Pre-operative Irradiation in the Treatment of Breast Cancer: A Critical Appraisal

  • A. De Schryver
Part of the Handbuch der Medizinischen Radiologie / Encyclopedia of Medical Radiology book series (HDBRADIOL, volume 19 / 2)


Ever since Gocht (1897) published his first — if somewhat questionable — observations concerning the effect of the “Roentgen rays” on two cases of advanced breast cancer, radiologists have endeavoured to make a meaningful contribution to the treatment of this disease. Those were the days of the breakthrough of radical surgery pioneered by Halsted (1894), Meyer (1894) and others, and it is just possible that the enthusiasm created in the wake of their first surgical reports may have contributed to the delay in exploration of the still untested, but anticipated possibilities of the new method. Understandably perhaps, we have to wait for more than a quarter of a century before reports concerning the pre-operative use of radiation treatment in breast cancer make their appearance in the literature. Whereas it would not have been difficult for most surgeons to adopt this new adjuvant therapeutic modality (whose cancericidal properties had been documented for a number of different tumours at a very early date, e.g. in the Béclère report of 1907) after their intervention, they would have been more hesitant about letting it interfere beforehand with the organs they would have to operate upon afterwards. And yet there were some plausible reasons to expect some benefit from the pre-operative use of radiation. In the words of Laborde (1925), one of the pioneers of French radiotherapy,

… in view of the extensive and potentially involved area of lymphatic drainage, no surgical operation, however large, can guarantee against recurrence... It would therefore seem logical to apply the radiation pre-operatively with the aim of preventing any spread of the tumour to both skin and lymph nodes, because adequately irradiated cancer cells should no longer be capable of forming colonies.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adair, F.E.: The effect of preoperative irradiation in primary operable cancer of the breast. Am. J. Roentgenol. 35, 359–370 (1936)Google Scholar
  2. Adair, F.E.: Cancer of the breast. Present status of surgery and irradiation therapy. N. Y. State J. Med. 37, 1758–1762 (1937)Google Scholar
  3. Adair, F.E.: The role of surgery and irradiation in cancer of the breast. J.A.M.A. 121, 553–559 (1943)CrossRefGoogle Scholar
  4. Alexander, P.: The bogey of the immunosuppressive action of local radiotherapy. Int. J. Radiol. Oncol. Biol. Phys. 1, 369–371 (1976)CrossRefGoogle Scholar
  5. Alexander, P., Hall, J.G.: The role of immunoblasts in host resistance and immunotherapy of primary sarcomata. In: Advances in cancer research. Klein, G., Weinhouse, S. (eds.), Vol. 13, pp. 1–37. New York, London: Academic Press 1970Google Scholar
  6. Ålund, M., Granberg, P.O., De Schryver, A., Sundblad, R.: Surgical complications after radiation therapy for carcinoma of the breast. Surg., Gynecol. Obst. 144, 235–238 (1977)Google Scholar
  7. Amirfallah, A., Becker, R., Fischedick, O.: Die prä-und postoperative sowie die alleinige postoperative Bestrahlung des Mammakarzinoms. Strahlentherapie 144, 381–392 (1972)PubMedGoogle Scholar
  8. Arão, H., Abrão.: Estudo anatómico da cadeia ganglionar mamária interna em 100 casos. Rev. Paul. Med. 45, 317 (1954)Google Scholar
  9. Baclesse, F.: Roentgentherapy as the sole method of treatment of cancer of the breast. Am. J. Roentgenol. 62, 311–319 (1949)Google Scholar
  10. Baclesse, F.: A method of preoperative roentgentherapy by high doses followed by radical operation for carcinoma of the breast (showing survivals up to 10 years). J. Fac. Radiol. 6, 145–163 (1955)CrossRefGoogle Scholar
  11. Baclesse, F.: Les irradiations préopératoires à dose élevée dans le traitement du cancer du sein à l’exclusion du stade I. Résultats à cinq, dix et vingt ans. J. Radiol. Electrol. Med. Nucl. 43, 826–830 (1962)PubMedGoogle Scholar
  12. Baclesse, F., Nezelof, C., Vilde, F.: Cancer du sein. Association cobaltothérapie à hautes doses-chirurgie. Confrontation des résultats histologiques, cliniques et évolutifs; à propos de 105 cas. Eur. J. Cancer 5, 219–229 (1969)PubMedCrossRefGoogle Scholar
  13. Baral, E., Blomgren, H., Petrini, B., Wasserman, J.: Blood lymphocytes in breast cancer following radiotherapy and surgery. Int. J. Radiat. Oncol. Ther. Phys. 2, 289–295 (1977a).CrossRefGoogle Scholar
  14. Baral, E., Blomgren, H., Petrini, B., Wasserman, J., Ogenstad, S., Silfverswärd, C.: Prognostic relevance of immunologic variables in breast carcinoma. Acta Radiol. Ther. Phys. Biol. 16, 417–426 (1977b)Google Scholar
  15. Béclère, A.: Influence des rayons de Roentgen sur les tumeurs malignes. Rapports 20ème Congr. Assoc. Fr. Chir., Paris, 1907Google Scholar
  16. Berven, E.: The technique at Radiumhemmet in the treatment of tumours except cancer uteri. Acta Radiol. 10, 3–48 (1929)Google Scholar
  17. Berven, E.: Die Strahlenbehandlung des Mammakarzinoms. Fortschr. Röntgenstr. 75, 10–25 (1951)CrossRefGoogle Scholar
  18. Blomgren, H., Berg, R., Wasserman, J., Glas, U.: Effect of radiotherapy on blood lymphocyte subpopulations in mammary carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 1, 177–188 (1976)PubMedCrossRefGoogle Scholar
  19. Blomgren, H., Wasserman, J., Edsmyr, F., Baral, E., Petrini, B.: Reduction of responder and stimulator capacities of peripheral lymphoid cells in the mixed lymphocyte culture following external radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2, 297–305 (1977)PubMedCrossRefGoogle Scholar
  20. Cade, S.: Treatment and results in cancer of the breast. Am. J. Roentgenol. 62, 326–327 (1949)Google Scholar
  21. Crile, G.: Conservative treatment of advanced breast cancer. Am. J. Surg. 126, 343–344 (1973)PubMedCrossRefGoogle Scholar
  22. Dao, T.L., Kovaric, J.P.: Incidence of pulmonary and skin metastases in women with breast cancer who received postoperative irradiation. Surgery 52, 203–212 (1962)Google Scholar
  23. De Backer, P., Derom, F.: Contribution à l’étude des formes de régression de tumeurs malignes sous l’action de l’irradiation. Bull. Cancer (Paris) 12, 635–663 (1923)Google Scholar
  24. Delarue, N.C., Ash, C.L., Peters, V., Fielden, R.: Preoperative irradiation in management of locally advanced breast cancer. Arch. Surg. 91, 136–154 (1965)CrossRefGoogle Scholar
  25. De Schryver, A.: The Stockholm breast cancer trial: Preliminary report of a randomized study concerning the value of preoperative or post-operative radiotherapy in operable disease. Int. J. Radiat. Oncol. Biol. Phys. 1, 601–609 (1976)PubMedCrossRefGoogle Scholar
  26. Edsmyr, F., Walstam, R.: Method for irradiation of parasternal lymph-node metastases. Acta Radiol. 51, 308–320 (1959)PubMedCrossRefGoogle Scholar
  27. Einhorn, N.: Effect of local radiotherapy on the level of EBV-associated membrane-reactive antibodies in the sera of patients with certain malignant tumors. Cancer 29, 714–723 (1972)PubMedCrossRefGoogle Scholar
  28. Einhorn, N., Einhorn, J.: Effect of radiotherapy and surgery on the immune reactivity to the target tissue. In: Front. Rad. Ther. Oncol. Vaeth, J. (ed.), Vol. 7, pp. 120–126. Basel: Karger and Baltimore: University Press 1972Google Scholar
  29. Einhorn, N., Jonsson, J., Fagraeus, A.: Immunological reactions after irradiation of the uterus. Radiat. Res. 40, 465–472 (1969)PubMedCrossRefGoogle Scholar
  30. Einhorn, N., Klein, G., Clifford, P.: Increase in antibody titer against the EBV-associated membrane antigen complex in Burkitt’s lymphoma and nasopharyngeal carcinoma after local irradiation. Cancer 26, 1013–1021 (1970)PubMedCrossRefGoogle Scholar
  31. Ellis, R.: Relationship of biological effect to dose-time fractionation factors in radiotherapy. In: Current topics in radiation research. Ebert, M., Howard, A. (eds.), Vol. 4, pp. 357–397. Amsterdam: North Holland 1968Google Scholar
  32. Engell, H.C.: Cancer cells in the circulating blood. Acta Chir. Scand. [Suppl. 201] (1955)Google Scholar
  33. Fish, V.: Results of treatment of patients with breast cancer at Palo Alto Medical Clinic, 1963–1970. Personal communication, 1977 (to be published)Google Scholar
  34. Fisher, B., Fisher, E.R.: Metastasis revisited. In: Fundamental aspects of metastasis. Weiss, L. (ed.), pp. 427–435. New York, Amsterdam: North Holland/Elsevier 1976Google Scholar
  35. Fisher, E.R., Turnbull, R.B.: The cytologic demonstration and significance of tumor cells in the mesenteric venous blood in patients with colorectal carcinoma. Surg. Gynecol. Obstet. 100, 102–108 (1955)PubMedGoogle Scholar
  36. Fletcher, G.H.: The advantages of preoperative irradiation. J.A.M.A. 200, 140–141 (1967)PubMedCrossRefGoogle Scholar
  37. Fletcher, G.H.: Local results of irradiation in the management of localized breast cancer. Cancer 29, 545–551 (1972)PubMedCrossRefGoogle Scholar
  38. Fletcher, G.H.: Textbook of Radiotherapy, 2nd ed., pp. 457–493. Philadelphia: Lea & Febiger 1973Google Scholar
  39. Fletcher, G.H., Montague, E.D., White, E.C.: Radiation in the primary management of breast cancer. Prog. Clin. Cancer 4, 242–256 (1970)PubMedGoogle Scholar
  40. Franzén, S., Zajicek, J.: Aspiration biopsy in diagnosis of palpable lesions of the breast. Acta Radiol. Ther. Phys. Biol. 7, 242–262 (1968)Google Scholar
  41. Glas, U., Wasserman, J., Blomgren, H., De Schryver, A.: Lymphopenia and metastatic breast cancer patients with and without radiation therapy. Int. J. Radiat. Oncol. Ther. Phys. 1, 189–195 (1976)CrossRefGoogle Scholar
  42. Gocht, H.: Therapeutische Verwendungen der Röntgenstrahlen. Fortschr. Röntgenstr. 1, 14–22 (1897)Google Scholar
  43. Green, I., Cohen, S., McCluskey, R.T.: Mechanisms of tumor immunity. New York, London, Sydney, Toronto: Wiley & Sons 1977Google Scholar
  44. Griffiths, J.D., Salsbury, A.J.: Circulating cancer cells. Springfield, Ill.: Thomas 1965Google Scholar
  45. Guttmann, R.: Radiotherapy in the treatment of primary operable carcinoma of the breast with proved lymph node metastases. Am. J. Roentgenol. 89, 58–63 (1963)Google Scholar
  46. Haendly, P.: Pathologisch-anatomische Ergebnisse der Strahlenbehandlung. Strahlentherapie 12, 1–87 (1921)Google Scholar
  47. Halsted, W.S.: The result of operations for cure of the breast performed at the Johns Hopkins Hospital. Ann. Surg. 20, 497–555 (1894)PubMedCrossRefGoogle Scholar
  48. Hatfield, P.M., Schulz, M.D.: Postirradiation sarcoma, including 5 cases after X-ray therapy of breast carcinoma. Radiology 96, 593–602 (1970)PubMedGoogle Scholar
  49. Hintze, A.: Unsere Fortschritte bei der Behandlung des Brustkrebses durch Nachbestrahlung. Strahlentherapie 41, 601–646 (1931)Google Scholar
  50. Howland, W.J., Loeffler, R.K., Starchman, D.E., Johnson, R.G.: Postirradiation atrophic changes of bone and related complications. Radiology 117, 677–685 (1975)PubMedGoogle Scholar
  51. Jonsson, J., Einhorn, N., Fagraeus, A., Einhorn, J.: Organ antibodies after local irradiation. Radiology 90, 536–540 (1968)PubMedGoogle Scholar
  52. Kaae, S.: The value of preoperative roentgen irradiation in operable breast cancer. Acta Radiol. 37, 568–576 (1952)PubMedCrossRefGoogle Scholar
  53. Kahr, E., Schreyer, H.: Zur Frage der präoperativen Bestrahlung des Mammakarzinoms im Stadium I und IIa. Strahlentherapie 130, 481–488 (1966)PubMedGoogle Scholar
  54. Kim, J.H., Chu, F.C.H., Pope, R.A., Woodard, H.Q., Bragg, D.B., Shidnia, H.: Time dose factors in radiation induced osteitis. Am. J. Roentgenol. 120, 684–690 (1974)Google Scholar
  55. Klein, G.: The Epstein-Barr virus (EBV). In: The herpes viruses. Kaplan, A. (ed.), pp. 521–555. New York: Academic Press 1973Google Scholar
  56. Kohler, A.: 10 Jahre präoperative Bestrahlung des Mamma-Carcinoms. Strahlentherapie 88, 150–163 (1952)PubMedGoogle Scholar
  57. Kohler, A.: Die Bedeutung der Vorbestrahlung bösartiger Geschwülste. Strahlentherapie 103, 342–347 (1957)PubMedGoogle Scholar
  58. Kratochvil, K.: Zur chirurgischen Frühdiagnose und Therapie des Mammakarzinoms unter Berücksichtigung der präoperativen Bestrahlung. Fortschr. Röntgenstr. 81, 727–734 (1954)CrossRefGoogle Scholar
  59. Laborde, S.: La curiethérapie des cancers. Pp. 245–248. Paris: Masson 1925Google Scholar
  60. Lee, B.J., Herendeen, R.E.: An evaluation of preoperative and post-operative radiation in the treatment of mammary carcinoma. Ann. Surg. 82, 404–412 (1925)PubMedCrossRefGoogle Scholar
  61. Lenz, M.: Tumor dosage and results in roentgen therapy of cancer of the breast. Am. J. Roentgenol. 56, 67–74 (1946)Google Scholar
  62. Lenz, M.: Tissue dosage in roentgen therapy of mammary cancer. Acta Radiol. 28, 583–592 (1947)PubMedCrossRefGoogle Scholar
  63. Lindgren, M., Borgström, S., Landberg, T.: Pre-operative radiotherapy in operable breast cancer. In: Prognostic factors in breast cancer. Proc. 1st Tenovus Symposium 1967, pp. 103–117. Edinburgh: Livingstone 1968Google Scholar
  64. Lumb, G.: Changes in carcinoma of the breast following irradiation. Br. J. Surg. 38, 82–93 (1950)PubMedCrossRefGoogle Scholar
  65. Malmgren, R.A.: Circulating cancer cells and their significance. — A re-appraisal. In: The proliferation and spread of neoplastic cells. Pp. 481–494. Baltimore: Williams & Wilkins 1968Google Scholar
  66. McCredie, J.A., Inch, W.R., Sutherland, R.M.: Effect of postoperative radiotherapy on peripheral blood lymphocytes in patients with carcinoma of the breast. Cancer 29, 349–356 (1972)PubMedCrossRefGoogle Scholar
  67. Meyer, K.K., Weaver, D.R., Luft, W.C., Boselli, B.D.: Lymphocyte immune deficiency following irradiation for carcinoma of the breast. In: Front. Rad. Ther. Oncol. Vaeth, J.M. (ed.), Vol. 7, pp. 179–198. Basel, New York: Karger 1972Google Scholar
  68. Meyer, W.: An improved method of the radical operation for carcinoma of the breast. Med. Ree. N.Y. 46, 746 (1894)Google Scholar
  69. Muntean, E.: Zur präoperativen Röntgenbestrahlung des Mamma-Karzinoms. Fortschr. Röntgenstr. 104, 546–553 (1966)CrossRefGoogle Scholar
  70. Neuman, Sluys, F., Coryn: Technique radiochirurgicale des cancers du sein. Arch. Electr. Med. 32, 33–36 (1924)Google Scholar
  71. Notter, G., Hallberg, O., Vikterlöf, K.J.: Strahlenschäden am Plexus brachialis bei Patienten mit Mammakarzinom. Strahlentherapie 139, 538–543 (1970)PubMedGoogle Scholar
  72. Paterson, R., Rüssel, M.H.: Clinical trials in malignant disease. Part III — Breast cancer: Evaluation of postoperative radiotherapy. J. Fac. Radiol. 10, 175–180 (1959)CrossRefGoogle Scholar
  73. Perez, C.A.: Preoperative irradiation in the treatment of cancer: Experimental observations and clinical implications. In: Front. Rad. Ther. One. Vaeth, J.M. (ed.), Vol. 5, pp. 1–29. Basel, New York: Karger 1970Google Scholar
  74. Petrini, B., Wasserman, J., Blomgren, H., Baral, E.: Blood lymphocyte subpopulations in breast cancer patients following radiotherapy. Clin. Exp. Immunol. 29, 36–42 (1977)PubMedGoogle Scholar
  75. Pfahler, G.E.: The treatment of carcinoma of the breast. Am. J. Roentgenol. 39, 1–18 (1938)Google Scholar
  76. Powers, W.E., Palmer, L.A.: Biologic basis of preoperative radiation treatment. Am. J. Roentgenol. 102, 176–192 (1968)Google Scholar
  77. Richards, G.E.: Mammary cancer. The place of surgery and of radiotherapy in its management. Part I: A study of some of the factors which determine success or failure in treatment. Br. J. Radiol. 21, 109–127 (1948a)CrossRefGoogle Scholar
  78. Richards, G.E.: Mammary cancer. The place of surgery and of radiotherapy in its management. Part II: Radiotherapeutic procedures. Br. J. Radiol. 21, 249–258 (1948b)CrossRefGoogle Scholar
  79. Roberts, S.S.: Spread (of cancer) by the vascular system. In: Dissemination of cancer. Prevention and therapy. Cole, W.H., McDonald, G.O., Roberts, S.S., Southwick, H.W. (eds.), pp. 61–222. New York: Appleton-Century-Crofts 1961Google Scholar
  80. Roberts, S., Jonasson, O., Long, L., McGrew, E.A., McGrath, R., Cole, W.H.: Relationship of cancer cells in the circulating blood to operation. Cancer 15, 232–240 (1962)PubMedCrossRefGoogle Scholar
  81. Rubin, Ph.: In: Front. Rad. Ther. Oncol. Vaeth, J.M. (ed.), Vol. 5, p. 224. Basel, New York: Karger 1970Google Scholar
  82. Scherer, F.: Chirurgische Erfahrungen bei der Operation des vorbestrahlten Mamma-Karzinoms. Strahlentherapie 104, 245–246 (1957)PubMedGoogle Scholar
  83. Schinz, H.R., Botsztejn, Ch.: Der Brustkrebs in Zürich. Oncology 1, 91–109 (1948)CrossRefGoogle Scholar
  84. Spengler, F.: Herzschäden durch Nachbestrahlung bei Mamma-amputierten Frauen? Münch. Med. Wochenschr. 1, 26–27 (1971)Google Scholar
  85. Stjernswärd, J.: Decreased survival related to irradiation postoperatively in early operable breast cancer. Lancet 2, 1285–1286 (1974)PubMedCrossRefGoogle Scholar
  86. Stjernswärd, J., Vánky, F., Jondal, M., Wigzell, H., Sealy, R.: Lymphopenia and change in distribution of human B and T lymphocytes in peripheral blood induced by irradiation for mammary carcinoma. Lancet 1, 1352–1356 (1972)PubMedCrossRefGoogle Scholar
  87. Strickland, P.: The management of carcinoma of the breast by radical supervoltage radiation. Br. J. Surg. 60, 569–573 (1973)PubMedCrossRefGoogle Scholar
  88. Suit, H.D., Gallager, H.S.: Intact tumor cells in irradiated tissue. Arch. Pathol. 78, 648–651 (1964)PubMedGoogle Scholar
  89. Turner-Warwick, R.T.: The lymphatics of the breast. Br. J. Surg. 46, 574–582 (1959)PubMedCrossRefGoogle Scholar
  90. UICC ( = International Union Against Cancer): TNM classification of malignant tumours, 2nd ed., pp. 51–55. Geneva, 1974Google Scholar
  91. Vaeth, J.M., Clark, J.C., Green, J.P., Schroeder, A.F., Lowy, R.O.: Radiotherapeutic management of locally advanced carcinoma of the breast. Cancer 30, 107–112 (1972)PubMedCrossRefGoogle Scholar
  92. Wallgren, A., Arner, O., Bergström, J., Blomstedt, B., Granberg, P.-O., Karnström, L., Räf, L., Silfverswärd, C.: Preoperative radiotherapy in operable breast cancer. Results in the Stockholm breast cancer trial. Cancer 42, 1120–1125 (1978)PubMedCrossRefGoogle Scholar
  93. Wallgren, A., Arner, O., Bergström, J., Blomstedt, B., Granberg, P.-O., Karnström, L., Räf, L., Silfverswärd, C.: The value of preoperative radiotherapy in operable mammary carcinoma. Intern. J. Rad. Oncol. Biol. Phys. 6, 287–290 (1980)CrossRefGoogle Scholar
  94. Widow, W., Marx, G., Peek, U.: Die Behandlung des operablen Brustdrüsenkrebses. In: Symposium über den Brustdrüsenkrebs. Gummel, H., Widow, W. (eds.), pp. 71–83. Berlin (GDR): Akademie 1973Google Scholar
  95. Zajicek, J., Raaschou, T., De Schryver, A.: unpublishedGoogle Scholar
  96. Zuppinger, A.: Die präbioptische Bestrahlung beim Mammakarzinom. In: Neue Aspekte der Krebsbekämpfung. Deutsche Akad. f. med. Fortbildung (ed.), pp. 101–107. Stuttgart: Thieme 1979Google Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1982

Authors and Affiliations

  • A. De Schryver

There are no affiliations available

Personalised recommendations