In response to Dr. Chopra

Abstract

We feel that it was justified to include patients with ductal carcinoma in situ (DCIS) in our study using the MammoSite breast brachytherapy applicator to deliver partial breast irradiation (PBI). As Dr. Chopra pointed out, the American Brachytherapy Society has proposed conservative selection criteria. The American Society of Breast Surgeons has also published PBI selection guidelines that include patients with DCIS ( 1 The American Society of Breast Surgeons. Consensus statement for accelerated partial breast irradiation. April 30, 2003. http://www.breastsurgeons.org/consensus.html. Google Scholar ). In addition, the upcoming National Surgical Adjuvant Breast and Bowel Project trial that randomizes patients between whole breast external beam radiation and PBI allows the inclusion of patients with DCIS ( 2 Kuerer H. Chung M. Gatti G. et al. The case for accelerated partial-breast irradiation for breast cancer. Contemp Surg. 2003; 59: 508-517 Google Scholar ). In regards to Dickler et al.: Treatment volume and dose optimization of mammosite breast brachytherapy applicator (Int J Radiat Oncol Biol Phys 2004;59:469–474)International Journal of Radiation Oncology, Biology, PhysicsVol. 61Issue 2PreviewDickler et al. describe a novel six-point dose optimization technique for the MammoSite device for accelerated partial breast irradiation (APBI) in early breast cancer (1). Although the efforts to improve the physical parameters are timely and laudable, it is imperative that the authors should not ignore the underlying biologic variants of early breast cancer. The conservative patient selection criteria (2) proposed by the American Brachytherapy Society (ABS) excludes patients with lobular carcinoma to limit the risk of microscopic disease outside the target area. Full-Text PDF