The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series

Veronesi, Umberto; Arnone, Paolo; Veronesi, Paolo; Galimberti, Viviana; Luini, Alberto; Rotmensz, Nicole; Botteri, Edoardo; Ivaldi, Giovanni Battista; Leonardi, M.C.; Viale, Giuseppe; Sagona, Andrea; Paganelli, Giovanni; Panzeri, R.; Orecchia, Roberto

doi:10.1093/annonc/mdn183

Cited by 107 publications

(71 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,5 Elective irradiation of the regional nodes remained widely used until the late 1980s, when it became less popular on the basis of an overview of older trials that showed no survival benefit, despite improvement in control of locoregional disease. 6 There was even a suggestion of decreased long-term survival owing to irradiation of the heart. [5][6][7] However, some studies predicted a beneficial effect in patients who had a high risk of regional involvement.…”

mentioning

confidence: 99%

“…6 There was even a suggestion of decreased long-term survival owing to irradiation of the heart. [5][6][7] However, some studies predicted a beneficial effect in patients who had a high risk of regional involvement. 8,9 Because of this controversy, many centers irradiated only the axilla and medial supraclavicular nodes in patients with risk factors and avoided the internal mammary nodes to protect the heart.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

View full text Add to dashboard Cite

BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Most of these patients would need adjuvant therapy such as chemotherapy and/or radiation and/or hormonal therapy. However, two recent European studies showed that IMN dissection improved accuracy of breast cancer staging and survival [35,36] . The patients with IMN metastases had a better 5-year survival after IMN radiotherapy and chemotherapy [34] .…”

Section: Fdg Pet/ct For Internal Mammary Lymph Nodesmentioning

confidence: 99%

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Liu¹

2014

WJCO

View full text Add to dashboard Cite

Fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Fluorodeoxyglucose positron emission tomography/computed tomography; Locoregional nodal disease; Axillary lymph node; Internal mammary lymph node; Axillary lymph node dissection; Sentinel lymph node biopsy Core tip: The presence and extent of locoregional nodal metastasis at diagnosis is the single most important prognostic factor in breast cancer. The predominant lymphatic drainage pathway from the breast cancer is toward the axilla. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity secondary to the limitation of its spatial resolution. The internal mammary node (IMN) involvement is of prognostic significance in breast cancer, and IMN metastasis has been associated with higher rate of distant metastasis and lower overall survival rates. Limited preliminary data indicated that FDG PET/CT plays a role in identification of positive IMN, and it is superior to conventional imaging modalities.

show abstract

“…IMN sampling was performed in 139 cases and metastasis were found in 31 (22%) cases (31/139) showing that patients with IMN drainage have a significant risk for metastasis. In contrast to this high positivity ratio, Veronesi et al 25 evaluated 663 breast cancer patients of whom 68 had metastasis in IMN (10.3%). Farrus et al 26 reported 14% positivity rate of IMN in patients with early stage breast cancer.…”

Section: Incidence Of Imn Drainage and Imn Metastasismentioning

confidence: 99%

Internal mammary node management in breast cancer. A review

Vrána¹,

Gatěk²,

Cwiertka³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Background. Internal mammary nodes visualized during sentinel node biopsy for breast cancer, remain an unresolved management issue. Further, both internal mammary node (IMN) radiotherapy and biopsy have attendant risks and hence should be used with caution. The purpose of this review is to highlight the available data and evidence. Methods and Results. A PubMed database from 1960 to 2012 using key words: internal mammary nodes, breast cancer radiotherapy planning, adjuvant radiotherapy, sentinel node biopsy in breast cancer and selected publications on the significance of internal mammary nodes in breast cancer treatment, published data and approaches used. We found 14513 relevant papers and we selected 30 that clearly investigated the management of internal mammary nodes during sentinel node search. We focused on the incidence of IMN metastasis (6 papers), risk factors associated with IMN drainage (9 reports), management of IMN and the impact on disease free and overall patient survival (15 papers). Conclusions. The evidence for breast cancer axillary nodes management is good but the data for other draining nodes such as internal mammary nodes are far less conclusive and further research is needed.

show abstract

The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series

Cited by 107 publications

References 23 publications

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Internal mammary node management in breast cancer. A review

Contact Info

Product

Resources

About