title: Tangential radiotherapy without axillary surgery in early-stage breast cancer: results of a prospective trial.
abstract: OBJECTIVE
  To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, "high tangential" breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field.
  
  
  METHODS
  Between September 1998 and November 2003, 74 patients who were >/=55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy.
  
  
  RESULTS
  For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes.
  
  
  CONCLUSIONS
  In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Wong
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
authors.forename: Aparna
authors.initials: A
authors.lastname: Keshaviah
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Barbara
authors.initials: B
authors.lastname: Silver
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000032:analysis; D012189:Retrospective Studies
chemical_list: D004965:Estrogen Antagonists; D011960:Receptors, Estrogen