Conservative management in breast tumors more than 3 cm in diameter: A 10-year follow-up period for 275 patients

We have investigated the possibility of conservative breast surgery in tumors greater than 3 cm in diameter. A series of 303 patients with tumors larger than 3 cm in diameter (T2 > 3 cm, T3, N0, N1a, N1b, M0) underwent a radiotherapeutic induction treatment. Ten weeks after the end of the radiotherapy, we eliminated 28 patients whose tumors remained larger than 3 cm in order to limit the study to a group of 275 patients having tumors smaller than 3 cm after radiotherapy. The surgery carried out on all these patients was tumorectomy with a sufficient safety margin and pathologically negative section. Postoperative adjuvant treatments were decided upon according to hormonal receptors, age of the patient, and nodal status. The mean follow-up period was 13 years (ranging from 5 to 18 years). The rate of tumoral sterilization was 25.8%. The rate of local recurrence was 6.2%: 5.4% for stage T2f tumors between 3 and 5 cm in diameter and 8.6% for stage T3 tumors. The 17 local recurrences were locally controlled by salvage mastectomy. Overall survival was 76.19% at 5 years, 57.14% at 10 years, and 53.97% at 15 years. Disease-free survival was 76.19% at 5 years, 50% at 10 years, and 27.08% at 15 years. Disease-free survival at 10 years was significantly influenced by the size of the breast tumor and the degree of axillary node invasion: T2f, 65.7%; T3, 37.2%; T2fNminus;, 71%; T2fN+, 60.5%; T3N−, 45.4%; T3N+, 25.1%. The overall and disease-free survival rates at 5 and 10 years are not statistically different with relation to tumor location, histological grade, age, menopausal status, or presence or absence of adjuvant treatment. Our results suggest that preoperative radiotherapy for tumors greater than 3 cm in diameter allows breast preservation with satisfactory local control and cosmetic results compared with mastectomy. Radiat Oncol Invest 1996;4:83–89. © 1996 Wiley-Liss, Inc.