Radiation Therapy (WBI Versus PBI) in Treating Women Who Have Undergone Surgery For Ductal Carcinoma In Situ or Stage I or Stage II Breast Cancer

DISEASE CHARACTERISTICS:

Histologically confirmed ductal carcinoma in situ (DCIS*) or invasive* adenocarcinoma of the breast

Stage 0, I, or II disease

Stage II tumors must be ≤ 3 cm

Gross disease must be unifocal

Microscopic multifocality allowed provided total pathological tumor size is ≤ 3 cm
No proven multicentric carcinoma in more than 1 quadrant or separated by ≥ 4 cm
No non-epithelial breast malignancies (e.g., sarcoma or lymphoma) NOTE: *Patients who are 50 years of age and over with DCIS regardless of hormone receptor status AND patients with invasive breast cancer meeting all of the following criteria: ≥ 50 years of age, node-negative, and hormone-receptor positive status will not be enrolled in study after 12/30/2006

Prior axillary staging required for patients with invasive breast cancer, including 1 of the following:

Sentinel node biopsy alone (if sentinel node is negative)
Sentinel node biopsy followed by axillary dissection or sampling with ≥ 6 axillary nodes (if sentinel node is positive)
Axillary dissection alone with ≥ 6 axillary nodes

No more than 3 positive axillary nodes

No axillary nodes with definite evidence of microscopic or macroscopic extracapsular extension
No positive non-axillary sentinel nodes (intramammary nodes are staged as axillary nodes)
No palpable or radiographically suspicious ipsilateral or contralateral axillary, supraclavicular, infraclavicular, or internal mammary nodes unless there is histologic confirmation that these nodes are negative for tumor

Must have undergone lumpectomy

Resected margins histologically free of tumor
Re-excision of surgical margins allowed
Target lumpectomy cavity clearly delineated AND target lumpectomy/whole breast reference volume ≤ 30% based on postoperative pre-randomization CT scan
Final surgery (i.e., lumpectomy, re-excision of margins, or axillary staging procedure) within the past 42 days
No suspicious microcalcifications, densities, or palpable abnormalities in the ipsilateral or contralateral breast unless biopsied and found to be benign
No Paget's disease of the nipple

No history of invasive breast cancer or DCIS

Prior lobular carcinoma in situ treated by surgery alone allowed
No synchronous bilateral invasive or non-invasive breast cancer
Partial breast irradiation deemed technically deliverable by radiation oncologist at a credentialed facility
Must have undergone a history and physical exam within the past 4 months AND a bilateral mammogram within the past 6 months

Hormone receptor status:

Estrogen receptor (ER) status known
Progesterone status known if ER analysis is negative
Marginal or borderline results are considered positive

PATIENT CHARACTERISTICS:

Age

18 and over

Sex

Female

Menopausal status

Premenopausal or postmenopausal

Performance status

Not specified

Life expectancy

At least 10 years, excluding diagnosis of breast cancer

Hematopoietic

Not specified

Hepatic

Not specified

Renal

Not specified

Other

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective non-hormonal contraception

No other malignancy within the past 5 years except previously treated carcinoma in situ of the cervix or colon, melanoma in situ, or basal cell or squamous cell skin cancer

Deemed to be at low risk for recurrence
No collagen vascular disease (e.g., systemic lupus erythematosus or scleroderma), specifically dermatomyositis with a creatine phosphokinase (CPK) level above normal, or active skin rash
No psychiatric or addictive disorder that would preclude study therapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

No prior biologic therapy for this malignancy

Chemotherapy

No prior chemotherapy for this malignancy
No concurrent chemotherapy during study radiotherapy

Endocrine therapy

No prior hormonal therapy for this malignancy unless total duration of hormonal therapy was no more than 28 days before randomization
Concurrent hormonal therapy allowed provided it is not administered during chemotherapy
No concurrent raloxifene, tamoxifen, or other selective estrogen receptor modulating drugs
No concurrent hormone replacement therapy
No concurrent Femring^®

Radiotherapy

No prior radiotherapy for this malignancy
No prior breast or thoracic radiotherapy
No concurrent brachytherapy boosts
No concurrent intensity modulated radiotherapy
No concurrent regional nodal irradiation

Surgery

See Disease Characteristics

No prior breast implants

Patients who have had implants removed are eligible

Other

No other concurrent anticancer therapy