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)
- Author:
Kyubo KIM
1
;
Yuri JEONG
;
Kyung Hwan SHIN
;
Jin Ho KIM
;
Seung Do AHN
;
Su Ssan KIM
;
Chang Ok SUH
;
Yong Bae KIM
;
Doo Ho CHOI
;
Won PARK
;
Jihye CHA
;
Mison CHUN
;
Dong Soo LEE
;
Sun Young LEE
;
Jin Hee KIM
;
Hae Jin PARK
;
Wonguen JUNG
Author Information
- Publication Type:Multicenter Study
- Keywords: Breast neoplasms; Supraclavicular lymph node; Internal mammary lymph node; Radiotherapy
- MeSH: Breast Neoplasms; Breast; Disease-Free Survival; Drug Therapy; Follow-Up Studies; Humans; Lymph Nodes; Mastectomy; Mastectomy, Segmental; Multivariate Analysis; Radiotherapy; Retrospective Studies; Survival Rate
- From:Cancer Research and Treatment 2019;51(4):1500-1508
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The 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 METHODS: A 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. RESULTS: The 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. CONCLUSION: Neoadjuvant 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.
