title: Breast-conserving therapy in patients with bilateral breast cancer: do today's treatment choices burn bridges for tomorrow?
abstract: OBJECTIVE
  To determine how often initial treatment choices limit treatment options for subsequent breast cancer management in patients undergoing breast-conserving therapy (BCT), in particular with treatment of internal mammary nodes.
  
  
  METHODS
  Between January 1985 and June 2001, 464 women with pathologic Stage 0, I, and II (T0-2, N0-1) breast cancer underwent BCT at our institution. All 464 patients had computed tomography-based treatment planning. In patients with bilateral breast cancer, the planning computed tomography scans were used to determine the impact initial radiation therapy fields had on treatment options for subsequent contralateral breast cancer.
  
  
  RESULTS
  There were 500 breast cancers diagnosed in 464 patients. Thirty-six patients (8%) had bilateral breast cancer with 9 (2%) synchronous and 27 (6%) metachronous primaries. In 80 patients, the ipsilateral internal mammary nodes were explicitly treated. Initial breast cancer treatment choices impacted subsequent treatment decisions for the contralateral breast in only 2 of 464 patients (0.4%) in the study: 2 of 80 patients (2.5%) whose internal mammary nodes were treated, and 2 of 27 patients (7.4%) who developed metachronous bilateral breast cancer.
  
  
  CONCLUSIONS
  Initial BCT, including internal mammary node irradiation, rarely compromised future contralateral breast-conserving therapy.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gilroy
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Nancy Price
authors.initials: NP
authors.lastname: Mendenhall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015182:Lymphatic Irradiation; D015412:Mastectomy, Segmental; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000628:therapy*; D011880:Radiotherapy Planning, Computer-Assisted; D019233:Retreatment; D015996:Survival Rate; D016896:Treatment Outcome