Longitudinal Changes in U.S. Parameters of Neurovascular Bundles Suggest Mechanism for Radiation-Induced Erectile Dysfunction

Janopaul‐Naylor, James; Liu, Tian; Zhou, Boran; Yang, Xiaofeng; McCall, Neal S.; Patel, Pretesh; Mehta, Akanksha; Nour, Sherif G.; Jani, Ashesh B.

doi:10.1016/j.adro.2022.100946

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Further, based on an analysis using Surveillance, Epidemiology, and End Results data, disparities in definitive treatment rates could be more profound amongst Black men with low compared to high income 38 . Beyond the standard of care, non‐White men are significantly underrepresented on clinical trials and have lower utilization of advanced radiotherapy techniques such as proton therapy 39–45 . The structural racism that Black patients face across healthcare settings perpetuates the disparate access and outcomes 12,46,47 .…”

Section: Discussionmentioning

confidence: 99%

“… 38 Beyond the standard of care, non‐White men are significantly underrepresented on clinical trials and have lower utilization of advanced radiotherapy techniques such as proton therapy. 39 , 40 , 41 , 42 , 43 , 44 , 45 The structural racism that Black patients face across healthcare settings perpetuates the disparate access and outcomes. 12 , 46 , 47 We show that timely access to definitive prostate cancer treatment remains a disproportionate albeit narrowing challenge for non‐White men even in the years after the ACA was implemented.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act

et al. 2023

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BackgroundDelayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown.MethodsMen with intermediate‐ and high‐risk PCa diagnosed 2010–2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran–Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays.ResultsOf 422,506 eligible men, 18,720 (4.4%) experienced >180‐day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72–1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28–1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84–1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52–0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58–0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays.ConclusionsNon‐White and Medicaid‐insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act

et al. 2023

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“…The growing use of stereotactic body radiation therapy (SBRT) and proton therapy may increase the risk of delivering high radiation dose to NVBs 6 . Thus, there is a critical clinical need to delineate the NVBs in prostate RT treatment planning to better understand the relationship between radiation dose and ED 7 . In addition, the contoured NVBs may be used in plan optimization to develop an intelligent NVB‐spared treatment planning platform for prostate proton and photon radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Automatic segmentation of neurovascular bundle on mri using deep learning based topological modulated network

et al. 2023

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PurposeRadiation damage on neurovascular bundles (NVBs) may be the cause of sexual dysfunction after radiotherapy for prostate cancer. However, it is challenging to delineate NVBs as organ‐at‐risks from planning CTs during radiotherapy. Recently, the integration of MR into radiotherapy made NVBs contour delineating possible. In this study, we aim to develop an MRI‐based deep learning method for automatic NVB segmentation.MethodsThe proposed method, named topological modulated network, consists of three subnetworks, that is, a focal modulation, a hierarchical block and a topological fully convolutional network (FCN). The focal modulation is used to derive the location and bounds of left and right NVBs’, namely the candidate volume‐of‐interests (VOIs). The hierarchical block aims to highlight the NVB boundaries information on derived feature map. The topological FCN then segments the NVBs inside the VOIs by considering the topological consistency nature of the vascular delineating. Based on the location information of candidate VOIs, the segmentations of NVBs can then be brought back to the input MRI's coordinate system.ResultsA five‐fold cross‐validation study was performed on 60 patient cases to evaluate the performance of the proposed method. The segmented results were compared with manual contours. The Dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95) are (left NVB) 0.81 ± 0.10, 1.49 ± 0.88 mm, and (right NVB) 0.80 ± 0.15, 1.54 ± 1.22 mm, respectively.ConclusionWe proposed a novel deep learning‐based segmentation method for NVBs on pelvic MR images. The good segmentation agreement of our method with the manually drawn ground truth contours supports the feasibility of the proposed method, which can be potentially used to spare NVBs during proton and photon radiotherapy and thereby improve the quality of life for prostate cancer patients.

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Relations entre doses dans les structures anatomiques et dysfonction érectile après radiothérapie pour un cancer de la prostate : revue systématique de la littérature

Ailloud,

Udrescu,

Horn

et al. 2023

Cancer/Radiothérapie

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Longitudinal Changes in U.S. Parameters of Neurovascular Bundles Suggest Mechanism for Radiation-Induced Erectile Dysfunction

Cited by 5 publications

References 16 publications

Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act

Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act

Automatic segmentation of neurovascular bundle on mri using deep learning based topological modulated network

Relations entre doses dans les structures anatomiques et dysfonction érectile après radiothérapie pour un cancer de la prostate : revue systématique de la littérature

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