SELECTIVE AVOIDANCE OF POSTOPERATIVE LOCOREGIONAL RADIOTHERAPY IN BREAST-CANCER SEEMS TO BE JUSTIFIED

Objective: To try and reduce the amount of routine postoperative radio therapy that we prescribed without causing an unacceptable rise in loc oregional recurrences. Design: Retrospective study. Setting: Teaching hospital, The Netherlands. Subjects: 836 women who were treated for br east cancer between January 1980 and December 1989. Interventions: The se 836 had been treated by modified radical mastectomy (n = 534), exci sion of the tumour and axillary dissection (n = 279), lumpectomy (n = 15), or total mastectomy (n = 8). In December 1984 we stopped giving r outine postoperative irradiation to women with T-1 or T-2 tumours unle ss there was any doubt about the operative specimen. Main outcome meas ures: The rate of locoregional recurrence 1985-9 compared with that fr om 1980-December 1984. Results: Only 1 patient of 836 had a clinically detectable recurrence in the internal mammary chain. There were only 2 recurrences in the 235 axillas that had not been irradiated. Conclus ion: By a process of careful selection of patients for locoregional ir radiation, the number of fields of irradiation given to patients with breast cancer can be reduced by up to 80% without causing a rise in th e rate of locoregional recurrences.