Conservative surgery followed by radical radiotherapy in the management of stage I carcinoma of the breast

• Published in: International journal of radiation oncology, biology, physics Vol. 8; no. 10; pp. 1775 - 1780
• Main Authors: Baeza, Mario R., Arraztoa, Juan, Sole, Juan, Rodriguez, Roberto
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.1982
• Subjects: Breast cancer; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breast Neoplasms - therapy; Female; Humans; Radiotherapy - adverse effects; Radiotherapy as main treatment; Radiotherapy Dosage; Retrospective Studies; Radiotherapy as main treatment; Breast cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/0360-3016(82)90301-7

Since October 1976, the treatment policy in our Radiotherapy Center for Stage I carcinoma of the breast has been excision of the tumor mass, when it was cosmetically suitable, followed by irradiation to the breast and periphereal lymphatics. Eighty-three patients were admitted between October 1976 and March 1980. They underwent local excision of the tumor and then received 5000 rad in 5 weeks to the breast, supraclavicular, axillary and internal mammary chain lymph nodes. Each field was treated every day. A boost was then given to the scar, bringing the dose up to 6500 rad, calculated at maximum tumor depth, depending upon the size of the tumor prior to surgery. Cosmetic results were quite good, and the local control rate at 54 months is 98 %. The survival with no evidence of disease (NED) at 54 months (actuarial) is 83 %. There have been 10 failures: 8 distant, 1 local (in axilla, controlled by surgery, actually NED), and 1 local and distant (scar and brain). Both local failures were found within 12 months after treatment, and 8/ 10 of the failures within 24 months. Twenty-one out of 83 patients have had complications (25.3% ); of these, 28.8% were surgical and the remainder resulted from radiotherapy after surgery, either from radiotherapy alone or from combination of treatments. Of the total of 21 complications, 18 were mild and 3 were serious. Of those 3 serious complications (3.6 %), 2 were a result of radiotherapy, and one because an ill-advised axillary dissection prior to radiotherapy gave a negative axilla and a serious arm edema and painful shoulder. This was the worst complication in the total of 83 patients. These results compare favorably with the results achieved in the same Hospital with radical surgery as far as local tumor control and survival with no evidence of disease (NED) is concerned. The results also compare with the great majority of surgical series reported in the literature, allowing us to conclude that patients treated with radiation have nothing to lose and much to gain by preserving the breast.