How would you approach reirradiation in a patient with a history of whole-breast RT many years ago, now with a small intermediate-grade DCIS s/p lumpectomy with an elevated DCISionRT?

I would favor PBI with 40 in 15 or 45 in 30 (BID) with VMAT/IMRT.

Short Answer:

• Re-irradiation to the breast is safe and effective for Stage 0 DCIS to decrease local recurrence.
• DCIS (with an elevated DCISionRT) can also be properly managed by BCS alone without re-irradiation as long as margins are widely negative.

Long Answer:

First, I want to acknowledge that re-...

It’s not exactly obvious to me that DCISionRT is validated for in-breast tumor recurrence after prior BCT and whole breast radiation. I suppose it was helpful here?

The utility (let alone the validity) of DCISionRT deserves some scrutiny here. I agree with modestly-hypofractionated once-daily PBI, but the option of a 5-fraction treatment could also be considered. The stem is missing the patient's age, and I reserve the right to flex to observation if we are dis...