Conservative treatment of breast cancer in Europe: report of the Groupe Européen de Curiethérapie

Abstract

These two meetings organised successively to discuss the conservative methods of treatment of breast cancer, made it possible to gather data on a substantial number of patients from an important number of European centers. It is encouraging to note that there is a general consensus among the various European centers concerning the basic principles of treatment and that long years of experience have led to the use of well defined technical protocols which are relatively similar from one center to another. Since serious complications have now become exceptional, we foresee that the conservative treatment of breast cancer will continue to evolve on a technical level as the indications for this approach continue to develop within the overall plan of patient care with the assurance that optimum results may be maintained. However, we must point out that the lack of a unified system of reporting irradiation doses in volumes corresponding to the possible and/or real extension of the tumor remains an obstacle in developing a truly unified attitude in the application of these techniques. Each center defines the radiation dose given by wide field techniques and the dose given by cone-down (boost) techniques in a relatively arbitrary way without true anatomic correlations. These correlations must be found and defined, so that a specified dose has a universal meaning. The role of the surgeon in the successful application of breast conserving techniques is far from negligible. Now that our colleagues who wield the scalpel have begun to gain confidence in the curative powers of irradiation, we may hope that a close collaboration between radiotherapist and surgeon will lead to the application of conservative techniques under optimal conditions in the breast, with the development of minimal tumorectomy and minimal curative cone-down dose; and in the axilla, with the development of axillary dissection limited to the lower border of the pectoralis minor and followed by radiation therapy only if more than two nodes show tumor involvement. However, it is important to point out that while it is possible to use radiation therapy alone to treat breast cancer and conserve the breast at all stages of the development of the disease, it is not possible to use conservative surgical techniques alone as a substitute for adequate irradiation. The development of protocols which routinely apply breast conserving methods in synonymous with the development and routine use of the best radiation therapy techniques. This article presents two separate and complementary studies of two different sets of data presented at two successive meetings.(ABSTRACT TRUNCATED AT 400 WORDS)