Breast Preservation Therapy in Stage I and II Carcinoma: Factors Affecting Outcome
Abstract
Records were reviewed of 511 patients with 519 histologically confirmed carcinomas of the breast treated with wide local excision of tumor and irradiation to the breast (4600 to 5000 cGy in 5 weeks) and, in 109 patients, to regional lymphatics. In 271 patients with T1 and 98 with T2 tumor, boost to primary tumor site (1000-2000 cGy) was delivered using electrons (9-12 MeV); in 72 patients with T1 and 34 with T2 tumors, 192Ir implant was performed. Pathologic staging was T1 in 373 and T2 in 146 lesions (1988 AJC). Sixty-seven patients (18%) with T1 and 46 (32%) with T2 tumors had microscopically positive axillary lymph nodes.
Actuarial breast relapse rates at 5 years were 5% in T1 and 10% in T2 tumors and at 10 years 12% and 18%, respectively. Lymph node recurrenses were noted in 1% of T1 and 5% of T2 tumors. Distant metastases were detected in 5% of T1 and 22% of T2 tumors. Five-year actuarial breast relapse rates were 10% in T1 tumors and 18% in T2 (p = 0.04). Differences in 5- years breast relapse for patients with extensive intraductal component (EIC) were not statistically signifi-cant ( 7% in T1 tumors with EIC and 4% without it; 14% in T2 tumors with EIC and 7% without it). There was minimal correlation of irradiation dose to primary tumor
with breast relapse (in T1 from 2% to 7% and in T2 from 7% to 9% with doses >5500 cGy in contrast to 20% with 5000 to 5500 cGy). No correlation was noted with either type of boost (electrons or interstitial brachytherapy). Desease-free survival for patients with T1 tumors was 87% at 5 years and 82% at 10 years; for patients with T2 tumors, it was 75% at 5 years and 70% at 10 years.
Excellent/good cosmetic results were obtained in 78% of the patients. No difference was observed between the group treated with electrons or 192 Ir implant to the boost area.
Better understanding of prognostic factors and refinement of treatment techniques will enhance the results of breast conservation therapy.
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