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ICRP: Free the Annals!

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Submitted by BHADRASAIN VIKRAM, MD, NATIONAL CANCER INSTITUTE
   Commenting as an individual
Document Accidental exposures in modern radiotherapy
 
It is clear from the report that these modern techniques are very labor intensive and, indeed, can be very dangerous for patients if considerable investments in improving QC/QA are not made.

This report should therefore also address the question of whether these techniques are even worthwhile for ANY patients based upon the current evidence?

1. The evidence suggests that for patients with a solitary brain metastasis the addition of stereotactic radiotherapy to conventional radiotherapy very slightly increases the survival (although the same may be possible with a conventional radiotherapy boost rather than an SRT boost).

2. The evidence suggests that for patients with early nasopharyngeal carcinoma IMRT only decreases doctor-assessed (but not patient-assessed) xerostomia, and there is also the risk that IMRT could lead to more local-regional failures.

3. In breast cancer it has been claimed that IMRT decreased skin damage but the same could also be accomplished without IMRT by conventional techniques that decrease the 'hot' spots.

Other than the above, minimal, evidence there is virtually no real evidence at this time that modern techniques benefit ANY patients. The ICRP report should emphasize that so resources are not wasted on equipment of little or dubious value.