Would you offer radiation to an elderly patient with DCIS who would otherwise not meet criteria for RTOG 9804?

I counsel elderly patients with DCIS about the risks and benefits of receiving radiation therapy. I offer radiation in patients with excellent performance status who are uncomfortable with the 1-2%/year recurrence risk with omission of radiation (extrapolating from RTOG 9804 as well as ECOG (Solin et al, JCO, 2015) and Harvard data (Wong et al, JCO, 2006). I counsel the patient that half of recurrences are once again DCIS, and that the receipt of radiation will not affect their survival. Some patients feel uncomfortable omitting radiation despite this information, and for those patients who also have a good performance status, I offer radiation.

Another comment: #1: What's the definition of elderly here? #2 What comorbidities are there? The death rate related to breast cancer is very low, even for larger, high grade DCIS. If a patient does not wish radiation therapy, I would be sure about margins. If there is any question, I would consider reexcision. If the margins are too close for comfort and no further surgery is planned, other options include PBI (remember that most DCIS recurrences are in the same area) or hypofractionation.