Combination of conservative surgery and irradiation for cancer of the breast

Gh, Fletcher; Montague, Eleanor D.; Aj, Nelson

doi:10.2214/ajr.126.2.216

Cited by 28 publications

(3 citation statements)

References 12 publications

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“…Dr. Montague's accomplishments were way ahead of the NSABP's practice-changing trial. She had previously implemented a breast-conserving therapy program at MD Anderson Hospital for her patients well before this cooperative group trial [5][6][7]. The NSABP B-04 protocol was informed by her data and emerged as the a pivotal prospective randomized study delivering evidence that lumpectomy and breast radiation is equivalent to mastectomy which, based on her own work, she had long anticipated.…”

Section: Scholarly Contributionsmentioning

confidence: 99%

Dr. Eleanor D. Montague

2020

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Section: Scholarly Contributionsmentioning

confidence: 99%

Dr. Eleanor D. Montague

2020

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“…Judging by the degree of the problem of local recurrence and what the effect will be of adding routine postoperative radiotherapy, the data in the table are probably more realistic than more extreme data published repeatedly from another center which is highly sophisticated and specialized in the technique of radiotherapy and bases its figures on non-randomized patient material. 33,3434 For instance, a recently published randomized trial (CRC/76, Table 13) shows that the frequency of parasternal recurrences from a randomized trial based on more than 2000 patients at 5 years after simple mastectomy is 15% as compared to 4.6% with postoperative irradiation in stage I and I1 patients. Decrease of locoregional recurrences by about 10 to 15% by irradiation is more realistic than the more exaggerated figures quoted from non-randomized studies, which also include T3 tumors.…”

Section: Postoperative Radiotherapymentioning

confidence: 99%

Adjuvant radiotherapy trials in breast cancer

Stjernswärd

1977

Cancer

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Adjuvant radiotherapy in breast cancer according to stage of disease, present diagnostic and therapeutic advances, and the biology of the tumor is summarized: Stage I: The increasing number of small localized tumors occuring with earlier diagnosis motivates controlled clinical studies of irradiation of the breast with surgical axillary node status for exact biological classification. Encouraging results with local breast irradiation need confirmation in controlled studies. Improved survival by local interventions will most probably be due to selection of cases with earlier diagnosis rather than to variations in local therapies. Curative therapy saving the breast may be envisaged. Stage 11: Systemic therapies with effect also on local-regional soft tissue disease necessitate rethinking on the role of radiotherapy in Stage I1 Disease. Preoperative irradiation trials are biologically not logical in patients who are strictly operable and with a high risk of occult dissemination at time of irradiation. Adjuvant half body o r total body irradiation to very high risk Stage I1 patients may now b e logical to explore in a controlled study. Identification of the very limited subgroup(s) of patients who will benefit from radiotherapy in Stage I1 is open for trials. The routine use of postoperative irradiation in strictly operable patients is highly questionable. In spite of a demonstrated decrease of local and regional recurrence and the psychological trauma of discovering a local growth, the following four facts weigh heavily against the routine use of post-operative radiotherapy: 1) Overtreatment: (a) less than 10% have local-regional recurrence without distant metastases. (b) in the approximately 25% who get local recurrences, a watch policy with later radiotherapy gives complete local control in 70%. 2) Increased morbidity: besides a local-regional morbidity an increased mortality (+ 1 to 10%) can be correlated with the use of radiotherapy in 8/10 randomized trials (p > 0.04). 3) Systemic therapies: the logical way to improve survival. Multiple drug chemotherapy has been shown to be most effective against soft tissue metastases. It can not be excluded that radiotherapy diminishes the effect of systemic therapies (chemo-hormone or immunotherapy). 4) Social-economic aspects: The patient's time and money, doctor's time and society's resources may be better used. Priorities are necessary even in oncology. The interaction of radiotherpy with systemic therapies needs clarification. Stage 111: Radio-therapy has a clear therapeutic role in inoperable tumors limited to the breast. Its exact role in synergism with systemic therapies in a multiple modality approach still must be defined in controlled studies. An improved local therapeutic ratio ought to result from exploring advancements in radiotherapy using radiosensitizers, high energy particle radiation, interaction with chemotherapy, and hyperthermia. With increasingly efficient systemic therapies, local tumor control in Stage 111 may translate into increased survival. Stage...

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“…made comparison difficult. 22 However, the Milanoz3 and the Guys Hospital24 studies meet the criteria for bias control as established by even the most critical of investigators and the results are comparable. Those studies showed identical five-year survival rates when comparing Halsted mastectomy and adjuvant radiotherapy to simple or segmental resection of the breast and radiotherapy in Stage I disease.…”

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confidence: 99%

Radiotherapy as an adjuvant in the treatment of carcinoma of the breast

Nevin

Baggerly

Laird

1982

Cancer

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During the period from 1950-1974, 510 patients with a diagnosis of invasive ductal carcinoma treated with the standard Halsted radical mastectomy were reviewed retrospectively from the records of the Tumor Clinic of The Memorial Hospital, Danville, Virginia. The primary aim of the study was to determine whether postoperative adjuvant radiation therapy (POART) as delivered in a community hospital setting contributed to better cancer control and effectively influenced five and ten year survival rates. The results of the review indicated that the use of POART whether from an orthovoltage or cobalt source did not differentially influence the patient's disease outcome. The use of POART did not improve the five- and ten-year survival rates regardless of lesion location in patients with Stages I, II, and III disease with positive lymph nodes. POART did cause a significant decline in five- and ten-year survival rates of patients with Stage II and III disease with negative nodes when compared to the survival of patients with the same stage of disease that did not receive POART, i.e., 75% versus 94% five-year difference, and a 65% versus 85% ten-year difference. These results suggest that radiotherapy may have a detrimental effect on immunocompetence and thus alter survival rates in certain circumstances. Therefore, any clinical investigation measuring the results of various therapeutic modalities singularly or in combination should be based on pathologic staging rather than clinical staging so that these factors can be adequately evaluated.

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Combination of conservative surgery and irradiation for cancer of the breast

Cited by 28 publications

References 12 publications

Dr. Eleanor D. Montague

Dr. Eleanor D. Montague

Adjuvant radiotherapy trials in breast cancer

Radiotherapy as an adjuvant in the treatment of carcinoma of the breast

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