Would you consider repeat lumpectomy and external beam partial breast reirradiation for in-breast recurrent cancers?

Patients experiencing a localized recurrence in a breast previously treated with lumpectomy and whole breast radiation are appropriately offered salvage mastectomy with or without reconstruction as an acceptable standard. However, many patients wish to have options that preserve the breast. Repeat lumpectomy alone has been associated with higher risks of another recurrence (See review: Alpert et al. Int J Rad Oncol Biol Phys, 2005).

Retrospective studies of repeat lumpectomy alone, with interstit...

I offer this as a reasonable alternative to mastectomy to eligible and motivated breast cancer patients who have had an in-breast recurrence. At 5 years, ~ 95% of patient's enrolled on NRG RTOG 1014 had kept their breast and were free of a second local recurrence event. Patient's received appropriate systemic therapy.

Our institution uses the 45 Gy/ 1.5 Gy BID fractionation and constraints utilized on the 1014 trial with some modifications. Individualized treatment planning is recommended—we find...