Rebuttal to Drs. Spratt and Zelefsky

摘要

Spratt and Zelefsky try to make the case that intermediate-risk prostate cancer should be managed by a combination of brachytherapy plus external beam irradiation intensity-modulated radiation therapy (IMRT) rather than brachytherapy alone (1). Unfortunately, for them, their arguments fall short of convincing brachytherapists. In table 1, the authors list a number of studies of biochemical results following brachytherapy alone (1). Although most of the results appear on the surface to be suboptimal compared with combination therapy, no data are shown that separate the higher dose implants from the lower dose ones. Thus, by presenting data with mixed dosimetry results, the reader is left with the incorrect impression that monotherapy is inferior to combination therapy. In addition, Spratt and Zelefsky further make my case for monotherapy by arguing that combination therapy increases biologic effective dose (BED) (which it does). As I discussed in my article (2), high BEDs can be achieved with implant alone.