ABSTRACT
In 1976, Fisher et al. began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of stage I and II breast tumours up to 4 cm in size. The operation removed only sufficient tissue to ensure that margins of resected specimens were free of tumour. Women were randomly assigned to total mastectomy, segmental mastectomy alone or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant disease-free and overall survival at 5 years that was no worse than after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (p 0.04) and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (p 0.07 and 0.06, respectively). A total of 92.3% of women treated with radiation remained free of breast tumor at 5 years, as compared with 72.1% of those receiving no radiation (p 0.001). Among patients with positive nodes, 97.9% of women treated with radiation and 63.8% of those receiving no radiation remained tumour-free (p 0.001) although both groups received chemotherapy. Fisher et al. concluded that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes is appropriate therapy for stage I and II breast tumours up to 4 cm in size, provided that margins of resected specimens are free of tumour.
