Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer

Journal Article · Thu Mar 14 04:00:00 EST 1985 · N.Engl. J. Med.; (United States)

DOI:https://doi.org/10.1056/NEJM198503143121101· OSTI ID:5834416

Fisher, B; Bauer, M; Margolese, R; Poisson, R; Pilch, Y; Redmond, C; Fisher, E; Wolmark, N; Deutsch, M; Montague, E

In 1976 the authors began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of State I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had auxillary dissections, and patients with positive nodes received chemotherapy. Life-tables estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy, and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy. A total of 92.3% of women treated with radiation remained free of breast tumor at five years, as compared with 72.1% of those receiving no radiation. Among patients with positive nodes 97.9% of women treated with radiation and 63.8% of those receiving no radiation remained tumor-free, although both groups received chemotherapy. They conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors less than or equal to 4 cm, provided that margins of resected specimens are free of tumor. 23 references, 4 figures, 6 tables.

• Research Organization: National Surgical Adjuvant Breast Project Headquarters, Pittsburgh, PA
• OSTI ID: 5834416
• Journal Information: N.Engl. J. Med.; (United States), Journal Name: N.Engl. J. Med.; (United States) Vol. 312:11; ISSN NEJMA
• Country of Publication: United States
• Language: English

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550603* -- Medicine-- External Radiation in Therapy-- (1980-)
62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CHEMOTHERAPY
COMPARATIVE EVALUATIONS
DATA
DATA COMPILATION
DISEASES
GLANDS
INFORMATION
MAMMARY GLANDS
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
NUMERICAL DATA
ORGANS
PATIENTS
RADIOLOGY
RADIOTHERAPY
SURGERY
SURVIVAL TIME
THERAPY