Would you offer whole-breast RT to a BRCA-positive patient who has multifocal recurrent disease after APBI?

Before considering re-irradiation, I would counsel this patient extensively that they should have a mastectomy in this situation given the BRCA2 positivity, and recurrence vs. new primary < 2 years after treatment with RT.

If the patient absolutely refuses mastectomy, re-irradiation could be consider...