Radiotherapy for Initial Clinically Positive Internal Mammary Nodes in Breast Cancer

Kim, Jonghyun; Chang, Jee Suk; Choi, Sang-Bang; Kim, Y.B.; Keum, Ki Chang; Suh, Chang Ok; Yang, Gyongseon; Cho, Y.; Kim, J.W.; Lee, I.J.

doi:10.1016/j.ijrobp.2019.06.254

Cited by 8 publications

(11 citation statements)

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“…Lastly, specific information about PORT techniques (dose, fractionation, target volume, boost administration, and so on) and related toxicities was also not available. Recently, diverse radiotherapy techniques have been applied and radiation-induced toxicities are decreasing [ 26 , 27 ]. Nevertheless, potential risk and benefits should be considered together so that LRT in stage IV can be tailored to individual patients.…”

Section: Discussionmentioning

confidence: 99%

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

Kim

et al. 2020

Cancers

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Purpose: Locoregional treatment has been increasingly adopted for metastatic breast cancer at presentation. This study aims to develop an individualized calculator to predict the benefit of postoperative radiotherapy (PORT) for patients with surgically resected de novo stage IV breast cancer. Methods and Materials: We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with stage IV breast cancer between 2010 and 2014. After applying exclusion criteria, a total of 4473 patients were included in the analysis. Propensity score matching was used to balance the individual characteristics of the patients. After identifying the significant prognosticators, a nomogram was developed using multivariate regression models and internally validated. A web-based calculator was then constructed using a fitted survival prediction model. Results: With a median follow-up of 34 months, the three-year overall survival (OS) rates were 54.1% in the surgery alone group and 63.5% in the surgery + PORT group (p < 0.001). The survival benefit of PORT was maintained after propensity score matching (p < 0.001). Interaction testing of the prognostic variables found significant interactions between PORT and the presence of brain metastasis (p = 0.001), and between PORT and hormonal receptor expression (p = 0.018). After reviewing the performance of various models, a log-normal distributed survival model was adopted, with a C-index of 0.695. A calibration plot verified that the predicted survival rates were strongly correlated with the actual OS rates. A web-based survival calculator was constructed to provide individualized estimates of survival according to PORT. Conclusion: PORT significantly improved OS rates, though the individual benefit was affected by a number of factors. We successfully developed a nomogram and web-based calculator that predicted the prognosis according to PORT in patients with surgically resected de novo stage IV breast cancer. These tools are expected to be useful in clinical practice and in the design of related trials.

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Section: Discussionmentioning

confidence: 99%

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

Kim

et al. 2020

Cancers

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“…In addition, internal mammary chain is a major local lymph drainages accounting for 25% of all lymphatics in breast cancer [ 5 ]. Although increasing clinical data suggest that internal mammary node irradiation (IMNI) would improve local regional control and overall survival in lymph node positive breast cancer, the survival benefits of IMNI in this patient population remains controversial due to increased risk of cardiac and pulmonary toxicity [ [6] , [7] , [8] ]. Due to the aforementioned issues, whether RNI with or without IMNI has additional value for T1-2N1 breast cancer after BCS remains undetermined.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant regional nodal irradiation did not improve outcomes in T1-2N1 breast cancer after breast-conserving surgery: A propensity score matching analysis of BIG02/98 and BCIRG005 trials

Cao

et al. 2020

The Breast

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Aim To determine whether the addition of regional nodal irradiation (RNI) to whole-breast irradiation (WBI) would improve outcomes over WBI alone in T1-2N1 breast cancer after breast-conserving surgery (BCS) and adjuvant systematic therapy. Methods Data were obtained from two randomized controlled trials (NCT00174655 and NCT00312208). Univariate and multivariate Cox-regression analysis were performed to investigate predictors for overall survival and disease-free survival. A 1:1 propensity score matching (PSM) analysis was applied to eliminate selection bias. Results With median follow-up 80 months (range: 3–155 months), the 5-year local regional recurrence in the WBI group was 2% vs. 5% ( p = 0.28) in the WBI + supraclavicular radiotherapy, and the rate of 5-year distant metastasis in the WBI group was 7% vs. 13% in the WBI + supraclavicular radiotherapy ( p = 0.0748); In addition, the 5-year local regional recurrence in the WBI group was 3% vs. 9% ( p = 0.19) in the WBI + internal mammary irradiation (IMI); However, the rate of 5-year distant metastasis in the in the WBI group was significantly lower than that in the WBI + IMI (8% vs. 24%, p = 0.036). After PSM, cox-regression analysis indicated that neither RNI nor IMI in combination with WBI in T1-2N1 breast cancer was associated with an improved overall survival and disease-free survival when compared to WBI alone. Conclusion The addition of RNI to WBI in T1-2N1 breast cancer after BCS and adjuvant systematic therapy did not improve outcomes in comparison with WBI alone. Further studies are still needed to identify patients who would most benefit from RNI in this patient population.

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“…Such TNBC was defined as tumors that were negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 on immunohistochemical staining of the breast tumor 2) Radiotherapy dose was calculated using the EQD2 assuming the α/β ratio of 3.5 Gy Abbreviations: IMN Internal mammary node, DFS Disease-free survival, TNBC Triple-negative breast cancer, FNABx Fine needle aspiration biopsy, ICS Intercostal space, EQD2 Biologically equivalent dose in 2 Gy fractions advances in the treatment of breast cancer have resulted in favorable tumor control in patients with cIMN+ breast cancer. There have been studies that reported the outcomes of multimodal treatments without IMN dissection for cIMN+ breast cancer (Table 8) [4,12,[25][26][27][28]. The IMN control rate was excellent, with an IMN recurrence rate of 0-11% after multimodal treatments.…”

Section: Discussionmentioning

confidence: 99%

“…A radiation dose of 45-50 Gy to the whole breast or chest wall plus a radiation boost to gross lesions has been recommended as a general guideline for postoperative RT for breast cancer [29]. For eradicating the gross tumor in the IMN, boost irradiation with 6-16 Gy has been administered to the IMN region in previous studies [4,12,[25][26][27][28]. Accordingly, the median radiation dose to the IMN was 50.0-63.6 Gy in the previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Given that tumor characteristics were not different between the age groups in our study (Table 9), other factors might contribute to the worse outcome in the patients > 40 years old. In previous studies on cIMN+ breast cancer, the prognostic impact of the patient's age on breast cancer outcome has not been evaluated [4,12,25,26,28]. Further studies are necessary to determine whether age is significantly associated with survival in patients with cIMN+ breast cancer.…”

Section: Discussionmentioning

confidence: 99%

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Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer

et al. 2020

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Background: This study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer. Methods: We retrospectively reviewed the medical records of 84 patients with cIMN+ breast cancer treated with curative surgery, taxane-based chemotherapy, and postoperative RT between January 2009 and December 2014. Postoperative RT was administered to the whole breast or chest wall using 50 Gy in 2 Gy fractions. Boost RT to the internal mammary lymph node (IMN) was administered at the physician's discretion. We categorized patients into two groups according to the IMN dose as follows: low-dose IMN RT (50.0-63.5 Gy) and high-dose IMN RT (63.6-70.4 Gy). Results: After a median follow-up of 58 months (range, 12-111 months), IMN recurrence was observed in 2 patients (2.4%), and all IMN recurrences developed simultaneously with distant metastases. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 89.1, 72.0, and 81.2%, respectively. The triple-negative subtype, IMN size ≥1.0 cm, old age, and low-dose IMN were significantly associated with poor DFS. Among the patients with IMN size ≥1.0 cm, the 5-year DFS was significantly higher in those treated with high-dose IMN RT than in those treated with low-dose IMN RT (69.3% vs. 33.3%, p = 0.019). Conclusions: IMN RT without IMN dissection resulted in favorable outcomes in cIMN+ breast cancer. For patients with a large IMN, a higher IMN radiation dose might be needed for disease control.

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Radiotherapy for Initial Clinically Positive Internal Mammary Nodes in Breast Cancer

Cited by 8 publications

References 0 publications

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

Adjuvant regional nodal irradiation did not improve outcomes in T1-2N1 breast cancer after breast-conserving surgery: A propensity score matching analysis of BIG02/98 and BCIRG005 trials

Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer

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