The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy.

The use of adjuvant radiation therapy in breast cancer patients treated with mastectomy and adjuvant chemotherapy has been controversial. In order to assess the necessity and effectiveness of adjuvant radiation therapy in this setting, we reviewed the results in 510 patients with T1-T3 tumors and pathologically positive nodes or tumors larger than 5 cm and negative nodes who were treated with adjuvant chemotherapy. Patients with four or more positive nodes or at least one positive apical node were randomized to receive either five or ten cycles of cyclophosphamide/Adriamycin (Adria Laboratories, Columbus, OH) (CA) and patients with one to three positive nodes or operable tumors larger than 5 cm and pathologically negative nodes were randomized to receive eight cycles of either cyclophosphamide, methotrexate, and 5-fluorouracil (5-FU) (CMF) or methotrexate and 5-FU (MF) chemotherapy.

Primary radiation therapy for locally advanced breast cancer.

The optimal local-regional treatment for patients with Stage III breast cancer has not been determined. To evaluate the effectiveness of radiation therapy as local treatment for such patients, the results of 192 patients (five with bilateral disease) treated with radiation therapy without mastectomy between July 1, 1968 and December 31, 1981 were reviewed. Excisional biopsy (gross tumor removal) was performed in only 54 of the 197 breasts.

Craniopharyngioma in an elderly patient.

Craniopharyngioma, a tumor most commonly diagnosed in the young, may occur at any age. The oldest patient known to have histologic documentation of a craniopharyngioma, an 82.5-year-old woman, presented with visual field changes, panhypopituitarism, and mental status changes.

Long-term survival in peritoneal mesothelioma. The role of radiotherapy and combined modality treatment.

Ten patients with peritoneal mesothelioma were treated at the Joint Center for Radiation Therapy between 1968 and 1985. Six of the ten patients remained free of disease at 19+ to 78+ months after diagnosis. The six patients received sequential surgical debulking, combination chemotherapy, and whole-abdomen irradiation.

Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy.

Gross excision of the tumor followed by radiotherapy is used for treatment of early breast cancer. Local recurrence after this form of treatment is uncommon except in patients with infiltrating ductal carcinoma whose excision specimens reveal an extensive intraductal component (EIC). It is unclear whether this observation is due to a qualitative difference in the response of tumors with EIC to radiation or to a quantitative difference in the tumor burden remaining after gross excision in patients with EIC.

Mammographic detection of recurrent cancer in the irradiated breast.

Recurrence of cancer in the irradiated breast is an uncommon but potentially curable problem. Posttreatment mammograms were studied in 45 patients who had biopsies of an irradiated breast for suspected local recurrence to evaluate the usefulness of mammography in detecting such recurrences. Of 23 biopsy-proven recurrences, eight (35%) were detected by mammography only, nine (39%) were detected by physical examination only, and six (26%) were detected by both.

Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy.

Edema of the arm can be a significant complication following treatment of breast cancer. To determine the risk of arm edema and factors associated with this risk in patients treated with primary radiotherapy, we reviewed the records of 475 women with early breast cancer treated between 1968 and 1980. During this period, the use of axillary surgery prior to radiation gradually increased, and all patients received full axillary irradiation until late in the series.

Emergency prebiopsy radiation for mediastinal masses: impact on subsequent pathologic diagnosis and outcome.

From 1968 to 1983, 19 patients were treated at the Joint Center for Radiation Therapy for symptomatic mediastinal masses before a biopsy was obtained. This study evaluates the impact of radiation on the ability to establish a pathologic diagnosis and the results of subsequent empirical therapy if no diagnosis was established. Eight of the 19 (42%) patients were not able to have a histologic diagnosis established at the time of biopsy.

Intraductal carcinoma of the breast: results of treatment with excisional biopsy and irradiation.

Between 1976 and 1983, 40 women with intraductal carcinoma of the breast without invasion underwent excisional biopsy and irradiation as an alternative to mastectomy. The median age was 53 years (range, 28 to 77 years) and the median follow-up time since initiation of radiation was 44 months (range, 14 to 97 months). Twenty-seven patients presented with a palpable mass; in 13 patients the tumor was detected only by mammography.

Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage.

Primary radiation therapy has become an accepted alternative to mastectomy for patients with early breast cancer. In order to improve the results of this treatment, we performed an analysis of failure on 366 clinical Stage I or II invasive breast carcinomas treated with primary radiation therapy. With a median follow-up of 52 months, there have been 30 recurrences in the treated breast, for a 5 year actuarial local recurrence rate of 9%.

Breast relapse following primary radiation therapy for early breast cancer. II. Detection, pathologic features and prognostic significance.

In order to define better the nature of breast relapse following primary radiation therapy for early-stage invasive breast cancer, we examined the clinical patterns, methods of detection, histopathology and prognosis in 25 patients. Eighty-eight percent of these relapses occurred in the vicinity of the original tumor at an average of 33 months after treatment. Twelve percent occurred in a location distinctly separate from the primary tumor area at an average of 75 months after treatment.

Current status of conservative surgery and radiotherapy as primary local treatment for early carcinoma of the breast.

Since it is now recognized that breast cancer is commonly a systemic disease at presentation, it is clear that local treatment is limited to providing local tumor control, and that effective systemic therapy is required for the eradication of micrometastatic disease. We here review the current status of conservative surgery and radiotherapy in the treatment of early breast cancer. Results from retrospective studies support the view that this combination is highly effective in achieving local control and maintaining good cosmetic results.

Time course and prognosis of local recurrence following primary radiation therapy for early breast cancer.

The frequency, time course, and prognosis of local recurrence following primary radiation therapy in 152 patients with early breast cancer treated before 1967 were examined. Local recurrence occurred at a constant rate over the first 14 years after treatment. The crude 15-year local recurrence rate was 22%.