CONSERVATIVE THERAPY FOR SMALL INFILTRATI NG BREAST CARCINOMAS - EFFECT OF LOCAL-CONTROL ON SURVIVAL

Recurrence of breast tumours after conservative treatment is considere d by some as a simple prognosis factor marking risk of distant metasta sis. Inversely, others consider small recurrent tumours as the startin g point of systemic disease and a possible cause of death. These confl icting opinions could lead to highly opposing management decisions. Fo llowing one theory, we would be prone see a new wave of mutilating bre ast resections and following the other, insufficient tumour resection. The question thus becomes how to treat small, < 3 cm, recurrent tumou rs. Several factors can help in decision making. The risk of metastasi s increases with large sized primary tumours, independently of lymph n ode invasion. The size number of the recurrent tumour(s) also play a r ole. Studies of the time interval between treatment and recurrence hav e shown that early recurrence within 24 months is associated with high risk of metastasis suggesting that in such cases local treatment shou ld be combined with systemic therapy. The controversy will continue to be debated, but the essential element of conservative treatment is to control local invasion of small tumours. Surgical exeresis must be co mplete and irradiation must be delivered with an optimal dose. It woul d appear reasonable to limit conservative treatment to patients with a 5-year risk of recurrence below 8% and a 10-year risk below 15%.