Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: University of Texas MD Anderson Cancer Center, Houston (firstname.lastname@example.org).
In Reply: Dr Khan and colleagues express concern about the validity of our outcome. Mastectomy is the most common salvage surgical procedure for local recurrence after brachytherapy.1 Prior studies internally validate subsequent mastectomy as a cancer outcome, demonstrating strong associations with known predictors of local recurrence, such as omission, delay, and incompletion of radiation therapy, large tumor size, estrogen receptor–negative status, and high grade.
Smith GL, Buchholz TA, Smith BD. Brachytherapy vs Whole-Breast Irradiation for Breast Cancer—Reply. JAMA. 2012;308(6):567-568. doi:10.1001/jama.2012.8490