Rebuttal to Drs. Good, Lalondrelle, and Blake

摘要

The arguments brought forward by Drs. Good, Lalon-drelle, and Blake in favor of parametrial boost (PMB) by external beam radiotherapy (EBRT) brilliantly display the many dilemmas facing the proponents of this technique. Unfortunately, solutions to the problems are not provided. A vivid anatomical description of the parametrium as an open landscape ready to be swept by the attacking malignant cells breaking through the cervix is used to promote the use of EBRT to boost the parametrium to a higher EBRT dose than used to "at-risk nodal areas." However, we are still left in the dark with regard to the central questions of when, where, and how much. Is PMB to be delivered routinely by EBRT to all patients with breach of the cervical stroma? Should we apply PMB unilaterally or bilaterally and what total dose of EBRT (50 or 62 Gy) is necessary to control microscopic disease in the parametrium?