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SUPPORT FOR ADJUVANT RADIOTHERAPY FOR SMALL BREAST CANCERS.

Over the past 20 years, mammography has identified more small breast cancers, and breast-conserving surgery has generally replaced mastectomy. Now, two randomized trials suggest that adjuvant radiotherapy protects against recurrences.

In the National Surgical Adjuvant Breast and Bowel Project, 818 women with ductal carcinoma in situ received lumpectomy either alone or followed by irradiation. Only 8 percent of tumors exceeded 2 cm in diameter, and the margins of all resected specimens were tumor-free. At follow-up (average, 43 months), second ipsilateral breast cancers were found in 16.4 percent of women treated with lumpectomy alone, but only 7.0 percent of women receiving adjuvant radiotherapy. More important, the 5-year cumulative incidence of second invasive cancers was 10.5 percent and 2.9 percent, respectively. Only 0.1 percent of both groups have had distant metastases.

The Milan Cancer Institute randomized 567 women with small invasive ductal or lobular tumors (less than 2.5 cm) to more extensive surgical resection (quadrantectomy, involving resection of the skin and pectoral fascia) with or without adjuvant radiotherapy. The two groups received equivalent adjuvant chemotherapy and tamoxifen therapy. All women received axillary dissection, and about 30 percent had evidence of nodal involvement. At a median of 39 months, 8.8 percent of women having surgery alone had local recurrences, versus 0.3 percent of women given adjuvant radiotherapy. The striking benefit of radiotherapy was seen primarily in women under age 55. About 6 percent of both groups have had distant metastases.

Follow-up in both studies thus far has been relatively brief, and neither study has shown an improvement in survival. But the studies provide relatively strong evidence in favor of adjuvant radiotherapy in small breast cancers.

— ALK

Published in Journal Watch General Medicine June 4, 1993

Citation(s):

Swain SM. In situ or localized breast cancer -- how much treatment is needed. N Engl J Med 1993 Jun 3 328 1633-1634.

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Veronesi U et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 1993 Jun 3 328 1587-1591.

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Fisher B et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993 Jun 3 328 1581-1586.

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• radiotherapy
  uche emeka, student, 15 Jun 2009 4:28 PM EST
  please remark more on radiotherapy