CONSERVATIVE SURGERY AND RADIATION IN THE TREATMENT OF SYNCHRONOUS IPSILATERAL BREAST CANCERS

Background. Conservative surgery (CS) and radiation therapy (RT) as an alternative to mastectomy is controversial in patients with two or mo re lesions in the same breast. The authors reviewed their experience w ith CS and RT in the management of patients with synchronous ipsilater al breast cancer (SIBC). Methods. Of 1060 patients treated with CS and RT at the authors' facilities before December 1988, 13 (1.2%) present ed with SIBC. All lesions were identified macroscopically and confirme d microscopically as carcinoma. After excision, patients were treated with radiation to the breast for a median tumor bed dose of 65 Gy, and regional lymphatics were treated as clinically indicated to a median dose of 48 Gy. These cases were retrospectively reviewed. Results. As of February 1992, with a median follow-up of 71 months, the 5-year act uarial survival rate of the 13 patients was 81%. Three of the 13 (23%) had an ipsilateral breast recurrence, resulting in a 72-month actuari al breast recurrence rate of 25%, compared with a rate of 12% in our s ingular lesion population. Two of these patients remain alive, no evid ence of disease at 135 and 93 months after diagnosis. The third patien t had chest wall progression and died with metastatic disease at 64 mo nths. Invasive lobular histology and three separate lesions were ident ified in two of the three patients with subsequent local recurrence. C onclusions. The local recurrence rate in conservatively treated patien ts with SIBC is greater than that seen in patients with single lesions , but because of the small sample size, significant conclusions are no t possible. Although the data are limited on this subject, these resul ts support consideration of CS and RT as an option in the management o f selected patients who favor a breast conservation management approac h.