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Lumpectomy/Mastectomy Equivalent in Early Breast Cancer

Lumpectomy/Mastectomy Equivalent in Early Breast Cancer

NEW ORLEANS—Eighteen-year results from a pivotal trial comparing
lumpectomy with mastectomy have demonstrated maintenance of efficacy for the
breast-sparing treatment. Matthew Poggi, MD, of the Radiation Oncology Branch
of the National Cancer Institute, updated the study results at the American
Society for Therapeutic Radiology and Oncology (abstract 91).

In the original study, 247 patients with stage I and II breast cancer were
randomly assigned to undergo either modified radical mastectomy or
lumpec-tomy plus level 1-3 axillary dissection and radiation therapy (4,500
to 5,040 cGy) for 5 to 5.5 weeks. A boost of 1,500 to 2,000 cGy was given to
all patients, and in some patients the internal mammary or supraclavicular
lymph nodes were treated. Node-positive patients received chemotherapy and
sometimes tamoxifen (Nolvadex). Negative surgical margins in the lumpectomy
group were not required.

Final analysis was done on 116 patients in the mastectomy arm and 121
women in the breast-conservation arm. At a median follow-up of 18.4 years,
overall survival was 58% for mastectomy patients and 54% for patients
receiving lumpectomy plus radiation. Disease-free survival was 67% and 63%,
respectively, after recurrences successfully salvaged by mastectomy were
censored from the analysis. Distant disease-free survival was 69% for
mastectomy vs 68% for breast conservation.

None of these differences were significant, Dr. Poggi reported. Over time,
the percentage of surviving patients declined similarly between the two arms,
he said.

In the subset of node-positive women, median follow-up is somewhat
shorter; however, the outcome was consistent with the findings for the whole
group. There was no significant difference in survival, with 46% of
mastectomy patients and 48% of breast-conservation patients alive at 15
years. For disease-free survival, however, the absolute percentages were
higher for the breast-conservation group: 45% for mastectomy and 54% for
breast conservation at 15 years, Dr. Poggi reported.

The investigators are currently analyzing the failure rates and patterns,
and what has emerged so far is an in-breast tumor rate—either recurrence or
new primary tumors—that is higher than in previous studies. Dr. Poggi
attributed this to the fact that negative surgical margins were not required
for lumpectomy, and to the likelihood that more events will occur with longer
follow-up.

He said that 21 of the 27 new or recurring ipsilateral breast tumors in
the breast-conservation group were successfully treated; three patients also
had distant failure, and four had salvage mastectomy that did not control the
local disease, he said. "There appears to be no detectable difference in two
very important clinical endpoints, overall survival and disease-free
survival, for early breast cancer patients treated with either mastectomy or
breast-conservation surgery plus radiation, after nearly 20 years of
follow-up," Dr. Poggi concluded. "These findings contribute to the growing
body of research that suggests that lumpectomy can be just as effective as
mastectomy."

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