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A series of 138 mucinous breast carcinomas was treated at the Institut Curie from 1970 to 1980: 107 were diagnosed as "pure" mucinous carcinoma and 31 as "mixed" mucinous carcinomas. Fifty per cent of the cases were stage T2 and 78% N0-N1a. Treatment methods were radical mastectomy in 113 cases (82%) with pre-operative irradiation for 37 patients and post-operative irradiation for 14 patients. A conservative treatment was used for 25 patients, consisting either of lumpectomy followed by radiotherapy (in 15 cases) or radiotherapy alone (in 10 cases). The five-year actuarial survival rate was 81% for the "pure" group and 87% for the "mixed" group; it was 70 and 75%, respectively, at ten years follow-up. In this series, survival was not influenced by the type of treatment. The efficacy of radiotherapy was evaluated from the local recurrence rate: only four local failures among the 25 conservative treatments were noted. Our conclusion is that radiotherapy, with or without lumpectomy, is efficient in mucinous breast carcinoma and could be useful in selected cases.

67 patients with tumors 3 cm or less and with negative axilla, who had lumpectomy and radiotherapy, and 122 patients with larger tumors or clinically positive axilla, who had radical radiotherapy without prior lumpectomy, were evaluated at five years to determine the optimum dose for local control. 7000 rad in seven to eight weeks controlled 85% of lumpectomy cases, whereas 8000 rad in 81/2 weeks were required to control two-thirds of cases treated by radical irradiation alone. Subclinical (N0, N1a) and clinical disease (N1b) in the axilla was controlled, in a very high percentage, when 6000 and 7000 rad were delivered, respectively. Dose response curves were obtained for clinical disease in the breast and axilla. No such response was elicited for subclinical disease. Undifferentiated cancers had higher recurrence rates than well differentiated tumors. Radiation fibrosis in lumpectomy cases was insignificant, whereas 10% of radically irradiated patients had fibrosis of the breast.

Seventy-seven patients with inflammatory breast carcinoma were included in a randomized trial between march 1977 and september 1979. All patients were treated with the same association of chemotherapy and radiation therapy. Chemotherapy included adriamycin on day 1 (45 mg/m2), vincristine on day 2(1,2 mg/m2), cyclophosphamide on days 3, 4 and 5 (400 mg/m2/day) and 5 fluoro-uracil on days 3, 4, and 5 (500 mg/m2/day). Each course of chemotherapy was repeated every 28 days for one year. Patients were then given a maintenance course of chemotherapy for one year. Radiation therapy with CO60 was applied after 4 courses of intensive chemotherapy. The dose distributed was 70 Gy over seven weeks. During radiation therapy, chemotherapy was administered according the same scheme, but adriamycin was excluded. All the patients were randomly distributed into two groups before treatment: group I patients received chemotherapy and radiation therapy alone; group II patients received chemotherapy and radiation therapy plus living BCG vaccinations. After chemotherapy, inflammatory manifestations disappeared in 51% of cases. The mean of disease-free interval was 26 months and the overall survival mean 34 months. No difference in favor of the BCG treated group was noted. Lymph node involvement, age, hormonal status, response to tuberculin, and disappearance of inflammatory signs after 4 months of chemotherapy are of insignificant prognostic value.