Background In a country where radiotherapy (RT) is not available, advocacy based on the relevance of surgery + adjuvant RT in locoregional control and survival is needed. Aim To evaluate the impact of surgery with RT on local control and survival compared to surgery alone in breast cancer (BC). Methods and results Between 2007 and 2016, 210 patients with BC were retrospectively reviewed, of which 90 patients underwent surgery with RT (group 1) and 120 patients' surgery (group 2). There were several treatment combinations, including surgery combined with neoadjuvant chemotherapy [ACT], RT, and ACT. The results showed 88 (41.9%) cases of relapse, including 31 (34.4%) (group 1) and 57 (47.5%) (group 2) ( p = .046). Recurrence occurred after a mean time of 1.5 years in group 1 versus 0.66 years in group 2 ( p = .006). The 5‐year overall and BC‐specific survivals were 49.5% and 62.5%, respectively. The 5‐year survival was 60.0% (group 1) and 40.0% (group 2) ( p < .05). In a multivariate analysis by Cox model, we found that the risk of death was 1.90 81 (95% CI [1.17 09–3.0701]) higher in group 2 ( p = .009022), 1.69 85 (95% CI 1.00087–23.86157) in obese patients and decreased by 0.21 (95% CI [0.129–0.368]) in patients who did not relapse ( p < .001). Conclusion In this study with several combination therapies, we cannot confirm that RT improves mainly locally advanced BC prognosis regardless of systemic treatment. However, we found that the risk of death correlated with the absence of RT, overweight, and risk of recurrence. Consideration of combinations of locoregional and systemic therapies, clinicopathological and biological data could improve the relevance of these results with a large sample size.

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