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Breast Cancer Importance of Adequate Surgical Excision Prior to Radiotherapy in the Local Control of Breast Cancer in Patients Treated Conservatively

Nametallah A. Ghossein, MD; Seymour Alpert, MD; Jose Barba, MD; Peter Pressman, MD; Patricia Stacey, RT; Eileen Lorenz; Mirela Shulman, MS; Gurmukh J. Sadarangani, MD
Arch Surg. 1992;127(4):411-415. doi:10.1001/archsurg.1992.01420040053009.
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• The extent of excision performed for mammary carcinoma prior to radiotherapy as a risk factor for local recurrence was studied in 503 patients. Three hundred twenty-three tumors (62%) were excised with a minimal rim of tissue (tumorectomy). One hundred forty-two patients (27%) had wide excision and 56 (11%) had quadrantectomy. Tumor stage, size, and radiation treatment were similar for all groups. Forty-one percent of tumorectomies had involved margins, and only 14% and 7% were involved in the wide excision and quadrantectomy groups, respectively. Local failure was 15% for tumorectomy, 7% for wide excision, and 5% for quadrantectomy. In T1 ductal carcinoma, only 4% of those with excisions greater than 5 cm had recurrences. Lesser excision had 20% recurrence. Extent of excision before radiotherapy is an important risk factor for recurrence. Failure was inversely proportional to the amount of breast tissue resected. Narrow excision should be discouraged since a larger tumor burden remains that may not be sterilized by radiation.

(Arch Surg. 1992;127:411-415)


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