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UPDATE ON SURGERY AND RADIOTHERAPY FOR BREAST CANCER.

The National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-06 provided important data to support lumpectomy plus irradiation as an acceptable approach for treating breast cancer. But the recent discovery that a Montreal researcher falsified data for a small number of subjects created apprehension among patients and physicians. The November 30 issue of N Engl J Med describes the National Cancer Institute's audit of data from 37 other participating centers. Fortunately, the audit did not reveal any systematic irregularities. An accompanying article provides a 12-year update of the NSABP study. With or without the Montreal data, the results continue to show that total mastectomy, lumpectomy alone, and lumpectomy plus irradiation all yield similar overall survival (about 63 percent), disease-free survival (about 50 percent), and survival without distant disease. However, the rate of cancer recurrence in the ipsilateral breast was significantly higher with lumpectomy alone than with lumpectomy plus irradiation (35 vs. 10 percent). Finally, an international collaborative group presents a meta-analysis of 58 randomized trials examining the addition of radiotherapy to surgery and comparing more- and less- extensive surgery for early breast cancer. These results mirror those of the NSABP study: breast-conserving surgery did not compromise ten-year overall survival, and local recurrence was reduced when radiotherapy was added to surgery. Adding radiotherapy to surgery did not change overall survival, but it slightly decreased the death rate from breast cancer, and slightly increased the risk of death from other causes.

— AS Brett

Published in Journal Watch General Medicine December 8, 1995

Citation(s):

Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer -- an overview of the randomized trials. N Engl J Med 1995 Nov 30 333 1444-1455.

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• Medline abstract (Free)

Fisher B, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995 Nov 30 333 1456-1474.

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• Medline abstract (Free)

Christian MC, et al. The National Cancer Institute audit of the National Surgical Adjuvant Breast and Bowel Project Protocol B-06. N Engl J Med 1995 Nov 30 333 1469-1474.

• Original article (Subscription may be required)
• Medline abstract (Free)