Cited by 612Breast Cancer Treatment StudiesBreast Lesions and CarcinomasEndometrial and Cervical Cancer Treatments

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Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group

Arriagada, R, Lê, M G, Rochard, F, Contesso, G·1996·Journal of Clinical Oncology

DOI 10.1200/jco.1996.14.5.1558

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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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“This result most likely represents the extrapolation of prospective, randomized controlled trials indicating that BCT produces outcomes comparable to those produced by mastectomy in patients who have stage I and II breast cancer and the single-institution reports indicating success with this approach.(11-17) Although…”
Result
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Lawenda, B. D., Taghian, A. G., Kachnic, L. A., Hamdi, H., Smith, B. L., Gadd, M. A., Mauceri, T., & Powell, S. N. (2003) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/s0360-3016(03)00071-3 · Cited by 108
Assessing breast tumor margin by multispectral photoacoustic tomography
Li, R., Wang, P., Lan, L., Lloyd, F. P., Goergen, C. J., Chen, S., & Cheng, J. (2015) · Biomedical Optics Express · doi:10.1364/boe.6.001273 · Cited by 111
Partial breast irradiation as second conservative treatment for local breast cancer recurrence
Hannoun‐Lévi, J., Houvenaeghel, G. F., Ellis, S., Teissier, E., Alzieu, C., Lallement, M., & Cowen, D. M. (2004) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2004.05.035 · Cited by 106
The activity and safety of electrochemotherapy in persistent chest wall recurrence from breast cancer after mastectomy: a phase-II study
Campana, L. G., Valpione, S., Falci, C., D, S. M. M., Basso, M., Corti, L., Balestrieri, N., Marchet, A., & Rossi, C. R. (2012) · Breast Cancer Research and Treatment · doi:10.1007/s10549-012-2095-4 · Cited by 104
Predictors of Local Recurrence After Breast-Conservation Therapy
Horst, K. C., Smitt, M. C., Goffinet, D. R., & Carlson, R. W. (2005) · Clinical Breast Cancer · doi:10.3816/cbc.2005.n.001 · Cited by 105
Triple-Negative Breast Cancer Is Not a Contraindication for Breast Conservation
Adkins, F. C., Gonzalez-Angulo, A. M., Lei, X. J., Hernandez-Aya, L. F., Mittendorf, E. A., Litton, J. K., Wagner, J. L., Hunt, K. K., Woodward, W. A., & Meric‐Bernstam, F. (2011) · Annals of Surgical Oncology · doi:10.1245/s10434-011-1920-z · Cited by 105
Fifteen-year results of breast-conserving surgery and definitive irradiation for Stage I and II breast carcinoma: the University of Pennsylvania experience
Santiago, R. J., Wu, L., Harris, E. E. R., Fox, K. R., Schultz, D., Glick, J. H., & Solin, L. J. (2003) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/s0360-3016(03)01460-3 · Cited by 101
A shorter fractionation schedule for postlumpectomy breast cancer patients
Shelley, W. E., Brundage, M., Hayter, C. R. R., Paszat, L. F., Zhou, S., & Mackillop, W. J. (2000) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/s0360-3016(00)00567-8 · Cited by 98
Pattern of local recurrence after conservative surgery and whole-breast irradiation
Freedman, G. M., Anderson, P. R., Hanlon, A. L., Eisenberg, D. F., & Nicolaou, N. (2005) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2004.08.026 · Cited by 93
The Impact of Age on Outcome in Early-Stage Breast Cancer
Beadle, B. M., Woodward, W. A., & Buchholz, T. A. (2010) · Seminars in Radiation Oncology · doi:10.1016/j.semradonc.2010.09.001 · Cited by 96
State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012
Nash, R., Goodman, M. G., Lin, C. C., Freedman, R. A., Dominici, L. S., Ward, K. C., & Jemal, A. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.0115 · Cited by 91
Incidence of isolated local breast cancer recurrence and contralateral breast cancer: A systematic review
Spronk, I., Schellevis, F., Burgers, J. S., de Bock, G. H., & Korevaar, J. C. (2018) · The Breast · doi:10.1016/j.breast.2018.03.011 · Cited by 89
Impact of Chemotherapy Sequencing on Local-Regional Failure Risk in Breast Cancer Patients Undergoing Breast-Conserving Therapy
Mittendorf, E. A., Buchholz, T. A., Tucker, S. L., Meric‐Bernstam, F., Kuerer, H. M., Gonzalez-Angulo, A. M., Bedrosian, I., Babiera, G. V., Hoffman, K. E., Yi, M., et al. (2013) · Annals of Surgery · doi:10.1097/sla.0b013e3182805c4a · Cited by 91
A device for real-time, intraoperative margin assessment in breast-conservation surgery
Karni, T., Pappo, I., Sandbank, J., Lavon, O., Stahl-Kent, V., Spector, R., Morgenstern, S., & LELCUK, S. (2007) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.06.013 · Cited by 90
“[5] Arriagada R, Le MG, Rochard F, Contesso G.”
Background
Compliance with breast‐conservation standards for patients with early‐stage breast carcinoma
White, J. R., Morrow, M., Moughan, J., Owen, J. B., Pajak, T. F., DesHarnais, S., Winchester, D. P., & Wilson, J. F. (2003) · Cancer · doi:10.1002/cncr.11141 · Cited by 89
Prognostic factors for death after an isolated local recurrence in patients with early‐stage breast carcinoma
Lê, M. G., Arriagada, R., Spielmann, M., Guinebretière, J., & Rochard, F. (2002) · Cancer · doi:10.1002/cncr.10572 · Cited by 87
“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.”
Background
Optimal timing for adjuvant radiation therapy in breast cancer
Tsoutsou, P. P., Koukourakis, M. I., Azria, D., & Belkacémi, Y. (2008) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2008.09.002 · Cited by 87
“[6] Arriagada R, Le MG, Rochard F, et al.”
Background
Similar long‐term results of breast‐conservation treatment for Stage I and II invasive lobular carcinoma compared with invasive ductal carcinoma of the breast
Santiago, R. J., Harris, E. E. R., Qin, L., Hwang, W., & Solin, L. J. (2005) · Cancer · doi:10.1002/cncr.21071 · Cited by 87
Cost-Effectiveness Analysis of Routine Frozen-Section Analysis of Breast Margins Compared with Reoperation for Positive Margins
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Intra-operative Sonography: A Valuable Aid During Breast-Conserving Surgery for Occult Breast Cancer
Haid, A., Knauer, M., Dunzinger, S., Jasarevic, Z., Köberle-Wührer, R., Schuster, A. H., Töpker, M., Haid, B., Wenzl, E., & Offner, F. A. (2007) · Annals of Surgical Oncology · doi:10.1245/s10434-007-9490-9 · Cited by 85
Comprehensive Review of The Management of Internal Mammary Lymph Node Metastases in Breast Cancer
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Controversies in the Treatment of Ductal Carcinoma in Situ
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Brooks, J. M., Chrischilles, E. A., Scott, S. D., & Chen-Hardee, S. (2003) · Health Services Research · doi:10.1111/j.1475-6773.2003.00184.x · Cited by 81
“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).”
Background
A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer
Lim, M. C. K., Bellon, J. R., Gelman, R. S., Silver, B. J., Recht, A., Schnitt, S. J., & Harris, J. R. (2006) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2006.02.006 · Cited by 80
Incidence of internal mammary node metastases after a sentinel lymph node technique in breast cancer and its implication in the radiotherapy plan
Farrus, B., Vidal‐Sicart, S., Velasco, M., Zanón, G., Fernández, P. L., Muñoz-Mateu, M., Santamaría, G., Albanell, J., & Biete, A. (2004) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2004.04.021 · Cited by 79
Minimizing Local Recurrence after Breast Conserving Therapy Using Intraoperative Shaved Margins to Determine Pathologic Tumor Clearance
Camp, R., McAuliffe, P. F., Gilroy, J. S., Morris, C. G., Lind, S. D., Mendenhall, N. P., & Copeland, E. M. (2005) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2005.06.274 · Cited by 79
Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery
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Prognosis after local recurrence after conservative surgery and radiation for early-stage breast cancer
Galper, S., Blood, E., Gelman, R. S., Abner, A. L., Recht, A., Kohli, A., Wong, J. S., Smith, D. N., Bellon, J. R., Connolly, J. L., et al. (2005) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2004.06.011 · Cited by 79
Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients
Tanis, P. J., Nieweg, O. E., Olmos, R. A. V., Peterse, J. L., Rutgers, E. J. T., Hoefnagel, C. A., & Kroon, B. B. R. (2002) · British Journal of Cancer · doi:10.1038/sj.bjc.6600359 · Cited by 77
Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy
Mansell, J., Weiler-Mithoff, E. M., Stallard, S., Doughty, J., Mallon, E., & Romics, L. (2017) · The Breast · doi:10.1016/j.breast.2017.02.006 · Cited by 79
The association between treatment-specific optimism and depressive symptomatology in patients enrolled in a Phase I cancer clinical trial
Cohen, L. G., de Moor, C., & Amato, R. J. (2001) · Cancer · doi:10.1002/1097-0142(20010515)91:10 · Cited by 110
Factors increasing local recurrence in breast-conserving surgery
Fatouros, M., Roukos, D. H., Arampatzis, I., Sotiriadis, A., Paraskevaidis, E. A., & Kappas, A. M. (2005) · Expert Review of Anticancer Therapy · doi:10.1586/14737140.5.4.737 · Cited by 75
Breast conservation for male breast carcinoma
Golshan, M. A., Rusby, J. E., Dominguez, F., & Smith, B. L. (2007) · The Breast · doi:10.1016/j.breast.2007.05.012 · Cited by 74
Recursive Partitioning Identifies Patients at High and Low Risk for Ipsilateral Tumor Recurrence After Breast-Conserving Surgery and Radiation
Freedman, G. M., Hanlon, A. L., Fowble, B. L., Anderson, P. R., & Nicoloau, N. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.03.155 · Cited by 73
Guidelines for the management of symptomatic breast disease
(2005) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2005.02.006 · Cited by 73
EZH2 and ALDH-1 mark breast epithelium at risk for breast cancer development
Kunju, L. P., Cookingham, C., Toy, K. A., Chen, W., Sabel, M. S., & Kleer, C. G. (2011) · Modern Pathology · doi:10.1038/modpathol.2011.8 · Cited by 73
Twenty-five year results of the national cancer institute randomized breast conservation trial
Simone, N. L., Dan, T., Shih, J., Smith, S. L., Sciuto, L. C., Lita, E., Lippman, M. E., GLATSTEIN, E. J., Swain, S. M., Danforth, D. N., et al. (2011) · Breast Cancer Research and Treatment · doi:10.1007/s10549-011-1867-6 · Cited by 72
Accuracy of Frozen Section Analysis Versus Specimen Radiography During Breast‐Conserving Surgery for Nonpalpable Lesions
Weber, W. P., Engelberger, S., Viehl, C. T., Zanetti‐Dällenbach, R., Dell‐Kuster, S., Dirnhofer, S., Wruk, D., Oertli, D., & Marti, W. R. (2008) · World Journal of Surgery · doi:10.1007/s00268-008-9757-8 · Cited by 70
New Trends in Breast Cancer Management
Pomahač, B., Recht, A., May, J. W., Hergrueter, C. A., & Slavin, S. A. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000217626.88430.c3 · Cited by 72
The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy
Vicini, F. A., Horwitz, E. M., Lacerna, M. D., Brown, D. M., White, J. R., Dmuchowski, C., Kini, V. R., & Martinez, A. A. (1997) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/s0360-3016(97)00555-5 · Cited by 72
Acute Toxicity of High-Dose-Rate Intracavitary Brachytherapy With the MammoSite Applicator in Patients With Early-Stage Breast Cancer
Richards, G. M., Berson, A. M., Rescigno, J., Sanghavi, S. N., Siegel, B., Axelrod, D., Bernik, S. F., Scarpinato, V., & Mills, C. D. (2004) · Annals of Surgical Oncology · doi:10.1245/aso.2004.02.009 · Cited by 72
“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: Arriagada, R
Lê, M G
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 1996-05
Volume: 14
Issue: 5
Pages: 1558-1564
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.1996.14.5.1558
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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Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group

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