Do you ever treat a recurrent breast cancer with RNI alone rather than chest wall and RNI?

As this is a de novo case and not a recurrence, it would be reasonable to treat the nodes and leave the chest wall alone given the small size, absence of LVI, and adequate margins.

Retreatment indications are not absolute and are a function of absolute benefit vs. morbidity. For the above case, I would favor comprehensive RT unless RT effects from previous RT or breast suggest high morbidity with chest wall RT.