IGRT analysis is focused on the average frequency and magnitude of corrections during treatment, and overall intra-fractional target drift. A margin value is derived using actual target motion data and the margin recipe from Van Herk et al., and is compared to the current one in practice. In addition, cumulative doses with and without per-beam IGRT corrections are compared to assess the benefit of online IGRT.Results: 1. No deviation has been found in 10 of 14 dosimetric constraints, with minor deviations in the rest 4 constraints.2. Online IGRT techniques including Calypso, OBI and CBCT supplement each other to create an effective and reliable system on tracking target and correcting intra-fractional motion.3. On average 1-Feb corrections have been performed per fraction, with magnitude of (0.22 ± 0.11) cm. Average target drift magnitude is (0.7 ± 1.3) mm in one direction during each fraction.4. Benefit from per-beam correction in overall review is small: most differences from no correction are < 0.1 Gy for PTV D1cc/Dmean and < 1%/1.5 cc for OAR parameters. Up to 1.5 Gy reduction was seen in PTV D99% without online correction. Largest differences for OARs are -4.1 cc and +1.6 cc in the V50% for the bladder and the rectum, respectively. However, online IGRT helps to catch unexpected significant target motion.5. Margin derived from actual target motion is 2.5 mm isotropic, consist with current practice.Conclusions: Clinical experience of the 37 Gy/5-fraction prostate SBRT from a single institution is reported. Dosimetric analysis demonstrated excellent target coverage and OAR sparing for our first 28 patients in this trial. Online IGRT techniques implemented are both effective and reliable. Per-beam correction in general provides a small benefit in dosimetry. Target motion measured by online localization devices confirms that current margin selection is adequate. © 2013 Wu et al.; licensee BioMed Central Ltd.

Authors
Wu, QJ; Li, T; Yuan, L; Yin, FF; Lee, WR
MLA Citation
Wu, QJ, Li, T, Yuan, L, Yin, FF, and Lee, WR. "Single Institution's Dosimetry and IGRT Analysis of Prostate SBRT." Radiation Oncology 8.1 (September 13, 2013).
PMID
24034234
Source
scopus
Published In
Radiation Oncology
Volume
8
Issue
1
Publish Date
2013
DOI
10.1186/1748-717X-8-215

A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: an example application to prostate cancer planning.

PURPOSE: Intensity modulated radiation therapy (IMRT) treatment planning can have wide variation among different treatment centers. We propose a system to leverage the IMRT planning experience of larger institutions to automatically create high-quality plans for outside clinics. We explore feasibility by generating plans for patient datasets from an outside institution by adapting plans from our institution. METHODS AND MATERIALS: A knowledge database was created from 132 IMRT treatment plans for prostate cancer at our institution. The outside institution, a community hospital, provided the datasets for 55 prostate cancer cases, including their original treatment plans. For each "query" case from the outside institution, a similar "match" case was identified in the knowledge database, and the match case's plan parameters were then adapted and optimized to the query case by use of a semiautomated approach that required no expert planning knowledge. The plans generated with this knowledge-based approach were compared with the original treatment plans at several dose cutpoints. RESULTS: Compared with the original plan, the knowledge-based plan had a significantly more homogeneous dose to the planning target volume and a significantly lower maximum dose. The volumes of the rectum, bladder, and femoral heads above all cutpoints were nominally lower for the knowledge-based plan; the reductions were significantly lower for the rectum. In 40% of cases, the knowledge-based plan had overall superior (lower) dose-volume histograms for rectum and bladder; in 54% of cases, the comparison was equivocal; in 6% of cases, the knowledge-based plan was inferior for both bladder and rectum. CONCLUSIONS: Knowledge-based planning was superior or equivalent to the original plan in 95% of cases. The knowledge-based approach shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced institutions.

Authors
Good, D; Lo, J; Lee, WR; Wu, QJ; Yin, F-F; Das, SK
MLA Citation
Good, D, Lo, J, Lee, WR, Wu, QJ, Yin, F-F, and Das, SK. "A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: an example application to prostate cancer planning." Int J Radiat Oncol Biol Phys 87.1 (September 1, 2013): 176-181.
PMID
23623460
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
87
Issue
1
Publish Date
2013
Start Page
176
End Page
181
DOI
10.1016/j.ijrobp.2013.03.015

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

In regard to Shah.

Authors
Lee, WR
MLA Citation
Lee, WR. "In regard to Shah." Int J Radiat Oncol Biol Phys 86.4 (July 15, 2013): 596-. (Letter)
PMID
23773384
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
86
Issue
4
Publish Date
2013
Start Page
596
DOI
10.1016/j.ijrobp.2013.02.023

Expanding the Number of Trainess in Radiation Oncology: Has the Pendulum Swung Too Far?

Authors
Lee, WR
MLA Citation
Lee, WR. "Expanding the Number of Trainess in Radiation Oncology: Has the Pendulum Swung Too Far?." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 86.4 (July 15, 2013): 596-596.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
86
Issue
4
Publish Date
2013
Start Page
596
End Page
596
DOI
10.1016/j.ijrobp.2013.03.023

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

An Editorial Note: The Long Arm of Practical Radiation Oncology

Authors
Bennett, KE; Lee, WR
MLA Citation
Bennett, KE, and Lee, WR. "An Editorial Note: The Long Arm of Practical Radiation Oncology." Practical Radiation Oncology 3.3 (July 2013): 145-146.
Source
crossref
Published In
Practical Radiation Oncology
Volume
3
Issue
3
Publish Date
2013
Start Page
145
End Page
146
DOI
10.1016/j.prro.2013.05.009

Hypofractionation for clinically localized prostate cancer.

This manuscript reviews the clinical evidence for hypofractionation in prostate cancer, focusing on data from prospective trials. For the purposes of this manuscript, we categorize hypofractionation as moderate (2.4-4 Gy per fraction) or extreme (6.5-10 Gy per fraction). Five randomized controlled trials have evaluated moderate hypofractionation in >1500 men, with most followed for >4-5 years. The results of these randomized trials are inconsistent. No randomized trials or other rigorous comparisons of extreme hypofractionation with conventional fractionation have been reported. Prospective single-arm studies of extreme hypofractionation appear favorable, but small sample sizes preclude precise estimates of efficacy and short follow-up prevents complication estimates beyond 3-5 years. Over the next several years, the results of 3 large noninferiority trials of moderate hypofractionation and 2 randomized trials of extreme hypofractionation should help clarify the role of hypofractionation in prostate cancer therapy.

Authors
Cabrera, AR; Lee, WR
MLA Citation
Cabrera, AR, and Lee, WR. "Hypofractionation for clinically localized prostate cancer." Semin Radiat Oncol 23.3 (July 2013): 191-197. (Review)
PMID
23763885
Source
pubmed
Published In
Seminars in Radiation Oncology
Volume
23
Issue
3
Publish Date
2013
Start Page
191
End Page
197
DOI
10.1016/j.semradonc.2013.01.005

Editor's Note: The importance of understanding patient safety, international scope, and scientific misconduct

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note: The importance of understanding patient safety, international scope, and scientific misconduct." Practical Radiation Oncology 3.2 (April 2013): 79-79.
Source
crossref
Published In
Practical Radiation Oncology
Volume
3
Issue
2
Publish Date
2013
Start Page
79
End Page
79
DOI
10.1016/j.prro.2013.02.003

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

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

56 Background: Image-guided radiation therapy (IGRT) has been widely adopted for both definitive and post-operative prostate radiotherapy. In the postoperative setting, numerous studies of prostate bed motion have recommended tight planning margins (<10mm) if IGRT is used daily. The purpose of this analysis is to determine the effect of IGRT on the efficacy and toxicity of post-operative prostate radiotherapy.Between 1998 and 2010, 286 patients received radiation therapy after prostatectomy at Duke. Recurrent disease following radiation therapy was defined as PSA >0.2 ng/ml and rising or initiation of salvage ADT. CTCAE v 4.0 and the RTOG/LENT late morbidity scores were used to grade acute and late toxicities. Risk for biochemical failure and late Grade 2+ GI toxicity were compared between IGRT (N = 113) and non-IGRT (N = 173) patients using multivariable adjusted Cox regression controlling for age, treatment technique (3D vs IMRT), radiation dose, androgen suppression, pathologic Gleason Score, margin status, pathologic stage, and pre-radiotherapy PSA level.The median margin size for patients with IGRT was 7mm (IQR 6-10mm) and 15mm (IQR 7-15mm) for those without IGRT (p < 0.001). Median follow up was 21 months (IQR 15-33 mo) for patients with IGRT and 49 months (IQR 30-73 mo) for those without IGRT (p < 0.001). On multivariate analysis, patients treated with IGRT had a greater risk of progression versus non-daily imaging (HR = 2.51, p < 0.001), as did patients who received salvage versus adjuvant radiotherapy (HR = 2.41, p = 0.005). Higher pathologic Gleason Score (HR = 1.96, p = 0.026) and pathologic stage (HR = 1.93, p = 0.003) conferred increased risk of progression, while positive margin status was protective (HR = 0.53, p = 0.002). Age, radiation dose, androgen suppression, and treatment technique did not affect biochemical outcome (p > 0.1). There were no differences in acute or late GI toxicity according to treatment technique or use of IGRT (both p > 0.1).The use of IGRT was associated with increased biochemical recurrence for patients receiving post-operative prostate radiotherapy. For these patients, we recommend using treatment margins of at least 10mm to address subclinical disease and organ motion.

Authors
Banez, LL; Gerber, L; Moul, JW; Anscher, MS; Lee, WR; Koontz, BF
MLA Citation
Banez, LL, Gerber, L, Moul, JW, Anscher, MS, Lee, WR, and Koontz, BF. "Image guidance for post-prostatectomy radiotherapy: Are we missing the mark?." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.6_suppl (February 2013): 56-.
PMID
28137048
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
6_suppl
Publish Date
2013
Start Page
56

Results from the Quality Research in Radiation Oncology (QRRO) survey: Evaluation of dosimetric outcomes for low-dose-rate prostate brachytherapy.

PURPOSE: We report on quality of dose delivery to target and normal tissues from low-dose-rate prostate brachytherapy using postimplantation dosimetric evaluations from a random sample of U.S. patients. METHODS AND MATERIALS: Nonmetastatic prostate cancer patients treated with external beam radiotherapy or brachytherapy in 2007 were randomly sampled from radiation oncology facilities nationwide. Of 414 prostate cancer cases from 45 institutions, 86 received low-dose-rate brachytherapy. We collected the 30-day postimplantation CT images of these patients and 10 test cases from two other institutions. Scans were downloaded into a treatment planning system and prostate/rectal contours were redrawn. Dosimetric outcomes were reanalyzed and compared with calculated outcomes from treating institutions. RESULTS: Median prostate volume was 33.4cm(3). Reevaluated median V(100), D(90), and V(150) were 91.1% (range, 45.5-99.8%), 101.7% (range, 59.6-145.9%), and 53.9% (range, 15.7-88.4%), respectively. Low gland coverage included 27 patients (39%) with a D(90) lower than 100% of the prescription dose (PD), 12 of whom (17% of the entire group) had a D(90) lower than 80% of PD. There was no correlation between D(90) coverage and prostate volume, number of seeds, or implanted activity. The median V(100) for the rectum was 0.3cm(3) (range, 0-4.3cm(3)). No outcome differences were observed according to the institutional strata. Concordance between reported and reevaluated D(90) values (defined as within ±10%) was observed in 44 of 69 cases. CONCLUSIONS: Central review of postimplantation CT scans to assess the quality of prostate brachytherapy is feasible. Most patients achieved excellent dosimetric outcomes, yet 17% had less than optimal target coverage by the PD. There was concordance between submitted target-coverage parameters and central dosimetric review in 64% of implants. These findings will require further validation in a larger cohort of patients.

Authors
Zelefsky, MJ; Cohen, GN; Bosch, WR; Morikawa, L; Khalid, N; Crozier, CL; Lee, WR; Zietman, A; Owen, J; Wilson, JF; Devlin, PM
MLA Citation
Zelefsky, MJ, Cohen, GN, Bosch, WR, Morikawa, L, Khalid, N, Crozier, CL, Lee, WR, Zietman, A, Owen, J, Wilson, JF, and Devlin, PM. "Results from the Quality Research in Radiation Oncology (QRRO) survey: Evaluation of dosimetric outcomes for low-dose-rate prostate brachytherapy." Brachytherapy 12.1 (January 2013): 19-24.
PMID
22819388
Source
pubmed
Published In
Brachytherapy
Volume
12
Issue
1
Publish Date
2013
Start Page
19
End Page
24
DOI
10.1016/j.brachy.2012.04.001

Results from the Quality Research in Radiation Oncology (QRRO) survey: Evaluation of dosimetric outcomes for low-dose-rate prostate brachytherapy

Purpose: We report on quality of dose delivery to target and normal tissues from low-dose-rate prostate brachytherapy using postimplantation dosimetric evaluations from a random sample of U.S. patients. Methods and Materials: Nonmetastatic prostate cancer patients treated with external beam radiotherapy or brachytherapy in 2007 were randomly sampled from radiation oncology facilities nationwide. Of 414 prostate cancer cases from 45 institutions, 86 received low-dose-rate brachytherapy. We collected the 30-day postimplantation CT images of these patients and 10 test cases from two other institutions. Scans were downloaded into a treatment planning system and prostate/rectal contours were redrawn. Dosimetric outcomes were reanalyzed and compared with calculated outcomes from treating institutions. Results: Median prostate volume was 33.4cm3. Reevaluated median V100, D90, and V150 were 91.1% (range, 45.5-99.8%), 101.7% (range, 59.6-145.9%), and 53.9% (range, 15.7-88.4%), respectively. Low gland coverage included 27 patients (39%) with a D90 lower than 100% of the prescription dose (PD), 12 of whom (17% of the entire group) had a D90 lower than 80% of PD. There was no correlation between D90 coverage and prostate volume, number of seeds, or implanted activity. The median V100 for the rectum was 0.3cm3 (range, 0-4.3cm3). No outcome differences were observed according to the institutional strata. Concordance between reported and reevaluated D90 values (defined as within ±10%) was observed in 44 of 69 cases. Conclusions: Central review of postimplantation CT scans to assess the quality of prostate brachytherapy is feasible. Most patients achieved excellent dosimetric outcomes, yet 17% had less than optimal target coverage by the PD. There was concordance between submitted target-coverage parameters and central dosimetric review in 64% of implants. These findings will require further validation in a larger cohort of patients. © 2013 American Brachytherapy Society.

Authors
Zelefsky, MJ; Cohen, GN; Bosch, WR; Morikawa, L; Khalid, N; Crozier, CL; Lee, WR; Zietman, A; Owen, J; Wilson, JF; Devlin, PM
MLA Citation
Zelefsky, MJ, Cohen, GN, Bosch, WR, Morikawa, L, Khalid, N, Crozier, CL, Lee, WR, Zietman, A, Owen, J, Wilson, JF, and Devlin, PM. "Results from the Quality Research in Radiation Oncology (QRRO) survey: Evaluation of dosimetric outcomes for low-dose-rate prostate brachytherapy." Brachytherapy 12.1 (2013): 19-24.
Source
scival
Published In
Brachytherapy
Volume
12
Issue
1
Publish Date
2013
Start Page
19
End Page
24
DOI
10.1016/j.brachy.2012.04.001

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

Evaluation of adherence to quality measures for prostate cancer radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey

Purpose: The purpose of this survey was to test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and nonacademic US institutions. Methods and Materials: A total of 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. Results: Among the 354 patients treated with EBRT, the beam energy was recorded in 353 patients. One hundred sixty-seven patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16-23 MV. For intermediate- plus high-risk patients (n = 181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n = 9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85 of 354), weekly electronic portal imaging was obtained as verification films without daily target localization, and the remaining 76% were treated with daily localization of the target using various methods. Conclusions: Adherence to defined quality indicators was observed in a majority of patients. Approximately 90% of high-risk patients were treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients received prescription doses ≥75 Gy, consistent with the published results of randomized trials. © 2013 American Society for Radiation Oncology.

Authors
Zelefsky, MJ; Lee, WR; Zietman, A; Khalid, N; Crozier, C; Owen, J; Wilson, JF
MLA Citation
Zelefsky, MJ, Lee, WR, Zietman, A, Khalid, N, Crozier, C, Owen, J, and Wilson, JF. "Evaluation of adherence to quality measures for prostate cancer radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey." Practical Radiation Oncology 3.1 (2013): 2-8.
Source
scival
Published In
Practical Radiation Oncology
Volume
3
Issue
1
Publish Date
2013
Start Page
2
End Page
8
DOI
10.1016/j.prro.2012.01.006

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 3.1 (2013): 1--.
Source
scival
Published In
Practical Radiation Oncology
Volume
3
Issue
1
Publish Date
2013
Start Page
1-
DOI
10.1016/j.prro.2012.11.003

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

A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: An example application to prostate cancer planning

Purpose: Intensity modulated radiation therapy (IMRT) treatment planning can have wide variation among different treatment centers. We propose a system to leverage the IMRT planning experience of larger institutions to automatically create high-quality plans for outside clinics. We explore feasibility by generating plans for patient datasets from an outside institution by adapting plans from our institution. Methods and Materials: A knowledge database was created from 132 IMRT treatment plans for prostate cancer at our institution. The outside institution, a community hospital, provided the datasets for 55 prostate cancer cases, including their original treatment plans. For each "query" case from the outside institution, a similar "match" case was identified in the knowledge database, and the match case's plan parameters were then adapted and optimized to the query case by use of a semiautomated approach that required no expert planning knowledge. The plans generated with this knowledge-based approach were compared with the original treatment plans at several dose cutpoints. Results: Compared with the original plan, the knowledge-based plan had a significantly more homogeneous dose to the planning target volume and a significantly lower maximum dose. The volumes of the rectum, bladder, and femoral heads above all cutpoints were nominally lower for the knowledge-based plan; the reductions were significantly lower for the rectum. In 40% of cases, the knowledge-based plan had overall superior (lower) dose-volume histograms for rectum and bladder; in 54% of cases, the comparison was equivocal; in 6% of cases, the knowledge-based plan was inferior for both bladder and rectum. Conclusions: Knowledge-based planning was superior or equivalent to the original plan in 95% of cases. The knowledge-based approach shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced institutions. © 2013 Elsevier Inc.

Authors
Good, D; Lo, J; Lee, WR; Wu, QJ; Yin, F-F; Das, SK
MLA Citation
Good, D, Lo, J, Lee, WR, Wu, QJ, Yin, F-F, and Das, SK. "A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: An example application to prostate cancer planning." International Journal of Radiation Oncology Biology Physics 87.1 (2013): 176-181.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
1
Publish Date
2013
Start Page
176
End Page
181
DOI
10.1016/j.ijrobp.2013.03.015

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

Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs

Purpose: To describe resident-reported experience in brachytherapy in Accreditation Council of Graduate Medical Education-accredited radiation oncology training programs over the last 5 years. Methods and Materials: Archived reports of Accreditation Council of Graduate Medical Education final resident case logs from the last 5 years were reviewed and summarized. Brachytherapy was categorized according to the dose rate (low dose rate vs. high dose rate), technique (interstitial vs. intracavitary), and primary tumor site. Linear regression was used to test for trends. Results: The mean number of total brachytherapy procedures performed per resident in the last 5 years has decreased from 80.8 in 2006-2007 to 71.0 in 2010-2011, but the trend is not statistically significant. The average number of intracavitary procedures has remained steady. The average resident experience with interstitial brachytherapy has decreased in a statistically significant manner. The average number of interstitial procedures has decreased by 25%. Conclusions: The average number of interstitial procedures reported by residents has decreased by 25%. The community charged with training residents in interstitial brachytherapy should consider methods to ensure that residents obtain sufficient experience in the future. © 2013 American Brachytherapy Society.

Authors
Compton, JJ; Gaspar, LE; Shrieve, DC; Wilson, LD; Griem, KL; Amdur, RJ; Lee, WR
MLA Citation
Compton, JJ, Gaspar, LE, Shrieve, DC, Wilson, LD, Griem, KL, Amdur, RJ, and Lee, WR. "Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs." Brachytherapy (2013).
PMID
23973187
Source
scival
Published In
Brachytherapy
Publish Date
2013
DOI
10.1016/j.brachy.2013.06.004

Can electronic web-based technology improve quality of life data collection? Analysis of Radiation Therapy Oncology Group 0828

Purpose: Missing data are a significant problem in clinical trials, particularly for quality of life (QOL), which cannot be obtained retrospectively. The purpose of this study was to evaluate the feasibility of an electronic web-based strategy for QOL data collection in a cooperative group radiation oncology trial setting. Methods and materials: Radiation Therapy Oncology Group (RTOG) 0828 was a prospective National Cancer Institute cooperative group companion study of RTOG-0415, a randomized study of conventional versus hypofractionated radiation. Forty-nine English-speaking patients with favorable risk prostate cancer who enrolled on RTOG-0415 consented to using web-based technology for completing QOL. In RTOG-0415, using paper forms, the 6-month QOL compliance rate was 52%. The purpose of RTOG-0828 was to test the feasibility of a web-based strategy with the goal of increasing the 6-month QOL completion rate by 25% (from 52% to 77%) for a relative improvement of ~ 50%. The web-based tool used in this study was VisionTree Optimal Care (VTOC; VisionTree Software, Inc, San Diego, CA), a Health-Insurance-Portability-Accountability-Act secure, online technology that allows real-time tracking and e-mail reminders. The primary endpoint was the 6-month compliance rate for the validated QOL instrument, Expanded Prostate Index Composite. Results: The QOL completion rate at baseline was 98%. Compared with the prior 52% QOL completion rate at 6 months using paper forms, the QOL web-based completion rate at 6 months was 90% (2-sided P value < .001). At 12 months, the EPIC completion rate was 82% (compared with 36% using paper forms). Conclusions: This RTOG study suggests that a web-based strategy to collect QOL appears to be feasible in the cooperative group radiation oncology trial setting and is associated with an increase in the 6-month QOL compliance rate compared with the prior method of using paper forms. The RTOG plans to further test this strategy in a head-and-neck cancer trial across all participating RTOG sites. © 2013 American Society for Radiation Oncology.

Authors
Movsas, B; Hunt, D; Watkins-Bruner, D; Lee, WR; Tharpe, H; Goldstein, D; Moore, J; Dayes, IS; Parise, S; Sandler, H
MLA Citation
Movsas, B, Hunt, D, Watkins-Bruner, D, Lee, WR, Tharpe, H, Goldstein, D, Moore, J, Dayes, IS, Parise, S, and Sandler, H. "Can electronic web-based technology improve quality of life data collection? Analysis of Radiation Therapy Oncology Group 0828." Practical Radiation Oncology (2013).
PMID
24766686
Source
scival
Published In
Practical Radiation Oncology
Publish Date
2013
DOI
10.1016/j.prro.2013.07.014

Quantitative analysis of the factors which affect the interpatient organ-at-risk dose sparing variation in IMRT plans.

PURPOSE: The authors present an evidence-based approach to quantify the effects of an array of patient anatomical features of the planning target volumes (PTVs) and organs-at-risk (OARs) and their spatial relationships on the interpatient OAR dose sparing variation in intensity modulated radiation therapy (IMRT) plans by learning from a database of high-quality prior plans. METHODS: The authors formulized the dependence of OAR dose volume histograms (DVHs) on patient anatomical factors into feature models which were learned from prior plans by a stepwise multiple regression method. IMRT plans for 64 prostate, 82 head-and-neck (HN) treatments were used to train the models. Two major groups of anatomical features were considered in this study: the volumetric information and the spatial information. The geometry of OARs relative to PTV is represented by the distance-to-target histogram, DTH. Important anatomical and dosimetric features were extracted from DTH and DVH by principal component analysis. The final models were tested by additional 24 prostate and 24 HN plans. RESULTS: Significant patient anatomical factors contributing to OAR dose sparing in prostate and HN IMRT plans have been analyzed and identified. They are: the median distance between OAR and PTV, the portion of OAR volume within an OAR specific distance range, and the volumetric factors: the fraction of OAR volume which overlaps with PTV and the portion of OAR volume outside the primary treatment field. Overall, the determination coefficients R(2) for predicting the first principal component score (PCS1) of the OAR DVH by the above factors are above 0.68 for all the OARs and they are more than 0.53 for predicting the second principal component score (PCS2) of the OAR DVHs except brainstem and spinal cord. Thus, the above set of anatomical features combined has captured significant portions of the DVH variations for the OARs in prostate and HN plans. To test how well these features capture the interpatient organ dose sparing variations in general, the DVHs and specific dose-volume indices calculated from the regression models were compared with the actual DVHs and dose-volume indices from each patient's plan in the validation dataset. The dose-volume indices compared were V99%, V85%, and V50% for bladder and rectum in prostate plans and parotids median dose in HN plans. The authors found that for the bladder and rectum models, 17 out of 24 plans (71%) were within 6% OAR volume error and 21 plans (85%) were within 10% error; For the parotids model, the median dose values for 30 parotids out of 48 (63%) were within 6% prescription dose error and the values in 40 parotids (83%) were within 10% error. CONCLUSIONS: Quantitative analysis of patient anatomical features and their correlation with OAR dose sparing has identified a number of important factors that explain significant amount of interpatient DVH variations in OARs. These factors can be incorporated into evidence-based learning models as effective features to provide patient-specific OAR dose sparing goals.

Authors
Yuan, L; Ge, Y; Lee, WR; Yin, FF; Kirkpatrick, JP; Wu, QJ
MLA Citation
Yuan, L, Ge, Y, Lee, WR, Yin, FF, Kirkpatrick, JP, and Wu, QJ. "Quantitative analysis of the factors which affect the interpatient organ-at-risk dose sparing variation in IMRT plans." Med Phys 39.11 (November 2012): 6868-6878.
PMID
23127079
Source
pubmed
Published In
Medical physics
Volume
39
Issue
11
Publish Date
2012
Start Page
6868
End Page
6878
DOI
10.1118/1.4757927

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 2.4 (October 2012): 241-241.
Source
crossref
Published In
Practical Radiation Oncology
Volume
2
Issue
4
Publish Date
2012
Start Page
241
End Page
241
DOI
10.1016/j.prro.2012.08.005

Pelvic normal tissue contouring guidelines for radiation therapy: a Radiation Therapy Oncology Group consensus panel atlas.

PURPOSE: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. METHODS AND MATERIALS: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. RESULTS: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa_R, Adnexa_L, Prostate, SeminalVesc, PenileBulb, Femur_R, and Femur_L. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. CONCLUSIONS: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.

Authors
Gay, HA; Barthold, HJ; O'Meara, E; Bosch, WR; El Naqa, I; Al-Lozi, R; Rosenthal, SA; Lawton, C; Lee, WR; Sandler, H; Zietman, A; Myerson, R; Dawson, LA; Willett, C; Kachnic, LA; Jhingran, A; Portelance, L; Ryu, J; Small, W; Gaffney, D; Viswanathan, AN; Michalski, JM
MLA Citation
Gay, HA, Barthold, HJ, O'Meara, E, Bosch, WR, El Naqa, I, Al-Lozi, R, Rosenthal, SA, Lawton, C, Lee, WR, Sandler, H, Zietman, A, Myerson, R, Dawson, LA, Willett, C, Kachnic, LA, Jhingran, A, Portelance, L, Ryu, J, Small, W, Gaffney, D, Viswanathan, AN, and Michalski, JM. "Pelvic normal tissue contouring guidelines for radiation therapy: a Radiation Therapy Oncology Group consensus panel atlas." Int J Radiat Oncol Biol Phys 83.3 (July 1, 2012): e353-e362.
PMID
22483697
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
83
Issue
3
Publish Date
2012
Start Page
e353
End Page
e362
DOI
10.1016/j.ijrobp.2012.01.023

Radiotherapy following radical prostatectomy.

Radiotherapy following radical prostatectomy has been controversial and no consensus has developed on the most appropriate use of radiotherapy after radical prostatectomy. In the last decade the results of three randomized controlled trials examining the effects of early radiotherapy after radical prostatectomy in patients with high-risk features (positive surgical margins, extracapsular extension and seminal vesical involvement) have been published. The results of these trials indicate that early radiotherapy changes the natural history of high-risk prostate cancer. Specifically, early radiotherapy reduces the risk of biochemical recurrence, improves clinical disease-free survival, decreases the utilization of salvage androgen suppression and, in the study with longest follow-up, early radiotherapy improves overall survival. This article will review the evidence, provide a commentary on the existing evidence, and describe key issues going forward (timing of radiotherapy, androgen suppression and radiotherapy techniques).

Authors
Patel, P; Lee, WR
MLA Citation
Patel, P, and Lee, WR. "Radiotherapy following radical prostatectomy." Expert Rev Anticancer Ther 12.7 (July 2012): 973-979. (Review)
PMID
22845412
Source
pubmed
Published In
Expert Review of Anticancer Therapy
Volume
12
Issue
7
Publish Date
2012
Start Page
973
End Page
979
DOI
10.1586/era.12.66

SU-E-J-16: Prostate Bed Motion during Post-Prostatectomy Radiotherapy.

To report the inter-fractional prostate bed motion (PBM) during post-prostatectomy radiotherapy using cone-beam CT (CBCT). The correlations between PBM, anterior rectal wall and posterior bladder wall shifts were also investigated.Seventy CBCT and 8 planning CT scans from 8 patients treated with prostate bed radiotherapy were retrospectively analyzed. For each CBCT-CT pair, two rigid image registrations were performed: one based on surgical clips and the other based on pelvic bony anatomy. Each registration gives a displacement vector. The difference between the two registration displacements represents the PBM. In addition, rectum/bladder contours on CT and CBCT scans were compared to identify the organ wall motion. Shifts of the anterior rectal wall and posterior bladder wall were assessed by averaging the slice-by-slice distances between contours on two image sets, measured along an anterior-posterior line passing through the symphysis pubis.The prostate bed motion in the left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions was (0.1±0.9)mm, (0.9±1.6)mm, and (-0.4±1.9)mm, respectively. The derived PTV-CTV margin for LR, AP and SI motion was 3mm, 5mm, and 6mm, respectively. Pearson's correlation coefficients between PBM and anterior rectal wall (whole length) shifts, PBM and the cranial half of anterior rectal wall shifts, and PBM and posterior bladder wall shifts, were 0.43, 0.47, and 0.67, respectively.The magnitude of PBM relative to pelvic bony anatomy in all three directions was small. The correlation between average anterior rectal wall shifts and PBM was weak-to-moderate, which may be due to rectum contouring inconsistency. Possible sources for this inconsistency include: non-uniform rectal wall motion through its length, low CBCT image contrast, and artifacts due to filling. Significant correlation between average posterior bladder wall shifts and PBM suggests bladder wall motion may also be a suitable surrogate for PBM in the AP direction.

Authors
Xu, Z; Li, T; Lee, W; Hood, R; Godfrey, D; Wu, Q
MLA Citation
Xu, Z, Li, T, Lee, W, Hood, R, Godfrey, D, and Wu, Q. "SU-E-J-16: Prostate Bed Motion during Post-Prostatectomy Radiotherapy." Medical physics 39.6Part6 (June 2012): 3655-.
PMID
28517611
Source
epmc
Published In
Medical physics
Volume
39
Issue
6Part6
Publish Date
2012
Start Page
3655
DOI
10.1118/1.4734849

SU-E-T-406: Online Image-Guidance for Prostate SBRT: Dosimetric Benefits and Margin Analysis.

To evaluate the dosimetric benefits of online image guidance during prostate stereotactic body radiotherapy (SBRT) and the potential on margin reduction.28 prostate SBRT patients were retrospectively studied, each treated with 37Gy in 5 fractions. RTOG recently opened a similar protocol (0938). During treatments, per-beam couch corrections were made based on the actual target motion provided by dynamic tracking with either Calypso or per-beam OBI imaging. Dosimetric benefits of online correction were evaluated by comparing delivered dose distributions with and without such correction. The dose distribution without correction was generated in the same treatment planning system by accumulating doses without online correction from the each beam and each fraction. Quantitative analyses include the dosimetric difference between delivered doses with and without correction; the correction magnitude and frequency; and the potential on margin reduction based on the margin recipe by Van Herk et al.(1) Delivery without online correction results in small reduction on target mean dose (0.03±0.05Gy), maximal dose (0.01±0.06Gy), and conformity index (<0.06). (2) Delivery without online correction has small impact on OAR dose: 26 out of 28 patients have <1%/1.5cc differences in V18.5Gy/V24Gy/V28Gy/V33Gy/V37Gy for both the bladder and the rectum. Maximal differences are 4cc of the bladder and 1.6cc of the rectum in mid-dose regions (V18.5Gy). (3) For femoral heads, <1cc/1Gy differences are observed in V20Gy/Dmean/D1cc.(4) Average number of couch corrections per fraction is 0.49. The magnitudes are: (-0.2±2)mm vertically, (-0.1±2.1)mm longitudinally, and (-0.2±1.4)mm laterally. (5) Margin determined by actual target motion in this patient population is 2.5mm isotropic.For both target coverage and OAR sparing, overall small benefit is seen from per-beam couch correction under dynamic tracking. The target motion between beams is small and random, and indicates a population-based margin size of 2.5mm.

Authors
Li, T; Yuan, L; Lee, W; Yin, F; Wu, QJ
MLA Citation
Li, T, Yuan, L, Lee, W, Yin, F, and Wu, QJ. "SU-E-T-406: Online Image-Guidance for Prostate SBRT: Dosimetric Benefits and Margin Analysis." June 2012.
PMID
28517233
Source
epmc
Published In
Medical physics
Volume
39
Issue
6Part16
Publish Date
2012
Start Page
3798
DOI
10.1118/1.4735495

Long-term results of an RTOG Phase II trial (00-19) of external-beam radiation therapy combined with permanent source brachytherapy for intermediate-risk clinically localized adenocarcinoma of the prostate.

PURPOSE: External-beam radiation therapy combined with low-doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. METHODS AND MATERIALS: All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. RESULTS: One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. CONCLUSION: Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high-dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high-dose external-beam radiation alone or permanent low-doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to normal structures or to unimodal radiotherapy techniques.

Authors
Lawton, CA; Yan, Y; Lee, WR; Gillin, M; Firat, S; Baikadi, M; Crook, J; Kuettel, M; Morton, G; Sandler, H
MLA Citation
Lawton, CA, Yan, Y, Lee, WR, Gillin, M, Firat, S, Baikadi, M, Crook, J, Kuettel, M, Morton, G, and Sandler, H. "Long-term results of an RTOG Phase II trial (00-19) of external-beam radiation therapy combined with permanent source brachytherapy for intermediate-risk clinically localized adenocarcinoma of the prostate." Int J Radiat Oncol Biol Phys 82.5 (April 1, 2012): e795-e801.
PMID
22330999
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
e795
End Page
e801
DOI
10.1016/j.ijrobp.2011.11.040

Development and clinical evaluation of a three-dimensional cone-beam computed tomography estimation method using a deformation field map.

PURPOSE: To develop a three-dimensional (3D) cone-beam computed tomography (CBCT) estimation method using a deformation field map, and to evaluate and optimize the efficiency and accuracy of the method for use in the clinical setting. METHODS AND MATERIALS: We propose a method to estimate patient CBCT images using prior information and a deformation model. Patients' previous CBCT data are used as the prior information, and the new CBCT volume to be estimated is considered as a deformation of the prior image volume. The deformation field map is solved by minimizing deformation energy and maintaining new projection data fidelity using a nonlinear conjugate gradient method. This method was implemented in 3D form using hardware acceleration and multi-resolution scheme, and it was evaluated for different scan angles, projection numbers, and scan directions using liver, lung, and prostate cancer patient data. The accuracy of the estimation was evaluated by comparing the organ volume difference and the similarity between estimated CBCT and the CBCT reconstructed from fully sampled projections. RESULTS: Results showed that scan direction and number of projections do not have significant effects on the CBCT estimation accuracy. The total scan angle is the dominant factor affecting the accuracy of the CBCT estimation algorithm. Larger scan angles yield better estimation accuracy than smaller scan angles. Lung cancer patient data showed that the estimation error of the 3D lung tumor volume was reduced from 13.3% to 4.3% when the scan angle was increased from 60° to 360° using 57 projections. CONCLUSIONS: The proposed estimation method is applicable for 3D DTS, 3D CBCT, four-dimensional CBCT, and four-dimensional DTS image estimation. This method has the potential for significantly reducing the imaging dose and improving the image quality by removing the organ distortion artifacts and streak artifacts shown in images reconstructed by the conventional Feldkamp-Davis-Kress (FDK) algorithm.

Authors
Ren, L; Chetty, IJ; Zhang, J; Jin, J-Y; Wu, QJ; Yan, H; Brizel, DM; Lee, WR; Movsas, B; Yin, F-F
MLA Citation
Ren, L, Chetty, IJ, Zhang, J, Jin, J-Y, Wu, QJ, Yan, H, Brizel, DM, Lee, WR, Movsas, B, and Yin, F-F. "Development and clinical evaluation of a three-dimensional cone-beam computed tomography estimation method using a deformation field map." Int J Radiat Oncol Biol Phys 82.5 (April 1, 2012): 1584-1593.
PMID
21477945
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
1584
End Page
1593
DOI
10.1016/j.ijrobp.2011.02.002

Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007.

In the absence of evidence from large clinical trials, optimal therapy for localized prostate cancer remains unclear; however, treatment patterns continue to change. We examined changes in the management of patients with prostate cancer in the Medicare population.We conducted a retrospective claims-based analysis of the use of radiation therapy, surgery, and androgen deprivation therapy in the 12 months after diagnosis of prostate cancer in a nationally representative 5% sample of Medicare claims. Patients were Medicare beneficiaries 67 years or older with incident prostate cancer diagnosed between 1999 and 2007.There were 20,918 incident cases of prostate cancer between 1999 and 2007. The proportion of patients receiving androgen deprivation therapy decreased from 55% to 36%, and the proportion of patients receiving no active therapy increased from 16% to 23%. Intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the most common method of radiation therapy, accounting for 77% of external beam radiotherapy by 2007. Minimally invasive radical prostatectomy began to replace open surgical approaches, being used in 49% of radical prostatectomies by 2007.Between 2002 and 2007, the use of androgen deprivation therapy decreased, open surgical approaches were largely replaced by minimally invasive radical prostatectomy, and intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the predominant method of radiation therapy in the Medicare population. The aging of the population and the increasing use of newer, higher-cost technologies in the treatment of patients with prostate cancer may have important implications for nationwide health care costs.

Authors
Dinan, MA; Robinson, TJ; Zagar, TM; Scales, CD; Curtis, LH; Reed, SD; Lee, WR; Schulman, KA
MLA Citation
Dinan, MA, Robinson, TJ, Zagar, TM, Scales, CD, Curtis, LH, Reed, SD, Lee, WR, and Schulman, KA. "Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007." International journal of radiation oncology, biology, physics 82.5 (April 2012): e781-e786.
PMID
22331001
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
e781
End Page
e786
DOI
10.1016/j.ijrobp.2011.11.024

We do not need randomized clinical trials to demonstrate the superiority of proton therapy

Authors
Sakurai, H; Lee, WR; Orton, CG
MLA Citation
Sakurai, H, Lee, WR, and Orton, CG. "We do not need randomized clinical trials to demonstrate the superiority of proton therapy." MEDICAL PHYSICS 39.4 (April 2012): 1685-1687.
PMID
22482593
Source
wos-lite
Published In
Medical physics
Volume
39
Issue
4
Publish Date
2012
Start Page
1685
End Page
1687
DOI
10.1118/1.3681013

Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group.

What's known on the subject? and What does the study add? Very few comparative studies to date evaluate the results of treatment options for prostate cancer using the most sensitive measurement tools. PSA has been identified as the most sensitive tool for measuring treatment effectiveness. To date, comprehensive unbiased reviews of all the current literature are limited for prostate cancer. This is the first large scale comprehensive review of the literature comparing risk stratified patients by treatment option and with long-term follow-up. The results of the studies are weighted, respecting the impact of larger studies on overall results. The study identified a lack of uniformity in reporting results amongst institutions and centres. A large number of studies have been conducted on the primary therapy of prostate cancer but very few randomized controlled trials have been conducted. The comparison of outcomes from individual studies involving surgery (radical prostatectomy or robotic radical prostatectomy), external beam radiation (EBRT) (conformal, intensity modulated radiotherapy, protons), brachytherapy, cryotherapy or high intensity focused ultrasound remains problematic due to the non-uniformity of reporting results and the use of varied disease outcome endpoints. Technical advances in these treatments have also made long-term comparisons difficult. The Prostate Cancer Results Study Group was formed to evaluate the comparative effectiveness of prostate cancer treatments. This international group conducted a comprehensive literature review to identify all studies involving treatment of localized prostate cancer published during 2000-2010. Over 18,000 papers were identified and a further selection was made based on the following key criteria: minimum/median follow-up of 5 years; stratification into low-, intermediate- and high-risk groups; clinical and pathological staging; accepted standard definitions for prostate-specific antigen failure; minimum patient number of 100 in each risk group (50 for high-risk group). A statistical analysis (standard deviational ellipse) of the study outcomes suggested that, in terms of biochemical-free progression, brachytherapy provides superior outcome in patients with low-risk disease. For intermediate-risk disease, the combination of EBRT and brachytherapy appears equivalent to brachytherapy alone. For high-risk patients, combination therapies involving EBRT and brachytherapy plus or minus androgen deprivation therapy appear superior to more localized treatments such as seed implant alone, surgery alone or EBRT. It is anticipated that the study will assist physicians and patients in selecting treatment for men with newly diagnosed prostate cancer.

Authors
Grimm, P; Billiet, I; Bostwick, D; Dicker, AP; Frank, S; Immerzeel, J; Keyes, M; Kupelian, P; Lee, WR; Machtens, S; Mayadev, J; Moran, BJ; Merrick, G; Millar, J; Roach, M; Stock, R; Shinohara, K; Scholz, M; Weber, E; Zietman, A; Zelefsky, M; Wong, J; Wentworth, S; Vera, R; Langley, S
MLA Citation
Grimm, P, Billiet, I, Bostwick, D, Dicker, AP, Frank, S, Immerzeel, J, Keyes, M, Kupelian, P, Lee, WR, Machtens, S, Mayadev, J, Moran, BJ, Merrick, G, Millar, J, Roach, M, Stock, R, Shinohara, K, Scholz, M, Weber, E, Zietman, A, Zelefsky, M, Wong, J, Wentworth, S, Vera, R, and Langley, S. "Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group." BJU Int 109 Suppl 1 (February 2012): 22-29. (Review)
PMID
22239226
Source
pubmed
Published In
Bju International
Volume
109 Suppl 1
Publish Date
2012
Start Page
22
End Page
29
DOI
10.1111/j.1464-410X.2011.10827.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

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 2.1 (January 2012): 1-1.
Source
crossref
Published In
Practical Radiation Oncology
Volume
2
Issue
1
Publish Date
2012
Start Page
1
End Page
1
DOI
10.1016/j.prro.2011.11.008

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

Improvement in prostate cancer survival over time: a 20-year analysis: the Will Rogers phenomenon returns.

Authors
Lee, WR
MLA Citation
Lee, WR. "Improvement in prostate cancer survival over time: a 20-year analysis: the Will Rogers phenomenon returns." Cancer J 18.1 (January 2012): 9-10.
PMID
22290250
Source
pubmed
Published In
Cancer Journal
Volume
18
Issue
1
Publish Date
2012
Start Page
9
End Page
10
DOI
10.1097/PPO.0b013e31824672e1

American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy.

PURPOSE: To provide updated American Brachytherapy Society (ABS) guidelines for transrectal ultrasound-guided transperineal interstitial permanent prostate brachytherapy (PPB). METHODS AND MATERIALS: The ABS formed a committee of brachytherapists and researchers experienced in the clinical practice of PPB to formulate updated guidelines for this technique. Sources of input for these guidelines included prior published guidelines, clinical trials, published literature, and experience of the committee. The recommendations of the committee were reviewed and approved by the Board of Directors of the ABS. RESULTS: Patients with high probability of organ-confined disease or limited extraprostatic extension are considered appropriate candidates for PPB monotherapy. Low-risk patients may be treated with PPB alone without the need for supplemental external beam radiotherapy. High-risk patients should receive supplemental external beam radiotherapy if PPB is used. Intermediate-risk patients should be considered on an individual case basis. Intermediate-risk patients with favorable features may appropriately be treated with PPB monotherapy but results from confirmatory clinical trials are pending. Computed tomography-based postimplant dosimetry performed within 60 days of the implant is considered essential for maintenance of a satisfactory quality assurance program. Postimplant computed tomography-magnetic resonance image fusion is viewed as useful, but not mandatory. CONCLUSIONS: Updated guidelines for patient selection, workup, treatment, postimplant dosimetry, and followup are provided. These recommendations are intended to be advisory in nature with the ultimate responsibility for the care of the patients resting with the treating physicians.

Authors
Davis, BJ; Horwitz, EM; Lee, WR; Crook, JM; Stock, RG; Merrick, GS; Butler, WM; Grimm, PD; Stone, NN; Potters, L; Zietman, AL; Zelefsky, MJ; American Brachytherapy Society,
MLA Citation
Davis, BJ, Horwitz, EM, Lee, WR, Crook, JM, Stock, RG, Merrick, GS, Butler, WM, Grimm, PD, Stone, NN, Potters, L, Zietman, AL, Zelefsky, MJ, and American Brachytherapy Society, . "American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy." Brachytherapy 11.1 (January 2012): 6-19.
PMID
22265434
Source
pubmed
Published In
Brachytherapy
Volume
11
Issue
1
Publish Date
2012
Start Page
6
End Page
19
DOI
10.1016/j.brachy.2011.07.005

Evaluation of adherence to quality measures for prostate cancer radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey

Purpose: The purpose of this survey was to test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and nonacademic US institutions. Methods and Materials: A total of 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. Results: Among the 354 patients treated with EBRT, the beam energy was recorded in 353 patients. One hundred sixty-seven patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16-23 MV. For intermediate- plus high-risk patients (n = 181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n = 9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85 of 354), weekly electronic portal imaging was obtained as verification films without daily target localization, and the remaining 76% were treated with daily localization of the target using various methods. Conclusions: Adherence to defined quality indicators was observed in a majority of patients. Approximately 90% of high-risk patients were treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients received prescription doses ≥75 Gy, consistent with the published results of randomized trials. © 2012 American Society for Radiation Oncology.

Authors
Zelefsky, MJ; Lee, WR; Zietman, A; Khalid, N; Crozier, C; Owen, J; Wilson, JF
MLA Citation
Zelefsky, MJ, Lee, WR, Zietman, A, Khalid, N, Crozier, C, Owen, J, and Wilson, JF. "Evaluation of adherence to quality measures for prostate cancer radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey." Practical Radiation Oncology (2012).
Source
scival
Published In
Practical Radiation Oncology
Publish Date
2012
DOI
10.1016/j.prro.2012.01.006

Phase III trial of selenium to prevent prostate cancer in men with high-grade prostatic intraepithelial neoplasia: SWOG S9917.

The threat of prostate cancer and the significant and often negative impact of its treatment underscore the importance of prevention. High-grade prostatic intraepithelial neoplasia (HGPIN) has been identified as a potential premalignant lesion marking an increased risk of prostate cancer and substantial evidence suggests that men with HGPIN are in need of prostate cancer prevention. In vitro, in vivo, epidemiologic, and clinical trial evidence that selenium supplementation protects against prostate cancer motivated the study we report here: a double-blind, randomized, placebo-controlled trial of selenium 200 (μg/d) as selenomethionine in men with HGPIN. The primary endpoint was progression of HGPIN to prostate cancer over a 3-year period. This National Cancer Institute Intergroup trial was coordinated by the Southwest Oncology Group (SWOG). Of 619 enrolled patients, 423 randomized men with HGPIN (212 selenium and 211 placebo) were eligible (by central pathology review) and included in the primary analysis. Three-year cancer rates were 36.6% (placebo) versus 35.6% (selenium; P = 0.73, adjusted). The majority of patients who developed cancer on trial (70.8%, selenium and 75.5%, placebo) had a Gleason score of 6 or less than 6; there were no differences in Gleason scores between the two arms. Subset analyses included the finding of a nonsignificantly reduced prostate cancer risk (relative risk = 0.82; 95% CI: 0.40-1.69) in selenium versus placebo patients in the lowest quartile of baseline plasma selenium level (<106 ng/mL). Overall, and in all other subsets defined by baseline blood selenium levels, selenium supplementation had no effect on prostate cancer risk. The 36% prostate cancer rate in men with HGPIN indicates the association of this lesion with an elevated prostate cancer risk. Future study in this setting should focus on selenium-deficient populations and selenium pharmacogenetics.

Authors
Marshall, JR; Tangen, CM; Sakr, WA; Wood, DP; Berry, DL; Klein, EA; Lippman, SM; Parnes, HL; Alberts, DS; Jarrard, DF; Lee, WR; Gaziano, JM; Crawford, ED; Ely, B; Ray, M; Davis, W; Minasian, LM; Thompson, IM
MLA Citation
Marshall, JR, Tangen, CM, Sakr, WA, Wood, DP, Berry, DL, Klein, EA, Lippman, SM, Parnes, HL, Alberts, DS, Jarrard, DF, Lee, WR, Gaziano, JM, Crawford, ED, Ely, B, Ray, M, Davis, W, Minasian, LM, and Thompson, IM. "Phase III trial of selenium to prevent prostate cancer in men with high-grade prostatic intraepithelial neoplasia: SWOG S9917." Cancer Prev Res (Phila) 4.11 (November 2011): 1761-1769.
PMID
21896650
Source
pubmed
Published In
Cancer Prevention Research
Volume
4
Issue
11
Publish Date
2011
Start Page
1761
End Page
1769
DOI
10.1158/1940-6207.CAPR-10-0343

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 1.4 (October 2011): 217-217.
Source
crossref
Published In
Practical Radiation Oncology
Volume
1
Issue
4
Publish Date
2011
Start Page
217
End Page
217
DOI
10.1016/j.prro.2011.09.001

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

Long-term results of a phase II trial of ultrasound-guided radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (RTOG 98-05).

PURPOSE: To evaluate the long-term effectiveness of transrectal ultrasound-guided permanent radioactive I125 implantation of the prostate for organ confined adenocarcinoma of the prostate compared with historical data of prostatectomy and external beam radiotherapy within a cooperative group setting. METHODS AND MATERIALS: Patients accrued to this study had histologically confirmed, locally confined adenocarcinoma of the prostate clinical stage T1b, T1c, or T2a; no nodal or metastatic disease; prostate-specific antigen level of ≤10 ng/ml; and a Gleason score of ≤6. All patients underwent transrectal ultrasound-guided radioactive I125 seed implantation into the prostate. The prescribed dose was 145 Gy to the prostate planning target volume. RESULTS: A total of 101 patients from 27 institutions were accrued to this protocol; by design, no single institution accrued more than 8 patients. There were 94 eligible patients. The median follow up was 8.1 years (range, 0.1-9.2 years). After 8 years, 8 patients had protocol-defined biochemical (prostate-specific antigen) failure (cumulative incidence, 8.0%); 5 patients had local failure (cumulative incidence, 5.5%); and 1 patient had distant failure (cumulative incidence, 1.1%; this patient also had biochemical failure and died of causes not related to prostate cancer). The 8-year overall survival rate was 88%. At last follow-up, no patient had died of prostate cancer or related toxicities. Three patients had maximum late toxicities of Grade 3, all of which were genitourinary. No Grade 4 or 5 toxicities were observed. CONCLUSIONS: The long-term results of this clinical trial have demonstrated that this kind of trial can be successfully completed through the RTOG and that results in terms of biochemical failure and toxicity compare very favorably with other brachytherapy published series as well as surgical and external beam radiotherapy series. In addition, the prospective, multicenter design highlights the probable generalizability of the outcomes.

Authors
Lawton, CA; Hunt, D; Lee, WR; Gomella, L; Grignon, D; Gillin, M; Morton, G; Pisansky, TM; Sandler, H
MLA Citation
Lawton, CA, Hunt, D, Lee, WR, Gomella, L, Grignon, D, Gillin, M, Morton, G, Pisansky, TM, and Sandler, H. "Long-term results of a phase II trial of ultrasound-guided radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (RTOG 98-05)." Int J Radiat Oncol Biol Phys 81.1 (September 1, 2011): 1-7.
PMID
21470793
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
81
Issue
1
Publish Date
2011
Start Page
1
End Page
7
DOI
10.1016/j.ijrobp.2010.05.056

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 1.3 (July 2011): 141-141.
Source
crossref
Published In
Practical Radiation Oncology
Volume
1
Issue
3
Publish Date
2011
Start Page
141
End Page
141
DOI
10.1016/j.prro.2011.06.007

Financial implications of changes in the initial treatment of prostate cancer among Medicare beneficiaries.

Authors
Dinan, MA; Robinson, TJ; Zagar, TM; Scales, CD; Curtis, LH; Reed, SD; Schulman, KA; Lee, WR
MLA Citation
Dinan, MA, Robinson, TJ, Zagar, TM, Scales, CD, Curtis, LH, Reed, SD, Schulman, KA, and Lee, WR. "Financial implications of changes in the initial treatment of prostate cancer among Medicare beneficiaries." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Does enrollment setting influence patient attributes and outcomes in RTOG prostate cancer trials?

Authors
Lee, WR; Dignam, J; Bruner, D; Efstathiou, JA; Yan, Y; Hanks, GE; Roach, M; Pilepich, MV; Sandler, HM
MLA Citation
Lee, WR, Dignam, J, Bruner, D, Efstathiou, JA, Yan, Y, Hanks, GE, Roach, M, Pilepich, MV, and Sandler, HM. "Does enrollment setting influence patient attributes and outcomes in RTOG prostate cancer trials?." JOURNAL OF CLINICAL ONCOLOGY 29.15 (May 20, 2011).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Does enrollment setting influence patient attributes and outcomes in RTOG prostate cancer trials?

4607 Background: The external validity of randomized trials (generalizability) has been called into question following the finding that patients treated on clinical trials vary substantially from patients treated in the usual care setting. The purpose of this secondary analysis is to examine whether results of prostate randomized trials within the RTOG differ according to enrollment setting.4,154 patients accrued into one of 4 RTOG trials between 1987-1999 were included in this analysis. There were 224 North American institutions enrolling in one or more trials. Patient attributes were compared by enrollment settings, controlling for trial. Survival regression models stratified by trial and including patient attributes were used to evaluate survival differences by enrollment setting.Academic institutions enrolled 36% of patients; community centers enrolled 49%; CCOPs enrolled 14%, and VHAs enrolled 2%. With respect to patient attributes, men from Academic and VHA centers tended to have better performance status, black men were less frequently enrolled from non-CCOP community institutions, and Gleason scores tended to be higher in men from CCOPs. Age at diagnosis did not differ materially by enrollment setting. Adjusted for patient attributes, survival by enrollment setting did not differ significantly (Table).Attributes of prostate cancer patients enrolled in these RTOG trials Phase III differed modestly according to enrollment site type. Accounting for these differences, overall survival did not depend on the type of institution from which patients were enrolled. These findings support the external validity of RTOG prostate trials.This project was supported by RTOG grant U10 CA21661, and CCOP grant U10 CA37422 from the National Cancer Institute (NCI). [Table: see text].

Authors
Lee, WR; Dignam, J; Bruner, D; Efstathiou, JA; Yan, Y; Hanks, GE; Roach, M; Pilepich, MV; Sandler, HM
MLA Citation
Lee, WR, Dignam, J, Bruner, D, Efstathiou, JA, Yan, Y, Hanks, GE, Roach, M, Pilepich, MV, and Sandler, HM. "Does enrollment setting influence patient attributes and outcomes in RTOG prostate cancer trials?." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): 4607-.
PMID
28024019
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
4607

Financial implications of changes in the initial treatment of prostate cancer among Medicare beneficiaries.

6115 Background: The traditional treament approaches for localized prostate cancer have included androgen suppression, watchful waiting, open radical prostatectomy, external beam radiation therapy and interstitial brachytherapy. In the last decade a number of novel treatment options have been developed including minimally invasive radical prostatectomy (MIRP) and intensity-modulated radiation therapy (IMRT).In this study, we examined changes in the treatment of Medicare beneficiaries diagnosed with incident prostate cancer between 1999 and 2007. The primary outcome was utiliziation of radiation, surgery, or androgen suppression therapy in the first 12 months following newly diagnosed prostate cancer by year of incidence.The study sample included 20 399 cases of incident prostate cancer identified between 1999 and 2007. Overall rates of surgery and radiotherapy within the first 12 months of diagnosis remained unchanged across the study period, however the proportion of beneficiaries receiving androgen suppression monotherapy decreased by half, with watchful waiting increasing from 16% to 23% of all beneficiaries. From 2002 to 2007, IMRT replaced 3-D conformal treatment as the most common method of prostate radiotherapy, and was used in two-thirds of all Medicare prostate cancer patients receiving any radiotherapy by 2007. During this same period, minimally invasive radical prostatectomy began to replace open surgical approaches, and was used in half of all radical prostatectomies by 2007.By 2007 IMRT had replaced 3D conformal radiotherapy (3D-CRT) as the predominant method of radiotherapy used in the Medicare prostate cancer population. With Medicare reimbursement for IMRT averaging $48,000 per beneficiary vs $22,000 for 3D-CRT, this trend has significant budgetary implications. The aging of the US population over the next decade will cause the number of men with newly diagnosed prostate cancer to climb. When combined with growth in the use of newer high-cost technologies, Medicare spending for prostate cancer will further accelerate.

Authors
Dinan, MA; Robinson, TJ; Zagar, TM; Scales, CD; Curtis, LH; Reed, SD; Schulman, KA; Lee, WR
MLA Citation
Dinan, MA, Robinson, TJ, Zagar, TM, Scales, CD, Curtis, LH, Reed, SD, Schulman, KA, and Lee, WR. "Financial implications of changes in the initial treatment of prostate cancer among Medicare beneficiaries." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): 6115-.
PMID
28022527
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
6115

Knowledge-based IMRT treatment planning for prostate cancer.

PURPOSE: To demonstrate the feasibility of using a knowledge base of prior treatment plans to generate new prostate intensity modulated radiation therapy (IMRT) plans. Each new case would be matched against others in the knowledge base. Once the best match is identified, that clinically approved plan is used to generate the new plan. METHODS: A database of 100 prostate IMRT treatment plans was assembled into an information-theoretic system. An algorithm based on mutual information was implemented to identify similar patient cases by matching 2D beam's eye view projections of contours. Ten randomly selected query cases were each matched with the most similar case from the database of prior clinically approved plans. Treatment parameters from the matched case were used to develop new treatment plans. A comparison of the differences in the dose-volume histograms between the new and the original treatment plans were analyzed. RESULTS: On average, the new knowledge-based plan is capable of achieving very comparable planning target volume coverage as the original plan, to within 2% as evaluated for D98, D95, and D1. Similarly, the dose to the rectum and dose to the bladder are also comparable to the original plan. For the rectum, the mean and standard deviation of the dose percentage differences for D20, D30, and D50 are 1.8% +/- 8.5%, -2.5% +/- 13.9%, and -13.9% +/- 23.6%, respectively. For the bladder, the mean and standard deviation of the dose percentage differences for D20, D30, and D50 are -5.9% +/- 10.8%, -12.2% +/- 14.6%, and -24.9% +/- 21.2%, respectively. A negative percentage difference indicates that the new plan has greater dose sparing as compared to the original plan. CONCLUSIONS: The authors demonstrate a knowledge-based approach of using prior clinically approved treatment plans to generate clinically acceptable treatment plans of high quality. This semiautomated approach has the potential to improve the efficiency of the treatment planning process while ensuring that high quality plans are developed.

Authors
Chanyavanich, V; Das, SK; Lee, WR; Lo, JY
MLA Citation
Chanyavanich, V, Das, SK, Lee, WR, and Lo, JY. "Knowledge-based IMRT treatment planning for prostate cancer." Med Phys 38.5 (May 2011): 2515-2522.
Website
http://hdl.handle.net/10161/3879
PMID
21776786
Source
pubmed
Published In
Medical physics
Volume
38
Issue
5
Publish Date
2011
Start Page
2515
End Page
2522
DOI
10.1118/1.3574874

Incorporating gross anatomy education into radiation oncology residency: a 2-year curriculum with evaluation of resident satisfaction.

PURPOSE: Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. METHODS: Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. RESULTS: Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. CONCLUSIONS: Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction.

Authors
Cabrera, AR; Lee, WR; Madden, R; Sims, E; Hoang, JK; White, LE; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Sims, E, Hoang, JK, White, LE, Marks, LB, and Chino, JP. "Incorporating gross anatomy education into radiation oncology residency: a 2-year curriculum with evaluation of resident satisfaction." J Am Coll Radiol 8.5 (May 2011): 335-340.
PMID
21531310
Source
pubmed
Published In
Journal of the American College of Radiology
Volume
8
Issue
5
Publish Date
2011
Start Page
335
End Page
340
DOI
10.1016/j.jacr.2010.10.005

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 1.2 (April 2011): 59-59.
Source
crossref
Published In
Practical Radiation Oncology
Volume
1
Issue
2
Publish Date
2011
Start Page
59
End Page
59
DOI
10.1016/j.prro.2011.03.002

Editorial comment.

Authors
Lee, WR
MLA Citation
Lee, WR. "Editorial comment." Urology 77.4 (April 2011): 991-.
PMID
21477730
Source
pubmed
Published In
Urology
Volume
77
Issue
4
Publish Date
2011
Start Page
991
DOI
10.1016/j.urology.2010.08.057

Adaptive prostate IGRT combining online re-optimization and re-positioning: a feasibility study.

In prostate radiation therapy, inter-fractional organ motion/deformation has posed significant challenges on reliable daily dose delivery. To correct for this issue, off-line re-optimization and online re-positioning have been used clinically. In this paper, we propose an adaptive images guided radiation therapy (AIGRT) scheme that combines these two correction methods in an anatomy-driven fashion. The AIGRT process first tries to find a best plan for the daily target from a plan pool, which consists of the original CT plan and all previous re-optimized plans. If successful, the selected plan is used for daily treatment with translational shifts. Otherwise, the AIGRT invokes the re-optimization process of the CT plan for the anatomy of the day, which is afterward added to the plan pool as a candidate for future fractions. The AIGRT scheme is evaluated by comparisons with daily re-optimization and online re-positioning techniques based on daily target coverage, organs at risk (OAR) sparing and implementation efficiency. Simulated treatment courses for 18 patients with re-optimization alone, re-positioning alone and AIGRT shows that AIGRT offers reliable daily target coverage that is highly comparable to daily re-optimization and significantly improves from re-positioning. AIGRT is also seen to provide improved OAR sparing compared to re-positioning. Apart from dosimetric benefits, AIGRT in addition offers an efficient scheme to integrate re-optimization to current re-positioning-based IGRT workflow.

Authors
Li, T; Thongphiew, D; Zhu, X; Lee, WR; Vujaskovic, Z; Yin, F-F; Wu, QJ
MLA Citation
Li, T, Thongphiew, D, Zhu, X, Lee, WR, Vujaskovic, Z, Yin, F-F, and Wu, QJ. "Adaptive prostate IGRT combining online re-optimization and re-positioning: a feasibility study." Phys Med Biol 56.5 (March 7, 2011): 1243-1258.
PMID
21285485
Source
pubmed
Published In
Physics in Medicine and Biology
Volume
56
Issue
5
Publish Date
2011
Start Page
1243
End Page
1258
DOI
10.1088/0031-9155/56/5/002

Teaching the anatomy of oncology: evaluating the impact of a dedicated oncoanatomy course.

PURPOSE: Anatomic considerations are often critical in multidisciplinary cancer care. We developed an anatomy-focused educational program for radiation oncology residents integrating cadaver dissection into the didactic review of diagnostic, surgical, radiologic, and treatment planning, and herein assess its efficacy. METHODS AND MATERIALS: Monthly, anatomic-site based educational modules were designed and implemented during the 2008-2009 academic year at Duke University Medical Center. Ten radiation oncology residents participated in these modules consisting of a 1-hour didactic introduction followed by a 1-hour session in the gross anatomy lab with cadavers prepared by trained anatomists. Pretests and posttests were given for six modules, and post-module feedback surveys were distributed. Additional review questions testing knowledge from prior sessions were integrated into the later testing to evaluate knowledge retention. Paired analyses of pretests and postests were performed by Wilcoxon signed-rank test. RESULTS: Ninety tests were collected and scored with 35 evaluable pretest and posttest pairs for six site-specific sessions. Posttests had significantly higher scores (median percentage correct 66% vs. 85%, p<0.001). Of 47 evaluable paired pretest and review questions given 1-3 months after the intervention, correct responses rates were significantly higher for the later (59% vs. 86%, p=0.008). Resident course satisfaction was high, with a median rating of 9 of 10 (IQR 8-9); with 1 being "less effective than most educational interventions" and 10 being "more effective than most educational interventions." CONCLUSIONS: An integrated oncoanatomy course is associated with improved scores on post-intervention tests, sustained knowledge retention, and high resident satisfaction.

Authors
Chino, JP; Lee, WR; Madden, R; Sims, EL; Kivell, TL; Doyle, SK; Mitchell, TL; Hoppenworth, EJ; Marks, LB
MLA Citation
Chino, JP, Lee, WR, Madden, R, Sims, EL, Kivell, TL, Doyle, SK, Mitchell, TL, Hoppenworth, EJ, and Marks, LB. "Teaching the anatomy of oncology: evaluating the impact of a dedicated oncoanatomy course." Int J Radiat Oncol Biol Phys 79.3 (March 1, 2011): 853-859.
PMID
20418025
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
79
Issue
3
Publish Date
2011
Start Page
853
End Page
859
DOI
10.1016/j.ijrobp.2009.10.054

American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the transperineal permanent brachytherapy of prostate cancer.

Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachytherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program.

Authors
Rosenthal, SA; Bittner, NHJ; Beyer, DC; Demanes, DJ; Goldsmith, BJ; Horwitz, EM; Ibbott, GS; Lee, WR; Nag, S; Suh, WW; Potters, L; American Society for Radiation Oncology, ; American College of Radiology,
MLA Citation
Rosenthal, SA, Bittner, NHJ, Beyer, DC, Demanes, DJ, Goldsmith, BJ, Horwitz, EM, Ibbott, GS, Lee, WR, Nag, S, Suh, WW, Potters, L, American Society for Radiation Oncology, , and American College of Radiology, . "American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the transperineal permanent brachytherapy of prostate cancer." Int J Radiat Oncol Biol Phys 79.2 (February 1, 2011): 335-341.
PMID
21106306
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
79
Issue
2
Publish Date
2011
Start Page
335
End Page
341
DOI
10.1016/j.ijrobp.2010.08.045

Editor's Note

Authors
Lee, WR
MLA Citation
Lee, WR. "Editor's Note." Practical Radiation Oncology 1.1 (January 1, 2011): 1-.
Source
scopus
Published In
Practical Radiation Oncology
Volume
1
Issue
1
Publish Date
2011
Start Page
1
DOI
10.1016/j.prro.2010.11.004

Incorporating gross anatomy education into radiation oncology residency: A 2-year curriculum with evaluation of resident satisfaction

Purpose: Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. Methods: Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. Results: Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. Conclusions: Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction. © 2011 American College of Radiology.

Authors
Cabrera, AR; Lee, WR; Madden, R; Sims, E; Hoang, JK; White, LE; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Sims, E, Hoang, JK, White, LE, Marks, LB, and Chino, JP. "Incorporating gross anatomy education into radiation oncology residency: A 2-year curriculum with evaluation of resident satisfaction." Journal of the American College of Radiology 8.5 (2011): 335-340.
Source
scopus
Published In
Journal of the American College of Radiology
Volume
8
Issue
5
Publish Date
2011
Start Page
335
End Page
340
DOI
10.1016/j.jacr.2010.10.005

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

The development of oncology treatment guidelines: An analysis of the National Guidelines Clearinghouse

Purpose: In the last 2 decades, guidelines have been developed to improve quality of patient care. A recent editorial of guideline development procedures suggested the process has significant limitations that affect their scientific validity.1 This prompted us to review oncology treatment guidelines to determine if such limitations are widespread. Methods and Materials: We performed a review of oncology treatment guidelines registered at the National Guidelines Clearinghouse (www.guideline.gov). Each guideline was independently reviewed by 2 authors and the following criteria were assessed: coordinating organization, guideline panel composition, reporting conflict of interest, peer review, dissent, expiration date, PubMed citation, and evidence-based scoring and grading of recommendations. Disagreements were resolved by consensus in subsequent discussions. Results: Sixty-four guidelines were reviewed (39 [61%] were developed by a medical specialty society and 25 [39%] were developed by government agencies). Fifty (78%) guideline panels were multidisciplinary and 44 (69%) included individuals with epidemiologic and health services research expertise. Potential conflicts of interest were disclosed in 43 (67%) guidelines. Sixty (94%) guidelines underwent peer review, with external review in 31 (48%). Seventeen (27%) guidelines are indexed by PubMed. Fifty-one (80%) guidelines included evidence-based methodologies and 46 (72%) used evidence-based scoring of recommendations. Significant differences were observed according to coordinating organization (eg, disclosure of conflict of interest in 46% of guidelines developed by medical specialty societies versus 100% authored by government agencies [. P < .0001]). Conclusions: The majority of oncology-related treatment guidelines registered at the National Guidelines Clearinghouse satisfy most of the criteria for sound guideline development. Significant differences in these criteria were observed according to the coordinating organization that developed the guideline. © 2011 American Society for Radiation Oncology.

Authors
Palta, M; Lee, WR
MLA Citation
Palta, M, and Lee, WR. "The development of oncology treatment guidelines: An analysis of the National Guidelines Clearinghouse." Practical Radiation Oncology 1.1 (2011): 33-37.
PMID
24673867
Source
scival
Published In
Practical Radiation Oncology
Volume
1
Issue
1
Publish Date
2011
Start Page
33
End Page
37
DOI
10.1016/j.prro.2010.09.003

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

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

Electronic Web-based Technology Significantly Improves Quality of Life (QOL) Data Collection: Analysis of RTOG 0828

Authors
Movsas, B; Hunt, D; Watkins-Burner, D; Lee, WR; Tharpe, H; Goldstein, D; Moore, J; Dayes, I; Parise, S; Sandler, H
MLA Citation
Movsas, B, Hunt, D, Watkins-Burner, D, Lee, WR, Tharpe, H, Goldstein, D, Moore, J, Dayes, I, Parise, S, and Sandler, H. "Electronic Web-based Technology Significantly Improves Quality of Life (QOL) Data Collection: Analysis of RTOG 0828." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S111-S111.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S111
End Page
S111

Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death.

OBJECTIVE: To investigate whether salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure can provide the same result as adjuvant RT, which decreases the risk of all-cause mortality (ACM) for men with positive margins (R1), or extra-capsular or seminal vesicle extension (pT3). METHODS: We studied 1638 men at Duke University who underwent radical prostatectomy for unfavourable-risk prostate cancer and whose postoperative PSA was undetectable. Cox regression was used to evaluate whether salvage vs adjuvant RT in men with a rapid (<10 months) or slow (≥10 months) PSA doubling time (DT) was associated with the risk of ACM, adjusting for adverse features (pT3, R1, Gleason score 8-10), age, preoperative PSA level, comorbidity and hormonal therapy use. RESULTS: Despite fewer men with two or more adverse features (61 vs 82%; P=0.016), salvage for a rapid PSA DT vs adjuvant RT increased the risk of ACM [adjusted hazard ratio (AHR)=3.42; 95% confidence interval (CI)=1.27-9.20; P=0.015]. There was no difference (AHR=1.39; 95% CI=0.50-3.90; P=0.53) in the risk of ACM among men who received salvage for a slow PSA DT or adjuvant RT. Nearly all (90%) men with a slow PSA DT had Gleason score ≤7 and the majority (59%) had at most pT3 or R1 disease. CONCLUSION: Radiation therapy after PSA failure as compared with adjuvant RT was not associated with an increased risk of ACM in men with Gleason score ≤7 and pT3R0 or pT2R1 disease.

Authors
D'Amico, AV; Chen, M-H; Sun, L; Lee, WR; Mouraviev, V; Robertson, CN; Walther, PJ; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
D'Amico, AV, Chen, M-H, Sun, L, Lee, WR, Mouraviev, V, Robertson, CN, Walther, PJ, Polascik, TJ, Albala, DM, and Moul, JW. "Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death." BJU Int 106.11 (December 2010): 1618-1622.
PMID
20553253
Source
pubmed
Published In
Bju International
Volume
106
Issue
11
Publish Date
2010
Start Page
1618
End Page
1622
DOI
10.1111/j.1464-410X.2010.09447.x

Editorial comment. Acute lower urinary tract symptoms after prostate brachytherapy with cesium-131.

Authors
Lee, WR
MLA Citation
Lee, WR. "Editorial comment. Acute lower urinary tract symptoms after prostate brachytherapy with cesium-131." Urology 76.5 (November 1, 2010).
Source
scopus
Published In
Urology
Volume
76
Issue
5
Publish Date
2010

Editorial comment. Acute lower urinary tract symptoms after prostate brachytherapy with cesium-131.

Authors
Lee, WR
MLA Citation
Lee, WR. "Editorial comment. Acute lower urinary tract symptoms after prostate brachytherapy with cesium-131." Urology 76.5 (November 2010): 1147-.
PMID
21056258
Source
pubmed
Published In
Urology
Volume
76
Issue
5
Publish Date
2010
Start Page
1147
DOI
10.1016/j.urology.2010.01.094

The beginning of a new journal.

Authors
Lee, WR
MLA Citation
Lee, WR. "The beginning of a new journal." Int J Radiat Oncol Biol Phys 78.1 (September 1, 2010): 1-2.
PMID
20708485
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
78
Issue
1
Publish Date
2010
Start Page
1
End Page
2
DOI
10.1016/j.ijrobp.2010.04.043

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

Editorial comment.

Authors
Lee, WR
MLA Citation
Lee, WR. "Editorial comment." Urology 75.6 (June 2010): 1416-1417.
PMID
20513503
Source
pubmed
Published In
Urology
Volume
75
Issue
6
Publish Date
2010
Start Page
1416
End Page
1417
DOI
10.1016/j.urology.2009.06.030

Seduced by dose?

Authors
Lee, WR
MLA Citation
Lee, WR. "Seduced by dose?." J Clin Oncol 28.7 (March 1, 2010): 1087-1089.
PMID
20124163
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
28
Issue
7
Publish Date
2010
Start Page
1087
End Page
1089
DOI
10.1200/JCO.2009.26.5579

Radiotherapy treatment plans with RapidArc for prostate cancer involving seminal vesicles and lymph nodes.

PURPOSE: Dosimetric results and treatment delivery efficiency of RapidArc plans to those of conventional intensity-modulated radiotherapy (IMRT) plans were compared using the Eclipse treatment planning system for high-risk prostate cancer. MATERIALS AND METHODS: This study included 10 patients. The primary planning target volume (PTV(P)) contained prostate, seminal vesicles, and pelvic lymph nodes with a margin. The boost PTV (PTV(B)) contained prostate and seminal vesicles with a margin. The total prescription dose was 75.6 Gy (46.8 Gy to PTV(P) and an additional 28.8 Gy to PTV(B); 1.8 Gy/fraction). Three plans were generated for each PTV: Multiple-field IMRT, one-arc RapidArc (1ARC), and two-arc RapidArc (2ARC). RESULTS: In the primary IMRT with PTV(P), average mean doses to bladder, rectum and small bowel were lower by 5.9%, 7.7% and 4.3%, respectively, than in the primary 1ARC and by 3.6%, 4.8% and 3.1%, respectively, than in the primary 2ARC. In the boost IMRT with PTV(B), average mean doses to bladder and rectum were lower by 2.6% and 4.8% than with the boost 1ARC and were higher by 0.6% and 0.2% than with the boost 2ARC. Integral doses were 7% to 9% higher with RapidArc than with IMRT for both primary and boost plans. Treatment delivery time was reduced by 2-7 minutes using RapidArc. CONCLUSION: For PTVs including prostate, seminal vesicles, and lymph nodes, IMRT performed better in dose sparing for bladder, rectum, and small bowel than did RapidArc. For PTVs including prostate and seminal vesicles, RapidArc with two arcs provided plans comparable to those for IMRT. The treatment delivery is more efficient with RapidArc.

Authors
Yoo, S; Wu, QJ; Lee, WR; Yin, F-F
MLA Citation
Yoo, S, Wu, QJ, Lee, WR, and Yin, F-F. "Radiotherapy treatment plans with RapidArc for prostate cancer involving seminal vesicles and lymph nodes." Int J Radiat Oncol Biol Phys 76.3 (March 1, 2010): 935-942.
PMID
20044214
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
76
Issue
3
Publish Date
2010
Start Page
935
End Page
942
DOI
10.1016/j.ijrobp.2009.07.1677

The effects of iohexol administration on technetium thyroid scintigraphy in normal cats.

Administration of iodinated contrast medium interferes with iodide uptake in the human thyroid gland and compromises diagnostic thyroid scintigraphy and radioiodine treatment for 4-6 weeks. However, the degree and duration of inhibition of thyroid uptake of pertechnetate (99mTcO4-) by iodinated contrast medium has not been established in any species. The main objective of this study was to better understand the temporal characteristics and magnitude of inhibition of feline thyroid uptake of 99mTcO4- due to iohexol administration. Routine thyroid scintigraphy was performed in eight cats by intravenous (IV) injection of 185 MBq (5 mCi) of 99mTcO4- both 4 days before and 0, 1, 3, 7, 14, and 28 days after IV administration of 880 mg I/kg iohexol (240 mg I/ml). Thyroid scintigraphy data were used to calculate thyroid:salivary gland ratios (T:S) and the percentage of total injected 99mTcO4- dose uptake within the thyroid (%TU) at 20 min postinjection. After iohexol administration, mean T:S was significantly decreased below baseline only on day 1. At no point during the study did any cat have a T:S that fell below the published normal reference range of 0.71 +/- 0.14. There was a significant decrease in %TU on day 1, 3, and 14; however, at no point during the study, did any cat have a %TU that fell below the published normal reference ranges of 0.64 +/- 0.57, 0.68 +/- 0.9, or 0.75 +/- 1.38.

Authors
Lee, WR; Pease, AP; Berry, CR
MLA Citation
Lee, WR, Pease, AP, and Berry, CR. "The effects of iohexol administration on technetium thyroid scintigraphy in normal cats." Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association 51.2 (March 2010): 182-185.
PMID
20402408
Source
epmc
Published In
Veterinary Radiology & Ultrasound
Volume
51
Issue
2
Publish Date
2010
Start Page
182
End Page
185

Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer.

PURPOSE: To define a prostate fossa clinical target volume (PF-CTV) for Radiation Therapy Oncology Group (RTOG) trials using postoperative radiotherapy for prostate cancer. METHODS AND MATERIALS: An RTOG-sponsored meeting was held to define an appropriate PF-CTV after radical prostatectomy. Data were presented describing radiographic failure patterns after surgery. Target volumes used in previous trials were reviewed. Using contours independently submitted by 13 radiation oncologists, a statistical imputation method derived a preliminary "consensus" PF-CTV. RESULTS: Starting from the model-derived CTV, consensus was reached for a CT image-based PF-CTV. The PF-CTV should extend superiorly from the level of the caudal vas deferens remnant to >8-12 mm inferior to vesicourethral anastomosis (VUA). Below the superior border of the pubic symphysis, the anterior border extends to the posterior aspect of the pubis and posteriorly to the rectum, where it may be concave at the level of the VUA. At this level, the lateral border extends to the levator ani. Above the pubic symphysis, the anterior border should encompass the posterior 1-2 cm of the bladder wall; posteriorly, it is bounded by the mesorectal fascia. At this level, the lateral border is the sacrorectogenitopubic fascia. Seminal vesicle remnants, if present, should be included in the CTV if there is pathologic evidence of their involvement. CONCLUSIONS: Consensus on postoperative PF-CTV for RT after prostatectomy was reached and is available as a CT image atlas on the RTOG website. This will allow uniformity in defining PF-CTV for clinical trials that include postprostatectomy RT.

Authors
Michalski, JM; Lawton, C; El Naqa, I; Ritter, M; O'Meara, E; Seider, MJ; Lee, WR; Rosenthal, SA; Pisansky, T; Catton, C; Valicenti, RK; Zietman, AL; Bosch, WR; Sandler, H; Buyyounouski, MK; Ménard, C
MLA Citation
Michalski, JM, Lawton, C, El Naqa, I, Ritter, M, O'Meara, E, Seider, MJ, Lee, WR, Rosenthal, SA, Pisansky, T, Catton, C, Valicenti, RK, Zietman, AL, Bosch, WR, Sandler, H, Buyyounouski, MK, and Ménard, C. "Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer." Int J Radiat Oncol Biol Phys 76.2 (February 1, 2010): 361-368.
PMID
19394158
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
76
Issue
2
Publish Date
2010
Start Page
361
End Page
368
DOI
10.1016/j.ijrobp.2009.02.006

We need better randomized comparison trials of prostate cancer.

Authors
Lee, WR
MLA Citation
Lee, WR. "We need better randomized comparison trials of prostate cancer." Cancer 116.2 (January 15, 2010): 270-272.
PMID
19924796
Source
pubmed
Published In
Cancer
Volume
116
Issue
2
Publish Date
2010
Start Page
270
End Page
272
DOI
10.1002/cncr.24780

On-line adaptive radiation therapy: feasibility and clinical study.

The purpose of this paper is to evaluate the feasibility and clinical dosimetric benefit of an on-line, that is, with the patient in the treatment position, Adaptive Radiation Therapy (ART) system for prostate cancer treatment based on daily cone-beam CT imaging and fast volumetric reoptimization of treatment plans. A fast intensity-modulated radiotherapy (IMRT) plan reoptimization algorithm is implemented and evaluated with clinical cases. The quality of these adapted plans is compared to the corresponding new plans generated by an experienced planner using a commercial treatment planning system and also evaluated by an in-house developed tool estimating achievable dose-volume histograms (DVHs) based on a database of existing treatment plans. In addition, a clinical implementation scheme for ART is designed and evaluated using clinical cases for its dosimetric qualities and efficiency.

Authors
Li, T; Zhu, X; Thongphiew, D; Lee, WR; Vujaskovic, Z; Wu, Q; Yin, F-F; Wu, QJ
MLA Citation
Li, T, Zhu, X, Thongphiew, D, Lee, WR, Vujaskovic, Z, Wu, Q, Yin, F-F, and Wu, QJ. "On-line adaptive radiation therapy: feasibility and clinical study." J Oncol 2010 (2010): 407236-.
PMID
21113304
Source
pubmed
Published In
Journal of Oncology
Volume
2010
Publish Date
2010
Start Page
407236
DOI
10.1155/2010/407236

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

Incorporating Gross Anatomy Education into Radiation Oncology Residency

Authors
Cabrera, AR; Lee, WR; Madden, R; Hoppenworth, EJ; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Hoppenworth, EJ, Marks, LB, and Chino, JP. "Incorporating Gross Anatomy Education into Radiation Oncology Residency." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S483
End Page
S484

Long-term Results of an RTOG Phase II Trial (00-19) of External Beam Radiation Therapy Combined with Permanent Source Brachytherapy for Intermediate Risk Clinically Localized Adenocarcinoma of the Prostate

Authors
Lawton, CA; Yan, Y; Lee, WR; Gillin, M; Firat, S; Baikadi, M; Crook, J; Kuettel, M; Morton, G; Sandler, H
MLA Citation
Lawton, CA, Yan, Y, Lee, WR, Gillin, M, Firat, S, Baikadi, M, Crook, J, Kuettel, M, Morton, G, and Sandler, H. "Long-term Results of an RTOG Phase II Trial (00-19) of External Beam Radiation Therapy Combined with Permanent Source Brachytherapy for Intermediate Risk Clinically Localized Adenocarcinoma of the Prostate." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S78
End Page
S79

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

ACR appropriateness criteria on external beam radiation therapy treatment planning for clinically localized prostate cancer expert panel on radiation oncology--prostate.

Authors
Michalski, JM; Roach, M; Merrick, G; Anscher, MS; Beyer, DC; Lawton, CA; Lee, WR; Pollack, A; Rosenthal, SA; Vijayakumar, S; Carroll, PR
MLA Citation
Michalski, JM, Roach, M, Merrick, G, Anscher, MS, Beyer, DC, Lawton, CA, Lee, WR, Pollack, A, Rosenthal, SA, Vijayakumar, S, and Carroll, PR. "ACR appropriateness criteria on external beam radiation therapy treatment planning for clinically localized prostate cancer expert panel on radiation oncology--prostate." Int J Radiat Oncol Biol Phys 74.3 (July 1, 2009): 667-672. (Review)
PMID
19386445
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
74
Issue
3
Publish Date
2009
Start Page
667
End Page
672
DOI
10.1016/j.ijrobp.2008.12.073

Variation in the definition of clinical target volumes for pelvic nodal conformal radiation therapy for prostate cancer.

PURPOSE: We conducted a comparative study of clinical target volume (CTV) definition of pelvic lymph nodes by multiple genitourinary (GU) radiation oncologists looking at the levels of discrepancies amongst this group. METHODS AND MATERIALS: Pelvic computed tomography (CT) scans from 2 men were distributed to 14 Radiation Therapy Oncology Group GU radiation oncologists with instructions to define CTVs for the iliac and presacral lymph nodes. The CT data with contours were then returned for analysis. In addition, a questionnaire was completed that described the physicians' method for target volume definition. RESULTS: Significant variation in the definition of the iliac and presacral CTVs was seen among the physicians. The minimum, maximum, mean (SD) iliac volumes (mL) were 81.8, 876.6, 337.6 +/- 203 for case 1 and 60.3, 627.7, 251.8 +/- 159.3 for case 2. The volume of 100% agreement was 30.6 and 17.4 for case 1 and 2 and the volume of the union of all contours was 1,012.0 and 807.4 for case 1 and 2, respectively. The overall agreement was judged to be moderate in both cases (kappa = 0.53 (p < 0.0001) and kappa = 0.48 (p < 0.0001). There was no volume of 100% agreement for either of the two presacral volumes. These variations were confirmed in the responses to the associated questionnaire. CONCLUSIONS: Significant disagreement exists in the definition of the CTV for pelvic nodal radiation therapy among GU radiation oncology specialists. A consensus needs to be developed so as to accurately assess the merit and safety of such treatment.

Authors
Lawton, CAF; Michalski, J; El-Naqa, I; Kuban, D; Lee, WR; Rosenthal, SA; Zietman, A; Sandler, H; Shipley, W; Ritter, M; Valicenti, R; Catton, C; Roach, M; Pisansky, TM; Seider, M
MLA Citation
Lawton, CAF, Michalski, J, El-Naqa, I, Kuban, D, Lee, WR, Rosenthal, SA, Zietman, A, Sandler, H, Shipley, W, Ritter, M, Valicenti, R, Catton, C, Roach, M, Pisansky, TM, and Seider, M. "Variation in the definition of clinical target volumes for pelvic nodal conformal radiation therapy for prostate cancer." Int J Radiat Oncol Biol Phys 74.2 (June 1, 2009): 377-382.
PMID
18947941
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
74
Issue
2
Publish Date
2009
Start Page
377
End Page
382
DOI
10.1016/j.ijrobp.2008.08.003

RTOG GU Radiation oncology specialists reach consensus on pelvic lymph node volumes for high-risk prostate cancer.

PURPOSE: Radiation therapy to the pelvic lymph nodes in high-risk prostate cancer is required on several Radiation Therapy Oncology Group (RTOG) clinical trials. Based on a prior lymph node contouring project, we have shown significant disagreement in the definition of pelvic lymph node volumes among genitourinary radiation oncology specialists involved in developing and executing current RTOG trials. MATERIALS AND METHODS: A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes. Data were presented to address the lymph node drainage of the prostate. Extensive discussion ensued to develop clinical target volume (CTV) pelvic lymph node consensus. RESULTS: Consensus was obtained resulting in computed tomography image-based pelvic lymph node CTVs. Based on this consensus, the pelvic lymph node volumes to be irradiated include: distal common iliac, presacral lymph nodes (S(1)-S(3)), external iliac lymph nodes, internal iliac lymph nodes, and obturator lymph nodes. Lymph node CTVs include the vessels (artery and vein) and a 7-mm radial margin being careful to "carve out" bowel, bladder, bone, and muscle. Volumes begin at the L5/S1 interspace and end at the superior aspect of the pubic bone. Consensus on dose-volume histogram constraints for OARs was also attained. CONCLUSIONS: Consensus on pelvic lymph node CTVs for radiation therapy to address high-risk prostate cancer was attained and is available as web-based computed tomography images as well as a descriptive format through the RTOG. This will allow for uniformity in evaluating the benefit and risk of such treatment.

Authors
Lawton, CAF; Michalski, J; El-Naqa, I; Buyyounouski, MK; Lee, WR; Menard, C; O'Meara, E; Rosenthal, SA; Ritter, M; Seider, M
MLA Citation
Lawton, CAF, Michalski, J, El-Naqa, I, Buyyounouski, MK, Lee, WR, Menard, C, O'Meara, E, Rosenthal, SA, Ritter, M, and Seider, M. "RTOG GU Radiation oncology specialists reach consensus on pelvic lymph node volumes for high-risk prostate cancer." Int J Radiat Oncol Biol Phys 74.2 (June 1, 2009): 383-387.
PMID
18947938
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
74
Issue
2
Publish Date
2009
Start Page
383
End Page
387
DOI
10.1016/j.ijrobp.2008.08.002

SU-FF-J-55: Acceptance Testing and Quality-Assurance Protocols for the Calypso® 4D Localization System™ and Q-Fix®/Calypso® Couchtop

Authors
O'Daniel, J; Wu, QJ; McMahon, R; Maurer, J; Lee, WR; Yin, F
MLA Citation
O'Daniel, J, Wu, QJ, McMahon, R, Maurer, J, Lee, WR, and Yin, F. "SU-FF-J-55: Acceptance Testing and Quality-Assurance Protocols for the Calypso® 4D Localization System™ and Q-Fix®/Calypso® Couchtop." June 2009.
Source
crossref
Published In
Medical physics
Volume
36
Issue
6Part6
Publish Date
2009
Start Page
2488
End Page
2488
DOI
10.1118/1.3181347

SU-FF-T-574: Radiotherapy Treatment Plans with RapidArc for Prostate Cancer Involving Seminal Vesicles

Authors
Yoo, S; Wu, Q; Lee, W; Yin, F
MLA Citation
Yoo, S, Wu, Q, Lee, W, and Yin, F. "SU-FF-T-574: Radiotherapy Treatment Plans with RapidArc for Prostate Cancer Involving Seminal Vesicles." June 2009.
Source
crossref
Published In
Medical physics
Volume
36
Issue
6Part18
Publish Date
2009
Start Page
2656
End Page
2656
DOI
10.1118/1.3182072

Comparison of online IGRT techniques for prostate IMRT treatment: adaptive vs repositioning correction.

This study compares three online image guidance techniques (IGRT) for prostate IMRT treatment: bony-anatomy matching, soft-tissue matching, and online replanning. Six prostate IMRT patients were studied. Five daily CBCT scans from the first week were acquired for each patient to provide representative "snapshots" of anatomical variations during the course of treatment. Initial IMRT plans were designed for each patient with seven coplanar 15 MV beams on a Eclipse treatment planning system. Two plans were created, one with a PTV margin of 10 mm and another with a 5 mm PTV margin. Based on these plans, the delivered dose distributions to each CBCT anatomy was evaluated to compare bony-anatomy matching, soft-tissue matching, and online replanning. Matching based on bony anatomy was evaluated using the 10 mm PTV margin ("bone10"). Soft-tissue matching was evaluated using both the 10 mm ("soft10") and 5 mm ("soft5") PTV margins. Online reoptimization was evaluated using the 5 mm PTV margin ("adapt"). The replanning process utilized the original dose distribution as the basis and linear goal programming techniques for reoptimization. The reoptimized plans were finished in less than 2 min for all cases. Using each IGRT technique, the delivered dose distribution was evaluated on all 30 CBCT scans (6 patients x 5 CBCT/patient). The mean minimum dose (in percentage of prescription dose) to the CTV over five treatment fractions were in the ranges of 99%-100% (SD = 0.1%-0.8%), 65%-98% (SD = 0.4%-19.5%), 87%-99% (SD = 0.7%-23.3%), and 95%-99% (SD = 0.4%-10.4%) for the adapt, bone10, soft5, and soft10 techniques, respectively. Compared to patient position correction techniques, the online reoptimization technique also showed improvement in OAR sparing when organ motion/deformations were large. For bladder, the adapt technique had the best (minimum) D90, D50, and D30 values for 24, 17, and 15 fractions out of 30 total fractions, while it also had the best D90, D50, and D30 values for the rectum for 25, 16, and 19 fractions, respectively. For cases where the adapt plans did not score the best for OAR sparing, the gains of the OAR sparing in the repositioning-based plans were accompanied by an underdosage in the target volume. To further evaluate the fast online replanning technique, a gold-standard plan ("new" plan) was generated for each CBCT anatomy on the Eclipse treatment planning system. The OAR sparing from the online replanning technique was compared to the new plan. The differences in D90, D50, and D30 of the OARs between the adapt and the new plans were less than 5% in 3 patients and were between 5% and 10% for the remaining three. In summary, all IGRT techniques could be sufficient to correct simple geometrical variations. However, when a high degree of deformation or differential organ position displacement occurs, the online reoptimization technique is feasible with less than 2 min optimization time and provides improvements in both CTV coverage and OAR sparing over the position correction techniques. For these cases, the reoptimization technique can be a highly valuable online IGRT tool to correct daily treatment uncertainties, especially when hypofractionation scheme is applied and daily correction, rather than averaging over many fractions, is required to match the original plan.

Authors
Thongphiew, D; Wu, QJ; Lee, WR; Chankong, V; Yoo, S; McMahon, R; Yin, F-F
MLA Citation
Thongphiew, D, Wu, QJ, Lee, WR, Chankong, V, Yoo, S, McMahon, R, and Yin, F-F. "Comparison of online IGRT techniques for prostate IMRT treatment: adaptive vs repositioning correction." Med Phys 36.5 (May 2009): 1651-1662.
PMID
19544782
Source
pubmed
Published In
Medical physics
Volume
36
Issue
5
Publish Date
2009
Start Page
1651
End Page
1662
DOI
10.1118/1.3095767

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

PHASE I TRIAL OF PROSTATECTOMY AFTER PLANNED PREOPERATIVE RADIOTHERAPY FOR HIGH RISK LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS

Authors
Koontz, BF; Quaranta, BP; Carroll, M; Vujaskovic, Z; Lee, WR; Robertson, CN; Polascik, TJ; Anscher, MS; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Carroll, M, Vujaskovic, Z, Lee, WR, Robertson, CN, Polascik, TJ, Anscher, MS, and Moul, JW. "PHASE I TRIAL OF PROSTATECTOMY AFTER PLANNED PREOPERATIVE RADIOTHERAPY FOR HIGH RISK LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS." April 2009.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
713
End Page
713

Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy COMMENT

Authors
Lee, WR
MLA Citation
Lee, WR. "Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy COMMENT." JOURNAL OF UROLOGY 181.4 (April 2009): 1671-1671.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
1671
End Page
1671

The ethics of hypofractionation for prostate cancer.

Authors
Lee, WR
MLA Citation
Lee, WR. "The ethics of hypofractionation for prostate cancer." Int J Radiat Oncol Biol Phys 73.4 (March 15, 2009): 969-970.
PMID
19251081
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
73
Issue
4
Publish Date
2009
Start Page
969
End Page
970
DOI
10.1016/j.ijrobp.2008.11.022

Clinical evaluation of positioning verification using digital tomosynthesis and bony anatomy and soft tissues for prostate image-guided radiotherapy.

PURPOSE: To evaluate on-board digital tomosynthesis (DTS) for patient positioning vs. two-dimensional (2D) radiography and three-dimensional cone beam (CBCT). METHODS AND MATERIALS: A total of 92 image sessions from 9 prostate cancer patients were analyzed. An on-board image set was registered to a corresponding reference image set. Four pairs of image sets were used: digitally reconstructed radiographs vs. on-board orthogonal paired radiographs for the 2D method, coronal-reference DTS vs. on-board coronal DTS for the coronal-DTS method, sagittal-reference DTS vs. on-board sagittal DTS for the sagittal-DTS method, and planning CT vs. CBCT for the CBCT method. The registration results were compared. RESULTS: The systematic errors in all methods were <1 mm/1 degrees . When registering the bony anatomy, the mean vector difference was 0.21 +/- 0.11 cm between 2D and CBCT, 0.11 +/- 0.08 cm between CBCT and coronal DTS, and 0.14 +/- 0.07 cm between CBCT and sagittal DTS. The correlation between CBCT to DTS was stronger (coefficient = 0.92-0.95) than the correlation between 2D and CBCT or DTS (coefficient = 0.81-0.83). When registering the soft tissue, the mean vector difference was 0.18 +/- 0.11 cm between CBCT and coronal DTS and 0.29 +/- 0.17 cm between CBCT and sagittal DTS. The correlation coefficient of CBCT to sagittal DTS and to coronal DTS was 0.84 and 0.92, respectively. CONCLUSION: DTS could provide equivalent results to CBCT when the bony anatomy is used as landmarks for prostate image-guided radiotherapy. For soft tissue-based positioning verification, coronal DTS produced equivalent results to CBCT, but sagittal DTS alone was insufficient. DTS could allow for comparable soft tissue-based target localization with faster scanning time and a lower imaging dose compared with CBCT.

Authors
Yoo, S; Wu, QJ; Godfrey, D; Yan, H; Ren, L; Das, S; Lee, WR; Yin, F-F
MLA Citation
Yoo, S, Wu, QJ, Godfrey, D, Yan, H, Ren, L, Das, S, Lee, WR, and Yin, F-F. "Clinical evaluation of positioning verification using digital tomosynthesis and bony anatomy and soft tissues for prostate image-guided radiotherapy." Int J Radiat Oncol Biol Phys 73.1 (January 1, 2009): 296-305.
PMID
19100923
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
73
Issue
1
Publish Date
2009
Start Page
296
End Page
305
DOI
10.1016/j.ijrobp.2008.09.006

Extreme hypofractionation for prostate cancer.

In ideal circumstances the fractionation schedule of radiotherapy should match the fractionation sensitivity of the tumor relative to the nearby normal tissues. A number of recent publications have suggested that the alpha/beta ratio for prostate tumors is low - in the range of 1-3 Gy. In fact, if alpha/beta is low, then hypofractionated schedules using fewer, larger fractions should improve the therapeutic ratio. This critical article examines two methods that represent schedules at the extreme end of the fractionation spectrum (3-5 fractions): high-dose-rate brachytherapy as monotherapy and stereotactic body radiotherapy.

Authors
Lee, WR
MLA Citation
Lee, WR. "Extreme hypofractionation for prostate cancer." Expert Rev Anticancer Ther 9.1 (January 2009): 61-65.
PMID
19105707
Source
pubmed
Published In
Expert Review of Anticancer Therapy
Volume
9
Issue
1
Publish Date
2009
Start Page
61
End Page
65
DOI
10.1586/14737140.9.1.61

In Reply to Dr. Lawrence

Authors
Lee, WR
MLA Citation
Lee, WR. "In Reply to Dr. Lawrence." International Journal of Radiation Oncology Biology Physics 75.4 (2009): 1276-1277.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
4
Publish Date
2009
Start Page
1276
End Page
1277
DOI
10.1016/j.ijrobp.2009.07.1710

Editorial Comment

Authors
Lee, WR
MLA Citation
Lee, WR. "Editorial Comment." Journal of Urology 181.4 (2009): 1671--.
Source
scival
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
1671-
DOI
10.1016/j.juro.2008.11.155

Development and Clinical Evaluation of a Novel 3D Digital Tomosynthesis (DTS) Reconstruction Method using a Deformation Field Map

Authors
Ren, L; Zhang, J; Thongphiew, D; Wu, Q; Yan, H; Brizel, DM; Lee, WR; Willett, CG; Yin, F
MLA Citation
Ren, L, Zhang, J, Thongphiew, D, Wu, Q, Yan, H, Brizel, DM, Lee, WR, Willett, CG, and Yin, F. "Development and Clinical Evaluation of a Novel 3D Digital Tomosynthesis (DTS) Reconstruction Method using a Deformation Field Map." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S96
End Page
S96

Hybrid IGRT Technique for Prostate Hypofractionation

Authors
Thongphiew, D; Zhu, X; Wu, QJ; Lee, WR; Wu, Q; Chankong, V; Yin, F
MLA Citation
Thongphiew, D, Zhu, X, Wu, QJ, Lee, WR, Wu, Q, Chankong, V, and Yin, F. "Hybrid IGRT Technique for Prostate Hypofractionation." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S648
End Page
S649

Long Term Results of a Phase II Trial of Ultrasound-guided Radioactive Implantation of the Prostate for Definitive Management of Localized Adenocarcinoma of the Prostate (RTOG 98-05)

Authors
Lawton, CA; Hunt, D; Lee, WR; Gomella, L; Grignon, D; Gillin, M; Morton, G; Pisansky, T; Sandler, H
MLA Citation
Lawton, CA, Hunt, D, Lee, WR, Gomella, L, Grignon, D, Gillin, M, Morton, G, Pisansky, T, and Sandler, H. "Long Term Results of a Phase II Trial of Ultrasound-guided Radioactive Implantation of the Prostate for Definitive Management of Localized Adenocarcinoma of the Prostate (RTOG 98-05)." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S12
End Page
S13

Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT): Aggregate Data from the First Year

Authors
Henderson, MA; Thomas, K; Lee, WR; Johnstone, PAS
MLA Citation
Henderson, MA, Thomas, K, Lee, WR, and Johnstone, PAS. "Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT): Aggregate Data from the First Year." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S495
End Page
S496

Low-dose-rate Prostate Brachytherapy: Predictors of Freedom from Biochemical Recurrence

Authors
Squire, SE; Lee, WR; Urbanic, JJ; Papagikos, MA; Rossi, PJ; King, JD; deGuzman, AF; Fried, DB
MLA Citation
Squire, SE, Lee, WR, Urbanic, JJ, Papagikos, MA, Rossi, PJ, King, JD, deGuzman, AF, and Fried, DB. "Low-dose-rate Prostate Brachytherapy: Predictors of Freedom from Biochemical Recurrence." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S348
End Page
S348

Treatment Plan Comparison between IMRT and Volumetric IMAT using One- and Two-arc Beams for Prostate Cancer

Authors
Yoo, S; Wu, J; Lee, WR; Yin, F
MLA Citation
Yoo, S, Wu, J, Lee, WR, and Yin, F. "Treatment Plan Comparison between IMRT and Volumetric IMAT using One- and Two-arc Beams for Prostate Cancer." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S707
End Page
S707

Radiation therapy for clinically localized prostate cancer

Radiation therapy (RT) is one of the two main local treatments for clinically localized prostate cancer; radical prostatectomy (RP) is the other. The treatment options that are available for a particular patient are extensive and can include expectant management, RP, external beam radiation therapy (EBRT), interstitial brachytherapy (IB), androgen deprivation therapy (ADT), or any combination of these. © 2008 Springer-Verlag London.

Authors
Papagikos, MA; Lee, WR
MLA Citation
Papagikos, MA, and Lee, WR. "Radiation therapy for clinically localized prostate cancer." (December 1, 2008): 505-517. (Chapter)
Source
scopus
Publish Date
2008
Start Page
505
End Page
517
DOI
10.1007/978-1-84628-738-1_29

Pretreatment prostate-specific antigen velocity is associated with freedom from biochemical recurrence of prostate cancer after low-dose-rate prostate brachytherapy alone.

PURPOSE: This report examines the relationship between pretreatment prostate-specific antigen (PSA) velocity (PSAV) and freedom from biochemical recurrence (FFBR) in men with prostate cancer treated with low-dose-rate prostate brachytherapy (LDRPB). METHODS AND MATERIALS: This is a report of 51 men treated with LDRPB between 1997 and 1999. INCLUSION CRITERIA: two or more evaluable PSA values >3 months apart and <18 months before treatment. PSAV is calculated using a linear regression equation. All patients had biopsy confirmed, clinically localized prostate cancer. All men were treated with (125)I LDRPB. The prescription dose was 144Gy. Biochemical failure is determined from PSA values over time using the ASTRO Consensus Definition. FFBR is estimated using Kaplan-Meier method. Pretreatment variables analyzed include percentage positive biopsy cores, D(90), risk group, and PSAV. All p values are two-sided. RESULTS: The median followup is 60 months. The median pretreatment PSA is 6.5, 75% of men were Stage T1c, and 88% had Gleason score > or =6; 10% developed evidence of biochemical recurrence at a median of 13 months (range, 6-36). The 6-year estimate of FFBR is 90% for the entire cohort. On univariate analysis, pretreatment PSAV and risk group are associated with FFBR. The 6-year estimate of FFBR in patients with a PSAV <2 ng/mL/yr is 100% vs. 80% (95% confidence interval: 64-96%) when the pretreatment PSAV is > or =2 ng/mL/yr before LDRPB (p = 0.017). CONCLUSIONS: Pretreatment PSAV is a predictor of FFBR after LDRPB in this population of men with prostate cancer. Men with a pretreatment PSAV > or =2 ng/mL/yr may warrant more aggressive treatment.

Authors
Rossi, PJ; Urbanic, J; Clark, PE; McCullough, DL; Lee, WR
MLA Citation
Rossi, PJ, Urbanic, J, Clark, PE, McCullough, DL, and Lee, WR. "Pretreatment prostate-specific antigen velocity is associated with freedom from biochemical recurrence of prostate cancer after low-dose-rate prostate brachytherapy alone." Brachytherapy 7.4 (October 2008): 286-289.
PMID
18928924
Source
pubmed
Published In
Brachytherapy
Volume
7
Issue
4
Publish Date
2008
Start Page
286
End Page
289
DOI
10.1016/j.brachy.2008.08.004

SU-GG-J-81: Efficacy of Patient Setup Correction Procedure in Prostate Radiotherapy

Authors
Zhou, S; Das, S; Yin, F; Yoo, S; Lee, W; Yan, H; Wu, Q; Wang, Z; Marks, L
MLA Citation
Zhou, S, Das, S, Yin, F, Yoo, S, Lee, W, Yan, H, Wu, Q, Wang, Z, and Marks, L. "SU-GG-J-81: Efficacy of Patient Setup Correction Procedure in Prostate Radiotherapy." June 2008.
Source
crossref
Published In
Medical physics
Volume
35
Issue
6Part6
Publish Date
2008
Start Page
2697
End Page
2697
DOI
10.1118/1.2961631

SU-GG-T-53: Integrating An Online Adaptive IMRT Process to the Prostate IGRT

Authors
Wu, Q; Thongphiew, D; Wang, Z; Yin, F; Yoo, S; Lee, W
MLA Citation
Wu, Q, Thongphiew, D, Wang, Z, Yin, F, Yoo, S, and Lee, W. "SU-GG-T-53: Integrating An Online Adaptive IMRT Process to the Prostate IGRT." June 2008.
Source
crossref
Published In
Medical physics
Volume
35
Issue
6Part9
Publish Date
2008
Start Page
2738
End Page
2738
DOI
10.1118/1.2961803

SU-GG-T-13: Fast Seed Localization On MR Images For Post-Prostate Implant Dosimetry

Authors
Wu, Q; Wang, Z; Thongphiew, D; Yin, F; Lee, W
MLA Citation
Wu, Q, Wang, Z, Thongphiew, D, Yin, F, and Lee, W. "SU-GG-T-13: Fast Seed Localization On MR Images For Post-Prostate Implant Dosimetry." June 2008.
Source
crossref
Published In
Medical physics
Volume
35
Issue
6Part9
Publish Date
2008
Start Page
2729
End Page
2729
DOI
10.1118/1.2961763

SU-GG-T-54: On-Line Adaptive IMRT for Prostate Cancer

Authors
Thongphiew, D; Wu, Q; Lee, W; Chankong, V; Yin, F
MLA Citation
Thongphiew, D, Wu, Q, Lee, W, Chankong, V, and Yin, F. "SU-GG-T-54: On-Line Adaptive IMRT for Prostate Cancer." June 2008.
Source
crossref
Published In
Medical physics
Volume
35
Issue
6Part9
Publish Date
2008
Start Page
2738
End Page
2738
DOI
10.1118/1.2961804

Technology assessment: vigilance required.

Authors
Lee, WR
MLA Citation
Lee, WR. "Technology assessment: vigilance required." Int J Radiat Oncol Biol Phys 70.3 (March 1, 2008): 652-653.
PMID
18262082
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
70
Issue
3
Publish Date
2008
Start Page
652
End Page
653
DOI
10.1016/j.ijrobp.2007.09.030

On-line re-optimization of prostate IMRT plans for adaptive radiation therapy.

For intermediate and high risk prostate cancer, both the prostate gland and seminal vesicles are included in the clinical target volume. Internal motion patterns of these two organs vary, presenting a challenge for adaptive treatment. Adaptive techniques such as isocenter repositioning and soft tissue alignment are effective when tumor volumes only exhibit translational shift, while direct re-optimization of the intensity-modulated radiation therapy (IMRT) plan maybe more desirable when extreme deformation or differential positioning changes of the organs occur. Currently, direct re-optimization of the IMRT plan using beamlet (or fluence map) has not been reported. In this study, we report a novel on-line re-optimization technique that can accomplish plan adjustment on-line. Deformable image registration is used to provide position variation information on each voxel along the three dimensions. The original planned dose distribution is used as the 'goal' dose distribution for adaptation and to ensure planning quality. Fluence maps are re-optimized via linear programming, and a plan solution can be achieved within 2 min. The feasibility of this technique is demonstrated with a clinical case with large deformation. Such on-line ART process can be highly valuable with hypo-fractionated prostate IMRT treatment.

Authors
Wu, QJ; Thongphiew, D; Wang, Z; Mathayomchan, B; Chankong, V; Yoo, S; Lee, WR; Yin, F-F
MLA Citation
Wu, QJ, Thongphiew, D, Wang, Z, Mathayomchan, B, Chankong, V, Yoo, S, Lee, WR, and Yin, F-F. "On-line re-optimization of prostate IMRT plans for adaptive radiation therapy." Phys Med Biol 53.3 (February 7, 2008): 673-691.
PMID
18199909
Source
pubmed
Published In
Physics in Medicine and Biology
Volume
53
Issue
3
Publish Date
2008
Start Page
673
End Page
691
DOI
10.1088/0031-9155/53/3/011

Hypofractionation for prostate cancer: a critical review.

In ideal circumstances, the fractionation schedule of radiotherapy should match the fractionation sensitivity of the tumor relative to the nearby normal tissues. A number of recent publications have suggested that the alpha-beta ratio (alpha/beta) for prostate is low, in the range of 1 to 3 Gy. If alpha/beta is truly low, then hypofractionated schedules using fewer, larger fractions should improve the therapeutic ratio. This critical review examines the clinical experience with hypofractionation. Several prospective trials indicate that toxicity is limited with sophisticated dose delivery and compact clinical target volume to planning target volume margins, but the single-arm nature of these trials precludes definitive statements on efficacy. Several large randomized trials comparing conventional fractionation to hypofractionation are ongoing and are described. Until these trials are completed and the results submitted for rigorous peer review, the notion that alpha/beta for prostate cancer is low remains an unconfirmed hypothesis.

Authors
Miles, EF; Lee, WR
MLA Citation
Miles, EF, and Lee, WR. "Hypofractionation for prostate cancer: a critical review." Semin Radiat Oncol 18.1 (January 2008): 41-47. (Review)
PMID
18082587
Source
pubmed
Published In
Seminars in Radiation Oncology
Volume
18
Issue
1
Publish Date
2008
Start Page
41
End Page
47
DOI
10.1016/j.semradonc.2007.09.006

Androgen suppression and radiotherapy? Yes, but...

Authors
Lee, WR
MLA Citation
Lee, WR. "Androgen suppression and radiotherapy? Yes, but.." American Journal of Hematology/ Oncology 7.4 (2008).
Source
scival
Published In
American Journal of Oncology Review
Volume
7
Issue
4
Publish Date
2008

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

Dosimetrical evaluation of an online adaptive IMRT technique

Authors
Thongphiew, D; Wu, QJ; Lee, WR; Yoo, S; Chankong, V; Yin, F
MLA Citation
Thongphiew, D, Wu, QJ, Lee, WR, Yoo, S, Chankong, V, and Yin, F. "Dosimetrical evaluation of an online adaptive IMRT technique." 2008.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
S562
End Page
S562
DOI
10.1016/j.ijrobp.2008.06.132

Reducing biochemical recurrence rates in EBRT-treated prostate cancer patients: the influence of dose and dose per fraction.

In the last 15-20 years, technological improvements in radiation treatment planning and delivery have allowed radiation oncologists to increase the total dose to the prostate gland. The results of four randomized trials using conventional daily doses (1.8-2 Gy) demonstrate that higher total doses lead to lower rates of biochemical recurrence, but with a modest increase in late toxicity. Preclinical data suggest that treatment schedules relying on fewer, larger daily fractions of radiotherapy (hypofractionation) may increase the therapeutic ratio. Early results from several uncontrolled trials indicate that schedules that rely on larger daily doses are associated with low toxicity, provided some form of daily target localization and sophisticated treatment delivery are used. The results of several randomized trials that compare hypofractionated regimens to conventionally fractionated regimens will be available in the next 5-10 years.

Authors
Lee, WR
MLA Citation
Lee, WR. "Reducing biochemical recurrence rates in EBRT-treated prostate cancer patients: the influence of dose and dose per fraction." Future Oncol 3.6 (December 2007): 649-654. (Review)
PMID
18041917
Source
pubmed
Published In
Future oncology (London, England)
Volume
3
Issue
6
Publish Date
2007
Start Page
649
End Page
654
DOI
10.2217/14796694.3.6.649

Male breast cancer during treatment with leuprolide for prostate cancer.

Authors
Yacoub, J; Richardson, C; Farmer, M; Lee, WR; Clark, PE; Hurt, G; Levine, EA
MLA Citation
Yacoub, J, Richardson, C, Farmer, M, Lee, WR, Clark, PE, Hurt, G, and Levine, EA. "Male breast cancer during treatment with leuprolide for prostate cancer." Clin Adv Hematol Oncol 5.7 (July 2007): 555-556.
PMID
17679929
Source
pubmed
Published In
Clinical advances in hematology & oncology : H&O
Volume
5
Issue
7
Publish Date
2007
Start Page
555
End Page
556

Three-dimensional MRI and cone-beam CT matching for localization of prostate cancer treatment

Authors
Wang, Z; Wu, QJ; Lee, WR; Yin, F
MLA Citation
Wang, Z, Wu, QJ, Lee, WR, and Yin, F. "Three-dimensional MRI and cone-beam CT matching for localization of prostate cancer treatment." June 2007.
Source
wos-lite
Published In
Medical physics
Volume
34
Issue
6
Publish Date
2007
Start Page
2379
End Page
2379
DOI
10.1118/1.2760553

SU-FF-J-68: 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. "SU-FF-J-68: Dosimetric Comparison of Patient-Specific Margins Vs. Uniform Margins for Prostate IMRT Treatments." June 2007.
Source
crossref
Published In
Medical physics
Volume
34
Issue
6Part5
Publish Date
2007
Start Page
2383
End Page
2384
DOI
10.1118/1.2760573

Does a delay in initiating definitive therapy affect biochemical recurrence rates in men with clinically localized prostate cancer?

PURPOSE: To assess whether a delay in initiating definitive therapy for clinically localized prostate cancer affects outcome. METHODS: We retrospectively reviewed 393 men with localized prostate cancer treated with radiation therapy or surgery without systemic therapy between 1991 and 2004. Data included: time from diagnosis to treatment initiation (more or less than 3 months); biopsy Gleason score grouped by low (2-6), intermediate (7), or high risk (8-10); clinical stage grouped by low (T1/T2a) or high risk (T2b or higher); pretreatment prostate-specific antigen (PSA) grouped by low (<10 ng/ml), intermediate (10-20), or high risk (>20); and biochemical recurrence-free survival. RESULTS: Median patient age was 63.1 years (range 39.7-79.5). Median pretreatment PSA was 6.5 ng/ml (range 0.4-411). Median time from diagnosis to treatment was 57 days (range 8-2927). A total of 310 patients (79%) were treated within 3 months. Median follow-up was 2.3 years (range 0.1-14.0). On univariate analysis using Kaplan-Meier survival curves and the log-rank test, only pretreatment PSA was associated with worse biochemical recurrence-free survival (P = 0.008). Biochemical recurrence-free survival was not associated with time from diagnosis to treatment (P = 0.28), clinical stage (P = 0.50), or biopsy Gleason score (P = 0.19). The results were the same when analyzed in a multivariable analysis using the Cox proportional hazards model. CONCLUSION: A delay in treatment of > or =3 months does not appear to affect adversely biochemical recurrence-free survival in patients who undergo definitive therapy for clinically localized prostate cancer in those with low risk features.

Authors
Phillips, JJ; Hall, MC; Lee, WR; Clark, PE
MLA Citation
Phillips, JJ, Hall, MC, Lee, WR, and Clark, PE. "Does a delay in initiating definitive therapy affect biochemical recurrence rates in men with clinically localized prostate cancer?." Urol Oncol 25.3 (May 2007): 196-200.
PMID
17483015
Source
pubmed
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
25
Issue
3
Publish Date
2007
Start Page
196
End Page
200
DOI
10.1016/j.urolonc.2006.06.004

Late toxicity and biochemical recurrence after external-beam radiotherapy combined with permanent-source prostate brachytherapy: analysis of Radiation Therapy Oncology Group study 0019.

BACKGROUND: The combination of external-beam radiotherapy and brachytherapy is used commonly to treat men with prostate cancer. In this analysis, the authors examined the rate of biochemical recurrence (BR) and late grade > or =3 genitourinary (GU) and gastrointestinal (GI) toxicity after treatment with external-beam radiotherapy and brachytherapy in a multiinstitutional, cooperative group setting. METHODS: All eligible patients received external-beam radiotherapy (45 Gray [Gy] in 25 fractions) followed 2 to 6 weeks later by an interstitial implant using iodine-125 to deliver an additional 108 Gy. BR was defined in 2 ways: according to the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Definition (ACD) and according to the Phoenix definition (PD) (prostate-specific antigen nadir +2 ng/mL). The Radiation Therapy Oncology Group(RTOG)/European Organization for Research and Treatment of Cancer late radiation morbidity scoring system was used to grade all toxicity. RESULTS: One hundred thirty-eight patients were enrolled, and 130 were eligible for the current analysis. The median follow-up for surviving patients was 49 months (range, 20-60 months). The 48-month estimate of late grade > or =3 GU/GI toxicity was 15% (95% confidence interval [95% CI], 8-21%), and the 48-month estimate of BR was 19% (95% CI, 12-26%) and 14% (95% CI, 8-20%) according to the ACD and PD, respectively. CONCLUSIONS: The morbidity observed in this multiinstitutional, cooperative group study was slightly higher than that reported in recent RTOG studies using brachytherapy alone or high-dose external-beam radiotherapy. The BR rate observed in this report was similar to that observed with high-dose external-beam radiotherapy alone in similar patients.

Authors
Lee, WR; Bae, K; Lawton, C; Gillin, M; Morton, G; Firat, S; Baikadi, M; Kuettel, M; Greven, K; Sandler, H
MLA Citation
Lee, WR, Bae, K, Lawton, C, Gillin, M, Morton, G, Firat, S, Baikadi, M, Kuettel, M, Greven, K, and Sandler, H. "Late toxicity and biochemical recurrence after external-beam radiotherapy combined with permanent-source prostate brachytherapy: analysis of Radiation Therapy Oncology Group study 0019." Cancer 109.8 (April 15, 2007): 1506-1512.
PMID
17340591
Source
pubmed
Published In
Cancer
Volume
109
Issue
8
Publish Date
2007
Start Page
1506
End Page
1512
DOI
10.1002/cncr.22560

A simple model predicts freedom from biochemical recurrence after low-dose rate prostate brachytherapy alone.

OBJECTIVE: The objective of this study was to describe a simple model that predicts freedom from biochemical recurrence (FFBR) in men with prostate cancer after treatment with low-dose rate prostate brachytherapy (LDRPB) alone. MATERIALS AND METHODS: One hundred thirty-two men were treated with LDRPB alone between September 1997 and April 2001. Sixty-four percent of men had low-risk disease (prostate-specific antigen [PSA] <10, Gleason <7, and T stage or =10, Gleason > or =7, or T stage T2b). The dosimetric quantifier D90 was calculated from a computed tomography scan performed 1 month after LDRPB. The percent positive biopsies (PPB) were determined for all patients. FFBR was estimated using the product limit method. All P values are 2-sided. RESULTS: The median follow-up is 65 months. The median D90 is 138 Gy (range, 47-221 Gy). Fourteen men have developed evidence of biochemical relapse at a median of 27 months (range, 6-42 months). The 5-year FFBR rate for the entire cohort is 88%. On univariate analysis, variables found to be associated with FFBR included: PSA, Gleason score, T stage, risk group, PPB, and D90. Multivariate analysis indicated that D90, PPB, and risk group were independently associated with FFBR. Patients were categorized based on the following 3 adverse prognostic factors: D90 <140 Gy, PPB > or =50%, and intermediate-risk group. Group 1 (0 factors, n = 30), group 2 (1 factor, n = 72), and group 3 (> or =2 factors, n = 30) patients had 5-year FFBR rates of 100% (+/-0%), 92% (+/-6%), and 67% (+/-18%) (P < 0.0001). CONCLUSIONS: We have developed a simple, robust model based on implant quality and disease factors that predicts FFBR in men with prostate cancer treated with LDRPB alone.

Authors
Papagikos, MA; Rossi, PJ; Urbanic, JJ; deGuzman, AF; McCullough, DL; Clark, PE; Lee, WR
MLA Citation
Papagikos, MA, Rossi, PJ, Urbanic, JJ, deGuzman, AF, McCullough, DL, Clark, PE, and Lee, WR. "A simple model predicts freedom from biochemical recurrence after low-dose rate prostate brachytherapy alone." Am J Clin Oncol 30.2 (April 2007): 199-204.
PMID
17414471
Source
pubmed
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
30
Issue
2
Publish Date
2007
Start Page
199
End Page
204
DOI
10.1097/01.coc.0000251402.85009.af

Prostate brachytherapy: a descriptive analysis from CaPSURE.

PURPOSE: The purpose of this study was to describe demographic and clinical characteristics in a large disease registry of prostate cancer patients treated with prostate brachytherapy (PB) and to identify factors influencing the use of supplemental external beam (SEB) radiation therapy and choice of isotope. METHODS AND MATERIALS: Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a disease registry of 11,804 men with various stages of prostate cancer. The study population consisted of those men who were diagnosed with prostate cancer between 1990 and 2003, had no prior history of cancer and were treated with PB (alone or with SEB). The influence of patient demographics, disease characteristics, and year of diagnosis on the use of SEB and isotope choice was examined. RESULTS: The study population included 791 men. Six hundred nine men (77%) were treated with PB alone and 182 men (23%) were treated with PB and SEB. Patient demographics were not associated with the use of SEB. Disease characteristics were associated with the use of SEB. Patients treated with PB and SEB had higher pretreatment prostate-specific antigen (PSA), higher T-stage, higher Gleason score, and were more likely to be placed in the high-risk category (all p<0.01). The use of SEB increased over the period studied. In a multivariate analysis, patients diagnosed after 1999 were much more likely to receive SEB after controlling for disease characteristics (PSA, T-stage, Gleason). Likewise, higher clinical PSA (odds ratio [OR]=1.08; 95% confidence interval [CI]: 1.04-1.13), higher biopsy Gleason (OR=3.64; 95% CI: 2.60-5.09), and cT2 vs. cT1 (OR=2.06; 95% CI: 1.22-3.48) were more likely to have PB with SEB than PB alone. Patient demographics differed according to isotope. Compared to men treated with 125)I, men treated with (103)Pd were older, less educated, less wealthy, and less likely to have private insurance. Disease characteristics also differed according to isotope. Compared to men treated with 125I, men treated with 103Pd had higher T-stages, higher Gleason scores, and were more likely to be placed in the intermediate- or high-risk category. The choice of isotope did not change over time. CONCLUSIONS: The use of SEB is associated with disease characteristics. SEB has increased over the period studied. Isotope choice is associated with patient demographics and disease characteristics.

Authors
Lee, WR; Sharkey, J; Cowan, JE; DuChane, J; Carroll, PR; CaPSURE Investigators,
MLA Citation
Lee, WR, Sharkey, J, Cowan, JE, DuChane, J, Carroll, PR, and CaPSURE Investigators, . "Prostate brachytherapy: a descriptive analysis from CaPSURE." Brachytherapy 6.2 (April 2007): 123-128.
PMID
17434105
Source
pubmed
Published In
Brachytherapy
Volume
6
Issue
2
Publish Date
2007
Start Page
123
End Page
128
DOI
10.1016/j.brachy.2007.01.007

Results of a phase II trial of transrectal ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05).

PURPOSE: To evaluate the effectiveness of transrectal ultrasound-guided permanent radioactive (125)I implantation of the prostate for organ-confined adenocarcinoma of the prostate compared with historical data of prostatectomy and external beam radiotherapy within a cooperative group setting. METHODS AND MATERIALS: Patients accrued to this study had histologically confirmed, locally confined, adenocarcinoma of the prostate with clinical Stage T1b, T1c, or T2a, no nodal or metastatic disease, prostate-specific antigen level of < or =10 ng/mL, and Gleason score of < or =6. All patients underwent transrectal ultrasound-guided radioactive (125)I permanent seed implantation into the prostate. The prescribed dose was 145 Gy to the prostate planning target volume. RESULTS: A total of 27 institutions accrued a total of 101 patients to this protocol, with no institution accruing >8 patients. Six patients were ineligible, leaving 95 properly entered as eligible in the study. The median follow-up was 5.3 years (range, 0.4-6.5 years). At 5 years, 5 patients had local failure, 1 had evidence of distant failure, and 6 (6%) had biochemical failure. The overall survival rate at 5 years was 96.7%. At last follow-up, no patient had died of prostate cancer or related toxicities. Eight patients had a maximal acute toxicity level of 3, and no patient had Grade 4 or 5 acute toxicity. During follow-up, 2 patients had maximal Grade 3 toxicity, both related to bladder issues, and no patient experienced Grade 4 or 5 toxicity. CONCLUSION: The results of this clinical protocol (a multi-institutional trial of brachytherapy for localized adenocarcinoma of the prostate) have demonstrated that this type of trial can be successfully completed through the Radiation Therapy Oncology Group. Biochemical disease-free survival was comparable with other brachytherapy published series and with the results after surgery and external beam radiotherapy.

Authors
Lawton, CA; DeSilvio, M; Lee, WR; Gomella, L; Grignon, D; Gillin, M; Morton, G; Pisansky, T; Sandler, H
MLA Citation
Lawton, CA, DeSilvio, M, Lee, WR, Gomella, L, Grignon, D, Gillin, M, Morton, G, Pisansky, T, and Sandler, H. "Results of a phase II trial of transrectal ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05)." Int J Radiat Oncol Biol Phys 67.1 (January 1, 2007): 39-47.
PMID
17084551
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
67
Issue
1
Publish Date
2007
Start Page
39
End Page
47
DOI
10.1016/j.ijrobp.2006.08.016

Adjuvant radiotherapy linked to better cause-specific survival: Commentary

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Adjuvant radiotherapy linked to better cause-specific survival: Commentary." Oncology Report FALL (2007): 62--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
62-

Follow-up after EBRT falls short of guideline: Commentary

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Follow-up after EBRT falls short of guideline: Commentary." Oncology Report FALL (2007): 56--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
56-

Adjuvant radiotherapy averts biochemical progression

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Adjuvant radiotherapy averts biochemical progression." Oncology Report FALL (2007): 51--.
Source
scival
Published In
Oncology Report
Issue
FALL
Publish Date
2007
Start Page
51-

On-line adaptive planning system for prostate IMRT treatment

Authors
Thengphiew, D; Wu, Q; Wang, Z; Yoo, S; Lee, WR; Vujaskovic, Z; Yin, F
MLA Citation
Thengphiew, D, Wu, Q, Wang, Z, Yoo, S, Lee, WR, Vujaskovic, Z, and Yin, F. "On-line adaptive planning system for prostate IMRT treatment." 2007.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
3
Publish Date
2007
Start Page
S20
End Page
S21

Interstitial implant alone or in combination with external beam radiation therapy for intermediate-risk prostate cancer: A survey of practice patterns in the United States

Purpose: This study is aimed at understanding and defining the current patterns of care with respect to prostate brachytherapy for patients with intermediate-risk localized disease in the combined academic and community setting. Methods and materials: A nomogram-based survey was developed at the Seattle Prostate Institute defining the accepted criteria for intermediate-risk prostate cancer. Patients were defined as having intermediate-risk prostate cancer if they met one of the following criteria: prostate-specific antigen (PSA) >10 ng/dL, Gleason score (GS) ≥7, or cT2b or cT2c disease. Additional potential predictive factors including perineural invasion (PNI), GS 3 + 4 vs. 4 + 3, and high-volume disease were included. Results: In the absence of PNI, all of those surveyed would perform monotherapy for intermediate-risk patients, GS 7 (3 + 4) or PSA 10-20, with cT1c and <30% cores +. Up to 80% would perform monotherapy for patients with cT1c, GS 7 (4 + 3), and <30% cores +. Eighty to 90% of physicians would perform an implant alone with cT2a and either a PSA of 10-20 or GS of 7 (3 + 4) and <30% cores +. Fifty to 60% of those surveyed stated that they would treat a patient with cT2b disease, GS 7 (3 + 4), or PSA 11-20, with less than two-thirds of the biopsy cores positive in the absence of PNI. Conclusions: This Patterns of Care (POC) study reveals that certain subsets of intermediate-risk localized prostate cancer patients are considered appropriate candidates for an interstitial implant alone. © 2007 American Brachytherapy Society.

Authors
Frank, SJ; Grimm, PD; Sylvester, JE; Merrick, GS; Davis, BJ; Zietman, A; Moran, BJ; Beyer, DC; III, MR; Clarke, DH; Stock, RG; Lee, WR; Michalski, JM; Wallner, KE; Hurwitz, M; Potters, L; Kuban, DA; Prestidge, BR; Vera, R; Hathaway, S; Blasko, JC
MLA Citation
Frank, SJ, Grimm, PD, Sylvester, JE, Merrick, GS, Davis, BJ, Zietman, A, Moran, BJ, Beyer, DC, III, MR, Clarke, DH, Stock, RG, Lee, WR, Michalski, JM, Wallner, KE, Hurwitz, M, Potters, L, Kuban, DA, Prestidge, BR, Vera, R, Hathaway, S, and Blasko, JC. "Interstitial implant alone or in combination with external beam radiation therapy for intermediate-risk prostate cancer: A survey of practice patterns in the United States." Brachytherapy 6.1 (2007): 2-8.
PMID
17284379
Source
scival
Published In
Brachytherapy
Volume
6
Issue
1
Publish Date
2007
Start Page
2
End Page
8
DOI
10.1016/j.brachy.2006.09.004

Can prostate-specific antigen nadir predict prostate cancer outcomes following radiotherapy?

Authors
Lee, WR; Moul, JW
MLA Citation
Lee, WR, and Moul, JW. "Can prostate-specific antigen nadir predict prostate cancer outcomes following radiotherapy?." Nat Clin Pract Oncol 3.10 (October 2006): 534-535.
PMID
17019429
Source
pubmed
Published In
Nature Clinical Practice Oncology
Volume
3
Issue
10
Publish Date
2006
Start Page
534
End Page
535
DOI
10.1038/ncponc0612

A descriptive analysis of postimplant dosimetric parameters from Radiation Therapy Oncology Group P0019.

BACKGROUND: To date, there are few descriptive analyses of postimplant dosimetry from multi-institutional clinical trials. The purpose of this report is to describe the postimplant dosimetry achieved in Radiation Therapy Oncology Group (RTOG) 0019. METHODS AND MATERIALS: Patients were treated with external beam radiation therapy (45 Gy/25 fractions) followed by a prostate implant (I-125, prescription dose 108 Gy). Postimplant dosimetric assessment was accomplished by obtaining a CT scan of the prostate 1 month after the date of the implant procedure. Prostate volume was outlined by the first author. Dose-volume histograms were calculated by the Radiologic Physics Center. Four dosimetric quantifiers (DQs) were examined: D90 is the dose (reported as percentage of the prescription dose) received by 90% of the prostate; V100, V150, V200 is the percentage of the prostate volume receiving 100%, 150%, and 200% of the prescription dose, respectively. For the purposes of analysis, institutions were divided into three groups according to accrual (<5, 6-9, 10-12). RESULTS: One hundred thirty-eight patients from 27 institutions were registered in the study. Nineteen patients were excluded from this analysis; 14 who had no data and 5 who were ineligible, leaving 119 for analysis. The mean, median, and range of the four DQs are as follows: D90 105.6%, 106.0%, 57.6-174.8%; V100 89.8%, 92.6%, 11.2-100%; V150 58.4%, 59.6%, 0.9-93.7%; and V200 27.9%, 25.1%, 0.3-85.2%. Statistically significant differences according to institutional accrual were observed for D90 (p = 0.0283) and V200 (p = 0.0075), but not for V100 (p = 0.1534) and V150 (p = 0.0509). CONCLUSIONS: The DQ observed in this multi-institutional prospective study are roughly comparable to series from single institutions with considerable brachytherapy experience. Differences in DQs were observed according to institutional accrual. These data could be used to determine a community standard with respect to postimplant dosimetry.

Authors
Lee, WR; Bae, K; Lawton, CA; Gillin, MT; Morton, G; Firat, S; Baikadi, M; Kuettel, M; Greven, K; Sandler, H
MLA Citation
Lee, WR, Bae, K, Lawton, CA, Gillin, MT, Morton, G, Firat, S, Baikadi, M, Kuettel, M, Greven, K, and Sandler, H. "A descriptive analysis of postimplant dosimetric parameters from Radiation Therapy Oncology Group P0019." Brachytherapy 5.4 (October 2006): 239-243.
PMID
17118317
Source
pubmed
Published In
Brachytherapy
Volume
5
Issue
4
Publish Date
2006
Start Page
239
End Page
243
DOI
10.1016/j.brachy.2006.08.005

Computer-based learning in medical education: a critical view.

A number of reports in the past decade have concluded that the medical education system must be reformed. These reports often call for the incorporation of new technologies into the educational process. One technology that has found its way into the medical educational environment is the personal computer. This essay critically examines the introduction of the personal computer into medical education, focusing on computer-based learning (CBL). The author concludes that evidence demonstrating the effectiveness of CBL is weak, and evidence supporting the notion that CBL enhances learning (compared with traditional methods) is weaker still. The author also argues that the decision to use CBL in the place of face-to-face traditional instruction has important negative implications for participants in medical education and may undermine the important role of patients in the education of doctors.

Authors
Lee, WR
MLA Citation
Lee, WR. "Computer-based learning in medical education: a critical view." J Am Coll Radiol 3.10 (October 2006): 793-798. (Review)
PMID
17412170
Source
pubmed
Published In
Journal of the American College of Radiology
Volume
3
Issue
10
Publish Date
2006
Start Page
793
End Page
798
DOI
10.1016/j.jacr.2006.02.010

Confidence intervals and survival estimates: a systematic review of 3 oncology journals.

PURPOSE: Kaplan-Meier methods generate an estimate of survival when follow-up is less than complete. Confidence intervals (CI) provide a range of values that is likely to contain the true result. We hypothesized that reporting of CI around survival estimates is not uniform. METHODS: We searched all articles in randomly selected issues of Journal of Clinical Oncology (JCO), Cancer, and International Journal of Radiation Oncology Biology, and Physics (IJROBP) years 1999, 2001, and 2004. Articles reporting overall or median survival were reviewed to determine if CI were reported in text or graphical form. Data regarding disease site, intervention, study size, and type of study were collected. RESULTS: A total of 313 articles reported overall or median survival from 35 issues of the 3 journals (IJROBP 115, JCO 132, Cancer 66). CI were reported in 97/313 (31.0%) articles reviewed. CI reporting was more common in prospective clinical trials (38%) than retrospective reviews (25%), P = 0.018. If patients were treated with chemotherapy the article was more likely to report CI (no chemo 20% versus chemo 40%; P = 0.001). CI reporting varied with journal (IJROBP 20%, Cancer 29%, JCO 42%, P = 0.001). CI reporting increased according to year of publication (25% in 1999, 27% in 2001, and 41% in 2004, P = 0.03). CONCLUSION: A majority of studies in major oncology journals do not report CI with survival estimates. The likelihood of reporting CI is associated with study type (prospective versus retrospective), use of chemotherapy, journal, and year of publication.

Authors
Urbanic, JJ; Lee, WR
MLA Citation
Urbanic, JJ, and Lee, WR. "Confidence intervals and survival estimates: a systematic review of 3 oncology journals." Am J Clin Oncol 29.4 (August 2006): 405-407. (Review)
PMID
16891871
Source
pubmed
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
29
Issue
4
Publish Date
2006
Start Page
405
End Page
407
DOI
10.1097/01.coc.0000227525.96972.2f

Phase I-II prospective dose-escalating trial of lycopene in patients with biochemical relapse of prostate cancer after definitive local therapy.

OBJECTIVES: To report a prospective trial of lycopene supplementation in biochemically relapsed prostate cancer. METHODS: A total of 36 men with biochemically relapsed prostate cancer were enrolled in a dose-escalating, Phase I-II trial of lycopene supplementation. Six consecutive cohorts of 6 patients each received daily supplementation with 15, 30, 45, 60, 90, and 120 mg/day for 1 year. The serum levels of prostate-specific antigen (PSA) and plasma levels of lycopene were measured at baseline and every 3 months. The primary endpoints were PSA response (defined as a 50% decrease in serum PSA from baseline), pharmacokinetics, and the toxicity/tolerability of this regimen. RESULTS: A total of 36 patients were enrolled. The median age was 74 years (range 56 to 83), with a median serum PSA at entry of 4.4 ng/mL (range 0.8 to 24.9). No serum PSA responses were observed, and 37% of patients had PSA progression. The median time to progression was not reached. Toxicity was mild, with 1 patient discontinuing therapy because of diarrhea. Significant elevations of plasma lycopene were noted at 3 months and then appeared to plateau for all six dose levels. The plasma levels for doses between 15 and 90 mg/day were similar, with additional elevation only at 120 mg/day. CONCLUSIONS: Lycopene supplementation in men with biochemically relapsed prostate cancer is safe and well tolerated. The plasma levels of lycopene were similar for a wide dose range (15 to 90 mg/day) and plateaued by 3 months. Lycopene supplementation at the doses used in this study did not result in any discernible response in serum PSA.

Authors
Clark, PE; Hall, MC; Borden, LS; Miller, AA; Hu, JJ; Lee, WR; Stindt, D; D'Agostino, R; Lovato, J; Harmon, M; Torti, FM
MLA Citation
Clark, PE, Hall, MC, Borden, LS, Miller, AA, Hu, JJ, Lee, WR, Stindt, D, D'Agostino, R, Lovato, J, Harmon, M, and Torti, FM. "Phase I-II prospective dose-escalating trial of lycopene in patients with biochemical relapse of prostate cancer after definitive local therapy." Urology 67.6 (June 2006): 1257-1261.
PMID
16765186
Source
pubmed
Published In
Urology
Volume
67
Issue
6
Publish Date
2006
Start Page
1257
End Page
1261
DOI
10.1016/j.urology.2005.12.035

Update on brachytherapy in localized prostate cancer: the importance of dosimetry.

PURPOSE OF REVIEW: Prostate brachytherapy has become a common treatment modality for clinical localized adenocarcinoma of the prostate. This is the result of prostate screening and improved technology that currently allows for an outpatient procedure that generally can be accomplished in 1-2 h. The modern technique of prostate brachytherapy includes three components, (1) treatment planning, (2) placement of the sources and (3) an evaluation of the implant quality. In this review, we will focus on the importance of dosimetric quantifiers in predicting freedom from biochemical recurrence. RECENT FINDINGS: A number of dosimetric quantifiers have been described. These include D90 (dose that covers 90% of the prostate volume) and V100 (fractional volume of the prostate that receives 100% of the prescription dose). The data from four recently reported series are reviewed. Each series looks at various dosimetric cutpoints that predict for freedom from biochemical recurrence making a definitive statement difficult. All series observe a relationship between freedom from biochemical recurrence and one or both of these dosimetric quantifiers. SUMMARY: It is clear that a dose-response relationship exists following treatment with prostate brachytherapy; in other words, dosimetry matters and poor dosimetry will result in fewer men being cured. The lack of consistency in the reports to date precludes any definitive statements about what constitutes a "good" compared with a "bad" implant. Further prospective data from multi-center trials are required.

Authors
Urbanic, JJ; Lee, WR
MLA Citation
Urbanic, JJ, and Lee, WR. "Update on brachytherapy in localized prostate cancer: the importance of dosimetry." Curr Opin Urol 16.3 (May 2006): 157-161. (Review)
PMID
16679852
Source
pubmed
Published In
Current Opinion in Urology
Volume
16
Issue
3
Publish Date
2006
Start Page
157
End Page
161
DOI
10.1097/01.mou.0000193391.77469.39

A phase II study of external beam radiotherapy combined with permanent source brachytherapy for intermediate-risk, clinically localized adenocarcinoma of the prostate: preliminary results of RTOG P-0019.

PURPOSE: To estimate the rate of acute and late Grade 3-5 genitourinary and gastrointestinal toxicity after treatment with external beam radiotherapy and permanent source brachytherapy in a multi-institutional, cooperative group setting. METHODS AND MATERIALS: All patients were treated with external beam radiotherapy (45 Gy in 25 fractions), followed 2-6 weeks later by an interstitial implant using 125I to deliver an additional 108 Gy. Late genitourinary toxicity was graded according to the Common Toxicity Criteria Version 2.0, and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring system was used for all other toxicity. RESULTS: A total of 138 patients from 28 institutions were entered on this study. Acute toxicity information was available in 131 patients, and 127 patients were analyzable for late toxicity. Acute Grade 3 toxicity was documented in 10 of 131 patients (7.6%). No Grade 4 or 5 acute toxicity has been observed. The 18-month month estimate of late Grade 3 genitourinary and gastrointestinal toxicity was 3.3% (95% confidence interval, 0.1-6.5). No late Grade 4 or 5 toxicity has been observed. CONCLUSIONS: The acute and late morbidity observed in this multi-institutional, cooperative group study is consistent with previous reports from single institutions with significant prostate brachytherapy experience.

Authors
Lee, WR; DeSilvio, M; Lawton, C; Gillin, M; Morton, G; Firat, S; Baikadi, M; Kuettel, M; Greven, K; Sandler, H
MLA Citation
Lee, WR, DeSilvio, M, Lawton, C, Gillin, M, Morton, G, Firat, S, Baikadi, M, Kuettel, M, Greven, K, and Sandler, H. "A phase II study of external beam radiotherapy combined with permanent source brachytherapy for intermediate-risk, clinically localized adenocarcinoma of the prostate: preliminary results of RTOG P-0019." Int J Radiat Oncol Biol Phys 64.3 (March 1, 2006): 804-809.
PMID
16289906
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
64
Issue
3
Publish Date
2006
Start Page
804
End Page
809
DOI
10.1016/j.ijrobp.2005.09.002

Percentage of positive biopsies associated with freedom from biochemical recurrence after low-dose-rate prostate brachytherapy alone for clinically localized prostate cancer.

OBJECTIVES: To examine the relationship between the percentage of positive biopsies (PPBs) and freedom from biochemical recurrence (FFBR) in men treated with low-dose-rate prostate brachytherapy (LDRPB) alone. The PPBs has been associated with FFBR in men treated with radical prostatectomy and external beam radiotherapy for prostate cancer. METHODS: This report concerns 108 men treated with LDRPB alone between November 1997 and December 1999. All patients had clinically localized prostate cancer confirmed by biopsy. All men were treated with iodine-125 to 144 Gy. FFBR was estimated using the product-limit method. Putative covariates for FFBR, including T stage, Gleason score, pretreatment prostate-specific antigen level, minimal dose received by 90% of the target volume, and PPBs, were examined using the proportional hazards regression model. RESULTS: The median follow-up was 61 months. Of the 108 men, 13 developed evidence of biochemical relapse at a median of 25 months. The 5-year estimate of FFBR was 87% (95% confidence interval 81% to 93%) for the entire cohort. On univariate analysis, prostate-specific antigen, T stage, minimal dose received by 90% of the target volume, and PPBs were associated with FFBR. In the multivariate model, the PPBs was the only variable that predicted for FFBR (P = 0.002). The 5-year estimate of FFBR was 95% for patients with less than 50% PPB disease versus 63% in patients with more than 50% PPB disease (P < 0.0001). CONCLUSIONS: The PPBs is an important independent predictor of FFBR after LDRPB alone. The FFBR after LDRPB in the group of patients with more than 50% PPBs was poor.

Authors
Rossi, PJ; Clark, PE; Papagikos, MA; McCullough, DL; Lee, WR
MLA Citation
Rossi, PJ, Clark, PE, Papagikos, MA, McCullough, DL, and Lee, WR. "Percentage of positive biopsies associated with freedom from biochemical recurrence after low-dose-rate prostate brachytherapy alone for clinically localized prostate cancer." Urology 67.2 (February 2006): 349-353.
PMID
16461084
Source
pubmed
Published In
Urology
Volume
67
Issue
2
Publish Date
2006
Start Page
349
End Page
353
DOI
10.1016/j.urology.2005.08.047

Computer-Based Learning in Medical Education: A Critical View

A number of reports in the past decade have concluded that the medical education system must be reformed. These reports often call for the incorporation of new technologies into the educational process. One technology that has found its way into the medical educational environment is the personal computer. This essay critically examines the introduction of the personal computer into medical education, focusing on computer-based learning (CBL). The author concludes that evidence demonstrating the effectiveness of CBL is weak, and evidence supporting the notion that CBL enhances learning (compared with traditional methods) is weaker still. The author also argues that the decision to use CBL in the place of face-to-face traditional instruction has important negative implications for participants in medical education and may undermine the important role of patients in the education of doctors. © 2006 American College of Radiology.

Authors
Lee, WR
MLA Citation
Lee, WR. "Computer-Based Learning in Medical Education: A Critical View." Journal of the American College of Radiology 3.10 (January 1, 2006): 793-798.
Source
scopus
Published In
Journal of the American College of Radiology
Volume
3
Issue
10
Publish Date
2006
Start Page
793
End Page
798
DOI
10.1016/j.jacr.2006.02.010

Computer-Based Learning in Medical Education: A Critical View

A number of reports in the past decade have concluded that the medical education system must be reformed. These reports often call for the incorporation of new technologies into the educational process. One technology that has found its way into the medical educational environment is the personal computer. This essay critically examines the introduction of the personal computer into medical education, focusing on computer-based learning (CBL). The author concludes that evidence demonstrating the effectiveness of CBL is weak, and evidence supporting the notion that CBL enhances learning (compared with traditional methods) is weaker still. The author also argues that the decision to use CBL in the place of face-to-face traditional instruction has important negative implications for participants in medical education and may undermine the important role of patients in the education of doctors. © 2006 American College of Radiology.

Authors
Lee, WR
MLA Citation
Lee, WR. "Computer-Based Learning in Medical Education: A Critical View." Journal of the American College of Radiology 3.10 (2006): 793-798.
Source
scopus
Published In
Journal of the American College of Radiology
Volume
3
Issue
10
Publish Date
2006
Start Page
793
End Page
798
DOI
10.1016/j.jacr.2006.02.010

Lycopene dietary supplements and prostate cancer treatment

Lycopene is the predominant carotenoid in tomatoes and is responsible for their red color. There is substantial epidemiologic evidence that suggests a protective effect of increased tomato and/or lycopene consumption and the development of prostate cancer. Studies on a direct therapeutic effect of lycopene on treating established prostate cancer are more limited and have met with mixed results. This review summarizes the currently available studies of lycopene supplementation as a treatment of prostate cancer. © 2006 Elsevier Inc. All rights reserved.

Authors
Clark, PE; Hall, MC; Lee, WR
MLA Citation
Clark, PE, Hall, MC, and Lee, WR. "Lycopene dietary supplements and prostate cancer treatment." Seminars in Preventive and Alternative Medicine 2.2 (2006): 72-75.
Source
scival
Published In
Seminars in Preventive and Alternative Medicine
Volume
2
Issue
2
Publish Date
2006
Start Page
72
End Page
75
DOI
10.1016/j.spre.2006.01.001

The Merrick/Wallner/Butler et al article reviewed

Authors
Papagikos, MA; Lee, WR
MLA Citation
Papagikos, MA, and Lee, WR. "The Merrick/Wallner/Butler et al article reviewed." ONCOLOGY 20.5 (2006): 524-525.
Source
scival
Published In
Oncology
Volume
20
Issue
5
Publish Date
2006
Start Page
524
End Page
525

Clinically localized adenocarcinoma of the prostate: Radiation therapy

Authors
Lee, WR
MLA Citation
Lee, WR. "Clinically localized adenocarcinoma of the prostate: Radiation therapy." (December 1, 2005): 477-493. (Chapter)
Source
scopus
Publish Date
2005
Start Page
477
End Page
493
DOI
10.1016/B978-0-7216-0003-1.50030-7

Redox-transmetalation process as a generalized synthetic strategy for core-shell magnetic nanoparticles.

Although multicomponent core-shell type nanomaterials are one of the highly desired structural motifs due to their simultaneous multifunctionalities, the fabrication strategy for such nanostructures is still in a primitive stage. Here, we present a redox-transmetalation process that is effective as a general protocol for the fabrication of high quality and well-defined core-shell type bimetallic nanoparticles on the sub-10 nm scale. Various core-shell type nanomaterials including Co@Au, Co@Pd, Co@Pt, and Co@Cu nanoparticles are fabricated via transmetalation reactions. Compared to conventional sequential reduction strategies, this transmetalation process has several advantages for the fabrication of core-shell type nanoparticles: (i) no additional reducing agent is needed and (ii) spontaneous shell layer deposition occurs on top of the core nanoparticle surface and thus prevents self-nucleation of secondarily added metals. We also demonstrate the versatility of these core-shell structures by transferring Co@Au nanoparticles from an organic phase to an aqueous phase via a surface modification process. The nanostructures, magnetic properties, and reaction byproducts of these core-shell nanoparticles are spectroscopically characterized and identified, in part, to confirm the chemical process that promotes the core-shell structure formation.

Authors
Lee, WR; Kim, MG; Choi, JR; Park, JI; Ko, SJ; Oh, SJ; Cheon, J
MLA Citation
Lee, WR, Kim, MG, Choi, JR, Park, JI, Ko, SJ, Oh, SJ, and Cheon, J. "Redox-transmetalation process as a generalized synthetic strategy for core-shell magnetic nanoparticles." Journal of the American Chemical Society 127.46 (November 2005): 16090-16097. (Academic Article)
Source
manual
Published In
Journal of the American Chemical Society
Volume
127
Issue
46
Publish Date
2005
Start Page
16090
End Page
16097

Pthiriasis capitis.

Authors
Lai, HH; Chuang, SD; Hu, CH; Lee, WR
MLA Citation
Lai, HH, Chuang, SD, Hu, CH, and Lee, WR. "Pthiriasis capitis." International journal of dermatology 44.9 (September 2005): 771-773. (Academic Article)
Source
manual
Published In
International Journal of Dermatology
Volume
44
Issue
9
Publish Date
2005
Start Page
771
End Page
773

Health-related quality of life in men receiving prostate brachytherapy on RTOG 98-05.

PURPOSE: To prospectively assess health-related quality of life (HRQOL) during the first year after treatment with prostate brachytherapy (PB) alone for T1c-2a prostate cancer. MATERIALS AND METHODS: Ninety-eight patients from 24 institutions were eligible and properly entered on this study. All patients were treated with PB alone using I-125 (Oncura Model 6711). The prescription dose was 145 Gy. Three separate health-related quality of life questionnaires (HRQOL) (Functional Assessment of Cancer Therapy-Prostate [FACT-P], Sexual Adjustment Questionnaire [SAQ], and International Prostate Symptom Score [IPSS]) were self-administered before and after PB (baseline; 3, 6, 9, and 12 months after PB). The standard error of the mean (SEM) was used to analyze changes in HRQOL scores over time. Patients who improved greater than the SEM were categorized as improved; patients that declined greater than the SEM were categorized as declined; patients were otherwise categorized as stable. All changes are measured using the pretreatment HRQOL score as baseline. RESULTS: The percentage of men who reported the ability to have an erection decreased from 73% at baseline (65% unassisted, 8% assisted) to 57% at 1 year (36% unassisted, 21% assisted). The rate of urinary incontinence increased to 14% at 6 months but had decreased to 1% at the 12-month follow-up. At 1 year after PB, 80% of men reported decreased sexual functioning according to SAQ scores. More than 60% of men reported decreased urinary function at 12 months compared with baseline. CONCLUSIONS: This article represents the first prospective, multi-institutional study of HRQOL in men treated with PB and demonstrates that patients undergoing PB have a very high overall HRQOL. The rate of incontinence by 1 year after PB is low, but many patients continue to have obstructive symptoms at 1 year. Although 78% of 1-year respondents state that they can achieve an erection with or without assistance, almost 50% report a decrease in sexual function.

Authors
Feigenberg, SJ; Lee, WR; Desilvio, ML; Winter, K; Pisansky, TM; Bruner, DW; Lawton, C; Morton, G; Baikadi, M; Sandler, H
MLA Citation
Feigenberg, SJ, Lee, WR, Desilvio, ML, Winter, K, Pisansky, TM, Bruner, DW, Lawton, C, Morton, G, Baikadi, M, and Sandler, H. "Health-related quality of life in men receiving prostate brachytherapy on RTOG 98-05." Int J Radiat Oncol Biol Phys 62.4 (July 15, 2005): 956-964.
PMID
15989995
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
62
Issue
4
Publish Date
2005
Start Page
956
End Page
964
DOI
10.1016/j.ijrobp.2004.12.061

What variables predict for metastasis in men with biochemical relapse following radiotherapy for prostate cancer?

Authors
Lee, WR
MLA Citation
Lee, WR. "What variables predict for metastasis in men with biochemical relapse following radiotherapy for prostate cancer?." Nat Clin Pract Oncol 2.7 (July 2005): 340-341.
PMID
16075790
Source
pubmed
Published In
Nature Clinical Practice Oncology
Volume
2
Issue
7
Publish Date
2005
Start Page
340
End Page
341

Morquio syndrome: electron microscopic findings.

Authors
Leslie, T; Siddiqui, MA; Aitken, DA; Kirkness, CM; Lee, WR; Fern, AI
MLA Citation
Leslie, T, Siddiqui, MA, Aitken, DA, Kirkness, CM, Lee, WR, and Fern, AI. "Morquio syndrome: electron microscopic findings." The British journal of ophthalmology 89.7 (July 2005): 925-926. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
89
Issue
7
Publish Date
2005
Start Page
925
End Page
926

Langmuir monolayers of Co nanoparticles and their patterning by microcontact printing.

In this paper, we describe an easy and reliable method for the production of patterned monolayers of Co nanoparticles. A two-dimensional monolayer of Co nanoparticles is fabricated by spreading a nanoparticle solution over an air-water interface and then transferring it to a hydrophobic substrate by using the Langmuir-Blodgett (LB) method. Transmission electron microscopy (TEM) was used to show that, with increasing surface pressure, the Co nanoparticles become well-organized into a Langmuir monolayer with a hexagonal close-packed structure. By controlling the pH of the subphase, it was found that a monolayer of Co nanoparticles with long-range order could be obtained. Further, by transferring the Langmuir monolayer onto a poly(dimethoxysilane) (PDMS) mold, the selective micropatterning of the Co nanoparticles could be achieved on a patterned electronic circuit. The electronic transport properties of the Co nanoparticles showed the ohmic I-V curve.

Authors
Park, JI; Lee, WR; Bae, SS; Kim, YJ; Yoo, KH; Cheon, J; Kim, S
MLA Citation
Park, JI, Lee, WR, Bae, SS, Kim, YJ, Yoo, KH, Cheon, J, and Kim, S. "Langmuir monolayers of Co nanoparticles and their patterning by microcontact printing." The journal of physical chemistry. B 109.27 (July 2005): 13119-13123. (Academic Article)
Source
manual
Published In
The Journal of Physical Chemistry Part B: Condensed Matter, Materials, Surfaces, Interfaces and Biophysical
Volume
109
Issue
27
Publish Date
2005
Start Page
13119
End Page
13123

Three tears for EMAS.

Authors
Lee, WR
MLA Citation
Lee, WR. "Three tears for EMAS." Occupational medicine (Oxford, England) 55.4 (June 2005): 340-. (Academic Article)
Source
manual
Published In
Occupational Medicine
Volume
55
Issue
4
Publish Date
2005
Start Page
340

Percutaneous coronary intervention versus coronary artery bypass grafting for diabetics with multivessel coronary artery disease: the Korean Multicenter Revascularization Registry (KORR).

This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years between two groups. Among diabetic patients, the three-year mortality rate in PCI group was 1.9-fold higher than that of CABG group, although it was not statistically significant (PCI 19.8%, CABG 11.4%, p=0.14). The three-year mortality rate was similar between the two groups in non-diabetics (PCI 8.3%, CABG 10.0%, p=0.50). The 30-day rate of cerebrovascular event was higher in CABG group, for both diabetic (CABG 3.6%, PCI 0.0%, p

Authors
Gwon, HC; Choi, SH; Choi, BI; Cho, SY; Ro, YM; Lee, WR; Investigators, KORR
MLA Citation
Gwon, HC, Choi, SH, Choi, BI, Cho, SY, Ro, YM, Lee, WR, and Investigators, KORR. "Percutaneous coronary intervention versus coronary artery bypass grafting for diabetics with multivessel coronary artery disease: the Korean Multicenter Revascularization Registry (KORR)." Journal of Korean medical science, Korea (South) 20.2 (April 2005): 196-203. (Academic Article)
Source
manual
Published In
Journal of Korean medical science
Volume
20
Issue
2
Publish Date
2005
Start Page
196
End Page
203

Is NNT AOK?

Authors
Lee, WR
MLA Citation
Lee, WR. "Is NNT AOK?." Int J Radiat Oncol Biol Phys 61.3 (March 1, 2005): 640-641.
PMID
15708240
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
61
Issue
3
Publish Date
2005
Start Page
640
End Page
641
DOI
10.1016/j.ijrobp.2004.10.029

Propafenone-induced acute generalized exanthematous pustulosis.

Authors
Huang, YM; Lee, WR; Hu, CH; Cheng, KL
MLA Citation
Huang, YM, Lee, WR, Hu, CH, and Cheng, KL. "Propafenone-induced acute generalized exanthematous pustulosis." International journal of dermatology 44.3 (March 2005): 256-257. (Academic Article)
Source
manual
Published In
International Journal of Dermatology
Volume
44
Issue
3
Publish Date
2005
Start Page
256
End Page
257

Plasmacellular differentiation in extranodal marginal zone B cell lymphomas of the ocular adnexa: an analysis of the neoplastic plasma cell phenotype and its prognostic significance in 136 cases.

AIM: To determine (a) the expression of plasma cell related antigens in extranodal marginal zone B cell lymphomas (EMZL) of the ocular adnexa; and (b) the prognostic value of plasmacellular differentiation in these tumours. METHODS: A consecutive case series of 136 ocular adnexal EMZL obtained from three ocular pathology centres over 20 years was analysed retrospectively. An extensive immunohistochemical panel, including the plasma cell related antigens VS38c, CD38, CD138, multiple myeloma oncogene-1-protein (MUM1/IRF4), and CREB binding protein (CBP) was performed. EMZL were defined as "plasmacellular differentiated" on the basis of morphological features, evidence of cytoplasmic immunoglobulin, negativity for BSAP/PAX5, and expression of at least one of the investigated plasma cell related antigens. Controls included normal or hyperplastic lymphatic tissues. Detailed clinical data were collected for most patients, and compared with the results of immunohistochemistry. The end points considered for statistical analysis were development of local tumour recurrence, development of systemic disease, and lymphoma related death. RESULTS: 57 (42%) of the 136 ocular adnexal EMZL showed a plasmacellular differentiation; 45 of these plasmacytoid cases were primary tumours. In contrast with most admixed normal plasma cells, which displayed co-expression of MUM1/IRF4, Vs38c, CD38, CD138, and CBP, the plasmacellular differentiated EMZL tumour cells demonstrated co-expression of all five plasma cell related antigens in only six of 57 (11%) plasmacellular differentiated ocular adnexal EMZL. The most commonly expressed plasma cell related antigen was MUM1/IRF4, immunoreactivity being seen in 56/57 (98%) plasmacellular differentiated EMZL examined. Although the association of plasmacellular differentiation in primary ocular adnexal EMZL and disseminated disease was statistically significant on univariate analysis (p = 0.042), this was weaker on multivariate analysis. CONCLUSION: Plasmacellular differentiated tumour cells in EMZL demonstrate an aberrant immune profile for plasma cell related antigens when compared with normal plasma cells. On multivariate analysis, plasmacellular differentiation in ocular adnexal EMZL was not significantly associated with local recurrence, the development of systemic disease, or with lymphoma related death.

Authors
Coupland, SE; Hellmich, M; Auw Haedrich, C; Lee, WR; Anagnostopoulos, I; Stein, H
MLA Citation
Coupland, SE, Hellmich, M, Auw Haedrich, C, Lee, WR, Anagnostopoulos, I, and Stein, H. "Plasmacellular differentiation in extranodal marginal zone B cell lymphomas of the ocular adnexa: an analysis of the neoplastic plasma cell phenotype and its prognostic significance in 136 cases." The British journal of ophthalmology 89.3 (March 2005): 352-359. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
89
Issue
3
Publish Date
2005
Start Page
352
End Page
359

Publication rate of abstracts from the annual ASTRO meeting: Comparison with other organizations

Purpose: One of the explicit goals of the American Society of Therapeutic Radiology and Oncology (ASTRO) is to promote research and disseminate research results. In the past few years, ASTRO has required that manuscripts be submitted for publication for all papers accepted for oral presentation at its annual meeting. The purpose of this study was to determine the publication rate of abstracts accepted for oral presentation at ASTRO's 1999, 2000, and 2001 annual meetings. Materials and Methods: The authors reviewed the proceedings of ASTRO's annual meetings in 1999, 2000, and 2001 to identify all abstracts accepted for oral presentation. The following information was collected: year of presentation, study design (phase I or II, phase III, or retrospective), country of origin (domestic or foreign), abstract category (clinical or nonclinical), disease site (if applicable), publication (yes or no), publication date, and publishing journal. A computer-based search using Medline was used to determine whether the full publication of each abstract had occurred. The computer search included publication up to November 1, 2003. Results: The publication rate was 56% (452 of 802). There was no difference in publication rate according to country of origin (domestic 56%, foreign 57%; p = NS), abstract category (clinical 59%, nonclinical 48%; p = NS), or study design. Half of the published abstracts were published within 1 year of the meeting, and 90% were published within 2 years. The 452 publications were distributed among 54 different journals. The majority of papers were published in the International Journal of Radiation Oncology, Biology and Physics (62%), followed by the Journal of Clinical Oncology (8%) and Radiotherapy and Oncology (3%). Conclusions: Slightly more than one-half of the abstracts accepted for oral presentation at the annual ASTRO meeting are published within 2 years. This rate is similar to those of other specialties and suggests that ASTRO is succeeding in its mission to promote and disseminate research. Copyright © 2005 American College of Radiology.

Authors
Papagikos, MA; Rossi, PJ; Lee, WR
MLA Citation
Papagikos, MA, Rossi, PJ, and Lee, WR. "Publication rate of abstracts from the annual ASTRO meeting: Comparison with other organizations." Journal of the American College of Radiology 2.1 (2005): 72-75.
Source
scival
Published In
Journal of the American College of Radiology
Volume
2
Issue
1
Publish Date
2005
Start Page
72
End Page
75
DOI
10.1016/j.jacr.2004.06.025

Dosimetric quantifiers for low-dose-rate prostate brachytherapy: is V(100) superior to D(90)?

PURPOSE: The purpose of the present report is to describe the relationship between two dosimetric quantifiers (V(100) and D(90)) and freedom from biochemical recurrence (FFBR) in a cohort of men treated with low-dose-rate prostate brachytherapy (LDRPB) alone. METHODS AND MATERIALS: One hundred three men were treated with LDRPB alone between September 1997 and December 1999. All men had histologically confirmed clinically localized prostate cancer. Fifty-nine percent of the cohort had low-risk disease (defined as PSA<10, Gleason <7, and T stage /=10, Gleason>/=7, or T stage T2b). The prescription dose was 144Gy according to the Task Group 43 formalism. LDRPB was performed jointly by a radiation oncologist and a urologist. Dosimetric quantifiers (D(90), V(100)) were calculated from a CT scan performed 1 month after LDRPB. Biochemical recurrence was defined according to the ASTRO Consensus Definition. FFBR was estimated using the product-limit method. Disease-specific and treatment variables were examined as putative covariates for FFBR using the proportional hazards regression method. Univariate and multivariate methods were used. All p values are two sided. RESULTS: The median followup for the entire cohort is 61 months. The median followup of patients at risk for biochemical failure is 66 months. The median D(90) is 129Gy (range 47-221Gy), and the median V(100) is 86% (range 51-99%). Thirteen men have developed evidence of biochemical relapse at a median of 25 months (range 6-42 months). The 5-year estimate of FFBR for the entire cohort is 87% (95% CI 80-94%). On univariate analysis, disease-specific variables found to be significantly associated with FFBR included pretreatment PSA and percent positive biopsies. When considered as a continuous variable, each of the dosimetric quantifiers was associated with FFBR (V(100): p=0.007; D(90): p=0.05). D'Amico risk group classification is highly predictive of FFBR after LDRPB (HR 5.68, p=0.003). Multivariate analysis indicated that each dosimetric quantifier was independently associated with FFBR, but due to the high degree of correlation (Pearson correlation coefficient 0.94, p<0.0001) between the dosimetric quantifiers both could not be included simultaneously in the model. In the two models explored, V(100) was at least as good as D(90) in predicting FFBR. CONCLUSIONS: Dosimetric quantifiers (V(100) and D(90)) are independent predictors of FFBR after treatment with LDRPB alone. In our experience, V(100) seems to be at least equivalent (and perhaps superior) to D(90) for predicting FFBR.

Authors
Papagikos, MA; Deguzman, AF; Rossi, PJ; McCullough, DL; Clark, PE; Lee, WR
MLA Citation
Papagikos, MA, Deguzman, AF, Rossi, PJ, McCullough, DL, Clark, PE, and Lee, WR. "Dosimetric quantifiers for low-dose-rate prostate brachytherapy: is V(100) superior to D(90)?." Brachytherapy 4.4 (2005): 252-258.
PMID
16344254
Source
pubmed
Published In
Brachytherapy
Volume
4
Issue
4
Publish Date
2005
Start Page
252
End Page
258
DOI
10.1016/j.brachy.2005.09.001

Publication rate of abstracts from the annual ASTRO meeting: Comparison with other organizations

Purpose: One of the explicit goals of the American Society of Therapeutic Radiology and Oncology (ASTRO) is to promote research and disseminate research results. In the past few years, ASTRO has required that manuscripts be submitted for publication for all papers accepted for oral presentation at its annual meeting. The purpose of this study was to determine the publication rate of abstracts accepted for oral presentation at ASTRO's 1999, 2000, and 2001 annual meetings. Materials and Methods: The authors reviewed the proceedings of ASTRO's annual meetings in 1999, 2000, and 2001 to identify all abstracts accepted for oral presentation. The following information was collected: year of presentation, study design (phase I or II, phase III, or retrospective), country of origin (domestic or foreign), abstract category (clinical or nonclinical), disease site (if applicable), publication (yes or no), publication date, and publishing journal. A computer-based search using Medline was used to determine whether the full publication of each abstract had occurred. The computer search included publication up to November 1, 2003. Results: The publication rate was 56% (452 of 802). There was no difference in publication rate according to country of origin (domestic 56%, foreign 57%; p = NS), abstract category (clinical 59%, nonclinical 48%; p = NS), or study design. Half of the published abstracts were published within 1 year of the meeting, and 90% were published within 2 years. The 452 publications were distributed among 54 different journals. The majority of papers were published in the International Journal of Radiation Oncology, Biology and Physics (62%), followed by the Journal of Clinical Oncology (8%) and Radiotherapy and Oncology (3%). Conclusions: Slightly more than one-half of the abstracts accepted for oral presentation at the annual ASTRO meeting are published within 2 years. This rate is similar to those of other specialties and suggests that ASTRO is succeeding in its mission to promote and disseminate research. Copyright © 2005 American College of Radiology.

Authors
Papagikos, MA; Rossi, PJ; Lee, WR
MLA Citation
Papagikos, MA, Rossi, PJ, and Lee, WR. "Publication rate of abstracts from the annual ASTRO meeting: Comparison with other organizations." Journal of the American College of Radiology 2.1 (2005): 72-75.
Source
scival
Published In
Journal of the American College of Radiology
Volume
2
Issue
1
Publish Date
2005
Start Page
72
End Page
75
DOI
10.1016/j.jacr.2004.06.025

In regard to Lee et al.: "Dosimetry and cancer control after low-dose-rate prostate brachytherapy" (Int J Radiat Oncol Biol Phys 2005;61:52-59) [5] (multiple letters)

Authors
Shanahan, TG; Mueller, PW; Maxey, RB; Lee, WR
MLA Citation
Shanahan, TG, Mueller, PW, Maxey, RB, and Lee, WR. "In regard to Lee et al.: "Dosimetry and cancer control after low-dose-rate prostate brachytherapy" (Int J Radiat Oncol Biol Phys 2005;61:52-59) [5] (multiple letters)." International Journal of Radiation Oncology Biology Physics 63.1 (2005): 311-312.
PMID
16111606
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
63
Issue
1
Publish Date
2005
Start Page
311
End Page
312
DOI
10.1016/j.ijrobp.2005.04.044

Dosimetry and cancer control after low-dose-rate prostate brachytherapy

Purpose To describe the relationship between two commonly used dosimetric quantifiers (dose received by 90% of the prostate [D90] and volume receiving 100% of dose [V100]) and biochemical disease-free survival (bDFS) in a cohort of men treated with low-dose-rate prostate brachytherapy (LDRPB). Methods and materials The information in this report concerned the first 63 men treated with LDRPB alone at our institution between September 1997 and September 1998. All men had histologically confirmed, clinically localized prostate cancer. All men were treated with125I. The prescription dose was 144 Gy according to the Task Group 43 formalism. LDRPB was performed jointly by a radiation oncologist and urologist. Dosimetric quantifiers (D 90, V100) were calculated from a CT scan performed 1 month after LDRPB. Biochemical recurrence was defined according to the American Society for Therapeutic Radiology and Oncology consensus definition. Biochemical relapse-free survival (bRFS) was estimated using the product-limit method. D90 and V100 were examined as putative covariates for bRFS using the proportional hazards regression method. All p values are two-sided. Results The median follow-up for the entire cohort was 62 months. The median D90 was 122 Gy (range, 57-171Gy), and in 16 (25%) of 63 patients, the calculated D90 was >140 Gy. The median V100 was 81% (range, 51-97%). Nine men developed evidence of biochemical relapse at a median of 19 months (range, 6-38 months). The 5-year estimate of bRFS was 85% (95% confidence interval, 80-90%). The 5-year estimates of bRFS according to D 90 were as follows: D90 ≥140 Gy, 86%; D90 <140 Gy, 84% (p = not statistically significant). No threshold value of D90 was predictive of the 5-year estimates of bRFS until the D 90 was <80 Gy (D90 ≥80 Gy, 89%; D90 <80 Gy, 50%; p = 0.02). The 5-year estimates of bRFS according to V 100 were as follows: V100 ≥85%, 87%; V100 <85%, 84% (p = not statistically significant). No threshold value of V 100 was predictive of the 5-year estimates of BRFS unless the dosimetry was particularly poor. The 5-year BRFS was 89% if the V100 was ≥65% compared with 40% if the V100 was <65% (p = 0.006). Conclusion The dosimetric quantifiers described in this report did not predict for bRFS after LDRPB unless the dosimetry was very poor. This finding is not in complete agreement with those of previous reports. Possible reasons for this observation are (1) the study in underpowered, (2) inherent measurement error, (3) dosimetric quantifiers are poor surrogates of the dose received by the cancer, and (4) length of follow-up. Additional work in the area of quality assessment after LDRPB is required. © 2005 Elsevier Inc.

Authors
Lee, WR; Deguzman, AF; McMullen, KP; McCullough, DL
MLA Citation
Lee, WR, Deguzman, AF, McMullen, KP, and McCullough, DL. "Dosimetry and cancer control after low-dose-rate prostate brachytherapy." International Journal of Radiation Oncology Biology Physics 61.1 (2005): 52-59.
PMID
15629593
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
61
Issue
1
Publish Date
2005
Start Page
52
End Page
59
DOI
10.1016/j.ijrobp.2004.05.006

Egr-1 is activated by 17beta-estradiol in MCF-7 cells by mitogen-activated protein kinase-dependent phosphorylation of ELK-1.

Early growth response-1 (Egr-1) is an immediate-early gene induced by E2 in the rodent uterus and breast cancer cells. E2 induces Egr-1 mRNA and protein levels in MCF-7 human breast cancer cells and reporter gene activity in cells transfected with pEgr-1A, a construct containing the -600 to +12 region of the Egr-1 promoter linked to the firefly luciferase gene. Deletion analysis of the Egr-1 promoter identified a minimal E2-responsive region of the promoter that contained serum response element (SRE)3 (-376 to -350) which bound Elk-1 and serum response factor (SRF) in gel mobility shift assays. Hormone-responsiveness of Egr-1 in MCF-7 cells was specifically inhibited by PD98059, a mitogen-activated protein kinase kinase inhibitor, but not by LY294002, an inhibitor of phosphatidylinositol-3-kinase (PI3-K). These results contrasted with hormone-dependent activation of the SRE in the c-fos promoter, which was inhibited by both PD98059 and LY294002. Differences in activation of the SREs in Egr-1 and c-fos were related to promoter sequence, which defines the affinities of Elk-1 and SRF to their respective binding sites. Thus, Egr-1, like c-fos, is activated through non-genomic (extranuclear) pathways of estrogen action in breast cancer cells.

Authors
Chen, CC; Lee, WR; Safe, S
MLA Citation
Chen, CC, Lee, WR, and Safe, S. "Egr-1 is activated by 17beta-estradiol in MCF-7 cells by mitogen-activated protein kinase-dependent phosphorylation of ELK-1." Journal of cellular biochemistry 93.5 (November 2004): 1063-1074. (Academic Article)
Source
manual
Published In
Journal of Cellular Biochemistry
Volume
93
Issue
5
Publish Date
2004
Start Page
1063
End Page
1074

Transdermal delivery of macromolecules by erbium:YAG laser.

The aim of this study was to assess the effect of molecular weight (MW) on the transdermal delivery of macromolecules by erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment. Fluorescein isothiocyanate (FITC)-labeled dextran (FD) of increasing MWs (4.4, 19.4, 38, and 77 kDa) was used as the model macromolecules to investigate the skin permeation in vitro. Fluorescence microscopy and scanning electron microscopic (SEM) images were utilized to examine the transport mechanisms of the macromolecules via the skin after laser treatment. The results indicate a significant increase in the permeation of FITC and FD across skin treated by the laser. The MWs of macromolecules and laser fluences were found to play important roles in controlling macromolecular absorption. Transdermal delivery of FD with a MW of at least 77 kDa could be achieved with laser treatment. Follicular routes were significant for FITC permeation, whereas intercellular pathways played important roles on the delivery of FD. Ablation of the stratum corneum (SC) layer, photomechanical stress on intercellular regions, and alterations of the morphology and arrangement of corneocytes are possible mechanisms of how the Er:YAG laser promotes macromolecular delivery. No alteration of viable skin morphology was observed after laser treatment and the partly ablation of the SC may be reversible. Hexameric insulin showed higher skin permeation than did FD with similar MWs (38 kDa) with laser enhancement. From the study presented herein, it is concluded that the Er:YAG laser can be effective for transdermal delivery of macromolecules and hydrophilic permeants such as peptides and protein-based drugs.

Authors
Fang, JY; Lee, WR; Shen, SC; Wang, HY; Fang, CL; Hu, CH
MLA Citation
Fang, JY, Lee, WR, Shen, SC, Wang, HY, Fang, CL, and Hu, CH. "Transdermal delivery of macromolecules by erbium:YAG laser." Journal of controlled release : official journal of the Controlled Release Society 100.1 (November 2004): 75-85. (Academic Article)
Source
manual
Published In
Journal of Controlled Release
Volume
100
Issue
1
Publish Date
2004
Start Page
75
End Page
85

Changes in graduate medical education: a view from radiation oncology.

The accreditation process of graduate medical education is changing. This change presents new challenges to teachers of radiation oncology. With the help of the ACR and other institutions, radiation oncology is well positioned to meet this challenge.

Authors
Lee, WR
MLA Citation
Lee, WR. "Changes in graduate medical education: a view from radiation oncology." J Am Coll Radiol 1.8 (August 2004): 576-582. (Review)
PMID
17411656
Source
pubmed
Published In
Journal of the American College of Radiology
Volume
1
Issue
8
Publish Date
2004
Start Page
576
End Page
582
DOI
10.1016/j.jacr.2004.03.013

Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion: a comparison with iontophoresis and electroporation.

BACKGROUND: 5-aminolaevulinic acid (ALA) is used as a protoporphyrin IX-precursor for the photodynamic therapy of superficial skin cancer and cutaneous metastases of internal malignancies. However, the permeability of hydrophilic ALA across the skin is very low. OBJECTIVES AND METHODS: The objective of this study was to optimize and enhance the in vitro skin permeation of ALA by two resurfacing techniques: erbium:yttrium-aluminium-garnet (Erb:YAG) laser and microdermabrasion. Light microscopic changes in pig skin caused by these techniques were also compared. The electrically assisted methods, iontophoresis and electroporation, were also used to facilitate ALA permeation across laser- or microdermabrasion-treated skin. RESULTS: Among the modalities tested in this study the Erb:YAG laser showed the greatest enhancement of ALA permeation. The laser fluence was found to play an important role in controlling the drug flux, producing enhancement ratios from 4-fold to 246-fold relative to the control. The skin permeation of ALA across microdermabrasion-treated skin was approximately 5-15-fold higher than that across intact skin. Both the ablated effect of the stratum corneum (SC) and ALA flux were proportional to the treatment duration of microdermabrasion. The application of iontophoresis or electroporation alone also increased the ALA permeation by approximately 15-fold and 2-fold, respectively. The incorporation of iontophoresis or electroporation with the resurfacing techniques caused a profound synergistic effect on ALA permeation. CONCLUSIONS: This basic study has encouraged the further investigation of ALA permeation by laser or microdermabrasion.

Authors
Fang, JY; Lee, WR; Shen, SC; Fang, YP; Hu, CH
MLA Citation
Fang, JY, Lee, WR, Shen, SC, Fang, YP, and Hu, CH. "Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion: a comparison with iontophoresis and electroporation." The British journal of dermatology 151.1 (July 2004): 132-140. (Academic Article)
Source
manual
Published In
British Journal of Dermatology
Volume
151
Issue
1
Publish Date
2004
Start Page
132
End Page
140

Characterization of superparamagnetic "core-shell" nanoparticles and monitoring their anisotropic phase transition to ferromagnetic "solid solution" nanoalloys.

The structure, magnetism, and phase transition of core-shell type CoPt nanoparticles en route to solid solution alloy nanostructures are systematically investigated. The characterization of Co(core)Pt(shell) nanoparticles obtained by a "redox transmetalation" process by transmission electron microscopy (TEM) and, in particular, X-ray absorption spectroscopy (XAS) provides clear evidence for the existence of a core-shell type bimetallic interfacial structure. Nanoscale phase transitions of the Co(core)Pt(shell) structures toward c-axis compressed face-centered tetragonal (fct) solid solution alloy CoPt nanoparticles are monitored at various stages of a thermally induced annealing process and the obtained fct nanoalloys show a large enhancement of their magnetic properties with ferromagnetism. The relationship between the nanostructures and their magnetic properties is in part elucidated through the use of XAS as a critical analytical tool.

Authors
Park, JI; Kim, MG; Jun, YW; Lee, JS; Lee, WR; Cheon, J
MLA Citation
Park, JI, Kim, MG, Jun, YW, Lee, JS, Lee, WR, and Cheon, J. "Characterization of superparamagnetic "core-shell" nanoparticles and monitoring their anisotropic phase transition to ferromagnetic "solid solution" nanoalloys." Journal of the American Chemical Society 126.29 (July 2004): 9072-9078. (Academic Article)
Source
manual
Published In
Journal of the American Chemical Society
Volume
126
Issue
29
Publish Date
2004
Start Page
9072
End Page
9078

Cancer control after low-dose-rate prostate brachytherapy performed by a multidisciplinary team with no previous prostate brachytherapy experience.

OBJECTIVES: To describe the biochemical disease-free survival observed in the first cohort men treated by a multidisciplinary team of clinicians with no previous experience in low-dose-rate prostate brachytherapy (LDRPB). METHODS: The information in this report concerns the first 63 men treated with LDRPB alone at our institution between September 1997 and September 1998. All men had histologically confirmed, clinically localized prostate cancer. All men were treated with iodine 125 according to published methods. The prescription dose was 144 Gy according to the Task Group 43 formalism. LDRPB was performed jointly by a radiation oncologist and urologist. Three definitions of biochemical recurrence were used: the American Society for Therapeutic Radiology and Oncology consensus definition; prostate-specific antigen level greater than 0.4 ng/mL at last follow-up; and prostate-specific antigen level greater than 0.2 ng/mL at last follow-up. Biochemical relapse-free survival was estimated using the product-limit method. Putative covariates for biochemical relapse-free survival were examined using the proportional hazards regression model. All P values are two-sided. RESULTS: The median follow-up for the entire cohort was 62 months. Of the 63 men, 45 (71%) had more than 60 months of follow-up. The median pretreatment prostate-specific antigen level was 6.68 ng/mL (range 1.1 to 23), and most men (44 of 63; 70%) had nonpalpable disease. The institutionally assigned Gleason score was less than 7 in 54 men (86%). Nine men developed evidence of biochemical relapse at a median of 19 months (range 6 to 38). The 5-year estimate of biochemical relapse-free survival was 85% (95% confidence interval 80% to 90%), 80% (95% confidence interval 74% to 86%), and 70% (95% confidence interval 64% to 76%) according to the three definitions given above. CONCLUSIONS: The biochemical results achieved in the first cohort of men treated with LDRPB by a previously inexperienced multidisciplinary team of clinicians are similar to the results reported from centers with extensive LDRPB experience.

Authors
McMullen, KP; deGuzman, AF; McCullough, DL; Lee, WR
MLA Citation
McMullen, KP, deGuzman, AF, McCullough, DL, and Lee, WR. "Cancer control after low-dose-rate prostate brachytherapy performed by a multidisciplinary team with no previous prostate brachytherapy experience." Urology 63.6 (June 2004): 1128-1131.
PMID
15183965
Source
pubmed
Published In
Urology
Volume
63
Issue
6
Publish Date
2004
Start Page
1128
End Page
1131
DOI
10.1016/j.urology.2003.12.031

In regards to Wallner et al: (125)I versus (103)PD for low-risk prostate cancer: preliminary PSA outcomes from a prospective randomized multicenter trial (Int J Radiat Oncol Biol Phys 2003;57:1297-1303).

Authors
Lee, WR
MLA Citation
Lee, WR. "In regards to Wallner et al: (125)I versus (103)PD for low-risk prostate cancer: preliminary PSA outcomes from a prospective randomized multicenter trial (Int J Radiat Oncol Biol Phys 2003;57:1297-1303)." Int J Radiat Oncol Biol Phys 59.1 (May 1, 2004): 319-. (Letter)
PMID
15093929
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
59
Issue
1
Publish Date
2004
Start Page
319
DOI
10.1016/j.ijrobp.2004.01.010

Cutaneous hyalohyphomycosis caused by Acremonium in an immunocompetent patient.

Authors
Kan, SF; Tsai, TH; Hu, CH; Lee, WR
MLA Citation
Kan, SF, Tsai, TH, Hu, CH, and Lee, WR. "Cutaneous hyalohyphomycosis caused by Acremonium in an immunocompetent patient." The British journal of dermatology 150.4 (April 2004): 789-790. (Academic Article)
Source
manual
Published In
British Journal of Dermatology
Volume
150
Issue
4
Publish Date
2004
Start Page
789
End Page
790

Milium-like syringoma: a case study on histogenesis.

BACKGROUND: Milium-like syringoma is a variant of syringoma first described in 1987. Only few cases have been reported in the literature. It may be misleading clinically, and its histogenesis has not been clarified. CASE REPORT: We present a case of periorbital milium-like syringoma, with studies on the histopathologic, histochemical, and immunohistochemical features. RESULTS: Histology showed a large keratin-filled cyst in the upper portion of the lesion approximating the epidermis. Serial sections revealed that the cyst connected with the underlying syringomatous epithelial strands. Melanin was absent in the wall of the cyst, as demonstrated by Fontana-Masson stain. Cytokeratin 7 was expressed neither in the milia nor in the solid epithelial parts. Carcinoembryonic antigen (CEA) reactivity was seen in the luminal cells of the keratinous cysts. However, in the largest keratin-filled cyst clinically suggesting a milium, only the lower half of the cyst was positive for CEA. These results proved that the milia were part of syringoma with eccrine duct differentiation. Fusion of the upper half of the largest cyst with the epidermis may explain the absence of CEA positivity in this part, analogous with eccrine duct milia. Review of the literature indicated that this variant of syringoma occurs more often in Asians. CONCLUSION: We present evidence, and propose the histogenesis of milium-like syringoma, that it is a variant of syringoma with a prominent cystic component showing features of eccrine duct milia. Recognition of its nature is of therapeutic significance. Further studies are required to verify its clinical characteristics as compared with ordinary syringomas.

Authors
Wang, KH; Chu, JS; Lin, YH; Hu, CH; Lee, WR
MLA Citation
Wang, KH, Chu, JS, Lin, YH, Hu, CH, and Lee, WR. "Milium-like syringoma: a case study on histogenesis." Journal of cutaneous pathology 31.4 (April 2004): 336-340. (Academic Article)
Source
manual
Published In
Journal of Cutaneous Pathology
Volume
31
Issue
4
Publish Date
2004
Start Page
336
End Page
340

Erbium:YAG laser pretreatment accelerates the response of Bowen's disease treated by topical 5-fluorouracil.

BACKGROUND: Topical 5-fluorouracil (5-FU) is a standard treatment for Bowen's disease. However, its efficacy may be limited by the presence of stratum corneum. The Er:YAG laser has shown a dramatic enhancement effect on the delivery of 5-FU in vitro by ablation of the stratum corneum. The efficacy of laser-assisted delivery of 5-FU has not been tested in human. OBJECTIVE: To see whether Er:YAG laser pretreatment can improve the efficacy of topical 5-FU in the treatment of Bowen's disease. METHODS: Three target lesions from a patient with multiple Bowen's disease were selected for a half-side comparison study. The Er:YAG laser was used to remove the cornified layer on one side of each lesion, followed by twice-daily application of 5-FU cream to both sides. Clinical and histologic responses were compared. RESULTS: Lesions pretreated with the Er:YAG laser showed more rapid clinical and histologic responses to topical 5-FU than those treated with 5-FU alone. Evaluation at 9 months after treatment showed no recurrences of lesions on both sides. CONCLUSIONS: Our preliminary study demonstrates that this Er:YAG laser-assisted modality is effective and shows accelerated clinical response and shortened treatment time compared with topical 5-FU as a single treatment.

Authors
Wang, KH; Fang, JY; Hu, CH; Lee, WR
MLA Citation
Wang, KH, Fang, JY, Hu, CH, and Lee, WR. "Erbium:YAG laser pretreatment accelerates the response of Bowen's disease treated by topical 5-fluorouracil." Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 30.3 (March 2004): 441-445. (Academic Article)
Source
manual
Published In
Dermatologic Surgery
Volume
30
Issue
3
Publish Date
2004
Start Page
441
End Page
445

Re: Dosimetric consequences of increased seed strength for I-125 prostate implants. Radiother Oncol. 2003 Sep;68(3):295-7.

Authors
Lee, WR
MLA Citation
Lee, WR. "Re: Dosimetric consequences of increased seed strength for I-125 prostate implants. Radiother Oncol. 2003 Sep;68(3):295-7." Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 70.2 (February 1, 2004): 209-210.
Source
scopus
Published In
Radiotherapy & Oncology
Volume
70
Issue
2
Publish Date
2004
Start Page
209
End Page
210

Re: Dosimetric consequences of increased seed strength for I-125 prostate implants. Radiother Oncol. 2003 Sep;68(3):295-7.

Authors
Lee, WR
MLA Citation
Lee, WR. "Re: Dosimetric consequences of increased seed strength for I-125 prostate implants. Radiother Oncol. 2003 Sep;68(3):295-7." Radiother Oncol 70.2 (February 2004): 209-210. (Letter)
PMID
15028411
Source
pubmed
Published In
Radiotherapy & Oncology
Volume
70
Issue
2
Publish Date
2004
Start Page
209
End Page
210
DOI
10.1016/j.radonc.2003.11.012

Prognostic value of cell-cycle markers in ocular adnexal lymphoma: an assessment of 230 cases.

BACKGROUND: To determine the prognostic value of cell-cycle associated markers in ocular adnexal lymphoma (OAL). METHODS: Two hundred sixty-one consecutive cases of ocular adnexal lymphoproliferative lesions were subdivided into reactive lymphoid hyperplasia (RLH), atypical lymphoid hyperplasia (ALH) and OAL. The latter were sub-typed according to the new WHO Lymphoma Classification. All lesions were investigated applying standard immunohistochemical methods with antibodies specific for pRB, p53, p16, p21, BCL-6 and for multiple myeloma oncogene-1-protein (MUM1, also known as IRF4). The main endpoints included the development of a local recurrence, of systemic disease and of lymphoma-related death. The association of prognostic variables with endpoints was assessed by multiple logistic and Cox regression models, respectively. RESULTS: The ocular adnexal lymphoproliferative lesions were categorised as OAL ( n=230; 88%), RLH ( n=29; 11%), and ALH ( n=2; 1%). The major lymphoma subtypes included 136 extranodal marginal zone B-cell lymphoma (EMZL), 31 diffuse large cell B-cell lymphomas, 27 follicular lymphomas, 9 plasmacytomas, 9 lymphoplasmocytic lymphoma/immunocytomas and 8 mantle cell lymphomas. The median follow-up time was 44.5 months. Most OAL patients had Stage IE disease and were treated with radiotherapy. Thirty-seven (25%) Stage IE patients had tumour relapses: these were significantly associated with an increased BCL6 blast percentage. Sixty-two (42%) Stage IE patients developed systemic disease: they had "non-EMZL" with large growth fractions and increased blast percentages for BCL6. Fifty-seven (25%) OAL patients died because of their lymphoma; lymphoma-related death was significantly associated on multivariable analysis with advanced clinical stage, an age >60 years and large tumour growth fractions. CONCLUSION: Subtyping of OAL according to the new WHO Lymphoma Classification, the stage of disease and tumour cell growth fraction aided the prediction of (1) tumour relapse, (2) the development of systemic disease and (3) lymphoma-related death in OAL.

Authors
Coupland, SE; Hellmich, M; Auw Haedrich, C; Lee, WR; Stein, H
MLA Citation
Coupland, SE, Hellmich, M, Auw Haedrich, C, Lee, WR, and Stein, H. "Prognostic value of cell-cycle markers in ocular adnexal lymphoma: an assessment of 230 cases." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 242.2 (February 2004): 130-145. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
242
Issue
2
Publish Date
2004
Start Page
130
End Page
145

Improved survival rates in sebaceous carcinoma of the eyelid.

PURPOSE: To review the clinicopathological features, management, and survival rates for patients with sebaceous gland carcinoma of the eyelid, and to analyse the reasons for improved survival. METHODS: In the west of Scotland between 1975 and 2001, 32 cases were identified through the pathology index for sebaceous carcinoma. Pathology specimens were reviewed in all cases. The clinical data were obtained from hospital records and the database provided by the Regional Cancer Registry. RESULTS: A total of 22 female and 10 male patients were identified. Follow-up ranged from 6 months to 15 years, median of 4.8 years. Primary treatment involved excisional techniques in 27 cases, exenteration in two cases, enucleation in two cases, and two cases required adjuvant radiotherapy. Intraepithelial spread and masquerade presentations delayed the diagnosis. Poorly differentiated tumours were associated with an unfavourable outcome. Three patients developed local tumour recurrence and one metastatic disease. In all, 10 patients died from nontumour-related causes and one died from metastatic sebaceous carcinoma. The overall tumour mortality rate in the west of Scotland was 3%. CONCLUSIONS: From this study, patients in the west of Scotland have a better prognosis than is indicated in the literature. Astute clinical suspicion and accurate histopathological diagnosis, together with radical and aggressive surgical approaches were key factors.

Authors
Muqit, MM; Roberts, F; Lee, WR; Kemp, E
MLA Citation
Muqit, MM, Roberts, F, Lee, WR, and Kemp, E. "Improved survival rates in sebaceous carcinoma of the eyelid." Eye (London, England) 18.1 (January 2004): 49-53. (Academic Article)
Source
manual
Published In
Eye
Volume
18
Issue
1
Publish Date
2004
Start Page
49
End Page
53

Changes in graduate medical education: A view from radiation oncology

The accreditation process of graduate medical education is changing. This change presents new challenges to teachers of radiation oncology. With the help of the ACR and other institutions, radiation oncology is well positioned to meet this challenge. Copyright © 2004 American College of Radiology.

Authors
Lee, WR
MLA Citation
Lee, WR. "Changes in graduate medical education: A view from radiation oncology." Journal of the American College of Radiology 1.8 (2004): 576-582.
Source
scival
Published In
Journal of the American College of Radiology
Volume
1
Issue
8
Publish Date
2004
Start Page
576
End Page
582
DOI
10.1016/j.jacr.2004.03.013

Medical malpractice and prostate brachytherapy.

Authors
Lee, WR
MLA Citation
Lee, WR. "Medical malpractice and prostate brachytherapy." Brachytherapy 3.4 (2004): 237-239.
PMID
15607156
Source
pubmed
Published In
Brachytherapy
Volume
3
Issue
4
Publish Date
2004
Start Page
237
End Page
239
DOI
10.1016/j.brachy.2004.10.001

Permanent prostate brachytherapy: the significance of postimplant dosimetry.

Recent developments in imaging science and treatment-planning software allow for accurate postimplant dosimetric assessment in all patients after prostate brachytherapy. This article reviews the available data correlating cancer control and morbidity with dosimetric quantifiers obtained from postimplant dosimetric assessment after prostate brachytherapy. Continued collection of dosimetric data in patients treated with prostate brachytherapy will allow for further refinements in the technique, leading to continued high rates of cure with increasingly lower rates of morbidity.

Authors
Lee, WR
MLA Citation
Lee, WR. "Permanent prostate brachytherapy: the significance of postimplant dosimetry." Rev Urol 6 Suppl 4 (2004): S49-S56.
PMID
16985870
Source
pubmed
Published In
Reviews in Urology
Volume
6 Suppl 4
Publish Date
2004
Start Page
S49
End Page
S56

In vitro efficacy of a polyhexamethylene biguanide-impregnated gauze dressing against bacteria found in veterinary patients.

OBJECTIVE: To evaluate the in vitro efficacy of polyhexamethylene biguanide (PHMB)-impregnated gauze dressing in limiting the growth of bacteria both within and underneath the dressing. STUDY DESIGN: In vitro study. METHODS: Squares of PHMB-impregnated and control gauze were placed on agar plates inoculated with 1 of 11 bacterial species, including 8 multi-resistant organisms. Growth under the gauze was assessed qualitatively after 24-hour incubation. Repeated use of sponges was used to evaluate residual inhibitory activity against Micrococcus lutea and Staphylococcus schleiferi ss. schleiferi. In a second procedure, PHMB-impregnated and control gauze squares were placed in sterile plastic wells and inoculated with 1 of 5 bacterial species, including Pseudomonas spp. and Klebsiella spp. Inhibition of bacterial growth within and underneath the dressing after 24-hour incubation was evaluated by quantifying the numbers of bacteria on the well floor and within each square. RESULTS: PHMB-impregnated gauze provided greater inhibition of growth of 4/4 Gram-positive species and 2/6 Gram-negative species on inoculated plates compared with control gauze. Residual inhibitory activity of PHMB-impregnated gauze was significantly greater against M. lutea on all days and against S. schleiferi ss. schleiferi on days 1 and 4 compared with control. No bacteria were recovered from inoculated PHMB-impregnated gauze squares placed in sterile wells or from the well floor underneath. More than 9 x 10(5) colony-forming units (CFU) were recovered from inoculated control samples placed in sterile wells and more than 8.4 x 10(4) CFU were recovered from control well floors. CONCLUSION: PHMB-impregnated gauze dressing, when placed on inoculated agar plates, reduces growth of underlying bacteria, particularly Gram-positive species. Wet-inoculated PHMB-impregnated dressing prevents growth of Gram-positive and Gram-negative bacteria both within and underneath the dressing. CLINICAL RELEVANCE: PHMB-impregnated dressings may be useful for reducing contamination of underlying wounds by bacterial pathogens.

Authors
Lee, WR; Tobias, KM; Bemis, DA; Rohrbach, BW
MLA Citation
Lee, WR, Tobias, KM, Bemis, DA, and Rohrbach, BW. "In vitro efficacy of a polyhexamethylene biguanide-impregnated gauze dressing against bacteria found in veterinary patients." Veterinary surgery : VS : the official journal of the American College of Veterinary Surgeons 33.4 (2004): 404-411. (Academic Article)
Source
manual
Published In
Veterinary Surgery
Volume
33
Issue
4
Publish Date
2004
Start Page
404
End Page
411

Facile fabrication of 2-dimensional arrays of sub-10 nm single crystalline Si nanopillars using nanoparticle masks.

A simple procedure for the fabrication of sub-10 nm scale Si nanopillars in a 2-D array using reactive ion etching with 8 nm Co nanoparticles as etch masks is demonstrated. The obtained Si nanopillars are single crystalline tapered pillar structures of 5 nm (top) x 8 nm (bottom) with a density of approximately 4 x 10(10) pillars cm(-2) on the substrate, similar to the density of Co nanoparticles distributed before the ion etching process. The uniform spatial distribution of the Si nanopillars can also be patterned into desired positions. Our fabrication method is straightforward and requires mild process conditions, which can be extended to patterned 2-D arrays of various Si nanostructures.

Authors
Hong, YK; Bahng, JH; Lee, G; Kim, H; Kim, W; Lee, S; Koo, JY; Park, JI; Lee, WR; Cheon, J
MLA Citation
Hong, YK, Bahng, JH, Lee, G, Kim, H, Kim, W, Lee, S, Koo, JY, Park, JI, Lee, WR, and Cheon, J. "Facile fabrication of 2-dimensional arrays of sub-10 nm single crystalline Si nanopillars using nanoparticle masks." Chemical communications (Cambridge, England) 24 (December 2003): 3034-3035. (Academic Article)
Source
manual
Published In
Chemical Communications
Issue
24
Publish Date
2003
Start Page
3034
End Page
3035

In regard to Ghaly et al., IJROBP 2003;55:1288-1293.

Authors
Lee, WR
MLA Citation
Lee, WR. "In regard to Ghaly et al., IJROBP 2003;55:1288-1293." Int J Radiat Oncol Biol Phys 57.4 (November 15, 2003): 1198-. (Letter)
PMID
14575858
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
57
Issue
4
Publish Date
2003
Start Page
1198

The 1999 patterns of care study of radiotherapy in localized prostate carcinoma: a comprehensive survey of prostate brachytherapy in the United States.

BACKGROUND: The objective of the current study was to provide descriptive information on a representative national sample of patients with prostate carcinoma who were treated with prostate brachytherapy (PB) in calendar year 1999. METHODS: A random survey was conducted by the Patterns of Care Study in radiation oncology of 59 facilities (1 facility had no eligible patients) that treated patients with prostate carcinoma in 1999 in the United States. A weighted sample size of 36,496 patients with prostate cancer was included in the 1999 survey (unweighted sample size, 554 patients). The main measures were the clinical characteristics of men prior to treatment and the technical characteristics of PB. Patients were classified into three prognostic groups according to T stage, pretreatment prostate specific antigen (PSA) level, and Gleason score. RESULTS: A weighted sample size of 13,293 patients (36%; unweighted sample size, 162 patients) was treated with PB. Compared with a weighted sample size of 23,203 patients (64%; unweighted sample size, 392 patients) was treated with external beam radiotherapy (EB), patients who received PB were significantly younger (mean age: PB group, 67.7 years; EB group, 70.8 years; P = 0.0006). The mean pretreatment PSA level for the PB group was lower compared with the EB group (9.9 ng/mL vs. 13.33 ng/mL; P = 0.0015). The prognostic groupings were more favorable for patients in the PB group compared with patients in EB group (P = 0.0365). The utilization of androgen deprivation therapy (ADT) in the PB group was similar to the utilization of ADT in the EB group (40.4% vs. 51.3%; P = 0.2282). The vast majority of men who were treated with PB received low-dose-rate, permanent sources (89%). Fifty-four percent of men received PB monotherapy (PBM), and the remaining 46% were treated with EB in addition to PB (EBPB). The prognostic groupings were more favorable for patients in the PBM group compared with patients in the EBPB group (P = 0.0037). Of the men who were treated with low-dose-rate PB, 59% were treated with iodine-125 (I-125), and 41% were treated with palladium-103 (Pd-103). I-125 was used more frequently in men who were treated with PBM, and Pd-103 was used more frequently in men who were treated with EBPB. Postimplantation dosimetry was documented in 61.0% of men who were treated with low-dose-rate PB. Computed tomography imaging was used for 46.5% of men. CONCLUSIONS: PB was used in 36% of men who were treated with radiotherapy nationally. The mean age of men who were treated with PB was younger than the population of men who were treated with EB alone. Nearly 50% of men who received PB also received EB. EB was used more frequently in men with higher-risk disease. ADT was used in 40% of patients in the PB group. Techniques and prescription doses were consistent with published guidelines.

Authors
Lee, WR; Moughan, J; Owen, JB; Zelefsky, MJ
MLA Citation
Lee, WR, Moughan, J, Owen, JB, and Zelefsky, MJ. "The 1999 patterns of care study of radiotherapy in localized prostate carcinoma: a comprehensive survey of prostate brachytherapy in the United States." Cancer 98.9 (November 1, 2003): 1987-1994.
PMID
14584083
Source
pubmed
Published In
Cancer
Volume
98
Issue
9
Publish Date
2003
Start Page
1987
End Page
1994
DOI
10.1002/cncr.11774

Increased transmigration of G-CSF-mobilized peripheral blood CD34+ cells after overnight storage at 37 degrees C.

BACKGROUND: G-CSF-mobilized PBPCs are utilized in allogeneic and autologous PBPC transplants. Homing, adhesion, and transmigration of hematopoietic CD34+ cells are required for successful engraftment. Hematopoietic CD34+ cells undergo directional migration toward the CXCR4 receptor ligand stromal-derived factor-1 (SDF-1). Limited data are available on the effects of liquid storage and cryopreservation on PBPC CD34+ cells. STUDY DESIGN AND METHODS: Magnetic-assisted cell sorting (MACS)-selected CD34+ cells were assayed for retention of in vitro transmigration and phenotypic changes of unit-matched liquid-stored and cryopreserved PBPC samples from healthy donors. Studies evaluated whether transmigration of CD34+ cells in Iscove's modified Dulbecco's medium plus 1 percent HSA alone or in medium supplemented with SCF or allogeneic plasma was affected by overnight incubation at 37 degrees C, relative to nonincubated conditions. RESULTS: Transmigration was maintained during liquid storage at 1 to 6 degrees C during a 2-day period and in unit-matched cryopreserved-thawed samples that had been initially liquid stored. Overnight incubation at 37 degrees C of MACS-selected unit-matched liquid-stored or cryopreserved-thawed CD34+ cells resulted in substantially increased transmigration, in particular with noncoated filters chemoattracted with the chemokine SDF-1. CONCLUSION: CD34+ cell transmigration was comparable between liquid-stored and cryopreserved samples, and both demonstrated similar increases after overnight incubation at 37 degrees C.

Authors
Greco, NJ; Lee, WR; Moroff, G
MLA Citation
Greco, NJ, Lee, WR, and Moroff, G. "Increased transmigration of G-CSF-mobilized peripheral blood CD34+ cells after overnight storage at 37 degrees C." Transfusion 43.11 (November 2003): 1575-1586. (Academic Article)
Source
manual
Published In
Transfusion
Volume
43
Issue
11
Publish Date
2003
Start Page
1575
End Page
1586

Lasers and microdermabrasion enhance and control topical delivery of vitamin C.

The objective of this study was to evaluate the ability of lasers and microdermabrasion, both of which are skin resurfacing modalities, to enhance and control the in vitro skin permeation and deposition of vitamin C. The topical delivery of magnesium ascorbyl phosphate, the pro-drug of vitamin C, was also examined in this study. All resurfacing techniques evaluated produced significant increases in the topical delivery of vitamin C across and/or into the skin. The erbium:yttrium-aluminum-garnet (Er:YAG) laser showed the greatest enhancement of skin permeation of vitamin C among the modalities tested. The laser fluence and spot size were found to play important parts in controlling drug absorption. An excellent correlation was observed in the Er:YAG laser fluence and transepidermal water loss, which is an estimation of skin disruption. Permeation of magnesium ascorbyl phosphate was not enhanced by the Er:YAG laser. The CO2 laser at a lower fluence promoted vitamin C permeation with no ablation of the stratum corneum or epidermal layers. Further enhancement was observed with the CO2 laser at higher fluences, which was accompanied by a prominent ablation effect. Microdermabrasion ablated the stratum corneum layers with minimal disruption of the skin barrier properties according to transepidermal water loss levels. The flux and skin deposition of vitamin C across microdermabrasion-treated skin was approximately 20-fold higher than that across intact skin. The techniques used in this study may be useful for basic and clinical investigations of enhancement of topical vitamin C delivery.

Authors
Lee, WR; Shen, SC; Kuo Hsien, W; Hu, CH; Fang, JY
MLA Citation
Lee, WR, Shen, SC, Kuo Hsien, W, Hu, CH, and Fang, JY. "Lasers and microdermabrasion enhance and control topical delivery of vitamin C." The Journal of investigative dermatology 121.5 (November 2003): 1118-1125. (Academic Article)
Source
manual
Published In
Journal of Investigative Dermatology
Volume
121
Issue
5
Publish Date
2003
Start Page
1118
End Page
1125

Differential apoptosis-inducing effect of quercetin and its glycosides in human promyeloleukemic HL-60 cells by alternative activation of the caspase 3 cascade.

Flavonoids were demonstrated to possess several biological effects including antitumor, antioxidant, and anti-inflammatory activities in our previous studies. However, the effect of glycosylation on their biological functions is still undefined. In the present study, the apoptosis-inducing activities of three structure-related flavonoids including aglycone quercetin (QUE), and glycone rutin (RUT; QUE-3-O-rutinoside), and glycone quercitrin (QUI; QUE-3-O-rhamnoside) were studied. Both RUT and QUI are QUE glycosides, and possess rutinose and rhamnose at the C3 position of QUE, respectively. Results of the MTT assay showed that QUE, but not RUT and QUI, exhibits significant cytotoxic effect on HL-60 cells, accompanied by the dose- and time-dependent appearance of characteristics of apoptosis including an increase in DNA ladder intensity, morphological changes, apoptotic bodies, and an increase in hypodiploid cells by flow cytometry analysis. QUE, but not RUT or QUI, caused rapid and transient induction of caspase 3/CPP32 activity, but not caspase 1 activity, according to cleavage of caspase 3 substrates poly(ADP-ribose) polymerase (PARP) and D4-GDI proteins, and the appearance of cleaved caspase 3 fragments being detected in QUE- but not RUT- or QUI-treated HL-60 cells. A decrease in the anti-apoptotic protein, Mcl-1, was detected in QUE-treated HL-60 cells, whereas other Bcl-2 family proteins including Bax, Bcl-2, Bcl-XL, and Bag remained unchanged. The caspase 3 inhibitor, Ac-DEVD-FMK, but not the caspase 1 inhibitor, Ac-YVAD-FMK, attenuated QUE-induced cell death. Results of DCHF-DA assay indicate that no significant increase in intracellular peroxide level was found in QUE-treated cells, and QUE inhibited the H(2)O(2)-induced intracellular peroxide level. Free radical scavengers N-acetyl-cysteine (NAC) and catalase showed no prevention of QUE-induced apoptosis. In addition, QUE did not induce apoptosis in an mature monocytic cell line THP-1, as characterized by a lack of DNA ladders, caspase 3 activation, PARP cleavage, and an Mcl-1 decrease, compared with those in HL-60 cells. Our experiments provide evidence to indicate that the addition of rutinose or rhamnose attenuates the apoptosis-inducing activity of QUE, and that the caspase 3 cascade but not free radical production is involved.

Authors
Shen, SC; Chen, YC; Hsu, FL; Lee, WR
MLA Citation
Shen, SC, Chen, YC, Hsu, FL, and Lee, WR. "Differential apoptosis-inducing effect of quercetin and its glycosides in human promyeloleukemic HL-60 cells by alternative activation of the caspase 3 cascade." Journal of cellular biochemistry 89.5 (August 2003): 1044-1055. (Academic Article)
Source
manual
Published In
Journal of Cellular Biochemistry
Volume
89
Issue
5
Publish Date
2003
Start Page
1044
End Page
1055

Histological and morphometric analysis of the effects of argon laser epilation.

AIM: To analyse the location and extent of tissue damage induced after argon laser epilation. METHODS: Laser burns were applied to the lid margins of four patients before excision for entropion ("live tissue") and the lid margin of one patient was lasered after an excision for ectropion ("dead tissue"). The laser burns were directed towards the lash follicle and between 10 and 50 burns were applied with an argon blue-green laser set at power 0.9-1.0 W, at 0.1-0.2 second duration and a 100 micro m spot size. The tissues were processed for conventional histology. Serial sections were obtained and used for area measurements and three dimensional reconstructions of the burns to determine the volume and location of tissue destruction. RESULTS: The laser created a cone-shaped region of tissue ablation with surrounding coagulative necroses. Maximum burn depth was 1.2 mm in dead tissue and 0.8 mm in live tissue. Maximum necrosis depth was 1.4 mm in dead tissue and 0.9 mm in live tissue. Follicle depth ranged from 0.8 mm to 1.9 mm. Some of the burns had been misdirected in the dermis leaving target hair follicles intact, despite being of adequate depth. CONCLUSIONS: The argon laser has some potential for ablation of lash follicles, but accurate placement of the burn is essential and energy levels greater than those currently recommended should be applied. The treatment is ineffective in patients unable to remain immobile.

Authors
Hanumanthu, S; Webb, LA; Lee, WR; Williamson, J
MLA Citation
Hanumanthu, S, Webb, LA, Lee, WR, and Williamson, J. "Histological and morphometric analysis of the effects of argon laser epilation." The British journal of ophthalmology 87.8 (August 2003): 984-987. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
87
Issue
8
Publish Date
2003
Start Page
984
End Page
987

Myxoid leiomyoma of the iris in a dog.

A leiomyoma of the iris is described in an 11-year-old Yorkshire Terrier. This is a rare primary intraocular tumor in dogs and we describe the clinical presentation, gross findings and histopathologic characteristics of this tumor. The diagnosis was made on the basis of light microscopy and immunohistochemical staining using antidesmin antibodies, which is specific for myogenic tissues. An unusual feature of the tumor was the presence of myxoid change. To our knowledge myxoid change has not been previously described in a primary intraocular leiomyoma.

Authors
Billson, FM; Mould, JR; Lee, WR
MLA Citation
Billson, FM, Mould, JR, and Lee, WR. "Myxoid leiomyoma of the iris in a dog." Veterinary ophthalmology 6.2 (June 2003): 173-176. (Academic Article)
Source
manual
Published In
Veterinary Ophthalmology
Volume
6
Issue
2
Publish Date
2003
Start Page
173
End Page
176

Characterization of multiple CD34+ cell populations in cord blood.

Unlike granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood, which show a single homogeneous population of CD34(+) cells, umbilical cord blood (CB) CD34(+) cells are present as multiple populations, CD34(regular) and CD34(bright) (the latter comprising 7.0-58.2% of the total CD34(+) cells), using the ProCOUNT trade mark procedure or with anti-CD34 labeling of immunoselected cells. The CD34(regular) population contains cells with high forward scatter (CD34(regular)FSC(high)) and with low forward scatter (CD34(regular) FSC(low)). Immunomagnetically selected CD34(+) cells, sorted into CD34(regular), CD34(regular) FSC(high), CD34(regular)FSC(low), and CD34(bright) cell populations, were used in in vitro assays: only the CD34(regular)FSC(high) population transmigrated and showed growth of colony-forming unit (CFU) and long-term culture initiating cells (LTC-IC) colonies. The absolute number of CD34(+) cells in CB samples was determined by ProCOUNT trade mark and Stem Kit trade mark enumeration protocols. In liquid stored CB units, ProCOUNT trade mark and Stem Kit trade mark count differences are accounted for by the enumeration of CD34(bright) cells. Differences between ProCOUNT trade mark and Stem Kit trade mark counts using cryopreserved/thawed samples are accounted for by increased CD34(regular) FSC(low) cell numbers (2.0 +/- 1.4% in liquid stored and 27.8 +/- 14.6% in cryopreserved/thawed samples). The ProCOUNT trade mark assay includes the nonfunctional CD34(bright) and CD34(regular)FSC(low) cells as part of the CD34(+) cell count, thereby elevating the absolute number of CD34(+) cells. Using the Stem Kit trade mark assay method of gating, CD34(bright) and CD34(regular)FSC(low) cells are not counted. Our data indicate that the CD34(regular)FSC(high) cell population has functional characteristics based on the in vitro assays and a more accurate count of these cells can be achieved using the Stem Kit trade mark assay.

Authors
Greco, NJ; Lee, WR; Kurtz, J; Seetharaman, S; Moroff, G
MLA Citation
Greco, NJ, Lee, WR, Kurtz, J, Seetharaman, S, and Moroff, G. "Characterization of multiple CD34+ cell populations in cord blood." Journal of hematotherapy & stem cell research 12.2 (April 2003): 199-213. (Academic Article)
Source
manual
Published In
Journal of hematotherapy & stem cell research
Volume
12
Issue
2
Publish Date
2003
Start Page
199
End Page
213

Bilaminar interepithelial bodies within fingerprint dystrophy-like changes in bilateral iridocorneal endothelial syndrome.

Authors
Auw Haedrich, C; Sengler, U; Lee, WR
MLA Citation
Auw Haedrich, C, Sengler, U, and Lee, WR. "Bilaminar interepithelial bodies within fingerprint dystrophy-like changes in bilateral iridocorneal endothelial syndrome." The British journal of ophthalmology 87.4 (April 2003): 508-509. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
87
Issue
4
Publish Date
2003
Start Page
508
End Page
509

A structured literature review to determine the use of the American Society for Therapeutic Radiology and Oncology consensus definition of biochemical failure.

OBJECTIVES: The American Society for Therapeutic Radiology and Oncology consensus definition (ACD) of biochemical failure after radiotherapy for prostate cancer requires three consecutive prostate-specific antigen increases from a nadir value. The members of the Consensus Panel recognized that the timing and frequency of prostate-specific antigen determinations could affect the comparability among different reports if this definition was used. For this reason, the Consensus Panel members recommended three guidelines for studies presented for publication (publication guidelines [PGs]). The present analysis examined the extent to which the ACD has been used in the peer-reviewed published literature and how frequently the PGs have been followed. METHODS: A structured literature review of 10 relevant journals was done. The inclusion criteria for the literature review required publication in calendar year 1999 or 2000; treatment with external beam radiotherapy and/or brachytherapy for previously untreated, nonmetastatic prostate cancer; and the use of a prostate-specific antigen-defined disease-free endpoint. A standardized checklist was created and completed by both of the authors. We independently reviewed each publication to determine whether the ACD of biochemical failure was used and whether the PGs were followed. Discrepancies between us were resolved by joint review of each publication in question to achieve a consensus. RESULTS: Fifty-seven articles met the inclusion criteria. The median number of patients in the articles reviewed was 302 (range 22 to 2222). The ACD was followed in 37 (64.9%) of 57 articles. None of the reviewed articles followed all three PGs. In five articles (8.7%), two of the three PGs were followed. The vast majority of the articles reviewed (52 of 57, 91.3%) followed one or none of the PGs recommended by the Consensus Panel. CONCLUSIONS: The ACD was used in two thirds of peer-reviewed published articles. The PGs were followed much less frequently. Consistent standards of reporting have not been uniformly applied to peer-reviewed manuscripts.

Authors
McMullen, KP; Lee, WR
MLA Citation
McMullen, KP, and Lee, WR. "A structured literature review to determine the use of the American Society for Therapeutic Radiology and Oncology consensus definition of biochemical failure." Urology 61.2 (February 2003): 391-396. (Review)
PMID
12597954
Source
pubmed
Published In
Urology
Volume
61
Issue
2
Publish Date
2003
Start Page
391
End Page
396

Predictors of positive head-up tilt test in patients with suspected neurocardiogenic syncope or presyncope.

Neurocardiogenic syncope is the most common cause of syncope in patients who present in outpatient clinics. Head-up tilt test (HUT) has been widely used to diagnose neurocardiogenic syncope. However, the HUT does not always produce a positive response in patients with suspected neurocardiogenic syncope. The aim of the present study was to assess the clinical history and characteristics of patients with suspected neurocardiogenic syncope or presyncope who undertook HUT, and to identify prognostic factors of a positive HUT response. During the first phase of HUT, patients were tilted to a 70-degree angle for 30 minutes. If the first phase produced a negative response, the second phase was subsequently performed involving intravenous isoproterenol administration. Of 711 patients, 423 (59.5%) patients showed a positive HUT response. In contrast to previous studies, this study showed that the vasodepressive type (76.6%) was the most common pattern of positive response, and that the rate of positive response during the first phase was low (7.1%). By multivariate analysis, the occurrence of junctional rhythm was found to be a predictor of an impending positive response in HUT (P

Authors
Oh, JH; Kim, JS; Kwon, HC; Hong, KP; Park, JE; Seo, JD; Lee, WR
MLA Citation
Oh, JH, Kim, JS, Kwon, HC, Hong, KP, Park, JE, Seo, JD, and Lee, WR. "Predictors of positive head-up tilt test in patients with suspected neurocardiogenic syncope or presyncope." Pacing and clinical electrophysiology : PACE 26.2 Pt 1 (February 2003): 593-598. (Academic Article)
Source
manual
Published In
Pacing and Clinical Electrophysiology
Volume
26
Issue
2 Pt 1
Publish Date
2003
Start Page
593
End Page
598

In regard to Ghaly et al., IJROBP 2003;55:1288-1293 [4] (multiple letters)

Authors
Lee, WR; Wallner, K; Merrick, G; Ghaly, M
MLA Citation
Lee, WR, Wallner, K, Merrick, G, and Ghaly, M. "In regard to Ghaly et al., IJROBP 2003;55:1288-1293 [4] (multiple letters)." International Journal of Radiation Oncology Biology Physics 57.4 (2003): 1198-1199.
Source
scival
Published In
International Journal of Radiation Oncology Biology Physics
Volume
57
Issue
4
Publish Date
2003
Start Page
1198
End Page
1199
DOI
10.1016/S0360-3016(03)00745-4

Diffuse hyperplasia of intratarsal ectopic lacrimal gland tissue.

Authors
Lee, WR; Aitken, DA; Kirkness, CM
MLA Citation
Lee, WR, Aitken, DA, and Kirkness, CM. "Diffuse hyperplasia of intratarsal ectopic lacrimal gland tissue." Archives of ophthalmology 120.12 (December 2002): 1748-1752. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
120
Issue
12
Publish Date
2002
Start Page
1748
End Page
1752

Emodin induces apoptosis in human promyeloleukemic HL-60 cells accompanied by activation of caspase 3 cascade but independent of reactive oxygen species production.

Emodin (1,3,8-trihydroxy-6-methylanthraquinone) is an active constituent of Rheum palmatum, and showed inhibitory activity on lipopolysaccharide-induced NO production in our previous study. However, the apoptosis-inducing activity of emodin has remained undefined. Among three structurally related anthraquinones, including emodin, physcion, and chrysophanol, emodin showed the most potent cytotoxic effects on HL-60 cells, accompanied by the dose- and time-dependent appearance of characteristics of apoptosis including an increase in DNA ladder intensity, morphological changes, appearance of apoptotic bodies, and an increase in hypodiploid cells. Emodin at apoptosis-inducing concentrations causes rapid and transient induction of caspase 3/CPP32 activity, but not caspase 1 activity, according to cleavage of caspase 3 substrates poly(ADP-ribose) polymerase and D4-GDI proteins, the appearance of cleaved caspase 3 fragments being detected in emodin- but not physcion- or chrysophanol-treated HL-60 cells. A decrease in the anti-apoptotic protein, Mcl-1, was detected in emodin-treated HL-60 cells, whereas other Bcl-2 family proteins including Bax, Bcl-2, Bcl-XL, and Bad remained unchanged. The caspase 3 inhibitor, Ac-DEVD-CHO, but not the caspase 1 inhibitor, Ac-YVAD-CHO, attenuated emodin-induced DNA ladders, associated with the blockage of PARP and D4-GDI cleavage. Free radical scavenging agents including NAC, catalase, SOD, ALL, DPI, L-NAME and PDTC showed no preventive effect on emodin-induced apoptotic responses, whereas NAC, CAT and PDTC prevented HL-60 cells from ROS (H(2)O(2))-induced apoptosis through inhibition of caspase 3 cascades. Induction of catalase, but not SOD, activity was detected in emodin-treated HL-60 cells by in gel activity assays, and H(2)O(2)-induced intracellular peroxide level was significantly reduced by prior treatment of emodin in HL-60 cells. Our experiments provide evidence that emodin is an effective apoptosis inducer in HL-60 cells through activation of the caspase 3 cascade, but that it is independent of ROS production.

Authors
Chen, YC; Shen, SC; Lee, WR; Hsu, FL; Lin, HY; Ko, CH; Tseng, SW
MLA Citation
Chen, YC, Shen, SC, Lee, WR, Hsu, FL, Lin, HY, Ko, CH, and Tseng, SW. "Emodin induces apoptosis in human promyeloleukemic HL-60 cells accompanied by activation of caspase 3 cascade but independent of reactive oxygen species production." Biochemical pharmacology 64.12 (December 2002): 1713-1724. (Academic Article)
Source
manual
Published In
Biochemical Pharmacology
Volume
64
Issue
12
Publish Date
2002
Start Page
1713
End Page
1724

Radioactive sources embedded in suture are associated with improved postimplant dosimetry in men treated with prostate brachytherapy.

BACKGROUND AND PURPOSE: Reports using the retropubic and transperineal technique of prostate brachytherapy suggest that adequate radiation doses are required for good clinical results with I-125. After 3 years of using loose sources (LS), radioactive sources embedded in suture (SES) were introduced into our prostate brachytherapy technique. The purpose of the present report is to determine whether dosimetric quantifiers of implant adequacy were affected by the use of SES. MATERIALS AND METHODS: Between September 1999 and April 2000, 20 patients were treated with prostate brachytherapy alone with a preplanned, preloaded needle technique using LS. Between May 2000 and February 2001, 20 patients were treated with prostate brachytherapy alone with a preplanned, preloaded needle technique using SES. Dosimetric quantifiers (DQ) of implant adequacy were calculated using a computed tomography scan performed 1 month following prostate brachytherapy. DQ were compared between patients treated with LS and patients treated with SES. RESULTS: The demographic characteristics were similar for each group. Men treated with SES had slightly smaller prostate glands compared to men treated with LS. The mean total activity and activity per seed were similar for each group but the activity per unit volume was slightly higher for the SES group. Patients treated with SES were found to have significantly improved DQ compared to patients treated with LS. The mean V100 for patients treated with SES was 94.10% compared to 86.54% in those patients treated with LS (P<0.001). CONCLUSIONS: In our experience using preplanning and preloaded needles, the use of SES is associated with improved postimplant DQ.

Authors
Lee, WR; deGuzman, AF; Tomlinson, SK; McCullough, DL
MLA Citation
Lee, WR, deGuzman, AF, Tomlinson, SK, and McCullough, DL. "Radioactive sources embedded in suture are associated with improved postimplant dosimetry in men treated with prostate brachytherapy." Radiother Oncol 65.2 (November 2002): 123-127.
PMID
12443808
Source
pubmed
Published In
Radiotherapy & Oncology
Volume
65
Issue
2
Publish Date
2002
Start Page
123
End Page
127

Interobserver variability leads to significant differences in quantifiers of prostate implant adequacy.

PURPOSE: To compare the prostate gland volumes and subsequent quantifiers of implant adequacy determined by five separate brachytherapists on postimplant CT images performed 1 day after prostate brachytherapy. METHODS AND MATERIALS: Ten consecutive patients underwent a CT scan 1 day after prostate brachytherapy, using 125I. Four experienced prostate brachytherapists were recruited to participate in this study in addition to the lead author. Each reviewer was asked to independently contour the prostate on sequential axial CT images for all 10 patients using a commercially available treatment planning system. Prostate volumes were calculated along with commonly reported quantifiers of implant adequacy (minimal dose received by 90% of the prostate gland [D(90)] and percentage of prostate volume receiving 100% of prescribed minimal peripheral dose [V(100)]). RESULTS: The mean prostate volume (SD) was significantly different according to the individual reviewers: Rev 1, 50.89 cm(3) (10.6); Rev 2, 55.42 cm(3) (15.79); Rev 3, 40.02 cm(3) (9.95); Rev 4, 56.70 cm(3) (12.16); and Rev 5, 44.52 cm(3) (10.95); p <0.0001. Significant differences were also observed for the mean V(100): Rev 1, 83.4% (5.5); Rev 2, 85.4% (7.6); Rev 3, 89.9% (5.4); Rev 4, 77.7% (6.3); and Rev 5, 81.5 (4.3); p <0.0001; and for the mean D(90), reported as the percentage of the prescription dose: Rev 1, 87.9 (8.9); Rev 2, 92.5 (15.4); Rev 3, 102.6 (16.7); Rev 4, 75.1 (11.3); and Rev 5, 81.4 (8.1); p <0.0001. Reproducibility was measured using the intraclass correlation coefficient (ICC). The reproducibility of the prostate volume was fair (ICC = 0.639) but was poor for the dosimetric quantifiers (V(100) ICC = 0.344 and D(90) ICC = 0.275). CONCLUSION: Significant interobserver differences in prostate volume defined on postimplant CT scans were observed. These differences led to significant differences in commonly used dosimetric quantifiers according to the individual reviewer. Until a greater degree of agreement among reviewers can be established, inferences concerning postimplant CT-based dosimetric analysis will be problematic at best. Additional efforts to increase interobserver agreement are required.

Authors
Lee, WR; Roach, M; Michalski, J; Moran, B; Beyer, D
MLA Citation
Lee, WR, Roach, M, Michalski, J, Moran, B, and Beyer, D. "Interobserver variability leads to significant differences in quantifiers of prostate implant adequacy." Int J Radiat Oncol Biol Phys 54.2 (October 1, 2002): 457-461.
PMID
12243822
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
54
Issue
2
Publish Date
2002
Start Page
457
End Page
461

Coexistence of localized Langerhans cell histiocytosis and cutaneous Rosai-Dorfman disease.

Rosai-Dorfman disease (RDD; sinus histiocytosis with massive lymphadenopathy) and Langerhans cell histiocytosis (LCH) are two different yet pathogenetically related histiocytic disorders. While systemic and localized forms have been identified in both diseases, each has its own characteristic histological, immunohistochemical and ultrastructural profile. Rarely, either RDD or LCH can also occur in the context of certain malignant neoplasms. However, the coexistence of RDD and LCH has never been described. We report a case of cutaneous RDD in which a focus of LCH was found. Clinical and laboratory examinations revealed no evidence of extracutaneous involvement of RDD or LCH. We believe that this is the first report of such a coexistence, and the possible pathogenesis is discussed.

Authors
Wang, KH; Cheng, CJ; Hu, CH; Lee, WR
MLA Citation
Wang, KH, Cheng, CJ, Hu, CH, and Lee, WR. "Coexistence of localized Langerhans cell histiocytosis and cutaneous Rosai-Dorfman disease." The British journal of dermatology 147.4 (October 2002): 770-774. (Academic Article)
Source
manual
Published In
British Journal of Dermatology
Volume
147
Issue
4
Publish Date
2002
Start Page
770
End Page
774

Flavanones structure-related inhibition on TPA-induced tumor promotion through suppression of extracellular signal-regulated protein kinases: involvement of prostaglandin E2 in anti-promotive process.

Biological functions of flavanones have been studied extensively, however, the structure-related activities of flavanones on 12-o-tetradecanoylphorbol 13-acetate (TPA)-induced promotive effects are still unclear. In this study, flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone showed the most significant dose-dependent inhibition on TPA-induced proliferative effects among eight tested flavanones in NIH3T3 cells. TPA-induced mitogen activated protein kinases (MAPK) phosphorylation, ornithine decarboxylase (ODC), c-Jun, and cyclooxygenase 2 (COX-2) protein expressions in a time-dependent manner, and the maximal inductive time point is at 1 h for MAPK phosphorylation and 6 h for others. Flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone showed the dose-dependent inhibition on TPA-stimulated MAPK phosphorylation, COX-2, ODC, c-Jun protein expressions. Induction of, prostaglandin E(2) (PGE(2)) production was detected in TPA-treated NIH3T3 cells, and flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone inhibited significantly PGE(2) production induced by TPA. Addition of PGE(2) reverses the inhibitory activities of flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone on TPA-induced proliferation. And, PD98059, a specific inhibitor of ERKs, inhibited TPA-induced MAPK phosphorylation, accompanied by decreasing COX-2, c-Jun, and ODC protein expression, and showed dose-dependent inhibition on TPA-induced proliferation in cells. These results demonstrated that PGE(2) is an important mediator in TPA-induced proliferation, and MAPK phosphorylation was located at the upstream of COX-2, c-Jun, and ODC gene expressions in TPA-induced responses. Furthermore, flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone (100 microM) suppressed TPA-induced colony formation associated with blocking MAPK phosphorylation, ODC, c-Jun, and COX-2 proteins expression. And, 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay showed that flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone did not perform potent anti-radical activities among these eight tested compounds. In conclusion, this study provided molecular evidences to demonstrate that flavanone, 2'-OH flavanone, 4'-OH flavanone, 6-OH flavanone were potent inhibitors on TPA-induced responses without notable cytotoxicity through suppression of PGE(2) production; and anti-radical activity of flavanones was not correlated with preventing the occurrence of tumor promotion. We proposed that blocking TPA-induced intracellular signaling responses might be involved in the anti-promotive mechanism of flavanones.

Authors
Ko, CH; Shen, SC; Lin, HY; Hou, WC; Lee, WR; Yang, LL; Chen, YC
MLA Citation
Ko, CH, Shen, SC, Lin, HY, Hou, WC, Lee, WR, Yang, LL, and Chen, YC. "Flavanones structure-related inhibition on TPA-induced tumor promotion through suppression of extracellular signal-regulated protein kinases: involvement of prostaglandin E2 in anti-promotive process." Journal of cellular physiology 193.1 (October 2002): 93-102. (Academic Article)
Source
manual
Published In
Journal of Cellular Physiology
Volume
193
Issue
1
Publish Date
2002
Start Page
93
End Page
102

Overview consensus statement. Newer approaches to androgen deprivation therapy in prostate cancer.

Authors
Carroll, PR; Kantoff, PW; Balk, SP; Brown, MA; D'amico, AV; George, DJ; Grossfeld, GD; Johnson, CS; Kelly, WK; Klotz, L; Lee, WR; Lubeck, DP; Mcleod, DG; Oh, WK; Pollack, A; Sartor, O; Smith, MR; Hart, C; Second International Conference on Newer Approaches to Androgen Deprivation Therapy (ADT) in Prostate Cancer,
MLA Citation
Carroll, PR, Kantoff, PW, Balk, SP, Brown, MA, D'amico, AV, George, DJ, Grossfeld, GD, Johnson, CS, Kelly, WK, Klotz, L, Lee, WR, Lubeck, DP, Mcleod, DG, Oh, WK, Pollack, A, Sartor, O, Smith, MR, Hart, C, and Second International Conference on Newer Approaches to Androgen Deprivation Therapy (ADT) in Prostate Cancer, . "Overview consensus statement. Newer approaches to androgen deprivation therapy in prostate cancer." Urology 60.3 Suppl 1 (September 2002): 1-6. (Review)
PMID
12231036
Source
epmc
Published In
Urology
Volume
60
Issue
3 Suppl 1
Publish Date
2002
Start Page
1
End Page
6
DOI
10.1016/s0090-4295(02)01559-5

The role of androgen deprivation therapy combined with prostate brachytherapy.

Several prospective randomized clinical trials have demonstrated improved outcomes in men receiving androgen deprivation therapy (ADT) in combination with definitive local therapy (external-beam radiotherapy or surgery). ADT is commonly combined with prostate brachytherapy (PB) to "downsize" the prostate gland. As PB is increasingly used, more men are being treated with a combination of ADT and PB. The purpose of this article is to review the effects of ADT in men treated with PB. A structured literature review was performed. The effects of ADT on 3 separate outcomes were examined: (1) volume of the prostate gland, (2) treatment-related morbidity, and (3) disease-free survival. No prospective randomized trials addressing the effects of ADT combined with PB were discovered. There is evidence that prostate volume is reduced by 25% to 40% after 3 months of ADT. There is some evidence that ADT may be associated with increased acute urinary morbidity and decreased erectile function after PB. There is little evidence that disease-free survival in men treated with PB is improved with the addition of ADT. Neoadjuvant ADT before PB reduces prostate volume. ADT may lead to increased acute urinary morbidity and decreased erectile function after PB. No substantial effects of ADT on disease-free survival are apparent. Prospective randomized trials of PB and ADT are required.

Authors
Lee, WR
MLA Citation
Lee, WR. "The role of androgen deprivation therapy combined with prostate brachytherapy." Urology 60.3 Suppl 1 (September 2002): 39-44. (Review)
PMID
12231045
Source
pubmed
Published In
Urology
Volume
60
Issue
3 Suppl 1
Publish Date
2002
Start Page
39
End Page
44

Isolated thrombocytopenia associated with oral terbinafine.

Authors
Tsai, HH; Lee, WR; Hu, CH
MLA Citation
Tsai, HH, Lee, WR, and Hu, CH. "Isolated thrombocytopenia associated with oral terbinafine." The British journal of dermatology 147.3 (September 2002): 627-628. (Academic Article)
Source
manual
Published In
British Journal of Dermatology
Volume
147
Issue
3
Publish Date
2002
Start Page
627
End Page
628

In regard to Brenner et al. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio) similar to late-responding normal tissue.

Authors
Lee, WR
MLA Citation
Lee, WR. "In regard to Brenner et al. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio) similar to late-responding normal tissue." Int J Radiat Oncol Biol Phys 53.5 (August 1, 2002): 1392-. (Letter)
PMID
12128142
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
53
Issue
5
Publish Date
2002
Start Page
1392

Quality of life after prostate cancer treatment.

Authors
Lee, WR
MLA Citation
Lee, WR. "Quality of life after prostate cancer treatment." J Clin Oncol 20.13 (July 1, 2002): 3038-. (Letter)
PMID
12089237
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
20
Issue
13
Publish Date
2002
Start Page
3038
DOI
10.1200/JCO.2002.20.13.3038

The effect of laser treatment on skin to enhance and control transdermal delivery of 5-fluorouracil.

The effect of three lasers (i.e., the ruby, erbium:YAG, and CO2) on the ability to enhance and control skin permeation of 5-fluorouracil (5-FU) was studied in vitro. Light microscopic and ultrastructural (scanning electron microscopic) changes in the nude mouse skin were also compared for these lasers. The histological observations and permeation profiles of each laser differed because the three lasers produce different physical and physiologic effects when striking the skin. The skin permeation of 5-FU could be moderately promoted by a single photomechanical wave generated by the ruby laser (at 4.0 and 7.0 J/cm(2)) without adversely affecting the viability or structure of the skin. The stratum corneum (SC) layer in the skin was partly ablated by an erbium:YAG laser, resulting in a greater enhancement effect on skin permeation of 5-FU. The flux of 5-FU across erbium:YAG laser-treated skin was 53-133-fold higher than that across intact skin. Both SC ablation and a thermal effect may contribute to the effect of the CO2 laser on skin structure. Lower energies of the CO2 laser did not modulate 5-FU permeation. A 36-41-fold increase in 5-FU flux was observed after exposure to higher fluences (4.0 and 7.0 J/cm(2)) of the CO2 laser. Histological changes induced by both the erbium:YAG and CO2 lasers had completely recovered within 4 days.

Authors
Lee, WR; Shen, SC; Wang, KH; Hu, CH; Fang, JY
MLA Citation
Lee, WR, Shen, SC, Wang, KH, Hu, CH, and Fang, JY. "The effect of laser treatment on skin to enhance and control transdermal delivery of 5-fluorouracil." Journal of pharmaceutical sciences 91.7 (July 2002): 1613-1626. (Academic Article)
Source
manual
Published In
Journal of Pharmaceutical Sciences
Volume
91
Issue
7
Publish Date
2002
Start Page
1613
End Page
1626

In vitro and in vivo inhibitory activities of rutin, wogonin, and quercetin on lipopolysaccharide-induced nitric oxide and prostaglandin E(2) production.

Flavonoids are widely distributed in plants, but their biological functions are still unclear. In the present study, in vitro and in vivo experiments were performed to demonstrate the inhibitory activities of rutin, wogonin, and quercetin on lipopolysaccharide-induced nitric oxide (NO) and prostaglandin E(2) production in RAW 264.7 macrophages, primary peritoneal macrophages, and Balb/c mice, respectively. In vitro results showed that wogonin and quercetin dose-dependently suppressed lipopolysaccharide-induced NO production in RAW 264.7 macrophages and primary peritoneal macrophages without a notable cytotoxic effect on either cell types associated with a decrease in inducible nitric oxide synthase (iNOS) protein expression in both cells. Rutin, at 80 microM only, had a slight but obvious inhibitory effect on lipopolysaccharide-induced NO production in primary peritoneal macrophages. Both wogonin and quercetin attenuated lipopolysaccharide-induced prostaglandin E(2) production in vitro. Intravenous injection of lipopolysaccharide (10 mg/kg, i.v.) resulted in a time-dependent induction of NO production in serum, and pretreatment with the L-arginine analog N-nitro-L-arginine methyl ester (L-NAME) blocked this induction. Intravenous pretreatment of Balb/c mice with rutin, wogonin or quercetin for 1 h followed by lipopolysaccharide treatment significantly inhibited lipopolysaccharide-induced NO production, but no inhibition of prostaglandin E(2) production was found. A decrease in iNOS protein, but not cyclooxygenase-2 protein, was detected in liver and lung specimens of lipopolysaccharide-treated Balb/c mice in the presence of rutin, wogonin or quercetin. In conclusion, data obtained both in vitro and in vivo suggest that wogonin and quercetin exert inhibitory activity on lipopolysaccharide-induced NO production through suppression of iNOS expression.

Authors
Shen, SC; Lee, WR; Lin, HY; Huang, HC; Ko, CH; Yang, LL; Chen, YC
MLA Citation
Shen, SC, Lee, WR, Lin, HY, Huang, HC, Ko, CH, Yang, LL, and Chen, YC. "In vitro and in vivo inhibitory activities of rutin, wogonin, and quercetin on lipopolysaccharide-induced nitric oxide and prostaglandin E(2) production." European journal of pharmacology 446.1-3 (June 2002): 187-194. (Academic Article)
Source
manual
Published In
European Journal of Pharmacology
Volume
446
Issue
1-3
Publish Date
2002
Start Page
187
End Page
194

Wogonin and fisetin induction of apoptosis through activation of caspase 3 cascade and alternative expression of p21 protein in hepatocellular carcinoma cells SK-HEP-1.

Wogonin and fisetin are flavonoids, which are widely distributed in plants. Our recent study demonstrated that, among seven structurally related flavonoids, wogonin and fisetin showed the most potent apoptosis-inducing activities in human promyeloleukemic cells HL-60. In the present investigation, we performed molecular studies to assess the apoptotic effects of wogonin and fisetin on hepatocellular carcinoma cells SK-HEP-1. Both wogonin and fisetin showed dose-dependent cytotoxic effects on SK-HEP-1 cells, accompanied by DNA fragmentation. Microscopic observation under Giemsa staining showed that wogonin and fisetin, at the dose of 80 microM, induced cellular swelling and the appearance of apoptotic bodies, characteristics of apoptosis, in SK-HEP-1 cells. Furthermore, flow cytometry analysis showed an increase of hypodiploid cells in wogonin- and fisetin-treated SK-HEP-1 cells. These data demonstrated that wogonin and fisetin were effective inducers of apoptosis in SK-HEP-1 cells. Treatment with an apoptosis-inducing concentration of wogonin or fisetin caused induction of caspase 3/CPP32 activity, but not of caspase 1 activity. In addition, a caspase 3 inhibitor, Ac-DEVD-CHO, but not the caspase 1 inhibitor Ac-YVAD-CHO, reversed the cytotoxic effects of wogonin and fisetin on SK-HEP-1 cells. Further, cleavage of caspase 3 substrates including poly(ADP-ribose) polymerase (PARP) and D4-GDI protein, and decrease of pro-caspase 3 protein were detected in wogonin- and fisetin-treated SK-HEP-1 cells. Increase of p53 protein was associated with wogonin- and fisetin-induced apoptosis; however, a p53-controlled gene, p21(Waf/Cip-1), was only induced in wogonin- (not fisetin-) treated SK-HEP-1 cells. Serum starvation elevated p21(Waf/Cip-1) protein expression, and enhanced the apoptotic induction activity of wogonin (not fiseitn) in SK-HEP-1 cells. Our study has provided molecular evidence to demonstrate that wogonin and fisetin had effective cytotoxic effects through apoptosis induction in hepatocellular carcinoma cells SK-HEP-1; activation of caspase 3 cascade, induction of p53 protein and alternative expression of p21(Waf/Cip-1) protein were involved.

Authors
Chen, YC; Shen, SC; Lee, WR; Lin, HY; Ko, CH; Shih, CM; Yang, LL
MLA Citation
Chen, YC, Shen, SC, Lee, WR, Lin, HY, Ko, CH, Shih, CM, and Yang, LL. "Wogonin and fisetin induction of apoptosis through activation of caspase 3 cascade and alternative expression of p21 protein in hepatocellular carcinoma cells SK-HEP-1." Archives of toxicology 76.5-6 (June 2002): 351-359. (Academic Article)
Source
manual
Published In
Archives of Toxicology
Volume
76
Issue
5-6
Publish Date
2002
Start Page
351
End Page
359

Epidemiology of 21-hydroxylase deficiency in Singapore.

We report the incidence and epidemiology of 21-hydroxylase deficiency in Singapore, based on a retrospective study of all known patients diagnosed with classical 21-hydroxylase deficiency in the past 21 years. The database was obtained from the case registry and questionnaire methodology, with 100% coverage of all practising pediatricians in Singapore. There were 42 patients affected with 21-hydroxylase deficiency in 964,558 live births over 21 years, comprising 64.3% salt wasters and 35.7% simple virilizers, of whom 50.0% were males and 50.0% females. The incidence of classical 21-hydroxylase deficiency is 4.5 per 100,000 live births, with a carrier frequency of 1:76, and a gene frequency of 0.0067. Although retrospective studies have inherent limitations, the gender and phenotype ratios suggest that the data provide a crude incidence level. This study underscores the necessity for prospective neonatal screening, so that the benefits of early diagnosis and treatment can be realized.

Authors
Loke, KY; Tan, IT; Lee, WR; Lee, YS
MLA Citation
Loke, KY, Tan, IT, Lee, WR, and Lee, YS. "Epidemiology of 21-hydroxylase deficiency in Singapore." Journal of pediatric endocrinology & metabolism : JPEM 15.4 (April 2002): 397-403. (Academic Article)
Source
manual
Published In
The Journal of pediatric endocrinology
Volume
15
Issue
4
Publish Date
2002
Start Page
397
End Page
403

Wogonin and fisetin induce apoptosis in human promyeloleukemic cells, accompanied by a decrease of reactive oxygen species, and activation of caspase 3 and Ca(2+)-dependent endonuclease.

Seven structurally related flavonoids including luteolin, nobiletin, wogonin, baicalein, apigenin, myricetin and fisetin were used to study their biological activities on the human leukemia cell line, HL-60. On MTT assay, wogonin, baicalein, apigenin, myricetin and fisetin showed obvious cytotoxic effects on HL-60 cells, with wogonin and fisetin being the most-potent apoptotic inducers among them. The cytotoxic effects of wogonin and fisetin were accompanied by the dose- and time-dependent appearance of characteristics of apoptosis including DNA fragmentation, apoptotic bodies and the sub-G1 ratio. Treatment with an apoptosis-inducing concentration of wogonin or fisetin causes rapid and transient induction of caspase 3/CPP32 activity, but not caspase 1 activity. Further, cleavage of poly(ADP-ribose) polymerase (PARP) and decrease of pro-caspase 3 protein were detected in wogonin- and fisetin-treated HL-60 cells. An increase in the pro-apoptotic protein, bax, and a decrease in the anti-apoptotic protein, Mcl-1, were detected in fisetin- and wogonin-treated HL-60 cells. However, Bcl-2, Bcl-XL, and Bad all remained unchanged in wogonin- and fisetin-treated HL-60 cells. In vitro chromatin digestion revealed that endonuclease activity was profoundly enhanced in wogonin- and fisetin-treated HL-60 cells, and the addition of ethylenediaminetetraacetic acid (EDTA) or ethyleneglycoltetraacetic acid (EGTA) into the reaction blocked endonuclease activation and at an optimum pH of 7.5. The caspase 3 inhibitor, Ac-DEVD-CHO, but not the caspase 1 inhibitor, Ac-YVAD-CHO, attenuated wogonin- and fisetin-induced DNA ladders, PARP cleavage, and endonuclease activation. Pretreatment of HL-60 cells with N-acetyl-cysteine or catalase efficiently inhibited H(2)O(2) (200 microM)-induced apoptosis, but showed no inhibitory effect on wogonin- and fisetin-induced DNA ladders, caspase 3 activation, or bax protein induction. Decrease in endogenous ROS production was detected in wogonin- and fisetin-treated HL-60 cells by DCHF-DA assay. In conclusion, our experiments indicate that a decrease in intracellular peroxide level was involved in wogonin- and fisetin-induced apoptosis; activation of caspase 3 and endonuclease, induction of bax protein and suppression of Mcl-1 protein were detected in the process.

Authors
Lee, WR; Shen, SC; Lin, HY; Hou, WC; Yang, LL; Chen, YC
MLA Citation
Lee, WR, Shen, SC, Lin, HY, Hou, WC, Yang, LL, and Chen, YC. "Wogonin and fisetin induce apoptosis in human promyeloleukemic cells, accompanied by a decrease of reactive oxygen species, and activation of caspase 3 and Ca(2+)-dependent endonuclease." Biochemical pharmacology 63.2 (January 2002): 225-236. (Academic Article)
Source
manual
Published In
Biochemical Pharmacology
Volume
63
Issue
2
Publish Date
2002
Start Page
225
End Page
236

Radiation dose to the neurovascular bundles or penile bulb does not predict erectile dysfunction after prostate brachytherapy.

PURPOSE: To examine the relationship between calculated doses to the neurovascular bundles (NVBs) and the penile bulb (PB) and the development of erectile dysfunction (ED) after low-dose-rate prostate brachytherapy (LDRPB) alone. METHODS AND MATERIALS: Between September 1997 and June 1999, 84 men were treated with LDRPB alone. Inclusion criteria for this study were (1) no ED according to a self-administered questionnaire before PB, (2) treatment with PB alone (125I; 144 Gy), (3) postimplant CT scan of the prostate 1 month after PB, and (4) minimum of 24 months of continuous follow-up. Fifty men met all inclusion criteria. ED was assessed by a self-administered questionnaire completed before and at each follow-up visit after LDRPB. Radiation doses to the NVB and PB were calculated on the basis of axial postimplant CT images. Multiple variables (patient-related and dosimetric quantifiers) that may predict for the development of ED were examined by univariate analysis. RESULTS: Thirty of the 50 men (60%) were potent at last follow-up. The only patient-related variable that predicted for the development of ED was patient age (<65 vs. >65 years; p=0.03). The calculated mean maximum doses to the NVB and PB were 684 Gy (range, 195-1277 Gy) and 498 Gy (range, 44-971 Gy), respectively. The mean calculated doses to 50% of the NVB and PB were 158 Gy (range, 76-240 Gy) and 43 Gy (range, 19-101 Gy), respectively. The calculated mean maximum, mean minimum, and mean doses to 50% of the NVB or PB did not differ between those men who developed ED and those men who did not develop ED. None of the dosimetric variables examined predicted the development of ED after LDRPB. CONCLUSIONS: In our experience, higher calculated doses to the NVB or PB are not associated with ED after LDRPB.

Authors
Kiteley, RA; Lee, WR; deGuzman, AF; Mirzaei, M; McCullough, DL
MLA Citation
Kiteley, RA, Lee, WR, deGuzman, AF, Mirzaei, M, and McCullough, DL. "Radiation dose to the neurovascular bundles or penile bulb does not predict erectile dysfunction after prostate brachytherapy." Brachytherapy 1.2 (2002): 90-94.
PMID
15062176
Source
pubmed
Published In
Brachytherapy
Volume
1
Issue
2
Publish Date
2002
Start Page
90
End Page
94

Nitric oxide and prostaglandin E2 participate in lipopolysaccharide/interferon-gamma-induced heme oxygenase 1 and prevent RAW264.7 macrophages from UV-irradiation-induced cell death.

Induction of heme oxygenase (HO)-1 during inflammation has been demonstrated in many cell types, but the contribution of inflammatory molecules nitric oxide (NO) and prostaglandin E(2) (PGE(2)) has remained unresolved. Here we show that NO donors including sodium nitroprusside (SNP) and spermine nonoate (SP-NO), and PGE(2) significantly stimulate HO-1 expression in RAW264.7 macrophages, associated with alternative induction on NO and PGE(2) in medium, respectively. NO donors also show the inductive effect on cyclo-oxygenase 2 protein and PGE(2) production. In the presence of lipopolysaccharide and interferon-gamma (LPS/IFN-gamma), HO-1 protein was induced slightly but significantly, and SNP, SP-NO, and PGE(2) enhanced HO-1 protein induced by LPS/IFN-gamma. L-Arginine analogs N-nitro-L-arginine methyl ester (L-NAME) and N-nitro-L-arginine (NLA) significantly block HO-1 protein induced by LPS/IFN-gamma associated with a decrease in NO (not PGE(2)) production. And, NSAIDs aspirin and diclofenase dose dependently inhibited LPS/IFN-gamma-induced HO-1 protein accompanied by suppression of PGE(2) (not NO) production. PD98059 (a specific inhibitor of MEKK), but not SB203580 (a specific inhibitor of p38 kinase), attenuated PGE(2) (not SP-NO) induced HO-1 protein. Under UVC (100 J/m(2)) and UVB (50 J/m(2)) irradiation, PGE(2) or SP-NO treatment prevents cells from UVC or UVB-induced cell death, and HO-1 inhibitor tin protoporphyrin (SnPP) reverses the preventive effects of PGE(2) and SP-NO. The protective activity induced by PGE(2) on UVC or UVB irradiation-induced cell death was blocked by MAPK inhibitor PD98059 (not SB203580). These results demonstrated that inflammatory molecules NO and PGE(2) were potent inducers of HO-1 gene, and protected cells from UV-irradiation-induced cell death through HO-1 induction.

Authors
Chen, YC; Shen, SC; Lee, WR; Lin, HY; Ko, CH; Lee, TJ
MLA Citation
Chen, YC, Shen, SC, Lee, WR, Lin, HY, Ko, CH, and Lee, TJ. "Nitric oxide and prostaglandin E2 participate in lipopolysaccharide/interferon-gamma-induced heme oxygenase 1 and prevent RAW264.7 macrophages from UV-irradiation-induced cell death." Journal of cellular biochemistry 86.2 (2002): 331-339. (Academic Article)
Source
manual
Published In
Journal of Cellular Biochemistry
Volume
86
Issue
2
Publish Date
2002
Start Page
331
End Page
339

Overview consensus statement

Authors
Carroll, PR; Kantoff, PW; Balk, SP; Brown, MA; D'amico, AV; George, DJ; Grossfeld, GD; Johnson, CS; Kelly, WK; Klotz, L; Lee, WR; Lubeck, DP; Mcleod, DG; Oh, WK; Pollack, A; Sartor, O; Smith, MR; Hart, C
MLA Citation
Carroll, PR, Kantoff, PW, Balk, SP, Brown, MA, D'amico, AV, George, DJ, Grossfeld, GD, Johnson, CS, Kelly, WK, Klotz, L, Lee, WR, Lubeck, DP, Mcleod, DG, Oh, WK, Pollack, A, Sartor, O, Smith, MR, and Hart, C. "Overview consensus statement." Urology 60.3 SUPPL. 1 (2002): 1-6.
Source
scival
Published In
Urology
Volume
60
Issue
3 SUPPL. 1
Publish Date
2002
Start Page
1
End Page
6
DOI
10.1016/S0090-4295(02)01559-5

The role of androgen deprivation therapy combined with prostate brachytherapy

Several prospective randomized clinical trials have demonstrated improved outcomes in men receiving androgen deprivation therapy (ADT) in combination with definitive local therapy (external-beam radiotherapy or surgery). ADT is commonly combined with prostate brachytherapy (PB) to "downsize" the prostate gland. As PB is increasingly used, more men are being treated with a combination of ADT and PB. The purpose of this article is to review the effects of ADT in men treated with PB. A structured literature review was performed. The effects of ADT on 3 separate outcomes were examined: (1) volume of the prostate gland, (2) treatment-related morbidity, and (3) disease-free survival. No prospective randomized trials addressing the effects of ADT combined with PB were discovered. There is evidence that prostate volume is reduced by 25% to 40% after 3 months of ADT. There is some evidence that ADT may be associated with increased acute urinary morbidity and decreased erectile function after PB. There is little evidence that disease-free survival in men treated with PB is improved with the addition of ADT. Neoadjuvant ADT before PB reduces prostate volume. ADT may lead to increased acute urinary morbidity and decreased erectile function after PB. No substantial effects of ADT on disease-free survival are apparent. Prospective randomized trials of PB and ADT are required. © 2002, Elsevier Science Inc.

Authors
Lee, WR
MLA Citation
Lee, WR. "The role of androgen deprivation therapy combined with prostate brachytherapy." Urology 60.3 SUPPL. 1 (2002): 39-44.
Source
scival
Published In
Urology
Volume
60
Issue
3 SUPPL. 1
Publish Date
2002
Start Page
39
End Page
44
DOI
10.1016/S0090-4295(02)01568-6

In regard to Brenner et al., IJROBP 2002;52:6-13 [1] (multiple letters)

Authors
Lee, WR
MLA Citation
Lee, WR. "In regard to Brenner et al., IJROBP 2002;52:6-13 [1] (multiple letters)." International Journal of Radiation Oncology Biology Physics 53.5 (2002): 1392-1393.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
53
Issue
5
Publish Date
2002
Start Page
1392
End Page
1393
DOI
10.1016/S0360-3016(02)02859-6

Quality of life after prostate cancer treatment [1] (multiple letters)

Authors
Lee, WR; Sanda, MG; McLaughlin, PW
MLA Citation
Lee, WR, Sanda, MG, and McLaughlin, PW. "Quality of life after prostate cancer treatment [1] (multiple letters)." Journal of Clinical Oncology 20.13 (2002): 3038-3039.
Source
scival
Published In
Journal of Clinical Oncology
Volume
20
Issue
13
Publish Date
2002
Start Page
3038
End Page
3039

The status of diabetes mellitus in primary care institution and restructured hospitals in Singapore.

The Diabcare-Asia Singapore 1998 project was carried out using data from 22 centres collected on paper forms to provide an overview of diabetes management and metabolic control status in 1697 diabetic patients from both primary health care clinic (PHC) (67%) and restructured hospital (RH) (33%) settings. PHC patients were on average older than RH patients (61.3 +/- 11.2 years vs 51.5 +/- 17.7 years), and had a shorter duration of diagnosed diabetes (9.2 +/- 6.8 years vs 12.0 +/- 8.5 years). The mean body mass index (BMI) for PHC patients was 25.5 +/- 4.4 kg/m2 vs 24.5 +/- 4.2 kg/m2 for RH patients. Proportionately more PHC than RH patients were overweight (BMI >25 kg/m2) (49% vs 42%). Patients with type I diabetes constituted 3.5% of PHC vs 18.1% of the RH cohort. HbA1c information was available for 92.5% of RH vs 69% of PHC patients. HbA1c measurements were 7.8 mmol/l in >61% of all patients. Proteinuria (>500 mg/24 hrs) was reported in 13% of PHC vs 26% of RH patients tested. Microalbuminuria (20-300 mg/l) was noted in 36% of 171 RH patients tested. Oral hypoglycaemic agents were used as sole therapy in 83.5% of PHC vs 43% of RH patients. Eye, feet, renal and severe late complications were more commonly reported by RH than PHC patients. There is a variation in the patient profiles and care between PHC and RH patients.

Authors
Lee, WR; Emmanuel, S; Lim, HS; Thai, AC; Chew, WL; Goh, LG; Lau, HC; Lee, CH; Soon, PC; Tambyah, JA; Tan, YT; Jorgensen, LN; Chua, A; Yeo, JP; Group, DSLW; Singapore, DSO
MLA Citation
Lee, WR, Emmanuel, S, Lim, HS, Thai, AC, Chew, WL, Goh, LG, Lau, HC, Lee, CH, Soon, PC, Tambyah, JA, Tan, YT, Jorgensen, LN, Chua, A, Yeo, JP, Group, DSLW, and Singapore, DSO. "The status of diabetes mellitus in primary care institution and restructured hospitals in Singapore." Singapore medical journal 42.11 (November 2001): 508-512. (Academic Article)
Source
manual
Published In
Singapore medical journal
Volume
42
Issue
11
Publish Date
2001
Start Page
508
End Page
512

A window on the current status of diabetes mellitus in Singapore--the Diabcare-Singapore 1998 study.

The Diabcare-Singapore project was carried out in 22 clinics (general hospitals, GH and primary healthcare centres, PHC) to provide an overview of diabetes management and metabolic control status. Data from 1697 diabetic patients were collected on paper forms and analysed centrally.Type 2 diabetes mellitus patients constituted 91.4% and type I patients constituted 8.1% of population. The proportion of type I patients was greater in GH (18.1%) vs PHC (3.4%).The mean age (+/- SD) was 58.1 +/- 14.4 years and mean duration of diabetes was 10.1 +/- 7.5 years. Mean body mass index (BMI) was 25.1 +/- 4.4 kg/m2 and more than half (53%) of patients were overweight (BMI >25 kg/m2). Mean HbA1c and FBG levels were 8.0 (1.9% and 9.1 +/- 3.1 mmol/l. A total of 51% of patients had HbA1c (1% above the Upper Limits of Normal (ULN). Fasting blood glucose (FBG) was >7.8 mmol/l in 61% of patients. The majority (70%) had satisfactory levels of fasting lipids (triglycerides, total cholesterol and HDL-cholesterol). Only 19.7% practised home blood glucose self-monitoring, while 99% reported receiving some diabetes education. Sixteen percent of patients had abnormal levels of protein (>500 mg/24 h) in the urine, 3% had elevated serum creatinine levels and 36% had microalbuminuria. Retinopathy (12%), cataract (16%) and neuropathy (12%) were commonly reported diabetic complications. The data revealed suboptimal glycaemic control in about half of patients studied.

Authors
Lee, WR; Lim, HS; Thai, AC; Chew, WL; Emmanuel, S; Goh, LG; Lau, HC; Lee, CH; Soon, PC; Tambyah, JA; Tan, YT; Jorgensen, LN; Chua, A; Yeo, JP; Group, DSLW; Singapore, DSO
MLA Citation
Lee, WR, Lim, HS, Thai, AC, Chew, WL, Emmanuel, S, Goh, LG, Lau, HC, Lee, CH, Soon, PC, Tambyah, JA, Tan, YT, Jorgensen, LN, Chua, A, Yeo, JP, Group, DSLW, and Singapore, DSO. "A window on the current status of diabetes mellitus in Singapore--the Diabcare-Singapore 1998 study." Singapore medical journal 42.11 (November 2001): 501-507. (Academic Article)
Source
manual
Published In
Singapore medical journal
Volume
42
Issue
11
Publish Date
2001
Start Page
501
End Page
507

Massive extraocular extension as the presenting feature of a choroidal melanoma.

Authors
Fenton, S; Sandinha, T; Lee, WR; Kemp, EG
MLA Citation
Fenton, S, Sandinha, T, Lee, WR, and Kemp, EG. "Massive extraocular extension as the presenting feature of a choroidal melanoma." Eye (London, England) 15.Pt 4 (August 2001): 550-551. (Academic Article)
Source
manual
Published In
Eye
Volume
15
Issue
Pt 4
Publish Date
2001
Start Page
550
End Page
551

Transdermal drug delivery enhanced and controlled by erbium:YAG laser: a comparative study of lipophilic and hydrophilic drugs.

The influence of an erbium:YAG laser on the transdermal delivery of drugs across skin was studied in vitro. Indomethacin and nalbuphine, which have the same molecular weight, were selected as model lipophilic and hydrophilic drugs, respectively, to compare skin permeation by laser treatment. The results indicate a significant increase in the permeation of indomethacin and nalbuphine across skin pretreated with an erbium:YAG laser. The laser had a greater effect on the permeation of hydrophilic molecules which usually possess low permeability. The laser intensity and its spot size were found to play an important role in controlling transdermal delivery of drugs. Permeation of the hydrophilic drug increased following an increase of laser energy. On the other hand, a different result was observed for the lipophilic drug transported across laser-treated skin. The stratum corneum (SC) layer in skin could be partly ablated by the erbium:YAG laser. The barrier function of the SC may also be modulated by a lower intensity of the laser without affecting the viability and structure of the epidermis/dermis as determined by histological observations. However, ultrastructural alteration of the epidermis/dermis may be caused by laser treatment. Use of an erbium:YAG laser is a good method for enhancing transdermal absorption of both lipophilic and hydrophilic drugs, because it allows precise control of SC removal, and this ablation of SC can be reversible to the original normal status.

Authors
Lee, WR; Shen, SC; Lai, HH; Hu, CH; Fang, JY
MLA Citation
Lee, WR, Shen, SC, Lai, HH, Hu, CH, and Fang, JY. "Transdermal drug delivery enhanced and controlled by erbium:YAG laser: a comparative study of lipophilic and hydrophilic drugs." Journal of controlled release : official journal of the Controlled Release Society 75.1-2 (July 2001): 155-166. (Academic Article)
Source
manual
Published In
Journal of Controlled Release
Volume
75
Issue
1-2
Publish Date
2001
Start Page
155
End Page
166

Alternative activation of extracellular signal-regulated protein kinases in curcumin and arsenite-induced HSP70 gene expression in human colorectal carcinoma cells.

We have investigated the regulation mechanism of chemical stress-induced HSP70 gene expression in human colorectal carcinoma cells (COLO205 and HT29). Our data show that chemical treatments including sodium arsenite and curcumin, induced significant synthesis of HSP70 and its mRNA. The induced HSP70 gene expression appears to be increased at the transcriptional level. The increase in HSP70 gene expression by both chemicals is associated with an increase in HSF binding to HSE and induction of HSF1 di- or trimerization. Phosphorylation and activation of extracellular signal-regulated proteins (ERK1/2) were detected in sodium arsenite-treated COLO205 and HT29 cells, and the free radical scavenger N-acetyl-L-cysteine (NAC) was able to inhibit this ERK1/2 activation and HSP70 gene expression. MAPK blockade by the specific MEK1 inhibitor (PD98059) decreased the ability of sodium arsenite to increase HSP70 gene expression in a dose-dependent manner along with dephosphorylation of ERK1/2 proteins. In contrast to arsenite treatment, activation of ERK1/2 was not detected in curcumin-treated colorectal carcinoma cells, and NAC and PD98059 did not show any inhibitory effect on HSP70 gene expression induced by curcumin. Overexpression of a dominant negative mutant of mitogen-activated protein kinase kinase kinase 1 (MEKK1-DN) prevents arsenite-induced ERK1/2 phosphorylation and HSP70 protein synthesis. These results indicated that the ERK signaling pathway can participate in HSP70 gene expression induced by the prooxidant sodium arsenite, but not by the antioxidant curcumin.

Authors
Chen, YC; Tsai, SH; Shen, SC; Lin, JK; Lee, WR
MLA Citation
Chen, YC, Tsai, SH, Shen, SC, Lin, JK, and Lee, WR. "Alternative activation of extracellular signal-regulated protein kinases in curcumin and arsenite-induced HSP70 gene expression in human colorectal carcinoma cells." European journal of cell biology 80.3 (March 2001): 213-221. (Academic Article)
Source
manual
Published In
European Journal of Cell Biology
Volume
80
Issue
3
Publish Date
2001
Start Page
213
End Page
221

Usefulness of diabetic retinopathy as a marker of risk for thallium myocardial perfusion defects in non-insulin-dependent diabetes mellitus.

Among 236 non-insulin-dependent diabetics with clinically suspected coronary artery disease, the rate of thallium-201 myocardial perfusion defects was significantly higher in subjects with (40.6%) than without (22.1%) diabetic retinopathy. Retinopathy was associated with a higher risk of perfusion defects in subjects with cardiac and noncardiac chest pain, and may thus be a useful marker for selecting patients in whom thallium scintigraphy screening is warranted.

Authors
Yoon, JK; Lee, KH; Park, JM; Lee, SH; Lee, MK; Lee, WR; Kim, BT
MLA Citation
Yoon, JK, Lee, KH, Park, JM, Lee, SH, Lee, MK, Lee, WR, and Kim, BT. "Usefulness of diabetic retinopathy as a marker of risk for thallium myocardial perfusion defects in non-insulin-dependent diabetes mellitus." The American journal of cardiology 87.4 (February 2001): 456-9, A6. (Academic Article)
Source
manual
Published In
The American Journal of Cardiology
Volume
87
Issue
4
Publish Date
2001
Start Page
456
End Page
9, A6

Radiation Therapy Oncology Group. Research Plan 2002-2006. Outcomes Committee.

Authors
Watkins Bruner, D; Berk, L; Bondy, M; Kachnic, LA; Konski, A; Layne, E; Lee, WR; Choucair, A; Movsas, B; Okunieff, P; Roach, M; Scott, C; Vijayakumar, S; Wenzel, L; Radiation Therapy Oncology Group,
MLA Citation
Watkins Bruner, D, Berk, L, Bondy, M, Kachnic, LA, Konski, A, Layne, E, Lee, WR, Choucair, A, Movsas, B, Okunieff, P, Roach, M, Scott, C, Vijayakumar, S, Wenzel, L, and Radiation Therapy Oncology Group, . "Radiation Therapy Oncology Group. Research Plan 2002-2006. Outcomes Committee." International journal of radiation oncology, biology, physics 51.3 Suppl 2 (January 2001): 66-74.
PMID
11641019
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
51
Issue
3 Suppl 2
Publish Date
2001
Start Page
66
End Page
74

A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy

Purpose: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after 3 different treatments for clinically localized prostate cancer. Methods and Materials: Ninety men with T1-T2 adenocarcinoma of the prostate were treated with curative intent between May 1998 and June 1999 and completed a quality-of-life Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire before treatment (T0) and 1 month (T1), 3 months (T3), and 12 months (T12) after treatment. Forty-four men were treated with permanent source interstitial brachytherapy (IB), 23 received external beam radiotherapy (EBRT), and 23 men were treated with radical prostatectomy (RP). The mean age of the entire study population was 65.9 years (median 67, range 42-79). The mean pretreatment prostate-specific antigen level of the entire study population was 6.81 ng/mL (median 6.25, range 1.33-19.6). The Gleason score was ≤6 in 65 (72%) of 90. The repeated measures analysis of variance and analysis of covariance were conducted on all quality-of-life and urinary outcome measures. Results: A comparison of the demographic characteristics of the 3 treatment groups demonstrated significant differences. The men treated with RP were significantly younger than the men in either the IB or EBRT group (median age 61.0 RP, 67.1 IB, 68.8 EBRT; p=0.0006). The men in the IB group were more likely to have a Gleason score of ≤6 than the EBRT group (Gleason score ≤6, 86% IB and 48% EBRT; p=0.015). The mean score (standard deviation) at T0, T1, T3, and T12 for the FACT-P questionnaire for each group was as follows: IB 138.4 (17.0), 120.5 (21.7), 130.0 (18.4), and 138.5 (14.2); EBRT 137.1 (12.1), 129.5 (21.0), 134.4 (19.2), and 136.9 (15.6); and RP 138.3 (14.7), 117.7 (18.3), 134.4 (17.8), and 140.4 (14.9), respectively. Statistically significant differences over time were observed for the FACT-P in the IB and RP groups (p <0.0001), but not for the EBRT group (p=0.08). The examination of the subscales within the FACT-P instrument demonstrated statistically significant changes over time in the IB and RP groups for the following: physical well-being, functional well-being, and prostate cancer symptoms. After adjusting for age, race, T stage, Gleason score, use of hormonal therapy, and baseline FACT-P scores, statistically significant differences in the FACT-P score at T1 according to treatment group were observed. At T12, the FACT-P scores were not significantly different than the baseline FACT-P scores for any group. Conclusions: The results of this analysis suggest that significant decreases in HRQOL, as measured by the FACT-P instrument, are evident in the first month after IB or RP, but not after EBRT. One year after treatment, however, the FACT-P scores were not statistically different from the baseline measures for any group. For all treatment groups, most of the HRQOL decreases were observed in the physical, functional, and prostate cancer-specific domains. These results suggest that the HRQOL changes are likely to be treatment-specific, further emphasizing the importance of a randomized trial comparing the different treatment options in this population of men. © 2001 Elsevier Science Inc.

Authors
Lee, WR; Hall, MC; McQuellon, RP; Case, LD; McCullough, DL
MLA Citation
Lee, WR, Hall, MC, McQuellon, RP, Case, LD, and McCullough, DL. "A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy." International Journal of Radiation Oncology Biology Physics 51.3 (2001): 614-623.
PMID
11597800
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
51
Issue
3
Publish Date
2001
Start Page
614
End Page
623
DOI
10.1016/S0360-3016(01)01707-2

Radiation Therapy Oncology Group. Research Plan 2002-2006. Genitourinary Cancer Committee.

Authors
Sandler, H; Shipley, WU; Gomella, L; Pienta, K; Bard, RH; Bruner, D; Clark, R; DeSilvio, M; Gaspar, L; Gillin, M; Grignon, D; Hammond, E; Hanks, G; Heydon, KH; Kaufman, DS; Lee, WR; Michalski, J; Mydlo, J; Pisansky, T; Pollack, A; Porterfield, H; Rifkin, M; Roach, M; Sanda, M; True, L; Vijayakumar, S; Winter, KA; Zeitman, A; Group, RTO
MLA Citation
Sandler, H, Shipley, WU, Gomella, L, Pienta, K, Bard, RH, Bruner, D, Clark, R, DeSilvio, M, Gaspar, L, Gillin, M, Grignon, D, Hammond, E, Hanks, G, Heydon, KH, Kaufman, DS, Lee, WR, Michalski, J, Mydlo, J, Pisansky, T, Pollack, A, Porterfield, H, Rifkin, M, Roach, M, Sanda, M, True, L, Vijayakumar, S, Winter, KA, Zeitman, A, and Group, RTO. "Radiation Therapy Oncology Group. Research Plan 2002-2006. Genitourinary Cancer Committee." International journal of radiation oncology, biology, physics 51.3 Suppl 2 (2001): 28-38. (Academic Article)
Source
manual
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
51
Issue
3 Suppl 2
Publish Date
2001
Start Page
28
End Page
38

Radiation Therapy Oncology Group. Research Plan 2002-2006. Outcomes Committee.

Authors
Bruner, DW; Berk, L; Bondy, M; Kachnic, LA; Konski, A; Layne, E; Lee, WR; Choucair, A; Movsas, B; Okunieff, P; 3rd, MR; Scott, C; Vijayakumar, S; Wenzel, L
MLA Citation
Bruner, DW, Berk, L, Bondy, M, Kachnic, LA, Konski, A, Layne, E, Lee, WR, Choucair, A, Movsas, B, Okunieff, P, 3rd, MR, Scott, C, Vijayakumar, S, and Wenzel, L. "Radiation Therapy Oncology Group. Research Plan 2002-2006. Outcomes Committee." International Journal of Radiation Oncology Biology Physics 51.3 Suppl 2 (2001): 66-74.
Source
scival
Published In
International Journal of Radiation Oncology Biology Physics
Volume
51
Issue
3 Suppl 2
Publish Date
2001
Start Page
66
End Page
74

Inhibition of nitric oxide synthase inhibitors and lipopolysaccharide induced inducible NOS and cyclooxygenase-2 gene expressions by rutin, quercetin, and quercetin pentaacetate in RAW 264.7 macrophages.

Several natural flavonoids have been demonstrated to perform some beneficial biological activities, however, higher-effective concentrations and poor-absorptive efficacy in body of flavonoids blocked their practical applications. In the present study, we provided evidences to demonstrate that flavonoids rutin, quercetin, and its acetylated product quercetin pentaacetate were able to be used with nitric oxide synthase (NOS) inhibitors (N-nitro-L-arginine (NLA) or N-nitro-L-arginine methyl ester (L-NAME)) in treatment of lipopolysaccharide (LPS) induced nitric oxide (NO) and prostaglandin E2 (PGE2) productions, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) gene expressions in a mouse macrophage cell line (RAW 264.7). The results showed that rutin, quercetin, and quercetin pentaacetate-inhibited LPS-induced NO production in a concentration-dependent manner without obvious cytotoxic effect on cells by MTT assay using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide as an indicator. Decrease of NO production by flavonoids was consistent with the inhibition on LPS-induced iNOS gene expression by western blotting. However, these compounds were unable to block iNOS enzyme activity by direct and indirect measurement on iNOS enzyme activity. Quercetin pentaacetate showed the obvious inhibition on LPS-induced PGE2 production and COX-2 gene expression and the inhibition was not result of suppression on COX-2 enzyme activity. Previous study demonstrated that decrease of NO production by L-arginine analogs effectively stimulated LPS-induced iNOS gene expression, and proposed that stimulatory effects on iNOS protein by NOS inhibitors might be harmful in treating sepsis. In this study, NLA or L-NAME treatment stimulated significantly on LPS-induced iNOS (but not COX-2) protein in RAW 264.7 cells which was inhibited by these three compounds. Quercetin pentaacetate, but not quercetin and rutin, showed the strong inhibitory activity on PGE2 production and COX-2 protein expression in NLA/LPS or L-NAME/LPS co-treated RAW 264.7 cells. These results indicated that combinatorial treatment of L-arginine analogs and flavonoid derivates, such as quercetin pentaacetate, effectively inhibited LPS-induced NO and PGE2 productions, at the same time, inhibited enhanced expressions of iNOS and COX-2 genes.

Authors
Chen, YC; Shen, SC; Lee, WR; Hou, WC; Yang, LL; Lee, TJ
MLA Citation
Chen, YC, Shen, SC, Lee, WR, Hou, WC, Yang, LL, and Lee, TJ. "Inhibition of nitric oxide synthase inhibitors and lipopolysaccharide induced inducible NOS and cyclooxygenase-2 gene expressions by rutin, quercetin, and quercetin pentaacetate in RAW 264.7 macrophages." Journal of cellular biochemistry 82.4 (2001): 537-548. (Academic Article)
Source
manual
Published In
Journal of Cellular Biochemistry
Volume
82
Issue
4
Publish Date
2001
Start Page
537
End Page
548

Iodine-123 MIBG imaging before treatment of heart failure with carvedilol to predict improvement of left ventricular function and exercise capacity.

BACKGROUND. We examined whether cardiac sympathetic imaging with iodine-123 metaiodobenzylguanidine (MIBG) would predict improvement of left ventricular (LV) function and exercise capacity in patients with heart failure after treatment with carvedilol. METHODS AND RESULTS. Eighteen patients with heart failure and 5 control subjects underwent I-123 MIBG imaging. Heart-to-mediastinum ratios at 20 minutes and 3 hours and myocardial washout rates (WR) were measured. Of the 18 patients, 11 were randomized to receive carvedilol medication, whereas the remaining 7 received a placebo. Only the carvedilol group demonstrated a significant improvement in both heart failure functional class and LV ejection fraction (EF) 1 year after the start of medication. Within the carvedilol group, MIBG WR showed a significant inverse correlation with improvement in LVEF (rho = -0.74, P =.02). The diagnostic accuracy of WR for predicting EF response to carvedilol was 91%. WR also appeared to be inversely related to the peak oxygen consumption rate (rho = -0.65, P =.08), although this did not reach statistical significance. CONCLUSION. I-123 MIBG imaging appears useful in predicting which patients with heart failure are likely to show the most improvement in LV function and exercise capacity after carvedilol treatment. Further studies in this area appear to be warranted.

Authors
Choi, JY; Lee, KH; Hong, KP; Kim, BT; Seo, JD; Lee, WR; Lee, SH
MLA Citation
Choi, JY, Lee, KH, Hong, KP, Kim, BT, Seo, JD, Lee, WR, and Lee, SH. "Iodine-123 MIBG imaging before treatment of heart failure with carvedilol to predict improvement of left ventricular function and exercise capacity." Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 8.1 (2001): 4-9. (Academic Article)
Source
manual
Published In
Journal of Nuclear Cardiology
Volume
8
Issue
1
Publish Date
2001
Start Page
4
End Page
9

Effect of mutagen-induced cell lethality on the dose response of germline mutations.

Molecular tests for mutations require a sample of tissue from which DNA is extracted, to determine the presence or absence of one or more mutations per sample. To ensure mutation fixation each sample must consist of an equal number of cells that have had one or more DNA replications. In an in vivo test, surviving stem cells compensate to give the same number of cells per sample, leaving as the only evidence for stem cell lethality the increase in mutants of clonal origin because the mutant clone developed from a population of fewer stem cells. A problem is that an increase in mutagen dose increases stem cell death, resulting in a decreased number of surviving target cells, thus giving a downward bias of samples with one or more mutations per sample. To compare in vivo tests with molecular tests we will use as a model system the sex-linked recessive lethal (SLRL) test for germ cell mutations in Drosophila melanogaster. Spermatogonia cells in male larvae were exposed to ENU and mutations detected in sperm cells from adults. The same SLRL data were analyzed by two methods: (1) The conventional analysis of SLRL data, in which each mutation of a cluster of mutations of common origin was counted. (2) An analysis was used to simulate a sample for molecular analysis by determining mutations per male with an equal size sample of progeny per male. With this second analysis a correction factor is required based on the change in cluster size of mutants of common origin.

Authors
Lee, WR; Perantie, DC; Clark, KB; Guillot, DA; Wilson, VL
MLA Citation
Lee, WR, Perantie, DC, Clark, KB, Guillot, DA, and Wilson, VL. "Effect of mutagen-induced cell lethality on the dose response of germline mutations." Environmental and molecular mutagenesis 37.4 (2001): 340-344. (Academic Article)
Source
manual
Published In
Environmental and Molecular Mutagenesis
Volume
37
Issue
4
Publish Date
2001
Start Page
340
End Page
344

Dipyridamole myocardial SPECT with low heart rate response indicates cardiac autonomic dysfunction in patients with diabetes.

BACKGROUND: Because dipyridamole is used to assess heart rate (HR) variability, we investigated whether a low HR response during dipyridamole single photon emission computed tomography (SPECT) in patients with diabetes indicates the presence of cardiac autonomic neuropathy (CAN). METHODS AND RESULTS: Subjects were 61 non-insulin-dependent diabetes patients without perfusion defects, myocardial infarction, or arrhythmia who underwent thallium 201 SPECT imaging. The control group comprised 28 subjects without diabetes. HR was measured during infusion of dipyridamole at a rate of 0.14 mg/kg/min, and peak-baseline ratios of 1.20 or less were defined as low. CAN severity was classified by standard autonomic function tests as severe (n = 22), mild (n = 19), or none (n = 20). HR ratios were significantly attenuated in patients with diabetes compared with those in control subjects (1.22 +/- 0.12 vs 1.32 +/- 0.12, P

Authors
Lee, KH; Yoon, JK; Lee, MG; Lee, SH; Lee, WR; Kim, BT
MLA Citation
Lee, KH, Yoon, JK, Lee, MG, Lee, SH, Lee, WR, and Kim, BT. "Dipyridamole myocardial SPECT with low heart rate response indicates cardiac autonomic dysfunction in patients with diabetes." Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 8.2 (2001): 129-135. (Academic Article)
Source
manual
Published In
Journal of Nuclear Cardiology
Volume
8
Issue
2
Publish Date
2001
Start Page
129
End Page
135

Genitourinary cancer committee

Authors
Sandler, H; Shipley, WU; Gomella, L; Pienta, K; Bard, RH; Bruner, D; Clark, R; DeSilvio, M; Gaspar, L; Gillin, M; Grignon, D; Hammond, E; Hanks, G; Heydon, KH; Kaufman, DS; Lee, WR; Michalski, JM; Mydlo, J; Pisansky, T; Pollack, A; Porterfield, H; Rifkin, M; III, MR; Sanda, M; True, L; Vijayakumar, S; Winter, KA; Zietman, A
MLA Citation
Sandler, H, Shipley, WU, Gomella, L, Pienta, K, Bard, RH, Bruner, D, Clark, R, DeSilvio, M, Gaspar, L, Gillin, M, Grignon, D, Hammond, E, Hanks, G, Heydon, KH, Kaufman, DS, Lee, WR, Michalski, JM, Mydlo, J, Pisansky, T, Pollack, A, Porterfield, H, Rifkin, M, III, MR, Sanda, M, True, L, Vijayakumar, S, Winter, KA, and Zietman, A. "Genitourinary cancer committee." International Journal of Radiation Oncology Biology Physics 51.3 SUPPL. 2 (2001): 28-38.
PMID
11641012
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
51
Issue
3 SUPPL. 2
Publish Date
2001
Start Page
28
End Page
38

Decreased entropy of symbolic heart rate dynamics during daily activity as a predictor of positive head-up tilt test in patients with alleged neurocardiogenic syncope.

Entropy measures of RR interval variability during daily activity over a 24h period were compared in 30 patients with a positive head-up tilt (HUT) test and 30 patients with a negative HUT test who had a history of alleged neurocardiogenic syncope. Two different entropies, approximate entropy (ApEn) and entropy of symbolic dynamics (SymEn), were employed. In patients showing a positive HUT test, the entropies were significantly decreased when compared with the patients with a negative HUT test. In addition, SymEn in the patients with a negative HUT test was significantly lower than in the normal controls. Discriminant analysis using SymEn could correctly identify 89.3% (520/582) of the 1 h RR interval data of the patients with a positive HUT test regardless of the time of day. Baseline entropies of heart rate dynamics during daily activity were found to be significantly lower in patients with alleged neurocardiogenic syncope and a positive HUT test than in those with the same history but with a negative HUT test. The decreased entropy of symbolic heart rate dynamics may be of predictive value of a positive HUT test in patients with alleged neurocardiogenic syncope.

Authors
Kim, JS; Park, JE; Seo, JD; Lee, WR; Kim, HS; Noh, JI; Kim, NS; Yum, MK
MLA Citation
Kim, JS, Park, JE, Seo, JD, Lee, WR, Kim, HS, Noh, JI, Kim, NS, and Yum, MK. "Decreased entropy of symbolic heart rate dynamics during daily activity as a predictor of positive head-up tilt test in patients with alleged neurocardiogenic syncope." Physics in medicine and biology 45.11 (November 2000): 3403-3412. (Academic Article)
Source
manual
Published In
Physics in Medicine and Biology
Volume
45
Issue
11
Publish Date
2000
Start Page
3403
End Page
3412

The changing demography of diabetes mellitus in Singapore.

Diabetes mellitus has been on the rise in Singapore, while Singaporeans are becoming more affluent, our lifestyles are more sedentary and our population is ageing rapidly. The prevalence of diabetes mellitus rose from 2% in 1975 to 4.7% in 1984, 8.6% in 1992 and 9.0% of adults 18-69 years old in 1998. Malay and Indian women and Indian men were at higher risk, with 14.3, 14.9 and 16.7% prevalence rates, respectively. A further 15% of the adult population have impaired glucose tolerance (IGT). Diabetes was a factor in 39.7% of strokes and in 9.3% of all deaths in Singapore, and is the sixth most common cause of death. In the Diabcare Singapore 1998 Study, 91% of participants were diagnosed with Type 2 diabetes, with mean BMI of 25.1+/-4.4 kg/m(2). The incidence of Type 1 diabetes in childhood is 2.46 per 100000 children 0-12 years of age, while Type 2 diabetes in childhood is an emerging problem. The prevalence of obesity (BMI >30 kg/m(2)) among persons aged 18-69 years rose to 6% in 1998, up from 5.1% in 1992. The prevalence of obesity was highest among the Malays (16.2%) followed by the Indians (12.2%) and the Chinese (3.8%). About 12% of schoolchildren are obese. Increased efforts must be made to change lifestyle and eating patterns in our society, reduce childhood obesity and encourage adults to make lifelong sports and exercise part of the Singaporean way of life. Singapore has one of the world's fastest ageing populations, and even now, 32.4% of Singaporeans 60-69 years of age have diabetes. We should consider screening for diabetes in obese schoolchildren and seek to improve quality of care for people with diabetes, including enlisting the aid of community organisations to improve access to diabetes education, monitoring, support and complications screening services.

Authors
Lee, WR
MLA Citation
Lee, WR. "The changing demography of diabetes mellitus in Singapore." Diabetes research and clinical practice 50 Suppl 2 (October 2000): S35-S39. (Academic Article)
Source
manual
Published In
Diabetes Research and Clinical Practice
Volume
50 Suppl 2
Publish Date
2000
Start Page
S35
End Page
S39

Transformation of cell type in uveal melanomas: a quantitative histologic analysis.

OBJECTIVE: To describe the cytologic transformation and tumor progression in a series of uveal melanomas. METHODS: Fifteen cases of uveal melanoma, treated by primary transscleral local resection without primary adjuvant treatment, needed enucleation because of local tumor recurrence. Cytologic and cell morphometric features of the primary tumor and the intraocular recurrence were compared, with evaluation of the amounts of intermediate cells, epithelioid cells, mitotic figures, and nucleolar area. RESULTS: The cases were categorized into 2 groups, according to their cytologic characteristics. In the first group (5 cases), there was no cytopathological transformation in the recurrent tumor. The nucleolar area was increased in only 1 case. In the second group (10 cases), the recurrent tumors showed transformation into a more epithelioid cell type. In all but 1 case there was an increase in epithelioid cells in the tumor recurrence. The nucleolar area was increased significantly in all cases. The mean local recurrence interval in all cases was 15.3 months, with no difference between the groups. Death from metastases occurred in 7 cases in which the nucleolar area was 4.2 microm(2) in the primary tumor. CONCLUSIONS: These findings demonstrate that, in an individual tumor, the cytologic phenotype can change considerably even after a relatively short time, resulting in an increase in tumor-related mortality. CLINICAL RELEVANCE: Studies on the natural course of uveal melanoma have been very limited and based purely on observations on the progression of melanomas in terms of size and alteration of various clinical characteristics.

Authors
Bechrakis, NE; Sehu, KW; Lee, WR; Damato, BE; Foerster, MH
MLA Citation
Bechrakis, NE, Sehu, KW, Lee, WR, Damato, BE, and Foerster, MH. "Transformation of cell type in uveal melanomas: a quantitative histologic analysis." Archives of ophthalmology 118.10 (October 2000): 1406-1412. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
118
Issue
10
Publish Date
2000
Start Page
1406
End Page
1412

Takayasu's arteritis: assessment of disease activity with contrast-enhanced MR imaging.

OBJECTIVE: The purpose of this study was to evaluate the role of contrast-enhanced MR imaging in the determination of disease activity in patients with Takayasu's arteritis. SUBJECTS AND METHODS: High-resolution contrast-enhanced T1-weighted spinecho MR imaging using small fields of view (14-20 cm) and thin slices (4-5 mm) was performed in 26 patients with Takayasu's arteritis and 16 healthy subjects. The degree of aortic mural enhancement was assessed by measuring signal intensity and by visually estimating it in comparison with that of the myocardium. RESULTS: Contrast-enhanced MR imaging showed more enhancement of thickened aortic wall compared with myocardium, thus suggesting active Takayasu's arteritis on MR imaging in 16 patients. Determination of disease activity using contrast-enhanced MR imaging was concordant with clinical findings in 23 patients (88.5%). Contrast-enhanced MR findings were concordant with laboratory findings in most patients (erythrocyte sedimentation rate in 92.3% [24/26] and C-reactive protein in 84.6% [22/26]). The measured signal intensity of the aortic wall relative to that of myocardium during the early phase of contrast-enhanced MR imaging correlated well with the erythrocyte sedimentation rate (r = 0.78, p

Authors
Choe, YH; Han, BK; Koh, EM; Kim, DK; Do, YS; Lee, WR
MLA Citation
Choe, YH, Han, BK, Koh, EM, Kim, DK, Do, YS, and Lee, WR. "Takayasu's arteritis: assessment of disease activity with contrast-enhanced MR imaging." AJR. American journal of roentgenology 175.2 (August 2000): 505-511. (Academic Article)
Source
manual
Published In
AJR. American journal of roentgenology
Volume
175
Issue
2
Publish Date
2000
Start Page
505
End Page
511

Prevalence and risk factors of silent cerebral infarction in apparently normal adults.

Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarctions or may lead to insidious progressive brain damage resulting in vascular dementia. This study was designed to evaluate the prevalence and risk factors of SCI in an apparently normal adult population. Nine hundred ninety-four consecutive symptom-free adults (mean age 49.0+/-7.7; men:women 830:164) who underwent brain magnetic resonance imaging at the Center for Health Promotion at Samsung Medical Center were assessed. All were neurologically normal in history and physical examination. A total of 121 SCI lesions was observed in 58 subjects. The lesion prevalence adjusted for patient age was 5.1%. There was no gender difference in prevalence. Ninety-nine lesions were 3 cm in diameter. The most frequent site of the SCI lesion was basal ganglia, after which the periventricular white matter, cerebral cortex, and thalamus were the most frequent sites. Old age, hypertension, a history of coronary artery disease, evidence of cardiomegaly in chest radiographs, and high fasting glucose/hemoglobin A1c levels were associated with SCI on univariate analysis. Multivariate analysis demonstrated old age and hypertension to be independent risk factors for SCI, and mild alcohol consumption was revealed as an independent protective factor against SCI.

Authors
Lee, SC; Park, SJ; Ki, HK; Gwon, HC; Chung, CS; Byun, HS; Shin, KJ; Shin, MH; Lee, WR
MLA Citation
Lee, SC, Park, SJ, Ki, HK, Gwon, HC, Chung, CS, Byun, HS, Shin, KJ, Shin, MH, and Lee, WR. "Prevalence and risk factors of silent cerebral infarction in apparently normal adults." Hypertension 36.1 (July 2000): 73-77. (Academic Article)
Source
manual
Published In
Hypertension
Volume
36
Issue
1
Publish Date
2000
Start Page
73
End Page
77

Retinal vasoproliferative tumors: surgical management and histological findings.

Vascular masses occurring in the peripheral retina have been described extensively in the literature. Many terms, including "presumed acquired hemangiomas," "hemangioma-like," "angiomatous masses," "angioma-like," "peripheral retinal telangiectasis," and "vasoproliferative tumors," have been suggested that reflect the lack of the known histological features and the potentially variable causes. We describe the histological features of 2 patients who underwent transcleral local resection as management for suspected choroidal melanoma. Pathological examination of these tumors reveals the constituents to be primarily benign glial cell proliferation with secondary vasoproliferation. The weight of the literature agrees with a reactionary process. We therefore suggest the term "reactionary retinal glioangiosis." Transcleral resection has a place where diagnosis is difficult. It prevents an unnecessary enucleation and allows accurate tissue diagnosis.

Authors
Irvine, F; O'Donnell, N; Kemp, E; Lee, WR
MLA Citation
Irvine, F, O'Donnell, N, Kemp, E, and Lee, WR. "Retinal vasoproliferative tumors: surgical management and histological findings." Archives of ophthalmology 118.4 (April 2000): 563-569. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
118
Issue
4
Publish Date
2000
Start Page
563
End Page
569

Oncogenic base substitution mutations in circulating leukocytes of normal individuals.

The background frequency of mutations in human tissues is an important issue in cancer susceptibility and genotoxic exposure determinations. Here we report the detection of rare mutant leukocytes containing oncogenic base substitutions of the Harvey-ras, N-ras, and p53 genes by the Needle-in-a-Haystack mutation assay with a sensitivity of one cell in a million. Altogether, we detected and identified 17 independent mutations of 66 separate base site analyses of peripheral blood specimens obtained from 19 apparently normal individuals. Two individuals harbored a substantially increased frequency of mutant cells, representing 9 of the 17 independent mutations found. These results suggest that up to 1 in 10 normal individuals may harbor a significant frequency of oncogenic mutations in circulating leukocytes.

Authors
Wilson, VL; Yin, X; Thompson, B; Wade, KR; Watkins, JP; Wei, Q; Lee, WR
MLA Citation
Wilson, VL, Yin, X, Thompson, B, Wade, KR, Watkins, JP, Wei, Q, and Lee, WR. "Oncogenic base substitution mutations in circulating leukocytes of normal individuals." Cancer research 60.7 (April 2000): 1830-1834. (Academic Article)
Source
manual
Published In
Cancer Research
Volume
60
Issue
7
Publish Date
2000
Start Page
1830
End Page
1834

Penile length of newborns in Singapore.

Micropenis is an important sign in congenital hypopituitarism and various disorders. Documented norms for penile length exist only for babies of Caucasian and Middle-Eastern origin. This study was carried out to establish such norms for Asian newborns. We studied 228 male live births within their first three days of life. Stretched penile lengths were marked off on unmarked wooden spatulas, which were placed vertically along the dorsal aspect of the penis, with one rounded end on the pubic bone. The mean penile length +/- S.D. for the full-term Asian baby was 3.6 +/- 0.4 cm. Race had a significant effect: Chinese 3.5 cm, Malay 3.6 cm and Indian 3.8 cm. Penile length correlated with birth weight and gestational age. Asian babies thus have similar norms to Caucasian babies. An Asian newborn whose penis measures less than 2.6 cm has micropenis and may need prompt investigation for underlying endocrine disorders.

Authors
Lian, WB; Lee, WR; Ho, LY
MLA Citation
Lian, WB, Lee, WR, and Ho, LY. "Penile length of newborns in Singapore." Journal of pediatric endocrinology & metabolism : JPEM 13.1 (January 2000): 55-62. (Academic Article)
Source
manual
Published In
The Journal of pediatric endocrinology
Volume
13
Issue
1
Publish Date
2000
Start Page
55
End Page
62

Aging affects the association between endothelial nitric oxide synthase gene polymorphism and acute myocardial infarction in the Korean male population.

OBJECTIVES: The aging process affects responsiveness and other functions of endothelium and vascular smooth muscle cells, predisposing the old vessels to the development of atherosclerotic lesions. Endothelial nitric oxide synthase (ecNOS) gene polymorphisms were shown to affect the occurrence of acute myocardial infarction (AMI). We hypothesized that aging may affect the association between the ecNOS gene polymorphism and AMI. METHODS: We investigated the age-related distribution of the ecNOS gene a/b polymorphism in 121 male AMI patients and 206 age-matched healthy male controls. RESULTS: The aa, ab and bb genotypes were found in 1, 49 and 156 cases among the control subjects and 5, 23 and 93 cases among the AMI patients, respectively. There was a significant correlation between the ecNOS polymorphism and AMI (p = 0.045). When the correlation was analyzed by age, the significance remained only in the group below the age of 51 (p = 0.009). The proportion of smokers was increased in the young patients when compared to the old patients (p = 0.033), indicating that smoking also has greater effect on the younger population. The incidences of hypertension and diabetes mellitus, however, were similar in both populations. CONCLUSION: Our work provides the first evidence that links ecNOS polymorphism to the risk of AMI in relation to age. Young persons who smoke or have ecNOSaa genotype may have an increased risk of developing AMI. The functional as well as structural changes associated with aging in the vascular endothelium may mask the effect of the ecNOS polymorphism in the development of AMI in old persons.

Authors
Park, JE; Lee, WH; Hwang, TH; Chu, JA; Kim, S; Choi, YH; Kim, JS; Kim, DK; Lee, SH; Hong, KP; Seo, JD; Lee, WR
MLA Citation
Park, JE, Lee, WH, Hwang, TH, Chu, JA, Kim, S, Choi, YH, Kim, JS, Kim, DK, Lee, SH, Hong, KP, Seo, JD, and Lee, WR. "Aging affects the association between endothelial nitric oxide synthase gene polymorphism and acute myocardial infarction in the Korean male population." The Korean journal of internal medicine, KOREA (SOUTH) 15.1 (January 2000): 65-70. (Academic Article)
Source
manual
Published In
The Korean journal of internal medicine
Volume
15
Issue
1
Publish Date
2000
Start Page
65
End Page
70

Staging evaluation for patients with adenocarcinoma of the prostate. American College of Radiology. ACR Appropriateness Criteria.

Authors
Forman, JD; Lee, WR; 3rd, MR; Perez, CA; Beyer, DC; Blasko, JC; Hussey, DH; Paryani, SB; Pollack, A; Potters, L; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
Forman, JD, Lee, WR, 3rd, MR, Perez, CA, Beyer, DC, Blasko, JC, Hussey, DH, Paryani, SB, Pollack, A, Potters, L, Scardino, P, Schellhammer, P, and Leibel, S. "Staging evaluation for patients with adenocarcinoma of the prostate. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1373-1382.
PMID
11037553
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1373
End Page
1382

A preliminary analysis of health-related quality of life in the first year after permanent source interstitial brachytherapy (PIB) for clinically localized prostate cancer

Purpose: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after permanent source interstitial brachytherapy (PIB).Methods and Materials: Thirty-one men treated with PIB between September 1997 and March 1998 completed a quality of life (functional assessment of cancer therapy-prostate: FACT-P) and a urinary symptom questionnaire (international prostate symptom score: IPSS) prior to treatment (T0), 1 month (T1), 3 months (T3), 6 months (T6), and 12 months (T12) following PIB. All participants were treated with 125I alone. Repeated measures analyses of variance (ANOVA) were conducted on all quality of life and urinary outcome measures for all 31 patients at all time points.Results: The median age of the study population was 66 (range 51-80). All men had clinical T1c-T2b prostate cancer. The Gleason score was ≤ 6 in 27/31 (87%). Median pretreatment PSA was 7.8 ng/ml (range 1.1-20.6). The mean score (and standard deviation) at T0, T1, T3, T6, and T12 for the FACT-P questionnaire are as follows: 140.5 (13.5), 132.7 (15.3), 137.2 (17.4), 140.1 (16.0), and 142.4 (15.3). For the global test across time, statistically significant differences were observed for the cumulative scores of FACT-P (p < 0.0012). The decrease in HRQOL was most marked 1 month following PIB. Examination of the subscales within the FACT-P instrument demonstrated statistically significant changes over time for the following: physical well-being (PWB), functional well-being (FWB), and prostate cancer (PCS). By 3 months, all HRQOL measures had returned to near baseline. The mean score (and standard deviation) at T0, T1, T3, T6, and T12 for the IPSS questionnaire are as follows: 8.3 (5.5), 18.4 (8.0), 15.7 (7.4), 13.7 (7.4), and 10.2 (5.7). For the global test across time, statistically significant differences were observed for the IPSS scores (p < 0.0001). The maximum increase in IPSS occurred 1 month following PIB.Conclusion: The results of this preliminary analysis suggest that clinically meaningful decreases in HRQOL, as measured by the FACT-P instrument, are evident within weeks after PIB. By 3 months, however, FACT-P scores return to near baseline levels. A validated instrument designed to measure urinary symptoms (IPSS) demonstrates that moderate to severe urinary symptoms persist for at least 3-6 months following PIB. One year following PIB, the scores on the FACT-P and IPSS questionnaires had returned to baseline. Copyright (C) 2000 Elsevier Science Inc.

Authors
Lee, WR; McQuellon, RP; Harris-Henderson, K; Case, LD; McCullough, DL
MLA Citation
Lee, WR, McQuellon, RP, Harris-Henderson, K, Case, LD, and McCullough, DL. "A preliminary analysis of health-related quality of life in the first year after permanent source interstitial brachytherapy (PIB) for clinically localized prostate cancer." International Journal of Radiation Oncology Biology Physics 46.1 (2000): 77-81.
PMID
10656376
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
46
Issue
1
Publish Date
2000
Start Page
77
End Page
81
DOI
10.1016/S0360-3016(99)00355-7

Permanent source brachytherapy for prostate cancer. American College of Radiology. ACR Appropriateness Criteria.

Authors
Potters, L; Perez, CA; Beyer, DC; Blasko, JC; Forman, JD; Hussey, DH; Lee, WR; Paryani, SB; Pollack, A; 3rd, MR; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
Potters, L, Perez, CA, Beyer, DC, Blasko, JC, Forman, JD, Hussey, DH, Lee, WR, Paryani, SB, Pollack, A, 3rd, MR, Scardino, P, Schellhammer, P, and Leibel, S. "Permanent source brachytherapy for prostate cancer. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1383-1400.
PMID
11037554
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1383
End Page
1400

Postimplant analysis of transperineal interstitial permanent prostate brachytherapy: Evidence for a learning curve in the first year at a single institution

Purpose: The utilization of transperineal interstitial permanent prostate brachytherapy (TIPPB) is increasing in the United States. Quality assessment of TIPPB is in its infancy, and to date, dosimetric analyses have only been reported from centers with a large experience in prostate brachytherapy. The purpose of this report is to critically analyze the dosimetric coverage achieved following TIPPB in the first 63 cases performed by a multidisciplinary group of investigators with no prior experience with TIPPB.Methods and Materials: The information in this report concerns the first 63 men treated with TIPPB alone at our institution between September 1997 and September 1998. All men were treated similarly, adapting the methods described by Blasko and Grimm. All men were treated with 125I. The prescription dose was 144 Gy according to the TG43 formalism. TIPPB was performed jointly by a radiation oncologist and a urologist. One month following TIPPB, all men underwent a computed tomography (CT) scan of the pelvis according to a protocol using 3-mm abutting slices. CT images were transferred by a local area network to a commercially available treatment planning system and dose-volume histograms were calculated with 0.5-mm pixel spacing. A variety of dosimetric endpoints were examined. A single measure of dose homogeneity, the dose-homogeneity index (DHI), is defined as the volume within the prostate that receives 100-150% of the prescription dose (144-216 Gy) divided by the volume within the prostate that receives 100% of the prescription dose (144 Gy). Three measures of target (prostate) dosimetric coverage are provided. C100 is defined as the percentage of the prostate volume defined on postimplant CT that receives at least 100% of the prescription dose. C90 and C80 are similar but represent the percentage of the prostate volume that receive 90% and 80% of the prescription dose, respectively. Statistical analyses were performed using commercially available computer software. To investigate any changes with time the first 30 cases (group 1) are compared to cases 31-63 (group 2). All p-values are two-sided.Results: The mean C100, C90, and C80 for all 63 patients were 80.7% (SD 10.1), 85.1% (SD 10.2), and 89.3% (SD 9.5). The quantifiers of implant adequacy were all improved in the most recent 33 patients compared to the first 30 patients, (group 1: C100, 75.8% [SD 12.2], C90 79.9% [SD 11.4], C80 84.3% [SD 11.1]; group 2: C100, 85.2 [SD 7.0], C90 89.9% [SD 5.8], C80 93.8% [SD 4.2]; p < 0.001). The mean DHI was 0.538 SD (0.124). A multivariate model incorporating a number of variables (ultrasound volume, CT volume, total activity, activity/seed, implant number) with C100 as the dependent variable found that the implant number was the only statistically significant predictor of C100 (p = 0.0001). Using C90 and C80 as the dependent variable produced similar results (C90, p = 0.0001; C80, p = 0.0001).Conclusion: In this single institution experience with the first 63 men receiving TIPPB by a multidisciplinary group of investigators, there is evidence for a learning curve. All quantifiers of implant adequacy improved as clinicians gained experience. In the most recent group of patients, quantifiers of implant adequacy are similar to those reported from other groups with significantly more experience with TIPPB. Copyright (C) 2000 Elsevier Science Inc.

Authors
Lee, WR; DeGuzman, AF; Bare, RL; Marshall, MG; McCullough, DL
MLA Citation
Lee, WR, DeGuzman, AF, Bare, RL, Marshall, MG, and McCullough, DL. "Postimplant analysis of transperineal interstitial permanent prostate brachytherapy: Evidence for a learning curve in the first year at a single institution." International Journal of Radiation Oncology Biology Physics 46.1 (2000): 83-88.
PMID
10656377
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
46
Issue
1
Publish Date
2000
Start Page
83
End Page
88
DOI
10.1016/S0360-3016(99)00359-4

Definitive external beam irradiation in stage T1 and T2 carcinoma of the prostate. American College of Radiology. ACR Appropriateness Criteria.

Authors
Perez, CA; Beyer, DC; Blasko, JC; Forman, JD; Hussey, DH; Lee, WR; Paryani, SB; Pollack, A; Potters, L; 3rd, MR; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
Perez, CA, Beyer, DC, Blasko, JC, Forman, JD, Hussey, DH, Lee, WR, Paryani, SB, Pollack, A, Potters, L, 3rd, MR, Scardino, P, Schellhammer, P, and Leibel, S. "Definitive external beam irradiation in stage T1 and T2 carcinoma of the prostate. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1449-1472.
PMID
11037559
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1449
End Page
1472

Locally advanced (high-risk) prostate cancer. American College of Radiology. ACR Appropriateness Criteria.

Authors
Pollack, A; Paryani, SB; Hussey, D; Perez, CA; Beyer, DC; Blasko, JC; Forman, JD; Lee, WR; Potters, L; 3rd, MR; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
Pollack, A, Paryani, SB, Hussey, D, Perez, CA, Beyer, DC, Blasko, JC, Forman, JD, Lee, WR, Potters, L, 3rd, MR, Scardino, P, Schellhammer, P, and Leibel, S. "Locally advanced (high-risk) prostate cancer. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1401-1412.
PMID
11037555
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1401
End Page
1412

Node-positive prostate cancer. American College of Radiology. ACR Appropriateness Criteria.

Authors
Lee, WR; Pollack, A; Perez, CA; Beyer, DC; Blasko, JC; Forman, JD; Hussey, DH; Paryani, SB; Potters, L; 3rd, MR; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
Lee, WR, Pollack, A, Perez, CA, Beyer, DC, Blasko, JC, Forman, JD, Hussey, DH, Paryani, SB, Potters, L, 3rd, MR, Scardino, P, Schellhammer, P, and Leibel, S. "Node-positive prostate cancer. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1413-1418.
PMID
11037556
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1413
End Page
1418

Postradical prostatectomy irradiation in carcinoma of the prostate. American College of Radiology. ACR Appropriateness Criteria.

Authors
Perez, CA; Beyer, DC; Blasko, JC; Forman, JD; Hussey, DH; Lee, WR; Paryani, SB; Pollack, A; Potters, L; 3rd, MR; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
Perez, CA, Beyer, DC, Blasko, JC, Forman, JD, Hussey, DH, Lee, WR, Paryani, SB, Pollack, A, Potters, L, 3rd, MR, Scardino, P, Schellhammer, P, and Leibel, S. "Postradical prostatectomy irradiation in carcinoma of the prostate. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1419-1439.
PMID
11037557
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1419
End Page
1439

Treatment planning for clinically localized prostate cancer. American College of Radiology. ACR Appropriateness Criteria.

Authors
3rd, MR; Blasko, JC; Perez, CA; Beyer, DC; Forman, JD; Hussey, DH; Lee, WR; Paryani, SB; Pollack, A; Potters, L; Scardino, P; Schellhammer, P; Leibel, S
MLA Citation
3rd, MR, Blasko, JC, Perez, CA, Beyer, DC, Forman, JD, Hussey, DH, Lee, WR, Paryani, SB, Pollack, A, Potters, L, Scardino, P, Schellhammer, P, and Leibel, S. "Treatment planning for clinically localized prostate cancer. American College of Radiology. ACR Appropriateness Criteria." Radiology 215 Suppl (2000): 1441-1448.
PMID
11037558
Source
scival
Published In
Radiology
Volume
215 Suppl
Publish Date
2000
Start Page
1441
End Page
1448

A prospective analysis of patients reported quality of life after prostate brachytherapy

The purpose of this study was to prospectively assess the patient- reported quality of life (QOL) and changes in QOL during the first 3 months after prostate brachytherapy (PB). Seventy-four men treated with PB between September 1997 and December 1998 completed a QOL questionnaire (Functional Assessment of Cancer Therapy-Prostate [FACT-P]) and a measurement of urinary symptoms (International Prostate Symptom Score [IPSS]) before treatment (T0), 1 month (T1), and 3 months (T3) following PB. All participants were treated with 125I alone. The mean score (and standard deviation) at T0, T1, and T3 FACT-P questionnaire are as follows: 139.2 (15.7), 125.4 (20.2), and 133.0 (18.2). For the global test across time, statistically significant differences were observed for the cumulative scores of FACT-P (P < .0001). Examination of the subscales within the FACT-P instrument demonstrated statistically significant changes over time for the following: physical well- being, functional well-being and the prostate cancer subscale. The mean score (and standard deviation) at T0, T1, and T3 for the IPSS questionnaire are as follows: 9.1 (5.9), 20.0 (7.8), and 16.6 (7.2). For the global test across time, statistically significant differences were observed for the IPSS scores (P < .0001). Clinically meaningful decreases in QOL are evident within weeks after PS. Moderate to severe urinary symptoms persist for at least 3 months following PB. (C) 2000 by W.B. Saunders Company.

Authors
Lee, WR; McQuellon, RP; McCullough, DL
MLA Citation
Lee, WR, McQuellon, RP, and McCullough, DL. "A prospective analysis of patients reported quality of life after prostate brachytherapy." Seminars in Urologic Oncology 18.2 (2000): 147-151.
PMID
10875457
Source
scival
Published In
Seminars in Urologic Oncology
Volume
18
Issue
2
Publish Date
2000
Start Page
147
End Page
151

Regarding Mohan, Kuplian, and Willoughby, IJROBP 2000;46:575-580.

Authors
Lee, WR
MLA Citation
Lee, WR. "Regarding Mohan, Kuplian, and Willoughby, IJROBP 2000;46:575-580." International Journal of Radiation Oncology Biology Physics 48.1 (2000): 303-304.
PMID
10950647
Source
scival
Published In
International Journal of Radiation Oncology Biology Physics
Volume
48
Issue
1
Publish Date
2000
Start Page
303
End Page
304

Myocardial injury-induced fibroblast proliferation facilitates retroviral-mediated gene transfer to the rat heart in vivo.

BACKGROUND: Efficient and stable transfer of therapeutic DNA into injured myocardium would be an initial step towards a genetic treatment aimed at myocardial repair after myocardial infarction. Proliferating cardiac fibroblasts in the healing myocardium could be a compelling target for retroviral infection. We evaluated the feasibility of direct in vivo gene transfer into injured myocardium using a high-titer, stable retroviral vector. METHODS: Using the TE-FLY-A-based MFG retroviral vector harboring nlsLacZ reporter, the gene transfer efficiency was assessed first in vitro in rat cardiac fibroblasts, followed by in vivo evaluation in healing rat myocardium after local freeze-thaw injury. A total of 2.5 x 10(7) infectious units of retrovirus were injected into the injured region of a beating rat heart. The transduced cells were identified by X-gal staining and immunohistochemistry. RESULTS: Highly efficient transduction of cardiac fibroblasts was observed in vitro with 98% of the cells transduced with single infection. The cell proliferation index in the cardiac granulation tissue appeared maximal 3 days after cryoinjury. Retroviral injection into the injured beating heart induced gene expression localized to the wound repair region. One week after retrovirus injection, 14% of the cells in the reparative tissue were beta-gal-positive, while 4% were beta-gal-positive after 4 weeks. The transduced cells were mostly myofibroblasts. CONCLUSIONS: Local gene transfer to the healing rat heart is feasible by retrovirus in vivo. This observation may serve as a useful guide for the development of gene therapy aimed at myocardial repair after myocardial infarction.

Authors
Byun, J; Huh, JE; Park, SJ; Jang, JE; Suh, YL; Lee, JS; Gwon, HC; Lee, WR; Cosset, FL; Kim, DK
MLA Citation
Byun, J, Huh, JE, Park, SJ, Jang, JE, Suh, YL, Lee, JS, Gwon, HC, Lee, WR, Cosset, FL, and Kim, DK. "Myocardial injury-induced fibroblast proliferation facilitates retroviral-mediated gene transfer to the rat heart in vivo." The journal of gene medicine 2.1 (2000): 2-10. (Academic Article)
Source
manual
Published In
The Journal of Gene Medicine
Volume
2
Issue
1
Publish Date
2000
Start Page
2
End Page
10

Takayasu arteritis: diagnosis with MR imaging and MR angiography in acute and chronic active stages.

Early diagnosis and treatment of Takayasu arteritis is important in prevention of serious complications. Spin-echo magnetic resonance imaging (MRI) can depict early wall thickening of the aorta and cine MRI can evaluate aortic valve function. Significant enhancement in and around the aorta and carotid arteries is observed on postcontrast MR images in acute phase Takayasu arteritis. In the chronic phase, contrast enhancement in the aortic wall stronger than in the myocardium suggests activity of the disease. Breath-hold contrast-enhanced three-dimensional MR angiography is very effective in noninvasive evaluation of luminal change of aortitis. Contrast-enhanced MRI and MR angiography have an important role in early diagnosis, activity determination, and follow-up of Takayasu arteritis. MRI and MR angiography can be utilized for initial diagnosis of Takayasu arteritis and replace catheterization angiography. J. Magn. Reson. Imaging 1999;10:751-757.

Authors
Choe, YH; Kim, DK; Koh, EM; Do, YS; Lee, WR
MLA Citation
Choe, YH, Kim, DK, Koh, EM, Do, YS, and Lee, WR. "Takayasu arteritis: diagnosis with MR imaging and MR angiography in acute and chronic active stages." Journal of magnetic resonance imaging : JMRI 10.5 (November 1999): 751-757. (Academic Article)
Source
manual
Published In
Journal of Magnetic Resonance Imaging
Volume
10
Issue
5
Publish Date
1999
Start Page
751
End Page
757

T-cell and T/natural killer-cell lymphomas involving ocular and ocular adnexal tissues: a clinicopathologic, immunohistochemical, and molecular study of seven cases.

OBJECTIVE: Lymphomas of the eye and its adnexa are frequently of B lineage. This study aims to characterize the clinical and histopathologic features of the rare non-B-cell non-Hodgkin lymphomas (NHL) of these locations. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Seven cases of T- and T/NK-cell lymphomas involving the ocular and ocular adnexal tissues. METHODS: A morphologic, immunohistochemical, and molecular analysis (polymerase chain reaction) of each of the tumors was undertaken. The lesions were classified according to the Revised European-American Lymphoma (REAL) classification. The clinical and follow-up data were collected. RESULTS: The patients included four women and three men ranging in age from 32 to 88 years (mean, 63 years). The presenting ophthalmic symptoms varied from a small nodule on the upper eyelid and conjunctival swellings to dramatic loss of vision associated with gross protrusion of the globe. Five of the cases presented were secondary manifestations of a systemic lymphoma in ocular tissues; two cases represented primary disease. Three cases were "peripheral T-cell lymphomas (PTCL), unspecified" with positivity for CD3, CD8, and betaF1 and negativity for CD56. Two cases were CD3+, CD30+, and CD56- and were classified as "anaplastic large-cell lymphomas of T-cell type" (T-ALCL). The remaining two cases showed an immunophenotype of CD3+, CD56+, and betaF1- and proved to contain Epstein-Barr virus (EBV) by in situ hybridization, consistent with "T/natural killer (NK)-cell lymphoma of nasal type." Clonal T-cell populations were shown in all three of the PTCLs by Southern blot (n = 1) and polymerase chain reaction (n = 2) for the T-cell receptor gamma and beta genes in one case of ALCL but not in the T/NK-cell lymphomas. Five patients died within 2 years; only two patients (one primary PTCL and one cutaneous T-ALCL) were disease free at 4 and 5 years' follow-up, respectively. CONCLUSION: This study shows that a heterogeneous group of T-cell lymphomas can involve the eye and its adnexal tissue. Most T-cell neoplasms are secondary manifestations of systemic disease and carry a poor prognosis. These findings, in conjunction with published data on ocular B-NHL, also indicate that immunophenotypic differentiation between T- and B-NHL in these locations is of clinical importance.

Authors
Coupland, SE; Foss, HD; Assaf, C; Auw Haedrich, C; Anastassiou, G; Anagnostopoulos, I; Hummel, M; Karesh, JW; Lee, WR; Stein, H
MLA Citation
Coupland, SE, Foss, HD, Assaf, C, Auw Haedrich, C, Anastassiou, G, Anagnostopoulos, I, Hummel, M, Karesh, JW, Lee, WR, and Stein, H. "T-cell and T/natural killer-cell lymphomas involving ocular and ocular adnexal tissues: a clinicopathologic, immunohistochemical, and molecular study of seven cases." Ophthalmology 106.11 (November 1999): 2109-2120. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
106
Issue
11
Publish Date
1999
Start Page
2109
End Page
2120

Angiotensin II stimulates proliferation of adventitial fibroblasts cultured from rat aortic explants.

It has been proposed that the local renin-angiotensin system is activated in the adventitia after vascular injury. However, the physiological role of Angiotensin II (Ang II) in the adventitia has not been studied at a cellular level. This study was designed to assess the role of Ang II in the growth response of cultured adventitial fibroblasts (AFs). Adventitial explants of the rat thoracic aorta showed outgrowth of AFs within 5-7 days. Ang II caused hyperplastic response of AF cultures. The Ang II-induced mitogenic response of AFs was mediated primarily by the AT1 receptor. Ang II caused a rapid induction of immediate early genes (c-fos, c-myc and jun B). Induction of c-fos expression was fully blocked by an AT1 receptor antagonist but not by an AT2 receptor antagonist. Epidermal growth factor (EGF), platelet-derived growth factor-BB (PDGF-BB) and basic fibroblast growth factor (bFGF) induced DNA synthesis in AFs. Co-stimulation of AFs with the growth factors and Ang II potentiated the incorporation of 3H-thymidine into DNA. Results from this study indicate that Ang II causes mitogenesis of AFs via AT1 receptor stimulation and potentiates the responses to other mitogens. These data suggest that the Ang II may play an important role in regulating AF function during vascular remodeling following arterial injury.

Authors
Kim, DK; Huh, JE; Lee, SH; Hong, KP; Park, JE; Seo, JD; Lee, WR
MLA Citation
Kim, DK, Huh, JE, Lee, SH, Hong, KP, Park, JE, Seo, JD, and Lee, WR. "Angiotensin II stimulates proliferation of adventitial fibroblasts cultured from rat aortic explants." Journal of Korean medical science, KOREA (SOUTH) 14.5 (October 1999): 487-496. (Academic Article)
Source
manual
Published In
Journal of Korean medical science
Volume
14
Issue
5
Publish Date
1999
Start Page
487
End Page
496

Skin manifestations, multiple aneurysms, and carotid-cavernous fistula in Ehlers-Danlos syndrome type IV.

Authors
Koh, JH; Kim, JS; Hong, SC; Choe, YH; Do, YS; Byun, HS; Lee, WR; Kim, DK
MLA Citation
Koh, JH, Kim, JS, Hong, SC, Choe, YH, Do, YS, Byun, HS, Lee, WR, and Kim, DK. "Skin manifestations, multiple aneurysms, and carotid-cavernous fistula in Ehlers-Danlos syndrome type IV." Circulation 100.13 (September 1999): e57-e58. (Academic Article)
Source
manual
Published In
Circulation
Volume
100
Issue
13
Publish Date
1999
Start Page
e57
End Page
e58

Idiopathic intracranial hypertension: a case report with optic nerve histopathology.

We present the clinical and pathologic findings in an atypical case of idiopathic intracranial hypertension. A 51-year-old man had headaches, visual deterioration, papilloedema, and deafness. Neuroimaging was normal, and cerebrospinal fluid pressure monitoring confirmed increased intracranial pressure. The patient was treated with a ventriculo-peritoneal shunt. Histopathology revealed grossly atrophic optic nerves with almost complete axonal loss. The prelaminar portion of the optic nerves was thickened by gliosis and hyalinized capillaries, which have not been described previously.

Authors
Horgan, HC; McFadzean, RM; Lee, WR
MLA Citation
Horgan, HC, McFadzean, RM, and Lee, WR. "Idiopathic intracranial hypertension: a case report with optic nerve histopathology." Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 19.3 (September 1999): 182-185. (Academic Article)
Source
manual
Published In
Journal of Neuro-Ophthalmology
Volume
19
Issue
3
Publish Date
1999
Start Page
182
End Page
185

Needle-in-a-haystack detection and identification of base substitution mutations in human tissues.

Background and induced germline mutagenesis and other genotoxicity studies have been hampered by the lack of a sufficiently sensitive technique for detecting mutations in a small cluster of cells or a single cell in a tissue sample composed of millions of cells. The most frequent type of genetic alteration is intragenic. The vast majority of oncogenic mutations in human and mammalian cancer involves only single base substitutions. We have developed universally applicable techniques that not only provide the necessary sensitivity and specificity for site specific mutagenesis studies, but also identify the point mutation. The exponential amplification procedures of polymerase chain reaction (PCR) and ligase chain reaction (LCR) have been combined with restriction endonuclease (RE) digestion to enable the selective enrichment and detection of single base substitution mutations in human oncogenic loci at a sensitivity of one mutant in more than 10(7) wild type alleles. These PCR/RE/LCR procedures have been successfully designed and used for codons 12 and 248 of the Ha-ras and p53 genes, respectively, both of which contain a natural MspI restriction endonuclease recognition sequence. These procedures have also been adapted for the detection and identification of mutations in oncogenic loci that do not contain a natural restriction endonuclease recognition sequence. Using PCR techniques, a HphI site was incorporated into the codons 12/13 region of the human N-ras gene, which was then used for the selective enrichment of mutants at this oncogenic locus. These PCR/RE/LCR procedures for base substitution mutations in codon 12 of the N-ras gene were found to have the sensitivity of detection of at least one mutant allele in the presence of the DNA equivalent of 10(6) wild type cells. Only one peripheral blood leukocyte DNA specimen out of nine normal individuals displayed an observable Ha-ras mutation that was present at frequency between 10(-5) and 10(-6). These PCR/RE/LCR techniques for detecting and identifying base substitution mutations are universally applicable to almost any locus or base site within the human or animal genome. With the added advantage of the adjustability of both the amount of DNA (number of genomes) to be tested and the sensitivity (10(-2) to 10(-7)) of the assay selection or enrichment procedures, these PCR/RE/LCR techniques will be useful in addressing a broad range of important questions in mutagenesis and carcinogenesis.

Authors
Wilson, VL; Wei, Q; Wade, KR; Chisa, M; Bailey, D; Kanstrup, CM; Yin, X; Jackson, CM; Thompson, B; Lee, WR
MLA Citation
Wilson, VL, Wei, Q, Wade, KR, Chisa, M, Bailey, D, Kanstrup, CM, Yin, X, Jackson, CM, Thompson, B, and Lee, WR. "Needle-in-a-haystack detection and identification of base substitution mutations in human tissues." Mutation research 406.2-4 (August 1999): 79-100. (Academic Article)
Source
manual
Published In
Mutation Research - Fundamental and Molecular Mechanisms of Mutagenesis
Volume
406
Issue
2-4
Publish Date
1999
Start Page
79
End Page
100

Moderate hyperhomocyst(e)inemia is associated with the presence of coronary artery disease and the severity of coronary atherosclerosis in Koreans.

To examine whether moderate hyperhomocyst(e)inemia is associated with coronary artery disease and the number of diseased coronary vessels in Koreans, we investigated 201 patients with angiographically documented coronary artery disease and 187 healthy subjects without evidence of stroke and coronary artery disease. The mean plasma total homocysteine in patients was higher than in controls (10.3 micromol/L; 95% confidence interval, 7.0-13.6 vs. 8.9 micromol/L; 6.0-11.8) (p=0.005). The prevalence of moderate hyperhomocyst(e)inemia, defined as the top 90th percentile in controls (13.2 micromol/L), was higher in patients than in controls (23.9% vs. 10.2%, p=0.001). Plasma homocyst(e)ine levels were not correlated to age, body mass index, levels of serum cholesterol, creatinine, and uric acid. Based on multiple logistic regression analyses with adjustment for total cholesterol, hypertension, smoking status, diabetes, age, and body mass index, the adjusted odds ratio of moderate hyperhomocyst(e)inemia for coronary artery disease was 1.53 (95% confidence interval: 1.39-1.65, p=0.0001). Moderate hyperhomocyst(e)inemia, diabetes mellitus, and old age were more prevalent in patients with triple-vessel disease than in single- or double-vessel disease (p=0.02). Multiple logistic regression analysis revealed that moderate hyperhomocyst(e)inemia was a significant predictor of triple-vessel disease with odds ratio of 2.78 (95% confidence interval: 1.08-7.10, p=0.02). We conclude that moderate hyperhomocyst(e)inemia is an independent risk factor for coronary artery disease, and also related significantly to the presence of triple-vessel disease.

Authors
Yoo, JH; Park, JE; Hong, KP; Lee, SH; Kim, DK; Lee, WR; Park, SC
MLA Citation
Yoo, JH, Park, JE, Hong, KP, Lee, SH, Kim, DK, Lee, WR, and Park, SC. "Moderate hyperhomocyst(e)inemia is associated with the presence of coronary artery disease and the severity of coronary atherosclerosis in Koreans." Thrombosis research 94.1 (April 1999): 45-52. (Academic Article)
Source
manual
Published In
Thrombosis Research
Volume
94
Issue
1
Publish Date
1999
Start Page
45
End Page
52

Immunohistochemical examination of an orbital alveolar soft part sarcoma.

BACKGROUND: A 32 year-old male patient had a 6-week history of left-sided proptosis. Computer tomography revealed a 16x15x15 mm smooth and well-defined mass between the optic nerve and the medial and superior rectus muscles in the left orbit. METHODS: The tumour was excised via a cranio-medial orbitotomy approach. RESULTS: Histopathological examination, immunohistochemistry and electron microscopy findings were consistent with an alveolar soft part sarcoma. Immunohistochemical staining showed positive immunoreactivity for neuronespecific enolase, vimentin, p53 (30%), p21 (10%) and cyclin D1 (20%), and negative immunoreactivity for CD45, cytokeratins, S-100 protein, glial fibrillary acidic protein, synaptophysin, chromogranin, calcitonin, serotonin, thyreoglobulin, desmin, myosin, actin, HMB-45, pRB, p16 and BCL-2. The growth fraction of the tumour cells was 3%. At examination 4 years after surgical excision, there was no evidence of local recurrence or for metastases. CONCLUSION: Alveolar soft part sarcoma of the orbit is a rare malignant tumour best controlled by surgery. The unpredictable behaviour of these neoplasms, however, indicates the need for long-term follow-up.

Authors
Coupland, SE; Heimann, H; Hoffmeister, B; Lee, WR; Foerster, MH; Gross, U
MLA Citation
Coupland, SE, Heimann, H, Hoffmeister, B, Lee, WR, Foerster, MH, and Gross, U. "Immunohistochemical examination of an orbital alveolar soft part sarcoma." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 237.4 (April 1999): 266-272. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
237
Issue
4
Publish Date
1999
Start Page
266
End Page
272

The fine structure of an iridectomy specimen from a patient with latanoprost-induced eye color change.

Authors
Grierson, I; Lee, WR; Albert, DM
MLA Citation
Grierson, I, Lee, WR, and Albert, DM. "The fine structure of an iridectomy specimen from a patient with latanoprost-induced eye color change." Archives of ophthalmology 117.3 (March 1999): 394-396. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
117
Issue
3
Publish Date
1999
Start Page
394
End Page
396

Early quality of life assessment in men treated with permanent source interstitial brachytherapy for clinically localized prostate cancer

Purpose: We prospectively assessed quality of life changes with time using validated instruments in men with clinically localized prostate cancer treated with permanent source interstitial brachytherapy. Materials and Methods: A total of 46 men consecutively treated with permanent source interstitial brachytherapy between September 1997 and June 1998 completed quality of life (Functional Assessment of Cancer Therapy-Prostate [FACT-P]) and urinary symptom (International Prostate Symptom Score [I-PSS]) questionnaires before (T0), and 1 (T1) and 3 (T3) months after treatment. All participants were treated with 125iodine alone. Repeated measures analyses of variance were conducted on all quality of life and urinary outcome measures for 44 patients with data at all 3 time points. Results: Median patient age was 68 years (range 51 to 80). All men had clinical T1c to T2b prostate cancer, Gleason score was 6 or less in 36 (78%) and median pretreatment prostate specific antigen was 7 ng./ml. (range 1.1 to 20.6). Mean score (and standard deviation) at T0, T1 and T3 for each questionnaire was FACT-P 138.9 (14.4), 128.6 (19.4) and 136.7 (17.4), T0 versus T1 p = 0.0005 and T0 versus T3 p = 0.6612, and I-PSS 8.3 (5.4), 19.7 (9.0) and 15.7 (7.2), T0 versus T1 p = 0.0001 and T0 versus T3 p = 0.0001. For the global test across time statistically significant differences were observed for the cumulative scores of FACT-P, I-PSS, physical well-being and prostate cancer subscales of the FACT-P and the Trial Outcome Index. By 3 months all quality of life measures had returned to baseline. Urinary symptoms as measured by I- PSS persisted for at least 3 months. Conclusions: Clinically meaningful decreases in quality of life, as measured by the FACT-P instrument, were evident within weeks after permanent source interstitial brachytherapy. However, by 3 months FACT-P scores returned to near baseline levels. A validated instrument designed to measure urinary symptoms (I-PSS) demonstrated that moderate to severe urinary symptoms persisted for at least 3 months following permanent source interstitial brachytherapy. An instrument specifically designed to measure urinary symptoms can provide additional clinical information when combined with FACT-P.

Authors
Lee, WR; McQuellon, RP; Case, LD; DeGuzman, AF; McCullough, DL
MLA Citation
Lee, WR, McQuellon, RP, Case, LD, DeGuzman, AF, and McCullough, DL. "Early quality of life assessment in men treated with permanent source interstitial brachytherapy for clinically localized prostate cancer." Journal of Urology 162.2 (1999): 403-406.
PMID
10411047
Source
scival
Published In
The Journal of Urology
Volume
162
Issue
2
Publish Date
1999
Start Page
403
End Page
406
DOI
10.1016/S0022-5347(05)68570-9

Recent advances in the treatment of prostate cancer

As new evidence for prostate cancer treatment has emerged in the last few years, longstanding controversies in the treatment of prostate cancer have resurfaced. A number of long-held tenets of prostate cancer therapy have been revisited, sometimes with surprising and challenging results. Although neoadjuvant hormonal therapy prior to radical prostatectomy decreases positive surgical margin rates, longer follow-up is needed to support survival improvement of this combined modality therapy. Androgen deprivation combined with radiation therapy appears to improve disease-free survival (and survival in one series) in patients with locally advanced cancer. Another approach to locally advanced prostate cancer using three-dimensional conformal radiation therapy may improve long term outcome. The data are currently insufficient to conclude that interstitial low dose rate brachytherapy is equivalent to conventional treatments: patients with small tumor volumes and low Gleason grade seem to obtain more benefit, whereas for large tumors with higher gleason grades this approach seems inferior to conventional treatments. In advanced prostate cancer recent data suggest that immediate hormonal therapy improves survival. In this group of patients the use of maximum androgen blockade remains controversial but may adversely affect quality of life compared to orchiectomy alone. Intermittent hormonal therapy may improve quality of life, although effect upon survival is unknown. Chemotherapy in combination with androgen deprivation is currently being studied as front-line therapy in advanced prostate cancer. Palliative benefit of chemotherapy for hormone refractory prostate cancer remains an important endpoint; survival advantage has not been seen in any randomized trials. Suramin may delay disease progression in hormone refractory prostate cancer. Many aspects of prostate cancer treatment will remain controversial until results of large, randomized trials with longer follow-up are available.

Authors
Kuyu, H; Lee, WR; Bare, R; Hall, MC; Torti, FM
MLA Citation
Kuyu, H, Lee, WR, Bare, R, Hall, MC, and Torti, FM. "Recent advances in the treatment of prostate cancer." Annals of Oncology 10.8 (1999): 891-898.
PMID
10509148
Source
scival
Published In
Annals of Oncology
Volume
10
Issue
8
Publish Date
1999
Start Page
891
End Page
898
DOI
10.1023/A:1008385607847

Dimorphic immunohistochemical staining in ocular sebaceous neoplasms: a useful diagnostic aid.

PURPOSE: We studied whether patterns of immunostaining in formalin-fixed, paraffin-embedded tissue could help to distinguish between sebaceous neoplasms of the eyelid and other eyelid neoplasms. METHODS: We applied antibodies to human milk fat globule-1 (HMFG1), cytokeratins (PKK1 and MNF116), epithelial membrane antigen (EMA) and carcino-embryonic antigen (CEA) to normal eyelid tissue and to a range of sebaceous lesions of the eyelid; these included sebaceous hyperplasia, sebaceous adenoma and sebaceous epithelioma, in addition to well to poorly differentiated sebaceous carcinoma. RESULTS: The central and peripheral cellular components of normal sebaceous glands and neoplastic sebaceous lesions showed a distinctive dimorphic staining pattern with the antibody panel used. The central foamy 'sebaceous' cells expressed HMFG1 and EMA, but not PKK1 or MNF116, whereas the smaller, peripheral basal and ductal cells expressed PKK1 or MNF116 but not HMFG1 or EMA. CEA expression in sebaceous cells was unhelpful diagnostically. CONCLUSION: Normal sebaceous glands and all sebaceous neoplasms show a dimorphic cell population that can be identified using a small panel of antibodies on formalin-fixed, paraffin-embedded tissue. This distinctive staining pattern can be assessed retrospectively, even in small biopsies, and largely removes the need for fat stains on frozen sections to differentiate sebaceous lesions from other ocular neoplasms. The results also support the suggestion that ocular sebaceous neoplasms arise from a common stem cell, rather than from either sebaceous or basal/ductal cells.

Authors
Johnson, JS; Lee, JA; Cotton, DW; Lee, WR; Parsons, MA
MLA Citation
Johnson, JS, Lee, JA, Cotton, DW, Lee, WR, and Parsons, MA. "Dimorphic immunohistochemical staining in ocular sebaceous neoplasms: a useful diagnostic aid." Eye (London, England) 13 ( Pt 1) (1999): 104-108. (Academic Article)
Source
manual
Published In
Eye
Volume
13 ( Pt 1)
Publish Date
1999
Start Page
104
End Page
108

Towards a more accurate assessment of the malignant potential in conjunctival melanosis.

Authors
Lee, WR
MLA Citation
Lee, WR. "Towards a more accurate assessment of the malignant potential in conjunctival melanosis." The British journal of ophthalmology 82.11 (November 1998): 1227-. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
82
Issue
11
Publish Date
1998
Start Page
1227

Terminology of sub-RPE deposits: do we all speak the same language?

Authors
Loeffler, KU; Lee, WR
MLA Citation
Loeffler, KU, and Lee, WR. "Terminology of sub-RPE deposits: do we all speak the same language?." The British journal of ophthalmology 82.10 (October 1998): 1104-1105. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
82
Issue
10
Publish Date
1998
Start Page
1104
End Page
1105

Magnetic resonance imaging diagnosis of Takayasu arteritis.

Conventional angiography has been used for diagnosis of Takayasu arteritis (TA). In early stage of TA, subtle inflammatory wall thickening of the aorta and its branches without significant stenosis may be the only morphologic change of TA. Magnetic resonance (MR) imaging appears to be useful in the diagnosis of early stage TA by visualizing concentric wall thickening of the vessels. T2-weighted images may show bright signal of edema in and around the inflamed vessel. Contrast media-enhanced MR shows enhanced wall of vessels even in chronic stage, which may indicate the activity of TA at the tissue level. MR angiography allows us noninvasive assessment of the vascular tree and it may replace conventional angiography.

Authors
Choe, YH; Lee, WR
MLA Citation
Choe, YH, and Lee, WR. "Magnetic resonance imaging diagnosis of Takayasu arteritis." International journal of cardiology 66 Suppl 1 (October 1998): S175-S179. (Academic Article)
Source
manual
Published In
International Journal of Cardiology
Volume
66 Suppl 1
Publish Date
1998
Start Page
S175
End Page
S179

Lymphoproliferative lesions of the ocular adnexa. Analysis of 112 cases.

OBJECTIVE: Lymphoproliferative lesions of the ocular adnexa were analyzed to examine (1) the suitability of the Revised European-American Lymphoma (REAL) classification for the subtyping of the lymphomas in these sites; (2) the predictive value of the REAL classification for the evolution of these tumors; and (3) the frequency and prognostic impact of tumor type, location, proliferation rate (Ki-67 index), p53, CD5 positivity and the presence of monoclonality within these tumors. DESIGN: Retrospective review. METHODS: The clinical, histomorphologic, immunohistochemical, and molecular biologic (polymerase chain reaction [PCR]) features of lymphoid proliferations of the ocular adnexa were studied. STUDY MATERIALS: The ocular adnexal lymphoproliferative lesions were located as follows: orbit in 52 patients (46%), conjunctiva in 32 patients (29%), eyelid in 23 patients (21%), and caruncle in 5 patients (4%). RESULTS: Reactive lymphoid hyperplasia was diagnosed in 12 cases and lymphoma in 99 cases; 1 case remained indeterminate. The five main subtypes of lymphoma according to the REAL classification were extranodal marginal-zone B-cell lymphoma (64%), follicle center lymphoma (10%), diffuse large cell B-cell lymphoma (9%), plasmacytoma (6%), and lymphoplasmocytic lymphoma (5%). Age, gender, and anatomic localization of the lymphomas did not have prognostic significance during a follow-up period of 6 months to 16.5 years (mean, 3.3 years). Extent of disease at time of presentation was the most important clinical prognostic factor: advanced disease correlated with increased risk ratios of having persistent disease at the final follow-up and with lymphoma-related death (P

Authors
Coupland, SE; Krause, L; Delecluse, HJ; Anagnostopoulos, I; Foss, HD; Hummel, M; Bornfeld, N; Lee, WR; Stein, H
MLA Citation
Coupland, SE, Krause, L, Delecluse, HJ, Anagnostopoulos, I, Foss, HD, Hummel, M, Bornfeld, N, Lee, WR, and Stein, H. "Lymphoproliferative lesions of the ocular adnexa. Analysis of 112 cases." Ophthalmology 105.8 (August 1998): 1430-1441. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
105
Issue
8
Publish Date
1998
Start Page
1430
End Page
1441

Myolipoma of the eyelid.

BACKGROUND: This report describes the pathology of a myolipoma which occurred in the eyelid. Myolipoma is a benign hamartomatous tumour in which smooth muscle cells are interspersed with adipocytes. PATIENT DETAILS: An irregular yellowish tumour (30 x 25 mm) with illdefined borders had been present for 50 years in the medial part of the left lower eyelid of a 67-year-old woman. The tumour was excised and studied by conventional histology, immunohistochemistry and transmission electron microscopy. RESULTS: The tumour was formed by bundles of spindle-shaped cells with cigarshaped nuclei intermingled with multiloculated clear cells containing small eccentric nuclei. By immunohistochemistry, positive staining of the spindle cells was restricted to smooth muscle actin and desmin; the clear cells were non-reactive with the immunohistochemical panel, but fat was identified within the cytoplasm. The ultrastructural features of the spindle cells were those of a leiomyoma, while the clear cells were classified as adipocytes. CONCLUSION: This tumour was considered to originate from the media of blood vessels within the tumour.

Authors
Sharara, N; Lee, WR; Weir, C
MLA Citation
Sharara, N, Lee, WR, and Weir, C. "Myolipoma of the eyelid." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 236.8 (August 1998): 630-634. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
236
Issue
8
Publish Date
1998
Start Page
630
End Page
634

Trevor lloyd davies

Authors
Lee, WR
MLA Citation
Lee, WR. "Trevor lloyd davies." BMJ (Clinical research ed.) 317.7151 (July 1998): 150-. (Academic Article)
Source
manual
Published In
BMJ (Clinical research ed.)
Volume
317
Issue
7151
Publish Date
1998
Start Page
150

Pheochromocytoma complicated with cardiomyopathy after delivery--a case report and literature review.

Pheochromocytoma in pregnancy is very rare but it is associated with very high maternal and fetal mortality. Therefore, it is important to include pheochromocytoma in the differential diagnosis of hypertension associated with pregnancy. It is difficult to make a diagnosis of pheochromocytoma in pregnancy before delivery. The characteristic symptoms of pheochromocytoma could be initiated during delivery because the process of delivery, general anesthesia, fetal movement, induce acute surge of catecholamine release, which could also induce cardiomyopathy. Early diagnosis and intensive care can affect the prognosis of cardiomyopathy induced by pheochromocytoma. Proper management with alpha-blockade, beta-blockade and angiotension converting enzyme inhibitor could acutely reverse the course of cardiomyopathy.

Authors
Kim, HJ; Kim, DK; Lee, SC; Yang, SH; Yang, JH; Lee, WR
MLA Citation
Kim, HJ, Kim, DK, Lee, SC, Yang, SH, Yang, JH, and Lee, WR. "Pheochromocytoma complicated with cardiomyopathy after delivery--a case report and literature review." The Korean journal of internal medicine 13.2 (July 1998): 117-122. (Academic Article)
Source
manual
Published In
The Korean journal of internal medicine
Volume
13
Issue
2
Publish Date
1998
Start Page
117
End Page
122

Left main coronary artery dissection after blunt chest trauma presented as acute anterior myocardial infarction: assessment by intravascular ultrasound: a case report.

Coronary artery injury after blunt chest trauma is very rare, but this can result in a serious acute myocardial infarction. Coronary artery dissection is an uncommon complication of thoracic injuries. We report a case of a 17-year-old male who was presented with an anterior myocardial infarction following blunt chest trauma after a bicycle accident. His coronary angiography revealed aneurysmal dilatation with dissection of the distal left main stem coronary artery. Intravascular ultrasound showed a dissecting flap at the left main stem coronary artery. The patient was treated conservatively and discharged without serious sequelae. When symptoms and electrocardiographic findings are compatible with acute myocardial infarction, careful evaluation is important in patients with thoracic injuries for proper management. If the patient is stable, medical therapy may be appropriate. But early intervention should be considered in the presence of ongoing myocardial ischemia.

Authors
Chun, JH; Lee, SC; Gwon, HC; Lee, SH; Hong, KP; Seo, JD; Lee, WR
MLA Citation
Chun, JH, Lee, SC, Gwon, HC, Lee, SH, Hong, KP, Seo, JD, and Lee, WR. "Left main coronary artery dissection after blunt chest trauma presented as acute anterior myocardial infarction: assessment by intravascular ultrasound: a case report." Journal of Korean medical science 13.3 (June 1998): 325-327. (Academic Article)
Source
manual
Published In
Journal of Korean medical science
Volume
13
Issue
3
Publish Date
1998
Start Page
325
End Page
327

Keratoacanthoma of the bulbar conjunctiva.

Authors
Coupland, SE; Heimann, H; Kellner, U; Bornfeld, N; Foerster, MH; Lee, WR
MLA Citation
Coupland, SE, Heimann, H, Kellner, U, Bornfeld, N, Foerster, MH, and Lee, WR. "Keratoacanthoma of the bulbar conjunctiva." The British journal of ophthalmology 82.5 (May 1998): 586-. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
82
Issue
5
Publish Date
1998
Start Page
586

Pleomorphic fibroma of the eyelid.

BACKGROUND: This report describes the pathology of an unusual variant of fibroma of the eyelid. The soft ovoid tumour was excised from the centre of the left lower lid in an 84-year-old patient had been growing slowly for several years. METHODS: The tumour was studied by conventional histology, immunohistochemistry and electron microscopy. RESULTS: The tumor was formed by fibroblasts of spindle and multinucleate type, and the collagenous stroma contained mast cells and blood vessels which exhibited minor inflammatory changes. With the immunohistochemical methods the only positive marker was for vimentin. CONCLUSION: On morphological grounds it was possible to distinguish this extremely rare tumour from other mesenchymal tumours. The presence of distinctive multinucleate giant cells makes the term pleomorphic fibroma an appropriate name for this type of lesion.

Authors
Sandinha, T; Lee, WR; Reid, R
MLA Citation
Sandinha, T, Lee, WR, and Reid, R. "Pleomorphic fibroma of the eyelid." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 236.5 (May 1998): 333-338. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
236
Issue
5
Publish Date
1998
Start Page
333
End Page
338

Distribution of antioxidant enzymes in the normal aged human conjunctiva: an immunocytochemical study.

BACKGROUND: The purpose of the study was to map the precise location of four antioxidant enzymes in the normal human conjunctiva. METHODS: Conjunctival tissue (seventeen specimens) from seven patients was processed for light microscopy and immunogold electron microscopy. Antibodies were used to label glutathione peroxidase, glutathione S-transferase (acidic and neutral forms) and copper/zinc superoxide dismutase. RESULTS: All layers of the epithelium exhibited labelling for all four enzymes, although there were differences in labelling intensities and distribution between the enzymes. Wing cells showed more intense labelling for glutathione peroxidase, glutathione S-transferase (neutral form) and copper/zinc superoxide dismutase than did basal and superficial cells. The strongest immunoreactivity was detected for glutathione S-transferase (acidic) and was equally strong in the superficial and wing cells. Wing cells demonstrated more immunoreactivity in the cell nuclei with antibodies against all four enzymes. A high degree of labelling was also observed in the microplicae and actin cortex of the superficial cells. Leukocytes, fibroblasts, endothelial cells and erythrocytes within the stroma exhibited minimal labelling. CONCLUSION: The subtle changes in distribution of antioxidant enzymes in the normal human conjunctival epithelium most probably reflect exposure to free radicals in the tear film and are based on the different proliferative and functional activities of each of the anatomical layers.

Authors
Módis, L; Marshall, GE; Lee, WR
MLA Citation
Módis, L, Marshall, GE, and Lee, WR. "Distribution of antioxidant enzymes in the normal aged human conjunctiva: an immunocytochemical study." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 236.2 (February 1998): 86-90. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
236
Issue
2
Publish Date
1998
Start Page
86
End Page
90

Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: A secondary analysis of RTOG 85-27

Purpose: The purpose of the present study is to investigate the strength of association between anemia and overall survival, locoregional failure, and late radiation therapy (RT) complications in a large prospective study of patients with advanced head and neck cancer treated with conventional radiotherapy with or without a hypoxic cell sensitizer. Methods and Materials: Between March 1988 and September 1991, 521 patients with Stage III or IV squamous cell carcinoma of the head and neck were entered into a randomized trial examining the addition of etanidazole (SR 2508) to conventional radiation therapy (RT) (66-74 Gy in 33-37 fractions, 5 days a week). Patients with hemoglobin (Hgb) levels measured and recorded prior to the second week of RT were included in this secondary analysis. Hemoglobin levels were stratified as normal (≥ 14.5 gm% for men, ≥ 13 gm% for women) or anemic (< 14.5 gm% for men, < 13 gm% for women). Locoregional failure rates were calculated using the cumulative incidence approach. Overall survival was estimated according to the Kaplan-Meier method. Late RT toxicity was scored according to the RTOG morbidity scale. Differences in rates of overall survival, locoregional failure, and late complications were tested by the Cox proportional hazard model. Results: Of 504 eligible patients, 451 had a Hgb level measured and recorded prior to the second week of RT. One hundred sixty-two patients (35.9%) were considered to have a normal Hgb level and 289 patients (64.1%) were considered to be anemic. The estimated survival rate is 35.7% at 5 years in patients with a normal Hgb, versus 21.7% in anemic patients (p = 0.0016). The estimated locoregional failure rate is 51.6% at 5 years in patients with a normal Hgb, versus 67.8% in anemic patients (p = 0.00028). The estimated rate of grade 3 or greater toxicity is 19.8% at 5 years in patients with a normal Hgb, versus 12.7% in anemic patients (p = 0.063). On multivariate analysis, several variables were found to be independent predictors of survival including: T stage, Karnofsky performance status, N stage, age, total radiation dose to the primary, and Hgb level. Independent predictors of locoregional control included T stage, Karnofsky performance status, N stage, radiation dose, and Hgb level. The only variables which predicted for the development of late RT complications were gender (p = 0.0109) and age (p = 0.0167). These findings were consistent regardless of whether Hgb level was considered a dichotomous or continuous variable. Conclusion: Low Hgb levels are associated with a statistically significant reduction in survival and an increase in locoregional failure in this large prospective study of patients with advanced head and neck cancer. Hgb level should be considered as a stratification variable in subsequent studies of head and neck cancer. Strategies to increase Hgb prior to RT in patients with head and neck cancer may lead to improved survival and loco- regional control.

Authors
Lee, WR; Berkey, B; Marcial, V; Fu, KK; Cooper, JS; Vikram, B; Coia, LR; Rotman, M; Ortiz, H
MLA Citation
Lee, WR, Berkey, B, Marcial, V, Fu, KK, Cooper, JS, Vikram, B, Coia, LR, Rotman, M, and Ortiz, H. "Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: A secondary analysis of RTOG 85-27." International Journal of Radiation Oncology Biology Physics 42.5 (1998): 1069-1075.
PMID
9869231
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
42
Issue
5
Publish Date
1998
Start Page
1069
End Page
1075
DOI
10.1016/S0360-3016(98)00348-4

Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: Initial results of Radiation Therapy Oncology Group 89-03

Purpose: To assess the efficacy of neoadjuvant methotrexate, cisplatin, and vinblastine (MCV) chemotherapy in patients with muscle-invading bladder cancer treated with selective bladder preservation. Patients and Methods: One hundred twenty-three eligible patients with tumor, node, metasasis system clinical stage T2 to T4aNXMO bladder cancer were randomized to receive (arm 1, n = 61) two cycles of MCV before 39.6-Gy pelvic irradiation with concurrent cisplatin 100 mg/m2 for two courses 3 weeks apart. Patients assigned to arm 2 (n = 62) did not receive MCV before concurrent cisplatin and radiation therapy. Tumor response was scored as a clinical complete response (CR) when the cystoscopic tumor-site biopsy and urine cytology results were negative. The CR patients were treated with an additional 25.2 Gy to a total of 64.8 Gy and one additional dose of cisplatin. Those with less than a CR underwent cystectomy. The median follow-up of all patients who survived is 60 months. Results: Seventy-four percent of the patients completed the protocol with, at most, minor deviations; 67% on arm 1 and 81% on arm 2. The actuarial 5-year overall survival rate was 49%; 48% in arm 1 and 49% in arm 2. Thirty-five percent of the patients had evidence of distant metastases at 5 years; 33% in arm 1 and 39% in arm 2. The 5-year survival rate with a functioning bladder was 38%, 36% in arm 1 and 40% in arm 2. None of these differences are statistically significant. Conclusion: Two cycles of MCV neoadjuvant chemotherapy were not shown to increase the rate of CR over that achieved with our standard induction therapy or to increase freedom from metastatic disease. There was no impact on 5-year overall survival.

Authors
Shipley, WU; Winter, KA; Kaufman, DS; Lee, WR; Heney, NM; Tester, WR; Donnelly, BJ; Venner, PM; Perez, CA; Murray, KJ; Doggett, RS; True, LD
MLA Citation
Shipley, WU, Winter, KA, Kaufman, DS, Lee, WR, Heney, NM, Tester, WR, Donnelly, BJ, Venner, PM, Perez, CA, Murray, KJ, Doggett, RS, and True, LD. "Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: Initial results of Radiation Therapy Oncology Group 89-03." Journal of Clinical Oncology 16.11 (1998): 3576-3583.
PMID
9817278
Source
scival
Published In
Journal of Clinical Oncology
Volume
16
Issue
11
Publish Date
1998
Start Page
3576
End Page
3583

Post-operative saccular endophthalmitis caused by macrophage-associated staphylococci.

Authors
Warheker, PT; Gupta, SR; Mansfield, DC; Seal, DV; Lee, WR
MLA Citation
Warheker, PT, Gupta, SR, Mansfield, DC, Seal, DV, and Lee, WR. "Post-operative saccular endophthalmitis caused by macrophage-associated staphylococci." Eye (London, England) 12 ( Pt 6) (1998): 1019-1021. (Academic Article)
Source
manual
Published In
Eye
Volume
12 ( Pt 6)
Publish Date
1998
Start Page
1019
End Page
1021

Gating provides improved accuracy for differentiating artifacts from true lesions in equivocal fixed defects on technetium 99m tetrofosmin perfusion SPECT.

BACKGROUND: Because equivocal fixed perfusion defects on single photon emission computed tomography (SPECT) often cause a diagnostic dilemma in patients with suspected coronary artery disease (CAD), we used receiver-operating characteristic (ROC) curve analysis to evaluate the degree of increased accuracy provided by adding gated images for interpretation of such cases. METHODS AND RESULTS: One hundred five (29%) of 365 consecutive patients undergoing technetium 99m tetrofosmin gated SPECT for evaluation of CAD demonstrated an equivocal fixed defect. Two independent observers graded the probability for true lesion with a 5-point system over 3 steps of interpretation: reviewing tomographic images alone (step 1), adding projection images (step 2), and adding gated cine images (step 3). Based on clinical criteria, 66 patients were categorized as disease negative and 25 as disease positive, while the final diagnosis was undetermined in 14 cases. Diagnostic performance was significantly higher at step 3 than at step 1 for both observers (p

Authors
Choi, JY; Lee, KH; Kim, SJ; Kim, SE; Kim, BT; Lee, SH; Lee, WR
MLA Citation
Choi, JY, Lee, KH, Kim, SJ, Kim, SE, Kim, BT, Lee, SH, and Lee, WR. "Gating provides improved accuracy for differentiating artifacts from true lesions in equivocal fixed defects on technetium 99m tetrofosmin perfusion SPECT." Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 5.4 (1998): 395-401. (Academic Article)
Source
manual
Published In
Journal of Nuclear Cardiology
Volume
5
Issue
4
Publish Date
1998
Start Page
395
End Page
401

The developmental basis for germline mosaicism in mouse and Drosophila melanogaster.

Data involving germline mosaics in Drosophila melanogaster and mouse are reconciled with developmental observations. Mutations that become fixed in the early embryo before separation of soma from the germline may, by the sampling process of development, continue as part of germline and/or differentiate into any somatic tissue. The cuticle of adult D. melanogaster, because of segmental development, can be used to estimate the proportion of mutant nuclei in the early embryo, but most somatic tissues and the germlines of both species continue from samples too small to be representative of the early embryo. Because of the small sample of cells/nuclei that remain in the germline after separation of soma in both species, mosaic germlines have percentages of mutant cells that vary widely, with a mean of 50% and an unusual platykurtic, flat-topped distribution. While the sampling process leads to similar statistical results for both species, their patterns of development are very different. In D. melanogaster the first differentiation is the separation of soma from germline with the germline continuing from a sample of only two to four nuclei, whereas the adult cuticle is a representative sample of cleavage nuclei. The presence of mosaicism in D. melanogaster germline is independent of mosaicism in the eye, head, and thorax. This independence was used to determine that mutations can occur at any of the early embryonic cell divisions and still average 50% mutant germ cells when the germline is mosaic; however, the later the mutation occurs, the higher the proportion of completely nonmutant germlines. In contrast to D. melanogaster, the first differentiation in the mouse does not separate soma from germline but produces the inner cell mass that is representative of the cleavage nuclei. Following formation of the primitive streak, the primordial germ cells develop at the base of the allantois and among a clonally related sample of cells, providing the same statistical distribution in the mouse germlines as in D. melanogaster. The proportion of mutations that are fixed during early embryonic development is greatly underestimated. For example, a DNA lesion in a postmeiotic gamete that becomes fixed as a dominant mutation during early embryonic development of the F1 may produce an individual completely mutant in the germ line and relevant somatic tissue or, alternatively, the F1 germline may be completely mutant but with no relevant somatic tissues for detecting the mutation until the F2. In both cases the mutation would be classified as complete in the F1 and F2, respectively, and not recognized as embryonic in origin. Because germ cells differentiate later in mammalian development, there are more opportunities for correlation between germline and soma in the mammal than Drosophila. However, because the germ cells and any somatic tissue, like blood, are derived from small samples, there may be many individuals that test negative in blood but have germlines that are either mosaic or entirely mutant.

Authors
Drost, JB; Lee, WR
MLA Citation
Drost, JB, and Lee, WR. "The developmental basis for germline mosaicism in mouse and Drosophila melanogaster." Genetica 102-103.1-6 (1998): 421-443. (Academic Article)
Source
manual
Published In
Genetica
Volume
102-103
Issue
1-6
Publish Date
1998
Start Page
421
End Page
443

Anti-GAD antibodies in Chinese patients with youth and adult-onset IDDM and NIDDM.

An autoimmune basis for the pathogenesis of insulin-dependent diabetes mellitus (IDDM) is supported by the frequent presence of autoantibodies - islet cell antibodies (ICAs) and GAD antibodies (GADab). However, in Chinese patients with clinical IDDM, a low prevalence of ICAs was observed. In non-insulin-dependent diabetic (NIDDM) patients, it has been suggested that the presence of GADab may identify a subset of latent autoimmune diabetes in adults (LADA). We determined the frequency of GADab in a large group of 134 IDDM and 168 NIDDM Chinese patients, and assessed the relation with ICAs status. Results showed that 39.6% IDDM and 16.1% NIDDM patients had GADab, and 20.1% and 4.8%, respectively had detectable ICAs. Frequency of GADab positivity was not influenced by whether the patients had youth or adult-onset IDDM or NIDDM, or by duration of diabetes. NIDDM patients seropositive for GADab shared similar clinical characteristics and fasting C-peptide levels with those who were GADab negative. Presence of GADab therefore did not serve to identify a subgroup of patients with latent or slow-onset IDDM. Half (53%) of our IDDM patients had neither GADab nor ICAs. The reason for this observation is unclear. One theory is that other autoantigens yet to be identified may be contributory. Alternatively, in the Chinese, autoimmunity may not be the major factor in the pathogenesis of IDDM.

Authors
Thai, AC; Ng, WY; Loke, KY; Lee, WR; Lui, KF; Cheah, JS
MLA Citation
Thai, AC, Ng, WY, Loke, KY, Lee, WR, Lui, KF, and Cheah, JS. "Anti-GAD antibodies in Chinese patients with youth and adult-onset IDDM and NIDDM." Diabetologia 40.12 (December 1997): 1425-1430. (Academic Article)
Source
manual
Published In
Diabetologia
Volume
40
Issue
12
Publish Date
1997
Start Page
1425
End Page
1430

Polymorphism of angiotensin converting enzyme gene is associated with circulating levels of plasminogen activator inhibitor-1.

The deletion (D) allele of the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene is strongly associated with an increased level of circulating ACE. The ACE gene polymorphism may influence the production of angiotensin II (Ang II). It has been shown that Ang II modulates fibrinolysis, that is, Ang II increases plasminogen activator inhibitor-1 (PAI-1) mRNA and plasma PAI-1 levels in vitro and in vivo. Considered together, we tested the hypothesis that the deletion allele of the ACE gene might be associated with increased levels of PAI-1. We related the ACE genotype to PAI-1 antigen levels in 603 men and 221 women attending a routine health screening. As a whole, the plasma PAI-1 level was not strongly associated with ACE genotype. Since the PAI-1 level was significantly influenced by well-known risk factors for coronary artery disease (CAD), we further analyzed the data after excluding subjects with major cardiovascular risk factors. In low-risk male subjects, the DD genotype had significantly higher levels of plasma PAI-1 (DD: 20.3 +/- 2.2; DI: 13.9 +/- 1.1; II: 13.6 +/- 1.3 ng/mL, P = .010 by ANOVA). In low-risk female subjects, the DD genotype showed a tendency to a high level of plasma PAI-1 without statistical significance. When analysis was restricted to postmenopausal women (age > or = 55 or FSH > or = 35 ng/mL), the DD genotype showed a significantly higher level of PAI-1 than subjects with the DI and II genotypes (27.7 +/- 6.2 versus 15.6 +/- 1.8 ng/mL, P = .028). The DD polymorphism of the ACE gene is associated with high PAI-1 levels in male and possibly in postmenopausal female subjects who have lower conventional cardiovascular risk factors. These results suggest that the increased ACE activity caused by DD polymorphism may play an important role in elevating the level of plasma PAI-1. Our data support the notion that the genetic variation of ACE contributes to the balance of the fibrinolytic pathway.

Authors
Kim, DK; Kim, JW; Kim, S; Gwon, HC; Ryu, JC; Huh, JE; Choo, JA; Choi, Y; Rhee, CH; Lee, WR
MLA Citation
Kim, DK, Kim, JW, Kim, S, Gwon, HC, Ryu, JC, Huh, JE, Choo, JA, Choi, Y, Rhee, CH, and Lee, WR. "Polymorphism of angiotensin converting enzyme gene is associated with circulating levels of plasminogen activator inhibitor-1." Arteriosclerosis, thrombosis, and vascular biology 17.11 (November 1997): 3242-3247. (Academic Article)
Source
manual
Published In
Arteriosclerosis, Thrombosis, and Vascular Biology
Volume
17
Issue
11
Publish Date
1997
Start Page
3242
End Page
3247

Microvilli elongate in response to hydrogen peroxide and to perturbations of intracellular calcium.

Using scanning electron microscopy and fluorescence microscopy, we have found that apical microvilli of diverse cell types, including nonepithelial cells, elongate in culture in response to the oxidative stress of hydrogen peroxide. The microvilli induced in culture on retinal pigment epithelial cells display a 30-nm axial periodicity similar to that described for stable microvilli of intestinal brush border. Microvilli can also be induced to elongate by chelating intracellular Ca2+ and by the Ca(2+)-uptake inhibitor thapsigargin. Thus a response of microvillar protrusion occurs widely and may be related to depletion of intracellular calcium stores.

Authors
Reid, GG; Edwards, JG; Marshall, GE; Sutcliffe, RG; Lee, WR
MLA Citation
Reid, GG, Edwards, JG, Marshall, GE, Sutcliffe, RG, and Lee, WR. "Microvilli elongate in response to hydrogen peroxide and to perturbations of intracellular calcium." Experimental cell research 236.1 (October 1997): 86-93. (Academic Article)
Source
manual
Published In
Experimental Cell Research
Volume
236
Issue
1
Publish Date
1997
Start Page
86
End Page
93

A histologic study (including DNA quantification and Ki-67 labeling index) in uveal melanomas after brachytherapy with ruthenium plaques.

PURPOSE: To investigate the proliferative potential and DNA damage in uveal melanomas treated by brachytherapy. METHODS: Forty-two enucleated eyes that had been treated with 106Ru/106Rh radioactive plaques for uveal melanoma were subgrouped according to the extent of irradiation damage. Cell proliferation was determined by immunoreactivity for the proliferation marker Ki-67 (Mib-1) and ploidy by quantitative DNA image analysis. Thirty globes containing uveal melanomas without prior brachytherapy served as a control group. RESULTS: The values for Ki-67 reactivity and ploidy could be correlated with radiation-induced changes within the tumors. In regions of the tumor where complete exposure to the prescribed radiation dose was assumed from the histologic findings, the Ki-67 index was close to or equal to zero. Hypoploidy was exclusive to irradiated tumors and was most often detected in effectively irradiated regions. Tumor regions classified as partially irradiated or recurrent showed an increase of Ki-67 indices and DNA content. Values obtained in recurrent tumors did not significantly differ from the control group. CONCLUSIONS: Tumor cell proliferation and variations in ploidy status could be detected after brachytherapy, but the response varied markedly both within individual tumors and within the irradiated group. Evidence of persisting proliferative potential could be obtained in ostensibly sterilized tumor tissue, but a negligible Ki-67 index and the presence of hypoploidy were considered to be reliable indicators for radiation-induced loss of proliferative potential.

Authors
Schilling, H; Sehu, KW; Lee, WR
MLA Citation
Schilling, H, Sehu, KW, and Lee, WR. "A histologic study (including DNA quantification and Ki-67 labeling index) in uveal melanomas after brachytherapy with ruthenium plaques." Investigative ophthalmology & visual science 38.10 (September 1997): 2081-2092. (Academic Article)
Source
manual
Published In
Investigative Ophthalmology and Visual Science
Volume
38
Issue
10
Publish Date
1997
Start Page
2081
End Page
2092

A novel pattern of oculocerebral malformation.

AIMS/BACKGROUND: To report a novel pattern of oculocerebral malformation related to the group of diseases characterised by cobblestone lissencephaly. METHODS: By means of a case report with specialist descriptions of the novel neuropathological and ophthalmic pathology features. RESULTS: The patient, born to healthy consanguineous parents, presented in the neonatal period with jaundice, convulsions, and macrocephaly. Computed tomography demonstrated hydrocephalus and abnormal cerebral gyration. Ophthalmic examination revealed severe myopia and segments of retinal atrophy. Cytogenetic investigation revealed a balanced reciprocal translocation (46,XX,t(5p11;19q13.1)) that was inherited from the mother and was present in several normal relatives. Mild short stature and profound mental handicap were evident. The child died aged 7 years. At necropsy the brain showed 'cobblestone' (type II) lissencephaly. Cerebellar cortical architecture was abnormal and the brain stem lacked cerebral peduncles, basis pontis, and pyramids. Biopsies of skeletal muscles were normal. The ocular abnormalities included discrete sectors of retina of varying thickness with disordered neuronal lamination and gliosis. The optic nerve was gliotic and contained few nerve fibres. The anterior iris surface was studded with cellular stromal nodules which appear to be melanocytic in nature. CONCLUSION: Retinal dysgenesis occurs in the group of syndromes with 'cobblestone lissencephaly', the best known being Walker-Warburg syndrome. In this case, relatively long survival, lack of muscular dystrophy, and novel ocular pathology distinguish it from the other diagnoses in this group of syndromes. We suggest this child was affected by a distinct and novel oculocerebral syndrome.

Authors
Clark, BJ; Lee, WR; Doyle, D; Arngrimsson, R; Tolmie, JL; Stephenson, JB
MLA Citation
Clark, BJ, Lee, WR, Doyle, D, Arngrimsson, R, Tolmie, JL, and Stephenson, JB. "A novel pattern of oculocerebral malformation." The British journal of ophthalmology 81.6 (June 1997): 470-475. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
81
Issue
6
Publish Date
1997
Start Page
470
End Page
475

Images in cardiovascular medicine. Bilateral congenital coronary arteriovenous fistulas with giant aneurysms.

Authors
Lee, WR; Kim, JS; Park, JE; Kim, DK
MLA Citation
Lee, WR, Kim, JS, Park, JE, and Kim, DK. "Images in cardiovascular medicine. Bilateral congenital coronary arteriovenous fistulas with giant aneurysms." Circulation 95.8 (April 1997): 2170-2171. (Academic Article)
Source
manual
Published In
Circulation
Volume
95
Issue
8
Publish Date
1997
Start Page
2170
End Page
2171

Cardiac tamponade due to a rupture of the coronary arteriovenous aneurysm--a case report.

We experienced an unusual case of cardiac tamponde caused by a rupture of the coronary arteriovenous aneurysm in a 54-year-old woman. The patient was suffered from sudden chest pain and syncope, and was initially managed by pericardiocentesis following an echocardiogram which revealed a massive pericardial effusion with signs of cardiac tamponade. She was referred to our hospital under the impression of aortic dissection with cardiac tamponade. She underwent an emergency operation and was found to have a 2 x 2 cm sized bleeding cystic mass protruding from the proximal anterior descending coronary artery. The aneurysm was excised and the openings connected with the coronary artery and right ventricular outflow tract were closed with sutures from the inside of aneurysm. Subsequent coronary arteriography supported the diagnosis.

Authors
Ryu, JC; Choe, YH; Park, PW; Park, JE; Chae, H; Lee, WR
MLA Citation
Ryu, JC, Choe, YH, Park, PW, Park, JE, Chae, H, and Lee, WR. "Cardiac tamponade due to a rupture of the coronary arteriovenous aneurysm--a case report." Journal of Korean medical science 12.2 (April 1997): 143-145. (Academic Article)
Source
manual
Published In
Journal of Korean medical science
Volume
12
Issue
2
Publish Date
1997
Start Page
143
End Page
145

Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy.

BACKGROUND: The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an inferior outcome compared with that of patients who have organ-confined disease. This study examined the association of PNI and treatment failure in a consecutive series of patients treated with three-dimensional conformal radiation therapy (3DCRT) alone. METHODS: The authors report actuarial biochemical no evidence of disease (bNED) survival rates for 484 consecutive patients with clinically localized prostate carcinoma diagnosed by transrectal needle biopsy who completed 3DCRT alone between May 1989 and December 1994. The median follow-up time was 28 months (range, 2-75 months), and the median dose to the center of the prostate was 7368 centigray (cGy) (range, 6316-8074 cGy). Patients were subdivided into 2 groups according to pretreatment prostate specific antigen (PSA) levels (< 20 ng/mL vs. > or = 20 ng/mL). Pathology records were reviewed for the presence or absence of PNI. bNED failure was defined as a PSA level > or = 1.5 ng/mL and rising on 2 consecutive occasions. bNED survival rates were calculated using Kaplan-Meier methodology and comparisons of survival curves were accomplished using the log rank test. RESULTS: The 3-year bNED survival for all 484 patients was 77%. The presence of PNI predicted decreased bNED survival in all patients. This detrimental effect, however, was confined to patients with pretreatment PSA values < 20 ng/mL. The bNED survival rates for patients with pretreatment PSA < 20 ng/mL demonstrated a highly significant decrease if PNI was present versus when it was absent (65% vs. 88% at 3 years, 39% vs. 65% at 5 years; P = 0.0009 for overall curve comparison). For patients with pretreatment PSA < 20 ng/mL, multivariate analysis of prognostic variables demonstrated a significant association between bNED survival and PNI (P = 0.002), palpation stage (P = 0.02), and pretreatment PSA (P = 0.006). Gleason score, age, and dose were not independent predictors of bNED survival in this group of patients. CONCLUSIONS: To the authors' knowledge, this is the first report demonstrating that PNI detected on diagnostic transrectal biopsy is a significant predictor of decreased bNED survival in patients treated with radiotherapy. The subgroup of patients affected are those with pretreatment PSA < 20 ng/mL. This result suggests that such patients may benefit from more aggressive treatment, particularly the use of larger planning target volumes or adjuvant therapies.

Authors
Bonin, SR; Hanlon, AL; Lee, WR; Movsas, B; al-Saleem, TI; Hanks, GE
MLA Citation
Bonin, SR, Hanlon, AL, Lee, WR, Movsas, B, al-Saleem, TI, and Hanks, GE. "Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy." Cancer 79.1 (January 1997): 75-80.
PMID
8988729
Source
epmc
Published In
Cancer
Volume
79
Issue
1
Publish Date
1997
Start Page
75
End Page
80
DOI
10.1002/(sici)1097-0142(19970101)79:1<75::aid-cncr11>3.0.co;2-3

Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy.

BACKGROUND: The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an inferior outcome compared with that of patients who have organ-confined disease. This study examined the association of PNI and treatment failure in a consecutive series of patients treated with three-dimensional conformal radiation therapy (3DCRT) alone. METHODS: The authors report actuarial biochemical no evidence of disease (bNED) survival rates for 484 consecutive patients with clinically localized prostate carcinoma diagnosed by transrectal needle biopsy who completed 3DCRT alone between May 1989 and December 1994. The median follow-up time was 28 months (range, 2-75 months), and the median dose to the center of the prostate was 7368 centigray (cGy) (range, 6316-8074 cGy). Patients were subdivided into 2 groups according to pretreatment prostate specific antigen (PSA) levels ( or = 20 ng/mL). Pathology records were reviewed for the presence or absence of PNI. bNED failure was defined as a PSA level > or = 1.5 ng/mL and rising on 2 consecutive occasions. bNED survival rates were calculated using Kaplan-Meier methodology and comparisons of survival curves were accomplished using the log rank test. RESULTS: The 3-year bNED survival for all 484 patients was 77%. The presence of PNI predicted decreased bNED survival in all patients. This detrimental effect, however, was confined to patients with pretreatment PSA values

Authors
Bonin, SR; Hanlon, AL; Lee, WR; Movsas, B; al Saleem, TI; Hanks, GE
MLA Citation
Bonin, SR, Hanlon, AL, Lee, WR, Movsas, B, al Saleem, TI, and Hanks, GE. "Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three-dimensional conformal radiation therapy." Cancer 79.1 (January 1997): 75-80. (Academic Article)
Source
manual
Published In
Cancer
Volume
79
Issue
1
Publish Date
1997
Start Page
75
End Page
80

Neck failure in T2N0 squamous cell carcinoma of the true vocal cords: The Fox Chase experience and review of the literature

There is a need for additional data in the literature regarding elective nodal irradiation in the treatment of T2N0 squamous cell carcinoma of the glottic larynx. We examined the experience at the Fox Chase Cancer Center and performed a literature review in order to define a treatment policy. Sixteen patients with T2 squamous cell carcinoma of the glottic larynx were treated with radiation therapy. Ten patients were irradiated to the larynx alone and six to the larynx and regional nodes. None of the patients in our series experienced a nodal recurrence regardless of whether the neck was electively irradiated. A literature review of 413 patients revealed that 2.6% of patients who did not have their nodes electively irradiated and had their primary tumor controlled experienced a nodal failure compared to 3.7% if the primary and regional nodes were irradiated (P = 0.88). Similarly, there was no significant difference in the rate of nodal failure for patients who experienced a recurrence at the primary site regardless of whether they received elective nodal irradiation (P = 0.36). We recommend treatment to the larynx alone since our policy is to treat the regional nodes only when the incidence of occult lymphadenopathy in the neck exceeds 15%.

Authors
Fein, DA; Hanlon, AL; Lee, WR; Ridge, JA; Coia, LR
MLA Citation
Fein, DA, Hanlon, AL, Lee, WR, Ridge, JA, and Coia, LR. "Neck failure in T2N0 squamous cell carcinoma of the true vocal cords: The Fox Chase experience and review of the literature." American Journal of Clinical Oncology: Cancer Clinical Trials 20.2 (1997): 154-157.
PMID
9124190
Source
scival
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
20
Issue
2
Publish Date
1997
Start Page
154
End Page
157
DOI
10.1097/00000421-199704000-00010

Late GI and GU complications in the treatment of prostate cancer

Purpose: To assess the factors that predict late GI and GU morbidity in radiation treatment of the prostate. Methods and Materials: Seven hundred twelve consecutive prostate cancer patients treated at this institution between 1986 and 1994 (inclusive) with conformal or conventional techniques were included in the analysis. Patients had at least 3 months follow-up and received at least 65 Gy. Late GI Grade 3 morbidity was rectal bleeding (requiring three or more procedures) or proctitis. Late Grade 3 GU morbidity was cystitis or stricture. Multivariate analysis (MVA) was used to assess factors related to the complication-free survival. The factors assessed were age, occurrence of side effects ≤ Grade 2 during treatment, irradiated volume parameters (use of pelvic fields, treatment of seminal vesicles to full dose or 57 Gy, and use of additional rectal shielding), dose, comorbidities, and other treatments (hormonal manipulation, TURP). Results: Acute GI and GU side effects (Grade 2 or higher) were noted in 246 and 201 patients, respectively; 67 of these patients exhibited both. GI side effects were not correlated with GU side effects acutely. Late and acute morbidities were correlated (both GI and GU). Fifteen of the 712 patients expressed Grade 3 or 4 GI injuries 3 to 32 months after the end of treatment, with a mean of 14.3 months. One hundred fifteen patients expressed Grade 2 or higher GI morbidity (mean: 13.7 months). The 43 Grade 2 or higher GU morbidities occurred significantly later (mean: 22.7 months). Central axis dose was the only independent variable significantly related to the incidence of late GI morbidity on MVA. No treatment volume parameters were significant for Grade 3. The following parameters were significantly related (by MVA) to Grade 2 GI morbidity: central axis dose, use of the increased rectal shielding, androgen deprivation therapy starting before RT. Acute and late GI morbidities were highly correlated. History of diabetes, treatment of pelvic nodes, and age less than 60 years were significantly related to acute GI side effects. The parameters significantly related to late Grade 2 or higher GU morbidity were central axis dose, androgen deprivation therapy (Zoladex or Lupron) prior to radiation therapy (RT), history of obstructive symptoms, and acute GU side effects. There were too few late Grade 3 GU morbidities to perform multivariate analysis. Acute GU side effects were highly correlated with late GU injury. The following were correlated with acute GU side effects: history of diabetes (+), treatment with conformal fields (-), TURP before RT (-), presentation with urinary obstructive symptoms. Conclusion: Both late GI and GU morbidity demonstrate a dose dependence, but only the volume dependence observed is a reduction in late Grade 2-4 GI morbidity by increasing the rectal shielding in the lateral fields for the final 10 Gy. Moreover, both late GI and GU morbidity was increased in patients treated with hormone manipulation prior to RT. GI and GU injuries were correlated with their corresponding acute side effects. GI and GU complications must not be combined for analysis to determine the factors related to their occurrence.

Authors
Schultheiss, TE; Lee, WR; Hunt, MA; Hanlon, AL; Peter, RS; Hanks, GE
MLA Citation
Schultheiss, TE, Lee, WR, Hunt, MA, Hanlon, AL, Peter, RS, and Hanks, GE. "Late GI and GU complications in the treatment of prostate cancer." International Journal of Radiation Oncology Biology Physics 37.1 (1997): 3-11.
PMID
9054871
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
37
Issue
1
Publish Date
1997
Start Page
3
End Page
11
DOI
10.1016/S0360-3016(96)00468-3

Optimization of conformal radiation treatment of prostate cancer: Report of a dose escalation study

Purpose: The development of conformal radiation technique including improved patient immobilization has allowed us to test the value of dose escalation in optimizing the radiation treatment of prostate cancer. Methods and Materials: Outcome is reported for 233 consecutive patients treated with conformal technique between March 1989 and October 1992. Dose was escalated from 68 Gy to 79 Gy. Patient status is reported at 3 years follow-up, which is available in all alive patients. Pretreatment and serial posttreatment prostate specific antigen (PSA) values are available for all patients. Biochemical freedom of disease (bNED) defines failure as PSA > 1.5 ngm/ml and rising on two consecutive measures. Dose response for bNED control of cancer and late morbidity are represented by logit response models fitted to the data. Kaplan-Meier methods, the log rank test, and Cox Regression models are also used. Results: No dose response is observed for bNED survival for patients with pretreatment PSA < 10 ngm/mi comparing patients treated above or below 71.5 Gy or on multivariate analysis. Dose response is observed for bNED survival for pretreatment PSA groups of 10-19.9 ngm/ml and 20+ ngm/ml. The dose associated with 50% bNED survival at 3 years is 64 Gy and 76 Gy, respectively. The slope of the dose responses are 13 and 9%, respectively. Dose response is demonstrated for Grade 2 gastrointestinal (GI), Grade 2 genitourinary (GU), and Grade 3,4 combined GI and GU late morbidity. The slopes of the morbidity responses are steeper than for cancer control (19 to 21%). Conclusions: Patients with pretreatment PSA <10 ngm/ml do not benefit from dose escalation, and the serious late morbidity of conformal radiation at 70 Gy is <3%. Patients with PSA values 10-19.9 ngm/ml and 20+ ngm/ml benefit from dose escalation beyond 70 Gy. Treatment beyond 75 Gy results in > 10% serious morbidity unless special precautions are taken to protect the rectal mucosa. All levels of severity of radiation morbidity show a dose response and combined with the dose response for bNED survival these data allow the optimization of treatment.

Authors
Hanks, GE; Schultheiss, TE; Hanlon, AL; Hunt, M; Lee, WR; Epstein, BE; Coia, LR
MLA Citation
Hanks, GE, Schultheiss, TE, Hanlon, AL, Hunt, M, Lee, WR, Epstein, BE, and Coia, LR. "Optimization of conformal radiation treatment of prostate cancer: Report of a dose escalation study." International Journal of Radiation Oncology Biology Physics 37.3 (1997): 543-550.
PMID
9112451
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
37
Issue
3
Publish Date
1997
Start Page
543
End Page
550
DOI
10.1016/S0360-3016(96)00602-5

Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: Clinical observations

Purpose: To examine the natural history of patients who have received definitive radiation therapy alone for clinically localized prostate cancer and have an increasing prostate-specific antigen (PSA) profile. Patients and Methods: One hundred fifty-one men with an increasing PSA profile after definitive radiotherapy were identified. The subsequent natural history of these men, including local recurrence, distant metastasis, and survival, was examined. In 119 men, posttreatment PSA doubling times (PSADT) were calculated using linear regression. Cox regression models were used to examine the effect of clinical and treatment variables on clinical failure and survival. Results: Patients with high pretreatment PSA values, high Gleason scores, and T3 tumors were more likely to develop a PSA elevation. The median calculated posttreatment PSADT was 13 months, and 95% of patients had posttreatment PSADT of less than 3 years. PSADT was correlated with tumor stage and Gleason score. Five years after PSA elevation, the estimated rate of clinical local recurrence is 26% and the estimated rate of distant metastases is 47%. Rapid PSADT (< 12 months) and a short interval from the end of treatment to PSA elevation (< 12 months) were significant independent predictors of distant metastases. The estimated rates of overall and cause- specific survival 5 years after PSA elevation are 65% and 76%, respectively. Gleason grade is the only significant independent predictor of overall and cause-specific survival after PSA elevation. Conclusion: The natural history of men who have an increasing PSA profile following definitive radiotherapy is heterogeneous. In the absence of salvage therapy, at least three quarters of men will have clinical evidence of recurrent disease 5 years after a PSA elevation is detected. Men with a rapid posttreatment PSADT and a short interval from the end of treatment to an increasing PSA profile are at a very high risk of developing distant metastasis within 5 years of PSA elevation.

Authors
Lee, WR; Hanks, GE; Hanlon, A
MLA Citation
Lee, WR, Hanks, GE, and Hanlon, A. "Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: Clinical observations." Journal of Clinical Oncology 15.1 (1997): 230-238.
PMID
8996147
Source
scival
Published In
Journal of Clinical Oncology
Volume
15
Issue
1
Publish Date
1997
Start Page
230
End Page
238

Initial clinical assessment of CT-MRI image fusion software in localization of the prostate for 3D conformal radiation therapy

Purpose: To assess the utility of image fusion software and compare MRI prostate localization with CT localization in patients undergoing 3D conformal radiation therapy of prostate cancer. Materials and Methods: After a phantom study was performed to ensure the accuracy of image fusion procedure, 22 prostate cancer patients had CT and MRI studies before the start of radiotherapy. Immobilization casts used during radiation treatment were also used for both imaging studies. After the clinical target volume (CTV) (prostate or prostate + seminal vesicles) was defined on CT, slices from the MRI study were reconstructed to precisely match the CT slices by identifying three common bony landmarks on each study. The CTV was separately defined on the matched MRI slices. Data related to the size and location of the prostate were compared between CT and MRI. The spatial relationship between the tip of urethrogram cone on CT and prostate apex seen on MRI was also estimated. Results: The phantom study showed the registration discrepancies between CT and MRI smaller than 1.0 mm in any pair in comparison. The patient study showed a mean image registration error of 0.9 (± 0.6) mm. The average prostate volume was 63.0 (± 25.8) cm3 and 50.9 (± 22.9) cm3 determined by CT and MRI, respectively. The difference in prostate location with the two studies usually differed at the base and at the apex of the prostate. On the transverse MRI, the prostate apex was situated 7.1 (± 4.5) mm dorsal and 15.1 (± 4.0) mm cephalad to the tip of urethrogram cone. Conclusions: CT-MRI image fusion study made it possible to compare the two modalities directly. MRI localization of the prostate is more accurate than CT, and indicates the distance from cone to apex is 15 min. CT-MRI image fusion technique provides valuable supplements to CT technology for more precise targeting of the prostate cancer.

Authors
Kagawa, K; Lee, WR; Schultheiss, TE; Hunt, MA; Shaer, AH; Hanks, GE
MLA Citation
Kagawa, K, Lee, WR, Schultheiss, TE, Hunt, MA, Shaer, AH, and Hanks, GE. "Initial clinical assessment of CT-MRI image fusion software in localization of the prostate for 3D conformal radiation therapy." International Journal of Radiation Oncology Biology Physics 38.2 (1997): 319-325.
PMID
9226318
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
38
Issue
2
Publish Date
1997
Start Page
319
End Page
325
DOI
10.1016/S0360-3016(96)00620-7

Changing indications for penetrating keratoplasty in the west of Scotland from 1970 to 1995.

In an attempt to predict the trends which might occur in the changing patterns of corneal surgery in the next decade and hence the financial implications, a retrospective study of the treatment of corneal disease was carried out using the pathological reports issued during the last 25 years in the West of Scotland Ophthalmic Pathology Service. This is a supra-regional specialist service which covers the major population areas in Scotland, although most of the specimens were submitted by consultants in the teaching hospitals in Glasgow. The major indications for surgery in the 1486 specimens received were post-inflammatory scarring (387 cases), repeat penetrating keratoplasty (309), keratoconus (257), Fuchs' dystrophy (120) and secondary endothelial failure after cataract surgery (158). In the past 6 years the indications changed and the commonest indications were secondary endothelial failure and post-inflammatory scarring. The study demonstrates a regional difference when compared with other reports and highlights the increasing demand for penetrating keratoplasty and the consequent resource implications.

Authors
Ramsay, AS; Lee, WR; Mohammed, A
MLA Citation
Ramsay, AS, Lee, WR, and Mohammed, A. "Changing indications for penetrating keratoplasty in the west of Scotland from 1970 to 1995." Eye (London, England) 11 ( Pt 3) (1997): 357-360. (Academic Article)
Source
manual
Published In
Eye
Volume
11 ( Pt 3)
Publish Date
1997
Start Page
357
End Page
360

Keratokyphosis in rabbits: a functional and morphologic study.

Keratokyphosis, a "nonfreeze keratomileusis" procedure, was applied in rabbits. The refractive changes were -6.5 +/- 0.7 (SD), -9.5 +/- 2.6, and -13.0 +/- 3.2 D for convex applanation surfaces with a vertex of +100 microns, +125 microns, and +150 microns in the microkeratome and +1.5 +/- 2.0 and +2.5 +/- 2.6 D for concave applanation surfaces with a vertex of -100 microns and -125 microns. The pachymetric corneal changes were +43 +/- 24 microns, +39 +/- 32 microns, and +71 +/- 24 microns for the convex applanation surfaces and -21 +/- 40 microns and -17 +/- 24 microns for the concave. Wound healing was uncomplicated. The scar at the interface was 0-5 microns wide. The mean central density of nerve endings was 1,255 +/- 532/mm2. The endothelial cell size was 25.1% (p

Authors
Kruse, H; Heimann, H; Schüler, A; Lee, WR; Hoffmann, F
MLA Citation
Kruse, H, Heimann, H, Schüler, A, Lee, WR, and Hoffmann, F. "Keratokyphosis in rabbits: a functional and morphologic study." Cornea 15.6 (November 1996): 622-632. (Academic Article)
Source
manual
Published In
Cornea
Volume
15
Issue
6
Publish Date
1996
Start Page
622
End Page
632

Multidrug resistance in ocular melanoma.

AIMS/BACKGROUND: Metastatic disease in patients with ocular melanoma is resistant to chemotherapy. One of the main mechanisms of modulating multidrug resistance is the expression of the multidrug resistance gene 1 (MDR1) product (p-glycoprotein) by tumour cells. The purpose of this study was to evaluate the frequency of expression of the MDR1 gene in ocular melanoma whose primary treatment was surgical excision or enucleation. METHODS: Twelve recent ocular melanomas were received fresh, snap frozen and cryostat sections of tumour were analysed for expression of MDR1 by immunohistochemistry using a well characterised monoclonal antibody to MDR1. Tumour explants were established in short term tissue culture from four tumours and cell blocks were examined by immunohistochemistry. RESULTS: MDR1 expression was present in five of 12 ocular melanomas. Upregulation of protein expression was found in four cell lines established in short term culture from tumour explants. A recurrent tumour, initially treated by local excision and radioactive plaque, showed overexpression of MDR1 mRNA. CONCLUSIONS: These results suggest that significant level of MDR1 may be intrinsically present in ocular melanomas before exposure to drugs involved in multidrug resistance, and indicate the possible importance of MDR1 in modulating chemoresistance in ocular melanoma. Chemosensitisation may be of potential value in planning adjuvant chemotherapy for patients with metastatic disease.

Authors
McNamara, M; Clynes, M; Dunne, B; NicAmhlaoibh, R; Lee, WR; Barnes, C; Kennedy, SM
MLA Citation
McNamara, M, Clynes, M, Dunne, B, NicAmhlaoibh, R, Lee, WR, Barnes, C, and Kennedy, SM. "Multidrug resistance in ocular melanoma." The British journal of ophthalmology 80.11 (November 1996): 1009-1012. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
80
Issue
11
Publish Date
1996
Start Page
1009
End Page
1012

Pretreatment serum prostate-specific antigen (PSA) level and PSA doubling times (PSADT) in black and white men with prostate cancer referred for radiation therapy

Numerous racial differences have been reported for carcinoma of the prostate diagnosed in African-American (AA) men when compared to whites. These differences include: (1) a higher incidence in AA compared to whites, (2) a more advanced stage at diagnosis in AA, and (3) higher mortality rates in AA even after adjusting for clinical stage. We examined pretreatment serum PSA levels and calculated PSA doubling times (PSADT) in men referred for radiation therapy with clinically localized prostate cancer and determined if there are any discernible differences between AA and whites. 739 men (670 whites, 69 AA) with histologically proven nonmetastatic prostate cancer who were referred for radiation therapy had a pretreatment serum PSA level (Hybritech assay) available at the rime of referral. PSADT were calculated by linear regression for 251 of these men (221 whites, 30 AA) who had at least three serum PSA values obtained prior to the start of definitive therapy. Differences in percentages for grouped pretreatment PSA and PSADT between AA and whites were evaluated by the Pearson chi-square test. The pretreatment serum PSA level was higher for AA than whites in patients with T1-2 tumors. One hundred eighty-three of the 251 patients (73%) with serial PSA determinations were noted to have rising values. Of the patients with rising PSA values, the calculated PSADT was less than 2 years in 39% of white patients and 56% of AA patients (P = .14). Conclusions: African-American men with organ-confined prostate cancer referred for radiation therapy had evidence of a higher volume of disease at diagnosis than whites. In patients with serial PSA levels that were noted to rise, there were no discernible differences between AA and whites, although the number of patients is relatively small and further follow-up is necessary.

Authors
Lee, WR; Hanks, GE; Hanlon, A; Schultheiss, TE
MLA Citation
Lee, WR, Hanks, GE, Hanlon, A, and Schultheiss, TE. "Pretreatment serum prostate-specific antigen (PSA) level and PSA doubling times (PSADT) in black and white men with prostate cancer referred for radiation therapy." Radiation Oncology Investigations 4.3 (September 14, 1996): 135-139.
Source
scopus
Published In
Radiation Oncology Investigations
Volume
4
Issue
3
Publish Date
1996
Start Page
135
End Page
139
DOI
10.1002/(SICI)1520-6823(1996)4:3<135::AID-ROI6>3.0.CO;2-Z

Prostate specific antigen nadir following external beam radiation therapy for clinically localized prostate cancer: the relationship between nadir level and disease-free survival.

PURPOSE: We determined whether the prostate specific antigen (PSA) nadir achieved following external beam radiation therapy alone predicts biochemical disease-free survival in a large cohort of men with clinically localized prostate cancer. MATERIALS AND METHODS: Between January 1986 and October 1993, 364 men with clinically localized, stages T1 to T3 adenocarcinoma of the prostate received definitive external beam radiation therapy with no prior, concomitant or adjuvant endocrine therapy. PSA was measured before treatment in 326 men (90%) and serial PSA was measured following treatment in all patients. All men were followed continuously for at least 24 months (median 44 months, range 24 to 90, mean 46). Biochemical failure after irradiation was defined as PSA of 1.5 ng./ml. or more and 2 consecutive serum PSA elevations. RESULTS: The 5-year overall biochemical disease-free survival rate for the entire group was 56%. PSA nadir was predictive of subsequent biochemical disease-free survival. The biochemical disease-free survival rate at 3 years was 93, 49 and 16% for PSA nadirs of 0 to 0.99, 1 to 1.99 and 2 or more ng./ml., respectively (p = 0.0001). In a multivariate analysis PSA nadir (0 to 0.99 versus 1.0 to 1.99 versus 2 or more ng./ml.) was an independent predictor of biochemical disease-free survival along with pretreatment PSA, central axis dose, Gleason grade and T stage. CONCLUSIONS: PSA nadir after radiation therapy is an indicator of subsequent biochemical disease-free survival. Patients who achieve a nadir of less than 1 ng./ml. following external beam radiation therapy have a favorable biochemical disease-free survival rate, while those with a nadir of greater than 1 ng./ml. have a high subsequent failure rate. Strategies to improve results should focus on techniques to increase the likelihood of achieving a PSA nadir of less than 1 ng./ml.

Authors
Lee, WR; Hanlon, AL; Hanks, GE
MLA Citation
Lee, WR, Hanlon, AL, and Hanks, GE. "Prostate specific antigen nadir following external beam radiation therapy for clinically localized prostate cancer: the relationship between nadir level and disease-free survival." The Journal of urology 156.2 Pt 1 (August 1996): 450-453. (Academic Article)
Source
manual
Published In
The Journal of Urology
Volume
156
Issue
2 Pt 1
Publish Date
1996
Start Page
450
End Page
453

Erratum to Mutation spectrum of 2-chloroethyl methanesulfonate in Drosophila melanogaster premeiotic germ cells' [Mutation Res. 331 (1995) 213-224].

The 2-chloroethyl methanesulfonate (2CIEMS)-induced alcohol dehydrogenase (Adh) null germline mutation frequency in treated Drosophila melanogaster second instar larval gonia was two orders of magnitude greater than the spontaneous mutation frequency. DNA sequence analysis of 83 Adh null mutations showed that 40 mutations of independent origin were at 23 sites in the Adh gene. The mutation spectrum contained only GC --> AT transitions with 35 mutations (87.5%) at the middle or 3' guanine. In addition, characteristics of glutathione (GSH)-mediated bioactivation were determined for 2CIEMS in vitro. Rates of GSH-mediated conjugation, catalyzed by purified rat liver glutathione-S-transferase (GST), and binding of [35S]GSH-mediated conjugation products to calf thymus DNA were determined for 2CIEMS, 1,2-dichloroethane (EDC) and 1,2-dibromoethane (EDB). The relative rates of GSH-mediated conjugation were the following: 5 mM EDB > 40 mM 2CIEMS > 40 mM EDC. A similar trend was observed for DNA binding of the [35S]GSH-mediated conjugation products when differences in mutagen concentration were considered: EDB > 2CIEMS > EDC. The ratios of DNA binding to GSH conjugation calculated for EDB, EDC and 2CIEMS were 6.8 x 10(-5), 9.3 x 10(-5) and 19.1 x 10(-5), respectively. A narrow range, less than a 3-fold difference, in the ratios of DNA binding to GSH conjugation indicates that the bioactivation of 2CIEMS is mediated by the same mechanism as EDB and EDC. Consequently, 2CIEMS, EDC and EDB may induce a specific mutation in premeiotic germ cells.

Authors
Fossett, NG; Byrne, BJ; Tucker, AB; Arbour Reily, P; Chang, S; Lee, WR
MLA Citation
Fossett, NG, Byrne, BJ, Tucker, AB, Arbour Reily, P, Chang, S, and Lee, WR. "Erratum to Mutation spectrum of 2-chloroethyl methanesulfonate in Drosophila melanogaster premeiotic germ cells' [Mutation Res. 331 (1995) 213-224]." Mutation research 354.1 (July 1996): 143-144. (Academic Article)
Source
manual
Published In
Mutation Research - Fundamental and Molecular Mechanisms of Mutagenesis
Volume
354
Issue
1
Publish Date
1996
Start Page
143
End Page
144

Metastatic choroidal melanoma to the contralateral orbit 40 years after enucleation.

Metastatic uveal melanoma to the contralateral orbit is extremely rare, with only eight cases in the literature having been reported. We reviewed the clinical presentation, the histologic findings of the primary and secondary tumors, and the clinical outcome of these cases and studied an additional case of metastatic choroidal melanoma to the contralateral orbit that occurred 40 years after enucleation for the primary tumor. The long interval between recognition of the primary tumor and the appearance of clinically manifest metastatic disease in the contralateral orbit is the longest reported in the literature to date. The histologic features of the tumor cells of the enucleation specimen and those of the orbital metastasis were similar, consisting of spindle-cell type with minimal atypia. Combined use of immuno-phenotyping and electron microscopy substantiated the diagnosis of melanoma.

Authors
Coupland, SE; Sidiki, S; Clark, BJ; McClaren, K; Kyle, P; Lee, WR
MLA Citation
Coupland, SE, Sidiki, S, Clark, BJ, McClaren, K, Kyle, P, and Lee, WR. "Metastatic choroidal melanoma to the contralateral orbit 40 years after enucleation." Archives of ophthalmology 114.6 (June 1996): 751-756. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
114
Issue
6
Publish Date
1996
Start Page
751
End Page
756

Prostate carcinoma patients upstaged by imaging and treated with irradiation. An outcome-based analysis.

BACKGROUND: The American Joint Committee on Cancer (AJCC) staging of prostate cancer relies upon digital rectal examination (DRE) findings, but suggests using all available information, including prostate imaging studies, prior to definitive treatment of prostate carcinoma. We have studied whether patients upstaged by imaging have a different outcome after treatment with external beam radiation therapy (RT) from those not upstaged. METHODS: The records of 499 men with clinically localized adenocarcinoma of the prostate treated with only definitive external beam irradiation from January 1986 to December 1993 were reviewed. The 348 patients with any one or a combination of the following pretreatment imaging studies were considered eligible; transrectal ultrasound (TRUS), pelvic MRI, or endorectal MRI. Patients were assigned two clinical stages: one based upon palpation criteria alone (palpation stage) and the other allowing for any upstaging by imaging abnormalities (AJCC or imaging stage). The Kaplan-Meier method was used to estimate biochemical no evidence of disease (bNED) survival where a failure was defined as a prostate specific antigen (PSA) greater than 1.5 and increasing. Differences in outcome were evaluated by the log-rank test. RESULTS: Overall upstaging by TRUS or MRI to any higher stage occurred in 115 of 312 palpation T1c-T2c patients (37%). These upstaged patients had an unexpected improvement in bNED survival (84% vs. 71%, P = 0.05) compared with those who were not upstaged due to the upstaged patients having a significantly greater number with a pretreatment PSA < 10 ng/mL. T1c patients were upstaged by imaging in 81% of the 94 patients. The 36-month bNED survival of palpation T1c and imaging T2 patients was similar (88% vs. 88%, P = NS), but both were significantly improved compared with the 36-month bNED survival for palpation T2 patients (88% vs. 71%, P = 0.04). There was no significant difference in 36-month bNED survival for imaging T2c (bilobar disease) patients compared with their original palpation stage disease. Upstaging to T3 occurred in 10% of palpation T1c-T2c patients. There was no difference in 36-month bNED survival for the imaging T3 patients compared with their original palpation stage (84% vs. 71%, respectively, P = 0.04). There was a significant improvement in the 36-month bNED survival for imaging T3 patients compared with palpation T3 patients (84% vs. 50% respectively, P = 0.01). Multivariate analysis demonstrated palpation stage to be a significant predictor of bNED survival (P = 0.001), while AJCC stage (including imaging) is not predictive. CONCLUSIONS: Using the endpoint of bNED survival, upstaging by TRUS/MRI does not separate prostate cancer patients treated with RT into groups with different prognoses. Upon multivariate analysis, palpation stage alone, not AJCC stage including imaging upstaging, is a significant predictor of bNED survival.

Authors
Pinover, WH; Hanlon, A; Lee, WR; Kaplan, EJ; Hanks, GE
MLA Citation
Pinover, WH, Hanlon, A, Lee, WR, Kaplan, EJ, and Hanks, GE. "Prostate carcinoma patients upstaged by imaging and treated with irradiation. An outcome-based analysis." Cancer 77.7 (April 1996): 1334-1341.
PMID
8608512
Source
epmc
Published In
Cancer
Volume
77
Issue
7
Publish Date
1996
Start Page
1334
End Page
1341
DOI
10.1002/(sici)1097-0142(19960401)77:7<1334::aid-cncr17>3.0.co;2-2

Ocular tumoral calcinosis. A clinicopathologic study.

Tumoral calcinosis is a rare systemic disorder characterized by para-articular ectopic soft-tissue calcification. This case report describes the ophthalmic features (palpebral conjunctival calcific nodules, the white limbal girdle of Vogt, disc drusen, and angioid streaks) in a 38-year-old Asian woman who had tumoral calcinosis associated with hyperphosphatemia. A morphologic study of the calcified nodules on the palpebral conjunctiva disclosed deposition of hydroxyapatite crystals in an extracellular matrix (deposit) containing alcianophilic mucopolysaccharides. Excision of the eyelid nodules was not followed by recurrence.

Authors
Ghanchi, F; Ramsay, A; Coupland, S; Barr, D; Lee, WR
MLA Citation
Ghanchi, F, Ramsay, A, Coupland, S, Barr, D, and Lee, WR. "Ocular tumoral calcinosis. A clinicopathologic study." Archives of ophthalmology 114.3 (March 1996): 341-345. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
114
Issue
3
Publish Date
1996
Start Page
341
End Page
345

Amebic keratitis in a wearer of disposable contact lenses due to a mixed Vahlkampfia and Hartmannella infection.

PURPOSE: To support the hypothesis that Acanthamoeba is not a unique cause of amebic keratitis, we report a case of amebic keratitis in which viable Acanthamoeba could not be isolated from corneal tissue. Vahlkampfia and Hartmannella, two other genera of free-living ameba, were isolated, however, using prolonged culture. METHODS: A 24-year-old wearer of soft contact lenses had keratitis. Extensive histologic and microbiologic investigations were performed on corneal scrape, biopsy, and keratoplasty tissue. Contact lenses, storage case, and the home water supply, where contact lens hygiene was practiced, were examined for the presence of micro-organisms. RESULTS: No viruses, pathogenic bacteria, or fungi were detected from corneal tissue samples. Amebae were observed using light and electron microscopy, but these could not be unequivocally classified using immunocytochemical staining. Viable Vahlkampfia and Hartmannella, but no Acanthamoeba, were isolated from the corneal biopsy sample. Indirect immunofluorescence with a range of polyclonal rabbit antisera raised against axenically cultivated stains of the three amebal genera was unhelpful because of cross-reactivity. A diverse range of micro-organisms was present within the storage case, including the three amebal species. Amebic cysts also were associated with the contact lens. CONCLUSION: A mixed non-Acanthamoeba amebic keratitis has been identified in a wearer of soft contact lenses where lack of storage case hygiene provided the opportunity for the free-living protozoa Vahlkampfia and Hartmannella to be introduced to the ocular surface. When Acanthamoeba-like keratitis occurs, but where Acanthamoeba cannot be isolated using conventional laboratory culture methods, alternate means should be used to identify other amebae that may be present. Polyclonal immunofluorescent antibody staining was unreliable for generic identification of pathogenic free-living amebae in corneal tissue.

Authors
Aitken, D; Hay, J; Kinnear, FB; Kirkness, CM; Lee, WR; Seal, DV
MLA Citation
Aitken, D, Hay, J, Kinnear, FB, Kirkness, CM, Lee, WR, and Seal, DV. "Amebic keratitis in a wearer of disposable contact lenses due to a mixed Vahlkampfia and Hartmannella infection." Ophthalmology 103.3 (March 1996): 485-494. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
103
Issue
3
Publish Date
1996
Start Page
485
End Page
494

Prostate carcinoma patients upstaged by imaging and treated with irradiation: An outcome-based analysis

BACKGROUND. The American Joint Committee on Cancer (AJCC) staging of prostate cancer relies upon digital rectal examination (DRE) findings, but suggests using all available information, including prostate imaging studies, prior to definitive treatment of prostate carcinoma. We have studied whether patients upstaged by imaging have a different outcome after treatment with external beam radiation therapy (RT) from those not upstaged. METHODS. The records of 499 men with clinically localized adenocarcinoma of the prostate treated only with definitive external beam irradiation from January 1986 to December 1993 were reviewed. The 348 patients with any one or a combination of the following pretreatment imaging studies were considered eligible; transrectal ultrasound (TRUS), pelvic MRI, or endorectal MRI. Patients were assigned two clinical stages: one based upon palpation criteria alone (palpation stage) and the other allowing for any upstaging by imaging abnormalities (AJCC or imaging stage). The Kaplan-Meier method was used to estimate biochemical no evidence of disease (bNED) survival where a failure was defined as a prostate specific antigen (PSA) greater than 1.5 and increasing. Differences in outcome were evaluated by the log-rank test. RESULTS. Overall upstaging by TRUS or MRI to any higher stage occurred in 115 of 312 palpation T1c-T2c patients (37%). These upstaged patients had an unexpected improvement in bNED survival (84% vs. 71%, P = 0.05) compared with those who were nor upstaged due to the upstaged patients having a significantly greater number with a pretreatment PSA < 10 ng/mL. T1c patients were upstaged by imaging in 81% of the 94 patients. The 36-month bNED survival of palpation T1c anti imaging T2 patients was similar (88% vs. 88%, P = NS), but both were significantly improved compared with the 36-month bNED survival for palpation T2 patients [88% vs. 71%, P = 0.04). There was no significant difference in 36-month bNED survival for imaging T2c (bilobar disease) patients compared with their original palpation stage disease. Upstaging to T3 occurred in 10% of palpation T1c-T2c patients. There was no difference in 36-month bNED survival for the imaging T3 patients compared with their original palpation stage (84% vs. 71%, respectively, P = 0.04). There was a significant improvement in the 36-month bNED survival for imaging T3 patients compared with palpation T3 patients (84% vs. 50% respectively, P = 0.01). Multivariate analysis demonstrated palpation stage to be a significant predictor of bNED survival (P = 0.001), while AJCC stage (including imaging) is not predictive. CONCLUSIONS. Using the endpoint of bNED survival, upstaging by TRUS/MRI does not separate prostate cancer patients treated with RT into groups with different prognoses. Upon multivariate analysis, palpation stage alone, not AJCC stage including imaging upstaging, is a significant predictor of bNED survival.

Authors
Pinover, WH; Hanlon, A; Lee, WR; Kaplan, EJ; Hanks, GE
MLA Citation
Pinover, WH, Hanlon, A, Lee, WR, Kaplan, EJ, and Hanks, GE. "Prostate carcinoma patients upstaged by imaging and treated with irradiation: An outcome-based analysis." Cancer 77.7 (1996): 1334-1341.
Source
scival
Published In
Cancer
Volume
77
Issue
7
Publish Date
1996
Start Page
1334
End Page
1341
DOI
10.1002/(SICI)1097-0142(19960401)77:7<1334::AID-CNCR17>3.0.CO;2-2

Urinary incontinence following external-beam radiotherapy for clinically localized prostate cancer

Objectives. To determine the incidence of urinary incontinence in men with prostate cancer treated with definitive external-beam radiation therapy and to analyze the impact of various patient and treatment variables on the development of urinary incontinence. Methods. The records of all 758 men who received definitive external-beam radiation therapy at our institution between October 1986 and December 1994 were reviewed. The development of incontinence was recorded and graded according to the Late Effects Normal Tissues/Radiation Therapy Oncology Group (LENT/RTOG) scoring system. Results. Late grade 2 or higher urinary incontinence developed in 4 of 758 patients (0.5%) (3 grade 2; 1 grade 3). The actuarial urinary incontinence rate was 1.3% at 5 years. Patients with a history of prior transurethral resection of the prostate (TURP) had higher rates of urinary incontinence than patients without prior TURP (prior TURP 3 of 132 [2%] versus 1 of 626 [0.2%]; P = 0.02). Conclusions. Urinary incontinence following definitive external-beam radiation therapy for clinically localized prostate cancer is a rare event. Previous TURP increases the risk of incontinence, although the risk remains low. There is no evidence that higher doses to the prostate using conformal techniques are associated with an increased risk of urinary incontinence.

Authors
Lee, WR; Schultheiss, TE; Hanlon, AL; Hanks, GE
MLA Citation
Lee, WR, Schultheiss, TE, Hanlon, AL, and Hanks, GE. "Urinary incontinence following external-beam radiotherapy for clinically localized prostate cancer." Urology 48.1 (1996): 95-99.
PMID
8693660
Source
scival
Published In
Urology
Volume
48
Issue
1
Publish Date
1996
Start Page
95
End Page
99
DOI
10.1016/S0090-4295(96)00085-4

Neutron-photon treatment; Modern day Pyrrhic victory? Regarding Haraf et al. IJROBP 33(1):3-14; 1995 [1]

Authors
Hanks, GE; Lee, WR; Haraf, DJ; Weichselbaum, RR
MLA Citation
Hanks, GE, Lee, WR, Haraf, DJ, and Weichselbaum, RR. "Neutron-photon treatment; Modern day Pyrrhic victory? Regarding Haraf et al. IJROBP 33(1):3-14; 1995 [1]." International Journal of Radiation Oncology Biology Physics 34.3 (1996): 757--.
PMID
8621304
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
34
Issue
3
Publish Date
1996
Start Page
757-

Conformal technique dose escalation for prostate cancer: Biochemical evidence of improved cancer control with higher doses in patients with pretreatment Prostate-Specific Antigen ≤10 ng/ml

Purpose: Conformal radiation technology results in fewer late complications and allows testing of the value of higher doses in prostate cancer. Methods and Materials: We report the biochemical freedom from disease (bNED) rates (bNED failure is Prostate Specific Antigen (PSA) ≤1.5 ng/ml and rising) at 2 and 3 years for 375 consecutive patients treated with conformal technique from 66 to 79 Gy. Median follow-up was 21 months. Biochemical freedom from disease was analyzed for patients treated above and below 71 Gy as well as above and below 73 Gy. Each dose group was subdivided by pretreatment PSA level (<10, 10-19.9, and ≤20 ng/ml). Dose was stated to be at the center of the prostate gland. Results: There was significant improvement in bNED survival for all patients divided by a dose above or below 71 Gy (p = 0.007) and a marginal improvement above or below 73 Gy (p = 0.07). Subdividing by pretreatment PSA level showed no benefit to the PSA < 10 ng/ml group at the higher dose but there was a significant improvement at 71 and 73 Gy for pretreatment PSA 10-19.9 ng/ml (p = 0.03 and 0.05, respectively) and for pretreatment PSA ≤20 ng/ml (p = 0.003 and 0.02, respectively). Conclusions: Increasing dose above 71 or 73 Gy did not result in improved bNED survival for patients with pretreatment PSA < 10 ng/ml at 2 or 3 years. Further dose escalation studies may not be useful in these patients. A significant improvement in bNED survival was noted for patients with pretreatment PSA ≤10 ng/ml treated above 71 or 73 Gy; further dose escalation studies are warranted.

Authors
Hanks, GE; Lee, WR; Hanlon, AL; Hunt, M; Kaplan, E; Epstein, BE; Movsas, B; Schultheiss, TE
MLA Citation
Hanks, GE, Lee, WR, Hanlon, AL, Hunt, M, Kaplan, E, Epstein, BE, Movsas, B, and Schultheiss, TE. "Conformal technique dose escalation for prostate cancer: Biochemical evidence of improved cancer control with higher doses in patients with pretreatment Prostate-Specific Antigen ≤10 ng/ml." International Journal of Radiation Oncology Biology Physics 35.5 (1996): 861-868.
PMID
8751393
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
35
Issue
5
Publish Date
1996
Start Page
861
End Page
868
DOI
10.1016/0360-3016(96)00207-6

Lateral rectal shielding reduces late rectal morbidity following high dose three-dimensional conformal radiation therapy for clinically localized prostate cancer: Further evidence for a significant dose effect

Purpose: Using conventional treatment methods for the treatment of clinically localized prostate cancer central axis doses must be limited to 65-70 Gray (Gy) to prevent significant damage to nearby normal tissues. A fundamental hypothesis of three-dimensional conformal radiation therapy (3DCRT) is that, by defining the target organ(s) accurately in three dimensions, it is possible to deliver higher doses to the target without a significant increase in normal tissue complications. This study examines whether this hypothesis holds true and whether a simple modification of treatment technique can reduce the incidence of late rectal morbidity in patients with prostate cancer treated with 3DCRT to minimum planning target volume (PTV) doses of 71-75 Gy. Methods and Materials; The 257 patients with clinically localized prostate cancer who completed 3DCRT by December 31, 1993 and received a minimum PTV dose of 71-75 Gy are included in this report. The median follow-up time was 22 months (range: 4-67 months); 98% of patients had follow-up of longer than 12 months. The calculated dose at the center of the prostate was < 74 Gy in 19 patients, 74-76 Gy in 206 patients, and > 76 Gy in 32 patients. Late rectal morbidity was graded according to the Late Effects Normal Tissue (LENT) scoring system. Eighty-eight consecutive patients were treated with a rectal block added to the lateral fields. In these patients the posterior margin from the prostate to the block edge was reduced from the standard 15 to 5 mm for the final 10 Gy, which reduced the dose to portions of the anterior rectal wall by approximately 4-5 Gy. Estimates of rates for rectal morbidity were determined by Kaplan-Meier actuarial analyses. Differences in morbidity percentages were evaluated by the Pearson chi-square test. Results: Grade 2-3 rectal morbidity developed in 46 out of 257 patients (18%) and in the majority of cases consisted of rectal bleeding. No patient has developed Grade 4 or 5 rectal morbidity. The actuarial rate of Grade 2-3 morbidity is 23% at 24 months and the median time to the development of Grade 2-3 complications is 15 months. A statistically significant dose effect is evident. The incidence of Grade 2-3 rectal morbidity increased as the dose at the center of the prostate increased (p = 0.05). In patients receiving minimum PTV doses of ≤ 76 Gy the use of a rectal block significantly reduced the incidence of Grade 2-3 toxicity; 6 out of 88 (7%) with a block vs. 30 out of 137 (22%) without a block, (p = 0.003). Conclusion: The incidence of late rectal morbidity with 3DCRT to minimum PTV doses of 71-75 Gy is acceptable and to date no Grade 4-5 rectal morbidities have been observed. In our experience, higher doses to the center of the prostate are associated with an increased likelihood of developing Grade 2-3 rectal morbidity but treatment techniques that reduce the total dose to the anterior rectal wall have reduced the incidence of late rectal morbidity. If clinical studies indicate improved tumor control with minimum PTV doses above 71 Gy, then dose escalation above 76 Gy to the center of the prostate should be pursued cautiously with treatment techniques that limit the total dose to the anterior rectal wall.

Authors
Lee, WR; Hanks, GE; Hanlon, AL; Schultheiss, TE; Hunt, MA
MLA Citation
Lee, WR, Hanks, GE, Hanlon, AL, Schultheiss, TE, and Hunt, MA. "Lateral rectal shielding reduces late rectal morbidity following high dose three-dimensional conformal radiation therapy for clinically localized prostate cancer: Further evidence for a significant dose effect." International Journal of Radiation Oncology Biology Physics 35.2 (1996): 251-257.
PMID
8635930
Source
scival
Published In
International Journal of Radiation Oncology Biology Physics
Volume
35
Issue
2
Publish Date
1996
Start Page
251
End Page
257
DOI
10.1016/0360-3016(96)00064-8

Young patients with prostate cancer have an outcome justifying their treatment with external beam radiation

Purpose: The majority of young patients with early stage prostate cancer in the United States are treated with radical prostatectomy. To determine whether this preference for surgical care is justified, we analyzed by patient age the survival without biochemical evidence of disease (bNED) of men with clinically organ-confined prostate cancer treated with external beam irradiation. Methods and Materials: One hundred and sixty-nine men with clinical stages T1-2 adenocarcinoma of the prostate received external beam radiation therapy alone at Fox Chase Cancer Center. All patients had serum prostate-specific antigen (PSA) values less than 10 ng/ml prior to initiation of treatment. Out of 169 patients, 167 had unstaged regional nodes (NX) and all had no evidence for distant metastasis (M0). The median age was 69 years. Criteria for bNED survival were posttreatment serum PSA ≤1.5 ng/ml and not rising on two consecutive values. The median follow-up is 35 months. Results: The actuarial 5-year bNED survival of all 169 patients was 85%. The bNED survival of patients less than 65 was not significantly different than that of patients 65 and older (89 vs. 84%, respectively). Patient age, American Joint Committee on Cancer (AJCC) stage, palpation stage, Gleason score, and dose to the center of the prostate were not found to be significant predictors of bNED survival on multivariate analysis. Conclusion: Our results using strict biochemical endpoints are comparable to reported series of similarly staged men treated with prostatectomy. In addition, the patient age of less than 65 is not a prognostic factor for worse outcome after radiation therapy. Young patients with clinically organ-confined prostate cancer who are fully informed of their treatment options can be appropriately accepted for external beam treatment.

Authors
Freedman, GM; Hanlon, AL; Lee, WR; Hanks, GE
MLA Citation
Freedman, GM, Hanlon, AL, Lee, WR, and Hanks, GE. "Young patients with prostate cancer have an outcome justifying their treatment with external beam radiation." International Journal of Radiation Oncology Biology Physics 35.2 (1996): 243-250.
PMID
8635929
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
35
Issue
2
Publish Date
1996
Start Page
243
End Page
250
DOI
10.1016/0360-3016(96)00017-X

Pretreatment prostate-specific antigen doubling times: Clinical utility of this predictor of prostate cancer behavior

Purpose: The distribution of pretreatment and posttreatment prostate specific antigen (PSA) doubling times (PSADT) varies widely. This report examines the pretreatment PSADT as an independent predictor of biochemical freedom from disease (bNED) and describes the clinical utility of PSADT. Methods and Materials: Ninety-nine patients with T1-3 NX, M-0 prostate cancer treated between February 1989 and November 1993 have pretreatment PSADTs calculated from three or more PSA levels. Biochemical disease-free (bNED) survival (failure is PSA ≥ 1.5 ngm/ml and rising) is evaluated by multivariate analysis of common prognostic indicators and PSADT. Results: Prostate-specific antigen doubling time (PSADT) is a significant predictor of survival along with radiation dose. Patients with a pretreatment PSADT of < 12 months show 50% failure by 18 months, while those with a PSADT that is not increasing show only 3% failure at 3 years. Conclusions: Prostate-specific antigen doubling time (PSADT) is a predictor of bNED outcome in prostate cancer. Patients with PSADT < 12 months have aggressive disease and should be considered for multimodal therapy. Slow PSADT (≥ 5 years) is observed in 57% of patients, and this end point may be considered in the decision to observe rather than to treat. After treatment failure, the PSADT may be used to determine which patients do not need immediate androgen deprivation.

Authors
Hanks, GE; Hanlon, AL; Lee, WR; Slivjak, A; Schultheiss, TE
MLA Citation
Hanks, GE, Hanlon, AL, Lee, WR, Slivjak, A, and Schultheiss, TE. "Pretreatment prostate-specific antigen doubling times: Clinical utility of this predictor of prostate cancer behavior." International Journal of Radiation Oncology Biology Physics 34.3 (1996): 549-553.
PMID
8621277
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
34
Issue
3
Publish Date
1996
Start Page
549
End Page
553
DOI
10.1016/0360-3016(95)02154-X

Do the results of systematic biopsies predict outcome in patients with T1-T2 prostate cancer treated with radiation therapy alone?

Objectives. The present study examines whether findings from systematic biopsies add any prognostic information in men with clinical Stage T1-T2 prostate cancer treated with external beam radiation therapy alone. Methods. Seventy-two men with clinical T1-T2 prostate cancer had ultrasound-guided quadrant or sextant prostate biopsies prior to treatment with external beam radiotherapy alone between January 1, 1988 and December 31, 1993, The median follow-up is 23 months (range, 11 to 65). Biochemical failure after irradiation was defined as a prostate-specific antigen (PSA) greater than 1.5 ng/mL (Hybritech assay) and rising. Results. The biochemical relapse-free survival was 90% at 36 months. The percentage of biopsies involved by cancer was not predictive of biochemical relapse-free survival on univariate analysis. Patients with less than 50% positive biopsies had similar biochemical relapse-free survival at 36 months compared to patients with 50% or more positive biopsies (93% versus 89%; P = 0.80). After stratifying according to pretreatment PSA level, the percentage of positive biopsies was not prognostic. A multivariate analysis demonstrated that pretreatment PSA level was the only variable that predicted relapse-free survival (P = 0.01). Conclusions: At present, the results of ultrasound-guided quadrant or sextant biopsies do not add further prognostic information, beyond that provided by the pretreatment PSA level, in patients with T1-T2 prostate cancer treated with radiation therapy alone. Further follow-up will be required to confirm these results.

Authors
Lee, WR; Hanlon, A; Hanks, GE
MLA Citation
Lee, WR, Hanlon, A, and Hanks, GE. "Do the results of systematic biopsies predict outcome in patients with T1-T2 prostate cancer treated with radiation therapy alone?." Urology 47.5 (1996): 704-707.
PMID
8650869
Source
scival
Published In
Urology
Volume
47
Issue
5
Publish Date
1996
Start Page
704
End Page
707
DOI
10.1016/S0090-4295(96)00015-5

Short communication: CT-MRI image fusion for 3D conformal prostate radiotherapy: Use in patients with altered pelvic anatomy

We describe the application of CT-MRI fusion software for 3D conformal radiotherapy in two patients with localized prostate cancer who had significantly altered pelvic anatomy due to prior surgery. Patient A had a hemipelvectomy for fibrosarcoma and Patient B had an abdominoperineal resection (APR) for rectal carcinoma. Using the Picker AcQSIM 3D treatment planning software equipped with C-T-MRI fusion capabilities, we were able to construct 3D conformal treatment plans for the two patients. The CT-MRI fusion was invaluable in the 3D conformal treatment planning of these cases with distorted pelvic anatomy. It allowed for accurate identification of the clinical target volume (CTV) and was also able to better visualize normal structures so that the radiation beams could be placed to minimize toxicity to the normal tissues.

Authors
Lau, HY; Kagawa, K; Lee, WR; Hunt, MA; Shaer, AH; Hanks, GE
MLA Citation
Lau, HY, Kagawa, K, Lee, WR, Hunt, MA, Shaer, AH, and Hanks, GE. "Short communication: CT-MRI image fusion for 3D conformal prostate radiotherapy: Use in patients with altered pelvic anatomy." British Journal of Radiology 69.828 (1996): 1165-1170.
PMID
9135474
Source
scival
Published In
British Journal of Radiology
Volume
69
Issue
828
Publish Date
1996
Start Page
1165
End Page
1170

Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of the glottic larynx?

Purpose: To evaluate treatment and patient related prognostic factors that may influence local control in the treatment of T1-T2 squamous cell carcinoma of the glottic larynx. Methods and Materials: One hundred nine patients with invasive, previously untreated T1-T2 squamous cell carcinoma of the glottic larynx were treated with curative intent with radiotherapy at the Fox Chase Cancer Center between June 1980 and November 1991. Follow-up ranged from 26- 165 months (mean 83 months). Results: The 2-year local control rates for patients with T1 and T2 lesions were 89% and 80%, respectively. The 2-year local control rate for patients whose overall treatment time was < 50 days was 92% vs. 82% for patients whose overall treatment time was > 50 days (p = 0.07). The 2-year local control rate for patients treated with an irradiated area < 36 cm2 was 90% compared to 86% in patients who were treated to an area ≥ 36 cm2. The 2-year local control rate for patients treated with 60Co was 83% vs. 92% for patients treated with 6 MV x-ray. Cox proportional hazards regression analysis was performed using the following variables: treatment energy, irradiated area, gender, tobacco pack years, tumor differentiation, overall treatment time, total dose, dose per fraction, and T stage. Overall treatment time (p = 0.05) was the only variable that significantly influenced local control. Conclusion: Extending the overall treatment time was found to adversely influence local control. Neither the irradiated area nor treatment energy was found to influence local control in early stage vocal cord carcinoma.

Authors
Fein, DA; Lee, WR; Hanlon, AL; Ridge, JA; Jr, WJC; Coia, LR
MLA Citation
Fein, DA, Lee, WR, Hanlon, AL, Ridge, JA, Jr, WJC, and Coia, LR. "Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of the glottic larynx?." International Journal of Radiation Oncology Biology Physics 34.4 (1996): 823-831.
PMID
8598359
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
34
Issue
4
Publish Date
1996
Start Page
823
End Page
831
DOI
10.1016/0360-3016(95)02205-8

Systematic biopsies: Do they add prognostic information in men with clinically localized prostate cancer treated with radiation therapy alone?

PURPOSE: To determine whether systematic biopsy can help predict treatment outcome in men with clinically localized prostate cancer treated with external-beam radiation therapy alone. MATERIALS AND METHODS: Two hundred twenty-four men with clinically localized prostate cancer underwent ultrasound-guided systematic biopsies before undergoing external-beam radiation therapy. Median follow-up was 25 (range, 4-80) months. Treatment failure after irradiation was defined as a prostate-specific antigen (PSA) level greater than 1.5 ng/mL and rising. RESULTS: Univariate analysis demonstrated that the percentage of biopsy specimens involved by cancer was predictive of relapse-free survival. Patients in whom more than 50% of biopsy specimens were positive had significantly lower relapse-free survival rates at 36 months than patients with 50% or fewer positive biopsy specimens. After stratifying patients according to pretreatment PSA level, however, the percentage of positive biopsy specimens was no longer prognostic. Multivariate analysis demonstrated that pretreatment PSA level was the only variable that enabled prediction of relapse-free survival. CONCLUSION: Systematic biopsy added little further prognostic information beyond that provided by pretreatment PSA level. A larger series with longer follow-up is necessary to verify these results.

Authors
Lee, WR; Hanlon, AL; Hanks, GE
MLA Citation
Lee, WR, Hanlon, AL, and Hanks, GE. "Systematic biopsies: Do they add prognostic information in men with clinically localized prostate cancer treated with radiation therapy alone?." Radiology 198.2 (1996): 439-442.
PMID
8596846
Source
scival
Published In
Radiology
Volume
198
Issue
2
Publish Date
1996
Start Page
439
End Page
442

Patterns-of-Failure Analysis of Patients with High Pretreatment Prostate-Specific Antigen Levels Treated by Radiation Therapy: The Need for Improved Systemic and Locoregional Treatment

Purpose: The patterns of failure (local and/or regional v metastatic) have been determined for patients with prostate cancer and pretreatment prostate-specific antigen (PSA) levels ≥ 20 ng/mL treated with radiation alone with the purpose to design appropriate multimodal treatments. Materials and Methods: One hundred twenty patients with pretreatment PSA levels ≥ 20 ng/mL were treated with external-beam radiation alone between February 1988 and October 1993. They were arbitrarily divided by PSA levels, 20 to 29.9 ng/mL, 30 to 49.9 ng/ mL, and ≥ 50 ng/mL, and analyzed in terms of freedom from any failure (no evidence of biochemical disease [bNED], and PSA level < 1.5 ngm/mL and not increasing), as well as freedom from imaging evidence of distant metastasis (fdm). Results: There was no significant difference in short-term outcome by pretreatment PSA level, and thus all patients were pooled for analysis. At 4 years, 81% were fdm and 28% were free of any failure. This suggests that approximately 50% have recurred with local and/or regional disease or undetectable metastatic disease. Multivariate analysis indicated that low palpation stage and higher center of prostate dose were associated with better bNED survival. Multivariate analysis indicated that increasing stage and younger age are significantly associated with increasing distant metastasis. Conclusion: Patients with pretreatment PSA levels ≥ 20 ng/mL are not optimally treated by irradiation alone. The pattern of failure suggests improvement may come from systemic treatment of metastatic disease and high-dose radiation to improve locoregional disease. To evaluate this, we have begun a multimodal trial of chemohormonal therapy followed by extended-field irradiation. © 1996 by American Society of Clinical Oncology.

Authors
Hanks, GE; Hanlon, AL; Hudes, G; Lee, WR; Suasin, W; Schultheiss, TE
MLA Citation
Hanks, GE, Hanlon, AL, Hudes, G, Lee, WR, Suasin, W, and Schultheiss, TE. "Patterns-of-Failure Analysis of Patients with High Pretreatment Prostate-Specific Antigen Levels Treated by Radiation Therapy: The Need for Improved Systemic and Locoregional Treatment." Journal of Clinical Oncology 14.4 (1996): 1093-1097.
PMID
8648362
Source
scival
Published In
Journal of Clinical Oncology
Volume
14
Issue
4
Publish Date
1996
Start Page
1093
End Page
1097

Oropharyngeal carcinoma treated with radiotherapy: A 30-year experience

Purpose: This study was done to determine the outcome in patients with oropharyngeal carcinoma treated at the University of Florida with radiotherapy alone to the primary site, for comparison with reported results of other types of treatment. Methods and Materials: Of a consecutive cohort of 785 patients with biopsy-proven, previously untreated, invasive squamous cell carcinoma of the oropharynx, this report is based on the 490 patients who had continuous-course irradiation with curative intent at the University of Florida between October 1964 and January 1991. All patients had a minimum 2-year follow-up. Forty-eight percent had Stage T3 or T4 disease, and 64% had clinically apparent neck node metastases. The median radiation dose was 68 Gy for once-a-day treatment and 76.8 Gy for twice-a-day treatment. Patients with advanced neck node disease had planned neck dissection(s) after radiotherapy. Results: The overall local control rate after radiotherapy alone was 73%. The ultimate local control rate (including surgical salvage) was 78%. At 5 years, the probability of control of neck disease was 85%; control above the clavicles, 67%; absolute survival, 44%; cause-specific survival, 77%; distant metastasis (as the first or only site of failure), 11%. Thirteen patients (2.6%) experienced severe treatment complications. Conclusion: Radiotherapy results in tumor control and survival rates comparable with rates achieved with combined irradiation and surgery, with less morbidity.

Authors
Fein, DA; Lee, WR; Amos, WR; Hinerman, RW; Parsons, JT; Mendenhall, WM; Stringer, SP; Cassisi, NJ; Million, RR
MLA Citation
Fein, DA, Lee, WR, Amos, WR, Hinerman, RW, Parsons, JT, Mendenhall, WM, Stringer, SP, Cassisi, NJ, and Million, RR. "Oropharyngeal carcinoma treated with radiotherapy: A 30-year experience." International Journal of Radiation Oncology Biology Physics 34.2 (1996): 289-296.
PMID
8567328
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
34
Issue
2
Publish Date
1996
Start Page
289
End Page
296
DOI
10.1016/0360-3016(95)02028-4

Prostate specific antigen nadir following external beam radiation therapy for clinically localized prostate cancer: The relationship between nadir level and disease-free survival

Purpose: We determined whether the prostate specific antigen (PSA) nadir achieved following external beam radiation therapy alone predicts biochemical disease-free survival in a large cohort of men with clinically localized prostate cancer. Materials and Methods: Between January 1986 and October 1993, 364 men with clinically localized, stages T1 to T3 adenocarcinoma of the prostate received definitive external beam radiation therapy with no prior, concomitant or adjuvant endocrine therapy. PSA was measured before treatment in 326 men (90%) and serial PSA was measured following treatment in all patients. All men were followed continuously for at least 24 months (median 44 months, range 24 to 90, mean 46). Biochemical failure after irradiation was defined as PSA of 1.5 ng./ml. or more and 2 consecutive serum PSA elevations. Results: The 5-year overall biochemical disease-free survival rate for the entire group was 56%. PSA nadir was predictive of subsequent biochemical disease-free survival. The biochemical disease-free survival rate at 3 years was 93, 49 and 16% for PSA nadirs of O to 0.99, 1 to 1.99 and 2 or more ng./ml., respectively (p = 0.0001). In a multivariate analysis PSA nadir (0 to 0.99 versus 1.0 to 1.99 versus 2 or more ng./ml.) was an independent predictor of biochemical disease-free survival along with pretreatment PSA, central axis dose, Gleason grade and T stage. Conclusions: PSA nadir after radiation therapy is an indicator of subsequent biochemical disease-free survival. Patients who achieve a nadir of less than 1 ng./ml. following external beam radiation therapy have a favorable biochemical disease-free survival rate, while those with a nadir of greater than 1 ng./ml. have a high subsequent failure rate. Strategies to improve results should focus on techniques to increase the likelihood of achieving a PSA nadir of less than 1 ng./ml.

Authors
Lee, WR; Hanlon, AL; Hanks, GE
MLA Citation
Lee, WR, Hanlon, AL, and Hanks, GE. "Prostate specific antigen nadir following external beam radiation therapy for clinically localized prostate cancer: The relationship between nadir level and disease-free survival." Journal of Urology 156.2 (1996): 450-453.
PMID
8683700
Source
scival
Published In
Journal of Urology
Volume
156
Issue
2
Publish Date
1996
Start Page
450
End Page
453

Pretreatment serum prostate-specific antigen (PSA) level and PSA doubling times (PSADT) in black and white men with prostate cancer referred for radiation therapy

Numerous racial differences have been reported for carcinoma of the prostate diagnosed in African-American (AA) men when compared to whites. These differences include: (1) a higher incidence in AA compared to whites, (2) a more advanced stage at diagnosis in AA, and (3) higher mortality rates in AA even after adjusting for clinical stage. We examined pretreatment serum PSA levels and calculated PSA doubling times (PSADT) in men referred for radiation therapy with clinically localized prostate cancer and determined if there are any discernible differences between AA and whites. 739 men (670 whites, 69 AA) with histologically proven nonmetastatic prostate cancer who were referred for radiation therapy had a pretreatment serum PSA level (Hybritech assay) available at the rime of referral. PSADT were calculated by linear regression for 251 of these men (221 whites, 30 AA) who had at least three serum PSA values obtained prior to the start of definitive therapy. Differences in percentages for grouped pretreatment PSA and PSADT between AA and whites were evaluated by the Pearson chi-square test. The pretreatment serum PSA level was higher for AA than whites in patients with T1-2 tumors. One hundred eighty-three of the 251 patients (73%) with serial PSA determinations were noted to have rising values. Of the patients with rising PSA values, the calculated PSADT was less than 2 years in 39% of white patients and 56% of AA patients (P = .14). Conclusions: African-American men with organ-confined prostate cancer referred for radiation therapy had evidence of a higher volume of disease at diagnosis than whites. In patients with serial PSA levels that were noted to rise, there were no discernible differences between AA and whites, although the number of patients is relatively small and further follow-up is necessary.

Authors
Lee, WR; Hanks, GE; Hanlon, A; Schultheiss, TE
MLA Citation
Lee, WR, Hanks, GE, Hanlon, A, and Schultheiss, TE. "Pretreatment serum prostate-specific antigen (PSA) level and PSA doubling times (PSADT) in black and white men with prostate cancer referred for radiation therapy." Radiation Oncology Investigations 4.3 (1996): 135-139.
Source
scival
Published In
Radiation Oncology Investigations
Volume
4
Issue
3
Publish Date
1996
Start Page
135
End Page
139
DOI
10.1002/(SICI)1520-6823(1996)4:3<135::AID-ROI6>3.0.CO;2-Z

Abnormal extracellular material in the levator palpebrae superioris complex in congenital ptosis.

OBJECTIVE: To determine the pathologic abnormalities of the levator palpebrae superioris in congenital ptosis. METHODS: By means of light and electron microscopy and immunohistochemistry, anterior levator tissue specimen from 15 patients with congenital ptosis excised during routine levator resections were examined. RESULTS: All specimens showed lack of muscle fibers with endomysial and perimysial fibrosis and thickening of the aponeurosis. In addition, in four of the 15 patients, an abnormal extracellular material was present. By light microscopy this appeared as an unusual amorphous material arranged in clumps and bands, and electron microscopy showed it to consist of parallel coarse bundles of fibrillogranular material. Collagen type III and fibronectin were identified within this material by immunohistochemistry. There was no detectable collagen types I, II, IV, V, VI, or VII or laminin, and the material did not stain for actin, myosin, myoglobin, amyloid P component, or amyloid A. CONCLUSIONS: In four of 15 samples of levator palpebrae superioris from patients with congenital ptosis, we identified an unusual amorphous extracellular material that stained positively for collagen type III and fibronectin on immunohistochemistry. This novel material, which we call "amorphocollagenoid," may represent a product of dysgenesis of the levator tissues. The source and full composition of this material merit further study.

Authors
Clark, BJ; Kemp, EG; Behan, WM; Lee, WR
MLA Citation
Clark, BJ, Kemp, EG, Behan, WM, and Lee, WR. "Abnormal extracellular material in the levator palpebrae superioris complex in congenital ptosis." Archives of ophthalmology 113.11 (November 1995): 1414-1419. (Academic Article)
Source
manual
Published In
Archives of Ophthalmology
Volume
113
Issue
11
Publish Date
1995
Start Page
1414
End Page
1419

Mutation spectrum of 2-chloroethyl methanesulfonate in Drosophila melanogaster premeiotic germ cells.

The 2-chloroethyl methanesulfonate (2ClEMS)-induced alcohol dehydrogenase (Adh) null germline mutation frequency in treated Drosophila melanogaster second instar larval gonia was two orders of magnitude greater than the spontaneous mutation frequency. DNA sequence analysis of 83 Adh null mutations showed that 40 mutations of independent origin were at 23 sites in the Adh gene. The mutation spectrum contained only GC-->AT transitions with 35 mutations (87.5%) at the middle or 3' guanine. In addition, characteristics of glutathione (GSH)-mediated bioactivation were determined for 2ClEMS in vitro. Rates of GSH-mediated conjugation, catalyzed by purified rat liver glutathione-S-transferase (GST), and binding of [35S]GSH-mediated conjugation products to calf thymus DNA were determined for 2ClEMS, 1,2-dichloroethane (EDC) and 1,2-dibromoethane (EDB). The relative rates of GSH-mediated conjugation were the following: 5 mM EDB > 40 mM 2ClEMS > 40 mM EDC. A similar trend was observed for DNA binding of the [35S]GSH-mediated conjugation products when differences in mutagen concentration were considered: EDB > 2ClEMS > EDC. The ratios of DNA binding to GSH conjugation calculated for EDB, EDC and 2ClEMS were 6.8 x 10(-5), 9.3 x 10(-5) and 19.1 x 10(-5), respectively. A narrow range, less than a 3-fold difference, in the ratios of DNA binding to GSH conjugation indicates that the bioactivation of 2ClEMS is mediated by the same mechanism as EDB and EDC. Consequently, 2ClEMS, EDC and EDB may induce a specific mutation in premeiotic germ cells.

Authors
Fossett, NG; Byrne, BJ; Tucker, AB; Arbour Reily, P; Chang, S; Lee, WR
MLA Citation
Fossett, NG, Byrne, BJ, Tucker, AB, Arbour Reily, P, Chang, S, and Lee, WR. "Mutation spectrum of 2-chloroethyl methanesulfonate in Drosophila melanogaster premeiotic germ cells." Mutation research 331.2 (October 1995): 213-224. (Academic Article)
Source
manual
Published In
Mutation Research - Fundamental and Molecular Mechanisms of Mutagenesis
Volume
331
Issue
2
Publish Date
1995
Start Page
213
End Page
224

Clinical and biochemical evidence of control of prostate cancer at 5 years after external beam radiation.

PURPOSE: We demonstrate the 5-year survival rate for patients with prostate cancer treated by irradiation, the value of the conformal technique and prostate specific antigen (PSA) doubling times after irradiation. MATERIALS AND METHODS: The outcome of 502 consecutive patients with stages T1 to T3 prostate cancer treated by irradiation alone is reported. PSA doubling times before and after failure are reported for 13 patients and posttreatment PSA doubling times are reported for 93 consecutive patients in whom radiation failed. RESULTS: The actuarial survival with biochemical freedom from disease (PSA nadir 1.5 or less not increasing) at 5 years was 44% for all patients, 50% for the conformal treatment group and 39% for the conventional therapy group. PSA doubling times after radiation failure were variable, with 42% greater than 12 months. CONCLUSIONS: The 5-year survival rate for patients with prostate cancer treated by irradiation is excellent. The conformal technique is superior to conventional therapy and there is no evidence that irradiation accelerates the growth rate of prostate cancer.

Authors
Hanks, GE; Lee, WR; Schultheiss, TE
MLA Citation
Hanks, GE, Lee, WR, and Schultheiss, TE. "Clinical and biochemical evidence of control of prostate cancer at 5 years after external beam radiation." The Journal of urology 154.2 Pt 1 (August 1995): 456-459. (Academic Article)
Source
manual
Published In
The Journal of Urology
Volume
154
Issue
2 Pt 1
Publish Date
1995
Start Page
456
End Page
459

Amino acids important in enzyme activity and dimer stability for Drosophila alcohol dehydrogenase.

We have determined the nucleotide sequences of eight ethyl methanesulphonate-induced mutants in Drosophila alcohol dehydrogenase (ADH), of which six were previously characterized by Hollocher and Place [(1988) Genetics 116, 253-263 and 265-274]. Four of these ADH mutants contain a single amino acid change: glycine-17 to arginine, glycine-93 to glutamic acid, alanine-159 to threonine, and glycine-184 to aspartic acid. Although these mutants are inactive, three mutants (Gly17Arg, Gly93Glu and Gly184Asp) form stable homodimers, as well as heterodimers with wild-type ADH, in which the wild-type ADH subunit retains full enzyme activity [Hollocher and Place (1988) Genetics 116, 265-274]. Interestingly, the Ala159Thr mutant does not form either stable homodimers or heterodimers with wild-type ADH, suggesting that alanine-159 is important in stabilizing ADH dimers. The mutations were analysed in terms of a three-dimensional model of ADH using bacterial 20 beta-hydroxysteroid dehydrogenase and rat dihydropteridine reductase as templates. The model indicates that mutations in glycine-17 and glycine-93 affect the binding of NAD+. It also shows that alanine-159 is part of a hydrophobic anchor on the dimer interface of ADH. Replacement of alanine-159 with threonine, which has a larger side chain and can hydrogen bond with water, is likely to reduce the strength of the hydrophobic interaction. The three-dimensional model shows that glycine-184 is close to the substrate binding site. Replacement of glycine-184 with aspartic acid is likely to alter the position of threonine-186, which we propose hydrogen bonds to the carboxamide moiety of NAD+. Also, the negative charge on the aspartic acid side chain may interact with the substrate and/or residues in the substrate binding site. These mutations provide information about ADH catalysis and the stability of dimers, which may also be useful in understanding homologous dehydrogenases, which include the human 17 beta-hydroxysteroid, 11 beta-hydroxysteroid and 15-hydroxyprostaglandin dehydrogenases.

Authors
Chenevert, SW; Fossett, NG; Chang, SH; Tsigelny, I; Baker, ME; Lee, WR
MLA Citation
Chenevert, SW, Fossett, NG, Chang, SH, Tsigelny, I, Baker, ME, and Lee, WR. "Amino acids important in enzyme activity and dimer stability for Drosophila alcohol dehydrogenase." The Biochemical journal 308 ( Pt 2) (June 1995): 419-423. (Academic Article)
Source
manual
Published In
The Biochemical journal
Volume
308 ( Pt 2)
Publish Date
1995
Start Page
419
End Page
423

Misleading aspiration biopsy in combined intraocular pathology.

Authors
Sekundo, W; Lee, WR; Hammer, HM
MLA Citation
Sekundo, W, Lee, WR, and Hammer, HM. "Misleading aspiration biopsy in combined intraocular pathology." The British journal of ophthalmology 79.5 (May 1995): 502-503. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
79
Issue
5
Publish Date
1995
Start Page
502
End Page
503

Do the current subclassifications of stage T3 adenocarcinoma of the prostate have clinical relevance?

OBJECTIVES. To compare the outcome of patients with T3a and T3c adenocarcinoma of the prostate and determine the utility of these substages as defined in the current American Joint Committee on Cancer and the International Union Against Cancer (AJCC/UICC) staging system. METHODS. An analysis was performed of patients with T3 (clinical) prostate cancer treated with definitive irradiation at the Fox Chase Cancer Center between 1986 and 1993. The series was composed of 66 patients with T3a tumors and 44 patients with T3c tumors. The endpoints studied included freedom from biochemical relapse (bNED) and rates of clinical local and distant failure. RESULTS. No statistically significant differences in freedom from biochemical relapse were observed when comparing patients with T3a and T3c disease (3 years bNED, 41%; difference not significant). Similarly, there was no difference in the patterns of clinical failure at 3 years when comparing patients with T3a and T3c disease (21% clinically detected distant metastases;

Authors
Corn, BW; Hanks, GE; Lee, WR; Schultheiss, T
MLA Citation
Corn, BW, Hanks, GE, Lee, WR, and Schultheiss, T. "Do the current subclassifications of stage T3 adenocarcinoma of the prostate have clinical relevance?." Urology 45.3 (March 1995): 484-489. (Academic Article)
PMID
7533460
Source
manual
Published In
Urology
Volume
45
Issue
3
Publish Date
1995
Start Page
484
End Page
489

Ultrastructural study of the corneal epithelium in the recurrent erosion syndrome.

BACKGROUND--This study describes the adhesion systems in the corneal epithelium in the recurrent erosion syndrome and the mechanisms by which binucleate and multinucleate cells are formed within the epithelium. METHODS--Twenty five samples of sliding epithelium were obtained from 23 patients and were examined by conventional light and transmission electron microscopy. RESULTS--The separation of the anchoring system occurred either below the level of the anchoring plaques or at the level of the epithelial cell membrane. Normal and degenerate polymorphonuclear leucocytes were found within and between the epithelial cells and within the anchoring layer. Binucleate and multinucleate cells were found within all the layers of the epithelium as were cysts containing degenerate cellular material. CONCLUSION--The presence of leucocytes and degenerate epithelial cells within the sliding epithelium suggests that these are the source of the metalloproteinases which cleave Bowman's layer below the anchoring system. The formation of binucleate and multinucleate giant cells does not appear to occur by fusion of adjacent cells, but rather by nuclear indentation and cleaving due to an abnormal microtubular system in the cytoskeleton.

Authors
Aitken, DA; Beirouty, ZA; Lee, WR
MLA Citation
Aitken, DA, Beirouty, ZA, and Lee, WR. "Ultrastructural study of the corneal epithelium in the recurrent erosion syndrome." The British journal of ophthalmology 79.3 (March 1995): 282-289. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
79
Issue
3
Publish Date
1995
Start Page
282
End Page
289

Hydrogen peroxide induces microvilli on human retinal pigment epithelial cells in culture.

We have found that hydrogen peroxide (10(-4)-10(-2) M) rapidly induces microvilli on separate cells and confluent sheets of human retinal pigment epithelium in culture. t-butyl hydroperoxide and sodium arsenite do not induce microvilli. A role for hydrogen peroxide as an intercellular messenger has previously been proposed in the inflammatory response, in which hydrogen peroxide from phagocytes may signal to vascular endothelial cells. Our observations thus provide a second example of the induction of what may be a physiological response by this potentially toxic agent. In the retina, hydrogen peroxide released from illuminated photoreceptors may elongate the microvilli which extend into the spaces between them. Increased numbers of microvilli and their protrusion further into the photoreceptor layer may enhance various interactions between the two cell types, including the antioxidant functions of the epithelium.

Authors
Reid, GG; Edwards, JG; Marshall, GE; Sutcliffe, RG; Lee, WR
MLA Citation
Reid, GG, Edwards, JG, Marshall, GE, Sutcliffe, RG, and Lee, WR. "Hydrogen peroxide induces microvilli on human retinal pigment epithelial cells in culture." Cell biology international 19.2 (February 1995): 91-101. (Academic Article)
Source
manual
Published In
Cell Biology International
Volume
19
Issue
2
Publish Date
1995
Start Page
91
End Page
101

Radiation therapy following radical prostatectomy

Background. The incidence of pathologic upstaging to stage T3 is a common occurrence in patients undergoing radical prostatectomy for clinical stage T1‐2 prostate cancer. There is a considerable risk of local recurrence owing radical prostatectomy for pathologic stage T3 cancers. Postoperative adjuvant radiation therapy has been used to reduce the incidence of local recurrence. Methods. The available data in series using radiation therapy following radical prostatectomy are reviewed. Results. The available data demonstrate that adjuvant pelvic radiation therapy reduces the risk of clinical local failure from 30‐60% to 0‐10% in patients with high risk pathologic features following radical prostatectomy, Most patients who receive radiation therapy to the pelvis for a persistently elevated serum prostate specific antigen (PSA) level following radical prostatectomy will have a subsequent decrease in the serum PSA level. The incidence of severe complications related to postprostatectomy radiation therapy is 5‐10%, and there is no evidence that the risk of incontinence or urethral stricture is increased with the addition of radiation therapy. Conclusions. Radiation therapy following radical prostatectomy can reduce the rate of clinical local failure in patients with high risk features following radical prostatectomy. Radiation therapy can be administered following radical prostatectomy with acceptable treatment‐related morbidity. There is no evidence that postprostatectomy radiation therapy improves disease free survival. Cancer 1995;75:1909–13. Copyright © 1995 American Cancer Society

Authors
Lee, WR; Hanks, GE
MLA Citation
Lee, WR, and Hanks, GE. "Radiation therapy following radical prostatectomy." Cancer 75.7 S (January 1, 1995): 1909-1913.
Source
scopus
Published In
Cancer
Volume
75
Issue
7 S
Publish Date
1995
Start Page
1909
End Page
1913
DOI
10.1002/1097-0142(19950401)75:7+<1909::AID-CNCR2820751625>3.0.CO;2-F

External beam irradiation of prostate cancer. Conformal treatment techniques and outcomes for the 1990

Background. This paper presents the results of external beam treatment of prostate cancer. Long term results are represented by the U.S. national averages from the Patterns of Care study. The modern innovations of three‐dimensional‐assisted conformal treatment are also shown to demonstrate the technologic progress in external beam treatment, the effect of pretreatment prostate specific antigen (PSA), the inaccuracy of clinical end points used for 30 years, and the new early outcome standards for the 1990s. Methods. The Patterns of Care study has surveyed the national practice for processes of care and outcome of care in the United States. Ten‐ and 15‐year outcomes are reported for patients treated in 1973 and 1978 by external beam irradiation. The conformal radiation therapy program developed at Fox Chase Cancer Center since 1989 is used to illustrate the advantage of this technology, the importance of pretreatment PSA level on outcome, the inaccuracies in clinical end point evaluation, and the reduction in morbidity associated with conformal treatment. Three hundred seventy‐three consecutive patients treated with conformal therapy were compared with 129 consecutive conventionally treated patients for survival end points. The outcome of 460 consecutive patients with pretreatment PSA are presented by pretreatment PSA level. Late morbidity is presented for 208 consecutive conformal treated patients who received 68‐71 Gy to the center of the prostate. Cancer control is defined as biochemical control of cancer (bNED) and requires a nonrising PSA with a nadir of less than or equal to 1.5 ng/ml. Results. Conformal treatment was superior to conventional in 12‐month PSA response (P = 0.00005), 4‐year bNED (P < 0.005), and multivariate analysis (P < 0.04). The difference between clinical absence of disease and bNED at 4 years was 8% for pretreatment PSA less than 10 ng/ml, 51% for PSA 10‐20 ng/ml, and 57% for pretreatment PSA greater than 20 ng/ml. Acute morbidity of conformal therapy was reduced (P < 0.00001), and late morbidity was observed at 5 years in only 4.2% of 208 consecutive patients treated to 68‐71 Gy. Conclusions. The conformal treatment method is superior to conventional treatment, and this technology should be further developed and disseminated. Dose escalation beyond 68‐71 Gy is not indicated by these data, although these results are preliminary, with short term follow‐up for the conformal group and longer follow‐up for the conventional group. PSA evaluation of cancer control shows that 83% of patients presenting with a pretreatment PSA level less than 10 are bNED at 5 years and only 13% of those with pretreatment PSA level greater than 20. Cancer 1995;75:1972–7. Copyright © 1995 American Cancer Society

Authors
Hanks, GE; Corn, BW; Lee, WR; Hunt, M; Hanlon, A; Schultheiss, TE
MLA Citation
Hanks, GE, Corn, BW, Lee, WR, Hunt, M, Hanlon, A, and Schultheiss, TE. "External beam irradiation of prostate cancer. Conformal treatment techniques and outcomes for the 1990." Cancer 75.7 S (January 1, 1995): 1972-1977.
Source
scopus
Published In
Cancer
Volume
75
Issue
7 S
Publish Date
1995
Start Page
1972
End Page
1977
DOI
10.1002/1097-0142(19950401)75:7+<1972::AID-CNCR2820751636>3.0.CO;2-P

Histopathology of macular holes.

Authors
Loeffler, KU; Lee, WR
MLA Citation
Loeffler, KU, and Lee, WR. "Histopathology of macular holes." Ophthalmology 102.1 (January 1995): 1-2. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
102
Issue
1
Publish Date
1995
Start Page
1
End Page
2

Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx

Purpose: A number of reports have documented the relationship between pretreatment hemoglobin level and local control and/or survival in the treatment of cervix, bladder, and advanced head and neck tumors. Consideration of correcting anemia before initiation of radiation therapy may prove increasingly important as clinical trials use intensive induction chemotherapy in the treatment of head and neck carcinomas. Neoadjuvant chemotherapy may produce anemia, which in turn may reduce the effectiveness of subsequent irradiation. Materials and Methods: One hundred nine patients with T1-2N0 squamous cell carcinoma of the glottic larynx were treated with definitive radiotherapy at the Fox Chase Cancer Center between June 1980 and November 1990. Follow-up times ranged from 26 to 165 months (median, 82). Results: The 2-year local control rate for patients who presented with a hemoglobin level ≤ 13 g/dL was 66%, compared with 95% for patients with a hemoglobin level more than 13 g/dL (P = .0018). The 2-year survival rate for patients with a hemoglobin level ≤ 13 g/dL was 46%, compared with 88% for patients with a hemoglobin level more than 13 g/dL (P < .001). Cox proportional hazards regression analysis showed that hemoglobin level (P = .0016) was the only variable that significantly influenced local control (P = .0016) and survival (P < .0001). Conclusion: Patients who presented with hemoglobin levels more than 13 g/dL had significantly higher local control and survival rates. The strong apparent correlation between hemoglobin level, local control, and survival supports consideration of correcting anemia before initiation of radiation therapy. © 1995 by American Society of Clinical Oncology.

Authors
Fein, DA; Lee, WR; Hanlon, AL; Ridge, JA; Langer, CJ; Jr, WJC; Coia, LR
MLA Citation
Fein, DA, Lee, WR, Hanlon, AL, Ridge, JA, Langer, CJ, Jr, WJC, and Coia, LR. "Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx." Journal of Clinical Oncology 13.8 (1995): 2077-2083.
PMID
7636551
Source
scival
Published In
Journal of Clinical Oncology
Volume
13
Issue
8
Publish Date
1995
Start Page
2077
End Page
2083

Conformal treatment of prostate cancer with improved targeting: Superior prostate-specific antigen response compared to standard treatment

Authors
Corn, BW; Hanks, GE; Schultheiss, TE; Hunt, MA; Lee, WR; Coia, LR
MLA Citation
Corn, BW, Hanks, GE, Schultheiss, TE, Hunt, MA, Lee, WR, and Coia, LR. "Conformal treatment of prostate cancer with improved targeting: Superior prostate-specific antigen response compared to standard treatment." International Journal of Radiation Oncology, Biology, Physics 32.2 (1995): 325-330.
PMID
7503847
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
32
Issue
2
Publish Date
1995
Start Page
325
End Page
330
DOI
10.1016/0360-3016(94)00618-U

Localized prostate cancer treated by external-beam radiotherapy alone: Serum prostate-specific antigen-driven outcome analysis

Purpose: To determine the 5-year rate of survival with no evidence of disease (NED) using strict biochemical criteria in men with prostate cancer treated by external-beam radiotherapy alone and to examine possible clinical and treatment factors that predict the likelihood of NED survival. Materials and Methods: Five hundred men with clinically localized prostate cancer consecutively treated with external-beam radiotherapy alone with no prior, concomitant, or adjuvant endocrine therapy were identified. All patients had serial serum prostate-specific antigen (PSA) values determined after treatment and 451 patients had pretreatment PSA values determined. The median follow-up duration is 20 months (range, 2 to 72; mean, 36). Results: The 5- year rate of overall survival in this group of patients was 80%. The 5-year rate of survival without clinical evidence of disease (cNED) was 72%. The 5- year rate of survival without evidence of clinical, radiographic, or biochemical relapse (bNED) was 51%. Multivariate analysis demonstrated that a pretreatment serum PSA level ≤ 15 ng/mL was the most important predictor of bNED survival (P < .0001). Patients with early-stage (T1, T2a/b) tumors and a pretreatment serum PSA less than 15 ng/mL had a 3-year rate of bNED survival of 86%. The rate of bNED survival for patients with a pretreatment PSA level greater than 15 ng/mL was 38% at 3 years. Conclusion: Pretreatment serum PSA level is the most important predictor of treatment outcome in this group of patients treated with definitive radiotherapy alone. External-beam radiation alone can produce acceptable early rates of bNED survival in patients with clinically organ-confined tumors and a pretreatment PSA level ≤ 15 ng/mL. To produce acceptable results in those patients with pretreatment PSA levels more than 15 ng/mL, effective adjuvant treatments in addition to aggressive local treatments are necessary.

Authors
Lee, WR; Hanks, GE; Schultheiss, TE; Corn, BW; Hunt, MA
MLA Citation
Lee, WR, Hanks, GE, Schultheiss, TE, Corn, BW, and Hunt, MA. "Localized prostate cancer treated by external-beam radiotherapy alone: Serum prostate-specific antigen-driven outcome analysis." Journal of Clinical Oncology 13.2 (1995): 464-469.
PMID
7531222
Source
scival
Published In
Journal of Clinical Oncology
Volume
13
Issue
2
Publish Date
1995
Start Page
464
End Page
469

Management of extremity soft tissue sarcomas with limbsparing surgery and postoperative irradiation: Do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control?

Authors
Fein, DA; Lee, WR; Lanciano, RM; Corn, BW; Herbert, SH; Hanlon, AL; Hoffman, JP; Eisenberg, BL; Coia, LR
MLA Citation
Fein, DA, Lee, WR, Lanciano, RM, Corn, BW, Herbert, SH, Hanlon, AL, Hoffman, JP, Eisenberg, BL, and Coia, LR. "Management of extremity soft tissue sarcomas with limbsparing surgery and postoperative irradiation: Do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control?." International Journal of Radiation Oncology, Biology, Physics 32.4 (1995): 969-976.
PMID
7607971
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
32
Issue
4
Publish Date
1995
Start Page
969
End Page
976
DOI
10.1016/0360-3016(95)00105-8

One step forward and two steps back [4]

Authors
Hanks, GE; Lee, WR; Cox, JA; Wilson, LD; Peschel, RE; Ennis, RD
MLA Citation
Hanks, GE, Lee, WR, Cox, JA, Wilson, LD, Peschel, RE, and Ennis, RD. "One step forward and two steps back [4]." International Journal of Radiation Oncology Biology Physics 31.4 (1995): 1026-1028.
PMID
7860380
Source
scival
Published In
International Journal of Radiation Oncology Biology Physics
Volume
31
Issue
4
Publish Date
1995
Start Page
1026
End Page
1028

Incidence of and factors related to late complications in conformal and conventional radiation treatment of cancer of the prostate

Authors
Schultheiss, TE; Hanks, GE; Hunt, MA; Lee, WR
MLA Citation
Schultheiss, TE, Hanks, GE, Hunt, MA, and Lee, WR. "Incidence of and factors related to late complications in conformal and conventional radiation treatment of cancer of the prostate." International Journal of Radiation Oncology, Biology, Physics 32.3 (1995): 643-649.
PMID
7790250
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
32
Issue
3
Publish Date
1995
Start Page
643
End Page
649
DOI
10.1016/0360-3016(95)00149-S

Prostate specific antigen density is not an independent predictor of response for prostate cancer treated by conformal radiotherapy

Although prostate specific antigen (PSA) density appears to be an important discriminator between benign and malignant prostatic disease, conflicting data exist concerning its prognostic value. The present study was undertaken to confirm whether PSA density represents a new prognostic indicator of disease-free survival for prostate cancer treated with conformal radiotherapy. Between April 1989 and December 1992, 186 patients with organ confined prostate cancer were treated with definitive irradiation according to previously published conformal guidelines. The PSA density was defined as the ratio of the pretreatment serum PSA (ng./ml.) to the prostate volume (ml.) as determined from treatment planning computerized tomography. The median PSA density was 0.15 with a range of 0.02 to 2.12. A statistically significant advantage in actuarial freedom from biochemical relapse was noted for patients with pretreatment PSA levels less than 15 ng./ml. when compared to those with higher pretreatment PSA levels (3-year freedom from biochemical relapse 85% versus 28%, p <0.001). Also, patients with PSA density of 0.15 or less had statistically superior freedom from biochemical relapse compared to their counterparts with higher PSA density (3-year freedom from biochemical relapse 88% versus 28%, p <0.001). In a multivariate analysis only the baseline PSA (p <0.002) and the Gleason score (p <0.002) emerged as significant predictors of prolonged freedom from biochemical relapse. The PSA density had no impact on freedom from biochemical relapse whether it was entered into this multivariate model as a continuous or a dichotomous variable. In our data base baseline PSA levels remain the most powerful independent discriminant of response to conformal irradiation. PSA density is only a surrogate for baseline PSA levels and does not refine the ability to predict prolongation of freedom from biochemical relapse following conformal radiotherapy.

Authors
Corn, BW; Hanks, GE; Lee, WR; Bonin, SR; Hudes, G; Schultheiss, T; McLeod, DG
MLA Citation
Corn, BW, Hanks, GE, Lee, WR, Bonin, SR, Hudes, G, Schultheiss, T, and McLeod, DG. "Prostate specific antigen density is not an independent predictor of response for prostate cancer treated by conformal radiotherapy." Journal of Urology 153.6 (1995): 1855-1859+1873.
PMID
7538598
Source
scival
Published In
Journal of Urology
Volume
153
Issue
6
Publish Date
1995
Start Page
1855
End Page
1859+1873

Observations of pretreatment prostate-specific antigen doubling time in 107 patients referred for definitive radiotherapy

Purpose: To determine pretreatment prostate-specific antigen doubling times (PSADT) in patients referred for definitive radiotherapy. Methods and Materials: One hundred and seven patients with histologically proven nonmetastatic prostate cancer and an elevated prostate-specific antigen (PSA) who were referred for radiation therapy had three serum PSA values obtained prior to the start of definitive therapy. Prostate-specific antigen doubling times were calculated by linear regression. Results: Prostate-specific antigen values increased during the period of observation in 78 patients (73%). Forty-three patients (40%) had calculated PSADT of less than 2 years and of those patients with pretreatment serum PSA values of greater than 10 ng/mL more than 50% has calculated PSADT of less than 2 years. Conclusions: A significant of minority of patients referred for radiotherapy have calculated PSADT of less than 2 years. The significance of this relatively fast growth rate is as yet undertermined, but suggests that patients referred for radiotherapy may have aggressive disease prior to treatment. © 1994.

Authors
Lee, WR; Hanks, GE; Corn, BW; Schultheiss, TE
MLA Citation
Lee, WR, Hanks, GE, Corn, BW, and Schultheiss, TE. "Observations of pretreatment prostate-specific antigen doubling time in 107 patients referred for definitive radiotherapy." International Journal of Radiation Oncology, Biology, Physics 31.1 (1995): 21-24.
PMID
7527798
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
31
Issue
1
Publish Date
1995
Start Page
21
End Page
24
DOI
10.1016/0360-3016(94)00339-M

Biological basis of germline mutation: comparisons of spontaneous germline mutation rates among drosophila, mouse, and human.

Spontaneous mutation rates per generation are similar among the three species considered here--Drosophila, mouse, and human--and are not related to time, as is often assumed. Spontaneous germline mutation rates per generation averaged among loci are less variable among species than they are among loci and tests and between gender. Mutation rates are highly variable over time in diverse lineages. Recent estimates of the number of germ cell divisions per generation are: for humans, 401 (30-year generation) in males and 31 in females; for mice, 62 (9-month generation) in males and 25 in females; and for Drosophila melanogaster, 35.5 (18-day generation) in males and 36.5 (25-day generation) in females. The relationships between germ cell division estimates of the two sexes in the three species closely reflect those between mutation rates in the sexes, although mutation rates per cell division vary among species. Whereas the overall rate per generation is constant among species, this consistency must be achieved by diverse mechanisms. Modifiers of mutation rates, on which selection might act, include germline characteristics that contribute disproportionately to the total mutation rates. The germline mutation rates between the sexes within a species are largely influenced by germ cell divisions per generation. Also, a large portion of the total mutations occur during the interval between the beginning of meiosis and differentiation of the soma from the germline. Significant genetic events contributing to mutations during this time may include meiosis, lack of DNA repair in sperm cells, methylation of CpG dinucleotides in mammalian sperm and early embryo, gonomeric fertilization, and rapid cleavage divisions.

Authors
Drost, JB; Lee, WR
MLA Citation
Drost, JB, and Lee, WR. "Biological basis of germline mutation: comparisons of spontaneous germline mutation rates among drosophila, mouse, and human." Environmental and molecular mutagenesis 25 Suppl 26 (1995): 48-64. (Academic Article)
Source
manual
Published In
Environmental and Molecular Mutagenesis
Volume
25 Suppl 26
Publish Date
1995
Start Page
48
End Page
64

Doyne Lecture. The pathology of the outflow system in primary and secondary glaucoma.

Authors
Lee, WR
MLA Citation
Lee, WR. "Doyne Lecture. The pathology of the outflow system in primary and secondary glaucoma." Eye (London, England) 9 ( Pt 1) (1995): 1-23. (Academic Article)
Source
manual
Published In
Eye
Volume
9 ( Pt 1)
Publish Date
1995
Start Page
1
End Page
23

20th annual Frank Costenbader Lecture--adult strabismus.

BACKGROUND: A retrospective analysis of adults with strabismus was done to examine the potential risks and the possible benefits of surgical treatment and to describe the types of adult strabismus. METHODS: Eight hundred ninety-two patients were analyzed. Age at time of surgery ranged from 9 years to 89 years. The average follow up was 34 months. Major types of strabismus were grouped by their original diagnoses. The group of patients with horizontal strabismus, which usually had an onset before 9, was termed the before visual maturity (BVM) group. The group of patients with paretic or restrictive strabismus usually had the onset of strabismus after age 9 and was termed the after visual maturity (AVM) group. RESULTS: Patients with adult strabismus can gain restoration of alignment, as well as binocular function. At the last postoperative visit, 74% of the BVM group were aligned within 15 prism diopters. Not only was restoration of alignment accomplished, many of them gained some degree of sensory fusion as measured by the Worth 4-Dot (W4D) or Titmus stereoacuity. Twenty-nine percent of patients with congenital esotropia had some sensory fusion. The other subtypes in the BVM group had even higher percentages of patients with postoperative stereoacuity. In the AVM group, 92% had fusion at the last postoperative visit. CONCLUSIONS: The outcomes of adult strabismics in our study show that certain benefits can be gained from correction of ocular alignment. Restoration of alignment, elimination of diplopia and sensory fusion are functional benefits that can be obtained through strabismus surgery in the adult patient. It is clear that adult strabismus is more than just a cosmetic problem and treatment is worthwhile.

Authors
Scott, WE; Kutschke, PJ; Lee, WR
MLA Citation
Scott, WE, Kutschke, PJ, and Lee, WR. "20th annual Frank Costenbader Lecture--adult strabismus." Journal of pediatric ophthalmology and strabismus 32.6 (1995): 348-352. (Academic Article)
Source
manual
Published In
Journal of pediatric ophthalmology and strabismus
Volume
32
Issue
6
Publish Date
1995
Start Page
348
End Page
352

Uveal melanoma: updated considerations on current management modalities.

Published data on growth rates of uveal melanomas and effects of treatment modalities raise important considerations. Dissemination from uveal melanomas starts after the tumour is larger than 7 mm diameter; growth from 7 to 10 mm diameter increases the risk of metastases incrementally to approximately 16%. Estimations of tumour doubling times indicate that metastatic death before 8 years is nearly always due to pre-therapeutic dissemination so that the impact on survival by therapy can only be assessed thereafter. Histopathology on irradiated melanomas reveals that reproductive activity has not been suppressed and the anticipated (and unfavourable) risk of metastases is not balanced by poor post-irradiation visual acuity. Also the psychological well-being of a patient with a functional fellow eye is better after primary enucleation. Conservative management is most appropriate for: small melanomas, patients with a short life expectancy, melanomas in a single functioning eye, and patients refusing enucleation.

Authors
Manschot, WA; Lee, WR; van Strik, R
MLA Citation
Manschot, WA, Lee, WR, and van Strik, R. "Uveal melanoma: updated considerations on current management modalities." International ophthalmology 19.4 (1995): 203-209. (Academic Article)
Source
manual
Published In
International Ophthalmology
Volume
19
Issue
4
Publish Date
1995
Start Page
203
End Page
209

Clinical and Biochemical Evidence of Control of Prostate Cancer at 5 Years After External Beam Radiation

Purpose: We demonstrate the 5-year survival rate for patients with prostate cancer treated by irradiation, the value of the conformal technique and prostate specific antigen (PSA) doubling times after irradiation. Materials and Methods: The outcome of 502 consecutive patients with stages T1 to T3 prostate cancer treated by irradiation alone is reported. PSA doubling times before and after failure are reported for 13 patients and posttreatment PSA doubling times are reported for 93 consecutive patients in whom radiation failed. Results: The actuarial survival with biochemical freedom from disease (PSA nadir 1.5 or less not increasing) at 5 years was 44 percent for all patients, 50 percent for the conformal treatment group and 39 percent for the conventional therapy group. PSA doubling times after radiation failure were variable, with 42 percent greater than 12 months. Conclusions: The 5-year survival rate for patients with prostate cancer treated by irradiation is excellent. The conformal technique is superior to conventional therapy and there is no evidence that irradiation accelerates the growth rate of prostate cancer. © 1995 American Urological Association, Inc.

Authors
Hanks, GE; Lee, WR; Schultheiss, TE
MLA Citation
Hanks, GE, Lee, WR, and Schultheiss, TE. "Clinical and Biochemical Evidence of Control of Prostate Cancer at 5 Years After External Beam Radiation." The Journal of Urology 154.2 (1995): 456-459.
PMID
7541863
Source
scival
Published In
The Journal of Urology
Volume
154
Issue
2
Publish Date
1995
Start Page
456
End Page
459
DOI
10.1016/S0022-5347(01)67073-3

External beam irradiation of prostate cancer: Conformal treatment techniques and outcomes for the 1990s

Background. This paper presents the results of external beam treatment of prostate cancer. Long term results are represented by the U.S. national averages from the Patterns of Care study. The modern innovations of three- dimensional-assisted conformal treatment are also shown to demonstrate the technologic progress in external beam treatment, the effect of pretreatment prostate specific antigen (PSA), the inaccuracy of clinical end points used for 30 years, and the new early outcome standards for the 1990s. Methods. The Patterns of Care study has surveyed the national practice for processes of care and outcome of care in the United States. Ten- and 15-year outcomes are reported for patients treated in 1973 and 1978 by external beam irradiation. The conformal radiation therapy program developed at Fox Chase Cancer Center since 1989 is used to illustrate the advantage of this technology, the importance of pretreatment PSA level on outcome, the inaccuracies in clinical end point evaluation, and the reduction in morbidity associated with conformal treatment. Three hundred seventy-three consecutive patients treated with conformal therapy were compared with 129 consecutive conventionally treated patients for survival end points. The outcome of 460 consecutive patients with pretreatment PSA are presented by pretreatment PSA level. Late morbidity is presented for 208 consecutive conformal treated patients who received 68-71 Gy to the center of the prostate. Cancer control is defined as biochemical control of cancer (bNED) and requires a nonrising PSA with a nadir of less than or equal to 1.5 ng/ml. Results. Conformal treatment was superior to conventional in 12-month PSA response (P = 0.00005), 4-year bNED (P < 0.005), and multivariate analysis (P < 0.04). The difference between clinical absence of disease and hNED at 4 years was 8% for pretreatment PSA less than 10 ng/ml, 51% for PSA 10-20 ng/ml, and 57% for pretreatment PSA greater than 20 ng/ml. Acute morbidity of conformal therapy was reduced (P < 0.00001), and late morbidity was observed at 5 years in only 4.2% of 208 consecutive patients treated to 68-71 Gy. Conclusions. The conformal treatment method is superior to conventional treatment, and this technology should be further developed and disseminated. Dose escalation beyond 68-71 Gy is not indicated by these data, although these results are preliminary, with short term follow-up for the conformal group and longer follow-up for the conventional group. PSA evaluation of cancer control shows that 83% of patients presenting with a pretreatment PSA level less than 10 are bNED at 5 years and only 13% of those with pretreatment PSA level greater than 20.

Authors
Hanks, GE; Corn, BW; Lee, WR; Hunt, M; Hanlon, A; Schultheiss, TE
MLA Citation
Hanks, GE, Corn, BW, Lee, WR, Hunt, M, Hanlon, A, and Schultheiss, TE. "External beam irradiation of prostate cancer: Conformal treatment techniques and outcomes for the 1990s." Cancer 75.7 SUPPL. (1995): 1972-1977.
Source
scival
Published In
Cancer
Volume
75
Issue
7 SUPPL.
Publish Date
1995
Start Page
1972
End Page
1977

Radiation therapy following radical prostatectomy

Background. The incidence of pathologic upstaging to stage T3 is a common occurrence in patients undergoing radical prostatectomy for clinical stage T1-2 prostate cancer. There is a considerable risk of local recurrence following radical prostatectomy for pathologic stage T3 cancers. Postoperative adjuvant radiation therapy has been used to reduce the incidence of local recurrence. Methods. The available data in series using radiation therapy following radical prostatectomy are reviewed. Results. The available data demonstrate that adjuvant pelvic radiation therapy reduces the risk of clinical local failure from 30-60% to 0-10% in patients with high risk pathologic features following radical prostatectomy. Most patients who receive radiation therapy to the pelvis for a persistently elevated serum prostate specific antigen (PSA) level following radical prostatectomy will have a subsequent decrease in the serum PSA level. The incidence of severe complications related to postprostatectomy radiation therapy is 5-10%, and there is no evidence that the risk of incontinence or urethral stricture is increased with the addition of radiation therapy. Conclusions. Radiation therapy following radical prostatectomy can reduce the rate of clinical local failure in patients with high risk features following radical prostatectomy. Radiation therapy can be administered following radical prostatectomy with acceptable treatment-related morbidity. There is no evidence that postprostatectomy radiation therapy improves disease free survival.

Authors
Lee, WR; Hanks, GE
MLA Citation
Lee, WR, and Hanks, GE. "Radiation therapy following radical prostatectomy." Cancer 75.7 SUPPL. (1995): 1909-1913.
Source
scival
Published In
Cancer
Volume
75
Issue
7 SUPPL.
Publish Date
1995
Start Page
1909
End Page
1913

Adding a positive charge at residue 46 of Drosophila alcohol dehydrogenase increases cofactor specificity for NADP+.

We previously reported that the D39N mutant of Drosophila alcohol dehydrogenase (ADH), in which Asp-39 is replaced with asparagine, has a 60-fold increase in affinity for NADP+ and a 1.5-fold increase in kcat compared to wild-type ADH [Chen et al. (1991) Eur. J. Biochem. 202, 263-267] and proposed that this part of ADH is close to the 2'-phosphate on the ribose moiety of NADP+. Here we report the effect of replacing Ala-46 with an argine residue, and A46R mutant, on binding of NADP+ to ADH and its catalytic efficiency with the NADP+ cofactor, and a modeling of the three-dimensional structure of the NAD(+)-binding region of ADH. The A46R mutant has a 2.5-fold lower Km(app)NADP+ and a 3-fold higher kcat with NADP+ compared to wild-type ADH; binding of NAD+ to the mutant was unchanged and kcat with NAD+ was lowered by about 30%. For the A46R mutant, the ratio of kcat/Km of NAD+ to NADP+ is 85, over ten-fold lower than that for wild-type ADH. Our model of the 3D structure of the NAD(+)-binding region of ADH shows that Ala-46 is over 10 A from the ribose moiety of NAD+, which would suggest that there is little interaction between this residue and NAD+ and explain why its mutation to arginine has little effect on NAD+ binding. However, the positive charge at residue 46 can neutralize some of the coulombic repulsion between Asp-39 and the 2'-phosphate on the ribose moiety of NADP+, which would increase its affinity for the A46R mutant. We also constructed a double mutant, D39N/A46R mutant, which we find has a 30-fold lower Km(app)NADP+ and 8-fold higher kcat with NADP+ as a cofactor compared to wild-type ADH; binding of NAD+ to this double mutant was lowered by 5-fold and kcat was increased by 1.5-fold. As a result, kcat/Km for the double mutant was the same for NAD+ and NADP+. The principle effect of the two mutations in ADH is to alter its affinity for the nucleotide cofactor; kcat decreases slightly in A46R with NAD+ and remains unchanged or increases in the other mutants.

Authors
Chen, Z; Tsigelny, I; Lee, WR; Baker, ME; Chang, SH
MLA Citation
Chen, Z, Tsigelny, I, Lee, WR, Baker, ME, and Chang, SH. "Adding a positive charge at residue 46 of Drosophila alcohol dehydrogenase increases cofactor specificity for NADP+." FEBS letters 356.1 (December 1994): 81-85. (Academic Article)
Source
manual
Published In
FEBS Letters
Volume
356
Issue
1
Publish Date
1994
Start Page
81
End Page
85

Early prostate cancer: the national results of radiation treatment from the Patterns of Care and Radiation Therapy Oncology Group studies with prospects for improvement with conformal radiation and adjuvant androgen deprivation.

Long-term outcome of the Patterns of Care Study and the Radiation Therapy Oncology Group are used to demonstrate the national average results of treating early prostate cancer in the United States. A group of patients with stage T1B2 disease and pathologically negative lymph nodes showed excellent 10-year survival rates and freedom from clinical evidence of disease, while prostate specific antigen (PSA) correlations in 10-year survivors indicate that 88% were clinically free of cancer and had a PSA level of less than 4.0 mg./nl., and 65% had a PSA level of less than 1.5 ng./ml. The latter group represented clinical and biochemical cures. The improvement noted in outcome of locally advanced prostate cancer treatment by Radiation Therapy Oncology Group prospective trials combining androgen deprivation and radiation therapy is presented. These trials will be extended to the poor prognosis group with stage T1,2 disease. The advantages of conformal therapy in acute and late morbidity are illustrated with preliminary evidence of improved PSA response as a result of improved technique and higher dose associated with conformal 3-dimensional treatment.

Authors
Hanks, GE; Hanlon, A; Schultheiss, T; Corn, B; Shipley, WU; Lee, WR
MLA Citation
Hanks, GE, Hanlon, A, Schultheiss, T, Corn, B, Shipley, WU, and Lee, WR. "Early prostate cancer: the national results of radiation treatment from the Patterns of Care and Radiation Therapy Oncology Group studies with prospects for improvement with conformal radiation and adjuvant androgen deprivation." The Journal of urology 152.5 Pt 2 (November 1994): 1775-1780. (Academic Article)
Source
manual
Published In
The Journal of Urology
Volume
152
Issue
5 Pt 2
Publish Date
1994
Start Page
1775
End Page
1780

Multirecurrence of corneal posterior polymorphous dystrophy. An ultrastructural study.

Posterior polymorphous corneal dystrophy (PPD) is a rare bilateral, autosomal-dominant disease. The presence of the epitheliumlike endothelium and the thickening of Descemet's membrane by the posterior collagenous layer (PCL) has been reported in the majority of published cases. Reepithelialization of the posterior cornea in donor tissue has been reported only once. Therefore, to examine this process we examined, by light and electron microscopy, three corneal buttons (an original and two subsequent keratoplasties after 3 and 4 years, respectively) from the left eye of a patient with bilateral disease. Our study showed a repopulation of the posterior surface of the donor corneas by the host epitheliumlike endothelium, which was of identical morphology in each case. In contrast to the previously published work, a posterior collagenous layer in the failed grafts was absent from the axial cornea, where the epitheliumlike endothelium was in direct contact with donor Descemet's membrane. A PCL at the periphery in the failed transplants was of the fibrocellular type and differed from the fibrillar PCL in the first keratoplasty specimen. The fibroblastlike cells within the fibrocellular PCL were distinct from the underlying epithelial-like cells and contained numerous tertiary phagolysosomes. We suggest that the major contributor to the fibrocellular PCL in the repeat keratoplasties was a fibrous ingrowth from the host/graft junction and not the epitheliumlike endothelium. It appears that the synthetic capacity of the epitheliumlike endothelium was similar to that of the normal epithelium and was much lower than that of normal native endothelium.

Authors
Sekundo, W; Lee, WR; Aitken, DA; Kirkness, CM
MLA Citation
Sekundo, W, Lee, WR, Aitken, DA, and Kirkness, CM. "Multirecurrence of corneal posterior polymorphous dystrophy. An ultrastructural study." Cornea 13.6 (November 1994): 509-515. (Academic Article)
Source
manual
Published In
Cornea
Volume
13
Issue
6
Publish Date
1994
Start Page
509
End Page
515

Immunogold study of non-collagenous matrix components in normal and exfoliative iris.

The present investigation was undertaken to determine if some of the components of exfoliation material in iris tissue were unique to exfoliation or were part of normal iris architecture. Eleven normal iris specimens and 10 exfoliative iris specimens were processed for cryoultramicrotomy and London resin white embedding. Immunogold electron microscopy was used to investigate the fine structural distribution of amyloid P component, elastin, entactin, fibronectin, gp115, and vitronectin in normal iris and their association with exfoliation material. Exfoliation material was positive for amyloid P component and possibly gp115, neither of which were present in normal iris tissue. Elastin and fibronectin were present in the normal iris stroma but were not associated with exfoliation material. The distribution of amyloid P component in the vessel lumen and wall led to the conclusion that amyloid P is a serum contaminant. The presence of gp115 in exfoliation material represents the synthesis of a component novel to the iris vascular cell synthetic repertoire.

Authors
Vogiatzis, A; Marshall, GE; Konstas, AG; Lee, WR
MLA Citation
Vogiatzis, A, Marshall, GE, Konstas, AG, and Lee, WR. "Immunogold study of non-collagenous matrix components in normal and exfoliative iris." The British journal of ophthalmology 78.11 (November 1994): 850-858. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
78
Issue
11
Publish Date
1994
Start Page
850
End Page
858

Bilateral uveal melanoma presenting simultaneously.

A case of bilateral uveal melanoma in a 54-year-old man is described. On admission of the patient for a choroidal melanoma of the left eye, an asymptomatic ciliary-body tumour was detected in his right eye. A thorough general examination did not reveal any metastases. The left eye was enucleated and local excision of the tumour in the right eye was performed 2 months later. Histology confirmed the presence of malignant melanomas in both eyes. The tumours were of similar A/B spindle-cell type. The patient remained healthy, showing no sign of metastasis or local recurrence of melanoma 9 months after the date of diagnosis. The visual acuity in his remaining eye remained 6/6. Immunological assessment of the blood serum revealed abnormally high interleukin 1 beta (IL-1 beta) and IL-2 levels. Possible implications of these findings are discussed.

Authors
Omulecki, W; Damato, BE; Sekundo, W; Lee, WR; Toczyska Rozentryt, E; Omulecka, A
MLA Citation
Omulecki, W, Damato, BE, Sekundo, W, Lee, WR, Toczyska Rozentryt, E, and Omulecka, A. "Bilateral uveal melanoma presenting simultaneously." German journal of ophthalmology 3.4-5 (August 1994): 228-231. (Academic Article)
Source
manual
Published In
German journal of ophthalmology
Volume
3
Issue
4-5
Publish Date
1994
Start Page
228
End Page
231

Corneal endothelial cell abnormalities in an early stage of the iridocorneal endothelial syndrome.

A corneal disc, obtained from a 52-year-old woman suffering from an early stage of the iridocorneal endothelial syndrome (ICE), was investigated by various morphological techniques to analyse the structural variations in the endothelial cells and to identify the collagen types within the abnormal layer of Descemet's membrane. Scanning electron microscopy of the posterior corneal surface revealed a mosaic of (a) flat hexagonal cells resembling irregular but normal endothelial cells, and (b) rounded hexagonal (ICE) cells with numerous surface microvilli. Degenerative changes were present in each cell type, but were more common in the flat hexagonal cells which contained intracytoplasmic spaces. By transmission electron microscopy the flat hexagonal cells exhibited many of the features of normal endothelial cells in terms of organelles and intercellular attachments, but lateral invaginations were absent. The ICE cells differed in that the apical surface was covered by microvilli and the cytoplasm contained tonofilaments, which were also observed by light microscopic immunocytochemical staining. Most commonly, intercellular attachments were rudimentary in both types of cell and intercellular spaces were dilated, but desmosomes were sometimes prominent in the ICE cells where interdigitations were pronounced. In some sectors, the basal surface of the ICE cells was indented by deposition of clumps of fibrillar collagenous material. An immunocytochemical study of the abnormal posterior deposits localised type IV collagen to the amorphous matrix and collagen types III and V, but not type I, to the collagen fibril bundles. Mononuclear inflammatory cells were identified between the ICE cells in the monolayer. The evidence suggests that some of the flat hexagonal cells were undergoing a degenerative change while others were transforming into ICE cells.

Authors
Lee, WR; Marshall, GE; Kirkness, CM
MLA Citation
Lee, WR, Marshall, GE, and Kirkness, CM. "Corneal endothelial cell abnormalities in an early stage of the iridocorneal endothelial syndrome." The British journal of ophthalmology 78.8 (August 1994): 624-631. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
78
Issue
8
Publish Date
1994
Start Page
624
End Page
631

Bacillary angiomatosis of the conjunctiva.

A 70-year-old man had unilateral congestion of the right upper eyelid, which contained a nodular mass. A biopsy was performed, and histologic, immunocytochemical, and ultrastructural studies disclosed a pseudoneoplastic proliferation of endothelial cells and pericytes in a region containing clumps of bacteria. This combination of histologic features is characteristic of bacillary angiomatosis, which has been described in the skin, particularly in association with immunodeficient states, especially acquired immunodeficiency syndrome, but not in the conjunctiva. A second biopsy contained a diffuse polyclonal lymphocytic infiltrate in which large lymphocytes with irregular nuclei and mitotic figures were prominent. Systemic examination disclosed mild splenomegaly and a benign paraproteinemia. Treatment with topical gentamicin and systemic erythromycin brought about a complete resolution of the symptoms and signs within eight weeks, and there has been no sign of recurrence for the past two years.

Authors
Lee, WR; Chawla, JC; Reid, R
MLA Citation
Lee, WR, Chawla, JC, and Reid, R. "Bacillary angiomatosis of the conjunctiva." American journal of ophthalmology 118.2 (August 1994): 152-157. (Academic Article)
Source
manual
Published In
American Journal of Ophthalmology
Volume
118
Issue
2
Publish Date
1994
Start Page
152
End Page
157

An ultrastructural investigation of an early manifestation of the posterior polymorphous dystrophy of the cornea.

BACKGROUND: Posterior polymorphous dystrophy of the cornea is an uncommon, but well-recognized, congenital disease affecting Descemet's membrane and endothelium. Visual impairment usually is minimal and slowly progressive. Edema develops in a small number of patients, necessitating a corneal graft in middle age. An early manifestation of posterior polymorphous dystrophy with corneal edema present at birth or soon thereafter is extremely rare; only a few ultrastructural reports are available. METHODS: The corneal button of a 5-month-old baby with posterior polymorphous dystrophy was examined by conventional light and electron microscopy. FINDINGS: The anterior banded zone of Descemet's membrane was thinned (2 microns) in the axial part of the cornea, contained defects in the paraxial part, and was absent at the periphery. Where present, the anterior banded zone was lined posteriorly by a fibrocellular layer (containing fibroblast-like spindle cells and striated collagen fibrils) and a fibrillar layer forming an abnormal posterior collagenous layer. This layer was lined posteriorly by degenerate overlapping endothelial cells, which also were in apposition to the stroma in regions with an absent anterior banded zone. The defects in Descemet's membrane were used by the abnormal keratocytes to migrate between the anterior banded zone and the posterior collagenous layer. At the periphery, a multilayer of spindle cells was present behind the stroma. CONCLUSIONS: Failure to produce a continuous anterior banded zone indicates an onset of the disease before the twelfth week of gestation. It appears that, in posterior polymorphous dystrophy, there is a mosaic of better preserved and dystrophic endothelial cells and that the presence or absence of the normal components of Descemet's membrane is determined by the proportion of dystrophic cells in the endothelial cell population.

Authors
Sekundo, W; Lee, WR; Kirkness, CM; Aitken, DA; Fleck, B
MLA Citation
Sekundo, W, Lee, WR, Kirkness, CM, Aitken, DA, and Fleck, B. "An ultrastructural investigation of an early manifestation of the posterior polymorphous dystrophy of the cornea." Ophthalmology 101.8 (August 1994): 1422-1431. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
101
Issue
8
Publish Date
1994
Start Page
1422
End Page
1431

Immuno-electron labelling of matrix components in congenital hereditary endothelial dystrophy.

Two corneal buttons were obtained from a patient with congenital hereditary endothelial dystrophy (CHED) at the ages of 2.5 years (right eye) and 14 years (left eye) and were studied by light and electron microscopy including immunogold labelling for collagen types I-V and laminin. The posterior collagenous layer (PCL) of Descemet's membrane contained collagen types I, III-V, and laminin: the latter was also localised to fine-banded and granular material in the posterior non-banded zone (PNBZ). Comparison of the endothelium 2.5 years and 14 years revealed occasional dystrophic changes in the former and extensive dystrophic changes in the latter. The distribution of collagen types I, III and V within the PCL supports previous morphological observations of fibroblast-like change of the endothelium in CHED. Persisting endothelial properties were manifest as positive labelling of type IV collagen and laminin. An excessive amount of laminin found in PNBZ and PCL is another stress-related endothelial reaction.

Authors
Sekundo, W; Marshall, GE; Lee, WR; Kirkness, CM
MLA Citation
Sekundo, W, Marshall, GE, Lee, WR, and Kirkness, CM. "Immuno-electron labelling of matrix components in congenital hereditary endothelial dystrophy." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 232.6 (June 1994): 337-346. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
232
Issue
6
Publish Date
1994
Start Page
337
End Page
346

A technique for serial spermatozoa collection in mice.

Authors
King, WW; St Amant, LG; Lee, WR
MLA Citation
King, WW, St Amant, LG, and Lee, WR. "A technique for serial spermatozoa collection in mice." Laboratory animal science 44.3 (June 1994): 295-296. (Academic Article)
Source
manual
Published In
Comparative Medicine (Memphis)
Volume
44
Issue
3
Publish Date
1994
Start Page
295
End Page
296

The influence of large deletions on the mutation frequency induced by tritiated water and X-radiation in male Drosophila melanogaster post-meiotic germ cells.

Tritium beta radiation (3H beta-radiation) in the form of tritiated water was used to induce mutations at the alcohol dehydrogenase (Adh) locus in male Drosophila melanogaster post-meiotic germ cells. All 23 Adh null mutations were large deletions (> 20 kb), determined by genetic complementation and Southern blot analyses. 27 Adh null mutations have been induced by 100-kVp X-rays (Aaron, 1979) and have been genetically and molecularly characterized (Ashburner et al., 1982; Chia et al., 1985; LoMonaco et al., 1987; Mahmoud et al., 1991). In contrast to 3H beta-radiation, 100-kVp X-rays induced a bimodal distribution of Adh null mutations, intragenic mutations, 100 kb. A statistically significant difference was observed between the frequency of large deletions (23/23 or 1.0) induced by 3H beta-radiation and the frequency of large deletions (19/27 or 0.7) induced by 100-kVp X-rays. However, a statistical difference was not observed between the size distribution of the large deletions induced by 3H beta-radiation and X-rays. The relative deletion frequency (RDF) induced by 3H beta-radiation and 100-kVp X-rays was (1.0/0.7 = 1.4). The relative biological effectiveness (RBE) of these two radiation sources was 1.4, determined from the ratio of the regression coefficients of the respective 3H beta-radiation and X-ray sex-linked recessive lethal (SLRL) dose-response data. The large difference in size between the two classes of X-ray-induced Adh null mutations and the increase in mutation frequency and deletion frequency for 3H beta-radiation with respect to X-rays may indicate that the relative deletion frequency (RDF) is the molecular biological basis for the increase in the RBE for radiation sources with a mean LET value

Authors
Fossett, NG; Byrne, BJ; Kelley, SJ; Tucker, AB; Arbour Reily, P; Lee, WR
MLA Citation
Fossett, NG, Byrne, BJ, Kelley, SJ, Tucker, AB, Arbour Reily, P, and Lee, WR. "The influence of large deletions on the mutation frequency induced by tritiated water and X-radiation in male Drosophila melanogaster post-meiotic germ cells." Mutation research 307.1 (May 1994): 213-222. (Academic Article)
Source
manual
Published In
Mutation Research - Fundamental and Molecular Mechanisms of Mutagenesis
Volume
307
Issue
1
Publish Date
1994
Start Page
213
End Page
222

Collagens in the aged human macula.

Immunogold cytochemistry was used to investigate the fine structural distribution of collagen types I-VI in Bruch's membrane and choroid of the aged human macula. Macular tissue was obtained from ten eyes, and processed for cryoultramicrotomy and London Resin white embedding. Striated collagen fibrils within the inner and outer collagenous layers were found to contain collagen types I, III and V. In addition, type V collagen was also present in the basement membrane of the choriocapillaris. Gross thickening of the choriocapillaris basement membrane was attributed to the deposition of type IV collagen. However, type IV collagen appeared to be absent from the basement membrane of the retinal pigment epithelium. The interesting location of type VI collagen on the choroidal side of the choriocapillaris suggested that its function is to anchor the choriocapillaris onto the choroid. The collagens studied were absent from fibrous banded material, long-spacing collagen, the elastic layer and amorphous granular material. It was concluded that, of the collagen types studied, only the deposition of type IV collagen contributes to the age-related thickening of Bruch's membrane.

Authors
Marshall, GE; Konstas, AG; Reid, GG; Edwards, JG; Lee, WR
MLA Citation
Marshall, GE, Konstas, AG, Reid, GG, Edwards, JG, and Lee, WR. "Collagens in the aged human macula." Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie, 232.3 (March 1994): 133-140. (Academic Article)
Source
manual
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
232
Issue
3
Publish Date
1994
Start Page
133
End Page
140

Pathology of hereditary retinal degeneration associated with hypobetalipoproteinemia.

BACKGROUND: The clinical features and previously unreported ocular pathology in a case of heterozygous hypobetalipoproteinemia (HBL) associated with a pigment epitheliopathy are documented. Night blindness developed in a white woman with familial heterozygous HBL (cholesterol and low-density lipoprotein levels

Authors
Brosnahan, DM; Kennedy, SM; Converse, CA; Lee, WR; Hammer, HM
MLA Citation
Brosnahan, DM, Kennedy, SM, Converse, CA, Lee, WR, and Hammer, HM. "Pathology of hereditary retinal degeneration associated with hypobetalipoproteinemia." Ophthalmology 101.1 (January 1994): 38-45. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
101
Issue
1
Publish Date
1994
Start Page
38
End Page
45

T2-T3 carcinoma of the supraglottic larynx:A comparison of surgery and radiotherapy

Authors
Fein, DA; Nichols, RC; Lee, WR; Mendenhall, WM; Parsons, JT; Stringer, SP; Cassisi, NJ; Million, RR
MLA Citation
Fein, DA, Nichols, RC, Lee, WR, Mendenhall, WM, Parsons, JT, Stringer, SP, Cassisi, NJ, and Million, RR. "T2-T3 carcinoma of the supraglottic larynx:A comparison of surgery and radiotherapy." Radiation Oncology Investigations 2.5 (1994): 237-244.
Source
crossref
Published In
Radiation Oncology Investigations
Volume
2
Issue
5
Publish Date
1994
Start Page
237
End Page
244
DOI
10.1002/roi.2970020507

Value of laryngeal cartilage sclerosis as a predictor of outcome in patients with stage T3 glottic cancer treated with radiation therapy

PURPOSE: To determine whether sclerosis of the laryngeal cartilages was a predictor of a poor outcome in patients with stage T3 glottic cancer treated with radiation therapy. MATERIALS AND METHODS: Thirty-three patients with stage T3 glottic cancer underwent computed tomography (CT) before radiation therapy. Twenty-two patients underwent posttreatment CT. The presence of cartilage sclerosis, cartilage erosion, marrow invasion, and cartilage necrosis was determined. RESULTS: Nineteen of the 33 patients had cartilage sclerosis at CT. Seventeen patients had sclerosis of a single laryngeal cartilage (14 arytenoid, two cricoid, and one thyroid), and two had sclerosis of adjacent laryngeal cartilages (arytenoid and cricoid in both cases). Of the 17 patients with isolated laryngeal cartilage sclerosis, disease was controlled with radiation therapy alone in 15 and with salvage laryngectomy in two. Both patients with cricoid and arytenoid sclerosis died of their original cancer despite undergoing early salvage laryngectomy. Of the 14 patients without sclerosis, eight had no evidence of disease, two died of their disease, and four died of intercurrent disease. CONCLUSION: T3 glottic cancer with isolated laryngeal cartilage sclerosis can be cured with radiation therapy.

Authors
Tart, RP; Mukherji, SK; Lee, WR; Mancuso, AA
MLA Citation
Tart, RP, Mukherji, SK, Lee, WR, and Mancuso, AA. "Value of laryngeal cartilage sclerosis as a predictor of outcome in patients with stage T3 glottic cancer treated with radiation therapy." Radiology 192.2 (1994): 567-570.
PMID
8029433
Source
scival
Published In
Radiology
Volume
192
Issue
2
Publish Date
1994
Start Page
567
End Page
570

Prostate cancer.

Prostate cancer is the most common noncutaneous malignancy diagnosed in American men, and in 1994 it will pass lung cancer as the most common cancer diagnosed in the United States, with an estimated 200,000 new cases. The molecular biology of prostate carcinogenesis is rapidly advancing, and it is clear that, to a degree, prostate cancer is a heritable disease. The use of serum prostate-specific antigen (PSA) as a screening tool has been widely accepted by the medical community, although the evidence to support the efficacy of screening is not yet available. The curative approaches to organ-confined, clinically localized prostate cancer include radiation therapy, radical prostatectomy, and close observation in selected patients. The absence of well-designed clinical trials contributes to the confusion surrounding which curative treatment is the best option in individual patients. The standard approach to patients with evidence of extracapsular spread without distant metastases has been external-beam radiotherapy, although the results with radiation therapy alone in these patients has left considerable room for improvement. Innovative combined-modality approaches are currently being investigated at a number of institutions for these poor-prognosis patients. Three-dimensional conformal radiation therapy is currently being investigated at multiple institutions and offers some hope for improved results. The treatment of metastatic disease remains hormonal manipulation, although the exact nature of optimal androgen deprivation is currently a matter of considerable debate. In patients with hormone-refractory disease newer regimens using novel chemotherapy regimens offer some promise.

Authors
Lee, WR; Giantonio, B; Hanks, GE
MLA Citation
Lee, WR, Giantonio, B, and Hanks, GE. "Prostate cancer." Current problems in cancer 18.6 (1994): 295-357. (Academic Article)
Source
manual
Published In
Current Problems in Cancer
Volume
18
Issue
6
Publish Date
1994
Start Page
295
End Page
357

Radiologic appearance of the irradiated larynx: Part I. Expected changes

PURPOSE: To present the expected appearance of the irradiated larynx and neck as seen at computed tomography (CT). MATERIALS AND METHODS: Sixty-one patients with primary squamous cell carcinoma of the larynx or hypopharynx were treated with radiation therapy. All patients underwent CT before and after treatment. RESULTS: Expected changes include symmetric thickening of the epiglottis, aryepiglottic folds, and false cords and increased attenuation of the paralaryngeal fat. The posterior pharyngeal wall tends to thicken and its mucosa enhances; retropharyngeal space edema is common. Glottic changes include increased attenuation of the paraglottic fat planes and thickening of the anterior and posterior commissures. Subglottic changes include thickening of the mucosa and submucosa. Soft-tissue changes include skin and platysmal thickening, as well as reticulation and increased attenuation of the subcutaneous and deeper fat. CONCLUSION: Familiarization with expected radiologic changes is essential for interpretation of CT images of the irradiated larynx so that such changes are not mistaken for signs of persistent or recurrent tumor.

Authors
Mukherji, SK; Mancuso, AA; Kotzur, IM; Mendenhall, WM; Kubilis, PS; Tart, RP; Lee, WR; Freeman, D
MLA Citation
Mukherji, SK, Mancuso, AA, Kotzur, IM, Mendenhall, WM, Kubilis, PS, Tart, RP, Lee, WR, and Freeman, D. "Radiologic appearance of the irradiated larynx: Part I. Expected changes." Radiology 193.1 (1994): 141-148.
PMID
8090882
Source
scival
Published In
Radiology
Volume
193
Issue
1
Publish Date
1994
Start Page
141
End Page
148

Radiologic appearance of the irradiated larynx: Part II. Primary site response

PURPOSE: To evaluate the computed tomographic (CT) appearance of laryngeal tumors treated with radiation therapy and the ability of CT to depict persistent or residual tumor. MATERIALS AND METHODS: Sixty-one patients with primary squamous cell carcinoma of the larynx or hypopharynx were treated with definitive radiation therapy. CT was performed in all patients before and after treatment. RESULTS: In 32 of 41 patients with cancer controlled at the primary site, CT showed complete resolution of tumor, whereas in 10 of 14 patients in whom radiation therapy failed, there was minimal or no reduction in tumor. In a subpopulation of patients who underwent repeat imaging, 18 of 19 with tumor controlled at the primary site had complete resolution of tumor. Overall, in four of 13 patients with 50%-75% reduction in tumor size or persistent substantial asymmetry at CT, therapy eventually failed at the primary site. CONCLUSION: Lesions that are reduced by 50% or less at 4-month follow-up CT are highly suspicious for treatment failure. Repeat CT studies every 4 months is recommended in addition to careful clinical follow-up.

Authors
Mukherji, SK; Mancuso, AA; Kotzur, IM; Mendenhall, WM; Kubilis, PS; Tart, RP; Freeman, D; Lee, WR
MLA Citation
Mukherji, SK, Mancuso, AA, Kotzur, IM, Mendenhall, WM, Kubilis, PS, Tart, RP, Freeman, D, and Lee, WR. "Radiologic appearance of the irradiated larynx: Part II. Primary site response." Radiology 193.1 (1994): 149-154.
PMID
8090883
Source
scival
Published In
Radiology
Volume
193
Issue
1
Publish Date
1994
Start Page
149
End Page
154

Radiotherapy alone for carcinoma of the vagina: The importance of overall treatment time

Purpose: Review treatment results, complications, and the importance of overall treatment time for carcinoma of the vagina treated with radiotherapy alone. Methods and Materials: Between October 1964 and October 1990, 65 patients with histologically confirmed carcinoma of the vagina received definitive radiotherapy at the University of Florida. All patients had a minimum 2-year follow-up. Most patients were treated with a combination of external-beam radiotherapy and brachytherapy. The probability of pelvic control, cause-specific survival, and complications was calculated and multivariate analyses were performed. The log-rank test was used to determine significance levels between the curves. Results: The 5-year cause-specific survival rates were, Stage 0 (six patients), 100%; Stage I (17 patients), 94%; Stage IIA (six patients), 80%; Stage IIB (ten patients), 39%; Stage III (twn patients), 79%; and Stage IVA (six patients), 62%. The pelvic control rates at 5 years were: Stage 0, 100%; Stage I, 87%; Stage IIA, 88%; Stage IIB, 68%; Stage III, 80%; and Stage IVA, 67%. The parameters of stage, patient age, total dose to primary site, and overall treatment time were evaluated in a multivariate analysis. The single most important predictor of pelvic control was overall treatment time. If the entire course of radiotherapy (external beam + implant) was completed within 9 weeks (63 days), the pelvic control rate was 97%. The pelvic control rate was only 54% if treatment time extended beyond 9 weeks (p = .0003). The rate of severe complications was 12%, and the incidence increased with increasing total primary dose. Conclusion: Radiotherapy alone can cure a significant proportion of patients with carcinoma of the vagina. Treatment should be completed without significant interruption, preferably within 9 weeks. © 1994.

Authors
Lee, WR; Jr, RBM; Sombeck, MD; Mendenhall, WM; Morgan, LS; Freeman, DE; Million, RR
MLA Citation
Lee, WR, Jr, RBM, Sombeck, MD, Mendenhall, WM, Morgan, LS, Freeman, DE, and Million, RR. "Radiotherapy alone for carcinoma of the vagina: The importance of overall treatment time." International Journal of Radiation Oncology, Biology, Physics 29.5 (1994): 983-988.
PMID
8083100
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
29
Issue
5
Publish Date
1994
Start Page
983
End Page
988

Congenital ocular defects associated with an abnormality of the human chromosome 1: trisomy 1q32-qter.

This article describes the detailed ocular pathology found in a premature neonate, born at 34 weeks, with multiple congenital anomalies resulting from de novo trisomy 1q32-qter. The ocular defects include goniodysgenesis, persistent tunica vasculosa lentis and hyaloid vessels, hypopigmentation of the posterior iris epithelium, ectopia of the ciliary processes, and abnormal insertion of the ciliary muscle and cataract. This is the first report of the detailed ocular pathology in a case of trisomy 1q and is also unusual in that the chromosomal defect has apparently arisen de novo in the proband.

Authors
Clark, BJ; Lowther, GW; Lee, WR
MLA Citation
Clark, BJ, Lowther, GW, and Lee, WR. "Congenital ocular defects associated with an abnormality of the human chromosome 1: trisomy 1q32-qter." Journal of pediatric ophthalmology and strabismus 31.1 (1994): 41-45. (Academic Article)
Source
manual
Published In
Journal of pediatric ophthalmology and strabismus
Volume
31
Issue
1
Publish Date
1994
Start Page
41
End Page
45

Keratitis due to the fungus Acremonium (Cephalosporium)

Authors
Kennedy, SM; Shankland, GS; Lee, WR; Sekundo, W
MLA Citation
Kennedy, SM, Shankland, GS, Lee, WR, and Sekundo, W. "Keratitis due to the fungus Acremonium (Cephalosporium)." Eye (London, England) 8 ( Pt 6) (1994): 692-694. (Academic Article)
Source
manual
Published In
Eye
Volume
8 ( Pt 6)
Publish Date
1994
Start Page
692
End Page
694

Prostate cancer

Prostate cancer is the most common noncutaneous malignancy diagnosed in American men, and in 1994 it will pass lung cancer as the most common cancer diagnosed in the United States, with an estimated 200,000 new cases. The molecular biology of prostate carcinogenesis is rapidly advancing, and it is clear that, to a degree, prostate cancer is a heritable disease. The use of serum prostate-specific antigen (PSA) as a screening tool has been widely accepted by the medical community, although the evidence to support the efficacy of screening is not yet available. The curative approaches to organ-confined, clinically localized prostate cancer include radiation therapy, radical prostatectomy, and close observation in selected patients. The absence of well-designed clinical trials contributes to the confusion surrounding which curative treatment is the best option in individual patients. The standard approach to patients with evidence of extracapsular spread without distant metastases has been external-beam radiotherapy, although the results with radiation therapy alone in these patients has left considerable room for improvement. Innovative combined-modality approaches are currently being investigated at a number of institutions for these poor-prognosis patients. Three-dimensional conformal radiation therapy is currently being investigated at multiple institutions and offers some hope for improved results. The treatment of metastatic disease remains hormonal manipulation, although the exact nature of optimal androgen deprivation is currently a matter of considerable debate. In patients with hormone-refractory disease newer regimens using novel chemotherapy regimens offer some promise. © 1994.

Authors
Lee, WR; Giantonio, B; Hanks, GE
MLA Citation
Lee, WR, Giantonio, B, and Hanks, GE. "Prostate cancer." Current Problems in Cancer 18.6 (1994): 298-357.
PMID
7536141
Source
scival
Published In
Current Problems in Cancer
Volume
18
Issue
6
Publish Date
1994
Start Page
298
End Page
357

Early prostate cancer: The national results of radiation treatment from the Patterns of Care and Radiation Therapy Oncology Group studies with prospects for improvement with conformal radiation and adjuvant androgen deprivation

Long-term outcome of the Patterns of Care Study and the Radiation Therapy Oncology Group are used to demonstrate the national average results of treating early prostate cancer in the United States. A group of patients with stage T1B2 disease and pathologically negative lymph nodes showed excellent 10-year survival rates and freedom from clinical evidence of disease, while prostate specific antigen (PSA) correlations in 10-year survivors indicate that 88% were clinically free of cancer and had a PSA level of less than 4.0 mg./nl., and 65% had a PSA level of less than 1.5 ng./ml. The latter group represented clinical and biochemical cures. The improvement noted in outcome of locally advanced prostate cancer treatment by Radiation Therapy Oncology Group prospective trials combining androgen deprivation and radiation therapy is presented. These trials will be extended to the poor prognosis group with stage T1,2 disease. The advantages of conformal therapy in acute and late morbidity are illustrated with preliminary evidence of improved PSA response as a result of improved technique and higher dose associated with conformal 3-dimensional treatment.

Authors
Hanks, GE; Hanlon, A; Schultheiss, T; Corn, B; Shipley, WU; Lee, WR
MLA Citation
Hanks, GE, Hanlon, A, Schultheiss, T, Corn, B, Shipley, WU, and Lee, WR. "Early prostate cancer: The national results of radiation treatment from the Patterns of Care and Radiation Therapy Oncology Group studies with prospects for improvement with conformal radiation and adjuvant androgen deprivation." Journal of Urology 152.5 II (1994): 1775-1780.
PMID
7523724
Source
scival
Published In
Journal of Urology
Volume
152
Issue
5 II
Publish Date
1994
Start Page
1775
End Page
1780

Localized carcinoma of the prostate (stages T1B, T1C, T2, and T3). Review of management with external beam radiation therapy.

BACKGROUND: Optimal treatment for patients with localized carcinoma of the prostate is controversial. Radiation therapy is an established modality in the management of these patients, and several reports indicate the results are comparable to those achieved with radical prostatectomy. Recently effectiveness of therapy for carcinoma of the prostate is being evaluated in light of post-treatment prostate-specific antigen (PSA) determinations. METHODS: A review was performed of multiple publications and data from selected institutions with large experience in the management of carcinoma of the prostate. Survival and clinical incidence of local recurrence and distant metastases were analyzed as well as preliminary data on postirradiation PSA levels. Factors that affect the outcome of therapy and relevant clinical trials are discussed. RESULTS: Reported differences in the age of patients treated with radical prostatectomy (59-63 years), irradiation (63-69 years), or observation (69-75.5 years) were identified. The effect of surgical staging on outcome of irradiation was significant. In multiple series of patients clinically and radiographically staged, the 5-year disease-free survival (DFS) with external irradiation was 95-100% for clinical stage T1a, 80-90% for Stage T1b,c, and 50-70% for clinical Stage T3. A correlation has been identified between the initial PSA levels and the probability from freedom of chemical failure (PSA elevation) after definitive irradiation. In five series comprising 814 patients with Stage T1c and T2 tumors, the DFS (end point chemical failure) was 95%, with initial PSA of less than 4 ng/ml, 83-92% with 4.1-10 ng/ml, 35-85% with 10.1-20 ng/ml, and 10-63% with PSA higher than 20 ng/ml. In the various series, follow-up ranged from a median of 1.5 years to a minimum of 4 years. In two series of 225 and 201 patients receiving doses of 7500-8000 cGy, less morbidity has been observed with three-dimensional treatment planning conformal radiation therapy than with conventional irradiation. New directions for future clinical trials are discussed, including dose escalation studies; use of high linear energy transfer to improve locoregional tumor control; and combination of irradiation and androgen suppression to enhance local tumor control, decrease distant metastasis, and improve survival. Preliminary results of a randomized study recently reported by RTOG strongly suggest that the use of goserelin acetate and flutamide decreases the incidence of clinical local recurrence (12.4% in 225 patients) compared with a control group treated with irradiation alone (25.2% in 230 patients) and enhances disease-free survival. CONCLUSIONS: Although modern approaches to the management of patients with localized carcinoma of the prostate with irradiation are effective, investigators must continue to critically assess policies of treatment, develop appropriately designed prospective clinical trials, and define the optimal management of patients with localized carcinoma of the prostate.

Authors
Perez, CA; Hanks, GE; Leibel, SA; Zietman, AL; Fuks, Z; Lee, WR
MLA Citation
Perez, CA, Hanks, GE, Leibel, SA, Zietman, AL, Fuks, Z, and Lee, WR. "Localized carcinoma of the prostate (stages T1B, T1C, T2, and T3). Review of management with external beam radiation therapy." Cancer 72.11 (December 1993): 3156-3173. (Review)
PMID
7694785
Source
epmc
Published In
Cancer
Volume
72
Issue
11
Publish Date
1993
Start Page
3156
End Page
3173
DOI
10.1002/1097-0142(19931201)72:11<3156::aid-cncr2820721106>3.0.co;2-g

Morphology of iris vasculopathy in exfoliation glaucoma.

Iris tissue obtained from 26 consecutive patients operated upon for exfoliation glaucoma and control iris tissue from 26 age-matched subjects operated upon for primary open angle glaucoma was used to investigate the iris vasculopathy associated with exfoliation glaucoma. By light microscopy exfoliation material was discerned by increased density of the perivascular matrix in affected vessels. By transmission electron microscopy exfoliation vasculopathy was divided into 4 grades. Grade I was characterized by focal accumulation of exfoliation material without evidence of cellular degeneration. In grade II, exfoliation material accumulation was accompanied by degeneration of vascular supporting cells; endothelial cells were unaffected. In grade III, endothelial cells exhibited degenerative changes and in grade IV, exfoliation material occupied an acellular vascular wall (ghost vessel). It is suggested that in iris vessels the synthesis of exfoliation material can be attributed primarily to the vascular supporting cells.

Authors
Konstas, AG; Marshall, GE; Cameron, SA; Lee, WR
MLA Citation
Konstas, AG, Marshall, GE, Cameron, SA, and Lee, WR. "Morphology of iris vasculopathy in exfoliation glaucoma." Acta ophthalmologica 71.6 (December 1993): 751-759. (Academic Article)
Source
manual
Published In
Acta Ophthalmologica
Volume
71
Issue
6
Publish Date
1993
Start Page
751
End Page
759

Morphometric assessment of the central retinal artery and vein in the optic nerve head.

The exact anatomy of the central retinal vein as it exits the eye is unknown. In this study serial sections of the central retinal vein and artery in the anterior optic nerve from six globes (five from cornea donors and one exenteration specimen) were examined by image analysis and three-dimensional reconstruction to determine their luminal characteristics. The retinal artery was found to have a uniform perimetric length and cross-sectional area. The vein, however, had a reduction in these measurements at the level of the lamina cribrosa, signifying a constriction of the vessel at this site. In addition, the cross section of the vein usually formed a "D" or crescentic shape adjacent to the circular artery. We propose that the constriction of the vein acts as a "throttle" mechanism on venous blood flow. Thus, a relatively high venous blood pressure is maintained within the high-pressure intraocular environment, thereby maintaining the patency of the retinal venules and capillaries.

Authors
Taylor, AW; Sehu, W; Williamson, TH; Lee, WR
MLA Citation
Taylor, AW, Sehu, W, Williamson, TH, and Lee, WR. "Morphometric assessment of the central retinal artery and vein in the optic nerve head." Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 28.7 (December 1993): 320-324. (Academic Article)
Source
manual
Published In
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie
Volume
28
Issue
7
Publish Date
1993
Start Page
320
End Page
324

Collagens in ocular tissues.

Authors
Marshall, GE; Konstas, AG; Lee, WR
MLA Citation
Marshall, GE, Konstas, AG, and Lee, WR. "Collagens in ocular tissues." The British journal of ophthalmology 77.8 (August 1993): 515-524. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
77
Issue
8
Publish Date
1993
Start Page
515
End Page
524

Erythropoietin structure-function relationships. Mutant proteins that test a model of tertiary structure.

On the basis of its primary sequence and the location of its disulfide bonds, we propose a structural model of the erythropoietic hormone erythropoietin (Epo) which predicts a four alpha-helical bundle motif, in common with other cytokines. In order to test this model, site-directed mutants were prepared by high level transient expression in Cos7 cells and analyzed by a radioimmuno assay and by bioassays utilizing mouse and human Epo-dependent cell lines. Deletions of 5 to 8 residues within predicted alpha-helices resulted in the failure of export of the mutant protein from the cell. In contrast, deletions at the NH2 terminus (delta 2-5), the COOH terminus (delta 163-166), or in predicted interhelical loops (AB: delta 32-36, delta 53-57; BC: delta 78-82; CD: delta 111-119) resulted in the export of immunologically detectable Epo muteins that were biologically active. The mutein delta 48-52 could be readily detected by radioimmunoassay but had markedly decreased biological activity. However, replacement of each of these deleted residues by serine resulted in Epo muteins with full biological activity. Replacement of Cys29 and Cys33 by tyrosine residues also resulted in the export of fully active Epo. Therefore, this small disulfide loop is not critical to Epo's stability or function. The properties of the muteins that we tested are consistent with our proposed model of tertiary structure.

Authors
Boissel, JP; Lee, WR; Presnell, SR; Cohen, FE; Bunn, HF
MLA Citation
Boissel, JP, Lee, WR, Presnell, SR, Cohen, FE, and Bunn, HF. "Erythropoietin structure-function relationships. Mutant proteins that test a model of tertiary structure." The Journal of biological chemistry 268.21 (July 1993): 15983-15993. (Academic Article)
Source
manual
Published In
The Journal of biological chemistry
Volume
268
Issue
21
Publish Date
1993
Start Page
15983
End Page
15993

Mutational analysis of the leucine zipper-like motif of the human immunodeficiency virus type 1 envelope transmembrane glycoprotein.

The N-terminal region of the envelope (env) transmembrane protein of human immunodeficiency virus type 1 (HIV-1) has a leucine zipper-like motif. This highly conserved zipper motif, which consists of a heptad repeat of leucine or isoleucine residues, has been suggested to play a role in HIV-1 env glycoprotein oligomerization. This hypothesis was tested by replacing the highly conserved leucine or isoleucine residues in the zipper motif with a strong alpha-helix breaker, proline. We report here that such substitutions did not abolish the ability of env protein to form oligomers, indicating that this highly conserved zipper motif does not have a crucial role in env protein oligomerization. However, the mutant viruses all showed impaired infectivity, suggesting that this conserved zipper motif can have an important role in the virus life cycle.

Authors
Chen, SS; Lee, CN; Lee, WR; McIntosh, K; Lee, TH
MLA Citation
Chen, SS, Lee, CN, Lee, WR, McIntosh, K, and Lee, TH. "Mutational analysis of the leucine zipper-like motif of the human immunodeficiency virus type 1 envelope transmembrane glycoprotein." Journal of virology 67.6 (June 1993): 3615-3619. (Academic Article)
Source
manual
Published In
Journal of virology
Volume
67
Issue
6
Publish Date
1993
Start Page
3615
End Page
3619

Prevalence, diagnostic features, and response to trabeculectomy in exfoliation glaucoma.

BACKGROUND: The "true" prevalence and clinical attributes of exfoliation glaucoma remain controversial. The authors studied these characteristics in glaucoma patients requiring trabeculectomy. METHODS: One hundred consecutive patients undergoing trabeculectomy for open-angle glaucoma were investigated by clinical examination (biomicroscopy and gonioscopy) and classified into three categories: exfoliation glaucoma, possible exfoliation glaucoma, and primary open-angle glaucoma (POAG). A definitive diagnosis of exfoliation glaucoma was provided by pathologic examination of iris tissue. RESULTS: All 22 patients with clinical evidence of exfoliation glaucoma and 4 of 18 patients with possible exfoliation glaucoma on clinical examination had ultrastructural evidence of exfoliation material. The prevalence of exfoliation glaucoma, therefore, was 26%. The clinical examination for the diagnosis of exfoliation glaucoma had an 85% sensitivity rate and a 100% specificity rate. In comparison with POAG, patients with exfoliation glaucoma had higher untreated intraocular pressure (IOP), higher IOP with medical therapy, and shorter duration of medical therapy. They were more often operated on for unacceptably high IOP. Exfoliation glaucoma patients exhibited significantly lower IOP after surgery. CONCLUSION: Exfoliation glaucoma is common in patients requiring trabeculectomy for open-angle glaucoma. This condition differs from POAG by a poorer response to medical therapy and a better response to trabeculectomy.

Authors
Konstas, AG; Jay, JL; Marshall, GE; Lee, WR
MLA Citation
Konstas, AG, Jay, JL, Marshall, GE, and Lee, WR. "Prevalence, diagnostic features, and response to trabeculectomy in exfoliation glaucoma." Ophthalmology 100.5 (May 1993): 619-627. (Academic Article)
Source
manual
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
100
Issue
5
Publish Date
1993
Start Page
619
End Page
627

Site-specific mutagenesis of Drosophila alcohol dehydrogenase: evidence for involvement of tyrosine-152 and lysine-156 in catalysis.

Amino acid sequence comparisons reveal that tyrosine-152 and lysine-156 of Drosophila alcohol dehydrogenase (ADH) are conserved in homologous dehydrogenases, suggesting that these residues are important in catalysis. To test this hypothesis, we used site-directed mutagenesis to substitute tyrosine-152 with phenylalanine, histidine, or glutamic acid or to substitute lysine-156 with isoleucine. All of these mutants are catalytically inactive. Two mutants were active: A cysteine mutation of tyrosine-152 has 0.25% of wild-type ADH activity, while an arginine substitution of lysine-156 retains 2.2% of wild-type ADH activity. Kinetic analysis shows that the cysteine mutant increases Km(ethanol) 56-fold and Km(propan-2-ol) 100-fold, while Km(NAD) values are essentially unaltered. The arginine mutant also shows the significant enlargement of Km(ethanol), but not of Km(NAD). Furthermore, the cysteine mutant and arginine mutant have different substrate specificity and behave differently on competitive inhibition than wild-type ADH. These results suggest that both tyrosine-152 and lysine-156 have essential roles in catalysis by Drosophila ADH.

Authors
Chen, Z; Jiang, JC; Lin, ZG; Lee, WR; Baker, ME; Chang, SH
MLA Citation
Chen, Z, Jiang, JC, Lin, ZG, Lee, WR, Baker, ME, and Chang, SH. "Site-specific mutagenesis of Drosophila alcohol dehydrogenase: evidence for involvement of tyrosine-152 and lysine-156 in catalysis." Biochemistry 32.13 (April 1993): 3342-3346. (Academic Article)
Source
manual
Published In
Biochemistry
Volume
32
Issue
13
Publish Date
1993
Start Page
3342
End Page
3346

Collagens in the aged human macular sclera.

Scleral tissue from the region of the human macula was studied by the immunogold labeling technique (cryoultramicrotomy and LR white resin embedding) in an attempt to identify the fine structural distribution of collagen types I-VI. Labeling of the striated collagen fibrils suggested colocalisation of collagen types I, III and V with type V occurring at the fibril surface. Both types V and VI collagen were localised to filamentous strands in the interfibrillar matrix. Collagen types II and IV were absent from the scleral stroma.

Authors
Marshall, GE; Konstas, AG; Lee, WR
MLA Citation
Marshall, GE, Konstas, AG, and Lee, WR. "Collagens in the aged human macular sclera." Current eye research 12.2 (February 1993): 143-153. (Academic Article)
Source
manual
Published In
Current Eye Research (Informa)
Volume
12
Issue
2
Publish Date
1993
Start Page
143
End Page
153

Uveitis and retinal vasculitis in acute experimental allergic encephalomyelitis in the Lewis rat: an ultrastructural study.

The histopathological features of uveitis and retinal vasculitis in acute experimental allergic encephalomyelitis (EAE) were investigated using light and electron microscopy. Lewis rats were immunized by spinal cord homogenate, complete Freund's adjuvant and Bordetella pertussis. The eyes of rats with EAE exhibited vasculitis in the iris, trabeculitis and endothelial abnormalities in the retinal vessels; vasculitis was observed in the optic nerve and brain. Endothelial cells in the vessels in the iris, retina, optic nerve and central nervous system were noted to be elevated (high endothelial-like venules, or HELV). Inflammatory cells in the vascular lumen were attached to the surface of endothelial cells in abnormal areas in the iris. By comparison with the findings in the iris and retina, there were no significant changes in the vessels of the ciliary body and choroid. The ultrastructural features indicated that anterior uveitis in acute EAE resulted from vasculitis in the iris due to changes of the endothelial cells and was not due to a reaction against the myelinated nerves or any other particular components of the iris. In addition, our results suggested that vasculitis in the iris was consequent upon specialized changes of the endothelial cells similar to HELV which were responsible for the transcellular emigration of lymphocytes in other inflammatory diseases or in experimental models. HELV change plays an important role in the perivascular inflammatory process in the iris, retina, optic nerve and central nervous system in EAE and possibly in multiple sclerosis.

Authors
Shikishima, K; Lee, WR; Behan, WM; Foulds, WS
MLA Citation
Shikishima, K, Lee, WR, Behan, WM, and Foulds, WS. "Uveitis and retinal vasculitis in acute experimental allergic encephalomyelitis in the Lewis rat: an ultrastructural study." Experimental eye research 56.2 (February 1993): 167-175. (Academic Article)
Source
manual
Published In
Experimental Eye Research
Volume
56
Issue
2
Publish Date
1993
Start Page
167
End Page
175

Carcinoma of the tonsillar region: A multivariate analysis of 243 patients treated with radical radiotherapy

Between October 1964 and June 1990, 243 patients with squamous cell carcinoma of the tonsillar region were treated with continuous-course radical radiotherapy at the University of Florida. All patients had a minimum 2-year follow-up. Patients were staged according to the AJCC system; stage IV was stratified into two subsets: favorable, IVA (T1-T3 or N2A-N3A); and unfavorable, IVB (T4 or N3B). The initial and ultimate local control rates (including surgical salvage) according to T stage were as follows: T1, 87% and 100%, T2, 79% and 92%; T3, 71% and 76%, and T4, 44% and 48%. Multivariate analysis demonstrated that anterior extension of the primary tumor (p = .0001) and T stage (p = .014) were the most significant parameters affecting local control after radiotherapy. For T4 lesions, twice-daily irradiation significantly improved local control (p = .04). The 5-year absolute and cause-specific survival rates as a function of modified AJCC stage were as follows: I, 37% and 100%; II, 55% and 90%; III, 55% and 85%; IVA, 35% and 60%; and IVB, 23% and 38%. The probability of a severe complication was 3% for the entire group of patients.

Authors
Lee, WR; Mendenhall, WM; Parsons, JT; Million, RR; Cassisi, NJ; Stringer, SP
MLA Citation
Lee, WR, Mendenhall, WM, Parsons, JT, Million, RR, Cassisi, NJ, and Stringer, SP. "Carcinoma of the tonsillar region: A multivariate analysis of 243 patients treated with radical radiotherapy." Head and Neck 15.4 (1993): 283-288.
PMID
8360047
Source
scival
Published In
Head and Neck
Volume
15
Issue
4
Publish Date
1993
Start Page
283
End Page
288

Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone?

Purpose: To determine if pretreatment computed tomography findings can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone. Methods and Materials: Twenty-nine patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with radiotherapy alone; all had a minimum 2-year follow-up. High-quality pretreatment computed tomography scans were retrospectively reviewed by a single head and neck radiologist for tumor involvement of various anatomic subsites within the larynx, and total tumor volumes were calculated for 18 of the most recent patients using a computer digitizer. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. Results: A significant decrease in the local control rate was observed for cancers involving the face of the arytenoid (11 of 20 [55%] vs. 9 of 9 [100%]; p = .02), or the paraglottic space at the false vocal cord level (7 of 16 [44%] vs. 13 of 13 [100%]; p ≠ < .01). Tumors assigned a high tumor score (6, 7, or 8) had a significantly decreased rate of local control with radiation therapy when compared with tumors assigned a low tumor score (≤ 5): 1 of 7 (14%) vs. 19 of 22 (86%) (p = .01). Total tumor volume also significantly correlated with the rate of tumor control. For tumors measuring 3.5 cm3 or less, local control was achieved in 11 of 12 patients (92%), whereas for tumors greater than 3.5 cm3, local control was achieved in 2 of 6 patients (33%) (p = .02). Conclusion: Pretreatment computed tomography scans can contribute significantly to the treatment decision for patients with T3 glottic carcinoma and can define a subset of patients with an excellent chance of being cured with preservation of a functional larynx after treatment with radiotherapy alone. © 1993.

Authors
Lee, WR; Mancuso, AA; Saleh, EM; Mendenhall, WM; Parsons, JT; Million, RR
MLA Citation
Lee, WR, Mancuso, AA, Saleh, EM, Mendenhall, WM, Parsons, JT, and Million, RR. "Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone?." International Journal of Radiation Oncology, Biology, Physics 25.4 (1993): 683-687.
PMID
8454487
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
25
Issue
4
Publish Date
1993
Start Page
683
End Page
687

Radical radiotherapy for T4 carcinoma of the skin of the head and neck: A multivariate analysis

Sixty-seven patients with 68 stage T4 carcinomas of the skin of the head and neck were treated with radical radiotherapy at the University of Florida between October 1964 and November 1989. Thirty-three lesions were previously untreated and 35 were recurrent. Twenty-nine lesions were squamous cell carcinomas, 37 were basal cell carcinomas, and 2 were baso-squamous carcinomas. Minimum follow-up was 2 years. The 5-year local control, local control including surgical salvage, and cause-specific survival probabilities were 53%, 74%, and 75%, respectively. Local control rates with radiotherapy alone were poorer in patients with recurrent lesions (41% vs. 67%, p = .07) or bone involvement (40% vs. 62%, p = .08). Results were analyzed by multivariate methods using local control, local control with surgical salvage, and cause-specific survival as endpoints. The parameters analyzed were histology; size of primary lesion; previous treatment (previously untreated vs. recurrent); involvement of bone, nerve, or cartilage; and skeletal muscle invasion. Three important prognostic factors were identified, each predictive of poorer ultimate local control and cause-specific survival rates: (a) bone involvement (p < .01); (b) recurrent lesions (p < .01); and (c) nerve involvement (p < .02). Radiotherapy alone can control advanced carcinomas of the skin of the head and neck, although lesions that have recurred after prior treatment and those with involvement of bone or nerve are associated with a lower likelihood of cure.

Authors
Lee, WR; Mendenhall, WM; Parsons, JT; Million, RR
MLA Citation
Lee, WR, Mendenhall, WM, Parsons, JT, and Million, RR. "Radical radiotherapy for T4 carcinoma of the skin of the head and neck: A multivariate analysis." Head and Neck 15.4 (1993): 320-324.
PMID
8360054
Source
scival
Published In
Head and Neck
Volume
15
Issue
4
Publish Date
1993
Start Page
320
End Page
324

Elective inguinal lymph node irradiation for pelvic carcinomas: The University of Florida experience

Background. There is little published information pertaining to elective inguinal lymph node irradiation for carcinomas originating in the pelvis that place the inguinal lymph nodes at risk. Methods. Between October 1964 and October 1988, 164 patients with primary carcinomas originating in the pelvis that placed the inguinal lymph nodes at risk for subclinical disease received elective inguinal lymph node irradiation at the University of Florida. All patients had a minimum follow-up of 2 years from the start of radiation therapy. Primary sites included the penis, urethra, vulva, anal canal, distal rectum (within 4 cm of the verge), and the cervix or vagina when the tumor involved the distal one-third of the vagina. In 148 patients, both groins were clinically negative; in 16 patients, one groin was positive and the other negative by clinical examination. Treatment techniques were individualized according to the primary site. Tumor doses to the inguinal lymph nodes varied, although more than 70% of patients received 4500-5000 cGy (range, 2650-6780 cGy) over 5 weeks (range, 2-7 weeks) at 180-200 cGy per fraction. Patients were excluded from the analysis of disease control in the inguinal area if they died less than 2 years from treatment with the inguinal lymph nodes continuously disease free or if they experienced recurrence at the primary site with the inguinal lymph nodes clinically negative at the time of recurrence. Results. The inguinal lymph node control rate was 96% (101 of 105). No patient in whom recurrent disease developed in the inguinal lymph nodes underwent salvage therapy. Conclusions. Elective irradiation of the inguinal lymph nodes is highly effective in controlling subclinical disease from carcinomas originating in the pelvis and can be accomplished with minimal acute or long-term complications.

Authors
Lee, WR; McCollough, WM; Mendenhall, WM; Jr, RBM; Parsons, JT; Million, RR
MLA Citation
Lee, WR, McCollough, WM, Mendenhall, WM, Jr, RBM, Parsons, JT, and Million, RR. "Elective inguinal lymph node irradiation for pelvic carcinomas: The University of Florida experience." Cancer 72.6 (1993): 2058-2065.
Source
scival
Published In
Cancer
Volume
72
Issue
6
Publish Date
1993
Start Page
2058
End Page
2065

Localized carcinoma of the prostate (stages T1B, T1C, T2, and T3): Review of management with external beam radiation therapy

Background. Optimal treatment for patients with localized carcinoma of the prostate is controversial. Radiation therapy is an established modality in the management of these patients, and several reports indicate the results are comparable to those achieved with radical prostatectomy. Recently effectiveness of therapy for carcinoma of the prostate is being evaluated in light of post-treatment prostate-specific antigen (PSA) determinations. Methods. A review was performed of multiple publications and data from selected institutions with large experience in the management of carcinoma of the prostate. Survival and clinical incidence of local recurrence and distant metastases were analyzed as well as preliminary data on postirradiation PSA levels. Factors that affect the outcome of therapy and relevant clinical trials are discussed. Results. Reported differences in the age of patients treated with radical prostatectomy (59-63 years), irradiation (63-69 years), or observation (69-75.5 years) were identified. The effect of surgical staging on outcome of irradiation was significant. In multiple series of patients clinically and radiographically staged, the 5-year disease-free survival (DFS) with external irradiation was 95-100% for clinical stage T1a, 80-90% for Stage T1b,c, and 50-70% for clinical Stage T3. A correlation has been identified between the initial PSA levels and the probability from freedom of chemical failure (PSA elevation) after definitive irradiation. In five series comprising 814 patients with Stage T1c and T2 tumors, the DFS (end point chemical failure) was 95%, with initial PSA of less than 4 ng/ml, 83-92% with 4.1-10 ng/ml, 35-85% with 10.1-20 ng/ml, and 10-63% with PSA higher than 20 ng/ml. In the various series, follow-up ranged from a median of 1.5 years to a minimum of 4 years. In two series of 225 and 201 patients receiving doses of 7500-8000 cGy, less morbidity has been observed with three-dimensional treatment planning conformal radiation therapy than with conventional irradiation. New directions for future clinical trials are discussed, including dose escalation studies; use of high linear energy transfer to improve locoregional tumor control; and combination of irradiation and androgen suppression to enhance local tumor control, decrease distant metastasis, and improve survival. Preliminary results of a randomized study recently reported by RTOG strongly suggest that the use of goserelin acetate and flutamide decreases the incidence of clinical local recurrence (12.4% in 225 patients) compared with a control group treated with irradiation alone (25.2% in 230 patients) and enhances disease-free survival. Conclusions. Although modern approaches to the management of patients with localized carcinoma of the prostate with irradiation are effective, investigators must continue to critically assess policies of treatment, develop appropriately designed prospective clinical trials, and define the optimal management of patients with localized carcinoma of the prostate.

Authors
Perez, CA; Hanks, GE; Leibel, SA; Zietman, AL; Fuks, Z; Lee, WR
MLA Citation
Perez, CA, Hanks, GE, Leibel, SA, Zietman, AL, Fuks, Z, and Lee, WR. "Localized carcinoma of the prostate (stages T1B, T1C, T2, and T3): Review of management with external beam radiation therapy." Cancer 72.11 (1993): 3156-3173.
Source
scival
Published In
Cancer
Volume
72
Issue
11
Publish Date
1993
Start Page
3156
End Page
3173
DOI
10.1002/1097-0142(19931201)72:11<3156::AID-CNCR2820721106>3.0.CO;2-G

Bilateral Kimura's disease of the eyelids.

A case of Kimura's disease affecting the eyelids bilaterally is reported in a 5-year-old boy of Afro-Caribbean extraction who has been followed for 12 years with repeat biopsies. He initially presented at 5 years of age with swelling of the left upper eyelid, left cervical lymphadenopathy, and eosinophilia. One year later he developed swelling of the right upper eyelid. There has been no change in the clinical appearance over the next 12 years. Repeated biopsies of the eyelids showed a diffuse inflammatory infiltrate with many eosinophils and lymphocytes. A lymph node biopsy showed reactive lymphoid hyperplasia. Immunohistochemistry using lymphoid markers showed a polyclonal pattern. Kimura's disease is a rare cause of eyelid swelling, particularly at such a young age and with bilateral involvement. This case demonstrates that bilateral orbital lymphoid lesions with cervical node involvement do not always imply lymphoma, but may have a benign pathogenesis. The unusually long follow up in this case confirms an excellent prognosis for Kimura's disease with conservative management. Accurate diagnosis in small orbital biopsies may spare the patient unnecessary radical surgery.

Authors
Kennedy, SM; Pitts, JF; Lee, WR; Gibbons, DC
MLA Citation
Kennedy, SM, Pitts, JF, Lee, WR, and Gibbons, DC. "Bilateral Kimura's disease of the eyelids." The British journal of ophthalmology 76.12 (December 1992): 755-757. (Academic Article)
Source
manual
Published In
British Journal of Ophthalmology
Volume
76
Issue
12
Publish Date
1992
Start Page
755
End Page
757

Variations in the ganglioside profile of uveal melanoma correlate with cytologic heterogeneity.

Gangliosides may play an important role in the proliferation and spread of human malignant melanoma. Because the frequency of metastases in uveal and cutaneous melanoma differs, it is possible that they may express different gangliosides. We analyzed the ganglioside profiles of primary uveal melanoma in 14 cases and of cutaneous melanoma metastasis in 19 cases. In cutaneous melanoma, GM3 ranged from 4.2% to 74.6% and GD3 from 22.1% to 91.8% of total lipid-bound sialic acid. GM2 (found in 13 of 19 cases, ranging from 0.5% to 11.7%), GD2 (11/19, 0.5%-22.0%) and 9-O-acetyl-GD3 (13/19, 0.5%-12.6%) were also frequently observed. By contrast, in 11 cases of uveal melanoma, GM3 was > 90%, GD3 was

Authors
Kanda, S; Cochran, AJ; Lee, WR; Morton, DL; Irie, RF
MLA Citation
Kanda, S, Cochran, AJ, Lee, WR, Morton, DL, and Irie, RF.