Radiotherapy following breast-conserving surgery

A. L. Appleton

Genolier, Sénologie, Geneva, Switzerland (E-mail: appleton@cdg.ch)

I read Chung and Cady’s letter urging caution with repeat sentinel node biopsy [1] with some alarm. Surely the other pertinent point that this case illustrates is the imperative to irradiate the breast following breast-conserving surgery, a procedure now accepted as standard, to reduce local recurrence in the remaining breast tissue [2]. The patient reported in this case did not receive radiotherapy to the breast following wide local excision, despite this being a standard procedure, and 20 months after diagnosis she presented with local recurrence. As the authors themselves state, local recurrence is an indication that the patient is at risk of systemic disease [3, 4], and indeed 10 months later, this 48-year-old patient with a T1a tumour presented with lung and liver metastases. This is clearly a very poor outcome for all concerned. Whilst the role of radiotherapy following mastectomy for histologically high-grade but node-negative breast cancer remains controversial, its use following breast-conserving surgery, even in seemingly low-risk women such as the patient described, is clear, and this unfortunate case clearly illustrates this point.

A. L. AppletonUnité de Sénologie, Clinique de Genolier, near Geneva, Switzerland, CH-1272 (E-mail: appleton@cdg.ch)

References

1. Chung MA, Cady B. Caution urged with repeat sentinel lymph node biopsies. Ann Oncol 2002; 13: 1951.[Free Full Text]

2. Morris AD, Morris RD, Wilson JF et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival. Cancer J Sci Am 1997; 3: 6–12.[ISI][Medline]

3. Vicini FA, Kestin L, Huang R, Martinez A. Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer 2003; 97: 910–919.[CrossRef][ISI][Medline]

4. Meric F, Mirza NQ, Vlastos G et al. Positive surgical margins and ipsilateral breast tumour recurrence predict disease-specific survival after breast-conserving therapy. Cancer 2003; 97: 926–933.[CrossRef][ISI][Medline]





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