Would you consider whole breast irradiation in a woman who develops a second primary breast cancer or recurrence after lumpectomy and partial breast balloon brachytherapy and declines mastectomy?

In the case of a recurrence or second primary where the original irradiated soft tissue will be resected, I would first review the amount of dose delivered from the original APBI to the chest wall and skin. I am mainly thinking of APBI delivered with a brachtherapy technique. If the dose was more limited to those regions, I do think in certain cases it is reasonable to deliver whole breast irradiation. I would treat at 1.8 Gy/ fraction to 45 Gy and not deliver a boost, to minimize the dose and volume of chest wall/muscle and skin re-treated.

In the case where the region that was treated with APBI brachytherapy in the past will not be resected, I would be less inclined to offer whole breast irradiation. Rather, if the patient and second di...

We have done it in few patients. To some extent, it is a function of the location of the new primary with respect to original disease and the effect of previous APBI on skin and cosmetic outcomes.