| Popis: |
From 1963–1973, 200 women with operable breast cancer were randomized in a trial comparing two local therapy policies: 97 to the ‘radical’ policy (radical mastectomy) and 103 to the ‘conservative’ (total mastectomy and axillary node sample). The extent of local therapy also varied with axillary node histology: if node negative or no node identified — no radiotherapy (XRT) and, if node positive, radiotherapy to the chest wall and regional lymph nodes in the radical group and to the axilla alone in the conservative group. There were no differences overall either in total survival (log rank test P = 0.23) or in distant disease-free rates ( P = 0.092). The risk of loco-regional relapse favoured those radically treated ( P = 0.047). 71 patients were found to have involved nodes (4 XRT violations). Following an axillary clearance 60 were node negative and 3 had no nodes identified whilst following an axillary sample 37 were node negative and 29 had no nodes identified ( 3 29 XRT violations). Excluding the XRT violations, the distant disease free rates for these three groups were 64%, 36% and 57% and the axillary relapse rates were 1.5%, 1.6% and 16% respectively. It is concluded that the node sampling was insufficient to identify the node positive cases to the detriment of the assessment of the conservative policy. |
