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| |  DG DISPATCH - ASTRO: Lumpectomy Offers Same Survival To Mastectomy In Breast Cancer Relapse By Robert H. Carlson Special to DG News SAN ANTONIO, TX -- November 2, 1999 -- Breast conserving lumpectomies have become accepted as a way to remove only the tumor (the "lump") in women with early-stage breast cancer which has not spread outside the breast. If these tumors recur in the breast, radical mastectomies are often called for as "salvage" treatment. Researchers at Yale University School of Medicine have proposed that some women with early-stage breast cancer -- who were primarily treated with radiation and breast-conserving surgery -- might do just as well after relapse if they have only a "salvage lumpectomy." Their study, presented at the 41st annual meeting of the American Society for Therapeutic Radiology and Oncology, in San Antonio, TX, Oct. 30-Nov. 3, 1999, showed that salvage treatment of the recurrence using lumpectomy was approximately equal to radical mastectomy in terms of survival. Dr. Daesung Lee of the Department of Therapeutic Radiation, Yale, said the best candidates for salvage lumpectomy are women with initial estrogen-receptor (ER) positive status, a node-negative status for the axilla, tumor size smaller than 1 cm at recurrence, and a recurrence diagnosed by mammography alone. In this retrospective study, 1152 consecutive patients were treated with conservative surgery and radiation at Yale New Haven Hospital. Dr Lee said that women with these favorable characteristics had less than a 15-percent chance of requiring radical mastectomy at the time of recurrence. "Our study showed there was no statistically significant difference in outcomes between women who had a radical mastectomy for recurrence and those who had lumpectomy, with respect to age, stage or other prognostic factors," Dr. Lee said. With a follow-up of 16 years since initial presentation and 10 years since recurrence, there have been no statistically significant differences in 10-year survival, Dr. Lee said -- 82 percent survival for salvage mastectomy versus 73 percent for lumpectomy salvage. There were also no statistically significant differences between distant metastatic survival (78 percent for mastectomy salvage, 58 percent lumpectomy salvage) or cause-specific survival (90 percent versus 78 percent).
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