In 1971, the National Surgical Adjuvant Breast Project (NSABP) implemented a prospective randomized clinical trial to compare the worth of alternative treatments with radical mastectomy in women with primary operable breast cancer. Information has been obtained from 1,665 patients eligible for follow-up from 34 NSABP member institutions in Canada and the United States. Results from that trial, at present in its sixth year with patients on study for an average of 36 months, (26 to 62 months), fail to demonstrate an advantage for those who had a radical mastectomy. No significant difference in the treatment failure or survival has as yet been observed in clinically negative node patients who have been randomly managed by conventional radical mastectomy, total mastectomy with postoperative regional radiation or total mastectomy followed by axillary dissection of those patients who subsequently develop positive nodes. Similarly, there presently exists no difference between patients with clinically positive nodes treated by radical mastectomy o r by total mastectomy followed by radiation. Of particular interest is the observation that based upon findings from radical mastectomy patients, there may be as many as 40% of patients having a total mastectomy who had histologically positive nodes unremoved, to date only 15% have developed positive nodes requiring a n axillary dissection. The persistence of such a difference in incidence would have profound biological significance. The discovery that leaving behind positive axillary nodes has as yet not been influential in enhancing the incidence of distant metastases o r the overall proportion of treatment failures and that a disproportionate number of treatment failures in the total mastectomy group occurred in those patients who subsequently required axillary dissection provides reinforcement to the view that positive axillary lymph nodes are not the predecessor of distant tumor spread but are a manifestation of disseminated disease.comer 39:2827-2839,1977. HERE HAS EXISTED GREAT CONTROVERSYtional Surgical Adjuvant Breast Project T concerning the treatment of primary breast (NSABP), after almost a decade of planning cancer. Prompted by that uncertainty, the Na-initiated in August of 1971, a prospective ran-

No abstract

Radiation nephritis is a process of necrosis, atrophy and sclerosis that follows exposure of the kidney to ionizing radiation. Experimental studies with electron microscopy demonstrate that this process begins as degeneration of the glomerular endothelium and the tubular epithelium, and their basement membranes, leading to collapse of these structures and the development of interstitial fibrosis. Rather late and complicating events are necrosis and thrombosis of arteries and arterioles, contributing to the destruction of the renal parenchyma. The process is the same with large doses (5,000 to 10,000 rads) and with medium doses (1,000 to 3,000 rads), the only difference being the extent and the speed with which the lesions develop and the frequency of arterial necrosis.