Conservative local treatment of breast cancer

A survey of controlled randomized trials of orthodox therapy directed to the breast and axillary nodes has indicated that 1) if radical mastectomy is performed, postoperative radiotherapy gives no advantage over a watching policy and 2) if postoperative radical radiotherapy is given, there is no need for other than a simple mastectomy. A large multicenter trial is also indicating that simple mastectomy alone with reservation of radiotherapy for treating local recurrent disease is safe initial treatment. These results refer to survival; postoperative radiotherapy does reduce the incidence of local recurrence but this apparently can be equally well treated when it occurs. Local excision of the tumor, followed by radiotherapy, has been reported to give inferior results to a radical approach in Stage II tumors. Recognition that all these methods of local treatment fail to cure the majority of patients has emphasized the need to define the extent of the disease and to apply treatment according to that extent. We have studied a policy of selective local therapy based on this principal in which total mastectomy is combined with biopsy of the pectoral lymph nodes and further treatment by radiotherapy given only if these nodes are involved by tumor. This policy has been compared with a standard radical approach and is giving similar results. In our current Edinburgh trials, pectoral node biopsy is also used to select patients for inclusion in trials of systemic therapy.