Radiation Therapy During Surgery in Treating Older Women With Stage I Breast Cancer

Phase 2 Study Evaluating the Feasibility and the Reproducibility of Concentrated Radiotherapy and Focalized Electrontherapy During Surgery for the Treatment of Older Patients With Breast Cancer

RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Giving intraoperative radiation therapy may reduce the amount of normal tissue that needs to be removed.

PURPOSE: This phase II trial is studying how well giving radiation therapy during surgery works in treating older women with stage I breast cancer.

OBJECTIVES:

Primary

• Study the feasibility and reproducibility of intraoperative radiotherapy as the only treatment after lumpectomy in older women with stage I breast cancer.

Secondary

• Study the impact of this regimen on maintaining self-care.
• Study the quality of life (QLQ-C30) and satisfaction with care.
• Study regimen tolerance and cosmetic results.
• Evaluate the economic impact of this treatment.
• Study relapse-free and disease-specific survival.

OUTLINE: Patients undergo conservative breast surgery and axillary node dissection (sentinel node or classic resection). At this point, patients must have either negative axillary lymph nodes after removal of ≥ 6 lymph nodes, negative sentinel nodes, or have had a limited lumpectomy with negative margins ≥ 2 mm. Patients undergo intraoperative radiotherapy during surgery, before closing and reconstruction of the breast.

Patients may begin hormonal therapy after completing study therapy.

After completion of study therapy, patients are followed every 3 months for 1 year, every 4 months for 1 year, and then every 6 months for 3 years.

DISEASE CHARACTERISTICS:

Inclusion criteria:

• Histologically confirmed stage I breast cancer

  • Size ≤ 20 mm (by ultrasound), N0, any quadrant

• Hormone receptor status not specified

Exclusion criteria:

• Distant metastases
• Inflammatory breast cancer
• Lobular in situ disease
• Invasive cancer or ductal carcinoma in situ
• Nonepithelial disease or sarcoma
• Multicentric disease
• Lymphatic embolism
• Margins of safety unknown or positive (in situ or invasive)
• Preoperative mammography showing diffuse microcalcification

PATIENT CHARACTERISTICS:

• Female
• Menopausal
• Karnofsky 70-100%
• No other prior cancer except basal cell skin cancer, uterine epithelioma in situ, or other cancer in complete remission for the past 5 years
• No geographic, social, or psychiatric reasons that would impede participation in study treatment

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior neoadjuvant therapy
• No concurrent participation in another study