Lumpectomy for breast cancer: an update of the NSABP experience. National Surgical Adjuvant Breast and Bowel Project.

The data in this report continue to indicate, as first noted in 1985, that lumpectomy followed by breast irradiation in all patients, and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for negative- or positive-node patients with tumors 4 cm or less in size, provided that the margins of the resected specimens are free of tumor. The value of irradiation in reducing the incidence of tumor in the ipsilateral breast after lumpectomy continues to be significant in all patients regardless of nodal status, age, or tumor size. A multivariate analysis indicates that, in all patients, three covariates, ie, treatment, tumors with poor histologic type, and tumors with a maximum pathologic size greater than or equal to 2 cm, are significant predictors of breast tumor recurrence following lumpectomy. Of particular significance is the continuing observation that the distant disease-free survival (DDFS) and survival (S) of patients in the three treatment groups (total mastectomy, lumpectomy alone, and lumpectomy followed by breast irradiation) demonstrate no significant difference through 9 years of follow-up, despite the fact that the total mastectomy group (by virtue of breast removal) had no breast tumor recurrence, that lumpectomy patients treated with breast irradiation had a 10% ipsilateral tumor recurrence, and that patients treated by lumpectomy alone demonstrated a 40% recurrence of tumor.(ABSTRACT TRUNCATED AT 250 WORDS)