TREATMENT OUTCOME AFTER TANGENTIAL RADIATION-THERAPY WITHOUT AXILLARYDISSECTION IN PATIENTS WITH EARLY-STAGE BREAST-CANCER AND CLINICALLY NEGATIVE AXILLARY NODES

purpose: To determine the risk of nodal failure in patients with early -stage invasive breast cancer with clinically negative axillary lymph nodes treated with two-field tangential breast irradiation alone, with out axillary lymph node dissection or use of a third nodal field, Meth ods and Materials: Between 1988 and 1993, 986 evaluable women with cli nical Stage I or II invasive breast cancer were treated with breast-co nserving surgery and radiation therapy, Of these, 92 patients with cli nically negative nodes received tangential breast irradiation (median dose, 45 Gy) followed by a boost, without axillary dissection. The med ian age was 69 years (range, 49-87), Eighty-three percent had T1 tumor s, Fifty-three patients received tamoxifen, 1 received chemotherapy, a nd 2 patients received both, Median follow-up time for the 79 survivor s was 50 months (range, 15-96), Three patients (3%) have been lost to follow-up after 20-32 months, Results: No isolated regional nodal fail ures were identified, Two patients developed recurrence in the breast only (one of whom had a single positive axillary node found pathologic ally after mastectomy). One patient developed simultaneous local and d istant failures, and six patients developed distant failures only, One patient developed a contralateral ductal carcinoma in situ, and two p atients developed other cancers, Conclusion: Among a group of 92 patie nts with early-stage breast cancer (typically T1 and also typically el derly) treated with tangential breast irradiation alone without axilla ry dissection, with or without systemic therapy, there were no isolate d axillary or supraclavicular regional failures, These results suggest that it is feasible to treat selected clinically node-negative patien ts with tangential fields alone, Prospective studies of this approach are warranted. (C) 1997 Elsevier Science Inc.