ABSTRACT
This was a large randomized trial comparing different treatments for breast cancer and it showed no difference in survival between radical mastectomy and total mastectomy and postoperative irradiation in node-positive patients; in node-negative patients there was no difference in survival between radical mastectomy, total mastectomy with postoperative irradiation or total mastectomy followed by axillary dissection in those patients who developed clinically positive nodes. The fact that leaving nodes behind did not appear to have an adverse effect on overall survival indicates that lymph node metastases are a marker of the presence of distant metastases rather than a prerequisite and that there is not an orderly pattern of spread from primary tumour to regional nodes and then more widespread dissemination.
