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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)

 Kyubo Kim  ;  Yuri Jeong  ;  Kyung Hwan Shin  ;  Jin Ho Kim  ;  Seung Do Ahn  ;  Su Ssan Kim  ;  Chang-Ok Suh  ;  Yong Bae Kim  ;  Doo Ho Choi  ;  Won Park  ;  Jihye Cha  ;  Mison Chun  ;  Dong Soo Lee  ;  Sun Young Lee  ;  Jin Hee Kim  ;  Hae Jin Park  ;  Wonguen Jung 
 CANCER RESEARCH AND TREATMENT, Vol.51(4) : 1500-1508, 2019-10 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Breast ; Breast Neoplasms / radiotherapy* ; Chemotherapy, Adjuvant ; Clavicle ; Female ; Humans ; Lymph Nodes / pathology* ; Lymphatic Metastasis / pathology ; Lymphatic Metastasis / radiotherapy* ; Mastectomy ; Mastectomy, Segmental ; Middle Aged ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Young Adult
Breast neoplasms ; Internal mammary lymph node ; Radiotherapy ; Supraclavicular lymph node
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.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Suh, Chang Ok(서창옥)
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