What risk/pathologic factors merit PMRT for a patient with recurrent breast cancer and a prior history of ipsilateral breast irradiation?

My threshold for reradiation PMRT is higher. Would do for upfront 4 or more positive node or persistence of nodal disease after chemotherapy. If there is complete response to chemotherapy, then would avoid PMRT unless inflammatory breast cancer.

With respect to PMRT following previous radiation, I consider for inflammatory recurrence, positive margins, ECE.

If the patient has not had previous RNI, can consider for node positive. If previous RNI, my threshold is higher given concerns regarding lymphedema, plexopathy.