the patients had bilateral disease. The median age was 55 years (27-85 years). The median follow-up was 37 months (12-95 months). Local control was never obtained in 13 cases (11%). An additional 27 cases (23%) failed locally with a median time to failure of 10 months (2-85 months). The total local failure rate was 34%. The actuarial 5 year overall and relapse free survivals were 29% and 28% respectively.

Local control was related to T and N subgroups. Within each sub- qroup local control was improved if an interstitial implant was

was no residual bulk disease after biopsy or ex- used'and if there cision.

There were 17 pat ients with inflammatory carcinoma of the breast; the local control rate in this group was 65% equaling that for the entire group of S tage III patients.

Primary radiation therapy of Stage III breast cancer provides sig- nificant local control and should be an integral part of the combined treatment of this disease.

(30) TECHNICAL CONSIDERATIONS IN THE PRIMARY RADIATION THERAPY OF BREAST CANCER

Jay R. Harris, Martin B. Levenet Goran Svennson and Samuel Hellman

Joint Center for Radiation Therapy and Department of Radiation Therapy, Harvard Medical School, Boston, Mass.

The gradual acceptance of primary radiation therapy as an alternative to mastectomy in the treatment of breast cancer has made it increasingly important to concentrate on the technical details of radiation therapy to achieve the best possible cosmetic result while preserving the excellent local control rate. We have reviewed the treatment techniques employed in the radiation therapy of 80 patients with Stage I and II breast cancer to determine those parameters most likely to influence the post-therapy appearance of the breast. There have been only two local failures in this group of patients. Certain factors have been identified as requiring special attention in planning the treatment to achieve these goals. These include such diverse items as the extent and technique of the biopsy, the avoidance of zones of overlapping beams due to divergence, the use of wedges, the minimalization of the use of bolus and the usual considerations of fraction size and total dose.

The role of the interstitial implant in maintaining local control at no sacrifice to cosmetic result is discussed and certain technical recommendations are made which have been found to enhance the appearance of the breast after treatment.

Recommendations are made for radiation doses to the breast and regional nodes which are commensurate with a high local control rate and yet do not impair functional or cosmetic results.

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