07/06/2025
Just another example of how MONEY MONEY MONEY gets in the way of proven medical science. And your health care.
Intraopetative Radiation Therapy “IORT” is under attack. Dr. Ley has performed almost 600 cases in past four years with exceptional results.
“This is another example of patient concerns taking a backseat to money. IORT is cost and time effective for patients, but guess what folks…thats taking reimbursements away from radiation centers. They’re losing money to IORT. And they don’t like it.”
Read my colleagues response for more:
L.A. Breast Chronicles
Urgent Bulletin
May 6, 2025
TARGIT IORT Under Threat, Again
When you last heard from me about Intraoperative Radiotherapy (IORT), I had solicited your assistance in getting the American Society of Therapeutic Radiation Oncology to change a proposed policy that could lead to the loss of insurance coverage for Targeted Intraoperative Radiotherapy (TARGIT) for early-stage breast cancer. Thanks to your outreach efforts, we were also to preserve the option of TARGIT IORT for women across the country.
Unfortunately, we are now facing the same challenge from the American Society of Breast Surgeons which at this moment is considering adopting a policy that will likely lead to many women losing access to Targeted Intraoperative Radiotherapy. Once again, I need you help to stop this from happening.
Here's the underlying issue: Intraoperative radiotherapy is a type of partial breast radiation that is given as a single dose in less that 30 minutes at the time of lumpectomy while the patient is asleep in surgery. By focusing the radiation dose to the walls of lumpectomy cavity, IORT reduces radiation exposure and side effects on nearby organs like the heart, lungs, and skin. In a randomized control trial called the TARGIT-A Trial (in while I and many of you were participants), TARGIT IORT was directly compared to the traditional 4-6 week-long course of daily whole breast radiation given after surgery. In the trial, TARGIT IORT was found to be equally effective as whole breast radiation in terms of long term survival without recurrence. TARGIT IORT was also safer in terms of side effects on the skin, heart and lungs.
Although breast surgeons have generally been among the strongest advocates for IORT, the leaders of the American Society of Breast Surgeons are likely being influenced by their radiation oncology colleagues who have a vested financial interest in opposing IORT. The bottom line (literally!) is that radiation oncologists make much less money doing IORT compared to traditional radiation. Although they make a lot of fuss about a 2-4% difference in IORT effectiveness compared to traditional radiation, the real elephant in the room is $$$.
Here's why targeted TARGIT IORT needs to be protected: TARGIT IORT is a single dose radiation treatment administered in < 30 minutes at the time of lumpectomy. For most (>80%) women, TARGIT IORT completely eliminates the need for a 4-6 week-long course of daily whole breast radiation that is traditionally administered after lumpectomy. (Whole breast radiation is still needed for women with more advanced breast cancer.)
Compared to traditional whole breast radiation, other benefits of TARGIT IORT include the following:
1. TARGIT is a convenient one stop treatment. Lumpectomy and radiation are completed in one visit to the hospital.
2. TARGIT has significantly less radiation exposure to the lungs and heart.
3. TARGIT has significantly less side effects on the breast, including less injury to the skin and no radiation-induced breast shrinkage
4. TARGIT is a patient centered treatment that eliminates the need for women to find time away from work, childcare, and/or homecare as required for other forms of breast radiation that must be administered over multiple days or multiple weeks.
5. TARGIT eliminates the financial burden of prolonged radiation treatments for those who do not have a car or money for gas, share ride, a taxi, or a job that gives them the freedom to take time away from work.
6. TARGIT has superior cosmetic results for women with breast implants who are at greater risk of having poor cosmetic results from whole breast radiation.
7. TARGIT reduces the physical burden of radiation for women with physical limitations or mobility challenges.
8. TARGIT makes it easier for women living in remote locations to preserve their breast rather than undergo mastectomy because that cannot commit to a longer course of radiation.
9. TARGIT does not prevent a woman from also safely receiving the traditional 4–6-week course of whole breast radiation after surgery if final surgical pathology results reveal unexpected high-risk findings most suitable for TARGIT alone.
10. TARGIT reduces the burden of radiotherapy by providing an effective, safer, and more convenient radiation treatment option for women who do not require whole breast radiation.
Critics of TARGIT complaint that targeted IORT has a higher recurrence rate compared to traditional whole breast radiation. Although some forms of IORT have been shown to have a 2-4% higher recurrence rate compared to whole breast radiation, that is NOT the case for TARGIT. Yet, the critics find it convenient to lump all forms of IORT together in their strategy to undermine TARGIT.
However, even IF IORT were associated with a higher risk of breast recurrence, the American Society of Breast Surgeons' proposed stance on IORT in general, and TARGIT IORT in particular, completely disregards patient choice in healthcare decision-making regarding radiotherapy, which is completely out of character for an organization that has built a reputation of promoting patient centered care. With patient centered care, individual patients have the right to balance the pros and cons of various treatment options and choose what suits them best--not what best suits the doctors. Patients also have the right to choose a treatment that has a HIGHER local recurrence rate if they perceive alternative treatments to be undesirable. For example, we routinely respect the right of patients to choose lumpectomy instead of mastectomy, the option to decline radiation altogether, and the option to skip chemotherapy and/or anti-estrogen treatment. In the context of patient centered care, patients should also have the right to choose IORT instead of traditional whole breast radiation
How You Can Help?
If you are interested in helping to preserve IORT as an option for women, please share your views directly with the American Society of Breast Surgeons.
Thank you in advance for helping to protect the right for women to choose their own healthcare.
Dennis R. Holmes, MD, FACS
Breast Cancer Surgeon and Researcher.
