Researchers Study Re-Irradiation Options for Breast Cancer Recurrence

If you’ve had a lumpectomy to remove a breast tumor and are facing a recurrence or a new primary breast tumor, you might think your only option is a mastectomy. But thanks to major advances in cancer care, a second breast-conserving treatment may be possible for some women.

The option is at the center of a trial being undertaken by physician-researchers at Lynn Cancer Institute and Miami Cancer Institute, which comprise Baptist Health Cancer Care. The study, which was launched recently and will follow participants for five years, is investigating the efficacy and safety of partial breast re-irradiation following a second lumpectomy in the same breast. Re-irradiation refers to administering a second course of radiotherapy to a region that has previously received radiation, often due to cancer recurrence or a new tumor in the same area.

“This approach can help patients avoid mastectomies, which are associated with greater physical side effects and often significant psychological impacts,” explains radiation oncologist Youssef Zeidan, M.D., Ph.D., the study’s principal investigator and a breast cancer specialist at Lynn Cancer Institute, based at Boca Raton Regional Hospital. “This trial will have major implications on our breast cancer population, offering patients a second chance for breast conservation.”

Preserving Most of the Breast with a Lumpectomy

Breast-conserving surgery — usually a lumpectomy — is a cornerstone for managing early-stage breast cancer. It involves surgically removing the tumor and a small margin of healthy tissue, preserving most of the breast. When followed by radiation therapy, its survival rates are comparable to a mastectomy, the full removal of the breast.

Historically, however, the 4-10 percent of patients who experience a recurrence of their cancer were deemed poor candidates for another lumpectomy and second course of radiation treatment.

“Re-irradiating the same breast was once considered too risky, but new technology is making it safer,” explains radiation oncologist Joseph Panoff, M.D., who is overseeing the trial at Baptist Health Miami Cancer Institute. “Patient selection is key; not everyone will qualify based on tumor biology, breast size or prior treatment.”

Studying the Benefits of Intensity-Modulated Radiation Therapy

The trial is investigating the safety and efficacy of using intensity-modulated radiation therapy (IMRT) on a breast previously treated with radiation following a lumpectomy. IMRT is a sophisticated radiation approach that allows for precise targeting of a tumor while minimizing exposure to surrounding healthy tissue, offering the possibility of a second lumpectomy for certain patients.

The study will track any adverse effects of additional radiation treatment, as well as local recurrence-free survival, any distant metastasis and overall survival compared to mastectomy. Participants in the trial must be at least 40 years old and have a diagnosis of ER-positive, HER2-negative breast cancer, among other requirements.

The groundbreaking trial is being sponsored by donor support to Boca Raton Regional Hospital Foundation. “We are very fortunate to have members of our community who are dedicated to the advancement of cancer treatment — not just for South Florida, but for everyone,” says Louise Morrell, M.D., chief medical executive of Lynn Cancer Institute. “Their generosity is making a lasting impact.”

The study also is a milestone because it combines the expertise of Lynn Cancer Institute and Miami Cancer Institute, solidifying a formidable partnership under the umbrella of Baptist Health Cancer Care, the largest cancer program in South Florida, with locations from the Florida Keys to the Palm Beaches.

The practice of attempting a second breast-conserving surgery (also called repeat lumpectomy) is still relatively rare. The trial, titled the Breast Re-irradiation After Second Ipsilateral Lumpectomy (BRASIL) trial, aims to expand options for patients. It is registered under clinicaltrials.gov (NCT06867484).

“While mastectomy remains necessary in many cases of breast cancer recurrence, advances in surgical, diagnostic and therapeutic techniques have significantly changed the clinical landscape, offering some patients a second chance at breast conservation,” explains Dr. Zeidan, who is serving on a committee of the American Society for Radiation Oncology to update national breast cancer radiation guidelines.

How IMRT Safely Enables Higher Radiation Doses

High-resolution imaging and precise IMRT planning can allow for targeted treatment, he says. This allows for customized treatment plans for each patient, tailored to the specific characteristics of their tumor.

IMRT utilizes advanced computer technology and detailed imaging techniques, such as 3D CT scans, to meticulously map the tumor’s location, size and shape, allowing radiation oncologists to design radiation beams that precisely conform to the tumor’s contours. The intensity of each beam is then carefully adjusted, enabling the delivery of higher doses to areas that require more aggressive treatment, while simultaneously reducing the dose to nearby critical structures.

“Partial breast re-irradiation is an evolving area of research for recurrent breast cancer as we actively explore its potential to improve outcomes and minimize toxicity in patients,” Dr. Panoff says. But, he notes, “IMRT is a complex treatment that requires careful planning by a specialized team to ensure accurate targeting and dose delivery while minimizing damage to healthy tissues.”

Youssef Zeidan, M.D., Ph.D., radiation oncologist and breast cancer specialist at Lynn Cancer Institute, based at Boca Raton Regional Hospital

Joseph Panoff, M.D., M.A., radiation oncologist and breast cancer specialist at Miami Cancer Institute