Post-irradiation toilet mastectomy in the management of locally advanced carcinoma of the breast

Abstract

Many patients with locally advanced carcinoma of the breast survive for long periods. This is a preliminary report on the use of post-irradiation toilet mastectomy to control local disease and improve the quality of survival. Between 1962 and 1970, 24 patients were selected for toilet mastectomy; all were in good general condition with no detectable metastases and tumours that could be adequately resected with primary skin closure. The operation was performed four to 16 weeks after radiotherapy, at a time when tumour response was maximal and the radiation reaction had settled. One patient has been lost to follow up. Twenty-three of the resected breasts showed microscopical evidence of residual viable tumour. Three patients have developed local recurrences, all in association with disseminated metastases. The remaining 20 patients have had their local diseases completely controlled, either until death or until the present time. This pilot trial indicates that post-irradiation toilet mastectomy may contribute in selected cases to the control of locally advanced breast carcinoma. A multicentre controlled trial to compare this treatment with the results of radio-therapy alone would appear worthwhile.