Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Benefit of Post-mastectomy Radiotherapy of the Supra-/infraclavicular Lymphatic Drainage Area in Breast Cancer Patients

  • He, Zhen-Yu (Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center) ;
  • Wu, San-Gang (Department of Radiation Oncology, Xiamen Cancer Center, the First Affiliated Hospital of Xiamen University) ;
  • Zhou, Juan (Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University) ;
  • Sun, Jia-Yuan (Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center) ;
  • Li, Feng-Yan (Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center) ;
  • Lin, Qin (Department of Radiation Oncology, Xiamen Cancer Center, the First Affiliated Hospital of Xiamen University) ;
  • Guo, Ling (Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center) ;
  • Lin, Huan-Xin (Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center)
  • Published : 2014.07.30
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Abstract

Background: This study investigated the survival benefit of radiotherapy (RT) of the supra- and infraclavicular lymphatic drainage area in Chinese women with T1-2N1M0 breast cancer receiving mastectomy. Methods: A total of 593 cases were retrospectively reviewed from 1998 to 2007. The relationship between supra- or infraclavicular fossa relapse (SCFR) and post-operative RT at the supra-/infraclavicular lymphatic drainage area was evaluated. Results: The majority of patients (532/593; 89. 8%) received no RT while 61 patients received RT. The median follow-up was 85 months. Among patients without RT, 54 (10. 2%) developed recurrence in the chest wall or ipsilateral SCFR. However, none of the 61 patients who underwent RT demonstrated SCFR. One patient who received RT (1. 6%) experienced recurrence in the chest wall. Univariate analysis revealed that age and molecular subtype (both P < 0. 05) were two prognostic factors related to supraclavicular and infraclavicular fossa relapse-free survival (SFRFS). Multivariate analysis revealed that only Her-2 positive status (P = 0. 011) was an independent predictor of SFRFS. RT had no influence on distant metastasis (P = 0. 328) or overall survival (P = 0. 541). SCFR significantly affected probability of distant metastasis (P < 0. 001) and overall survival (P < 0. 001). Conclusion: Although RT was not significantly associated with SFRFS, postoperative RT was significantly associated with a lower locoregional (i. e., supraclavicular/infraclavicular and chest wall) recurrence rate. SCFR significantly influenced distant metastasis-free survival, which significantly influenced the overall survival of T1-2N1M0 breast cancer patients after mastectomy. Thus, prophylactic RT is recommended in T1-2N1M0 breast cancer patients, especially those who have Her-2 positive lesions.

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References

  1. National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology, Breast Cancer. Version 1, 2011.
  2. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. (Accessed June 6, 2012).
  3. New Zealand Guidelines Group (NZGG). Management of Early Breast Cancer. Evidence-based Best Practice Guideline, Ministry of Health, Wellington, 2009. (http://www. Health.Govt. Nz/publication/management-early-breast-cancerevidence- based-best-practice-guideline).
  4. Professional Committee of Breast Cancer of Chinese Anti-Cancer Association (2011). Guideline for diagnosis and treatment of breast cancer of Chinese Anti-Cancer Association. Chin Oncol, 21, 367-417 (in Chinese).
  5. Aebi S, Davidson T, Gruber G, Cardoso F (2011). Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 22, 12-24.
  6. Biancosino A, Bremer M, Karstens JH, Biancosino C, Meyer A (2012). Postoperative periclavicular radiotherapy in breast cancer patients with 1-3 positive axillary lymph nodes. Outcome and morbidity. Strahlenther Onkol, 188, 417-23. https://doi.org/10.1007/s00066-012-0083-6
  7. Cosar R, Uzal C, Tokatli F, et al (2011). Postmastectomy irradiation in breast in breast cancer patients with t1-2 and 1-3 positive axillary lymph nodes: is there a role for radiation therapy? Radiat Oncol, 6, 28. https://doi.org/10.1186/1748-717X-6-28
  8. Duraker N, Demir D, Bati B, et al (2012). Survival benefit of post-mastectomy radiotherapy in breast carcinoma patients with t1-2 tumor and 1-3 axillary lymph node (s) metastasis. Jpn J Clin Oncol, 42, 601-8. https://doi.org/10.1093/jjco/hys052
  9. Fan Y, Xu B, Liao Y, Yao S, Sun Y (2010). A retrospective study of metachronous and synchronous ipsilateral supraclavicular lymph node metastases in breast cancer patients. Breast, 19, 365-9. https://doi.org/10.1016/j.breast.2010.03.022
  10. Goldhirsch A, Wood WC, Coates AS, et al (2011). Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol, 22, 1736-47. https://doi.org/10.1093/annonc/mdr304
  11. Grotenhuis BA, Klem TM, Vrijland WW (2013). Treatment outcome in breast cancer patients with ipsilateral supraclavicular lymph node metastasis at time of diagnosis: a review of the literature. Eur J Surg Oncol, 39, 207-12. https://doi.org/10.1016/j.ejso.2012.11.002
  12. Han SJ, Guo QQ, Wang T, et al (2013). Prognostic significance of interactions between ER alpha and ER beta and lymph node status in breast cancer cases. Asian Pac J Cancer Prev, 14, 6081-4. https://doi.org/10.7314/APJCP.2013.14.10.6081
  13. Huang CJ, Hou MF, Chuang HY, et al (2012). Comparison of clinical outcome of breast cancer patients with t1-2 tumor and one to three positive nodes with or without postmastectomy radiation therapy. Jpn J Clin Oncol, 42, 711-20. https://doi.org/10.1093/jjco/hys080
  14. Jia WJ, Jia HX, Feng HY, et al (2014). HER2-enriched tumors have the highest risk of local recurrence in Chinese patients treated with breast conservation therapy. Asian Pac J Cancer Prev, 15, 315-20. https://doi.org/10.7314/APJCP.2014.15.1.315
  15. Kaufmann M, von Minckwitz G, Smith R, et al (2003). International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations. J Clin Oncol, 21, 2600-8. https://doi.org/10.1200/JCO.2003.01.136
  16. Kong M, Hong SE (2013). Predictive factors for supraclavicular lymph node recurrence in n1 breast cancer patients. Asian Pac J Cancer Prev, 14, 2509-14. https://doi.org/10.7314/APJCP.2013.14.4.2509
  17. Kunkler IH, Canney P, van Tienhoven G, Russell NS (2008). Mrc/eortc (big 2-04) supremo trial management group, elucidating the role of chest wall irradiation in 'intermediaterisk' breast cancer: The mrc/eortc supremo trial. Clin Oncol (R Coll Radiol), 20, 31-4. https://doi.org/10.1016/j.clon.2007.10.004
  18. 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
  19. Macdonald SM, Abi-Raad RF, Alm El-Din MA, et al (2009). Chest wall radiotherapy: middle ground for treatment of patients with one to three positive lymph nodes after mastectomy. Int J Radiat Oncol Biol Phys, 75, 1297-303. https://doi.org/10.1016/j.ijrobp.2009.01.007
  20. Nandi M1, Mahata A, Mallick I, et al (2014). Hypofractionated radiotherapy for breast cancers--preliminary results from a tertiary care center in eastern India. Asian Pac J Cancer Prev, 15, 2505-10. https://doi.org/10.7314/APJCP.2014.15.6.2505
  21. 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
  22. 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
  23. Overgaard M, Nielsen HM, Overgaard J (2007). Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the dbcg 82 b&c randomized trials. Radiother Oncol, 82, 247-53. https://doi.org/10.1016/j.radonc.2007.02.001
  24. Panoff JE, Hurley J, Takita C, et al (2011). Risk of locoregional recurrence by receptor status in breast cancer patients receiving modern systemic therapy and post-mastectomy radiation. Breast Cancer Res Treat, 128, 899-906. https://doi.org/10.1007/s10549-011-1495-1
  25. 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
  26. Reddy JP, Levy L, Oh JL, et al (2011). Long-term outcomes in patients with isolated supraclavicular nodal recurrence after mastectomy and doxorubicin-based chemotherapy for breast cancer. Int J Radiat Oncol Biol Phys, 80, 1453-7. https://doi.org/10.1016/j.ijrobp.2010.04.015
  27. Sautter-Bihl ML, Souchon R, Budach W, et al (2008). Degro practical guidelines for radiotherapy of breast cancer ii. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease. Strahlenther Onkol, 184, 347-53. https://doi.org/10.1007/s00066-008-1901-8
  28. Siponen ET, Vaalavirta LA, Joensuu H, Leidenius MH (2012). Axillary and supraclavicular recurrences are rare after axillary lymph node dissection in breast cancer. World J Surg, 36, 295-302. https://doi.org/10.1007/s00268-011-1399-6
  29. Strom EA, Woodward WA, Katz A, et al (2005). Clinical investigation: regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy. Int J Radiat Oncol Biol Phys, 63, 1508-13. https://doi.org/10.1016/j.ijrobp.2005.05.044
  30. Tendulkar RD, Rehman S, Shukla ME, et al (2012). Impact of postmastectomy radiation on locoregional recurrence in breast cancer patients with 1-3 positive lymph nodes treated with modern systemic therapy. Int J Radiat Oncol Biol Phys, 83, e577-81. https://doi.org/10.1016/j.ijrobp.2012.01.076
  31. Wai ES, Lesperance M, Speers CH, et al (2010). Increased use of regional radiotherapy is associated with improved outcome in a population-based cohort of women with breast cancer with 1-3 positive nodes. Radiother Oncol, 97, 301-6. https://doi.org/10.1016/j.radonc.2010.08.008
  32. Wu SG, He ZY, Li FY, et al (2010). The clinical value of adjuvant radiotherapy in patients with early stage breast cancer with 1 to 3 positive lymph nodes after mastectomy. Chin J Cancer, 29, 668-76. https://doi.org/10.5732/cjc.009.10744
  33. Yarnold J (2009). Early and locally advanced breast cancer: diagnosis and treatment national institute for health and clinical excellence guideline 2009. Clin Oncol (R Coll Radiol), 21, 159-60. https://doi.org/10.1016/j.clon.2008.12.008
  34. 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
  35. 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
  36. Yu JI, Park W, Shin KH, et al (2013). Prophylactic supraclavicular radiotherapy after surgery in high-risk n1 breast cancer. Oncology, 85, 14-20. https://doi.org/10.1159/000352002
  37. Zhou SF1, Shi WF, Meng D, et al (2012). Interoperative radiotherapy of seventy-two cases of early breast cancer patients during breast-conserving surgery. Asian Pac J Cancer Prev, 13, 1131-5. https://doi.org/10.7314/APJCP.2012.13.4.1131
  38. Zhu ZL, Zhang J, Chen ML, et al (2013). Efficacy and safety of Trastuzumab added to standard treatments for HER2- positive metastatic breast cancer patients. Asian Pac J Cancer Prev, 14, 7111-6. https://doi.org/10.7314/APJCP.2013.14.12.7111
  39. Ziegler RG, Anderson WF, Gail MH (2008). Increasing breast cancer incidence in China: the numbers add up. J Natl Cancer Inst, 100, 1339-41. https://doi.org/10.1093/jnci/djn330