Dear IORT Physician and Medical Physicist,

ASTRO has decided to update their Partial Breast Irradiation (PBI) guidelines and is bundling the TARGIT-A (photon radiation) data with the ELIOT (electron radiation) trial data and trying to deny all IORT since ELIOT Ipsilateral Breast Recurrence (IBR) results are poor (the opposite of TARGIT-A results)

We have a template of points and are asking folks to reply to ASTRO during the public opinion period which is NOW.  Deadline is technically this Monday, July 17th.

Attached is the condensed rebuttal version and the link to reply to ASTRO for your rebuttal is:

https://astro.az1.qualtrics.com/jfe/form/SV_eKjm0xHrvwgGfBA

I also attached the ASTRO proposed PBI guideline in case you want the details of what they proposed.

I GREATLY appreciate your input to ASTRO.

I hope you all feel as I do-that TARGIT-IORT has solid long term data with MANY advantages over EBRT.

Also, why are they so picky about IBR when two randomized prospective trials show 10x the IBR with no radiation for women >65 y/o and >70 y/o (PRIME and CALGB trials) yet OS is the same and thus we offer no radiation to these ladies??  

With TARGIT-IORT the G1 and G2 pts actually have IMRPOVED OS!!!

The Prime II trial included women 65 years or older with tumors measuring less than 3 cm, ER positive, node negative, to receive hormonal therapy and radiation versus hormonal therapy alone after partial mastectomy. The 10 year local recurrence rate was 9.8% with no radiation versus 0.9% with the addition of radiation.

The CALGB 9343 trial randomized women 70 years or older with clinical stage I (T1N0M0) breast cancer, ER positive, to receive tamoxifen and radiation or tamoxifen alone. At 10 years, there was an improvement in local recurrence rates, from 10% to 2% with the addition of radiation, but no difference in overall survival (Hughes K et al, JCO 2013).

The future of IORT depends on all of us convincing the ASTRO PBI Committee to change their proposed PBI Guidelines to INCLUDE TARGIT-IORT.

ASTRO tried to do this in 2016 (the last time) and the rebuttals overturned their decision and so ASTRO has approved IORT for appropriate pts x > 7 years!  I can't imagine they will deny IORT for our pts when the long term TARGIT-A data has only gotten better and better:  

Improved OS for G1 and G2 pts and stat sig less chance of mets with a breast cancer recurrence after IORT than after WBI with EBRT.

Please consider writing a reply.  Make it personal.  You know how grateful our pts are to have this as a Rx option.

Thank you so much,

Valery Uhl, MD

President, TARGIT Collaborative Group (TCG)

2023 PBI Guideline for Public Comment

Condensed ASTRO PBI Reply