Is there solid evidence for the proper sequencing of tamoxifen/SERM and breast radiation?  

There is no solid evidence one way or another. Three independent retrospective reviews published simultaneously in JCO nearly 10 years ago all showed that whether tamoxifen was given simultaneously or after radiation did not impact on local control. There is some laboratory theoretical evidence that...

My approach is like above with one more factor to be considered: some retrospective clinical data and basic science experiments suggest that the concomitant use of tamoxifen appears to increase radiation-induced pulmonary fibrosis. If patient has not started TAM, then I have her start afte...