The significance of a supraclavicular node metastasis in patients with breast cancer

Debois, J. M.

doi:10.1007/bf03039187

Cited by 34 publications

(19 citation statements)

References 41 publications

(57 reference statements)

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“…Die Vorteile der Axilladissektion sind eine ausgezeichnete lokale Tumorkontrolle und eine eventuelle Hilfe zur Indikationsstellung fur eine Systemtherapie [32,40,43], da ein Befall der axill~iren Lymphknoten als wichtigster Prognosefaktor gilt [22,24,28,36,69,82,113,124]. Der Wert der Axilladissektion for das GesamtUberleben wird allerdings noch diskutiert, die dazu bekannten Daten sind begrenzt und unbefriedigend.…”

Section: Stellenwert Der Axilladissektionunclassified

Is axillary dissection further required in clinically node negative breast cancer?

Böhler

Eiter²,

Rhomberg

1998

Strahlenther Onkol

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Definitive radiotherapy of the axilla is a valid treatment option for patients without palpable axillary nodes with the potential advantage of being less cost intensive and better tolerated. If the indication for systemic therapy is no more dependent on the axillary status, axillary dissection may be replaced by axillary radiotherapy. In small tumors without risk factors and without indication for systemic therapy, SLND seems to be the best treatment option.

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Section: Stellenwert Der Axilladissektionunclassified

Is axillary dissection further required in clinically node negative breast cancer?

Böhler

Eiter²,

Rhomberg

1998

Strahlenther Onkol

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“…For example, Debois and others demonstrated that patients presenting with supraclavicular metastases have a poor prognosis and that more than 50% succumb to disease within three years of diagnosis 6,13,14 . In contrast, Olivotto et al showed that a significant minority (approximately 13%) may be long-term survivors 7 .…”

Section: Discussionmentioning

confidence: 99%

“…This classification of stage was justified by evidence suggesting that the prognosis in patients with neck disease was poor, with five-year survival rates in the order of 5–34% 2–4 . Evidence also suggested this poor prognosis to be similar to that of patients with metastases in other sites (ie bone, liver) 5 with treatment not seeming to influence survival 6 . Since limited literature exists guiding treatment for isolated ipsilateral cervical metastases, management remains controversial.…”

mentioning

confidence: 99%

“…Since the literature is scarce and inconsistent regarding the fate of breast carcinoma patients with cervical disease, our impression was that in view of the attendant morbidity of treatment and lack of knowledge regarding the influence of management on long-term survival, a unified approach to these patients does not exist 6 . We therefore hypothesised that current practice varies across the UK.…”

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confidence: 99%

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Survey of UK practice for management of breast cancer metastases to the neck

Bisase

Kerawala

2012

annals

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INTRODUCTIONCervical metastases from breast carcinoma are rare and their management is controversial. Between 1987 and 2002 the American Joint Committee on Cancer (AJCC) staged patients with supraclavicular fossa nodal disease as M1 but the subsequent demonstration that patients with regional stage IV disease had better outcomes than visceral stage IV disease led to a reclassification of the former to stage IIIC in 2003. The literature remains inconsistent regarding the fate of these patients. Despite the attendant morbidity of treatment and lack of knowledge regarding long-term survival, we hypothesised that current practice varies in the UK and a unified approach does not exist. The aim of this study was therefore to determine current practice and opinion of both head and neck specialists and breast cancer clinicians in the UK.METHODSQuestionnaires were disseminated to 185 head and neck surgeons, breast surgeons and their oncology counterparts. These outlined a clinical scenario of a patient with a history of T3 primary breast cancer presenting with cervical and supraclavicular nodal metastases, with opinion being sought regarding the significance of this status and the individual’s practical approach to the problem. The extent of any proposed neck dissection was also explored.RESULTSOf the 117 respondents, a noticeable variation in opinion was evident. Contrary to the current AJCC staging, 61% of clinicians felt that both level V and III metastases represented stage IV disease. There was a tendency towards aggressive surgical treatment with a third recommending comprehensive neck dissection despite a lack of evidence base. A disparity was noted between adjuvant treatments offered and the final pN stage.CONCLUSIONSThis study suggests that at present there is widespread inconsistency in the management of breast carcinoma cervical metastases in the UK. There is a need to unify practice with an evidence base in order to improve informed multidisciplinary decision making and, ultimately, patient care. This study goes some way to supporting multicentre collaboration in order to achieve that aim.

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“…However, the previous edition of the AJCC Manual for Staging of Cancer 4 had multiple sources of evidence 5−7 to support its decision to include supraclavicular lymph node metastases as M1 disease. The study by Kiricuta et al.…”

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confidence: 99%

Revised AJCC staging of breast cancer: Significance of supraclavicular lymph node metastases

Rath

Sharma

2004

Australasian Radiology

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Revised AJCC staging of breast cancer: Significance of supraclavicular lymph node metastasesThe Staging system for every tumour site should be reviewed from time to time due to progress in medical technology and increasing research findings. Currently, the American Joint Committee on Cancer-Tumor Node Metastasis (AJCC-TNM) staging system is, undoubtedly, the most widely practised and best staging system available. A recent revision 1 of the breast cancer staging system by AJCC is indeed worthwhile in certain aspects; however, the reclassification of supraclavicular node metastases as N3 disease is arguable The revised breast cancer staging is based on the recommendations of the Breast Task Force, an advisory body constituted by AJCC. 2 Although most of the changes recommended by the Task Force in the Staging system are evidencebased, the inclusion of supraclavicular lymph node metastases as N3 stage disease does not have firm and sufficient evidence in our opinion. The only basis for this change, as evident from the publication by Singletary et al. 2 is the study by Brito et al. 3 To make a change on the basis of one study is certainly a debatable decision because it is a non-randomised, retrospective study with a small sample size of 70 patients, and thus constitutes weak evidence. However, the previous edition of the AJCC Manual for Staging of Cancer 4 had multiple sources of evidence 5-7 to support its decision to include supraclavicular lymph node metastases as M1 disease. The study by Kiricuta et al. 5 revealed almost similar survival rates among patients with supraclavicular lymph node metastases and with distant metastases. The dismal outcome of such patients has been consistently documented in the published literature. 5-7 In our opinion, both AJCC and the Task Force have reclassified supraclavicular lymph node metastases in a hasty manner and without any convincing evidence in the literature. Various other professional organizations such as FIGO (International Federation of Gynecology and Obstetrics), and NWTSG (National Wilms' Tumor Study Group) have also modified their staging systems in the past. For instance, the subdivision of stage IB cervical cancer into IB1 and IB2 by FIGO in the revised staging 8 is based on published results of at least five studies, thus having a convincing basis. Although future revisions of Staging systems for all individual malignancies should be done as and when required, it is suggested that panellists involved should be more stringent in finding robust evidence to make such new recommendations;furthermore, every modification is likely to alter subsequent oncology practice throughout the world as the AJCC staging system is followed worldwide. REFERENCES 1.Greene FL,

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The significance of a supraclavicular node metastasis in patients with breast cancer

Abstract: The prognosis is rather dismal as supraclavicular nodes are mostly the prelude to new metastases. Supraclavicular nodes can well be treated but the treatment does not influence survival.

Cited by 34 publications

References 41 publications

Is axillary dissection further required in clinically node negative breast cancer?

Is axillary dissection further required in clinically node negative breast cancer?

Survey of UK practice for management of breast cancer metastases to the neck

Revised AJCC staging of breast cancer: Significance of supraclavicular lymph node metastases

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