Hypofractionated Regional Nodal Irradiation Clinical Trial for Women With Breast Cancer

Inclusion Criteria: * Karnofsky performance status of 70-100% * Histologic documentation of invasive adenocarcinoma of the breast * One of the breast disease stages listed below: * Note: In the definitions below, definitive surgery is defined as the final surgery performed to obtain clear surgical margins * Neoadjuvant chemotherapy was not administered \*\* If neoadjuvant chemotherapy was NOT administered, pathologic staging must be T1-3, N1-2a following definitive surgery * Neoadjuvant chemotherapy was administered * If prior to initiation of neoadjuvant chemotherapy clinical staging was T1-3, N0, pathologic staging must be T1-3, N1-2a following definitive surgery * If prior to initiation of neoadjuvant chemotherapy clinical staging was T1-3, N1, pathologic staging must be T0-3, N0-2a following definitive surgery * If prior to initiation of neoadjuvant chemotherapy there was cytologic or pathologic confirmation of axillary nodal involvement (per any of the criteria listed below), pathologic staging must be T0-3, N0-2a following definitive surgery * Positive fine-needle aspiration (FNA) (ie, demonstrating malignant cells) * Positive core needle biopsy (ie, demonstrating invasive adenocarcinoma) * Positive sentinel lymph node biopsy (ie, demonstrating invasive adenocarcinoma) * Complete resection of known breast disease by one of the following surgeries: * Lumpectomy with sentinel lymph node or axillary lymph node dissection * Mastectomy alone with sentinel lymph node or axillary lymph node dissection * Mastectomy plus reconstruction with sentinel lymph node or axillary lymph node dissection * Margins of the resected specimen or re-excision specimen must be histologically free of invasive tumor and ductal carcinoma in situ (DCIS) as determined by the pathologist \* Notes: Additional operative procedures may be performed to obtain clear margins; focally positive margins are acceptable based on technical feasibility of additional surgery and/or the potential for benefit with further surgery based on the extent and location of the positive margin (eg, focally positive deep margin at the pectoralis fascia); also, patients with margins positive for lobular carcinoma in situ (LCIS) are eligible without additional resection * Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) testing performed on the primary breast tumor; when applicable, testing must have been performed prior to neoadjuvant chemotherapy * Interval between the last surgery for breast cancer (including re-excision of margins) or the completion of adjuvant chemotherapy and study enrollment must be =\< 56 days (ie, a maximum of 8 weeks) \* Note: Radiotherapy must begin within 10 weeks following the last surgery for breast cancer or the last dose of adjuvant chemotherapy * Recovery from surgery with the incision completely healed and no signs of infection * If adjuvant chemotherapy was administered, chemotherapy-related toxicity that may interfere with delivery of external beam radiation therapy (EBRT) should have resolved * Women who are not postmenopausal or have not undergone hysterectomy must have a documented negative pregnancy test within 14 days prior to study registration \* Note: Postmenopausal is defined as one or more of the following: * Age \>= 60 years * Age \< 60 years and amenorrheic for at least 1 year with follicle-stimulating hormone (FSH) and plasma estradiol levels in the postmenopausal range * Bilateral oophorectomy * Women of child-bearing potential (WCBP) must agree to use a medically accepted form of pregnancy prevention for the duration of study treatment * Ability to understand and willingness to sign the consent form written in English pregnancy test within 14 days prior to study registration \* Note: Postmenopausal is defined as one or more of the following: * Age \>= 60 years * Age \< 60 years and amenorrheic for at least 1 year with follicle-stimulating hormone (FSH) and plasma estradiol levels in the postmenopausal range * Bilateral oophorectomy * Women of child-bearing potential (WCBP) must agree to use a medically accepted form of pregnancy prevention for the duration of study treatment * Ability to understand and willingness to sign the consent form written in English Exclusion Criteria: * Known definitive clinical or radiologic evidence of metastatic disease * T4 tumors including inflammatory breast cancer * Clinical nodal staging of N2 or N3 disease * Pathologic nodal staging of N2b, N2c, or N3 disease * Microscopic positive margins after definitive surgery \* Note: Patients with microscopically focally positive margins following lumpectomy or mastectomy are not excluded if re-excision is not technically feasible and/or there is no benefit to further surgery based on the extent and location of the positive margin * Any history, not including the index cancer, of ipsilateral or contralateral invasive breast cancer or ipsilateral or contralateral DCIS treated with radiation therapy (RT) \* Note: Patients with synchronous or previous ipsilateral LCIS are eligible * Any radiation therapy (RT) for the currently diagnosed breast cancer prior to study enrollment * History of ipsilateral or contralateral breast or thoracic RT for any condition * History of ipsilateral or contralateral axillary surgery for any condition * History of lymphedema involving the ipsilateral or contralateral arm at present or at any time in the past * Synchronous contralateral breast cancer requiring RT * Overall geometry (eg, breast size if intact breast) precludes the ability to achieve dosimetric requirements \* Note: Set-up devices for breast positioning are permitted * Unresolved post-surgical complications (eg, significant infection) with healing difficulties * Active collagen vascular disease, specifically dermatomyositis with a creatine phosphokinase (CPK) level above normal or with an active skin rash, systemic lupus erythematosus, or scleroderma * Pregnancy or breastfeeding * Diagnosis or treatment for a non-breast malignancy within 5 years of study registration, with the following exceptions: complete resection of basal cell carcinoma or squamous cell carcinoma of the skin and any in situ malignancy after curative therapy * Medical, psychological, or social condition that, in the opinion of the investigator, may increase the patient's risk or limit the patient's adherence with study requirements