Letter to NBC News Regarding IORT Coverage
ASTRO CEO Vivek S. Kavadi, MD, MBA, FASTRO, sent the following letter to NBC News executives on October 9, 2025:
As Chief Executive Officer of the American Society for Radiation Oncology (ASTRO), I am writing to express serious concern about NBC News’ October 7 story on intraoperative radiation therapy (IORT). The piece presents an alarmist, one-sided narrative that portrays an unproven treatment as mainstream and misrepresents the motives of an entire medical specialty.
The article and segment repeat inaccurate claims about the evidence base for IORT. Multiple randomized clinical trials and high-quality reviews show higher local recurrence rates with IORT compared with modern external-beam breast irradiation, as detailed in this recent review published by the Annals of Surgical Oncology.
The suggestion that physicians avoid IORT for financial reasons is categorically false. Limited adoption of IORT by the breast oncology community reflects a clear, evidence-based consensus that, based on current knowledge, it is not the most effective treatment for most patients. This is not based on reimbursement or financial motives. Notably, ASTRO’s position also aligns with the U.K. National Health Service, the U.S. Agency for Healthcare Research and Quality and the American Society of Breast Surgeons.
By including the unsubstantiated allegation that radiation oncologists recommend against IORT due to “money and greed,” the story undermines trust between patients and their doctors. It also includes inflammatory and inaccurate descriptions of modern radiation therapy — for example, that it causes patients to “burn like a piece of meat on a barbecue grill,” that patients cannot work during treatment (in fact, most do) and that the radiation therapy machine “travels over the body for 20 to 30 minutes every day” (it’s 1 to 5 minutes and is targeted to the site being treated). These statements are inaccurate, inappropriate and irresponsible, and they misinform your audience about what our patients actually experience with contemporary treatment. Radiation therapy today is highly precise, safe, well-tolerated, and delivered in far shorter courses than implied here, and most patients continue their normal activities, including work, during treatment.
Such rhetoric is profoundly harmful and can scare patients into rejecting treatments that are proven to save lives. Depicting a proven, lifesaving therapy in such sensationalized terms is shown to spread fear and misinformation that can deter patients from appropriate care and lead to worse outcomes from avoiding treatment. That mistrust is not abstract; it causes real harm to people facing a life-threatening disease when they are most vulnerable.
The false financial insinuations are also inconsistent with our field’s clear trajectory toward shorter courses of radiation, which directly reduces revenue under current reimbursement models. Across disease sites, when evidence supports shorter, simpler care, ASTRO recommends it. Indeed, as the story notes, partial breast irradiation and hypo-fractionated whole breast irradiation generate less revenue than traditional six week courses of external beam treatment. Nevertheless, ASTRO endorses these shorter-course approaches because the data support their use for appropriate patients.
This is also the case with our guidelines for breast, prostate, lung and many other cancers. Our guidelines are based solely on evidence, developed through a transparent, peer-reviewed process that includes surgeons, medical oncologists and patient advocates. The guidelines are never intended to be insurance documents, but tools to help patients and clinicians weigh options based on the best available data.
Responsible journalism requires challenging all sides with equal rigor. In this case, NBC amplified the views of a small group of IORT advocates with interests in promoting the technology, without adequately addressing the documented recurrence risks or the rationale behind guideline caution from multidisciplinary experts. Additionally, they did not counterbalance these views with facts readily available from experts also interviewed for this story. The result is a story that misinforms the public and risks eroding confidence in physicians who deliver lifesaving cancer care.
We ask NBC News to review this coverage against your standards for accuracy, fairness and context. At a minimum, a corrective note or follow-up segment that accurately reflects the clinical evidence would serve the public interest. Cancer experts from ASTRO and from other medical societies, including surgeons, are available to assist your team in ensuring that patients receive accurate, reliable information about their treatment options.
Sincerely,
Vivek S. Kavadi, MD, MBA, FASTRO
Chief Executive Officer
American Society for Radiation Oncology
