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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
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 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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“Although the results of six prospective randomized trials in patients with invasive breast cancer have demonstrated that lumpectomy/quadrantectomy plus RT and mastectomy have equivalent survival results [55-60], it is worthwhile to remember that the first conservation trial, the Guy ’s wide excision study initiated in…”
Survival Implications Associated with Variation in Mastectomy Rates for Early-Staged Breast Cancer
Brooks, J. M., Chrischilles, E. A., Landrum, M. B., Wright, K. B., Fang, G., Winer, E. P., & Keating, N. L. (2012) · International Journal of Surgical Oncology · doi:10.1155/2012/127854 · Cited by 35
Evolution of radiotherapy techniques in breast conservation treatment
Boyages, J., & Baker, L. (2018) · Gland Surgery · doi:10.21037/gs.2018.11.10 · Cited by 35
“The initial trials of breast conservation compared the procedure of total mastectomy and axillary dissection to various breast conservation techniques with radiation (11-16).”
BackgroundRe-excision of margins before breast radiation—diagnostic or therapeutic?
Chism, D. B., Freedman, G. M., Li, T., & Anderson, P. R. (2006) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2006.02.017 · Cited by 34
Breast-conserving surgery for breast cancer.
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Disparities in the Local Management of Breast Cancer in the US according to Health Insurance Status
Churilla, T. M., Egleston, B. L., Bleicher, R. J., Dong, Y., Meyer, J. E., & Anderson, P. R. (2016) · The Breast Journal · doi:10.1111/tbj.12705 · Cited by 38
Oncoplastic partial breast reconstruction: concepts and techniques
Chu, C. K.-C., Hanson, S. E., Hwang, R. F., & Wu, L. C. (2021) · Gland Surgery · doi:10.21037/gs-20-380 · Cited by 33
“for patients with early-stage breast cancer (2-7).”
Livi, L., Paiar, F., Saieva, C., Scoccianti, S., Dicosmo, D., Borghesi, S., Agresti, B., Nosi, F., Orzalesi, L., Santini, R., et al. (2006) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2006.11.009 · Cited by 34
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Survival, quality of life and breast cancer
Mosconi, P., Colozza, M., Laurentiis, M. D., Placido, S. D., & Maltoni, M. C. (2001) · Annals of Oncology · doi:10.1093/annonc/12.suppl_3.s15 · Cited by 34
Mansell, J., Weiler-Mithoff, E. M., Martin, J. K., Khan, A., Stallard, S., Doughty, J., & Romics, L. (2015) · The Breast · doi:10.1016/j.breast.2015.05.003 · Cited by 33
Golshan, M. A., Miron, A., Nixon, A. J., Garber, J. E., Cash, E. P., Iglehart, J. D., Harris, J. R., & Wong, J. S. (2006) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2005.12.005 · Cited by 33
Latissimus Dorsi Reconstruction
Freeman, M. E., Perdikis, G., Sternberg, E. G., TerKonda, S. P., & Waldorf, J. C. (2006) · Annals of Plastic Surgery · doi:10.1097/01.sap.0000215252.05233.b0 · Cited by 34
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Landercasper, J., Ramirez, L. D., Borgert, A. J., Ahmad, H. F., Parsons, B. M., Dietrich, L. L., & Linebarger, J. H. (2019) · Clinical Breast Cancer · doi:10.1016/j.clbc.2019.02.006 · Cited by 36
Optimization of combined electron and photon beams for breast cancer
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Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran
Najafi, M., Ebrahimi, M., Kaviani, A., Hashemi, E., & Montazeri, A. (2005) · BMC Cancer · doi:10.1186/1471-2407-5-35 · Cited by 32
“Many prospective randomized trials have demonstrated that overall and disease-free survival rates for early-stage breast cancer are equivalent after mastectomy or BCS with postoperative radiotherapy [2-4], [8,9].”
BackgroundContralateral breast cancer risk.
Unnithan, J., & Macklis, R. (2001) · Radiotherapy and Oncology · doi:10.1016/s0167-8140(01)00369-3 · Cited by 32
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Metadata
- 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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