Daily Partial Radiation Therapy for Patients with Ipsilateral Breast Tumor Recurrence Treated Initially with Breast Conserving Surgery and Whole Breast Radiation Therapy

Inclusion Criteria

• Patients’ recurrences must have histologically confirmed ductal carcinoma in-situ, invasive ductal, medullary, papillary, colloid (mucinous), tubular or mixed histologies. Three years of time must have elapsed since the end of the last course of whole breast irradiation
• Lesion size < 3 cm treated with a partial mastectomy. Patients invasive cancer and clinically and radiographically negative axillas do not require an axillary lymph node sampling unless they did not have prior axillary lymph node sampling (e.g. previous cancer was ductal carcinoma in situ [DCIS]). Patients with DCIS as their recurrence do not require surgical assessment of the axilla. Repeat sentinel lymph node biopsy is permitted.
• Negative resection margins with at least a no tumor on ink or a negative re-excision.
• Patients with invasive recurrence must have a negative re-staging work-up consisting of either a CT chest/abdomen and a bone scan or a PET scan
• Hormonal therapy is allowed. If chemotherapy is planned, it can be delivered either prior to or after the radiation is delivered. There must be at least 2 weeks between radiation and chemotherapy. HER2 directed therapy can be delivered concurrently with radiation.
• Patients must be > 18 years of age. Because no dosing or adverse event data are currently available on the use of breast re-irradiation in subjects =< 18 years of age, children are excluded from this study.
• Subjects must have the ability to understand and the willingness to sign a written informed consent document.
• Performance status: Eastern Cooperative Oncology Group (ECOG) Performance status ≤ 2.
• Life expectancy of >= 12months, in the opinion of and as documented by the investigator.
• Not based on gender; this trial is open to any gender, defined as self-representation of gender identity.

Exclusion Criteria

• Patients with nodal or distant metastatic disease < 3 years since prior radiation
• Patients with invasive pure lobular carcinoma, extensive lobular carcinoma in-situ, extensive ductal carcinoma in-situ (spanning more than 3 cm), or uncontrolled nonepithelial breast malignancies such as lymphoma or sarcoma.
• Patients with multicentric carcinoma (tumors in different quadrants of the breast or tumors separated by at least 4 cm). Palpable or radiographically suspicious contralateral axillary, ipsilateral or contralateral supraclavicular, infraclavicular, or internal mammary lymph nodes unless these are histologically or cytologically confirmed negative.
• Patients with Paget’s disease of the nipple.
• Patients with skin involvement.
• Patients with scleroderma or dermatomyositis.
• Patients with psychiatric, neurologic, or addictive disorders that would preclude obtaining informed consent.
• Patients who are pregnant or lactating due to potential fetal exposure to radiation and unknown effects of radiation on lactating females.
• Patients with known BRCA 1/BRCA 2 mutations.