Adjuvant radiation therapy improved health-related quality of life (HRQOL) and reduced treatment-related adverse effects (TRAEs) compared to endocrine therapy alone at 24 months in older patients with stage I hormone receptor–positive, HER2-negative breast cancer, according to the EUROPA trial. Radiation therapy showed better outcomes in physical, role, emotional, cognitive, and social functioning, and more favorable symptom outcomes. No ipsilateral breast tumor recurrence, locoregional relapse, or breast cancer-related death occurred in either group at 24 months. Treatment-related adverse events were less frequent in the radiation therapy group.