life is the possibility of hidden metastases. Radiotherapy , which may limit drug dosages, can begin later, as early as three months after chemotherapy has begun or even after six months when chemotherapy has been completed. While radiotherapy to the chest wall decreases the chance of local recurrence it does not affect tumor cells that may be elsewhere in the body. The exact timing of radiotherapy is a question still being addressed by clinical studies.
The Conservative Surgical Option The June 1990 NIH Consensus Conference ( see "STAGE II" ) held that breast conservation treatment—with close follow-up to detect local recurrences early—is appropriate primary therapy for most women with Stages I and II breast cancers and is preferable because it provides the surgical equivalent to total mastectomy while preserving the breast.
Conservative surgery followed by primary radiation therapy depends upon careful patient selection, however. Not all women with early-stage cancer are good candidates for this approach.
• It is sometimes not used in patients with a large tumor in small breasts where excision would produce a
significant loss of breast tissue and compromise symmetry.
• Conservative surgery plus radiotherapy is not suggested if there are multiple malignant or in situ tumors in one
breast, widespread microcalcifications on mammography or a history of collagen vascular disease. The latter
patients often develop scar tissue (reactive fibrosis) with radiation therapy, undesirable breast changes that
