Results of conservative surgery for limited-sized infiltrating breast cancer: Analysis of 962 tested patients: 24 years of experience

Background and Objectives: Breast-conserving treatment (BCT) is the electiv e approach to early stage breast cancer. We report on our 24 years of exper ience. Methods: Between 1975 and 1998, 980 conservative surgical procedures in 962 patients for limited-sized infiltrating breast cancer (T1 to "small" T2, N 0-N1, M0) were performed. BCT consisted of a local wide excision, axillary dissection and postoperative radiation therapy to the entire breast (50 Gy) . An adjuvant systemic treatment (chemo- and/or hormonotherapy) was adminis tered to the large majority of patients. Data on age, menopausal status, hi stologic subtype of tumor, quadrant site of cancer, tumor size (T1a, T1b, T 1c, or T2), axillary nodal status (N- or N+, with involvement of 1-3 nodes, or more), and follow-up were stored fur each patient. Overall, N+ patients constituted 29.2% of the total number. Survival data were analyzed using t he Berkson-Gage actuarial method. Results: The 15-year overall and disease-free survival rates were 72% and 6 7%, respectively. Nevertheless, the more interesting results concern surviv al rates in relation to T and N parameters. T-related survival showed a sha rp distinction among the subgroups T1a + T1b and T1c, with values of 90% fo r the former versus 62% for the latter. Even more significative results wer e achieved by comparing N with survival. In fact, it was 84% for N-patients and 31% for N+ patients; for N+ patients, outcome was Door for the subgrou p showing an involvement of more than 3 nodes, with no patient surviving at 15 years. None of the other evaluated parameters proved to be related to s urvival. The validity of our protocol is confirmed by the low number of loc al relapses: only 33 (3.4%) of 980 total treated cases. Cosmetic results we re excellent or good in a high percentage of patients (>80%). Conclusions: These results unquestionably confirm the validity of BCT, prov ided certain prerequisites are fulfilled. J, Surg. Oncol. 2000:74:108-115. (C) 2000 Wiley-Liss, Inc.