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)

Abstract

PurposeThe 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 MethodsA 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.ResultsThe 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.ConclusionNeoadjuvant 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.

<p>Combined Therapy Can Improve the Outcomes of Breast Cancer with Isolated Supraclavicular Lymph Node Involvement</p>

“…28 And a multicenter study of 353 patients from South Korea showed that high-dose RT did not translate into survival benefits. 11 These were also consistent with our preliminary study results of radiation dose.…”

“…These findings supported that combined therapy can improve the survival outcomes of mISLM patients and were in agreement with those of current mainstream studies. [9][10][11][12] Additionally, we found in the multivariate analyses that the pN3 stage was an important factor affecting PFS. This indicated that ISLM patients with pN3 stage had a higher risk of supraclavicular lymph node failure and were more likely to develop disease progression, which was also consistent with the previous results of Fan et al And this may be related to the micrometastasis of tumor cells in supraclavicular vessels.…”

“…26 And the study of Kim et al confirmed the positive effect of neck radiotherapy on the survival of ISLM patients. 11 Some centers also analyzed the effects of high-dose RT. In theory, more aggressive treatments should be helpful for improving the local control rate.…”

Prognostic significance of the primary tumor site and immune indexes in patients with estrogen receptor-positive, human epidermal growth factor receptor-2-negative breast cancer

“…In their study, Aleknavičius et al found that IMN-RT was correlated with a better survival outcome for patients with moderate-risk disease (stage T1-2N1), and showed no association for better survival for high-risk disease (stage T3-4N2-3) (18). In their study, Kim et al reported that IMN-RT was not associated with DFS in IMN patients (19). The result of our study was largely consistent with the findings of the abovementioned clinical retrospective studies; inferior results of the innerquadrant tumors were more prominent for patients with a better survival prognosis.…”

Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14)

“…[4][5][6] Despite the possibility of over-diagnosis, more patients with SCN and/or IMN involvement are referred for RT, but there is a paucity of data regarding the outcomes for these patients. Neoadjuvant chemotherapy is usually administered to these patients [7][8][9] ; however, upfront surgery can also be a viable option at the discretion of the attending surgeons. 10,11 In particular, in the upfront surgery setting, SCN excision can be performed along with breast surgery during the same operation; however, the benefit of aggressive regional therapy is controversial.…”