title: Breast conservation therapy for early stage breast carcinoma with outstanding 10-year locoregional control rates: a case for aggressive therapy to the tumor bearing quadrant.
abstract: OBJECTIVE
  Between 1982 and 1988 233 American Joint Committee on Cancer Stage I and II invasive breast carcinomas were prospectively treated in 225 women with conservative tumor excision, careful assessment of histopathological margins, and dose-adjusted irradiation to maximum doses of 70 Gy to the tumor bearing quadrant of the breast.
  
  
  METHODS
  The pathological stages at presentation were T1N0 and T1N1 in 57% and 13% and T2N0 and T2N1 in 19% and 10% of the patients, respectively. All patients were irradiated according to a policy that, beyond the 50 Gy to the whole breast and draining lymphatics, the tumor-bearing quadrant was boosted in adjustment to the histopathological margin. Normal tissue margins of < 2 mm were considered positive, margins 2-5 mm close, and margins > 5 mm negative and were boosted with 20, 15, and 10 Gy, respectively. Patients in whom the margin could not be assessed were re-excised or boosted to 20 Gy. Re-excisions with no residual carcinoma were not boosted. Most patients boosted to 20 Gy to the tumor-bearing quadrant received interstitial 192-Ir implantations.
  
  
  RESULTS
  The actuarial local control rates in the treated breast were 97.5% at 10 years with three recurrences having occurred at a median of 4.5 years after completion of radiotherapy. An additional two patients failed regionally outside the irradiation portals. The overall and disease-free survival of the whole group is 87.5% and 77%, respectively.
  
  
  CONCLUSIONS
  The approach to breast conservation therapy followed in this study has resulted in outstanding local control rates and suggests that there may be a subset of patients that could be irradiated to the tumor bearing quadrant only.
authors.affiliation: Dept. of Radiation Oncology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, MA.
authors.forename: R K
authors.initials: RK
authors.lastname: Schmidt-Ullrich
authors.forename: D E
authors.initials: DE
authors.lastname: Wazer
authors.forename: T
authors.initials: T
authors.lastname: DiPetrillo
authors.forename: D J
authors.initials: DJ
authors.lastname: Marchant
authors.forename: T J
authors.initials: TJ
authors.lastname: Smith
authors.forename: H
authors.initials: H
authors.lastname: Safaii
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.forename: M J
authors.initials: MJ
authors.lastname: Homer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D015996:Survival Rate