Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Predictive Factors for Supraclavicular Lymph Node Recurrence in N1 Breast Cancer Patients

  • Kong, Moonkyoo (Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Hong, Seong Eon (Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine)
  • Published : 2013.04.30
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Abstract

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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References

  1. Ceilley E, Jagsi R, Goldberg S, et al (2005). Radiotherapy for invasive breast cancer in North America and Europe: results of a survey. Int J Radiat Oncol Biol Phys, 61, 365-73. https://doi.org/10.1016/j.ijrobp.2004.05.069
  2. Chen SC, Chen MF, Hwang TL, et al (2002). Prediction of supraclavicular lymph node metastasis in breast carcinoma. Int J Radiat Oncol Biol Phys, 52, 614-9. https://doi.org/10.1016/S0360-3016(01)02680-3
  3. Clarke M, Collins R, Darby S, et al (2005). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet, 366, 2087-106. https://doi.org/10.1016/S0140-6736(05)67887-7
  4. Fentiman IS, Lavelle MA, Caplan D, et al (1986). The significance of supraclavicular fossa node recurrence after radical mastectomy. Cancer, 57, 908-10. https://doi.org/10.1002/1097-0142(19860301)57:5<908::AID-CNCR2820570504>3.0.CO;2-Q
  5. Fodor J, Toth J, Major T, Polgar C, Nemeth G (1999). Incidence and time of occurrence of regional recurrence in stage I-II breast cancer: value of adjuvant irradiation. Int J Radiat Oncol Biol Phys, 44, 281-7. https://doi.org/10.1016/S0360-3016(99)00013-9
  6. Goldhirsch A, Glick JH, Gelber RD, et al (2005). Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol, 16, 1569-83. https://doi.org/10.1093/annonc/mdi326
  7. Grills IS, Kestin LL, Goldstein N, et al (2003). Risk factors for regional nodal failure after breast-conserving therapy: regional nodal irradiation reduces rate of axillary failure in patients with four or more positive lymph nodes. Int J Radiat Oncol Biol Phys, 56, 658-70. https://doi.org/10.1016/S0360-3016(03)00017-8
  8. Halverson KJ, Taylor ME, Perez CA, et al (1993). Regional nodal management and patterns of failure following conservative surgery and radiation therapy for stage I and II breast cancer. Int J Radiat Oncol Biol Phys, 26, 593-9. https://doi.org/10.1016/0360-3016(93)90274-Y
  9. Harris EE, Hwang WT, Seyednejad F, Solin LJ (2003). Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy. Cancer, 98, 2144-51. https://doi.org/10.1002/cncr.11767
  10. Kahan Z, Csenki M, Varga Z, et al (2007). The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys, 68, 673-81. https://doi.org/10.1016/j.ijrobp.2006.12.016
  11. Kiricuta IC, Willner J, Kolbl O, Bohndorf W (1994). The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys, 28, 387-93. https://doi.org/10.1016/0360-3016(94)90062-0
  12. Liu AN, Sun P, Liu JN, et al (2012). Clinicopathologic characteristics and prognostic factors in patients with operable HER-2 overexpressing breast cancer. Asian Pac J Cancer Prev, 13, 1197-201. https://doi.org/10.7314/APJCP.2012.13.4.1197
  13. McKinna F, Gothard L, Ashley S, Ebbs SR,Yarnold JR (1999). Lymphatic relapse in women with early breast cancer: a difficult management problem. Eur J Cancer, 35, 1065-9. https://doi.org/10.1016/S0959-8049(99)00101-X
  14. Overgaard M, Hansen PS, Overgaard J, et al (1997). Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med, 337, 949-55. https://doi.org/10.1056/NEJM199710023371401
  15. Overgaard M, Jensen MB, Overgaard J, et al (1999). Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet, 353, 1641-8. https://doi.org/10.1016/S0140-6736(98)09201-0
  16. Ragaz J, Olivotto IA, Spinelli JJ, et al (2005). Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst, 97, 116-26. https://doi.org/10.1093/jnci/djh297
  17. Reddy SG, Kiel KD (2007). Supraclavicular nodal failure in patients with one to three positive axillary lymph nodes treated with breast conserving surgery and breast irradiation, without supraclavicular node radiation. Breast J, 13, 12-8. https://doi.org/10.1111/j.1524-4741.2006.00357.x
  18. Truong PT, Jones SO, Kader HA, et al (2009). Patients with t1 to t2 breast cancer with one to three positive nodes have higher local and regional recurrence risks compared with node-negative patients after breast-conserving surgery and whole-breast radiotherapy. Int J Radiat Oncol Biol Phys, 73, 357-64. https://doi.org/10.1016/j.ijrobp.2008.04.034
  19. Vicini FA, Horwitz EM, Lacerna MD, et al (1997). The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breastconserving therapy. Int J Radiat Oncol Biol Phys, 39, 1069-76. https://doi.org/10.1016/S0360-3016(97)00555-5
  20. Yates L, Kirby A, Crichton S, et al (2012). Risk factors for regional nodal relapse in breast cancer patients with one to three positive axillary nodes. Int J Radiat Oncol Biol Phys, 82, 2093-103. https://doi.org/10.1016/j.ijrobp.2011.01.066
  21. Yu JI, Park W, Huh SJ, et al (2010). Determining which patients require irradiation of the supraclavicular nodal area after surgery for N1 breast cancer. Int J Radiat Oncol Biol Phys, 78, 1135-41. https://doi.org/10.1016/j.ijrobp.2009.09.037
  22. Zare N, Doostfatemeh M, Rezaianzadeh A (2012). Modeling of breast cancer prognostic factors using a parametric loglogistic model in Fars province, Southern Iran. Asian Pac J Cancer Prev, 13, 1533-7. https://doi.org/10.7314/APJCP.2012.13.4.1533

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