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Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14)

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Affiliated Author(s)
김진희
Alternative Author(s)
Kim, Jin Hee
Journal Title
Clinical breast cancer
ISSN
1938-0666
Issued Date
2020
Keyword
Internal mammary nodeNon-axillary regional lymph nodePrognostic factors, Radiation therapyUpfront surgery
Abstract
Micro-Abstract:
With the development of imaging technologies, supraclavicular (SCN) and/or internal mammary nodes are increasingly detected in locally advanced breast cancers. The impact of aggressive treatment such as SCN excision was investigated via a large-scale multicenter study. When breast surgery, systemic therapy, and adjuvant radiotherapy were given, SCN excision did not improve locoregional control or survival.

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.
Department
Dept. of Radiation Oncology (방사선종양학)
Publisher
School of Medicine (의과대학)
Citation
Kyubo Kim et al. (2020). Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14). Clinical breast cancer, 20(1), 51–60. doi: 10.1016/j.clbc.2019.09.004
Type
Article
ISSN
1938-0666
DOI
10.1016/j.clbc.2019.09.004
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43017
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학)
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