Unfortunately, for them, their arguments fall short of convincing click here brachytherapists. In table 1, the authors list a number of studies of biochemical results following brachytherapy alone (1). Although most of the results appear on the surface to be suboptimal compared with combination therapy, no data are shown that separate the higher dose implants from the lower dose ones. Thus, by presenting data with mixed dosimetry results, the reader is left with the incorrect impression that monotherapy is inferior to combination therapy. In addition, Spratt and Zelefsky further make

my case for monotherapy by arguing that combination therapy increases biologic effective dose (BED) (which it does). As I discussed in my article (2), high BEDs can be achieved with implant alone. The authors see more would like to argue that combination therapy is also necessary to increase the dose at the margin of the gland in case capsular penetration is present. We have always

advocated using higher activity seeds placed just under the capsule (many choose strands placed just outside the prostate in intermediate risk group patients). With this technique and the use of intraoperative dose adjustments, it is not difficult to get sufficiently high doses 5 mm and more outside the gland periphery. In addition, because of the irregular shape of the prostate and the variability of its posterior surface in relation to the anterior rectal wall, implant alone is far more conformal than combination therapy. The high dose conformity is one of the reasons there are fewer rectal complications when implant Celastrol alone is used instead of combination therapy. Spratt and Zelefsky anticipate that the results of RTOG 0232 may substantiate their position. Unfortunately, it is not

sufficient to just compare implant alone with combination therapy without consideration of delivered BED. If patients are stratified by BED, I predict there will be no differences in prostate-specific antigen (PSA) control in this study. A well done implant should be the treatment of choice for intermediate-risk prostate cancer patients. “
“Brachytherapy has been used to treat intraocular tumors since 1930 (1). Subsequent reports described 60Co, 106Ru, 125I, 103Pd, 90Sr, and 131Cs plaque sources [2], [3], [4], [5], [6], [7], [8], [9], [10], [11] and [12]. Modern plaques currently include assemblies of gold shells with low-energy photon seeds (125I, 103Pd, and 131Cs) or solid beta (106Ru and 90Sr) plaques (13). Despite the international use of ophthalmic brachytherapy for both uveal melanoma and retinoblastoma (Rb), there exist no prospective randomized or case-matched clinical trials comparing the clinical effectiveness or side effects related to these radionuclides.