Excisional biopsy, axillary node dissection and definitive radiotherapy for stages I and II breast cancer

From 1977 to 1982, 189 patients with clinical Stage I and II breast cancer underwent excisional biopsy and axillary node dissection followed by definitive radiotherapy at the University of Pennsylvania. One hundred and nine patients had T 1 lesions and 80 had T 2 lesions. Histologically negative nodes were found in 136 patients (72%) and histologically positive nodes in 53 patients. Seventy-four percent of those with positive nodes had 13 positive nodes. Median follow-up from the completion of radiotherapy was 26 months. The cumulative probability of local-regional failure only at 48 months is 5%. The incidence of local recurrence was unrelated to T stage or nodal status. Regional failure was unrelated to T stage, but appeared more frequently in node positive patients. Three patients have died, two of disease and one of an unrelated cause. Ten patients are alive with disease. The four year actuarial disease free survival is 82% for pathologic Stage I (T 1 pathologic N 0 and 70% for pathologic Stage II (T 1 pathologic N 1, T 2 pathologic N 0 or N 1). Cosmesis was judged to be good to excellent in 90% and fair in 9%. Complications included arm edema (7%), symptomatic pneumonitis (1%), rib fractures (1%), pericarditis (1%) and pleural effusion (1%). No patient experienced a brachical plexus injury. Primary radiotherapy for Stages I and II breast cancer produces a local-regional control rate of 95% and good to excellent cosmesis in 90% of the patients. While these results are preliminary, they compare favorably with other reported series.