How would you treat an early-stage ER/PR+ Her-2 negative breast cancer s/p lumpectomy in an elderly patient who had sentinel node biopsy omission?  

Given the CALGB 9343 trial, as well as the recent "Choosing Wisely" recommendation ( not to routinely use sentinel lymph node biopsy in this patient population, how should radiation oncologists approach this increasing clinical situation?

ASTRO guidelines consider patients who did not have a lymph node evaluation as "unsuitable" for partial breast.

Is WBRT indicated in this situation, or would this be over-treatment? 

Answer from: Radiation Oncologist at Academic Institution