Journal of the National Cancer Institute Advance Access originally published online on August 26, 2008
JNCI Journal of the National Cancer Institute 2008 100(17):1266-1267; doi:10.1093/jnci/djn258
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© The Author 2008. Published by Oxford University Press.
CORRESPONDENCE |
Response: Re: Intensity-Modulated Radiation Therapy Dose Prescription, Recording, and Delivery: Patterns of Variability Among Institutions and Treatment Planning Systems
Affiliations of authors: Department of Radiation Oncology, Boston Medical Center, Boston, MA (JW, LK) and Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (JW, LK)
Correspondence to: John Willins, PhD, Department of Radiation Oncology, Boston Medical Center, Moakley Building, Ste LL100, 830 Harrison Ave, Boston, MA 02118 (e-mail: john.willins{at}bmc.org).
We note with appreciation the comments of Deye et al. on the recent article by Das et al. (1) and our accompanying editorial (2). The authors make a valid point. The guidance provided to clinical trials by the National Cancer Institute through the Advanced Technology Consortium (ATC) and other mechanisms is valuable. Specifically, the existence of published ATC guidelines for the use of intensity-modulated radiation therapy (IMRT) in multicenter trials and a detailed credentialing process can be credited with ensuring that high standards of dose planning and delivery are already in force in current trials. We did not intend, by omission, to obscure this fact.
We did not refer to the ATC guidelines because our focus was on a different aspect of IMRT plan evaluation and comparison. The ATC guidelines and the credentialing process ensure that the planning and delivery of IMRT by institutions is done with a high degree of accuracy. However, the ATC guidelines do not yet address the question of what constitutes a desirable planning result. Our editorial was concerned with the use of metrics such as minimum and median doses to specify plan quality and with the larger question of how a "good" plan can best be recognized. As we expressed in our editorial, we are wary of the assumption that, for example, minimum planning target volume dose has high merit as a planning metric. The question of which IMRT plan indices should be employed clinically is one that falls outside the scope of the current ATC guidelines. But, as Deye et al. correctly point out, the databases that have been developed by the ATC will allow retrospective analyses that can address connections between dosimetry and outcome, and thus help investigators create a common framework for comparison of IMRT plans.
REFERENCES
1. Das IJ, Cheng C-W, Chopra KL. Intensity-modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. J Natl Cancer Inst (2008) 100(5):300–307.
2. Willins J, Kachnic L. Clinically relevant standards for intensity-modulated radiation therapy dose prescription. J Natl Cancer Inst (2008) 100(5):288–290.
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