Cancer Res Treat.  2017 Oct;49(4):970-980. 10.4143/crt.2016.382.

Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study

Affiliations
  • 1Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
  • 2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wonro.park@samsung.com
  • 3Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 4Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
  • 6Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
  • 8Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 9Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 10Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 11Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Korea.
  • 12Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, Korea.
  • 13Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea.

Abstract

PURPOSE
This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy.
MATERIALS AND METHODS
We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups.
RESULTS
A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI.
CONCLUSION
We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.

Keyword

Breast neoplasms; Adjuvant radiotherapy; Lymphatic irradiation; Taxane; Case-control studies

MeSH Terms

Breast Neoplasms*
Breast*
Case-Control Studies*
Disease-Free Survival
Drug Therapy*
Humans
Lymph Nodes
Lymphatic Irradiation
Lymphedema
Mastectomy, Segmental*
Neoplasm Metastasis
Propensity Score
Radiation Pneumonitis
Radiotherapy
Radiotherapy, Adjuvant
Recurrence

Figure

  • Fig. 1. Survival according to radiation field. Disease-free survival (A), loco-regional recurrence-free survival (LRRFS) (B), distant metastasis-free survival (DMFS) (C), and overall survival (D) are shown. WBI, whole-breast irradiation; SCNRT, supraclavicular lymph node radiotherapy.


Reference

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