Conservation surgery and irradiation as an alternative to mastectomy in the treatment of clinically favorable breast cancer

Abstract

The combination of conservation surgery and radiation therapy for early breast cancer is gaining acceptance as an alternative to radical mastectomy. This article reviews the results of randomized trials showing that there is no advantage to a radical mastectomy in patients with early breast cancer. In addition, the article will review multiple reports concerning the local and regional tumor control and survival of patients treated with conservation surgery and irradiation as well as a comparison of 1073 patients with TIS T1 T2 N0 N1 breast cancer treated at University of Texas (UT) M. D. Anderson Hospital between 1955 and 1980, of whom 345 were treated with conservation surgery and irradiation and 728 were treated with radical or modified radical mastectomy alone. The locoregional recurrence in the patients treated with an intact breast is 4.9%, and 5.6% in patients treated with radical or modified radical mastectomy. There is no significant difference in the 10‐year disease‐free survival rates between the two groups of patients. In addition, a comparison of 2467 patients with Stage I and Stage II breast cancer treated at the UT M. D. Anderson Hospital shows no significant difference in the incidence of consecutive second breast carcinoma as a result of the use of radiation therapy in the treatment of the first breast cancer.

Radiation therapy for operable breast cancer

“…107 Montague et al reported a locoregional recurrence rate of 4.9% with BCS and radiation, comparable to a comparison group of patients at the same institution treated by radical or modified radical mastectomy. 120,121 There was no apparent difference in 10-year disease-free survival or incidence of second primary breast cancers. Harris et al reported results in 366 women, most treated with excisional biopsy before radiation, with a 6-year local control rate of 88% for stage I and 87% for stage II patients.…”

Complications of radiation therapy and factors in their prevention

“…Variable degrees of subcutaneous fibrosis and atrophy may develop, Subsequent trauma, including surgery, infection, and the normal aging process may contribute to the acute or chronic radiation effects on the skin. Ex-cept for irradiation of cancer of the skin [114] and carcinoma of the breast [115], cutaneous and subcutaneous effects of radiations are almost entirely avoidable. If the dose of radiation is high, or a higher dose per daily fraction is given, or certain chemotherapeutic agents are combined with radiation, the frequency of severe late effects will increase [116][117][118].…”

The effect on pulmonary function of tangential field technique in radiotherapy for carcinoma of the breast

“…Recent studies, however, have convincingly demonstrated that acceptable long-term survival can be obtained if conservation surgery (lumpectomy) of small breast tumours is followed by radiotherapy (Montague et al, 1984). Such breast-preserving treatment can be offered to women with small solitary tumours (diameter <2cm), and without clinical evidence of lymph node involvement or tumour infiltration outside the breast, i.e.…”