Publications by authors named "W Ray Butler"

1,247 Publications

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Clinical outcomes as a function of the number of samples taken during stereotactic needle biopsies: a meta-analysis.

J Neurooncol 2021 Jul 12. Epub 2021 Jul 12.

Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.

Background: Stereotactic needle biopsy remains the cornerstone for tissue diagnosis for tumors located in regions of the brain that are difficult to access through open surgery.

Objective: We perform a meta-analysis of the literature to examine the relation between number of samples taken during biopsy and diagnostic yield, morbidity and mortality.

Methods: We identified 2416 patients from 28 cohorts in studies published in PubMed database that studied stereotactic needle biopsies for tumor indications. Meta-analysis by proportions and meta-regression analyses were performed.

Results: On meta-analysis, the morbidity profile of the published needle biopsy studies clustered into three groups: studies that performed < 3 samples (n = 8), 3-6 samples (n = 13), and > 6 samples during biopsy (n = 7). Pooled estimates for biopsy related morbidity were 4.3%, 16.3%, and 17% for studies reporting < 3, 3-6, and > 6 biopsy samples, respectively. While these morbidity estimates significantly differed (p < 0.001), the diagnostic yields reported for studies performing < 3 biopsies, 3-6 samples, and > 6 samples were comparable. Pooled estimates of diagnostic yield for these three groups were 90.4%, 93.8%, and 88.1%, respectively. Mortality did not significantly differ between studies reporting differing number of samples taken during biopsy.

Conclusions: Our meta-analysis suggests that morbidity risk in needle biopsy is non-linearly associated with the number of samples taken. There was no association between the number of biopsies taken, and diagnostic yield or mortality.
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http://dx.doi.org/10.1007/s11060-021-03785-9DOI Listing
July 2021

The Impact of Body Mass Index on Freedom From Therapeutic Intervention and Quality of Life in Active Surveillance Prostate Cancer Patients.

Am J Clin Oncol 2021 Jun 7. Epub 2021 Jun 7.

Schiffler Cancer Center, Urologic Research Institute Departments of Urology Pathology, Wheeling Hospital, Wheeling, WV.

Objective: The objective of this study was to evaluate the impact of body mass index (BMI) on overall survival, freedom from distant metastases, rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients.

Materials And Methods: Three hundred forty consecutive, prospectively evaluated AS patients underwent a staging transperineal template-guided mapping biopsy before AS enrollment and were stratified by BMI (<25, 25 to 29.9, 30 to 34.9, and >35 kg/m2). Evaluated outcomes included overall survival, freedom from distant metastases, TI, QOL to include urinary, bowel, sexual function and depression and serial postvoid residual urine measurements. The relationship between BMI and anterior prostate cancer distribution was evaluated. Repeat biopsy was based on prostate specific antigen kinetics, abnormal digital rectal examination and patient preference.

Results: Of the 340 patients, 323 (95%) were Gleason 3+3 and 17 patients (5.0%) were Gleason 3+4. The median follow-up was 5.2 years (range: 1 to 14 y). At 10 years, TI was instituted in 4.7%, 2.2%, 9.5%, and 25.0% of patients in BMI cohorts <25, 25 to 29.9, 30 to 34.9, and ≥35 (P=0.075). No patient has developed distant metastases. The median time to TI was 4.86 years. In multivariate analysis, TI was most closely predicted by prostate specific antigen density (P=0.071). At 8 years, no statistical differences in urinary function, bowel function, depression or postvoid residual were noted. However, a trend for erectile dysfunction was identified (P=0.106).

Conclusion: At 10 years, BMI did not statistically predict for TI, geographic distribution of prostate cancer or QOL parameters.
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http://dx.doi.org/10.1097/COC.0000000000000839DOI Listing
June 2021

Effect of the timing of hydrogel spacer placement on prostate and rectal dosimetry of low-dose-rate brachytherapy implants.

J Contemp Brachytherapy 2021 Apr 14;13(2):145-151. Epub 2021 Apr 14.

Schiffler Cancer Center, Wheeling Hospital, Wheeling, WV, USA.

Purpose: To verify the dose sparing effect of hydrogel spacer (SpaceOAR™) on rectal dosimetry for prostate brachytherapy, and to determine whether prostate and rectal dosimetry was affected by the time gap between hydrogel spacer injection and brachytherapy dosimetry.

Material And Methods: The Pd brachytherapy dosimetry of 174 consecutive intermediate- and high-risk patients injected with hydrogel was compared with a dosimetry of 174 contemporaneous patients without hydrogel injections. Of the SpaceOAR™ patients, 91 had hydrogel injected upon completion of brachytherapy implant, while the remaining 83 patients had hydrogel placed prior to external beam radiation therapy (EBRT), followed 2-10 weeks later by brachytherapy. Brachytherapy implants were either planned with the prostate undistorted by any hydrogel or planned with hydrogel in place. Dosimetry of the prostate and tissues at risk was determined from CT imaging on the day of brachytherapy implant.

Results: SpaceOAR™ significantly reduced mean and maximum rectal doses as well as rectal wall V, but there was a statistically significant reduction of planning target volume (PTV) D to 121.1% of the prescribed dose in hydrogel patients compared to 123.3% in the non-hydrogel patients. Rectal dosimetry was similar between patients injected with hydrogel after brachytherapy and those with spacer injected prior to EBRT. However, patients who had hydrogel placed prior to EBRT had statistically significantly higher dosimetry indices of PTV and urethra relative to those with spacer placed at the completion of brachytherapy.

Conclusions: There was a significant rectal dose sparing in the cohort with hydrogel spacer compared to a reference group without spacer injection. The rectal dose sparing effect was similar in the sub-group of patients injected with hydrogel prior to EBRT and the sub-group injected with hydrogel at the conclusion of brachytherapy.
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http://dx.doi.org/10.5114/jcb.2021.105281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060959PMC
April 2021

Neuroendocrine cells of the prostate: Histology, biological functions, and molecular mechanisms.

Precis Clin Med 2021 Mar 28;4(1):25-34. Epub 2021 Jan 28.

Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA.

Prostate cancer (PCa) is a common cause of cancer-related mortality in men worldwide. Although most men are diagnosed with low grade, indolent tumors that are potentially curable, a significant subset develops advanced disease where hormone therapy is required to target the androgen receptor (AR). Despite its initial effect, hormone therapy eventually fails and the tumor progresses to lethal stages even through continued inhibition of AR. This review article focuses on the role of PCa cellular heterogeneity in therapy resistance and disease progression. Although AR-positive luminal-type cells represent the vast majority of PCa cells, there exists a minor component of AR-negative neuroendocrine (NE) cells that are resistant to hormonal therapy and are enriched by the treatment. In addition, it is now well accepted that a significant subset of hormonally treated tumors recur as small cell neuroendocrine carcinoma (SCNC), further highlighting the importance of targeting NE cells in addition to the more abundant luminal-type cancer cells. Although it has been long recognized that NE cells are present in PCa, their underlying function in benign prostate and molecular mechanisms contributing to PCa progression remains poorly understood. In this article, we review the morphology and function of NE cells in benign prostate and PCa as well as underlying molecular mechanisms. In addition, we review the major reported mechanisms for transformation from common adenocarcinoma histology to the highly lethal SCNC, a significant clinical challenge in the management of advanced PCa.
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http://dx.doi.org/10.1093/pcmedi/pbab003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023015PMC
March 2021

Decompression Sickness Risk Assessment and Awareness in General Aviation.

Aerosp Med Hum Perform 2021 Mar;92(3):138-145

Decompression sickness (DCS) can occur during unpressurized flight to altitudes >18,000 ft (FL180; 5486 m). To our knowledge, this has not been studied in general aviation (GA). This knowledge gap may have public health and safety implications because the most popular models of GA aircraft by sales volume are capable of flying >FL180. Data from a 1-yr period in a commercial flight tracking database were analyzed to identify flights >FL180 in unpressurized, piston aircraft in the United States. Peak altitude and duration at that altitude were used to calculate DCS risk employing the U.S. Air Force (USAF) Altitude Decompression Sickness Risk Assessment Computer (ADRAC). Registration numbers were cross referenced in publicly available federal databases to identify any events that might be attributable to impairment due to DCS. A web-based survey of practices and associated symptoms was also made available to GA pilots through an online discussion forum. During the data collection period, 1696 flights occurred. The DCS risk was calculated to be 1.9 4.2%. There were 42 responses to the survey. Of these, 25 (59.5%) pilots reported having flown at altitudes >FL180 and 21 (84%) of them reported symptoms possibly attributable to DCS. None sought medical attention. No safety events were identified for any of the aircraft during the study period. The risk of DCS in the GA community is not zero. As GA aircraft performance profiles advance and sales increase, this may have significant implications from a public health and safety perspective. Further study is warranted.
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http://dx.doi.org/10.3357/AMHP.5623.2021DOI Listing
March 2021
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