Treatment of the Advanced Disease

Trials recently established by the International Union Against Cancer is a welcome move. 7 Quite correctly most of the clinical trials in progress arc comparing methods which include treatment of the whole breast and the regional lymph nodes. We are now entering an era when serious consideration is being given to the set- ting up of trials in which one group of patients will have no primary treatment to the regional nodes even if they are thought to be involved clinically. Participation in such an investigation must to a certain extent be a matter of individual conviction and conscience, and my own personal opinion is that such a trial would be premature. We cannot ignore the fact that many women with early involvement of the axillary lymph nodes are cured of the disease only by primary treatment to the whole of the diseased region. Treatment of the patient in this category must be based on the expectation of cure. Equally we have to concede that to this day we remain undecided over the methods of treating the whole region and perhaps this should be settled before unorthodox methods are introduced.