An analysis of the role of radiotherapy alone and in combination with chemotherapy and surgery in the management of advanced breast carcinoma.

One hundred-eight consecutive patients with Stage III breast carcinoma received radiotherapy as the primary method of treatment. Of these, 53 had prior chemotherapy and 47 had a postirradiation mastectomy as planned adjunct modalities. The overall actuarial survival probability is 40 +/- 6% at five years and 14 +/- 6% at ten years. The corresponding probabilities of freedom from metastases are 27 +/- 5% and 14 +/- 5%, while those of local control are 58 +/- 8% and 52 +/- 8% respectively. The patients receiving chemotherapy show both increased five and ten year probabilities of metastatic control of 38 +/- 7% and 22 +/- 8% and also a five and ten year local control rate of 73 +/- 8%. The patients with additional mastectomy exhibit an improved five year local control rate of 80 +/- 8% but the probability of remaining free from metastatic disease is unaltered being 31 +/- 7% at five and 12 +/- 7% at ten years. The 23 patients receiving chemotherapy prior to radiotherapy, without a subsequent mastectomy have the highest metastatic control of 41 +/- 12% at five years. In this group, eight patients treated with time-dose factors (TDFs) of over 80 have had only one local failure with a preliminary five year local control probability of 80 +/- 18% and metastases-free rate of 58 +/- 19%. Based on these results recommendations are made for minimum tumor doses of 6000 rad and adjuvant chemotherapy. This should be delivered before radiotherapy, since with this sequence of treatment both local control and survival are improved.