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Breast Conservation Effective in Occult Primary Cancer With Axillary Metastases

Breast Conservation Effective in Occult Primary Cancer With Axillary Metastases

WASHINGTON—Mastectomy does not improve either survival or local
control when patients present with axillary node metastases and an occult
primary tumor, Georges Vlastos, MD, of Geneva University Hospital, Geneva,
Switzerland, said at the 54th Annual Cancer Symposium of the Society of
Surgical Oncology. He described a retrospective study of 45 women with this
rare condition, conducted when he was at M. D. Anderson Cancer Center.

Treatment remains controversial when the primary carcinoma is unknown in
patients with axillary metastases, Dr. Vlastos said. First described by
Halstead in 1907, this condition affects only 1% of all cases, he said, and
only 400 such cases appear in the literature.

Mastectomy was formerly the treatment of choice, but breast preservation
plus chemotherapy is now gaining attention as an alternative, he stated, noting
that the unknown primary disease may occur outside the breast.

45 With Unknown Primary

A register compiled from 1951 to 1998 contained 479 women initially
registered as having axillary metastases and unknown primary. Diagnostic
workups that included mammogram, however, had eliminated all but 45, whose
clinical and pathologic histories were reviewed.

Of these 45 patients, 71% presented with N1 clinical nodal status and the
remainder with N2. Ages ranged from 32 to 79 years (median, 54). Modified
radical mastectomy was performed in 13 patients, while the remainder were
treated with the intent to preserve the breast. Seventy-one percent received
locoregional radiotherapy, and 75% received systemic chemotherapy.

When the Kaplan-Meier method was used to calculate survival from the date of
first diagnosis, the mastectomy and nonmastectomy groups showed identical
overall and disease-free survival, Dr. Vlastos reported.

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