The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy

Vicini, Frank A.; Horwitz, Eric M.; Lacerna, Mario D.; Brown, Douglas M.; White, Julia; Dmuchowski, Carl; Kini, Vijay R.; Martínez, Álvaro

doi:10.1016/s0360-3016(97)00555-5

Cited by 67 publications

(42 citation statements)

References 42 publications

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“…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.…”

Section: Discussionmentioning

confidence: 98%

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

Kong

Hong

2013

Asian Pacific Journal of Cancer Prevention

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Background: The purpose of this study was to identify predictive factors for supraclavicular lymph node recurrence (SCLR) in N1 breast cancer patients and define a high-risk subgroup who might benefit from supraclavicular nodal radiotherapy (RT). Materials and Methods: From January 1995 to December 2009, 113 breast cancer patients with 1 to 3 positive axillary lymph nodes were enrolled in this study. All patients underwent breast-conserving surgery (BCS) or modified radical mastectomy (MRM). RT was given to all patients who received BCS. Among the patients given MRM, those with breast tumors >5 cm in size received RT. Regional nodal irradiation was not applied. Systemic chemotherapy was given to 105 patients (92.9%). Patient data were retrospectively reviewed and analyzed to identify predictive factors for SCLR. Results: The median follow-up duration was 6.5 years, with 5-and 10-year actuarial SCLR rates of 9.3% and 11.2%, respectively. Factors associated with SCLR on univariate analysis included histologic grade, number of dissected axillary lymph nodes, lymphovascular invasion, extracapsular extension (ECE), and adjuvant chemotherapy. On multivariate analysis, histologic grade and ECE remained significant. The patient group with grade 3 and ECE had a significantly higher rate of SCLR compared with the remainder (5-year SCLR rate; 71.4% vs. 4.0%, p<0.001). Conclusions: Histologic grade and ECE status are significant predictive factors for SCLR. Supraclavicular nodal RT is necessary in N1 breast cancer patients featuring histologic grade 3 and ECE.

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Section: Discussionmentioning

confidence: 98%

“…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…”

Section: Introductionmentioning

confidence: 99%

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

Kong

Hong

2013

Asian Pacific Journal of Cancer Prevention

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“…[5][6][7][8] Three of these studies addressed disease recurrence in postmastectomy patients 5,6 and two studies evaluated patients who underwent breast-conserving surgery. 7,8 However, all but one of these studies included some patients who had received adjuvant radiotherapy. Donegan et al 5 conducted a retrospective study comprised of 143 patients who underwent modified radical mastectomy for lymph node positive breast carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 27 patients with ETE, 1 (4%) had an axillary recurrence as a component of first failure compared with none of the 45 patients without ETE. Vicini et al 8 performed a retrospective study of 106 lymph node positive patients who underwent breast-conserving therapy with adjuvant radiotherapy, 25 of whom (24%) were ETE positive. Univariate analysis demonstrated that extracapsular extension was not associated with ANF.…”

Section: Discussionmentioning

confidence: 99%

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Significance of axillary lymph node extranodal soft tissue extension and indications for postmastectomy irradiation

Mignano

Zahurak

Chakravarthy

et al. 1999

Cancer

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Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast‐conserving therapy at a single institution

Pass

Vicini

Kestin

et al. 2004

Cancer

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BACKGROUND The authors reviewed changes in the initial clinical presentation, management techniques, and patterns of disease recurrence over time (1981–1996) in patients with breast carcinoma treated with breast‐conserving therapy (BCT) at a single institution. The goals of the current study were to determine the frequency and use of optimal local and systemic therapy techniques and to evaluate the impact of these changes on treatment efficacy. METHODS Six hundred seven patients with American Joint Committee on Cancer Stage I or II invasive breast carcinomas treated with BCT at William Beaumont Hospital (Royal Oak, MI) constituted the study population. All patients received at least an excisional biopsy of the primary tumor, an axillary lymph node staging procedure, and postoperative radiotherapy (RT) (a median tumor bed dose of 61 Gray [Gy] was administered). All sides were reviewed by one pathologist. Numerous clinicopathologic and treatment‐related factors were analyzed to monitor changes that occurred over time. Changes in patterns of disease recurrence and treatment efficacy over time also were analyzed. RESULTS Over the time period analyzed, changes at initial presentation included an increase in the mean age at diagnosis (age 56.1 years vs. 61.4 years; P < 0.001), a decrease in the number of patients with clinically palpable tumors (78% vs. 36%; P < 0.001), a decrease in the mean tumor size (2.2 cm vs. 1.6 cm; P < 0.001), but no change in the percentage of patients with negative lymph nodes (79% vs. 78%; P = 0.83). No differences over time were observed in mean tumor grade (2.0 vs. 1.9; P = 0.2) or the presence of angiolymphatic invasion (27% vs. 26%; P = 0.25). Changes in surgical management and pathologic assessment included the more frequent use of reexcision (46% vs. 81%; P < 0.001), larger mean total volumes of breast tissue specimens excised (115 cm3 vs. 189 cm3; P = 0.001), a larger percentage of patients with final negative surgical margins (74% vs. 97%; P < 0.001), and a small increase in the mean number of lymph nodes excised (13.8 lymph nodes vs. 14.1 lymph nodes; P = 0.01). The only other significant change in the pathologic management of patients over time included a doubling in the mean number of slides examined (10.6 slides vs. 21.1 slides; P < 0.001). Changes in adjuvant local and systemic therapy included an increase in the percentage of patients treated with > 60 Gy to the tumor bed (66% vs. 95%; P < 0.001), a doubling in the mean number of days from the last surgery to the start of RT (24 days vs. 50 days; P < 0.001), and a decrease in the use of regional lymph node RT (24% vs. 8%; P < 0.001). The use of adjuvant tamoxifen increased from 10% to 61% (P < 0.001). Finally, improvements were observed in the 5‐year and 12‐year actuarial rates of local disease recurrence (8% vs. 1% and 21% vs. 9%, respectively; P = 0.001) and distant metastases (12% vs. 4% and 22% vs. 9%, respectively; P = 0.006). No changes in the mean number of years to ipsilateral (6.5 years vs. 6.4 years; P = 0.59...

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The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy

Cited by 67 publications

References 42 publications

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

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

Significance of axillary lymph node extranodal soft tissue extension and indications for postmastectomy irradiation

Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast‐conserving therapy at a single institution

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