Biopsy and definitive radiation therapy in Stage I and II adenocarcinoma of the female breast: analysis of cosmesis and the role of electron beam supplementation.

The cosmetic and functional outcome in 130 patients with Stages I and II carcinoma of the breast treated by biopsy and radiation therapy were evaluated. The cosmetic outcome was excellent in 107 patients (82%), acceptable in 17 patients (13%), and unacceptable in six patients (5%). Complete axillary dissection (CAD) was more morbid than limited axillary dissection (LAD) as a means of preradiotherapy staging of the axilla. The former was more often associated with breast edema, hematoma formation, and subsequent development of arm edema than the latter. A multivariate analysis revealed that the four most dominant variables associated with the attainment of an excellent cosmetic outcome were: 1) the performance of a conservative biopsy procedure; 2) small breast size (cup size A and B); 3) the use of electron energies equal to or less than 12 MeV; and 4) the presence of primary tumors less than or equal to 4 cm in diameter when adjusted for breast size. Postexternal beam supplementation to the area of the primary tumor was accomplished with electrons in 107 patients (82%) and with interstitial implantation in 23 patients (18%). Excellent cosmetic results were achieved in 97 of the 107 patients (91%) treated with electrons. The use of electrons appears to produce local control and cosmesis equal to that of interstitial implantation if specific indications and guidelines are followed, and is superior to implantation in certain clinical settings.