Breast conservation therapy without axillary dissection. A rational treatment strategy in selected patients
B. G. Haffty, C. McKhann, M. Beinfield, D. Fischer and J. J. Fischer
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Conn.
PURPOSE: Patients with early stage breast cancer are being treated with
adjuvant systemic therapy with increasing frequency regardless of the
pathological status of the axillary lymph nodes. The purpose of this study
was to determine the outcome for local regional control in patients treated
with radiation therapy to the intact breast and regional lymph nodes
without axillary dissection. PATIENTS AND METHODS: The patient population
for this study consists of 327 patients with clinical stage I or II
invasive breast cancer who were treated by lumpectomy alone without
axillary dissection followed by radiation therapy to the intact breast and
regional lymph nodes. Outcome for local regional control and survival is
reported. RESULTS: As of December 1990, with a median follow-up of more
than 10 years, the overall 10-year survival rate was 71%. There were a
total of eight regional nodal failures resulting in a 5-year actuarial
nodal control rate of 97%. Minimal morbidity was associated with this
treatment policy. CONCLUSIONS: For selected patients undergoing breast
preservation therapy, lumpectomy alone without axillary dissection followed
by radiation therapy to the intact breast and regional lymph nodes results
in a high rate of local regional control. Selected patients in whom the
results of the axillary lymph node dissection will not influence decisions
regarding systemic therapy are candidates for this approach.
