Unmasking enteritis: reply to commentary titled "Clarifying Gastrointestinal toxicity attribution in WP-SBRT: A commentary on Dinesan et al. and proposal of a bladder-bowel displacement index".

Abstract

We thank the authors for their insightful commentary on our manuscript, "Acute Enteritis with Pelvic SBRT: Influence of Bowel Delineation Methods." In this response, we clarify our methodological decision to focus exclusively on acute enteritis and to exclude proctitis. We highlight the distinct clinical profiles of proctitis and enteritis, emphasizing the importance of careful history taking and clinical evaluation. We believe enteritis is grossly under-reported, despite its clinical relevance, and the dose volume constraints are still being defined for pelvic SBRT. With the increasing adoption of WP-SBRT for high-risk prostate cancer, we felt it was both timely and clinically meaningful to focus exclusively on acute enteritis in this manuscript. We also reflect on the proposed concept of a Bladder-Bowel Displacement Index (BBDI), while intriguing, relative bladder-bowel geometry is only one amongst many patient-related factors that could impact treatment-related toxicity. Developing a geometric predictor for toxicity will warrant careful statistical modelling and prospective validation in large cohorts to be useful in the clinic.