William Lee

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

University of Virginia

M.S. 2000

Wake Forest University

Grants:

Image-Guide Radiation Therapy of Prostate Cancer

Administered By
Radiation Oncology
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

A Prospective Comparative Study of Outcoems with Proton and Photon Radiation in Prostate Cancer PCS-2017C1-0422

Administered By
Radiation Oncology
Awarded By
University of Florida
Role
Principal Investigator
Start Date
End Date

Publications:

Unfilled Positions in the 2022 Radiation Oncology Match: A Reduction in Positions.

Authors
Bates, JE; Amdur, RJ; Lee, WR
MLA Citation
Bates, James E., et al. “Unfilled Positions in the 2022 Radiation Oncology Match: A Reduction in Positions.Pract Radiat Oncol, vol. 12, no. 4, July 2022, pp. e245–47. Pubmed, doi:10.1016/j.prro.2022.03.014.
URI
https://scholars.duke.edu/individual/pub1524881
PMID
35717051
Source
pubmed
Published In
Pract Radiat Oncol
Volume
12
Published Date
Start Page
e245
End Page
e247
DOI
10.1016/j.prro.2022.03.014

The Influence of the Pretreatment Immune State on Response to Radiation Therapy in High Risk Prostate Cancer: A Validation Study from NRG/RTOG 0521.

PURPOSE/OBJECTIVES: The immuno-inflammatory state has been shown to be associated with poor outcomes following radiation therapy (RT). We conducted an a priori designed validation study using serum specimens from RTOG 0521. It was hypothesized the pre-treatment inflammatory state would correlate with clinical outcomes. MATERIALS/METHODS: Patients on RTOG 0521 had serum banked for biomarker validation. This study was designed to validate previous findings showing an association between elevations in C-Reactive Protein (CRP) and shorter biochemical disease free survival (bDFS). CRP levels were measured in pre-treatment samples. An exploratory panel of related cytokines were also measured including: monocyte chemotactic protein-1 (MCP-1), granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-γ), IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-23, and tumor necrosis factor (TNFα). The primary endpoint examined was bDFS. Additional exploratory endpoints included overall survival, distant metastases, and toxicity events attributed to RT. RESULTS: 202 patients in RTOG/NRG 0521 had serum samples available. Median age was 66 years (48-83), 90% of patients were white. There was not an association between high sensitivity (hsCRP) and bDFS (adjusted hazard ratio [HR]=1.07 per one log increase in CRP, 95% CI: 0.83 - 1.38, p=0.60). In the exploratory, unplanned analysis, pre-treatment IL-10 was significantly associated with worse bDFS (adjusted HR=1.61 per log increase, p=0.0027) and distant metastases (HR=1.55 per log increase, p=0.028). The association of IL-10 with bDFS was maintained on a multiplicity adjustment. The exploratory analysis of pretreatment levels of IFN-γ, IL-1b, IL-2, IL-13, IL-23 were negatively associated with g 2 or higher pollakiuria (adjusted OR=0.64, 0.65, 0.71, 0.72, and 0.74, respectively, all p<0.05) and IL-6 was negatively associated with g 2 or higher ED (OR=0.62, p=0.027). CONCLUSIONS: Pretreatment CRP is not associated with a poorer bDFS following RT. In a hypothesis generating analysis, higher baseline levels of IL-10 were associated with lower rates of bDFS. These findings require additional prospective evaluation.
Authors
Hall, WA; Karrison, TG; Rosenthal, SA; Amin, MB; Gomella, LG; Purdy, JA; Sartor, AO; Michalski, JM; Garzotto, MG; Bergom, CR; Jani, AB; Lawton, CAF; Simko, JP; Moore, JK; Gore, EM; Lee, WR; Nguyen, PL; Danielson, BL; Sandler, HM; Feng, FY
MLA Citation
Hall, William A., et al. “The Influence of the Pretreatment Immune State on Response to Radiation Therapy in High Risk Prostate Cancer: A Validation Study from NRG/RTOG 0521.Int J Radiat Oncol Biol Phys, June 2022. Pubmed, doi:10.1016/j.ijrobp.2022.05.048.
URI
https://scholars.duke.edu/individual/pub1524207
PMID
35675855
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Published Date
DOI
10.1016/j.ijrobp.2022.05.048

Methodological Comparison of Mapping the Expanded Prostate Cancer Index Composite to EuroQoL-5D-3L Using Cross-Sectional and Longitudinal Data: Secondary Analysis of NRG/RTOG 0415.

PURPOSE: To compare the predictive ability of mapping algorithms derived using cross-sectional and longitudinal data. METHODS: This methodological assessment used data from a randomized controlled noninferiority trial of patients with low-risk prostate cancer, conducted by NRG Oncology (ClinicalTrials.gov identifier: NCT00331773), which examined the efficacy of conventional schedule versus hypofractionated radiation therapy (three-dimensional conformal external beam radiation therapy/IMRT). Health-related quality-of-life data were collected using the Expanded Prostate Cancer Index Composite (EPIC), and health utilities were obtained using EuroQOL-5D-3L (EQ-5D) at baseline and 6, 12, 24, and 60 months postintervention. Mapping algorithms were estimated using ordinary least squares regression models through five-fold cross-validation in baseline cross-sectional data and combined longitudinal data from all assessment periods; random effects specifications were also estimated in longitudinal data. Predictive performance was compared using root mean square error. Longitudinal predictive ability of models obtained using baseline data was examined using mean absolute differences in the reported and predicted utilities. RESULTS: A total of 267 (and 199) patients in the estimation sample had complete EQ-5D and EPIC domain (and subdomain) data at baseline and at all subsequent assessments. Ordinary least squares models using combined data showed better predictive ability (lowest root mean square error) in the validation phase for algorithms with EPIC domain/subdomain data alone, whereas models using baseline data outperformed other specifications in the validation phase when patient covariates were also modeled. The mean absolute differences were lower for models using EPIC subdomain data compared with EPIC domain data and generally decreased as the time of assessment increased. CONCLUSION: Overall, mapping algorithms obtained using baseline cross-sectional data showed the best predictive performance. Furthermore, these models demonstrated satisfactory longitudinal predictive ability.
Authors
Khairnar, R; DeMora, L; Sandler, HM; Lee, WR; Villalonga-Olives, E; Mullins, CD; Palumbo, FB; Bruner, DW; Shaya, FT; Bentzen, SM; Shah, AB; Malone, S; Michalski, JM; Dayes, IS; Seaward, SA; Albert, M; Currey, AD; Pisansky, TM; Chen, Y; Horwitz, EM; DeNittis, AS; Feng, F; Mishra, MV
MLA Citation
Khairnar, Rahul, et al. “Methodological Comparison of Mapping the Expanded Prostate Cancer Index Composite to EuroQoL-5D-3L Using Cross-Sectional and Longitudinal Data: Secondary Analysis of NRG/RTOG 0415.Jco Clin Cancer Inform, vol. 6, June 2022, p. e2100188. Pubmed, doi:10.1200/CCI.21.00188.
URI
https://scholars.duke.edu/individual/pub1526753
PMID
35776901
Source
pubmed
Published In
Jco Clinical Cancer Informatics
Volume
6
Published Date
Start Page
e2100188
DOI
10.1200/CCI.21.00188

Effect of Large Prostate Volume on Efficacy and Toxicity of Moderately Hypofractionated Radiation Therapy in Patients With Prostate Cancer.

Purpose: To evaluate the effect of prostate volume on outcomes after moderately hypofractionated radiation therapy (mHFRT) for prostate cancer. Methods and Materials: Prostate cancer patients treated with mHFRT at a Veteran's Affairs Medical Center from August 20, 2008, to January 31, 2018, were identified. Patients were placed into a large prostate planning target volume (LPTV) cohort if their prostate PTV was in the highest quartile. Acute/late genitourinary (GU) and gastrointestinal toxicity events among patients with and without LPTV were compared. Multivariable analyses estimated the effect of factors on toxicity. Overall survival, biochemical recurrence-free survival, and freedom from late GU/gastrointestinal toxicity of patients with and without LPTV were estimated via Kaplan-Meier. Results: Four hundred and seventy-two patients were included. Ninety-three percent received 70 Gy in 2.5 Gy fractions; 75% received androgen deprivation therapy. Median follow-up was 69 months. Patients with LPTV (PTV >138.4 cm3) had a higher late 2 + GU toxicity compared with those without (59% vs 48%, P = .03). Earlier time to late 2 + GU toxicity was associated with LPTV (hazard ratio 1.36; 95% confidence interval [CI], 1.00-1.86; P = .047), androgen deprivation therapy use (hazard ratio 1.60; 95% CI, 1.13-2.27; P = .01), and higher baseline American Urologic Association symptom score (odds ratio 1.03; 95% CI, 1.02-1.05; P < .001). At 2 years, freedom from late 2 + GU toxicity was 46% (95% CI, 47%-54%) for those with LPTV versus 61% (95% CI, 55%-65%) for those without (P = .04). Late grade 3 GU toxicity was 7% for those with LPTV and 4% for those without. No differences in overall survival or biochemical recurrence-free survival were observed between patients with or without LPTV. Conclusions: LPTV did not affect efficacy of mHFRT for prostate cancer; however, it was associated with increased risk and earlier onset of late grade 2 + GU toxicity.
Authors
Natesan, D; Carpenter, DJ; Floyd, W; Oyekunle, T; Niedzwiecki, D; Waters, L; Godfrey, D; Moravan, MJ; Lee, WR; Salama, JK
MLA Citation
Natesan, Divya, et al. “Effect of Large Prostate Volume on Efficacy and Toxicity of Moderately Hypofractionated Radiation Therapy in Patients With Prostate Cancer.Adv Radiat Oncol, vol. 7, no. 2, Mar. 2022, p. 100805. Pubmed, doi:10.1016/j.adro.2021.100805.
URI
https://scholars.duke.edu/individual/pub1504660
PMID
35387417
Source
pubmed
Published In
Advances in Radiation Oncology
Volume
7
Published Date
Start Page
100805
DOI
10.1016/j.adro.2021.100805

Radiation technique and outcomes following moderately hypofractionated treatment of low risk prostate cancer: A secondary analysis of the NRG oncology RTOG 0415 randomized clinical trial.

<jats:p> 243 </jats:p><jats:p> Background: While intensity-modulated radiotherapy (IMRT) is commonly used to deliver moderately hypofractionated radiotherapy (MHRT) for prostate cancer (PC), IMRT has not been prospectively compared to three-dimensional conformal radiotherapy (3D-CRT) in the context of MHRT. This secondary analysis of the phase III RTOG 0415 trial compares survival outcomes and toxicity across RT technique between IMRT and 3D-CRT for low-risk PC. Methods: The phase III, non-inferiority trial RTOG 0415 randomized patients with low risk PC to either MHRT (70Gy at 2.5Gy/fraction) or conventionally fractionated radiation (CFRT; 73.8Gy at 1.8Gy/fraction) with stratification by RT technique. A secondary analysis for differences in overall (OS), biochemical recurrence free survival (BRFS), or toxicity by EPIC scores and Common Terminology Criteria for Adverse Events (CTCAE) was performed. For patient and tumor characteristics, continuous data were compared with Wilcoxon rank sum test and categorical data with Chi-squared test, as appropriate. Rates of BRFS and overall survival (OS) were calculated using the Kaplan-Meier method. Results: 1079 patients received the allocated intervention with a median follow up of 5.8 years. RT technique was balanced between treatment arms, with 79.1% of patients receiving IMRT. RT protocol compliance was &gt; 95% for both IMRT and 3D-CRT. There were no significant differences in BRFS between patients treated with 3D-CRT versus IMRT for all patients (p = 0.33), those randomized to CFRT (p = 0.78), or those randomized to MHRT (p = 0.24). Overall survival did not differ by RT technique as well. For all patients, there was no difference in acute and late GI and GU toxicity rates across RT technique. For patients treated with MHRT, late grade 2 GU toxicity was more common with IMRT than 3D-CRT (31.3% vs 23.4%; p = 0.004). On logistic regression analysis, only poor baseline urinary function, defined as an EPIC score of 90 or below, correlated with acute (p &lt; 0.001) or late (p &lt; 0.001) GU toxicity. Baseline bowel function did not correlate to GI toxicity. Conclusions: RT technique did not impact survival outcomes or toxicity rates following MHRT for low risk PC. Higher rates of late CTCAE grade 2+ GU and GI toxicity observed within the RTOG 0415 MHRT arm were not disproportionally observed following 3D-CRT than IMRT. These data highlight the need for careful consideration of target delineation and normal tissue constraints in the selection and delivery of appropriate RT technique. </jats:p>
Authors
Carpenter, DJ; Salama, JK; Lee, WR; Boyer, MJ
MLA Citation
Carpenter, David James, et al. “Radiation technique and outcomes following moderately hypofractionated treatment of low risk prostate cancer: A secondary analysis of the NRG oncology RTOG 0415 randomized clinical trial.Journal of Clinical Oncology, vol. 40, no. 6_suppl, American Society of Clinical Oncology (ASCO), 2022, pp. 243–243. Crossref, doi:10.1200/jco.2022.40.6_suppl.243.
URI
https://scholars.duke.edu/individual/pub1518029
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
40
Published Date
Start Page
243
End Page
243
DOI
10.1200/jco.2022.40.6_suppl.243