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James F. Holland, MD
JAMA. 1987;258(16):2261-2263. doi:10.1001/jama.1987.03400160115030.
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For patients with breast cancer whose tumors are 4 cm in diameter or less, there is a continuing trend toward lumpectomy followed by breast irradiation and chemotherapy. Irradiation of the breast is essential to successful treatment, but the adjuvant use of radiotherapy to potential node-bearing areas has been superseded by the use of adjuvant chemotherapy. Meta-analysis of the several published randomized series of patients who received either adjuvant radiotherapy or no treatment after simple or radical mastectomy1 demonstrated no difference in survival for the first ten years and significantly inferior survival for the irradiated radical mastectomy groups thereafter.

Hryniuk and Levine2 have analyzed dose intensity in the adjuvant chemotherapy of breast cancer. The amount of drugs scheduled per unit time was determined in 27 subgroups involving 6106 women, and the data plotted against three-year diseasefree survival. A nearly linear, significant increase in therapeutic activity (P =.00001) was found


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