Evidence Based

For invasive breast cancerBCT is Tumor excision, axillary node

dissection, whole breast radiationModified mastectomy is total

mastectomy and axillary node dissection

BCT = Modified Mastectomy, in both Recurrence and OS

Recurrence

BCT 1-2%/yr - Recurrence is in-breast, 80 % in primary treated field, 20% new primary or regional

Post mastectomy - Recurrence is chest wall The recurrences are different biologies, and

etiologies The type of recurrence for BCT is eliminated

by mastectomy The type of recurrence for mastectomy is

eliminated by radiation therapy

Recurrence

Since these recurrence “rates” are approximately equal, the treatment successes look the same.

But if you add radiation to mastectomy then there will be a gain in overall survival, i.e. Mastectomy+Rad is superior to BCT, most effect with node positive. Gain of >5% at 15 years.

Radiation

Partial breast radiation Eliminates treatment of “out of field” cancers

known to exist in 20-40% Provides a shell of inadequate therapeutic

radiation ideal for induction of cancer. It should fail to treat each of the distinct risk

issues unique to BCT and Mastectomy Predicts an increase in late failures

Effect of radiotherapy after breast-conserving surgery (10 trials of BCS RT) on local recurrence and on breast cancer mortality

6097 women with node-negative disease

Effect of radiotherapy after breast-conserving surgery (10 trials of BCS RT) on local recurrence and on breast cancer mortality

1214 women with node-positive disease

Effect of radiotherapy after mastectomy and axillary clearance (25 trials of Mast+AC RT) on local recurrence and on breast cancer mortality

1428 women with node-negative disease

Effect of radiotherapy after mastectomy and axillary clearance (25 trials of Mast+AC RT) on local recurrence and on breast cancer mortality

8505 women with node-positive disease

Effect of radiotherapy on breast cancer mortality and on all-cause mortality after mastectomy with axillary clearance (Mast+ACRT)

8505 women with node-positive disease

Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in all women

(9933 women, 86% with node-positive disease)

Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in women with node-negative disease

(1428 women)

Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in all women with node-positive disease

(8505 women, many with the actual number of involved nodes unknown)

Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in women with 1-3 involved lymph nodes (pN1-3)

(1890 women)

Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in women with 4 or more involved lymph nodes (pN4+)

(1868 women)