Postoperative Radiotherapy of Breast Cancers

Abstract

Listen

Translate article

In general, five-year statistics tend to establish the value of postoperative radiotherapy in cancer of the breast. Especially in cases beyond Stage I (Steinthal) the procedure may be looked upon as imperative. For comparable statistical results, identical record systems and adequate follow-up are essential. Unfortunately the record systems employed in different countries vary widely and follow-up is hampered by the fact that patients can with difficulty be persuaded to report for re-examination when they are feeling well. Usually they return only when they experience discomfort. Particularly is it difficult to control those who live at a distance from therapeutic centers, who may constitute a considerable proportion of those treated. Thus, of 609 patients seen in Istanbul, only about one-third came from the city itself, and many of these were temporary residents. The figures, which have no geographic significance except as they are proportional to the density of the population, are as follows: The present report is based upon 654 cases sent by various clinics to the Istanbul Institute for treatment between 1936 and 1946. Of these patients, 646 were women; 8 were men. Here only the female patients will be considered. The age range was from the third to the ninth decade; 289 of the women were in the premenopausal and 357 in the postmenopausal period. In 108 castration had been effected by irradiation and these will be the subject of another report. The object of postoperative radiotherapy in mammary carcinoma is to prevent local recurrences. Creyssel and Morel found that the incidence of recurrence and metastasis after operation was about 73 per cent. Of our series, 343 were referred for treatment of recurrent or metastatic growths, as compared to 303 receiving postoperative radiation therapy. Clinical observations throughout the world have indicated the danger of recurrence or metastasis following surgery for breast cancer, from the first few weeks after operation onward to the seventh, eighth, or even the fifteenth or twentieth year. Such recurrences are most frequently seen in the third to the twelfth month; they are relatively rare after the fifth year. The interval between operation and recurrence in our 343 cases is shown in Table I and the site of involvement in Table II. Irradiation in such cases is given for the recurrence or metastasis and is not to be considered as postoperative treatment. In 290 cases of this group, local irradiation was given, associated in 53 cases with irradiation castration. One hundred and eleven patients discontinued treatment before its completion and have not been heard from. In the remaining 179 cases, followed for six months to six years, favorable results were obtained in 134, as follows: As will be seen, 49 of these cases have been followed for two years or longer, giving a two-year recovery rate of about 27 per cent for those completing treatment.