Determining Which Patients Require Irradiation of the Supraclavicular Nodal Area After Surgery for N1 Breast Cancer

Predictive Factors for Supraclavicular Lymph Node Recurrence in N1 Breast Cancer Patients

“…The median duration from primary diagnosis to SCLR was 3.4 years, and the crude, 5-year and 10-year actuarial SCLR rates were 9.2%, 7%, and 10%, respectively. Inconsistencies in the reported SCLR rate may be mainly attributable to the different number of dissected axillary lymph nodes; the reported number of dissected axillary lymph nodes in previous studies ranges from less than 10 to 24 (Vicini et al, 1997;Fodor et al, 1999;Grills et al, 2003;Truong et al, 2009;Yu et al, 2010;Yates et al, 2012). Other possible reasons for inconsistent SCLR rates include different indications for post-operative RT, inconsistent RT field and fractionation schedule, and different indications and regimens for adjuvant chemotherapy.…”

“…On multivariate analysis, only histologic grade and number of positive axillary lymph nodes remained significant. Yu et al (2010) included 448 N1 breast cancer patients in their retrospective review, and reported LVI, ECE, number of positive axillary lymph nodes, and level of involved axillary lymph nodes as significant predictors for SCLR on both univariate and multivariate analysis. Truong et al (2009) included 1,255 N1 breast cancer patients in their retrospective study, and reported age, histologic grade, hormone receptor status, number of positive axillary lymph nodes, and percentage of positive axillary lymph nodes as significant predictive factors for SCLR.…”

“…Some of the above studies divided their patients into subgroups according to predictive factors for SCLR and proposed specific subgroups who had a high SCLR rate and would benefit from supraclavicular nodal RT. Yu et al (2010) divided patients into low-, intermediate-, and high-risk groups according to the number of predictive factors. Patients with no or one predictive factor were defined as the low-risk group and had a 3.2% SCLR rate at 5 years.…”

“…A few studies have reported a subgroup of N1 breast cancer patients who may be at particularly high risk of SCLR and might benefit from supraclavicular nodal RT (Chen et al, 2002;Grills et al, 2003;Reddy and Kiel, 2007;Truong et al, 2009;Yu et al, 2010). However, there is a lack of consensus between these studies.…”

“…However, because the reported SCLR rate in N1 breast cancer patients is very low (0.9-10%) (Vicini et al, 1997;Fodor et al, 1999;Grills et al, 2003;Truong et al, 2009;Yu et al, 2010;Yates et al, 2012), and supraclavicular nodal RT increases the risk of treatment complications such as lymphedema and pneumonitis…”