Combined therapy in carcinomas of the female breast

Of 606 female breast cancers treated, 364 of them in stage I, II and III, only 7 cases were in stage I. All stage II and III cases in good general condition received radical preoperative irradiation to the entire breast volume and the regional lymphatic areas over a period of 4 wk, followed 4 wk later by a radical mastectomy. No postoperative irradiation was administered. The biological basis of this therapeutic policy is explained in detail and the 5-yr disease-free survival of patients in relation to stage of disease, treatment method, histology of the primary tumor, histologic nodal metastatic status, postradiational status of the breast primary, the menstrual status of the patient, and the general metabolic status is discussed. It is explicitly shown by meticulous histological study of the breasts and the axillary lymph nodes removed at surgery that radical irradiation per se is inadequate to sterilize the breasts and that subsequent radical surgery is essential. Furthermore, two-thirds of the stage III cancers, which would have been considered inoperable by conventional criteria, were rendered operable by preoperative irradiation, with a near 50% 5-yr disease-free survival.