- Email: [email protected]
In Regard to Vashistha et al
International Journal of
Radiation Oncology biology
physics
www.redjournal.org
COMMENTS Don’t Forget Brachytherapy In Regard to Vashistha et al To the Editor: We read with interest the recently published report by Vashistha et al, “Radical cystectomy compared to combined modality treatment for muscle-invasive bladder cancer: A systemic review and meta-analysis” (1). The authors searched 7 databases, found 19 studies evaluating 12,380 subjects, and finally selected 8 studies encompassing 9554 subjects eligible for meta-analysis. They reported no difference in overall survival at 5 years or progression-free survival at 10 years within this cohort of 9554 patients. With great pleasure we read this conclusion; however, we have 2 important remarks. Two Dutch studies were found eligible for the meta-analysis (2, 3), both were analyzed in Table 1, but regrettably the radiation parameters were insufficiently cited. The Vashistha article says that Nieuwenhuijzen et al applied external beam radiation therapy (EBRT) of 30 Gy in 15 fractions and that Van der Steen-Banasik et al applied EBRT of 40 Gy in 20 fractions or 2 to 4 fractions of 3.5 Gy (should be 3 or 4 fractions). In both cases the applied brachytherapy boost was not mentioned. One might incorrectly conclude that a very low dose of external beam radiation could control muscle-invasive bladder cancer! The treatment applied in the Dutch centers consisted of 3 steps: transurethral resection for bladder tumor (TURBT), EBRT, and a brachytherapy boost. The table entries should therefore read as follows: Nieuwenhuijzen et al: Radiation: TURBT followed by EBRT 15 2 Gy and a brachytherapy boost of 40 Gy Van der Steen-Banasik et al: Radiation: TURBT followed by EBRT 20 2 Gy (cT2) or 3 or 4 3.5 Gy (cT1) and a brachytherapy boost of 30 Gy or 60 Gy EQD2, respectively. Brachytherapy is an essential part of the treatment and according to the Groupe Europe´en de Curiethe´rapieeEuropean Society for Radiotherapy and Oncology recommendations is applied after EBRT to a cumulative dose of 70 Gy EQD2 (4).
Conflict of interest: none.
Int J Radiation Oncol Biol Phys, Vol. 99, No. 3, pp. 757e758, 2017 0360-3016/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved.
Additionally, it is worth mentioning that this modality was recently modified after modern developments in surgery and radiation oncology (5). Another important issue when comparing cystectomy with organ-sparing treatment is the patient’s quality of life. This is definitely an area of new clinical research. Elzbieta M. van der Steen-Banasik, MD Bernard J. Oosterveld, PhD Radiotherapiegroep Arnhem, The Netherlands Geert A. Smits, MD, PhD Department of Urology, Rijnstate Hospital Arnhem, The Netherlands http://dx.doi.org/10.1016/j.ijrobp.2017.07.001
References 1. Vashista V, Wang H, Mazzone A, et al. Radical cystectomy compared to combined modality treatment for muscle-invasive bladder cancer: A systemic review and meta-analysis. Int J Radiat Oncol Biol Phys 2017;97:1002-1020. 2. Nieuwenhuijzen JA, Pos F, Moonen LM, et al. Survival after bladder preservation with brachytherapy versus cystectomy; a single institution experience. Eur Urol 2005;48:239-245. 3. Van der Steen-Banasik EM, Ploeg M, Witjes A, et al. Brachytherapy versus cystectomy in solitary bladder cancer: A case control multicenter, East-Netherlands. Radiother Oncol 2009;93:352-357. 4. Pieters BR, van der Steen-Banasik EM, Smits GA, et al. GECESTRO/ACROP recommendations for performing bladder-sparing treatment with brachytherapy for muscle-invasive bladder carcinoma. Radiother Oncol 2017;122:340-346. 5. Van der Steen-Banasik EM, Smits GA, Oosterveld BJ, et al. The CurieDa Vinci connection: 5 years’ experience with laparoscopic (robotassisted) implantation for high-dose-rate brachytherapy of solitary T2 bladder tumors. Int J Radiat Oncol Biol Phys 2016;95:1439-1442.
In Reply to van der Steen-Banasik et al To the Editor: We appreciate the comments by Dr van der Steen-Banasik and colleagues (1). We agree with the assessment that the work previously conducted by van der Conflict of interest: none.
Radiation Oncology biology
physics
www.redjournal.org
COMMENTS Don’t Forget Brachytherapy In Regard to Vashistha et al To the Editor: We read with interest the recently published report by Vashistha et al, “Radical cystectomy compared to combined modality treatment for muscle-invasive bladder cancer: A systemic review and meta-analysis” (1). The authors searched 7 databases, found 19 studies evaluating 12,380 subjects, and finally selected 8 studies encompassing 9554 subjects eligible for meta-analysis. They reported no difference in overall survival at 5 years or progression-free survival at 10 years within this cohort of 9554 patients. With great pleasure we read this conclusion; however, we have 2 important remarks. Two Dutch studies were found eligible for the meta-analysis (2, 3), both were analyzed in Table 1, but regrettably the radiation parameters were insufficiently cited. The Vashistha article says that Nieuwenhuijzen et al applied external beam radiation therapy (EBRT) of 30 Gy in 15 fractions and that Van der Steen-Banasik et al applied EBRT of 40 Gy in 20 fractions or 2 to 4 fractions of 3.5 Gy (should be 3 or 4 fractions). In both cases the applied brachytherapy boost was not mentioned. One might incorrectly conclude that a very low dose of external beam radiation could control muscle-invasive bladder cancer! The treatment applied in the Dutch centers consisted of 3 steps: transurethral resection for bladder tumor (TURBT), EBRT, and a brachytherapy boost. The table entries should therefore read as follows: Nieuwenhuijzen et al: Radiation: TURBT followed by EBRT 15 2 Gy and a brachytherapy boost of 40 Gy Van der Steen-Banasik et al: Radiation: TURBT followed by EBRT 20 2 Gy (cT2) or 3 or 4 3.5 Gy (cT1) and a brachytherapy boost of 30 Gy or 60 Gy EQD2, respectively. Brachytherapy is an essential part of the treatment and according to the Groupe Europe´en de Curiethe´rapieeEuropean Society for Radiotherapy and Oncology recommendations is applied after EBRT to a cumulative dose of 70 Gy EQD2 (4).
Conflict of interest: none.
Int J Radiation Oncol Biol Phys, Vol. 99, No. 3, pp. 757e758, 2017 0360-3016/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved.
Additionally, it is worth mentioning that this modality was recently modified after modern developments in surgery and radiation oncology (5). Another important issue when comparing cystectomy with organ-sparing treatment is the patient’s quality of life. This is definitely an area of new clinical research. Elzbieta M. van der Steen-Banasik, MD Bernard J. Oosterveld, PhD Radiotherapiegroep Arnhem, The Netherlands Geert A. Smits, MD, PhD Department of Urology, Rijnstate Hospital Arnhem, The Netherlands http://dx.doi.org/10.1016/j.ijrobp.2017.07.001
References 1. Vashista V, Wang H, Mazzone A, et al. Radical cystectomy compared to combined modality treatment for muscle-invasive bladder cancer: A systemic review and meta-analysis. Int J Radiat Oncol Biol Phys 2017;97:1002-1020. 2. Nieuwenhuijzen JA, Pos F, Moonen LM, et al. Survival after bladder preservation with brachytherapy versus cystectomy; a single institution experience. Eur Urol 2005;48:239-245. 3. Van der Steen-Banasik EM, Ploeg M, Witjes A, et al. Brachytherapy versus cystectomy in solitary bladder cancer: A case control multicenter, East-Netherlands. Radiother Oncol 2009;93:352-357. 4. Pieters BR, van der Steen-Banasik EM, Smits GA, et al. GECESTRO/ACROP recommendations for performing bladder-sparing treatment with brachytherapy for muscle-invasive bladder carcinoma. Radiother Oncol 2017;122:340-346. 5. Van der Steen-Banasik EM, Smits GA, Oosterveld BJ, et al. The CurieDa Vinci connection: 5 years’ experience with laparoscopic (robotassisted) implantation for high-dose-rate brachytherapy of solitary T2 bladder tumors. Int J Radiat Oncol Biol Phys 2016;95:1439-1442.
In Reply to van der Steen-Banasik et al To the Editor: We appreciate the comments by Dr van der Steen-Banasik and colleagues (1). We agree with the assessment that the work previously conducted by van der Conflict of interest: none.