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- W2038968056 abstract "As stated in the second sentence of our original submisprobability of achieving the threshold? These are the sion, we do not question the existence of a dose response for low dose rate brachytherapy. We also agree that whole prostate D90 and V100 have been helpful in illuminating some aspects of the dose response. However the steep dose gradients at the periphery of the gland impose substantial uncertainty on D90 and V100 values, which like all dose volume metrics depend on postimplant prostate segmentation, which in turn is limited by image quality and subject to random and systematic errors and unquantifiable observer bias. Furthermore, D90 and V100 capture no information on regional dose distribution or extraprostatic doses, which may be at least as important as whole prostate metrics. To illustrate these concerns, we compared a Mount Sinai subset analysis with a median D90 of nearly 200 Gy (minimum D90 of 180 Gy) to a much larger British Columbia Cancer Agency consecutive cohort with a median D90 of ~150 Gy. Despite this substantial dose disparity, the implants seem to be isoeffective. The apparent anomaly is easily explained by postulating a dose threshold above which local tumor control approaches 100%; the data from both the Mount Sinai subset and our consecutive series supports the existence of a such a threshold. But what numeric value should we assign to the purported threshold? Which metric or metrics are best suited to characterize and measure the threshold? Are there any specific planning algorithms and implant techniques that will improve the" @default.
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- W2038968056 date "2010-10-01" @default.
- W2038968056 modified "2023-09-26" @default.
- W2038968056 title "Rebuttal to Dr. Stock" @default.
- W2038968056 cites W2033993613 @default.
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- W2038968056 doi "https://doi.org/10.1016/j.brachy.2010.08.003" @default.
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