What fractionation would you recommend in a patient with recurrent early stage breast cancer who has had prior lumpectomy and IORT and refuses mastectomy?  

While there is no standard of care, several options exist. It is important to delineate where recurrence is (true recurrence vs. elsewhere failure in breast). Also, IORT technique is important a low energy IORT (50 kv) has limited dose deposition beyond a few mm (5-6 Gy at 1 cm) and as such much of ...