Advanced Cancer of the Breast Treated Primarily with Irradiation

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Abstract
The 5-year results in 109 patients treated primarily with irradiation for cancer of the breast, mostly in the late stages, have been analyzed. In all cases, the initial intent was to control with X radiation alone the primary tumor involving the breast and its entire lymphatic drainage. Irradiation remained essentially the sole method of treatment in 84 cases. Postirradiation mastectomy was performed in the 25 other patients, who initially had been considered inoperable. The plan of treatment has consisted of a single continuous course of radiation therapy, protracted over a period of 75 to 100 days and administered in 3 closely integrated phases. Tissue doses, superficial and deep, must be brought to the highest level required for maximum biological effects within the tolerance of the structures involved. The immediate effects of irradiation alone have been remarkable. The regression of neoplastic manifestations in the breast and palpable nodes, the degree of healing of ulcerated carcinoma, and the incidence of recurrence have been recorded and assessed to determine the efficacy of treatment. The long-term results have been evaluated by the crude 5-year survival and recovery rates presented side by side. The 10-year survival rates are also indicated where applicable. Comparison of survival rates has been made between treated and untreated patients, using Daland''s series of untreated patients. The influence of certain clinical factors, such as inflammatory, ulcerated, and bilateral carcinoma, on the results of treatment has been discussed. Reactions related to radical irradiation, especially postirradiation pneumonitis and fibrosis, have been assessed. From our clinical results, together with the survival and recovery rates, it is evident that a major contribution of radiation therapy to the treatment of cancer of the breast rests in the management of advanced and inoperable cases. Considering the favorable results obtained in the few cases in this series which were treated in the early stages, one is inclined to wonder what the results might be if all patients with cancer of the breast were treated primarily with irradiation and subsequently by postirradiation mastectomy in carefully selected cases.

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