Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy

BACKGROUND. The purpose of the current study was to evaluate the locoregion al :recurrence rate after treatment of patients with operable breast carcin oma with a :modification of the Halsted radical mastectomy and the selectiv e use of radiotherapy and to identify risk factors for locoregional recurre nce. METHODS. Between 1979-1987, 691 consecutive patients underwent mastectomy;a fter a negative biopsy of the axillary apical lymph nodes. The median age o f the patients was 59 years (range, 26-89 years). The clinical tumor size w as < 2 cm in 72 patients, 2-5 cm in 387 patients, and >5 cm in 169 patients ; 16 patients had a T4 tumor. Surgery was comprised of a modification of th e Halsted radical mastectomy, including at least part of the pectoralis maj or muscle and the entire pectoralis minor muscle, in 573 patients; 303 pati ents had positive axillary lymph nodes. Adjuvant radiotherapy to the chest wall and regional lymph nodes was given to 74 patients, whereas an addition al 414 patients underwent irradiation to the internal mammary and medial su praclavicular lymph nodes. The median follow-up was 91 months. RESULTS. The actuarial overall survival rate was 82% at 5 years and 63% at 10 years. The 10-year chest wall and regional lymph node control rates, inc luding patients with prior distant failures; were 95% and 94%, respectively . The only two significant prognostic factors for locoregional recurrence o n multivariate analysis were lymph node status and pathologic tumor size. CONCLUSIONS. Excellent locoregional control can be achieved with a modified technique of radical mastectomy in patients with negative apical biopsy an d the selective use of comprehensive radiotherapy. These results may serve as a reference outcome for comparison with other locoregional treatment str ategies. (C) 1999 American Cancer Society.