Would you offer whole-breast RT to a BRCA-positive patient who has multifocal recurrent disease after APBI?

The patient is BRCA2 positive and previously received 30 Gy in 5 fraction APBI to the right breast for an ER/PR+ pT2N0 IDC. She then developed multifocal recurrent disease while on adjuvant tamoxifen (grade 3, ER/PR+, 8 mm and 2.5 mm, 0/2 SLN) 18 months after her prior RT.

Would you offer re-treatment to the right breast in this instance if the patient declines mastectomy? If so, what dose and fractionation would you consider, and why?

Answer from: Radiation Oncologist at Academic Institution

Before considering re-irradiation, I would counsel this patient extensively that they should have a mastectomy in this situation given the BRCA2 positivity, and recurrence vs. new primary < 2 years after treatment with RT.If the patient absolutely refuses mastectomy, re-irradiation could be consi...

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Radiation Oncologist at Cancer Care Centers of Brevard
Begs the question of whether APBI would have been ...

Radiation Oncologist at West Virginia University
Was the in breast recurrence within the initial RT...

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Would you offer whole-breast RT to a BRCA-positive patient who has multifocal recurrent disease after APBI?

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