RESCUE MASTECTOMY IN 192 BREAST-CANCER PATIENTS WITH T2 TUMORS LARGERTHAN 3 CM OR T3 TUMORS FIRST TREATED BY BREAST-CONSERVATION PROTOCOLSAND FOLLOWED UP FOR AT LEAST 10 YEARS

Breast conservation therapy was used in 192 breast cancer patients tre ated between 1980 and 1986 for T2 tumors larger than 3 cm or T3 tumors . Primary chemotherapy was followed by external beam radiation therapy then by boost brachytherapy and adjuvant chemotherapy. Locoregional r ecurrences were treated whenever possible by tumorectomy and/or axilla ry node clearance. Median follow-up was 13 years. Of the three patient s with local therapeutic failures at completion of the locoregional tr eatment, two were treated by tumorectomy and one by mastectomy. Subseq uently, 21 mastectomies were performed for oncological reasons in 20 c ases. Overall survival was 55 % after five years, 60 % after ten years , and 56 % after 15 years. Local control rates were 82 %, 77 %, and 75 % after five, ten, and 15 years, respectively. After exclusion of the patients who required mastectomy, cosmetic results were satisfactory in 68 % of patients overall, 67 % of five-year survivors, and 73 % of ten-year survivors. These results show that the conventional approach involving routine initial mastectomy is no longer appropriate in patie nts with T3 or large T2 breast cancers.