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December 28, 1984

Conservative Management of Breast Cancer: New Surgical and Radiotherapeutic Techniques

Author Affiliations

University of Chicago

JAMA. 1984;252(24):3422. doi:10.1001/jama.1984.03350240066053

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The policy of treating breast cancer primarily by radiotherapy raises two questions: (1) Is this method an improvement on radical surgery? (2) How does one deal with the uncertainty as to the extent of local and regional disease? These questions are addressed in 30 papers, mostly by radiotherapists from leading centers in the world, originally presented at a symposium held in May 1982. The presentations are grouped under the following topics: retrospective studies, prospective studies, pathology, surgery, internal mammary nodes, irradiation, sequelae, and adjuvant chemotherapy with primary irradiation. A critical consensus is presented after each group and at the end.

The first question is answered affirmatively, on the basis of apparently equal survival, with improved cosmesis, in all but one of the 11 papers in the first two groups. The first eight papers, however, lack randomized controls; other statistical defects include variations within treatment protocols, exclusion of cases deemed unsuitable,