How do you decide between high tangents or regional nodal radiation in patients with small, ER+ breast cancers who have a single positive sentinel node?

I tend to look at factors such as age, LVSI as well as number of SLN (1/1 vs. 1/2,3,4).

After lumpectomy, for cases like this, my bias is to offer whole breast and RNI. I have also started offering more 40/15 to breast and lymph nodes so this approach doesn't lengthen course of treatment as compared to high tangents which I hypofractionate as well.

That being said, I don't think its wrong and I know plenty who would treat this case with high tangents.

Post-mastectomy, I almost always will includ...

There is wide variation in practice and to standardized across our network we follow guidelines as published by us

https://www.ncbi.nlm.nih.gov/pubmed/28939351