Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trial

Background:Breast-conserving surgery followed by radiotherapy isa widely accepted form of treatment in patients with breast cancer of limitedextent. Many attempts have been made to identify subgroups of patients whomight avoid radiotherapy.Patients and methods:Between 1987 and 1989, 579 women withcarcinoma of the breast were randomly assigned to quadrantectomy, axillarydissection and radiotherapy (299) and to quadrantectomy with axillarydissection without radiotherapy (280). Eligible patients were women with abreast carcinoma less than 2.5 cm in maximum diameter up to 70 years of age.Primary endpoints were intra-breast tumour reappearance (IBTR) and all-causemortality.Results:The number of IBTRs was significantly higher in patientstreated with surgery alone (59 cases out of 273; 10-year crude cumulativeincidence of 23.5%) than in patients treated with surgery plusradiotherapy (16 cases out of 294; 10-year crude cumulative incidence of5.8%). The difference in IBTR frequency between the two treatmentsappeared to be particularly high in women up to 45 years of age, tending todecrease with increasing age up to no apparent difference in women older than65 years. Overall survival curves for the two groups, did not differsignificantly (P = 0.326). However, a limited survival advantagewas evident after radiotherapy for node-positive women.Conclusions:After breast-conserving surgery radiotherapy appearsindicated in all patients up to 55 years of age, in patients with positiveaxillary nodes, and in patients with extensive intraductal component athistology. The data suggest that radiotherapy may be avoided in patients olderthan 65, and may be optional in women aged 56–65 years with negativenodes.