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Breast Diseases pp 174–188Cite as

Rationale for the Choice of Treatment

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Abstract

The treatment of breast cancer is currently based on the following ideas:

  1. 1.

    In the majority of cases the tumor has already reached the stage of dissemination at the time of the primary treatment. This can be inferred from the mortality among patients with locally completely cured breast cancer, especially against the backdrop of what we know about the comparatively slight influence of the radicality of locoregional treatment on survival rates. In 60%–80% of cases distant metastases are the first indication of tumor recurrence [38]. The concept of adjuvant systemic cytotoxic therapy is derived from these facts.

  2. 2.

    The prognosis is dependent primarily on how aggressive the tumor is and on its growth behavior. Indications of the aggressiveness of the cancer can be obtained from a number of morphological and biochemical characteristics of the tumor. These are currently used to allocate patients to particular risk groups and thus to tailor the therapy to suit the level of risk in individual patients.

  3. 3.

    The prognosis is obviously also dependent on the immune status of the affected organism, though the degree of this dependence cannot be quantitatively es-timated. According to Donegan and Spratt (1979, 1988) and Fisher et al. (1980), involvement of the axillary lymph nodes by carcinoma is an indicator of the tumor-host relationship and should alert us to the likelihood that the tumor is also attacking the organism at other locations. Attempts to influence the immunological defense situation have so far not been successful or are still experimental [29,41]. An effect of psychic factors has not been rejected [22] but has not been unequivocally demonstrated, and the extent of their importance is completely undefined.

  4. 4.

    There is still no consensus on the bearing of the radicality of the locoregional treatment of the tumor on the survival rates, Atkins et al. [2] have shown that inadequate clearance of quite large tumor masses (breast-conserving treatment without axillary lymph node dissection and with inadequately dosed radio-therapy) reduces the chances of survival significantly: their follow-up period is now 15 years [see Hayward, this volume]. Local control of disease is an essential part of conservation treatments, especially in small (Tl) tumors with negative nodes, in which cure can be achieved.

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Authors
  1. D. von Fournier
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  2. F. Kubli
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Editor information

Editors and Affiliations

  1. Women’s Hospital, University of Heidelberg, Voßstr. 9, D-6900, Heidelberg, Germany

    F. Kubli  & M. Kaufmann  & 

  2. Department of Gynecological Radiology, University Women’s Hospital, Hugstetterstr. 5, D-7800, Freiburg/Brsg., Germany

    M. Bauer

  3. Women’s Hospital and Clinic of Radiology, University of Heidelberg, Voßstr. 9, D-6900, Heidelberg, Germany

    D. von Fournier  & H. Junkermann  & 

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© 1989 Springer-Verlag Berlin Heidelberg

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von Fournier, D., Kubli, F. (1989). Rationale for the Choice of Treatment. In: Kubli, F., Bauer, M., Kaufmann, M., von Fournier, D., Junkermann, H. (eds) Breast Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73523-3_16

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  • DOI: https://doi.org/10.1007/978-3-642-73523-3_16

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-73525-7

  • Online ISBN: 978-3-642-73523-3

  • eBook Packages: Springer Book Archive

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