Hypofractionated Image Guided Radiation Therapy in Treating Patients With Stage IV Breast Cancer

PRIMARY OBJECTIVES:

I. To evaluate the feasibility of correlating changes in the number of circulating tumor
cells in metastatic breast cancer patients with time to progression following
hypofractionated image guided radiotherapy to all known sites (=< 5) of disease.

SECONDARY OBJECTIVES:

I. To determine the progression free survival, overall survival, pattern of failure, and
toxicity of hypofractionated image guided radiotherapy to all active sites (=< 5) of
metastatic disease.

II. To assess the feasibility of the Interferon-Related DNA Damage Resistance Gene Signature
(IRDS) for its predictive value in treatment failure, both in and out of the radiation
field.

OUTLINE:

Patients with metastases in the lung, liver, abdomen, and extremities undergo 10 fractions
or less of hypofractionated radiation therapy and patients with brain metastases undergo a
single fraction of stereotactic radiosurgery.

After completion of study treatment, patients are followed up every 2 weeks for 2 months, at
3 months, every 3 months for a year, and then every 6 months thereafter.

Inclusion Criteria:

- Histologically or cytologically proven diagnosis of breast cancer (invasive ductal,
lobular, medullary, papillary, colloid, tubular)

- Completion of standard of care treatment for local and regional disease with no known
residual

- American Joint Committee on Cancer (AJCC) (6th edition, 2002) Stage IV ( Any T, Any
N, M1) based upon the following minimum diagnostic workup:

- History/physical examination within 8 weeks prior to registration

- Computed tomography (CT), magnetic resonance imaging (MRI) and/or positron emission
tomography (PET) CT of the whole body within 60 days prior to registration

- MRI of the brain, if clinically indicated

- Documentation of 1-5 sites of metastatic tumor; each individual site of tumor must be
=< 10 cm or < 500 cc volume and amenable to radiation therapy as seen on standard
imaging (CT, MRI, bone scan)

- Pathology from at least one metastatic site confirming breast primary is recommended

- Zubrod performance status =< 2 (Karnofsky >= 60%)

- Absolute neutrophil count (ANC) >= 1,800 cells/mm^3

- Platelets >= 100,000 cells/mm^3

- Hemoglobin >= 8.0 g/dl (Note: The use of transfusion or other intervention to achieve
hemoglobin [Hgb] >= 8.0 g/dl is acceptable)

- Total bilirubin within institutional limits

- Albumin > 2.9 g/dl

- Alkaline phosphatase < 2.5x upper limit of normal (ULN)

- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 x ULN

- Room air saturation (saturated oxygen [Sa02]) > 90%

- Life expectancy > 3 months

- Patient complete study specific informed consent process and sign consent form prior
to study entry

- Patients with prior metastatic treatment are eligible if they have been disease free
for > 3 years; participants may receive hormonal and Herceptin treatment at any time

Exclusion Criteria:

- Patients are ineligible if they have had prior treatment for their metastatic disease
within 3 years

- Prior radiotherapy that would result in overlap of radiation therapy fields

- Co-existing or prior invasive malignancy (except non-melanomatous skin cancer) unless
disease free for a minimum of 3 years (for example, carcinoma in situ of the breast,
oral cavity, or cervix are all permissible)

- Severe, active co-morbidity, defined as follows:

- Clinically significant pulmonary dysfunction, cardiomyopathy, any history of
clinically significant congestive heart failure (CHF), unstable angina pectoris, or
cardiac arrhythmia

- Transmural myocardial infarction within the last 6 months

- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of
registration

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy at the time of registration

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
note, however, that laboratory tests for liver function and coagulation parameters
are not required for entry into this protocol

- Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers for Disease
Control (CDC) definition; note, however, that human immunodeficiency virus (HIV)
testing is not required for entry into this protocol; the need to exclude patients
with AIDS from this protocol is necessary because the treatments involved in this
protocol may be significantly immunosuppressive; protocol-specific requirements may
also exclude immunocompromised patients

- Pregnancy, breast feeding or women of childbearing potential and men who are sexually
active and not willing/able to use medically acceptable forms of contraception during
treatment and for at least three months following completion; this exclusion is
necessary because the treatment involved in this study may be significantly
teratogenic

- Prior treatment with anti-angiogenic therapy

- Significant atelectasis such that CT definition of the gross tumor volume (GTV) is
difficult to determine

- Exudative, bloody or cytologically malignant effusions

- Evidence of pleural or pericardial effusion prior to study start; patients with
pleural effusion that is transudative, cytologically negative, and non-bloody are
eligible; if a pleural effusion is too small for diagnostic thoracentesis, the
patient will be eligible