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From January 1984 to December 1992, twenty-eight patients affected with breast carcinoma in situ were treated with surgery (8 with radical mastectomy, 20 with quadrantectomy) at Umberto I Hospital in Mestre, Italy. The patients with multicentric lesions and treated with quadrantectomy received also radiation therapy. The dose was 50 Gy/25 fractions with 60Co and a boost of 10 Gy to the tumor bed. The mean age of our patients was 55 years (range: 34-74 years). Histology diagnosed lobular carcinoma in situ in 7 cases, intraductal carcinoma in 19 cases and comedocarcinoma in 2 cases. The median and the mean follow-up are 37 and 42 months (range: 24-128), respectively. The eight-year local control and the cause-specific survival rates are 100%. No local relapses have been observed. One patient died, of another neoplastic disease, free from breast disease. We believe that the conservative approach in breast carcinoma in situ, according to literature results and to our personal experience, should be more frequently preferred to radical surgery even in the patients with multicentric lesions.

From January 1984 through December 1990, 311 patients affected with breast cancer were treated with quadrantectomy plus lymphadenectomy and radiation therapy (QUART) at the Umberto I Hospital in Mestre, Italy. The patients with positive nodes (N+) were treated with adjuvant chemotherapy (CMF) or hormonotherapy (Tamoxifen) according to pausal status. Most patients were in the 5th, 6th and 7th decades of life; 60.5% of them were over 50. Staging was always performed according to TNM classification (UICC criteria) and demonstrated mostly stage-I lesions (66.9%). Overall and disease-free (NED) survival rates were 95%; mean survival rates were 7.47 (+/- 0.138) and 7.22 (+/- 0.164) years, respectively. Ten patients died (5 from breast cancer); 6 local relapses were observed and 8 metastases. Metastases were seen mostly in patients with breast cancer in the internal quadrants (QI) N0, with no statistically significant differences relative to the other groups. This is probably due to the existence of an axillary pN0 and parasternal N+ group of patients, who receive insufficient treatment.

Complex mechanisms of various nature, not only physical, can influence the patterns of metastases. We compared the patients with recurrences to the brain as the only metastatic site from breast cancer with the patients relapsing in the brain and other organs. All cases were staged and treated following professional protocols. When brain metastases were diagnosed, the patients were accurately restaged before being submitted to radiation therapy; the whole brain was irradiated with various total doses and the same fractionation. The patients underwent clinical examination before and after irradiation. Survival analysis was carried out using the product-limit method considering the following periods: total survival, relapse-free survival, elapsed time till the appearance of brain metastases, and survival after radiation therapy. The cases were grouped and compared using Mantel-Cox and Breslow methods according to the following prognostic factors: brain as the first site of recurrence, pausal state, total radiation dose, stage (TNM), T and N. No significant difference in survival was observed between the cases with brain as the first metastasized organ and the others. The patients were grouped according to the extant prognostic factors: longer total and postirradiation survival rates were observed in patients in premenopausal state (Breslow: p = 0.025 and 0.005) and in the cases treated with total radiation doses greater than 40 Gy (Breslow: p = 0.023 and 0.005). T levels seemed to significantly affect all the examined periods--which influences the stage effect. Conversely, N levels seemed to be of no significant value. The menopausal factor may reflect the effects of age, from which it cannot be separated. These results can be useful for treatment planning.

The radiation therapy of internal mammary chain, according to many other authors, is indicated in patients with N + breast cancer or with inner quadrant disease. Since the direct field with gamma radiation seems to induce important adverse effects on myocardium, the authors were induced to check experimentally dose distributions of 12-15 MeV electron beams and compare the results to gamma photon dose distribution. Materials and dosimetric methods as well as experimental results are described. Moreover theoretic and practical point of view are discussed coming to the conclusion that electron beams are more suitable for myocardial saving. Nevertheless some technical variations are required, to maintain the typical homogeneity of photon beams.

The three-field technique is the most common method used for breast and regional node treatment after conservative surgery. Several variants of this technique, which are characterized by complex geometrical problems, have been described. A possible simplification of this technique and the use of individualized shielding blocks both for anterior and for tangential fields is proposed, thus allowing for the simultaneous shielding of the half beam and the critical areas. Advantages of isocentrical techniques are thereby maintained, but the number of mechanical movements required is minimized and collimators and couch rotations are not needed. Patient set-up time is also greatly shortened. The accuracy of this technique has been verified using both photographic methods and thermoluminescent dosimetry.

Between January 1981 and December 1985, 364 female patients underwent surgical treatment for breast cancer in Mestre General Hospital. The pathological stage of the disease was stage I in 60 patients, stage II in 215 patients, stage III A in 30 patients, stage III B in 44 patients and stage IV in 15 patients. The patients with T1-T2 N0 lesions located in the outer quadrants received no additional treatment after surgery, while the others received adjuvant therapy. The patients with stage-IV disease (M+) were treated with chemo and/or hormonotherapy. All patients were followed for an average of 33 months up to December 1986 (range 1-71 months). Local-regional relapses developed in 17 patients, 15 on the chest wall and 2 in the drainage lymph nodes (only 7 within the previously-treated area). A 5-year actuarial survival rate was observed of about 78%, and 66% of relapse-free survival, in the whole group of patients (100% and 92% in stage I; 92.5% and 76% in stage II; 51% and 33% in stage III A; 32% and 19% in stage III B; 31% in stage IV, respectively). As far as our series of patients is concerned, the massive involvement of axillary lymph nodes seems to be the most adverse prognostic factor in survival rates. Even though the short follow-up does not allow definitive conclusions to be drawn, the authors believe such loco-regional treatments as surgery and radiation therapy to be extremely important in the local control of breast cancers, as well as in the patients' survival in the long run.