Commentary on "Accelerated partial breast irradiation consensus statement: Update of an ASTRO Evidence-Based Consensus Statement".

5 Although the new American Society for Radiation Oncology (ASTRO) consensus statement on accelerated partial breast irradiation (APBI) reflects many important changes relative to case selection and inclusion criteria for APBI, we would like to address our concerns specifically regarding the recommendations on the use of low-energy x-ray intraoperative radiation therapy (IORT). The consensus should include a statement that targeted intraoperative radiation therapy (TARGIT) IORT achieves local control similar to external beam radiation therapy (EBRT) with a potential for a survival benefit.1-4 Although the panel correctly recognized that the local recurrence rate in prepathology (TARGIT given simultaneously during lumpectomy) stratum was NOT significantly different from the whole-breast external beam irradiation (WBI) arm (2.1% vs 1.1%, P = .31), the panel gave “greater weight” to the local recurrence rate of the entire IORT cohort (prepathology and postpathology [TARGIT given after lumpectomy as a second procedure by reopening the wound at a median of 37 days after the initial excision] strata combined). Sometimes the devil is in the details. The TARGIT-A trial specified stratification between preand postpathology before randomization to