Hypofractionated Radiation Therapy in Treating Patients with Stage II-III Breast Cancer Undergoing Total Nodal Irradiation

Inclusion Criteria

• Ability to understand and the willingness to sign a written informed consent
• Female age >= 18 years
• Karnofsky performance status 50% to 100%
• Diagnosis of stage IB to III node-positive breast cancer; NOTE: Stages include: T4a-cNany, TxN2, TxN1, T3N0 * For patients with T1N1 disease, ONE of the following criteria is strongly suggested, but not required: ** Grade 3 ** =< 60 years of age at time of screening for this study ** Lymphovascular space invasion (LVSI) ** 2 or more lymph nodes positive ** If only 1 lymph node positive, measures 5 mm or greater ** Hormone-negative disease ** Positive lymph nodes after chemotherapy ** Extracapsular extension ** Close or positive margin *** For patients with T3N0 disease, one of the following high risk features is strongly suggested, but not required: * Triple negative disease * Status post neoadjuvant chemotherapy NOTE: Patients with evidence of infraclavicular (axillary level III), supraclavicular or internal mammary adenopathy on ultrasound or magnetic resonance imaging (MRI) imaging after diagnosis will be included ONLY if this disease can be included in the initial treatment field and supplemented with a 10 Gy boost at the time of mastectomy flap boost
• Prior surgery and chemotherapy allowed, no prior radiation to the target area (breast or chest and nodes); NOTE: Radiation should occur 3-12 weeks after last chemotherapy or surgery, whichever occurs last
• Women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; a woman of child-bearing potential is any female (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: * Has not undergone a hysterectomy or bilateral oophorectomy; or * Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months)

Exclusion Criteria

• Diagnosis of inflammatory breast cancer
• Previously diagnosed malignancy excluding basal or squamous cell carcinoma of the skin (unless disease-free for 5 years or more)
• Diagnosis of scleroderma
• Diagnosis of active lupus
• Diagnosis of active dermatomyositis
• Diagnosis of metastatic disease
• Pregnant or nursing. There is a potential for congenital abnormalities and for this regimen to harm nursing infants