BREAST-CONSERVING SURGERY AND DEFINITIVE RADIATION - A COMPARISON BETWEEN QUADRANTECTOMY AND LOCAL EXCISION WITH SPECIAL FOCUS ON LOCAL-REGIONAL CONTROL AND COSMESIS

Purpose: Breast-conserving surgery and definitive radiation as an alte rnative to mastectomy is a well-accepted practice. However, there is l imited information addressing the extent of surgical resection. The pu rpose of this study is to compare the outcome of patients treated with local excision or quadrantectomy, followed by definitive radiation wi th particular emphasis on local-regional control and cosmetic results. Methods and Materials: Between 1978 and 1989, 425 patients with Stage I and II breast cancer underwent conservative surgery followed by def initive radiation. Fifty-four patients had a local excision and 371 ha d a quadrantectomy. Median follow-up was 42 months. Axillary dissectio n (levels 1/11) was performed in 317 patients, and of these 126 patien ts had positive axillary lymph nodes. Radiation consisted of 4500-5000 cGy to the breast with Co6 or 4 MV photons, plus a boost to the tumor site (356/425 patients) for a total dose of 6000-6500 cGy. Treatment of the regional lymph nodes was given to patients with undissected or inadequately dissected axillas and usually to patients with multiple p ositive lymph nodes. Of the patients with positive lymph nodes, 46% re ceived systemic chemotherapy. Results: The 5-year actuarial freedom fr om local-regional recurrence rates for patients treated with local exc ision and quadrantectomy followed by definitive radiation were 92% and 93%, respectively (p = 0.7). The 5-year actuarial survival rates for local excision and quadrantectomy were as follows: overall (83% and 82 %; p = 0.7), cause-specific disease-free (74% and 71%; p = 0.9), and d istant disease-free (82% and 76%, p = 0.4). Estimated 10-year results are also presented. Cosmetic analysis required a minimum follow-up of 5 years. In the local excision, 77% of the patients had excellent-good result, compared to 53% following quadrantectomy (p = 0.03). Excludin g patients who received chemotherapy, the excellent-good scores were 7 6% and 57%, respectively (p = 0.1). The most unfavorable cosmetic resu lts were associated with quadrantectomy followed by radiation with boo st dose and chemotherapy, excellent-good in 22%. Conclusion: Conservat ive surgery consisting of local excision or quadrantectomy resulted in comparable local-regional control, overall, disease-free and distant disease-free survival, although cosmetic results were superior in the local excision group.