Conservative treatment of early breast cancer: long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy

Today, approximately 40 percent of all treated cases of breast cancer involve small (less than 2 centimeters, or three-quarters of an inch) tumors. This is due to early detection, and has resulted in development of techniques designed to save as much of the breast tissue as possible. In 1981, results were reported using the QUART technique, which is conservative surgery involving excision of only that quadrant of the breast which contains the tumor, removal of the lymph nodes in the axilla, and radiation therapy. These results showed survival rates using the QUART technique that were comparable to those of patients who had undergone radical mastectomy (removal of the entire breast, underlying muscle, axillary lymph nodes and all adjacent fat, fascia and other tissue). Results are reported in this article of 1,232 women with cancerous tumors of less than 2 cm who were treated with QUART therapy. The overall survival rate at five years after surgery was 91 percent, and at 10 years, 78 percent. Probability of survival tended to decrease as the size of the tumor increased; the seven-year survival for patients with tumors 1.6 to 2 cm was 84 percent, compared with 94 percent for patients with tumors under 0.5 cm. Patients who had more than one lymph node involved in the cancer process showed a lower probability of survival (79 percent at seven years). There were 45 cases of cancer that developed in the opposite breast during the period of follow-up (averaging 72 months). The incidence of recurrence in the QUART-treated breast was 2.8 percent (35 patients), and the incidence of a new primary tumor in that breast was 1.6 percent (19 patients). These patients underwent a second operation; five died and 49 are still alive. The low rate of recurrence in the QUART-treated breast is remarkable. It appears that local recurrence after QUART does not have as great an affect on long-term survival as does local recurrence following more traditional surgery. The heavy irradiation of the breast does not appear to have increased the risk of new cancers within 10 years of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)