Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group
Abstract
PURPOSES: A randomized trial was conducted to compare tumorectomy and breast irradiation with modified radical mastectomy. We have analyzed the patterns of failure in each arm of the trial and the prognostic factors that have an independent effect on treatment failures and overall survival. PATIENTS AND METHODS: The trial included 179 patients with breast cancer of up to 20 mm in diameter at macroscopic examination. Eighty-eight patients had conservative management and 91 a mastectomy. All patients had axillary dissection with frozen-section examination. For patients with positive axillary nodes (N+), a second randomization was performed: lymph node irradiation versus no further regional treatment. Patterns of failure were determined by a competing-risk approach and multivariate analysis. A prognostic-score was determined by multivariate analysis. RESULTS: Overall survival, distant metastasis, contralateral breast cancer, new primary malignancy, and locoregional recurrence rates were not significantly different between the two surgical groups, or between lymph node irradiation groups. Most recurrences appeared during the first 10 years. Three distinct prognostic groups were determined taking into account age, tumor size, histologic grading, and number of positive axillary nodes. CONCLUSION: Long-term results support conservative treatment with limited surgery and systematic breast irradiation as a safe procedure for the management of small breast cancers. Four easily obtainable clinical and histologic factors may be combined in a prognostic score that is highly predictive of overall and event-free survival.
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Advances in radiation oncology have improved outcomes in a number of different cancers.
“This has resulted in improved outcomes in a number of different cancers (2, 342–350).”
From Adrenocortical carcinoma (2014) · cites this paper as [342]
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“(pro (16) C1, (17) C2, (18) C3, (15) C3; con (19) C1).”
InfluentialPopulation‐based analysis of occult primary breast cancer with axillary lymph node metastasis
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The Impact of Age on Outcome in Early-Stage Breast Cancer
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A device for real-time, intraoperative margin assessment in breast-conservation surgery
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“[5] Arriagada R, Le MG, Rochard F, Contesso G.”
BackgroundCompliance with breast‐conservation standards for patients with early‐stage breast carcinoma
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“6 Moreover, the locoregional recurrence rate decreased in some of the breast-conserving treatment groups due to the use of systematic local irradiation.(1) However, it has not been established clearly whether the type of initial local treatment may influence survival after a local recurrence.”
BackgroundOptimal timing for adjuvant radiation therapy in breast cancer
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“[6] Arriagada R, Le MG, Rochard F, et al.”
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Comprehensive Review of The Management of Internal Mammary Lymph Node Metastases in Breast Cancer
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“The RCT evidence supports the survival equivalence of BCSI and MAS for the ‘‘average’’ ESBC patient in each RCT (Veronesi et al. 1990; Arriagada et al. 1996; Jacobson et al. 1995; Fisher et al. 1995; van Dongen et al. 2000).”
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Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients
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“Patients qualified for intracavitary brachytherapy if they met the following criteria: (1) age 45 years, (2) tumor 2 cm, (3) nodal status N1 or less (maximum of three nodes), (4) no distant metastasis, and (5) 2-mm microscopically negative margins after final surgery.”
Method
- Authors
- Arriagada, R., Lê, M. G., Rochard, F., & Contesso, G.
- Affiliations
- Institut Gustave Roussy (FR)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 1996-05
- Volume
- 14
- Issue
- 5
- Pages
- 1558-1564
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W1782647475
- Cited by
- 612
- References
- 27
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 8 · 2023: 9 · 2022: 17 · 2021: 19 · 2020: 24 · 2019: 23 · 2018: 24 · 2017: 26 · 2016: 29 · 2015: 29 · 2014: 25 · 2013: 17 · 2012: 31
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- early breast cancer, breast-conserving surgery, modified radical mastectomy, breast cancer radiotherapy, axillary lymph node irradiation, failure patterns, prognostic score, overall survival, locoregional recurrence, contralateral breast cancer, distant metastasis, small breast tumors
- MeSH terms
- Adult, Aged, Breast Neoplasms, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Risk Factors, Mastectomy, Modified Radical, Mastectomy, Segmental, Survival Analysis, Treatment Failure
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