Breast-Conserving Surgery and Radiation Therapy in Patients With Multiple Ipsilateral Breast Cancer

DISEASE CHARACTERISTICS:

• Upon clinical exam and pre-operative imaging by MRI and mammogram both, two or three foci of biopsy-proven breast cancer separated by ≥ 3 cm of normal breast tissue on clinical exam and preoperative imaging; foci must include at least one focus of invasive breast carcinoma with another focus of either invasive breast carcinoma or ductal carcinoma in situ (DCIS); no more than 2 quadrants with biopsy-positive breast cancer

  • Ultrasound cannot be used to determine patient eligibility; eligibility to be determined by bilateral mammogram and MRI only
• Bilateral mammogram ≤ 60 days prior to registration
• Bilateral breast MRI ≤ 45 days prior to registration

• cN0 or cN1 disease

  • No cNX, cN2, or cN3 disease
• Willing to provide tissue samples for correlative research purposes
• Largest single focus of disease > 5 cm by either mammogram or MRI or both (measurement of the largest single focus should include any satellite lesions within 1 cm of the index lesion)
• No clinical or radiographic evidence of metastatic disease
• No prior or current lobular carcinoma in situ (LCIS), DCIS, or invasive breast cancer in the opposite breast (i.e., bilateral disease is not allowed)
• No patients with known BRCA mutations

PATIENT CHARACTERISTICS:

• Life expectancy of at least 5 years, excluding diagnosis of breast cancer (comorbid conditions should be taken into consideration, but breast cancer diagnosis is not a consideration)
• Men are excluded from this study
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2
• Hemoglobin (Hgb) ≥ 8 g/dL
• Peripheral platelet count (PLT) ≥ 50,000/mm³
• Ability to complete questionnaire(s) by themselves or with assistance
• Willing to return to enrolling institution for follow-up during the Active Monitoring Phase (the active treatment and observation portions) of the study
• Negative serum or urine pregnancy test done ≤ 7 days prior to registration, for women of childbearing potential only

• None of the following:

  • Pregnant women
  • Nursing women
  • Women of childbearing potential who are unwilling to employ adequate contraception (as determined by the treating physician)
• No co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would interfere significantly with whole-breast irradiation (such as connective tissue disorders, lupus, or scleroderma)
• No uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements

• No other active malignancy ≤ 5 years prior to registration; EXCEPTIONS: non-melanotic skin cancer or carcinoma-in-situ of the cervix

  • If there is a history of prior malignancy, they must not be receiving other specific treatment for their cancer

PRIOR CONCURRENT THERAPY:

• No surgical axillary staging procedure prior to study entry

  • Fine-needle aspiration (FNA) or core-needle biopsy of axillary node is permitted

• No breast implants at time of diagnosis

  • Patients who have had implants previously removed prior to diagnosis are eligible
• No treatment including radiation therapy, chemotherapy, biotherapy, or hormonal therapy for this cancer prior to registration
• No neoadjuvant endocrine therapy or neoadjuvant hormonal therapy
• No planned partial-breast radiation
• No administration of any investigational agent ≤ 30 days prior to registration