EXPERIENCE OF QUADRANTECTOMY WITH AXILLARY DISSECTION WITHOUT RADIOTHERAPY SUSTAINED BY SERIAL PATHOLOGICAL EXAMINATION FOR STAGE-I BREAST-CANCER

Breast conserving treatment usually consists of lumpectomy and axillar y dissection followed by a limited dose of irradiation so that no sign ificant side-effects occur. However, the precision of lumpectomy depen ds on the surgical maneuver and pathological evaluation performed at e ach institution. For this reason, post-operative irradiation to the pr eserved breast and for the occult carcinoma in the same breast is abso lutely mandatory, and effectively becomes a routine step. In 1986, we started to adopt the new breast-conservation method of quadrantectomy with axillary dissection for restricted stage I breast cancer without using radiotherapy, at the Cancer Institute Hospital, Tokyo, Japan. As an alternative to irradiation to ensure safety, we chose to administe r an elaborate pathological examination on serial sections. The pathol ogical proof has saved troublesome post-operative irradiation, and the results have shown this method to be safe and clear-cut compared to t he traditional breast-conserving treatment cited in the literature. Fr om July 1986 to December 1994, we performed 321 cases of quadrantectom y and axillary dissection (Q+Ax). If the detailed pathological examina tion of 5-mm serial sections revealed the stump to be negative, we did not treat the preserved breast with radiotherapy. Out of 321 cases, 2 47 were analyzed as being stump-negative and of these 235 did not rece ive radiotherapy at all. During a 5 year 4 month observation period, w e have not yet encountered any local recurrence. However, we have expe rienced 4 cases (1.70%) in which a second cancer developed in the cons erved breast. The annual incidence rate was 0.32%. These results are t he best so far compared to other published world reports.