Segmental mastectomy without radiotherapy. Short-term follow-up

Short-term treatment failures following 43 segmental mastectomies without radiation therapy and 157 total mastectomies for primary operable breast cancer Stages I and II (T1-2, N0-1, M0) are compared. Although not randomized by design, the patients in the two treatment groups were of similar age and had tumors of comparable histologic type, size, grade, and stage. The overall recurrence rates in an average follow-up of 24 months (range, 6-48 months) were 5% for patients treated by standard mastectomy and 19% for those treated by segmental mastectomy. Recurrence rates in patients with the more commonly encountered carcinomas of 11 to 50 mm in size treated by surgery alone were 7.5% for total mastectomy and 28.0% for segmental mastectomy. Nearly all of this difference relates to a higher frequency of local recurrence in the segmental mastectomy group (P = less than 0.005). Recurrent disease in both groups developed at comparable intervals, averaging 17 months for segmental mastectomy and 16 months for total mastectomy. Using a serial subgross technique, which permitted detection of clinically unsuspected involvement of resection margin by microscopic foci of carcinoma, it was noted that such involvement was an important prognostic indicator for local recurrence. Five of eleven breast resections with this feature developed local recurrence, compared with only 3 of 32 without such involvement of the resection margin.