Does the presence of DCIS in conjunction with invasive breast cancer require consideration of adjuvant RT where invasive disease alone may allow for omission?

I'm not sure there is a lot of data in the PRIME II/CALGB 9343 subset of patients looking at impact of associated DCIS in conjunction with invasive disease and its impact on recurrence with and without radiation therapy.

I have not considered this an additional risk factor and have offered omission ...

In most cases of invasive disease, if you look, you will find some DCIS and thus the presence of DCIS with invasive disease would not change my management.