Managing primary breast cancer

Management of breast cancer by surgery combined with irradiation can only affect disease within the treated area. In patients who have distant metastases at the time of therapy, there is no evidence of improved overall survival rates by the use of irradiation, either preoperatively or postoperatively. Survival may be affected by these measures, as well as by extensive surgical procedures, in only a very small subset of the patient population with breast cancer. A study of adjunctive systemic therapy with thiotepa has also failed to show a change in overall survival. Control of local and regional disease is the realistic goal of surgical and radiotherapeutic treatment. This goal can be best achieved by the use of surgical procedures ranging from radical mastectomy to excisional biopsy combined with a tumor dose of 4,500 to 5,000 rads to the areas of potential subclinical disease. Elective chemotherapy, immunotherapy, or both may be beneficial in preventing or retarding the development of distant metastases. However, use of these modalities should be restricted to controlled clinical trials to determine their actual effectiveness. It is not appropriate to institute such treatment as a substitute for established methods of controlling regional disease.