Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques: Reply

Published:November 10, 2021DOI:https://doi.org/10.1016/j.radonc.2021.11.006
      We are grateful to Dr. Blanchard and colleagues for their commentary on our study, “Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques.” [
      • Dee E.C.
      • Muralidhar V.
      • King M.T.
      • Martin N.E.
      • D'Amico A.V.
      • Mouw K.W.
      • et al.
      Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques.
      ,
      • Blanchard P.
      • Zelefsky M.J.
      • Bossi A.
      • Chargari C.
      • Cosset J.M.
      About «Second malignancy (SM) in prostate cancer patients treated with SBRT and other contemporary radiation techniques» by Edward Christopher Dee and colleagues.
      ]. Briefly, using a large database of men with localized prostate cancer, we found stereotactic body radiotherapy (SBRT) and brachytherapy (BT) to be associated with a lower risk of second malignancy (SM) compared to conventionally fractionated IMRT. We therefore agree with the initial premise of the response letter that BT is associated with a reduced the risk of SM compared to IMRT for the reasons stated, and this is indeed supported by our data as well as multiple other studies. We have not made the claim that is attributed to the manuscript that SBRT reduces the risk of SM below that of BT; our analysis does not support this. As stated in our results section: “On pairwise subgroup analyses of the BT and SBRT cohorts, we found no difference in probability of SM between HDR BT vs. LDR BT…all BT vs. SBRT…HDR vs. SBRT…and LDR vs. SBRT, Supplementary Fig. 3b)”.
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      References

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        • Muralidhar V.
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        Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques.
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      • Second malignancy (SM) in prostate cancer patients treated with SBRT and other contemporary radiation techniques
        Radiotherapy and OncologyVol. 164
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          We read with interest the article by Christopher Dee and colleagues [1], but feel that the conclusion of this article, namely that “Patients treated with SBRT may be at lower risk of second malignancy” is an overstatement given the data available to the authors. Whether stereotactic body radiotherapy (SBRT) can be associated with lower secondary cancers compared to conventional or hypofractionated radiotherapy is reasonable, as both the physical dose and tumor volumes are reduced with SBRT. However it is surprising to read that SBRT results in less secondary cancers compared to brachytherapy.
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