Salvage Therapy for Local-Regional Breast Cancer Recurrence: What, When, and How Much?

Breast cancer recurrence after prior definitive multimodality treatment is an increasingly common clinical situation faced by practitioners, with long-term new primary or recurrent non-metastatic locoregional recurrence developing not infrequently over 10 years following initial treatment. Because primary therapy often involves radiotherapy, delivering reirradiation in the salvage setting has commonly not been considered, or, when delivered, has been approached with much hesitation and with heterogeneous treatment approaches due to concern for excess and serious adverse effects of a second course of radiotherapy to normal tissues. However, salvage radiotherapy is an important component of multidisciplinary management of non-metastatic breast cancer recurrence in order to achieve disease control to areas at high risk of further relapse. Recent data have emerged to better understand the implications and outcomes associated with reirradiation, and with this additional experience, more clarity on best practices in the delivery of reirradiation for breast cancer recurrence has been gained, including treatment modality/technique selection, treatment field and target volume delineation, and dose-fractionation regimens. Additionally, new data supporting the utilization of several novel systemic therapy agents have further advanced the overall treatment landscape for non-metastatic breast cancer recurrence. In this activity, recent literature in reirradiation and systemic salvage agents are discussed, and the current landscape in multimodality management of non-metastatic breast cancer is presented, with a focus on treatment options, patient selection, and clinical considerations when delivering salvage therapies.

Topics:

  1. Repeat Breast Conservation Therapy for In-Breast Recurrence: Rationale and Considerations
    Danielle Rodin, MD, MPH, FRCPC
  2. Salvage Reirradiation for High-Risk Local-Regional Breast Cancer Recurrence: Field, Modality and Dose Selection
    Atif J. Khan, MD, MS
  3. Advances in Salvage Systemic Therapy Options for Breast Cancer Recurrence
    Joseph A. Sparano, MD
  4. Q and A
    Isabelle Jehee Choi, MD - Moderator
    Full Panel

This activity is available from April 29, 2025, through 11:59 p.m. Eastern time on April 28, 2027. 

The content was originally presented and recorded at the 2024 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, physicists, nurses, radiation therapists, radiation dosimetrists and residents.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Characterize recurrent breast cancer presentations and understand their respective implications on salvage treatment paradigms and impact on prognosis. 
  • Understand patient selection and describe reirradiation options in the setting of prior breast radiotherapy. 
  • Characterize different classes of salvage systemic therapy options and considerations in the administration of novel systemic agents.  
Course summary
Available credit: 
  • 1.25 AMA PRA Category 1 Credit™
    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.
Course opens: 
04/29/2025
Course expires: 
04/28/2027
Cost:
$149.00
Rating: 
0
  • Isabelle Jehee Choi, MD, is employed by Memorial Sloan Kettering Cancer Center, New York Proton Center. Dr. Choi serves as Chair of the Publications Committee with the Proton Collaborative Group and is Chair of the Physician Advisory Committee with the National Association of Proton Therapy. 
  • Danielle Rodin, MD, MPH, FRCPC, is employed by Princess Margaret Cancer Centre, University Health Network, University of Toronto. Dr. Rodin receives compensation/payment from Need, Inc. 
  • Atif J. Khan, MD, MS, is employed by Memorial Sloan Kettering Cancer Center. Dr. Khan receives grant/research funding from Merck, Clovis and Varian. Dr. Khan owns stock in Novavax and Xtrava, Inc. Dr. Khan is the patent holder and inventor of a drug being developed and licensed by Biohaven through a use patent filed by Rutgers University. Dr. Khan serves as Chair of the Oral exam committee, Breast section with the American Board of Radiology.   
  • Joseph A. Sparano, MD, is employed by Icahn School of Medicine at Mt. Sinai. Dr. Sparano is a DSMB member for Cytel, Genentech/Roche and Pfizer. Dr. Sparano receives honoraria as a consultant from AstraZeneca, Eli Lilly, Pfizer, GE, Roche, Sanofi, Seagen, Olema and Novartis. 

The person(s) above served as the developer(s) of this activity. Additionally, the ASTRO Education Committee had control over the content of this activity. All relevant financial relationships have been mitigated.

Disclosure link: 
ASTRO Education Committee

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Available Credit

  • 1.25 AMA PRA Category 1 Credit™
    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.

Price

Cost:
$149.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

  • Nonmember: $149
  • Member: $99
  • Member-in-Training: $49
  • Student/Graduate Student/PGY-1 Member: $49
  • Postdoctoral Fellow Member: $49

If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date. 

Participants using ASTRO Academy activities to satisfy the requirement of a Continuing Certification (MOC) program should verify the credit number and type and availability dates of any activity before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased activities that do not align with their MOC requirement.

The activity and its materials will only be available on the ASTRO website until April 28, 2027, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date. 

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