How would you manage a patient presenting with recurrent cT4 breast cancer?

This is similar to a question I answered on August 9, 2023. My answer then is very similar to the one now.

There is little data on whether prophylactic re-irradiation of the chest wall is justified. I do not feel it will be beneficial if the second breast cancer represents a relapse of the first one,...

In my practice, we consider reirradiation for high risk scenarios, in which I suspect surgery alone will not offer the same likelihood of cure and local control and the benefits of radiation outweigh the risks of adverse effects of the cumulative course. Factors that weigh into decision-making inclu...

I tend to repeat RT for these scenarios although, one can look at pathological staging after chemo and surgery to assess the pros of RT and the downside of reradiation.