OBJECTIVE. To study the clinical outcomes of patients with invasive or non-invasive breast cancer after breast conservation treatment.

DESIGN. Retrospective study.

SETTING. Clinical oncology department of a public hospital, Hong Kong.

PATIENTS. Two hundred and three patients who received postlumpectomy radiotherapy in Pamela Youde Nethersole Eastern Hospital between January 1994 and June 1999.

INTERVENTIONS. Adjuvant radiotherapy with or without systemic adjuvant treatment.

MAIN OUTCOME MEASURES. Actuarial local control rate, progression-free survival rate, disease-specific survival rate, and cosmetic score.

RESULTS. The median follow-up of the whole group was 3.5 years. Two out of the 25 patients with carcinoma-in-situ only developed local recurrence; the 5-year actuarial local control rate was 91.3%. Among the 178 patients with invasive cancer, seven suffered local recurrence and 12 developed distant metastases without local failure. The 5-year actuarial local control, progression-free survival, and disease-specific survival rates for patients with invasive cancer were 95.5%, 85.8%, and 95.2%, respectively. The risk of local recurrence was significantly increased in younger patients (age <40 years) and those with positive final margins. Cosmetic scores were rated good to excellent by 95.6% of patients.

CONCLUSIONS. The early clinical outcomes of our patients are comparable to that in large overseas trials, which have demonstrated the equivalence of mastectomy and breast conservation treatment in terms of survival. In addition to mastectomy, with or without breast reconstruction, breast conservation treatment should be offered as an alternative in suitable Chinese women. To maximise local control, further excision or mastectomy is recommended for patients with positive final margins.

Key words: Breast neoplasms; Mastectomy; Radiotherapy

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