James B Yu

• Doctor of Medicine
• St. Francis Hospital

Importance The polyethylene glycol-based hydrogel spacer (PHS) system temporarily separates the rectum from the prostate in patients undergoing radiotherapy (RT) for prostate cancer (PCa). Objective To compare incidence of bowel disorders and related procedures in patients receiving RT with and without PHS. Design, Setting, and Participants This...

Background Black patients with non‐small cell lung cancer (NSCLC) are more often diagnosed at a later stage and receive inadequate evaluation and treatment compared to White patients. We aimed to identify factors representing exposure to structural racism that mediate the association between race and NSCLC care. Methods We queried Surveillance, Ep...

105 Background: Next-generation sequencing (NGS) testing is used for prognostication and to guide treatment choice in metastatic prostate cancer (mPC). While NGS testing is increasingly available, how its usage has impacted real-world selection of next line therapies including olaparib in mPC is unclear. Methods: We performed a retrospective observ...

Stereotactic body radiation therapy (SBRT) is increasingly becoming an effective alternative to other treatment modalities in the treatment of cancer. Evidence from a variety of different data sources including prospective and retrospective series, large database analyses, and cost-effectiveness studies demonstrates that SBRT is effective in the tr...

Background IDH-wildtype (-wt) status is a pre-requisite for the diagnosis of glioblastoma (GBM); however, IDH-wt gliomas with low grade or anaplastic morphology have historically been excluded from GBM trials and may represent a distinct prognostic entity. While alkylating agent chemotherapy improves overall survival (OS) and progression-free survi...

5101 Background: Patients with high-risk features who experience biochemical relapse (BCR) after radical prostatectomy (RP) benefit from the addition of androgen deprivation therapy (ADT) to salvage radiotherapy (SRT). We hypothesized that intensification of androgen receptor (AR) blockade with enzalutamide would improve SRT outcomes for high-risk...

Artificial intelligence use in prostate cancer encompasses 4 main areas including diagnostic imaging, prediction of outcomes, histopathology, and treatment planning.

The COVID-19 pandemic caused widespread disruptions in cancer care. We hypothesized that the greatest disruptions in diagnosis occurred in screen-detected cancers. We identified patients (≥18 years of age) with newly diagnosed cancer from 2019 to 2020 in the US National Cancer Database and calculated the change in proportion of early-stage to late-...

PURPOSE Previous comparative effectiveness studies have not demonstrated a benefit of proton beam therapy (PBT) compared with intensity-modulated radiation therapy (IMRT) for prostate cancer. An updated comparison of GI and genitourinary (GU) toxicity is needed. METHODS We investigated the SEER-Medicare linked database, identifying patients with l...

Over the past decade, innovations in radiation technology and technique have led to the increasing use of stereotactic body radiotherapy (SBRT) for the treatment of renal cell carcinoma. We provide an overview of SBRT and review the role of SBRT for treatment of localized and oligometastatic RCC. We also provide a brief overview of the current stat...

131 Background: Patients with high-risk features who experience biochemical relapse (BCR) after radical prostatectomy (RP) benefit from the addition of androgen deprivation therapy (ADT) to salvage radiotherapy (SRT). We hypothesized that intensification of androgen receptor (AR) blockade with enzalutamide would improve SRT outcomes for high-risk p...

260 Background: The randomized FORMULA-509 trial demonstrated that for patients with a PSA >0.5 after RP receiving salvage radiation and 6 months of GnRH Agonist, the addition of AAP and Apa improved metastasis-free survival compared to bicalutamide. Here we present the patient-reported health-related quality of life (HRQoL) results. Methods: Valid...

Standard-of-care for 1p19q-intact anaplastic gliomas is defined by the international randomized phase III CATNON trial, which found an overall survival (OS) benefit for adjuvant temozolomide (TMZ) when added to radiotherapy. Paradoxically, TMZ did not appear to benefit patients with IDH-wildtype gliomas, regardless of MGMT promoter status. The auth...

Radiation oncology plays an important role in the local treatment of cancers. Understanding recent advances in the application of radiation therapy to solid tumors is important for all disciplines. The radiation oncology section editors for this journal have selected the following articles for their overall significance, relevance to surgical oncol...

Introduction Suicide rates are elevated after cancer diagnosis. Existential distress caused by awareness of one’s impending death is well‐described in patients with cancer. The authors hypothesized that suicide risk is associated with cancer prognosis, and the impact of prognosis on suicide risk is greatest for populations with higher baseline suic...

Purpose To maximize the therapeutic ratio, it is important to identify adverse prognostic features in men with prostate cancer, especially among those with intermediate risk disease, which represents a heterogeneous group. These men may benefit from treatment intensification. Prior studies have shown pretreatment mpMRI may predict biochemical failu...

Importance Randomized clinical trials have demonstrated the noninferiority of shorter radiotherapy (RT) courses (termed hypofractionation ) compared with longer RT courses in patients with localized prostate cancer. Although shorter courses are associated with cost-effectiveness, convenience, and expanded RT access, their adoption remains variable....

Objective Standard-of-care for 1p19q-intact anaplastic gliomas is defined by the international randomized phase III CATNON trial, which found an overall survival (OS) benefit for adjuvant temozolomide (TMZ) when added to radiotherapy. Paradoxically, TMZ did not appear to benefit patients with IDH-wildtype gliomas, regardless of MGMT promoter status...

Introduction: With the diminishing use of whole-brain radiotherapy (WBRT), there is increasing debate regarding the maximum number of brain metastases that should be treated with stereotactic radiosurgery (SRS). In patients with >10-15 lesions, some groups are proposing a new approach - selected-lesion SRS (SL- SRS) - where only a subset of intracr...

Purpose: While MGMT promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy and guides treatment decisions in glioblastoma, its role in grade 2 and 3 glioma remains unclear. Recent data suggests that mMGMT is prognostic of progression-free survival in 1p/19q-codeleted oligodendrogliomas, but an effect on overall survival...

Social determinants of health may impact prostate cancer presentation. Since neighborhoods may influence adjacent neighborhoods across often porous and arbitrary borders, we performed generalized spatial two stage least squares cross sections regression to assess direct and indirect (via adjacent neighborhoods) impact of neighborhood level independ...

Purpose: Patients with cancer are particularly vulnerable to coronavirus disease (COVID). Transportation barriers made travel to obtain medical care more difficult during the pandemic. Whether these factors led to changes in the distance traveled for radiotherapy and the coordinated location of radiation treatment is unknown. Materials and method...

6634 Background: Suicide rates are elevated acutely after cancer diagnosis. We sought to create a unifying theory that explains variations in suicide risk across cancer sites, stages, and demographics. Based on the stress-diathesis model, we hypothesized that suicide risk correlates with cancer prognosis and that the impact of prognosis on suicide...

Importance: O6-methylguanine-DNA methyltransferase (MGMT [OMIM 156569]) promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy for glioblastomas and is routinely used to guide treatment decisions. However, the utility of MGMT promoter status for low-grade and anaplastic gliomas remains unclear due to molecular heterogene...

Radiation oncology, as a technologically intensive discipline that requires communication between multiple and diverse computer systems, is vulnerable to cyberattack. Given the enormous amount of the loss of time, energy, and money that results from a cyberattack, it behooves radiation oncologists and their teams to minimize cybersecurity threats t...

This cohort study uses national surveillance data to describe the incidence and risk of squamous cell carcinoma after postmastectomy implant reconstruction in women with breast cancer.

187 Background: Intraprostatic radiation dose escalation is an area of clinical interest. Dose escalation within the prostate must be balanced with maintaining acceptable dose to the organs at risk, OAR (bladder, rectum, and urethra). Treatment planning therefore requires simultaneous consideration of multiple competing plan optimization goals, for...

303 Background: Six months of a GnRH agonist with SRT is a standard of care for patients with unfavorable features and a detectable PSA post-RP. FORMULA-509 was designed to evaluate whether adding six months of AAP and Apa to this regimen could improve outcomes. Methods: FORMULA-509 (NCT03141671) is an investigator-initiated, multi-center, open-lab...

Introduction: Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) of the central nervous system (CNS) is a rare meningeal tumor. Given the absence of prospective or randomized data, there are no standard indications for radiotherapy. Recently, the NRG Oncology and EORTC cooperative groups successfully accrued and completed the first prospective tr...

Introduction Adaptive MRI-guided linear accelerators (aMRI-LINACs) are an emerging technology with the potential to improve radiation treatment for cancer through improved visualization and adaptive treatment. Given the competing forces of the increased cost, knowledge and staff required for MRI-LINAC therapy, it is unpredictable how rapidly and fo...

Purpose/Objective(s) Despite the recognition that women with triple-negative (TNBC) and HER2+ breast cancer have a higher risk of developing brain metastases than other subtypes of breast cancer, the recently updated NCCN guidelines for breast cancer do not recommend MR imaging of the brain in women with either primary or metastatic breast cancer (...

Purpose/Objective(s) The rising cost of health care is a major concern in the United States. Though radiation oncology was targeted for cost reductions based on expenditure growth, subsequent analyses suggested stabilization of radiation oncology charges. In 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a new radiation oncolog...

Objectives Distant metastases (DM) are the primary driver of mortality for patients with early stage non-small cell lung cancer (NSCLC) receiving stereotactic body radiation therapy (SBRT), yet patient-level risk is difficult to predict. We developed and validated a model to predict individualized risk of DM in this population. Methods We utilized...

Introduction Our goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020–2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults wit...

Background Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL). Although it often has an indolent course, it can progress to more aggressive CTCL forms. There is sparse data in current literature describing specific clinical factors associated with in-hospital mortality in mycosis fungoides patients. An understanding...

Objective: Because of the aggressive nature of glioblastoma, patients with unresected disease are encouraged to begin radiotherapy within approximately 1 month after craniotomy. The aim of this study was to investigate the potential association between time interval from biopsy to radiotherapy with overall survival in patients with unresected glio...

Health economics research, defined as research that evaluates how patients, health-care providers, and governments make health-care decisions using economic theory, models, and empirical techniques, requires broad domains of knowledge that are not fully encompassed by a single discipline. Collaboration between disciplines provides different perspec...

The National Cancer Institute Division of Cancer Control and Population Science hosted a virtual conference on the Future of Cancer Health Economics Research and included a presentation from a workgroup that considered current challenges and future directions in health economics research centered on cancer treatment. The workgroup identified 3 broa...

Brain metastases are a challenging manifestation of renal cell carcinoma. We have a limited understanding of brain metastasis tumor and immune biology, drivers of resistance to systemic treatment, and their overall poor prognosis. Current data support a multimodal treatment strategy with radiation treatment and/or surgery. Nonetheless, the optimal...

TPS5115 Background: Roughly 20%-30% of prostate cancer patients experience biochemical recurrence (BCR), rising prostate-specific antigen (PSA) levels, after definitive therapy with radical prostatectomy (RP) or radiation therapy (RT). The optimal therapy and timing of treatment for BCR is unknown, however, for patients who are not eligible for sal...

12061 Background: Limited research is available about cancer survivors’ level of stress, social connectedness and loneliness during the COVID-19 that can put them at increased risk for poor physical and mental health. We estimated relative decreased rate of social connectedness and increased rates of loneliness/sadness and stress/anxiety among canc...

Purpose Whole brain radiation therapy (WBRT) is often used as an effective treatment for patients with brain metastasis, although it is also known to have deleterious cognitive effects. Multiple trials have identified strategies to help mitigate neurocognitive decline after WBRT, although there may be barriers to integrating these techniques into r...

PURPOSE As prostate-specific membrane antigen (PSMA) positron emission tomography (PET) becomes increasingly available in the United States, the greater sensitivity of the technology in comparison to conventional imaging poses challenges for clinical trials. The NCI Clinical Imaging Steering Committee (CISC) PSMA PET Working Group was convened to c...

Objectives To elucidate the national burden of emergency department (ED) visits for radiation cystitis (RC), a known complication of radiation therapy (RT) to the pelvic area, among patients with a prostate cancer history, and identify those who are at increased risk of requiring invasive measures. Patients and methods This study queried the Natio...

Introduction: We sought to understand patient- and institution-level factors associated with use of locoregional therapy for newly diagnosed metastatic prostate cancer in the era before the availability of evidence supporting its efficacy. Methods: We queried the National Cancer Database to identify patients diagnosed with metastatic prostate ad...

Importance In April 2017, the US Preventive Services Task Force (USPSTF) published a draft guideline that reversed its 2012 guidance advising against prostate-specific antigen (PSA)–based screening for prostate cancer in all men (grade D), instead endorsing individual decision-making for men aged 55 to 69 years (grade C). Objective To evaluate cha...

Purpose/Objective(s) Whole brain radiation therapy (WBRT) is often employed as an effective treatment to palliate symptoms, improve intracranial control, and potentially improve survival for patients with brain metastasis, although it is also known to have deleterious cognitive effects. Despite multiple trials having identified strategies to help m...

Purpose/Objective(s) There is mounting evidence that curative-intent stereotactic body radiation therapy (SBRT) may improve overall survival (OS) in patients with oligometastatic disease. However, the optimal sequencing and timing of radiation in this setting remains unclear. Delaying SBRT in favor of upfront systemic therapy can reduce tumor burde...

Purpose/Objective(s) Studies have suggested that prior radiation dose to normal lung tissue is associated with poor COVID-19 outcomes. However, radiation dose to the heart may be an equally important consideration, given the impact of COVID-19 on cardiovascular/thrombotic complications, and of cardiac dose on overall mortality after breast and lung...

Background: The current distribution of radiation therapy (RT) facilities in the US is not well established. A comprehensive inventory of US RT facilities was last assessed in 2005, based on data from state regulatory agencies and dosimetric quality assurance bodies. We updated this database to characterize population-level measures of geographic a...

The progression of cancer is an evolutionary process that is challenging to monitor between sampling timepoints. However, investigation of cancer evolution over specific time periods is crucial to the elucidation of key events such as the acquisition of therapeutic resistance and subsequent fatal metastatic spread of therapy-resistant cell populati...

Importance: The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. Objective: To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. Design, setting, and parti...

Introduction The study aimed to describe the brain metastases (BM) incidence, at diagnosis and follow-up, in patients initially presenting with stage III or IV melanoma and characterize their metastatic brain lesions. We also sought to describe the association of common genetic mutations and immunotherapy with BM development in advanced melanoma.Me...

Objectives: Post-operative radiation therapy (PORT) in locally advanced non-small cell lung cancer (LA-NSCLC) has historically been associated with toxicity. Conformal techniques like intensity modulated radiation therapy (IMRT) have the potential to reduce acute and long-term toxicity from radiation therapy. Among patients receiving PORT for LA-N...

Objective: The impact of immunotherapy and stereotactic radiosurgery (SRS) in treatment of brain metastases (BM) from renal cell carcinoma (RCC) has not been well investigated. Materials and methods: Forty-eight patients with 372 RCC BM were treated with SRS and divided into those ever treated with immunotherapy versus those who never received i...

Comparative effectiveness research (CER) using national registries influences cancer clinical trial design, treatment guidelines, and patient management. However, the extent to which treatment selection bias (TSB) affects overall survival (OS) in cancer CER remains poorly defined. We sought to quantify the TSB effect on OS in the setting of low-ris...

Background: There exists wide practice variability in palliative treatment schedules for bone metastases. In an effort to reduce variation and promote high-quality, cost-conscious care, the National Quality Forum (NQF) endorsed measure 1822 in 2012. This measure recommends the use of 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fraction...

Purpose: Ductal carcinoma in situ (DCIS) accounts for 20% of breast cancer cases in the United States and is potentially overtreated, leading to high expenditures and low-value care. We conducted a cost-effectiveness analysis evaluating all adjuvant treatment strategies for DCIS. Methods: A Markov model was created with six competing treatment s...

e20550 Background: Soon after the publication of the PACIFIC trial, the Food and Drug Administration (FDA) approved durvalumab following definitive chemoradiation in patients with unresectable stage III non-small cell lung cancer (NSCLC). However, patterns of durvalumab adoption within the United States are currently unknown. We investigated the pa...

The progression of cancer—including the acquisition of therapeutic resistance and the fatal metastatic spread of therapy-resistant cell populations—is an evolutionary process that is challenging to monitor between sampling timepoints. Here we apply mutational signature analysis to clinically correlated cancer chronograms to detect and describe the...