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Rosso and colleagues are correct that BCT remains controversial in IBC, but they note that our management is consistent with the recommendations of the UK IBC Working Group although contrary to earlier expert panels. Rosso and colleagues use data from NSABP B-18 to argue that BCT would produce an unacceptable rate of LR failure in IBC. Our study showed that in very carefully selected patients (21 out of 139 IBC from January 2005 to December 2013 had BCT) there was no evident excess of LR failure. Data soon to be published identified 150 patients with IBC from the SEER database treated by BCT and this study likewise showed no detriment to outcome.  In a multivariate analysis of a cohort of over 3000 women with patients with IBC treated included in this study, surgical treatment was not a significant prognostic factor for Breast Cancer-Specific or Overall survival. Rosso and colleagues accept that IBC is rare but suggest that BCT should be limited to a trial. We accept that...
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