How do you manage patients with early stage breast cancer with autoimmune disorders such as rheumatoid arthritis and collagen vascular disorders?

The historical perspective has been to treat in 180 cGy daily fractions to a total dose of 45 Gy with a tumor bed boost (assuming the need) to 50-55 Gy based on intrinsic increased radiosensitivity of normal and tumorous tissues. It is unclear whether this dose-fractionation schedule is effective beyond small retrospective series (certainly no level 1 evidence exists) but I believe it is a community standard. I do not offer breast radiotherapy to women with scleroderma or dermatomyositis based on a retrospective JCRT series, particularly given a mastectomy is a very appropriate treatment option. Hypofractionation has been used in patients with pelvic malignancies and UC or Crohn's Disease but I am unaware of its use in breast cancer patient...