Breast conservation therapy in patients with stage T1-T2 breast cancer: current challenges and opportunities

Despite the fact that breast conservation therapy has been established as an effective treatment, a number of issues and controversies currently surround the application of this treatment for patients with stage T1 and T2 breast cancer.

Records of patients with histologically confirmed stage T1 (n = 1172) and stage T2 (n = 349) breast cancer, treated with wide local tumor excision and whole breast irradiation between January 1970 and December 2000, were prospectively registered on our database. Median follow-up was 6.6 years. Numerous publications addressing issues to be reviewed were collected, and data and prevailing controversies are discussed.

The 10-year actuarial incidence of ipsilateral breast relapse was 7% for T1 and 11% for T2 tumors. Results with breast conservation therapy were equivalent in white or black women with T1 or T2 tumors. In patients younger than 40 years, incidence of failures was 10% for T1 (in contrast to 4% for other age groups) and 15% for T2 lesions (in contrast to 6% in other groups). The incidence of ipsilateral recurrences in women younger than 40 years was, for T1 tumors, 9% with negative surgical margins and 12% with close or positive margins and for T2 tumors 12% and 22%, respectively (difference not statistically significant).

Use of breast-conserving surgical therapy should be optimized to enhance therapeutic outcome. Many developments in the oncological field and refinements in treatment planning and delivery of radiation therapy provide unique opportunities for the radiation oncologist to continue to play an integral role in the management of patients with breast cancer.