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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 Research and Treatment 2019년 51권 4호 p.1500 ~ 1508
 ( Kim Kyu-Bo ) - Ewha Womans University School of Medicine Department of Radiation Oncology

 ( Jeong Yu-Ri ) - Wonkwang University School of Medicine Wonkwang University Hospital Department of Radiation Oncology
 ( Shin Kyung-Hwan ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Kim Jin-Ho ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Ahn Seung-Do ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
 ( Kim Su-Ssan ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
 ( Suh Chang-Ok ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Kim Yong-Bae ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
최두호 ( Choi Doo-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
 ( Park Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
 ( Cha Ji-Hye ) - Wonju Severance Christian Hospital Department of Radiation Oncology
 ( Chun Mi-Son ) - Ajou University School of Medicine Department of Radiation Oncology
 ( Lee Dong-Soo ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Radiation Oncology
이선영 ( Lee Sun-Young ) - Chonbuk National University Hospital Department of Radiation Oncology
 ( Kim Jin-Hee ) - Keimyung University School of Medicine Keimyung University Dongsan Medical Center Department of Radiation Oncology
 ( Park Hae-Jin ) - Hanyang University College of Medicine Department of Radiation Oncology
 ( Jung Won-guen ) - Ewha Womans University School of Medicine Department of Radiation Oncology

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.

키워드

Breast neoplasms; Supraclavicular lymph node; Internal mammary lymph node; Radiotherapy
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