In Reply to Murakami et al.

We thank Murakami et al for their interest 1 Murakami N Tereo Y Shikama N et al. In regard to Vittrup et al. Int J Radiat Oncol Biol Phys. 2023; 116: 953 Abstract Full Text Full Text PDF Scopus (1) Google Scholar in our article “Overall Severe Morbidity After Chemo-Radiation Therapy and Magnetic Resonance Imaging-Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer: Results From the EMBRACE-I Study.” 2 Vittrup AS, Kirchheiner K, Pötter R, et al. EMBRACE Collaborative Group. Overall severe morbidity after chemo-radiation therapy and magnetic resonance imaging-guided adaptive brachytherapy in locally advanced cervical cancer: Results from the EMBRACE-I study [e-pub ahead of print]. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2023.01.002, accessed April 26, 2023. Google Scholar Murakami et al propose the use of rectal gel spacers to reduce late morbidity for gynecologic brachytherapy using the overall actuarial risk of severe morbidity (grade ≥3) at 5 years of 26.6% reported in our article as an argument. We welcome the focus on reducing morbidity. However, when advocating the use of a gel spacer, this should be based on endpoints linked to rectal doses. The overall actuarial risk reported in EMBRACE-I encompasses 38 prospectively assessed endpoints which were both organ- and non–organ-related (eg, fatigue, insomnia, and neuropathy). Literature on standard radiograph-based brachytherapy has focused on organ-related morbidity. Organ-related morbidity in EMBRACE-I compared favorably to previously published prospective cohorts. 2 Vittrup AS, Kirchheiner K, Pötter R, et al. EMBRACE Collaborative Group. Overall severe morbidity after chemo-radiation therapy and magnetic resonance imaging-guided adaptive brachytherapy in locally advanced cervical cancer: Results from the EMBRACE-I study [e-pub ahead of print]. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2023.01.002, accessed April 26, 2023. Google Scholar