514
1. J. Radiation Oncology 0 Biology 0 Physics
enable us to achieve some improvement in the survival of patients with this, so far, intractable disease. MAURO G. TROVE, M.D. GIUSEPPED. ZANELLI, PH.D*
EMILIOMINATEL,M.D. GIOVANNIFRANCHIN,M.D. CARLOGOBITTI,M.D. Radiotherapy Division Centro di Riferimento Oncologico (C.R.O.) 3308 1 Aviano (PN)-Italy Komaki, R. Is concomitant cisplatin and radiotherapy more efficacious treatment than radiotherapy alone in Stage III non-small cell lung cancer? Int. J. Rad. Oncol.-Biol. Phys. 24(l): 185- 186;1992. Zanelli. G. D.: Rota. L.: Trove. M.: Grinoletto. E.: Roncadin. M. The uptake of 3H-Vincristine by’a mouse &cinoma’during a course of fractionated radiotherapy. Br. J. Cancer 60:3 IO-3 14;1989. Zanelli, G. D.; Rota, L.; Innocente, R.; Trove, M. The effect of timing of Vincristine administration during a course of fractionated radiotherapy in a mouse carcinoma. Eur. J. Cancer 28:64-66; 1992.
HIGH-DOSE-RATE
BRACHYTHERAPY CARCINOMA
FOR CERVICAL
To the Editor: Medical procedures that require a high level of technical expertise and professional staff support should be performed in centers that have adequate patient volume, so that proficiency and high levels of quality control can be sustained. Brachytherapy for curative treatment of cervical carcinoma meets these requirements whether the brachytherapy uses low-dose-rate or high-dose-rate isotopes. The “Patterns of Care Studies” demonstrated that in the United States women treated
Volume 24, Number 3, 1992 for Stage III cervical carcinoma at institutions treating more than 50 cervical patients per year with conventional techniques have improved 4-year cancer free survival over those treated at institutions with lower patient volume (2). In the previous issue, Dr. Eifel contends that compared with low-doserate brachytherapy, high-dose-rate offers only economic advantages-reduced cost to the patient due to the outpatient treatment, and possible increased billing by the practitioner (1). Thus, patient welfare will be sacrificed, resulting in more complications and/or lower survival rates. As support for the increased complications, she sites earlier studies which showed just such results. These studies did not have the benefit of current radiobiological models to guide dose selection. Nor was computerized dose optimization performed to tailor the dose distribution to the patients disease and anatomy as can be done only with high-dose-rate brachytherapy. In an era of precision dose delivery techniques using stereotatic irradiation, 3-D conformal therapy, and high-dose-rate brachytherapy, advanced treatment methods must be evaluated in the best possible situation. By quoting Henry Kaplans’ aphorism, Dr. Eifel implies that the use of HDR brachytherapy is not worth pursuing even in the most meticulous fashion. To quote Jack Fowler, “A new method ought to be done with the best feasible accuracy, or else it’s not a fair test of the new method.” JUDITH ANNE STITT, M.D. BRUCER. THOMADSEN,PH.D. JACK F. FOWLER,PH.D., D.Sc. University of Wisconsin Comprehensive Cancer Center 600 Highland Avenue K4/B 100 Madison, WI 53593 1. Eifel, P. J. High-dose-rate brachytherapy for carcinoma of the cervix: High tech or high risk? Int. J. Rad. Oncol. Biol. Phys. 24(2):383386; 1992.
1. J. Radiation Oncology 0 Biology 0 Physics
enable us to achieve some improvement in the survival of patients with this, so far, intractable disease. MAURO G. TROVE, M.D. GIUSEPPED. ZANELLI, PH.D*
EMILIOMINATEL,M.D. GIOVANNIFRANCHIN,M.D. CARLOGOBITTI,M.D. Radiotherapy Division Centro di Riferimento Oncologico (C.R.O.) 3308 1 Aviano (PN)-Italy Komaki, R. Is concomitant cisplatin and radiotherapy more efficacious treatment than radiotherapy alone in Stage III non-small cell lung cancer? Int. J. Rad. Oncol.-Biol. Phys. 24(l): 185- 186;1992. Zanelli. G. D.: Rota. L.: Trove. M.: Grinoletto. E.: Roncadin. M. The uptake of 3H-Vincristine by’a mouse &cinoma’during a course of fractionated radiotherapy. Br. J. Cancer 60:3 IO-3 14;1989. Zanelli, G. D.; Rota, L.; Innocente, R.; Trove, M. The effect of timing of Vincristine administration during a course of fractionated radiotherapy in a mouse carcinoma. Eur. J. Cancer 28:64-66; 1992.
HIGH-DOSE-RATE
BRACHYTHERAPY CARCINOMA
FOR CERVICAL
To the Editor: Medical procedures that require a high level of technical expertise and professional staff support should be performed in centers that have adequate patient volume, so that proficiency and high levels of quality control can be sustained. Brachytherapy for curative treatment of cervical carcinoma meets these requirements whether the brachytherapy uses low-dose-rate or high-dose-rate isotopes. The “Patterns of Care Studies” demonstrated that in the United States women treated
Volume 24, Number 3, 1992 for Stage III cervical carcinoma at institutions treating more than 50 cervical patients per year with conventional techniques have improved 4-year cancer free survival over those treated at institutions with lower patient volume (2). In the previous issue, Dr. Eifel contends that compared with low-doserate brachytherapy, high-dose-rate offers only economic advantages-reduced cost to the patient due to the outpatient treatment, and possible increased billing by the practitioner (1). Thus, patient welfare will be sacrificed, resulting in more complications and/or lower survival rates. As support for the increased complications, she sites earlier studies which showed just such results. These studies did not have the benefit of current radiobiological models to guide dose selection. Nor was computerized dose optimization performed to tailor the dose distribution to the patients disease and anatomy as can be done only with high-dose-rate brachytherapy. In an era of precision dose delivery techniques using stereotatic irradiation, 3-D conformal therapy, and high-dose-rate brachytherapy, advanced treatment methods must be evaluated in the best possible situation. By quoting Henry Kaplans’ aphorism, Dr. Eifel implies that the use of HDR brachytherapy is not worth pursuing even in the most meticulous fashion. To quote Jack Fowler, “A new method ought to be done with the best feasible accuracy, or else it’s not a fair test of the new method.” JUDITH ANNE STITT, M.D. BRUCER. THOMADSEN,PH.D. JACK F. FOWLER,PH.D., D.Sc. University of Wisconsin Comprehensive Cancer Center 600 Highland Avenue K4/B 100 Madison, WI 53593 1. Eifel, P. J. High-dose-rate brachytherapy for carcinoma of the cervix: High tech or high risk? Int. J. Rad. Oncol. Biol. Phys. 24(2):383386; 1992.
