FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 328:1587-1591 June 3, 1993 Number 22 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Conservative surgery and radiotherapy have become well-established treatments for breast cancer, and many trials in progress are attempting to define the most acceptable type of procedure. Between 1987 and 1989 we randomly assigned 567 women with small breast cancers (<2.5 cm in diameter) to quadrantectomy followed by radiotherapy or to quadrantectomy without radiotherapy. All patients underwent total axillary dissection. The median follow-up period was 39 months (range, 28 to 54).

Results The incidence of local recurrence was 8.8 percent among the patients treated with quadrantectomy without radiotherapy, as compared with 0.3 percent among those treated with postsurgical radiotherapy (P = 0.001). However, there was a substantial effect of age: patients more than 55 years old who did not receive radiotherapy had a low rate of local recurrence (3.8 percent). The four-year overall survival was similar in the two treatment groups.

Conclusions Administering radiotherapy after quadrantectomy reduces the risk of local recurrence in women with small cancers of the breast, but radiotherapy may not be necessary in elderly women.

Source Information

From the Istituto Nazionale per lo Studio e la Cura dei Tumori, Via G. Venezian 1, 20133 Milan, Italy, where reprint requests should be addressed to Dr. Veronesi.

Full Text of this Article

Related Letters:

Radiation Therapy for in Situ or Localized Breast Cancer
Verhoeven D., Van Marck E., van Oosterom A.T., Lagios M. D., Page D. L., Sinoff C. L., Fisher B., Redmond C. K., Fisher E., Veronesi U.
Extract | Full Text  
N Engl J Med 1993; 329:1577-1579, Nov 18, 1993. Correspondence

This article has been cited by other articles:

• Godinez, J., Gombos, E. C., Chikarmane, S. A., Griffin, G. K., Birdwell, R. L. (2008). Breast MRI in the Evaluation of Eligibility for Accelerated Partial Breast Irradiation. Am. J. Roentgenol. 191: 272-277 [Abstract] [Full Text]  
• Osako, T., Oguchi, M., Kumada, M., Nemoto, K., Iwase, T., Yamashita, T. (2008). Acute Radiation Dermatitis and Pneumonitis in Japanese Breast Cancer Patients with Whole Breast Hypofractionated Radiotherapy Compared to Conventional Radiotherapy. Jpn J Clin Oncol 38: 334-338 [Abstract] [Full Text]  
• Belletti, B., Vaidya, J. S., D'Andrea, S., Entschladen, F., Roncadin, M., Lovat, F., Berton, S., Perin, T., Candiani, E., Reccanello, S., Veronesi, A., Canzonieri, V., Trovo, M. G., Zaenker, K. S., Colombatti, A., Baldassarre, G., Massarut, S. (2008). Targeted Intraoperative Radiotherapy Impairs the Stimulation of Breast Cancer Cell Proliferation and Invasion Caused by Surgical Wounding. Clin. Cancer Res. 14: 1325-1332 [Abstract] [Full Text]  
• Hershman, D. L., Buono, D., McBride, R. B., Tsai, W. Y., Joseph, K. A., Grann, V. R., Jacobson, J. S. (2008). Surgeon Characteristics and Receipt of Adjuvant Radiotherapy in Women With Breast Cancer. JNCI J Natl Cancer Inst 100: 199-206 [Abstract] [Full Text]  
• Casalini, P., Carcangiu, M. L., Tammi, R., Auvinen, P., Kosma, V.-M., Valagussa, P., Greco, M., Balsari, A., Menard, S., Tagliabue, E. (2008). Two Distinct Local Relapse Subtypes in Invasive Breast Cancer: Effect on their Prognostic Impact. Clin. Cancer Res. 14: 25-31 [Abstract] [Full Text]  
• Sanders, M. E., Scroggins, T., Ampil, F. L., Li, B. D. (2007). Accelerated Partial Breast Irradiation in Early-Stage Breast Cancer. JCO 25: 996-1002 [Abstract] [Full Text]  
• Ollila, D. W., Klauber-DeMore, N., Tesche, L. J., Kuzmiak, C. M., Pavic, D., Goyal, L. K., Lian, J., Chang, S., Livasy, C. A., Sherron, R. F., Sartor, C. I. (2007). Feasibility of Breast Preserving Therapy with Single Fraction In Situ Radiotherapy Delivered Intraoperatively. Ann. Surg. Oncol. 14: 660-669 [Abstract] [Full Text]  
• Klimberg, V. S., Kepple, J., Shafirstein, G., Adkins, L., Henry-Tillman, R., Youssef, E., Brito, J., Talley, L., Korourian, S. (2006). eRFA: Excision Followed by RFA--a New Technique to Improve Local Control in Breast Cancer. Ann. Surg. Oncol. 13: 1422-1433 [Abstract] [Full Text]  
• Whelan, T. J. (2005). Use of Conventional Radiation Therapy As Part of Breast-Conserving Treatment. JCO 23: 1718-1725 [Full Text]  
• Fyles, A. W., McCready, D. R., Manchul, L. A., Trudeau, M. E., Merante, P., Pintilie, M., Weir, L. M., Olivotto, I. A. (2004). Tamoxifen with or without Breast Irradiation in Women 50 Years of Age or Older with Early Breast Cancer. NEJM 351: 963-970 [Abstract] [Full Text]  
• Smith, I. E., Ross, G. M. (2004). Breast Radiotherapy after Lumpectomy -- No Longer Always Necessary. NEJM 351: 1021-1023 [Full Text]  
• Punglia, R. S., Kuntz, K. M., Lee, J. H., Recht, A. (2003). Radiation Therapy Plus Tamoxifen Versus Tamoxifen Alone After Breast-Conserving Surgery in Postmenopausal Women With Stage I Breast Cancer: A Decision Analysis. JCO 21: 2260-2267 [Abstract] [Full Text]  
• Resch, A., Fellner, C., Mock, U., Handl-Zeller, L., Biber, E., Seitz, W., Potter, R. (2002). Locally Recurrent Breast Cancer: Pulse Dose Rate Brachytherapy for Repeat Irradiation Following Lumpectomy—A Second Chance to Preserve the Breast. Radiology 225: 713-718 [Abstract] [Full Text]  
• Whelan, T. (2002). A Trial of Two Questions. JCO 20: 4135-4138 [Full Text]  
• Fisher, B., Bryant, J., Dignam, J. J., Wickerham, D. L., Mamounas, E. P., Fisher, E. R., Margolese, R. G., Nesbitt, L., Paik, S., Pisansky, T. M., Wolmark, N. (2002). Tamoxifen, Radiation Therapy, or Both for Prevention of Ipsilateral Breast Tumor Recurrence After Lumpectomy in Women With Invasive Breast Cancers of One Centimeter or Less. JCO 20: 4141-4149 [Abstract] [Full Text]  
• Morrow, M., Strom, E. A., Bassett, L. W., Dershaw, D. D., Fowble, B., Harris, J. R., O'Malley, F., Schnitt, S. J., Singletary, S. E., Winchester, D. P. (2002). Standard for the Management of Ductal Carcinoma In Situ of the Breast (DCIS). CA Cancer J Clin 52: 256-276 [Abstract] [Full Text]  
• Morrow, M., Strom, E. A., Bassett, L. W., Dershaw, D. D., Fowble, B., Giuliano, A., Harris, J. R., O'Malley, F., Schnitt, S. J., Singletary, S. E., Winchester, D. P. (2002). Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma. CA Cancer J Clin 52: 277-300 [Abstract] [Full Text]  
• Classe, J.-M., Dupre, P. F., Francois, T., Robard, S., Theard, J. L., Dravet, F. (2002). Axillary Padding as an Alternative to Closed Suction Drain for Ambulatory Axillary Lymphadenectomy: A Prospective Cohort of 207 Patients With Early Breast Cancer. Arch Surg 137: 169-172 [Abstract] [Full Text]  
• Bartelink, H., Horiot, J.-C., Poortmans, P., Struikmans, H., Van den Bogaert, W., Barillot, I., Fourquet, A., Borger, J., Jager, J., Hoogenraad, W., Collette, L., Pierart, M., the European Organization for Research and Treatme, (2001). Recurrence Rates after Treatment of Breast Cancer with Standard Radiotherapy with or without Additional Radiation. NEJM 345: 1378-1387 [Abstract] [Full Text]  
• Hayman, J. A., Hillner, B. E., Harris, J. R., Pierce, L. J., Weeks, J. C. (2000). Cost-Effectiveness of Adding an Electron-Beam Boost to Tangential Radiation Therapy in Patients With Negative Margins After Conservative Surgery for Early-Stage Breast Cancer. JCO 18: 287-287 [Abstract] [Full Text]  
• Morris, E. A., Schwartz, L. H., Drotman, M. B., Kim, S. J., Tan, L. K., Liberman, L., Abramson, A. F., Van Zee, K. J., Dershaw, D. D. (2000). Evaluation of Pectoralis Major Muscle in Patients with Posterior Breast Tumors on Breast MR Images: Early Experience1. Radiology 214: 67-72 [Abstract] [Full Text]  
• Liljegren, G., Holmberg, L., Bergh, J., Lindgren, A., Tabar, L., Nordgren, H., Adami, H.O. (1999). 10-Year Results After Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: A Randomized Trial. JCO 17: 2326-2326 [Abstract] [Full Text]  
• Riley, G. F., Potosky, A. L., Klabunde, C. N., Warren, J. L., Ballard-Barbash, R. (1999). Stage at Diagnosis and Treatment Patterns Among Older Women With Breast Cancer: An HMO and Fee-for-Service Comparison. JAMA 281: 720-726 [Abstract] [Full Text]  
• Esserman, L., Hylton, N., Yassa, L., Barclay, J., Frankel, S., Sickles, E. (1999). Utility of Magnetic Resonance Imaging in the Management of Breast Cancer: Evidence for Improved Preoperative Staging. JCO 17: 110-110 [Abstract] [Full Text]  
• Veronesi, U., Zurrida, S. (1996). Optimal Surgical Treatment of Breast Cancer. The Oncologist 1: 340-346 [Abstract] [Full Text]  
• Dixon, J M. (1995). Surgery and radiotherapy for early breast cancer. BMJ 311: 1515-1516 [Full Text]  
• Henderson, I. C. (1995). Paradigmatic Shifts in the Management of Breast Cancer. NEJM 332: 951-952 [Full Text]  
• Verhoeven, D., Van Marck, E., van Oosterom, A.T., Lagios, M. D., Page, D. L., Sinoff, C. L., Fisher, B., Redmond, C. K., Fisher, E., Veronesi, U. (1993). Radiation Therapy for in Situ or Localized Breast Cancer. NEJM 329: 1577-1579 [Full Text]  
• (1993). SUPPORT FOR ADJUVANT RADIOTHERAPY FOR SMALL BREAST CANCERS. JWatch General 1993: 1-1 [Full Text]  
• Swain, S. M. (1993). In Situ or Localized Breast Cancer -- How Much Treatment Is Needed?. NEJM 328: 1633-1634 [Full Text]