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Current status of conservative surgery and radiotherapy as primary local treatment for early carcinoma of the breast

  • Seventh Annual San Antonio Breast Cancer Symposium
  • Published:
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Summary

Since it is now recognized that breast cancer is commonly a systemic disease at presentation, it is clear that local treatment is limited to providing local tumor control, and that effective systemic therapy is required for the eradication of micrometastatic disease. We here review the current status of conservative surgery and radiotherapy in the treatment of early breast cancer. Results from retrospective studies support the view that this combination is highly effective in achieving local control and maintaining good cosmetic results. Results at five and ten years from prospective trials indicate that survival using this approach is comparable to that of mastectomy. Though further follow-up is required, we do not believe that a large survival difference in favor of either approach will emerge.

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References

  1. Fisher B, Slack N, Katrych D, Wolmark N: Ten year follow up results of patients with carcinoma of the breast in a cooperative clinical trial evaluating surgical adjuvant chemotherapy. Surg Gynecol Obstet 140: 528, 1975

    PubMed  Google Scholar 

  2. Valagussa P, Bonadonna G, Veronesi U: Patterns of relapse and survival following radical mastectomy. Cancer 41: 1178, 1978

    Google Scholar 

  3. Baker RR, Montague ACW, Childs JN: A comparison of modified radical mastectomy to radical mastectomy in the treatment of operable breast cancer. Ann Surg 189: 553–559, 1979

    PubMed  Google Scholar 

  4. Patey DH, Dryson WH: The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer 2: 7–13, 1948

    Google Scholar 

  5. Handley RS: The technique and results of conservative radical mastectomy (Patey's operation). Prog Clin Cancer 1: 462–470, 1965

    Google Scholar 

  6. Handley RS: The conservative radical mastectomy of Patey: 10 year results in 425 patients. Breast, Diseases of the Breast 2: 16–19, 1976

    Google Scholar 

  7. Hermann RE, Steiger E: Modified radical mastectomy. Surg Clin North Am 58: 743–754, 1978

    PubMed  Google Scholar 

  8. Robinson GN, Van Heerden JA, Payne WS, Taylor WF, Gaffey TA: The primary surgical treatment of carcinoma of the breast: A changing trend toward modified radical mastectomy. Mayo Clin Proc 51: 433–442, 1976

    PubMed  Google Scholar 

  9. Turner L, Swindell R, Bell WGT, Hartley RC, Taskeh JH, Wilson WW, Alderson MR, Leck IM: Radical versus modified radical mastectomy for breast cancer. Ann Roy Col Surgeons Eng 63: 239–243, 1981

    Google Scholar 

  10. Maddox WA, Carpenter JT, Laws HL, Soong SJ, Cloud G, Urist MM, Balch CM: A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients. Ann Surg 198: 207–212, 1983

    PubMed  Google Scholar 

  11. Clark RM: Breast cancer: a 21 year experience with conservative surgery and radiation. Int J Radiat Oncol Biol Phys 8: 967–975, 1982

    PubMed  Google Scholar 

  12. Montgomery AC, Greening WP, Levene AL: Clinical study of recurrence rate and survival time of patients with carcinoma of the breast treated by biopsy excision without any other therapy. J Royal Society of Medicine 71: 339–342, 1978

    Google Scholar 

  13. Tagart REB: Partial mastectomy for breast cancer. British Medical Journal 2: 1268, 1978

    Google Scholar 

  14. Freeman CR, Belliveau NJ, Kim TH, et al.: Limited surgery with or without radiotherapy for early breast carcinoma. J Canadian Association of Radiologists 32: 125–128, 1981

    Google Scholar 

  15. Lagios MD, Richards VE, Rose M, Yee F: Segmental mastectomy with radiotherapy: short-term follow-up. Cancer 52: 2173–2179, 1983

    PubMed  Google Scholar 

  16. Fisher B, Slack NH, Cavanaugh PJ, Gardner B, Ravdin RG, Cooperating Investigators: Post operative radiotherapy in the treatment of breast cancer: Results of the NSABP clinical trial. Ann Surg 172: 711–730, 1970

    PubMed  Google Scholar 

  17. Host H: Adjuvant radiation therapy. In: Levison EF, Montague ACW (eds): Diagnosis and Treatment of Breast Cancer: International Clinical Forum. Baltimore: Williams and Wilkins, 1981; 201–208

    Google Scholar 

  18. Fletcher GH: Local results of irradiation in the primary management of localized breast cancer. Cancer 29: 545–552, 1972

    PubMed  Google Scholar 

  19. McWhirter R: Simple mastectomy and radiotherapy in the treatment of breast cancer. Br J Radiol 28: 128–139, 1955

    PubMed  Google Scholar 

  20. Fisher B, Redmond C, Fischer E, and participating NSABP Investigators: The contribution of recent NSABP clinical trials of primary breast cancer therapy to an understanding of tumor biology: An overview of findings. Cancer 46: 1009–1025, 1980

    PubMed  Google Scholar 

  21. Williams FH: A further note on a new method of using Roentgen rays; consideration of primary treatment of some early cases of breast cancer by these rays. Boston Med Surg J 154: 641, 1906

    Google Scholar 

  22. Peters MU: Cutting the ‘Gordian Knot’ in early breast cancer. Ann R Coll Phys Surg Can 8: 186–191, 1975

    Google Scholar 

  23. Baclesse FL: Roentgen therapy as the sole method of treatment of cancer of the breast. Am J Roentgenol Radium Ther Nucl Med 62: 311–319, 1949

    Google Scholar 

  24. Calle R, Vilcoq JR, Pilleron JP, Schlienger P, Durand JC: Conservative treatment of operable breast carcinoma by irradiation with or without limited surgery — ten year results. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott Co., Philadelphia, 1983, pp 3–9

    Google Scholar 

  25. Amalric R, Santamaria F, Robert F, et al.: Conservation therapy of operable breast cancer — results at 5, 10 and 15 years in 2216 consecutive cases. In: Harris JR, Hellman S, Silen W, eds. Conservative Management of Breast Cancer. J.B. Lippincott Co., Philadelphia, 1983, pp 15–22

    Google Scholar 

  26. Harris JR, Recht A, Amalric R, Calle R, Clark RM, Reid JG, Spitalier JM, Vilcoq JR, Hellman S: Time course and prognosis of local recurrence following primary radiation therapy for early breast cancer. J Clin Oncol 2: 37–41, 1984

    PubMed  Google Scholar 

  27. Recht A, Silver B, Harris JR: The patterns of failure within the treated breast following primary radiation therapy. Proc ASTRO 1984

  28. Montague ED, Ames FC, Schell SE, Romsdahl MM: Conservative surgery and irradiation as an alternative to mastectomy in the treatment of clinically favorable breast cancer. Cancer 54: 2668–2672, 1984

    PubMed  Google Scholar 

  29. Prosnitz ER, Goldenberg IS, Packard RA, et al.: Radiation therapy as initial treatment for early stage cancer of the breast without mastectomy. Cancer 39: 917–923, 1977

    PubMed  Google Scholar 

  30. Schwartz GF, Rosenberg AL, Danoff BF, Mansfield CM, Feig SA: Lumpectomy and level I axillary dissection prior to irradiation for ‘operable’ breast cancer. Ann Surg 200: 554–559, 1984

    PubMed  Google Scholar 

  31. Beadle GF, Silver B, Botnick L, Hellman S, Harris JR: Cosmetic results following primary radiation therapy for early breast cancer. Cancer, in press

  32. Harris JR, Levene MB, Svensson G, Hellman S: Analysis of cosmetic results following primary radiation therapy for stage I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 5: 257–261, 1979

    PubMed  Google Scholar 

  33. Svensson GK, Bjarngard BE, Larsen RD, Levene MB: A modified three-field technique for breast treatment. Int J Radiat Oncol Biol Phys 6: 689–694, 1980

    PubMed  Google Scholar 

  34. Siddon RL, Buck BA, Harris JR, Svensson GK: Threefield technique for breast irradiation using tangential field corner blocks. Int J Radiat Oncol Biol Phys 9: 583–588, 1983

    PubMed  Google Scholar 

  35. Veronesi U, Saccozzi R, DelVecchio M, et al.: Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl J Med 305: 6–11, 1981

    PubMed  Google Scholar 

  36. Veronesi U, DelVecchio M, Greco M, et al.: Results of quadrantectomy, axillary dissection, and radiotherapy (QU.A.RT) in T1 NO patients. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott, Philadelphia, 1983, pp 101–111.

    Google Scholar 

  37. Sarrazin D, Lê MG, Fontaine MF, Arriagada R: Conservative treatment versus mastectomy in T1 or small T2 breast cancer. A randomized clinical trial. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott Company, Philadelphia, 1983, pp 101–111

    Google Scholar 

  38. Harris JR, et al.: The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy. Ann Surg in press

  39. Rose CM, Botnick LE, Goodman R, Harris JR, Findlay PA, Richter MP, Silen W, Hellman S: The role of limited axillary dissection in the treatment of breast cancer by primary irradiation. In: Harris JR, Hellman S, Silen W, eds. Conservative Management of Breast Cancer. J.B. Lip-pincott Company, Philadelphia, 1983, pp 155–162

    Google Scholar 

  40. Fisher B, Wolmark N, Bauer M, Redmond C, Gebhart M: The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast. Surg Gynecol Obstet 152: 765–772, 1981

    PubMed  Google Scholar 

  41. deMoss EV, Lichter AS, Lippman ME, Gerber NL, Reichert CM, Edwards BK, Schain WS, Gorrell CR, D'Angelo TM, Rosenberg SA: Complete axillary lymph node dissection before radiotherapy for primary breast cancer. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott Company, Philadelphia, 1983, pp 163–182

    Google Scholar 

  42. Bonadonna G, Valagussa P, Zucali R, DelVecchio M, Veronesi U: Feasibility of adjuvant chemotherapy plus radiotherapy in operable breast cancer. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott Company, Philadelphia, 1983, pp 329–336

    Google Scholar 

  43. Botnick LE, Come S, Rose CM, Goldstein M, Lange R, Tischler S, Schnipper L: Primary breast irradiation and concomitant adjuvant chemotherapy. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott Company, Philadelphia, 1983, pp 321–328

    Google Scholar 

  44. Glick JH, Danoff BF, Haller DG, Weiler C, Goodman RL. Adjuvant chemotherapy in patients undergoing definitive irradiation for primary breast cancer: The University of Pennsylvania experience. In: Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. J.B. Lippincott Company, Philadelphia, 1983, pp 311–320

    Google Scholar 

  45. Lichter AS, Lippman ME, deMoss EV, Edwards B, D'Angelo T, Gorrell C: The influence of primary breast cancer treatment — mastectomy or excisional biopsy plus radiation — on the ability to deliver adjuvant chemotherapy. Proc ASCO 1: 81, 1982

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Therapy, Joint Center for Radiation Therapy, 50 Binney St., 02115, Boston, MA, USA

    Jay R. Harris, Abram Recht & Barbara Silver

  2. Department of Pathology, Beth Israel Hospital, Boston, MA, USA

    Stuart Schnitt & James Connolly

  3. Departments of Medicine, Beth Israel Hospital, Boston, MA, USA

    Steven Come

  4. Dana-Farber Cancer Institute, Boston, MA, USA

    I. Craig Henderson

  5. Breast Evaluation Clinic, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Jay R. Harris, Abram Recht, Stuart Schnitt, James Connolly & I. Craig Henderson

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  1. Jay R. Harris
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  2. Abram Recht
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  3. Stuart Schnitt
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  4. James Connolly
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  5. Barbara Silver
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  6. Steven Come
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  7. I. Craig Henderson
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Harris, J.R., Recht, A., Schnitt, S. et al. Current status of conservative surgery and radiotherapy as primary local treatment for early carcinoma of the breast. Breast Cancer Res Tr 5, 245–255 (1985). https://doi.org/10.1007/BF01806019

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