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Previous Volume 332:907-911 April 6, 1995 Number 14 Next

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ABSTRACT

Background Breast-conservation therapy for early-stage breast cancer is now an accepted treatment, but there is still controversy about its comparability with mastectomy. Between 1979 and 1987, the National Cancer Institute conducted a randomized, single-institution trial comparing lumpectomy, axillary dissection, and radiation with mastectomy and axillary dissection for stage I and II breast cancer. We update the results of that trial after a median potential follow-up of 10.1 years.

Methods Two hundred forty-seven patients with clinical stage I and II breast cancer were randomly assigned to undergo either modified radical mastectomy or lumpectomy, axillary dissection, and radiation therapy. The 237 patients who actually underwent randomization have been followed for a median of 10.1 years. The primary end points were overall survival and disease-free survival.

Results At 10 years overall survival was 75 percent for the patients assigned to mastectomy and 77 percent for those assigned to lumpectomy plus radiation (P = 0.89). Disease-free survival at 10 years was 69 percent for the patients assigned to mastectomy and 72 percent for those assigned to lumpectomy plus radiation (P = 0.93). The rate of local regional recurrence at 10 years was 10 percent after mastectomy and 5 percent after lumpectomy plus radiation (P = 0.17) after recurrences successfully treated by mastectomy were censored from the analysis.

Conclusions In the management of stage I and II breast cancer, breast conservation with lumpectomy and radiation offers results at 10 years that are equivalent to those with mastectomy.

Source Information

From the Radiation Oncology Branch (J.A.J., P.O.), Surgery Branch (D.N.D.), Medicine Branch (K.H.C.), Biostatistics and Data Management Section (S.M.S.), and Cancer Nursing Service (T.D.) of the Clinical Oncology Program, Division of Cancer Treatment, National Cancer Institute, Bethesda, Md.; the Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor (L.P., A.S.L.); Lombardi Cancer Center, Georgetown University Hospital, Washington, D.C. (M.E.L.); and the Department of Radiation Oncology, Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas (E.G.).

Address reprint requests to Dr. Jacobson at the Radiation Oncology Branch, National Cancer Institute, Bldg. 10, Rm. B3-B69, Bethesda, MD 20892.

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