Breast-conserving therapy in breast cancer patients--a 12-year experience

Twenty years ago prospective randomised controlled trials were initiated to compare conservative breast surgery plus radiation with radical mastectomy in the treatment of early-stage breast cancer. The results have shown no survival advantage for mastectomy over breast-conserving therapy (BCT). However, local recurrence of cancer after BCT has been reported to be as high as 14%, necessitating salvage mastectomy.

This retrospective study was performed on 165 breast cancer patients undergoing BCT in the 12 years up to August 2002. Resection and intraoperative cytological assessment were used to achieve clear excision margins. Adjuvant therapy (hormones, chemotherapy) was undertaken, and the incidence and times of local recurrence and distant metastases were recorded.

Ninety-four per cent of patients had clear margins at the initial operation. This was achieved irrespective of ductal carcinoma in situ alone or surrounding the cancer in 62% of cases. At a median follow-up of 65 months one patient developed local recurrence (LR) in the breast synchronously with distant relapse. Two patients had non-nodal axillary recurrences but no patient suffered LR in isolation in the treated breast.

BCT is a safe alternative to mastectomy provided that the tumour is completely excised. The segment containing the cancer should be resected from the nipple to the periphery of the breast. Intraoperative cytological assessment helps to ensure clear margins. Reexcision is recommended for patients with close/involved margins.