Radiation Therapy in Treating Women With Locally Recurrent Breast Cancer Previously Treated With Repeat Breast-Preserving Surgery

DISEASE CHARACTERISTICS:

• Histologically confirmed locally recurrent breast carcinoma consistent with the following cell types:

  • Invasive ductal breast carcinoma
  • Medullary ductal breast carcinoma
  • Tubular ductal breast carcinoma
  • Mucinous ductal breast carcinoma
  • Lobular breast carcinoma

  • Ductal carcinoma in situ

    • No Paget disease of the nipple

• Initial lumpectomy followed by whole-breast radiotherapy performed over 1 year ago

  • Repeat lumpectomy performed within the past 42 days
• Target lumpectomy cavity must be clearly defined and the target lumpectomy cavity/ whole-breast reference volume must be < 30% based on a post-operative, pre-treatment CT scan

• Histopathologic confirmation via lumpectomy of local in-breast ipsilateral recurrence within the past 120 days and the following must be true:

  • Tumor size ≤ 3 cm in greatest dimension on pathologic specimen

  • Negative histologic margins of resection and no tumor on ink following breast-preserving surgery

    • Re-excision to achieve negative margins allowed
  • Axilla negative or ≤ 3 positive lymph nodes without extracapsular extension

• If the in-breast recurrence is DCIS and/or microinvasive disease, a sentinel lymph node (SLN) evaluation is not required, but if performed:

  • Patients with a negative sentinal lymph node (SLN) biopsy are eligible for enrollment
  • Patients with a positive SLN biopsy require an axillary lymph node (ALN) dissection (ALND is not required if the SLN is not identified)
  • Patient is eligible if 0-3 positive ALNs without extracapsular extension is documented

• If the in-breast recurrence is invasive disease and:

  • No prior ALN dissection or SLN dissection only:

    • Patient is required to undergo axillary evaluation with either a SLN or ALN dissection
    • If the SLN is not identified or if the SLN is positive for metastatic disease then an ALN dissection is required
    • Patient is eligible for enrollment if encounter 0-3 positive lymph nodes without extracapsular extension

  • • Prior ALN dissection: negative clinical exam: patient is eligible for enrollment

    • It is recommended, but not required, that the patient undergo ultrasound evaluation of the axilla and the lymph node draining regions of the breast; any suspicious areas are to be biopsied and if positive followed with an ALN dissection
    • Patient is eligible for enrollment if biopsies are negative or 0-3 axillary lymph nodes without extracapsular extension are encountered

  • Prior ALN dissection: positive clinical exam: biopsy required

    • If biopsy is negative, patient is eligible for enrollment
    • If biopsy is positive an ALN dissection is required
    • Patient is eligible for enrollment if biopsies are negative or 0-3 axillary lymph nodes without extracapsular extension encountered
• Ipsilateral breast mammogram and MRI within 120 days prior to study entry
• Contralateral breast mammogram within 12 months of study entry
• No more than 120 days since whole-body PET-CT scan OR CT scan of the chest, abdomen, and pelvis, and bone scan
• No multicentric ipsilateral breast recurrence or regional recurrence (other than axilla)
• Patients must have a breast technically amenable to partial-breast irradiation
• No metastatic disease documented by physical exam or radiographic evaluation (for patients with invasive disease)
• No skin involvement
• No prior contralateral mastectomy
• Estrogen and progesterone status must be known

PATIENT CHARACTERISTICS:

• Zubrod performance status 0-1
• Menopausal status not specified
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No other invasive malignancy within the past 3 years except ipsilateral breast cancer and/or nonmelanoma skin cancer
• No collagenous diseases, specifically systemic lupus erythematosus, scleroderma, or dermatomyositis
• No psychiatric or addictive disorders that would preclude obtaining informed consent

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 2 weeks since prior chemotherapy and recovered
• No concurrent intensity-modulated radiotherapy
• No concurrent chemotherapeutic agents, including trastuzumab