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Comment & Response
September 2015

Radiation Oncologist Concerns About Increased Electronic Brachytherapy Use for Skin Cancer

Author Affiliations
  • 1Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
  • 2Rutgers Robert Wood Johnson Medical School, State University of New Jersey, New Brunswick
  • 3Arizona Oncology Services Physicians, Phoenix
  • 4Department of Radiation Oncology, University of Colorado School of Medicine, Denver
JAMA Dermatol. 2015;151(9):1036. doi:10.1001/jamadermatol.2015.2006

To the Editor As Fellows in the American Society for Radiation Oncology (ASTRO), the world’s leading radiation oncology society, we commend the caution and concern raised by Linos et al1 in “A Sudden and Concerning Increase in the Use of Electronic Brachytherapy for Skin Cancer.”1 The recent sharp increase in use of electronic brachytherapy (EBT) for patients with nonmelanoma skin cancer and the possible abuse of the physician self-referral law are indeed troubling developments. The authors’ confirmation of the dramatic increase in EBT use are reminiscent of the alarming reports by the Government Accountability Office (GAO)2 and Mitchell3 regarding overutilization of intensity-modulated radiation therapy (IMRT) for prostate cancer. These earlier reports confirmed abuse of the in-office ancillary service (IOAS) exception to the Stark law,4 the federal physician self-referral law.

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