Rebuttal to Dr. Cuttino

Abstract

What has not been mentioned in the reference to treatment volume with the SAVI, published in the same papers, is that 5% of these patients had skin bridges of <3 mm and 27% <7 mm, and 7% had both chest wall and skin <7 mm. When normal tissues are that close, the PTV is trimmed (per B-39 guidelines, excluding pectoralis/chestwall and 5-mm margin from the skin) leading to smaller targets, or PTV-EVALs ( [1] Yashar C.M. Blair S. Wallace A. et al. Initial clinical experience with the Strut-Adjusted Volume Implant brachytherapy applicator for accelerated partial breast irradiation. Brachytherapy. 2009; 8: 367-372 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar ). Again, published data demonstrate that based on device size without the need to spare normal tissues, the average-treated PTV-EVAL is equivalent for the 8-1 SAVI, the 10-1 SAVI, and the Contura and MammoSite balloons. Therefore, the argument that the balloon devices treat more tissue is just not based on the published data ( 1 Yashar C.M. Blair S. Wallace A. et al. Initial clinical experience with the Strut-Adjusted Volume Implant brachytherapy applicator for accelerated partial breast irradiation. Brachytherapy. 2009; 8: 367-372 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar , 2 Dickler A. Kirk M. Choo J. et al. Treatment volume and dose optimization of MammoSite breast brachytherapy applicator. Int J Radiat Oncol Biol Phys. 2004; 59: 469-474 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar , 3 Arthur D.W. Vicini F.A. Todor D.A. et al. Improvements in critical dosimetric endpoints using the Contura multilumen balloon breast brachytherapy catheter to deliver accelerated partial breast irradiation: Preliminary dosimetric findings of a phase IV trial. Int J Radiat Oncol Biol Phys. 2011; 79: 26-33 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar ).