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

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
• •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