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 (DCIS)

No Paget disease of the nipple
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
Tumor size ≤ 3 cm in greatest dimension on pathologic specimen
Negative histologic margins of resection and no tumor on ink following breast-preserving surgery of local recurrence (Re-excision is permitted to achieve negative margins)
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
For invasive in-breast recurrence, no more than 120 days since whole-body (positron emission tomography) 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