Cancer Res Treat.  2019 Oct;51(4):1500-1508. 10.4143/crt.2018.575.

Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14)

• Kim K
• Jeong Y
• Shin KH
• Kim JH
• Ahn SD
• Kim SS
• Suh CO
• Kim YB
• Choi DH
• Park W
• Cha J
• Chun M
• Lee DS
• Lee SY
• Kim JH
• Park HJ
• Jung W

• KMID: 2460598
• DOI: http://doi.org/10.4143/crt.2018.575

Abstract

PURPOSE
The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.
MATERIALS AND METHODS
A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.
RESULTS
The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients.
CONCLUSION
Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.

Keyword

Breast neoplasms; Supraclavicular lymph node; Internal mammary lymph node; Radiotherapy

MeSH Terms

Breast Neoplasms*
Breast*
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Lymph Nodes*
Mastectomy
Mastectomy, Segmental
Multivariate Analysis
Radiotherapy
Retrospective Studies*
Survival Rate

Figure

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  Fig. 1. Disease-free and overall survival curves among all the patients (n=353).

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  Fig. 2. Internal mammary lymph node (IMN) failure-free survival curves in patients with IMN involvement who did not undergo IMN excision and whose response to neoadjuvant systemic therapy was available (n=184). RT, radiotherapy.

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  Fig. 3. Disease-free survival curves according to the dose to the supraclavicular lymph node (SCL) among those patients with SCL involvement (n=201). Four patients not receiving radiation to the SCL were excluded.

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  Fig. 4. Disease-free survival curves according to the receipt of internal mammary lymph node (IMN) irradiation among those patients with IMN involvement (n=217). RT, radiotherapy.

Reference

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