Twelve years' experience with irradiation as the primary treatment for breast cancer

Ninety patients received comprehensive, high-dose, supervoltage teletherapy as the primary treatment for carcinoma of the breast, following a biopsy or a segmental resection. The tumor doses delivered to the breast ranged between 5600 and 7000 rad in six to nine weeks; the draining lymph nodes received tumor doses of 5000 to 7000 rad in six to eight weeks. In five cases, Iridium-192 implants were employed to boost the radiation dose to the breast, and in seven instances a toilette mastectomy was performed for residual cancer. Satisfactory local control and cosmetic results were achieved in 86 patients. The patients were followed for 2 1/2 to 12 1/2 years. The local control rates were: Stage I, 100%, Stage II, 95%; Stage III, 100%; Stave IV (M-0), 89%; Stave IV (M-1), 100%. The overall disease-free survival figures were: Stage I, 85%; Stage II, 48%; Stage III, 50%; and Stage IV (M-0), 29%. We feel that this approach to the initial management of breast cancer is a practical, useful, and successful substitute for mastectomy when medical or surgical contraindications exist, or when the patient refuses a mastectomy