Would you consider hormonal therapy and no RT in an elderly pt who developed a contralateral early stage, ER+ breast cancer while on Tamoxifen for previous breast cancer?  

I agree with @Sushil Beriwal. I view these cases as more aggressive as the malignancy developed while on hormonal therapy. Of course each case depends on the individual performance status and goals of the patient. 

I have offered treatment to this subset as their response rate with anti estrogen therapy is not same and risk of LR is would not be same as PRIME 2 or CALGB