Results of treating 1,178 patients with breast cancer by radical mastectomy and postoperative irradiation where metastases to axillary lymph nodes occurred.

A retrospective study of 1,178 females suffering from cancer of the breast and treated by radical mastectomy is presented. All operations were performed by essentially one group of four senior surgeons, each either trained or connected with Memorial Sloan Kettering Hospital in New York and spent practically all of his professional career in the treatment of cancer. The same techniques of surgery were practiced. The same principles of the overall treatment were utilized; namely, if there were no metastases to lymph nodes detected on histologic studies, no radiation therapy was given. If metastases were present in the axillary lymph nodes, each of the patients received postoperative radiation therapy. None received either chemotherapy nor immunotherapy, as primary treatment. The study includes all patients treated between 1930 and 1965 and complete follow-up data were obtained in 94.6% of all patients. Five hundred and ninety-six patients were classified histologically as Stage I (50.6%), 291 as Stage II (24.7%), 74 as Stage III (6.3%), and 217 patients (18.4%) were undetermined. The total number of patients who developed a second primary cancer in the remaining breast was 91 (7.7%), and only 51 patients (4.3%) developed local recurrences in the chest wall or axilla. The mean age of the patients was 51.9 years. The absolute 5-year survival of all patients was 64% and the 10-year survival equaled 54.6%. The 9.4% mortality between the 5- and 10-year survival emphasizes that the 10-year survival figures are a more accurate index of survival. The larger the tumor, usually the poorer the prognosis, except where the tumor was 8 cm or larger where the prognosis was rather good. This indicates some biologic resistance to the tumor, making patients with large tumors candidates for "curative" radical mastectomy. The delay in seeking treatment had minimal effect on the overall survival. Staging had a significant effect and the 5-year survival for the Stage I group was 81.7% which declined to 60.3% at the 10-year period. In the Stage II group, these values were less and averaged 63.7% 5-year survival and 47.2% 10-year survival. The 74 patients wiival at the 10-year period. It is concluded that radical mastectomy plays an important role in curing a significant number of patients with breast cancer. Whether it should be abandoned for more conservative surgery is a matter which further studies will indicate. This study presents a baseline investigation, under a more-or-less standard clinical situation for evaluating the accomplishments of the radical mastectomy.