title: Recent experience in the radical irradiation of primary breast cancer at Mount Vernon Hospital.
abstract: In order to improve the long-term cosmetic results following the radical irradiation of primary breast cancer at Mount Vernon Hospital, dosage was reduced in the early 1970s. The clinical impression that local recurrence had become more frequent at the reduced dose level led to an early review of the results. This report details the results in 159 patients who formed the two largest groups of patients treated between 1968 and 1980. Sixty-five patients were treated between 1968 and 1973, using 6500 cGy to the whole breast in 25 daily fractions over 5 weeks, with alternate breast fields treated each day. Forty-two of these patients were with TNM stage I and II disease [TNM Classification of Malignant Tumours, Geneva, UICC, 1978] and had 5-yr actuarial survival and local recurrence figures of 59 and 10% respectively. The corresponding figures in 52 patients with stage I and II disease treated between 1974 and 1980 with 5500 cGy to the whole breast in 25 daily fractions over 5 weeks with both breast fields treated each day were 79 and 26.6%. In spite of the small numbers involved and the bias in favour of the latter group of patients, who had a greater proportion of T1,N0 lesions, the difference in local recurrence rate in favour of the former group (who received 6500 cGy) almost reached statistical significance at the 0.05 level. A difference was also observed when the two subgroups of stage I and II patients who had had their primaries excised prior to irradiation were compared. The 23 patients with TNM stage IIIa and b disease treated with 6500 cGy between 1968 and 1973 had similar local recurrence (49.7% at 18 months) and survival experience (32.5% at 5 yr) to the 42 similarly staged patients treated with 5500 cGy between 1974 and 1980 (48 and 36.4% respectively). It is possible that the addition of combination cytotoxic therapy to the primary management in 12 patients with stage IIIb disease in the latter group favourably influenced the local control data obtained. Cosmetic results were substantially better in the groups receiving 5500 cGy, with approximately 20% developing disfiguring retraction and skin changes. In contrast, these sequelae were almost inevitable in the patients who received 6500 cGy.
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors