In Regard to Samuelian et al

Abstract

To the Editor: We read with a great interest the article “Reduced acute bowel toxicity in patients with intensity-modulated radiotherapy for rectal cancer” by Samuelian et al ( 1 Samuelian J.M. Callister M.D. Ashman J.B. et al. Reduced acute toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2012; 82: 1981-1987 Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar ). This retrospective study included patients with rectal cancer who had received either pre- or postoperative conventional radiation therapy (CRT) or intensity modulated radiation therapy (IMRT). Radiation therapy was combined with 5-fluorouracil-based chemotherapy. The analysis of treatment-related toxicity that was evaluated by using the Common Terminology Criteria for Adverse Events, version 3.0, showed a clinically significant reduction in grade 2 gastrointestinal toxicity for patients undergoing IMRT vs CRT (32% vs 62%, respectively). The corresponding rates for grade 2 diarrhea were 23% vs 48%, respectively ( 1 Samuelian J.M. Callister M.D. Ashman J.B. et al. Reduced acute toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2012; 82: 1981-1987 Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar ). Reduced Acute Bowel Toxicity in Patients Treated With Intensity-Modulated Radiotherapy for Rectal CancerInternational Journal of Radiation Oncology, Biology, PhysicsVol. 82Issue 5PreviewWe have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. Full-Text PDF In Reply to Vassiliou and KountourakisInternational Journal of Radiation Oncology, Biology, PhysicsVol. 84Issue 3PreviewTo the Editor: The observations of Drs Vassiliou and Kountourakis highlight the limitations of retrospective studies (1, 2). Prospective, randomized trials are needed to define whether the potential benefits of intensity modulated radiation therapy are applicable in both the preoperative and postoperative settings for rectal cancer. The small imbalances between treatment groups in our study would likely have not altered the overall findings. If anything, the intensity modulated radiation therapy group would have been predisposed to more risk of acute toxicity, owing to the increased percentage of patients receiving postoperative therapy compared with the conformal group. Full-Text PDF