Surgery and radiotherapy for primary breast cancer. What we have learned from the controlled clinical trials.

The history of the use of surgery and radiotherapy for the management of primary breast cancer is reviewed with an emphasis on the conclusions to be reached from the controlled clinical trials. Prophylactic treatment of clinically negative regional nodes by either surgical extirpation or radiotherapy does not improve survival in comparison with a policy of observation and treatment at the time of clinical progression. Axillary node dissection is currently important for histologic staging of the axillary nodes. Early results of the controlled trials appear to support the concept that for selected patients, a regimen of complete excision of the primary tumor and breast irradiation produces results equivalent to those of total mastectomy in terms of distant recurrence and survival.