Breast conservation surgery (BCS) has become a standard treatment for early breast cancers with results equivalent to modified radical mastectomy (MRM) as evident from various randomized trials. Based on available evidence, the Breast Unit at Tata Memorial Hospital (TMH) has also evolved a standard protocol for the management of breast cancer. The proportion of cases undergoing BCS in operable breast cancer has shown a significant upward trend from 12.6 % in the year 1997 to 59.3% in the year 2001. In operable breast cancer, the overall incidence of gross positive cut margin has been 4 % after BCS. With encouraging results in early breast cancer, BCS is also being offered to women with larger, locally advanced breast cancer (LABC) after downsizing with neo-adjuvant chemotherapy. In 1997, 0.4% of LABC had breast conservation as compared to 34% in the year 2001. The gross positive margin rate in LABC after BCS was 2.4% in our patients (p=0.43). The local recurrence rate after BCS in our patients was 2% in both operable breast cancer (15 out of 726 women) and locally advanced cancers (2 out of 101 women).
Even as conservative surgical treatment in early breast cancer is fast becoming the gold standard, conservative radiotherapy to tumour bed alone is also under study. Presently, radical radiotherapy to whole breast plus tumour bed boost is the standard protocol for all women after BCS. A feasibility study of conservative radiotherapy with a high dose brachytherapy for tumour bed alone in early breast cancer is presently on at TMH with a close collaboration between the departments of Breast Services Surgical Oncology and Radiation Oncology with early morbidity as the end-point.