Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of XXXX .

@entity1 @entity5 @entity204 @entity0
BACKGROUND: In 1976, we initiated a randomized trial to determine whether lumpectomy with or without radiation therapy was as effective as total mastectomy for the treatment of @entity0 . METHODS: A total of 1851 @entity1 for whom follow-up data were available and nodal status was known underwent randomly assigned treatment consisting of total mastectomy, lumpectomy alone, or lumpectomy and breast irradiation. Kaplan-Meier and cumulative-incidence estimates of the outcome were obtained. RESULTS: The cumulative incidence of @entity5 in the ipsilateral breast was 14.3 percent in the @entity1 who underwent lumpectomy and breast irradiation, as compared with 39.2 percent in the @entity1 who underwent lumpectomy without irradiation (P<0.001). No significant differences were observed among the three groups of @entity1 with respect to disease-free survival, distant-disease-free survival, or overall survival. The hazard ratio for @entity204 among the @entity1 who underwent lumpectomy alone, as compared with those who underwent total mastectomy, was 1.05 (95 percent confidence interval, 0.90 to 1.23; P=0.51). The hazard ratio for @entity204 among the @entity1 who underwent lumpectomy followed by breast irradiation, as compared with those who underwent total mastectomy, was 0.97 (95 percent confidence interval, 0.83 to 1.14; P=0.74). Among the lumpectomy-treated @entity1 whose surgical specimens had @entity5 -free margins, the hazard ratio for @entity204 among the @entity1 who underwent postoperative breast irradiation, as compared with those who did not, was 0.91 (95 percent confidence interval, 0.77 to 1.06; P=0.23). Radiation therapy was associated with a marginally significant decrease in deaths due to @entity0 . This decrease was partially offset by an increase in deaths from other causes. CONCLUSIONS: Lumpectomy followed by breast irradiation continues to be appropriate therapy for @entity1 with @entity0 , provided that the margins of resected specimens are free of @entity5 and an acceptable cosmetic result can be obtained.
