Adjuvant breast radiotherapy is offered to patients with localized breast cancer. We performed a retrospective review of older women receiving adjuvant breast radiotherapy in University Malaya Medical Centre, Malaysia (UMMC) in 2014. Out of 191 women, 23% (43) were 60 years old and above. At a median follow up of 6.6 years, 4.6% (2) had local recurrence and 19% (8) distant metastasis. In a subgroup of low risk older patients with hormone-sensitive, HER2 negative, T1N0 disease, all (3/43) are still alive with no local recurrence. We propose further research for treatment de-escalation in low risk elderly patients.