title: Breast cancer. Importance of adequate surgical excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively.
abstract: 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.
authors.affiliation: Department of Radiotherapy, Albert Einstein College of Medicine, New York, NY.
authors.forename: N A
authors.initials: NA
authors.lastname: Ghossein
authors.forename: S
authors.initials: S
authors.lastname: Alpert
authors.forename: J
authors.initials: J
authors.lastname: Barba
authors.forename: P
authors.initials: P
authors.lastname: Pressman
authors.forename: P
authors.initials: P
authors.lastname: Stacey
authors.forename: E
authors.initials: E
authors.lastname: Lorenz
authors.forename: M
authors.initials: M
authors.lastname: Shulman
authors.forename: G J
authors.initials: GJ
authors.lastname: Sadarangani
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors