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:

Mapping expanded prostate cancer index composite to EQ5D utilities to inform economic evaluations in prostate cancer: Secondary analysis of NRG/RTOG 0415.

PURPOSE: The Expanded Prostate Cancer Index Composite (EPIC) is the most commonly used patient reported outcome (PRO) tool in prostate cancer (PC) clinical trials, but health utilities associated with the different health states assessed with this tool are unknown, limiting our ability to perform cost-utility analyses. This study aimed to map EPIC tool to EuroQoL-5D-3L (EQ5D) to generate EQ5D health utilities. METHODS AND MATERIALS: This is a secondary analysis of a prospective, randomized non-inferiority clinical trial, conducted between 04/2006 and 12/2009 at cancer centers across the United States, Canada, and Switzerland. Eligible patients included men >18 years with a known diagnosis of low-risk PC. Patient HRQoL data were collected using EPIC and health utilities were obtained using EQ5D. Data were divided into an estimation sample (n = 765, 70%) and a validation sample (n = 327, 30%). The mapping algorithms that capture the relationship between the instruments were estimated using ordinary least squares (OLS), Tobit, and two-part models. Five-fold cross-validation (in-sample) was used to compare the predictive performance of the estimated models. Final models were selected based on root mean square error (RMSE). RESULTS: A total of 565 patients in the estimation sample had complete information on both EPIC and EQ5D questionnaires at baseline. Mean observed EQ5D utility was 0.90±0.13 (range: 0.28-1) with 55% of patients in full health. OLS models outperformed their counterpart Tobit and two-part models for all pre-determined model specifications. The best model fit was: "EQ5D utility = 0.248541 + 0.000748*(Urinary Function) + 0.001134*(Urinary Bother) + 0.000968*(Hormonal Function) + 0.004404*(Hormonal Bother)- 0.376487*(Zubrod) + 0.003562*(Urinary Function*Zubrod)"; RMSE was 0.10462. CONCLUSIONS: This is the first study to identify a comprehensive set of mapping algorithms to generate EQ5D utilities from EPIC domain/ sub-domain scores. The study results will help estimate quality-adjusted life-years in PC economic evaluations.
Authors
Khairnar, R; Pugh, SL; Sandler, HM; Lee, WR; Villalonga Olives, E; Mullins, CD; Palumbo, FB; Bruner, DW; Shaya, FT; Bentzen, SM; Shah, AB; Malone, SC; Michalski, JM; Dayes, IS; Seaward, SA; Albert, M; Currey, AD; Pisansky, TM; Chen, Y; Horwitz, EM; DeNittis, AS; Feng, FY; Mishra, MV
MLA Citation
Khairnar, Rahul, et al. “Mapping expanded prostate cancer index composite to EQ5D utilities to inform economic evaluations in prostate cancer: Secondary analysis of NRG/RTOG 0415.Plos One, vol. 16, no. 4, 2021, p. e0249123. Pubmed, doi:10.1371/journal.pone.0249123.
URI
https://scholars.duke.edu/individual/pub1478628
PMID
33852571
Source
pubmed
Published In
Plos One
Volume
16
Published Date
Start Page
e0249123
DOI
10.1371/journal.pone.0249123

Prostate Radiotherapy With Adjuvant Androgen Deprivation Therapy (ADT) Improves Metastasis-Free Survival Compared to Neoadjuvant ADT: An Individual Patient Meta-Analysis.

PURPOSE: There remains a lack of clarity regarding the influence of sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) on outcomes in prostate cancer (PCa). Herein, we evaluate the optimal sequencing of ADT with prostate-directed RT in localized PCa. METHODS: MEDLINE (1966-2018), Embase (1982-2018), ClinicalTrials.gov, and conference proceedings (1990-2018) were searched to identify randomized trials evaluating the sequencing, but not duration, of ADT with RT. Two randomized phase III trials were identified, and individual patient data were obtained: Ottawa 0101 and NRG Oncology's Radiation Therapy Oncology Group 9413. Ottawa 0101 randomly assigned patients to neoadjuvant or concurrent versus concurrent or adjuvant short-term ADT. Radiation Therapy Oncology Group 9413, a 2 × 2 factorial trial, included a random assignment of neoadjuvant or concurrent versus adjuvant short-term ADT. The neoadjuvant or concurrent ADT arms of both trials were combined into the neoadjuvant group, and the arms receiving adjuvant ADT were combined into the adjuvant group. The primary end point of this meta-analysis was progression-free survival (PFS). RESULTS: The median follow-up was 14.9 years. Overall, 1,065 patients were included (531 neoadjuvant and 534 adjuvant). PFS was significantly improved in the adjuvant group (15-year PFS, 29% v 36%, hazard ratio [HR], 1.25 [95% CI, 1.07 to 1.47], P = .01). Biochemical failure (subdistribution HR [sHR], 1.37 [95% CI, 1.12 to 1.68], P = .002), distant metastasis (sHR, 1.40 [95% CI, 1.00 to 1.95], P = .04), and metastasis-free survival (HR, 1.17 [95% CI, 1.00 to 1.37], P = .050) were all significantly improved in the adjuvant group. There were no differences in late grade ≥ 3 gastrointestinal (2% v 3%, P = .33) or genitourinary toxicity (5% v 5%, P = .76) between groups. CONCLUSION: The sequencing of ADT with prostate-directed RT has significant association with long-term PFS and MFS in localized PCa. Our findings favor use of an adjuvant over a neoadjuvant approach, without any increase in long-term toxicity.
Authors
Spratt, DE; Malone, S; Roy, S; Grimes, S; Eapen, L; Morgan, SC; Malone, J; Craig, J; Dess, RT; Jackson, WC; Hartman, HE; Kishan, AU; Mehra, R; Kaffenberger, S; Morgan, TM; Reichert, ZR; Alumkal, JJ; Michalski, J; Lee, WR; Pisansky, TM; Feng, FY; Shipley, W; Sandler, HM; Schipper, MJ; Roach, M; Sun, Y; Lawton, CAF
MLA Citation
Spratt, Daniel E., et al. “Prostate Radiotherapy With Adjuvant Androgen Deprivation Therapy (ADT) Improves Metastasis-Free Survival Compared to Neoadjuvant ADT: An Individual Patient Meta-Analysis.J Clin Oncol, vol. 39, no. 2, Jan. 2021, pp. 136–44. Pubmed, doi:10.1200/JCO.20.02438.
URI
https://scholars.duke.edu/individual/pub1468786
PMID
33275486
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
39
Published Date
Start Page
136
End Page
144
DOI
10.1200/JCO.20.02438

Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network.

BACKGROUND: Implementation methods of risk-stratified cancer screening guidance throughout a health care system remains understudied. OBJECTIVE: Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system. DESIGN: Comparison of men seen pre-implementation (2/1/2016-2/1/2017) vs. post-implementation (2/2/2017-2/21/2018). PARTICIPANTS: Men, aged 40-75 years, without a history of prostate cancer, who were seen by a primary care provider. INTERVENTIONS: The algorithm was integrated into two components in the electronic health record (EHR): in Health Maintenance as a personalized screening reminder and in tailored messages to providers that accompanied prostate-specific antigen (PSA) results. MAIN MEASURES: Primary outcomes: percent of men who met screening algorithm criteria; percent of men with a PSA result. Logistic repeated measures mixed models were used to test for differences in the proportion of individuals that met screening criteria in the pre- and post-implementation periods with age, race, family history, and PSA level included as covariates. KEY RESULTS: During the pre- and post-implementation periods, 49,053 and 49,980 men, respectively, were seen across 26 clinics (20.6% African American). The proportion of men who met screening algorithm criteria increased from 49.3% (pre-implementation) to 68.0% (post-implementation) (p < 0.001); this increase was observed across all races, age groups, and primary care clinics. Importantly, the percent of men who had a PSA did not change: 55.3% pre-implementation, 55.0% post-implementation. The adjusted odds of meeting algorithm-based screening was 6.5-times higher in the post-implementation period than in the pre-implementation period (95% confidence interval, 5.97 to 7.05). CONCLUSIONS: In this preliminary analysis, following implementation of an EHR-based algorithm, we observed a rapid change in practice with an increase in screening in higher-risk groups balanced with a decrease in screening in low-risk groups. Future efforts will evaluate costs and downstream outcomes of this strategy.
Authors
Shah, A; Polascik, TJ; George, DJ; Anderson, J; Hyslop, T; Ellis, AM; Armstrong, AJ; Ferrandino, M; Preminger, GM; Gupta, RT; Lee, WR; Barrett, NJ; Ragsdale, J; Mills, C; Check, DK; Aminsharifi, A; Schulman, A; Sze, C; Tsivian, E; Tay, KJ; Patierno, S; Oeffinger, KC; Shah, K
MLA Citation
Shah, Anand, et al. “Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network.J Gen Intern Med, vol. 36, no. 1, 2021, pp. 92–99. Pubmed, doi:10.1007/s11606-020-06124-2.
URI
https://scholars.duke.edu/individual/pub1441099
PMID
32875501
Source
pubmed
Published In
J Gen Intern Med
Volume
36
Published Date
Start Page
92
End Page
99
DOI
10.1007/s11606-020-06124-2

Editorial comment.

Authors
Roach, M
MLA Citation
Roach, Mack. “Editorial comment.Urology, vol. 77, no. 4, Apr. 2011, pp. 991–92. Pubmed, doi:10.1016/j.urology.2010.08.056.
URI
https://scholars.duke.edu/individual/pub1471759
PMID
21477731
Source
pubmed
Published In
Urology
Volume
77
Published Date
Start Page
991
End Page
992
DOI
10.1016/j.urology.2010.08.056

Gratitude Is the Attitude: Acknowledgments After 10 Years With Practical Radiation Oncology.

Authors
MLA Citation
Lee, W. Robert. “Gratitude Is the Attitude: Acknowledgments After 10 Years With Practical Radiation Oncology.Pract Radiat Oncol, vol. 11, no. 1, Jan. 2021, pp. 1–2. Pubmed, doi:10.1016/j.prro.2020.09.011.
URI
https://scholars.duke.edu/individual/pub1470942
PMID
33390241
Source
pubmed
Published In
Pract Radiat Oncol
Volume
11
Published Date
Start Page
1
End Page
2
DOI
10.1016/j.prro.2020.09.011