Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group.

Abstract

Long-term results support conservative treatment with limited surgery and systematic breast irradiation as a safe procedure for the management of small breast cancers. Four easily obtainable clinical and histologic factors may be combined in a prognostic score that is highly predictive of overall and event-free survival.

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

“…Lacour et al (1983) and Meier et al (1989) performed randomised studies of extended radical mastectomy vs radical mastectomy and found no survival difference. Randomised trials of post-mastectomy radiation encompassing the internal mammary nodes did not result in an improvement in overall survival either (Fisher et al, 1970;Palmer and Ribeiro, 1985;Høst et al, 1986;Veronesi et al, 1986;Arriagada et al, 1996). Obfuscating factors of such studies can be the use of adjuvant systemic treatment and the fact that internal mammary nodes may be situated in the breast irradiation field (Freedman et al, 2000).…”

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

“…[1][2][3][4][5][6][7][8][9] Whole breast irradiation with doses of 45 to 50 Gy was used in all of the trials, and a boost to the primary site was employed in five of the six trials. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) trial, a dose of 50 Gy was delivered to the entire breast without a boost.…”

“…Overall, the incidence of a recurrence in the treated breast ranges from 3 to 20 percent (Table 3). 3,4,6,7,9,10 The majority of failures in the treated breast can be salvaged with mastectomy, and survival following such treatment is approximately 70 percent at five years. As demonstrated in Table 3, primary mastectomy does not guarantee freedom from local recurrence in Stage I and II breast cancer.…”

Potential applicability of balloon catheter–based accelerated partial breast irradiation after conservative surgery for breast carcinoma

“…Numerous randomized studies have proven that local surgical extirpation plus whole breast RT is equally as effective as mastectomy for the treatment of breast carcinoma. [1][2][3][4][5] Currently, conventional RT after breastconserving surgery is generally delivered to the whole breast over 5 weeks with a boost to the operative bed over the following 1-1.5 weeks depending on margin status. However, the protracted course of whole breast RT has been cited as one of the main reasons that patients decline BCT.…”

“…Multiple prospective randomized trials have demonstrated equivalent disease-specific and overall survival rates comparing mastectomy with lumpectomy plus whole breast external-beam irradiation. [1][2][3][4][5] Despite this equivalence, many patients who are candidates for BCT do not pursue this approach for various reasons, including the inability to complete 6 weeks of daily RT owing to logistic considerations. 6 -8 This has led several investigators to evaluate BCT options using more focused RT given over a shorter treatment time.…”