In a patient with a history of prior BCS+RT for early stage breast cancer who is now s/p repeat lumpectomy for a low risk in-breast recurrence, what dose/fractionation regimens are appropriate for reirradiation?

PBI using IMRT to 1.5 Gy BID to 45 Gy like phase 2 RTOG.

If declines, can do once a day conventional fractionation to 45-50.4 Gy.

I typically use 40 Gy in 15 fractions. Although the historical paradigm has been to employ small dose per fraction regimens in the setting of reirradiation (presumably extrapolated from disease sites such as head and neck where the alpha/beta ratio of the tumor is high relative to the response of su...

For the (fellow) data geeks out there, here are some sample references on this topic:

Review/selection criteria: Montagne et al., PMID 31945697.

Brachytherapy re-irradiation; Univ of Pittsburgh (BID * 1wk), Trombetta et al., PMID 24950822.

External beam partial breast re-irradiation (BID * 3 weeks; RT...

This paper by Merino et al., PMID 26459388 demonstrated that full dose re-irradiation may not be as worrisome as we presume. Provides good % on risks and benefits we can tell patients.

The thing that confuses me about this question is, if a patient had a lumpectomy and RT, and now has a recurrence... why do a lumpectomy again? Is that guideline concordant by any guideline? Maybe the best dose is zero gray, and re-discussion with the surgeon for a mastectomy. I think it's within re...