How do you decide upon a preferred dose/fractionation scheme for breast RT?

Our default fractionation for all situations with or without RNI is 40 in 15 followed by boost, if indicated.

If clinically and technically suitable for PBI, then preferred is 6 Gy x 5.

Use 50 in 25 if inflammatory breast cancer or poor response to chemo or residual undissected node in IM or axilla...

I prefer whole breast 42.56 Gy in 16 fx, 3D, and APBI 30 Gy in 5 fx, VMAT.

APBI with VMAT since 2016 at my center -- 229 patients treated to date -- median follow-up 26 months. No toxicity. Three recurrences, all salvaged with MRM. One with pN2a axillary recurrence and multifocal IBTR (rpT1c(m)) and ...