We read with interest the Volume 12, Issue 1 of Brachy-therapy, in which Hindson et al. (1) provide another in a growing list of articles on the problem of strictures following high-dose-rate implants for prostate cancer (2, 3). In their large fraction schedule, the 2-year actuarial stricture rate jumped to an alarming 30%. The authors recommended a decrease in maximum fraction size to decrease the risk to acceptable levels. Calling this conclusion into question are articles delivering a comparable dose per fraction, but without a prohibitive level of strictures (4). The wide range in stricture rates with the same high-dose-rate schedule poses a challenge to sorting out the responsible anatomic, technical, and biologic factors. Solving this is imperative and is similar in urgency to the challenge of rectal fistulas with permanent seed implants a few years ago. It is a serious, potentially life-altering complication requiring a well-defined, clinically achievable solution. In the modern era, treatment success is defined as cure and quality of life. Potential anatomic, technical, and biologic factors are worth reviewing to fully define the challenge and proposed solutions.
展开▼
