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Feng K, Xing Z, Dai Q, Cheng H, Wang X. Role of aggressive locoregional surgery in treatment strategies for ipsilateral supraclavicular lymph node metastasis of breast cancer: a real-world cohort study. Front Mol Biosci 2023; 10:1248410. [PMID: 37916188 PMCID: PMC10616842 DOI: 10.3389/fmolb.2023.1248410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Background: Breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastases (ISLNM) have unfavorable prognoses. The role of supraclavicular lymph node dissection (SLND) as a surgical intervention in the treatment of this condition remains controversial. In this study, we aimed to evaluate the prognostic factors associated with breast cancer with ISLNM and to assess the potential impact of aggressive locoregional surgical management on patient outcomes. Methods: We conducted a retrospective analysis of 250 breast cancer patients with ISLNM who were treated with curative intent at our institution between 2000 and 2020. The cohort was stratified into groups based on the extent of axillary surgery. The first group, comprising 185 patients, underwent level I/II axillary dissection. The second group, consisting of 65 patients, underwent aggressive locoregional surgery, including levels I/II/III (infraclavicular) dissection in 37 patients and levels I/II/III + SLND in 28 patients. Our study evaluated overall survival (OS) and disease-free survival (DFS) as primary endpoints, and locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS) as secondary endpoints. Results: The median follow-up time among all patients was 5.92 years (1.05-15.36 years). The 5-year OS rate was 71.89%, while the DFS rate, LRRFS rate, and DMFS rates were 59.25%, 66.38%, and 64.98%, respectively. A significant difference in OS, DFS, LRRFS, and DMFS was observed between the second group and the first group (p < 0.01). No beneficial impact on recurrence, metastasis, or survival outcomes was observed in the levels I/II/III + SLND group compared to the levels I/II/III dissection group. Multivariate logistic regression analysis revealed that levels I/II/III ± SLND surgery and T stage were associated with OS (p = 0.006 and p = 0.026), while levels I/II/III ± SLND surgery, ER+/HER2-, and histologic grade were associated with DFS (p = 0.032, p = 0.001, p = 0.032). Conclusion: Breast cancer with ISLNM may be considered a locoregional disease, requiring a combination of systemic and local therapies. Aggressive locoregional surgery has been shown to positively impact recurrence, metastasis, and survival outcomes. This approach may provide improved management of the ISLNM for breast cancer patients.
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Affiliation(s)
| | | | | | | | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Li S, Qi W, Cao L, Xu C, Cai R, Chen J, Cai G. Nodal response to primary systemic therapy predicts prognosis of cN3c breast cancer patients receiving multimodality therapy. Breast 2023; 70:92-99. [PMID: 37423063 DOI: 10.1016/j.breast.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/22/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023] Open
Abstract
AIM To investigate the survival outcomes, patterns and risks of recurrence in cN3c breast cancer patients after multimodality therapy, as well as the predictors of candidates for ipsilateral supraclavicular (SCV) area boosting. METHOD Consecutive cN3c breast cancer patients from January 2009 to December 2020 were retrospectively reviewed. Based on nodal response to primary systemic therapy (PST), patients were categorized into three groups: clinical complete response (cCR) not achieved in SCV lymph nodal (SCLN, Group A), SCLN cCR but axillary node (ALN) did not achieve pathological complete response (pCR, Group B), cCR in SCLN and pCR in ALN (Group C). RESULTS The median follow-up time was 32.7 months. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 64.6% and 43.7% respectively. Multivariate analysis showed cumulative SCV dose and ypT stage, ALN response and SCV response to PST were significantly associated with OS and RFS respectively. Compared with Group A or B, Group C showed significantly improved 3 y-RFS (53.8% vs 73.6% vs 100%, p = 0.003), and the lowest rate of DM as first failure (37.9% vs 23.5% vs 0%, p = 0.010). In Group A, the 3 y-OS for patients receiving the cumulative SCV dose of ≥60 Gy versus <60 Gy was 78.0% versus 57.3% (p = 0.029). CONCLUSION Nodal response to PST is an independent prognostic factor for survival and pattern of failure. A cumulative SCV dose of ≥60 Gy is positively associated with improved OS, especially in Group A. Our data supports the perspective of optimizing radiotherapeutic strategy based on nodal response.
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Affiliation(s)
- Shuyan Li
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weixiang Qi
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Rong Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Gang Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Song YC, Kong J, Li N, Liu XL, Li XH, Zhu LY, Wang YW, Fang H, Jing H, Tang Y, Li YX, Wang XH, Zhang J, Wang SL. Comparison of supraclavicular surgery plus radiotherapy versus radiotherapy alone in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis: a multicenter retrospective study. Radiother Oncol 2023; 183:109639. [PMID: 36990395 DOI: 10.1016/j.radonc.2023.109639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/27/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To evaluate and compare the outcomes of supraclavicular lymph node dissection plus radiotherapy (RT) and RT alone for patients with synchronous ipsilateral supraclavicular lymph node metastasis. METHODS In all, 293 patients with synchronous ipsilateral supraclavicular lymph node metastasis across three centers were included. Of these, 85 (29.0%) received supraclavicular lymph node dissection plus RT (Surgery + RT) and 208 (71.0%) received RT alone. All patients received preoperative systemic therapy followed by mastectomy or lumpectomy and axillary dissection. Supraclavicular recurrence-free survival (SCRFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated by using the Kaplan-Meier method and multivariate Cox models. Multiple imputation was used for missing data. RESULTS The median follow-up duration of the RT and Surgery + RT groups were 53.7 and 63.5 months, respectively. For the RT and Surgery + RT groups, the 5-year SCRFS rates were 91.7% vs. 85.5% (P=0.522), LRRFS rates were 79.1% vs. 73.1% (P=0.412), DMFS rates were 60.4 vs. 58.8% (P=0.708), DFS rates were 57.6% vs. 49.7% (P=0.291), and OS rates were 71.9% vs. 62.2% (P=0.272), respectively. There was no significant effect on any outcome when comparing Surgery +RT versus RT alone in the multivariate analysis. Based on four risk factors of DFS, patients were classified into three risk groups: the intermediate- and high-risk groups had significantly lower survival outcomes than the low-risk group. Surgery +RT did not improve outcomes of any risk group compared with RT alone. CONCLUSIONS Patients with synchronous ipsilateral supraclavicular lymph node metastasis may not benefit from supraclavicular lymph node dissection. Distant metastasis remained the major failure pattern, especially for intermediate- and high-risk groups.
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Definitive Radiation With Nodal Boost for Patients With Locally Advanced Breast Cancer. Pract Radiat Oncol 2023; 13:e103-e114. [PMID: 36435389 DOI: 10.1016/j.prro.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The optimal local therapy of patients with nodal disease in supraclavicular (SCV), internal mammary nodes (IMN) and level III axilla is not well studied. We aimed to evaluate the outcomes of patients with breast cancer and advanced nodal disease that received a nodal boost. METHODS AND MATERIALS This retrospective study included 79 patients with advanced nodal disease who underwent adjuvant radiation with a nodal boost to the SCV, IMNs, and/or axilla. All patients had radiographic changes after systemic therapy concerning for gross nodal disease. Overall survival, disease-free survival (DFS), and local recurrence-free survival were estimated using the Kaplan-Meier method. RESULTS All patients received an initial 50 Gy to the breast/chest wall and regional nodes, of whom 46.8% received an IMN boost, 38.0% axillary (ax)/SCV boost, and 15.2% both IMN and ax/SCV boost (IMN + ax/SCV). Most patients had hormone receptor positive (74.7%) and human epidermal growth factor receptor 2 negative disease (83.5%). In addition, 12.7% of patients had clinical (c) N2 disease, 21.5% cN3A disease, 51.9% cN3B disease, and 5.1% cN3C disease. Most patients received chemotherapy (97.5%). The median nodal boost dose was 10 Gy (range, 10-20 Gy), with 21.6% of IMN, 16.7% of ax/SCV, and 16.7% of IMN + ax/SCV receiving 14 to 20 Gy. With a median follow up of 30 months, the 3-year local recurrence-free survival, DFS, and overall survival rates were 94.5%, 86.3%, and 93.8%, respectively. Crude rates of failure were 13.9% (10.1% distant failure [DF] alone; 3.8% DF + locoregional failure [LRF]). Rates of failure by boost group were 13.3% for ax/SCV (10.0% DF alone; 3.3% DF + LRF), 5.4% for IMN (2.7% DF alone, 2.7% DF + LRF), and 41.7% for IMN + ax/SCV (33.3% DF, 8.3% DF + LRF). There were no LRFs without DFs. The median time to failure was 22.8 months (interquartile range, 18-34 months). Clinical tumor size and IMN + ax/SCV versus IMN or ax/SCV alone was associated with worse DFS (hazard ratio [HR]: 9.78; 95% confidence interval [CI], 2.07-46.2; P = .004 and HR: 9.49; 95% CI, 2.67-33.7; P = .001, respectively). On multivariate analysis, IMN + ax/SCV versus IMN or ax/SCV alone retained significance (HR: 4.80; 95% CI, 1.27-18.13; P = .02). CONCLUSIONS In this population of patients with locally advanced breast cancer, the majority of failures were distant with no isolated LRFs. Failures were the highest in the IMN + ax/SCV group (∼40%). Further treatment escalation is necessary for these patients.
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Chen W, Su Y, Zhang H, Zhang Y, Zhu L, Lin M, Lin Z, Yu M, Yang S, Zhang Y. 99mTc-rituximab tracer injection for guiding internal mammary sentinel lymph nodes biopsy in primary breast cancer: A prospective observational study. Front Oncol 2023; 13:1100077. [PMID: 36845718 PMCID: PMC9950501 DOI: 10.3389/fonc.2023.1100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
Objective To explore the use of 99mTc-rituximab tracer injection for internal mammary sentinel lymph node (IM-SLN) detection in patients with primary breast cancer. Methods This prospective observational study enrolled female patients with primary breast cancer between September 2017 and June 2022 at Fujian Provincial Hospital. The participants were divided into the peritumoral group (two subcutaneous injection points on the surface of the tumor), two-site group (injections into the glands at 6 and 12 o'clock around the areola area), and four-site group (injections into the gland at 3, 6, 9, and 12 o'clock around the areola area). The outcomes were the detection rates of the IM-SLNs and axillary sentinel lymph nodes (A-SLNs). Results Finally, 133 patients were enrolled, including 53 in the peritumoral group, 60 in the two-site group, and 20 in the four-site group. The detection rate of the IM-SLNs in the peritumoral group (9.4% [5/53]) was significantly lower than in the two-site (61.7% [37/60], P<0.001) and four-site (50.0% [10/20], P<0.001) groups. The detection rates of A-SLNs among the three groups were comparable (P=0.436). Conclusion The two-site or four-site intra-gland injection of 99mTc-rituximab tracer might achieve a higher detection rate of IM-SLNs and a comparable detection rate of A-SLNs compared with the peritumoral method. The location of the primary focus has no impact on the detection rate of the IM-SLNs.
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Affiliation(s)
- Wenxin Chen
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China,Fujian Research Institute of Nuclear Medcine, Fuzhou, China,*Correspondence: Wenxin Chen, ; Mengbo Lin,
| | - Yaodong Su
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China,Fujian Research Institute of Nuclear Medcine, Fuzhou, China
| | - Hui Zhang
- Department of Oncology Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Oncology Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Yu Zhang
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China,Fujian Research Institute of Nuclear Medcine, Fuzhou, China
| | - Lin Zhu
- Department of Ultrasonic Diagnostics, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Ultrasonic Diagnostics, Fujian Provincial Hospital, Fuzhou, China
| | - Mengbo Lin
- Department of Oncology Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Oncology Surgery, Fujian Provincial Hospital, Fuzhou, China,*Correspondence: Wenxin Chen, ; Mengbo Lin,
| | - Zhiyi Lin
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China,Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China,Fujian Research Institute of Nuclear Medcine, Fuzhou, China
| | - Mingdian Yu
- Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Shengping Yang
- Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Yanmin Zhang
- Department of Nuclear Medicine, Fujian Provincial Hospital, Fuzhou, China
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A multi-center cross-sectional investigation of the diagnosis and treatment of breast cancer with synchronous ipsilateral supraclavicular lymph node metastases based on the CSBrs-009. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:1482-1487. [PMID: 36611099 DOI: 10.1007/s12094-022-03053-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The diagnosis and management of breast cancer with ipsilateral supraclavicular lymph node metastases currently lack any applicable criteria or guidelines (ISLM), and diagnostic and treatment strategies are varied by medical centers. This study aimed to determine the current status of the diagnosis and treatment of breast cancer with ISLM among Chinese patients. METHODS Data from 30 hospitals on ISLM breast cancer patients between January 1, 2018, and December 31, 2018, were systematically analyzed for the detection rate, clinicopathological characteristics, diagnosis and treatment strategies of breast cancer with ISLM among Chinese patients. RESULTS A total of 26,723 women presented with breast cancer in 30 hospitals over the study period. A total of 127 ISLM breast cancer patients were finally enrolled. Synchronous ISLM without distant metastases was present in 0.48% of cases. The diagnosis of patients with 86.6% of ISLM was based on ultrasound examinations. The proportion of ISLM diagnosed by fine-needle aspiration biopsy (FNA) or core-needle biopsy (CNB) before surgery was 16.5% and 37.0%, respectively. Moreover, 45.7% of the ISLM patients had no pathological evidence. Regarding treatment strategies, 69.3% of ISLM patients received neoadjuvant chemotherapy (NAC) for more than 4 cycles, while 15.7% of patients did not receive NAC. 86.6% of ISLM patients underwent a mastectomy, and breast-conserving surgery was performed in 3.9% of ISLM patients. Moreover, 41.7% of ISLM patients received supraclavicular lymph node dissection (SCLD), while 47.2% were not treated with SCLD. CONCLUSIONS The overall detection rate of breast cancer in patients with ISLM is low in China and varies widely between hospitals. There is no consensus on the optimal diagnosis and treatment of patients with ISLM breast cancer.
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Coopey SB. Supraclavicular and Contralateral Axillary Lymph Node Involvement in Breast Cancer Patients. Ann Surg Oncol 2022; 29:6100-6105. [PMID: 35794365 DOI: 10.1245/s10434-022-12134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022]
Abstract
Ipsilateral supraclavicular disease was reclassified from Stage IV, distant metastatic disease, to Stage IIIC, locally advanced breast cancer 20 years ago. Treatment with curative intent with multimodality therapy has led to improved outcomes over time. In contrast, metastatic disease to contralateral axillary lymph nodes remains as Stage IV distant disease. Despite this, in the absence of other distant metastases, many patients with contralateral axillary disease are treated more aggressively than other Stage IV patients. Outcomes of patients with contralateral axillary disease treated with curative intent are more like patients with ipsilateral supraclavicular disease and other locally advanced breast cancers than patients with de novo distant metastases elsewhere. Therefore, some favor reclassification of contralateral axillary metastases without distant metastasis from Stage IV to Stage III breast cancer similar to ipsilateral supraclavicular metastases.
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Andring LM, Diao K, Sun S, Patel M, Whitman GJ, Schlembach P, Arzu I, Joyner MM, Shaitelman SF, Hoffman K, Stauder MC, Smith BD, Woodward WA. Locoregional Management and Prognostic Factors in Breast Cancer Patients with Ipsilateral Internal Mammary and Axillary Lymph Node Involvement. Int J Radiat Oncol Biol Phys 2022; 113:552-560. [PMID: 35248602 DOI: 10.1016/j.ijrobp.2022.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Breast cancer patients with ipislateral axillary and internal mammary (IM) lymph node involvement (cN3b) often forego IM node resection. Therefore, radiation is important for curative therapy. However, prognosis is not well-described in the era of modern systemic therapy and limited data exist to guide optimal locoregional treatment recommendations. METHODS We retrospectively reviewed 117 patients with non-metastatic cN3b breast cancer treated at our institution between 2014-2019. Staging included ultrasound evaluation of all regional nodal basins. All patients received neoadjuvant chemotherapy (NAC), resection of the breast primary and axillary nodal dissection, followed by adjuvant radiation to the breast/chest wall and regional nodes. Institutional guidelines recommend a 10 Gy boost to radiographically resolved nodes, and 16 Gy boost to unresolved nodes. Overall survival (OS), recurrence (RFS), locoregional (LRRFS), internal mammary (IMRFS), and distant metastasis free survival (DMFS) were evaluated with Kaplan Meier analysis. A multivariable model for RFS was constructed. RESULTS Median follow-up for 117 patients was 3.82 years. Median age at diagnosis was 46 years and 56 (48%) patients were receptor group ER+/HER2-. Mastectomy was performed in 96 (82%) of patients, 38 (32%) had biopsy confirmed IMC involvement, and 8 (7%) had IM node dissection. The median initial radiation dose was 50 Gy (range, 50-55) and IMC boost 10 Gy (range, 0-16). The 5-year OS, IMRFS, LRRFS, DMFS, and RFS were 74%, 98%, 89%, 68% and 67% respectively. On multivariable analysis, a clinical complete response (CR) of the IM nodes or pathologic ypN0 status had improved 5-year RFS with HR 0.24 (p=0.006) and HR 0.27 (p=0.05), respectively. Extranodal extension or lymphovascular invasion were associated with worse 5-year RFS with HR 4.13 (p=0.001) and HR 2.25 (p=0.04), respectively. CONCLUSION Multimodality therapy provides excellent locoregional control of 89% at 5 years for cN3b breast cancer patients. Adjuvant radiation yields a 5-year IMRFS of 98%. Clinical and pathologic response of IM nodes are independently prognostic for RFS.
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Affiliation(s)
| | | | | | | | - Gary J Whitman
- Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
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Contemporary Outcomes After Multimodality Therapy in Patients With Breast Cancer Presenting With Ipsilateral Supraclavicular Node Involvement. Int J Radiat Oncol Biol Phys 2022; 112:66-74. [PMID: 34710521 PMCID: PMC8688264 DOI: 10.1016/j.ijrobp.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Patients with breast cancer and ipsilateral supraclavicular (SCV) node involvement at the time of diagnosis (TNM cN3c) have historically had poor outcomes. Radiation therapy (RT) has an important role because SCV nodes are not routinely surgically dissected. However, optimal locoregional management, contemporary outcomes, and prognostic factors are not well defined. METHODS AND MATERIALS We reviewed the data of patients with cN3c breast cancer treated at our institution between 2014 and 2019 with curative intent, including neoadjuvant chemotherapy, surgery, and adjuvant RT. All patients received comprehensive regional RT, including to the SCV nodes. Institutional guidelines recommend a 10-Gy or 16-Gy boost to resolved and unresolved N3 nodes, respectively. Overall survival (OS), recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS), and supraclavicular recurrence-free survival (SCRFS) were analyzed. RESULTS Data from 173 consecutive patients were analyzed with a median follow-up time of 2.8 years. The median age was 54 years, 76 patients (44%) were estrogen receptor positive/human epidermal growth factor receptor 2 negative, 100 patients (58%) had T3/4 disease, and 10 patients (6%) underwent a neck dissection. In addition, 156 patients (90%) received a cumulative SCV dose of ≥60 Gy. The 5-year OS, SCRFS, LRRFS, and RFS rates were 73%, 95%, 86%, and 50%, respectively. The 5-year OS rate for a cumulative SCV dose of ≥60 Gy versus <60 Gy was 75% versus 39% (P = .04). In the multivariable analysis, a cumulative SCV dose of ≥60 Gy, extranodal extension, receptor status, and Eastern Cooperative Oncology Group performance status were associated with OS. The 5-year SCRFS rates with and without neck dissection were 100% versus 95% (P = .57). Among patients with a postchemotherapy SCV node size of ≥1 cm without neck dissection, the 5-year SCRFS rate was 83%. CONCLUSIONS In one of the largest series of patients with cN3c breast cancer, multimodality therapy using adjuvant RT with a SCV boost resulted in a 5-year LRRFS rate of 86%. There is a limited role for neck dissection as the 5-year SCRFS rate was 95% overall and 83% for residual SCV disease ≥1 cm after chemotherapy with RT alone. A cumulative SCV dose of ≥60 Gy was associated with improved OS, but not SCRFS, LRRFS, or RFS. A SCV boost should be considered in these patients as treatment was well-tolerated. Despite advances in systemic therapy, nearly half of patients developed distant metastases, highlighting the need for close observation after treatment.
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Jin K, Luo J, Wang X, Yang Z, Zhang L, Mei X, Ma J, Chen X, Zhang X, Zhou Z, Wang X, Shao Z, Zhang Z, Guo X, Yu X. Symptoms Related to Brachial Plexus Neuropathy After Supraclavicular Irradiation and Boost in Breast Cancer. Pract Radiat Oncol 2021; 12:e13-e23. [PMID: 34450336 DOI: 10.1016/j.prro.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the incidence of symptoms related to brachial plexus neuropathy (BPN) and the dose distribution to the brachial plexus (BP) in patients with breast cancertreated with supraclavicular (SCV) irradiation and boost. METHODS AND MATERIALS In this study, 117 patients with initial ipsilateral supraclavicular lymph node (SLN) metastasis and 39 with recurrent SLN metastasis between 2008 and 2018 in our cancer center were retrospectively analyzed. All patients were treated with 50 Gy of SCV irradiation in 25 fractions and a boost (median dose, 10 Gy; range, 10-16 Gy) to involved nodes in the SCV area. Symptoms related to BPN (including ipsilateral arm numbness, pain, and weakness) were recorded and graded according to the Common Terminology Criteria for Adverse Events, version 5.0. The BP was delineated on simulation computed tomography, and the dose distributions to the BP were evaluated. Meanwhile, 297 patients treated with SCV irradiation without boost during the same period were identified as a control group to compare the incidences of BPN-related symptoms and dosimetric data with patients who received an SCV boost. RESULTS The 5-year overall survival rate was 80.3% for patients with initial SLN metastasis and 51.0% for patients with recurrent SLN metastasis. For patients who received an SCV boost, incidence rates of ipsilateral arm numbness, pain, and weakness were 23.9%, 18.3%, and 34.3%, respectively. Four patients (5.6%) developed grade 2 numbness and 3 (4.3%) developed grade 2 arm weakness. In the control group, incidence rates of arm numbness, pain, and weakness were 31.6%, 21.9%, and 36.0%, respectively. The incidence of BPN-related symptoms was not significantly different between the 2 groups. Symptoms of grade 3 were not observed in either cohort. The mean doses to the BP in patients who received boost and who did not were 56.8 and 46.8 Gy, respectively (P < .001). The maximum doses to the BP in patients who received boost and who did not were 64.5 and 53.5 Gy, respectively (P < .001). The BP volumes receiving at least 50 Gy, 60 Gy, 61 Gy, and 62 Gy were also significantly higher in the boosted group compared with the control group (P < .001). CONCLUSIONS This study found that an SCV boost of 10 Gy did not increase the incidence of BPN-related symptoms and that the toxicity to the BP was acceptable. Comprehensive treatment including SCV irradiation and boost led to satisfactory survival outcomes in patients with breast cancer who had SLN metastasis.
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Affiliation(s)
- Kairui Jin
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jurui Luo
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuanyi Wang
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhaozhi Yang
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Zhang
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Mei
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinli Ma
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xingxing Chen
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomeng Zhang
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huanshan Hospital
| | - Xiaofang Wang
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Breast Surgery, Fudan University Shanghai Cancer Center
| | - Zhen Zhang
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Xiaoli Yu
- Key Laboratory of Radiation Oncology, Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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11
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Lian CL, Zhang HY, Wang J, Lei J, Hua L, Chen YX, Wu SG. Staging for Breast Cancer With Internal Mammary Lymph Nodes Metastasis: Utility of Incorporating Biologic Factors. Front Oncol 2021; 10:584009. [PMID: 33520700 PMCID: PMC7840897 DOI: 10.3389/fonc.2020.584009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To validate the 8th edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging system for breast cancer patients with internal mammary lymph nodes (IMN) metastasis (N3b disease, stage IIIC in 7th AJCC anatomical staging). Methods Breast cancer patients with IMN metastasis diagnosed between 2010 and 2014 were retrieved from the Surveillance, Epidemiology, and End Results program. Chi-squared test, Log-rank test, Kaplan-Meier method, and Cox proportional hazard analysis were applied to statistical analysis. Results We included 678 patients with N3b disease in this study. Overall, 68.4% of patients were downstaged to IIIA and IIIB diseases from the 7th anatomical staging to 8th pathological prognostic staging. The new pathological prognostic staging system had better discriminatory value on prognosis prediction among IMN-metastasized breast cancer patients, with a 5-year breast cancer-specific survival (BCSS) of 92.7, 77.4, and 66.0% in stage IIIA, IIIB, and IIIC diseases, respectively (P<0.0001), and the 5-year overall survival (OS) rates was 85.9, 72.1, and 58.7%, respectively (P<0.0001). The results of the multivariate prognostic analysis showed that the new pathological prognostic staging was the independent prognosis related to BCSS and OS, the 8th AJCC pathological prognostic stages showed worse BCSS and OS with gradually increased hazard ratios. Conclusion The 8th AJCC pathological prognostic staging system offers more refined prognostic stratification to IMN-metastasized breast cancer patients and endorses its use in routine clinical practice for this specific subgroup of breast cancer.
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Affiliation(s)
- Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Hai-Yan Zhang
- The Sixth People's Hospital of Huizhou, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
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12
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Kim H, Kim SS, Lee IJ, Shin KH, Kim K, Jung J, Kim YB, Chang JS, Choi DH, Park W, Yang K, Chang JH, Cha J, Kim JH, Lee DS. Outcome of radiotherapy for clinically overt metastasis to the internal mammary lymph node in patients receiving neoadjuvant chemotherapy and breast cancer surgery. Breast 2020; 55:112-118. [PMID: 33422790 PMCID: PMC7809433 DOI: 10.1016/j.breast.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE This study was aimed to assess the outcome of radiotherapy and determine prognostic factors for survival in breast cancer patients with clinically overt metastasis to the internal mammary lymph node (IMN+). METHODS We retrospectively reviewed the medical records of 193 patients with IMN + breast cancer who received neoadjuvant chemotherapy (NAC), breast surgery without internal mammary lymph node (IMN) dissection, and postoperative radiotherapy at 9 hospitals between 2009 and 2013. Breast-conserving surgery or mastectomy was performed after taxane-based NAC. Radiotherapy was administered to the whole breast/chest wall and regional nodes. IMN-covering radiotherapy was performed in 92.2% of patients with median dose of 58.4 Gy (range, 44.9-69.1 Gy). The overall survival (OS), disease-free survival (DFS), and IMN failure-free survival (IMNFFS) were analyzed. RESULTS After median follow-up of 71 months, 9 patients (4.7%) developed IMN failure and simultaneous distant metastasis. The 5-year DFS, OS, and IMNFFS was 68.6%, 81.8%, and 95.3%, respectively. Non-triple-negative breast cancer, Ki-67 ≤ 10%, pathological complete response (CR) in tumor and axillary node, and radiologic CR of IMN after NAC were significant factors for predicting higher DFS; however, IMN radiation dose was not significant determinants for DFS. The 5-year DFS of patients with IMN-dose ≤ 50.0 Gy and those with >50.0 Gy was 86.7% and 76.7%, respectively (p = 0.41). CONCLUSIONS A multimodality strategy including NAC, breast surgery, and IMN-covering radiotherapy was effective for patients with overt IMN + breast cancer. Even without an IMN dissection, most patients were IMN failure-free with an IMN-focusing radiotherapy.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei College of Medicine, Seoul, South Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
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13
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Ma T, Mao Y, Wang H. Combined Therapy Can Improve the Outcomes of Breast Cancer with Isolated Supraclavicular Lymph Node Involvement. Cancer Manag Res 2020; 12:11857-11869. [PMID: 33239916 PMCID: PMC7682445 DOI: 10.2147/cmar.s276996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to evaluate the efficacy of systemic combined with local therapies in isolated metachronous ipsilateral supraclavicular lymph node metastasis (mISLM) breast cancer patients. Patients and Methods We reviewed the data of mISLM patients admitted by Breast Disease Center of the Affiliated Hospital of Qingdao University, from January 2009 to July 2019. Ninety-nine patients were included and were divided into two groups: the systemic group, which referred to patients who received only systemic therapy, and the combined group, which referred to patients who received systemic therapy plus local therapy (including neck radiotherapy (RT) and/or supraclavicular lymph node dissection surgery). In the combined group, patients were further divided into systemic therapy plus: 1) neck RT, 2) supraclavicular lymph node dissection surgery, and 3) neck RT and supraclavicular lymph node dissection surgery. Results The median duration of follow-up was 36 months. The median PFS was 15 months, and the median OS was 35 months. Local control rates of 1 year, 2 years and 3 years were 92.9%, 86.9% and 84.8%, respectively. The combined group (n=56) had a significantly better PFS (P<0.001) and OS (P=0.001) than the systemic group (n=43). Compared with Group B (n=13) and Group C (n=14), Group A (n=29) had a significantly better PFS (P=0.007). Higher dose and conventional dose showed no significant differences regarding the local control rate (P=1.000), PFS (P=0.787) or OS (P=0.690) in the patients who received RT. In multivariate analysis, pN3 stage and combined therapy (systemic therapy plus local therapy) for mISLM affected PFS (P<0.001 and P=0.002, respectively). Neck RT was an independent parameter affecting OS (P=0.002). Conclusion In breast cancer patients with mISLM, systemic therapy combined with local therapy could improve PFS and OS. Based on systemic therapy, RT had a better effect on survival than surgery. However, more aggressive methods, such as systemic therapy combined with both RT and surgery or a higher dose of RT, may not be associated with improved PFS or OS in these patients.
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Affiliation(s)
- Tianyi Ma
- Department of Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Yan Mao
- Department of Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Haibo Wang
- Department of Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
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14
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Tamirisa NP, Ren Y, Campbell BM, Thomas SM, Fayanju OM, Plichta JK, Rosenberger LH, Force J, Hyslop T, Hwang ES, Greenup RA. Treatment Patterns and Outcomes of Women with Breast Cancer and Supraclavicular Nodal Metastases. Ann Surg Oncol 2020; 28:2146-2154. [PMID: 32946012 DOI: 10.1245/s10434-020-09024-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 2002, breast cancer patients with supraclavicular nodal metastases (cN3c) were downstaged from AJCC stage IV to IIIc, prompting management with locoregional treatment. We sought to estimate the impact of multimodal therapy on overall survival (OS) in a contemporary cohort of cN3c patients. METHODS Women ≥ 18 years with cT1-T4c/cN3c invasive breast cancer who underwent systemic therapy were identified from the 2004-2016 National Cancer Database. We compared three patient cohorts: (a) cN3c + multimodal therapy (systemic therapy, surgery, and radiation); (b) cN3c + non-standard therapy; and, (c) cM1. Logistic regression identified factors associated with receipt of multimodal therapy and Kaplan-Meier was used to estimate unadjusted OS. The Cox proportional hazards model estimated effects of diagnosis and treatment on OS after adjustment. RESULTS Overall, 1827 (3.7%) patients with cN3c disease and 46,919 (96.3%) cM1 patients were identified. Of cN3c patients, 74.5% (n = 1362) received multimodal therapy and 25.5% (n = 465) received non-standard therapy; receipt of multimodal therapy was associated with improved 5-year OS (multimodal: 59% vs. M1: 28% vs. non-standard: 28%, log-rank p < 0.001). Adjusting for covariates, non-standard therapy was associated with an increased risk of death compared with receipt of multimodal therapy (HR 2.20, 95% CI 1.71-2.83, p < 0.001). Private insurance was the only patient characteristic associated with a greater likelihood of receiving multimodal therapy (OR 2.81; 95% CI, 1.64-4.82; p < 0.001). CONCLUSION Women with cN3c breast cancer who received multimodal therapy demonstrated improved overall survival when compared with patients undergoing non-standard therapy and those with metastatic (M1) disease. Although selection bias may contribute to worse overall survival among cN3c patients undergoing non-standard therapy, national guidelines should encourage locoregional treatment in carefully selected patients.
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Affiliation(s)
- Nina P Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi Ren
- Duke Cancer Institute, Durham, NC, USA
| | | | | | - Oluwadamilola M Fayanju
- Duke Cancer Institute, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer K Plichta
- Duke Cancer Institute, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Laura H Rosenberger
- Duke Cancer Institute, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jeremy Force
- Duke Cancer Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Terry Hyslop
- Duke Cancer Institute, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - E Shelley Hwang
- Duke Cancer Institute, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rachel A Greenup
- Duke Cancer Institute, Durham, NC, USA. .,Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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15
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Ai X, Liao X, Li J, Tang P, Jiang J. Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database. Cancer Manag Res 2020; 12:5331-5343. [PMID: 32753951 PMCID: PMC7342555 DOI: 10.2147/cmar.s246162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Although stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated. Material and Methods Data from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes. Results In our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001). Conclusion Breast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.
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Affiliation(s)
- Xiang Ai
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Xin Liao
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Junyan Li
- Department of Breast Surgery, People's Hospital of DeYang City, Deyang 618000, People's Republic of China
| | - Peng Tang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
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16
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Loganadane G, Truong PT, Taghian AG, Tešanović D, Jiang M, Geara F, Moran MS, Belkacemi Y. Comparison of Nodal Target Volume Definition in Breast Cancer Radiation Therapy According to RTOG Versus ESTRO Atlases: A Practical Review From the TransAtlantic Radiation Oncology Network (TRONE). Int J Radiat Oncol Biol Phys 2020; 107:437-448. [PMID: 32334035 DOI: 10.1016/j.ijrobp.2020.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/05/2023]
Abstract
Regional nodal irradiation has gained interest in recent years with the publication of several important randomized trials and the availability of more conformal techniques. Target volume delineation represents a critical step in the radiation planning process. Adequate coverage of the microscopic tumor spread to regional lymph nodes must be weighed against exposure of critical structures such as the heart and lungs. Among available guidelines for delineating the clinical target volume for the breast/chest wall and regional nodes, the Radiation Therapy Oncology Group and European Society for Radiotherapy and Oncology guidelines are the most widely used internationally. These guidelines have been formulated based on anatomic boundaries of areas historically covered in 2-dimensional field-based radiation therapy but have not been validated by patterns-of-failure studies. In recent years, an important body of data has emerged from mapping studies documenting patterns of local and regional recurrence. We aim to review, discuss, and compare contouring guidelines for breast cancer radiation therapy in the context of contemporary data on locoregional relapse to improve their implementation in modern practice.
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Affiliation(s)
- Gokoulakrichenane Loganadane
- Henri Mondor Breast Center and Department of Radiation Oncology, APHP; University of Paris-Est Creteil (UPEC) and INSERM Unit 955 - Team 21. Creteil, France
| | - Pauline T Truong
- Department of Radiation Oncology, British Columbia Cancer Agency and University of British Columbia, Vancouver, Canada
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dušanka Tešanović
- Medical Faculty of University of Novi Sad, Novi Sad and Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Mawei Jiang
- University Hospital of Xinhua and Jiao Tong University, Shanghai, China
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon
| | - Meena S Moran
- Department of Radiation Oncology, Yale University School of Medicine, Smilow Cancer Center, New Haven, Connecticut
| | - Yazid Belkacemi
- Henri Mondor Breast Center and Department of Radiation Oncology, APHP; University of Paris-Est Creteil (UPEC) and INSERM Unit 955 - Team 21. Creteil, France.
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17
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Ai X, Wang M, Li J, Hu Y, Hou L, Zheng X, Yan Y, Pan Q, Jin Y, Liu W, Tan X, Tian Y, Zhang Y, Tang P, Jiang J. Supraclavicular lymph node dissection with radiotherapy versus radiotherapy alone for operable breast cancer with synchronous ipsilateral supraclavicular lymph node metastases: a real-world cohort study. Gland Surg 2020; 9:329-341. [PMID: 32420257 DOI: 10.21037/gs.2020.03.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The role of supraclavicular lymph node dissection (SCLD) in the treatment of breast cancer with ipsilateral supraclavicular lymph node metastasis (ISLM) remains controversial. We evaluated the role of SCLD in the treatment of breast cancer with ISLM and identified patients who may benefit from SCLD. Methods Data on patients presenting with breast cancer to the Breast Disease Center, Southwest Hospital, The Army Medical University from January 2004 and December 2017 were retrospectively screened. The median duration of follow-up was 36 months (2-175 months). 305 patients who were recently diagnosed with ISLM were eligible for the analysis. Results Overall, 9,236 women presented with breast cancer during the study period. Among the patients included, 146 and 159 received SCLD with radiotherapy (RT) and RT alone, respectively. Synchronous ISLM without distant metastases were present in 3.6% cases. The 3- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 79.5% and 73.9%, respectively, and 67.5% and 54.8%, respectively. However, SCLD with RT was not associated with superior survival on both univariate and multivariate analyses. On stratified analyses, patients with non-luminal A tumors with 4-9 positive axillary lymph nodes who underwent SCLD with RT had both superior OS (HR =5.296; 95% CI: 1.857-15.107; P=0.001) and DFS (HR =5.331; 95% CI: 2.348-12.108; P<0.001) compared with those who received RT alone. Conclusions SCLD may not beneficial in improving survival for unselected breast cancer patients with ISLNM. There is less of a tendency to perform SCLD in the luminal A group.
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Affiliation(s)
- Xiang Ai
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Minghao Wang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Junyan Li
- Department of Breast Surgery, People's Hospital of DeYang City, Deyang 618000, China
| | - Ying Hu
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Lingmi Hou
- Department of Thyroid Breast Surgery, First Affiliated Hospital, North Sichuan Medical College, Nanchong 637000, China
| | - Xiaodong Zheng
- Department of Breast Surgery, Chongqing University Cancer Hospital, Chongqing 40044, China
| | - Yuzhao Yan
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Qinwen Pan
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Yuting Jin
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Wei Liu
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Xuanni Tan
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Yuan Tian
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Yi Zhang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Peng Tang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, China
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18
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Yang K, Kim H, Choi DH, Park W, Noh JM, Cho WK. Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer. Radiat Oncol 2020; 15:16. [PMID: 32122399 PMCID: PMC7052982 DOI: 10.1186/s13014-020-1464-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer. Methods We retrospectively reviewed the medical records of 84 patients with cIMN+ breast cancer treated with curative surgery, taxane-based chemotherapy, and postoperative RT between January 2009 and December 2014. Postoperative RT was administered to the whole breast or chest wall using 50 Gy in 2 Gy fractions. Boost RT to the internal mammary lymph node (IMN) was administered at the physician’s discretion. We categorized patients into two groups according to the IMN dose as follows: low-dose IMN RT (50.0–63.5 Gy) and high-dose IMN RT (63.6–70.4 Gy). Results After a median follow-up of 58 months (range, 12–111 months), IMN recurrence was observed in 2 patients (2.4%), and all IMN recurrences developed simultaneously with distant metastases. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 89.1, 72.0, and 81.2%, respectively. The triple-negative subtype, IMN size ≥1.0 cm, old age, and low-dose IMN were significantly associated with poor DFS. Among the patients with IMN size ≥1.0 cm, the 5-year DFS was significantly higher in those treated with high-dose IMN RT than in those treated with low-dose IMN RT (69.3% vs. 33.3%, p = 0.019). Conclusions IMN RT without IMN dissection resulted in favorable outcomes in cIMN+ breast cancer. For patients with a large IMN, a higher IMN radiation dose might be needed for disease control.
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Affiliation(s)
- Kyungmi Yang
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351.
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea, 06351
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19
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Kim K, Kim SS, Shin KH, Kim JH, Ahn SD, Choi DH, Park W, Lee SY, Chun M, Kim JH, Kim YB, Cha J, Park HJ, Lee DS, Jung W. Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14). Clin Breast Cancer 2019; 20:51-60. [PMID: 31629642 DOI: 10.1016/j.clbc.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the outcomes of upfront surgery followed by radiation therapy (RT) for ipsilateral supraclavicular (SCN) and/or internal mammary (IMN) node-positive breast cancer. MATERIALS AND METHODS One hundred fifty-eight patients were included; among these, 91 patients were SCN-positive, 54 were IMN-positive, and 13 were SCN- and IMN-positive. Patients underwent breast conserving surgery (n = 74) or mastectomy (n = 84) followed by systemic therapy, and adjuvant RT to whole breast/chest wall with or without regional nodal RT. Regarding regional treatments for SCN and IMN, SCN excision was performed in 59 (37.3%) patients, IMN excision in 10 (6.3%) patients, SCN RT in 143 (90.5%) patients, and IMN RT in 68 (43.0%) patients. RESULTS The median duration of follow-up was 72 months (range, 7-182 months). There were 20 locoregional recurrences and 45 distant metastases. In-field failure was observed only in SCN (n = 8), and 6 of these patients initially underwent SCN excision. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 87.3%, 71.6%, and 89.7%, respectively. Neither SCN excision nor SCN RT dose ≥ 54 Gy improved locoregional control (P = .927 and P = .693, respectively) or DFS (P = .394 and P = .686, respectively). Having ≥ 10 involved axillary lymph nodes was the only independent prognosticator for DFS after adjusting for covariates (P = .003). CONCLUSION Regional control rate in initially involved SCN and/or IMN was acceptable in patients treated with upfront surgery followed by systemic therapy plus adjuvant RT. More aggressive regional therapy such as SCN excision did not improve locoregional control or survival.
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Affiliation(s)
- Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Kim J, Chang JS, Choi SH, Kim YB, Keum KC, Suh CO, Yang G, Cho Y, Kim JW, Lee IJ. Radiotherapy for initial clinically positive internal mammary nodes in breast cancer. Radiat Oncol J 2019; 37:91-100. [PMID: 31266290 PMCID: PMC6610003 DOI: 10.3857/roj.2018.00451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.
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Affiliation(s)
- Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Gowoon Yang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kim K, Jeong Y, Shin KH, Kim JH, Ahn SD, Kim SS, Suh CO, Kim YB, Choi DH, Park W, Cha J, Chun M, Lee DS, Lee SY, Kim JH, Park HJ, Jung W. 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). Cancer Res Treat 2019; 51:1500-1508. [PMID: 30913866 PMCID: PMC6790841 DOI: 10.4143/crt.2018.575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/13/2019] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yuri Jeong
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
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Joo JH, Kim SS, Ahn SD, Choi EK, Jung JH, Jeong Y, Ahn SH, Son BH, Lee JW, Kim HJ, Go BS, Kim HH, Cha JH, Shin HJ, Chae EY. Impact of pathologic diagnosis of internal mammary lymph node metastasis in clinical N2b and N3b breast cancer patients. Breast Cancer Res Treat 2017; 166:511-518. [PMID: 28785909 DOI: 10.1007/s10549-017-4422-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the prognostic role of pathologic confirmation of internal mammary lymph nodes (IMNs) for breast cancer patients who received neoadjuvant chemotherapy. METHODS Of the patients who were treated with neoadjuvant chemotherapy, surgery, and radiation therapy between 2009 and 2013, 114 women had suspicious IMNs and FNAB was attempted. Clinical IMN metastasis was diagnosed by 18F-FDG PET/CT positivity or pathologic confirmation (N = 70). Patients were divided into the FNAB(+) or FNAB(-) IMN group. RESULTS The pathologic confirmation rate was 57% (40 of 70 patients). Rates were 74% in US-positive, 70% in MRI-positive, and 55% in PET-positive patients. Nodal stage was cN2b (6%) or cN3b (94%). Five-year progression-free survival (PFS) was significantly worse in patients with FNAB(+) IMN metastasis than FNAB(-) IMN metastasis (61% vs. 87%, P = 0.03). FNAB(+) IMN patients showed worse distant metastasis and regional recurrence-free survival without statistical significance (69% vs. 86%, P = 0.06, and 81% vs. 96%, P = 0.06). With median follow-up of 50.5 months (13.0-97.0 months), overall survival at 5 years was 77%, and PFS was 72%. CONCLUSIONS Patients with FNAB-proven IMN metastasis had worse treatment outcomes compared to patients with clinically diagnosed IMN metastasis in cN2b/N3b breast cancer.
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Affiliation(s)
- Ji Hyeon Joo
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea.
| | - Seung-Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Jin Hong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Yuri Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Sei Hyun Ahn
- Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Ho Son
- Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong Won Lee
- Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jung Kim
- Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Beom Seok Go
- Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hak Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Hee Cha
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jung Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Young Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Liu XH, Zhang L, Chen B. A meta-analysis of the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer. Chronic Dis Transl Med 2016; 1:236-242. [PMID: 29063013 PMCID: PMC5643591 DOI: 10.1016/j.cdtm.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage IIIb/c or IV breast cancer, so as to provide evidence for clinical practice and research. Methods Computer retrieval from PubMed, Cochrane Libratory, CNKI (China National Knowledge Infrastructure), CBM and Wanfang Database with the assistance of other retrieval tools. All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer were collected. Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study. Meta-analysis was performed using RevMan 5.3 software. Results A total of four references (1277 patients) were included. Assessment of influences on prognosis: As compared to the stage IIIb/c group, the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95% confidence interval (CI) 0.59–1.06; Z = 1.55, P = 0.12), but there was no statistical significance; in contrast, the 5-year survival rate was significantly increased in the SLNM group as compared to the stage IV group (RR = 2.70; 95%CI: 1.36–5.37; Z = 2.84, P = 0.005). As compared to the stage IIIb/c group, the 5-year disease-free survival rate was lower in the SLNM group (RR = 0.65; 95%CI: 0.40–1.05; Z = 1.75, P = 0.08); however, there was no statistical significance. Conclusions In patients with advanced breast cancer receiving combined therapy, the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage IV breast cancer, and slightly worse than those with stage IIIb/c breast cancer. However, with the scarcity and poor quality of these observational studies, the long-term prognosis remains to be further verified in large-sample, high-quality studies.
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Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy. Breast 2015; 24:637-41. [PMID: 26283599 DOI: 10.1016/j.breast.2015.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/16/2015] [Accepted: 07/13/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the prognostic influence of involvement of both internal mammary nodes (IMNs) and supraclavicular nodes (SCNs) in clinical stage IIIc breast cancer patients who underwent primary systemic treatment, surgery, and radiotherapy (RT). MATERIALS AND METHODS Between 2001 and 2009, 110 breast cancer patients with IMN or SCN involvement were treated with primary systemic treatment followed by surgery and RT. The median age was 50 years. Clinical N-stage was cN3b and cN3c in 29 (26.4%) and 81 (73.6%) patients, respectively. Among the 81 patients with cN3c disease, 18 patients had both IMN and SCN involvement. Primary systemic treatment regimen was most commonly doxorubicin plus docetaxel (54.5%) or cyclophosphamide (20.0%). Mastectomy was performed in 71 (64.5%) patients. The RT dose delivered to the chest wall or whole breast was 50-50.4 Gy in 25-28 fractions. IMN and SCN regions were irradiated in 77 (70.0%) and 107 (97.6%) patients, respectively. RESULTS At a median follow-up of 57.4 months (range, 8.6-149.9 months), 44 patients (40.0%) developed disease recurrence. Among the 18 patients with both IMN and SCN involvement, 12 patients experienced disease recurrence and 11 of them had distant metastases. The 5-year disease-free survival (DFS) and overall survival (OS) of all patients were 60.2% and 75.5%, respectively. Decreased DFS and OS were observed in the 18 patients with both IMN and SCN involvement (5-year rates, 33.3% and 50.0%; P = 0.0051 and 0.0010, respectively). CONCLUSION Involvement of both IMNs and SCNs was associated with worse survival outcomes in patients with clinical stage IIIc breast cancer.
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Jung J, Kim SS, Ahn SD, Lee SW, Ahn SH, Son BH, Lee JW, Choi EK. Treatment Outcome of Breast Cancer with Pathologically Proven Synchronous Ipsilateral Supraclavicular Lymph Node Metastases. J Breast Cancer 2015; 18:167-72. [PMID: 26155293 PMCID: PMC4490266 DOI: 10.4048/jbc.2015.18.2.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/31/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the prognosis, patterns of failure, and prognostic factors for breast cancer patients with pathologically proven synchronous ipsilateral supraclavicular lymph node (ISCLN) metastases. METHODS We reviewed the records of breast cancer patients with pathologically proven ISCLN metastases. Local aggressive treatment was defined as treatment including surgery, axillary lymph node dissection (ALND), ISCLN excision, radiotherapy (RT), and chemotherapy. RESULTS A total of 111 patients were included. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.2% and 56.2%, respectively. On univariate analysis, RT, ALND, trastuzumab treatment, hormone receptor (HR) status, and local aggressive treatment were identified as significant factors for OS. The 5-year OS for 73 patients who received local aggressive treatment was superior to that of 38 patients who received nonaggressive treatment (70.9% vs. 49.3%, p=0.036). Multivariate analysis showed that RT, HR status, and trastuzumab were significant variables for the 5-year OS and DFS. CONCLUSION Multimodality treatment with surgery, taxane-based chemotherapy, hormone therapy, and RT is strongly recommended for breast cancer patients with synchronous ISCLN metastases.
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Affiliation(s)
- Jinhong Jung
- Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei-Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wu SG, Sun JY, Zhou J, Li FY, Lin Q, Lin HX, He ZY. The value of radiotherapy in breast cancer patients with isolated ipsilateral supraclavicular lymph node metastasis without distant metastases at diagnosis: a retrospective analysis of Chinese patients. Onco Targets Ther 2014; 7:281-8. [PMID: 24627640 PMCID: PMC3931660 DOI: 10.2147/ott.s56596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the prognosis of ipsilateral supraclavicular lymph node metastasis (ISLM) without evidence of distant metastases at diagnosis in Chinese women with breast cancer and to elucidate the clinical value of adjuvant radiotherapy. Methods We performed a retrospective analysis of clinical data for 39 patients with ISLM from breast cancer without distant metastasis at diagnosis. Combined modality therapy, consisting of neoadjuvant chemotherapy, surgery, and adjuvant chemotherapy with or without adjuvant radiotherapy, was offered to the patients. Results The patients in this study accounted for 1% of all breast cancer patients treated during the same time period. The median follow-up was 35 months. The 5-year locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival (DFS), and overall survival (OS) were 57.3%, 42.3%, 34.4%, and 46.2%, respectively. Twenty-three patients received postoperative adjuvant radiotherapy. However, there was no significant difference in the 3- and 5-year locoregional recurrence-free survival (P=0.693), ISLM-free recurrence (P=0.964), distant metastasis-free survival (P=0.964), DFS (P=0.234), and OS (P=0.329) rates between the groups of patients who received or did not receive adjuvant radiotherapy (P=0.840). No significant difference in the 3-year locoregional control rate (P=0.900) was found between patients who were treated with adjuvant radiotherapy at ≤50 Gy and >50 Gy. Univariate analysis showed that clinical tumor size stage and age were prognostic factors that impacted DFS and OS. Conclusion Combined modality treatment may achieve satisfactory efficacy in Chinese women with ISLM from breast cancer without distant metastasis at the time of diagnosis, suggesting that ISLM might be considered a curable locoregional disease. Adjuvant radiotherapy did not, however, improve the results of these patients.
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Affiliation(s)
- San-Gang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jia-Yuan Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Juan Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Feng-Yan Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Qin Lin
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Huan-Xin Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Zhen-Yu He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Yang DJ, Ren GS, Wang XY. Bilateral chylothorax following left supraclavicular lymph node dissection for breast cancer: one case report and literature review. CHINESE JOURNAL OF CANCER 2014; 33:317-20. [PMID: 24417875 PMCID: PMC4059869 DOI: 10.5732/cjc.013.10102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even rarer. However, both are potentially serious and sometimes life-threatening, especially those that are associated with left neck dissection for head and neck neoplasms. We report one case of bilateral chylothorax following left supraclavicular dissection for breast cancer. This case was treated successfully with a new conservative management approach.
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Affiliation(s)
- De-Juan Yang
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China.
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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 2013; 39:207-12. [DOI: 10.1016/j.ejso.2012.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/09/2012] [Accepted: 11/21/2012] [Indexed: 11/23/2022] Open
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Groheux D, Hindié E, Delord M, Giacchetti S, Hamy AS, de Bazelaire C, de Roquancourt A, Vercellino L, Toubert ME, Merlet P, Espié M. Prognostic impact of (18)FDG-PET-CT findings in clinical stage III and IIB breast cancer. J Natl Cancer Inst 2012; 104:1879-87. [PMID: 23243198 PMCID: PMC3525816 DOI: 10.1093/jnci/djs451] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background This study prospectively evaluated the yield of fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET-CT) in patients with clinical stages II and III breast cancer and the impact of PET-CT results on prognosis. Methods In the course of 71 months, 254 consecutive patients with clinical stages II and III breast cancer (based on clinical examination, mammography, breast magnetic resonance imaging, and locoregional ultrasonography) underwent 18FDG-PET-CT. The yield was assessed in the whole population and for each American Joint Committee on Cancer subgroup. The prognostic impact of PET-CT findings was analyzed. Tests of statistical significance were two-sided. Results 18FDG-PET-CT changed the clinical stage in 77 of 254 patients (30.3%; 95% confidence interval [CI] = 25.0% to 36.2%). It showed unsuspected N3 disease (infraclavicular, supraclavicular, or internal mammary nodes) in 40 patients and distant metastases in 53. PET-CT revealed distant metastases in 2.3% (1 of 44) of clinical stage IIA, 10.7% (6 of 56) of stage IIB, 17.5% (11 of 63) of stage IIIA, 36.5% (27 of 74) of stage IIIB, and 47.1% (8 of 17) of stage IIIC patients. Among 189 patients with clinical stage IIB or higher disease and adequate follow-up, disease-specific survival was statistically significantly shorter in the 47 patients scored M1 on 18FDG-PET-CT in comparison with those scored M0, with a three-year disease-specific survival of 57% vs 88% (P < .001). In multivariable analysis, only distant disease on PET-CT and triple-negative phenotype were statistically significant prognostic factors. The relative risk of death was 26.60 (95% CI = 6.60 to 102.62) for M1 vs M0 patients. Conclusions The yield of 18FDG-PET-CT appeared substantial in patients with clinical stage IIB or higher breast cancer. In these patients, 18FDG-PET-CT provided powerful prognostic stratification.
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Affiliation(s)
- David Groheux
- Service de Médecine Nucléaire, Hôpital Saint-Louis, Assistance publique Hôpitaux de Paris, 1 Ave Claude Vellefaux, 75475 Paris Cedex 10, France.
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