Abstract
In 1976 the National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated a randomized trial (B-06) to evaluate the worth of lumpectomy in the treatment of patients with stages I and II breast cancer. This report presents, for the first time, findings from that trial through 10 years of follow-up relative to ipsilateral breast tumor recurrence (IBTR), distant disease-free survival, and survival of patients who were treated by modified radical mastectomy, lumpectomy, or lumpectomy followed by breast irradiation. The report indicates that the incidence of IBTR observed in the B-06 trial is decreased by effective systemic therapy as well. Also commented on are a number of issues regarding the use of lumpectomy that are of concern to clinicians. They relate to the need for tumor specimen margins, the size of tumors amenable to lumpectomy, treatment of breast tumor recurrence, lumpectomy in older women, and other concerns. No patient or tumor characteristics have been identified that preclude the use of lumpectomy and radiation therapy. All evidence continues to justify the use of lumpectomy and breast irradiation for the treatment of invasive breast cancer. In addition, we have noted findings that indicate the propriety of lumpectomy and breast irradiation for treatment of localized ductal carcinoma in situ.
Résumé
En 1976, a débuté un essai randomisé (B-06) sur la valeur de la tumorectomie (“lumpectomie”) dans les cancers du sein aux stades I et II entrepris par la National Surgical Adjuvant Breast and Bowel Project (NSABP). Ce rapport présente, pour la première fois, les résultats du suivi à 10 ans de cet essai, en ce qui concerne la récidive homolatérale (RHL), la survie à distance sans maladie et la survie globale des patientes traitées respectivement par la mastectomie radicale modifiée, la tumorectomie ou la tumorectomie suivie de radiothérapie locale. L'incidence de la RHL est diminuée par une chimiothérapie systémique efficace. Les principaux problèmes soulevés par l'utilisation de la tumorectomie sont discutés: entre autres, l'importance des marges de sécurité, la taille des tumeurs susceptibles d'être traitées ainsi, l'attitude thérapeutique visa-vis des récidives locales, l'utilisation de la technique chez la femme âgée. Il n'a été mis en évidence aucun type particulier de patiente ou de caractéristique tumorale qui exclue à priorité la tumorectomie et la radiothérapie d'emblée. Tout semble justifier la continuation de l'utilisation de la tumorectomie associée la radiothérapie locale, pour les cancers invasifs du sein. Les indications propres à la tumorectomie associée a la radiothérapie dans les cancers in situ intracanalaires localisés sont données.
Resumen
En 1976 en National Surgical Adjuvant Breast and Bowel Project (NSABP) inició un ensayo randomizado (B-06) destinado a valorar la tumorectomía en el tratamiento de pacientes con cáncer mamario en estados I y II. El presente artículo presenta, por primera vez, los hallazgos en tal ensayo a través de 10 años de seguimiento en relación a recurrencia tumoral ipsilateral (RTI), sobrevida libre de enfermedad a largo plazo y supervivencia de las pacientes tratadas mediante mastectomía radical modificada, tumorectomía sola o tumorectomía seguida de irradiación. El informe también indica que la incidencia de RTI observada en el ensayo B-06 se disminuye con una efectiva terapia sistémica. Así mismo, se comentan diversos aspectos de la tumorectomía que son motivo de preocupación por parte de los médicos: necesidad de obtener márgenes libres de tumor, tamaño del tumor susceptible de tumorectomía, tratamiento de las recurrencias mamarias, tumorectomía en mujeres ancianas y otras materias. No se han identificado características pertinentes a la paciente o al tumor que contraindiquen el uso de la tumorectomía y radioterapia. Toda la evidencia disponible continúa justificando el uso de la tumorectomía e irradiación en el tratamiento del cáncer mamario invasivo. Además, anotamos hallazgos que apuntan a favorecer la tumorectomía e irradiación en el tratamiento del carcinoma ductal in situ del seno.
Similar content being viewed by others
References
Fisher, B., Bauer, M., Margolese, R., et al.: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N. Engl. J. Med. 312:665, 1985
Fisher, B.: The biological and clinical justification for relegating radical breast cancer operations to the archives of surgical history. In Debates in Clinical Surgery, R.L. Simmons, A.O. Udekwu, editors. Chicago, Year Book, 1990, pp. 14–26
Fisher, B., Redmond, C., Poisson, R., et al.: Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N. Engl. J. Med. 320:822, 1989
Fisher, B., Redmond, C.: Lumpectomy for breast cancer: an update of the NSABP experience. J. Natl. Cancer Inst. Monogr. 11:7, 1992
Fisher, B., Wickerham, D.L., Deutsch, M., Anderson, S., Redmond, C., Fisher, E.: Breast tumor recurrence following lumpectomy with and without breast irradiation: an overview of recent NSABP findings. Semin. Surg. Oncol. 8:153, 1992
Fisher, B., Wolmark, N., Fisher, E., Deutsch, M.: Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations. World J. Surg. 9:692, 1985
Fisher, E., Sass, R., Fisher, B., Gregorio, R., Brown, R., Wickerham, D.L.: Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 5). II. Relation of local breast recurrence to multicentricity. Cancer 57:1717, 1986
Margolese, R., Poisson, R., Shibata, H., Pilch, Y., Lerner, H., Fisher, B.: The technique of segmental mastectomy (lumpectomy) and axillary dissection: a syllabus from the National Surgical Adjuvant Breast Project workshops. Surgery 102:828, 1987
Fisher, B., Wolmark, N.: Conservative surgery: the American experience. Semin. Oncol. 13:425, 1986
Fisher, E., Anderson, S., Redmond, C., Fisher, B.: Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06. Semin. Surg. Oncol. 8:161, 1992
Fisher, E., Anderson, S., Redmond, C., Fisher, B.: Pathologic findings from the National Surgical Adjuvant Breast Project protocol B-06. Cancer 71:2507, 1993
Fisher, B., Anderson, S., Fisher, E., et al.: Significance of ipsilateral breast tumor recurrence after lumpectomy. Lancet 338:327, 1991
Fisher, B.: Reappraisal of breast biopsy prompted by the use of lumpectomy. J.A.M.A. 253:3585, 1985
Fisher, B.: Justification for lumpectomy in the treatment of breast cancer: a commentary on the underutilization of that procedure. J. Am. Med. Wom. Assoc. 47:169, 1992
Fisher, B., Ore, L.: On the underutilization of breast-conserving surgery for the treatment of breast cancer. Ann. Oncol. 4:96, 1993
Fisher, B., Wolmark, N.: Limited surgical management for primary breast cancer: a commentary on the NSABP reports. World J. Surg. 9:682, 1985
Fisher, B.: The evolution of paradigms for the management of breast cancer: a personal perspective. Cancer Res. 52:2371, 1992
Fisher, B.: Changing patterns of surgical treatment for breast cancer: the status of lumpectomy. J. Irish Coll. Physicians Surg. 21:173, 1992
Fisher, B., Costantino, J., Redmond, C., et al.: Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N. Engl. J. Med. 328:1581, 1993
Lazovich, D., White, E., Thomas, D.B., Moe, R.E.: Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. J.A.M.A. 266:3433, 1991
Interdisciplinary Group for Cancer Care Evaluation: Survey of treatment of primary breast cancer in Italy. Br. J. Cancer 57:630, 1988
Greenfield, S., Blanco, D.M., Elashoff, R.M., Ganz, P.A.: Patterns of care related to age of breast cancer patients. J.A.M.A. 257:2766, 1987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fisher, B., Anderson, S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. World J. Surg. 18, 63–69 (1994). https://doi.org/10.1007/BF00348193
Issue Date:
DOI: https://doi.org/10.1007/BF00348193