[Symposium on the management of early breast cancer (stages I and II). Part II: Clinical experience with treatment methods. 2. Conservative surgery followed by cobalt therapy in the treatment of breast cancer].

At the Institut Curie in Paris 452 invasive breast cancers (T1 and T2 less than 3 cm in diameter) were managed conservatively. The patients were treated by "conservative" surgery with or without axillary dissection. All received radiotherapy postoperatively. The 5-year survival without evidence of disease was 86% (249 cases). The survival at 10 years was 77% (93 cases). These statistics are comparable to those obtained by total mastectomy with axillary clearance. The local recurrence rate was 14.5%, most of these patients being "curable" by radical surgery. There was evidence of isolated axillary node metastases in only 2% of the patients. Radiotherapy is therefore effective in treating subclinical node invasion which was observed in 30% of axillary specimens. The cosmetic results were satisfactory in 80% and complications were rare. Follow-up of these patients is difficult and must be rigorous including clinical examination and mammography and, in case of doubt, cytology by aspiration or "Tru-cut" biopsy. The authors conclude that this conservative method, in addition to its cosmetic and emotional advantages, allows us to treat with as much security as radical surgery, the early cancers of the breast (T1 and T2 less than 3 cm in diameter), with no clinically suspicious node metastases.