Lumpectomy and level I axillary dissection prior to irradiation for "operable" breast cancer

Between July 1, 1979 and March 1, 1984, we treated 154 women by irradiation as an alternative to mastectomy. Excision of the primary tumor without the sacrifice of a large volume of contiguous normal breast (lumpectomy) was performed, and all but ten women also underwent concomitant level I axillary node dissection. The mean node count in the level I dissection was 27 nodes, indicating that this dissection offered accurate information about axillary node status, so that the extent of radiation therapy and subsequent adjuvant chemotherapy could be planned appropriately. Subdivision of the level I nodes into anatomic groups and their separate histologic analysis suggested that less than a complete level I dissection might miss involved nodes in almost one-half the patients with clinically negative axillae but histologically positive nodes. Postoperative complications occurred in 13% of patients, not an insignificant number, most of them being either infections or the persistent accumulation of lymph in the axillary wound. Later complications, such as infection or arm edema, also occurred, just as after mastectomy. The median follow-up of these 154 patients has been only 12 months, the maximum being not quite 5 years, so that any long-term speculations are not justified. We believe that the continued use of this combination therapy is warranted preceding irradiation by lumpectomy and level I axillary dissection as described, with careful follow-up to assess the long-term results of this option.