If a patient has a history of lumpectomy and adjuvant radiation, and then develops an in-breast recurrence s/p mastectomy with breast only disease and no nodal disease, would you re-irradiate the chest wall?

Typically not. Now, if the breast lesion is very large or has a positive margin, or was stuck to the muscle, I would consider re-RT. In the adjuvant setting, PMRT is beneficial, but the therapeutic ratio is not that large. Remember some of the older studies (and studies w/o chemotherapy) did not dem...

In addition, if there are bad factors such as lots of lymphovascular invasion or positive nodes, don't forget the nodes. Provided they have not been irradiated. We were part of a retreatment study that showed you can get away with chest wall RT. Take into account details of prior RT such as energy u...