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

• Kim H
• Park W
• Yu JI
• Choi DH
• Huh SJ
• Kim YJ
• Lee ES
• Lee KS
• Kang HS
• Park IH
• Shin KH
• Wee CW
• Kim K
• Park KR
• Kim YB
• Ahn SJ
• Lee JH
• Kim JH
• Chun M
• Lee HS
• Kim JS
• Cha J

• KMID: 2394816
• DOI: http://doi.org/10.4143/crt.2016.382

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

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  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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