[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
September 1992

Breast Conservation Management of Breast Tumors 4 cm or Larger

Author Affiliations

From the Department of Radiation Oncology, UCLA (Drs Khanna and Juillard); the Radiation Medical Group, San Diego, Calif (Dr Mark); the Department of Surgery, The Breast Center, Van Nuys, Calif (Dr Silverstein); the Western Tumor Medical Group, Van Nuys (Dr Lewinsky); and The John Wayne Cancer Institute at Saint John's Hospital, Santa Monica, Calif (Dr Giuliano).

Arch Surg. 1992;127(9):1038-1043. doi:10.1001/archsurg.1992.01420090042007

• Randomized studies of stage I and II breast cancer have shown that breast conservation treatment is equivalent to modified radical mastectomy in regard to local-regional control and survival. Little has been published on breast conservation for patients with large tumors. We analyzed 68 patients with tumors measuring 4 cm or larger (range, 4 to 12 cm) treated with breast-conserving surgery and radiation therapy. The median follow-up was 46 months; the mean tumor size was 5 cm. The 5-year actuarial localregional recurrence rate was 8.5%, and the overall survival and disease-free survival rates were 76% and 68%, respectively. We conclude that breast conservation treatment may be a reasonable alternative to mastectomy in patients with tumors 4 cm or larger without compromise in local-regional control or survival, while achieving acceptable cosmesis.

(Arch Surg. 1992;127:1038-1043)

Fisher B, Redmond C, Poisson R, et al.  Eight-year results of randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer . N Engl J Med . 1989;320:822-828.Article
Sarrazin D, Le MG, Fontaine MF, Arriagada R.  Conservative treatment versus mastectomy in T1 or small T2 breast cancer: a randomized clinical trial . In: Harris J, Hellman S, Silen W, eds. Conservative Management of Breast Cancer . Philadelphia, Pa: JB Lippincott; 1983:101-111.
Veronesi U, Saccozzi R, Del Vecchio M, et al.  Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast . N Engl J Med . 1981;305:6-11.Article
Glatstein E, Strause K, Lichter A, et al. Results of the NCI early breast cancer trial. In: Proceedings of the National Institutes of Health Consensus Development Conference on Early Stage Breast Cancer; June 18-21, 1990; Bethesda, Md.
Clarke D, Le M, Sarrazin D, et al.  Analysis of local-regional relapse in patients with early breast cancer treated by excision and radiotherapy: experience of the Institut Gustave-Roussy . Int J Radiat Oncol Biol Phys . 1985;11: 137-145.Article
Fowble B, Solin L, Schultz D, Goodman R.  Ten year results of conservative surgery and irradiation for stage I and II breast cancer . Int J Radiat Oncol Biol Phys . 1991;21:269-277.Article
Recht A, Silen W, Schnitt S, et al.  Time-course of local recurrence following conservative surgery and radiotherapy for early stage breast cancer . Int J Radiat Oncol Biol Phys . 1988;15:255-261.Article
Fourquet A, Campana D, Zafrani B, et al.  Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up . Int J Radiat Oncol Biol Phys . 1989;17:719-725.Article
Bartelink H, Borger J, Van Dongen J, Peterse J.  The impact of tumor size and histology on local control after breast conserving therapy . Radiother Oncol . 1988;11:297-303.Article
Ryoo M, Kagan R, Wollin M, et al.  Prognostic factors for recurrence and cosmesis in 393 patients with early mammary carcinoma . Radiology . 1989;172:555-559.Article
Zafrani B, Vielh P, Fourquet A, et al.  Conservative treatment of early breast cancer: prognostic value of the ductal in situ component and other pathological variables on local control and survival . Eur J Cancer Clin Oncol . 1989;25:1645-1650.Article
Locker A, Ellis O, Morgan D, et al.  Factors influencing local recurrence after excision and radiotherapy for primary breast cancer . Br J Surg . 1989;76:890-894.Article
National Institutes of Health Consensus Conference.  Treatment of early stage breast cancer . JAMA . 1991;265:391-395.Article
Kaplan E, Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Article
Rosenman J, Bernard S, Kober C, et al.  Local recurrences in patients with breast cancer at the North Carolina Memorial Hospital (1970-1982) . Cancer . 1986;57:1421-1425.Article
Donegan WL.  Staging and primary treatment . In: Donegan WL, Spratt JS, eds. Cancer of the Breast . Philadelphia, Pa: WB Saunders Co; 1988:336-402.
Dao T, Nemoto T.  The clinical significance of skin recurrence after radical mastectomy in women with cancer of the breast . Surg Gynecol Obstet . 1963;117:447-453.
Maddox W, Carpenter J, Laws H, et al.  A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients . Ann Surg . 1983;198:207-212.Article
Toonkel L, Fix I, Jacobson L, Bamberg N, Wallach C.  Locally advanced breast carcinoma: results with combined regional therapy . Int J Radiat Oncol Biol Phys . 1986;12:1583-1587.Article
Bedwinek J, Rao V, Perez C, Lee J, Fineberg B.  Stage III and localized stage IV breast cancer: irradiation alone vs irradiation plus surgery . Int J Radiat Oncol Biol Phys . 1982;8:31-36.Article
Brown G, Horiot J, Fletcher C, White E, Ange D.  Simple mastectomy and radiation therapy for locally advanced breast cancers technically suitable for radical mastectomy . AJR Am J Roentgenol . 1974;120:67-73.Article
Sheldon T, Hayes C, Cady B, et al.  Primary radiation therapy for locally advanced breast cancer . Cancer . 1987;60:1219-1225.Article
Fowble B, Solin L, Schultz M, Rubenstein J, Goodman R.  Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implication for treatment . Int J Radiat Oncol Biol Phys . 1990;19:833-842.Article
Montague ED.  Conservation surgery and radiation therapy in treatment of operable breast cancer . Cancer . 1984;53:700-704.Article
Kurts J, Jacquemier J, Amalric R, et al.  Why are local recurrences after breast conserving therapy more frequent in younger patients? J Clin Oncol . 1990;8:591-598.
Solin L, Fowble B, Schultz D, Goodman R.  The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer . Int J Radiat Oncol Biol Phys . 1991;21:279-287.Article
Boyages J, Recht A, Connolly J, et al.  Early breast cancer: predictors of breast recurrence for patients treated with conservative surgery and radiation therapy . Radiother Oncol . 1990;19:29-41.Article
Beadle G, Harris J, Silver B, et al.  Cosmetic results following primary radiation therapy for early breast cancer . Cancer . 1984;54:2911-2918.Article
Fisher B, Slack N, Bross I, et al. Cancer of the breast: size of neoplasm and prognosis. Cancer . 1969;24:1071-1080.Article
Carter C, Allen C, Henson D.  Relation of tumor size, lymph node status and survival in 24,740 breast cancer cases . Cancer . 1989;63:181-187.Article
Lacour J, Bucalossi E, Cacers G, et al.  Radical mastectomy versus radical mastectomy plus internal mammary dissection . Cancer . 1976;37:206-214.Article
Schottenfeld D, Nash A, Robbins G, Beattie E.  Ten-year results of the treatment of primary operable breast carcinoma . Cancer . 1976;38:1001-1007.Article