Does radical mastectomy still have a place in the treatment of primary operable breast cancer?
W. A. Maddox, J. T. Carpenter Jr, H. T. Laws, S. J. Soong, G. Cloud, C. M. Balch and M. M. Urist
Department of Surgery, University of Alabama, Birmingham 35294.
This study (Alabama Breast Cancer Project) reports the ten-year surgical
results of a prospective randomized trial comparing Halsted radical
mastectomy (RM) with modified radical mastectomy (MRM) for breast cancer.
We entered 311 patients in the study between 1975 and 1978. Patients with
histologically positive axillary lymph nodes were randomized after
operation to receive melphalan or intermittent intravenous
cyclophosphamide, methotrexate, and fluorouracil for one year. After a
median follow-up of ten years, there was no significant difference in the
survival of the two groups (RM, 71%; MRM, 64%). Local recurrence after RM
was significantly lower than after MRM. A subset of patients with more
advanced cancers (T3 and T2 with clinically positive axillary nodes)
experienced significantly better survival at ten years following RM
compared with MRM (59% vs 38%, respectively). These results indicate that
overall survival is similar for patients treated by either RM or MRM.
However, there is subset of patients with more advanced cancers whose
ultimate survival can be favorably influenced by RM.