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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.
PMID: 34243797
ISSN: 1748-717x
CID: 4965222

Ethnicity and insurance status predict metastatic disease presentation in prostate, breast, and non-small cell lung cancer

Aghdam, Nima; McGunigal, Mary; Wang, Haijun; Repka, Michael C; Mete, Mihriye; Fernandez, Stephen; Dash, Chiranjeev; Al-Refaie, Waddah B; Unger, Keith R
BACKGROUND:Ethnicity and insurance status have been shown to impact odds of presenting with metastatic cancer, however, the interaction of these two predictors is not well understood. We evaluate the difference in odds of presenting with metastatic disease in minorities compared to white patients despite access to the same insurance across three common cancer types. METHODS:Using the National Cancer Database, a multilevel logistic regression model that estimated the odds of metastatic disease was fit, adjusting for covariates including year of diagnosis, ethnicity, insurance, income, and region. We included adults diagnosed with metastatic prostate, non-small cell lung cancer (NSCLC), and breast cancer from 2004 to 2015. RESULTS:The study cohort consisted of 1 191 241 prostate cancer (PCa), 1 310 986 breast cancer (BCa), and 1 183 029 NSCLC patients. Private insurance was the most protective factor against metastatic presentation. Odds of presenting with metastatic disease were 0.190 [95% CI, 0.182-0.198], 0.616 [95% CI, 0.602-0.630], and 0.270 [95% CI, 0.260-0.279] for PCa, NSCLC, and BCa compared to uninsured patients, respectively. Private insurance provided the most significant benefit to non-Hispanic White PCa patients with 81% reduction in odds of metastatic presentation and conferred the least benefit to African-American NSCLC patients at 30.4% reduction in odds of metastatic presentation. CONCLUSIONS:Insurance status provided the single most protective effect against metastatic presentation. This benefit varied for minorities despite similar insurance. Reducing metastatic disease presentation rates requires addressing social barriers to care independent of insurance.
PMID: 32511873
ISSN: 2045-7634
CID: 4510432

Prostate Fiducial Marker Placement in Patients on Anticoagulation: Feasibility Prior to Prostate SBRT

Iocolano, Michelle; Blacksburg, Seth; Carpenter, Todd; Repka, Michael; Carbone, Susan; Demircioglu, Gizem; Miccio, Maryann; Katz, Aaron; Haas, Jonathan
Background and Purpose: Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) or image-guided radiation therapy (IGRT) for prostate cancer. Many patients take antiplatelet or anticoagulant medication due to other medical comorbidities. They are often required to temporarily discontinue these medications prior to invasive medical procedures as they are prone to bleed. Some patients are unable to discontinue therapy due to an elevated risk of thromboembolic events. The purpose of this study is to report this institution's experience placing fiducial markers in prostate cancer patients who are on chronic antiplatelet or anticoagulant medication. Materials and Methods: From August 2015-March 2019 57 patients on chronic antiplatelet or anticoagulation therapy who were not cleared to stop these medications underwent transrectal ultrasound guided (TRUS) fiducial marker placement for SBRT/IGRT. All patients were monitored by a registered nurse during the procedure for prolonged bleeding that required staff to hold pressure to the area with a 4 × 4 gauze until it resolved. All patients were also called the following day to assess for ongoing bleeding events. Treatment planning CT scan confirmed the ideal geometry of the marker placement. Results: All 57 patients on antiplatelet or anticoagulant medication who underwent fiducial marker placement were discharged home the same day of the procedure. Four patients experienced persistent bleeding that required a nurse to hold prolonged pressure to the area. No patient experienced significant bleeding the following day or any untoward cardiovascular event. Conclusions: This series suggests the use of antiplatelet or anticoagulant medication is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. These patients should be closely monitored after the procedure for bleeding complications. Practitioners may consider the patient's medical comorbidities, risk factors for thromboembolism, and overall functional status as there is no standardized protocol for discontinuing anticoagulant or antiplatelet therapy for fiducial marker placement.
PMID: 32175274
ISSN: 2234-943x
CID: 4371092

Assessing Clinical and Dosimetric Predictors For Low PSA Nadir after Stereotactic Body Radiation Monotherapy with Intraprostatic Dose Escalation [Meeting Abstract]

Blacksburg, S. R.; Sheu, R.; Carpenter, T. J.; Demircioglu, G.; Repka, M. C.; Witten, M. R.; Mendez, C.; Shin, W.; Chieng, T.; Katz, A. E.; Haas, J. A.
ISSN: 0360-3016
CID: 4686362

Comparisons Between Patients at Suburban and Inner-City Facilities Treated With Prostate SBRT: Long-Term Parity in Outcomes Despite Measurable Differences in Demographic and Disease Profiles [Meeting Abstract]

Blacksburg, S. R.; Carpenter, T. J.; Marans, H.; Demircioglu, G.; Witten, M. R.; Repka, M. C.; Mendez, C.; Katz, A. E.; Haas, J. A.
ISSN: 0360-3016
CID: 4686232

Obstructive Uropathy after Prostate SBRT is Rare: Characterizing Clinical and Dosimetric Predictors From a Large Patient Cohort [Meeting Abstract]

Blacksburg, S. R.; Sheu, R.; Carpenter, T. J.; Repka, M. C.; Demircioglu, G.; Witten, M. R.; Mendez, C.; Auto, H.; Shin, W.; Zafar, S.; Ilyas, A.; Haas, J. A.
ISSN: 0360-3016
CID: 4686352

Stereotactic Body Radiation Therapy: A Versatile, Well-Tolerated, and Effective Treatment Option for Extracranial Metastases From Primary Ovarian and Uterine Cancer

Aghdam, Nima; Repka, Michael C.; McGunigal, Mary; Pepin, Abby; Paydar, Ima; Rudra, Sonali; Paudel, Nitika; Pernia Marin, Monica; Suy, Simeng; Collins, Sean P.; Barnes, Willard; Collins, Brian T.
ISSN: 2234-943x
CID: 4736432

Lessons Learned From Mock Radiation Oncology Interviews

Sura, Karna; Repka, Michael; Lischalk, Jonathan W
PMID: 30611385
ISSN: 1558-349x
CID: 3627332

Robotic Stereotactic Accelerated Partial-Breast Irradiation for Early-Stage Breast Cancer: 5-Year Results of a Single-Institution Pilot Study [Meeting Abstract]

Kataria, S.; Obayomi-Davies, O., Jr.; Lischalk, J. W.; Repka, M. C.; Danner, M.; Suy, S.; Collins, S. P.; Elie, G.; Campbell, L.; Rashid, A.; Makariou, E. V.; Rudra, S.; Collins, B. T.
ISSN: 0360-3016
CID: 4111902

Evidence of Stage Migration to Higher Risk Prostate Cancer and its Financial Implications in a Single Institution [Meeting Abstract]

Haas, J. A.; Mendez, C.; Sanchez, A.; Mirza, A.; Carpenter, T. J.; Witten, M. R.; Demircioglu, G.; Katz, A. E.; Repka, M. C.; Blacksburg, S. R.
ISSN: 0360-3016
CID: 4111992