Would you offer APBI in patients with a high Oncotype who are otherwise considered “suitable” per ASTRO guidelines?

I would be reluctant based on limited data showing high oncotype predicting for increased risk of local relapse even after RT.

I would favor treating with whole breast plus a boost.

I have offered patients with high risk oncotype APBI as I have not seen strong data that high oncotype predicts for LRR and that WBI mitigates that risk as compared to APBI. That being said WBI with boost is completely appropriate as well.