Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy

• Published in: Cancer 1999-04, Vol.85 (8), p.1773-1781
• Main Authors: Bijker, Nina, Rutgers, Emiel J. T., Peterse, Johannes L., van Dongen, Joop A., Hart, August A. M., Borger, Jacques H., Kroon, Bin B. R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Biopsy; Breast; breast carcinoma; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Chemotherapy, Adjuvant; Combined Modality Therapy; Disease-Free Survival; Female; Humans; Life Tables; local recurrence; Lymphatic Metastasis - prevention & control; Mastectomy, Modified Radical; Medical sciences; Middle Aged; modified radical mastectomy; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Netherlands - epidemiology; radiotherapy; Radiotherapy, Adjuvant; regional recurrence; Retrospective Studies; Risk; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Survival Analysis; Survival Rate; Thoracic Neoplasms - epidemiology; Thoracic Neoplasms - secondary; Treatment Outcome
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19990415)85:8<1773::AID-CNCR18>3.0.CO;2-M

BACKGROUND The purpose of the current study was to evaluate the locoregional recurrence rate after treatment of patients with operable breast carcinoma with a modification of the Halsted radical mastectomy and the selective use of radiotherapy and to identify risk factors for locoregional recurrence. METHODS Between 1979–1987, 691 consecutive patients underwent mastectomy after a negative biopsy of the axillary apical lymph nodes. The median age of the patients was 59 years (range, 26–89 years). The clinical tumor size was < 2 cm in 72 patients, 2–5 cm in 387 patients, and >5 cm in 169 patients; 16 patients had a T4 tumor. Surgery was comprised of a modification of the Halsted radical mastectomy, including at least part of the pectoralis major muscle and the entire pectoralis minor muscle, in 573 patients; 303 patients had positive axillary lymph nodes. Adjuvant radiotherapy to the chest wall and regional lymph nodes was given to 74 patients, whereas an additional 414 patients underwent irradiation to the internal mammary and medial supraclavicular lymph nodes. The median follow‐up was 91 months. RESULTS The actuarial overall survival rate was 82% at 5 years and 63% at 10 years. The 10‐year chest wall and regional lymph node control rates, including patients with prior distant failures, were 95% and 94%, respectively. The only two significant prognostic factors for locoregional recurrence on multivariate analysis were lymph node status and pathologic tumor size. CONCLUSIONS Excellent locoregional control can be achieved with a modified technique of radical mastectomy in patients with negative apical biopsy and the selective use of comprehensive radiotherapy. These results may serve as a reference outcome for comparison with other locoregional treatment strategies. Cancer 1999;85:1773–81. © 1999 American Cancer Society. Excellent locoregional control was achieved using a modification of the Halsted radical mastectomy and the selective use of comprehensive radiotherapy.