Stage III carcinoma of the breast. A detailed analysis.

A ten-year study of Stage III breast carcinoma has been reviewed in detail. The single most dominant variable was axillary nodal involvement. Four hundred and thirty patients had nodal metastases, 58 patients did not. Four hundred and thirty patients with axillary nodal involvement had fiveand ten-year recurrence rates of 68 and 77%, while the survival rates were 41 and 21%, respectively. Life span was influenced by extent of nodal disease, being best for those with micrometastases only, and worse for those with four or more positive nodes. Skin edema, infiltration, or ulceration in the positive node group were grave signs. Muscle invasion or node matting, however, did not appear to influence length of life. Postoperative prophylactic therapy did not appear to affect survival rates. Radiation therapy alone did not influence either local recurrence or survival rates. Not enough time has elapsed to evaluate the results of postoperative chemotherapy. Patients who underwent oophorectomy and radiation therapy appeared to do better, but the number of patients was small. Of the 58 patients without nodal invasion, 82% were alive at five years and 75% were alive at 10 years. Grave signs did not influence the survival rate in this group. While the majority of patients with Stage III carcinoma had unfavorable variables, there were some patients who demonstrated a low recurrence rate and a long survival time. Aggressive treatment should be designed to save those patients who can be helped and to improve those patients whose life expectancy is limited. There is no place for timid initial treatment whether by operation or by irradiation. It must be given with intent to cure even though palliation is most often attained.