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Breast Conservation Therapy Without Axillary Dissection: A Rational Treatment Strategy in Selected Patients

Breast Conservation Therapy Without Axillary Dissection: A Rational Treatment Strategy in... Abstract Purpose: Patients with early stage breast cancer are being treated with adjuvant systemic therapy with increasing frequency regardless of the pathological status of the axillary lymph nodes. The purpose of this study was to determine the outcome for local regional control in patients treated with radiation therapy to the intact breast and regional lymph nodes without axillary dissection. Patients and Methods: The patient population for this study consists of 327 patients with clinical stage I or II invasive breast cancer who were treated by lumpectomy alone without axillary dissection followed by radiation therapy to the intact breast and regional lymph nodes. Outcome for local regional control and survival is reported. Results: As of December 1990, with a median follow-up of more than 10 years, the overall 10-year survival rate was 71%. There were a total of eight regional nodal failures resulting in a 5-year actuarial nodal control rate of 97%. Minimal morbidity was associated with this treatment policy. Conclusions: For selected patients undergoing breast preservation therapy, lumpectomy alone without axillary dissection followed by radiation therapy to the intact breast and regional lymph nodes results in a high rate of local regional control. Selected patients in whom the results of the axillary lymph node dissection will not influence decisions regarding systemic therapy are candidates for this approach.(Arch Surg. 1993;128:1315-1319) References 1. 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 . 1989;320:822-828.Crossref 2. Veronesi U, Sacozzi R, Del Vecchio M. et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast . N Engl J Med . 1981;305:6-11.Crossref 3. National Institutes of Health. Treatment of early-stage breast cancer . Natl Inst Health Consensus Dev Conf Consensus Statement . 1990;8:18-21. 4. Haffty BG, Fischer D, Rose M, Beinfield M, McKhann C. Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data . J Clin Oncol . 1991;9:997-1003. 5. Fisher B, Redmond C, Dimitriov N, Bowman D, Legault-Poisson S, Wicerman D. A randomized clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen receptor negative tumors . N Engl J Med . 1989;320:473-478.Crossref 6. Fisher B, Constantino J, Redmond C, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen receptor positive tumors . N Engl J Med . 1989;320:479-484.Crossref 7. RutqvistLE, CedermarkB, Glas U,Johansson H, Rotstein S, Skoog L. Radiotherapy, chemotherapy, and tamoxifen as adjuncts to surgery in early breast cancer: a summary of three randomized trials . Int J Radiat Oncol Biol Phys . 1989;16:629-639.Crossref 8. The Ludwig Breast Cancer Group. Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer . N Engl J Med . 1989;320:491-496.Crossref 9. Mansour E, Gray R, Shatila A, Osborne C, Tormey D, Gilchrist K. Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer . N Engl J Med . 1989;320:485-490.Crossref 10. Haffty BG, Fischer D, Fischer JJ. Regional nodal irradiation in the conservative treatment of breast cancer . Int J Radiat Oncol Biol Phys . 1990;19:859-865.Crossref 11. Kissin MW, Querci della Roveret G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer . Br J Surg . 1986;73:580-584.Crossref 12. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma . J Clin Oncol . 1991;9:988-996. 13. Dewar JA, Sarrazin D, Benhamou E, et al. Management of the axilla in conservatively treated breast cancer: 592 patients treated at Institut Gustave-Roussy . Int J Radiat Oncol Biol Phys . 1987;13:475-481.Crossref 14. Fowble B, Solin L, Schultz D, Goodman R. Frequency, sites of relapse and outcome of regional node failures following conservative surgery and radiation for early breast cancer . Int J Radiat Oncol Biol Phys . 1989;17:703-710.Crossref 15. Fisher B. Redmond C, Fisher ER, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation . N Engl J Med . 1985;312:674-681.Crossref 16. Fisher B, Wolmark N, Bauer M, Redmond C, Gebhardt 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 Gyn Obstet . 1981;152:765-772. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Breast Conservation Therapy Without Axillary Dissection: A Rational Treatment Strategy in Selected Patients

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1993.01420240023002
Publisher site
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Abstract

Abstract Purpose: Patients with early stage breast cancer are being treated with adjuvant systemic therapy with increasing frequency regardless of the pathological status of the axillary lymph nodes. The purpose of this study was to determine the outcome for local regional control in patients treated with radiation therapy to the intact breast and regional lymph nodes without axillary dissection. Patients and Methods: The patient population for this study consists of 327 patients with clinical stage I or II invasive breast cancer who were treated by lumpectomy alone without axillary dissection followed by radiation therapy to the intact breast and regional lymph nodes. Outcome for local regional control and survival is reported. Results: As of December 1990, with a median follow-up of more than 10 years, the overall 10-year survival rate was 71%. There were a total of eight regional nodal failures resulting in a 5-year actuarial nodal control rate of 97%. Minimal morbidity was associated with this treatment policy. Conclusions: For selected patients undergoing breast preservation therapy, lumpectomy alone without axillary dissection followed by radiation therapy to the intact breast and regional lymph nodes results in a high rate of local regional control. Selected patients in whom the results of the axillary lymph node dissection will not influence decisions regarding systemic therapy are candidates for this approach.(Arch Surg. 1993;128:1315-1319) References 1. 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 . 1989;320:822-828.Crossref 2. Veronesi U, Sacozzi R, Del Vecchio M. et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast . N Engl J Med . 1981;305:6-11.Crossref 3. National Institutes of Health. Treatment of early-stage breast cancer . Natl Inst Health Consensus Dev Conf Consensus Statement . 1990;8:18-21. 4. Haffty BG, Fischer D, Rose M, Beinfield M, McKhann C. Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data . J Clin Oncol . 1991;9:997-1003. 5. Fisher B, Redmond C, Dimitriov N, Bowman D, Legault-Poisson S, Wicerman D. A randomized clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen receptor negative tumors . N Engl J Med . 1989;320:473-478.Crossref 6. Fisher B, Constantino J, Redmond C, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen receptor positive tumors . N Engl J Med . 1989;320:479-484.Crossref 7. RutqvistLE, CedermarkB, Glas U,Johansson H, Rotstein S, Skoog L. Radiotherapy, chemotherapy, and tamoxifen as adjuncts to surgery in early breast cancer: a summary of three randomized trials . Int J Radiat Oncol Biol Phys . 1989;16:629-639.Crossref 8. The Ludwig Breast Cancer Group. Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer . N Engl J Med . 1989;320:491-496.Crossref 9. Mansour E, Gray R, Shatila A, Osborne C, Tormey D, Gilchrist K. Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer . N Engl J Med . 1989;320:485-490.Crossref 10. Haffty BG, Fischer D, Fischer JJ. Regional nodal irradiation in the conservative treatment of breast cancer . Int J Radiat Oncol Biol Phys . 1990;19:859-865.Crossref 11. Kissin MW, Querci della Roveret G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer . Br J Surg . 1986;73:580-584.Crossref 12. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma . J Clin Oncol . 1991;9:988-996. 13. Dewar JA, Sarrazin D, Benhamou E, et al. Management of the axilla in conservatively treated breast cancer: 592 patients treated at Institut Gustave-Roussy . Int J Radiat Oncol Biol Phys . 1987;13:475-481.Crossref 14. Fowble B, Solin L, Schultz D, Goodman R. Frequency, sites of relapse and outcome of regional node failures following conservative surgery and radiation for early breast cancer . Int J Radiat Oncol Biol Phys . 1989;17:703-710.Crossref 15. Fisher B. Redmond C, Fisher ER, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation . N Engl J Med . 1985;312:674-681.Crossref 16. Fisher B, Wolmark N, Bauer M, Redmond C, Gebhardt 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 Gyn Obstet . 1981;152:765-772.

Journal

Archives of Surgery – American Medical Association

Published: Dec 1, 1993

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