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• W2037600178 abstract "To the Editor: We appreciate the comments of Drs. Koch and Evans on our commentary ( 1 Brown J.M. Diehn M. Loo Jr., B.W. Stereotactic ablative radiotherapy should be combined with a hypoxic cell radiosensitizer. Int J Radiat Oncol Biol Phys. 2010; 78: 323-327 Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar ) which suggested that the efficacy of stereotactic ablative radiotherapy (SABR) could be improved by the addition of a hypoxic cell radiosensitizer such as etanidazole.We note that they are “in favor of this approach” but caution that there are assumptions that may limit its therapeutic success. The first assumption, that hypoxic tumors can be selected by their size, was not one we intended to suggest and is not one we would agree with. As Koch and Evans suggest, one should ideally assess tumor hypoxia by using a direct assay. The second assumption, that the hypoxic fraction (HF) of human tumors is typically 0.2, was used by us for illustrative purposes. We have recently published more extensive calculations using HF values of 0.1 to 0.3, which show that the calculated tumor cell surviving fraction to typical radiotherapy courses (including SABR) depend very little on the assumed HF ( 2 Carlson D.J. Keall P.J. Loo Jr., B.W. et al. Hypofractionation results in reduced tumor cell kill compared to conventional fractionation for tumors with regions of hypoxia. Int J Radiat Oncol Biol Phys. 2011; 79: 1188-1195 Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar ). Indeed, we have noted that even an HF of 0.01 (1% hypoxic fraction) makes only a small difference to the calculated tumor cell survival in response to SABR compared to an HF of 0.2 (6 vs. 7 logs of additional cell survival compared to a fully oxygenated tumor) ( 3 Brown J.M. Loo B.W. Diehn M. et al. Influence of tumor hypoxia on stereotactic ablative radiotherapy (SABR): Response to Drs. Meyer and Timmerman. Int J Radiat Oncol Biol Phys. 2011; 79: 1600 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ). In Regard to Brown et al. (Int J Radiat Oncol Biol Phys 2010;78:323–327)International Journal of Radiation Oncology, Biology, PhysicsVol. 80Issue 5PreviewTo the Editor: Brown et al. suggested the use of the hypoxic cell sensitizer etanidazole with single or hypofractionation radiation dose schemes (1), allowing more drug and hence more sensitization per radiation administration. While we are in favor of this approach, assumptions that may limit therapeutic success included (a) hypoxic tumors can be selected by their relative size; (b) the hypoxic fraction (HF) of tumors is typically 0.2; and (c) etanidazole is the optimal sensitizer. Full-Text PDF" @default.
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• W2037600178 date "2011-08-01" @default.
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• W2037600178 title "In Reply to Drs. Koch and Evans" @default.
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• W2037600178 doi "https://doi.org/10.1016/j.ijrobp.2011.03.032" @default.
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