Breast cancer. Importance of adequate surgical excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively
N. A. Ghossein, S. Alpert, J. Barba, P. Pressman, P. Stacey, E. Lorenz, M. Shulman and G. J. Sadarangani
Department of Radiotherapy, Albert Einstein College of Medicine, New York, NY.
The extent of excision performed for mammary carcinoma prior to
radiotherapy as a risk factor for local recurrence was studied in 503
patients. Three hundred twenty-three tumors (62%) were excised with a
minimal rim of tissue (tumorectomy). One hundred forty-two patients (27%)
had wide excision and 56 (11%) had quadrantectomy. Tumor stage, size, and
radiation treatment were similar for all groups. Forty-one percent of
tumorectomies had involved margins, and only 14% and 7% were involved in
the wide excision and quadrantectomy groups, respectively. Local failure
was 15% for tumorectomy, 7% for wide excision, and 5% for quadrantectomy.
In T1 ductal carcinoma, only 4% of those with excisions greater than 5 cm
had recurrences. Lesser excision had 20% recurrence. Extent of excision
before radiotherapy is an important risk factor for recurrence. Failure was
inversely proportional to the amount of breast tissue resected. Narrow
excision should be discouraged since a larger tumor burden remains that may
not be sterilized by radiation.
