Notes: Abstract: Recent discussions have questioned the need or benefit of radical axillary lymphadenectomy for some patients as part of treatment for breast carcinoma. An evaluation of the need for discontinuous lymphadenectomy is presented with proposal to eliminate lymphadenectomy in the breast-conserving therapy of some patients.From 1977 through 1993, 101 breasts in 95 patients with breast carcinoma were treated by breast conservation without radical axillary lymphadenectomy.At median follow-up of 76 months, only four patients (4.0% of cancers) had occurrence of axillary disease requiring invasive evaluation of delayed clinically positive axillae. One of the four patients had negative nodes. Two patients had positive lymph nodes without recurrent disease in the ipsilateral breast or distant metastasis. The fourth patient had distant metastasis, and a positive fine-needle aspiration biopsy of an axillary lymph node was sufficient for diagnosis. Discontinuous radical axillary lymphadenectomy was neither technically different nor more difficult that primary lymphadenectomy.Some breast cancer patients may forego surgical evaluation of the axilla as part of their breast conservation therapy without compromise in adjuvant therapy decisions or detriment in outcome. The authors strongly recommend large prospective, clinical studies be performed in the near future.

Notes: We conducted a single-institution study to determine whether local therapy plus six cycles of chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) followed by 5 years of tamoxifen is superior to local treatment alone in terms of disease-free survival (DFS) and overall survival (OS) in patients with stage IV breast cancer with no evidence of disease (stage IV-NED breast cancer). Patients with breast cancer were eligible if they had histologic proof of a locoregional or distant recurrence that had been curatively resected, irradiated, or both and had no other evidence of disease. Patients who had received prior anthracycline therapy were not eligible. All patients received six cycles of intravenous FAC, with cycles repeated every 3 weeks. After completion of chemotherapy, patients whose tumors had not previously demonstrated resistance to tamoxifen and had positive or unknown estrogen receptor status received tamoxifen 20 mg by mouth daily for 5 years. Patients in this study were compared with a historical control population (patients with stage IV-NED breast cancer who never received systemic therapy) as well as with the patients in two previously reported trials of chemotherapy for stage IV-NED disease. Forty-seven patients were registered, but only 45 were evaluable. There was a highly statistically significant difference ( p 〈 0.001) in OS and DFS among the four groups, with patients in our most recent study having the best OS and DFS at 3 years compared with the control group (84% vs. 55% and 66% vs. 11%, respectively). When patients in all four groups were analyzed together in search of prognostic factors, we found that patients whose primary tumors had negative axillary lymph nodes had a statistically significant improvement in OS and DFS (p 〈 0.01) compared with patients with positive axillary lymph nodes. No survival differences were found between patients with positive and those with negative hormone receptor status. This study demonstrates a benefit in terms of OS and DFS for patients with stage IV-NED breast cancer who receive doxorubicin-based adjuvant chemotherapy. The benefit was greater on patients with node-negative primary tumors. In patients with stage IV-NED disease, doxorubicin-based chemotherapy should be considered standard treatment after adequate local control is achieved.