Rebuttal to Dr. Cuttino

摘要

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). 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 Mammo-Site balloons. Therefore, the argument that the balloon devices treat more tissue is just not based on the published data (1-3).