Selecting patients for breast conservation without radiation therapy

The majority of breast cancer patients treated with breast conservation without adjuvant radiation therapy do not develop local recurrences. We reviewed the results of breast conservation by the senior author for 198 consecutive cancers, 109 treated without radiation therapy, in order to identify patients at an acceptable risk of local recurrence treated without radiation. Using multivariate analysis, only stage was significantly (p = 0.014) related to distant disease-free survival. No single variable was significantly related to the risk of local recurrence, although radiation therapy was of borderline significance (p = 0.076). None of the 29 patients over 50 years of age with cancers measuring less than 1 cm in diameter removed by segmental resection or quadrantectomy (20 of 29 without radiation) developed a local recurrence compared to 16% of the remaining patients. This study indicates that it is possible to select patients for breast conservation without adjuvant radiation therapy at an acceptably low risk of local recurrence.