902-903 / 2605
Problems with comparison
•
No adjustment for difference in radiation dose between IMRT
and PBT. All PBT pts received radiation dose about 10-15%
higher than IMRT pts.
•
“GI morbidity” was defined not by RTOG criteria but by CPT
code, i.e. code showing GI diagnosis/procedure=GI morbidity.
All PBT pts were treated on protocol which mandated GI
evaluation for any complaints of rectal bleeding, no matter how
minimal so bias towards “increased GI morbidity in PBT pts”.
•
No analysis of volume of rectum included in PBT vs. IMRT plans
(standard procedure when comparing radiotherapy modalities)
or of use of and type of patient immobilization, image-guidance,
etc.
The “JAMA paper”