Try a new search

Format these results:

Searched for:

person:evansa03

in-biosketch:true

Total Results:

104


High-volume prostate biopsy core involvement is not associated with an increased risk of cancer recurrence following 5-fraction stereotactic body radiation therapy monotherapy

Lischalk, Jonathan W; Sanchez, Astrid; Santos, Vianca F; Mendez, Christopher; Akerman, Meredith; Carpenter, Todd; Tam, Moses; Byun, David; Wise, David R; Mahadevan, Anand; Evans, Andrew; Huang, William; Katz, Aaron; Lepor, Herbert; Haas, Jonathan A
PURPOSE/OBJECTIVE:Percentage of positive cores involved on a systemic prostate biopsy has been established as a risk factor for adverse oncologic outcomes and is a National Comprehensive Cancer Network (NCCN) independent parameter for unfavorable intermediate-risk disease. Most data from a radiation standpoint was published in an era of conventional fractionation. We explore whether the higher biological dose delivered with SBRT can mitigate this risk factor. METHODS:A large single institutional database was interrogated to identify all patients diagnosed with localized prostate cancer (PCa) treated with 5-fraction SBRT without ADT. Pathology results were reviewed to determine detailed core involvement as well as Gleason score (GS). High-volume biopsy core involvement was defined as ≥ 50%. Weighted Gleason core involvement was reviewed, giving higher weight to higher-grade cancer. The PSA kinetics and oncologic outcomes were analyzed for association with core involvement. RESULTS:From 2009 to 2018, 1590 patients were identified who underwent SBRT for localized PCa. High-volume core involvement was a relatively rare event observed in 19% of our cohort, which was observed more in patients with small prostates (p < 0.0001) and/or intermediate-risk disease (p = 0.005). Higher PSA nadir was observed in those patients with low-volume core involvement within the intermediate-risk cohort (p = 0.004), which was confirmed when core involvement was analyzed as a continuous variable weighted by Gleason score (p = 0.049). High-volume core involvement was not associated with biochemical progression (p = 0.234). CONCLUSIONS:With a median follow-up of over 4 years, biochemical progression was not associated with pretreatment high-volume core involvement for patients treated with 5-fraction SBRT alone. In the era of prostate SBRT and MRI-directed prostate biopsies, the use of high-volume core involvement as an independent predictor of unfavorable intermediate risk disease should be revisited.
PMCID:10913228
PMID: 38439040
ISSN: 1748-717x
CID: 5664372

Risk and Prognostics of Second Primary Cancer after Prostate Radiation Therapy

Liu, Elisa K.; Daniels, Thomas B.; Lischalk, Jonathan W.; Oh, Cheongeun; Haas, Jonathan A.; Evans, Andrew J.; Byun, David J.
Introduction:As overall survival in prostate cancer increases due to advances in early detection and management, there is a growing need to understand the long-Term morbidity associated with treatment, including secondary tumors. The significance of developing radiation-Associated secondary cancers in an elderly population remains unknown.Methods:Patients diagnosed with prostate cancer between 1975 and 2016 in one of 9 Surveillance, Epidemiology, and End Results registries were included in this study. Risk of second primary pelvic malignancies (SPPMs) were assessed with death as a competing risk using the Fine-Gray model. Time-varying Cox proportional hazard models were employed to analyze risk to overall mortality based on secondary tumor status.Results:A total of 569,167 primary prostate cancers were included in analysis with an average follow-up of 89 months. Among all prostate cancer patients, 4956 SPPMs were identified. After controlling for differences in age, year of diagnosis, and surgery at time of prostate cancer treatment, radiation receipt was associated with a significantly higher incidence of SPPMs (1.1% vs 1.8% at 25 years). Among those who received radiation during initial prostate cancer treatment (n = 195,415), developing an SPPM is significantly associated with worse survival (adjusted hazard ratio = 1.76), especially among younger patients (under age 63, adjusted hazard ratio = 2.36).Conclusions:While developing a secondary malignancy carries a detrimental effect on overall survival, the absolute risk of developing such tumors is exceedingly low regardless of radiation treatment.
SCOPUS:85181833354
ISSN: 2352-0779
CID: 5630052

Risk and Prognostics of Second Primary Cancer After Prostate Radiation Therapy

Liu, Elisa K; Daniels, Thomas B; Lischalk, Jonathan W; Oh, Cheongeun; Haas, Jonathan A; Evans, Andrew J; Byun, David J
INTRODUCTION/UNASSIGNED:As overall survival in prostate cancer increases due to advances in early detection and management, there is a growing need to understand the long-term morbidity associated with treatment, including secondary tumors. The significance of developing radiation-associated secondary cancers in an elderly population remains unknown. METHODS/UNASSIGNED:Patients diagnosed with prostate cancer between 1975 and 2016 in one of 9 Surveillance, Epidemiology, and End Results registries were included in this study. Risk of second primary pelvic malignancies (SPPMs) were assessed with death as a competing risk using the Fine-Gray model. Time-varying Cox proportional hazard models were employed to analyze risk to overall mortality based on secondary tumor status. RESULTS/UNASSIGNED:A total of 569,167 primary prostate cancers were included in analysis with an average follow-up of 89 months. Among all prostate cancer patients, 4956 SPPMs were identified. After controlling for differences in age, year of diagnosis, and surgery at time of prostate cancer treatment, radiation receipt was associated with a significantly higher incidence of SPPMs (1.1% vs 1.8% at 25 years). Among those who received radiation during initial prostate cancer treatment (n = 195,415), developing an SPPM is significantly associated with worse survival (adjusted hazard ratio = 1.76), especially among younger patients (under age 63, adjusted hazard ratio = 2.36). CONCLUSIONS/UNASSIGNED:While developing a secondary malignancy carries a detrimental effect on overall survival, the absolute risk of developing such tumors is exceedingly low regardless of radiation treatment.
PMID: 37917577
ISSN: 2352-0787
CID: 5612762

A Prospective Evaluation of Infant Cerebellar-Cerebral Functional Connectivity in Relation to Behavioral Development in Autism Spectrum Disorder

Hawks, Z W; Todorov, A; Marrus, N; Nishino, T; Talovic, M; Nebel, M B; Girault, J B; Davis, S; Marek, S; Seitzman, B A; Eggebrecht, A T; Elison, J; Dager, S; Mosconi, M W; Tychsen, L; Snyder, A Z; Botteron, K; Estes, A; Evans, A; Gerig, G; Hazlett, H C; McKinstry, R C; Pandey, J; Schultz, R T; Styner, M; Wolff, J J; Zwaigenbaum, L; Markson, L; Petersen, S E; Constantino, J N; White, D A; Piven, J; Pruett, J R
Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder diagnosed based on social impairment, restricted interests, and repetitive behaviors. Contemporary theories posit that cerebellar pathology contributes causally to ASD by disrupting error-based learning (EBL) during infancy. The present study represents the first test of this theory in a prospective infant sample, with potential implications for ASD detection.
Method(s): Data from the Infant Brain Imaging Study (n = 94, 68 male) were used to examine 6-month cerebellar functional connectivity magnetic resonance imaging in relation to later (12/24-month) ASD-associated behaviors and outcomes. Hypothesis-driven univariate analyses and machine learning-based predictive tests examined cerebellar-frontoparietal network (FPN; subserves error signaling in support of EBL) and cerebellar-default mode network (DMN; broadly implicated in ASD) connections. Cerebellar-FPN functional connectivity was used as a proxy for EBL, and cerebellar-DMN functional connectivity provided a comparative foil. Data-driven functional connectivity magnetic resonance imaging enrichment examined brain-wide behavioral associations, with post hoc tests of cerebellar connections.
Result(s): Cerebellar-FPN and cerebellar-DMN connections did not demonstrate associations with ASD. Functional connectivity magnetic resonance imaging enrichment identified 6-month correlates of later ASD-associated behaviors in networks of a priori interest (FPN, DMN), as well as in cingulo-opercular (also implicated in error signaling) and medial visual networks. Post hoc tests did not suggest a role for cerebellar connections.
Conclusion(s): We failed to identify cerebellar functional connectivity-based contributions to ASD. However, we observed prospective correlates of ASD-associated behaviors in networks that support EBL. Future studies may replicate and extend network-level positive results, and tests of the cerebellum may investigate brain-behavior associations at different developmental stages and/or using different neuroimaging modalities.
Copyright
EMBASE:2016992717
ISSN: 2667-1743
CID: 5514012

A Tool to Integrate Electrophysiological Mapping for Cardiac Radioablation of Ventricular Tachycardia

Wang, Hesheng; Barbhaiya, Chirag R; Yuan, Ye; Barbee, David; Chen, Ting; Axel, Leon; Chinitz, Larry A; Evans, Andrew J; Byun, David J
PURPOSE/UNASSIGNED:Cardiac radioablation is an emerging therapy for recurrent ventricular tachycardia. Electrophysiology (EP) data, including electroanatomic maps (EAM) and electrocardiographic imaging (ECGI), provide crucial information for defining the arrhythmogenic target volume. The absence of standardized workflows and software tools to integrate the EP maps into a radiation planning system limits their use. This study developed a comprehensive software tool to enable efficient utilization of the mapping for cardiac radioablation treatment planning. METHODS AND MATERIALS/UNASSIGNED:After the scar area is outlined on the mapping surface, the tool extracts and extends the annotated patch into a closed surface and converts it into a structure set associated with the anatomic images. The tool then exports the structure set and the images as The Digital Imaging and Communications in Medicine Standard in Radiotherapy for a radiation treatment planning system to import. Overlapping the scar structure on simulation CT, a transmural target volume is delineated for treatment planning. RESULTS/UNASSIGNED:The tool has been used to transfer Ensite NavX EAM data into the Varian Eclipse treatment planning system in radioablation on 2 patients with ventricular tachycardia. The ECGI data from CardioInsight was retrospectively evaluated using the tool to derive the target volume for a patient with left ventricular assist device, showing volumetric matching with the clinically used target with a Dice coefficient of 0.71. CONCLUSIONS/UNASSIGNED:HeaRTmap smoothly fuses EP information from different mapping systems with simulation CT for accurate definition of radiation target volume. The efficient integration of EP data into treatment planning potentially facilitates the study and adoption of the technique.
PMCID:10320498
PMID: 37415904
ISSN: 2452-1094
CID: 5539402

Stereotactic body radiation therapy for the treatment of localized prostate cancer in men with underlying inflammatory bowel disease

Lischalk, Jonathan W; Blacksburg, Seth; Mendez, Christopher; Repka, Michael; Sanchez, Astrid; Carpenter, Todd; Witten, Matthew; Garbus, Jules E; Evans, Andrew; Collins, Sean P; Katz, Aaron; Haas, Jonathan
BACKGROUND:Historically, IBD has been thought to increase the underlying risk of radiation related toxicity in the treatment of prostate cancer. In the modern era, contemporary radiation planning and delivery may mitigate radiation-related toxicity in this theoretically high-risk cohort. This is the first manuscript to report clinical outcomes for men diagnosed with prostate cancer and underlying IBD curatively treated with stereotactic body radiation therapy (SBRT). METHODS:A large institutional database of patients (n = 4245) treated with SBRT for adenocarcinoma of the prostate was interrogated to identify patients who were diagnosed with underlying IBD prior to treatment. All patients were treated with SBRT over five treatment fractions using a robotic radiosurgical platform and fiducial tracking. Baseline IBD characteristics including IBD subtype, pre-SBRT IBD medications, and EPIC bowel questionnaires were reviewed for the IBD cohort. Acute and late toxicity was evaluated using the CTCAE version 5.0. RESULTS:A total of 31 patients were identified who had underlying IBD prior to SBRT for the curative treatment of prostate cancer. The majority (n = 18) were diagnosed with ulcerative colitis and were being treated with local steroid suppositories for IBD. No biochemical relapses were observed in the IBD cohort with early follow up. High-grade acute and late toxicities were rare (n = 1, grade 3 proctitis) with a median time to any GI toxicity of 22 months. Hemorrhoidal flare was the most common low-grade toxicity observed (n = 3). CONCLUSION/CONCLUSIONS:To date, this is one of the largest groups of patients with IBD treated safely and effectively with radiation for prostate cancer and the only review of patients treated with SBRT. Caution is warranted when delivering therapeutic radiation to patients with IBD, however modern radiation techniques appear to have mitigated the risk of GI side effects.
PMCID:8267228
PMID: 34243797
ISSN: 1748-717x
CID: 4965222

The 2019 International Society of Urological Pathology (ISUP) Consensus Conference on Grading of Prostatic Carcinoma

van Leenders, Geert J L H; van der Kwast, Theodorus H; Grignon, David J; Evans, Andrew J; Kristiansen, Glen; Kweldam, Charlotte F; Litjens, Geert; McKenney, Jesse K; Melamed, Jonathan; Mottet, Nicholas; Paner, Gladell P; Samaratunga, Hemamali; Schoots, Ivo G; Simko, Jeffry P; Tsuzuki, Toyonori; Varma, Murali; Warren, Anne Y; Wheeler, Thomas M; Williamson, Sean R; Iczkowski, Kenneth A
Five years after the last prostatic carcinoma grading consensus conference of the International Society of Urological Pathology (ISUP), accrual of new data and modification of clinical practice require an update of current pathologic grading guidelines. This manuscript summarizes the proceedings of the ISUP consensus meeting for grading of prostatic carcinoma held in September 2019, in Nice, France. Topics brought to consensus included the following: (1) approaches to reporting of Gleason patterns 4 and 5 quantities, and minor/tertiary patterns, (2) an agreement to report the presence of invasive cribriform carcinoma, (3) an agreement to incorporate intraductal carcinoma into grading, and (4) individual versus aggregate grading of systematic and multiparametric magnetic resonance imaging-targeted biopsies. Finally, developments in the field of artificial intelligence in the grading of prostatic carcinoma and future research perspectives were discussed.
PMID: 32459716
ISSN: 1532-0979
CID: 4473402

Changes in expression of hormone-regulated and proliferation-associated genes across the menstrual cycle in oestrogen receptor-positive breast cancer [Meeting Abstract]

Haynes, B P; Ginsburg, O; Gao, Q; Folkerd, E; Afentakis, M; Buus, R; Quang, L H; Han, P T; Khoa, P H; Van, Dinh N; Van, To T; Clemons, M; Holcombe, C; Osborne, C; Evans, A; Skene, A; Sibbering, M; Rogers, C; Laws, S; Noor, L; Smith, I E; Dowsett, M
Introduction: Differences in the expression of estrogen-regulated genes (ERG), and proliferation-associated genes (PAG) have been shown in ER+ tumours as a result of the major changes in hormone levels during the menstrual cycle. Here, we extend that observation in a prospective study.
Aim(s): To determine if there are changes in the expression of ERGs, PAGs and progesterone-regulated genes (PRG) in ER+ breast cancer during the menstrual cycle.
Method(s): Paired tumour samples from 96 patients in two independent prospective studies were used. Tumours were assigned to one of three pre-defined menstrual cycle windows: W1 (days 27-35 and 1-6; low E2 and low progesterone), W2 (days 7-16; high E2 and low progesterone) and W3 (days 17-26; intermediate E2 and high progesterone) based on plasma hormone measurements. RNA expression of 50 genes, including 27 ERGs, 11 PRGs and seven PAGs was measured.
Result(s): The AvERG, a composite measure of ERG expression, showed significant changes between the individual windows (Kruskal- Wallis (KW) P = 0.0002), increasing between W1 and W2 (fold change (FC) 2.2) and decreasing between W2 and W3 (FC 0.62) and between W3 and W1 (FC 0.58). PAG expression also changed significantly (KW P = 0.012), but to a lesser extent. Significant changes in the expression of eight individual ERGs, including GREB1, PGR and TFF1, and two PAGs were observed between W1 and either W2 or W3 with all genes showing higher levels in W2 or W3 (FC 1.3-2.4; FDR 0.016-0.05). Mean protein levels of PgR increased between W1 and W2 or W3 (+18.3%; FDR 0.024). The AvProg, a composite measure of PRG expression, increased significantly (FC 1.5, Spearman P = 0.026) in W3 compared to W1 or W2.
Conclusion(s): Significant changes in ERG, PRG and PAG expression in ER+ breast tumours occur during the menstrual cycle that may affect the assessment and interpretation of prominent biomarkers
EMBASE:631581268
ISSN: 1573-7217
CID: 4416562

Dataset for the reporting of carcinoma of renal tubular origin: recommendations from the International Collaboration on Cancer Reporting (ICCR)

Delahunt, B; Srigley, J R; Judge, M J; Amin, M B; Billis, A; Camparo, P; Evans, A J; Fleming, S; Griffiths, D; Lopez-Beltran, A; Martignoni, G; Moch, H; Nacey, J N; Zhou, M
AIMS/OBJECTIVE:The International Collaboration on Cancer Reporting (ICCR) has provided detailed datasets based upon the published reporting protocols of the Royal College of Pathologists, The Royal College of Pathologists of Australasia and the College of American Pathologists. METHODS AND RESULTS/RESULTS:The dataset for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology and the fourth edition of the World Health Organization Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are Required and Recommended components of the report. Required elements are; specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co-existing pathology. Recommended reporting elements are; pre-operative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). CONCLUSIONS:It is anticipated that the implementation of this dataset in routine clinical practise will inform patient treatment as well as provide standardized information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations.
PMID: 30325065
ISSN: 1365-2559
CID: 3369982

Statin use and time to progression in men on active surveillance for prostate cancer

Jayalath, Viranda H; Nayan, Madhur; Finelli, Antonio; Komisarenki, Maria; Timilshina, Narhari; Kulkarni, Girish S; Fleshner, Neil E; Bhindi, Bimal; Evans, Andrew; Zlotta, Alexandre R; Hamilton, Robert J
PURPOSE:Recent evidence suggests that statins may improve prostate cancer outcomes; however, their role in active surveillance (AS) is poorly characterized. We aimed to evaluate the association between statin use at diagnosis and time to progression on AS. MATERIALS AND METHODS:Data were obtained from a prospectively maintained cohort of men undergoing AS between 1995 and 2016 at our institution. All men satisfied the low-risk criteria: Gleason score <7, <4 positive cores, <50% involvement of any core, and prostate-specific antigen level <10.0 ng/dL. Kaplan-Meier curves and multivariable Cox proportional hazards were used to assess statin exposure at diagnosis and at time to pathological progression (failing to meet the low-risk criteria at biopsy) and therapeutic progression (first of pathological progression or initiation of definitive therapy). Reclassification at confirmatory biopsy (first postdiagnostic biopsy) and progression beyond confirmatory biopsy were evaluated independently. RESULTS:Low-risk criteria were met by 797 men. Reclassification at the confirmatory biopsy occurred in 194 (24%) men, 51 (26%) of whom were statin users. Statin use was not associated with reclassification at confirmatory biopsy (odds ratio (OR): 1.24, 95% confidence interval (CI): 0.77-1.99). Among the remaining 603 men (median age: 63 years; follow-up: 60 months; 23% statin users), 149 (24%) had pathologic progression, while 200 (33%) had therapeutic progression. Statin exposure was not associated with pathological (multivariable hazard ratio (HR) 0.79, 95% CI: 0.51-1.23) or therapeutic (multivariable-HR 0.81, 95% CI: 0.55-1.19) progression beyond the confirmatory biopsy. Sensitivity analyses did not alter conclusions. CONCLUSIONS:In our study, statin use at diagnosis was not significantly protective against pathological or therapeutic progression in men undergoing AS for localized, low-risk prostate cancer.
PMID: 29875433
ISSN: 1476-5608
CID: 5308992