In Reply

Radiotherapy and Hormone Treatment in Prostate Cancer by PD Dr. med. Dirk Böhmer, Prof. Dr. med. Manfred Wirth, Prof. Dr. med. Kurt Miller, Prof. Dr. med. Dr. h. c. Volker Budach, Prof. Dr. med. Axel Heidenreich, and Prof. Dr. med. Thomas Wiegel in issue 14/2016

We appreciate the constructive feedback. In particular, we are pleased to see the comments from Dr. Jongen about the issue of performing a biopsy after endoscopic diagnosis of radiation proctitis. This highlights the importance of interdisciplinary cooperation in side effect management. However, we would like to point out that a routine colonoscopy is not indicated before radiotherapy.

We agree with Dr. Jongen that the issues of side effects of external beam radiation therapy or seed brachytherapy were presented too briefly in the article (1), mainly due to space limitations. Indeed, a small proportion of patients (0.1%–6%) have serious late side effects after radiotherapy. The sentence quoted by Dr. Jongen from the original article is indeed confusing—even though “usually” was intended to clarify “all,”, it could be misleading.

Hyperbaric oxygen therapy is evidence-based. In our experience, an individual application to the respective health insurance company indicating the randomized study usually leads to a positive decision for the patient.

Overall, there is no doubt that ionizing radiation can induce secondary cancer. However, the studies and publications of second primary tumors following radiotherapy of prostate cancer patients show a high degree of heterogeneity, reflecting the extremely heterogeneous group of patients with a high risk of bias included in these studies. For example, the increased rate of rectal cancer after radiation therapy compared to radical prostatectomy reflects the naturally increased rate in a population treated with radiotherapy that is older by an average of five years (2).

An analysis published in 2011 found a significant increase only in patients who had been treated with outdated radiation techniques. For brachytherapy, no significant differences were observed between 3-D conformal radiation therapy and intensity-modulated radiation therapy (3). However, as the patients were around 70 years old, this was a rare side effect.

DOI: 10.3238/arztebl.2016.0678b

PD Dr. med. Dirk Böhmer

Klinik für Radioonkologie und Strahlentherapie

Charité-Universitätsmedizin Berlin– Campus Benjamin Franklin

Prof. Dr. med. Axel Heidenreich

Klinik für Urologie, Uniklinik RWTH Aachen

Prof. Dr. med. Thomas Wiegel

Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Ulm

Conflict of interest statement

Dr. Böhmer has received conference delegate fees and travel expenses as well as lecture honoraria from Takeda Pharma GmbH. He is the principal investigator of an EORTC phase III study of prostate cancer that is funded by Ferring Arzneimittel (Pharmaceuticals) GmbH.

Prof. Heidenreich has received consultant fees from Astellas, Ipsen, Takeda, and Sandoz and speaker fees from Ipsen and Sanofi.

Prof. Wiegel has received consultant fees from Janssen and Ipsen and speaker fees from Ipsen, Janssen, and Hexal.

References

1. Böhmer D, Wirth M, Miller K, Budach V, Heidenreich A, Wiegel T: Radiotherapy and hormone treatment in prostate cancer—the use of combined percutaneous radiotherapy and hormonal ablation to manage in situ and locally spread tumors. Dtsch Arztebl Int 2016; 113: 235–41

2. Krebs in Deutschland 2011/2012. 10. Ausgabe. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg), Berlin 2015.

3. Huang J, Kestin LL, Ye H, Wallace M, Martinez AA, Vicini FA: Analysis of second malignancies after modern radiotherapy versus prostatectomy for localized prostate cancer. Radiother Oncol; 98: 81–86