The second ten years: long-term risks of breast conservation in early XXXX .

@entity1 @entity0 @entity242 @entity5 @entity3
A retrospective cooperative study was undertaken to analyze the fate of 300 clinical @entity0 @entity1 who were alive and apparently cured with both breasts preserved, 10 years following primary limited surgery with irradiation. All @entity1 had been treated by @entity5 excision, with or without axillary dissection, followed by megavoltage radiation therapy. Follow-up ranged from 10.5 to 26 years, median 14.5 years. The overall actuarial survival (Kaplan-Meier) of the 300 "cured" @entity1 was 86% at 15 years and 78% at 20 years, with 38.5% of deaths attributable to @entity0 . The actuarial probability of remaining free of @entity3 was 91% at both 15 and 20 years, independent of age or clinical stage. Sixteen @entity1 (5.3%) developed recurrent @entity5 in the treated breast beyond the tenth year, the actuarial probability of remaining free of breast recurrence being 94% and 90% at 15 and 20 years, respectively. Contralateral @entity0 developed during the second decade in 5 @entity1 , with a cumulative risk of 6.5% at 20 years. Significant treatment-related problems appeared during the second decade in 5 @entity1 , including one chest wall @entity242 ; all of these @entity1 had received at least 60 Gy to breast and regional nodal areas. A comparison of these results with those in the literature allowed the following conclusions to be drawn: (a) the risk of death, as well as @entity0 mortality during the second decade, are similar for both conservatively and radically treated @entity1 with @entity0 ; (b) the risk of @entity0 is not greater than that observed following primary radical surgery without radiation therapy; (c) ipsilateral breast "recurrences" continue to occur at about 1% per year during the second decade. Such late recurrences are highly operable and have a favorable prognosis; (d) late progression of treatment-related sequelae is uncommon. This analysis supports the continued use of breast-conserving surgery with radiation therapy in the treatment of @entity0 .
