Clinical Analysis of Patients with Early-Stage Breast Cancer Treated by Breast-Preserving Surgery or Modified Radical Mastectomy

ABSTRACT

Recently, a combination of a partial mastectomy, axillary dissection, and radiation has been accepted as therapy for early-stage breast cancer because various significant trials have demonstrated that the combination therapy and the radical mastectomy produce comparable actuarial survival rates. The authors reviewed the cases of 62 patients who were treated for stage I and II breast cancer, 22 with breast-preserving surgery (quadrantectomy, axillary dissection and latissimus dorsi myocutaneous flap) and 40 with a modified radical mastectomy at Pusan National University Hospital during the period of 2.5 years from January 1994 to June 1996. The results are as follows 1) The mean age of the breast-preserving group was 44.8 years, and that of the modified radical mastectmy group was 51.2 years. 2) The mean size of tumor mass was 2.1 cm and 2.5 cm, respectively. The most frequent site was the upper outer quadrant in both groups. 3) According to TNM classification, 8 patients (36.4%) had stage I tumors and 12 patients (54.5%) had stage II tumors in the breast-preserving group. The respective numbers of patients were 8 (20.0%) and 31 (77.5%) in the modified radical mastectomy group. 4) In the breast-preserving group, the number of axillary lymph-node metastasis was 0 in 16 cases (72.7%), 1~3 in 5 cases (22.7%), and 4 in 1 case (4.6%). In the modified radical mastectomy group, the number was 0 in 23 cases (57.5%), 1~3 in 13 cases (32.5%), and 4 in 4 cases (10.0%). 5) In the breast-preserving group, a local recurrence developed in one case at 12 months after the operation, and a salvage mastectomy was done. In the modified radical mastectomy group, a local recurrence developed in two cases, one at 14 months and the other at 16 months after the operation, and a wide excision was done. 6) Complications associated with axillary dissection were impaired arm mobility, arm edema, seroma, and skin necrosis. However, complications were well treated with no difficulty. 7) The overall subjective cosmetic results in the breast-preserving group were excellent in 7 cases (31.8%), good in 12 cases (54.1%), fair in 3 cases (13.7%), and poor in 0 cases. Postoperative asymmetry of the nipple is a problem to be solved. 8) The fear of recurrence was observed in 10 cases (45.5%) in the breast-preserving group and in 18 cases (45.0%) in the modified radical mastectomy group. 9) The complications associated with radiotherapy in the breast-preserving group were transient radiation dermatitis, breast fibrosis, radiation pneumonitis, and limited motion of shoulder. Our review shows a high loco-regional control rate (95.5%) and a satisfactory cosmetic result (86.3%) in the breast-preserving group for early-stage breast cancer. Thus breast-preserving procedures seem to be acceptable alternatives to a modified radical mastectomy in highly selective group of patients with early-stage breast cancer.