Ninety-four patients with T2 NO, N1a, N1b, MO were treated with primary radiotherapy (RT) because of old age or poor general conditions. In 32 patients (34%), younger in age and in better general conditions, Halsted radical mastectomy could be performed 5-8 months from starting RT; surgery was not done at random, but decided case by case on the basis of a good response to RT and an improvement of general status. Relapse was documented in 42 patients. Relapse rate was 50% in the group treated with RT alone (high incidence of breast recurrences) and 33% in the group operated on after RT. Distant metastases had the same incidence in the 2 groups, with a median free interval of 14 months. Overall disease-free survival rates at 5 to 10 years were 46% and 35%, respectively; these results are not particularly different from the data of historical series of T2 breast cancer treated with surgery alone. The patients operated on after RT had a significantly better survival, but the results were clearly influenced by the selection of patients. For the future, a safe policy could be a conservative combined treatment consisting of tumorectomy followed by curative RT; adjuvant medical therapy could be scheduled for high-risk patients (N1b).