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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2018.575    [Accepted]
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)
Kyubo Kim1, Yuri Jeong2, Kyung Hwan Shin3, Jin Ho Kim3, Seung Do Ahn4, Su Ssan Kim4, Chang-Ok Suh5, Yong Bae Kim5, Doo Ho Choi6, Won Park6, Jihye Cha7, Mison Chun8, Dong Soo Lee9, Sun Young Lee10, Jin Hee Kim11, Hae Jin Park12, Wonguen Jung1
1Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
2Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
3Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
4Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
5Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
6Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
7Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea
8Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
9Department of Radiation Oncology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
10Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Korea
11Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
12Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea
Correspondence  Kyung Hwan Shin ,Tel: 82-2-2072-2524 , Fax: 82-2-765-3317, Email: radiat@snu.ac.kr
Su Ssan Kim ,Tel: 82-2-3010-5680 , Fax: 82-2-3010-6950, Email: watermountain@hanmail.net
Received: October 20, 2018;  Accepted: March 13, 2019.  Published online: March 15, 2019.
*Kyubo Kim and Yuri Jeong contributed equally to this work.
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.
Key words: Breast neoplasms, Supraclavicular lymph node, Internal mammary lymph node, Radiotherapy
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