Early breast cancer: significance and effectiveness of local control by conservative surgery and primary radiation therapy.

The significance of local-regional control in patients with early breast cancer is examined in the light of data from recent studies. Information from prospectively randomized studies assessing early detection, surgical and radiation therapy procedures, and adjuvant systemic therapies, supports the importance of achieving optimal local-regional control. In most patients effective local control can be achieved without removal of the breast. Wide excision of the primary tumor, axillary dissection and radiation therapy, result in good local control and survival rates that are equal to those achieved with radical mastectomy. The historical development of alternatives to mastectomy is described. Recent data from retrospective and prospective randomized studies evaluating the effectiveness of limited surgery and primary radiotherapy are reviewed and analyzed.