Would you offer re-irradiation for a patient with a left sided medial DIEP flap recurrence with a history of prior whole breast radiation 25 years ago?

With all favorable features, would suggest exploring the option of systemic treatment alone. If treating, may assess localized field rather than comprehensive RT.

I would favor reirradiation if otherwise healthy, though favorable features, she has had 2 recurrences (albeit 15 and now 10 years later).

If hyperthermia is available, I would consider 32-40 Gy/twice weekly with hyperthermia.

If not hyperthermia, I would offer 40 Gy/15 fractions and boost the area...

What about a 2-year interval (originally T1cN0 Oncotype 39 refused chemo, had short course plus 1k boost)?

Choices might include:

• Mod hypofrac partial breast as suggested above
• SBRT (30/5 2x week) given the good cosmetic outcomes in de novo patients

Or... what would make you willing to retreat t...